Unintentional injuries among children aged 1-4 years at home

A hospital based case-control study was performed to determine causes of unintentional injuries among children aged 1-4 years at home. Data were obtained by interviewing parents and guardians of 242 children at Lerdsin Hospital in Bangkok, from August to October 1999. The results showed that falls were the most common type of injuries (54.6%). The age of 2 years comprised the major group (28.9%). The study subjects were injured within the home (60.7%). Sunday and Saturday were the most frequent days of injuries (18.2% and 16.5% respectively). The proportion of cases involving playing with others was 71.1%. Most of the injuries occurred in the period 16.00-19.00 hours (32.2%). Head and neck were the main injured area (45.5%). The multivariate model showed that children who had previous injuries were 19.22 times more likely to be injured again than those who had not previously been injured. Children with vigorous physical activities also had a higher risk (OR = 19.73, 95% CI 6.11-63.74). Outdoor working mothers were at higher risk than houseworking mothers (OR = 4.14, 95% CI 1.57-10.93) of having children affects. Children who spent most of the daytime at their relatives' houses had a higher risk than those who stayed at their home (OR = 3.48, 95% CI 1.02-11.81), while, 37.9% of children injured at their relatives' houses and 50.8% of all injured children were without supervision.     

Normal palatal sutures in newborns and fetuses: a critical fact for successful palatal distraction

Distraction osteogenesis (DO) has recently been applied to the palate. Successful posterior lengthening and medial advancement of the palates was continuously reported. Based on these studies, it is obvious that DO will play a major role in the management of problems related to palatal defects in the near future. Although the results are appealing, they may not be applicable for humans due to anatomic differences. All experimental studies used normal palatal sutures of young dogs for size expansion. Therefore, it is necessary to know normal palatal sutures in infants before one can clinically apply this new technique. With consent, palates of fetuses and neonates who died of various causes were examined. Eight fresh cadavers were available for the dissection, with two being skeletonized using the boiling process. There were three fetal deaths in utero (33-41 weeks of gestational age) and five postnatal deaths (aged between 5 hours and 6 months). All specimens were grossly normal in shape and size except for one with a unilateral complete cleft of lip and palate. A midline palatal suture was found in every noncleft specimen, while premaxillary and transverse palatomaxillary sutures were present in every specimen. Laterally, there was no true suture except for the most posterior portion, which was contiguous with the greater palatine foramen. The palatal sutures of third-trimester fetuses and neonates are not different from adult ones. There is no lateral suture that will allow distraction in the medial direction. It is only the posterior hard palate (palatine bones) that can potentially be moved medially and posteriorly by sutural expansion with DO.     

Eczematous Skin Reaction from Patch Testing with Aeroallergens in Atopic Children With and Without Atopic Dermatitis

Abstract: To determine whether aeroaltergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 end 14 years of age. Patch testing with five aeroallergens—housedust, mite, cockroach, mold mix, and grass mixwas done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with staple dermatitis, patch testing with aeroallergens Induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions In 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis ( P < 10⁻⁵). Intradermai skin tests in both groups were not significantly different This study supports previous reports that aeroallergens play an Important role in causing eczamatous skin lesions.     

Synchronous and metachronous malignancy in endometrial cancer patients treated in a tertiary care center of Thailand

Objective

To evaluate the prevalence and features of non-endometrial cancers in Thai endometrial cancer (EC) patients.

Methods

EC patients treated in our institution were identified and the following data were collected: age, EC stage, histopathology, adjuvant therapy, other cancers, living status, and cause of death.

Results

The mean age of the 344 patients was 56.8±10.8 years. Fifty (14.5%) had other synchronous and metachronous cancers. Mean ages of the patients with or without other cancers were not significantly different, 55.7±10.04 years versus 57.1±11.0 years, respectively (p=0.358). History of any cancer in the family and tumor in the lower uterine segment were more frequent among the patients with other cancers (6.0% vs. 1.7%, p=0.095; 12.0% vs. 1.0%, p<0.001; respectively). Six patients had ≥2 other cancers. Ovarian, breast, and colon were the three most common other cancers. After a median follow-up of 57.1 months, 18.3% of patients had died: 30.0% of patients with other cancers and 16.3% of those without other cancers. The corresponding EC deaths were 14.0% and 11.2%. The 5-year overall survival was significantly lower in patients who had other cancers: 79.3% (95% confidence interval [CI], 68.3 to 90.3) vs. 86.0% (95% CI, 81.7 to 90.3) than in those without (p=0.023). However, the corresponding disease-specific survival was not significantly different: 85.1% (95% CI, 75.5 to 94.7) compared with 89.0% (95% CI, 85.1 to 92.9), respectively (p=0.514).

Conclusion

Thai EC patients had a high incidence of other cancers. Overall survival of EC patients who had other cancers was worse than those without, while disease-specific survival was not significantly different.     

Spray coating of foley urinary catheter by chlorhexidine-loadedpoly(ε-caprolactone) nanospheres: effect of lyoprotectants,characteristics, and antibacterial activity evaluation

In this study, chlorhexidine-loaded poly(ε-caprolactone) nanospheres (CHX-NS) were prepared and successfully coated on the urinary catheters. Properties of CHX-NS were evaluated including drug loading content and the nanosphere size. Effects of different lyoprotectants for long-term storage of CHX-NS were also investigated. In vitro release study and antibacterial activity were also conducted using 20 cycles coated-urinary catheters. Results showed that the high-pressure emulsification-solvent evaporation technique provided the drug loading content at 1.14?±?0.16% and the size of nanospheres was 152?±?37?nm. The suitable lyoprotectant for long-term storage of CHX-NS was sucrose which provided noticeably no aggregation at the degree of reconstitution at 89.95%. The amount of CHX loading on coated catheters was at 4.55?±?0.31?mg. Drug release from the coated catheters in artificial urine could be prolonged up to 2 weeks and bacteria proliferation was inhibited up to 14?days. These results suggest that the antimicrobial activity of CHX-NS reduces the adherence of the uropathogens to the catheter surface. Chlorhexidine-loaded polymeric nanospheres were fabricated which can be successfully coated on urinary catheters. These systems have potential use for prolonged antimicrobial applications.     

Treatment of Kasabach-Merritt syndrome: a stepwise regimen of prednisolone,dipyridamole, and interferon

BACKGROUND: Kasabach-Merritt syndrome (KMS) is a rare, aggressive, vascular tumor with thrombocytopenia and consumptive coagulopathy. A standard treatment regimen for KMS has not been established. We reviewed our experience of a stepwise approach for the treatment of 10 children with KMS. METHODS: All patients were first treated with oral corticosteroid (initially 3 mg/kg/day then 5 mg/kg/day) and dipyridamole. Interferon-alpha-2b (IFNalpha2b) was used as second therapy for steroid-resistant cases for 12 months, then tapered to an alternate-day regimen, and then discontinued. Adjunctive therapy, including embolization of the feeding vessel or chemotherapy, was additionally used in patients who failed to respond to IFN or could not be taken off IFN. RESULTS: Ten patients were treated on this protocol with a follow-up time of 1-6 years. Oral corticosteroid plus dipyridamole was successful in four patients, but was tapered off by 12 months without recurrence in only two cases. Of the eight steroid-resistant cases, IFNalpha2b successfully induced regression of the tumor and increased the platelet count in six patients; however, IFNalpha2b was successful as monotherapy in only three cases; two patients died of aspiration pneumonia whilst on therapy and one patient could not be taken off IFNalpha2b until weekly vincristine was given (eight doses). Two other patients did not respond to IFNalpha2b in 4 weeks; embolization and vinblastine was used in one patient to induce regression of the tumor and resolution of thrombocytopenia. Hypertension developed in all children on high-dose prednisolone. CONCLUSIONS: KMS may be treated in a stepwise approach. High-dose steroid does not result in a high response rate and is not tolerated well. The response to IFNalpha2b is more favorable, but life-threatening adverse events may occur. Chemotherapy with vincristine or vinblastine may be useful as adjunctive therapy in KMS, but experience is still limited.     

Community awareness and perceptions of health sector preparedness and response to Cyclone Nargis

Community awareness, preparedness and response to public health emergencies are essential for a successful response to public health emergencies. This study was carried out to determine community awareness and perceptions regarding health sector preparedness and response to Cyclone Nargis in Myanmar. Six focus group discussions were carried out in 3 villages severely affected by Cyclone Nargis. Thematic content analysis was carried out to determine community perceptions. Focus group participants, consisting of community members, community leaders and government personnel, were aware of the cyclone, but were unaware of its intensity and where it would make landfall. There was inadequate knowledge on how to prepare for a cyclone. There was some training on cyclone preparation but coverage was not wide enough. Participants received service and relief from health sector; they had a positive attitude toward health services provided to them. However, 5 out of 6 focus groups stated most villagers were not interested in health education. Only a few participants had some knowledge on how to prepare for a cyclone. Based on these results, there are evident weaknesses on how to prepare for cyclones. Community preparedness is essential to prevent disasters with cyclones, such as with Cyclone Nargis.     

Association between Bcl-2 expression and tumor recurrence in cervical cancer: a matched case-control study

OBJECTIVES: To evaluate the association between bcl-2 expression, some pathological factors (lymph-vascular space invasion (LVSI), tumor grade, depth of stromal invasion), and tumor recurrence in cervical cancer. METHODS: A matched case-control study was performed in cervical cancer patients who underwent radical hysterectomy and were found to have negative lymph node between January 1992 and June 1998 in Bangkok Metropolitan Administration Medical College and Vajira Hospital and Maharaj Nakorn Chiangmai Hospital, Thailand. Cases were 32 patients who had tumor recurrence within 5 years after surgery. Controls were 63 patients who were disease free for at least 5 years after surgery. Cases and controls were matched for age, stage, histology, and tumor size. All except one case, who had only one matching control, had two controls. Paraffin-embedded cervical cancer tissues of cases and controls were immunohistochemical stained for bcl-2. RESULTS: Bcl-2 positive was demonstrated in 43.7% of tumor from recurrent cases, which was not different from 50.8% from non-recurrent controls (P = 0.378). Tumor grade and LVSI had significant association with tumor recurrence. From multivariable analysis, the patients with grade 2-3 tumors had the odds ratio of 6.9 for recurrence compared to patients with grade 1 tumors. The patients whose tumors had LVSI had the recurrent odds ratio of 5.4 compared to those without LVSI. CONCLUSIONS: There was no association between bcl-2 expression and tumor recurrence in cervical cancer, while tumor grade and LVSI had significant association with tumor recurrence.     

Purpuric-like rash as cutaneous eruptions in parvovirus B19 infection in Thai infant

An 8-month-old girl presented with fever, rash, and diarrhea. Physical examination revealed multiple well-circumscribed, brownish-black, purpuric-like rashes on the face, arms, and legs with cervical and suboccipital lymphadenopathy. Laboratory findings showed mild anemia with thrombocytopenia and positive polymerase chain reaction for parvovirus 819 DNA in the serum. The patient recovered uneventfully with symptomatic and supportive treatment. Since the infection can manifest in many dermatological patterns, it should also be included in the differential diagnosis of febrile illness with purpuric rash in children.