Factors associated with electrocardiographic left ventricular hypertrophy among patients with hypertension in Thailand.

BACKGROUND: Left ventricular hypertrophy (LVH) strongly predicts cardiovascular diseases (CVD) and death. One-fourth of Thai adults suffer from hypertension. Nevertheless, the information on LVH among Thai patients with hypertension is not well characterized. We aimed to identify the prevalence and factors associated with electrocardiographic LVH (ECG-LVH) among patients with hypertension in Thailand. METHODS: The present study obtained the dataset from the Thailand Diabetes Mellitus/Hypertension study, which included hypertension patients aged 20 years and older receiving continuous care at outpatient clinics in hospitals nationwide in 2011-2015 and 2018. Meanwhile, those without a record of 12-lead electrocardiography (ECG) were excluded from the analysis. ECG-LVH was defined as the LVH noted regarding ECG interpretation in the medical records. Multivariable logistic regression analysis was utilized for determining factors associated with ECG-LVH and presented as the adjusted odds ratio (AOR) and 95% confidence interval (CI). RESULTS: From 226,420 hypertensive patients in the Thailand Diabetes Mellitus/Hypertension study, 38,807 individuals (17.1%) with ECG data recorded were included in the analysis. The mean age was 64.8 ± 11.5 years, and 62.2% were women. Overall, 1,557 study participants had ECG-LVH, with an estimated prevalence of 4.0% (95% CI, 3.8-4.2%). Age-adjusted ECG-LVH prevalence among women and men was 3.4 and 5.1%, respectively (P < 0.001). Multivariable analysis determined factors associated with ECG-LVH, including being men (AOR, 1.49; 95% CI, 1.31-1.69), individuals aged 70 to 79 years (AOR, 1.56; 95% CI, 1.20-2.02) and ≥ 80 years (AOR, 2.10; 95% CI, 1.58-2.78) compared to individuals aged less than 50 years, current smokers (AOR, 1.26; 95% CI, 1.09-1.46) compared to those who never smoked, systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg (AOR, 1.58; 95% CI, 1.30-1.92) compared to systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. CONCLUSIONS: The current study illustrated the prevalence of ECG-LVH among Thai patients with hypertension who had ECG recorded and identified high-risk groups who tended to have ECG-LVH. The findings underscore the need for targeted interventions, particularly among high-risk groups such as older individuals, men, and current smokers, to address modifiable factors associated with ECG-LVH.

Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021.

Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.

Rising trends in the predicted 10-year risk of cardiovascular diseases among Royal Thai Army personnel from 2017 to 2021.

Deaths from cardiovascular diseases (CVD) are becoming a growing threat to global health, including in Thailand. The aim of the present study was to identify the recent trends in the predicted 10-year risk of CVD among Royal Thai Army (RTA) personnel from 2017 to 2021. The predicted 10-year risk for CVD was calculated through the use of the 2008 updated version of the risk algorithm derived from the Framingham Heart Study data. The current study included 346,355 active-duty RTA personnel aged 30-60 years. The age- and sex-adjusted mean of the predicted 10-year risk for CVD significantly increased from 10.8% (95% CI: 10.8-10.9%) in 2017 to 11.7% (95% CI: 11.6-11.7%) in 2021 (p for trend < 0.001). The overall age- and sex-adjusted prevalence of intermediate-to-high predicted 10-year risk for CVD remarkably surged from 24.9% (95% CI: 24.4-25.4%) in 2017 to 29.5% (95% CI: 29.0-30.0%) in 2021 (p for trend < 0.001). The modifiable risk factors for CVD, including high systolic blood pressure, high body mass index, and current smoking in this population, should be alleviated to mitigate the risk for CVD in the future.

Incidence and risk factors of metabolic syndrome among Royal Thai Army personnel.

Metabolic Syndrome is a clustering of obesity, hyperglycemia/insulin resistance, dyslipidemia, and hypertension. We aimed to determine the incidence of metabolic syndrome among Royal Thai Army (RTA) personnel and its risk factors. We conducted a retrospective cohort study using data from 2017 to 2021. Metabolic syndrome was defined by NCEP ATP III (2005 Revision). A total of 98,264 participants were enrolled in the present study. The overall incidence rate of metabolic syndrome was 3.7 per 100 person-year (95% CI 3.7-3.8). The statistically significant risk factors for metabolic syndrome included male sex (aHR 1.40; 95% CI 1.29-1.51), age > 35 years, current alcohol consumption, and no exercise. When stratified by sex, the incidence rate of metabolic syndrome among participants aged ≥ 45 years was higher than those aged < 35 years with aHR 6.34; 95% CI 6.01-6.70 for males and aHR 9.59; 95% CI 7.55-12.19 for females. Our data demonstrated that metabolic syndrome is a common health issue, especially among RTA personnel over 35 years. Alcohol consumption and sedentary behavior played an essential role in facilitating metabolic syndrome in this study population and are potential targets for intervention to enhance primary prevention of the sequelae of metabolic syndrome.

Prevalence of hypertriglyceridemia among Royal Thai Army personnel and its related cardiometabolic risk factors, from 2017 to 2021.

BACKGROUND: Hypertriglyceridemia is a common health problem independently associated with an increased risk of atherosclerosis cardiovascular diseases (ASCVD), including ischemic heart disease and stroke. This study aims to determine the prevalence of hypertriglyceridemia among Royal Thai Army (RTA) personnel and its behavioral and cardiometabolic risk factors using the RTA personnel database of the physical health examination from 2017 to 2021. METHODS: A serial cross-sectional study was conducted from 2017 to 2021. A total of 257,683 active-duty RTA personnel aged 35-60 years were included in the study. We defined hypertriglyceridemia as fasting triglyceride ≥150 mg/dL. Moreover, we performed a multivariable logistic regression analysis to investigate behavioral and cardiometabolic risk factors for the prevalence of hypertriglyceridemia. The magnitude of the association was presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS: The hypertriglyceridemia prevalence among RTA personnel was 43.4% (95% CI: 42.9-43.8%) in 2017. It then continuously decreased to 40.3% (95% CI: 39.9-40.7%) in 2020 and slightly rose to 41.0% (95% CI: 40.6-41.4%) in 2021 (p for trend < 0.001). The prevalence of hypertriglyceridemia was higher for males than females (AOR 2.15; 95% CI: 2.07-2.23); RTA personnel aged 40-44 years compared with those aged 35-39 years (AOR 1.05; 95% CI: 1.02-1.08); and RTA personnel residing in the northeast (AOR; 1.15 95% CI: 1.11-1.18) and the north (AOR 1.05; 95% CI: 1.02-1.08) compared with those residing in Bangkok. The independent behavioral factors associated with hypertriglyceridemia included alcohol consumption, smoking, and sedentary behavior. Moreover, cardiometabolic risk factors, including higher body mass index, high fasting plasma glucose (≥ 100 mg/dL), high blood pressure (≥ 140/90 mmHg), and hypercholesterolemia (≥ 200 mg/dL), were significantly related to hypertriglyceridemia. CONCLUSION: Our data demonstrated that hypertriglyceridemia is a frequent health issue, especially among males, participants aged 40-44 years, and RTA personnel residing in the northeast and the north. The prevalence of hypertriglyceridemia in this population was greatly influenced by alcohol consumption, cigarette smoking, and sedentary behavior. Both behavioral and cardiometabolic risk factors are potential targets for intervention to enhance the primary prevention of sequelae of hypertriglyceridemia, including ASCVD.

Model development to improve primary care services using an innovative network of homecare providers (WinCare) to promote blood pressure control among elderly patients with noncommunicable diseases in Thailand: a prospective cohort study.

BACKGROUND: Thailand has been rapidly approaching an aging society in conjunction with an increase in noncommunicable diseases (NCDs) especially hypertension and type 2 diabetes. Demographics and epidemiologic transitions create several challenges to the health system in Thailand in the case of long term care policies, in particular, modality to support home care. Therefore, the model development to facilitate primary care home services for elderly patients with NCDs using an innovative network of homecare providers (WinCare) was established. The study aimed to evaluate the effectiveness of WinCare to improve blood pressure (BP) control as well as health-related quality of life (HRQoL) among elderly patients with NCDs. METHODS: A prospective cohort study was conducted between July 2019 and January 2020 in a suburban area, Chiang Mai Province, Thailand. The intervention included WinCare providers and WinCare application. WinCare provided check-in visits to measure subjects blood pressure and body weight (once weekly), played the roles of other home caregivers for the patients and recorded measurements and activities in the WinCare app for 6 months. The primary outcomes of the study were differences in systolic BP, diastolic BP, and controlled BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) at 6-month follow-up between the intervention and control groups, adjusting for age, sex, marital status, comorbidities, alcohol consumption and smoking status. RESULTS: A total of 104 subjects were initially recruited. Of the remaining 98 individuals, 52 were allocated to the intervention group and 46 to the control group. After adjusting baseline characteristics, no association existed between decreasing average systolic BP and intervention groups. However, diastolic BP of patients in the intervention group was on average 5.19 mmHg (95% CI -8.22, - 2.17) lower compared than that of the control group at 6-month follow-up. Furthermore, compared with patients in the control group, those in the intervention group were more likely to control BP, (AOR 3.03; 95% CI 1.02-9.01) at 6-month follow-up. CONCLUSION: Establishing a network of homecare providers (WinCare) was feasible in a community setting. This innovative network was able to facilitate elderly patients with NCDs residing in a suburban community to improve BP control at least at 6-month follow-up. TRIAL REGISTRATION: Trial identification number was TCTR20200312007 , First submitted date:12/03/2020.

Prevalence of and factors associated with stroke in hypertensive patients in Thailand from 2014 to 2018: A nationwide cross-sectional study.

Stroke is a significant cause of death and disability. In Thailand, it imposes a major health burden, and the prevalence of stroke is increasing, particularly in patients with hypertension (HT), diabetes mellitus (DM), and dyslipidemia (DLP). We aimed to determine the trends in the prevalence of stroke and the associated factors among Thai patients with HT. Nationwide cross-sectional studies were conducted annually in 2014, 2015 and 2018 based on data obtained from the Thailand DM/HT study. Nationally, representative patients with HT in Thailand were sampled with stratified one-stage cluster sampling. A total of 104,028 participants were included in this study. The prevalence of stroke remained constant, with prevalence rates of 4.0%, 3.8%, and 3.9% in 2014, 2015 and 2018, respectively (p for trend = 0.221). Our findings suggested that the management of stroke patients who are covered by the universal coverage scheme should be evaluated. Effective interventions, including promoting smoking cessation, attenuating cholesterol levels, and controlling blood pressure should be provided to hypertensive patients to prevent ischemic stroke. Young adults with HT should be more concerned about the possibility of stroke. The use of prophylactic low-dose aspirin should be carefully monitored to prevent hemorrhagic stroke.

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease Among Agriculturists in a Rural Community, Central Thailand.

Purpose: The present study aimed to determine the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among agriculturists in a remote rural community in central Thailand. Methods: A cross-sectional study was conducted in January 2020. Face-to-face interviews were conducted using standardized questionnaires to determine demographic characteristics and risk behaviors. COPD was defined by the spirometric criterion for airflow limitation constituting a postbronchodilator fixed ratio of FEV1/FVC <0.70 following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2019. Multivariable logistic regression analysis was used to determine the risk factors for COPD, and the magnitude of association was presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI). Results: A total of 546 agriculturists were enrolled in the study. The overall prevalence of COPD was 5.5% (95% CI: 3.6-7.4). The prevalence of COPD among males was 8.0% (95% CI: 4.7-11.3), and 3.2% (95% CI: 1.1-5.2) among females. The risk factors of COPD included age ≥60 years old (AOR 2.7, 95% CI: 1.1-7.0), higher intensity of smoking (AOR 1.1, 95% CI: 1.0-1.1), swine farm worker (AOR 4.1, 95% CI: 1.7-10.3), cattle farm worker (AOR 3.3, 95% CI: 1.4-8.2) and home cooking (AOR 2.7, 95% CI: 0.8-9.7). Conclusion: Our data emphasized that COPD was one of the significant health problems among agriculturists in a rural community. Agricultural jobs such as animal farmers and behavioral factors such as smoking were associated with COPD. Effective public health interventions, especially, modifying risk behaviors, should be promoted in remote rural areas to prevent the disease and reduce its morbidity and mortality.

Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018.

BACKGROUND: Obesity is one principle risk factor increasing the risk of noncommunicable diseases including diabetes, hypertension and atherosclerosis. In Thailand, a 2014 study reported obesity (BMI ≥25 kg/m2) in a Thai population aged ≥15 years was 37.5, 32.9 and 41.8% overall and among males and females, respectively. The study aimed to determine trends in the prevalence of obesity among adults residing in a Thai rural community between 2012 and 2018 and investigate the associations between obesity and behavioral factors. METHODS: Serial cross-sectional studies were conducted in 2012 and 2018 among adults in Na-Ngam rural community. In 2012 and 2018, all 635 and 627 individuals, respectively, were interviewed using structured questionnaires related to demographics, risk behaviors, comorbidities and arthrometric measurement. Spot urine was collected by participants and obesity was defined as BMI ≥25 kg/m2. The risk factors for obesity were analyzed in the 2018 survey. RESULTS: A total of 1262 adults in Na-Ngam rural community were included in the study. The prevalence of obesity was 33.9% in 2012 and 44.8% in 2018 (P < 0.001). The average BMI increased from 23.9 ± 4.2 kg/m2 in 2012 to 25.0 ± 4.52 kg/m2 in 2018 (P < 0.001). Obesity was associated with higher age (AOR 0.99; 95%CI 0.97-0.99), smoking (AOR 0.52; 95%CI 0.28-0.94), instant coffee-mix consumption > 1 cup/week (AOR 1.44; 95%CI 1.02-2.04), higher number of chronic diseases (≥1 disease AOR 1.82; 95%CI 1.01-2.68, > 2 diseases AOR 2.15; 95%CI 1.32-3.50), and higher spot urine sodium level (AOR 1.002; 95%CI 0.99-1.01). CONCLUSION: Our data emphasized that obesity constituted a serious problem among adults residing in a rural community. A trend in significant increase was found regarding the prevalence of obesity and average BMI in the rural community over 6 years. Effective public health interventions should be provided at the community level to reduce BMI. Moreover, modifiable risk factors for obesity should be attenuated to inhibit the progression of metabolic syndrome, noncommunicable diseases and their complications.

Association between serum uric acid and chronic kidney disease in patients with hypertension: A multicenter nationwide cross-sectional study.

INTRODUCTION: Current data on the role of hyperuricemia as a risk factor for renal progression in patients with hypertension is inconclusive. This study aimed to assess the association of uric acid and chronic kidney disease (CKD) in hypertensive patients using a nationwide patient sample. METHODS: We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult patients with hypertension from 831 Thailand public hospitals in the year 2014. Serum uric acid (SUA) was categorized into quintiles (≤4.5, 4.6 to 5.4, 5.5 to 6.2, 6.3 to 7.4, ≥7.5 mg/dL). CKD was defined as estimated glomerular filtration rate of ≤ 60 mL/min/1.73 m2 . Multivariate logistic regression was performed to assess the association between SUA and CKD using uric acid of ≤4.5 mg/dL as the reference group. RESULTS: A total of 9776 hypertensive patients with available SUA were included in the analysis. The mean SUA was 6.1±1.8 mg/dL. The prevalence of CKD in hypertensive patients was 31.8%. SUA of 4.6 to 5.4, 5.5 to 6.2, 6.3 to 7.4, and ≥7.5 mg/dL were associated with an increased CKD with ORs of 1.57 (95% CI 1.28 to 1.92), 2.15 (95% CI 1.74 to 2.66), 3.31 (95% CI 2.72 to 4.04), and 7.11 (95% CI 5.76 to 8.78), respectively. The restricted cubic spline showed significant increased CKD prevalence when uric acid ≥4.6 mg/dL. CONCLUSION: Higher SUA was associated with increased CKD prevalence in patients with hypertension. SUA should be monitored in hypertensive patients for CKD prevention.

Hazards and Intensive Care Unit Economic Burden of Cigarette Smoking on Critically Ill Surgical Patients: Analysis of the THAI-SICU Study.

Objective: Cigarette smoking is not only has detrimental effects on the respiratory system but also contributes to development of atherosclerosis and inflammatory vascular reactions. We hypothesized whether smoking is associated with increased risk of acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), sepsis, distant organ dysfunctions, and the increase of total cost of surgical intensive care unit (SICU) in critically ill surgical patients. Material and Method: We performed analysis using the THAI-SICU data, a prospective, observational, multicenter study in patients who admitted to SICU in nine university-based hospitals in Thailand. The patients were categorized into 3 groups based on their smoking histories, which were 1) never smoked, 2) former smoker, and 3) current smoker. The primary outcome was probability of ARDS and the secondary outcomes included incidences of SIRS, sepsis, distant organ dysfunction (included acute kidney injury (AKI) and acute myocardial infarction (AMI)), total SICU cost, and 28-day mortality Results: A total of 4,652 patients had complete data of smoking and were analyzed. The smoking status was never smoked (2,947 patients), former smokers (1,148 patients), and current smokers (557 patients). Compared to current smokers and former smokers, patients who had never smoked had significantly lower proportion of patients with chronic obstructive pulmonary disease (p<0.01) and had significantly higher PaO2/FiO2 ratio on SICU admission (p = 0.02). Compared to patients who had never smoked and former smokers, current smokers had significantly higher probability of ARDS (p = 0.003), higher incidence of SIRS (p = 0.006), and AKI (p<0.001), after adjustment for age, gender, APACHE II score, and patients' pre-existing diseases. We found that every 1-pack year of cigarette smoking increased risk of ARDS with a hazard ratio of 1.02 (95% CI 1.01-1.03, p = 0.001). There was no difference in incidence of sepsis, AMI, and 28-day mortality among three groups of patients. Current smokers had significantly higher SICU cost, followed by former smokers, and patients who had never smoked (p = 0.02). Conclusion: In critically ill surgical patients, we found dose-response association between smoking pack year and risk of ARDS. Compared to patients who had never smoked and former smokers, current smokers had significantly higher probability of ARDS, higher incidence of SIRS, AKI, and higher total SICU cost. Our findings demonstrated harm of cigarette smoking in critically ill surgical patients who admitted to SICU.

A randomized controlled trial comparing dexamethasone with loteprednol etabonate on postoperative photorefractive keratectomy.

PURPOSE: To compare loteprednol etabonate 0.5%/tobramycin 0.3% (Zylet(®)) with dexamethasone 0.1%/tobramycin 0.3% (Tobradex(®)) in terms of the epithelial healing time, postoperative visual acuity, corneal haziness score, and intraocular pressure (IOP) in postoperative treatment after photorefractive keratectomy (PRK). METHODS: This prospective, randomized, double-masked (participants and assessors blinded) controlled study included 32 patients who underwent PRK. The patients were allocated equally into 2 groups by block randomization to receive either loteprednol etabonate (Lot) or dexamethasone (Dex) for 1 month after the surgery. The epithelial healing time, uncorrected visual acuity (UCVA), corneal haziness score, and IOP were evaluated at 1 week, 1 month, and 3 months. RESULTS: The corneal epithelium was healed within 3 days in both groups; however, the epithelium was closed on the second day in 3 cases in the Lot group compared with 1 case in the Dex group. No significant differences were found for UCVA at 1 and 3 months (Fisher exact test, P>0.01). Similarly, there was no statistically significant difference in corneal haziness scores between the 2 groups at 1 and 3 months (Mann-Whitney U test, P>0.05). The number of patients experiencing significantly increased IOP (≥5 mmHg) from baseline at any visit for the Lot group (1/16 patients) was fewer than for the Dex group (3/16 patients). CONCLUSIONS: Loteprednol etabonate was effective in postoperative PRK management and was significantly less likely to produce elevations in IOP than was dexamethasone.

Outbreak of Pythium keratitis during rainy season: a case series.

PURPOSE: To describe typical clinical and laboratory characteristics of severe fungal keratitis caused by Pythium insidiosum during the rainy season in Northeast Thailand and to report the efficacy of P. insidiosum vaccine in the treatment of Pythium keratitis. METHODS: A series of hospital-based consecutive cases of Pythium keratitis were diagnosed and treated at Srinagarind Hospital (Khon Kaen University, Khon Kaen, Thailand). The clinical presentations, diagnostic tests, and management are described. RESULTS: Severe fungal keratitis caused by P. insidiosum was diagnosed in 5 eyes of 4 patients between May 2009 and July 2009. All cases had a history of fungal keratitis after being exposed to contaminated water. Upon slit-lamp examination, subepithelial and superficial stromal opacities were observed in a reticular pattern in all cases. Pythium insidiosum was identified and confirmed by both microbiological culture and polymerase chain reaction. Clinical worsening was detected after conventional treatment with antifungal agents. Therapeutic penetrating keratoplasty with either donor cornea or scleral graft was performed together with topical antifungal administration and P. insidiosum vaccination. Subsequent evisceration was performed in 1 eye. CONCLUSIONS: An outbreak of Pythium keratitis in Northeast Thailand was reported. Distinctive clinical features are a suggestive clue for early diagnosis. Combination treatment including topical antifungal agents, radical surgery, and P. insidiosum vaccine may be considered for the management of Pythium keratitis.

A randomized controlled trial of intralesional bevacizumab injection on primary pterygium: preliminary results.

PURPOSE: To evaluate the efficacy and safety of intralesional injection of bevacizumab on primary pterygium treatment. METHODS: In this randomized controlled trial, each primary pterygium patient was randomized to receive either an intralesional injection of bevacizumab 2 mg (1 mg/0.04 mL) or a combination of topical antihistamine (antazoline HCl 0.05%) and vasoconstrictor (tetrahydrozoline HCl 0.04%) as a control. The main outcome measurements were symptoms and signs (including eye irritation, epiphora, redness, amount of discharge, inflammation and elevation of pterygium, and percentage of corneal pterygium area). RESULTS: A total of 74 pterygium eyes in 66 patients were randomized and allocated into a treatment group (N = 34) and a control group (N = 40). In the treatment group, there was a statistically significant reduction of symptoms (including irritation, photophobia, epiphora, redness, discharge, and blurred vision) and signs (inflammation and corneal pterygium area) compared with the baseline, up to at least 6 months. Between the treatment and control groups, no significant differences were found for all visits with respect to the (1) symptoms, (2) signs, and (3) percentage of corneal pterygium. CONCLUSIONS: Intralesional bevacizumab may have a therapeutic effect on symptoms and signs of primary pterygium for at least 6 months (ie, the follow-up period), with no serious ocular or systemic adverse effects.

HIV-1 incidence estimates among young Thai men using IgG-capture BED-enzyme immunoassay (BED-CEIA) during 2005-2006.

BACKGROUND: Knowledge about the most recent HIV epidemic among young generation in Thailand is crucial for improving the prevention programs. It is important to distinguish between recent and long-term HIV-1 infections among the sero-surveillance populations to estimate the HIV-1 incidence. OBJECTIVE: To obtain the HIV-1 incidence estimates in young Thai men from the HIV-1 sero-surveillance among the Royal Thai Army (RTA) conscripts inducted between November 2005 and November 2006. MATERIAL AND METHOD: The confirmed HIV-1 positive serum samples obtained from the November 2005, May 2006, and November 2006 rounds of RTA conscripts induction were selected to be included in the study. The recent HIV-1 infections were detected among the confirmed HIV-1 positive serum samples using an HIV-1 BED incidence EIA Kit (Calypte HIV-1 BED Incidence EIA, Calypte Biomedical Corporation, Maryland, USA. The incidence estimates were obtained in each round of the induction using a consensus formula was agreed upon at the US Centers for Disease Controls and Preventions (CDC). RESULTS: Eighty seven thousand one hundred seventy eight RTA conscripts were tested for HIV-1 infection between November 2005 and November 2006. The prevalence of HIV-1 infection was 0.51%, 0.60%, and 0.50% for the period of November 2005, May 2006, and November 2006, respectively. The HIV-1 incidence estimates were 0.14%/year (95% CI, 0.09-0.20), 0.20% year (95% CI, 0.13-0.28), and 0.17%/year (95% CI, 0.10-0.29) in November 2005, May 2006, and November 2006, respectively. CONCLUSION: We reported the HIV-1 incidence estimates obtained from the IgG-capture BED-enzyme immunoassay (BED-CEIA) method in the RTA conscripts sero-surveillance population. The incidence estimates were ranging from 0.14% - 0.20%/year between November 2005 and November 2006. The estimates could serve as the recent baseline information for future HIV prevention interventions in Thailand.

Prevalence of overweight and obesity in Royal Thai Army personnel.

OBJECTIVE: Determine the prevalence of overweight and obesity in the Royal Thai Army (RTA) personnel. MATERIAL AND METHOD: A cross-sectional study was performed on 4,276 RTA personnel aged 20-60 years between January and July 2005. They were interviewed for general health status, history of smoking, alcohol consumption, and physical activity. Blood pressure, weight, height, waist, and hip circumference were measured. RESULT: The prevalence of overweight and obesity in RTA personnel were 27.1% and 4.9% respectively. The mean value of age, weight, body mass index, waist, and hip circumference, waist hip ratio, blood pressure in overweight, and obese personnel were significantly higher than those of non-overweight personnel. Logistic regression analysis showed that significant risks of being overweight were positively associated with age, male, and working in a combat unit. Current smoking was inversely associated with overweight and obesity, whereas physical activity > or = 3 times/wk was inversely associated with obesity. Overweight and obesity were also associated with hypertension. CONCLUSION: These baseline data are useful for future trends monitoring and may be used for health promotion planning to prevent obesity in RTA personnel.

Trends in long-term survival following liver resection for hepatic colorectal metastases.

OBJECTIVE: To examine trends in outcomes of patients undergoing resection at a single tertiary care referral center over a 16-year period. SUMMARY BACKGROUND DATA: Hepatic resection is considered the treatment of choice in selected patients with colorectal metastasis confined to the liver. Although a variety of retrospective studies have demonstrated improvements in short-term outcomes in recent years, changes in long-term survival over time are less well-established. METHODS: Data from 226 consecutive patients undergoing potentially curative liver resection for colorectal metastases between 1984 and 1999 were analyzed. Actuarial survival rates related to prognostic determinants were analyzed using the log-rank test. RESULTS: The median survival for the entire cohort was 46 months, with 5- and 10-year survival rates of 40% and 26% respectively. Ninety-three patients operated on between 1984 and 1992 were found to have an overall survival of 31% at 5 years, compared to 58% for the 133 patients operated on during the more recent period (1993-1999). Both overall and disease-free survival were significantly better in the recent time period compared with the earlier period on both univariate and multivariate analyses. Other independent factors associated with improved survival included number of metastatic tumors < or = 3, negative resection margin, and CEA < 100. Comparisons were made between time periods for a variety of patient, tumor and treatment-related factors. Among all parameters studied, only resection type (anatomical versus nonanatomical), use of intraoperative ultrasonography, and perioperative chemotherapy administration differed between the early and recent time periods. CONCLUSIONS: Long-term survival following liver resection for colorectal metastases has improved significantly in recent years at our institution. Although the reasons for this survival trend are not clear, contributing factors may include the use of newer preoperative and intraoperative imaging, increased use of chemotherapy, and salvage surgical therapy.