Consecutive cutaneous and visceral leishmaniasis manifestations involving a novel Leishmania species in two HIV patients in Thailand

Leishmaniasis is an emerging disease in Thailand. Herein, we report on two human immunodeficiency virus (HIV)-infected patients with leishmaniasis who presented with overlapping manifestations between cutaneous and visceral leishmaniasis. Sequencing analysis of the internal transcribed spacer 1 (ITS1) of the ribosomal RNA gene showed that the species was identical to a new species recently described in Thailand. The detection of DNA of this Leishmania species in saliva may have important implications for transmission and epidemiological studies.     

Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii

The efficacy and safety of intrathecal (ITH) or intraventricular (IVT) colistin in addition to intravenous (IV) colistin for meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii (CRAB) is unclear. In this retrospective observational study of 40 patients with post-neurosurgical meningitis and ventriculitis due to CRAB, 33 patients without concomitant infection received appropriate dosage regimens of IV colistin. Of the 33 patients, 17 received additional ITH/IVT colistin and 16 received only IV colistin. The 14-day, 30-day and in-hospital mortality rates were nominally lower for patients who received ITH/IVT colistin adjunctive therapy versus patients who received only IV colistin (24% vs. 38%, 29% vs. 56% and 29% vs. 56%, respectively). The costs of treatment were significantly lower, the lengths of hospital and intensive care unit (ICU) stay were significantly shorter, and the number of ventilator days was significantly less among patients who received ITH/IVT colistin compared with patients who did not receive ITH/IVT colistin. The initial Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were associated with 30-day mortality with odds ratios (95% confidence intervals) of 1.21 (1.08–1.46) and 0.77 (0.44–0.85), respectively. Chemical meningitis from ITH/IVT colistin was mild and resolved spontaneously. Treatment of post-neurosurgical CRAB meningitis and ventriculitis with ITH/IVT colistin as an adjunct to IV colistin was associated with shorter lengths of hospital and ICU stay and a trend to lower mortality, especially among severely ill patients.     

Quercus infectoria: a candidate for the control of methicillin-resistant Staphylococcus aureus infections

Acetone, ethyl acetate, 95% ethanol and aqueous extracts of Quercus infectoria (Q. infectoria) demonstrated significant antibacterial activities against all strains of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). Inhibition zones were in the range 11.75-16.82 mm. Both MRSA and MSSA strains exhibited minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values at 0.13 and 0.13-1.00 mg/mL, respectively. At 2 MIC, the growth of two representative MRSA strains was continually inhibited for at least 20 h. Surviving MRSA cells were not detected within 12-14 h after treatment with the extract at 4 MIC concentration. Staphylococcus aureus ATCC 25923 demonstrated similar results.     

A retrospective study of multiple sclerosis in Siriraj Hospital, Bankok, Thailand

OBJECTIVE: To determine the demographic and clinical data of Thai multiple sclerosis (MS) patients. METHODS: A retrospective study of 72 patients attending the MS clinic at Siriraj Hospital, Mahidol University, Thailand between January 1997 and June 2004. RESULTS: Fifty-eight patients (81%) were classified as clinically definite MS, 5 (7%) as Devic's syndrome, and 9 (13%) as possible MS. There were 62 females (86%) and 10 males (14%). Age at onset was 33 +/- 12 years with a mean relapse rate of 1.2 +/- 1.0 attacks per annum. None had a family history of MS. Visual impairment (53%) was the most common manifestation. Only 16% had classic (western) form of MS. Positive oligoclonal bands were found in 21%, visual evoked potentials with a typical delayed latency in 28%. MRI brain lesions compatible with McDonald's criteria were seen in only 24%, and spinal MRI brain longer than 2 vertebral bodies in 62%. The mean Kurtzke's Expanded Disability Status Scale (EDSS) was 3.0. CONCLUSIONS: Thai MS patients had much more female occurrence, no family history, common optico-spinal form, long spinal MRI lesions and low positive CSF oligoclonal bands.     

Evolutionary consequences of G9 rotaviruses circulating in Thailand

Infection with group A rotaviruses is the main cause of acute gastroenteritis in infants and young children worldwide. Rotavirus G9 is recognized as the fifth most predominant G genotype that spreads throughout the world. In this study, we describe the changing distribution of rotavirus G9 genotype in Chiang Mai, Thailand, from 1989 to 2005. Molecular genetic evolutionary analysis of the G9 rotavirus VP7 gene was performed. The G9 rotavirus in Thailand was first detected in Chiang Mai in 1989 with a low prevalence of 1.98%, but in 2000 and 2001 it had become the most predominant genotype, reaching prevalence of 75% and 92.2%, respectively. Then, the prevalence of G9 reached a peak of 100% in 2002 and decreased abruptly over the next 3 years, i.e. 16.7% in 2003, 32.1% in 2004, and 4.7% in 2005. Our phylogenetic analysis demonstrates that all the G9 rotaviruses circulating in Thailand belonged to lineage III, and clustered closely together based on the year of virus isolation. One amino acid change from Thr to Ile was observed in antigenic region C at position 208 between the G9 strains isolated in 1989 and the strains of 1997–2005. These findings provide the overall picture and genomic data of G9 rotaviruses circulating in Chiang Mai, Thailand.     

Music reduces sensation and distress of labor pain.

Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer.     

Arterial spin labeling in neuroimaging

Arterial spin labeling (ASL) is a magnetic resonance imaging technique for measuring tissue perfusion using a freely diffusible intrinsic tracer. As compared with other perfusion techniques, ASL offers several advantages and is now available for routine clinical practice in many institutions. Its noninvasive nature and ability to quantitatively measure tissue perfusion make ASL ideal for research and clinical studies. Recent technical advances have increased its sensitivity and also extended its potential applications. This review focuses on some basic knowledge of ASL perfusion, emerging techniques and clinical applications in neuroimaging.