Serotypes of Escherichia coli that hybridized with DNA probes for genes encoding Shiga-like toxin I, Shiga-like toxin II, and serogroup O157 enterhemorrhagic E. coli fimbriae isolated from adults with diarrhea in Thailand.

Escherichia coli strains isolated from adults with diarrhea in Bangkok, Thailand, were examined for hybridization with DNA probes for genes that code for Shiga-like toxin (SLT)-I, SLT-II, and serogroup O157 enterhemorrhagic E. coli (EHEC) fimbriae. Seven isolates that hybridized with the SLT-I, SLT-II, and O157 EHEC fimbria probes and produced verocytotoxin (VT; group A) were isolated from two patients with diarrhea. Two strains that hybridized with only the SLT-II probe and the O157 EHEC fimbria probe and were VT+ (group B) were isolated from two patients with diarrhea, 7 strains that hybridized with only the SLT-II probe and were VT+ (group C) were isolated from two patients with diarrhea, and 26 strains that hybridized with only the O157 EHEC fimbria probe and were VT- (group D) were isolated from four patients with diarrhea. Seven strains in group A had serotypes O2:H1 (n = 1), O110:H19 (n = 1), and Ont:H8 (n = 5); 2 strains in group B were O112ab:H21 (n = 1) and O113:H21 (n = 1); 7 strains in group C were O6:H28 (n = 1), O22:H16 (n = 1), O52:H25 (n = 1), O112ab:H21 (n = 1), OR:H45 (n = 2), and OR:H11 (n = 1); and 26 strains in group D were O76:H7 (n = 18), O146:H3 (n = 2), O146:H10 (n = 1), O146:Hnt (n = 1), OR:H16 (n = 1), Ont:H2 (n = 1), Ont:H8 (n = 1) and Ont:H16 (n = 1). In Thailand, E. coli strains that hybridized with SLT-I, SLT-II, and O157 EHEC fimbria probes were of a variety of serotypes, none of which were O157:H7.     

A review of Hib epidemiology in Asia.

Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.     

Comparative study of two automated high-sensitivity C-reactive protein methods in a large population

OBJECTIVES: Increased serum C-reactive protein (CRP) is associated with future risk of coronary heart disease in apparently healthy individuals. Numerous high-sensitivity CRP (hs-CRP) methods are available but their comparability in large populations has not been assessed. This study aimed to evaluate the performance of two CRP methods in a large Asian population. DESIGN AND METHODS: We compared the Tina-quant CRP immunoturbidimetric assay (Roche COBAS INTEGRA) to the N high-sensitivity latex-enhanced immunonephelometric (BN 100 nephelometer, Dade Behring) assay using 4118 serum samples from the International Collaborative Study on Atherosclerosis and Stroke in Asia (Inter ASIA). RESULTS: The median hs-CRP value for the N high-sensitivity CRP method (1.23 mg/L) was significantly lower than that for the Tina-quant method (1.50 mg/L), P < 0.001. The two methods were highly associated (r = 0.9916). Deming regression analysis gave a slope of 0.958 [95% confidence interval (CI): 0.954-0.962] with an intercept of 0.280 [95% confidence interval (CI): 0.268-0.292]. The mean of the method differences was 0.19 mg/L and the limits of agreement (LOA), which encompass 95% of results, were -0.36-0.74 mg/L. We found the percentages of low, average, and high-risk results were 42.9, 33.8, and 23.3 for the N high-sensitivity CRP and 33.2, 41.1, and 25.7 for the Tina-quant method. The percentage of samples concordant by both methods was 87.4%. The Tina-quant CRP classified more subjects into the high-risk group. CONCLUSIONS: The two hs-CRP methods were highly associated and are suitable for screening large populations.     

A comparison of pain scales in Thai children

Three commonly used pain scales, the visual analogue scale, the Wong-Baker Faces Pain Scale, and the Faces Pain Scale Revised were administered to 122 Thai children, of whom half were HIV infected, in order to assess their validity. These scales presented moderate to good correlation and moderate agreement, sufficient for valid use in Thai children.     

Pain: a common symptom in human immunodeficiency virus-infected Thai children

Aim: To determine the prevalence and characteristics of pain in Thai human immunodeficiency virus-infected children. Methods: A cross-sectional study was performed at the HIV/AIDS outpatient clinic at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand from November 2002 to January 2003. Sixty-one human immunodeficiency virus-infected patients aged 4 to 15 y, an equal number of age-matched children with no chronic disease and their caregivers participated. We interviewed children and their caregivers using a structured questionnaire on pain. The main outcome measure was the percentage of human immunodeficiency virus-infected children reporting pain. Results: Forty-four percent of the human immunodeficiency virus-infected children reported pain compared to 13% of the children with no chronic disease (odds ratio, OR = 5.3; 95% CI: 2.0-14.3). Seven percent of the infected children experienced chronic pain. Children in human immunodeficiency virus clinical categories B and C reported more pain than children in categories N and A (OR = 4.0, 95% CI: 1.1-14.7). Pain in infected children tended to occur in the abdomen, lower limbs or head. Only 44 percent of the infected children experiencing pain received analgesic medication.

Conclusion: Despite being a common experience, pain is insufficiently taken into account and treated in Thai children with HIV/AIDS. Therefore, adequate pain identification, assessment and management should be systemically considered in their routine care.     

Deproteinization of serum: another best approach to eliminate all forms of bilirubin interference on serum creatinine by the kinetic Jaffe reaction

The negative interference of conjugated, unconjugated, and delta bilirubin on patient serum creatinine determined by the kinetic Jaffe reaction is the unresolved problem. We compared bilirubin interference on thirty patients' serum creatinine obtained from four analyzers, with and without deprotenization before the Jaffe reaction, to the Vitros dry enzymatic method. We found significant negative interference from bilirubin on serum creatinine in all samples directly applied to four wet chemical methods, except the one incorporated with serum blank rate. The negative interferences linearly related to bilirubin concentration. However, bilirubin did not interfere on serum creatinine obtained from all wet chemical methods incorporated with deproteinization process before the reaction. We conclude that deproteinized serum before the reaction is the best approach to eliminate all forms of bilirubin interference on serum creatinine determined by the kinetic Jaffe reaction.