Serum transcobalamin II levels in patients with acute and chronic renal failure.

Serum TCII levels were determined in 57 patients with acute and chronic renal failure. They were divided into 3 groups, group I was malarial patients with acute renal failure, group II and III were patients with acute renal failure and chronic renal failure from other underlying causes, respectively. All patients in group I had serum TCII over 2000 pg/ml while these values were within the normal limits in the other 2 groups. These findings indicated that elevated serum TCII occurred only in malarial patients with acute renal failure. The clearance and urinary excretion of TCII in malarial patients were found to be lower and increased to the normal levels after recovery from azotemia, indicating that the failure of excretion of TCII by the kidneys may be responsible for elevated serum TCII levels. The pathophysiological changes in the kidneys in malarial patients may reduce the amount of filtered TCII-B12 through the glomeruli and decrease TCII-B12 uptake by the renal tubules resulting in the decreased TCII degradation by tubular cells. Therefore, the intravascular TCII survival is prolonged with elevated serum TCII levels in these patients.

Effects of antithrombin III and antivenom on procoagulant activity of Russell's viper venom in a whole blood model.

The procoagulant activities of Russell's viper venom were assessed in an in vitro whole blood model. Sequential samplings showed that the generation of fibrinopeptide A (FPA), a marker of thrombin activity, and platelet factor 4 (PF4), a marker of platelet activity, exhibited bi-phasic kinetics with an initial slow phase followed by a rapid phase of secretion. In the presence of Russell's viper venom, the generation of both FPA and PF4 was accelerated with the bi-phasic kinetics of PF4 being maintained while that of FPA completely disappeared. Administration of either antivenom (1,600 ng) or 10 IU antithrombin III (AT-III) had no antagonistic effect against the venom but combination of both resulted in a significant prolongation of both FPA and PF4 release (p < 0.05). High dose AT-III (20 IU) resulted in normalization of both FPA and PF4 kinetics and serial levels of both parameters were lower than those treated with the combined regimen, although these were not statistically significant. Unlike the untreated venom activated whole blood, there was no clot formation following treatment with either the combined regimen or high dose AT-III. The results of this study suggested that the effect of Russell's viper venom on the clotting cascade is more potent and direct than that on platelet activity. There were complementary effects between antivenom and AT-III is controlling of both FPA and PF4 release induced by the venom. Furthermore, in this in vitro experiment, AT-III alone when administered in a sufficient dose, abolished the procoagulant effects of Russell's viper venom.

Serum transcobalamin II levels in patients with malaria infection.

Serum transcobalamin II (TCII) levels were determined in 56 patients with P. falciparum malaria infection. They were divided into 3 groups: severe (malarial parasite > 5% or patients with cerebral malaria or renal insufficiency), moderate (1-5% infection without complications) and mild (1% infection). Elevated serum TCII values were found only in patients with severe malaria infection. These values correlated directly with parasitemia, blood urea nitrogen and creatinine, but were not correlated with alkaline phosphatase. As 17 patients with azotemia had elevated serum TCII levels while other 3 patients with normal BUN and creatinine concentrations had serum TCII levels within the normal limits. These findings indicated that malarial patients with renal insufficiency had increased serum TCII. A possible mechanism is the reduced TCII-B12 that filtered through the glomeruli due to the reduced renal blood flow with the decreased its uptake by proximal tubular cells resulting in the decreased degradation of TCII by the tubular lysosomal enzymes. Determination of serum TCII level may be used as an indicator of renal function in malarial patients with renal insufficiency.

Persistently elevated serum transcobalamin II in a patient with cerebral malaria and typhus infections.

A 25-year-old man presented with a history of fever, chills and vomiting for three days. The parasite count was 207 ring-forms of P. falciparum per 1000 red cells. He developed hemoglobinuria and excreted hemoglobin in the urine 0.20-0.30 g/dl for 14 days during admission. Many blood transfusions were administered for correcting anemia. Although the malarial parasites disappeared one week after anti-malarial therapy, however, the fever and hemoglobinuria persisted. The Weil-Felix reaction OXK was positive with a titre of 1:40 on admission and increased to 1:160 on the second week. Chloramphenical and prednisolone were given for treatment of typhus fever and all symptoms subsided. Serum TCII levels were found to be increased and persisted high during the hemoglobinuria. The clearance of TCII was lower and increased relatively slowly to the normal level on day 30. On the other hand, TCII excretion in the urine was found to be increased during hemoglobinuria. These findings indicate that the catabolism and clearance of TCII in this patients is impaired with increased TCII excretion in the urine in parallel to the hemoglobinuria. Serum TCII level is, therefore, increased and persistently high in a patient with malaria and typhus fever infections with hemoglobinuria.

Abnormally elevated serum transcobalamin II levels in patients with cerebral malaria.

Transcobalamin II (TCII) levels have been reported to be elevated in patients with many clinical conditions including proliferative reticuloendothelial system. As reactive macrophage hyperplasia frequently occurs in patients with malaria, the objective of the present study was to determine TCII in patients with Plasmodium falciparum with cerebral symptoms. The studies were performed on 14 cerebral malaria patients as well as 60 normal subjects. The mean values of serum vitamin B12 and TCII levels were significantly higher in the patient group and 6 and 7 patients had serum vitamin B12 and TCII levels higher than the normal values. There was direct relationship between serum TCII levels and BUN or creatinine levels. These findings indicated that raised serum TCII level occurred only in patients with renal insufficiency. A decreased glomerular fiLtration rate reduced the amount of vitamin B12 and TCII-B12 that filtered through the glomeruli resulting in the reduced proximal tubular cells uptake and its degradation of TCII. This reduced lysosomal enzyme activity, therefore, prolongs the intravascular TCII survival and increased secretion of TCII into the circulation. Therefore, serum TCII levels were elevated in these cerebral malaria patients.

Does laparoscopy have a limited role in diagnosis of fibroadhesive tuberculous peritonitis?

The information on the limitations of laparoscopy (LP), particularly in the diagnosis of fibroadhesive form of tuberculous peritonitis (TP) is insufficient. Some reports suggested the risk and insufficient information obtained from LP in the diagnosis of fibroadhesive tuberculous peritonitis (FTP). The objectives of this study were to determine the usefulness and limitations of LP in the diagnosis of FTP and ascitic TP. The clinical and laparoscopic features of 64 patients with TP were analyzed. FTP was observed in 44 patients (68.8%) comprising 14 cases with small tubercles with thin fibrous adhesions in the peritoneum, 28 cases with large tubercles or confluent nodules with severe adhesions of intestinal loops omentum, and abdominal walls, and 2 cases with caseous material in the abdominal cavity with multiple peritoneal adhesions. Ascitic TP with multiple white nodules were found in 20 patients (31.2%). Laparoscopic diagnosis was confirmed by intralaparoscopic biopsies in all patients. No complications or limitations were found. Our study revealed that laparoscopy was a safe, accurate, and uncomplicated method for diagnosis of FTP and ascitic TP. It gave sufficient information, so diagnostic laparotomy was unnecessary.

Helicobacter pylori prevalence in northeastern Thailand.

Helicobacter pylori is distributed worldwide and has been demonstrated in Thailand. However, no study has been conducted so far in northeastern Thailand. The objective of this study was to find the prevalence of H. pylori in patients undergoing upper gastrointestinal endoscopy in northeastern part of Thailand. One hundred and twenty-six patients undergoing surgery between November 1992 and January 1993 were studied. Biopsies were done at antrum, corpus, and other positive lesions. Diagnostic tests of H. pylori by using CLO test, microbiological tests (Gram stain and culture), and histological examination (hematoxylin and eosin) were carried out. The prevalence of H. pylori by CLO test, Gram stain, culture, and histology were 49.2%, 61.9%, 22.2%, and 45.2% respectively. The overall prevalence of H. pylori by all diagnostic tests was 73.8% (95% confidence interval = 66.1-81.5%). This study revealed a high prevalence rate of H. pylori in patients which should alert clinicians who practice in this geographical area.

Efficacy of single-dose mebendazole, polymorphic forms A and C, in the treatment of hookworm and Trichuris infections.

A therapeutic trial of single mebendazole, 300 mg polymorph A, 300 mg polymorph C and 500 mg polymorph C, in the treatment of hookworm and Trichuris infections was carried out at primary schools in Southern Thailand. The total of 958 children were randomly allocated in seven treatment groups including the placebo control and the standard dose control (100 mg polymorph C bid for 3 days). The egg reduction rates and the cure rates of 300 mg and 500 mg polymorph C were similar, but inferior to those of the standard dose in both hookworm and Trichuris infections. The efficacy of single dose 300 mg polymorph A was not different from that of the placebo control (alpha = 0.05) in both infections.

Treatment of acute uncomplicated falciparum malaria with a short course of artesunate followed by mefloquine.

The clinical results of this study indicate that a half-dose regimen of artesunate followed by mefloquine produces an acceptable cure rate when compared to other commonly available drugs for treating acute uncomplicated falciparum malaria in Thailand. The 90% cure rate was comparable to the results with either a full dose of artesunate (600 mg over 5 days) or mefloquine (25 mg/kg in divided doses six hours apart) as well as the combination of quinine-tetracycline administered for seven days. This abbreviated regimen, however was less effective than the full dose regimen of both drugs previously reported.

Dyspepsia in acute falciparum malaria: a clinico-pathological correlation.

Gastrointestinal symptoms are common in acute falciparum malaria. Dyspepsia often occurs in such patients and sometimes it is exceptionally severe. However, the pathogenesis of the dyspeptic symptoms in malaria has not been clearly defined. Upper gastrointestinal endoscopy was performed in 40 patients with acute falciparum malaria in order to correlate the dyspeptic symptoms with the macroscopic (endoscopic) and microscopic (histologic) pathology of stomach and duodenum. The patients were divided into a dyspeptic group (n = 20, male/female ratio = 17/3, age range 18-50 years, mean age = 28.85 + 9.14 years), and a non-dyspeptic group (n = 20, male/female ratio = 16/4, age range 15-47, mean age 26.05 + 9.98 years). The findings revealed that dyspepsia correlated with topographic endoscopic pangastritis (p = 0.0014), the category of endoscopic antral gastritis (p = 0.013), and the histologic severity of antral gastritis (p = 0.0434). The results suggested that gastritis should be considered in acute falciparum malaria patients presenting with dyspepsia.

Vitamin B1, B2 and B6 status of vegetarians.

The vitamin B1, B2 and B6 status was determined in 132 healthy vegetarians, age range 25-57 years who have been practising vegetarianism for 1-22 years. Sixty-eight healthy non-vegetarians were chosen as controls. The conventional methods to measure the activation coefficient alpha ETK, alpha EGR and alpha EAST were applied to assess the vitamin status of B1, B2 and B6 respectively. The value of 1.25 alpha ETK, 1.5 alpha EGR and 2.0 alpha EAST and above indicate a deficiency in the vitamin status. The results showed significantly poorer vitamin B1 and B6 status in vegetarians than in non-vegetarians, whereas, no significant difference in vitamin B2 status was found. None of the non-vegetarians were deficient in vitamin B1 but 3 of them (4.4%) were deficient in vitamin B6. On the other hand, 10 of vegetarians (7.6%) were deficient in vitamin B1; 38 (28.8%) in vitamin B6. A high prevalence of riboflavin deficiency was found in 32 (24.2%) of the vegetarians; as well as in 15 (22.2%) of the non-vegetarians. Only riboflavin status was significantly related with the duration of vegetarianism practiced. Vegetarians should be considered as the vulnerable group for vitamin B2 and vitamin B6 deficiencies. B-vitamins status should be checked and efforts should be made to improve through dietary counselling and nutritional education should be included and stress in the health education program in order to improve nutritional deficiencies.

G6PD deficiency and fava bean consumption do not produce hemolysis in Thailand.

Favism, a hemolytic condition associated with fava bean consumption among the glucose-6-phosphate dehydrogenase (G6PD) deficient persons, is well described in the Middle East and Mediterranean areas. However, it is not well documented among the Thais or other Southeast Asians. It is possible that it does exist but that hemolysis which develops is of very minor degree and thus escapes clinical detection. This cross-sectional study hypothesizes that if the fava bean and G6PD deficiency interact in the Thai population, they should cause a significant difference in hematocrit level. The study was carried out in a community hospital in a malaria endemic area. We found that there was a trivial difference of the hematocrit (approximately 1%) which was too small to warrant any clinical significance after controlling for the extraneous effects of age, sex, use of malaria chemoprophylaxis, falciparum infection, use of analgesics/antipyretics and admission status of the patients (p = 0.668). This may be due to the presence of different G6PD mutants to those found elsewhere or due to different consumption patterns of fava beans among the Thais compared to people in other areas with high prevalence of G6PD deficiency.

The optimum dose of Puag-Haad in the treatment of taeniasis.

Forty-two per cent of 24 patients with Taeniasis saginata were cured by two-gram dose of a crude aqueous extract of the wood Artocarpus lakoocha, Puag-Haad, while eighty per cent of 25 patients were cured by three-gram dose which is comparable to the results of five-gram dose but had less side-effect. Thus, the three-gram dose of Puag-Haad is recommended in the treatment of taeniasis.

Investigation of the causes of suboptimal haemoglobin response to iron supplementation.

The investigation concerned 572 children, 6-11 years of age, who were divided into three groups: urban control, rural control and rural study. During the first phase of supplementation, each child received 120 mg of elemental iron (as ferrous sulphate) with 0.50 mg of folic acid daily for 60 school days (five days a week) which resulted in a suboptimal haemoglobin concentration. During the second phase, all groups continued to take iron-folate tablets for 60 school days while the children in the study group also received protein, vitamins and minerals. Final blood examinations showed no significant difference in mean haemoglobin concentrations between the rural study and rural control groups. Only 1.5% of all children had haemoglobin below 12 g/dl. It can therefore be concluded that strict supervision of iron tablet intake and long-term supplementation with iron are essential for optimal haemoglobin response.

Subcutaneous phycomycosis mimics elephantiasis.

A case of subcutaneous phycomycosis involving the right thigh for 1 year duration which mimic elephantiasis was reported in a 21-year-old military man. An initial diagnosis was that of a subcutaneous tissue lesion attributed to parasitic manifestation but turned out to be that of subcutaneous fungal infection both clinically and histologically. The lesion was successfully treated with cotrimoxazole for a period of one month, and followed up for 4 1/2 months with complete cure.