Assessment of hepatitis C virus infection in two adjacent Thai provinces with drastically different seroprevalence.

Improved awareness of the hepatitis C virus (HCV) transmission has contributed to the overall decline in the HCV infection rate in some developing countries including Thailand. Chronic HCV infection in some rural Thai communities, however, presents a challenge in the efforts to treat and manage HCV-related diseases. Published and unpublished studies have suggested an unusually high incidence of HCV infection in a Thai province of Phetchabun compared to elsewhere in Thailand. To determine the magnitude of HCV infection and identify potential factors contributing to the higher rate of HCV infection in this province, we performed a population-based study in Phetchabun (n = 1667) and the neighboring Khon Kaen province (n = 1410) where HCV prevalence is much lower. Individuals between 30 and 64 years old completed detailed questionnaires designed to identify HCV risk factors and provided blood samples for anti-HCV antibody screening. The anti-HCV seropositive rates were 15.5% (259/1667) in Phetchabun and 3.6% (51/1410) in Khon Kaen. Positive samples were subsequently genotyped for HCV core gene sequence and assessed for the hepatitis B virus surface antigen (HBsAg) and human immunodeficiency virus antigen/antibody (HIV Ag/Ab). More individuals in Phetchabun possessed the combined presence of HBsAg (5.0%) and HIV Ag/Ab (0.4%) than those in Khon Kaen (3.9% HBsAg and 0.0% HIV Ag/Ab). While male gender, intravenous drug use (IVDU) and tattoos were significant HCV risk factors in both provinces (p <0.05), education less than high school and agriculture-related occupation were additionally associated with HCV in Phetchabun. HCV genotypes 6, 3, and 1 were identified in similar frequency in both provinces. We estimated that prevalence of HCV seropositivity and viremic carriers were higher in Phetchabun (143 and 111 per 1000) than in Khon Kaen (34 and 22 per 1000). Finally, we derived a simple risk factor-based scoring system as a useful preclinical tool to screen individuals at risk of chronic HCV infection prior to intervention. Knowledge gained from this study will assist in HCV screening and promote access to anti-viral treatment in high-risk groups.

Incidence and risk factors of acute delirium in older patients with hip fracture in Siriraj Hospital.

OBJECTIVE: To determine the incidence and associated factors of delirium in older patients admitted with hip fracture. MATERIAL AND METHOD: Eighty patients with fall-related hip fracture who admitted to orthopedics wards in Siriraj Hospital were recruited. Baseline characteristics, functional ability and cognitive status, treatment-related factors, clinical outcomes, length of stay, and direct medical cost were evaluated. Delirium was diagnosed by experienced geriatricians using DSM-IV RESULTS: Thirty-six patients (45%,) developed delirium. Hyperactive and hypoactive delirium was 24:12 patients. Preoperative and postoperative delirium was developed in 18:18 patients. Age, TMSE score on admission, modified IQCODE score, premorbid mRS, receiving NSAIDs around the clock postoperatively, and sedative drug use were significantly different between the non-delirium and delirium groups in multivariate logistic regression analysis. Patients with delirium did not have significantly higher postoperative complications, hospital length ofstay, functional status (mRS) at discharge, mortality, and direct cost of the treatment in hospital. CONCLUSION: Delirium is common in elderly hip fracture undergoing hip repair. Age, premorbid function, dementia/cognitive impairment, NSAIDs, and sedative use were associated factors of delirium. Identifying those with high-risk factors should be routinely performed rigorously and strategies to reduce delirium incidence and severity should be planned and conducted.

Causes and course of falls resulting in hip fracture among elderly Thai patients.

OBJECTIVE: To investigate causes and course off all-related hip fractures in elderly individuals admitted to a hospital. MATERIAL AND METHOD: The authors collected data from older patients admitted with fall-related hip fractures. The cause and the clinical course of falls were evaluated by consultants in geriatric medicine. All patients were followed-up until discharge from the hospital. RESULTS: Falls usually occurred indoors (78.6%) during the daytime (67.5%). Only 27.5% of the falls were attributable to purely extrinsic causes. Neurological, musculoskeletal, and visual problems along with orthostatic hypotension were the leading causes of falls in the present study. Women demonstrated more intrinsic causes (41.9% vs. 28.9%), such as musculoskeletal (33.9% vs. 11.1%), and visual impairment (21.0% vs. 11.1%), whereas falls involving men were more likely to be caused by orthostatic hypotension (21.8% vs. 8.1%). Most patients received surgical treatment (92.5%). The most common complications during the hospital stay were delirium (45%). The modified Rankin Scale of 2-5 at discharge was noted in 46.3% ofpatients, and mortality was 3.8%. The median length of hospital stay was 15 days (7-75 days). The direct costs of in-hospital care were 2,427.2 (761.9-8,348.6) US dollars for general wards, and 3,739.1 (1,333.6-11,871.7) US dollars for special wards. CONCLUSION: Intrinsic causes (pure and combined with extrinsic) lead to falls with hip fractures more often than purely extrinsic causes. Women and men had different etiologies for falls. Hip fracture leads to a number of in-hospital complications and significantfunctional impairment. Preventive strategies following the present study would likely lead to more accurate and beneficial outcomes.