Factors correlating quality of life in patients with myasthenia gravis

We studied factors associated with quality of life (QOL) among myasthenia gravis (MG) patients in two university hospitals in Thailand: Thammasat University (TU) and Khon Kaen University (KKU). Consecutive MG patients from an outpatient neurology clinic of both sites were enrolled and their clinical variables and QOL by the Short-Form 36 questionnaire were assessed. There were 31 and 40 subjects enrolled at TU and KKU, respectively. The mean values of the SF-36 score in seven dimensions were higher at the TU site. The significant factors between both sites were mean age, and numbers of participants with myasthenic symptoms and steroid treatment. The frequency of MG symptoms was the only factor associated with the SF-36 score (correlation coefficient −0.66, p value < 0.01). In conclusion, the frequency of MG symptoms might be the main factor that lowers QOL in MG patients in both physical and mental aspects.     

Rivastigmine patch for treatment of Alzheimer's disease in clinical practice in Thailand

Background: Rivastigmine is a cholinesterase inhibitor for treatment of mild to moderate Alzheimer's disease (AD) and dementia associated with Parkinson's disease. The new patch formulation was recently made available. We assessed the safety, tolerability, and cognitive outcome of rivastigmine patch in treatment of mild to moderate AD in clinical practice in Thailand. Methods: A multicentre, hospital‐based, prospective observational study was conducted in nine hospitals across Thailand. Patients with probable mild to moderate AD who received the rivastigmine patch were enrolled. Data were collected data at baseline, weeks 4–8 and after week16. Results: A total of 116 AD patients were screened, and three were excluded. Of 113 patients, 62.8% were women with a mean age of 73.3 ± 9.2 years; 79.7% were newly diagnosed. One‐third of all patients had been using antipsychotic or antidepressant medication. Common comorbidities were hypertension and dyslipidemia. The Thai Mental State Examination score significantly increased from 18.6 to 20.3 (weeks 4–8) and 20.4 (week 16+) (P < 0.001). Scores based on physicians’ (Clinical Global Impression) and caregivers’ (Patients’ Caregiver Global Impression of Change) impressions of improvement suggested minimal improvement. Because of adverse events, seven patients's dosages were reduced 10 cm² to 5 cm² or from 5 cm² to nothing. Itching was the most common adverse symptom. Conclusions: During the first 16 weeks after initiation of rivastigmine patch therapy, patients with probable mild to moderate AD had statistically significant improvement in cognitive function, but clinically marginal benefit. Rivastigmine was safe and well tolerated.     

Biomechanical comparison of four sliding knots and three high‐strength sutures: Loop security is much different between each combination

There are many types of sliding knots and suture materials used in arthroscopic surgery. The purposes of this study are (i) to evaluate the loop security of standard sliding knots when using different types of high‐strength suture materials and (ii) to compare the loop security of a new sliding knot (Chula knot) to other standard sliding knots. Four configurations of sliding locking knots (Weston, SMC, Tennessee and Chula knots) were tied using three commonly used suture materials: MagnumWire, Hi‐Fi, and FiberWire. The suture loops were mounted on two metallic hooks of the universal testing machine. Then, the suture loop was pulled apart until failure. The Weston knot demonstrated the greatest load to failure in all suture materials. By using MagnumWire, the load to failure was as follow: Weston 53.2 N, Chula 48.8 N, SMC 39.2 N, and Tennessee 29.3 N. By using Hi‐Fi, the load to failure was as follow: Weston 58.8 N, Chula 51.5 N, SMC 38.1 N, and Tennessee 28.7 N. By using FiberWire, the load to failure was as follow: Weston 38.8 N, Chula 29.7 N, SMC 23.2 N, and Tennessee 21.9 N. Weston knot has the highest loop security in all suture materials. Weston—HiFi combination demonstrate the strongest loop security. Conversely, the weakest combination is Tennessee—FiberWire. Chula knot has similar properties to other commonly used arthroscopic sliding knots. Our findings indicate that surgeons should be careful in selecting proper knot—suture combinations. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1804–1807, 2016.     

Can Rowland Universal Dementia Assessment Scale (RUDAS) replace Mini-mental State Examination (MMSE) for dementia screening in a Thai geriatric outpatient setting?

Mini-mental-State Examination (MMSE) is a widely used tool for dementia screening. However, several limitations are found and the Rowland Universal Dementia Assessment Scale (RUDAS) appears to be an alternative test. The objective in this study was to compare the performance of MMSE-Thai 2002 and RUDAS-Thai for dementia screening, and to determine their performances and identify their optimal cut-off points. The participants were older patients from a Geriatric and Neurology Outpatient Clinic, Srinagarind Hospital, Khon Kaen University. The RUDAS-Thai and the MMSE-Thai 2002 were administered to each participant. Subsequently, a specialist physician assessed each participant for dementia. Results showed the area under receiver operating characteristic curve for both RUDAS-Thai (81.0%; 95%CI, 74.8-87.2) and MMSE-Thai 2002 (81.2%; 95%CI, 74.9-87.4) were equal. A score of 24 or lower provided an optimal cut-off point. Our finding supports that the RUDAS-Thai can be an effective alternative test for dementia screening. For both test scores, a score of 24 or lower is an optimal cut-off point to provide an indication of developing dementia.     

HLA‐B*1502 Strongly Predicts Carbamazepine‐Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Thai Patients with Neuropathic Pain

Background: Carbamazepine (CBZ) is one of the standard pharmacological treatments for neuropathic pain. However, its serious adverse drug reactions include Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Recently, HLA‐B*1502 allele was implicated as a genetic marker of CBZ‐induced SJS/TEN in some Asian epilepsy populations. Methods: This is a case control study to describe the clinical characteristics of SJS/TEN in Thai patients with neuropathic pain who were treated with CBZ, and to determine the association of HLA‐B*1502 in these patients, comparing with those who exposed to CBZ for at least 6 months without any cutaneous reactions. Results: Thirty‐four SJS/TEN patients and 40 control patients were included in this study. Mean age of SJS/TEN patients was 47 years. SJS/TEN was developed in 10.8 ± 1.4 days after initiation of CBZ. HLA‐B*1502 allele was found in 32 of 34 SJS/TEN patients (94.1%) but it was found only in 7 of 40 control patients (17.5%). The association was very strong with an odds ratio of 75.4. Sensitivity and specificity of this HLA‐B*1502 genotype test were 94.1% and 82.5%, respectively, while the positive predictive value and negative predictive value were 1.43% and 99.98%, respectively. Positive and negative likelihood ratios were 5.37 and 0.07, respectively. Conclusions: HLA‐B*1502 is a strong genetic marker for CBZ‐induced SJS/TEN in Thai patients with neuropathic pain. The screening for this marker should be performed prior to initiation of CBZ treatment to assess the risk of this serious side effect.     

Diterpenoids from the roots of Croton oblongifolius

Two new clerodane diterpenes, methyl 15,16-epoxy-3,13(16),14- ENT-clerodatrien-18,19-olide-17-carboxylate ( 1) and dimethyl 15,16-epoxy-12-oxo-3,13(16),14- ENT-clerodatriene-17,18-dicarboxylate ( 2), together with seven known compounds ( 3 - 9), were isolated from the roots of Croton oblongifolius. The isolated compounds showed only mild cytotoxic activity against HuCCA-1, KB, HeLa, MDA-MB231, and T47D cell lines with IC (50) values ranging from 10 to 50 microg/mL.     

Sexually transmitted infection services as a component of HIV care: findings of a demonstration project among HIV-infected women in Thailand

OBJECTIVES: As Thailand scales up its antiretroviral treatment program, the role of sexually transmitted infection (STI) services to prevent HIV transmission has not been addressed. We provided STI services for HIV-infected women as a component of HIV care and assessed STI prevalence and risk behaviors. METHODS: HIV-infected women attending an infectious disease clinic and an STI clinic in Bangkok were screened for the presence of genital ulcers by visual inspection, for gonorrhea and chlamydial infection by polymerase chain reaction, for trichomoniasis by wet mount, and for syphilis by serology. Women were asked about sexual risk behavior and use of antiretroviral treatment. Risk-reduction counseling, condoms, and STI treatment were provided. RESULTS: Two-hundred ten HIV-infected women at an infectious disease clinic (n = 150) and an STI clinic (n = 60) received STI services from July 2003 through February 2004. The prevalence for any STI was 8.0% at the infectious disease clinic and 30.0% at the STI clinic (P < 0.01). Of the 116 (55.2%) sexually active women, 42 (36.2%) reported sex without a condom during the last 3 months. Women receiving antiretroviral treatment reported condom use during last sex more often compared with those not receiving antiretroviral treatment (82.2% vs. 58.8%; P = 0.03). CONCLUSION: STIs and sexual risk behavior were common among these HIV-infected women, and STI services for HIV-infected persons have been expanded to more clinics in Thailand. Further analysis of HIV transmission risk is necessary for developing a national strategy for prevention of HIV transmission among HIV-infected persons.     

Concurrent influenza virus infection and tuberculosis in patients hospitalized with respiratory illness in Thailand

Thailand, where influenza viruses circulate year‐round, is one of 22 WHO‐designated high‐burden countries for tuberculosis (TB). Surveillance for hospitalized respiratory illness between 2003 and 2011 revealed 23 (<1% of 7180 tested) with concurrent influenza and TB. Only two persons were previously known to have TB suggesting that acute respiratory illness may bring patients to medical attention and lead to TB diagnosis. Influenza/TB was not associated with higher disease severity or mortality.