Immunofluorescent Staining of Platelet Suspensions and Detection of Antiplatelet Antibody in Patients with Idiopathic Thrombocytopenic Purpura

Direct immunofluorescent staining of 31 specimens of platelets obtained from 13 cases of idiopathic thrombocytopenic purpura (ITP) revealed positive staining on the surface of platelets for both immunoglobulins (Igs) and human B1C globulin in 9 specimens, for only Igs in 1 specimen and for human B1C alone in 5 specimens. The pattern of the positive immunofluorescent staining was granular. Indirect immunofluorescent staining of normal platelets in serum obtained from patients with ITP was positive for antiplatelet antibody in 9 out of 31 specimens. This suggests that platelets in patients with ITP may be damaged by an antiplatelet autoantibody acting directly on the platelet surface and/or by antigen antibody complexes binding via Fc IgG receptors on the surface of the platelets.     

Demonstration of dengue antibody complexes on the surface of platelets from patients with dengue hemorrhagic fever.

By the direct immunofluorescent technic, dengue antigen, human immunoglobulins, and beta 1C globulin were detectable on the surfaces of platelet suspensions from 48% of patients with dengue hemorrhagic fever. The percentages of positive-staining platelets were not related to the severity of thrombocytopenia, which was marked on the day after the patient developed shock or subsidence of fever. It is suggested that an immunologic mechanism is one of the factors associated with the thrombocytopenia caused by increased platelet destruction.     

Risk factors for hypertension among rural Thais

A community based case-control study was conducted to determine the risk factors for hypertension among a rural population in Nakhon Ratchasima Province, Thailand. Seventy-two subjects diagnosed with hypertension (BP > or = 140/ 90 mmHg) were randomly selected. Seventy-two controls with normal blood pressure (BP < 120-80 mmHg) were also randomly selected from the same or nearest house to the subjects. Data collection was carried out in February 2010 using a structured questionnaire. Statistics used were percentages, arithmetic means, standard deviations, odds ratios (OR), adjusted odds ratios (aOR), confidence interval (95% CI) for the OR and logistic regression. After adjusting for the effect of other variables in the study, significant risk factors for hypertension were age > or = 50 years old (aOR 5.67, 95% CI 1.98-16.24), education level of primary school or lower (aOR 8.09, 95% CI 2.17-30.20), occupation of farmer or unemployed (aOR 2.88, 95% CI 1.14-7.30), body mass index 230.0 kg/m2 (aOR 7.43, 95% CI 1.68-32.87), presence of high cholesterol (aOR 11.26, 95% CI 2.55-49.75), and having mild stress to high stress (aOR 5.33, 95% CI 1.45-19.61). Forty percent of the variation in the presence of hypertension is explained by the developed model for the above risk factors. These findings are useful for health education and health promotion program development in order to prevent hypertension among rural Thai populations.     

Infection of young adult mice with dengue virus type 2

Young adult female mice, five to six weeks old, were injected intraperitoneally with 2·5 × 10^6·3 LD₅₀ of dengue-2 virus, New Guinea C strain. The mice were killed on day 1, 2, 3, 4, 5, 6, 7, 10, 14, 21, 28 and 35 respectively. By means of the immunofluorescent antibody technique, viral antigen appeared as irregular granules in the reticuloendothelial cells of liver, lymph nodes and spleen of infected mice on the first day after inoculation and then diminished. From the fifth to sixth day of infection dengue antigen appeared again as homogeneous staining in the cytoplasm of single or groups of mononuclear cells in the lymphatic sinuses only. Later, by the third week of infection, dengue antigen could be seen in the mononuclear cells located in the marginal zone of lymphoid follicle of the spleen, the pattern of staining changing to bright spherical granules. At the same time, the deposition of immune complexes (composed of dengue antigen, mouse gamma and β1C globulin) could be seen in the renal glomeruli of infected mice.Serum antibody to dengue virus was found at low levels, being maximal on the 14th day after infection. Dengue virus was not isolated from the sera or from the infected organs. Granulomatous inflammation developed in lymph nodes and liver of mice infected with dengue virus and in mice inoculated with normal mouse brain suspension. Proliferative glomerular lesion was observed on day 14 after inoculation without definite abnormal urine findings.     

Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan

Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).     

An empowerment program to enhance women's ability to prevent and control malaria in the community, Chiang Mai Province, Thailand

Paulo Freire's theory was modified to empower a women's group in Chiang Mai Province, Thailand, to prevent and control malaria. This study conducted an intervention in Mueang Na Wan Village, Mueang Na Sub-district, Chiang Dao District, Chiang Mai Province, where 45 women were systematically recruited into the study cohort. Navail Village was selected as a control village because it resembled the intervention village. The empowerment program emphasized enhancement of malaria preventive levels, using insecticide-treated bed nets, self-esteem, and self confidence expectation to prevent and control malaria. Intensive training was conducted and activities performed among the women's group, with 10 participatory meetings in all. Data collection was conducted for the pre-test in month 1, and post-intervention in months 3, 6, 9, and 12. The qualitative methods used were focus-group discussions, non-participant observations, and in-depth interviews with housewives, their husbands, and youths at risk for malaria. The results showed that, post-intervention, there were significantly increased levels for malaria preventive behaviors, behaviors of using insecticide-treated nets, self-esteem, and self confidence expectations, in the intervention village compared with the control village. Insecticide-treated net usage and insecticide-treated net usage behaviors increased in the intervention village more than before and more than that in the control village. The women's group in the intervention village created the following plans, which were crucial to malaria prevention: (1) a family protection plan, (2) providing malaria education to community members, (3) a mosquito-control campaign, (4) scaling-up insecticide-impregnated bed nets, and (5) malaria control among foreign laborers. Finally, the empowered women's group performed sustainable activities. Between malaria-prevention activities, they conducted a joint program to raise income for their families.     

Strengthening the capability of family health leaders for sustainable community-based health promotion

The Family Health Leader (FHL) Project was initiated in 1997 to encourage self-care and health promotion. Since then, there has been no retraining. This study aimed to strengthen the FHLs' capability to sustain community-based health promotion and network establishment. The study, of a quasi-experimental design, was conducted in a village in Phan Thong district, Chon Buri Province, Thailand. The intervention emphasized enhancing the FHLs' knowledge, ability, leadership and motivation to advance health promotion activities. Before implementing the main intervention, 5 community health workers were trained as facilitators to strengthen 36 FHL capabilities. The curriculum and manual for training facilitators and FHLs were also developed. The intervention for strengthening FHLs' capabilities lasted for 7 months using participatory training. A within-subject repeated ANOVA was used to measure changes in the main outcome variables immediately, and at three and six months after the intervention. A qualitative methodology was utilized to assess network establishment. The results indicate that the FHLs' knowledge of self-care and health promotion, ability, leadership and motivation had increased significantly after the intervention (p < 0.001). The FHLs also sought to extend their network by involving both the community committee and the local authorities. The intervention appeared to be successful in strengthening the FHLs' capabilities to sustain health promotion within the community, and it established networks vertically and horizontally. The FHLs were the key persons to bring good health to family members. Periodical participatory learning and group empowerment are recommended for encouraging the FHLs to maximize their potential for family self-care and health promotion.     

The defined antigen substrate sphere system with direct immunohistoperoxidase for detection of soluble dengue antigen in sera of patients with dengue hemorrhagic fever.

The defined antigen substrate sphere system is a simple method for detecting antigen or antibody in the circulation. The technic is based on the coupling of antigen or antibody with Sepharose 4B beads that have been activated by cyanogen bromide. In this study the activated beads were exposed to dengue antigen in the serum from a patient with dengue hemorrhagic fever and then stained with antidengue antibody conjugated with horseradish peroxidase. The positive reaction showed brown beads by light microscopy, whereas the negative reaction gave colorless beads. The authors examined 134 specimens from 91 cases. The results were positive in 53.85%. The dengue antigen appeared in the sera on the day before shock or subsidence of fever. The percentages of sera containing soluble dengue antigen were greatest on the day of shock or subsidence of fever (33.33%) and on the fifth day of fever (28.07%). The highest titers of soluble dengue antigen (1:40 to 1:80) appeared in the sera of patients who had Grade III disease on the day of shock. The dengue antigen appeared most often in sera that had high titers of dengue antibody. It is postulated that this detected dengue antigen may be a part of soluble immune complexes formed during the hyperimmune stage of the immune response, and plays a significant role in the pathogenesis of dengue hemorrhagic fever and shock syndrome.