Snakebites at Maharat Nakhon Ratchasima Regional Hospital.

One hundred and ninety-nine victims of snakebite hospitalized at Maharat Nakhon Ratchasima Hospital between 1898 and 1991 were studied. The male:female ratio was 1.9:1 and their mean age (+/- SD) was 30.0 +/- 18.6 years. The most common of victims were farmers and laborers. Dead snakes were identified as follows: 72 were Trimeresurus sp. (36.2%), 36 were Naja kaouthia (17.6%), 4 were Bungarus fasciatus (2.0%), 1 were Colloselasma rhodostoma (0.5%) and 1 was Vipera russelli (0.5%). No death was noted among the victims bitten by Trimeresurus sp, C. rhodostoma and V. russelli. Fifty-eight victims exhibited complications, constituting 29.1%. Four cases died from the bite of N. kaouthia, 2 from B. fasciatus and 1 from unidentified snake. A total death rate was 3.5% (7 in 199 cases). The mean duration in the hospital for patients bitten by Trimeresurus sp. and N. kaouthia were 2.3 days and 2.0 days, respectively. In order to decrease the morbidity and mortality of snakebite victims in Nakhon Ratchasima Province, prevention and control of this entity should be emphasized in health education of local people, training programs on appropriate management of snakebites for the medical and paramedical personnel working in the remote rural district hospitals and health centers. In addition, antivenoms and other necessary medical supplies should be adequately provided.

Detection of human immunodeficiency virus type 1 (HIV-1) proviral DNA in breast milk and colostrum of seropositive mothers.

There is increasing evidence of vertical transmission of HIV-1 to infants through breast feeding of milk from HIV-1 infected mothers. It has been postulated that transmission occurs mainly via ingestion of infected cells in breast milk and colostrum. In this study, detection of HIV-1 proviral DNA was used to prove that cells from colostrum and milk do contain HIV. DNA were extracted from these cells of colostrum and milk of 18 seropositive mothers and amplified by nested PCR for HIV-1 gag and pol and 44 per cent were positive mostly by two primers. All ten negative control samples from seronegative mothers were negative. This study demonstrated the infectivity of breast milk and colostrum. Nevertheless, recommendation against breast-feeding should be weighed against poor alternatives in low socioeconomic families.

An intervention model for breast feeding in Maharat Nakhon Ratchasima Hospital.

To promote breast feeding and/or prevent further decline of adverse infant feeding practices, we developed an integrated comprehensive breast feeding promotion program, and implemented it in Maharat Nakhon Ratchasima Hospital in 1987. The program provided sound knowledge and attitudes toward breast feeding to all mothers at the Antenatal Care Unit, delivery room, the Postnatal Care Unit, and the Outpatient Department. The program activities included early bonding, assistance with initiation of breast feeding, rooming-in, provision of a breast feeding corner in the special care unit, collecting breast milk for sick babies, a lactation clinic and home visits. The impact of the program was evaluated in 1992. Altogether 1,428 mothers were interviewed using structured questionnaires. The results were highly encouraging. A majority of the mothers were of low socioeconomic status, 60 percent of them worked outside the home, and 40 percent were housewives. Compared with baseline data reported in 1986, breast feeding in infants aged 0 to one month increased from 85 to 90 percent, and the practice in the nine- to 12-month old group increased from 39 to 47 percent. However, the acute drop of the practice from 90 percent at birth to 50 percent at the one- to two-month old stage observed was similar in the two studies. The main reasons given by mothers for prematurely stopping breast feeding were the mothers' working outside the home (46%), and insufficient milk (23%). Provision of breast feeding education, along with improved maternal nutrition, extension of maternity leave, and availability of nurseries at the work place, may sustain a longer period of breast feeding.

Medical emergencies at Ramathibodi Hospital, Bangkok, and Maharaj Hospital, Nakorn Ratchasema.

This report is based on a retrospective analysis of 14;914 medical emergency patients at Ramathibodi Hospital and Maharaj Hospital, Nakorn Ratchasema during 1985. It was found that : 1. The commonest medical emergencies were gastrointestinal emergencies (22-31%), followed by emergencies of the respiratory system (15-21%), infections (12-17%), cardiovascular system (7-15%) and the nervous system (10-11%). The prevalence rates of the remaining systems were less than 6%, the majority being less than 2%. 2. The commonest medical emergencies in each system were 2.1 Gastrointestinal system : acute abdomen (44-5%), followed by serve diarrhoea and gastrointestinal haemorrhage. 2.2 Respiratory system : severe asthma (35-64%), followed by pneumonia and breathlessness. 2.3 Cardiovascular system : heart failure (38-54%), followed by angina and myocardial infarction, severe hypertension and cardiac arrhythmias. 2.4 Nervous system : stroke (37-47%) followed by encephalitis and meningitis, status epilepticus and severe headache. 2.5 Endocrine system : glycaemic crises (82-87%) 2.6 Haematological system : severe anaemia (64-83%). The differences in prevalence rates of the medical emergencies at Ramathibodi Hospital (Bangkok), Maharaj Hospital (Nakorn Ratchasima) and John Radcliffe Hospital (England) are discussed.

ELISA testing in cases of clinical angiostrongyliasis in Thailand.

The sera from 116 Thais admitted to Nakhon Ratchasima hospital in northeastern Thailand with eosinophilic meningitis were tested for antibodies to Angiostrongylus cantonensis by ELISA. Ninety-six percent of the sera were considered positive with ELISA values exceptionally high for most patients. The clinical aspects of the disease are also presented. The ELISA test is considered to be of value in the diagnosis of the disease but tests for the antigen would provide a more definitive diagnosis.