Comparison of bacterial eradication between standard and double-painted antiseptic application method in minor hand surgery.

Background: Bacteria need to be eliminated for skin preparation in minor hand surgery. The standard method of skin preparation uses an antiseptic scrub and antiseptic solution, which is expensive and time-consuming. Objective: Design a “double-painted antiseptic application method”, and compare the effectiveness of eliminating bacteria at the area around the hand and wrist between the standard method and the double-painted antiseptic application method. Methods: This cross-over designed experimental study was performed on seven volunteers. The standard and the double-painted antiseptic application method were alternately used for skin preparation around the hand, wrist, and half of the forearm. The bacterial colony counts were collected before, immediately after, and at 45 minutes after skin preparation by using the modified glove-juice technique. The primary outcomes were the eradication rate and the number of bacterial colonies. Results: There was no statistical difference in bacterial colonies between either method before skin preparation. The median of bacterial colony counts immediately after and at 45 minutes after skin preparation were zero colony forming units per milliliter in both methods. The eradication rate was 61.5% and 76.9% in the standard and doublepainted antiseptic application method, respectively, for a risk difference of -15.4. There was no statistically significant difference (p=0.67). Conclusion: The number of bacterial colonies and eradication rate were not significantly different between either method. The double-painted antiseptic application method can be used instead of the standard method for the skin preparation in minor hand surgery, which has an expected duration of about 45 minutes or less.

Outcome of myringotomy with ventilation tube for otitis media with effusion in Thai children: Ramathibodi experiences.

OBJECTIVE: Study the otologic and audiologic outcome when using a ventilation tube (VT) for the treatment of otitis media with effusion (OME) in Thai children. MATERIAL AND METHOD: The medical records of twenty-three pediatric patients, 17 male and 6 female, aged 4 to 11 (mean age of 6.8 years), with the diagnosis of OME who attended the Department of Otolaryngology, Faculty of Medicine Ramathibodi Hospital, between January 2001 and December 2006 were reviewed. Seventeen (73.9%) patients had associated diseases, 26% with allergic rhinitis (AR), 21.7% with obstructive sleep apnea from chronic hypertrophic tonsillitis and adenoid hypertrophy (OSA), and 26% with cleft palate (CP). The audiometric with tympanometric assessment were done pre- and post-operative with mean of 47.3 and 294.2 days respectively. All children were treated with myringotomy and insertion of VT. Oto-microscopic examinations for tympanic membrane pathologic abnormalities were confirmed Post operative otorrhea cases were identified. The extrusion rates of VT were also recorded after the insertion. RESULTS: Twenty-three patients were enrolled in the present study. Mean air-bone gap was 18.24 (SD = 13.04) and 10.83 (SD = 8.26) before and after the operation respectively, and the difference was statistically significant (p = 0.0013). This could be interpreted that myringotomy with insertion VT could improve hearing by decreasing the air-bone gap dB. Having assessed the effect of associated diseases (i.e., AR, OSA, and CP) on differences of air-bone gap between before and after operation, the authors found that having AR, OSA, and CP did not statistically affect the results of the operation. However the mean differences of air-bone gap between before and after operation were quite different for AR versus non-AR (-11.58 vs. -5.78), and OSA versus the non-OSA group (-12.10 vs. -5.95). This might have the effects of the two factors but with this small sample size and thus low power could not detect the effect. Tympanometric pattern was mainly type B in the pre-operative (79.3%) and post operative (62.5%) period after tympanic membrane closure in both ears. Mucoid fluid in the middle ear cavity of both ears was detected during the operation in all patients. Post operative otorrhoea occurred in 16.7%. The mean of extrusion rate of VT was 307.2 +/- 204.7 days with maximum of 760 days. The mean duration of OME before surgery was 384.1 days. CONCLUSION: The effects of conventional VT in Thai children with OME could improve statistical significant hearing by decreasing the air-bone gap. The associated diseases (i.e., AR, OSA, and CP) did not statistically affect the results of the operation.

Efficacy of a generic fixed-dose combination of stavudine, lamivudine and nevirapine (GPO-VIR) in Thai HIV-infected patients.

BACKGROUND: GPO-VIR, fixed-dose combination of stavudine 30/40 mg, lamivudine 150 mg, and nevirapine 200 mg are widely used in Thailand. OBJECTIVE: Determine the efficacy and tolerability of GPO-VIR in naive HIV-infected patients. MATERIAL AND METHOD: Primary outcome was the time of initiation to achieve the goal of therapy, which was HIV RNA < 50 copies/mL or 50% increased of CD4 cell count. Ninety patients were eligible for the present study. Mean +/- SD age was 35 +/- 7 years and 51% were male. Median baseline CD4 and HIV RNA were 52 cells/ mm3 and 280,000 (5.4 log10) copies/mL, respectively. Sixty-two (69%) patients had previous opportunistic infections. RESULTS: In a median follow-up period of 15 weeks, 49 (54%) patients achieved the goal of therapy. The probability of goal achievement showed that 12-, 24-, 36- and 48- weeks success rates were 8.5% [95% confidence interval (CI): 3.9-18.0%], 62.7% (95% CI: 50.8-74.6%), 80.0% (95% CI: 67.3-90.1%), and 93.3% (95% CI: 76.3-99.4%), respectively. The median success time to achieve the goal was 21 weeks. Eleven (12%) patients needed to discontinue GPO-VIR because of adverse drugs reaction. CONCLUSION: GPO-VIR may be one of the antiretroviral regimens for HIV-infected patients in Thailand and other resource-limited countries. Its efficacy is good in patients with advanced HIV infection.

Virological and immunological responses of efavirenz-based HAART regimen initiated in HIV-infected patients at CD4 < 100 versus CD4 > or = 100 cells/mm3.

OBJECTIVE: To compare virological and immunological responsiveness of efavirenz (EFV)-based highly active anti retroviral therapy (HAART) between patients with baseline CD4 < 100 and CD4 > or = 100 cells/mm3. MATERIAL AND METHOD: A prospective cohort study in antiretroviral-naive HIV-infected patients was conducted between February and April 2002. Donated HAART regimen, consisting of stavudine, didanosine, and EFV was initiated. The primary outcome was time to undetectable HIV RNA, < 50 copies/mL. Patients were followed up every 12 weeks until 48 weeks (the end of the study). RESULTS: Forty-six patients were included, 21 patients for CD4 < 100 cells/mm3 and 25 patients for CD4 > or = 100 cells/mm3. Median CD4 cell counts of these corresponding groups were 26.5 and 177 cells/mm3. Patients' characteristics were similar between the two groups except CD4. The probability of undetectable HIV RNA at 12, 24, 36, and 48 weeks were 57.1% (95% CI, 37.7-78.1%), 76.2% (95% CI, 56.9-91.3%), 80.9% (95% CI, 62.3-94.0%), and 90.5% (95% CI, 68.9-99.1%) for the former group; and 64.0% (95% CI, 45.8-81.8%), 92.0% (95% CI, 77.5-98.6%), 96.0% (95% CI, 83.0-99.7%), and 96.0%.(95% CI, 83.0-99.7%) for the latter group. Median time to undetectable HIV RNA was 12 weeks for both groups. Median CD4 change at 48 weeks was 171 and 132 cells/mm3, respectively (p = 0.232). The adverse events were similar between the two groups. CONCLUSION: Initiation of EFV-based HAART regimen in HIV-infected patients at CD4 < 100 and > or = 100 cells/ mm3 gains similar immunological and virological response.

A mixture model application in disease mapping of malaria.

Disease mapping, a method for displaying the geographical distribution of disease occurrence, has received attention for more than 2 decades. Because traditional approaches to disease mapping have some deficiencies and disadvantages in presenting the geographical distribution of disease, the mixture model--as an alternative approach--overcomes some of these deficiencies and provides a clearer picture of the spatial risk structure. The purpose of this study was twofold: (1) to investigate the geographical distribution of malaria in Thailand during 1995, 1996, and 1997 by applying the mixture model to disease mapping, and (2) to investigate the dynamic nature of malaria in Thailand during the 3-year time frame by applying the space-time mixture model. Non-parametric maximum likelihood estimation was employed to estimate the parameters of both the mixture model and the space-time mixture model. Applying Bayes' theorem, the 76 provinces of Thailand were classified into component risk levels by the rate of malaria for each province. Malaria intensively occurred in 4 provinces on the Thai-Myanmar border and in 2 provinces on the Thai-Cambodian border. Of the 76 provinces studied, 10 showed an increasing trend over the 3-year period. A comparison of the map based on the mixture model with the map based on the traditional percentiles method indicates that the non-parametric mixture model removes random variability from the map and provides a clearer picture of the spatial risk structure. The advantage of the mixture model approach to disease mapping is the graphical visual presentation of the prevalence of disease. The space-time mixture model more adequately investigates the dynamic nature of disease than does the mixture model.