COMPARISON OF THE THAI VERSION OF THE ROSE QUESTIONNAIRE FOR ANGINA PECTORIS WITH THE EXERCISE TREADMILL TEST
Kamol Udol1, Nithi Mahanonda2
1Department of Preventive
and Social Medicine,
2Department of Medicine, Faculty of Medicine Siriraj
Hospital, Mahidol University, Bangkok 10700, Thailand
Key words : Angina, Exercise Test, Questionnaire, Rose Questionnaire
Prior
to exercise treadmill testing (ETT), 157 patients (92
males and 65 females)
were interviewed twice separately, using a Thai version of the Rose questionnaire
for angina pectoris. One interview was conducted by a physician and the other
by a nurse. The questionnaire responses were compared with ETT results. Based
on physician-conducted interview, the Rose questionnaire had a sensitivity of
30.3 per cent, a specificity of 83.9 per cent, a positive predictive value of
35.3 per cent, a negative predictive value of 81.9 per cent, and the total accuracy
of 72.6 per cent. There were gender differences in the validity of the questionnaire,
with higher specificity, higher positive predictive value, and lower negative
predictive value in males than in females. The sensitivity and accuracy were not
different between the two sexes. In 87.9 per cent of cases, responses to physician-conducted
and nurse-conducted interview were the same. There were no significant differences
between responses to the questionnaires by the physicians and by the nurses.
(J Med Assoc Thai 2000;83:514-2
PREVALENCE OF DYSLIPIDEMIA IN THE ELDERLY IN RURAL AREAS OF THAILAND
Yamwong P, Assantachai P, Amornrat A
Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok 10700, Thailand.
Key Words: Dyslipidemia, Cholesterol, Triglyceride, Elderly
Dyslipidemia is highly prevalent in the urban areas of Thailand but information in the rural area, particularly in the elderly, is limited. The objective of this study was to determine the prevalence of dyslipidemia in the elderly who live in the rural areas of Thailand. Random sampling of the volunteers aged > or = 60 years in 3 districts of Samut Songkhram and Ratchaburi provinces was done. After 12-hour fast, the blood sampling was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Eighty men and 123 women, aged 60-87 years old, were included in the study. Mean serum lipid levels of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 261.74+/-47.58, 180.35+/-45.06, 43.72+/-12.06, and 188.38+/-103.84 mg/dl respectively. Women had significantly higher body mass index, cholesterol and LDL cholesterol levels than men. Seventy percent of them had cholesterol > or = 240 mg/dl and LDL cholesterol > or = 160 mg/dl. Twenty-five percent had HDL cholesterol < or = 35 mg/dl. However, LDL/HDL cholesterol ratio > 5which indicated high risk for coronary heart disease were found in only 34%. In conclusion, prevalence of dyslipidemia was very high in Thai rural elderly. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in Thai elderly people.
(Southeast Asian J Trop Med Public Health 2000;31:158-62)
UPDATE
ON ANTIRETROVIRAL TREATMENT
Surapol
Suwanagool, Thanomsak Anekthananon, Winai Ratanasuwan,
Wichai Techasathit
Department of Preventive and Social Medicine, Faculty of Medicine,
Siriraj
Hospital, Mahidol University, Bangkok 10700, Thailand
Key word : Antiretroviral treatment
Although
HIV infection is still classified as uncurable
disease, there are a dramatic
progression in antiretroviral treatment in the past five years. HAART therapy
can suppress HIV viral RNA to undetectable level and CD4 increase within 16 wk.
and maintain for more than 3 years (since PI is available). Patients return to
nearly normal. There are 3 groups of antiretroviral drugs approved to use in HIV
patients at present. These three groups of drugs attack HIV virus at different
sites. Because of extremely high level of replication and mutation of HIV virus,
the current recommendation of antiretroviral treatment is multiple drugs regimen.
How to choose antiretroviral drugs for the patient is very important. There are
6 NRTIs (Zidovudine, Lamivudine, Didanosine, Zalcitabine, Stavudine and Abacavir),
3 NNRTIs (Nevirapine, Delaverdine, and Efavirenz), 5PIs (Saquinavir, Ritonavir,
Indinavir, Nelfinavir, and Amprenavir). The big problems of using antiretroviral
drugs are drug interaction, side effects, adherance, and socioeconomic problem,
etc.
In conclusion of antiretroviral treatment, if possible, and
affordable,
we recommend "hit early, hit hard and maintain durability of treatment resposne."
The current recommendation are 3 drug combination which currently include; 2 NRTIs
+ PI or NNRTI + 2 NRTIs or 2PIs + NRTIs or PI + NRTI + NNRTI, or 3 NRTIs
MYCOBACTERIOSIS IN HIV/AIDS : THE REAL CHALLENGE OF THE NEW MILLENNIUM
Surapol
Suwanagool, Thanomsak Anekthananon, Winai Ratanasuwan,
Wichai Techasathit
Department of Preventive and Social Medicine, Faculty of Medicine,
Siriraj
Hospital, Mahidol University, Bangkok 10700, Thailand
Key words : Mycobacteriosis /AIDS
The
leading cause of admission of adult AIDS patients
during 1997-1999 were tuberculosis
(37%), cryptococcosis (22%), pneumocystosis (16%) and others. Extrapulmonary tuberculosis
were common as well as pulmonary tuberculosis (51% versus 45%). Tuberculous lymphadenitis
presented as peripheral solitary lymphadenopathy was the commonest site of extrapulmonary
tuberculosis. A retrospective study of culture positive M.tuberculosis cases were
reviewed over 12 months. A total 366 (29%) of 1,262 cases of culture positive
of M.tuberculosis were adult AIDS patients which presented in emergency room,
HIV clinic and medical wards. The biggest problem was the nonadherence of AIDs
patients and loss of their follow-up, majority were the cases in the observation
room and emergency room (67.4%). In addition, the cause of prolonged fever was
prospectively investigated in 171 advanced AIDS patients during March 97-December
98 and blood culture with Bactec 9240 media was obtained from each patient. Mycobacterium
avium complex was the most common blood isolate in 24.6% of the patients; followed
by mycobacterium tuberculosis in 21%. We concluded that in AIDS patients, tuberculosis
present more often with extrapulmonary involvement particulary tuberculous peripheral
lymphadenitis. The diagnosis was not difficult, the cost of treatment was not
the problem but the nonadherence, poor compliance and loss of their follow-up
were the biggest problem in managing them. Disseminated MAC infection exists among
Thai AIDS patients and the prevalence of MAC infection was high in comparable
to that in the western countries as the etiology of prolonged fever in advance
AIDS patients. In clinical practice mycobacterium blood culture using Bactec media
was the most valuable tool contributing to the diagnosis.
A COMPARISON OF TWO DOSING REGIMENS OF ZIDOVUDINE IN THAI ADULTS WITH EARLY SYMPTOMATIC HIV INFECTION CONDUCTING CLINICAL HIV TRIALS IN SOUTH-EAST ASIA
Phanuphak
P 1,7, Grayson ML 2, Sirivichayakul S 3,7, Suwanagool S 4,8,
Ruxrungtham
K 5,7, Hanvanich M 6,7, Ratanasuwan W 4,8, Ubolyam S 7,
Hughes MD 9, Wanke
CA 10, Hammer SM 10
1Departments of
Medicine and Microbiology, 2Department of
Epidemiology and Preventive Medicine,
Monash University,
Melbourne, 3Department of Medicine, 4Department of Preventive
and
Social Medicine, 5Division of Allergy and Clinical Immunology,
6Division
of Infectious Diseases, 7Faculty of Medicine, Chulalongkorn
University, Bangkok,
8Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, 9Department
of Biostatistics, Harvard School of
Public Health, Boston, MA, USA, 10Division
of Infectious Diseases,
Beth Israel Deaconess Medical Center, Boston, MA,
USA.
Key words : Zidovudine,
HIV, AIDS, Therapy, Efficacy, Toxicity,
Clinical, Thailand, Asia
Aim
: To compare the clinical and immunological efficacy, and tolerance of two dosage
regimens of zidovudine (ZDV) in an adult Thai population with early symptomatic
human immunodeficiency virus (HIVX disease and to identify important clinical
issues associated with conductiong HIV trials in South-East Asia.
Methods
: HIV-infected Thai adults, with early symptomatic HIV disease and CD4 lymphocyte
counts less than 400/mm3, who were managed in the infectious diseases clinics
at two university teaching hospitals in Bangkok, Thailand, were enrolled in a
randomised, open-label, dose-regimen comparison trial of ZDV. Two oral ZDV dosing
regimens : regimen A, 100 mg tid+200 mg nocte (ZDV-A) vs regimen B, 250 mg bid
(ZDV-B) were compared. The main outcome measures were:
1. Clinical efficacy
: rate of progression to acquired immundeficiency syndrome (AIDS) or death.
2. Immunologic efficacy : changes in CD4 lymphocyte numbers compared to baseline;
rate of decline of CD4 lymphocyte numbers to less than 100mm3.
3. Toxicity,
as defined by clinical symptomatology and laboratory parameters.
Results:
Two Hundred and four patients were enrolled (103
ZDV-A; 101 ZDV-B) of whom
195 were followed beyond baseline. Patients were typical of those encountered
with HIV in Thailand : men age 33 years; 89% male; 88% heterosexual HIV acquisition;
mean baseline CD4 lymphocyte count 241mm3. Follow-up while on therapy was comparable
for the two groups (mean + SD): 533+236 days (ZDV-A) vs 592+210 days (ZDV-B).
One hundred and eleven patients (57%; 51 ZDV-A 60 ZDV-B) were treated for at least
22 months (669+30 days). Clinical and immunological outcomes for ZDV-A and ZDV-B,
including rate of progression to AIDS or death, development of non-AIDS-defining
opportunistic infections, mean changes in CD4 lymphocyte numbers/mm3, difference
in area under the CD4:time distribution curve and difference in the rate of decline
of CD4 lymphocyte numbers to less than 100/ mm3, were not significantly different.
The presence of oral hairy leukoplakia or unintential weight loss of 10-20% enrolment
were significantly associated with the later development of AIDS (p=0.03 and 0.04,
respectively). ZDV-associated toxicity was similar for both regimens. Maintaining
protocol adherence and appropriate clinical follow-up emerged as important practical
issues.
Conclusion : In Thai adults, ZDV 100 mg tid + 200 mg nocte and ZDV
250 mg bid have similar clinical and immunological efficacy. Rates of ZDV toxicity
are comparable to those reported in non-Asian populations. Despite limitations
in medical care access and maintaining long-term follow-up, successful trials
of antiretroviral agents are feasible in South-East Asia and multi-drug treatment
trials should be pursued in appropriate institutions.
(Aust NZ J Med 2000;30:11-20.)
EVALUATION OF ANTIRETROVIRAL DRUG EFFICACY FOR HIV-1 ENCEPHALITIS IN SCID MICE
Limoges
J, Persidsky Y, Poluektova L, Rasmussen J, Ratanasuwan W1
Zelivyanskaya M,
McClernon DR, Lanier ER, Gendelman HE
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-5215, USA,1Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Key words: HIV-1, Encephalitis, Antiretroviral drugs, Efficacy
Objectives
: To compare the efficacy of the nucleoside reverse transcriptase inhibitors (NRTIs)
abacavir, zidovudine (AZT), Iamivudine (3TC), didanosine (ddI), and stavudine
(d4T) to inhibit viral replication in brain macrophages. A severe combined immunodeficiency
(SCID) mouse model of HIV-1 encephalitis (HIVE) was used to monitor spreading
viral infection in the CNS.
Backgroud : The development of antiretroviral
therapies with CNS efficacy against neuroinvasive virus is important if eradication
of HIV-1 can be achieved within critical "hidden reservoirs."
Methods
: HIV-1-infected human monocyte-derived macrophages (MDMs) (after a single round
of viral replication) were inoculated into the caudate and putamen of SCID mice.
This resulted in the spreading of viral infection with a concomitant multinucleated
giant cell encephalitis (astrogliosis, microglial activation, and neuronal injury).
NRTIs were administered to animals at the time of intracerebral MDM inoculations
and continued until the time of sacrifice. Antiretroviral effects were assessed
by viral load and percentages of infected MDMs.
Results : In brains of SCID
mice with HIVE, abacavir and Iamivudine reduced HIV-1 p24 antigen-positive cells
by 80% and 95%, respectively, whereas both decreased viral load by approximately
1 log. Zidovudine, didanosine, and stavudine showed variable effects.
Conclusions
: Abacavir and lamivudine showed significant antiretroviral activity in SCID mice
with HIVE when compared with other NRTIs. The extrapolation of these results to
humans with HIV-1 dementia awaits future investigations.
(Neurology 2000;54:379-89)
A
RANDOMIZED, CONTROLLED 24-WEEK STUDY OF INTERMITTENT SUBCUTANEOUS INTERLEUKIN-2
IN HIV-1
INFECTED PATIENTS IN THAILAND
Ruxrungtham K, Suwanagool S, Tavel JA, Chuenyam M, Kroon E, Ubolyam S, Buranapraditkun S, Techasathit W, Li Y, Emery S, Davey RT, Fosdick L, Kunanusont C, Lane HC, Phanuphak P
HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
OBJECTIVES:
To assess the immunological and virological effects, safety profile and feasibility
of subcutaneous interleukin-2 (scIL-2) therapy in an HIV-infected Thai population.
DESIGN: Seventy-two patients with baseline CD4 cell count of > or = 350 x 10(6)/l
and no history of opportunistic infection were randomized to receive antiretroviral
therapy plus scIL-2 (scIL-2 group) or antiretroviral therapy alone (control group).
scIL-2 was administered at one of three doses for at least 24 weeks. The main
measure of treatment efficacy was change in CD4 cell count.
RESULTS: The time-weighted
mean change in CD4 cell count from baseline to week 24 was + 252 x 10(6)/l for
the scIL-2 group compared with + 42 x 10(6)/l for the control group (P< 0.0001).
Changes in plasma HIV RNA were not significantly different between the groups
over the same time period: there was a 0.83 log10 copies/ml decrease for the scIL-2
group and a 0.70 log copies/ml decrease for the control group (P= 0.362).
CONCLUSIONS: This study provides the most extensive experience of scIL-2 therapy
in HIV-1 infected women and Asians, and demonstrates the immunological efficacy,
tolerability and feasability of scIL-2 therapy in this population. Data from this
study were instrumental in guiding the selection of the scIL-2 dosing regimen
for ongoing phase III trials.
( AIDS 2000;14:2509-13)
ANTIBODY RESPONSE OF PATIENTS AFTER POSTEXPOSURE RABIES VACCINATION WITH SMALL INTRADERMAL DOSES OF PURIFIED CHICK EMBRYO CELL VACCINE OR PURIFIED VERO CELL RABIES VACCINE
Briggs DJ, Banzhoff A, Nicolay U, Sirikwin S, Dumavibhat B, Tongswas S, Wasi C.
College of Veterinary Medicine, Kansas State University, USA.
Although the introduction of tissue culture vaccines for rabies has dramatically improved the immunogenicity and safety of rabies vaccines, they are often prohibitively expensive for developing countries. To examine whether smaller doses of these vaccines could be used, we tested the safety and immunogenicity of purified chick embryo cell vaccine (PCECV) on 211 patients in Thailand with World Health Organization (WHO) category II and III exposures to rabies. The patients presented at two Thai hospitals and were randomized into three groups. Patients in Group 1 received 0.1 ml PCECV intradermally at two sites on days 0, 3, 7, and at one site on days 30 and 90. Group 2 was treated similarly, except that purified Vero cell rabies vaccine (PVRV) was used instead of PCECV. Group 3 received 1.0 ml PCECV intramuscularly on days 0, 3, 7, 14, 30 and 90. After 0, 3, 7, 14, 30 and 90 days serum was collected from the subjects and the geometric mean titres (GMTs) of rabies virus neutralizing antibody determined. After 14 days the GMT of 59 patients vaccinated intradermally with PCECV was equivalent to that of patients who received PVRV. Adverse reactions were more frequent in patients who received vaccines intradermally, indicating the reactions were associated with the route of injection, rather than the vaccine per se. We conclude that PCECV is a safe and highly immunogenic vaccine for postexposure rabies vaccination when administered intradermally in 0.1-ml doses using the two-site method ("2,2,2,0,1,1") recommended by WHO.
[Bull World Health Organ. 2000;78(5):693-8]
A
SURVEY OF AGRICULTURAL INSECTICIDES IN THAILAND, 1998
Supachai
Ratanamaneechat, Prapan Cherdchoo-ngarm
Department of Preventive and Social
Medicine, Faculty of Medicine,
Siriraj Hospital, Mahidol University, Bangkok
10700, Thailand
Key words : Insecticide, Agricultural Insecticide
The purpose of this survey was to recognize and identify the insecticides used for agriculture in Thailand. This survey will be a great benefit for doctors who were dealing with the patients suffering from taking toxic insecticides especially by attempted suicide or accidental intake for early clinical diagnosis and immediate treatment. It was found out that there were 5 main groups of insecticides namely : organophosphate, carbamate, organochlorine, pyrethroid and miscellaneous group with different formulation types containing hundreds of trade names which sold in the agricultural markets. The most common cholinesterase inhibitor insecticides were methyl parathion, dimethoate, monocrotophos, methamidophos and mevinphos with 258, 171, 152, 137 and 136 trade names, respectively. These organophosphate insecticides were among the relatively high toxic to human being if not use in the proper way or not follow the direction. The most common insecticides belong to organochlorine and pyrethroid were dicofol and cypermethrin with 123 and 190 trade names. Dicofol is low toxic while cypermethrin is synthetic pyrethroid with moderate toxicity.
(Presented at the XIVth Congress of the International Association of Agricultural Medicine and Rural Health, May 25-27, 2000 Pecs, Hungary.)
sipcn@mahidol.ac.th