Association between cigarette smoking and the intraoral distribution of periodontal disease in Thai men over 50 years of age

Aim: This study aimed to investigate the effects of cigarette smoking on periodontal conditions in specific tooth regions of older Thai men. Methods: There were 272 current smokers, 714 former smokers, and 477 non‐smokers enrolled in the present study. Differences between groups in the mean probing depth or attachment loss were compared using ancova . The relationship between smoking exposure or cessation duration and periodontal conditions was examined using linear trend analysis. Results: Smokers had deeper pockets and attachment loss than non‐smokers. The greatest differences between smokers and non‐smokers were observed in the maxillary posterior palatal region, where current smokers had 0.88 mm greater attachment loss than non‐smokers, compared to 0.36–0.60 mm observed in other tooth regions. Among the current smokers, there was a trend towards an increase in attachment loss with increasing smoking exposure in the maxillary posterior regions. However, it was not statistically significant. Among the former smokers, a better periodontal condition was observed, depending on the length of time since smoking cessation; this was most pronounced in the maxillary posterior palatal region. Conclusions: The palatal site of maxillary posterior teeth was the area most affected by cigarette smoke. The results suggest a possible local effect of smoking in addition to its systemic effects.     

The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury

Sae-Sia W, Wipke-Tevis DD, Williams DA. The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury.

Objective

To test the effect of clinically relevant duration of pressure loading (2h) on sacral skin blood flow (SBF) and skin temperature in subjects with spinal cord injury (SCI) within 24 to 96 hours after injury compared with subjects with acute orthopedic trauma and healthy subjects.

Design

Three-group, repeated-measures, inception cohort.

Setting

Three acute care hospitals in southern Thailand.

Participants

Convenience sample of 20 subjects with acute SCI within 24 to 96 hours after injury. Age- and sex-matched subjects with acute orthopedic trauma (n=35) and healthy subjects (n=47) served as comparison groups.

Interventions

Not applicable.

Main Outcome Measures

Sacral SBF and skin temperature were measured simultaneously by using a laser Doppler sensor and thermocouple sensor, respectively, with subjects lying in the lateral (baseline, no pressure, 30min), supine (pressure loading, 2h), and lateral position (recovery, no pressure, 90min).

Results

Baseline skin temperature was higher in subjects with acute SCI (P<.05) compared with subjects with orthopedic trauma and healthy subjects. A relative decrease in sacral SBF occurred in subjects with acute SCI (P<.01) over 2 hours of pressure loading compared with subjects with orthopedic trauma and healthy subjects. During the same time course, subjects with acute SCI had a smaller increase in sacral skin temperature compared with subjects with orthopedic trauma and healthy subjects (P<.001). During recovery, the time to the initial sacral SBF-reactive hyperemia response was shorter in subjects with acute SCI compared with subjects with orthopedic trauma (P<.001) and healthy subjects (P=.003). Additionally, the initial positive slope of the SBF reactive hyperemia response was higher in subjects with acute SCI than subjects with orthopedic trauma (P=.005) and healthy (P=.004) subjects.

Conclusions

Collectively, a negative change in SBF during pressure loading plus a shorter time to increase and greater slope for SBF after pressure release reveal microvascular dysfunction in acute SCI subjects. The clinical relevance of the protocol suggests that turning interval guidelines may require reevaluation for patients with acute SCI.     

The epidemiology of patients with severe malaria who died at the Hospital for Tropical Diseases, 1991-2004

This study is a retrospective case series of the causes of death among patients with severe malaria. Data from the medical records of patients who were admitted to the Intensive Care Unit (ICU) of the Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand between 1991 and 2004 were analyzed. The overall hospital mortality rate was 0.2% and the ICU mortality rate was 1.8% for patients with malaria. Thirty-five patients died of malaria in the ICU during the study period, while a total of 1,866 patients were treated for malaria in the ICU during the study period. The most common complication of malaria was cerebral malaria (77.1%). The socioeconomic and demographic characteristics of those who died are examined here, as well as the cost of their treatment.     

Clinical features of community-acquired pneumonia treated at Srinagarind Hospital,Khon Kaen,Thailand

Pneumonia is a serious illness associated with significant morbidity and mortality. The interpretation guidelines for pneumonia management requires knowledge of both the clinical presentation of the disease and local epidemiology. We studied the clinical features, initial laboratory results, antibiotic sensitivities, and outcomes of patients diagnosed with acute community-acquired pneumonia between January 1999 and December 2000 at Srinagarind Hospital. The causative organisms were identified in only 52.2% patients; Streptococcus pneumoniae accounted for 23.1% of infections. Other common causes included Klebsiellapneumoniae (19.2%), Burkholderia pseudomallei (15.4%), Hemophilus influenzae (11.5%), Mycoplasma pneumoniae (6.2%), and Staphylococcus aureus (4.6%). Younger patients were more likely to be infected with M. pneumoniae, while the mean age of those with other types of infections was 50. Healthy adults were infected with M. pneumoniae and S. pneumoniae; specific pathogens attacked patients with certain co-morbidity : i) diabetes mellitus and ageing, ii) diabetes mellitus and renal disease, iii) cardiovascular diseases, and iv) connective tissue diseases and steroid-use; these patients were vulnerable to i) K. pneumoniae, ii) B. pseudomallei, iii) H. influenzae, and iv) S. aureus respectively. White blood cell counts were normal in M. pneumoniae infection. Gram-stained sputum had some limitations, especially when determining Gram-negative infections; chest x-rays could not differentiate pathogens. Bactermia was found in one half of patients infected with B. pseudomallei and S. aureus. Antibiotic-resistant organisms were not common in our study. Because morbidity and mortality were high among patients infected with S. aureus and B. pseudomallei, empirical antibiotic treatment should be considered in suspected cases, especially when patients present with acute severe community-acquired pneumonia.     

Validity of the Thai EQ-5D in an occupational population in Thailand

Purpose

To assess the construct validity of the Thai EuroQoL (EQ-5D) among an occupational population in Thailand.

Methods

Data were derived from a large cohort study among employees of the Electricity Generating Authority of Thailand. In 2008 and 2009, 4,850 participants completed the Thai EQ-5D and Short-Form 36 version 2 (SF-36v2). Thai preferences weights were used to convert EQ-5D health states into EQ-5D index scores. Construct validity of the Thai EQ-5D was examined by specifying and testing hypotheses about the relationships between the EQ-5D, SF-36v2, and participants’ demographic and medical characteristics.

Results

Construct validity of the Thai EQ-5D was supported by expected relationships with SF-36v2 scale and summary scores. For example, SF-36v2 scores on the mental health scale were much lower for participants who reported having problems on the EQ-5D anxiety/depression dimension compared to those reporting no problems (mean norm-based SF-36v2 scores: 52.9 vs. 41.8, p < 0.001). Additionally, reporting a problem in a given EQ-5D dimension was generally associated with lower SF-36v2 summary scores. The EQ-5D index score distinguished between groups of participants in the expected manner, on the basis of sex, age, education and self-reported health, thus providing evidence of known-groups validity.

Conclusion

The study demonstrated good construct validity of the Thai EQ-5D in a large occupational population in Thailand.     

Emergence and clearance of gametocytes in uncomplicated Plasmodium falciparum malaria

We reviewed the records of 1,175 patients with uncomplicated Plasmodium falciparum malaria to determine the prevalence of gametocytemia. All patients were admitted and received artemisinin combination therapy. Blood films were checked daily until discharge. Circulating gametocytes were observed in 240 (20.2%) of patients and in most cases (222 of 240, 92.5%) gametocytemia was detected during the first 24 hours after admission. Gametocytes were first seen in 174 cases on admission, in 24 cases at 12 hours, and in 24 cases at 24 hours. The longest interval between admission and first appearance of gametocytes was 192 hours. The median gametocyte clearance time was 163 hours (range = 12-806) in the 219 patients in whom gametocytemia resolved. However, 21 patients (9.8%) still had gametocytemia on discharge. Gametocytemia generally is present within the first 24 hours after admission, and emerges in only 1.9% of patients later on during treatment with artemisinin.     

Novel CTSK mutation resulting in an entire exon 2 skipping in a Thai girl with pycnodysostosis

Pycnodysostosis is a rare autosomal recessive skeletal dysplasia characterized by osteosclerosis, short stature, acro‐osteolysis of the distal phalanges, bone fragility and skull deformities. Mutations in the cathepsin K (CTSK) gene, which encodes a lysosomal cysteine protease highly expressed in osteoclasts, have been found to be responsible for the disease. We identified a Thai girl with pycnodysostosis. Her parents were first cousins. Polymerase chain reaction sequencing of the entire coding regions of CTSK of the proband's complementary DNA revealed that the whole exon 2 was skipped. We subsequently amplified exon 2 using genomic DNA, which showed that the patient was homozygous for a c.120G>A mutation. The mutation was located at the last nucleotide of exon 2. Its presence was confirmed by restriction enzyme analysis using BanI. The skipping of exon 2 eliminates the normal start codon. The mutation has never been previously reported, thus the current report expands the CTSK mutational spectrum.     

Associations between serum lipids and causes of mortality in a cohort of 3,499 urban Thais: The Electricity Generating Authority of Thailand (EGAT) study

The association between serum lipids and mortality has not previously been established in Thailand. Baseline data from the Electricity Generating Authority of Thailand (EGAT) cohort study, plus a resurvey of the cohort 15 years later were analyzed. Participants were employees of EGAT: 2,702 men and 797 women. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were taken as predictive variables; age, sex, hypertension, diabetes, cigarette smoking, alcohol drinking, and body mass index were taken as confounders. Dependent variables were all-causes and specific causes of mortality over 17 years of follow-up. The major cause of death among men was cardiovascular disease (CVD); among women, it was cancer. Relative risks (RR) for specific causes of death, for a mmol/L increase in each lipid, were estimated after adjustment for confounding factors using Cox proportional hazards regression. TC and LDL-C were negatively associated with liver cirrhosis mortality, although it was likely that the low cholesterol concentration was a consequence of the disease. HDL-C was negatively associated with CVD mortality (RR = 0.59; 95% confidence interval [CI], 0.39-0.93), coronary heart disease (CHD) mortality (RR = 0.36; 95% CI, 0.17-0.75) and all cause-mortality (RR = 0.68; 95% CI, 0.54-0.87). TG was not associated with mortality. HDL-C is an important risk factor for CVD in middle-class urban Thais. Health promotion programs to improve lipid profiles, such as effective exercise campaigns and dietary advice, are required to increase HDL-C and to help prevent CVD and premature death in Thailand.     

Multidrug-resistant tuberculosis at Srinagarind Hospital,Khon Kaen,Thailand

Pulmonary tuberculosis is a very common infectious disease in Thailand. Multidrug-resistant tuberculosis (MDR-TB) is the most serious form of the disease. Failure to control resistant tuberculosis is associated with its resurgence. The objective of this study was to analyze the drug susceptibility pattern of M. tuberculosis and to study the clinical characteristics and outcome of patients diagnosed with MDR-TB at Srinagarind Hospital. Between January 1995 and December 2000, 899 isolates of M. tuberculosis were recovered. Rifampicin (RIF) resistance was the most common finding (8.2%). Twenty-two patients (2.4%) were infected with MDR-TB. Other susceptibility results showed resistance to isoniazid (INH) (4.2%), ethambutol (EMB) (4.3%), streptomycin (SM) (3.7%), kanamycin (Kana) (3.0%), and ofloxacin (Oflox) (2.3%). Twenty MDR-TB patients were retrospectively reviewed. The mean age was 37 years (range: 17 to 64). The male to female ratio was 3:1. The mean duration of symptoms before treatment was 3.8 months (range: 3 days to 2 years). The commonest comorbidity was HIV-infection (7 patients). Eleven patients (55%) had a past history of treatment with anti-TB drugs. In addition to INH and RIF resistance, many organism also resisted EMB (35%), SM (30%), Oflox (30%), and Kana (10%). Only five patients (25%) responded to medical treatment. Seven patients (35%) died, and the other eight were unavailable for an evaluation of clinical outcome. Although the prevalence of MDR-TB was not high in Srinagarind Hospital, the treatment was costly and the outcomes were poor. Preventing new cases of MDR-TB by using effective treatment strategies for patients with drug-sensitive TB is a priority.     

Severe community-acquired pneumonia (CAP) treated at Srinagarind Hospital, Khon Kaen, Thailand

In Thailand, the death rate from community-acquired pneumonia (CAP), especially severe CAP, has increased steadily over the past decade. To optimize the outcome, rapid start of appropriate antibiotics and supportive care are the mainstay of management. We therefore assessed the local etiology and outcome of adult patients with severe CAP admitted between January 1, 1999 and December 31, 2001. One hundred and five of 383 patients (27.4%) met the ATS criteria for severe CAP. The mean age was 56.9 (SD 18.2) years. The male to female ratio was 60:45. Duration of symptoms before admission was 5.3 (SD 4.0) days. Most of them (91.4%) had co-morbidity, diabetes mellitus being most common. A microbiological pathogen was isolated in 62 patients (59%). The pathogens most commonly isolated were B. pseudomallei (29.4%), S. pneumoniae (20.6%), K. pneumoniae (19.1%), and H. influenzae (11.8%). Other less common pathogens were E. coli (5.9%), S. aureus (5.9%), M. pneumoniae (1.5%), M. catarrhalis (1.5%), P. aeruginosa (1.5%), P. fluorescens (1.5%), and S. stercoralis (1.5%). Hospitalization averaged 14.7 (SD 14.3) days and mortality was 21%. Clinicals in 17.1 % of patients did not improve and they transferred home. Most (81.9%) patients required mechanical ventilation, while 60 (57.1%) developed septic shock, and 13 (12.3%) acute renal failure. Severe CAP carried high mortality, despite intensive care. Empirical therapy for B. pseudomallei should be considered, where endemic, and for patients with diabetes mellitus or chronic renal failure.