Contextual and individual demographic determinants of alcohol consumption and smoking: a comparative study in southwestern China and southern Thailand.

The aim of this study was to investigate the association between contextual and individual demographic characteristics and alcohol consumption and smoking in southwestern China and southern Thailand. In 2000, a cross-sectional study was carried out in southern Thailand on 703 subjects > or = 45 years old, and in 2005 in southwestern China on 6,006 subjects. Each participant was interviewed by trained interviewers using a standard questionnaire. Information regarding demographic characteristics, alcohol drinking and smoking was obtained. Multilevel logistic regression was used to model variation in the prevalence of alcohol consumption and tobacco smoking. The findings in both countries indicate that age was negatively associated with the probability of consuming alcohol and males were more likely to consume alcohol and tobacco than females. Chinese communities with a lower level of education were more likely to smoke. Thai individuals with a higher educational level were less likely to smoke. Yi ethnicity was associated with a higher probability of drinking both at the contextual level and at the individual level in China. Non-Muslims were more likely to consume alcohol in Thailand. Future contextual and individual level interventions regarding alcohol drinking and smoking are needed in China, and further studies with larger sample sizes are needed in Thailand before conclusions can be drawn.

An equation to explain variations in blood NT-proBNP in ambulatory cardiac subjects.

BACKGROUND: NT-proBNP is being used as a biomarker for prognosticating and delineating cardiac dysfunction. The cut-off value for deciding normal versus abnormal levels has always been a point of contention since it depends on the degree of dysfunction as well as other associated conditions often termed non-cardiac factors and parameters. Such association had not been formally presented. OBJECTIVE: To determine the direction and magnitude of effect of cardiac and non-cardiac parameters on NT-proBNP variability. MATERIAL AND METHOD: The present study included 78 cardiac ambulatory patients with a history of heart failure and/or low left ventricular ejection fraction. Their cardiac and non-cardiac parameters were recorded at the time of blood sampling for NT-proBNP. Multivariate linear regression analysis was used to correlate cardiac and non-cardiac parameters with NT-proBNP level and, from this, a predictive equation was derived. RESULTS: Log [NT-proBNP (pmol/l)] was 1.424 + 0.348 (for EF of 18-27) + 0.636 (for EF < 18) + 0.021 CTR - 0.002 SMW- 0.326 for female + 0.430 Cr - 0.010 BW [EF = LV ejectionfraction in %; CTR = cardio-thoracic ratio in %; SMW = 6-minute walking distance in meters; Cr = serum creatinine in mg/dl; BW = body weight in kg]. The adjusted R-square for this regression was 0.659. Omitting the non-cardiac variables (sex, Cr, BW) would decrease the adjusted R-square to 0.493. CONCLUSION: Cut-off value for NT-proBNP concentration in subjects without severe systolic heart failure has to account for these non-cardiac factors.

Perioperative desaturation and risk factors in general anesthesia.

OBJECTIVE: Despite advances in anesthetic technique, the incidence of perioperative desaturation in general anesthesia has remained high. Knowledge on factors associated with intraoperative desaturation is relatively scanty. The purpose of the present study was to investigate the distribution of time dependent intraoperative desaturation and factors predicting perioperative desaturation. MATERIAL AND METHOD: A prospective observational analytic study was conducted. One thousand and ninety three patients schedule for elective surgery under general anesthesia (GA) were enrolled. Exclusion criteria were patients with preoperative arterial oxygen saturation (SpO2) < or = 95%, pregnant women, obvious difficult airway and those requiring mechanical ventilation postoperatively. Desaturation was defined as oxygen saturation < or = 95% for > or = 10 seconds. RESULTS: Among 1093 eligible cases, 30 cases (2.74%) developed intraoperative desaturation. The probability of desaturation during induction, maintenance, and emergence were 0.55% (6/1093), 2.01% (22/1093), and 0.18% (2/1093), respectively. Occurrences of desaturation at the recovery room (RR) were noted in 224 patients (20.49%). Younger, obese patients, snorers, and lower respiratory tract infection were significant high-risk groups of intraoperative desaturation. Elderly, obese patients, snorers, positive history of pulmonary disease, modified Aldrete's score < or = 8, and duration of GA > or = 180 minutes predicted desaturation at RR. CONCLUSION: Obesity and snorers were the high-risk groups of perioperative desaturation. Elderly patients are at lower risk of desaturation than children intraoperatively, but at a higher risk in the postoperative period Higher FiO2 should be given to high-risk patients during the intraoperative period. Desaturation can still occur at RR, even in patients who received oxygen. Pulse oximeter monitoring should be continued throughout RR care.

Endometrial cancer in Thai women aged 45 years or younger.

The aim of this retrospective study was to clarify the clinopathologic profile of endometrial cancers in women aged 45 years or younger. All patients with histopathologically confirmed endometrial cancer treated at Songklanagarind Hospital from 1996-2005 were included. Of the 51 identified, 40 (78.4%) were in stage I, 7 (13.7%) in stage II, and 4 (7.8%) in stage III. The age range was 25-45 years (median 41) with a body mass index ranging from 17.6-44.2 (median 27.2). Eighty one percent reported abnormal vaginal bleeding, and twenty four percent polycystic ovaries. Prevalences of diabetes mellitus, hypertension and thyroid disease were 17.7%, 15.7%, and 3.9%, respectively. Seven cases (13.7%) had synchronous ovarian cancer with endometriod adenocarcinoma as the most common histopathological form. Forty patients had well differentiated, 8 moderately differentiated and 2 poorly differentiated tumors. The 5-year disease-free survival (and 95% CI) and 5-year overall survival rates were 88.0% (75.1-94.4%) and 87.5% (74.1-94.2%), respectively. Univariate analysis revealed that patients who had a history of hypertension or lymph node metastasis had a poor prognosis. We conclude that the majority of women aged 45 years or younger with endometrial cancer were obese and the tumors were most commonly in an early stage and were well differentiated.

Reliability and validity of the Thai version of the Health of the Nation Outcome Scales (hoNOS).

BACKGROUND: Measurement in psychiatric services is important for the development of a psychiatric tool for budget allocation. OBJECTIVE: To translate the Health of the Nation Outcome Scales (HoNOS) into Thai and to assess its psychometric properties. MATERIAL AND METHOD: The HoNOS was translated into Thai, by using the standard of "forward-backward" translation procedure. Two psychiatric nurses interviewed subjects together but independently rated their scores. The subjects were 23 acute inpatients and 23 sub-acute inpatients. The reliability and validity was assessed. RESULTS: The Cronbach's alpha coefficient of the Thai HoNOS was 0.68. It had a high correlation (r > 0.80) with the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) and the Clinical Global Impression (CGI). It suggested high concurrent validity. It had a satisfactory power (p < 0.05) in discriminating overall clinical outcomes between acute and sub-acute psychiatric inpatients. CONCLUSION: The Thai HoNOS fulfils the requirements of a psychiatric outcome scale for routine use in inpatient service.

Association between prognostic factors and disease-free survival of cervical cancer stage IB1 patients undergoing radical hysterectomy.

This study was designed to identify prognostic factors of patients with cervical cancer stage IB1 undergoing radical hysterectomy. The medical records and specimens of two hundred and five patients with cervical cancer stage IB1 undergoing radical hysterectomy at Songklanagarind Hospital from July 1995 to June 2005 were reviewed. Patients' age, tumor size, histologic type, tumor grade, depth of invasion, degree of stromal invasion, lymph-vascular space invasion (LVSI), surgical margin status, pelvic node status, and adjuvant treatment were assessed for correlation with disease-free survival (DFS). The mean age of these patients was 44.2 years and the median follow up was 56 months. Twenty five patients (12.2%) developed recurrent disease. The overall 5-year DFS was 86%. In univariate analysis, depth of invasion, degree of stromal invasion, LVSI, and pelvic node status were significant prognostic factors. In multivariate analysis, degree of stromal invasion remained the only independent prognostic factor. In conclusion, degree of stromal invasion was the main independent predictor of prognosis in surgical cases of cervical cancer stage IB1.

Lack of effect of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib.

The aim of this retrospective study was to analyze the effects of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib. A total of 295 patients who had undergone surgery from 1987-2002 were included. Forty seven patients underwent conization before definite surgery, and 2 patients were subsequently lost to follow up. Among the remaining 246 patients, 97 received allogenic blood transfusion, 38 received autologous blood transfusion, and 111 received no transfusion. The clinicopathologic finding of these three groups were reviewed and analyzed. There was no significant difference among three groups in age, chief complaints, duration of symptoms, size of lesion, histopathology, grade, margin or parametrium involvement, node status or postoperative adjuvant treatment. The most prominent presenting symptoms were abnormal vaginal discharge, abnormal vaginal bleeding, and postcoital bleeding. Although the 5-year disease-free survival (DFS) (and 95% CI) for autologous blood transfused group was 90.9% (74.4-97.0%), falling to 88.1% (77.8-93.8%) in untransfused blood group and 81.7% (71.3-88.6%) in allogenic transfused blood group, there were no significant differences among three groups (P = 0.699). In multivariate analyses, only age (P = 0.046), size of lesion (P = 0.024) and histology (P = 0.046) were statistically significantly associated with DFS, whereas transfusion status was not. In conclusion, there is no evidence that perioperative blood transfusion affects DFS of patients undergoing radical hysterectomy and pelvic lymphadenectomy. Only age, size of lesion and histology were statistically significantly associated with DFS.

A comparison of APACHE II and SAPS II scoring systems in predicting hospital mortality in Thai adult intensive care units.

OBJECTIVE: To assess the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in Thai critically ill patients. MATERIAL AND METHOD: Prospective observational cohort study conducted between July 1, 2004 and October 31, 2005 in the Intensive Care Unit (ICU) of Songklanagarind Hospital, an 800-beds tertiary referral university teaching hospital. RESULTS: One thousand three hundred sixteen patients were enrolled. There were 310 deaths (23.6%) at hospital discharge. APACHE II and SAPS II predicted hospital mortality 30.5 +/- 28.2 and 30.5 +/- 29.8 respectively. Both models showed excellent discrimination. The discrimination of APACHE II was better than SAPS II (0.911 and 0.888, p < 0.001). However both systems presented a poor calibration. The Hosmer-Lemeshow goodness-of-fit Hand C statistics were 66.59 and 66.65 of APACHE II (p < 0.001) and 54.01 and 71.44 of SAPS II (p < 0.001). CONCLUSION: APACHE II provided better discrimination than SAPS II, but both models showed poor calibration in over predicting mortality in our ICU patients. Customized or new severity scoring systems should be developed for critically ill patients in Thailand.

Associations between floor activities and knee osteoarthritis in Thai Buddhist monks: the Songkhla study.

OBJECTIVE: Whether floor activity, a common daily activity among Buddhist monks, is a risk factor for knee osteoarthritis remains controversial. The objective of the present study was to search for any association between floor activities and knee osteoarthritis. MATERIAL AND METHOD: This population-based survey involved 261 monks, 40 years of age or older from Songkhla province in the southern part of Thailand Histories were taken on lifetime floor activities in four common positions, squatting, lotus, side-knee bending, and kneeling. Radiographic investigations included antero-posterior and skyline views of both knees. Diagnosis of osteoarthritis in each compartment was based on Kellgren & Lawrence grade 2 or more. Logistic regression analysis adjusted for age, body mass index and smoking status was used to identify the associations between lifetime floor activity and knee osteoarthritis. RESULTS: The mean age (SD) of monks in the present study was 60.4 (12.7) with mean age at ordination 44.4 (17.6) years. The lotus and side-knee bending positions were the two most common practices. Using the lowest tertile of exposure to lotus position as a reference, the third tertile had an odds ratio of 1.0 (95% CI; 0.5-2.2) associated with radiographic knee osteoarthritis. The corresponding odds ratio for side-knee bending was 0.8 (95% CI; 0.3-1.7), for squatting 2.1 (95% CI; 0.9-4.5), and for kneeling 0.7 (95% CI; 0.3-1.5). There was no significant association between the average daily lifetime floor activity in any positions and symptomatic radiographic knee osteoarthritis. CONCLUSION: Floor activities involving squatting, lotus, side-knee bending and kneeling do not increase the risk of knee osteoarthritis in Thai Buddhist monks.

Comparison of validity, and responsiveness between general and disease-specific quality of life instruments (Thai version) in knee osteoarthritis.

Short-form 36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) are common instruments for measuring quality of life (QoL) in patients with knee osteoarthritis. The goal of the present study was to compare the performance of both instruments in evaluating QoL in patients with knee osteoarthritis as diagnosed by the American College of Rheumatology (ACR) criteria. Treatment included nonsteroidal anti-inflammatory drugs and patient education for 6 weeks. Face-to-face interview by an orthopaedist was done at baseline and after treatment, including collection of demographic data and use of both SF-36 and WOMAC questionnaires. Evaluation of instrument performance included reliability, validity, and responsiveness measures. Reliability was tested by analysis of internal consistency using Cronbach's alpha at baseline and after treatment. Construct validity was computed by determining the correlation between each domain of SF-36 and WOMAC (Pearson's test). Responsiveness was compared between baseline and after treatment of both SF-36 and WOMAC in each domain using the paired t test. Fifty-two patients (8 men, 48 women) with a mean age of 58.4 years were included in the present study. About 75% of subjects had less than secondary education levels and most were from agricultural communities. Sixty-four percent had mild grade knee osteoarthritis. The internal consistency of WOMAC revealed good levels of reliability, both at baseline and after treatment, in all dimensions. The reliability of SF-36 was relatively low, especially in the role physical and bodily pain dimensions (Cronbach's alpha < 0.700). Construct validity between each dimension in SF-36 and WOMAC demonstrated coefficients ranging from -0.05 to -0.409. Both WOMAC and SF-36 showed good responsiveness when comparing scores before and after treatment in all domains. In conclusion, both the Thai version WOMAC and SF-36 were valid, reliable, and sensitive to change in evaluating QoL in Thai patients with knee osteoarthritis.

Antenatal care providers' practices and opinions on the services of antenatal syphilis screening in Ulaanbaatar, Mongolia.

The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings were all 16 antenatal care clinics, and a random selection of 30 family units from six districts in Ulaanbaatar, Mongolia. Interviews were conducted with 150 antenatal care providers and 27 antenatal care heads/leaders. Antenatal syphilis screening in Ulaanbaatar was complex. Most pregnant women had antenatal care at family units or antenatal clinics, but syphilis blood testing could be performed only in some district general hospitals. Syphilis positive-screening cases were referred to the venereologists for confirmation of results, appropriate treatment, contact tracing, and follow-up. The providers agreed with the need for syphilis screening in pregnant women but identified as constraints the limited time for performing the screening due to late antenatal visit, women's lack of knowledge, poverty, and geographic barriers. The practice of providers varied, and the opinion on a one-stop service was positive. The main conclusions concerning the failure of universal antenatal syphilis screening were limited accessibility and feasibility of the service, and the ignorance of both women and providers on the importance of screening. It was agreed that decentralization of antenatal syphilis screening would improve the system.

Clinical severity and financial burden among road traffic injury patients in Kunming, China.

This study aimed to describe the severity of injury (RTI), length of stay, costs, financial burden, and sources of payment for RTI patients in the Kunming area, Yunnan Province, China. Information was collected from interviewing 420 patients admitted with RTI during January to May 2005 and from medical records reviewed of all the patients admitted from January to 30 May 2005. The costs and financial burden of road casualties on the medical sector resources were found to be large (median = RMB 94,496) compared to the average per capita monthly income of the Yunnan population (RMB 798). Most patients had injuries of moderate severity. Pedestrians and passengers had the highest Injury Severity Score (ISS). The mean payments out-of-pocket, from the government and by compensation were RMB 5320, 10,190 and 11,190, respectively. In addition to prevention of RTI, a suitable insurance system is needed in the country.

Radium-contaminated water: a risk factor for cancer of the upper digestive tract.

There is a high incidence of oral, pharynx and esophagus cancer among males in Na Mom district in Songkhla Province in Thailand, an area where radium concentration in shallow well water is found to be higher than other areas in this province. A population-based case control study was conducted from June to November 2004 to determine the association of oral exposure to radium-contaminated water and cancer of the upper digestive tract in the district.Thirty-two confirmed cases and 128 sex and five-year birth cohort matched neighborhood controls were selected by multistage sampling from six villages in four sub-districts. All subjects were verified to have been permanent residents in the district for more than 10 years. Thirty cases were dead at the time of the study, thus their relatives were interviewed to determine their amount of water drinking, tobacco smoking, alcohol drinking, betel chewing and exposure to other potential risk factors in the past. The other two cases and all controls were directly interviewed.The concentration of radium in shallow well water at the subject's houses was estimated using a contour map of Ra-226 in the water at the location of their residence. The results showed a strong and dose-dependent associationb etween consumption of radium-contaminated shallow well water and cancer of the upper digestive tract. In multivariate analysis controlled for important risk factors of the cancer, the odds ratios for exposure to oral radium consumption 50-100 mBq/day and >100 mBq/day compared with <50 mBq/day were 2.83 (95% CI: 0.50-16.19) and 29.76 (95% CI: 4.39-201.6) respectively. The risk also increased with consumption of fresh water fish which might have been contaminated by dissolved radium in the water. This study offers the first evidence of the association between radium and cancer of the upper digestive tract to the world literature. Further studies with other methods such as area-wide correlation of radium-uranium concentration and the incidence of the cancer and case-control studies in other populations are needed to confirm the evidence.

Placental weight and its ratio to birth weight in normal pregnancy at Songkhlanagarind Hospital.

OBJECTIVES: To quantify placental weight and its ratio to birth weight in normal pregnancy; and to determine whether abnormal placental weight and its ratio are associated with poor pregnancy outcomes. DESIGN: Prospective, cross-sectional study. MATERIAL AND METHOD: From January 1st, 2004, to December 31st, 2004, placentae were obtained from 238 normal pregnancies, between the 36th-40th gestational weeks. The trimmed and drained placenta was weighed and the mean placental weight at term was defined Distribution curves for placental weight and their ratios with gestational age were constructed. The outcomes for the intrapartum and perinatal periods were compared with normal placental weight, its ratio to the group above the 90th percentile and below the 10th percentile. Fisher's Exact Test was used to analyze the data. A p value < 0.05 was considered significant. RESULTS: The placental weight increased according to the birth weight (r = 0.450, p < 0.005). The mean placental weight at 36-40 gestational age was 519 g (SD = 89.01g). The mean placental weight to birth weight ratio was 17.08%. This ratio decreased slightly with advancing gestational age. There was an association between placental weight below the 10th percentile and fetal distress (p = 0.003). Placental weight to birth weight ratio below the 10th percentile was also associated with fetal distress (p = 0.02). Placental weight above the 90th percentile was associated with newborns requiring neonatal intensive care admission (p = 0.016). CONCLUSION: The placental weight increased according to the birth weight. The placental weight to birth weight ratio decreased slightly with advancing gestational age. Abnormal placental weight and its ratio were significantly associated with some adverse pregnancy outcomes.

Clinico-pathological profile of vulva cancer in southern Thailand: analysis of 66 cases.

OBJECTIVE: To evaluate the clinico-pathologic findings and treatment outcome of women with vulva cancer in Southern Thailand. MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of 66 women who had been treated with surgery from June 1984 to October 2003 at the Department of Obstetrics and Gynecology, Prince of Songkla University. RESULTS: The patients' age ranged from 30 to 87 years, mean 58.2 years. Two most common presentations were vulva mass (89.4%) and pruritus (57.6%). Duration of symptoms at presentation ranged form 1 month to 5 years. Most cases were squamous cell carcinoma (82.0%). The distribution by FIGO surgical stage I, II, III and IV was 9.1%, 47.0%, 34.8% and 9.1%, respectively. The most common complication was wound infection (45.5%), followed by wound dehiscence, lymphosis and leg edema (each 15.2%). The 5-year survival (and 95% CI) for stages I, II, III and IV was 100%, 96% (76-99%), 94% (63-99%) and 60 (13-88%), respectively. The 5-year survival for node-positive cases was 82% (54-94%) versus 100% for node-negative cases (p = 0.0003). Stage was a significant predictor of survival (p = 0.0142) and disease-free survival (p = 0.0112). CONCLUSION: Stage and nodal involvement are predictors of survival, and stage is a predictor of disease-free survival.

Neonatal mortality in rural Bangladesh: an exploratory study.

Bangladesh has a neonatal death rate that is substantially high and demands urgent attention. To assess the causes of neonatal mortality, 1,019 pregnant women were followed up in eight randomly-selected rural areas of the country. Trained female interviewers visited the households of the subjects at four-week intervals to record neonatal deaths (within 28 days after birth). For each death, they administered a structured verbal autopsy questionnaire to the mother and/or a close family member. Based on these field data, three neonatologists arrived at a consensus to assign two causes of death--an originating cause and a direct cause. The neonatal mortality rate was 53.5 per 1,000 livebirths. The originating causes of death were pre-maturity/low birth-weight (30%), difficult labour (16%), unhygienic birth practices (16%), others (4%), and unknown (34%). The direct causes were sepsis (32%), asphyxia (26%), tetanus (15%), respiratory distress (6%), others (6%), and unknown (14%). According to the prevailing causes of neonatal deaths, implementation of intervention programmes, often in the community, that do not depend on highly-technical training or sophisticated equipment should be implemented.

Socio-demographic and environmental factors associated with Aedes breeding places in Phuket, Thailand.

This study aimed to determine the socio-demographic and environmental factors influencing potential breeding sites of the dengue vector in Phuket Province. Three hundred houses were recruited by cluster random sampling for larval inspection. Of all the types of water containers, a high proportion of tires and discarded items were infested by Aedes larva (42% and 32%, respectively). Due to the abundance of water tanks, jars for using water and discarded containers (1.7, 2.1, 0.8 per house), these were the main breeding sites (0.29, 0.35, and 0.28 infested containers per house, respectively). Buddhists' houses were significantly more likely to have a larvae-infested flower vase than Muslims' houses. Townhouses had relatively few infested containers, while those on rubber plantations had 18.3 times higher odds of having at least one container with larva. No window screens increased the odds of larva infestation in the discarded containers by 4.2 times. With this information and given a reliable piped water supply, the number of water containers can be reduced to minimize the breeding places. Garbage should be properly disposed of. Screens should be installed, if possible. Buddhists should be advised on the proper protection of flower vases.

The climatic factors influencing the occurrence of dengue hemorrhagic fever in Thailand.

The aim of this study was to determine the independent effects of climatic factors: rainfall, temperature and relative humidity, on the occurrence of dengue hemorrhagic fever (DHF) in Thailand after adjustment for cyclical pattern. Data regarding monthly DHF reported cases by province, monthly rainfall, rain-days, average daily maximum temperature, average daily minimum temperature and average relative humidity, and mid-year province population from 1978 to 1997 (240 months) in 73 provinces were collected from various governmental departments. The general equation: Incidence of DHF = constant + trends + cyclic effects + climatic factors + noise was used as the statistical model. Out of 73 provinces examined, an increase in temperature was associated with a rise in the incidence of DHF in 9 provinces, whereas increased rainfall was associated with a decreased incidence of DHF in 7 provinces. Analysis by region shows that DHF incidence was negatively associated with extra rainfall in the southern region, but was positively associated with elevated temperatures in the central and northern regions. Variability in incidence was explained mostly (14.7% to 75.3%) by trend and cyclic change and much less (0.2% to 3.6%) by independent climatic factors.

Comparison of the quality of life of general hospital outpatients in southwest China with southern Thailand.

This is a collaborative study comparing the quality of life (QoL) and its predictors between outpatients of university teaching hospitals in southwest China and southern Thailand in terms of different domains of QoL as well as whether socio-economic variables affect the QoL of the two groups of patients to the same extent. Two hundred sixty-one and two hundred forty-eight randomly chosen outpatients were recruited at Chinese and Thai hospitals, respectively, and were interviewed using the SF-36 scale. The QoL of the Chinese patients had a higher adjusted score for 'physical functioning', but the scores for 'role limitations attributed to physical problems and emotional problems' were higher in the Thai patients. Multiple regression analysis showed that sex, marital status, education, family income and residency were predictors of the total QoL score. Age and area had significant interactions with 'country' in the general health domain.

Acute bacterial meningitis in adults: a 20 year review.

During the period Jaunuary 1982 to December 2001 (20 years), a retrospective study in patients 15 years or older with acute bacterial meningitis who were admitted to Songklanagarind Hospital was carried out. There were 180 episodes in 161 cases of acute bacterial meningitis with an increasing incidence of disease during the study. Fifty-nine percent of episodes were nosocomial infection. The classic triad of acute bacterial meningitis was found in 54% of cases. The most common pathogen was Streptococcus pneumoniae (11.7%) in which 19% of these strain were penicillin-resistant. Gram-negative bacilli were common organisms in nosocomial meningitis (32.1%). Twenty-five patients died from meningitis with a mortality rate of 15.5%. Risk factors for mortality older age were than 60 years, HIV infection, impaired mental status and shock.