Risk factors for HIV among prostitutes in Chiangmai, Thailand

The discovery of a 44% (44 out of 100) prevalence rate of HIV infection among female prostitutes working in brothels in Chiangmai in Thailand in June 1989, prompted this follow-up study in August to confirm the high prevalence rate and to look for risk factors for infection. We studied 238 female prostitutes working in 14 brothels and confirmed this high prevalence rate. Eighty-seven (36.5%) out of 238 prostitutes were found to be HIV-positive by enzyme-linked immunosorbent assay with IFA or Western blot confirmation. Logistic regressions found a significant association between HIV infection and frequency of sexual intercourse greater than 3 times per day [odds ratio (OR) = 2.82, 95% confidence interval (CI) = 1.47-5.41], sexual service charge less than 150 Baht (OR = 9.1, 95% CI = 2.9-33.3), and post sexual cleansing with water alone (OR = 3.85, 95% CI = 1.90-7.80). Of 56 women found seronegative in the June survey, 35 were re-tested in the August study. Seven (20%) of them were seropositive, giving an HIV seroconversion incidence rate of 10% per month. The findings of this study prompted intensive health education programmes among prostitutes, their customers, and owners of brothels.     

Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients

The objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200-250 mL/min and an ultrafiltrate flow rate of 800-1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71 ± 0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73 ± 0.21 L/h or 12.11 ± 3.50 mL/min) constituted 49.4 ± 20.8% of total vancomycin clearance (1.59 ± 0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9 ± 104.0 mg). The volume of distribution was 24.69 ± 11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08 ± 0.05 h⁻¹ and 12.02 ± 7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50% of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500-750 mg every 12 h to provide a steady-state trough concentration of 15-20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.     

Sclerosing lipogranuloma of the nose: a new treatment using adipose tissue transplantation

We report a series of 45 patients visiting our clinic with distorted contour of the nose after having their noses augmented with injectable substances. The most common clinical presentation was a palpable mass on the dorsum of the nose, erythema with or without telangiectasia on the overlying skin, and nodularity of the nose. The onset of symptoms varied from 1 to 16 years after injection. They were treated by surgical excision, but this was always followed by a saddle-nose deformity. To correct this defect, we propose a new technique of adipose tissue transplantation that yields satisfactory results. Pathological reports of the excised mass showed a foreign body granuloma known as a sclerosing lipogranuloma (paraffinoma or siliconoma).     

Genetic variation at three enzyme loci within a Thailand population of <Emphasis Type="Italic">Opisthorchis viverrini</Emphasis>

Genetic variation among 231 individuals of Opisthorchis viverrini from the Ban Phai District, Khon Kaen Province (Thailand) was examined at three polymorphic enzymes: enolase (ENOL), phosphoglucomutase (PGM), and triose phosphate isomerase (TPI). Four alleles were detected for TPI and PGM, whereas only two alleles were detected for ENOL. The inferred genotype frequencies for both TPI and ENOL were not significantly different from Hardy–Weinberg equilibrium. In contrast, the inferred genotype frequencies for PGM showed a significant departure from Hardy–Weinberg equilibrium, with a lack of heterozygous individuals. This heterozygote deficiency suggests non-random mating and/or potentially high self fertilization.     

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90–120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient''s cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow‐up are possible target areas to improve hypertension control in Thailand.     

Genetic Structure Inferred from Mitochondrial 12S Ribosomal RNA Sequence of Oncomelania quadrasi,the Intermediate Snail Host of Schistosoma japonicum in the Philippines

Species and subspecies of the Oncomelania hupensis species complex are recognized as intermediate hosts of Schistosoma japonicum. Of these species and subspecies, O. quadrasi is distributed throughout the Philippines. This study used 12S ribosomal RNA sequences to explore the genetic structure of O. quadrasi populations in the Philippines. Three subspecies, O. h. hupensis, O. h. formosana, and O. h. chiui of this group were also examined. The phylogenetic tree and haplotypes network showed that O. quadrasi separated from the subspecies. Ten O. quadrasi haplotypes (Oq1–Oq10) clustered in relation to their geographic origin. Genetic differentiation (F_ST) and estimated gene flow (Nm) among populations showed significant differences, ranging from 0.556–1.000 to 0.00–0.74, respectively. Genetic differences among groups (F_CT = 0.466), populations within a group (F_SC = 0.727), and populations (F_ST = 0.854) were observed. These results indicate that the O. quadrasi populations in the Philippines have a substructure associated with their geographic origin.     

Exceptionally high prevalence of infection of Bithynia siamensis goniomphalos with Opisthorchis viverrini cercariae in different wetlands in Thailand and Lao PDR

The carcinogenic liver fluke, Opisthorchis viverrini, requires Bithynia snail intermediate hosts in its life cycle. However, the prevalence of O. viverrini in snail intermediate hosts is typically low (< 1%). Here, we examined B. siamensis goniomphalos from 48 localities in Thailand and The Lao People's Democratic Republic (Lao PDR) and reported high-prevalence levels of O. viverrini. The highest-prevalence levels per locality were 6.93% (mean = 3.04%) in Thailand and 8.37% (mean = 2.01%) in Lao PDR; 4 of 13 localities examined showed prevalence higher than any prevalence previously recorded. The number of cercariae infecting snails and their prevalence were positively correlated with the size of the snails. High prevalence occurred in the Songkram River wetland (Thailand) and the Nam Ngum River wetland (Lao PDR). Our results show that transmission of O. viverrini from humans as well as animal reservoir hosts to snail intermediate hosts is ongoing and potentially increasing in endemic areas across Thailand and Lao PDR.     

Genetic differentiation of Artyfechinostomum malayanum and A. sufrartyfex (Trematoda: Echinostomatidae) based on internal transcribed spacer sequences

Genetic differentiation between two synonymous echinostomes species, Artyfechinostomum malayanum and Artyfechinostomum sufrartyfex was determined by using the first and second internal transcribed spacers (ITS1 and ITS2), the non-coding region of rDNA as genetic makers. Of the 699 bp of combined ITS1 and ITS2 sequences examined, 18 variable nucleotide positions (2.58 %) were observed. Of these, 17 positions could be used as diagnostic position between these two sibling species, whereas the other one variation was intraspecific variation of A. malayanum. A clade of A. malayanum was closely aligned with A. sufrartyfex and clearly distance from the cluster of other echinostomes. Our results may sufficiently suggest that the current synonymy of these species is not valid.