Factors Influencing Acceptance of Hepatitis B Vaccination by Hospital Personnel in an Area Hyperendemic for Hepatitis B

A free-of-charge vaccination program against hepatitis B, in which plasma-derived vaccine was used, was offered to 1,299 hospital personnel of Chulalongkorn University Hospital, Bangkok. The initial acceptance rate for vaccination was 65.7%, with 10.0% nonacceptance and 24.3% undecided. The highest rates of acceptance were among medical students (75.5%), student nurses (68.8%), and newly graduated nurses (63.6%). The lowest rate of acceptance was among physicians (48.2%). Factors strongly associated with the acceptance of vaccination were nature of work, age of personnel (< or = 40 yr), number of years spent in profession (< or = 15 yr), knowledge of hepatitis B, confidence in vaccine efficacy and safety, no history of hepatitis B infection, and contact with blood or blood product. Different types of fear, as well as lack of knowledge, were the main reasons responsible for 46.2% of all refusals. More specific educational efforts about vaccine safety and efficacy may positively influence the acceptance of hepatitis vaccination program among health care personnel.     

Cost analysis of different types of tuberculosis patient at tuberculosis centers in Thailand

Tuberculosis (TB) has recently re-emerged as a major public health problem in Thailand. As a consequence of the HIV epidemic in the country, the TB burden has been rising in terms of both morbidity, and mortality which have tremendous socioeconomic impact. However, a study of the cost of various anti-TB drugs in Thailand has never been conducted. A specific aim of this study was to compare the total provider costs of delivering services to different types of TB patient in four zonal TB centers located in the east, northeast, north, and south of Thailand. This aim was accomplished by calculating the unit costs of TB treatment services at these TB centers during the year 1996-1997. All units of the zonal TB centers were classified into 5 cost-center categories: treatment units, laboratory units, radiology units, pharmaceutical units, and administrative/supportive units. The results showed that the average total provider cost of multidrug resistant TB (MDR TB) patients was 89,735.49 baht which was the highest of any type of patient and was 17 times higher than the cost of smear-negative TB cases; this finding was attributed to the high cost of anti-TB drugs for MDR TB cases (65,870 baht), some 95 times higher than the cost for smear-negative cases. Total provider costs were highest in the northeastern region TB centers and lowest in the southern centers for every type of TB patient: smear-negative TB cases (7.727 baht vs 3.916 baht). newly smear positive TB cases (12,539 baht vs 7.020 baht), TB with AIDS cases (15,108 baht vs 8,369 baht). re-treatment TB cases (16,679 baht vs 9,696 baht), and MDR TB cases (102.330 baht vs 82,933 baht). The information from this study may be useful when reviewing the role, function, and cost structure of each TB center in Thailand in order to establish a strategic plan for effective TB control.     

Intraspecies variation of Brugia spp. in cat reservoirs using complete ITS sequences

The internal transcribed spacer (ITS) region was used to study the intraspecies variation of Brugia spp. in cat reservoirs. Blood specimens from seven naturally infected cats were collected from two different geographical brugian-endemic areas in Thailand. The DNAPAR tree of these Brugia spp. was constructed using a maximum likelihood approach based on ITS nucleotide sequences and was compared to those of Brugia malayi, Brugia pahangi, and Dirofilaria immitis that were previously reported in GenBank. The phylogenetic trees inferred from ITS1, ITS2, and complete ITS sequences indicated that B. malayi and B. pahangi were separated into two clades, and subgroups were generated within each clade. The data revealed that ITS2 sequences were less informative than ITS1 for studying intraspecies variation of Brugia spp. Our results are primary data for intraspecies variation of B. malayi and B. pahangi in cat reservoirs. The information could be applicable for studying the molecular epidemiology and the dynamic nature of the parasites. GenBank accession numbers of Brugia malayi and Brugia pahangi complete ITS regions using in this study were EU373601-EU373625 and EU373626- EU373655, respectively.     

Examination of Peripheral Blood Mononuclear Cells and Sera from Thai Adults Naturally Infected with Malaria in Assays of Blastogenic Responsiveness to Mitogenic Lectins and Allogeneic Cell Surface Antigens

We have previously observed that Thai adults who are infected with malaria have a loss of peripheral blood T cells, and that patient sera contain lymphocytotoxic antibodies. In the present study, we examined peripheral blood mononuclear cells from Thai adults naturally infected with Plasmodium falciparum and Plasmodium vivax for the capacity to undergo blastogenesis in response to phytohemagglutinin, concanavalin A, pokeweed mitogen, and allogeneic cell surface antigens in a one-way mixed leukocyte reaction. In addition, sera from actively infected patients were examined with regard to suppressive capabilities toward normal lymphocyte blastogenesis by using the same assays. We found that patient mononuclear cells exhibited normal reactivity to phytohemagglutinin, concanavalin A, and pokeweed mitogen when compared with controls. However, peripheral blood mononuclear cells from patients had a decreased stimulatory capacity in the allogeneic mixed leukocyte reaction, and P. vivax, but not P. falciparum, lymphocytes exhibited decreased responsiveness in the mixed leukocyte reaction. Furthermore, sera from patients with active malaria induced decreased responsiveness by normal mononuclear cells to phytohemagglutinin and concanavalin A, but not pokeweed mitogen; pooled P. falciparum sera caused decreased responsiveness to allogeneic cell surface antigens in the mixed leukocyte reaction. These studies indicate that despite the lost of circulating T cells during the course of infection with malaria, blastogenic responsiveness remains intact, and that sera from patients with malaria are capable of exerting negative immunoregulatory effects.     

Prevalence of β-lactamase-negative ampicillin-resistant haemophilus influenzae isolated from patients of a teaching hospital in Thailand

The aim of this study was to investigate the prevalence of β-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae isolated from patients of a teaching hospital in Thailand. Eighty-eight isolates of H. influenzae were collected between September 2005 and March 2008. All isolates were identified and characterized for biotypes and capsular types. The β-lactamase production of these isolates was examined, and their susceptibility to the following 12 antimicrobial agents was determined: ampicillin (AMP), amoxicillin-clavulanate (AMC), cefotaxime (CTX), cefuroxime (CXM), meropenem (MEM), clarithromycin (CLR), telithromycin (TEL), tetracycline (TET), ciprofloxacin (CIP), levofloxacin (LEV), trimethoprim-sulfamethoxazole (SXT), and chloramphenicol (CHL). Of the 88 H. influenzae isolates, 69 (78.4%), 13 (14.8%), 4 (4.5%), and 2 (2.3%) were from the respiratory tract, pus, the genital tract, and blood, respectively. Half of the isolates were biotype II (44 isolates, 50%). The other half comprised biotypes I (23 isolates, 26.1%), III (15 isolates, 17.1%), and IV (6 isolates, 6.8%). All isolates were capsular non-typeable, except for 2 isolates that were type f. Antimicrobial susceptibility showed that all isolates were susceptible to AMC, CTX, MEM, TEL, CIP, and LEV (100%), whereas 96.6%, 94.3%, 80.7%, 68.2%, 50.0%, and 44.3% were susceptible to CXM, CLR, CHL, TET, AMP, and SXT, respectively. The β-lactamase-production rate of H. influenzae isolates was 40.9%, and the prevalence of BLNAR was 18.2%.     

A newly designed sticker-plastic sheet platform and smartphone-based digital imaging for protein assay in food samples with downscaling Kjeldahl digestion

A low-cost and reliable analytical method based on the combination of a newly designed sticker-plastic sheet platform, digital image-based colorimetry and down scaled Kjeldahl digestion is proposed for the determination of protein content in food samples. The yellowish-brown colloidal products, obtained from the reaction between the ammonium–nitrogen after digestion and the working Nessler''s reagent on the miniaturized sticker-plastic sheet platform, were captured for imaging with a smartphone camera. The operational parameters and reaction conditions were optimized. A down scaled Kjeldahl digestion procedure was performed using the newly designed digestion block. The parameters influencing the digestion efficiency, including the mass of the sample, volume of acid, mass of the catalyst and digestion time, were evaluated. Under the selected conditions, a linear calibration in the range of 5–60 mg L⁻¹ ammonium–nitrogen was obtained with limits of detection and quantification of 2.8 and 7.6 mg L⁻¹, respectively. The repeatability and reproducibility were 6.7% and 8.8%, respectively. The accuracy of the proposed method was evaluated by applying the developed procedure for milk powder and feeding stuff reference materials and comparing it with the conventional Kjeldahl method. The proposed method was successfully applied for the determination of protein contents in soy foods and protein-based foods. The results agreed well with those obtained from the conventional Kjeldahl method.

The combination of a newly designed sticker-plastic sheet platform, smartphone-based digital imaging and down scaled Kjeldahl digestion is proposed for the determination of protein contents in food samples.     

Cost-effectiveness of using angiotensin-converting enzyme inhibitors to slow nephropathy in normotensive patients with diabetes type II and microalbuminuria

SUMMARY: We assessed the cost-effectiveness of prescribing angiotensin-converting enzyme (ACE) inhibitors to delay progression of diabetic nephropathy in normotensive patients with type II diabetes and microalbuminuria. The Markov models determined by DATA T ree AGE software were used to calculate the lifetime medical costs and life expectancy in patients treated with or without ACE inhibitors. The incremental cost-effectiveness ratio (ICER), defined as the change in medical costs divided by the change in life expectancy, was the main outcome parameter. The ICER for ACE inhibitor therapy was US$788.37 per life-year saved. Sensitivity analysis showed that ACE inhibitor therapy had no cost-effectiveness value when the cost of ACE inhibitors was increased for more than 90% or when the cost of haemodialysis was decreased for greater than 48%, or when the efficacy of the treatment was reduced until the cumulative incidence of macroalbuminuria was increased from 18 to 48%.     

Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis

The objective was to assess the cost-effectiveness of various DMARDs compared with antimalarials (AM) for rheumatoid arthritis (RA) treatment. The data on disease activity, functional status and societal costs were collected from a 1-year cohort of 152 patients with RA receiving at least one DMARD for ≥ 6 months. Incremental cost effectiveness ratio (ICER) was calculated from the societal costs of DMARD treatment compared with AM per one unit of HAQ improvement. All costs were presented in 2001 US dollars. Mean (SD) societal cost of AM treatment was US$ 2,285 (1,154) per patient per year. MTX + AM was less costly and more effective than AM, as the ICER of this combination would save US$ 834 per 1 U of HAQ improvement. MTX + SSZ, leflunomide, and triple therapy (AM + MTX + SSZ) were more effective than AM with additional costs. RA treatment with non MTX-based DMARDs was not cost-effective.