Diarrhea among children admitted to a private tertiary-care hospital, Bangkok, Thailand: a case series.

We report here a case series of pediatric diarrhea cases admitted to a private tertiary-care hospital in Bangkok, Thailand. Retrospective data were collected from computerized medical records of 2,001 children with diarrhea (80.9% Thai), ages birth to 14 years, admitted to our facility during 2000-2005. The most common symptom leading to admission was vomiting (34.6%), while the most common sign was dehydration (63.6%). The largest proportion was comprised of toddlers (45.4%), followed by infants (24.2%). Of the total 2,564 admissions, 1,874 (73.1%) stool samples were collected and examined for red blood cells (RBC) and white blood cells (WBC); 57.1% and 70.6% were negative for RBC and WBC, respectively. Of the 1,878 blood specimens collected for electrolytes, 21.6% show acidosis. Of 1,793 stool specimens collected, the majority revealed normal flora (72.9%). Enteropathogenic Escherichia coli (EPEC) were seen in 10.8%. Campylobacter jejuni was found in only 2.9% of specimens, while of 1,065 specimens tested for rotavirus antigen, 23.9% were positive. In addition to bacterial cultures and their anti-microbial sensitivities, factors associated with rotavirus infection, C. jejuni, and metabolic acidosis, were also explored in this study. Rotavirus infections were more likely to be associated with children older than toddlers (3-14 years old), being admitted within the first day of the symptoms, those who were more acidotic, and was more common in the first 3 months of each year. Our data were little different from community-acquired infections reported among the general population.

Social harms in injecting drug users participating in the first phase III HIV vaccine trial in Thailand.

OBJECTIVE: To study related social harms due to identification with a group of participants in an HIV-1 vaccine trial who are potentially high risk for HIV/AIDS. MATERIAL AND METHOD: Two thousand five hundred forty six injecting drug users (IDU) were enrolled in a 36-month vaccine trial. Volunteers received education and risk reduction counseling at every six-month study visit. Social harms were not actively solicited, but volunteers were encouraged to report any during the process of counseling at every six-month visit. If a social harm was reported, a questionnaire was administered and the harm was tracked If necessary, clinic staff assisted in resolving the social harm. RESULTS: Thirty-nine social harms were reported by 37 participants; 33 (84.6%) were disturbances in personal relationships, three (7.7%) in employment, one (2.6%) was medically related, one (2.6%) was related to admission in the military and one (2.6%) was related with misbelieve about the vaccine. The most common reason for disturbances in personal relationships was suspicion of HIV infection (n=20). The impact of these harms on quality of life was characterized as minimal by 31 (79.5%) participants, as moderate by seven (17.9%), and as major by one (2.6%). All social harms were documented to be resolved by the end of the study. CONCLUSION: A few participants reported study-related social harms during the course of the trial. Most harm had minimal impact and all could be resolved by the end of the present study.

Intussusception in a private tertiary-care hospital, Bangkok, Thailand: a case series.

This was a retrospective case series study of patients with intussusception at a private tertiary-care hospital in Bangkok, Thailand. The computerized hospital records of all 94 children aged 0-14 years diagnosed with intussusception from 2000 to 2005 were reviewed. About half (51.1%) were males, 23.4% were less than 1 year old. Most (78.7%) were Thai nationals. The highest case frequency was in August (n=12, Poisson means = 7.8, 95% confidence interval 6.3-9.6). Of these, none had the classical triad of vomiting, colicky pain, and mucous bloody stools. Only 12.8% had fever; abdominal mass was detected in 4.3%, and 4.3% had increased bowel sounds, while 34.0% had no specific signs. The most frequent site of intussusception was the ileocolic (62.6%). Stool cultures for bacteria and stool for rotavirus antigen obtained in some cases revealed no significant findings. Of the cases, 10 (10.6%) had spontaneous reduction, 84 (89.4%) underwent barium enema intervention, 10 of the latter (11.9%) required further surgical intervention. There were no mortalities during the observation period. There were 10 recurrent events in this series. The 7-day recurrence-free probability was 84.9% (95% CI 49.2, 96.3%). This study provides baseline data regarding intussusception in Thailand which may be useful for future epidemiological and/or clinical studies.

Factors related to volunteer comprehension of informed consent for a clinical trial.

The informed consent process has become a universal requirement for research involving human subjects. Its goal is to inform volunteers regarding research in order to make decision to participate or not. This study aimed to measure volunteers' comprehension levels concerning the clinical trial and to find out factors associated with that comprehension levels. Eighty-one volunteers who enrolled in a malaria clinical trial were recruited into the study. A semi-structured questionnaire was used to collect the information. Non-participant observation was used to observe the process of informed consent. Volunteers were interviewed three days after being recruited into the trial. The results show the volunteers' comprehension was low. Only 44% of volunteers had an acceptable level of comprehension. It also revealed that 20 volunteers were not aware of being volunteers. Most volunteers knew about the benefits of participating in the trial and realized that they had the right to withdraw from the study, but not many knew about the risks of the trial. The results indicated the method of informing about the trial affected the volunteers' comprehension level. No relationship was found between comprehension level and volunteers' socio-demographic characteristics and their attitude toward the consent process. The findings from this study demonstrate volunteers who participated in the clinical trial were not truly informed. Further studies regarding enhancing volunteers' understanding of the trial are needed.

Modified Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia for Thai elderly.

A potential test for early detection of dementia in the elderly is the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which is based on information from the informant for the elderly about the changes of the elderly in everyday cognitive functioning associated with dementia. The present study aimed to modify and assess the reliability and validity of the modified IQCODE consisting of 32 items. The study consisted of two methods of assessing dementia: DSMIV diagnosis carried out by clinicians, and informants responding to the IQCODE. The subjects were 200 pairs of elderly subjects and their informants who visited the Geriatric Clinic, Ramathibodi Hospital. The optimal cutoff score on the modified IQCODE was 3.42, with 90% sensitivity and 95% specificity. The positive predictive values, negative predictive values, and accuracy were 0.94, 0.90, and 0.92, respectively. The IQCODE items had high internal consistency. The IQCODE associated with the elderly person's age, but not with their gender and educational level; nor were they associated with the demographic characteristics of the informant. Therefore, the IQCODE could be used as an alternative screening test for dementia in Thailand with acceptable sensitivity and specificity. This tool may be useful for dementia screening in the community and the geriatric clinic for early detection of disease.

Missed appointments at a tuberculosis clinic increased the risk of clinical treatment failure.

We investigated the charts of 381 new smear-positive tuberculosis patients at Khon Kaen Medical School during 1997-2001 using World Health Organization definitions to evaluate associations among treatment success or failure (defaulted, failed, died, or not evaluated) and tuberculosis clinic contact, demographics and clinical characteristics of the patients. Multinomial logistic regression was used for three-category outcome analysis: treatment success, transferred-out and clinical treatment failure. The treatment success and clinical treatment failure rates were 34.1% and 34.4%, respectively. About 46.5% and 85.8% of patients missed appointments at the tuberculosis clinic in the treatment success and treatment failure groups, respectively. The results show that patients who were absent from the tuberculosis clinic were 5.95 times more likely to have clinical treatment failure than treatment success, having adjusted for the effect of transfering-out and the effect of the treatment regimen and the sputum conversion status (adjusted odds ratio = 5.95; 95% CI: 2.99 to 11.84). The review showed that absence from the tuberculosis clinic was an independent risk factor for clinical treatment failure. We recommended that all new smear-positive tuberculosis patients should be followed closely at a tuberculosis clinic.

The prevalence of lower genital tract infections among ante-natal care (ANC) clinic patients in two central hospitals, Vientiane, Lao People's Democratic Republic.

This study of lower genital tract infections in pregnant women attending antenatal clinics in Vientiane, Lao PDR is a response to the reported rapid increase in the number of HIV infections in neighboring countries, and is a recognition of the important role of reproductive tract infections in facilitating HIV transmission. This cross-sectional study determines the prevalence of lower genital tract infections among 500 antenatal attendees (gestational age < or = 20 weeks) attending two hospitals serving urban areas in Vientiane, between September 2001 and March 2002. Most participants were housewives (64.4%) and government workers (16.0%). Their husbands were mainly government officers (31.4%), laborers or farmers (30.2%), and businessmen (12.4%). Sixty-four percent reported a past history of "any vaginal complaints" with 44.2% having sought treatment. Candida spp had the highest prevalence of all infections (27.0%), followed by bacterial vaginosis (14.4% by Amsel's criteria and 22.0% by Nugent's score), C. trachomatis (10.2% by nucleic acid hybridization and 9.6% by PCR), T. vaginalis (1.8%), and N. gonorrhoeae (0.8%), but no syphilis serological markers. Taken in conjunction with other surveillance data from the same period, this study indicates an opportunity to prevent epidemic spread into the community of both sexually transmitted disease and HIV by appropriate preventative programed activities, including treatment services targeted at higher risk community groups.

Development of multiplex PCR for the detection of total coliform bacteria for Escherichia coli and Clostridium perfringens in drinking water.

Multiplex PCR amplification of lacZ, uidA and plc genes was developed for the simultaneous detection of total coliform bacteria for Escherichia coli and Clostridium perfringens, in drinking water. Detection by agarose gel electrophoresis yielded a band of 876 bp for the lacZ gene of all coliform bacteria; a band of 147 bp for the uidA gene and a band of 876 bp for the lacZ gene of all strains of E. coli; a band of 280 bp for the p/c gene for all strains of C. perfringens; and a negative result for all three genes when tested with other bacteria. The detection limit was 100 pg for E. coli and C. perfringens, and 1 ng for coliform bacteria when measured with purified DNA. This assay was applied to the detection of these bacteria in spiked water samples. Spiked water samples with 0-1,000 CFU/ml of coliform bacteria and/or E. coli and/or C. perfringens were detected by this multiplex PCR after a pre-enrichment step to increase the sensitivity and to ensure that the detection was based on the presence of cultivable bacteria. The result of bacterial detection from the multiplex PCR was comparable with that of a standard plate count on selective medium (p=0.62). When using standard plate counts as a gold standard, the sensitivity for this test was 99.1% (95% CI 95.33, 99.98) and the specificity was 90.9 % (95% CI 75.67, 98.08). Multiplex PCR amplification with a pre-enrichment step was shown to be an effective, sensitive and rapid method for the simultaneous detection of these three microbiological parameters in drinking water.

HLA class II (DRB1, DQA1 and DQB1) allele and haplotype frequencies among HIV-infection discordant Thai couples.

We investigated the association of HLA-DRB1, -DQA1 and -DQB1 alleles and haplotypes in 33 Thai HIV discordant couples. A significantly lower frequencies of DRB1*14 (3.0% vs 11.3%, p = 0.048) and DQA1*0103 (0.0% vs 5.63%, p = 0.042) alleles were found in the seropositive individuals when compared with HIV-negative controls. In contrast, there was no significant difference in HLA-DQB1* allele frequencies. The haplotype analysis revealed that DRB1*1501-DQA1*0102-DQB1*0601 (7.6% vs 0.0%, p = 0.002), DRB1*0405-DQA1*0302-DQB1*0401 (7.6% vs 1.3%, p = 0.024) and DRB1*1401-DQA1*0104-DQB1*05031 (6.1% vs 0.0%, p = 0.007) were found to be significantly higher frequencies when compared between HIV seronegative partners and HIV negative controls, but DRB1*1501-DQA1*0102-DQB1*0502 (0.0% vs 8.1%, p = 0.01) was significantly lower. The DRB1*1602-DQA1*0101-DQB1*0502 (4.6% vs 0.0%, p = 0.024) haplotype was found to be significantly higher frequencies in HIV seropositive individuals when compared to HIV negative controls but the DRB1*1502-DQA1*0101-DQB1*0501 (1.5% vs 8.1%, p = 0.049) haplotype was lower.

Simultaneous determination of trans, transmuconic acid and s-phenylmercapturic acid by high pressure liquid chromatography and its application.

The simultaneous determination of urinary trans,trans-muconic acid (t,t-MA) and S-phenylmercapturic acid (S-PMA) was performed by liquid extraction with ethyl acetate and reversed-phase high performance liquid chromatography (RP-HPLC) on a Hypersil-ODS column using the gradient mobile phase of methanol and 0.0012 N perchloric acid and diode array detection at 205 and 264 nm for S-PMA and t,t-MA, respectively. The retention times for t,t-MA and S-PMA were 3.8 and 12.3 minutes, respectively. The recoveries of t,t-MA and S-PMA were > 97%; between-day precisions were all within 8% RSD (100x SD/mean). The method was applied to analyze the urinary t,t-MA and S-PMA of 59 service station attendants exposed to average benzene concentrations in the air of 0.20+/-0.18 ppm. Significant differences in pre-shift and post-shift urinary t,t-MA between smokers and non-smokers were found.

Prevalence of lower genital tract infection among women attending maternal and child health and family planning clinics in Hanoi, Vietnam.

To determine the prevalence of lower genital tract infection (LGTI) with Candida spp, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis among symptomatic and asymptomatic women attending maternal and child health and family planning (MCH/FP) clinics in Hanoi, Vietnam. A multi-centered, cross-sectional descriptive study stratified by reported symptoms of vaginal discharge was carried out in three MCH/FP clinics among 1,000 women aged 18-44 years in 1998. Of these, 89.1% lived in Hanoi, 97.6% were currently married, and 99.2% had only one sexual partner in the past 12 months. Regarding their contraceptive use, 28.2% did not use any contraception, 25.6% used an intrauterine device (IUD), 22.8% used condoms, and 23.4% used other methods. The overall prevalence of Candida spp was 11.1% (95% CI = 9.1-13.1%); T. vaginalis, 1.3% (95% CI = 0.6-2.0%); no gonococcal infection was found; the prevalence of C. trachomatis was 4.4% (95% CI = 3.1-5.7%); and of bacterial vaginosis, 3.5% (95% CI = 2.4-4.6%). The presence of LGTI was not associated with reported symptom of vaginal discharge. LGTI was common among married and monogamous women attending MCH/FP clinics in Hanoi, of whom many used IUDs and may have an increased risk of complications in the presence of LGTI. The lack of association between symptoms and laboratory-confirmed infection underscores the challenge of diagnosing LGTI when laboratory testing is not available.