Risk Factors of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease Among Patients Regularly Managed by Pulmonologists.

Objective: The present study intended to determine the risk factors of severe exacerbation in chronic obstructive pulmonary disease patients even though managed by pulmonologists on a regular basis. Material and Method: A retrospective case-controlled study was conducted at the chest clinic, Maharaj Nakorn Chiang Mai Hospital from 1st August 2009 to 31st July 2010. The clinical relevant data for acute exacerbation (age, sex, co-morbidity, severity of COPD, COPD medication, annual influenza vaccination, compliance with inhaled drug use, chest radiographic abnormality, and long-term oxygen therapy) were compared between severe AECOPD and stable COPD patients by logistic regression analysis. Results: Out of 137 COPD patients, 17 (12.4%) had severe AECOPD with 29 episodes (21.2%). Six risk factors were identified, two modifiable and four non-modifiable. The two modifiable risk factors were annual influenza non-vaccination (odds ratio [OR] 27.79; 95% confidence interval [CI], 2.29-337.66, p-value = 0.01) and improper use of inhaled devices (OR 9.94, 95%CI 1.07-92.54, p-value = 0.04). The four non-modifiable risk factors were age <60 yrs (OR, 10.67; 95%CI, 1.92-59.31, p-value = 0.01), hypertension (OR, 4.03; 95%CI. 1.05-15.44, p-value = 0.04), enlarged pulmonary trunk as demonstrated by chest radiograph (OR, 8.61; 95%CI, 1.49-49.85, p-value = 0.02), and long-term oxygen therapy (OR, 7.09; 95%CI, 1.36-37.00, p-value = 0.02). Conclusion: Six risk factors of severe AECOPD among patients whom were provided regularly managed by pulmonologists were identified; two of them, annual influenza non-vaccination and improper use of inhaled devices, could be potentially modified.

First isolation of Leishmania from Northern Thailand: case report, identification as Leishmania martiniquensis and phylogenetic position within the Leishmania enriettii complex.

Since 1996, there have been several case reports of autochthonous visceral leishmaniasis in Thailand. Here we report a case in a 52-year-old Thai male from northern Thailand, who presented with subacute fever, huge splenomegaly and pancytopenia. Bone marrow aspiration revealed numerous amastigotes within macrophages. Isolation of Leishmania LSCM1 into culture and DNA sequence analysis (ribosomal RNA ITS-1 and large subunit of RNA polymerase II) revealed the parasites to be members of the Leishmania enriettii complex, and apparently identical to L. martiniquensis previously reported from the Caribbean island of Martinique. This is the first report of visceral leishmaniasis caused by L. martiniquensis from the region. Moreover, the majority of parasites previously identified as "L. siamensis" also appear to be L. martiniquensis.