Clinical Application of Toothbrush Technique for Specimen Collection of Tinea Capitis

Objective: To demonstrate the efficacy of toothbrush culture test. Moreover, influential factors which affected the success of these methods were analyzed. Methods: To retrospectively analyze clinical presentation and investigation data of 59 Buddhist novices who diagnosed TC. The laboratory data of the toothbrush technique was reviewed and the efficacy of this technique was investigated. Results: The efficacy of toothbrush technique was demonstrated as 49.2% by comparing to the standard method. The analysis proved that more than 15% area TC involvement of scalp group achieved higher positive fungal culture outcome to be 65.5 % (p-value = 0.013). In the aspect of the clinical presentation, the effectiveness of the hairbrush technique significantly increased in the gray patch TC group (p-value 0.024). For the reason that the toothbrush technique demonstrated statistically higher efficacy in a group of patients with > 15 % gray patch area involvement (p-value = 0.007). Conclusion: The toothbrush technique was a good cooperation method that was recommended to apply in TC patients who presented as gray-patch type and more than 15% scalp area involvement

Clinical Application of Toothbrush Technique for Specimen Collection of Tinea Capitis

Objective: To demonstrate the efficacy of toothbrush culture test. Moreover, influential factors which affected the success of these methods were analyzed. Methods: To retrospectively analyze clinical presentation and investigation data of 59 Buddhist novices who diagnosed TC. The laboratory data of the toothbrush technique was reviewed and the efficacy of this technique was investigated. Results: The efficacy of toothbrush technique was demonstrated as 49.2% by comparing to the standard method. The analysis proved that more than 15% area TC involvement of scalp group achieved higher positive fungal culture outcome to be 65.5 % (p-value = 0.013). In the aspect of the clinical presentation, the effectiveness of the hairbrush technique significantly increased in the gray patch TC group (p-value 0.024). For the reason that the toothbrush technique demonstrated statistically higher efficacy in a group of patients with > 15 % gray patch area involvement (p-value = 0.007). Conclusion: The toothbrush technique was a good cooperation method that was recommended to apply in TC patients who presented as gray-patch type and more than 15% scalp area involvement

Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Cervical cancer is one of the most common AIDS-related malignancies in Thailand. To prevent cervical cancer, The US Public Health Service and The Infectious Disease Society of America have recommended that all HIV-infected women should obtain 2 Pap smears 6 months apart after the initial HIV diagnosis and, if results of both are normal, should undergo annual cytological screening. However, there has been no evidence in supporting whether this guideline is appropriate in all settings - especially in areas where HIV-infected women are living in resource-constrained condition.</p> <p>Methods</p> <p>To determine the appropriate interval of Pap smear screenings for HIV-infected Thai women and risk factors for subsequent abnormal cervical cytology, we assessed the prevalence, cumulative incidence and associated factors of cervical cell abnormalities (atypical squamous cell of undetermined significance or higher grades, ASCUS+) among this group of patients.</p> <p>Results</p> <p>The prevalence of ASCUS+ was 15.4% at the first visit, and the cumulative incidence of ASCUS+ gradually increased to 37% in the first 3.5 years of follow-up appointments (first 7 times), and tended to plateau in the last 2 years. For multivariate correlation analysis, women with a CD4 count <350 cells/μL had a significant correlation with ASCUS+ (<it>P </it>= 0.043). There were no associations of subsequent ASCUS+ with age, pregnancy, contraceptive method, highly active anti-retroviral treatment, assumed duration of infection, or the CD4 count nadir level.</p> <p>Conclusion</p> <p>There are high prevalence and cumulative incidence of ASCUS+ in HIV-infected Thai women. With a high lost-to-follow-up rate, an appropriate interval of Pap smear screening cannot be concluded from the present study. Nevertheless, the HIV-infected Thai women may require more than two normal semi-annual Pap smears before shifting to routinely annual cytologic screening.</p

The relationship between creamatocrit and cumulative percentage of total milk volume: a cross-sectional study in mothers of very preterm infants in Bangkok, Thailand

Abstract Background Human hindmilk contains higher concentrations of fat than foremilk and is more desirable for growth in preterm infants who can tolerate limited volumes of breastmilk. There is currently no clear demarcation between foremilk and hindmilk. This study characterized the change in breastmilk’s fat content from the start to end of milk flow and defined this demarcation. Methods Mothers of infants born at ≤ 32 weeks gestational age and ≥ 14 days after childbirth in a University hospital in Bangkok, Thailand between July, 2011, and April, 2012 were included in this cross-sectional study. Breastmilk samples were sequentially collected from the start to end of milk flow in 5-mL aliquots using breast pumps. The fat content of each aliquot from each breast was determined through creamatocrit. The average creamatocrit of foremilk and hindmilk were compared in predefined foremilk to hindmilk ratios of 20:80, 25:75, 33:67, and 50:50. Creamatocrit of the first and last aliquots were compared for mothers who expressed low- (≤ 25-mL per breast) and high-volumes (> 25-mL per breast) of breastmilk. Results Of the 25 mothers enrolled, one was excluded due to unsuccessful creamatocrit measurement. The last aliquot of breastmilk had a significantly higher creamatocrit than the first from the same breast (median [interquartile range] of 12.7% [8.9%, 15.3%] vs. 5.6% [4.3%, 7.7%]; test statistic 1128, p < 0.001). Mean creamatocrit in hindmilk portions (9.23%, 9.35%, 9.81%, and 10.62%, respectively) was significantly higher than foremilk portions (6.28%, 6.33%, 6.72%, and 7.17%, respectively) at all predefined ratios. Creamatocrit increased by 1% for every 10% incremental increase in expressed breastmilk volume until the breast was emptied. Low-volume mothers had a significantly higher creamatocrit in the first aliquot compared with high-volume mothers (U = 437, p = 0.002). No significant difference in breastmilk volume was observed between mothers with and without breastfeeding experience. Conclusions Fat content in breastmilk increased on an incremental basis. More fluid definitions of foremilk and hindmilk should be adopted. Mothers should prepare their breastmilk into aliquots based on the required feeding volume of their infant. Hindmilk aliquots can be prioritized over foremilk aliquots to ensure infants obtain optimal caloric intake

Residual lung volume of female Thai adults

ABSTRACT: Lung volumes including residual volume (RV) are ethnicity-dependent parameters which are useful in clinical diagnosis of lung diseases and in assessing body density, and hence total body adiposity. The latter predisposes an individual to cardiovascular and/or metabolic diseases which are serious health problems worldwide. At present, RV of Thai people has not been reported. This study determines RV of young adult Thai women and proposes a prediction equation to compare it with other equations previously reported for the Asian population. A group of 161 healthy young women aged between 18 and 29 years were recruited for constructing and cross-validating the equation. RV was measured by an O2 dilution technique using a computerized spectrometer. Anthropometric variables were determined using a beam balance, a stadiometer, and bioelectric impedance analysis. The mean residual volume for the selected group of young Thai women is 1.18 ± 0.23 l and best described by the equation RV = −3.236 + 0.024H + 0.028A where H is the height in cm and A is the age in years. Goldman and Becklake’s equation for Caucasians overestimated our RV whereas those of Ching and Horsfall, and Demura et al for Chinese and Japanese people, respectively, underestimated it. Chin’s equation for Singaporeans yields similar value to the measured residual volume. The results confirm that residual volume is ethnically and geographically dependent. The equations for Thais and Singaporean of the same age and sex are comparable

Success Rate of Radioactive Iodine Ablation in Low-Risk of Recurrence Well-Differentiated Thyroid Carcinoma Patients

Objective: To evaluate success rate and factors affecting the success of radioactive iodine (RAI) ablation in low-risk of recurrence well-differentiated thyroid carcinoma patients. Methods: Retrospective review of medical records was done in 132 low-risk of recurrence well-differentiated thyroid cancer (WDTC) patients between January 2007 and December 2013. All patients underwent 1) total thyroidectomy or equal surgery and 2) pre-ablative evaluationwith 99mTc-pertechnetate thyroid scan and 24-hour 131I thyroid uptake. RAI ablation using low activity (30 mCi: n = 17) or high activity (80 or 100 mCi: n = 115) were given. Success rate of each activity and a comparison of success rates between 2 doses were analyzed. Criteria of successful ablation were composed of 1) no palpable neck mass 2) no demonstrable thyroid and tumor uptake on the follow up 6-12 months diagnostic whole body scan (WBS) and 3) stimulated thyroglobulin (Tg) lower than 2 ng/mL in the absence of interfering thyroglobulin antibodies (TgAb <40 IU/mL). Factors that may affect success of radioactive iodine ablation were studied; age, gender, tumor size, stage, pathological result, number of lesions, pre-ablation 24-hour 131I thyroid uptake, serum T4, TSH, Tg and TgAb at time of ablation. Results: Overall success rate of RAI ablation was achieved in 95 patients out of 132 patients (72%). Low and high dose RAI ablation were completed in 9/17 patients (52.9%) and in 86/115 patients (74.8%), respectively (p-value = 0.082). Baseline Tg at time of ablation was a factor related to the success of ablation. Median Tg in success and failure group was 2.61 and 7.18 ng/mL, respectively (p = 0.023). Conclusion: Success of 131I ablation in low-risk of recurrence well-differentiated thyroid cancer patients was 72%. The factor relating to ablative success was Tg level at time of ablation

Association of cleft palate and craniofacial syndromic anomalies with the outcome of tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion

This research was aimed to study the association of cleft palate and craniofacial syndromic anomalies with the outcome of the tympanic membrane after tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion. A retrospective cohort study was done in 85 children with cleft palate and 102 non-cleft children who had tympanostomy tube insertion for otitis media with effusion. The desired outcome was the recovery of recurrent otitis media with effusion with intact tympanic membrane. Craniofacial syndromic anomalies were found in 11.8% of the children in both groups. Intact tympanic membrane was found most commonly in noncleft children without craniofacial anomalies (63.7%). Cleft palate was the most significant risk for the non-intact tympanic membrane after adjusting for syndromic anomalies and the number of tympanostomy tube insertion (p = 0.047). Time to recovery from recurrent otitis media with effusion was shortest in the non-cleft children without craniofacial anomalies (4.9 years) with the highest probability of cure (hazard ratio and 95% CI 3.46 (1.62, 7.39)). Children with cleft palate had higher probability of cure than the children with cleft palate and craniofacial syndromic anomalies (hazard ratio and 95% CI 2.59 (1.16, 5.80)). Children with cleft palate and craniofacial syndromic anomalies had highest incidence of otorrhea (59.1%) and repeated tympanostomy tube insertion (86.4%). Craniofacial syndromic anomalies with cleft palate contributed to a longer time to recovery and higher incidence of complications from tympanostomy tube

Distinguishing SARS-CoV-2 Infection and Non-SARS-CoV-2 Viral Infections in Adult Patients through Clinical Score Tools

This study aimed to determine distinguishing predictors and develop a clinical score to differentiate COVID-19 and common viral infections (influenza, respiratory syncytial virus (RSV), dengue, chikungunya (CKV), and zika (ZKV)). This retrospective study enrolled 549 adults (100 COVID-19, 100 dengue, 100 influenza, 100 RSV, 100 CKV, and 49 ZKV) during the period 2017–2020. CKV and ZKV infections had specific clinical features (i.e., arthralgia and rash); therefore, these diseases were excluded. Multiple binary logistic regression models were fitted to identify significant predictors, and two scores were developed differentiating influenza/RSV from COVID-19 (Flu-RSV/COVID) and dengue from COVID-19 (Dengue/COVID). The five independent predictors of influenza/RSV were age > 50 years, the presence of underlying disease, rhinorrhea, productive sputum, and lymphocyte count 3. Likewise, the five independent predictors of dengue were headache, myalgia, no cough, platelet count 3, and lymphocyte count 3. The Flu-RSV/COVID score (cut-off value of 4) demonstrated 88% sensitivity and specificity for predicting influenza/RSV (AUROC = 0.94). The Dengue/COVID score (cut-off value of 4) achieved 91% sensitivity and 94% specificity for differentiating dengue and COVID-19 (AUROC = 0.98). The Flu-RSV/COVID and Dengue/COVID scores had a high discriminative ability for differentiating influenza/RSV or dengue infection and COVID-19. The further validation of these scores is needed to ensure their utility in clinical practice

Predictive performance of a multivariable difficult intubation model for obese patients.

BACKGROUND:A predictive model of scores of difficult intubation (DI) may help physicians screen for airway difficulty to reduce morbidity and mortality in obese patients. The present study aimed to set up and evaluate the predictive performance of a newly developed, practical, multivariate DI model for obese patients. METHODS:A prospective multi-center study was undertaken on adults with a body mass index (BMI) of 30 kg/m2 or more who were undergoing conventional endotracheal intubation. The BMI and 10 preoperative airway tests (namely, malformation of the teeth in the upper jaw, the modified Mallampati test [MMT], the upper lip bite test, neck mobility testing, the neck circumference [NC], the length of the neck, the interincisor gap, the hyomental distance, the thyromental distance [TM] and the sternomental distance) were examined. A DI was defined as one with an intubation difficulty scale (IDS) score ≥ 5. RESULTS:The 1,015 patients recruited for the study had a mean BMI of 34.2 (standard deviation: 4.3 kg/m2). The proportions for easy intubation, slight DI and DI were 81%, 15.8% and 3.2%, respectively. Drawing on the results of a multivariate analysis, clinically meaningful variables related to obesity (namely, BMI, MMT, and the ratio of NC to TM) were used to build a predictive model for DI. Nevertheless, the best model only had a fair predictive performance. The area under the receiver operating characteristic curve (AUC) was 0.71 (95% confidence interval 0.68-0.84). CONCLUSIONS:The predictive performance of the selected model showed limited benefit for preoperative screening to predict DI among obese patients

Long-term Outcome of the Management of Otitis Media with Effusion in Children with and Without Cleft Palate Using the House-brand Polyethylene Ventilation Tube Insertion

Objective: To study the long-term outcome of otitis media with effusion in children with and without cleft palate treated with the same protocol of ventilation tube insertion. Materials and Methods: A retrospective cohort study was conducted in eighty-five children with cleft palate and 80 children without cleft palate who had otitis media with effusion and had follow-up between 2001 and 2019. Both groups were treated with ventilation tube insertion for longstanding middle ear effusion more than 90 days. The main outcome was the cumulative incidence of surgical management, time of the indwelling ventilation tubes, conditions of the tympanic membrane, and the hearing outcome. Results: At 24 months old, 63.5% of children with cleft palate and 11.3% of children without cleft palate had their first ventilation tube insertion. Repeated surgery was done in 81.2% of children with cleft palate and 50% of children without cleft palate (p < 0.001). The median duration of the indwelling tube was 11.3 months in the children with cleft palate and 12.4 months in the non-cleft children (p = 0.82). At the end of the study, 63.7% of children without cleft palate and 43.5% of children with cleft palate had normal tympanic membrane (p = 0.009). The hearing outcomes of children with and without cleft palate were 20.7 dB and 19.3 dB, respectively. Conclusion: Children with and without cleft palate were managed under the same guideline and the hearing outcome was favorable in both groups