Efficacy of pulsed dyed laser (585 nm) in the treatment of molluscum contagiosum subtype 1

Molluscum contagiosum is a common cutaneous disease that may be difficult to treat when there are multiple lesions; especially in children. This study was conducted to determine the efficacy of pulsed dye laser (585 nm) in the treatment of molluscum contagiosum in 20 children. In the treated group, 70.5% of lesions healed after the first treatment; the remaining 10.6% after the second treatment (2 weeks later). The overall cure rate was significantly different from the control group (p< 0.01). The therapy was also well tolerated. Only mild transient hypopigmentation and erythema were observed. None encountered infectious events. In conclusion, pulsed dye laser is a good alternative treatment for molluscum contagiosum due to high efficacy and mild transient side effects.     

A statistical method for forecasting demographic time series counts, with application to HIV/AIDS and other infectious disease mortality in southern Thailand

This study investigated regional and temporal patterns of death reported from infectious diseases (including HIV/AIDS) in 14 provinces of southern Thailand over the period 1999-2004, using data obtained from the Thailand Bureau of Policy and Strategy, Ministry of Public Health. Causes of deaths were identified using the International Classification of Diseases 10th revision (ICD-10), and mortality incidence rates were then calculated using populations obtained from the 2000 population census. Poisson and negative binomial lagged observation-driven regression models for mortality incidence were fitted to the data separately for HIV/ AIDS and other infectious diseases. Overall, the hospital mortality rates started to increase sharply in 2003 - 2004. The in-hospital mortality for HIV/AIDS showed peaks in urban districts and decreased from north to south with mortality for males approximately double that of females. For other infectious diseases, an upward trend in hospital mortality age 40 and over started in 2003-2004, particularly among persons reported as dying from septicemia, while showing a slightly increasing trend for other infectious diseases. Identifying the real cause of hospital deaths recorded as septicemia would substantially improve hospital mortality data quality.     

Relationship between vascular reactivity and lipids in Mexican-Americans with type 2 diabetes treated with pioglitazone

CONTEXT: Vascular dysfunction and insulin resistance precede atherosclerosis in type 2 diabetes (T2DM). Better knowledge of the interaction between these is of considerable clinical interest. OBJECTIVE: The objective of this study was to examine the association between inflammation, glucose, and lipid metabolism and vascular dysfunction. DESIGN AND SETTING: We conducted a randomized, double-blind, controlled trial of pioglitazone vs. placebo and other therapies aimed at equal glycemic control for 24 wk at an academic tertiary referral clinic. PATIENTS AND INTERVENTIONS: Mexican-American subjects with T2DM and no complications were randomly assigned to pioglitazone 45 mg daily (PIO, n=16) or placebo (CON, n=15) and matched for age, gender, body mass index, diabetes duration, and glycemic control. All subjects completed the study. MAIN OUTCOME MEASURE: We looked for improved vascular reactivity independent of glycemic control but closely related to plasma adiponectin, lipids, and insulin sensitivity. RESULTS: After 24 wk, there was an equal decrease in fasting plasma glucose (approximately 135 mg/dl), glycosylated hemoglobin (approximately 7.0%), and glucose production (approximately 15%). The decrease in free fatty acids (30 vs. 10%) and increase in glucose disposal (40 vs. 25%) were greater in PIO vs. CON (P<0.05). In PIO, plasma high-density lipoprotein rose by 15% (P<0.05), and low-density lipoprotein and high-density lipoprotein particle size rose significantly (P<0.01). Plasma adiponectin doubled in PIO (from 6.1+/-0.8 to 12.7+/-2.1 microg/ml). Forearm blood flow rose equally (approximately 130%) during reactive hyperemia in both groups, although after therapy, the increase was greater (P<0.001) in PIO (153%) than in CON (137%); vasodilation was greater (P=0.01) in PIO (92, 160, and 204%) than in CON with acetylcholine (74, 130, and 144%) and with sodium nitroprusside (PIO=164 and 253% vs. 116 and 230%; P=0.04). The elevation in diameter was also greater in PIO (13 vs. 10%; P<0.05). Vascular responses correlated with plasma free fatty acids, adiponectin, and low-density lipoprotein particle size but not with glycemic control. CONCLUSION: These data indicate that pioglitazone improves vascular reactivity irrespective of glycemic control and suggest a close association with changes in fat cell metabolism.     

Effect of acute exercise on AMPK signaling in skeletal muscle of subjects with type 2 diabetes: a time-course and dose-response study

Activation of AMP-activated protein kinase (AMPK) by exercise induces several cellular processes in muscle. Exercise activation of AMPK is unaffected in lean (BMI approximately 25 kg/m(2)) subjects with type 2 diabetes. However, most type 2 diabetic subjects are obese (BMI >30 kg/m(2)), and exercise stimulation of AMPK is blunted in obese rodents. We examined whether obese type 2 diabetic subjects have impaired exercise stimulation of AMPK, at different signaling levels, spanning from the upstream kinase, LKB1, to the putative AMPK targets, AS160 and peroxisome proliferator-activated receptor coactivator (PGC)-1alpha, involved in glucose transport regulation and mitochondrial biogenesis, respectively. Twelve type 2 diabetic, eight obese, and eight lean subjects exercised on a cycle ergometer for 40 min. Muscle biopsies were done before, during, and after exercise. Subjects underwent this protocol on two occasions, at low (50% Vo(2max)) and moderate (70% Vo(2max)) intensities, with a 4-6 week interval. Exercise had no effect on LKB1 activity. Exercise had a time- and intensity-dependent effect to increase AMPK activity and AS160 phosphorylation. Obese and type 2 diabetic subjects had attenuated exercise-stimulated AMPK activity and AS160 phosphorylation. Type 2 diabetic subjects had reduced basal PGC-1 gene expression but normal exercise-induced increases in PGC-1 expression. Our findings suggest that obese type 2 diabetic subjects may need to exercise at higher intensity to stimulate the AMPK-AS160 axis to the same level as lean subjects.     

Primary vesicoureteral reflux mediated renal scarring after urinary tract infection in Thai children

AIM: To evaluate the association between primary vesicoureteral reflux (VUR) and renal scarring in children using 99 m Technetium-labelled dimercaptosuccinic acid (DMSA). METHODS: Children attending at Songklanagarind Hospital from 1987 to 2002 were evaluated. RESULTS: Ages at diagnosis of VUR in 46 boys and 52 girls were 1.1+/-1.6 and 2.9+/-2.5 years, median 0.6 and 2.3 years, respectively (P<0.001). DMSA scans were performed at 4.1+/-3.6 years. Renal parenchymal damage was detected in 34 kidneys (22%) of 154 demonstrated refluxing ureters, and one kidney (2%) of 42 non-refluxing ureters (P=0.002). Of 79 refluxing ureters in boys and 75 refluxing ureters in girls, there were 25 and nine renal scars, respectively (32% and 12%, P=0.003). Renal scars in VUR grades I-V were 11%, 7%, 12%, 44% and 64%, respectively (P<0.001). Multivariate analysis revealed that high grade VUR (P<0.001), age of diagnosis of VUR greater than 5 years (P=0.001), and male gender (P=0.002) were the most significant risk factors for renal scarring. CONCLUSION: High-grade VUR, age of diagnosis of VUR greater than 5 years and male gender were the most significant risk factors for renal scarring.     

Declining trend in the seroprevalence of infection with hepatitis A virus in Thailand

Since the mid 1970s, infection with hepatitis A virus (HAV) in Thailand has shifted from hyper-endemic to mesoendemic. In 2004, to explore this trend in prevalence further, 3997 subjects from four geographically distinct provinces of Thailand were tested, in a commercial ELISA, for antibodies to HAV. The results indicate that the seroprevalence of HAV continues to fall, almost certainly because the profound socio-economic development that has occurred over the last few decades in Thailand has brought with it significant improvements in sanitation and personal hygiene. As exposure to HAV declines, however, the risks of symptomatic and potentially severe infection in adulthood (rather than asymptomatic infection during childhood) and of epidemics of such infection, which would lead to profound economic loss, increases. Improvements in hygiene and sanitation to reduce exposure to the virus and measures to reduce the incidence of symptomatic disease in those infected, such as vaccination (which may only be cost-effective when targeted at high-risk groups), need to be carefully considered.     

Changing Pattern of Dengue Virus Serotypes in Thailand between 2004 and 2010

Dengue virus infection is a major concern in several countries, and more than 50 million people are infected worldwide each year. Thailand is one of the countries where people are susceptible to infection due to favourable geographical and environmental conditions. In this retrospective study, we reported the changing pattern of dengue virus serotypes during the period between 2004 and 2010. The following percentage prevalence showed different serotypes of dengue virus (DENV) predominant in respective years: DENV1 in 2004 (56.41%), DENV4 in 2007 (50%), DENV1 in 2008 (57.41%), and DENV3 in 2010 (38.7%). Moreover, the major serotypes were not stable as they showed a shift from one serotype to another. We also found co-infection with two different serotypes and reported the clinical manifestations, which were not different from infection with a single serotype. Co-infection with various serotypes may not necessarily cause more severe disease.Key words: Co-infection, Dengue virus, Prevalence, Serotype, Thailand     

Persistence of antibodies to the surface antigen of the hepatitis B virus (anti-HBs) in children subjected to the Expanded Programme on Immunization (EPI), including hepatitis-B vaccine, in Thailand

Will hepatitis-B vaccine administered at birth, and at 2 and 6 months of age, as an integral part of Thailand's Expanded Programme on Immunization, provide long-term protection? In an attempt to answer this question, residents of five provinces (representing five distinct geographical areas of Thailand) who were aged 1-10 years and had received this course of vaccination were enrolled on a serological study. Each was tested, with ELISA, for the surface antigen of hepatitis B (HBsAg) and for antibodies against this antigen (anti-HBs) or against the core antigen (anti-HBc). Over all age-groups, the prevalences of HBsAg, anti-HBs and anti-HBc were 0.67%, 71.4% and 5.5%, respectively. Although the prevalence of anti-HBs decreased with age, it remained at 56%-65% among those aged 6-10 years. Between 2% and 17% of the subjects aged 1-9 years had high titres of anti-HBs. Based on these results, an additional booster, still a controversial issue, does not appear to be required in order to prevent infection with hepatitis B virus and thus permit the eventual eradication of chronic carriage and its fatal sequelae in Thailand.