Cytokine responses during exacerbation compared with stable phase in asthmatic children.

Bronchial asthma is a chronic inflammatory disorder of the airways. Balancing in Th1 and Th2 response is a target in the treatment. Recent studies show that interleukin-10 (IL-10) has an important role in the regulation of Th2 and allergic responses and its amount was found to decrease in asthmatic patients. This study was to focus on cytokine responses, including interferon-gamma (IFN- γ), IL-4 and IL-10 in asthmatic children during acute exacerbation compared to stable period. Peripheral blood mononuclear cells (PBMCs) from fourteen asth-matic children during exacerbation and stable phase were stimulated with phytohemagglutinin (PHA) and mite allergen (Der p) for 72 hours. Levels of IFN-γ, IL-4 and IL-10 in cell culture supernatants were measured using en-zyme-linked immunosorbent assay. The median level of IL-10 in PBMCs stimulated with PHA was significantly low-er in acute asthma exacerbation compared with stable phase (464 vs. 859.5 pg/ml, p= 0.03). However, there was no difference in the level of IL-10 in PBMCs stimulated with Der p. The level of IFN-γ and IL-4 were not different between exacerbation and stable phase both in PHA and Der p-stimulated PBMCs. The decrease of IL-10 production in asthmatic children during acute exacerbation may emphasize the role of IL-10 in immune regulation in allergic disease.

Serum TGF-beta1 in atopic asthma.

Asthma is a chronic inflammatory disease of the airway. Pathological repair of chronic inflammation leads to airway remodeling. Transforming growth factor-beta (TGF-beta), a profibrotic cytokine, plays an important role in promoting the structural changes of airway remodeling. TGF-beta effects on the proliferation, differentiation and extracellular matrix (ECM) metabolism of airway structural cells. This study assessed serum TGF-beta1 in different severity of atopic asthma compared to non-atopic controls. Thirty-one atopic asthmatic patients and 34 non-atopic controls, aged 7-18 years, were recruited as to the asthma severity: steroid naïve mild asthma, moderate asthma, and asthma in remission. Serum TGF-beta1 was measured by enzyme-linked immunosorbent assay. There was a significant difference between serum TGF-beta1 in asthmatic patients and that in control patients (39.59 ng/ml vs. 0.26 ng/ml, p < 0.001). Serum TGF-beta1 was highest in steroid naïve mild asthma group when compared to the moderate asthma and asthma in remission groups (47.44 ng/ml vs. 38.64 ng/ml and 47.44 ng/ml vs. 35.94 ng/ml, p = 0.013 and 0.001, respectively). There were no correlations among serum TGF-beta1 and pulmonary function test parameters, duration of asthma, and duration of inhaled corticosteroid treatment. These data support the role of TGF-beta1 in airway remodeling in asthma.

Serum ferritin levels in children with dengue infection.

The purpose of this study was to evaluate the levels of ferritin, an acute-phase reactant, in predicting the risk of dengue hemorrhagic fever (DHF) in patients with dengue infection. One hundred seventy-seven Thai children (100 males, 77 females) 4-16 years old (median age 11 years) with DF (n = 44) and DHF (n = 133) were enrolled in the study. All patients had serologic confirmation of dengue infection. Each had a venous blood sample drawn daily during hospitalization and at the outpatient clinic 2-4 weeks after discharge from the hospital, to determine serum ferritin levels. The median serum ferritin levels (ng/ml) in children with DHF (Day 2, 974; Day 3, 624; Day 4, 1,136; Day 5, 1,912; Day 6, 2, 105; Day 7, 1,840; Day 8, 1,478 and Day 9, 1,144 of illness) were higher than those with DF (Day 2, 25.4; Day 3, 45.6; Day 4, 655; Day 5, 1,050; Day 6, 1,075; Day 7, 615; Day 8, 764 and Day 9, 600 of illness) with p-values of 0.013, 0.001 and 0.013 on Days 5, 6 and 7 of illness, respectively. A cutoff level of serum ferritin of 1,200 ng/ml was used to calculate sensitivity and specificity for DHF. The results reveal the sensitivities on Days 5, 6 and 7 of illness were 81.5, 84.4 and 89.9%, respectively, and the specificities were 42.4, 39.0 and 36.4%, respectively. High serum ferritin levels > or = 1,200 ng/ml may be a predictor of dengue hemorrhagic fever.

Compliance with hepatitis B and hepatitis C virus infection screening among HIV-1 infected patients in a resource-limited setting.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important risk factors for mortality among HIV-infected patients. We assessed compliance with screening for HBV and HCV infection prior to initiation of ART in a resource-limited setting. Six hundred thirty-eight patients with a mean age of 38.4 years (53% males) were studied. Prior to initiation of antiretroviral therapy (ART) 371 patients (58%) were screened for HBV and 273 (43%) were screened for HCV infection. Of those screened, 9.7% had HBV infection and 8.8% had HCV infection. Given the relatively high prevalence of HBV and HCV infection among HIV-infected patients, screening for HBV and HCV infections prior to ART initiation should not be omitted in the resource-limited setting.

Clinical usefulness of a HPLC method for simultaneous quantitation of plasma homocysteine and cysteine.

OBJECTIVE: Homocysteine (Hcy) is a risk for vascular occlusion. It is metabolized via remethylation to methionine and transsulfuration to cysteine which has also been related to vascular occlusion. Simultaneous determination of Hcy and cysteine has additional clinical usefulness in providing a presumptive clue to the nature of hyperhomocysteinemia. MATERIAL AND METHOD: A manual HPLC method has been worked out for simultaneous determination of plasma Hcy and cysteine. Concentrations of Hcy were validated with the widely used automated Abbott AxSYM assay. Its usefulness was tested in 87 omnivores and 111 vegans. RESULTS: Excellent correlation between the values of Hcy was found between the manual HPLC method and the automated Abbott assay. The vegans had significantly higher levels of Hcy but lower levels of cysteine than the omnivores (mean +/- SD, micromol/L 23.6 +/- 18.0 vs. 8.8 +/- 2.1 p < 0.001, 225 +/- 30 vs. 245 +/- 34 p < 0.001, respectively). In contrast, the vegans had significantly lower levels of serum vitamin B12 and plasma vitamin B6 than the omnivores (median values 186 vs 565 pg/ml, p < 0.001; 37.4 vs. 47.4 nmol/L, p < 0.001 respectively). These findings indicate that the hyperhomocysteinemia in the vegans results from impairment of both remethylation and transsulfuration pathways of Hcy secondary to inadequacy of vitamins B12 and B6 respectively. Thus simultaneous determination of Hcy and cysteine is more useful than determination of only Hcy in that it provides a clue to the nature of hyperhomocysteinemia. CONCLUSION: The manual HPLC method and the Abbott assay gave comparable Hcy values, and thus can be used interchangeably. The HPLC method is economical, useful for hospitals with less demand for determination of Hcy, and capable of simultaneously determining cysteine which has implication in clinical practice.

Comparable between rapid one step immunochromatographic assay and ELISA in the detection of prostate specific antigen in vaginal specimens of raped women.

BACKGROUND: Rape is a crime found in Thailand nowadays. The crime is often lacking of eyewitnesses. Therefore, examination for forensic biological evidence becomes quite important, especially investigating sperm and semen in vaginal specimens of the victim. Acid phosphatase test for semen is commonly used in Thailand but is just a presumptive test. Recently, confirmatory kit tests became available in Thailand for detecting the prostate specific antigen (PSA) from semen. This test is simpler and cheaper than ELISA. OBJECTIVE: To compare the rapid one-step immunochromatographic assay with ELISA for the detection of prostate specific antigen in vaginal specimens of raped women. MATERIAL AND METHOD: A diagnostic test was conducted on the vaginal specimens of raped women that were sent to the laboratory of the Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University during April-August 2006. One hundred vaginal specimens were examined for prostate specific antigen by rapid one step immunochromatographic assay and compared with ELISA. RESULTS: There were 85% and 83% of sensitivity, 85% and 85% of specificity, 85% and 85% of accuracy, 89% and 89% of positive predictive value, and 79% and 77% of negative predictive value from rapid one-step test kit and ELISA respectively CONCLUSION: The result showed that there was no difference on specificity, accuracy and positive predictive value between the two methods but sensitivity and negative predictive value of rapid one-step test kit was better than ELISA. The research team recommends that rapid one-step test kit for prostate specific antigen should be routine service in vaginal specimens of raped women.

Fecal alpha1--antitrypsin in healthy and intestinal-disorder Thai children.

OBJECTIVE: Determine the normal FA1-AT level in random wet stool of Thai children using RID and NPL, and to study the correlation between RID and NPL methods for measurement of FA1-AT. MATERIAL AND METHOD: Random stool samples were collected from healthy children and intestinal-disorders patients. Alpha1-antitrypsin (FA1-AT) in wet stool samples was measured by nephelometry (NPL) and radial-immunodiffusion (RID) methods. RESULTS: Newborn infants had the highest FA1-AT level during the first day of life and declined to the same level as older children on day 3-4. Median and geometric mean of FA1-AT levels by NPL from healthy children aged 1 month-15 years was 1.23 and 1.11 mg/dL respectively. FA1-AT levels by NPL from children with severe intestinal disorders, displaying median and geometric mean at 6.77 and 12.39 mg/dL respectively, were much higher than healthy children. The RID and NPL methods showed a correlation of r = 0.87 (p < 0.01) and R2 = 0.75. CONCLUSION: Random FA1-AT assay in wet stool is a non-invasive and simple test for supporting diagnosis of protein-losing enteropathy.

Factors for predicting successful immune response to hepatitis B vaccination in HIV-1 infected patients.

This study aimed to determine the predicting factors for successful hepatitis B vaccination among HIV-1 infected patients. A prospective study was conducted among HIV-1 infected patients who had negative HBV serologies. Anti-HBs antibody was evaluated one month after completing a 3-injection course of hepatitis B vaccine. Patients who had an anti-HBs antibody level >10 mlU/ml were defined as responders. There were 65 patients with a mean age of 39+/-8.5 years, 68% were females. Fifty-seven (88%) patients had received antiretroviral therapy for a mean (SD) duration of 26.1 (22.3) months and 75% of these had an HIV-1 RNA count <50 copies/ml. The mean (SD) CD4 cell count and percentage at the time of vaccination were 345 (194) cells/mm3 and 16 (7) %, respectively. Thirty patients (46%) were responders. Compared to non-responders, responders had a higher mean CD4 cell count (p = 0.047) and a trend toward a younger age (p = 0.052). On multivariate analysis, younger age (p = 0.049) and higher CD4 cell count (p = 0.048) were predictors for successful response to hepatitis B vaccination. Determination of antibody levels after vaccination in HIV-infected patients is warranted.

An autopsy report case of rape victim by the application of PSA test kit as a new innovation for sexual assault investigation in Thailand.

The case of a 30 year-old Thai female found dead on the floor at the base of a small monument on Rajadumnern Road, Bangkok, Thailand with blood stains around the body and a naked bottom. The scene investigation and autopsy findings suggested a sexual assault and multiple sharp force injuries. The approach to the postmortem examination using different laboratory tests is reviewed. The specificity and sensitivity of prostate specific antigen (PSA) in specimens from rape victims is better than acid phosphatase test. The ELISA test for PSA was tested to confirm the PSA test kit. The present report suggests the PSA test kit in addition to conventional sperm smear and acid phosphatase test for sexual assault investigation in Thailand.

Prevalence of hepatitis B virus and hepatitis C virus co-infection with human immunodeficiency virus in Thai patients: a tertiary-care-based study.

BACKGROUND: Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV share the route of transmission. HBV or HCV co-infection with HIV has been associated with a reduced survival rate, an increased risk of progression to severe liver disease, and an increased risk of hepatotoxicity associated with active antiretroviral therapy. Information regarding prevalence of HBV and HCV co-infection with HIV in Thailand is limited. PATIENTS AND METHOD: A cross-sectional study of prevalence and risk factors of HBV and HCV co-infection in HIV-infected patients was conducted. All HIV-infected patients who were cared for in March 2003 at Ramathibodi Hospital were included. RESULTS: There were 529 HIV-infected patients with a mean age of 36.7 years and 56.5% males. Of these, 58.8% lived in Bangkok, whereas, the others were from provincial areas. Heterosexual contact were the acquisition of HIV infection in 98.1% of all patients. The prevalence of HBV infection was 8.7%, and HCV infection was 7.8%. There was no difference between the prevalence of these infections in Bangkok and provincial areas (p = 0.115). History of intravenous drug use was associated with both HBV and HCV co-infection (p < 0.001). HCV co-infection group was also associated with male gender (p = 0.002) and elevated serum alanine transaminase (ALT) level (p = 0.0003). CONCLUSIONS: The prevalence of HBV and HCV co-infection with HIV in Thai patients is significant. In the author s resources-limited setting, history of intravenous drug use is a major indicator to screen for both HBV and HCV co-infection. Male gender and elevated serum ALT level are also suggestive of HCV co-infection.