Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

ObjectiveTo determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI).BackgroundPatients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks.MethodsThis was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m²): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors.ResultsPatients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001).ConclusionAmong patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.     

Antibiotic Use in Thailand: Quantifying Impact on Blood Culture Yield and Estimates of Pneumococcal Bacteremia Incidence

No studies have quantified the impact of pre-culture antibiotic use on the recovery of individual blood-borne pathogens or on population-level incidence estimates for Streptococcus pneumoniae. We conducted bloodstream infection surveillance in Thailand during November 2005–June 2008. Pre-culture antibiotic use was assessed by reported use and by serum antimicrobial activity. Of 35,639 patient blood cultures, 27% had reported pre-culture antibiotic use and 24% (of 24,538 tested) had serum antimicrobial activity. Pathogen isolation was half as common in patients with versus without antibiotic use; S. pneumoniae isolation was 4- to 9-fold less common (0.09% versus 0.37% by reported antibiotic use; 0.05% versus 0.45% by serum antimicrobial activity, P < 0.01). Pre-culture antibiotic use by serum antimicrobial activity reduced pneumococcal bacteremia incidence by 32% overall and 39% in children < 5 years of age. Our findings highlight the limitations of culture-based detection methods to estimate invasive pneumococcal disease incidence in settings where pre-culture antibiotic use is common.     

Trefoil factors in saliva and gingival tissues of patients with chronic periodontitis

Background: Trefoil factors (TFFs) are secreted molecules that are involved in cytoprotection against tissue damage and the immune response. TFFs have been detected in saliva and oral tissues, but their clinical significance has never been investigated in patients with chronic periodontitis. The objective of this study is to determine whether TFF expression in saliva and gingival tissues is associated with periodontal pathology. Methods: Saliva and gingival tissue samples were collected from 25 non‐periodontitis individuals and 25 patients with chronic periodontitis (CP). Enzyme‐linked immunosorbent assay and immunohistochemical methods were used to evaluate the expression of TFFs (TFF1, TFF2, and TFF3) in saliva and gingival tissues, respectively. Periodontopathic bacteria were quantified by real‐time polymerase chain reaction. Results: Reduced salivary TFF1 and TFF3 concentrations were observed in patients with CP (P = 0.003 and P <0.001, respectively). Decreased TFF3 expression in gingival tissues of patients with CP was demonstrated (P = 0.041). Levels of salivary TFF3 concentrations were negatively correlated with periodontal pathology and number of Porphyromonas gingivalis and Tannerella forsythia (formerly known as Bacteroides forsythus). Conclusions: Altered expression of TFFs in saliva and gingival tissues was detected in patients with CP. The results suggest that TFF3 may be involved in the pathogenesis of periodontal disease.     

Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms

BACKGROUND: Regular physical exercise may improve a variety of physiological and psychological factors in depressive persons. However, there is little experimental evidence to support this assumption for adolescent populations. We conducted a randomized controlled trial to investigate the effect of physical exercise on depressive state, the excretions of stress hormones and physiological fitness variables in adolescent females with depressive symptoms. METHODS: Forty-nine female volunteers (aged 18-20 years; mean 18.8 +/- 0.7 years) with mild-to-moderate depressive symptoms, as measured by the Centre for Epidemiologic Studies Depression (CES-D) scale, were randomly assigned to either an exercise regimen or usual daily activities for 8 weeks. The subjects were then crossed over to the alternate regimen for an additional 8-week period. The exercise program consisted of five 50-min sessions per week of a group jogging training at a mild intensity. The variables measured were CES-D rating scale, urinary cortisol and epinephrine levels, and cardiorespiratory factors at rest and during exercise endurance test. RESULTS: After the sessions of exercise the CES-D total depressive score showed a significant decrease, whereas no effect was observed after the period of usual daily activities (ANOVA). Twenty-four hour excretions of cortisol and epinephrine in urine were reduced due to the exercise regimen. The training group had a significantly reduced resting heart rate and increased peak oxygen uptake and lung capacity. CONCLUSIONS: The findings of this study suggest that a group jogging exercise may be effective in improving depressive state, hormonal response to stress and physiological fitness of adolescent females with depressive symptoms.     

Incidence of bacteremic melioidosis in eastern and northeastern Thailand

Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in northeastern Thailand. Population-based disease burden estimates are lacking and limited data on melioidosis exist from other regions of the country. Using active, population-based surveillance, we measured the incidence of bacteremic melioidosis in the provinces of Sa Kaeo (eastern Thailand) and Nakhon Phanom (northeastern Thailand) during 2006-2008. The average annual incidence in Sa Kaeo and Nakhon Phanom per 100,000 persons was 4.9 (95% confidence interval [CI] = 3.9-6.1) and 14.9 (95% CI = 13.3-16.6). The respective population mortality rates were 1.9 (95% CI = 1.3-2.8) and 4.4 (95% CI = 3.6-5.3) per 100,000. The case-fatality proportion was 36% among those with known outcome. Our findings document a high incidence and case fatality proportion of bacteremic melioidosis in Thailand, including a region not traditionally considered highly endemic, and have potential implications for clinical management and health policy.     

Vaginal bleeding in young children

To evaluate prospectively vaginal bleeding in young children with emphasis on the cause, management and outcome, we analyzed the data of all children aged under 10 years old who presented with vaginal bleeding at the King Chulalongkorn Memorial Hospital between 1981 and 2000. There were 55 girls presenting with vaginal bleeding with variable degrees of severity. In 41 of the 55 girls (74.5%), the bleeding resulted from a local lesion of the genital tract. Genital tumors were seen in four girls, ie hemangioma of the vulva, sarcoma botryoides of the vagina, functional ovarian cyst and granulosa cell tumor of the ovary. In the remaining 14 girls (25.5%), the bleeding originated from systemic hormonal etiology. In one girl with precocious puberty, it was associated with hypothyroidism, whereas in the other six girls it was due to constitutional causes. In addition, the cause of bleeding in 10 girls was the vaginal manifestation of leeches, which is a unique problem for Thailand. Although vaginal bleeding in young children is rare, it can be an alarming clinical presentation, and serious underlying causes should be excluded. Prompt and correct diagnosis will lead to successful management.     

Pneumococcal antigen testing of blood culture broth to enhance the detection of Streptococcus pneumoniae bacteremia

The purpose of this investigation was to enhance the detection of pneumococcal bacteremia cases using the Binax NOW? immunochromatographic test (ICT) on blood culture broth as part of surveillance in two rural Thailand provinces. Blood cultures were collected as clinically indicated from hospitalized patients. ICT was performed on broth from culture bottles flagged as positive by BactT/ALERT? (alarm-positive) but which failed to grow organisms on subculture. During the period May 2005–June 2007, ICT was positive on 43 (24%) of 182 alarm-positive blood cultures with no growth on subculture. Compared to pneumococcal bacteremia cases confirmed by culture, cases detected only by ICT had a longer median time from culture collection to incubation and a longer median time from alarm positivity to subculture, and were more likely to be from patients pretreated with antibiotics. In a subsequent surveillance period (July 2007–December 2009), ICT continued to detect additional pneumococcal cases, but in a lower proportion of samples (7 of 221, 3.2%). Recently, as part of a separate study, ICT applied to uninoculated blood culture broth produced weak-positive results, mandating caution if testing broth from patient blood cultures. The antigen testing of blood culture broth appears to enhance the detection of pneumococcal bacteremia, but a controlled evaluation is needed.     

Incidence and risk factors for nosocomial pneumonia among intubated patients in a provincial hospital, Eastern Thailand

The present study was conducted to determine the incidence and risk factors for nosocomial pneumonia (NP) among intubated patients in a provincial hospital, eastern Thailand. Three hundred five intubated patients who voluntarily participated and signed informed consent were observed and medical records were collected. The respiratory secretion specimens from NP patients, diagnosed by doctors under the definition of the International Statistical Classification of Disease and Related Health Problems Tenth Revision (ICD-10), were collected for bacterial culture. Data from patients with and without NP were analyzed to identify risk factors. The results revealed that the incidence of NP was 38.4% (117/305 cases). Of 117 NP patients, 35% were positive on bacterial culture. The most frequently isolated bacteria were Klebsiella pneumoniae and Klebsiella spp (32%), and the incidence of methicillin resistant Stapylococcus aureus (MRSA) was 6%. Risk factors for NP from univariate analysis were (a) age more than 60 years (OR = 9.2, p < 0.001), (b) admitted to the ICU (OR = 1.7, p=0.042), (c) comatose (OR = 12.2, p < 0.001), (d) chronic pulmonary disease (OR = 5.3, p < 0.001), tuberculosis (OR = 14.3, p < 0.001), (e) smoking (OR = 7.1, p < 0.001), and (f) duration of intubation greater than 5 days (OR = 8.8, p < 0.001). After controlling for confounders using multivariate analysis, the significant risk factors were (a) age greater than 60 years (OR = 9.9, p < 0.001), (b) comatose (OR = 9.4, p = 0.031), (c) chronic pulmonary disease (OR = 5.2, p < 0.001), tuberculosis (OR=I 1.4, p = 0.003), (d) smoking (OR = 3.6, p < 0.001), and (e) duration of intubation more than 5 days (OR = 18.9, p < 0.001). When an intubated patient has these risk factors, they should be considered a potential risk for NP and preventive measures should be taken to reduce the risk.