Availability and Price of Low-Sodium Condiments and Instant Noodles in the Bangkok Metropolitan Region.

INTRODUCTION: Excess sodium consumption can cause hypertension. One component of Thailand's 5-part strategy to reduce sodium intake is reform of the food environment to increase access to low-sodium foods. Our research aimed to describe the availability and price of low-sodium food products in retail stores in the Bangkok Metropolitan Region. METHODS: In June and July 2021, we used multistage cluster sampling to conduct a cross-sectional study of the availability of low-sodium foods. Availability referred to a retail store offering at least 1 version of low-sodium condiment or instant noodles. We applied the Thai Healthier Choice criteria and World Health Organization (WHO) global benchmark as the low-sodium criteria for these products. We surveyed 248 retail stores in 30 communities in 6 districts in the Bangkok Metropolitan Region. We observed store shelf availability and price by using a survey form and used the Fisher exact test and independent t test to compare availability and price by sodium content and store size. RESULTS: All subcategories of low-sodium condiments, except black soy sauce in small stores, were less available than regular-sodium condiments. The proportional difference ranged from 11.3% to 90.6% (P < .001). We found no difference in the 4 condiment subcategories, including fish sauce, thin soy sauce, seasoning sauce, and oyster sauce in large stores. Low-sodium versions of instant noodles were unavailable in either large or small stores. The price of low-sodium condiments was 2 to 3 times higher than that of regular-sodium condiments (P < .05). CONCLUSION: Low-sodium food options are not generally available in the Bangkok Metropolitan Region, and access to them is inequitable because of pricing. Instant noodles, a popular food, were unavailable in low-sodium versions. Their reformulation should be promoted. Government subsidies of the price of commonly used low-sodium condiments could increase their use and reduce sodium consumption overall.

Integration of basic occupational health services into primary health care in Thailand: Current situation and progress.

Background: Informal workers are high-risk groups for getting occupational diseases. They also have difficulties in accessing occupational health services (OHSs). The Basic OHS (BOHS) program integrates BOHS activities into existing primary health care. The study aims to describe how the BOHS program has been developed and to update the situation of BOHS in Thailand. Methods: Four steps for the development of the program include (1) preparation, (2) model development, (3) implementation and expansion, and (4) quality assurance (QA). The program started with the study of the situation of OHS in primary care units (PCUs) and identification of the gap for OH practice among PCUs' staff. The pilot study was conducted in 19 PCUs. After that, expansion of the model and quality assurance of the services have been implemented until now. Results: In 2019, 84% of PCUs (8242) provided BOHS, but the number decreased to 22% (2123 PCUs) in 2020. The target groups were mainly farmers. The OHS activities include an arrangement of farmers' clinics and conducting outreach activities in the field. The latest health surveillance program for farmers reported that 40.5% of 862,585 farmers had high pesticide exposure by field-kit testing. Regarding the QA audit, 75% of PCUs were certified for basic or higher levels of BOHS standards. Conclusions: Integration of OHS into the PCUs is feasible, successful and replicable. Its sustainability requires policy support, continued empowerment of staff, and resource allocation.

Epidemiological Situation of Necrotizing Fasciitis and Factors in Thailand and Factors Associated with Its Morbidity and Mortality, 2014-2018.

INTRODUCTION: Necrotizing fasciitis (NF) is a rare skin and soft-tissue bacterial infection with high morbidity and mortality. Knowledge about the prevalence and incidence of NF in Thailand is quite sparse. The objective of this study was to determine the prevalence of NF in Thailand and factors that may be potentially associated with NF morbidity and mortality. METHODS: A cross-sectional study using secondary data from Thailand's national health databases between 2014 and 2018 was conducted. Descriptive statistics using median and percentage formats were used. This was complemented by multivariable logistic regression to determine the association between various factors (such as age and underlying diseases) with NF morbidity and mortality. Univariate spatial data analysis was exercised to identify the geographical hot spots in which the disease appeared. RESULTS: During 2014-2018, we found 90,683 NF cases. About 4.86% of the cases died. The median age for all cases was 59.39 years old. The annual incidence of NF demonstrated an upward trend (from 26.08 per 100,000 population in 2014 to 32.64 per 100,000 population in 2018). The monthly incidence was highest between May and August. A high incidence cluster (as indicated by local Moran's I) was found in the north-eastern region of Thailand. The most infected sites were on the ankles and feet (43.18%) with an amputation rate of 7.99% in all cases. Multivariable logistic regression indicated that the significant risk factor for amputation was a presence of underlying diseases, namely diabetes (OR 7.94, 95% CI 7.34-8.61). Risk factors for mortality included being elderly (OR 1.82, 95% CI 1.68-1.98) and a presence of underlying hypertension (OR 1.16, 95% CI 1.07-1.27), cirrhosis (OR 4.67, 95% CI 4.17-5.21), and malignancy (OR 1.88, 95% CI 1.55-2.26). DISCUSSION AND CONCLUSION: As the elderly and those with chronic underlying diseases are likely to face non-preferable health outcomes from NF, healthcare providers should pay great attention to these groups of patients. Early and intensive treatment might be considered in these groups of patients. Further studies that aim to validate the volume of actual NF cases and reported NF cases are recommended.

A Cobalt Schiff-Base Complex as a Putative Therapeutic for Azide Poisoning.

There is presently no antidote available to treat azide poisoning. Here, the Schiff-base compound Co(II)-2,12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]heptadeca-1(17)2,11,13,15-pentaenyl dibromide (Co(II)N4[11.3.1]) is investigated to determine if it has the capability to antagonize azide toxicity through a decorporation mechanism. The stopped-flow kinetics of azide binding to Co(II)N4[11.3.1] in the absence of oxygen exhibited three experimentally observable phases: I (fast); II (intermediate); and III (slow). The intermediate phase II accounted for ∼70% of the overall absorbance changes, representing the major process observed, with second-order rate constants of 29 (±4) M-1 s-1 at 25 °C and 70 (±10) M-1 s-1 at 37 °C. The data demonstrated pH independence of the reaction around neutrality, suggesting the unprotonated azide anion to be the attacking species. The binding of azide to Co(II)N4[11.3.1] appears to have a complicated mechanism leading to less than ideal antidotal capability; nonetheless, this cobalt complex does protect against azide intoxication. Administration of Co(II)N4[11.3.1] at 5 min post sodium azide injection (ip) to mice resulted in a substantial decrease of righting-recovery times, 12 (±4) min, compared to controls, 40 (±8) min. In addition, only two out of seven mice "knocked down" when the antidote was administered compared to the controls given toxicant only (100% knockdown).

Reaction Kinetics of Cyanide Binding to a Cobalt Schiff-Base Macrocycle Relevant to Its Mechanism of Antidotal Action.

The Co(II/III)-containing macrocycle, cobalt 2,12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]-heptadeca-1(17)2,11,13,15-pentaenyl cation, or CoN4[11.3.1], is a potential cyanide-scavenging agent. The rate of reduction of Co(III)N4[11.3.1] by ascorbate is reasonably facile under pseudo-first-order conditions; a second-order rate constant of 11.7(±0.4) M-1 s-1 was determined at 25 °C and pH 7.4, along with the activation parameters for the reaction (ΔH⧧ = 53.9(±0.8) kJ mol-1; ΔS -79(±3) J mol-1 K-1). It follows that any cyanide-decorporating capability of the cobalt complex should depend more on the cyanide-binding characteristics of Co(II)N4[11.3.1] than the oxidized form. The kinetics of the reaction of cyanide with Co(II)N4[11.3.1] under anaerobic pseudo-first-order conditions is rapid and resulted in a linear dependence on the cyanide concentration, kHCN = 8 × 104 M-1 s-1, with a nonlinear intercept of 420 s-1 at 10 °C, pH 7.6. The observed reaction rate increases significantly with increasing pH. A rate law is suggested, kobs = k'[X] + (kHCN + kCNKa/[H+])[HCN], where kCN is estimated to be ∼2 × 106 M-1 s-1. Activation parameters for the reaction with HCN (ΔH⧧ = 10.7(±0.4) kJ mol-1; ΔS⧧ = -153(±1) J mol-1 K-1) suggest an associative mechanism. In the presence of excess oxygen, i.e., at higher levels than free oxygen in vivo, the reaction rate was too fast to be measured, and the final product was the oxidized complex, Co(III)N4[11.3.1], where any cyanide ligands had been lost. This is much more rapid than the oxidation of the parent compound by oxygen, for which a second-order rate constant of 0.5(±0.02) M-1 s-1 at 25 °C was obtained. The study has gone some way toward enhancing our understanding of the reaction of Co(II)N4[11.3.1] with cyanide. The fast reaction rate implies a high efficacy of the cyanide-scavenging capability of the complex and further supports the suggestion stemming from our previous work that Co(II)N4[11.3.1] could prove to be a better and more cost-effective cyanide antidote than the FDA-approved hydroxocobalamin.

Assessing modulators of cytochrome c oxidase activity in Galleria mellonella larvae.

Caterpillars of the greater wax moth, Galleria mellonella, are shown to be a useful invertebrate organism for examining mitochondrial toxicants (inhibitors of electron transport) and testing putative antidotes. Administration of sodium azide, sodium cyanide, or sodium (hydro)sulfide by intra-haemocoel injection (through a proleg) results in a dose-dependent paralysed state in the larvae lasting from <1 to ~40 min. The duration of paralysis is easily monitored, because if turned onto their backs, the larvae right themselves onto their prolegs once they are able to move again. The efficacy of putative antidotes to the three toxicants can routinely be assessed by observing shortened periods of paralysis with larvae given toxicant and antidote compared to larvae administered only the same dose of toxicant. The validity of the approach is demonstrated with agents previously shown to be antidotal towards cyanide intoxication in mice; namely, sodium nitrite and CoN4[11.3.1] (cobalt(II/III) 2,12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]-heptadeca-1(7)2,11,13,15-pentaenyl cation). These same compounds are shown to be antidotal towards all three toxicants in the G. mellonella caterpillars; findings that may prove important in relation to azide and sulfide poisonings, for which there are currently no effective antidotes available. The observation that sodium nitrite ameliorates cyanide toxicity in the larvae is additionally interesting because it unambiguously demonstrates that the antidotal action of nitrites does not require the involvement of methemoglobin, contributing to the resolution of an ongoing controversy.

A Comparison of the Cyanide-Scavenging Capabilities of Some Cobalt-Containing Complexes in Mice.

Four cobalt-containing macrocyclic compounds previously shown to ameliorate cyanide toxicity have been comparatively evaluated with an acute sublethal toxicity model in conscious (unanesthetized) adult male Swiss-Webster mice. All of the compounds (the cobalt-corrins cobalamin and cobinamide, a cobalt-porphyrin, plus a cobalt-Schiff base macrocycle) given 5 min prior to the toxicant dose significantly decreased the righting-recovery time of cyanide-intoxicated mice, but the doses required for maximal antidotal effect varied. Additionally, all of the compounds tested significantly reduced the righting-recovery time when administered at either 1 or 2 min after cyanide intoxication, but none of the compounds tested significantly reduced the righting-recovery time when delivered 5 min after the toxicant dose. Using the lowest effective dose of each compound determined during the first (prophylactic) set of experiments, neuromuscular recovery following cyanide intoxication in the presence/absence of the cobalt-based antidotes was assessed by RotaRod testing. All the compounds tested accelerated recovery of neuromuscular coordination, and no persistent impairment in any group, including those animals that received toxicant and no antidote, was apparent up to 2 weeks postexposures. The relative effectiveness of the cobalt compounds as cyanide antidotes are discussed and rationalized on the basis of the cyanide-binding stoichiometries and stability constants of the Co(III) cyano adducts, together with consideration of the rate constants for axial ligand substitutions by cyanide in the Co(II) forms.