1
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Boonyong S, Hunnangkul S, Vijit S, Wattano S, Tantayapirak P, Loymek S, Wongkamchai S. High-throughput detection of parasites and ova in stool using the fully automatic digital feces analyzer, orienter model fa280. Parasit Vectors 2024; 17:13. [PMID: 38185634 PMCID: PMC10771706 DOI: 10.1186/s13071-023-06108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Intestinal parasitic infections can harm health by causing malnutrition, anemia, impaired growth and cognitive development, and alterations in microbiota composition and immune responses. Therefore, it is crucial to examine stool samples to diagnose parasitic infections. However, the traditional microscopic detection method is time-consuming, labor-intensive, and dependent on the expertise and training of microscopists. Hence, there is a need for a low-complexity, high-throughput, and cost-effective alternative to labor-intensive microscopic examinations. METHODS This study aimed to compare the performance of a fully automatic digital feces analyzer, Orienter Model FA280 (People's Republic of China) with that of the formalin-ethyl acetate concentration technique (FECT). We assessed and compared the agreement between the FA280 and the FECT for parasite detection and species identification in stool samples. The first part of the study analyzed 200 fresh stool samples for parasite detection using the FECT and FA280. With the FA280, the automatic feces analyzer performed the testing, and the digital microscope images were uploaded and automatically evaluated using an artificial intelligence (AI) program. Additionally, a skilled medical technologist conducted a user audit of the FA280 findings. The second set of samples comprised 800 preserved stool samples (preserved in 10% formalin). These samples were examined for parasites using the FECT and FA280 with a user audit. RESULTS For the first set of stool samples, there was no statistically significant difference in the pairwise agreements between the FECT and the FA280 with a user audit (exact binomial test, P = 1). However, there were statistically significant differences between the pairwise agreements for the FECT and the FA280 with the AI report (McNemar's test, P < 0.001). The agreement for the species identification of parasites between the FA280 with AI report and FECT showed fair agreement (overall agreement = 75.5%, kappa [κ] = 0.367, 95% CI 0.248-0.486). On the other hand, the user audit for the FA280 and FECT showed perfect agreement (overall agreement = 100%, κ = 1.00, 95% CI 1.00-1.00). For the second set of samples, the FECT detected significantly more positive samples for parasites than the FA280 with a user audit (McNemar's test, P < 0.001). The disparity in results may be attributed to the FECT using significantly larger stool samples than those used by the FA280. The larger sample size used by the FECT potentially contributed to the higher parasite detection rate. Regarding species identification, there was strong agreement between the FECT and the FA280 with a user audit for helminths (κ = 0.857, 95% CI 0.82-0.894). Similarly, there was perfect agreement for the species identification of protozoa between the FECT and the FA280 with user audit (κ = 1.00, 95% CI 1.00-1.00). CONCLUSIONS Although the FA280 has advantages in terms of simplicity, shorter performance time, and reduced contamination in the laboratory, there are some limitations to consider. These include a higher cost per sample testing and a lower sensitivity compared to the FECT. However, the FA280 enables rapid, convenient, and safe stool examination of parasitic infections.
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Affiliation(s)
- Sudarat Boonyong
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Saowalak Hunnangkul
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Sirirat Vijit
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Suphaluck Wattano
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Parwin Tantayapirak
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Sumas Loymek
- Filaria Project, Phikulthong Royal Development Study Center, Narathiwat, 96000, Thailand
| | - Sirichit Wongkamchai
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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2
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Chularojanamontri L, Tuchinda P, Rujitharanawong C, Hunnangkul S, Pochanapan O, Panjapakkul W, Kulthanan K. New-onset and exacerbated skin diseases after COVID-19 infection: A systematic review. J Dermatol 2022; 49:e419-e421. [PMID: 35775731 PMCID: PMC9349745 DOI: 10.1111/1346-8138.16501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oraya Pochanapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waratchaya Panjapakkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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3
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Suputtamongkol Y, Avirutnan P, Mairiang D, Angkasekwinai N, Niwattayakul K, Yamasmith E, Saleh-Arong FAH, Songjaeng A, Prommool T, Tangthawornchaikul N, Puttikhunt C, Hunnangkul S, Komoltri C, Thammapalo S, Malasit P. Ivermectin Accelerates Circulating Nonstructural Protein 1 (NS1) Clearance in Adult Dengue Patients: A Combined Phase 2/3 Randomized Double-blinded Placebo Controlled Trial. Clin Infect Dis 2021; 72:e586-e593. [PMID: 33462580 DOI: 10.1093/cid/ciaa1332] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Dengue is the most significant mosquito-borne viral disease; there are no specific therapeutics. The antiparasitic drug ivermectin efficiently inhibits the replication of all 4 dengue virus serotypes in vitro. METHODS We conducted 2 consecutive randomized, double-blind, placebo-controlled trials in adult dengue patients to evaluate safety and virological and clinical efficacies of ivermectin. After a phase 2 trial with 2 or 3 days of 1 daily dose of 400 µg/kg ivermectin, we continued with a phase 3, placebo-controlled trial with 3 days of 400 µg/kg ivermectin. RESULTS The phase 2 trial showed a trend in reduction of plasma nonstructural protein 1 (NS1) clearance time in the 3-day ivermectin group compared with placebo. Combining phase 2 and 3 trials, 203 patients were included in the intention to treat analysis (100 and 103 patients receiving ivermectin and placebo, respectively). Dengue hemorrhagic fever occurred in 24 (24.0%) of ivermectin-treated patients and 32 (31.1%) patients receiving placebo (P = .260). The median (95% confidence interval [CI]) clearance time of NS1 antigenemia was shorter in the ivermectin group (71.5 [95% CI 59.9-84.0] hours vs 95.8 [95% CI 83.9-120.0] hours, P = .014). At discharge, 72.0% and 47.6% of patients in the ivermectin and placebo groups, respectively had undetectable plasma NS1 (P = .001). There were no differences in the viremia clearance time and incidence of adverse events between the 2 groups. CONCLUSIONS A 3-day 1 daily dose of 400 µg/kg oral ivermectin was safe and accelerated NS1 antigenemia clearance in dengue patients. However, clinical efficacy of ivermectin was not observed at this dosage regimen.
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Affiliation(s)
- Yupin Suputtamongkol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panisadee Avirutnan
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Dumrong Mairiang
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Eakkawit Yamasmith
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Adisak Songjaeng
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanapan Prommool
- Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Nattaya Tangthawornchaikul
- Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Chunya Puttikhunt
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Saowalak Hunnangkul
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chulaluk Komoltri
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwich Thammapalo
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Prida Malasit
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
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4
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Kulthanan K, Hunnangkul S, Tuchinda P, Chularojanamontri L, Weerasubpong P, Subchookul C, Maurer M. Treatments of cold urticaria: A systematic review. J Allergy Clin Immunol 2019; 143:1311-1331. [PMID: 30776418 DOI: 10.1016/j.jaci.2019.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. OBJECTIVES We sought to meta-analyze and review the efficacy and safety of ColdU treatments. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Suitable reports were identified by searching PubMed, Scopus, and Web of Science. Our systematic review included 16 studies, 9 of which met the eligibility criteria for the meta-analysis. We analyzed the effects of treatments on critical temperature thresholds (CTTs) and critical stimulation time thresholds (CSTTs), as well as on rates of complete response and adverse events. RESULTS Our pooled meta-analyses showed that nonsedating second-generation H1-antihistamines (nsAHs) are effective in the treatment of ColdU and that updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. In 4 studies involving CSTTs, updosing of nsAHs also resulted in significantly better CSTTs than their own standard doses or placebos. Omalizumab resulted in a marked reduction of CTTs in H1-antihistamine-resistant patients. Of 118 adverse events in 8 studies, standard-dose nsAHs, updosed nsAHs, and omalizumab produced lower numbers of adverse events than first-generation antihistamines. CONCLUSIONS Our study showed that greater dosages of nsAHs were more effective than standard dosages in controlling ColdU symptoms. Increasing the dosages was not significantly associated with higher adverse event rates. Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for patients with ColdU refractory to antihistamines.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Office of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puncharas Weerasubpong
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Subchookul
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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5
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Siwaponanan P, Keawvichit R, Udompunturak S, Hunnangkul S, Reesukumal K, Sukapirom K, Pattanapanyasat K, Krittayaphong R. Altered profile of circulating microparticles in nonvalvular atrial fibrillation. Clin Cardiol 2019; 42:425-431. [PMID: 30680757 PMCID: PMC6712324 DOI: 10.1002/clc.23158] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Nonvalvular atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with the prothrombotic state. Circulating microparticles (cMPs) are membrane vesicles that are shed from many cell types in response to cell activation and cell apoptosis. Several studies reported that cMPs may play a role in the hypercoagulable state that can be observed in patients with AF. The aim of this study was to determine the levels of total cMPs and characterize their cellular origins in AF patients. Methods Atotal of 66 AF patients and 33 healthy controls were enrolled. This study investigated total cMP levels and their cellular origin in AF patients using polychromatic flow cytometry. Results AF patients had significantly higher levels of total cMPs (median 36.38, interquartile range [IQR] 21.16‐68.50 × 105 counts/mL vs median 15.21, IQR 9.91‐30.86 × 105 counts/mL; P = 0.004), platelet‐derived MPs (PMPs) (median 10.61, IQR 6.55‐18.04 × 105 counts/mL vs median 7.83, IQR 4.44‐10.26 × 10/mL; P = 0.009), and endothelial‐derived MPs (EMPs CD31+ CD41−) (median 2.94, IQR 1.78‐0.60 × 105 counts/mL vs median 1.16, IQR 0.71‐2.30 × 105 counts/mL; P = 0.001) than healthy controls after adjusting for potential confounders. Phosphatidylserine positive MP (PS + MP) levels were similar compared between AF patients and healthy controls. Conclusion The results of this study revealed a marked increase in total cMP levels, and evidence of elevated endothelial damage and platelet activation, as demonstrated by increased PMP and EMP levels, in AF patients. Additional study is needed to further elucidate the role of cMPs (PMPs and EMPs) in the pathophysiology of and the complications associated with AF.
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Affiliation(s)
- Panjaree Siwaponanan
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence in Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rassamon Keawvichit
- Siriraj Center of Research Excellence in Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthipol Udompunturak
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanit Reesukumal
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kasama Sukapirom
- Siriraj Center of Research Excellence in Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kovit Pattanapanyasat
- Siriraj Center of Research Excellence in Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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6
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Kulthanan K, Subchookul C, Hunnangkul S, Chularojanamontri L, Tuchinda P. Factors Predicting the Response to Cyclosporin Treatment in Patients With Chronic Spontaneous Urticaria: A Systematic Review. Allergy Asthma Immunol Res 2019; 11:736-755. [PMID: 31332983 PMCID: PMC6658402 DOI: 10.4168/aair.2019.11.5.736] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022]
Abstract
Purpose This study aimed to systemically review literature relating to factors that could potentially predict a favorable response to cyclosporine A (CsA) treatment for chronic spontaneous urticaria (CSU). Methods A systematic literature review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Results A total of 13 studies (404 patients with CSU and 200 healthy patients) were included. There were only 1 randomized controlled trial (RCT) and 12 non-RCTs. Our systematic review showed that positive autologous serum skin test results, positive baseline basophil histamine release assays, positive baseline basophil activation test responses, elevated baseline plasma D-dimer levels, elevated baseline serum interleukin (IL)-2, IL-5, and tumor necrosis factor-alpha (TNF-α) levels, and low baseline serum IgE levels might assist in predicting favorable CsA responses in CSU patients. Decreased plasma D-dimer levels; and decreased serum IL-2, IL-5, and TNF-α levels were reported to be correlated with clinical improvement after CsA treatment. Conclusions Since most positive results were from non-RCT articles and some data were still inconsistent, this systematic review identified no reliable practical biomarker for predicting CsA treatment response in patients with CSU. There were no positive predictors with good consistency and mechanical plausibility.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Chanika Subchookul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Office of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Vorapun-Senanarong, Kate M, Chaewwit P, Rattanabannakit C, Hunnangkul S, Aoonkaew N, Atthapon-Raksthaput, Chaichanettee S, Scheltens P. P3‐445: FACTORS PREDICTING MORTALITY AT THE MEMORY CLINIC AT SIRIRAJ HOSPITAL: 815 THAI COHORT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Mara Kate
- Alzheimer Center and Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Pipat Chaewwit
- Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | | | | | - Nutthapol Aoonkaew
- Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Faculty of Medicine Sirraj HospitalMahidol UniversityBangkokThailand
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8
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Senanarong V, Hunnangkul S, Harnphadungkit K. Dementia risk score from Thai population study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Kulthanan K, Chaweekulrat P, Komoltri C, Hunnangkul S, Tuchinda P, Chularojanamontri L, Maurer M. Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review. J Allergy Clin Immunol Pract 2017; 6:586-599. [PMID: 28916431 DOI: 10.1016/j.jaip.2017.07.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/07/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite widely recommended usage of cyclosporine A (CsA) in chronic spontaneous urticaria (CSU), there is no meta-analysis concerning its efficacy and safety. OBJECTIVE To meta-analyze and review the efficacy and safety of CsA in CSU. METHODS Efficacy was assessed by the relative change in urticaria activity score at 4 weeks and response rates at 4, 8, and 12 weeks. Safety was assessed by analyzing the number of patients with 1 or more adverse event. RESULTS Eighteen studies (909 participants) including 2 randomized controlled trials were included, with 125, 363, and 266 patients with CSU receiving very low (<2 mg/kg/d), low (from 2 to< 4 mg/kg/d), and moderate (4-5 mg/kg/d) doses of CsA, respectively. After 4 weeks, the mean relative change in urticaria activity score of CsA-treated patients was -17.89, whereas that of controls was -2.3. The overall response rate to CsA treatment with low to moderate doses at 4, 8, and 12 weeks was 54%, 66%, and 73%, respectively. No studies of very low-dose CsA evaluated response rates at 4, 8, and 12 weeks. Among patients treated with very low, low, and moderate doses of CsA, 6%, 23%, and 57% experienced 1 or more adverse event, respectively. CONCLUSIONS Given the limited number and quality of studies, our results should be interpreted with caution. CsA is effective at low to moderate doses. Adverse events appear to be dose dependent and occur in more than half the patients treated with moderate doses of CsA. We suggest that the appropriate dosage of CsA for CSU may range from 1 to 5 mg/kg/d, and 3 mg/kg/d is a reasonable starting dose for most patients.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichanee Chaweekulrat
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chulaluk Komoltri
- Office of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Office of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Chaicharoentanaporn C, Slisatkorn W, Hunnangkul S, Pipatsatukit U, Saposnik G, Nilanont Y. Abstract WP332: Early Stroke Detection in Postoperative Patients: A Simple Educational Intervention and Feasibility Study. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Stroke is one of the most feared postoperative complications. However, the diagnosis is usually delayed leading to a reduced therapeutic window.
Objective:
To develop a protocol aimed to shorten the time of detecting a neurological deficit in postoperative patients.
Methods:
We used a pre-post intervention design to evaluate time of stroke recognition in post-opened heart surgery patients. The intervention consisted of: 1) A new postoperative protocol to evaluate any new neurological deficit
<
14 days after surgery. Nurses were trained to perform a simple sequential neurological assessment including observing eye deviation and testing for asymmetrical limb movement. The protocol was applied during the vital sign measurement schedule. Stroke code was activated if the deficit was confirmed by MD. 2) Educational program for nurses concerning postoperative stroke complications and the importance of time.
Results:
During Jan, 2014 - Oct, 2015, we consecutively reviewed 27 patients with acute neurological deficit
<
14 days after surgery. Twenty-five consecutive patients with postoperative neurological deficit were enrolled during post-intervention period (Nov, 2015 - Jul, 2016). Male consisted of 19/27 (70.4%)
and
179/297 (60.3%) (
P
=0.303), the mean ± SD age of 64.56 ± 13.13 and 62.43 ± 13.45 years (
P
=0.432) and the mean initial NIHSS of 16.25 ± 8.45 and 12.92 ± 10.78 (
P
=0.402) in pre and post intervention respectively. When comparing between pre and post intervention, we found that stroke fast track activation was significantly increased from 4/27(14.8%) to 13/25(52%) (
P
=0.004), the median (min-max) duration from time last seen normal to first neurological deficit detection reduced from 690 (20-9190) to 120 (5-5935) minutes (
P
=0.004), the median duration from onset to CT decreased from 150 (33-11009) to 65 (31-3779) minutes (
P
=0.163). Number needed to treat for early detection when the protocol being used was 2.4. There was an increasing trend in endovascular treatment from 0 to 2/25 (8%) after the intervention.
Conclusions:
A simple protocol for a postoperative neurological assessment after cardiac surgery showed a significant reduction in the time to diagnosis thus, increasing the patients’ therapeutic opportunity.
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Affiliation(s)
| | | | | | - Usa Pipatsatukit
- Dept of Nursing Siriraj Hosp, Siriraj Hosp, Mahidol Univ, Bangkok, Thailand
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11
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Supavekin S, Hunnangkul S, Pravitsitthikul N, Kutanavanishapong S, Chiewvit S, Piyaphanee N, Pattaragarn A, Sumboonnanonda A. Delayed Therapeutic Response Time Predicts Renal Damage in the First Episode of Febrile Urinary Tract Infection. J Med Assoc Thai 2016; 99:861-867. [PMID: 29947486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the relationship of therapeutic delay time (TDT) and therapeutic response time (TRT) with renal damage in the first episode of febrile urinary tract infection (UTI). MATERIAL AND METHOD A prospective study was conducted in 67 children with the first episode of UTI at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital between 2008 and 2010. To assess for renal damage, dimercaptosuccinic acid (DMSA) renal scintigraphy was performed at one and six months after the acute episode. RESULTS Abnormal DMSA renal scintigraphy was detected in 20 (29.9%) patients. There was no difference in TDT but TRT was different between the patients with normal and abnormal DMSA renal scintigraphy at p-value 0.001. The area under receiver operating characteristic (ROC) curve for TRT was 0.76 (95% confidence interval (CI) 0.64-0.86) at p-value 0.001. The optimal cut-off value for TRT was 22 hours with sensitivity 80.0% (56.3-94.1) and specificity 63.6% (47.8-77.6). In 50 patients with no vesicoureteral reflux (VUR), there was difference in TRT at p-value 0.002. The area under ROC curve for TRT was 0.82 (95% CI 0.69-0.96) at p-value 0.004. The optimal cut-off value for TRT was 25 hours with sensitivity 88.9% (95% CI 51.7-98.2) and specificity 68.4% (95% CI 51.3- 82.5). CONCLUSION TRT at or more than 22 hours predicts renal damage after first episode of UTI. In patients with no VUR, TRT at or more than 25 hours predicts renal damage. DMSA renal scintigraphy in the first episode of UTI should be considered in these patients.
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Tresukosol D, Suktitipat B, Hunnangkul S, Kamkaew R, Poldee S, Tassaneetrithep B, Likidlilid A. Effects of cytochrome P450 2C19 and paraoxonase 1 polymorphisms on antiplatelet response to clopidogrel therapy in patients with coronary artery disease. PLoS One 2014; 9:e110188. [PMID: 25329996 PMCID: PMC4199712 DOI: 10.1371/journal.pone.0110188] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/08/2014] [Indexed: 12/20/2022] Open
Abstract
Clopidogrel is an antiplatelet prodrug that is recommended to reduce the risk of recurrent thrombosis in coronary artery disease (CAD) patients. Paraoxonase 1 (PON1) is suggested to be a rate-limiting enzyme in the conversion of 2-oxo-clopidogrel to active thiol metabolite with inconsistent results. Here, we sought to determine the associations of CYP2C19 and PON1 gene polymorphisms with clopidogrel response and their role in ADP-induced platelet aggregation. Clopidogrel response and platelet aggregation were determined using Multiplate aggregometer in 211 patients with established CAD who received 75 mg clopidogrel and 75–325 mg aspirin daily for at least 14 days. Polymorphisms in CYP2C19 and PON1 were genotyped and tested for association with clopidogrel resistance. Linkage disequilibrium (LD) and their epistatic interaction effects on ADP-induced platelet aggregation were analysed. The prevalence of clopidogrel resistance in this population was approximately 33.2% (n = 70). The frequencies of CYP2C19*2 and *3 were significantly higher in non-responder than those in responders. After adjusting for established risk factors, CYP2C19*2 and *3 alleles independently increased the risk of clopidogrel resistance with adjusted ORs 2.94 (95%CI, 1.65–5.26; p<0.001) and 11.26 (95%CI, 2.47–51.41; p = 0.002, respectively). Patients with *2 or *3 allele and combined with smoking, diabetes and increased platelet count had markedly increased risk of clopidogrel resistance. No association was observed between PON1 Q192R and clopidogrel resistance (adjusted OR = 1.13, 95%CI, 0.70–1.82; p = 0.622). Significantly higher platelet aggregation values were found in CYP2C19*2 and *3 patients when compared with *1/*1 allele carriers (p = 1.98×10−6). For PON1 Q192R genotypes, aggregation values were similar across all genotype groups (p = 0.359). There was no evidence of gene-gene interaction or LD between CYP2C19 and PON1 polymorphisms on ADP-induced platelet aggregation. Our findings indicated that only CYP2C19*2 and *3 alleles had an influence on clopidogrel resistance. The risk of clopidogrel resistance increased further with smoking, diabetes, and increased platelet count.
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Affiliation(s)
- Damrus Tresukosol
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
| | - Bhoom Suktitipat
- Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
- Integrative Computation BioScience Center (ICBS), Mahidol University, Salaya, Nakhon Prathom, Thailand
| | - Saowalak Hunnangkul
- Department of Health Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
| | - Ruttakarn Kamkaew
- Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
| | - Saiphon Poldee
- Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
| | - Boonrat Tassaneetrithep
- Department of Health Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
| | - Atip Likidlilid
- Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Siriraj, Bangkoknoi, Bangkok, Thailand
- * E-mail:
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Sumpradit N, Suttajit S, Hunnangkul S, Wisaijohn T, Putthasri W. Comparison of self-reported professional competency across pharmacy education programs: a survey of Thai pharmacy graduates enrolled in the public service program. Adv Med Educ Pract 2014; 5:347-357. [PMID: 25337000 PMCID: PMC4199843 DOI: 10.2147/amep.s67391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Thai pharmacy education consists of two undergraduate programs, a 5-year Bachelor of Science in Pharmacy (BScPsci and BScPcare) degree and a 6-year Doctor of Pharmacy (Pharm D). Pharmacy students who wish to serve in the public sector need to enroll in the public service program. This study aims to compare the perception of professional competency among new pharmacy graduates from the three different pharmacy programs available in 2013 who enrolled in the public service program. METHODS A cross-sectional survey was conducted among new pharmacy graduates in 2013 using a self-administered, structured, close-ended questionnaire. The questionnaire consisted of respondents' characteristics and perception of professional competencies. The competency questions consisted of 13 items with a 5-point scale. Data collection was conducted during Thailand's annual health professional meeting on April 2, 2013 for workplace selection of pharmacy graduates. RESULTS A total of 266 new pharmacy graduates responded to the questionnaire (response rate 49.6%). There were no significant differences in sex and admission modes across the three pharmacy programs. Pharm D graduates reported highest competency in acute care services, medication reconciliation services, and primary care services among the other two programs. BScPsci graduates reported more competence in consumer health protection and herbal and alternative medicines than BScPcare graduates. There were significant differences in three competency domains: patient care, consumer protection and community health services, and drug review and information, but no significant differences in the health administration and communication domain among three pharmacy programs. CONCLUSION Despite a complete change into a 6-year Pharm D program in 2014, pharmacy education in Thailand should continue evolving to be responsive to the needs of the health system. An annual survey of new pharmacy graduates should be continued, to monitor changes of professional competency across different program tracks and other factors which may influence their contribution to the health service system. Likewise, a longitudinal monitoring of their competencies in the graduate cohort should be conducted.
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Affiliation(s)
- Nithima Sumpradit
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Food and Drug Administration, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Thunthita Wisaijohn
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Weerasak Putthasri
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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14
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Jiamton S, Kaewarpai T, Ekapo P, Kulthanan K, Hunnangkul S, Boitano JJ, Wongkamchai S. Total IgE, mosquito saliva specific IgE and CD4+ count in HIV-infected patients with and without pruritic papular eruptions. Asian Pac J Allergy Immunol 2014; 32:53-9. [PMID: 24641291 DOI: 10.12932/ap0317.32.1.2014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/04/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pruritic Papular Eruption (PPE) is a skin disorders found in HIV infected patients. However, the exact etiology of PPE is not documented. It has been suggested that PPE might result from arthropod bites. OBJECTIVE The aim of this study was to investigate those factors in the HIV patient contributing to the occurrence of PPE, including specific IgE against mosquito saliva allergens, total IgE, CD4 cell counts and their associations. METHODS Specific IgE against saliva allergens of Cx. quinquefasciatus mosquito was measured in 25 HIV patients with PPE and in 60 HIV without PPE by a time-resolved fluorescence immunoassay (TRIFA). The total IgE levels and CD4cell counts were also determined. RESULTS Among the HIV patients with PPE, 84% (21/25) had CD4 cell counts less than 200 cells/μl in contrast to 30% (18/60) of the HIV without PPE patients. These differences were statistically significant (p =0.0005, χ2 test). The total IgE scores for the HIV patients with PPE were significantly higher than for those without PPE. A comparison of the mean arbitrary scores of the specific IgE in HIV patients, with and without PPE, was non-significant (p = 0.152). However, 44% (11/25) of the HIV patients with PPE had an arbitrary score above the mean score of mosquito bite allergic subjects, as compared to only 3.3% (2/60) of HIV patients without PPE. CONCLUSIONS It may be concluded that the etiology of PPE in the HIV patient may be heterogeneous or multi-causal with allergic responses to the mosquito saliva allergen being only partially responsible.
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Affiliation(s)
- Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Benner MT, Townsend J, Kaloi W, Htwe K, Naranichakul N, Hunnangkul S, Carrara VI, Sondorp E. Reproductive health and quality of life of young Burmese refugees in Thailand. Confl Health 2010; 4:5. [PMID: 20338037 PMCID: PMC2907534 DOI: 10.1186/1752-1505-4-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Of the 140,000 Burmese* refugees living in camps in Thailand, 30% are youths aged 15-24. Health services in these camps do not specifically target young people and their problems and needs are poorly understood. This study aimed to assess their reproductive health issues and quality of life, and identifies appropriate service needs. METHODS We used a stratified two-stage random sample questionnaire survey of 397 young people 15-24 years from 5,183 households, and 19 semi-structured qualitative interviews to assess and explore health and quality of life issues. RESULTS The young people in the camps had very limited knowledge of reproductive health issues; only about one in five correctly answered at least one question on reproductive health. They were clear that they wanted more reproductive health education and services, to be provided by health workers rather than parents or teachers who were not able to give them the information they needed. Marital status was associated with sexual health knowledge; having relevant knowledge of reproductive health was up to six times higher in married compared to unmarried youth, after adjusting for socio-economic and demographic factors. Although condom use was considered important, in practice a large proportion of respondents felt too embarrassed to use them. There was a contradiction between moral views and actual behaviour; more than half believed they should remain virgins until marriage, while over half of the youth experienced sex before marriage. Two thirds of women were married before the age of 18, but two third felt they did not marry at the right age. Forced sex was considered acceptable by one in three youth. The youth considered their quality of life to be poor and limited due to confinement in the camps, the limited work opportunities, the aid dependency, the unclear future and the boredom and unhappiness they face. CONCLUSIONS The long conflict in Myanmar and the resultant long stay in refugee camps over decades affect the wellbeing of these young people. Lack of sexual health education and relevant services, and their concerns for their future are particular problems, which need to be addressed. Issues of education, vocational training and job possibilities also need to be considered.*Burmese is used for all ethnic groups.
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Hunnangkul S, Nitsch D, Rhodes B, Chadha S, Roberton CA, Pessôa-Lopes P, Norsworthy PJ, Fernando MMA, Charles P, Mackworth-Young C, Isenberg DA, Whittaker JC, Vyse TJ. Familial clustering of non-nuclear autoantibodies and C3 and C4 complement components in systemic lupus erythematosus. ACTA ACUST UNITED AC 2008; 58:1116-24. [DOI: 10.1002/art.23400] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Wongkamchai S, Rochjanawatsiriroj C, Monkong N, Nochot H, Loymek S, Jiraamornnimit C, Hunnangkul S, Choochote W. Diagnostic value of IgG isotype responses against Brugia malayi antifilarial antibodies in the clinical spectrum of brugian filariasis. J Helminthol 2007; 80:363-7. [PMID: 17125545 DOI: 10.1017/joh2006365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To study the diagnostic significance of antifilarial IgG subclasses in the clinical spectrum of brugian filariasis, IgG1, IgG3 and IgG4 antifilarial antibodies were determined in an exposed population comprising 74 asymptomatic amicrofilaraemics, 30 microfilaraemics, 20 lymphangitis and 16 elephantiasis patients resident in Narathiwart province, an area endemic for Brugia malayi lymphatic filariasis in southern Thailand. The dominant isotype of antifilarial antibody was IgG4. A significantly higher percentage of individuals were positive for IgG1 in the microfilaraemic and lymphangitis groups compared with the elephantiasis and endemic normal patients, while a significantly higher positive rate of IgG3 was found in those with lymphangitis. The possible role of these isotypes for diagnostic purposes and the pattern of antibody response in various clinically manifesting groups are discussed.
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Affiliation(s)
- S Wongkamchai
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-Noi, Bangkok, Thailand.
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Supavekin S, Kucivilize K, Hunnangkul S, Sriprapaporn J, Pattaragarn A, Sumboonnanonda A. The relation of vesicoureteral reflux and renal scarring in childhood urinary tract infection. J Med Assoc Thai 2006; 89 Suppl 2:S41-7. [PMID: 17044453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Assess the relation of age and sex in vesico ureteral reflux (VUR) and renal scarring and the relation of VUR and renal scarring in childhood urinary tract infection. MATERIAL AND METHOD A descriptive study of one hundred and twenty-six children who received renal cortical scintigraphy from 1st Jan 2000 to 31st Dec 2004 in the Department of Radiology, Faculty of Medicine Siriraj Hospital, was conducted. Ninety-three (50 males, 43 females) patients were diagnosed with urinary tract infections (UTIs) but only ninety-one of them had renal cortical scintigraphic results available. The male to female ratio was 1.16:1. The mean age of the patients was 4.33 years (SD +/- 4.17, range 7 days-16 years). During the 1st year of life the male to female ratio is 2.6:1. Fever, dysuria, and poor feeding were the most presenting signs and symptoms. Eighty-five (45 males, 40 females) patients received Voiding Cysto Urethro Gram (VCUG). RESULT The authors did not find the correlation between the age groups and sex with VCUG results on right and left side, respectively (p = 0.856, p = 0.145, p = 0.77, p = 0.75). Ninety-one (49 males, 42 females) patients received DMSA renal scintigraphy. Fifty-two patients (57.1%) had abnormal DMSA renal scan results. However; the authors did not find the correlation between age groups and sex with DMSA renal scan results on the right and left kidneys, respectively. (p = 0.202, p = 0.416, p = 0.511, p = 0.791). The authors compared times of UTIs with and DMSA renal scintigraphy in each side of the kidney. Even though the authors did find the correlation between episodes of UTIs and abnormal DMSA on the left kidneys (p = 0.017), it was not found on the right kidneys (p = 0.081). There were 80 patients who received both VCUG and DMSA renal scintigraphy. The authors found the correlation between severity of VUR and abnormal DMSA results on right and left kidneys (p = 0.001, p = 0.01). CONCLUSION The authors recommend that all children who have repeated UTI and/or VUR, irrespective of age and sex, should receive DMSA renal scintigraphy to detect renal scarring and follow up future complications.
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Affiliation(s)
- Suroj Supavekin
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Abstract
OBJECTIVES To determine clinical manifestations, prognostic factors, and therapeutic outcomes of severe pneumococcal infection. METHODS Hospitalized patients with specimens cultured positive for Streptococcus pneumoniae were identified retrospectively by reviewing hospital records from 1992 to May 1998 at Siriraj Hospital. RESULTS Of 205 evaluable cases, 130 (63.4%) patients were male. Nineteen (9.3%) patients were less than 2 years old, 29 (14.1%) were between 2 and 13 years, 99 (48.3%) were between 14 and 60 years, and 58 (28.3%) were over 60 years of age. From 1992 to 1997, the average admission rate was highest (36.4%) between January and March (range = 20-45%). Average admission rates during other periods ranged from 20.0% to 23.1%. Pneumonia (50.7%) and acute exacerbation of chronic obstructive pulmonary disease or infected bronchiectasis or bronchopneumonia (21.0%) were the most frequent diagnoses, followed by meningitis (14.6%) and primary sepsis without localized lesion (8. 3%). The mortality rate during the first 7 days of hospitalization was 28.8%, and thereafter, 11.7%. The odds ratios (95% CI) of old age, congestive heart failure, and alcoholism for death were 3.4 (1. 4-8.2), 8.6 (0.97-76.1), and 8.0 (3.1-20.9), respectively. For pneumonitis only, mortality rates among alcoholic and nonalcoholic patients were 76.9% and 39.6%, respectively (P = 0.025). CONCLUSIONS Patients who were alcoholic, over 60 years of age, or had congestive heart failure were vulnerable to severe pneumococcal infection with significant mortality, in spite of proper selection of empirical antimicrobials. Diabetes mellitus and multiple myeloma also contributed to late mortality after 7 days of hospitalization.
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Affiliation(s)
- A Leelarasamee
- Division of Infectious Disease and Tropical Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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