Viable metacercariae of Opisthorchis viverrini in northeastern Thai cyprinid fish dishes—as part of a rational program for control of O. viverrini-associated cholangiocarcinoma

Among the various types of chronic helminthic infections, only schistosomiasis hematobium, opisthorchiasis, and clonorchiasis in a long-standing inflammation are found to be causative agents of cancer. Opisthorchiasis and Opisthorchis viverrini-associated bile duct cancer are prevalent among the residents in northeastern Thailand, who prefer consuming raw or improperly cooked cyprinid fish. Although numerous studies have reported on the presence of O. viverrini metacercariae in freshwater cyprinid fishes, none of the data has been derived directly from cyprinid fish dishes. Here, we have demonstrated the presence of viable metacercariae in a number of cyprinid fish dishes that are among the favorite foods of northeastern Thais. Traditional salt-fermented and grilled cyprinid fish were found to be safe to consume, but not raw fish salad or cyprinid fish fermented in sticky rice for 69 h. This information could be used as part of a rational and sustainable control program for O. viverrini-associated bile duct cancer     

Mental health and psychosocial support after the tsunami in Thailand

This article presents an overview of the psychosocial and mental health response after the Asian Tsunami hit Thailand in 2004. The organization and deployment of service modalities that used pre-existing community and school advisory programmes for rapid emergency response were seen as key elements of the response. Mental health programmes were provided to mitigate and ameliorate the effects of the catastrophic event. We describe these strategies and report on lessons learnt.     

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

AIM:To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization(WGO) Endoscopy Training Center in Thailand.METHODS:Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed.The patients’ characteristics,pre-anesthetic problems,anesthetic techniques,anesthetic agents,anesthetic time,type and route of procedure and anesthesia-related complications were assessed.RESULTS:One hundred and forty-four patients underwent this procedure during the study period.The mean age of the patients was 57.6 ± 17.2 years,andmost were American Society of Anesthesiologists(ASA) class Ⅱ(53.2%).Indications for this procedure were gastrointestinal bleeding(59.7%),chronic diarrhea(14.3%),protein losing enteropathy(2.6%) and others(23.4%).Hematologic disease,hypertension,heart disease and electrolyte imbalance were the most common pre-anesthetic problems.General anesthesia with endotracheal tube was the anesthetic technique mainly employed(50.6%).The main anesthetic agents administered were fentanyl,propofol and midazolam.The mean anesthetic time was 94.0 ± 50.5 min.Single balloon and oral(antegrade) intubation was the most common type and route of enteroscopy.The anesthesia-related complication rate was relatively high.The overall and cardiovascular-related complication rates including hypotension in the older patient group(aged ≥ 60 years old) were significantly higher than those in the younger group.CONCLUSION:During anesthetic management for small bowel enteroscopy,special techniques and drugs are not routinely required.However,for safety reasons anesthetic personnel need to optimize the patient’s condition.     

Pharmacokinetic studies of cyclosporine in Oriental kidney transplantation patients

SUMMARY: Pharmacokinetic studies were performed in 10 stable kidney transplantation patients who received microemulsion formulation (Neoral^®) of cyclosporine A (CsA) twice daily. No agents having pharmacokinetic effects on CsA had been used in these patients. The values of various basic pharmacokinetic parameters were similar to those reported in Western literature. The complete area under the blood concentration–time curve (AUC) of CsA for the duration of 12 h (12‐h AUC) was determined using the linear trapezoidal rule from seven concentrations at 0, 1, 2, 4, 6, 8, and 12 h after CsA administration. The mean values of 12‐h AUC were 4603.63 ± 344.61 ng h/mL. CsA concentrations at 2 h after dosing (not the trough levels) showed the best correlation with the complete AUC (r² = 0.9322). The abbreviated AUC of CsA was calculated either by stepwise multiple linear regression analysis or by the linear trapezoidal rule from a few sampling time points. Using stepwise multiple linear regression analysis, which was used in calculating abbreviated AUC in all previous studies, the model equation that had the highest correlation and the lowest prediction error with the complete AUC was derived by using CsA concentrations at 2 and 8 h after dosing (12‐h AUC = 4.262C₂ + 8.390C₈? 669.417; r² = 0.9808, absolute prediction error = 3.97 ± 0.96). Two model equations derived using the linear trapezoidal rule provided the best correlation with the complete AUC: (1) The two time points selected model equation 12‐h AUC = 4C₂ + 5C₈; r² = 0.9780, absolute prediction error = 6.41 ± 1.22). (2) The three time points selected model equation 12‐h AUC = 4C₀ + 3C₂ + 5C₆; r² = 0.9475, absolute prediction error = 5.00 ± 1.41). When different pharmacokinetic data sets were applied to the model equations derived using regression analysis, the values of coefficients and the constant of the regression equation had changed from the initial equation. Thus, new model equations will emerge every time the new data are applied. In contrast, the values of coefficients in the model equation calculated using trapezoidal rule were unaltered when tested by the new pharmacokinetic data set. Thus, the abbreviated AUC derived using the linear trapezoidal rule would be simpler than and superior to that obtained using stepwise multiple linear regression analysis in prediction of the complete AUC.     

A new circulating recombinant form,CRF15_01B,reinforces the linkage between IDU and heterosexual epidemics in Thailand

HIV-1 subtype B and CRF01_AE have been in circulation in Thailand and Southeast Asia for more than a decade. Initially separated by risk group, the two strains are increasingly intermixed, and two recombinant strains of essentially reciprocal structure have been recently reported. Here we identify additional CRF_01B recombinants and provide the evidence that HIV-1 strains now pass freely between the two high-risk populations. HIV isolates that showed discordance between CRF01_AE and subtype B in multi-region genotyping assays were selected for the study. They were drawn from 3 different cohorts in Thailand representing different risk behaviors and demographic characteristics: a drug user cohort in the north, a family planning clinic attendee cohort in the southeast, and a cohort study of the mucosal virology and immunology of HIV-1 infection in Thailand. The DNA from these isolates was PCR amplified to recover the full HIV-1 genome and subjected to sequencing and phylogenetic analysis. We establish that one particular CRF_01B recombinant, with the external envelope of subtype B and the rest of the genome from CRF01_AE, is circulating widely in Thailand. Termed CRF15_01B (also referred to as CRF15), the strain was primarily heterosexually transmitted, although injecting drug use (IDU) also played a role. In aggregate data from the studies, CRF15 constituted 1.7% of all HIV-1 infections (95% confidence interval 0.5-4.4%) and was dispersed widely in the country. The previously separate heterosexual and IDU epidemics have apparently been bridged by a new CRF. The entry of CRF15 into the mainstream of the epidemic signals new complexity in the long stable molecular picture in Thailand. These recombinants must be considered in ongoing or projected efficacy evaluations of HIV-1 vaccines and antiviral therapies.     

Screening HIV-infected women for cervical cancer in Thailand: findings from a demonstration project

OBJECTIVES: Although cervical cancer is an AIDS-defining illness, few HIV-infected women are routinely screened for cervical cancer in Thailand. We screened HIV-infected women for cervical cancer as a component of HIV care and assessed high-risk human papillomavirus (HPV) and cervical cancer prevalence. METHODS: From July 2003 through February 2004, HIV-infected women attending either an infectious disease clinic or a sexually transmitted infection (STI) clinic in Bangkok were tested for high-risk HPV types by Hybrid Capture 2 and screened for cervical cancer by Pap test; those with abnormal cervical cytology were referred for diagnosis and treatment. RESULTS: Two hundred ten HIV-infected women at an infectious disease clinic (n = 150) and an STI clinic (n = 60) received cervical cancer screening. The high-risk HPV prevalence was 38.6% and the prevalence of abnormal cervical cytology was 20.4%. Abnormal cervical cytology and high-risk HPV detection were associated (P < 0.001). We received pathology reports for 23 (53.5%) of 43 women, including all those with a Pap test showing high-grade squamous intraepithelial lesions; the cervical cancer prevalence was 1.9% (4 of 210; 95% confidence interval, 0.5-4.8%). CONCLUSION: The estimated prevalence of high-risk HPV and cervical cancer among HIV-infected women in Thailand was high. This emphasizes the need to integrate cervical cancer screening into HIV care.     

Food behavior and folate status of hill-tribe schoolchildren and women of childbearing age on the northern border of Thailand

An insight into the folate nutritional status of the population is important from a public health perspective. The protective effect of folate against neural tube defects (NTDs) is widely recognized. To assess the health and nutritional status, especially folate status, of vulnerable hill-tribe groups, a cross-sectional study was conducted on 197 schoolchildren and 136 women of childbearing age in Chaloem Phra Kiat District, Nan Province, Thailand. The nutritional status of the study group was investigated by dietary survey, and blood samples were taken to determine hematocrit, protein, and serum and red blood cell folate. Anthropometric measurements were taken to assess body size, composition and nutritional indexes. The health and nutritional status of the hill-tribe schoolchildren and women of childbearing age were found to be unacceptable, particularly inregard to folate status, which was indicated by low folate levels found in the blood samples, and in the intake of this micronutrient.