A case-control auditory evaluation of patients treated with artemisinin derivatives for multidrug-resistant Plasmodium falciparum malaria.
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The artemisinin derivatives are now used widely in areas with multidrug-resistant Plasmodium falciparum malaria such as Southeast Asia, but concerns remain over their potential for neurotoxicity. Mice, rats, dogs, and monkeys treated with high doses of intramuscular artemether or arteether develop an unusual pattern of focal damage to brain stem nuclei (particularly those involved in auditory processing). To investigate whether a similar toxic effect occurs in patients treated with these compounds, clinical neurologic evaluation, audiometry and early latency auditory evoked responses were measured in a single-blind comparison of 79 patients who had been treated with > or =2 courses of oral artemether or artesunate within the previous 3 years, and 79 age- and sex-matched controls living in a malaria-endemic area on the northwestern border of Thailand. There were no consistent differences in any of these test results between the cases and controls. This study failed to detect any evidence of significant neurotoxicity in patients treated previously with oral artemether or artesunate for acute malaria. (+info)
Distribution and content of class 1 integrons in different Vibrio cholerae O-serotype strains isolated in Thailand.
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In this study, 176 clinical and environmental Vibrio cholerae strains of different O serotypes isolated in Thailand from 1982 to 1995 were selected and studied for the presence of class 1 integrons, a new group of genetic elements which carry antibiotic resistance genes. Using PCR and DNA sequencing, we found that 44 isolates contained class 1 integrons harboring the aadB, aadA2, blaP1, dfrA1, and dfrA15 gene cassettes, which encode resistance to gentamicin, kanamycin, and tobramycin; streptomycin and spectinomycin; beta-lactams; and trimethoprim, respectively. Each cassette array contained only a single antibiotic resistance gene. Although resistance genes in class 1 integrons were found in strains from the same epidemic, as well as in unrelated non-O1, non-O139 strains isolated from children with diarrhea, they were found to encode only some of the antibiotic resistance expressed by the strains. Serotype O139 strains did not contain class 1 integrons. However, the appearance and disappearance of the O139 serotype in the coastal city Samutsakorn in 1992 and 1993 were associated with the emergence of a distinct V. cholerae O1 strain which contained the aadA2 resistance gene cassette. A 150-kb self-transmissible plasmid found in three O1 strains isolated in 1982 contained the aadB gene cassette. Surprisingly, several strains harbored two integrons containing different cassettes. Thus, class 1 integrons containing various resistance gene cassettes are distributed among different V. cholerae O serotypes of mainly clinical origin in Thailand. (+info)
National Health Accounts development: lessons from Thailand.
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National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports. (+info)
Single small enhancing CT lesion in Thai patients with acute symptomatic seizures: a clinico-radiological study.
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OBJECTIVE: To identify the frequency of single small enhancing CT lesion cases (SSECTL) in a provincial hospital in Thailand and verify a set of clinico-radiological criteria for the diagnosis of benign SSECTL. METHODS: All patients who fulfilled the following criteria were recruited: acute symptomatic focal seizures with or without secondary generalization; minimal or no neurological deficit; no evidence of raised intracranial pressure; no evidence of systemic disease; CT scan showing SSECTL of < 20 mm diameter. After recruitment, patients received antiepileptic drugs and other symptomatic treatment. A CT scan of the brain was repeated every 2 weeks until the lesion had significantly resolved, which was defined as a 50% decrease in size. A CT scan was then taken every 4 weeks until the lesion had completely disappeared or turned into a calcified spot. The data from all other patients presenting with seizures and solitary enhancing lesion on the CT scan who did not fulfil the inclusion criteria were also reviewed. RESULTS: 972 patients with seizure disorder were recruited. 110 patients (11.3%) presented with seizure and solitary enhancing lesion on the CT scan, 22 of whom (20%) fulfilled the inclusion criteria. 20 of the 22 patients had SSECTL with a spontaneous resolution: 14 (70%) within 4 weeks and 18 (90%) within 8 weeks. Two patients had a progressive course. One patient with a solitary enhancing CT lesion > 20 mm had spontaneous resolution. 87 patients had another diagnoses. The diagnostic criteria for benign SSECTL were 95.23% sensitive, 97.75% specific, had a positive predictive value of 90.91% and a negative predictive value of 98.86%. CONCLUSION: SSECTL is not uncommon in our provincial hospital. The clinico-radiological criteria proposed by Rajshekhar (1991) are valid and reliable in predicting a benign outcome. CT follow-up within the first 4 weeks is critical. (+info)
Pseudomonas (Burkholderia) pseudomallei in Thailand, 1964-1967: geographic distribution of the organism, attempts to identify cases of active infection, and presence of antibody in representative sera.
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The purpose of this study, initiated in 1964 and concluded in 1967, was to define the distribution of Pseudomonas (now Burkholderia) pseudomallei in Thailand, to evaluate its importance as an etiologic agent, and to survey the presence of antibody in people that might indicate prior infection and/or contact with the microorganism. (+info)
Mixed dentition space analysis in a Thai population.
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This study produced simple linear regression equations to be used for mixed dentition space analysis for males and females, and sexes pooled in a population living in northeastern Thailand. Measurements of teeth were made to within 0.01 mm on the dental casts of 215 boys and 215 girls (mean age 15.7 years). All dentitions were required to be free of any signs of dental pathology or anomalies. It was found that males had significantly larger teeth than females as represented by summations of mandibular incisor, canine, and premolar widths. ANOVA of regression indicated a close relationship between mandibular incisor summation and corresponding summations of canine and premolars. The low coefficients of determination (r2) of the regressions ranged between 0.29 and 0.42, and were higher for females than males, which might be attributable to the ethnic diversity of the sampled population. The regression equations produced predictions of mesio-distal width summations for maxillary and mandibular canine, and premolar arch segments that were slightly different from other reported Asian studies. Moyers' prediction tables at the 50th percentile were found to under-estimate tooth size summation compared with the present investigation. The predictions from simplified regression equations matched well with those of this study for sexes pooled, and for males and females separately. (+info)
Multivariate analysis in skull osteometry of the common tree shrew from both sides of the Isthmus of Kra in Southern Thailand.
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The Isthmus of Kra in Southern Thailand consists of a lowland of about 70 km in length. It has been suggested that the Isthmus may sink beneath the sea surface according to the change of level of the sea, and may function as a zoogeographical barrier in land mammals in this region. So, the geographical variation was osteometrically examined in skull of the common tree shrew (Tupaia glis) from the both sides of Isthmus of Kra. The osteometrical examination demonstrated that the skull is larger in southern population than in northern one. In the charts of the principal component analysis, however, the morphological separation between two populations can not be obviously seen in female. While, the results of the discriminant analysis indicated the morphological separation between the two populations. These findings suggest that the zoogeographical barrier of Isthmus of Kra may have influence on the osteometrical variation in the common tree shrew, when the Isthmus was covered with sea. (+info)
Disease progression and survival with human immunodeficiency virus type 1 subtype E infection among female sex workers in Thailand.
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This study describes rates and correlates of disease progression and survival among 194 female sex workers in northern Thailand who were infected with human immunodeficiency virus type 1 (HIV-1; 96% with subtype E). The median rate of CD4 T lymphocyte decline (3.9 cells/microL/month), median time from infection to <200 CD4 T lymphocytes/microL (6.9 years), and time to 25% mortality (6.0 years) were similar to those found in studies performed in Western countries before highly active antiretroviral therapy was available to populations infected with HIV-1 subtype B. Mortality rates among women with >100,000 HIV-1 RNA copies/mL were 15.4 times higher (95% confidence interval, 5.2-45.2) than among women with <10,000 copies. Initial CD4 T lymphocyte counts and serum virus load were independently strong predictors of survival. These results can help in assessing the effects of the epidemic in Thailand and in determining the prognoses for individual patients. (+info)