ABSTRACT
An 80-year-old man was referred to our hospital due to anorexia and loss of body weight. Blood examination showed a severe inflammatory reaction and <i>Streptococcus oralis </i>was detected in his blood culture. Echocardiogram demonstrated severe aortic valve regurgitation and vegetation located on the valve. Although we diagnosed infective endocarditis (IE) and started to treat with antibiotics, the patient refused treatment and was discharged. Ten days later, he was readmitted to our hospital because of chest pain. Electrocardiogram demonstrated an anteroseptal acute myocardial infarction and an emergency coronary angiogram revealed complete obstruction of the left anterior descending coronary artery (LAD). He was successfully treated with thrombus aspiration using a catheter device. Pathological examination of the thrombus revealed that the coronary embolism was caused by infective endocarditis (IE). To prevent re-embolization, we performed aortic valve replacement 8 days after the intervention and CABG was also carried out for residual stenosis on the LAD. Coronary embolism caused by IE is a rare problem. We reported a case of AMI associated with IE that was initially treated with thrombus aspiration which was followed by aortic valve replacement.
ABSTRACT
<b>Introduction</b><br> During the course of primary health care activities in Khammouane province of Lao PDR by non- profit organization, international support and partnership for health, an exceedingly high infant mortality rate was recognized in some villages. As thiamine deficiency was strongly suspected for the main cause of the high mortality, the household survey with an emphasis on nutritional aspect and the measurement of thiamine level in the blood of mothers as well as their breast-milk were carried out for the confirmation.<br><b>Methods</b><br> The survey was conducted at Sibounhouane sub-district (Group 1) with the highest infant mortality and Hatkhamhieng sub-district (Group 2) with the lowest mortality. Fifty families of the two groups, each consisting of randomly selected 25 families with less than one year old infant(s) were interviewed by using prepared questionnaire. The body weight of both mother and infant was measured and blood and milk were taken from the mother.<br><b>Results</b><br> The ethnic minorities of the group 1 consisted of Lao Lum (44%) and Lao Theung (56%), whereas only Lao Lum in the group 2. The economical indicators and the mother's educational level in the group 1 were inferior to those in the group 2. There was no significant difference in the methods of preparing staple glutinous rice, likely to flux thiamine and intake of thiaminases between the two groups. High infant mortality rate was documented in the group 1 whose clinical symptoms were mostly consistent with those of infantile beriberi. The concentration of thiamine in the blood and milk of mothers in both groups were considerably lower and significant reduction of thiamine level was observed in the group 1 than the group 2. Nevertheless, both groups of those infants tended to be inadequately fed with the foods except for breast-milk during their early infantile phase.<br><b>Conclusions</b><br> The low concentration of thiamine in the blood and milk of mothers was strongly suggestive that infantile beriberi due to thiamine deficiency was the principal cause of the infant mortality in the study region. We hereby surmise that thiamine deficiency could be extensively prevalent in Lao PDR than the currently studied areas because of their traditional preparing methods of staple dietary rice, postpartum food taboos and intake of thiaminases. For the prevention of infant death due to severe thiamine deficiency, necessary measures including the exchange of information among the institutions concerned, adequate thiamine supplementation and nutritional counseling have to be urgently adopted.
ABSTRACT
In 1999, an insecticide-treated net (ITN) distribution project was started in several malaria-endemic villages in Lao P.D.R., namely Vientiane, Bolikhamxay and Khammouanne Provinces. After the completion of the project, it was found that the ITNs were effective for malaria control based on the analysis of the slide positivity rate for malaria parasites between 1999 and 2000 [6]. We conducted malariometric, entomological and KAP surveys in 2005-06 to confirm the status of malaria and to determine the effectiveness of ITNs in three different socioepidemiological areas (<I>near city, rural and remote</I>), represented by the Xebangfay and Boualapha districts, Khammouanne Province.<br>A marked decrease in the annual malaria incidence and slide positivity rate was noted from 1999 to 2006 in the two districts. The malaria prevalence was significantly reduced in <I>near city</I> areas (5.6%-10.7% in 1999 to 0% in 2005-06) and <I>rural</I> areas (21.4%-50.9% in 1999 to 0%-1% in 2005-06). Twelve positive cases were recorded in <I>remote</I> areas (3.4 - 7.7% in 2006).<br>The illiteracy rate was significantly higher among the respondents in the <I>remote</I> (83.9%) than among those in the <I>near city</I> (32.7%) and <I>rural</I> (54%) areas. In all areas, more than 50% of the villagers indicated that they were not aware of malaria. Similarly, about 60% of the respondents were found to have incorrect knowledge concerning malaria transmission. In <I>remote</I>, 40.9% of the respondents were aware of the methods to prevent malaria infection and 49.5% used mosquito nets throughout the year, rates significantly lower than the corresponding rates in <I>near city</I> and <I>rural</I>. The density of persons per net in <I>remote</I> (3.1-5.9) was considerably higher than that in <I>near city</I> (1.8-2.1) and <I>rural</I> (1.2-2.7). Malaria vector mosquitoes, such as <I>An. minimus</I> and <I>An. nivipes</I> were collected by human-baited adult collection, and cow-baited and CDC light traps. The results of the analysis suggested that the lower the number of persons per net the more effective the reduction of malaria morbidity in these areas. It is imperative that ITN distribution and health education regarding malaria be strengthened, especially in <I>remote</I>, but also in other areas.