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Objective: To report the case of a young woman with Graves' disease in whom ototoxicity developed because of propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis., Methods: We present the clinical findings, pertinent laboratory data, and follow-up course of a patient with Graves' disease and bilateral sensorineural hearing loss. We also provide a literature review regarding thionamide-induced ANCA-associated vasculitis., Results: In a 22-year-old Thai woman with Graves' disease, tinnitus, hearing impairment in the left ear (with progression to the right ear), and vertigo developed after 3 years of therapy with PTU. Audiograms showed bilateral sensorineural hearing loss with cochlear lesions. She also had low-grade fever, intermittent chronic abdominal pain, weight loss, polyarthralgia, and conjunctivitis. An indirect immunofluorescence test for ANCA was positive. The hearing impairment and tinnitus were gradually reduced after PTU withdrawal and corticosteroid and azathioprine treatment. Definitive therapy by subtotal thyroidectomy was subsequently performed and yielded good results., Conclusion: This rare case of PTU-induced ANCA-associated vasculitis manifested with ototoxicity in combination with systemic involvement.

In the present study we developed and assessed the performance of a simple prediction rule and a neural network model to predict beta-cell reserve in young adults with diabetes. Eighty three young adults with diabetes were included in the study. All were less than 40 years old and without apparent secondary causes of diabetes. The subjects were randomly allocated to 2 groups; group 1 (n = 59) for developing a prediction rule and training a neural network, group 2 (n = 24) for validation purpose. The prediction rule was developed by using stepwise logistic regression. Using stepwise logistic regression and modification of the derived equation, the patient would be insulin deficient if 3(waist circumference in cm) + 4(age at diagnosis) < 340 in the absence of previous diabetic ketoacidosis (DKA) or < 400 in the presence of previous DKA. When tested in the validation set, the prediction rule had positive and negative predictive values of 86.7 per cent and 77.8 per cent respectively with 83.3 per cent accuracy while the ANN model had a positive predictive value of 88.2 per cent and a negative predictive value of 100 per cent with 91.7 per cent accuracy. When testing the performance of the prediction rule and the ANN model compared to the assessment of 23 internists in a subgroup of 9 diabetics whose age at onset was less than 30 years and without a history of DKA, the ANN had the highest ability to predict beta-cell reserve (accuracy = 88.9), followed by the prediction rule (accuracy = 77.8%) and assessments by internists (accuracy = 60.9%). We concluded that beta-cell reserve in young adults with diabetes mellitus could be predicted by a simple prediction rule or a neural network model. The prediction rule and the neural network model can be helpful clinically in patients with mixed clinical features of type 1 and type 2 diabetes.

A prospective randomized, double-blind, controlled study of cefoperazone/sulbactam (cefoperazone 25 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) vs ceftazidime (100 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) in the treatment of severe melioidosis was conducted at Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, from July 1995 to September 1996. A total of 84 patients were enrolled in the study. Forty of them (48%) had culture-proven melioidosis and were randomly assigned to one of the two treatment groups, each group with 20 patients. Two cases (one in each treatment group) were excluded from the final analysis due to incomplete data. There was no significant difference in the mortality rate between the two groups-16 per cent (3/19) in the cefoperazone/sulbactam group vs 21 per cent (4/19) in the ceftazidime group (p > 0.05). Bacteriological responses of successfully treated patients were similar in both groups, and both treatment regimens were well tolerated. Cefoperazone/sulbactam + co-trimoxazole can therefore be used as an alternative treatment for severe melioidosis. However, to further support this conclusion, a study with a larger patient population is needed.