rss_2.0Asian Biomedicine FeedSciendo RSS Feed for Asian Biomedicine Biomedicine 's Cover of impaired lower airway function in Thai patients with allergic rhinitis<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.467_s_001"> <title style='display:none'>Background</title> <p>Allergy is a chronic inflammatory disease, which may affect the upper and lower airway in reversible airflow obstruction or asthma. Spirometry is a noninvasive way to assess lower airway function routinely and to detect reversible airflow obstruction.</p> </sec> <sec id="j_1905-7415.1001.467_s_002"> <title style='display:none'>Objective</title> <p>To determine the prevalence of abnormal spirometry in Thai patients with allergic rhinitis (AR) who did not have lower airway symptoms.</p> </sec> <sec id="j_1905-7415.1001.467_s_003"> <title style='display:none'>Method</title> <p>Spirometry and bronchodilation testing were performed in AR patients.</p> </sec> <sec id="j_1905-7415.1001.467_s_004"> <title style='display:none'>Result</title> <p>We included 153 patients aged from 20 to 60 years who had AR (diagnosed by clinical data and positive skin prick test) and who fulfilled the study criteria. Twenty-three patients with AR (15%) showed decreased forced expiratory volume in 1 s (FEV<sub>1</sub>) compared with normal values (FEV<sub>1</sub> &lt;80% of predicted value). Four patients with AR (3%) showed reversible airflow obstruction. Thirty-seven patients with AR (24%) showed decreased forced expiratory flow during 25-75 s (FEF<sub>25-75</sub>) compared with the reference value (FEF<sub>25-75</sub> &lt;80% of predicted value). The sensitization to both indoor and outdoor allergens was statistically and significantly associated with the decreased FEV<sub>1</sub> (odds ratio (OR) = 7.79, 95% confidence interval (CI) 1.08-55.91, P = 0.03). The duration of AR was more than 10 years significantly affected FEF<sub>25-75</sub> (adjusted OR = 2.6; 95%CI = 1.01-6.72, P = 0.04).</p> </sec> <sec id="j_1905-7415.1001.467_s_005"> <title style='display:none'>Conclusion</title> <p>Impaired lower airway function and reversible airflow obstruction in patients with AR are not uncommon. Spirometry should be performed to detect lower airway impairment early in patients with AR, especially those sensitized to indoor and outdoor allergens.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Key approaches to nosocomial infection control resistance, multidrug resistance and enterobacterial repetitive intergenic consensus polymerase chain reaction profiles of clinically important Klebsiella species<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.463_s_001"> <title style='display:none'>Background</title> <p><italic>Klebsiella</italic> species are important opportunistic pathogens causing a variety of infections, especially in hospitalized and immunocompromised patients.</p> </sec> <sec id="j_1905-7415.1001.463_s_002"> <title style='display:none'>Objectives</title> <p>To investigate the clinical prevalence of five different <italic>Klebsiella</italic> species (<italic>K. pneumoniae</italic>, <italic>K. ornithinolytica</italic>, <italic>K. oxytoca</italic>, <italic>K. terrigena</italic>, and <italic>K. rhinoscleromatis</italic>) including antibiotic resistance profiles using six different antibiotics and combinations (trimethoprim-sulfamethoxazole, ampicillin-sulbactam, imipenem, piperacillin-tazobactam, ciprofloxacin, ceftizoxime).</p> </sec> <sec id="j_1905-7415.1001.463_s_003"> <title style='display:none'>Methods</title> <p>Resistance of <italic>Klebsiella</italic> spp. including multidrug resistant (MDR) strains was determined by using a Kirby–Bauer disk diffusion method and genotypical analysis was performed by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR).</p> </sec> <sec id="j_1905-7415.1001.463_s_004"> <title style='display:none'>Results</title> <p>Urine samples and the urology service unit were the most common sources of <italic>K. ornithinolytica, K. pneumoniae</italic>, and <italic>K. terrigena</italic> strains. The greatest drug resistance was observed against trimethoprim-sulfamethoxazole (88%), the least resistance was observed against imipenem (12%). Apart from these, 11 different antibiotypes were generated and antibiotype AI (resistant only to trimethoprim-sulfamethoxazole) was the most frequently observed (40%). MDR profiles of <italic>Klebsiella</italic> spp. were also investigated and 25% of all <italic>Klebsiella</italic> spp. strains were found to be MDR; and 65% of these were isolated from urine samples. MDR strains were mostly found to be <italic>K. ornithinolytica</italic> (35%) followed by <italic>K. pneumoniae</italic> (29%). Genotyping was performed by using ERIC PCR and <italic>Klebsiella</italic> spp. strains were grouped in 23 genotypes with a similarity coefficient of 70%.</p> </sec> <sec id="j_1905-7415.1001.463_s_005"> <title style='display:none'>Conclusions</title> <p>Antibiotyping and antibiotype profiles may provide valuable information for hospitalized patients that could identify problem spots and allow evidence-based provision of preventive measures against nosocomial emergence of infections with new MDR strains.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Prednisolone-induced immune hemolysis: a case report<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.469_s_001"> <title style='display:none'>Background</title> <p>Drug induced immune hemolysis is potentially serious. Most commonly antibiotics are responsible, while immunosuppressive drugs have been reported rarely.</p> </sec> <sec id="j_1905-7415.1001.469_s_002"> <title style='display:none'>Objectives</title> <p>To report a rare case of suspected prednisolone-induced immune hemolysis.</p> </sec> <sec id="j_1905-7415.1001.469_s_003"> <title style='display:none'>Methods</title> <p>A 59-year-old male patient with hemoglobin H disease and lymphoma developed hemagglutination and immune hemolytic anemia 20 days after receiving prednisolone.</p> </sec> <sec id="j_1905-7415.1001.469_s_004"> <title style='display:none'>Results</title> <p>A direct antiglobulin test was positive for C3d. A test indicated prednisolone-dependent red blood cell antibody of the “immune complex” type. Tests with all other medications administered to the patient were negative. Dexamethasone was given to the patient without any reaction, as consistent with in vitro test results.</p> </sec> <sec id="j_1905-7415.1001.469_s_005"> <title style='display:none'>Conclusions</title> <p>Physicians should be aware of possible prednisolone-induced complement-mediated immune hemolysis by an immune complex mechanism and request appropriate diagnostic tests as indicated.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Colistin susceptibility of gram-negative clinical isolates from Tamil Nadu, India<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.462_s_001"> <title style='display:none'>Background</title> <p>Colistin is one of the oldest antibiotics in the polymyxin group, and is used mostly against gramnegative bacteria. Because of developing resistance among clinical isolates colistin has become an alternative drug for multidrug resistant bacteria.</p> </sec> <sec id="j_1905-7415.1001.462_s_002"> <title style='display:none'>Objectives</title> <p>To determine colistin resistance among isolates from Tamil Nadu, India.</p> </sec> <sec id="j_1905-7415.1001.462_s_003"> <title style='display:none'>Methods</title> <p>We included 94 gram-negative isolates from two centers in Tamil Nadu in the present study. Isolates were identified by 16S rRNA sequencing. Minimal inhibitory concentrations (MICs) were determined by agar dilution.</p> </sec> <sec id="j_1905-7415.1001.462_s_004"> <title style='display:none'>Results</title> <p>The isolates identified at species level included 48 <italic>Escherichia coli</italic>, 9 <italic>Klebsiella pneumoniae</italic>, 10 <italic>Pseudomonas aeruginosa</italic>, 5 <italic>Proteus mirabilis</italic>, 4 <italic>Salmonella enterica</italic>, 3 <italic>Enterobacter hormaechei</italic>, 3 <italic>Enterobacter cloacae</italic>, 2 <italic>Achromobacter xylosoxidans</italic>, 2 <italic>Acinetobacter baumannii</italic>, 1 <italic>Providencia vermicola</italic>, 1 <italic>Acinetobacter towneri</italic>, 1 <italic>Enterobacter gergoviae</italic>, 2 <italic>Providencia rettgeri</italic>, 1 <italic>Enterobacter asburiae</italic>, 1 <italic>Pseudomonas stutzeri</italic>, and 1 <italic>Salmonella typhi</italic>. The MIC of colistin ranged from 0.12 μg/ml to 128 μg/ml. The MIC<sub>50</sub> was 1 μg/mL and MIC<sub>90</sub> was &gt;128 μg/ml. The MIC ≥ 8 μg/mL was resistant breakpoint for all the species. A total of 27 isolates were resistant to colistin. Colistin resistant isolates included <italic>E. coli</italic> (9/48), <italic>K. pneumoniae</italic> (6/9), <italic>P. aeruginosa</italic> (3/10), <italic>A. baumannii</italic> (1/2), <italic>P</italic>. <italic>mirabilis</italic> (4/5), <italic>E. cloacae</italic> (1/3), <italic>P. rettgeri</italic> (2/2), and <italic>S. enterica</italic> (1/4). Carbapenem susceptibility of colistin resistant isolates was tested and 14 were found to be resistant to meropenem.</p> </sec> <sec id="j_1905-7415.1001.462_s_005"> <title style='display:none'>Conclusions</title> <p>Our study indicates the emergence of colistin resistant isolates from clinical samples among different groups of gram-negative organisms. Resistance to both carbapenem and colistin occurs. Developing new antibiotics and programs to reduce nosocomial infections is necessary especially for multidrug resistant isolates.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00The prevalence of some gastrointestinal nematodes and cestodes in Iraqis<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.466_s_001"> <title style='display:none'>Background</title> <p>Infections with helminths are associated with deficient sanitary facilities, unsafe human waste disposal, inadequate and lack of safe drinking water, and low socioeconomic status.</p> </sec> <sec id="j_1905-7415.1001.466_s_002"> <title style='display:none'>Objective</title> <p>To determine the prevalence of some gastrointestinal helminths among Iraqi people, and association of infections with age, sex, and region in Iraq.</p> </sec> <sec id="j_1905-7415.1001.466_s_003"> <title style='display:none'>Method</title> <p>This study is retrospective, including reported cases of infections using an available surveillance database from January 2013 to December 2013 of all provinces of Iraq by the Ministry of Health.</p> </sec> <sec id="j_1905-7415.1001.466_s_004"> <title style='display:none'>Result</title> <p>The overall prevalence of gastrointestinal helminthiasis was 1.39%. Enterobius vermicularis found to be the predominant helminth parasite. No significant (P &lt; 0.05) relationship was found between sex and infection, although male individuals tended to show greater helminthiasis, while a significant relationship was found between age and infection. The common infections were more frequent among the 5-14 year age group. We found a lower prevalence of helminth infections in the northern (Ninevah, Suleimaniyah, Ta’mim, Erbil, and Dohuk) and middle Euphrates (Babil, Karbala, Najaf, Qadisiyah, and Muthanna) region provinces, compared with the middle (Baghdad, Anbar, Diyala, and Salahuddin) and southern (Wasit, Dhi-qar, Misan, and Basrah) region provinces where the prevalence was higher.</p> </sec> <sec id="j_1905-7415.1001.466_s_005"> <title style='display:none'>Conclusion</title> <p>In this study, we found lower prevalence of infections in Iraq than similar studies conducted in other parts of Asia, which may be a consequence of the sample size, seasonal diversity, general personal hygiene, and public health services.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Genotypic characterization of species isolated from the oral cavity and their pattern of antibiotic susceptibility<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.464_s_001"> <title style='display:none'>Background</title> <p>Enterococci comprise a small share of oral flora and occur as contaminants in food such as meat and cheese. They are commonly encountered in patients with infections of oral tissues such as necrotic pulp, root canals and periodontitis.</p> </sec> <sec id="j_1905-7415.1001.464_s_002"> <title style='display:none'>Objective</title> <p>To characterize the genotypes of Enterococcus isolated from patients with oral infection and to determine their antibiotic susceptibility.</p> </sec> <sec id="j_1905-7415.1001.464_s_003"> <title style='display:none'>Method</title> <p>We genotypically characterized a number of isolates of Enterococcus species derived from patients with various oral infections. All the isolates were tested for the presence of putative virulence genes; efaA (gene for endocarditis), gelE (gene for gelatinase), ace (gene for collagen binding antigen), asa (gene for aggregation substance), cylA (gene for cytolysin activator), and esp (gene for surface adhesin) of E. faecalis and E. faecium as described in previous studies.</p> </sec> <sec id="j_1905-7415.1001.464_s_004"> <title style='display:none'>Result</title> <p>E. faecalis dominated in oral infections compared with E. faecium. Isolates were susceptible to most antibiotics (only four were resistant to vancomycin). To our knowledge, the first report from this region.</p> </sec> <sec id="j_1905-7415.1001.464_s_005"> <title style='display:none'>Conclusion</title> <p>Treatment of enterococcal infections of the oral mucosal and deep oral areas necessitate microbiological diagnosis and identification of resistance strains.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Correlation between broth microdilution, E-test and disk diffusion methods for testing antifungal susceptibility of species isolated from Thai blood samples<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.468_s_001"> <title style='display:none'>Background</title> <p>Broth microdilution (BMD) is a standard assay for susceptibility of Candida to antifungals, but complexity limits its routine application. E-test (ET) and disk diffusion (DD) assays are attractive alternatives because of their simplicity and reproducibility.</p> </sec> <sec id="j_1905-7415.1001.468_s_002"> <title style='display:none'>Objectives</title> <p>To determine the correlation between BMD, and ET and DD assay results for Candida isolates.</p> </sec> <sec id="j_1905-7415.1001.468_s_003"> <title style='display:none'>Methods</title> <p>We tested 63 Candida isolates for their susceptibility to fluconazole and voriconazole using BMD, ET, and DD, and recorded minimum inhibitory concentrations (MIC) and inhibitory zone diameters (ZD). Spearman correlations were determined and the Clinical and Laboratory Standards Institute recommendations were used to assess major and minor errors in test results.</p> </sec> <sec id="j_1905-7415.1001.468_s_004"> <title style='display:none'>Results</title> <p>The isolates included 32 (51%) C. albicans, 14 (22%) C. tropicalis, 12 (19%) C. parapsilosis, 4 (6%) C. glabrata, and 1 (2%) C. guilliermondii. The BMD-MIC and ET-MIC had good correlation for fluconazole (r = 0.94; P &lt; 0.001) and voriconazole (r = 0.95; P &lt; 0.001). The BMD-MIC for both antifungals were significantly correlated with the ZD of the DD assays (r = −0.47; P &lt; 0.001; r = −0.75; P &lt; 0.001, respectively). Agreement between the BMD and the ET and DD results exceeded 90%. No major errors were identified in any comparisons.</p> </sec> <sec id="j_1905-7415.1001.468_s_005"> <title style='display:none'>Conclusions</title> <p><italic>C. albicans</italic> were predominant among the isolates and were susceptible to fluconazole and voriconazole. The BMD results were well correlated with ET and DD assay results, and therefore ET and DD assays can be recommended as initial screening tools in resource-limited hospitals because of their relatively low cost.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Current trends in the risk prediction for hepatitis B virus-related hepatocellular carcinoma<abstract> <title style='display:none'>Abstract</title> <p>Chronic hepatitis B related hepatocellular carcinoma (HCC) is a leading cause of cancer death in hepatitis B virus endemic areas including the Asia-Pacific region. The risk of HCC development can be reduced by antiviral therapy and surveillance programs. However, this would place a heavy fiscal burden on low- and middle-income countries, which are in these endemic areas. Therefore, there is a need for accurate prediction of HCC risk to prioritize patient care. Based on well-established host and viral risk factors, several HCC risk scores have been derived and validated: GAG-HCC, CU-HCC, and REACH-B for Asians and PAGE-B for white people of European ancestry. Each score has been shown to be accurate in predicting HCC up to 10 years into the future when applied to the appropriate patient group, especially with regards to their ethnicity and antiviral therapy status. Recently noninvasive tests of liver fibrosis have been integrated into existing HCC risk scores with encouraging results. As HCC risk prediction continues to evolve, the future promises a more individualized approach to HCC surveillance, ultimately leading to improved patient care and resource allocation.</p> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Comparison of slow and fast action gel baits for pest management of (German cockroach) infestation in housing<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.465_s_001"> <title style='display:none'>Background</title> <p>Gel baits are important for integrated pest management (IPM). The relative efficacy of various baits is unknown.</p> </sec> <sec id="j_1905-7415.1001.465_s_002"> <title style='display:none'>Objective</title> <p>To evaluate the efficacy of different gel belts (hydramethylnon 2%, fipronil 0.05%, and imidacloprid 2.15%) for control of Blattella germanica (German cockroach) infestation.</p> </sec> <sec id="j_1905-7415.1001.465_s_003"> <title style='display:none'>Method</title> <p>All the tested (field) strains were collected from housing in Yasuj city, Iran. Ten German cockroaches for each developmental stage were placed in separate labeled glass rearing jars of the same size. Mortality was observed at 12 h intervals after exposure to baits. Each study was conducted in triplicate.</p> </sec> <sec id="j_1905-7415.1001.465_s_004"> <title style='display:none'>Result</title> <p>All gel baits produced 100% mortality of cockroaches within 1 to 5 days. However, imidacloprid killed cockroaches more rapidly (LT<sub>50</sub> = 13.3 h) than fipronil (LT<sub>50</sub> = 32.5 h) or hydramethylnon (LT<sub>50</sub> = 61.6 h). The results showed rapid, quick, and slow action for the three baits respectively. Comparison between the baits showed that the slow action bait is more compatible with IPM, being the most effective in 3 or more days; increased potential for secondary mortality through horizontal transmission of lethal dose and also via residue; decreased risk of food contamination by dead cockroaches; will decrease the chance of behavioral resistance, and it had higher feeding stimulation potential than the others.</p> </sec> <sec id="j_1905-7415.1001.465_s_005"> <title style='display:none'>Conclusion</title> <p>Hydramethylnon is preferred for IPM. Fipronil is a plausible alternative.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Factors associated with mortality and high treatment expense of adult patients hospitalized with chronic kidney disease in Thailand<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.460_s_001"> <title style='display:none'>Background</title> <p>Chronic kidney disease (CKD) is a global public health problem with a high risk of hospitalization and death. Few nationwide data have been reported regarding the outcomes of patients hospitalized with CKD in developing countries.</p> </sec> <sec id="j_1905-7415.1001.460_s_002"> <title style='display:none'>Objectives</title> <p>To study the risk factors associated with mortality and high treatment costs of adult patients hospitalized with CKD in Thailand.</p> </sec> <sec id="j_1905-7415.1001.460_s_003"> <title style='display:none'>Methods</title> <p>The medical data forms for adult inpatients with CKD collected in fiscal year 2010 were analyzed to determine the number of CKD admissions, associated comorbidities and complications, mortality rates, and hospital charges. Factors influencing mortality rates were evaluated by multiple logistic regression.</p> </sec> <sec id="j_1905-7415.1001.460_s_004"> <title style='display:none'>Results</title> <p>The total number of CKD patients was 128,338. After adjustment, the major factors associated with high hospital charges were (a) comorbidities (e.g. pneumonia OR 3.18, 95% CI 3.03–3.34; sepsis OR 2.87, 95% CI 2.74–3.00; acute kidney injury (AKI) on preexisting CKD OR 2.83, 95% CI 2.69–2.98) and (b) dialysis treatment (i.e., hemodialysis OR 5.16, 95% CI 4.94–5.39; peritoneal dialysis OR 3.40, 95% CI 3.14–3.69). The risk factors for high mortality were: being male, elderly, having comorbidity (viz., sepsis, respiratory failure, stroke, pneumonia, ischemic heart disease, AKI in addition to CKD, heart failure, and diabetes), and CKD complications (viz., metabolic acidosis, hyperkalemia, volume overload, and anemia requiring blood transfusion).</p> </sec> <sec id="j_1905-7415.1001.460_s_005"> <title style='display:none'>Conclusions</title> <p>Prevention and early treatment of any comorbidity and complications of CKD might reduce mortality and treatment costs of patients hospitalized with CKD.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Skilled birth attendance in Balochistan, Pakistan<abstract> <title style='display:none'>Abstract</title> <sec id="j_1905-7415.1001.461_s_001"> <title style='display:none'>Background</title> <p>Pakistan faces high maternal and neonatal mortality despite interventions from government, national, and international organizations.</p> </sec> <sec id="j_1905-7415.1001.461_s_002"> <title style='display:none'>Objective</title> <p>To assess factors associated with the use of skilled birth attendance in Balochistan.</p> </sec> <sec id="j_1905-7415.1001.461_s_003"> <title style='display:none'>Methods</title> <p>A logistic regression model was used to identify factors influencing use of skilled birth attendance from data obtained from the Balochistan Multiple Indicator Cluster Survey 2010, together with social and economic determinants..</p> </sec> <sec id="j_1905-7415.1001.461_s_004"> <title style='display:none'>Results</title> <p>Only 25.7% of the expectant mothers in Balochistan Province used skilled birth attendance. Women from rural areas were less likely to use skilled attendance compared with compared with those from urban areas (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.51–0.95). Poverty was negatively associated with use (OR = 0.26, 95% CI = 0.02–0.51). Lack of education was negatively associated with skilled birth attendance (OR = 0.38, 95% CI = 0.09–0.67). Women from 25 to 34 years old were more likely to use skilled birth attendance than younger women (OR = 1.51, 95% CI = 1.03 –2.81). Women who justified being beaten by their husbands were less likely to use skilled attendance (OR = 0.64; 95% CI = 0.39–0.89).</p> </sec> <sec id="j_1905-7415.1001.461_s_005"> <title style='display:none'>Conclusions</title> <p>There are gaps in use of skilled birth attendance between women in urban and rural settings, rich and poor, the educated and those with no schooling. Their age, age at first marriage, number of children ever born, attitude toward being beaten by their husband, and source of skilled antenatal care significantly influenced the expectant mothers to use skilled birth attendance.</p> </sec> </abstract>ARTICLE2017-01-31T00:00:00.000+00:00Serum level of estrogen in Iranian patients with oral lichen planus<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Oral lichen planus (OLP) is one of the most common diseases in the oral cavity and has a chronic inflammatory nature. The etiology of this disease remains unclear. OLP is more prevalent in women, but to our knowledge, no study yet evaluated estrogen levels in women with OLP.</p></sec> <sec><title style='display:none'>Objectives</title><p>To determine the serum level of estrogen in female patients with OLP.</p></sec> <sec><title style='display:none'>Methods</title><p>This case–control observational study was conducted in patients who were referred to the Department of Oral and Maxillofacial Medicine at the Tehran University of Medical Sciences. After clinical and histopathological confirmation of OLP diagnosis, and according to exclusion and inclusion criteria, 47 women with OLP and 47 healthy women (10 premenopausal and 37 postmenopausal) were included, as case and control groups, respectively. We obtained blood samples (5 mL) from each participant to measure the serum level of 17β-estradiol. Data were analyzed by Spearman rank correlation coefficients and a two-way analysis of variance with Bonferroni post hoc tests.</p></sec> <sec><title style='display:none'>Results</title><p>Serum estrogen level in women with OLP was significantly higher than that in healthy women (<italic>P</italic> = 0.002), and it was also significantly higher in premenopausal women than postmenopausal women (<italic>P</italic> &lt; 0.001). The severity of OLP lesions correlated with estrogen level in postmenopausal women (<italic>r</italic> = 0.650; <italic>P</italic> &lt; 0.001); in premenopausal women (<italic>r</italic> = 0.618; <italic>P</italic> = 0.008), and in all women with OLP (<italic>r</italic> = 0.535; <italic>P</italic> &lt; 0.001).</p></sec> <sec><title style='display:none'>Conclusion</title><p>OLP, like other autoimmune diseases, is affected by the serum level of sex hormones such as estrogen.</p></sec> </abstract>ARTICLE2021-06-30T00:00:00.000+00:00Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery.</p></sec> <sec><title style='display:none'>Objective</title><p>To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length.</p></sec> <sec><title style='display:none'>Methods</title><p>We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 20<sup>0/7</sup> and 36<sup>6/7</sup> weeks’ gestation without ruptured membranes and with cervical dilatation &lt;3 cm and effacement &lt;80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated.</p></sec> <sec><title style='display:none'>Results</title><p>Pregnant women with labor pain who had cervical length &lt;30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length &lt;15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length &lt;25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth &lt;7 days was 0.61 (0.50, 0.73) and &lt;14 days was 0.60 (0.49, 0.70).</p></sec> <sec><title style='display:none'>Conclusions</title><p>Cervical length ranging 15–30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation &lt;3 cm in clinical practice.</p></sec> </abstract>ARTICLE2021-06-30T00:00:00.000+00:00Congenital limb defects in a married female population of the Rahim Yar Khan District in Pakistan<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Congenital limb defects (CLD) have a range of phenotypes and can be a substantial cause of disability. The prevalence of CLD in the adult population of Pakistan is not well described.</p></sec> <sec><title style='display:none'>Objectives</title><p>To investigate the prevalence of CLD and their associated factors in a married female population of the Rahim Yar Khan (RYK) District in Pakistan.</p></sec> <sec><title style='display:none'>Methods</title><p>A cross-sectional population-based study was conducted in 4 tehsils of RYK District, and married women and girls from 22 different localities were enrolled by convenience sampling in public places and through door-to-door visits. Data regarding limb phenotype and demographic variables were obtained from participants.</p></sec> <sec><title style='display:none'>Results</title><p>We enrolled 2,204 married women and girls. We found 11 participants with CLD suggesting a prevalence of 4.99/1,000 (proportion: 0.005; 95% confidence interval [CI] &lt;0.001–0.01). Polydactyly was the most frequent (n = 5; prevalence: 2.27/1,000), followed by others in the following sequence: brachydactyly (n = 4; prevalence: 1.81/1,000), camptodactyly (n = 1; prevalence: 0.45/1,000), and oligodactyly (n = 1; prevalence: 0.45/1,000). The odds of occurrence of CLD were higher in individuals originating from Khanpur tehsil (odds ratio [OR] 2.05; 95% CI 0.37–11.27), speaking languages other than Punjabi and Saraiki (OR 2.35; 95% CI 0.24–22.80), belonging to Araien caste (OR 2.35; 95% CI: 0.24–22.80), of a nuclear family (OR 3.35; 95% CI 0.79–16.97), or having parental consanguinity (OR 1.87; 95% CI 0.49–7.06).</p></sec> <sec><title style='display:none'>Conclusion</title><p>Preliminary estimate of CLD prevalence in the married female sample population in RYK appears high compared with estimates from birth defects registries in other countries.</p></sec> </abstract>ARTICLE2021-06-30T00:00:00.000+00:00Prediction of preterm birth and imminent spontaneous delivery: a management challenge for health care providers with extensive ochronotic degeneration of the Achilles tendon and its surgical treatment: a case report and literature review<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Alkaptonuria is a rare genetic metabolic disorder due to deficiency of homogentisate 1,2-dioxygenase (HGD), an enzyme catalyzing the conversion of homogentisate to 4-maleylacetoacetate in the pathway for the catabolism of phenylalanine and tyrosine. HGD deficiency results in accumulation of homogentisic acid and its pigmented polymer. Ochronosis is a bluish-black discoloration due to the deposition of the polymer in collagenous tissues. Extensive ochronotic involvement of the Achilles tendon in alkaptonuria and its surgical treatment is rarely reported.</p></sec> <sec><title style='display:none'>Case report</title><p>A 43-year-old man presented to our clinic in March 2019 with sudden onset of left Achilles tendon pain with no history of prior trauma. Surgical exploration revealed a complete disruption of the tendon at its attachment to the calcaneus. Black pigmentation was extensive and reached the calcaneal tuberosity, extending about 7 cm from the insertion.</p></sec> <sec><title style='display:none'>Discussion</title><p>Achilles reconstruction was performed using flexor hallucis longus tendon transfer. The patient experienced uncomplicated healing with satisfactory functional results.</p></sec> <sec><title style='display:none'>Conclusion</title><p>Orthopedic surgeons should be aware of the progressive nature of alkaptonuria. Extensive degenerative changes of the ruptured tendon should be suspected so that physicians can plan tendon repair and facilitate prompt surgical intervention.</p></sec> </abstract>ARTICLE2021-06-30T00:00:00.000+00:00Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity.</p></sec> <sec><title style='display:none'>Objectives</title><p>To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI.</p></sec> <sec><title style='display:none'>Methods</title><p>We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied.</p></sec> <sec><title style='display:none'>Results</title><p>We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test–retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test–retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity.</p></sec> <sec><title style='display:none'>Conclusions</title><p>The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.</p></sec> </abstract>ARTICLE2021-06-30T00:00:00.000+00:00Peguero–Lo Presti criteria modified by body surface area for the electrocardiographic diagnosis of left ventricular hypertrophy in Thai patients<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Several electrocardiographic (ECG) criteria are used to diagnose left ventricular hypertrophy (LVH); however, they have low sensitivity.</p> </sec> <sec><title style='display:none'>Objective</title> <p>To assess the sensitivity of LVH diagnosis using Peguero–Lo Presti criteria modified by body surface area (BSA).</p> </sec> <sec><title style='display:none'>Methods</title> <p>This study used retrospective data from 9,438 patients who attended the Central Chest Institute of Thailand from January 2017 to December 2017 with available echocardiography, and who were categorized into those with and without LVH to determine diagnostic accuracy. We randomly selected 317 patients after excluding others based on various conditions. The left ventricular mass of the 317 patients was estimated using echocardiography. Peguero–Lo Presti criteria were modified by dividing original criteria by BSA. The accuracy of the modified criteria was compared with that of the original Peguero–Lo Presti, Sokolow–Lyon, and Cornell voltage criteria. A McNemar test was used to determine the agreement of all ECG criteria examined with LV mass index. The area under a receiver operating characteristic curve (AUC) was used to assess the performance of the criteria.</p> </sec> <sec><title style='display:none'>Results</title> <p>LVH was diagnosed in 164 of the 317 patients using echocardiography. The sensitivity of modified Peguero–Lo Presti criteria was 50.6% (95% confidence interval [CI] 42.7% to 58.5%), and specificity was 88.2% (95% CI 82.0% to 92.9%), with an AUC of 0.67 (95% CI 0.61–0.73).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Peguero–Lo Presti criteria modified by dividing them by BSA can improve sensitivity with acceptable specificity for the diagnosis of LVH compared with other ECG criteria examined, at least in selected Thai patients. The modified Peguero–Lo Presti criteria have accuracy similar to that for the original criteria.</p> </sec> </abstract>ARTICLE2021-04-30T00:00:00.000+00:00Cytogenetic characteristics of and prognosis for acute myeloid leukemia in 107 children<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Patients diagnosed with acute myeloid leukemia (AML) in childhood have a poor prognosis. A better understanding of prognostic factors will assist patients and clinicians in making difficult treatment decisions.</p> </sec> <sec><title style='display:none'>Objectives</title> <p>To understand further the cytogenetic characteristics of and reassess the prognostic value of cytogenetic abnormalities in childhood AML.</p> </sec> <sec><title style='display:none'>Methods</title> <p>Conventional karyotypes of 107 children with AML were analyzed retrospectively. The cases were divided into 4 groups based on genetic rearrangements; namely patients with: t(15;17)/<italic>PML-RARA</italic>; t(8;21)/<italic>RUNX1-RUNX1T1</italic> or inv(16)(p13;q22) and t(16;16)/<italic>CBFB-MYH11</italic>; −7 or complex karyotypes; normal karyotypes or other cytogenetic changes. Differences in age, sex, leukocyte count, event-free survival (EFS), and overall survival (OS) were analyzed.</p> </sec> <sec><title style='display:none'>Results</title> <p>All French-American-British (FAB) subtypes of AML were detected in 107 patients. We successfully cultured 81 of 107 bone marrow specimens, of which 60 cases had abnormal karyotypes. The most common abnormal karyotypes were t(8;21) (17/81 cases), followed by t(15;17) (13/81 cases), –X/Y (10/81 cases). There were no significant differences (<italic>P</italic> &gt; 0.05) in age, sex, or leukocyte counts between the 4 groups. The differences in 3-year EFS and OS between each pair were significant, except for groups of patients with t(8;21)/<italic>RUNX1-RUNX1T1</italic> and patients with normal karyotypes or other cytogenetic changes (<italic>P</italic> = 0.054).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Chromosomal abnormalities may provide important prognostic factors for AML in children and be helpful for risk stratification and individual treatment.</p> </sec> </abstract>ARTICLE2021-04-30T00:00:00.000+00:00en-us-1