Prevalence and some important risk factors of hypertension in Ban Paew District, second report.

BACKGROUND: Hypertension (HT) has been one of the leading global risk factors for health. Therefore, it is important to indicate groups ofpeople with high risk(s) of HT to provide them with lifestyles modification and checking blood pressure (BP) periodically for early detection of HT. OBJECTIVE: To determine the prevalence of HT and some important risk factors in suspected high-risk group. MATERIAL AND METHOD: Randomized villages in Ban Paew District, Samuthsakorn Province, Central Thailand, which were near the sea, were selected for this study. The authors conducted the survey between February and April 2002 and 2003, getting one volunteer from each house who was in the age of 40-69 years (y). Volunteers were advised to fast from 8 pm until next morning for blood drawn, checking the weight, height, and waist. BP was measured by using the automatic BP and history, physical examination, etc were done. BP at 140/90 mm Hg or higher either systole or diastole and persons with currently treatment would be diagnosed as hypertension. RESULTS: One thousand seventy nine volunteers with completed data were included. One hundred fifty three (14.2%) were known HT, 143 (19.5%) out of 735 and 62 (32.5%) out of 191 volunteers, with no history of HT did not know that their BP reached hypertensive level. Therefore, 205 (22.1%) from 926 volunteers were hypertensive with 89 (26.6%) from 335 men, 116 (19.6%) from 591 women (p = 0.0145) and 32 (3.5%) with isolated systolic hypertension. HT increased significantly in age of 60-69 y, more than 50-59 y and 40-49 y, BMI over 25 (p = 0.0002) and drinking alcohol (p = 0.0384). However, it did not increase with smoking (p = 0.2139) and eating salty foods (p = 0.6568). The group which ate sour taste had borderline significance for negative risk of hypertension (p = 0.0489). CONCLUSION: The authors reported the prevalence of 22.1% having hypertension in the age group of 40-69 years and up to 32.5% in the group of not knowing their BP. Hypertension significantly increased with older age group from 40-49 to 60-69y, male gender, BMI over 25, drinking alcohol. However, it didnot with borderline significance for being a negative risk of hypertension in eating sour taste group.

The accuracy in using modified Friedewald equation to calculate LDL from non-fast triglyceride: a pilot study.

BACKGROUND: Total cholesterol, HDL (high-density lipoprotein) and LDL (low-density lipoprotein) are important risk factors of coronary heart disease. It is costly to perform the LDL test for follow-up cardiovascular diseases (CVD) especially for Gold Card Holders (Thirty Bahts Universal Coverage). Hypertriglyceridemia is also important as it is associated with uncontrolled type 2 Diabetes mellitus, low HDL, and metabolic syndrome. Because the serum triglyceride level changes with time after meal consumption, blood test for triglyceride level should be taken after fasting 12 hours. However this causes hunger and inconvenience in many patients. OBJECTIVE: To find out the optimal time to take blood for triglyceride measurement and using it for calculation of LDL with the original Friedewald Formula and the new Modified Friedewald Formula. MATERIAL AND METHOD: Patients were asked the approximate time of last meal/eating, drinking soft drink, milk. Additionally, the time of blood drawn from the patients was recorded The blood samples were drawn as usual amounts and the tests were done as the physicians ordered If enough sera were left, it would be analyzed for lipid profiles. LDL was also calculated by using standard Friedewald equation (sfLDL) and Modified Friedewald equation (mfLDL = total cholesterol - HDL - 1/6 triglyceride). Comparison between direct measured LDL (dmLDL), sfLDL, and mfLDL with time interval of last food, drink intake was done. RESULTS: There were 999 serum tubes left to be analyzed for lipid profiles and 919 sera (92.0%) left having triglyceride less than 300 mg/dl. Of those, 381, 84, and 454 samples came after fasting (nothing per oral = NPO) approximately less than 8 hours (h), 8-11.9 h, and 12 h or more respectively with sfLDL to dmLDL +/- 10 mg, comparison of 64.0%, 65.5% and 68.3% respectively. In contrast, comparing mfLDL to dmLDL +/- 10 mg being of 82.7%, 83.3% and 84.8% from the same samples and time intervals respectively thus, statistical significant (p-value < 0.001, odd ratios (OR) 2.59- 2.68). If blood drawn regardless of time from last food intake with triglyceride less than 300 mg/dl and with the above condition mfLDL, it gave 83.8% related to dmLDL while sfLDL gave only 66.3% p < 0.0001 and OR = 2.63. CONCLUSION: The present pilot study showed 919 of 999 sera (92.0%) with serum triglyceride less than 300 mg/ dl, regardless of the time of the last food intake. The authors used the new Modified Friedewald equation to calculate that the LDL had 83.8% accuracy when compared to direct measured LDL +/- 10 mg. This equation is more accurate than the standard (original) Friedewald equation with OR of 2.63. The authors offer that to save the cost, the new Modified Friedewald equation should be used to calculate LDL. Then, direct LDL measurement could be reserved for patients with hypertriglyceridemia, in the treatment of LDL in high-risk CVD.

Comparative study of LDL-cholesterol levels in Thai patients by the direct method and using the Friedewald formula.

In this study, low-density lipoprotein cholesterol (LDL-C) levels by direct measurement and estimation using the Friedewald formula, were compared among 1,016 Thai patients. The study assessed blood samples from out-patients sent to the Clinical Chemistry Laboratory, Department of Clinical Pathology, Rajvithi Hospital, Ministry of Public Health, for measurement of total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels, January 2004-December 2005. Patients' ages ranged 8-89 years, 573 (56.4%) were females. Linear regression analysis showed the two methods had highly significant correlation coefficients (p<0.001). Upon comparing the two methods, at TG levels of 151-200 mg/dl, bias was 18.3 mg/dl; and for TG levels of 201-300 mg/dl, bias was lower at 11.4 mg/dl; for TG levels of 301-400 mg/dl, bias increased to 20.9 mg/dl. The direct assay meets currently established analytical performance targets and may be useful for the diagnosis and management of hyperlipidemic patients. The Friedewald formula did not give a homogeneous performance when estimating LDL-C levels in samples with different TG levels.

An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory failure.

BACKGROUND: Northern Thailand's biggest botulism outbreak to date occurred on 14 March 2006 and affected 209 people. Of these, 42 developed respiratory failure, and 25 of those who developed respiratory failure were referred to 9 high facility hospitals for treatment of severe respiratory failure and autonomic nervous system involvement. Among these patients, we aimed to assess the relationship between the rate of ventilator dependence and the occurrence of treatment by day 4 versus day 6 after exposure to bamboo shoots (the source of the botulism outbreak), as well as the relationship between ventilator dependence and negative inspiratory pressure. METHODS: We reviewed the circumstances and timing of symptoms following exposure. Mobile teams treated patients with botulinum antitoxin on day 4 or day 6 after exposure in Nan Hospital (Nan, Thailand). Eighteen patients (in 7 high facility hospitals) with severe respiratory failure received a low- and high-rate repetitive nerve stimulation test, and negative inspiratory pressure was measured. RESULTS: Within 1-65 h after exposure, 18 of the patients with severe respiratory failure had become ill. The typical clinical sequence was abdominal pain, nausea and/or vomiting, diarrhea, dysphagia and/or dysarthria, ptosis, diplopia, generalized weakness, urinary retention, and respiratory failure. Most patients exhibited fluctuating pulse and blood pressure. Repetitive nerve stimulation test showed no response in the most severe stage. In the moderately severe stage, there was a low-amplitude compound muscle action potential with a low-rate incremented/high-rate decremented response. In the early recovery phase, there was a low-amplitude compound muscle action potential with low- and high-rate incremented response. In the ventilator-weaning stage, there was a normal-amplitude compound muscle action potential. Negative inspiratory pressure variation among 14 patients undergoing weaning from mechanical ventilation was observed. Kaplan-Meier survival analysis identified a shorter period of ventilator dependency among patients receiving botulinum antitoxin on day 4 (P=.02). CONCLUSIONS: Patients receiving botulinum antitoxin on day 4 had decreased ventilator dependency. In addition, for patients with foodborne botulism, an effective referral system and team of specialists are needed.

Panel 2.5: mass-casualty management and hospital care.

This is a summary of the presentations and discussion of Panel 2.5, Mass-Casualty Management and Hospital Care of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to mass-casualty management and hospital care as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) recommendations; and (3) conclusions. Subsections of the conclusion section include: (1) lessons learned; (2) what was done well?; and (3) what could have been done better?.

Is calculated LDL-C by using the new modified Friedewald equation better than the standard Friedewald equation?

The patients who have CHD or CHD risk equivalents should have LDL-C level less than 100 mg/dL because of the great reduction of risk for major coronary events. Direct measurement of LDL-C is the most accurate but is expensive. But with the practical use of the Friedewald equation for calculating LDL-C, the authors noticed that the accuracy declined with triglyceride level being higher than 300 mg/dL. The authors determined the correlation of direct measurement of LDL-C with calculation LDL-C from the Friedewald equation and postulated the new modified Friedewald equation for calculating LDL-C by using 1/6 triglyceride to minus. From a total of 1079 fasting serum samples analysis, and determining the correlation of LDL-C from the direct measurement (dm LDL) while calculating LDL-C from equations of the standard Friedewald (sf LDL), and the new modified Friedewald (mf LDL), by using 1/6 triglyceride to minus instead of 1/5 triglyceride, if triglyceride was over 200 mg/dL. The authors found an excellent correlation within 0 +/- 10% difference of dm LDL and sfLDL if triglyceride was less than 200 mg/dL, but sf LDL is less accurate when the triglyceride level is high, and mf LDL has better correlation with dm LDL within 0 +/- 10% that sf LDL vs mf LDL, 72.3% vs 91.6% (p = 0.0001), and 58.3% vs 83.3%, (p = 0.01) when the triglyceride level is 200-299, and 300-399 mg/dL respectively. It is shown that sf LDL has more underestimation than mf LDL when compared with dm LDL (more than 10 mg/dL) as 26.9% vs 2.5% (p < 0.0001) and 41.6% vs 5.6% (p = 0.0003 ) with triglyceride of 200-299, and 300-399 mg/dL respectively, although mf LDL showed overestimation of more than 10 mg/dL difference with dm LDL as sf LDL vs mf LDL of 0.8% vs 5.8% (p = 0.03), and 0.0% vs 11.1% (p=0.03) if the triglyceride is in the range of 200-299 and 300-399 mg/dL respectively, even with a triglyceride level of 400-499 mg/dL, mfLDL still has good correlation with dm LDL up to 75.0%. The authors conclude that the standard Friedewald equation is excellent for LDL calculation if triglyceride is less than 200 mg/dL, but the accuracy is declined when triglyceride is over 200 mg/dL, the authors offer a new modified Friedewald equation to calculate LDL-C if triglyceride is in the range of 200-499 mg/dL which has a better correlation with direct measured LDL-C. However this new modified Friedewald equation needs to be testified again especially with dyslipidemic patient sera.