High Sensitivity C-Reactive Protein Level and Psoriasis Severity in Thai Patients.

Background: Psoriasis vulgaris severity have been widely assessed by psoriasis area severity index (PASI) score. However, it may not be not the best measure because of the high variability and inability to tell the other aspect of the disease including co-morbidity and cardiovascular risk. Objective: To determine the correlation between high sensitivity C-reactive protein (hs-CRP) level and psoriasis severity and to determine co-morbidities of psoriasis patients. Material and Method: One hundred eighty psoriasis patients and thirty control patients were enrolled in the present cross-sectional study. Fasting venous blood were collected and analyzed for fasting plasma glucose, hemoglobin A1c, lipid profile, and hs-CRP. The psoriasis patients were assessed for skin severity by PASI scoring. The correlation was assessed by regression analysis. Results: The hs-CRP level was found significantly higher in the psoriasis group (p-value <0.001). The hs-CRP level significantly correlated with PASI score by using multivariate regression analysis. Conclusion: This correlation between hs-CRP level and the psoriasis severity has led to the proposition that hs-CRP be used as a biomarker for overall inflammation including skin severity and cardiovascular risk factor in psoriasis.

Prevalence of hyperuricemia in Bangkok population.

To investigate the prevalence of hyperuricemia in general Thai population and to evaluate its association with metabolic syndrome. A total of 1,945 subjects who sought for routine annual health checkup in our hospital from 1 October 2009 to 31 March 2010 were enrolled into the study. Inclusion criteria were healthy individuals, aged ≥35 years old, and lived in Bangkok for over 10 years. Data of general health status, age, gender, history of alcoholic consumption, body weight, height, and waist circumference were obtained by an interview-structured questionnaire. Fasting blood sample was collected from each subject early in the morning for uric acid, total cholesterol, high density lipoprotein cholesterol, triglycerides, and glucose levels. The prevalence of hyperuricemia in our study population was 24.4%, being significantly more common in men than women (59% vs. 11%, p < 0.001). The condition was also associated with various features of high body mass index or waist circumference, alcohol consumption, dyslipidemia, and high fasting blood glucose. Metabolic syndrome was found in 35% and 23% of men and women with hyperuricemia; direct relationship between level of uric acid and prevalence of metabolic syndrome was observed. Hyperuricemia is common among Bangkok population in our study. This disorder is frequently associated with metabolic syndrome.

Accuracy of Amsler grid in screening for chloroquine retinopathy.

OBJECTIVE: Determine the accuracy, sensitivity, and specificity of an Amsler grid testingfor chloroquine retinopathy screening. MATERIAL AND METHOD: One hundred and forty patients who received chloroquine phosphate or hydroxychloroquine sulfate and attended the rheumatology clinic of BMA Medical College and Vajira Hospital between March 2008 and May 2009 were included. The patients underwent Amsler grid testing, which would be interpreted by a rheumatologist, for any evidence of chloroquine retinopathy. The resultsfrom Amsler grid testing were then compared to the results from a Humphrey 10-2 fields testing, which was subsequently performed by an experienced ophthalmologist and was used as a gold standard. RESULTS: Out of 140 patients, chloroquine retinopathy was evidenced in 11 patients (7.9%). Kappa value of the Amsler grid testing interpreted by rheumatologist and the Humphrey 10-2 fields testing interpreted by ophthalmologist was 0.89. The accuracy for screening chloroquine retinopathy by the Amsler grid testing was 98.6% (95% confidence interval [CI], 98.1-100.0%) with the sensitivity of81.8% (95% CI, 75.4-88.2%). The specificity and positive predictive value were 100.0% while the negative predictive value was 98.4% (95% CI, 96.4-100.0%). CONCLUSION: Amsler grid testing is an accurate screening test for chloroquine retinopathy with very high specificity. The test could be achieved by a rheumatologist who could practically serve the patients in one visit at the rheumatology clinic.

Clonal spread of carbapenem resistant Acinetobacter baumannii in the patients and their environment at BMA Medical College and Vajira Hospital.

OBJECTIVE: To determine the clonal spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in the patients and their environment at BMA Medical College and Vajira Hospital. MATERIAL AND METHOD: A prospective study on CRAB isolated from the clinical specimens of 30 patients and 300 from their environmental samples were carried out from September 1-15, 2008. The CRAB isolates were genotyped using PCR-based typing method. RESULTS: Twenty-six (86.7%) and 20 (66.7%) cases of 30 patients had their environment contaminated with A. baumannii and CRAB, respectively Environmental contamination rates of A. baumannii and CRAB were 18.0% (54/300) and 13.0% (39/300), respectively. The most contaminated sites with CRAB were bedside cupboards (26.7%), followed by bedrails and bed sheets (20%), BP cuffs (16.7%), over bed tables and nurse station counters (13.3% each) and push carts (10%). Four molecular types were classified among 65 CRAB isolates. Molecular type 1 was the most prevalent (90.7%) and found in all kinds of environmental samples except patient record folder and computer keyboard/mouse. About 37% of the patients had at least one of their environmental samples contaminated with CRAB clonally related with their own types. CONCLUSION: Clonal spread of CRAB was demonstrated to emphasize the important of hand hygiene, contact precaution and patient's environmental decontamination in controlling the spread of CRAB in the hospital.

Four years follow-up of bone mineral density change in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To measure the change in bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) during 4 years of follow-up, and to identify the role of glucocorticoid and disease related variables. METHOD: Premenopausal women with SLE were clinically evaluated and underwent BMD measurement of the lumbar spine, femoral neck and trochanter by dual energy x-ray absorptiometry. RESULTS: 106 SLE patients were evaluated with a mean age of 31.7 +/- 7.5 years, duration of SLE 2.5 +/- 2.6 years, mean daily dose 17.1 +/- 14 mg/d, duration of prednisolone treatment 16.3 +/- 19.9 months during 4 years of follow-up. There was no significant change in BMD at the lumbar spine (1.051 +/- 0.15 vs 1.052 +/- 0.14 vs 1.056 +/- 0.17 vs 1.056 +/- 0.19; p = 0.27), femoral neck (0.861 +/- 0.12 vs 0.867 +/- 0.12 vs 0.846 +/- 0.12 vs 0.844 +/- 0.12, p = 0.28) and trochanter (0.718 +/- 0.12 vs 0.726 +/- 0.13 vs 0.717 +/- 0.13 vs 0.709 +/- 0.14; p = 0.26) at the baseline, first, second and fourth year follow-up study. Furthermore, annual percentage BMD changes were not significant in lumbar BMD (p = 0.37), femoral neck BMD (p = 0.65) and trochanteric BMD (p = 0.47) during the 4 years follow-up study. The average annual percentage change of BMD was not significantly associated with change in age, body mass index (BMI), disease activity, disease severity, disease duration and prednisolone treatment. In addition, there were no significant bone changes between subgroups treated with < or = 7.5 mg and > 7.5 mg daily dose of prednisolone as indicated by BMD at the lumbar spine, femoral neck and trochanter as well as annual percentage BMD changes over the study period. CONCLUSION: There was no significant change of lumbar spine, femoral neck or trochanteric BMD in premenopausal SLE women treated with corticosteroid. These findings suggest that low dose prednisolone may not be detrimental to bone in premenopausal women with SLE during longterm treatment.

Bone mineral density in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To study bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) and to evaluate the influence of disease activity and use of corticosteroids. METHODS: A cross-sectional study on BMD of 118 premenopausal women with SLE. Patients were divided into 2 groups, 74 who had been treated with corticosteroids and 44 who had not. BMD at lumbar spine, femoral neck, and trochanter was measured. RESULTS: BMD in patients without and with corticosteroid treatment was 1.13 +/- 0.13 vs 1.05 +/- 0.14 g/cm2 (p = 0.005) at lumbar spine, 0.92 +/- 0.12 vs 0.86 +/- 0.12 g/cm2 (p = 0.005) at femoral neck, and 0.78 +/- 0.13 vs 0.72 +/- 0.12 g/cm2 (p = 0.014) at trochanter, respectively. Stepwise multilinear regression analysis showed that corticosteroid exposure was independently associated with decreased BMD in the corticosteroid treated patients (r2 = 7% for lumbar and 6.6% for trochanter model). No significant difference in BMD in corticosteroid treated patients appeared when they were subgrouped according to whether they were taking calcium supplements. Prevalence of osteoporosis at lumbar spine in corticosteroid treated patients was 1.4%, and was lower than reported for age and sex matched Caucasians. CONCLUSION: BMD measurements were significantly lower in premenopausal SLE patients who had had corticosteroid treatment than those who had not. There was a negative correlation between BMD and corticosteroid therapy, but not disease activity. Prevalence of osteoporosis, based on lumbar spine BMD, was lower than that reported in Caucasians.