Hospitalization trends, costs, and risk factors in HIV-infected children on antiretroviral therapy

OBJECTIVE:: To assess hospitalization trends in HIV-infected children on antiretroviral therapy (ART) in Thailand, an important indicator of morbidity, ART effectiveness, and health service utilization. DESIGN:: Prospective observational cohort METHOD:: Children initiating ART in 1999-2009 were followed in 40 public hospitals. Hospitalization rate per 100 person-years were calculated from ART initiation to last follow-up/death. Costs to the healthcare provider were calculated using WHO inpatient estimates for Thailand. Zero-inflated Poisson models were used to examine risk factors for early (<12 months of ART) and late hospitalization (≥12 months) and frequency of admissions. RESULTS:: A total of 578 children initiated ART, median follow-up being 64 months [interquartile range (IQR) 43-82]; 211 (37%) children were hospitalized with 451 admissions. Hospitalization rates declined from 63 per 100 person-years at less than 6 months to approximately 10 per 100 person-years after 2 years of ART, and costs fell from $35 per patient-month to under $5, respectively. Age less than 2 years, US Centers of Disease Control and Prevention stage B/C, and stunting at ART initiation were associated with early hospitalization. Among those hospitalized, baseline CD4 cell percentage less than 5%, wasting, initiation on dual therapy, late calendar year, and female sex were associated with higher incidence of early admissions (P?<0.02). There were no predictors of late hospitalization, although previous hospitalization in less than 12 months of ART was associated with three times higher incidence of late admissions (P?相似文献   

Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury

Background

The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.

Methods

We performed a 2-year analysis of all patients on prehospital Ibuprofen with traumatic brain injury and intracranial hemorrhage. Patients on preinjury Ibuprofen were matched using propensity score matching to patients not on Ibuprofen in a 1:2 ratio for age, Glasgow Coma Scale, head-abbreviated injury scale, injury severity score, International Normalized Ratio, and neurologic examination. Outcome measures were progression on repeat head computed tomography (RHCT) and neurosurgical intervention.

Results

A total of 195 matched (Ibuprofen 65, no-Ibuprofen 130) patients were included. There was no difference in the progression on RHCT (Ibuprofen 18% vs no-Ibuprofen 24%; P = .50). The neurosurgical intervention rate was 18.9% (n = 37). There was no difference for need for neurosurgical intervention (26% vs 16%; P = .10) between the 2 groups.

Conclusions

In a matched cohort of trauma patients, preinjury Ibuprofen use was not associated with progression of initial intracranial hemorrhage and the need for neurosurgical intervention. Preinjury use of Ibuprofen as an independent variable should not warrant the need for a routine RHCT scan.     

Low-dose aspirin therapy is not a reason for repeating head computed tomographic scans in traumatic brain injury: a prospective study

Background

Most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate the utility of repeat head computed tomography (RHCT) and outcomes in patients on low-dose aspirin (acetylsalicylic acid; ASA) therapy.

Methods

Patients with traumatic brain injury with intracranial hemorrhage on initial head computed tomography (CT) were prospectively enrolled. Patients on prehospital low-dose (81 mg) aspirin therapy were matched with patients exclusive of antiplatelet and anticoagulation therapy using propensity score matching in a 1:1 ratio for age, Glasgow Coma Scale, head Abbreviated Injury Scale score, Injury Severity Score, and neurological examination. Outcome measures were progression on RHCT and subsequent neurosurgical intervention.

Results

A total of 144 patients who had intracranial hemorrhage on initial CT scan (ASA group: 72; No-ASA group: 72) were enrolled. The mean age was 72.8 ± 11.7 years, 59.7% were male, and median head Abbreviated Injury Scale was 3 (2–3). There was no difference in progression on RHCT (25% in ASA versus 16.6% in no-ASA), change in management as a result of RHCT (1.4% versus 1.4%), RHCT as a result of neurological decline (0 versus 1.4%), discharge Glasgow Coma Scale (15 [14–15] versus 15 [14–15]), and mortality (0 versus 1.4%) between the two groups.

Conclusions

Low-dose aspirin therapy is not associated with progression of initial insult on RHCT or clinical deterioration. Prehospital low-dose aspirin therapy as a sole criterion should not warrant a routine repeat head CT in traumatic brain injury.     

Improved microstructure and significantly enhanced dielectric properties of Al3+/Cr3+/Ta5+ triple-doped TiO2 ceramics by Re-balancing charge compensation

The charge compensation mechanism and dielectric properties of the (Al_xCr_0.05−x)Ta_0.05Ti_0.9O₂ ceramics were studied. The mean grain size slightly changed with the increase in the Al³⁺/Cr³⁺ ratio, while the porosity was significantly reduced. The dielectric permittivity of the co-doped Cr_0.05Ta_0.05Ti_0.9O₂ ceramic was as low as ε′∼ 10³, which was described by self-charge compensation between Cr³⁺–Ta⁵⁺, suppressing the formation of Ti³⁺. Interestingly, ε′ can be significantly increased (6.68 × 10⁴) by re-balancing the charge compensation via triple doping with Al³⁺ in the Al³⁺/Cr³⁺ ratio of 1.0, while a low loss tangent (∼0.07) was obtained. The insulating grains of [Cr_0.05³⁺Ta_0.05⁵⁺]Ti_0.9⁴⁺O₁₂ has become the semiconducting grains for the triple-doped Al_x³⁺[Cr_0.05−x³⁺Ta_0.05−x⁵⁺][Ta_x⁵⁺Ti_x³⁺Ti_0.9+x⁴⁺]O_12+3x/2. Considering an insulating grain with low ε′ of the Cr_0.05Ta_0.05Ti_0.9O₂ ceramic, the electron-pinned defect-dipoles and interfacial polarization were unlikely to exist supported by the first principles calculations. The significantly enhanced ε′ value of the triple-doped ceramic was primarily contributed by the interfacial polarization at the interface between the semiconducting and insulating parts, which was supported by impedance spectroscopy. This research gives an underlying mechanism on the charge compensation in the Al³⁺/Cr³⁺/Ta⁵⁺-doped TiO₂ system for further designing the dielectric and electrical properties of TiO₂-based ceramics for capacitor applications.

The dielectric properties of Cr³⁺/Ta³⁺ co-doped TiO₂ can be significantly improved by triple doping with Al³⁺ due to the re-balance of charge compensation.     

Hantaan virus antibody prevalence in rodent populations of several provinces of northeastern Thailand

We conducted a serological survey of 632 rodents from the northeast region of Thailand in order to assess the presence of Hantaan-like viruses that may be a risk to the human population. Rodents were collected from rice fields, houses and domestic gardens in five northeastern provinces and tested for IgG reacting sera to Hantaan antigen using enzyme-linked immunoassays. The overall prevalence of Hantavirus infection in rodents was 2.1% (13/632). Species that tested positive included Bandicota indica (4.3% positive within species), Rattus exulans (2.1%), R. losea (1.6%) and R. rattus (0.9%). Species such as R. exulans and R. losea are candidate hosts of unidentified Hantaan-like viruses in Thailand.     

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.     

Structure-activity relationships of dengue antiviral polycyclic quinones

The virucidal and antiviral photoactivities of three compounds, hypericin, tetrabromohypericin and gymnochrome B, were evaluated against dengue viruses. All the three products were active, and both the virucidal and antiviral activities were enhanced by light. Gymnochrome B was more potent than hypericin and tetrabromohypericin. The presence of the side chains on the hypericin core of gymnochromes appears to be beneficial for both virucidal and antiviral activities. This enhanced activity is likely to be linked to a complementary mechanism independent of photoactivation.