Fornix Rupture in Duplex Kidney due to Internal Iliac Artery Aneurysm

A 70-year-old man presented with severe pain on the right side of the abdomen for 7 days. An abdominal CT angiographic scan showed an impending rupture of a large right internal iliac artery aneurysm which compressed to a right ureter causing hydroureteronephrosis. Fornix rupture of a right duplex kidney was also detected. Selective embolization of right gluteal arteries and then ligation of the right internal iliac artery and right ureterotomy with double J stenting were performed. At the 4-month follow-up appointment, an abdominal ultrasound demonstrated a decrease in the size of the aneurysm and no hydroureteronephrosis after the removal of double J stent

Associations between maternal overweight/obesity during pregnancy and body composition in young adult offspring

BackgroundMaternal obesity is associated with an increased risk of large-for-gestational-age births and childhood obesity. However, evidence on its potential associations with long-term offspring body composition remains limited. This prospective cohort study examined associations between maternal body mass index (BMI) during pregnancy and body composition in the young adult offspring.MethodsParticipants were the offspring from a birth cohort in Chiang Mai (Thailand). Maternal BMI was assessed at the first antenatal clinic visit (≤24 weeks of gestation) in 1989–1990. In 2010–2011, we followed up the offspring at approximately 20 years of age, assessing their body composition using whole-body dual-energy X-ray absorptiometry (DXA) scans. Associations between maternal BMI and offspring body composition were explored using unadjusted and adjusted analyses.ResultsWe assessed 391 young adults (55% were females). Higher maternal BMI was associated with increased offspring fat mass and lean mass. In adjusted analyses, offspring of mothers with overweight/obesity exhibited total body fat percentages 1.5 (95% CI 0.1, 2.9; p = 0.032) and 2.3 (95% CI 0.2, 4.5; p = 0.036) percentage points higher than offspring of normal-weight and underweight mothers, respectively. Fat mass index was similarly higher: 0.9 kg/m2 (95% CI 0.3, 1.5 kg/m2; p = 0.002) and 1.4 kg/m2 (95% CI 0.5, 2.3 kg/m2; p = 0.002), respectively. However, no differences in visceral adiposity were detected.ConclusionHigher maternal BMI during pregnancy was associated with increased adiposity in young adult offspring. Our findings suggest that the cross-generational transmission of maternal obesity-related traits is associated with increased offspring adiposity in the long term

Early life urban exposure as a risk factor for developing obesity and impaired fasting glucose in later adulthood: results from two cohorts in Thailand.

BACKGROUND: Obesity and obesity related conditions, driven by processes such as urbanization and globalization, are contributing to pronounced cardiovascular morbidity and mortality in developing countries. There is limited evidence on the influence of living in an urban environment in early life on obesity and obesity related conditions later in life in developing countries such as Thailand. METHODS: We used data from two cohort studies conducted in Thailand, the Thai Cohort Study (TCS) and the Chiang Mai University (CMU) Health Worker Study, to investigate the association between early life urban (vs rural) exposure and the later development of obesity. We additionally explored the association between early life urban exposure and impaired fasting glucose in adulthood using data from the CMU Health Worker Study. RESULTS: Among 48,490 adults from the TCS, 9.1 % developed obesity within 4 years of follow-up. Among 1,804 initially non-obese adults from CMU Health worker study, 13.6 % developed obesity within 5 years of follow-up. Early life urban exposure was associated with increased risk of developing obesity in adulthood in both cohorts. Adjusting for age and sex, those who spent their early lives in urban areas were 1.21 times more likely to develop obesity in the TCS (OR 1.21, 95 % CI 1.12 to 1.31) and 1.65 times more likely in the CMU Health Worker study (OR 1.65, 95 % CI 1.23 to 2.20). These associations remained significant despite adjustment for later life urban exposure and current household income. No evidence for an association was found for impaired fasting glucose. CONCLUSIONS: Early life urban exposure was associated with increased risk of developing obesity in adulthood. These findings support public health intervention programs to prevent obesity starting from early ages

Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol.

INTRODUCTION: Type 2 diabetes mellitus is among the foremost health challenges facing policy makers in Thailand as its prevalence has more than tripled over the last two decades, accounting for considerable death, disability and healthcare expenditure. Diabetes self-management education (DSME) programmes show promise in improving diabetes outcomes, but this is not routinely used in Thailand. This study aims to test a culturally tailored DSME model in Thailand, using a three-arm cluster randomised controlled trial comparing a nurse-led model, a peer-assisted model and standard care. We will test which model is effective and cost effective to improve cardiovascular risk and control of blood glucose among people with diabetes. METHODS AND ANALYSIS: 21 primary care units in northern Thailand will be randomised to one of three interventions, enrolling a total of 693 patients. The primary care units will be randomised (1:1:1) to participate in a culturally-tailored DSME intervention for 12 months. The three-arm trial design will compare effectiveness of nurse-led, peer-assisted (Thai village health volunteers) and standard care. The primary trial outcomes are changes in haemoglobin A1c and cardiovascular risk score. A process evaluation and cost effectiveness evaluation will be conducted to produce policy relevant guidance for the Thai Ministry of Public Health. The planned trial period will start in January 2020 and finish October 2021. ETHICS AND DISSEMINATION: Ethical approval has been obtained from Thailand and the UK. We will share our study data with other researchers, advertising via our publications and web presence. In particular, we are committed to sharing our findings and data with academic audiences in Thailand and other low-income and middle-income countries. TRIAL REGISTRATION NUMBER: NCT03938233

The risk factors associated with carotid artery disease

Atherosclerosis plays a primary role in ischaemic heart disease, the most common cause of death in the developed world.  Inflammation, the fundamental pathological process in atherogenesis and formation of plaque, was investigated in a randomised controlled trial conducted on 189 patients awaiting carotid endarterectomy (CEA).  The main objective of this study was to compare the effect of n-3 polyunsaturated fatty acid (PUFA) supplements on the inflammatory process in carotid plaques compared with n-6 PUFA supplements and a placebo.  It was found that the number of macrophages in the plaque was significantly lower in patients taking n-3 PUFA supplements than in those of the other groups, which may make these plaques more stable and less likely to rupture.  The level of high sensitivity C-reactive protein was significantly higher in patients with symptomatic carotid stenosis than in those without symptoms, which may help to identify carotid stenosis patients at a high risk of developing neurological deficits.  Another objective of this study was to assess the extent to which physicians recognised the importance of control of hyperlipidaemia in patients with severe atherosclerosis.  It was found that 32.1% of these patients had higher levels of plasma cholesterol than the recommended value and 22% of them had never had any tests for blood lipids.  Many large randomised controlled trials have found that CEA in patients with symptomatic severe carotid stenosis has clearly reduced the incidence of stroke, compared with medical treatment only.  From a systematic review of the literature of carotid endarterectomy in the period 1960 -  2000 and a meta-analysis, it was found that the risk of stroke and death in patients with symptomatic carotid stenosis was 4.6% and has not changed significantly over the last 15 years.  Presentation, such as stroke, transient ischaemic attacks and amaurosis fugax, strongly influences stroke/death rates and therefore, reports of the outcome of surgery should always be stratified accordingly. Furthermore, this figure for risk varied enormously and depended on research design and reporting.  One should take the quality of study design and reporting into account before judging the performance of the surgeons in these studies.</p