Vajira Medical Journal : Journal of Urban Medicine

Concomitant Streptococcus Suis Septic Arthritis and Gouty Arthritis: A Case Report

2024-11-27T09:16:18+07:00

Septic arthritis, when occurring together with crystal-induced arthritis such as gout, can make the diagnosis more difficult and increase the risk of complications compared with septic arthritis without concomitant gout. Streptococcus suis, a common pathogen in swine, can be transmitted from animals to humans. Human infections are rare. Patients often have a history of contact with or consumption of undercooked pork. Most patients present with meningitis, septicemia, endocarditis, and septic arthritis. A 71-year-old man presented with bilateral knee pain, swelling, and fever. Synovial fluid aspiration from the knee revealed intracellular urate crystals and Streptococcus suis on the culture. He was diagnosed with septic arthritis due to Streptococcus suis with concomitant gouty arthritis. The patient was treated with intravenous ceftriaxone and bilateral knee arthrotomy. After clinical improvement, he was switched to oral amoxicillin and completed a total of 4 months of antibiotics. At the 1-year follow-up, his function was near pre-infection levels. This is the first reported case of septic arthritis due to Streptococcus suis, an uncommon pathogen, in a patient with gouty arthritis. Concurrent septic arthritis and gouty arthritis can make the diagnosis more difficult. A high index of suspicion for septic arthritis with gouty arthritis is important for the accurate diagnosis and appropriate treatment in order to minimize complications.

Vitamin D Level of Individuals Having Medical Service in a Tertiary Hospital

2024-08-21T13:29:26+07:00

OBJECTIVE: This study aimed to investigate the status of vitamin D level, rates of insufficiency and deficiency in individuals seeking medical services in a tertiary hospital.
METHODS: This retrospective study was conducted between October 1, 2022, and December 24, 2023. Inclusion criteria were individuals aged 18 years or older who had sought medical services in our hospital between August 2021 to May 2022. Information such as age, gender, ethnicity, and personal health data including vitamin D level, blood pressure, body mass index, and bone mineral density were collected. The percentages and risk features among the individuals with inadequate vitamin D levels were analyzed.
RESULTS: Among the 2,459 participants, the mean age was 52.0 years (interquartile range [IQR] 40, 67 years). Approximately one third had one or more health disorders (31.1%), with 29.7% being overweight, 10.8% being obese, and 57.3% having high blood pressure. Osteopenia or osteoporosis was found in 33.2%. The median vitamin D level was 26.3 ng/mL (IQR 19.4, 36.0 ng/mL), with 61.8% had inadequate vitamin D levels as insufficiency in 35.2% and deficiency in 26.6%. Univariable analysis revealed the following three features showing significant association with inadequate vitamin D levels: age younger than 60 years (odds ratio [OR] 2.3, p-value < 0.001), Thai ethnicity (OR 1.3, p-value = 0.014), and overweight/obesity (OR 1.3, p-value = 0.002). Multivariable analysis showed that all three features were independent risk factors for inadequate vitamin D levels.
CONCLUSION: This study showed a high percentage of inadequate vitamin D levels among the participants, with insufficiency in approximately one third and deficiency in one fourth. Older people, Thai people, and overweight/obese people were at risk of inadequate vitamin D levels.

A Randomized, Double-Blind Study on the Combined Effects of Low-Level Laser Therapy and Exercise on Pain, Functional Level, and Range of Motion in Patients with Chronic Non-Specific Low Back Pain

2024-10-08T08:10:44+07:00

OBJECTIVE: To investigate the combined effects of low-level laser therapy (LLLT) in conjunction with an exercise program (LLLT group) compared to exercise alone (control group) on pain, functional level, and range of motion in patients with chronic non-specific low back pain (CNLBP).
METHODS: Sixty participants with CNLBP were randomized and divided into 2 groups: laser group (30 participants) and control group (30 participants). Both groups were assigned the same homework exercises (once a day, 3 days a week for 4 weeks). The assessments were performed at baseline and 4 weeks after low-level laser therapy application 3 times per week for 4 weeks. Pain level (visual analogue scale), functional level (the Oswestry low back pain disability questionnaires Thai version) and range of motion (Schober’s test) were evaluated.
RESULTS: The participants who completed the study totaled 60, with 30 in the LLLT group and 30 in the control group. Both groups showed statistically significant differences in improved pain level and functional level (p < 0.001) from baseline to the 4^th week, with the exception of range of motion in the control group (p = 0.644). Outcome of mean difference across the intervention arm for group comparison analysis indicated statistically significant differences in favor of the experimental group across all measures (p < 0.01, p < 0.03 and p < 0.01, respectively).
CONCLUSION: Combining LLLT with exercise significantly reduced pain, improved functional ability, and increased lumbar range of motion, providing a more effective treatment for Thai patients with CNLBP compared to exercise alone. The Minimal Clinically Important Difference for Visual Analog Scale (0.211) and Oswestry Disability Index (0.216) confirmed that the improvements at week 4 were clinically significant beyond natural recovery.

Referral Time for Diabetic Retinopathy Screening and Impact on the Visual Acuity of Patients in a Tertiary Hospital

2024-10-24T10:08:35+07:00

OBJECTIVE: To evaluate the referral time for the screening of diabetic retinopathy (DR) from the initial diagnosis of diabetes to retinal examination. We also compared visual results among groups screened at various duration of referral time.
METHODS: This cross-sectional study was conducted retrospectively from medical records for the poorer-seeing eyes of 100 patients with type 2 diabetes from January 2021 to December 2022 at the tertiary eye center. Patients were classified based on the time duration from the initial diagnosis of diabetes to retinal examination or imaging. Visual acuity (VA) and DR stages categorized by the period of referral time were compared among each group.
RESULTS: Seventy-five patients (75%) took > 2 months from the first diagnosis of diabetes to DR screening performed by an ophthalmologist. Twenty-three patients (23%) were diagnosed with DR at the first ophthalmic visit; among these, 16 had a referral time of > 2 months. Twelve patients were diagnosed with vision-threatening DR; six of these had diabetic macular edema. The receiver operating characteristic (ROC) curve analysis indicates that patients receiving ophthalmic examination within 91 days from the diagnosis of diabetes likely maintain a best-corrected VA of ≥ 20/50. This recommended period of referral time yielded an area under the ROC curve, sensitivity, and specificity of 70.63%, 61.90%, and 83.33%, respectively.
CONCLUSION: In clinical practice, a prolonged period for the first DR screening is relatively common and may result in more patients with vision-threatening DR. Proactive and systematic work should be undertaken to create patient awareness on the importance of detection of asymptomatic and early-stage DR to prevent irreversible visual loss.

Factors Associated with Malnutrition in Older Patients with Type 2 Diabetes in Bangkok, Thailand

2024-11-12T13:35:40+07:00

OBJECTIVE: Malnutrition is a widespread but often neglected concern among older individuals with type 2 diabetes mellitus (T2DM), especially in Thailand, where research on this issue is limited. In this group, malnutrition can result in adverse outcomes, such as diminished physical function, decreased quality of life, longer hospitalizations, and increased mortality. This study aimed to examine the prevalence of malnutrition and the factors contributing to it among older adults with T2DM.
METHODS: This cross-sectional study was conducted in August and September 2024 at our local hospital. Older patients diagnosed with T2DM for at least 6 months were included in the analysis. Nutritional status was evaluated using the Global Leadership Initiative on Malnutrition criteria, which assess weight loss, low body mass index, and reduced muscle mass. Logistic regression was used to determine predictors of malnutrition.
RESULTS: Of the 176 participants, 30.1% were malnourished. Factors significantly associated with malnutrition included being underweight (adjusted odds ratio [AOR]: 11.07, 95% CI: 2.69–45.53), being married (AOR: 5.29, 95% CI: 1.14–24.64), living with diabetes for more than 10 years (AOR: 2.99, 95% CI: 1.23–7.25), poor medication adherence (AOR: 2.55, 95% CI: 1.06–6.17), and having a glomerular filtration rate below 60 (AOR: 4.70, 95% CI: 1.95–11.34).
CONCLUSION: Malnutrition is prevalent in older individuals with T2DM. Routine nutritional evaluations should be implemented to reduce health risks and improve patient outcomes in this population.

Characterization of Entercytozoon bieneusi and Drug Resistance-Associated Mutations Using the β-Tubulin Gene

2024-12-03T08:38:18+07:00

OBJECTIVE: In the β-tubulin gene of Enterocytozoon bieneusi, five mutations: His₆, Phe₁₆₇, Glu₁₉₈, Phe₂₀₀, and Arg₂₄₁ have been implicated in reducing albendazole efficacy, with Glu₁₉₈ and Phe₂₀₀ being particularly significant. The primary objective of this study was to characterize mutations in the β-tubulin gene of E. bieneusi associated with albendazole resistance. Specifically, the study focused on mutations at codons Glu₁₉₈ and Phe₂₀₀ using newly developed primers (EbBtu198/200) with DNA extracted from fecal samples of pigs and humans.
METHODS: A total of 38 stored DNA samples, comprising 30 from different pigs and eight from different humans, were analyzed to evaluate the sensitivity of the newly designed primers and optimize the polymerase chain reaction (PCR) conditions. The encoded amino acid sequences were examined to identify the mutations at codons 198 and 200 in the β-tubulin gene of E. bieneusi. Additionally, a phylogenetic analysis was performed using the β-tubulin nucleotide sequences to determine the genetic relationships among different isolates.
RESULTS: PCR-amplification of the β-tubulin gene yielded a 427 bp product, with a primer sensitivity rate of 94.74%. Sequencing of 18 gene products revealed that ten sequences from pigs corresponded to Haplotype A, while human samples showed four haplotypes: A, B, C, and D. Notably, a mutation resulting in the substitution of glutamic acid with glutamine at codon 198 (E198Q) was identified, uncovering a potential mechanism for albendazole resistance. Phylogenetic analysis applying the maximum likelihood method demonstrated that all β-tubulin sequences formed a monophyletic group, indicating low genetic diversity among the E. bieneusi isolates.
CONCLUSION: This study underscores the significance of mutations in the β-tubulin gene, particularly at codon Glu₁₉₈, as key factors potentially contributing to albendazole resistance in E. bieneusi. These findings may offer valuable insights for improving treatment strategies in patients harboring isolates with such mutations. Furthermore, the β-tubulin gene analysis revealed limited genetic diversity among E. bieneusi isolates, with distinct haplotypes detected in pig and human samples, suggesting possible host-specific adaptations or transmission patterns.