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Background@#Isoniazid (INH) is metabolized by polymorphic N-acetyltransferase 2 (NAT2) enzyme, which noticeably alters INH plasma concentration. We aimed to determine the distribution of NAT2 genotype in Thai tuberculosis (TB) patients and correlate their genotype with plasma INH concentrations. @*Methods@#Blood samples from 55 newly diagnosed pulmonary tuberculosis participants from three hospitals were collected to classify the subject by NAT2 genotype performed by the Multiplex haplotype-specific polymerase chain reaction method. Patients were grouped into three acetylators (fast, intermediate, and slow). On day 14 of tuberculosis treatment, the second blood sample was taken to estimate the peak plasma concentration at 2 hours after oral administration. INH plasma concentration was analyzed by liquid chromatography‒tandem mass spectrometry/mass spectrometry method. @*Results@#The NAT2 genotype distribution of fast, intermediate, and slow acetylator was 10.9%, 36.4%, and 52.7%, from six, 20, and 29 patients, respectively. The median (interquartile range) of INH plasma concentration at 2 hours post drug administration for these three genotypes were 0.75 (0.69–0.86), 2.56 (2.12–3.97), and 4.25 (3.56–5.50) µg/mL from four, 14, and 12 cases, respectively. The INH plasma concentration at 2 hours after administration was significantly associated with body weight and NAT2 acetylator. @*Conclusion@#The INH plasma concentration was found lower in fast than intermediate and slow acetylators. Body weight and NAT2 acetylator influenced INH plasma concentrations at 2 hours after drug administration. Therefore, the NAT2 genotype should be known before starting TB treatment to maximize therapeutic outcomes.
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To demonstrate the effect of indoor spraying and window screens on Aedes aegypti mosquito density after space spraying. Methods: A total of 141 households (the study houses) in six communities of Songkhla City, located in Songkhla Province of southern Thailand, were randomly selected and the adult Ae. aegypti populations were assessed pre- and post-insecticide spraying from March to October, 2014. Houses close to (within a 20 m radius) the study houses were analyzed using spatial analysis tools. The Aedes aegypti density in the study houses and house density index were compared with the density in the neighbouring houses, based on three spraying conditions: (i) unsprayed (ii) only outdoor sprayed and (iii) indoor plus outdoor sprayed. Results: Only spraying houses indoors was the most effective (P<0.05). There was insufficient evidence that the source of the increase in the number of mosquitoes in unsprayed houses was due to their migration from neighbouring houses which had been sprayed. However, the study houses without screens on their windows were found to have a likely higher dengue vector population after spraying, but the difference was not significant. Conclusions: In dengue endemic areas, all houses should be fully screened and the number of houses ultra-low volume sprayed indoor plus outdoor should be increased with the cooperation of householders and communities during epidemics.
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Background@#Isoniazid (INH) is metabolized by polymorphic N-acetyltransferase 2 (NAT2) enzyme, which noticeably alters INH plasma concentration. We aimed to determine the distribution of NAT2 genotype in Thai tuberculosis (TB) patients and correlate their genotype with plasma INH concentrations. @*Methods@#Blood samples from 55 newly diagnosed pulmonary tuberculosis participants from three hospitals were collected to classify the subject by NAT2 genotype performed by the Multiplex haplotype-specific polymerase chain reaction method. Patients were grouped into three acetylators (fast, intermediate, and slow). On day 14 of tuberculosis treatment, the second blood sample was taken to estimate the peak plasma concentration at 2 hours after oral administration. INH plasma concentration was analyzed by liquid chromatography‒tandem mass spectrometry/mass spectrometry method. @*Results@#The NAT2 genotype distribution of fast, intermediate, and slow acetylator was 10.9%, 36.4%, and 52.7%, from six, 20, and 29 patients, respectively. The median (interquartile range) of INH plasma concentration at 2 hours post drug administration for these three genotypes were 0.75 (0.69–0.86), 2.56 (2.12–3.97), and 4.25 (3.56–5.50) µg/mL from four, 14, and 12 cases, respectively. The INH plasma concentration at 2 hours after administration was significantly associated with body weight and NAT2 acetylator. @*Conclusion@#The INH plasma concentration was found lower in fast than intermediate and slow acetylators. Body weight and NAT2 acetylator influenced INH plasma concentrations at 2 hours after drug administration. Therefore, the NAT2 genotype should be known before starting TB treatment to maximize therapeutic outcomes.
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PURPOSE: This study aimed to describe the system of continuing medical education (CME) in the Guangxi Zhuang Autonomous Region and to ascertain the perceived needs related to that system, in order to improve the performance of health professionals in Chinese township health centers (THCs). METHODS: In-depth key informant interviews were conducted to gain insights into the current CME system. A cross-sectional survey using a self-administered structured questionnaire was also carried out from March to August 2014 in order to identify perceived needs among THC personnel in the Guangxi Zhuang Autonomous Region. Logistic regression was used to identify factors related to respondents' interest in pursuing different levels of degree study. RESULTS: The areas of need perceived by the respondents included general clinical competence and emergency or first aid knowledge. Most respondents wanted to study at medical colleges in order to obtain a higher degree. Respondents aged below 45 years with neutral or positive attitudes about the benefit of degree study for the licensure examination were more likely to attend a bachelor-level CME program than their older peers and respondents with negative attitudes towards degree study. Female respondents and respondents aged below 45 years were more likely to attend a junior college CME program than males and older respondents, respectively. CONCLUSION: It is necessary to develop degree-linked CME programs to meet the need for young health professionals in Chinese THCs; therefore, this programs can improve the expertise of poorly educated young health workers, who overwhelm rural Chinese heath systems.
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Feminino , Humanos , Masculino , Povo Asiático , China , Competência Clínica , Estudos Transversais , Inquéritos e Questionários , Dronabinol , Educação Médica Continuada , Emergências , Primeiros Socorros , Ocupações em Saúde , Necessidades e Demandas de Serviços de Saúde , Licenciamento , Modelos Logísticos , Saúde da CriançaRESUMO
Objective:To examine the resurgence rate, house density index (HDI) and parous rate of the Aedes aegypti vector after space spraying carried out by the routine spraying team, and compare with the rates after standard indoor ultra low volume (SID-ULV) spraying carried out by the trained research spraying team. Methods:Between March and September 2014, a cluster randomized controlled trial including 12 clusters (6 regular ULV, 6 SID-ULV) with totally 4 341 households was conducted, and around 20–31 houses in each cluster were selected for assessment. The parous rate and HDI of collected mosquitoes 2 days before and 1, 2 and 6 days after spraying were obtained and compared. Results:The HDI dropped significantly from the baseline 1 and 2 days after spraying to a non-zero value in the SID-ULV treated locations but not in the regular ULV group locations. However, by 6 days after spraying, the HDI of both groups had returned to the base value measured 2 days before spraying. There were no statistically significant differences in the parous rate between groups. Conclusions: SID-ULV is more effective in reducing Aedes aegypti populations. However, rapid resurgence of dengue vector after spraying in urban areas was observed in both groups.
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<p><b>OBJECTIVE</b>To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing.</p><p><b>METHODS</b>From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery.</p><p><b>RESULTS</b>At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery.</p><p><b>CONCLUSIONS</b>The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.</p>
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Idoso , Animais , Feminino , Humanos , Masculino , Envelhecimento , Patologia , Catarata , Extração de Catarata , China , Seguimentos , População Urbana , Transtornos da VisãoRESUMO
Objective: To examine the resurgence rate, house density index (HDI) and parous rate of the Aedes aegypti vector after space spraying carried out by the routine spraying team, and compare with the rates after standard indoor ultra low volume (SID-ULV) spraying carried out by the trained research spraying team. Methods: Between March and September 2014, a cluster randomized controlled trial including 12 clusters (6 regular ULV, 6 SID-ULV) with totally 4. 341 households was conducted, and around 20-31 houses in each cluster were selected for assessment. The parous rate and HDI of collected mosquitoes 2 days before and 1, 2 and 6 days after spraying were obtained and compared. Results: The HDI dropped significantly from the baseline 1 and 2 days after spraying to a non-zero value in the SID-ULV treated locations but not in the regular ULV group locations. However, by 6 days after spraying, the HDI of both groups had returned to the base value measured 2 days before spraying. There were no statistically significant differences in the parous rate between groups. Conclusions: SID-ULV is more effective in reducing Aedes aegypti populations. However, rapid resurgence of dengue vector after spraying in urban areas was observed in both groups.
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OBJECTIVES: The objective of this study was to use factor analysis to explore patterns of symptoms and signs from patients with chronic low-back pain (CLBP) based on the Traditional Chinese Medicine (TCM) theory. DESIGN, SETTINGS, AND SUBJECTS: A cross-sectional study was carried out among 513 patients with CLBP in four hospitals affiliated with Yunnan University of Traditional Chinese Medicine, China. OUTCOME MEASURES: Outcome measures comprised 31 symptoms and signs on a six-level self-report questionnaire. RESULTS: Four (4) factors were extracted. They were eventually interpreted as (1) "Qi and/or Blood Stagnation," which includes eight items such as piercing pain; activity limited by feeling of local heaviness, lumbar and flank stiffness with bending limitation and purple tongue, etc.; (2) "Cold/Damp," which has seven items (for example, Cold/Damp pain, pallid face and greasy coating, etc.); (3) a part of "Kidney Deficiency," which includes two items: "dull pain and recurrent vague pain"; (4) "Warmth/Heat," which is related to three items (namely, purple tongue, yellow tongue coating, and burning pain). The four factors accounted for 12.7%, 8.2%, 8.2%, and 7.8% of the total variance, respectively. There are seven items with uniqueness over 0.8. CONCLUSIONS: Four (4) TCM major groups of pathophysiology could explain 37% of variance of 31 symptoms and signs of the CLBP patients. Thirteen (13) items are not groupable.
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Diagnóstico Diferencial , Dor Lombar/diagnóstico , Medicina Tradicional Chinesa , Adulto , Doença Crônica , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e QuestionáriosRESUMO
The aim of this study was to determine the prevalence of impaired glucose regulation status in Sherpa adults living in the Everest area and in Kathmandu valley. A cross-sectional survey was conducted in Chaurikharka village (Everest area) and Kathmandu city on 119 and 121 randomly selected individuals, aged 30-70 years. They were assessed on conventional risk factors for diabetes, and an oral glucose tolerance test was performed. Based on the 2003 American Diabetes Association criteria, the prevalence in the Kathmandu city and Everest region of any impaired glucose regulation (IGR), isolated impaired fasting plasma glucose (isolated IFG), isolated impaired glucose tolerance (isolated IGT), and combined isolated IFG and isolated IGT were 55.4% vs. 23.5%, 42.1% vs. 14.3%, 1.7% vs. 0.8%, 11.6 vs. 8.4%, respectively. Using the subjects with normal glucose tolerance as the referent group and after adjusting for age, sex, physical activity, calories, and waist circumference, the odds ratios for isolated IFG and combined isolated IFG and isolated IGT of living in the highland region were 0.19 (0.08-0.44) and 0.33 (0.09-1.18), respectively. Isolated IFG was more common among the lowland Sherpas. Unlike combined isolated IFG and isolated IGT, this isolated IFG difference could not be explained by the difference of conventional diabetes mellitus risk factors.
