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1.
Chuansumrit A Mahasandana C Chinthammitr Y Pongtanakul B Laossombat V Nawarawong W Lektakul Y Wangruangsatid S Sriboriboonsin L Rojnakarin P Angchaisuksiri P;Hemophilia Study Group 《The Southeast Asian journal of tropical medicine and public health》2004,35(2):445-449
A national survey of patients with hemophilia and other congenital bleeding disorders in Thailand was conducted in the years 2000 to 2002. Questionnaires were sent to physicians working at hospitals throughout the country. Although the overall response rate to the questionnaires was 19%, the two highest rates of 80% and 73.7% were found at university and regional hospitals, respectively, where most of the patients received their diagnosis and treatment. A total of 1,450 patients comprised of hemophilia 1,325 cases, von Willebrand disease, 69 cases, congenital factor VII deficiency, 15 cases, hereditary platelet dysfunction, 22 cases, and undefined causes of congenital bleeding disorders, 19 cases. Most were pediatric patients <15 years of age. Treatment was mainly given on demand for a bleeding episode, while only 8.6% received additional home treatment for early bleeding episodes. Replacement therapy primarily relied on fresh frozen plasma, cryoprecipitate and cryo-removed plasma. Factor concentrate was seldom used because of the high price. As a result, hemophilia care services in Thailand should be strengthened by providing comprehensive education for medical personnel, making available simple laboratory kits to determine hemophilia A and B, ensuring an adequate supply of blood components and affordable factor concentrate, and establishing home care treatment. 相似文献
2.
Sasanakul W Chuansumrit A Ajjimakorn S Krasaesub S Sirachainan N Chotsupakarn S Kadegasem P Rurgkhum S 《The Southeast Asian journal of tropical medicine and public health》2003,34(4):891-898
The cost-effectiveness of carrier detection and prenatal diagnosis for hemophilia at the International Hemophilia Training Center, Bangkok, Thailand was studied. From 1991 to 2002, 209 females from 124 families with hemophilia A and B were included. There were 180 hemophilia A carriers and 29 hemophilia B carriers which could be classified into 78 obligate and 131 possible carriers. The phenotypic analysis for possible carriers involved the determination of levels of factor VIII or IX clotting activity (FVIII:C, FIX:C) and the ratio of FVIII:C and von Willebrand factor antigen. The result revealed that 49 females (37.4%) were diagnosed as carriers, 65 females (49.6%) were normal and 17 females (13%) were undetermined. Additional genotypic analysis was provided to 46 families with 74 females with obligate, proven or undetermined carriers within the reproductive life. The polymorphisms associated with factor VIII and IX genes were used including Bcl I for the factor VIII gene and combined use of Mse I, Sal I, Nru I, Hha I and Dde I for the factor IX gene. The informative rate was 59.4% (44/74). Consequently, 12 prenatal diagnoses for fetus at risk were performed. Sex determination was initially determined and followed by the diagnosis of hemophilia through informative gene tracking and/or the measurement of fetal levels of FVIII:C or FIX:C. The result revealed that 3 male fetuses were affected. The total cost of carrier detection and prenatal diagnosis that the families had to pay in the government hospital was 238,600 Baht (US dollars 5,965). It was compared to the estimated cost of minimal replacement therapy using lyophilized cryoprecipitate for the survival time of 30 years in one patient with hemophilia of 1,012,500 Baht (US dollars 25,312.5). The cost of prevention was much less than the replacement therapy. In conclusion, it is cost-effective to establish the service for carrier detection and prenatal diagnosis for hemophilia especially in developing countries with limited health resources. 相似文献
3.
Wasant P Liammongkolkul S 《The Southeast Asian journal of tropical medicine and public health》2003,34(Z3):244-248
Maternal serum screening has gained widespread acceptance as a major prenatal screening tool for chromosomal abnormalities in the US and Europe since Merkatz et al described an association between low maternal serum alpha fetoprotein (AFP) levels and increased risk for trisomy 21 in 1984. In 1988, Wald et al proposed a screening program based on maternal age in combination with three biochemical markers--AFP, hCG and unconjugated estriol. This study from January 1996--September 2002 included 1,793 pregnant women (between 14-22 weeks gestation) which were divided into 2 groups--1,083 women > 35 years (60.40%) and 710 women < 35 years (39.60%). A second trimester risk for trisomy 21 > 1 : 270 was considered a positive screen and genetic counseling to discuss risks and benefits of amniocentesis was offered. This study had 1,376 cases (76.7%) with negative screening (not increased risk for DS and NTD), 21 (1.2%) with negative screening (not increased risk for DS only) ; 292 (16.3%) with increased risk for DS; 5 cases (0.3%) with increased risk for DS and elevated AFP; 19 cases (1.1%) with elevated AFP; 33 cases (1.8%) with previous DS only; and 9 cases (0.5%) with previous NTD only. Two percent (2.1%) of the results could not be interpreted either because the test was done too early, too late or were grand multiple pregnancies. This study demonstrated that multiple marker screening offers another option for older women who traditionally have all been considered candidates for amniocentesis. 相似文献
4.
Sathit Pichyangkul Somporn Krasaesub Anan Jongkaewwattana Arunee Thitithanyanont Suwimon Wiboon-ut Kosol Yongvanitchit Amporn Limsalakpetch Utaiwan Kum-Arb Duangrat Mongkolsirichaikul Nuanpan Khemnu Rangsini Mahanonda Jean-Michel Garcia Carl J. Mason Douglas S. Walsh David L. Saunders 《The American journal of tropical medicine and hygiene》2014,90(1):149-152
We studied cross-reactive antibodies against avian influenza H5N1 and 2009 pandemic (p) H1N1 in 200 serum samples from US military personnel collected before the H1N1 pandemic. Assays used to measure antibodies against viral proteins involved in protection included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay. Viral neutralization by antibodies against avian influenza H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based and H1N1 microneutralization assays. Some US military personnel had cross-neutralizing antibodies against H5N1 (14%) and 2009 pH1N1 (16.5%). The odds of having cross-neutralizing antibodies against 2009 pH1N1 were 4.4 times higher in subjects receiving more than five inactivated whole influenza virus vaccinations than those subjects with no record of vaccination. Although unclear if the result of prior vaccination or disease exposure, these pre-existing antibodies may prevent or reduce disease severity.Outbreaks of 1997 avian influenza H5N1 and 2009 pandemic (p) H1N1 in humans have provided an opportunity to gain insight into cross-reactive immunity. The US military periodically collects and stores serum samples from service members linked to medical records.1 We measured cross-reactive antibodies in stored serum to avian influenza H5N1 and 2009 pH1N1 from US military personnel and identified factors associated with presence of neutralizing antibodies.Two hundred archived serum samples were obtained from the US Department of Defense Serum Repository. They were representative of a wide cross-section of active military personnel at the times of collection, whereas specific geographic information was not available on the individual selected; the cohort represents the general US military population, which is deployed throughout the United States and globally. Fifty samples each were selected from four birth cohorts: (1) < 1949, (2) 1960–1965, (3) 1966–1971, and (4) 1972–1977. Within each cohort, 25 samples were collected in the year 2000 (before the introduction of intranasal live attenuated influenza vaccine [LAIV]), and 25 samples were collected in 2008 (where 51% of donors had received LAIV). It has been suggested that LAIV elicits cross-reactive immunity.2,3 The samples were all collected before the outbreak of 2009 pH1N1, and there have not been any reported outbreaks of H5N1 in US military personnel.Assays used to measure antibodies included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay.4 Viral neutralization by antibodies against H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based (H5pp)5 and microneutralization assays, respectively. Electronic medical and vaccination records from the Defense Medical Surveillance System (DMSS), which captured records before the serum sample date, were linked to samples and compared with the in vitro results.1The odds ratios (ORs) and 95% confidence intervals (95% CIs) of univariate and multivariate binary logistic regression analyses were used to determine the association between donor characteristics and positive antibody responses. A multiple logistic regression model was constructed, and it included independent variables with a P value of < 0.05 in univariate logistic regression. A P value of < 0.05 was considered to indicate statistical significance. SPSS 12.0 for Windows (SPSS Inc., Chicago, IL) was used to perform all statistical analysis.Cross-reactivity is summarized in 5 and 22.5% for the NI assay. H5pp and NI antibody titers to H5N1 were evenly distributed among birth cohorts and did not differ substantially based on history of vaccination or prior respiratory infections. Of those individuals with neutralizing antibodies to H5N1 (N = 28), 32.1% also had neutralizing antibodies to pH1N1, whereas 19.3% of those individuals with any H5N1-specific antibody response also had neutralizing antibodies to pH1N1 (Characteristics (n) H5N1 2009 pH1N1§ HI assay* % positive (GM titer) H5pp† % positive (GM titer) NI assay‡ % positive (GM titer) HI assay % positive (GM titer) Neutralization % positive (GM titer) NI assay % positive (GM titer) Total 200 0.5 (5.1) 14.0 (21.4) 22.5 (121.6) 5.5 (7.1) 16.5 (20.4) 9.0 (92.8) Birth cohort 1936–1949 (50) 2.0 (5.3) 18.0 (22.0) 24.0 (126.0) 6.0 (7.3) 16.0 (19.5) 12.0 (97.6) 1960–1965 (50) 0.0 (5.0) 16.0 (20.3) 26.0 (129.6) 6.0 (7.7) 30.0 (27.5) 6.0 (90.3) 1966–1971 (50) 0.0 (5.0) 12.0 (23.3) 20.0 (117.9) 10.0 (8.0) 16.0 (23.6) 10.0 (92.2) 1972–1977 (50) 0.0 (5.3) 10.0 (20.0) 20.0 (113.7) 0.0 (5.7) 4.0 (13.6) 8.0 (91.5) Serum collection year Y2000 (100) 0.0 (5.1) 15.0 (21.7) 21.0 (120.3) 7.0 (7.3) 16.0 (20.6) 11.0 (94.5) Y2008 (100) 1.0 (5.2) 13.0 (21.1) 24.0 (123.0) 4.0 (7.0) 17.0 (20.1) 7.0 (91.2) Sex Female (32) 3.1 (5.7) 21.9 (26.3) 12.5 (102.4) 3.1 (6.9) 12.5 (19.2) 6.3 (96.7) Male (168) 0.0 (5.0) 12.5 (20.5) 24.4 (125.7) 6.0 (7.2) 17.3 (20.6) 9.5 (92.1) Any cross-reactive antibody to H5N1 (57) 8.8 (8.9) 19.3 (25.2) 22.8 (119.9) pH1N1 (45) 2.2 (5.3) 28.9 (31.2) 37.8 (165.2) Neutralizing antibodies to H5N1 H5pp (28) 10.7 (9.5) 32.1 (33.6) 25.0 (116.9) 2009 pH1N1 neutralization (33) 3.0 (5.4) 27.3 (28.9) 30.3 (140.3) Lifetime seasonal vaccinations No record (66) 0.0 (5.1) 10.6 (20.2) 27.7 (128.1) 7.6 (7.4) 15.2 (20.6) 12.1 (96.5) 1–5 vaccinations (88) 1.1 (5.2) 15.9 (21.5) 17.0 (109.2) 5.7 (7.1) 17.0 (20.5) 6.8 (89.1) > 5 vaccinations (46) 0.0 (5.1) 15.2 (22.2) 32.6 (138.8) 2.2 (6.8) 17.4 (19.7) 8.7 (95.0) Time since last vaccine No record (66) 0.0 (5.1) 10.6 (20.2) 22.7 (128.1) 7.6 (7.4) 15.2 (20.6) 12.1 (96.5) ≤ 1 year (96) 0.0 (5.1) 15.6 (21.5) 24.0 (120.7) 4.2 (7.1) 19.8 (21.0) 8.3 (91.2) > 1 year (38) 2.6 (5.3) 15.8 (22.4) 18.4 (113.4) 5.2 (6.8) 10.5 (18.3) 5.3 (90.6) Vaccination history lifetime (at least one dose) No record of vaccination (66) 0.0 (5.1) 10.6 (20.2) 22.7 (128.1) 7.6 (7.4) 15.2 (20.6) 12.1 (96.5) Inactivated whole virus (71) 0.0 (5.0) 14.1 (20.4) 22.5 (115.7) 2.8 (6.4) 15.5 (19.6) 5.6 (87.1) Split type (102) 1.0 (5.0) 15.7 (20.4) 21.6 (115.7) 4.9 (6.4) 19.6 (19.6) 6.9 (87.1) Influenza vaccine not otherwise specified (16) 0.0 (5.2) 12.5 (27.9) 37.5 (166.4) 0.0 (6.2) 6.3 (16.1) 12.5 (102.3) Live attenuated intranasal (50) 0.0 (5.1) 10.0 (18.8) 20.0 (112.2) 4.0 (7.0) 18.0 (20.3) 4.0 (85.2) History of respiratory illness No record of illness (119) 0.0 (5.0) 10.1 (18.5) 18.5 (112.6) 4.2 (7.0) 15.1 (20.5) 8.4 (90.7) Influenza-like illness (4) 0.0 (5.0) 25.0 (20.7) 0.0 (80.0) 0.0 (8.4) 25.0 (28.3) 25.0 (100.2) Upper respiratory infection (65) 1.5 (5.4) 23.1 (29.3) 27.7 (135.0) 7.7 (7.3) 18.5 (20.7) 9.2 (93.1) Lower respiratory infection (37) 2.7 (5.6) 18.9 (30.2) 35.1 (157.6) 8.1 (8.1) 21.6 (22.4) 13.5 (108.4) Respiratory illness past year (28) 0 (5.1) 25.0 (25.1) 32.1 (154.9) 7.1 (8.0) 28.6 (24.4) 3.6 (86.3)