Signs and symptoms predictive of respiratory failure in patients with foodborne botulism in Thailand

We conducted a clinical study of 137 patients with home-canned bamboo shoot botulism at Nan Hospital, northern Thailand. The median age of the patients was 44 years (range = 14-74 years) and 36.2% were male. The median incubation period was 2 days (range = 1-8 days). Forty-three patients (31.4%) developed respiratory failure, but there were no deaths. Patients who did not have either nausea or vomiting and did not have urinary retention that required Foley catheterization was less likely to develop respiratory failure. This clinical predictor rule had a sensitivity of 75.5% and a specificity of 90.7%. The clinical syndrome most predictive of respiratory failure was nausea or vomiting and any cranial neuropathy with urinary retention or difficulty swallowing. This clinical syndrome had a sensitivity of 69.8% and a specificity of 93.6%. These clinical characteristics could help triage large numbers of patient in the event of a future outbreak.     

Increased Risks of Preterm Birth and a Low‐Birth‐Weight Baby in Thai Human Immunodeficiency Virus‐Positive Pregnant Women With Periodontitis

Background: Many studies have investigated the risks of adverse neonatal outcomes associated with the presence of periodontitis in non‐human immunodeficiency virus (HIV)‐infected pregnant women. To the best of our knowledge, there has been no study to investigate the risk of neonatal outcomes associated with periodontitis in HIV‐infected pregnant women. The aim of this study is to measure the risk of having adverse neonatal outcomes: preterm delivery (<37 weeks of gestation), low birth weight (<2,500 g at birth), and preterm and low‐birth‐weight baby (<37 weeks of gestation and <2,500 g at birth) associated with the presence of periodontitis in HIV‐infected women. Methods: A total of 292 HIV‐infected pregnant women were interviewed for demographic information and medical history and were examined for their periodontal status during weeks 16 to 34 of gestation. Follow‐up sessions were done after the delivery to record the baby's data. Periodontitis defined by various criteria were evaluated as exposures. Binomial regression (generalized linear model) was used to examine the risk ratios (RRs). Logistic regression, t tests, and χ² test were used to examine the associations of periodontitis with adverse neonatal outcomes. Results: Forty women had preterm delivery, 39 women delivered a low‐birth‐weight baby, and 22 women gave birth to a baby that was preterm and low birth weight. We found significant elevated risks of having preterm delivery as RR = 3.08, 95% confidence interval (CI) = 1.29 to 7.38, low birth weight RR = 2.55, 95% CI = 1.04 to 2.65, and preterm and low birth weight as RR = 4.08, 95% CI = 1.55 to 10.76 in women who had at ≥1 5‐mm periodontal pocket. Conclusion: This study found a positive risk of adverse neonatal outcomes in HIV‐infected pregnant women who had moderate periodontitis.     

Hantavirus infection in Thailand: first clinical case report

This study involved 115 cases of Fever of Unknown Origin (FUO) in patients who were admitted to the Department of Medicine, Siriraj Hospital from May 1999 to November 2000. Among the patient sera screened by ELISA for IgG Hantavirus, five were positive for IgG Hantavirus-reacting antibodies and eight tested positive for IgM Hantavirus-reacting antibodies. One serum had both IgG and IgM antibodies. The patient exhibited acute encephalitic febrile illness, thrombocytopenia, high AST and ALT levels, and prolonged coagulation time. It appears that a form of the Hantaan virus is circulating in Thailand, which can infect humans and be pathogenic in some instances.     

两种不同导电剂在心电图检查中的应用

[目的]观察两种不同导电剂在心电图检查中的应用效果.[方法]将1 000例常规心电图检查的住院病人随机分为对照组和观察组,每组500例,对照组采用75%乙醇作为导电剂,观察组采用生理盐水作为导电剂.比较两组病人一次采图成功率、病人满意度、舒适度和皮肤过敏情况.[结果]观察组的一次采图成功率为97.6%,对照组为96.2%,两组比较差异无统计学意义;观察组病人满意度、舒适度均高于对照组;观察组无一例发生皮肤不良反应,对照组发生皮肤过敏18例(0.2%).[结论]采用温生理盐水作为导电剂可提高心电图检查病人的满意度和舒适度,减少皮肤变态反应的发生.     

Atraumatic Restorative Treatment (ART): a Three-year Community Field Trial in Thailand—Survival of One-surface Restorations in the Permanent Dentition

This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.     

A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis.

A prospective, open, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of the conventional four-drug combination (chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline) with that of doxycycline alone in oral maintenance treatment of melioidosis. Adult Thai patients with culture-confirmed melioidosis were randomized to receive treatment with either regimen for a minimum of 12 weeks, usually following intravenous treatment of severe disease. The main outcome measure was culture-confirmed relapse. One hundred sixteen patients were enrolled; 109 had culture-confirmed melioidosis, and 87 were considered evaluable (43 had received doxycycline). Culture-confirmed relapse occurred in one patient randomized to the conventional regimen and in 11 (25.6%) randomized to the doxycycline regimen (P = .009), and treatment failed for 8 (18.2%) versus 20 (46.5%), respectively (P = .009). Adverse effects occurred in 26% of patients overall. Doxycycline alone cannot be recommended for a first-line regimen of oral maintenance treatment of melioidosis.     

聚合酶链反应检测弓形虫的实验研究

目的建立敏感、特异、稳定的聚合酶链反应（ＰＣＲ）法,以检测弓形虫感染。方法建立ＰＣＲ法,确定最佳扩增条件;用ＰＣＲ法检测实验感染家兔血液中ＤＮＡ的动态变化,并与ＥＬＩＳＡ法检测ＣＡｇ进行比较。结果兔感染弓形虫后第２ｄ,ＰＣＲ开始出现阳性,阳性率为７６．９％（１０／１３）,总检出率达１００％。与ＥＬＩＳＡ法查ＣＡｇ进行平行检测,前者出现阳性时间早,且阳性率明显高于后者。该法敏感性高,可检测到１０ｆｇＤＮＡ含量;特异性强,对其它９种寄生虫和微生物ＤＮＡ均无交叉现象;稳定性好,对阳、阴性同一样品重复５次,结果一致。结论提示本法可用于临床诊断,在一定范围内替代病原学和免疫学检测。     

从肺脾论治小儿太息症

从肺脾论治小儿太息症是对中医理论的完善,文章从对太息症的中西医认识、小儿太息症气机不畅与肺脾的关系等方面进行阐述,为临床维护小儿身心健康提供了新思路。