Virological, immunological and host factors in HIV-1 discordant couples in Thailand.

The potential factors of resistance to HIV-1 infection were investigated in 23 HIV discordantly infected couples, of each, one partner had HIV infection and the matched spouse was not infected. Both partners of the HIV discordant couples possessed comparable number of CD4+ cells expressing CCR5. Our study demonstrated that resistance to HIV-1 infection was not due to low level of HIV viral load in their infected-matched spouses. In addition, selective biological phenotype of HIV clinical isolates, which is indicative for risk of transmission, could not be determined in this study. However, we have demonstrated that the unknown genetic factor(s), and neutralizing antibody of broad and high activity could be taken into an account for resistance to HIV infection in the HIV discordant couples.

Comparison between virus isolation method, Papanicolaou stain, immunoperoxidase stain and polymerase chain reaction in the diagnosis of genital herpes.

Papanicolaou (Pap) stain, immunoperoxidase (IP) stain and polymerase chain reaction (PCR) were evaluated against the virus isolation method for their sensitivity and specificity in the diagnosis of herpes simplex virus (HSV) infection in 96 women who were suspected of genital herpes. The result showed that the sensitivity of PCR, IP and Pap stain was 100, 92.0 and 62.7%, respectively, while the specificity was 76.2, 66.7 and 81.0%, respectively. PCR was even more sensitive than the virus isolation technique. As Pap stain is the technique routinely performed for diagnosing genital herpes in most of the hospitals in Thailand, its low sensitivity should be taken into consideration. Based on the investigation by all four techniques together, HSV infection was diagnosed in 91.6% of the cases suspected of genital herpes which reflected higher precision of the clinical diagnosis over Pap stain.

Prevalence of herpes simplex virus infection in patients suspected of genital herpes; and virus typing by type specific fluorescent monoclonal antibodies.

During the period between April 1994 and February 1996, a total of 154 female patients who attended the Clinic of Female Sexually Transmitted Diseases, Siriraj Hospital with clinical symptoms suspected of genital herpes were investigated for herpes simplex virus (HSV) infection by the virus isolation method in Vero cell cultures. Swabs from external genital lesions and the cervix from each patient were collected separately and used as the clinical specimens for isolation of HSV. The virus isolates were identified by indirect immunofluorescence (IIF) staining of the infected cell cultures using polyclonal HSV-2 specific antiserum which was reactive to common HSV antigens for both types of viruses. Typing of HSV was performed by direct IF using monoclonal antibody specific to HSV-1 or HSV-2. HSV was isolated from 78.6 per cent (121 of 154) of the cases studied; and among the infected cases, there were 47.9 per cent (58 of 121) in whom the infection involved both external genital lesions and cervixes, and 50.4 per cent (61) in whom the infection was limited to external genital lesions only. There were 2 cases (1.7%) in whom HSV was isolated from cervixes but not external genital lesions. Seventy-five HSV isolates were further subjected to typing. The present study showed that HSV-1 was accounted for 18.7 per cent (14 isolates), while HSV-2 took the remaining part of 81.3 per cent (61 isolates). The data demonstrated an increase in the prevalence of HSV-1 in genital herpes in our people.

The use of lenograstim (Granocyte) in chemotherapy for ovarian cancer.

We have conducted an open, controlled study on the febrile neutropenia effects by Lenograstim (Granocyte) therapy following cytotoxic chemotherapy of cisplatinum and cyclophosphamide in patients with primary advanced epithelial ovarian cancer. Eligible patients (n = 17) were divided into 2 groups receiving a combined chemotherapy of intravenous cisplatinum (70 mg/m2) and cyclophosphamide (700 mg/m2) with or without the addition of Lenograstim. Subcutaneous administration of Lenograstim (100 micrograms/day) for 7 consecutive days was given from day 8 to day 14 of the 3rd to the 5th cycle of chemotherapy in Lenograstim treated patients. After 3 cycles of treatment, Lenograstim treated patients (group 1, n = 10) showed a significant improvement in white blood cell (WBC) count as compared with group 2 (control) of 7 patients (p = 0.00002). Group 1 patients also showed an increased C-reactive protein, though of no significance. There were no significant differences among the 2 groups regarding ESR, hematocrit, platelet counts and blood chemistry profiles. This preliminary data encourages more study of the benefits of Lenograstim in the treatment of ovarian cancer.

Shedding of HIV-1 subtype E in semen and cervico-vaginal fluid.

The uneven expansion of HIV-1 subtypes in each transmitted group raises the possibility that some viruses have less/more potential by qualitative/quantitative for heterosexual transmission compared to others. In Thailand, HIV-1 subtype E is mainly spread via heterosexual route and accounts for about 95 per cent of the infected cases. To determine whether high sexual infectivity of HIV-1 subtype E is due to the presence of a virus in genital fluid, we conducted a study to characterize shedding of HIV-1 in seminal and cervico-vaginal fluids of 30 HIV-1 subtype E infected Thai couples by PCR and virus isolation methods. All subjects had no HIV-associated diseases and other sexually transmitted diseases. HIV-1 subtype E DNA was detected in 22/30 (77.33%) of cervico-vaginal and also 22/30 (77.33%) of seminal fluid samples. The isolation rate of HIV-1 from semen and cervico-vaginal secretion was 36.67 per cent and 16.67 per cent, respectively. Number of HIV-1 subtype E DNA copies in the blood is reversely correlated with the number of blood CD4+ T cells, while that in genital fluid was not related to CD4+ T cell count. An increase in shedding of HIV- DNA subtype E in female genital tract compared to other HIV subtypes reported by other investigators might be one reason to explain the rapid spread of subtype E by heterosexual transmission in Thailand.

Detection of HIV-1 proviral DNA by polymerase chain reaction: a preliminary study in Bangkok.

Nested polymerase chain reaction (nested PCR) was used to separately amplify part of gag, pol, and env genes of human immunodeficiency virus type 1 (HIV-1) to evaluate that primer specific to either gag (SK380/390&SK38/39), pol (JA17/18&JA19/20), or env (JA9/10&JA11/12) genes is suitable for HIV-1 PCR based diagnosis in Thailand. The positive PCR results in 70 HIV-1 infected adults are 100, 97, 89 per cent and in 75 HIV-1 infected infants are 100, 94, 74 per cent by gag, pol, env primer, respectively. The specificity of all three primer sets is 100 per cent. The unamplified samples by pol and env primers were identified as HIV-1 subtype E by PELISA method. False negative in HIV-1 PCR based diagnosis caused by high genetic variation of HIV-1 can be overcome by using several primer sets as shown in this study.

Carpal tunnel syndrome during pregnancy: prevalence and blood level of pyridoxine.

The prevalence of CTS in third trimester pregnant women in the study in 28 per cent. With the use of NCS it was able to detect nearly 80 per cent of them who had no symptoms or signs. There was no association between the level of vitamin B6 or B6 deficiency and CTS. Since CTS may result in a permanent disability if undiagnosed or left untreated it is essential to make an early diagnosis and treat it especially older women and those who are edematous.

The study of HCV antibody and serologic tests for syphilis in Thai patients with gynecologic disorders.

Investigation for prevalence of antibodies to hepatitis C virus (HCV) and to Treponema pallidum was conducted in 883 females with gynecologic disorders who were admitted to the gynecological ward of the Department of Obstetrics and Gynecology, Siriraj Hospital during April to August 1991. The study population consisted of 678 patients with malignancies and 205 patients with benign diseases. Anti-HCV antibody was found in 3.1% of the cases with malignancies and 1.46% of those with benign diseases. Among the gynecologic malignant group, the patients with carcinoma of cervix had the highest prevalence of HCV antibody (3.6%). The positive serologic tests for syphilis in patients with carcinoma of cervix (9.8%) were significantly higher from those in patients with ovarian carcinoma (3.75%) (p < 0.01). There were 3 cases with carcinoma of cervix who were simultaneously sero-positive for both HCV and syphilis.

Itraconazole in the treatment of acute vaginal candidosis.

An open non-comparative multicenter study of Itraconazole (Sporal) 400 mg as a single day therapy for vaginal candidosis was carried out at Siriraj Hospital and Chulalongkorn Hospital from 1st November 1988 to 31st August, 1989. Fifty-nine female out patients with vaginal candidosis were included in the study after excluding pregnancy, lactation, mixed vaginal infection and prior antimycotic therapy. Two capsules of 100 mg Itraconazole were given b.i.d. as a single day 400 mg dose. The patients were evaluated at the beginning prior to treatment for physical signs and symptoms, direct microscopic examination, and culture of vaginal fluid. The first and second follow-up were arranged at the end of one week and one month after therapy. The evaluations were the same as in the first visit. The clinical cure rate was 89 and 90 per cent at first and second follow-up respectively. The mycological cure rates were 83.3 and 69.57 per cent at the first and second follow-up respectively. There was one case of Torulopsis glabarta at the second follow-up.

Risk factors in puerperal infection.

Puerperal infection is one of the most common obstetric complications which leads to certain serious sequelas for those parturients. The study of 92 postpartum women at Siriraj Hospital from April 1, 1980 to March 1, 1983 was conducted to investigate the risk factors of puerperal infection. All 92 cases were diagnosed for puerperal infection according to the criteria of the Joint Committee on Maternal Welfare. Irregular antenatal care or no antenatal care, sexual intercourse during the last week before delivery and pelvic examination during pregnancy were found to be important predisposing factors in the antepartum period. Pelvic examination during labor accounted for 78 per cent of the patients and played an important role, while operative obstetrics (30%) and concomitant diseases during pregnancy (27%) were the next significant factors.

Treatment of puerperal infection.

Ninety-two patients with puerperal infection admitted to Siriraj Hospital from April 1, 1980 to March 1, 1983 were studied. The treatment in this study was both medical and surgical, blood transfusion was given in some cases with low hematocrit level. The medical treatment alone was based on the causative organisms which were detected by cervical & intrauterine swab, smear & gram stain and cultures. PGS & Kanamycin were the most frequently used antibiotics which were intended to treat both gram-positive and gram-negative bacteria and adjunctive chloramphenicol for anaerobes. The surgical procedures which were performed in combination with medical treatment included total abdominal hysterectomy, uterine curettage, appendectomy and drainage of subdiaphragmatic abscess. The result of the treatment was satisfactory, 96.7 per cent improved after therapy with slight morbidity in some patients.

Causative organisms in puerperal infection.

Ninety-two postpartum women who had been admitted to Siriraj Hospital from April 1, 1980 to March 1, 1983 were studied for the causative organisms of puerperal infection. Cervical and intrauterine swab & smear-gram stain as well as cultures were performed. Hemocultures were done in some cases. Only 50 per cent of all cases had positive cervical and intrauterine swab smears which showed different kinds of micro-organisms, 78 per cent were gram-positive cocci, gram-negative rod was found in 4 specimens, 2 specimens of gonococcal smears, one for trichomonads. Cervical and intrauterine swab cultures were positive in only 31.5 per cent. E. Coli was the most common and Staphylococci & Streptococci were the second most common.

Rapid eradication of trichomonads by single-dosed nimorazole.

Previous in vitro studies demonstrated the rapidity of trichomonacidal action of nimorazole (Naxogin 500) which was twice that of metronidazole and many times that of tinidazole. Since rapid eradication of parasites can lead to a significant decrease in transmission rate, and hence, a lower prevalence of this sexually transmitted disease, a pilot study was designed to investigate the in vivo speed of action of nimorazole. Twenty females with positive wet smears for trichomonas vaginalis were treated with a single 2 gram-dose of nimorazole orally. Without any antiseptics, specimens of vaginal discharge were collected at 0 hour (before treatment), 3, 24 and 72 hours for parasite count and culture. After a single treatment with 2 g of nimorazole the cure rate was 65 per cent at 3 hours and 100 per cent at all points thereafter. The result of this pilot study supports previous in vitro findings that nimorazole rapidly eradicates vaginal parasites.