How can clinicians ensure the diagnosis of meningitic angiostrongyliasis?

Meningitic angiostrongyliasis (MA), caused by Angiostrongylus cantonensis, is often diagnosed by clinical criteria alone, because the confirmative serologic tests are not always available in the rural endemic areas. In this study, we evaluated the relationship between various clinical parameters of MA and the sero-positivity to sort out the predictive parameters to ensure the diagnosis. We enrolled consecutive adults in whom MA had been clinically diagnosed, who had serologic results for A. cantonensis, and negative serologic results for Gnathostoma spinigerum. There were 75 eligible patients; 26 (34.7%) and 49 (65.3%) patients who had negative and positive serologic tests for A. cantonensis, respectively. Baseline characteristics and laboratory results were comparable between sero-positive and -negative groups. Only the cerebrospinal fluid (CSF) eosinophil counts of 40% or higher was significantly predictive for positive serologic test with the adjusted odds ratio of 4.970 (95% confidence interval of 1.337-18.477). In diagnostic facilities in the endemic areas with the limited availability of serologic tests, clinicians can ensure the diagnosis of MA by using CSF eosinophil level.     

Regioselective O-methylation of tetrahydropapaveroline and tetrahydroxyberbine in vivo in rat brain

Enzymatic O-methylation is a primary pathway for the metabolism of catecholamines in mammals and of isoquinoline alkaloids in plants. This report describes the differential O-methylation patterns of the racemates and enantiomers of two catecholamine-derived alkaloids, tetrahydropapaveroline (THP) and 2,3,10,11-tetrahydroxyberbine (THB), in the brain of the rat. One hour after intracerebroventricular administration of a specific isomeric form of each alkaloid, the O-methylated metabolites were isolated from the rat brain and subsequently quantified using high performance liquid chromatography. The isomeric form of THP or THB which was administered markedly influenced the pattern of O-methylation. The racemate and R-(+)-enantiomer of THP were mono-O-methylated predominantly at the 7 and 3′ positions, while the S-(?)-enantiomer of THP was mono-O-methylated to an essentially equal degree at the 6, 7 and 3′ positions. Minimal mono-O-methylation at the 4′ position was detectable only with the racemate and (?)-enantiomer of THP. The racemate and enantiomers of THB were mono-O-methylated predominantly at the 2 and 11 positions and to a lesser extent at the 3 and 10 positions. Although minimal with the R-(+)-enantiomer, the 3 and the 10-O-methylation pathways were enhanced significantly with the S-(?)-enantiomer of THB. These results demonstrate that both enantiomers of THP and THB are O-methylated in vivo in rat brain and that the chiral centers of these alkaloids influence the position of O-methylation, thereby dictating the relative amounts of specific products formed.     

The necessity of routine clinic follow-up visits after third molar removal.

PURPOSE: This randomized clinical trial was conducted to evaluate the clinical necessity of routine follow-up visits after third molar removal under local anesthesia and intravenous sedation in patients aged 15 to 35 years. PATIENTS AND METHODS: Sixty consecutive cases that required surgical removal of impacted third molars in an outpatient basis were performed by board-certified oral and maxillofacial surgeons. Sixty patients were divided randomly into 2 groups: one group received a 2-week postoperative follow-up appointment and the other received no follow-up. All patients received postoperative instructions and were contacted by telephone on the day after surgery. At 2 weeks postoperatively, all patients either returned to the clinic or were interviewed by telephone. RESULTS: Forty-eight patients were included in this study. The mean age was 20.35 years (range, 15 to 33 years). There were no statistical differences in the number of patients and gender between groups of patients who received clinic or telephone follow-up (significance <.05). Seventy-three percent (35 of 48) of total patients preferred telephone follow-up, and 27% (13 of 48) of patients preferred clinic follow-up. Eighty-five percent (29 of 34) of patients who did not have any complaints on postoperative day 1 preferred telephone follow-up (significance <.01). CONCLUSIONS: A routine follow-up visit following third molar removal under intravenous sedation is not necessary in patients between 15 and 35 years of age. However, preoperative and postoperative instruction should be clearly specified. A selective review policy may be appropriate if a patient is mentally retarded, is taking psychoactive drugs, or has an intraoperative complications or a complaint registered via telephone call.     

Forensic entomology cases in Thailand: a review of cases from 2000 to 2006

This paper presents and discusses 30 cases of cadavers that had been transferred for forensic entomology investigations to the Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, northern Thailand, from 2000 to 2006. Variable death scenes were determined, including forested area and suburban and urban outdoor and indoor environments. The fly specimens found in the corpses obtained were the most commonly of the blow fly of family Calliphoridae, and consisted of Chrysomya megacephala (F.), Chrysomya rufifacies (Macquart) Chrysomya villeneuvi Patton, Chrysomya nigripes Aubertin, Chrysomya bezziana Villeneuve, Chrysomya chani Kurahashi, Lucilia cuprina (Wiedemann), Hemipyrellia ligurriens (Wiedemann), and two unknown species. Flies of the family Muscidae [Hydrotaea spinigera Stein, Synthesiomyia nudiseta (Wulp)], Piophilidae [Piophila casei (L.)], Phoridae [Megaselia scalaris (Loew)], Sarcophagidae [Parasarcophaga ruficornis (F.) and three unknown species], and Stratiomyiidae (Sargus sp.) were also collected from these human remains. Larvae and adults of the beetle, Dermestes maculatus DeGeer (Coleoptera: Dermestidae), were also found in some cases. Chrysomya megacephala and C. rufifacies were the most common species found in the ecologically varied death scene habitats associated with both urban and forested areas, while C. nigripes was commonly discovered in forested places. S. nudiseta was collected only from corpses found in an indoor death scene.     

CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes

Purpose

To determine whether the Alberta Stroke Program Early CT Scores (ASPECTS) can predict posttreatment functional outcomes in hyperacute stroke patients who receive recombinant tissue-type plasminogen activator (rt-PA) treatment within 4.5 h.

Materials and methods

We studied 162 patients treated with rt-PA within 4.5 h of clinical onset. Of those, 29 patients (17.90 %) received rt-PA treatment between 3 and 4.5 h. Systematic CT scoring with the ASPECTS method was done. The primary outcome was the correlations between ASPECTS and the functional status at 3 months follow-up using the modified Rankin Scale.

Results

Clinical variables between those who received rt-PA treatment before and after 3 h were mostly comparable except the proportion of male gender. There were 116 patients (71.60 %) who were classified as independent. Time to receive CT scan or rt-PA treatment was not significantly associated with patients’ functional status. Baseline NIHSS and ASPECTS scores were significant factors associated with dependent status or death at 3 months after rt-PA treatment. The adjusted odds ratios were 1.133 [95 % confidence interval (CI), 1.047–1.226] and 0.844 (95 % CI, 0.720–0.990), respectively.

Conclusion

The ASPECTS predicts the functional status of acute stroke patients who received rt-PA treatment within the 4.5-h golden period.     

Phenylethanoid and flavone glycosides from Ruellia tuberosa L.

A new phenylethanoid glycoside, isocassifolioside (8), and two new flavone glycosides, hispidulin 7-O-α-l-rhamnopyranosyl-(1′″ → 2″)-O-β-d-glucuronopyranoside (11) and pectolinaringenin 7-O-α-l-rhamnopyranosyl-(1′″ → 2″)-O-β-d-glucuronopyranoside (12) were isolated from the aerial portions of Ruellia tuberosa L., together with verbascoside (1), isoverbascoside (2), nuomioside (3), isonuomioside (4), forsythoside B (5), paucifloside (6), cassifolioside (7), hispidulin 7-O-β-d-glucuronopyranoside (9) and comanthoside B (10). The structure elucidations were based on analyses of chemical and spectroscopic data including 1D- and 2D-NMR. The isolated compounds 1–12 exhibited radical scavenging activity using ORAC assay.     

Mycobacterium bovis (Bacille Calmette-Guérin) bacteremia in immunocompetent neonates following vaccination

We describe four cases of Mycobacterium tuberculosis complex bacteremia diagnosed in immunocompetent neonates, who presented with high fever and/or jaundice within 72 h after Bacille Calmette-Guérin (BCG) vaccination. All neonates were hospitalized, and none received anti-mycobacterial therapy. All recovered completely and remain healthy 2-3.5 years later. Genotyping of one available isolate identified the pathogen as Mycobacterium bovis BCG. The similar clinical presentations and close temporal association between BCG vaccination and illness suggest that all four neonates likely had BCG bacteremia. BCG bacteremia shortly following vaccination among healthy neonates has not been previously described and merits further study to determine its frequency and clinical significance.     

HIV/AIDS care and treatment in three provinces in northern Thailand before the national scale-up of highly-active antiretroviral therapy

In 2003, Thailand launched a program to place 50,000 persons on highly active antiretroviral therapy (HAART) by the end of 2004, following a series of efforts since the early 1990s to develop comprehensive HIV/AIDS care services. To evaluate existing services and needs in advance of the national HAART scale-up, in 2002 we surveyed 31 hospitals and 389 community health centers in three northern Thai provinces, and interviewed 1,015 HIV-infected patients attending outpatient clinics. All hospitals offered voluntary HIV counseling and testing, 84% provided primary prophylaxis for Pneumocystis carinii pneumonia, 58% for tuberculosis, 39% for cryptococcal meningitis, and 87% had some experience providing antiretroviral therapy. Community health centers provided more limited service coverage. Of patients interviewed, 63% had been diagnosed with symptomatic HIV disease, and of these, 32% reported ever receiving antiretroviral therapy; 51 % of all patients had received a CD4 T-lymphocyte count. Thailand's current national HAART scale-up is being performed in a setting of well-developed hospital-based services introduced over the course of the epidemic.     

Risk score predictive of mortality in status epilepticus according to a national database

Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD‐10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors‐associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41‐60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21‐40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver‐operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.