Orbital apex syndrome from gnathostomiasis.

A 16-year-old Thai girl presented with acute unilateral visual loss, proptosis, and ophthalmoparesis. CT demonstrated thickening and enhancement of orbital tissues including the orbital apex. A history of consumption of raw fish, together with the findings of cutaneous migratory swelling and eosinophilia, made the diagnosis of gnathostomiasis likely. Her serum was positive for Gnathostoma spinigerum using an immunoblotting technique. Parasites removed from the skin lesions revealed the typical head bulbs with 4 circumferential rows of hooklets and fine cuticular spines on their surface. Treatment with an antihelminthic and systemic corticosteroids led to resolution of orbital inflammation but left a persistent optic neuropathy marked by nerve fiber bundle visual field loss with normal visual acuity. Gnathostomiasis should be suspected in patients with an orbital apex syndrome who live or travel in an endemic area, have eaten raw fish, and develop a migratory skin rash.     

The meaning of acceptance (Thum‐jai) in Thai people: Letting it go…so life goes on

The purpose of this qualitative study was to explore the meaning of acceptance (Thum‐jai) as a culturally embedded coping strategy in the lives of Thai people who have experienced adversity that caused suffering. Thematic analysis was used to examine the responses of 47 participants to written, open‐ended questions or face‐to‐face interviews. The EQUATOR's COREQ checklist for qualitative research was followed. Participants came from diverse religious’ traditions and geographic regions throughout Thailand. Findings revealed seven themes: circumstance and emotion; thought and action; time, experience, and effort; social and moral support; religious and spiritual ethos; acceptance and hope; and survive and thrive. The adverse circumstance is central to the concept of acceptance. Before acceptance, there is often hope; yet Thai people reach an existential point whether to accept the reality of the situation or continue in distress. Purposeful approaches to deal with the event flow from the cultural contexts of spirituality and social support. Drawing upon psychological strength, Thai people undertake purposive thought and action to facilitate redirecting their lives for better mental health. Thum‐jai brings release and peace of mind. Clinicians may find that people experiencing adverse life events are best served by nondirective approaches. Acceptance and change in thoughts and behaviours may come from meditation and therapeutic mindfulness practices that allow those in Western and non‐Western cultures to use their own values, expressions, and societal expectations to cope with suffering and formulate effective decisions.     

Epidemiologic and virologic characteristics of hepatitis B virus genotype B having the recombination with genotype C

BACKGROUND & AIMS: Hepatitis B virus (HBV) isolates of genotype B (HBV/B) with or without the recombination with genotype C over the precore region plus core gene have been reported. METHODS: All the 41 HBV/B isolates having the recombination with genotype C (HBV/Ba) possessed the nucleotide 1838 of A in contrast to that of G in all 29 of those without the recombination (HBV/Bj). Taking advantage of this single nucleotide polymorphism, a restriction fragment length polymorphism method was developed that distinguished HBV/Ba from HBV/Bj. RESULTS: HBV/Bj was detected in 90 of the 97 (93%) carriers of HBV/B from Japan, whereas HBV/Ba occurred in all 177 carriers of HBV/B from other countries (China, 20; Hong Kong, 45; Taiwan, 32; Thailand, 30; Vietnam, 30; and the United States, 20 [all of an Asian ethnicity]). In a case-control study, hepatitis B e antigen (HBeAg) and the double mutation in the core promoter (T1762/A1764) were significantly more frequent in 80 carriers each of HBV/Ba than HBV/Bj (35% vs. 18%, P < 0.05 and 33% vs. 15%, P < 0.05, respectively). Differences in the prevalence of HBeAg were more conspicuous between the carriers of HBV/Bj and HBV/Ba older than 30 years (5 of 66 or 8% vs. 16 of 62 or 26%, P < 0.01). CONCLUSIONS: HBV/B having the recombination with genotype C is frequent in Asia, except in Japan, and HBeAg is more prevalent in carriers of HBV/Ba than HBV/Bj.     

Antitubercular sesterterpenes from the Thai sponge Brachiaster sp

A new scalarane-type sesterterpene, 12-deacetoxyscalarin 19-acetate (2), and two naturally new derivatives of manoalide-type sesterterpenes, (E)- and (Z)-neomanoalide 24,25-diacetates (3 and 4), were isolated from the Thai sponge Brachiaster sp., along with five other known sesterterpenes: heteronemin (1), heteronemin acetate (5), 12-epi-19-deoxyscalarin (6), 12-deacetyl-12-epi-19-deoxyscalarin (7), and manoalide 25-acetate (8). The antitubercular and cytotoxic activities of all eight compounds were evaluated to reveal the potent activity of compounds 1, 2, 5, and 8. Among these, compound 2 showed an interesting bioactivity profile, in possessing potent antitubercular activity and being practically inactive in the cytotoxicity bioassay.     

The unique characteristics of Thai Leber hereditary optic neuropathy: analysis of 30 G11778A pedigrees

Leber hereditary optic neuropathy (LHON) is characterized by acute or subacute bilateral visual loss, and affects mostly young males. The most common mitochondrial DNA mutation responsible for LHON worldwide is G11778A. Despite different genetic backgrounds, which are believed to influence the disease expression, most features of LHON are quite common in different populations. However, there seem to be a few ethnic-specific differences. Analyses of our 30 G11778A LHON pedigrees in Thailand showed some characteristics different from those of Caucasians and Japanese. In particular, our pedigrees showed a lower male to female ratio of affected persons (2.6:1) and much higher prevalence of G11778A blood heteroplasmy (37% of the pedigrees contained at least one heteroplasmic G11778A individual). Heteroplasmicity seemed to influence disease manifestation in our patients but did not appear to alter the onset of the disease. The estimated overall penetrance of our G11778A LHON population was 37% for males and 13% for females. When each of our large pedigrees were considered separately, disease penetration varied from 9 to 45% between the pedigrees, and also varied between different branches of the same large pedigree. Survival analysis showed that the secondary LHON mutations G3316A and C3497T had a synergistic deleterious effect with the G11778A mutation, accelerating the onset of the disease in our patients.     

Bifunctionalized amphilectane diterpenes from the sponge Stylissa cf. massa

Two new amphilectane-type diterpenes, 8-isocyanato-15-formamidoamphilect-11(20)-ene (1) and 8-isothiocyanato-15-formamidoamphilect-11(20)-ene (2), along with two known derivatives, 8-isocyano-15-formamidoamphilect-11(20)-ene (3) and 7-formamidoamphilect-11(20),15-diene (4), were isolated from the sponge Stylissa cf. massa. Diterpenes bearing two different isonitrile-related functionalities, as in 1-3, are rare. The coexistence of these compounds, all of which possess the identical carbon skeleton, in the same sponge specimen suggests interconversion among them. All the isolated compounds were tested for antimalarial activity. Compound 3 proved approximately 10 times more active than 1 and 2, indicating the importance of the isonitrile moiety to antimalarial activity versus the isocyanate and isothiocyanate groups, respectively. Compound 4, which contains only the formamide group, was inactive at the highest concentration tested.     

Sclerosing therapy for orbital lymphangioma using sodium tetradecyl sulfate

PURPOSE: To describe the results of intralesional injection of the sclerosing agent sodium tetradecyl sulfate in patients with orbital lymphangioma. METHODS: Four young patients with a history of orbital lymphangioma were treated on one or more occasions with percutaneous puncture and injection of sodium tetradecyl sulfate under computed tomography guidance. Resolution of the signs and symptoms, complications resulting from surgery, and recurrence of bleeding were studied. RESULTS: Three patients with a long-standing history of unilateral proptosis and one patient with progressive unilateral visual loss from multiple recurrent orbital hemorrhages were studied. Treatment ranged from one to three sodium tetradecyl sulfate injections. All patients showed improvement of their signs and symptoms after treatment. A decrease in the size of lesions was demonstrated by orbital imaging. Visual acuity and intraocular pressure remained unchanged. Complications included transient postoperative localized inflammation in all cases and transient ophthalmoparesis in one patient. Follow-up time ranged between 15 and 36 months, during which no recurrence of bleeding was observed. CONCLUSIONS: Our study suggests that intralesional injection of sodium tetradecyl sulfate under computed tomography guidance is an effective treatment for patients with orbital lymphangioma and is not associated with vision-threatening complications.     

Litchi-Derived Polyphenol Alleviates Liver Steatosis and Gut Dysbiosis in Patients with Non-Alcoholic Fatty Liver Disease: A Randomized Double-Blinded,Placebo-Controlled Study

Preclinical data suggest the role of litchi extract in alleviating non-alcoholic fatty liver disease (NAFLD) by modulating gut microbiota. We aimed at investigating whether oligonol, a litchi-derived polyphenol, could improve liver steatosis and gut dysbiosis in patients with NAFLD. Adults with grade ≥2 steatosis, defined by an MRI proton density fat fraction (MRI-PDFF) of ≥11%, were randomly assigned to receive either oligonol or placebo for 24 weeks. The alteration in the MRI-PDFF and gut microbiota composition assessed by 16S ribosomal RNA sequencing were examined. There were 38 patients enrolled (n = 19 in each group). A significant reduction in the MRI-PDFF between week 0 and week 24 was observed in the oligonol group, while there was a non-significant decrease in the placebo group. A significant improvement in alpha-diversity was demonstrated in both of the groups. The oligonol-induced microbiota changes were characterized by reduced abundance of pathogenic bacteria, including Dorea, Romboutsia, Erysipelotrichaceae UCG-003 and Agathobacter, as well as increased abundance of short-chain fatty acids (SCFAs)-producing bacteria, such as Akkermansia, Lachnospira, Dialister and Faecalibacterium. In summary, this study is the first to provide evidence that supports that oligonol improves steatosis through the modulation of gut bacterial composition. Our results also support the beneficial and complementary role of oligonol in treating NAFLD.