Detection of airborne Mycobacterium tuberculosis complex in high-risk areas of health care facilities in Thailand.

In high-risk areas (sputum collection room in a tuberculosis [TB] clinic, patient rooms in a TB ward, the emergency department and the bronchoscopy unit) in seven health care facilities located in central Thailand. To detect airborne Mycobacterium tuberculosis complex and other environmental parameters using the liquid impinger and real-time quantitative polymerase chain reaction (real-time qPCR) technique in high-risk areas. Cross-sectional study. M. tuberculosis was detected in 3 of 99 (3.0%, 95%CI 0.6-8.6) areas: one sputum collection room and one TB in-patient room in one facility and one sputum collection room in another facility. In these three areas, the M. tuberculosis copy number/m³ ranged from 9.6 to 1671. Lower air change rate (<6 h-1), higher relative humidity (>65%), and contact with coughing patient(s) were more common in airborne M. tuberculosis-positive areas than in M. tuberculosis-negative areas. Air sampling using a liquid impinger followed by real-time qPCR is effective for quantitative detection of airborne M. tuberculosis in high-risk areas. Our findings indicate TB risk among health care workers, and suggest that improved ventilation, enhanced appropriate cough etiquette and respiratory protection are needed to mitigate M. tuberculosis transmission. .

Association between matrix metalloproteinase-3 polymorphism and anterior cruciate ligament ruptures.

Anterior cruciate ligament (ACL) ruptures are considered to be the most severe joint injury in sports. However, the precise etiologies of ACL injuries are not fully understood. Recently, the gene encoding the matrix metalloproteinase-3 (MMP-3, stromelysin-1) was shown to be associated with anterior cruciate ligament ruptures. The 5A/6A polymorphism in the promoter of the MMP-3 gene affects the regulation of MMP-3 gene expression. We examined the association between polymorphism within -1612 of the MMP-3 gene and ACL rupture in an independent population. Eighty-six participants between 20 and 40 years of age with surgically diagnosed ACL ruptures and 100 healthy controls between 18 and 28 years of age without history of ligament or tendon injuries were recruited for the study. All participants were genotyped for the MMP-3 polymorphism (-1612 5A/6A). Statistical analyses of genotype frequencies between patients and healthy controls were performed by the chi-square test. A significant difference was found between ACL rupture subgroups in terms of genotype association (5A+ (5A/5A, 5A/6A): 37.5% in contact sports vs 20% in non-contact sports; P = 0.02). In allelic association, there were significant differences (6A: 81.2% in contact sports vs 89.1% in non-contact sports, 5A: 18.8% in contact sports vs 10.9% in non-contact sports, P = 0.01). The 5A+ genotype of MMP-3 was represented in ACL ruptures in contact sport participants. We propose that this sequence variant is a specific genetic element that should be included in a multifactorial model to understand the etiologies and risk factors for ACL rupture.

Inadequate ventilation for nosocomial tuberculosis prevention in public hospitals in Central Thailand.

SETTING: Forty-two community and general hospitals in central Thailand. OBJECTIVE: To examine the adequacy of indoor ventilation for nosocomial tuberculosis (TB) prevention in public hospitals in central Thailand. DESIGN: A cross-sectional survey was conducted among 323 patient care and ancillary areas in the target hospitals. Data on indoor ventilation rate were collected by the tracer gas method and reported as air changes per hour (ACH). The adequacy of the measured ventilation rates were then determined by comparison with the international recommended standard values. RESULTS: Indoor ventilation rates were inadequate in almost half of the studied areas (144/323, 44.6%). The inadequacy was particularly serious in the emergency rooms (ERs) and radiological areas, where 73.8% (31/42 each) of the rooms had ACH below the recommended standards. Detailed analysis showed that most of the rooms with natural ventilation had air exchange rates that exceeded the recommended standards, while the opposite was the case for rooms with air-conditioning, particularly the window or wall-mount type. CONCLUSION: Indoor ventilation in high-risk nosocomial TB areas in public hospitals in Thailand was inadequate due to the installation of air-conditioning systems in modern buildings.

A prevalence of posttransplantation cancers compared with cancers in people with human immunodeficiency virus/acquired immunodeficiency syndrome after highly active antiretroviral therapy.

BACKGROUND: Organ transplant recipients and human immunodeficiency virus & acquired Immunodeficiency Syndrome (HIV/AIDS) patients have immune deficiencies that are possible mechanisms to develop malignancy. The type of cancers associated with these 2 conditions might elucidate this premise. AIM: Our aim was to compare prevalence and type of cancers between kidney transplant recipients and patients with HIV/AIDS. PATIENTS AND METHODS: We retrospectively reviewed 344 patients who underwent kidney transplantation from 1973 to 2007 compared them with 863 subjects with HIV/AIDS at the HIV-Netherlands/Australia/Thailand Research Collaboration (HIV-NAT) from 1997 to 2007. AIDS-defining cancers were excluded from the analysis. We compared the relative tumor risk with the age- and gender- matched general population of metropolitan Bangkok. RESULTS: The overall cancer risk for kidney transplant recipients (standardized incidence ratio [SIR] = 4.21) was comparable with HIV-infected patients (SIR = 3.88). Uroepithelial cancer was the most prevalent type in kidney transplant recipients, whereas cervical cancer was the most common malignancy in HIV-infected patients. The risks of developing hepatoma and non-Hodgkin's lymphoma were comparable between the groups. CONCLUSION: Kidney transplant recipients and HIV-infected patients show increased overall risks of certain types of cancers.

Increased alanine aminotransferase level and future risk of type 2 diabetes and impaired fasting glucose among the employees in a university hospital in Thailand.

AIM: The purpose of this study was to determine the association between baseline alanine aminotransferase (ALT) levels, and future risk of impaired fasting glucose and type 2 diabetes among the employees of a university hospital in Bangkok, Thailand. METHODS: Totally, 2370 and 1619 workers without diabetes and impaired fasting glucose (IFG) at baseline, respectively, who were 35 years or older were followed during 2001-2005. Diagnosis of IFG and type 2 diabetes was based on the fasting plasma glucose levels of 100-125 and greater or equal to 126 mg/dl, respectively. RESULTS: Higher baseline ALT levels were associated with future diabetes risk in an obvious dose-response manner (the OR [95% CI] for the groups with baseline ALT of 17-22, 23-38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1-16 mg/dl were 4.75 [1.25-18.10], 6.14 [1.54-24.45], and 7.19 [1.32-39.16], respectively). Magnitude of association were even higher among those with existing IFG at baseline. The association patterns were consistent for both genders. Concerning the IFG risk, while those who developed IFG had significantly higher baseline ALT levels than those who remained normal at the end of follow-up period, further analyses did not show that baseline ALT was significantly associated with future IFG risk. CONCLUSION: Present study provided supporting evidence from a cohort of Asian subjects about the ALT and future type 2 diabetes risk.

Tuberculosis among health care workers at King Chulalongkorn Memorial Hospital, 1988-2002.

SETTING: It is still not well determined whether health care workers (HCWs) in developing countries-where background tuberculosis (TB) prevalence in the general population is high-have a higher risk of TB than other occupations. OBJECTIVE: To examine the risk of TB among HCWs in an area where TB prevalence is high. DESIGN: A cohort of 3959 HCWs at Chulalongkorn Memorial Hospital, Thailand, was observed from 1988 to 2002. RESULTS: The overall TB incidence rate was 188 per 100 000 person-years (py), with specific incidence rates of 77, 48 and 63/100 000 py, respectively, for confirmed, possible and self-reported TB cases. The highest risk work site was the emergency room, with rate ratios (RRs) of 10.4 (95%CI 3.0-44.7), 22.6 (95%CI 2.7-1041.2) and 9.4 (95%CI 1.5-99.1) for overall, confirmed and possible TB cases, respectively. The 11 TB cases in this area were 9 registered nurses, 1 nursing auxiliary and 1 housekeeper. The occupation of highest risk was nurse, with RRs of 2.4 (95%CI 0.9-9.1) for overall TB cases. However, only the increased RRs for the emergency room were statistically significant. CONCLUSION: The results of this study support the premise that certain groups of HCWs in developing countries are occupationally at increased risk of TB.