Factors affecting patients' acceptance of H.I.V. infections.

A study on patients' acceptance of the diagnosis of HIV infection was done in 36 patients at Ramathibodi Hospital. Patients were interviewed based on the data in a questionnaire. Over one half of the patients were 21-40 years old. Eighteen patients were prostitutes. The stages of the infection were: AIDS in 1, AIDS-related complex in 9 and asymptomatic in 26 cases. The rate of acceptance of having the infection did not differ regarding age, education, income, risk factors in acquiring the infection, and the stage of the disease. However, all patients who had worked in a foreign country did not accept the diagnosis while all who had never worked abroad did. Patients whose family knew that they had the infection accepted the diagnosis better than those whose family did not know. It is concluded that a substantial portion of patients did not accept that they had HIV infection. Counselling must be appropriately applied to each individual.

HIV seroconversion in Thai hemophiliacs up to 1991.

In Thailand, the anti-HIV screening in the donor blood was started in 1987 and was compulsory nationwide in February 1989. Sixty-six hemophilia A and 10 hemophilia B patients who received approximately six million units of factor VIII and IX in the form of fresh frozen plasma, frozen cryoprecipitate, cryoprecipitate removed plasma, fresh dry plasma and factor concentrate during 1976 to 1991 were tested for anti-HIV since 1987. The age ranged from 1-39 year (mean +/- SD = 15 +/- 7.3). The anti-HIV test was performed by ELISA and/or gel agglutination and confirmed by Western blot analysis. The patients would be checked 1-2 times per year and as necessary. A total of 174 tests for the first, second, third, fourth, fifth and sixth tests were studied in 76, 49, 27, 14, 5 and 3 patients respectively during 1987 to 1991. The prevalence of HIV seroconversion in the year 1987, 1988, 1989, 1990 and 1991 was 2.2% (1/45), 1.9% (1/53), 1.6% (1/63), 1.5% (1/67) and 3.9% (3/76) respectively. Three HIV seroconversion were found in the first, fourth and fifth anti-HIV test in 3 hemophilia A patients who received massive infusion of blood components during orthopedic corrective surgery. One case of HIV seroconversion found in 1987 was transmitted by HIV unscreened blood while 2 cases in 1991 by anti-HIV seronegative blood whose donors were in the window period of HIV infection. The prevalence of HIV seroconversion in Thai hemophiliacs is much lower than those in western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis B vaccination in Ramathibodi health personnel 1986-1987.

Hevac-B-Pasteur 5 mcg, H-B-Vax I 20 mcg, and Engerix B 20 mcg, were given to 23, 34, 15 health personnel in Ramathibodi hospital. The seroconversion rate for Pasteur vaccine was 85 per cent compared to 95 per cent for the other two groups. Adverse reactions were few and transient.

Prevalence of chlamydial infection in patients with gonococcal urethritis.

Using a fluorescein labelled monoclonal antibody ("Microtrak") to identify Chalmydia elementary bodies in urethral smears, we detected Chlamydia trachomatis in 32 (26.67%) of 120 male patients after treatment of their gonococcal urethritis. Sixteen of these 32 patients (50%) had normal urethral smear. Only 16 (50%) of the patients yielding chlamydia would have received treatment in the absence of diagnostic service for chlamydial infection.

Prevalence, detection and control of hypertension in Thai population of a central rural community.

Epidemiolagical survey of hypertension was carried out on 2,374 villagers, aged 15 years and above, residing in Bang-Pa-in district, Ayutthaya province. The overall prevalence of hypertension was 11.3 per cent. The prevalence rate of pure systolic hypertension rose with age up to elderly; whereas the prevalence rate of diastolic hypertension increased with age up to late middle age, then declined in the elderly. Regarding the detection of hypertension, only 41.6 per cent of the cases were previously detected. And only 30.1 per cent of the cases were under current treatment. Females had a greater proportion of previously detected and currently treated cases than males. Among those currently treated hypertensive patients, 50.5 per cent went to see a physician, 29.5 per cent went to the local health centers; the rest sought the services of local quacks, traditional healers and drug stores. It yielded only 24.7 per cent of the treated cases whose BP were under control. Since the people prefer seeking help from local personnel, the role of community health personnel should be strengthened to bring more effective control of the disease.

Salmonella and Shigella carrier rates and environmental sanitation in a rural district, Central Thailand.

The study of Salmonella and Shigella carrier rates were carried out in two Tambol (sub districts). Klongjik, Kanon-Laung and Amphur (district) Bang-Pa-In. The carrier rates of Salmonella and Shigella were 3.3% and 0.8% respectively. Most Salmonella strains were sensitive to the antibiotics commonly used; only 6.4% and 3.2% were resistant to tetracycline and neomycin. All Shigella isolated were resistant to chloramphenicol and 75% to tetracycline. One fourth of the families defecated in the river or canal or went to the field and one third disposed the garbage into the river or canal. This contaminated water was used for drinking by 62.7% of all families and only 28.1% treated the water by boiling. The disease vectors bothering the villagers were rats 58.8%, flies and cockroaches which served as important vehicles for cross contamination. The prevalence rate of diarrhoeal disease in the villages was 1933 per 100,000 and presented as the morbidity rate of this disease in the district hospital, only 355 to 363 per 100,000 in 1979 and 1980. Health care for diarrhoeal diseases in these villages were 61% by self-medication, 36% using the village healer and only 3% went to the district hospital. The effective means to eliminate transient and chronic carriers of Shigella and Salmonella typhi may be very important but other means of prevention of diarrhoeal diseases of typhoid fever are through the sanitary disposal of human excreta and the development of safe water supply should be emphasized.

Tachypleus lysate test for endotoxin in patients with Gram negative bacterial infections.

Amoebocyte lysate from the horseshoe crabs (Tachypleus gigas) which abounds in the Gulf of Thailand was used to detect endotoxin in patients with Gram-negative bacteremia, in patients with Gram-positive bacterial infections as well as in the control. The Tachypleus lysate test (TLT) was positive in 94.4% of 36 patients with Gram-negative bacteremia before initiation of antibiotic therapy. Only 4% of 50 healthy individuals were positive and all 7 patients with Gram-positive bacterial infections were negative. The threshold sensitivity of TLT was 0.625 micrograms endotoxin per ml of the plasma. In comparison with the commercial Limulus lysate test (LLT), the TLT was slightly more sensitive in exhibiting higher grade of reaction, eventhough the threshold sensitivity was the same.