ABSTRACT
Death due to Japanese encephalitis usually occurs in the first 5 days of hospitalization as a result of deepening coma with respiratory arrest. Death may result from edema-induced increases in intracranial pressure that might be reduced by the administration of steroids. Sixty-five patients presenting in Thailand to four hospitals with a diagnosis of acute Japanese encephalitis were randomized in a double-masked fashion and stratified by initial mental status into a placebo group (saline) or a treatment group (dexamethasone 0.6 mg/kg intravenously as a loading dose followed by 0.2 mg/kg every 6 h for 5 days). Fifty-five of the 65 had confirmed Japanese encephalitis as demonstrated by detection of virus or by Japanese encephalitis virus-specific IgM antibody. Important outcome measures included mortality (24%, treatment group; 27%, control group), days to alert mental status (3.9 vs. 6.2), and neurologic status 3 months after discharge (45% abnormal in each group). No statistically significant benefit of high-dose dexamethasone could be detected.
Subject(s)
Dexamethasone/therapeutic use , Encephalitis, Japanese/drug therapy , Acute Disease , Adolescent , Adult , Child , Child, Preschool , Dexamethasone/administration & dosage , Dexamethasone/pharmacology , Double-Blind Method , Encephalitis, Japanese/mortality , Female , Follow-Up Studies , Glucose/cerebrospinal fluid , Humans , Infant , Injections, Intravenous , Intracranial Pressure/drug effects , Male , Middle Aged , Neurologic Examination , Treatment OutcomeABSTRACT
Capsicum, a hot appetizer and seasoning, has been found to induce increased fibrinolytic activity and simultaneously cause hypocoagulability of blood when ingested or when retained in the mouth for a short time. The effect on fibrinolysis and blood coagulation of capsicum can be reproduced in the same subjects within a short time after the first stimulation. More investigations on this effect may lead to the discovery of some ideal drugs for both treatment and prevention of thromboembolism. Fibrinolytic activity measured by euglobulin lysis time in 88 Thai subjects (mean +/- SD = 167 +/- 66.84 min) was significantly higher than in 55 American whites (mean +/- SD = 254 +/- 126.70 min) residing in Thailand for a period of time (p less than 0.001). The Thai people consume capsicum with their meals. Their fibrinolytic activity, therefore, is activated several times during the day and this activation could be an important factor in causing high fibrinolytic activity. This customary habit of food ingestion is very likely a factor contributing to the racial difference in fibrinolysis. Furthermore, the Thais also have lower plasma fibrinogen and higher antithrombin III compared to Americans. These could certainly be additional factors, in addition to fibrinolytic activity, that play a role in the rarity of thromboembolism among Thais.
