Showing papers by "Mahidol University published in 1995"

Determination of HIV-1 subtypes in injecting drug users in Bangkok, Thailand, using peptide-binding enzyme immunoassay and heteroduplex mobility assay: evidence of increasing infection with HIV-1 subtype E.

Abstract: This study sought to evaluate the sensitivity and specificity of peptide-binding enzyme immunoassay (PEIA) and heteroduplex mobility assay (HMA) for the determination of HIV-1 subtypes B and E; to determine the proportions of infections due to subtypes B and E over time; and to generate data on DNA sequences of the C2-V3 region of the env genes. HIV-1 subtyping was conducted by PEIA and HMA on blood specimens obtained from 97 injecting drug users (IDU) infected with HIV between 1988 and 1993. Genetic sequencing was performed on 84 specimens. Both laboratory methods were highly sensitive and specific for the determination of HIV-1 subtypes B and E. The two tests were complementary; samples which could not be typed by HMA were correctly typed by PEIA and vice versa. While subtype B accounted for 80.4% (78 out of 97) of infections overall the proportion of new infections due to subtype E increased from 2.6% (1 out of 38) in 1988-1989 to 25.6% (11 out of 43) in 1990-1991 and to 43.8% (7 out of 16) in 1992-1993 (chi squared for linear trend p < 0.001). HMA and PEIA are practical sensitive and specific laboratory methods for the determination of HIV-1 subtypes in Thailand and may be useful in other geographic areas to define the molecular epidemiology of the global HIV-1 pandemic. Data suggest that the proportion subtype E infections have increased among Bangkok IDU from 1988 through 1993. (authors)

Effect of aloe vera gel to healing of burn wound a clinical and histologic study.

Abstract: In a study of twenty-seven patients with partial thickness burn wound, they were treated with aloe vera gel compared with vaseline gauze. It revealed the aloe vera gel treated lesion healed faster than the vaseline gauze area. The average time of healing in the aloe gel area was 11.89 days and 18.19 days for the vaseline gauze treated wound. Statistical analysis by using t-test and the value of P < 0.002 was statistically significant. In histologic study, it showed early epithelialization in the treated aloe vera gel area. Only some minor adverse effects, such as discomfort and pain were encountered in the 27 cases. This study showed the effectiveness of aloe vera gel on a partial thickness burn wound, and it might be beneficial to do further trials on burn wounds.

Isolation of Pseudomonas pseudomallei from soil in north-eastern Thailand.

Abstract: In order to optimize the recovery from soil of Pseudomonas pseudomallei , the cause of melioidosis, 3 selective broths were compared A basal salt solution containing l -threonine (TBSS) performed significantly better than trypticase soy broth containing crystal violet and colistin 50 mg/L (CVC50), both in isolation rate and suppression of overgrowth of other organisms, but the addition of colistin to TBSS gave the best results overall In a survey in north-eastern Thailand, P pseudomallei was recovered from 114 (68%) of the 167 sites tested A detailed study of a single rice farm showed that the isolation rate increased with depth of soil sample, and P pseudomallei could still be isolated during the dry season, although only from moist soil in areas where other crops were cultivated and around the water source

Magnetic resonance imaging of the brain in patients with cerebral malaria.

Abstract: In a prospective study of cerebral malaria, 24 adults with this disease underwent magnetic resonance imaging (MRI) of the brain. Four patients died. Two of these patients (nos. 17 and 24) had breathing abnormalities requiring ventilatory support followed by clinical signs of brain death. Four days later MRI of patient 17 showed gross swelling of the brain, and 5 hours later MRI of patient 24 showed foramen magnum herniation. Twenty-two patients had no evidence of cerebral edema, but MRI revealed that brain volume during acute cerebral malaria was slightly greater than that during the convalescent phase of the disease. This difference was attributed to an increase in the volume of intracerebral blood. The cerebral volume was lower during early convalescence than several months later. The volume of the brain in patients with cerebral malaria is increased. This increased volume probably results from sequestration of parasitized erythrocytes and compensatory vasodilatation rather than from edema. Brain stem herniation may occur, but its temporal relation to brain death in cases of cerebral malaria remains uncertain.

Urease production correlates with possession of the trh gene in Vibrio parahaemolyticus strains isolated in Thailand.

Abstract: A total of 489 Vibrio parahaemolyticus isolates from patients in Thailand with diarrhea was examined for the presence of thermostable direct hemolysin (TDH) and TDH-related hemolysin genes (tdh and trh, respectively), their serovars, TDH production, and urease activity. Of the strains, 81% were positive only for the tdh gene, 6% for both trh and tdh genes, and 2% for the trh gene only. Thirty-seven (8%) of the 489 isolates were positive for urease production. Of special interest, all urease-positive strains possessed the trh gene, and conversely, urease-negative strains lacked the gene, indicating that urease production by V. parahaemolyticus strains strongly correlates with the possession of the trh gene. Thus, the urease-positive phenotype of V. parahaemolyticus can be considered an indication of virulent (trh-possessing) V. parahaemolyticus strains in clinical diagnosis.

Artesunate versus artemether in combination with mefloquine for the treatment of multidrug-resistant falciparum malaria

Abstract: To compare the therapeutic efficacy of oral artesunate and artemether in combination with mefloquine for the treatment of multidrug resistant malaria, a trial was conducted in 540 adults and children on the Thai-Myanmar border. Three regimens were compared: artesunate (4 mg/kg/d for 3 d), artemether (4 mg/kg/d for 3 d), both in combination with mefloquine (25 mg/kg), and a single dose of mefloquine (25 mg/kg). The artesunate and artemether regimens gave very similar clinical and parasitological responses, and were both very well tolerated. There was no significant adverse effect attributable to the artemisinin derivatives. Fever and parasite clearance times with mefloquine alone were significantly longer (P < 0.001). After adjusting for reinfections the failure rates were 13.9% for the artesunate combination, 12.3% for the artemether combination and 49.2% for mefloquine alone (P < 0.0001; relative risk 3.8 [95% confidence interval 2.6-5.4]). Mefloquine should no longer be used alone for the treatment of multidrug resistant falciparum malaria in this area. Three-day combination regimens with artesunate or artemether are well tolerated and more effective.

Mefloquine treatment of acute falciparum malaria: a prospective study of non-serious adverse effects in 3673 patients

Abstract: Between 1990 and 1994, a series of prospective studies were conducted to optimize the treatment of multidrug-resistant falciparum malaria on the borders of Thailand. The tolerance of various treatment regimens containing either mefloquine 15 mg/kg (M15) or 25 mg/kg (M25) was evaluated in 3673 patients aged between 6 months and 88 years. Early vomiting (within 1 hour) is an important determinant of treatment outcome in these areas, despite re-administration of the dose. Overall, 7 % of the patients vomited within an hour. Significant risk factors were age or 50 years (RR, 2.7), the higher mefloquine dose (M25) (RRm 2.7), vomiting 38.0 degrees C (RR, 1.6), and parasitaemia > 10,000/microliter (RR, 1.3). In children < or = 2 years, 30% vomited with M25, and 13% did not tolerate a repeat dose. Vomiting was reduced 40% by splitting the higher dose (RR, 0.6; 95% CI, 0.4-0.8), and 50% by giving mefloquine on the second day in combination with artesunate (RR, 0.5; CI, 0.3-0.9). Anorexia, nausea, vomiting, dizziness, and sleeping disorders were 1.1-1.4 times more frequent with M25 than M15 in the three days following treatment, but were similar in the single or split-dose M25 groups, despite twofold higher mefloquine concentrations obtained with the latter. There was no evidence that diarrhoea, headache, and abdominal pain were associated with mefloquine use. High-dose mefloquine is well tolerated but should be given as a split dose.

Quantitative recovery of Burkholderia pseudomallei from soil in Thailand

Abstract: Melioidosis is common in north-eastern Thailand, but is reported rarely from the adjacent areas of central Thailand, although rice farming is common to both regions. Quantitative soil cultures for Burkholderia pseudomallei were therefore prepared on 12 rice farms in both regions. B. pseudomallei was isolated from a similar proportion of rice fields in the central region (6/12) and in the north-east (7/12). Within the culture-positive sites, the number of B. pseudomallei colony-forming units (cfu) per mL of soil/water supernatant was significantly higher in the north-east (median 230 cfu/mL; range 1-17,000) than in the central region (median 10 cfu/mL; range 1-600). As bacterial counts in the soil are probably related to the risk of developing melioidosis, differences in exposure to B. pseudomallei probably contribute to the considerable differences in the incidence of this disease between these 2 adjacent regions.

Brachial plexus injury in Thailand: a report of 520 cases.

Abstract: Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty-two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty-seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty-one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to suprascapular, axillary, and musculotaneous) intercostal (to musculotaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo- plexal methods gave a significant number of good results. Language: en

Predictors of mefloquine treatment failure: a prospective study of 1590 patients with uncomplicated falciparum malaria

Abstract: The factors which identify patients at risk of treatment failure were characterized in 1590 children and adults with uncomplicated falciparum malaria treated with 15 or 25 mg/kg of mefloquine on the borders of Thailand. Six independent predictors of failure were identified using multiple logistic regression. Age ≤2 years (odds ratio [OR] 4.54), 3-15 years (OR 4.4), vomiting 10 000/mm 3 (OR 1.4), and fever with a history of recent vomiting (OR 1.6) were risk factors for recrudescence of the infection between days 10 and 28. Patients treated with mefloquine in the previous 2 months were also at increased risk of failure (OR 2.38), particularly if they were anaemic (haematocrit <30%) (OR 5.96), which suggested that they had recrudescent infections at presentation. Combined, these 6 factors identified half of all treatment failures. Vomiting and diarrhoea accounted for 24% of the early failures in children. Patients at increased risk of treatment failure should be monitored closely and given early alternative treatment if fever and parasites persist for ≥3 d.

Transplantation of Cord-Blood Stem Cells into a Patient with Severe Thalassemia

Abstract: Several different kinds of thalassemia and hemoglobinopathy are prevalent in Southeast Asia.1,2 The frequency of the α-thalassemias reaches 30 to 40 percent in northern Thailand, whereas the β-thalassemias occur at a frequency of 3 to 9 percent. Hemoglobin E, the hallmark hemoglobinopathy of Southeast Asia, occurs at a frequency of 50 to 60 percent at the junction of Thailand, Laos, and Cambodia. Mutation and gene interaction account for more than 60 different clinical syndromes. Of these, homozygous β-thalassemia and hemoglobin E –β-thalassemia disease are the most common and the most severe clinical syndromes compatible with live birth. Hemoglobin E–β-thalassemia . . .

Rosette formation by Plasmodium vivax

Abstract: In contrast to Plasmodium falciparum, infections with P. vivax are seldom fatal. Red blood cells containing mature forms of P. falciparum sequester in the microvasculature of vital organs, and adhere to vascular endothelium (cytoadherence) and to uninfected red cells (rosetting). Rosetting of P. falciparum has been associated with the lethal syndrome of cerebral malaria. We have studied the rosetting properties of red blood cells infected with P. vivax obtained from adults with acute malaria in Thailand. Of 35 parasite isolates studied, 25 (71%) showed rosetting with a mean proportion of 41% of infected red cells (SD 34%, range 14-100%). Rosetting of P. vivax was related to maturation of the parasite; only cells containing parasites with visible malaria pigment rosetted. Rosetting and parasitaemia were not correlated. However, unlike P. falciparum, cells infected with P. vivax did not adhere to human umbilical vein endothelial cells, to C32 melanoma cells, to platelets, or to purified adhesion receptor molecule CD36. These findings suggest that thrombocytopenia in vivax malaria is not related to platelet-red cell attachment, and that rosetting alone is insufficient to cause the syndrome of cerebral malaria.

A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis

Abstract: An open randomized comparison of the oral ‘conventional’ regimen (combination of chloramphenicol, cotrimoxazole and doxycycline) and co-amoxiclav for the maintenance treatment of melioidosis was conducted in Ubon Ratchatani, north-eastern Thailand, between 1989 and 1992. The total antibiotic treatment duration was 20 weeks. Of 101 patients followed, 10 (10%; 95% confidence interval [CI] 4·9–17·5%) subsequently relapsed: 2 of 52 patients (4%) in the oral ‘conventional’ group, and 8 of 49 patients (16%) receiving oral co-amoxiclav. This compares with a relapse rate of 23% in our previous study of 8 weeks' total therapy. Only 50% of patients complied with the 20 weeks' treatment regimen and poor compliance proved the most significant risk factor for subsequent relapse (relative risk [RR] 4·9, 95% CI 1·2–20·3). Neither the presence of known underlying disease nor choice of initial patenteral treatment was significantly associated with a higher risk of relapse. Co-amoxiclav is safer and better tolerated, but may be less effective (RR of relapse 0·4, 95%CI 0·2–1·2) than the oral ‘conventional’ regimen. The minimum duration of total treatment with either regimen should be 12–20 weeks, depending on clinical progress.

Antibodies that block virus attachment to vero cells are a major component of the human neutralizing antibody response against dengue virus type 2

Abstract: Epidemiological data strongly implicate a role for the host humoral immune response in both protection against and exacerbation of dengue virus-caused disease. In an effort to characterize elements of the normal human immune response against dengue virus we have addressed the issue of antibody-mediated neutralization of dengue virus. We show here the ability of both mouse monoclonal antibody 3H5 and human anti-dengue neutralizing sera to block binding of dengue-2 virus to monkey kidney (Vero) cells. Since Vero cells possess virus receptors but not Fc receptors we conclude that the major effect of host neutralizing antibodies is to block virus attachment to Vero cell dengue virus receptors. Analysis of 61 patient antisera yielded good correlation (Pearson's coefficient = 0.90; P < 0.001) between neutralizing activity and ability to block virus-cell attachment suggesting that antibody-mediated neutralization of dengue virus occurs primarily extracellularly and less by a postat-tachment mechanism as has been described for certain other viruses. © 1995 Wiley-Liss, inc.

Prognostic Significance of Quantitative Bacteremia in Septicemic Melioidosis

Abstract: Pour-plate blood cultures were performed for 418 adult patients with suspected septicemic melioidosis in order to determine the relationship between quantitative bacterial counts in blood and mortality. Of 108 patients whose hemocultures yielded Burkholderia pseudomallei, 53% had 100 cfu/mL. High blood bacterial counts were more common than reported previously with regard to other gram-negative septicemias and were significantly associated with the development of hypotension (P = .008) and a fatal outcome (P = .0001). The overall mortality was 63% (95% CI, 53%-72%); however, counts of 100 cfu/mL. Heavy bacteremia (> 50 cfu/mL) is common in septicemic melioidosis and is usually fatal.

The relational determinants of condom use with commercial sex partners in Thailand.

Abstract: 678 women in brothels 330 male truck drivers and 1075 men aged 17-45 years participated in focus groups and were interviewed in Udon Thani Saraburi and Bangkok in 1992 to analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. Consistent condom use was reported by 61% of women in brothels 25% of truck drivers and 29% of men in the low-income population. The single strongest predictor of consistent condom use for all groups is the nature of the relational bond between the partners rather than their individual characteristics knowledge or attitudes. Consistent use drops significantly with multivisit commercial sex partners compared with single visit commercial partners. Brothel women report that 20% of their commercial partners are regulars while 20% of the young men who report a commercial partner also report visiting a "regular" commercial sex partner. To raise condom use further programs will have to move beyond the standard knowledge attitudes and practices approach to address the contextual determinants of behavior.

Effects of glass ionomer cement, resin-based pit and fissure sealant and HF applications on occlusal caries in a developing country field trial.

Abstract: The aim of this community-oriented study was to evaluate different methods to prevent fissure caries. The following products and measures were tested: 1) glass ionomer cement (GIC) applied by dentist; 2) same material applied by short term (3 days) trained personnel (teachers); 3) application of a 0.5% HF solution three times; 4) an established autopolymerized resin based sealant (Delton). The study was performed in Bangkok, Thailand, a city in a developing country experiencing increasing caries prevalence. Children with at least three sound permanent molars from two age groups, 7–8 and 12–13-yr-olds respectively were chosen from very low to medium socioeconomic level families. 1264 children were systematically assigned to experiment or control groups based on school and DMFT. For the younger age group, the 2 yr mean DFS occlusal increment in the Control group was 0.66 surfaces. Significantly lower increments were observed in the GIC experimental group: O.I7 surfaces applied by the teachers and 0.32 applied by dentist, corresponding to 74% and 52% reductions, respectively. The mean increment in the HF group was 0.44 surfaces, a 33% reduction in relation to the Control group. For the 12–13-yr-olds, the mean occlusal surface DF increment was 0.70 surfaces in the Control group. Almost no occlusal increment was found in the Delton group, 0.05 DFS, a 93% reduction. In the GIC Dentist group, the DFS increment was 0.48 and in the Teacher group 0.56, corresponding to 31% and 20% reduction, respectively. A slight and nonsignificant increase of caries in relation to the Control group was observed in the HF group. Retention of Delton sealant was high, 92% after 6 months, retention of the GIC sealants was low. At the 6-months checkup, only 2–8% of these sealants were still present and also after reapplication, a majority was lost.

Elevated serum procalcitonin levels in patients with melioidosis.

Abstract: The prognostic value of serum procalcitonin levels in 43 patients with acute melioidosis, an infection with a wide range of clinical manifestations, was assessed. In eight patients with mild localized infections, the median procalcitonin levels were 0.13 ng/mL (range, 0.02-0.46 ng/mL), which were similar to those in 19 healthy controls (median, 0.07 ng/mL; range, 0.03-0.15 ng/mL). In the patients with severe infections, the initial procalcitonin levels were significantly higher in the patients who died (median, 350 ng/mL; range, 63-3,538 ng/mL) than in the survivors (median, 19 ng/mL; range, 0.55-387 ng/mL) (P 100 ng/mL died, compared with 2 of 16 patients with levels of < 100 ng/mL (relative risk, 6.7; 95% confidence interval, 1.8-25; P = .0001). In those patients who survived, the subsequent procalcitonin levels reflected closely the clinical course of their infection. The serum concentration of procalcitonin correlates well with the severity of Pseudomonas pseudomallei infection and is comparable with other acute-phase markers. However, this prognostic indicator and marker of continuing disease activity is not specific to melioidosis and could be applied to other severe infections.

Application of a Multi-Generation Diffusion Model to Milk Container Technology

Abstract: A recently introduced multi-generation model 1181, developed for high-technology industries and tested on a high-tech product class, is applied to a very different situation. It is tested by fitting and forecasting use of three generations of packaging technology in the fluid milk market, glass, paperboard cartons, and plastic, across two submarkets: gallons and half gallons. Results in the gallon market show that the model can be successfully applied to industries not usually associated with high technology, and to specific submarkets, rather than across a whole product class. It is less successful in the half-gallon market, which violates some of the assumptions underlying the model. Extension of the model with the addition of pricing and growth terms allows slightly improved forecasts over the basic model without these terms.

Serum testosterone and its relation to bone mineral density and body composition in normal males

Abstract: Summary OBJECTIVE Bone mineral density (BMD) declines with age in both men and women, predisposing the elderly to osteoporosis and fractures. Although there are extensive data about post-menopausal osteoporosis, there is relatively little information concerning the decrease in BMD with age in normal men, particularly the contribution of declining gonadal function with age to BMD. In the present study, we investigated the effect of age on the pituitary-gonadal axis in normal males and its relation to BMD and body composition. SUBJECTS Ninety healthy Thai males in the Bangkok Metropolitan area without a history of smoking or significant alcohol consumption were studied. MEASUREMENTS Serum testosterone (T), free testosterone (FT), LH and FSH were measured by radioimmunoassay in fasting blood samples obtained In the morning between 0600 and 1000h. BMD at anteroposterior L2-L4, lateral L2-L4, femoral neck, femoral trochanter and Ward's triangle were determined by dual-energy X-ray absorptiometry. RESULTS There were significant declines with age in BMD at lateral L2-L4 (r= 0.37, P < 0.001), femoral neck (r=−0.49, P<0.0001), Ward's triangle (r=−0.54, P < 0.0001) but not at anteroposterior L2-L4 or femoral trochanter. Serum FT (r=−0.56, P < 0.0001) but not T (r=−0.19, P= 0.07) decreased with age. Serum LH (r= 0.27, P <0.001) and FSH (r= 0.4, P <0.0001) increased with age suggesting a defect in gonadal androgen synthesis or possibly a secretion of bioinactive LH. Serum FT concentrations were significantly correlated to lateral L2-L4 (r= 0.27, P<0.05), femoral neck (r= 0.48, P < 0.0001) and Ward's triangle (r= 0.50, P < 0.0001) BMD. After controlling for age, declining FT with age was still associated with a decrease In BMD in femoral neck (P < 0.05) and Ward's triangle (P < 0.05) but not in lateral L2-L4. The proportion of body fat increased with age (r= 0.3, P < 0.01). Decreased serum T, but not FT, was associated with increased body fat after age was taken into account (P < 0.0001). CONCLUSIONS There is a decline in serum free testosterone together with increases In LH and FSH with age In healthy males. The decrease in serum free testosterone Is partially associated with the age-related decline in bone mineral density added to the effect of age at the femoral neck and Ward's triangle. Testosterone but not free testosterone Is associated with age-related increase in body fat.

Melasma in Orientals

Abstract: Melasma is an acquired hyperpigmentary disorder commonly seen in Orientals. The pattern of pigmentary change in this condition is very characteristic and the diagnosis is usually evident to the patient. A number of pigmentary disorders mimicking melasma have been reported in Asian people. They include Riehl’s melanosis, pigmented actinic lichen planus, and acquired bilateral naevus of Otalike macules. Increased awareness of these pigmentary disorders should lead to the correct diagnosis.

Occurrence of Penicillium marneffei infections among wild bamboo rats in Thailand.

Abstract: Penicilliosis marneffei has emerged as an endemic systemic mycosis in Southeast Asia among humans and wild bamboo rats. To gain an insight into the epidemiology of this life-threatening disease, a survey of bamboo rats for natural infections byPenicillium marneffei was carried out in the central plains of Thailand during June-September, 1987. Thirty-one lesser bamboo rats (Cannomys badius) and eight hoary bamboo rats (Rhizomys pruinosus) were trapped. Portions of their internal organs were cultured to determine if they had been infected byP. marneffei. Six each ofC. badius (19.4%) andR. pruinosus (75%) yielded cultures of this unique, dimorphicPenicillium species. All of the isolates were readily converted to their unicellular form that multiplies by the process of schizogony by incubating them at 37 °C on plates of brain heart infusion agar. Their identity was further confirmed by a specific immunological test. Among the internal organs of the positive rats, the lungs had the highest positivity (83.3%), next in decreased order of frequency were the liver (33.3%) and the pancreas (33.3%). The use and value of domestic and wild animals in locating and demarcating endemic areas of geophilic fungal pathogens are discussed. Penicilliosis marneffei is considered to be a zooanthroponosis — a disease that occurs in lower animals, as well as, humans.

A novel E250X mutation of the PIT1 gene in a patient with combined pituitary hormone deficiency.

Abstract: PIT1 abnormality is defined as a genetic abnormality in the PIT1 gene that encodes a pituitary specific transcription factor, Pit-1/GHF-1. PIT1 abnormality indicates combined deficiency of thyrotropin (TSH), growth hormone (GH) and prolactin (PRL), and has been reported in several cases. We studied the PIT1 gene in a patient with combined deficiency of TSH, GH and PRL. A novel mutation substituting a termination codon for Glutamate at 250th codon (E250X) was identified in the homozygous state in the patient. Both of the healthy parents harbored this mutation in the heterozygous state. This nonsense mutation results in complete loss of helix 3 of the POU homeodomain of Pit-1/GHF-1. As helix 3 of the homeodomain is involved directly in DNA binding, the mutant Pit-1/GHF-1 may lose the DNA binding activity of the POU homeodomain and lose its transcriptional activation. The E250X mutation is therefore considered to be the cause of the combined deficiency of TSH, GH and PRL in this patient.

UVB phototherapy for pityriasis rosea: A bilateral comparison study

Abstract: Background: Pityriasis rosea is a common self-limiting disease. UV light has been mentioned as helpful, but only a few studies substantiate this possibility. Objective: Our purpose was to evaluate the clinical efficacy of UVB phototherapy in pityriasis rosea and the course of the disease after treatment. Methods: Seventeen patients with extensive pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study. One joule of UVA was used as a "placebo" on the untreated side. The treatments were given five times per week for 2 weeks. The rate of clearing was monitored by estimation of the severity score. Results: Ten daily erythemogenic exposures of UVB resulted in substantially decreased severity of disease, greater than that on the untreated side in 15 of 17 patients. The overall reduction of severity score showed a significant difference after the third treatment; the UVB irradiation was superior. However, during the follow-up period the two sides were indistinguishable in regard to severity score ( p = 0.6784). No significant difference in pruritus was noted between the two sides ( p > 0.1638). The duration of disease did not relate to the success of UVB phototherapy. Conclusion: During the treatment period UVB phototherapy resulted in decreased severity of disease. However, the itching and the course of the disease were unchanged.

Evaluation of a monoclonal antibody-based enzyme linked immunosorbent assay for the diagnosis of Opisthorchis viverrini infection in an endemic area.

Abstract: A monoclonal antibody-based enzyme-linked immunosorbent assay (MAb-ELISA) was evaluated for its potential in the diagnosis of opisthorchiasis in an area endemic for Opisthorchis viverrini infection. The method, based on the detection of the 89-kD O. viverrini metabolic antigen in the feces (coproantigen), was previously estimated to be sensitive enough to detect antigen excreted by a single mature fluke. In the present study, fecal specimens from 207 apparently healthy villagers in northeastern Thailand were analyzed in a double-blind test for the presence of O. viverrini eggs by microscopic examination and for antigen by MAb-ELISA. The microscopic examination was carefully done to minimize false-positive results due to eggs of Lecithodendriid trematodes. The specimens were divided into six groups based on the number of eggs per gram of feces, namely, egg negative, 1-500, 501-1,500, 1,501-3,000, 3,001-6,000, and more than 6,000. The results showed that the ELISA is sufficiently sensitive and specific for the diagnosis of O. viverrini infection. The slightly higher rate of coproantigen positive by the ELISA compared with microscopic examination may reflect lower specificity of the ELISA or its higher sensitivity over microscopic examination in detecting light infections. Different lines of evidence presented here support the latter explanation.

Electron microscopy study of the mode of growth of Pseudomonas pseudomallei in vitro and in vivo

Abstract: The mode of growth of Pseudomonas pseudomallei in culture media and in the lung tissue of infected humans and animals was studied using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). In culture media, P. pseudomallei cells were seen to be entrapped in microcolonies within large amounts of intercellular fibrous material. The lung tissue of infected humans and animals showed that bacterial cells growing in lung tissue were surrounded by radially arranged fibres that constitute a very well defined glycocalyx structure. In the infected areas of the animal lung tissue, bacterial cell could be seen to have formed glycocalyx enclosed microcolonies that displaced host cell components, e.g. the nucleus of a phagocyte. The presence of bacteria in unusual locations indicated that effective phagocytosis was not occurring. The demonstration that cells of P. pseudomallei produce exopolysaccharide glycocalyces and form glycocalyx enclosed microcolonies in laboratory media and in lung tissue of infected humans and animals and the presence of bacteria in unusual locations contribute to a new understanding of the mechanism whereby this organism can cause persistent chronic infections.