Microbial killing activity of peracetic acid.

In vitro killing activity of peracetic acid (Perasafe) at a concentration of 0.26 per cent w/v was tested against Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Salmonella paratyphi A, Acinetobacter baumannii, Sternotrophomonas maltophilia, Enterococcus faecium, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus (MRSA), Bacillus subtilis spore, Mycobacterium tuberculosis and human immuno-deficiency virus type I. Exposure to Peracetic acid (0.26% w/v) for 10 minutes resulted in massive killing of all the aforementioned organisms and spore.

Bacterial infections in hospitalized patients in Thailand in 1997 and 2000.

Two surveys to determine the patterns of bacterial infections and trends in resistance to antibiotics of bacteria causing infections in patients admitted to hospitals in Thailand were conducted in 36 and 37 hospitals throughout Thailand in June 1997 and February 2000. Approximately 50 per cent of infections in hospitalized patients in Thailand were hospital-acquired infections. Urinary tract and lower respiratory tract were the most common sites of infections. Eighty per cent of infections were caused by gram negative bacteria. Gram negative bacteria causing infections in 2000 were more resistant to most commonly used antibiotics when compared with those in 1997. The prevalence of gram positive bacteria causing hospital-acquired infections significantly increased during this period. The trend of increase in resistance in most gram positive bacteria in 2000 was not clearly observed.

Epidemiology of arabinose assimilation in burkholderia pseudomallei isolated from patients and soil in Thailand.

Burkholderia pseudomallei is an environmental saprophyte that has been isolated widely from soil in Southeast Asia and the relationship between environmental contamination and clinical melioidosis has been established. It has been shown that the arabinose assimilation property of B. pseudonrallei is probably one of the determinants indicating virulence of this organism. Therefore, the distribution of arabinose assimilation biotypes of B. pseudomallei collected from four geographic regions of Thailand was studied in order to determine an association between arabinose assimilation of B. pseudomallei and the uneven distribution of melioidosis found among these four areas. A total of 830 isolates of B. pseudomallei (412 patient isolates and 418 soil isolates) collected from the patients and soil in four regions of Thailand in 1997 were tested for an ability to grow on a minimal agar medium supplemented with L-arabinose. All patient isolates except one could not utilise arabinose (Ara-). For 418 soil isolates, 232 (55.5%) isolates were identified as Ara type. They comprised 180 (62.5%), 36 (46.8%), 6 (35.3%) and 10 (27.8%) isolates derived from northeastern, southern, northern and central regions respectively. The ratios of Ara- to Ara, were 1.7, 0.9. 0.5 and 0.4 among isolates collected from northeastern, southern, northern and central regions respectively. The prevalence of Ara- in soil isolates in northeast is significantly higher than those in other regions. This observation suggests that in addition to the presence of B. pseudomallei in soil which is one of the factors contributing to a burden of melioidosis in northeastern Thailand, the distribution of more virulent biotype (Ara-) soil isolates is a factor contributing to a high prevalence of melioidosis in northeastern Thailand as well.

Synergy study of vancomycin or teicoplanin plus gentamicin against enterococci, Staphylococcus aureus and coagulase-negative staphylococci by time-kill method.

We conducted a time-kill study comparing the combination of vancomycin plus gentamicin versus teicoplanin plus gentamicin against 20 clinical isolates each, of enterococci, S. aureus and coagulase-negative staphylococci. The concentrations of vancomycin and teicoplanin were selected so that cultures containing these drugs alone contained 10(3) to 10(6) cfu/ml after 24 hr, mostly 2 to 4 times the MIC for each isolate. In this way we could be certain that synergism or antagonism would not go undetected. One-fourth of the gentamicin MIC for each isolate was used throughout the study. In vitro bactericidal synergy was considered to be present when vancomycin plus gentamicin or teicoplanin plus gentamicin yielded at least a 2 log 10 decline in cfu/ml compared to vancomycin or teicoplanin alone. There was no significant difference between the two antibiotic combinations against these gram-positive cocci. The antibiotic combinations showed synergy against 75 per cent of enterococcal isolates, 70 per cent of S. aureus isolates and 50 per cent of coagulase-negative staphylococcal isolates when measured at 24 hr of incubation. Five (25%) enterococcal strains resistant to the synergistic effect of the antibiotic combinations had gentamicin MICs greater than 64 mg/L. For staphylococcal isolates, no association was found between synergy and gentamicin susceptibility, methicillin resistance, or tolerance to vancomycin or teicoplanin.

A correlation of clinical performance on written test and standardised patient.

The objective of the study was to determine the relationship between written responses and actual performance on a patient with a sore throat. The written test was in a format of modified essay question. The standardised patient was a medical student who had chronic recurrent pharyngotonsillitis. The study subjects were residents in the Department of Medicine who were not aware of the study objective. The 37 residents were asked to complete the written test and 18 of them were randomly selected for actual performance assessment. The standardised patient saw the selected residents during their usual service hours. The information obtained from the standardised patient, medical records and prescription slips were analysed. The results revealed: 1) Thirty per cent of the information actually performed were not recorded. 2) Thirty-four per cent of the actions described in the written test were not actually performed, most of these actions were unnecessary and superfluous. 3) There was a good correlation between written responses and actual performance on a standardised patient.

Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults.

One hundred and fifty-two adult patients with pharyngotonsillitis were enrolled in the randomized double blind study to assess the efficacy of Andrographis paniculata. The patients were randomized to receive either paracetamol or 3 g/day of Andrographis paniculata or 6 g/day of Andrographis paniculata for 7 days. The baseline characteristics of the patients among the three groups were not different. The efficacy of paracetamol or high dose Andrographis paniculata was significantly more than that of low dose Andrographis paniculata at day 3 in terms of the relief of fever and sore throat. The clinical effects were not different at day 7. Minimal and self limiting side effects were found in about 20 per cent in each group.

Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers.

Sixty-five adult asymptomatic chronic carriers of hepatitis B virus were enrolled to the randomized controlled efficacy study of Phyllanthus amarus. Thirty-four received Phyllanthus amarus 600 mg per day for 30 days and 31 received placebo in identical capsules. The conversion rate of HBsAg was 6 per cent in the study group at day 30. When 20 subjects in the Phyllanthus amarus group were given a further 30-day treatment and 22 placebo recipients given Phyllanthus amarus 1,200 mg per day for 30 days, the conversion was observed in 1 (5%) in the higher dose group. Adverse effects were not observed in all patients receiving the plant. The results indicated that Phyllanthus amarus, whole plant except root, grown in the central part of Thailand, given at the studied dosage and duration, had a very minimal effect on eradication of HBsAg from Thai adult asymptomatic chronic carriers.

Native valve infective endocarditis at Siriraj Hospital, 1982-1989.

During January 1982 to June 1989, there were 105 evaluable adult cases of native valve infective endocarditis admitted to Department of Medicine, Siriraj Hospital. The incidence was approximately 2.6 per 1,000 admissions. The male to female ratio was 1.4 and the mean age was 31.6 years. Thirty (28.5%) were cases associated with intravenous drug abuse. All non-addicts had pre-existing cardiac lesions susceptible to endocarditis especially rheumatic mitral regurgitation, aortic regurgitation, VSD and PDA. The clinical features of cases without intravenous drug abuse were low grade fever for few weeks, malaise, dyspnea and heart murmur. The addicts with endocarditis presented with acute febrile illness and pulmonary symptoms. Mucocutaneous embolic lesions were detected in one third of the patients. Echocardiography detected vegetations in 50 per cent of the patients. Streptococci were the most common causative agent in 93 per cent of non-addicts whereas the same percentage in addicts were caused by S. aureus. Most of the patients were treated with beta lactams (pen G, ampicillin or cloxacillin) alone or combined with aminoglycosides (streptomycin or gentamicin) for a duration from 10 days to 16 week. Six cases had valve replacement operation due to intractable heart failure and valve ring abscess, 2 had embolectomy of major arteries and 2 had craniotomy due to intracerebral hemorrhage. The overall case fatality rate was 14 per cent. The causes of death were heart failure, cerebral complications and severe pulmonary infections. Clinical response was observed sooner in non-addict patients.

Efficacy of dosage schedule for rational dosage prescribing of gentamicin.

In our pilot study of 30 patients who were on gentamicin, the adequate peak level (5-10 mg/dl) was found in 27 per cent, trough level (less than 2 mg/dl) in 67 per cent and both peak and trough level in only 10 per cent. We have several reasons to believe that it is due to inappropriate dosage prescribing. The objective of the study is to test the efficacy of using a recommended dosage schedule for rational dosage prescribing of gentamicin. All medical residents were invited to attend a 2-hour session on gentamicin pharmacokinetics. The problems and the use of recommended dosage schedule were extensively discussed. Then serum gentamicin levels were re-monitored by Fluorescence Polarization Immunoassay (TDx). Of 73 gentamicin recipients, 39 (53%, C gr.) were given at the correct dosage according to the schedule and 34 (47%, IC gr) were given incorrectly. The characteristics of the patients in both groups were not different. The appropriate peak, trough, peak and trough levels in C gr were 87, 80, 67 per cent respectively compared with 24, 80 and 9 per cent in the IC group, p less than 10(-4) for peak, peak and trough. The incidence of nephrotoxicity was not different between the two groups. The patients' outcomes were difficult to assess because most of the patients received antibiotic combinations. However, case fatality of documented gram-negative infection tended to be less in the C group. It is concluded that dosage schedule can improve rational dosage prescribing of gentamicin. Most of the patients given gentamicin may not need monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of community-acquired pneumonia with ofloxacin.

Our study of 28 carefully selected patients proved that ofloxacin is a safe and effective drug for mild to moderately severe community-acquired pneumonia. An effective oral antimicrobial drug such as ofloxacin can be used as an alternative to conventional therapy in community-acquired pneumonia.

Pasteurella multocida infective endocarditis: a case report.

A 17-year-old man presented with acute febrile illness with jaundice, embolic skin lesion, heart murmur, renal insufficiency and abnormal CSF. Pasteurella multocida was isolated from blood cultures. In spite of adequate antibiotic treatment for endocarditis of the mitral valve, he developed a fatal ruptured cerebral mycotic aneurysm. Post mortem examination revealed an atrial septal defect, vegetation at the anterior mitral leaflet, intraventricular, subarachnoid and intracerebral hemorrhage.

Liver abscess: a clinical study of 222 patients.

The medical records of 222 patients with liver abscess at Siriraj Hospital from 1978 to 1985 were analysed. Amoebic abscess was three times more prevalent than pyogenic abscess. In both groups middle aged males were affected more often than others. The main clinical manifestations were fever, right upper quadrant pain and hepatomegaly. History of colitis in the past, marked leukocytosis, elevation of alkaline phosphatase and a single abscess confined to the right lobe were suggestive of amoebic liver abscess. The presence of concurrent abdominal infection, marked anemia and jaundice were associated with pyogenic abscess. Patients with pyogenic abscess developed complications more often and the case fatality rate was greater than patients with amoebic abscess. Most of the patients were successfully treated with a combination of antimicrobials and drainage.

Randomized controlled trial of Cassia alata Linn. for constipation.

Cassia alata Linn. is a medical plant. Its leaves have been claimed to be effective as a laxative. The studies done so far have shown no toxicity as a result of consuming Cassia alata Linn. leaves. The plant has been found to contain anthraquinones, presumed to be the active ingredient causing the laxative effect. The objective of the study was to test efficacy of Cassia alata Linn. leaves for treatment of constipation compared with a placebo and mist. alba in a multicenter randomized controlled trial carried out in one provincial and 5 community hospitals. Eighty adult patients admitted to 5 community hospitals and one provincial hospital with at least 72 hours of constipation were included in the study. Twenty-eight patients were in the placebo group, 28 in the mist. alba group, and 24 in Cassia alata Linn. group. Each patient was given 120 ml of fluid with caramel color, mist. alba, or Cassia alata Linn. infusion at bed time. Evaluation was performed after 24 hours whether the patient defecated or not. The characteristics of the patients among the three groups were not different. Eighteen per cent of patients in the placebo group passed stools within 24 hours, whereas, 86 and 83 per cent of patients in mist. alba and Cassia alata Linn. groups respectively, passed stools. The differences observed between placebo and mist. alba, placebo and Cassia alata Linn. were statistically highly significant, P less than 0.001 and clinically important. Minimal self-limited side effects, i.e., nausea, dyspepsia, abdominal pain and diarrhea were noted in 16-25 per cent of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Vibrio bacteremia in Siriraj Hospital.

From January 1983 to March 1988, 26 isolates of Vibrio spp. were recovered from the blood of patients admitted to Siriraj Hospital. Thirteen strains were identified as non 0-1 Vibrio cholerae, 3 were Vibrio vulnificus and 10 were Vibrio spp. The medical records of 20 patients were available for clinical analysis. Most of them were adult men with cirrhosis. Clinical features included fever, abdominal pain, diarrhea, peritonitis, shock and skin lesions. Some patients had a history of seafood consumption or seawater exposure. The isolates were sensitive to commonly used antibiotics. All patients except one received at least one antibiotic that was sensitive in vitro. However, the case fatality rate was still high, 50 per cent. Clinicians should be aware of the clinical syndrome caused by Vibrio spp. in order to manage those patients promptly and appropriately.

Randomized double blind study of Curcuma domestica Val. for dyspepsia.

Curcuma domestica Val. is a medicinal plant. It has been claimed to be effective for dyspepsia. The studies done so far showed no toxicity due to consuming Curcuma domestica Val. The plant has been found to contain volatile oil and curcuminoids which are believed to be the active ingredients. The objective of the study was to test the efficacy of Curcuma domestica Val. rhizome for treatment of dyspepsia compared with a placebo and flatulence in a multicenter, randomized, double-blind trial carried out in one provincial and 5 community hospitals. One hundred and sixteen adult patients who had acid dyspepsia, flatulent dyspepsia, or atonic dyspepsia were included in the study. Forty-one (41) patients were in the placebo group, 36 and 39 were in the flatulence and Curcuma domestica Val. groups respectively. Each patient received 2 capsules of placebo or study drugs 4 times a day for 7 days. Each patient was then assessed for symptoms response, side effects and satisfaction. Ten patients did not participate in the follow-up. The baseline characteristics of the patients among the three groups were not significantly different. Fifty-three (53) per cent of the patients receiving placebo responded to the treatment whereas 83 per cent of the patients receiving flatulence and 87 per cent of patients receiving Curcuma domestica Val. responded to the treatment. The differences in efficacy between placebo and active drugs were statistically significant and clinically important. Mild and self-limited side effects were observed at similar frequency in the three groups. About 50 per cent of the patients in each group were satisfied with the treatment they received.(ABSTRACT TRUNCATED AT 250 WORDS)

A model for testing antiseptic efficacy: a preliminary study on Betadine and Germidine.

Efficacy of povidone iodine antiseptic, betadine and germidine, was tested against normal skin flora and four pathogenic bacteria namely S. aureus, S. epidermidis, E. coli and Pseudomonas aeruginosa by a new model. The study was performed on the volar surface of forearms of ten patients. First of all, the skin flora was cultured then 10(8) cu/ml of the tested organisms was applied by a cotton swab and left to dry for 1 minute before the culture was repeated. Betadine or germidine was applied over the area previously painted with the organism. The culture was taken 1 to 2 minutes thereafter. The results showed that this model was feasible and convenient. Betadine and germidine are efficacious against normal skin flora and pathogenic bacteria.

Cryptosporidiosis in Siriraj Hospital, Bangkok, Thailand.

During January to July 1986, 1,500 fecal specimens from out and in-patients attending Siriraj Hospital, Bangkok were examined for Cryptosporidium oocysts by modified acid fast technique. Eight were found to be positive. The prevalence of cryptosporidiosis was 3.7% in children with acute diarrhoea. Medical records of the patients showed that the main clinical presentation was acute diarrhoea with fever for one to 7 days duration. Stool examinations and cultures revealed no white blood cells or parasites or other enteropathogenic bacteria. All recovered within two weeks. The study suggest that Cryptosporidium is a relatively common nonviral cause of acute diarrhoea in young children and routine laboratory study to detect Cryptosporidium may be justified.