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Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 4 (2010): Heft 2 (April 2010)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

19 Artikel
access type Uneingeschränkter Zugang

Emergent opportunities in humans: playful kittens, an arthropod vector, and a zoonotic agent

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 191 - 198

Zusammenfassung

Abstract

Bartonella henselae is implicated as the main etiologic agent of Cat scratch disease (CSD, Cat-scratch fever). A majority of domestic cats may harbor the intra-erythrocytic agent for extended periods without apparent disease. In humans, B. henselae most commonly results in a subacute, bacterial infection that presents with one or more reddish papules which may progress to pustules and regional lymph node enlargement. Usual features include fever, malaise, and a granulomatous lymphadenitis on biopsy. However, atypical clinical presentations occur, albeit with infrequence, and may result in a difficult and protracted diagnostic process. The infection in susceptible hosts such as immunocompromised or elderly patients may result in endocarditis, encephalitis, fever of unknown origin, and general malaise. It is not transmitted from person to person and quarantine is not necessary. The arthropod vector, Ctenocephalides felis, or the cat flea, plays a major role in transmission among cats and to humans. The transmission risk to humans can be substantially reduced through elimination of flea infestations in companion animals. There are numerous recent reviews and case reports in the veterinary and medical literature reflecting increased recognition of this zoonotic agent. All this notwithstanding, many physicians and other providers may not be familiar with this agent and the potential spectrum of human disease; this may lead to delays in diagnosis and unnecessary diagnostic procedures. This article emphasizes the aspects of B. henselae infection, including a typical case report and a table with selected human case reports of unusual clinical manifestations from the published literature.

Schlüsselwörter

  • Bartonella henselae
  • cat scratch disease
  • zoonosis
access type Uneingeschränkter Zugang

Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 199 - 206

Zusammenfassung

Abstract

Background: Bleeding is an important complication of cirrhosis. Currently, there is no coagulation test that can reliably predict clinical hemorrhage. However, previous studies demonstrated significant correlations between hyperfibrinolysis and following bleeding in advanced cirrhotic patients. Objectives: Estimate the prevalence of hyperfibrinolysis in cirrhotic patients at stable conditions and to assess its role in predicting subsequent hemorrhage. Methods: The prospective cohort study included 58 consecutive cirrhotic patients at the Liver Clinic, Chulalongkorn Hospital. Assays for liver functions, PT, APTT, fibrinogen, fibrin degradation products (FDPs) and euglobulin lysis time (ELT) were performed at baseline. The subjects were followed-up for 10 months to observe clinical hemorrhage and survival. Results: The mean age was 56.4 years and 47% were male. The etiologies of liver diseases were virus (62.1%), alcohol (24.1%) or unknown (8.6%). Hyperfibrinolysis as reflected by ELT<120 minutes or FDPs>10 μg/mL was present in 32.8% and 74.1%, respectively. Fibrinolytic activity was significantly correlated with platelet counts and coagulation times, but not as much with liver function tests. By 10 months, 13 cases (22.4%) showed hemorrhagic episodes and 7 (12.1%) were expired, including 2 from bleeding. The significant predictors for death were Child class B or C, presence of ascites, hyperbilirubinemia, hypoalbuminemia, and prolonged APTT. However, none of the clinical, biochemical, or hemostatic factors was associated with clinical bleeding. Conclusion: Hyperfibrinolysis is common in cirrhotic outpatients. However, it cannot predict subsequent hemorrhage or survival. Novel hemostatic tests are required to assess the probability of bleeding in this disorder.

Schlüsselwörter

  • Bleeding
  • cirrhosis
  • euglobulin lysis time
  • hyperfibrinolysis
  • survival
access type Uneingeschränkter Zugang

Lytic replication of Epstein-Barr virus in human peripheral T-lymphocytes

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 207 - 214

Zusammenfassung

Abstract

Background: There are few reports about the interactions of EBV with peripheral T-cells, especially during the early phase of infection. Objective: Demonstrate the capability of EBV to infect and replicate in human peripheral T-cells in vitro. Methods: After treating with EBV, the susceptibility of in vitro EBV infection into T-cells was confirmed using electron microscopy, the expression of EBV mRNA using RT-PCR, and the expression of EBV proteins using Western blot analysis. The expression of CD19 and CD21 mRNA was determined using RT-PCR. The induction of cell death was measured using trypan blue exclusion assay. Results: The susceptibility of in vitro EBV infection was confirmed by the presence of virus particles in the cytoplasm. The entering to lytic infection was confirmed by detection the expression of EBV lytic (BZLF1) mRNA, and the expression of late lytic proteins (VCA and gp350/220). The expression of CD19 and CD21 were not observed using RT-PCR. The interactions of EBV with T-cells leaded to induction of T-cell death. Conclusion: Peripheral T-cells are a direct target of EBV infection. At the beginning of infection by EBV, EBV infection of T-cells leads to the entering into lytic virus replication. EBV binds to these cells through a receptor distinct from the CD21.

Schlüsselwörter

  • CD21
  • entry
  • Epstein-Barr virus (EBV)
  • lytic replication
  • T-lymphocytes
access type Uneingeschränkter Zugang

Magnetic resonance imaging in the evaluation of meniscal tear

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 215 - 222

Zusammenfassung

Abstract

Background: Magnetic resonance imaging (MRI) has been recognized as the imaging method for non-invasive evaluation of knee pathology, particular meniscus and ligaments. Objective: Compare the sensitivity, specificity, and accuracy of MRI in the detection of meniscal tears with arthroscopy. Material and methods: Twenty-seven patients who were diagnosed as meniscal tear on arthroscopy with preoperative MRI were included in this study between January 2003 and June 2008. MRI was performed with a 1.5 Tesla Signa Horizon Echospeed MRI for eight patients between January 2003 and June 2005 and a 1.5 Tesla Signa Excited HD MRI for nineteen patients between July 2005 and June 2008. The location of meniscal tear was evaluated by studying three areas: anterior horn, body and posterior horn. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the anterior horn, body, posterior horn and overall meniscus were calculated. Results: The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn, and overall medial meniscus was 42.9%, 87.5%, 94.1%, and 81.3%, respectively. The specificity was 95.0%, 84.2%, 81.8%, and 88.0%, respectively. The accuracy was 81.5%, 85.2%, 89.3%, and 85.4%, respectively. The PPV was 75.0%, 70.0%, 88.9%, and 81.2%, respectively. The NPV was 82.6%, 94.1%, 90.0%, and 88.0%, respectively. The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn and overall lateral meniscus was 0%, 100%, 85.7%, and 80.0%, respectively. The specificity was 100%, 100%, 90.5% and 97.2%, respectively. The accuracy was 96.0%, 100%, 90.5%, and 97.2%, respectively. The PPV was 100%, 75% and 80%, respectively. The NPV was 96.3%, 100%, 95.0%, and 97.2%, respectively. Conclusion: MRI is a helpful technique to detect meniscal tear with different sensitivity and accuracy on the meniscal location.

Schlüsselwörter

  • Arthroscopy
  • magnetic resonance imaging
  • meniscal tears
access type Uneingeschränkter Zugang

Serum vascular endothelial growth factor per platelet count in patients with biliary atresia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 223 - 229

Zusammenfassung

Abstract

Background: Biliary atresia (BA) is a progressive, sclerosing, inflammatory process resulting in complete obliteration of the extrahepatic bile ducts. The obstruction of bile flow engenders worsening cholestasis, hepatic fibrosis, and cirrhosis, which lead to portal hypertension and a decline in hepatic synthetic function. Hepatic stellate cells, which play roles in hepatic fibrogenesis, are an important source of various inflammatory mediators including vascular endothelial growth factor (VEGF) in the injured liver. Objectives: Investigate the level of serum VEGF and serum VEGF per platelet count in patients with BA and its relation to clinical characteristics. Methods: Peripheral blood samples were taken from 70 BA patients and 15 healthy control children. Serum VEGF was measured by enzyme-linked immunosorbent assay. We compared serum VEGF and serum VEGF per platelet count in BA patients with the respective results obtained in healthy control children. The relation of serum VEGF per platelet count with clinical variables of BA patients was investigated. Results: Serum VEGF levels and serum VEGF per platelet count in BA patients were not significantly different from those in normal controls (289.64±230.01 pg/mL vs. 312.36±189.05 pg/mL; p=0.72 and 1.72±1.21x106 vs. 1.57±0.97x106; p=0.66). Significant differences were observed among BA patients when VEGF per platelet count was categorized by the presence of esophageal varice (p=0.03). Only in BA patients was the serum level of VEGF correlated with the number of platelets (r=0.53, p<0.001). Conclusion: A high serum VEGF per platelet count is a useful marker for the development of portal hypertension in BA patients, especially for esophageal varice. Serum VEGF per platelet count may be useful for monitoring disease course in BA after hepatic portoenterostomy.

Schlüsselwörter

  • Biliary atresia
  • platelet
  • vascular endothelial growth factor
access type Uneingeschränkter Zugang

Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 243 - 251

Zusammenfassung

Abstract

Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.

Schlüsselwörter

  • Bupivacaine
  • craniotomy
  • intra-operative analgesia
  • post-operative analgesia scalp
  • nerve block
access type Uneingeschränkter Zugang

Distribution of hepatitis C virus genotypes, hepatic steatosis and their correlation with clinical and virological factors in Pakistan

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 253 - 262

Zusammenfassung

Abstract

Background: Due to the inherently unstable nature of HCV, various genotypes have been identified. Steatosis is a histological feature in the progression of HCV-associated liver disease and has been shown to alter the host lipid metabolism. Objective: Assess the distribution of HCV genotypes in the two provinces of Pakistan, and determine the association of hepatic steatosis with altered clinical and virological factors in chronic HCV patients. Methods: One hundred twenty six chronic HCV patients (steatosis in 49 patients) were enrolled for qualitative analysis by PCR. Out of 126 ELISA and PCR positive samples, 119 (48 with hepatic steatosis) chronic HCV patients (mean age 42.0±13.3 years, mean body mass index (BMI) 24.2±4.1) were proved positive after PCR-based detection. Biochemical and virological factors such as HCV genotype, or glucose, in 119 CHC patients were determined and compared between patients with and without hepatic steatosis. Results: Out of 126 samples, 119 were HCV positive, where 58 (48.7%) were genotype 3a, 24 (20.2%) were 3b, 12 (10.1%) were 1a, eight (6.7%) were 2a, six (5.0%) were 1b, and one (0.8%) was 4. Furthermore, seven (5.9%) had a co-infection and three (2.5%) were untypable. BMI (p=0.004), genotype 3a (p<0.001), and triglycerides (p=0.002) were significantly associated with steatosis. It is noteworthy that cholesterol (p=0.281), glucose (p=0.305), lowdensity lipoprotein (p=0.101), high-density lipoprotein (p=0.129), alanine amino transferase (p=0.099), aspartate transaminase (p=0.177), bilirubin (p= 0.882), and age (p=0.846) showed non-significant association. Conclusion: Genotype 3a is the predominant genotype in Pakistan. Hepatic steatosis is quite frequent feature in HCV patients and strongly correlates with BMI, genotype 3a, and triglyceride contents in patients infected with HCV.

Schlüsselwörter

  • Clinical parameters
  • genotypes
  • hepatitis C virus
  • steatosis
  • subtype 3a
access type Uneingeschränkter Zugang

Novel genetic marker in TGFB2 gene associated with expression of TGF-β2 in leukocyte and SLE susceptibility

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 263 - 269

Zusammenfassung

Abstract

Background: TGF-β2 has a role in immune regulation, and genetic variance within the gene might contribute to systemic lupus erythematosus (SLE) pathogenesis. The TGFB2 gene is one candidate gene within the major SLE genetic susceptibility loci. Objective: Investigate the TGFB2 gene located on chromosome 1q41 as a SLE susceptibility gene. Materials and methods: One hundred fifty three SLE patients and 133 healthy controls participated in this study. Four markers selected in two haplotype blocks that have a minor allele frequency greater than 5% in Thai population were genotyped and analyzed in the association study. Results: There was no significant association between SLE susceptibility and the polymorphism in the promoter area (+67_68insACAA) and +89835 (A/G) at the intron 5 of TGFB2 gene. Instead, minor allele of the two new genetic markers at the intron 1 (+720) (corrected p-value = 0.024, OR = 0.4141, 95%CI = 0.22-0.80) and intron 6 (+94399_94400) (corrected p-value = 0.000143, OR = 0.3367, 95%CI = 0.20-0.58) were independently associated as a protective factor to SLE. Additionally, the real time RT-PCR results showed that patients with the protective allele (minor allele) at the +94399_94400 position have higher TGF-β2 mRNA level in leukocytes than patients with the risk allele (p=0.011). Conclusion: Two new genetic markers at intron1 (+720) and intron 6 (+94399_94400) were independently associated with SLE. The observed results have to be confirmed in other populations with a large sample size.

Schlüsselwörter

  • Gene polymorphism
  • TGFB2
  • SLE
  • Thai population
access type Uneingeschränkter Zugang

Effects of N(2-propylpentanoyl)urea on hippocampal amino acid neurotransmitters in spontaneous recurrent seizure rats

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 271 - 279

Zusammenfassung

Abstract

Background: N(2-propylpentanoyl) urea (VPU) is a new valproic acid (VPA) analog with higher anticonvulsant activity than its parent compound in various animal models including seizure acutely induced by pilocarpine. Objective: Investigate its effects on hippocampal amino acid neurotransmitters in spontaneous recurrent seizure (SRS) rats. Methods: Pilocarpine hydrochloride was used to induce status epilepticus (SE). Animals were visually observed for two hours/day for an episode of SRS for six weeks. Microdialysis experiment was performed to detect hippocampal amino acid neurotransmitters on those rats that developed SRS. Results: In comparison to normal rats, hippocampal glutamate, gamma-aminobutyric acid (GABA), and glycine, significantly increased in SRS rats. Occurrence of SRS in the faces of increased level of inhibitory neurotransmitters suggests the key role played by glutamate in the genesis and control of SRS. Based on the observation in pilocarpine-induced SE, the level of glutamate in SRS rats significantly decreased by a clinically effective anticonvulsant, VPA (300 and 600 mg/kg, i.p). Similar profile on hippocampal glutamate was also exhibited by VPU (50 and 100 mg/kg, i.p.). Conclusion: The possible role of VPU in controlling seizure in SRS rats and subsequently human temporal lobe epilepsy as VPA was suggested.

Schlüsselwörter

  • N-(2-propylpentanoyl)urea
  • valproic acid
  • pilocarpine
  • spontaneous recurrent seizure
  • amino acid neurotransmitters
access type Uneingeschränkter Zugang

Stem cell factor in gingival crevicular fluid in periodontal health and disease

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 281 - 287

Zusammenfassung

Abstract

Background: Stem cell factor is a pleiotropic cytokine produced by several cell types including fibroblasts, bone marrow stromal cells, mast cells, and endothelial cells. In addition, stem cell factor is an important hematopoietic growth factor, which binds to and activates the ligand for the tyrosine kinase-type receptor c-kit. Objectives: Analyze concentration of stem cell factor within gingival crevicular fluid (GCF) in both periodontal health and disease and to determine the correlation of stem cell factor in GCF and inflammatory status of periodontal tissues. Materials and methods: Forty-five subjects (aged 24 to 75 years) were classified into the following three groups according to their periodontal tissue status as group I (clinically healthy gingiva with no loss of attachment), group II (gingivitis with no attachment loss), and group III (periodontitis). GCF samples collected from each patient were examined for stem cell factor level using enzyme-linked immunosorbant assay. Results: The maximum level of stem cell factor in GCF was obtained for group III (71.8±7.8 pg/g protein), and the lowest mean stem cell factor concentration in GCF was observed for group I (22.1±7.3 pg/g protein). The GCF stem cell factor level of patients in group III was statistically higher than that in group II (p <0.04) and group I (p <0.001). In addition, the mean GCF levels of stem cell factor in group II (48.1±7.5 pg/g protein) were significantly higher than those in group I (p <0.02). There was a positive correlation between stem cell factor in GCF and gingival inflammation index (r=0.59, p <0.001) Conclusion: GCF levels of stem cell factor increased in parallel with the severity of periodontal disease. Its levels in GCF could be potentially useful as a biochemical marker of periodontal inflammation and the host response.

Schlüsselwörter

  • Gingival crevicular fluid
  • gingivitis
  • inflammation
  • periodontitis
  • stem cell factor
access type Uneingeschränkter Zugang

Efficacy of a 3-day artesunate-mefloquine combination in the treatment of uncomplicated falciparum malaria in Kanchanaburi province of Thailand

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 289 - 295

Zusammenfassung

Abstract

Background: In Kanchanaburi province located on the Thai-Myanmar border, Plasmodium falciparum parasites have developed significant resistance to commonly-used anti-malarials. For use against falciparum malaria, 2-day artesunate-mefloquine combination (MAS2) has recently been replaced by a 3-day artesunate-mefloquine combination (MAS3) that is an artemisinin-based combination therapy regimen recommended by the WHO. Objective: Investigate the efficacy and safety of MAS3 in the treatment of uncomplicated falciparum malaria in patients of Kanchaburi province. Methods: The study was conducted at Bongtee sub-district, Sai Yok district, Kanchanaburi province between June and November 2009. Fifty-one uncomplicated falciparum malaria patients were enrolled. Inclusion, exclusion and study method followed the WHO protocol for assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Patients received a MAS3 and were followed for 42 days. Results: All patients clinically recovered, but four patients were again parasitaemic on day 21, (1 patient) 28 (2 patients) and 42 (1 patient), respectively. Molecular analyses suggested that all recurrences were caused by recrudescence. There were no severe adverse events, but complaints of headache, gastrointestinal upset, nausea, and vomiting. Delay in parasite clearance was found. Proportion of parasite clearance on day 1, 2, 3 and 7 were 17.7%, 62.7%, 80.4%, and 100%, respectively. Conclusion: MAS3 is comparable to MAS2, and meet the WHO efficacy criteria for use against falciparum malaria, but the effect on parasite clearance was inferior to that of MAS2. Close monitoring evaluation is required.

Schlüsselwörter

  • Artesunate-mefloquine combination
  • efficacy study
  • falciparum malaria
  • Kanchanaburi province
access type Uneingeschränkter Zugang

Co-expression of human malaria parasite Plasmodium falciparum orotate phosphoribosyltransferase and orotidine 5’-monophosphate decarboxylase as enzyme complex in Escherichia coli: a novel strategy for drug development

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 297 - 306

Zusammenfassung

Abstract

Background: Human malaria parasite Plasmodium falciparum operates de novo pyrimidine biosynthetic pathway. The fifth and sixth enzymes of the pathway form a heterotetrameric complex, containing two molecules each of orotate phosphoribosyltransferase (OPRT) and orotidine 5’-monophosphate decarboxylase (OMPDC). Objective: Define the function of OPRT-OMPDC enzyme complex of P. falciparum by co-expressing the enzymes in Escherichia coli. Methods: The constructed plasmids containing either P. falciparum OPRT or OMPDC were cloned in E. coli by co-transformation. Both genes were co-expressed as OPRT-OMPDC enzyme complex and the complex was purified by chromatographic techniques, including N2+-NTA affinity, Hi Trap Q HP anion-exchange, uridine 5’- monophosphate affinity, and Superose 12 gel-filtration columns. Physical and kinetic properties of the enzyme complex were analyzed for its molecular mass. Results: Co-transformation of PfOPRT and PfOMPDC plasmids in E. coli were achieved with a clone containing DNA ratio of 1:2, respectively. Both plasmids remained stable and were functionally expressed in the E. coli cell for at least 20 weeks. The P. falciparum OPRT-OMPDC enzyme complex were co-expressed and the complex was co-eluted in all chromatographic columns during purification and physical analysis. The molecular mass of the complex was 130 kDa, whereas the PfOPRT and PfOMPDC component were 35.6 and 41.5 kDa, respectively. The enzymatic activities of the complex were competitively inhibited by their products of each enzyme component. Conclusion: P. falciparum OPRT and OMPDC in E. coli as an enzyme complex were co-transformed and functionally co-expressed. These have similar properties to the native enzyme purified directly from P. falciparum, and this character is different from that of the human host organism. The enzyme complex would be suitable as new target to research selective inhibitors as suitable drugs to better control this disease.

Schlüsselwörter

  • Co-expression
  • co-transformation
  • enzyme complex
  • orotate phosphoribosyltransferase (OPRT)
  • orotidine 5’-monophosphate decarboxylase (OMPDC)
  • Plasmodium falciparum
access type Uneingeschränkter Zugang

Association between angiotensin II type-1 receptor A1166C polymorphism and the presence of angiographically-defined coronary artery disease in an Iranian population

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 307 - 314

Zusammenfassung

Abstract

Background: There are reported associations between a polymorphism of the angiotensin II type 1 receptor (AT1R/A1166C) gene and coronary artery disease (CAD), hypertension, and myocardial infarction in some populations. Objective: Investigate the association between A1166C polymorphism and CAD in an Iranian population. Methods: Four hundred and thirteen patients with suspected CAD were recruited. Based on coronary angiography, the patients were classified into CAD+ (n=315) and CAD- (n=98) groups defined as >50% and <50% stenosis of any major coronary artery, respectively. One hundred and thirty-five healthy subjects were also recruited as the control group. The AT1R polymorphism was assessed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) based method. Results: A higher frequency of the AC and CC genotypes and lower frequency of the AA genotype was observed in both CAD+ and CAD- groups, compared with the control group (p <0.05). CAD+ and CAD- groups also had a higher frequency of the C allele than controls (p <0.01). There was no significant difference in genotype and allele frequencies between hypertensive and non-hypertensive patients (p > 0.05). In addition, the AT1R genotype frequencies did not differ significantly among different subgroups of CAD+ patients, based on the number of affected coronary vessels (p >0.05). Conclusion: The frequency AT1R/A1166C polymorphism was higher among patients with some degrees of coronary stenosis who are candidates of coronary angiography.

Schlüsselwörter

  • Angiography
  • angiotensin receptor
  • coronary artery disease
  • hypertension
  • polymorphism
access type Uneingeschränkter Zugang

Correlation of microvascular density and proliferation index in undifferentiated nasopharyngeal carcinoma

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 315 - 321

Zusammenfassung

Abstract

Background: Undifferentiated nasopharyngeal carcinoma is a highly malignant tumor with an endemic distribution. Several histologic parameters have been studied to provide prognostic information for patient management. Both proliferation index and microvascular density are commonly determined on such tumors, but the relationship between these two parameters has not been studied fully. Objectives: Determine the association between microvascular density and cellular proliferation in undifferentiated nasopharyngeal carcinoma. Methods: A series of 60 cases were studied in patients of Southeast Asian origin. Cellular proliferation was determined using Ki67 immunostaining, and vessel proliferation using CD31 immunostaining in terms of areas of increased staining (‘hot spots’). Ki67 results were scored on a scale of 0-4+ and CD31 results as a microvascular density/mm2. Results: The mean of the microvascular density was 22/mm2 in the Ki67-negative group (25 cases). In the Ki67- positive group (35 cases), the mean was 35/mm2. The difference between the positive and negative group was statistically significant (p <0.001). Microvascular density significantly increased as the Ki67 score increased (p<0.001). However, the ‘hot spots’ for microvascular density in tissue sections did not correspond to areas of increased cellular proliferation. Conclusion: Pathologists usually determine only one of these two prognostic factors when dealing with undifferentiated nasopharyngeal carcinoma. The proliferation index is suggested because it is easier to perform and can be done on small biopsies not to contain enough surface area for microvascular density determination.

Schlüsselwörter

  • CD31
  • Ki67
  • microvascular density
  • morphometry
  • nasopharyngeal carcinoma
  • proliferation index
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Intranasal location of lacrimal sac in Thai cadavers

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 323 - 327

Zusammenfassung

Abstract

Background: Many current literatures have described that the lacrimal sac is located just anterior to the anterior attachment (axilla) of the middle turbinate. However, there was no data on the exact boundary of the sac, especially the distance related with a permanent landmark such as the middle turbinate attachment. Objective: Determine the intranasal location of the lacrimal sac related to the middle turbinate attachment in Thai fresh cadavers. Methods: The study was performed in 26 Thai fresh cadavers, donated to Khon Kaen University, Thailand between July 2006 and July 2007. The height and width of the lacrimal sac were recorded, as well as the distances from the upper, lower, anterior and posterior border of the lacrimal sac to the axilla of the middle turbinate were measured. Results: The mean height and width of 52 lacrimal sacs were 11.2 and 6.2 mm. The mean distances from the upper, lower, anterior, and posterior border of lacrimal sac to the axilla of the middle turbinate were 4.9 mm (95%CI=4.4-5.4), 5.6 mm (95%CI=5.1-6.1), 3 mm (95%CI=2.4-3.6), and 2.9 mm (95%CI=2.3-3.5), respectively. The upper border of all lacrimal sacs were located superior to the axilla of the middle turbinate (95%CI=93.1-100), and posterior border of 44 sacs (85%, 95%CI=72.5-92.0) were located posterior to the axilla. Additionally, the anterior wall did not extend anterior to the anterior attachment of the middle turbinate in 21% of the sac. Conclusion: This study revealed the more exact intranasal location of lacrimal sacs. This is useful for surgeons to perform adequate endoscopic dacryocystorhinostomy to prevent postoperative lacrimal sump syndrome.

Schlüsselwörter

  • Anatomy
  • lacrimal sac
  • dacryocystorhinostomy
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The apolipoprotein E (APOE) gene and the risk of diabetic nephropathy (DN): a meta-analysis in East Asian populations

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 329 - 335

Zusammenfassung

Abstract

Background: Several studies have examined the association between DN and the APOE gene, but the results have been inconsistent. Objective: Determine whether APOE is a risk factor for DN by a meta-analysis. Methods: A meta-analysis was performed using all findings of 16 similar case-control studies in East Asian to evaluate the effect of APOE as a risk factor for DN. Several electronic databases were searched for relevant articles up to 2009. After data collection, a meta-analysis was used to assess heterogeneity, combine results and evaluate variations by using software STATA SE 9.0. Publication bias was examined by the Egger’s linear regression test and fail-safe number. Results: The meta-analysis showed that the ε2 allele almost doubled the risk of DN in East Asians (pooled ORs [95% CI]: 1.85 [1.49-2.29]). In contrast, studies relating the ε4 allele to DN risk were very heterogeneous and the pooled ORs were 1.05 [95% CI: 0.72-1.52]. In the subgroup meta-analysis, ε4 was substantially related to an increased risk for DN in studies conducted in China (pooled ORs [95% CI]: 1.51 [1.11-2.06]), which was different from previous results. However, the higher risk of DN associated with ε4 was not found in Japanese or Korean populations (pooled ORs [95% CI]: 0.46 [0.27-0.80] and 0.58 [0.09-3.55], respectively). Conclusion: The ε2 allele conferred a higher risk of DN in East Asians, and no significant result was obtained with the ε4 allele.

Schlüsselwörter

  • Apolipoprotein E
  • diabetic nephropathy
  • meta-analysis
  • polymorphism
  • type 2 diabetic
  • mellitus
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Effect of omeprazole, rabeprazole, and rebamipide on the accuracy of urea breath test in patients with Helicobacter pylori infection

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 337 - 342

Zusammenfassung

Abstract

Background: The urea breath test (UBT) has been widely used for H. pylori eradication after treatment. The breath test could be adversely affected by various factors including proton pump inhibitors (PPIs) that are also used in the therapy for H. pylori infection. Objective: Determine the effect of omeprazole, rabeprazole and the mucoprotective agent rebamipide, on the UBT. Methods: Fifty-six patients with dyspepsia and positive for H. pylori by rapid urease test were enrolled. They were classified into three groups: Group 1 (n=25) received omeprazole 20 mg once daily, group 2 (n=13) received rabeprazole 20 mg once daily, and group 3 (n=18) received rebamipide 100 mg three times a day. All patients received a 14-day course of their medications. UBT was performed on day 0 as a baseline and on day 14 in all patients. In patient with negative results of UBT on day 14, the UBT was performed in consecutive week until the test became positive. Results: Fifty-six patients (20 men and 36 women) participated in the study. Their mean age was 46.77±14.3 years. False negative rate after 14-day treatment in omeprazole, rabeprazole and rebamipide group were 20.0%, 30.8%, and 0% respectively. There was a significant difference between 13C level in patients with negative and positive UBT results (2.7±0.7 vs.22.9±3.7/mL, p=0.025). The reversal of false negative to true positive tests occurred within two weeks after discontinuation of omeprazole and rabeprazole. Conclusion: Proton pump inhibitors had an effect on the accuracy of H. pylori detection using UBT. Rabeprazole revealed a higher false negative rate in the UBT than omeprazole. The mucoprotective drug, rebamipide, did not influence negative results in the UBT.

Schlüsselwörter

  • Helicobacter pylori
  • rabeprazole
  • rebamipide
  • urea breath test
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Prescribing pattern of higher generation antibiotics in the out-patient setting in Bhutan hospitals

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 349 - 353

Zusammenfassung

Abstract

Background: The emergence of antibiotic resistance is a complex problem contributed by the interplay of various parties such as prescribers, patients or health settings. In particular, prescribers play a vital role in the use of antibiotics both in rational prescribing of drugs and influencing patients on the appropriate use. Objectives: Determine the appropriateness of the higher generation antibiotics (cephalosporin and flouroquonolone groups) in the out-patient setting of Bhutan hospitals. Materials and method: A cross-sectional study was conducted in three referral hospitals of Bhutan where the prescriptions were collected from the pharmacy. All prescriptions containing higher generation antibiotics were selected based on the appropriateness using a modified Medication Appropriateness Index. Three hundred thirty three prescriptions containing higher generation antibiotics were analyzed. Results: The use of antibiotics was common with 37.1% of the prescriptions containing antibiotics out of which 14% were higher generation antibiotics. When assessed on the appropriateness of the prescription, 55.9% of the prescriptions containing higher generation antibiotics were prescribed inappropriately. In addition, only 47.1% of the prescriptions had appropriate indications for higher generation antibiotics. Conclusion: There is a widespread inappropriate use of higher generation antibiotics in Bhutan.

Schlüsselwörter

  • Antibiotics
  • Bhutan
  • medication appropriateness index
  • prescribing pattern
  • rational use
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Modeling tuberculosis incidence in Nepal

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 355 - 360

Zusammenfassung

Abstract

Background: Tuberculosis (TB) constitutes a large burden of infectious disease in Nepal. Objective: Model incidence of TB between 2003 and 2008 in Nepal. Methods: A retrospective study was conducted in Nepal of tuberculosis incidence by gender and location over the six years period. Data were obtained for 198,719 tuberculosis cases from the Nepal Tuberculosis Center (NTC). A negative binomial model with two multiplicative components as predictors was used and provided a good fit. Results: The model extracted a decreasing trend during the first five years followed by a drop in 2008.The overall incidence of TB was 1.31 cases per 1,000 population with a male to female incidence rate ratio of 1.86. There were pronounced spatial variations with higher rates occurring in the Terai region, followed by the Hill, and Mountain regions. Conclusion: Tuberculosis incidence showed a steady decreasing trend, but the number of cases was still very high. Gender differences existed in TB incidence in Nepal. Higher rates were observed in the Terai Region and urban areas. These findings highlight the need for the tuberculosis control measures to remain on a sustained and long-term basis for the high TB burden rate of Nepal.

Schlüsselwörter

  • Modeling
  • negative binomial model
  • tuberculosis
19 Artikel
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Emergent opportunities in humans: playful kittens, an arthropod vector, and a zoonotic agent

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 191 - 198

Zusammenfassung

Abstract

Bartonella henselae is implicated as the main etiologic agent of Cat scratch disease (CSD, Cat-scratch fever). A majority of domestic cats may harbor the intra-erythrocytic agent for extended periods without apparent disease. In humans, B. henselae most commonly results in a subacute, bacterial infection that presents with one or more reddish papules which may progress to pustules and regional lymph node enlargement. Usual features include fever, malaise, and a granulomatous lymphadenitis on biopsy. However, atypical clinical presentations occur, albeit with infrequence, and may result in a difficult and protracted diagnostic process. The infection in susceptible hosts such as immunocompromised or elderly patients may result in endocarditis, encephalitis, fever of unknown origin, and general malaise. It is not transmitted from person to person and quarantine is not necessary. The arthropod vector, Ctenocephalides felis, or the cat flea, plays a major role in transmission among cats and to humans. The transmission risk to humans can be substantially reduced through elimination of flea infestations in companion animals. There are numerous recent reviews and case reports in the veterinary and medical literature reflecting increased recognition of this zoonotic agent. All this notwithstanding, many physicians and other providers may not be familiar with this agent and the potential spectrum of human disease; this may lead to delays in diagnosis and unnecessary diagnostic procedures. This article emphasizes the aspects of B. henselae infection, including a typical case report and a table with selected human case reports of unusual clinical manifestations from the published literature.

Schlüsselwörter

  • Bartonella henselae
  • cat scratch disease
  • zoonosis
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Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 199 - 206

Zusammenfassung

Abstract

Background: Bleeding is an important complication of cirrhosis. Currently, there is no coagulation test that can reliably predict clinical hemorrhage. However, previous studies demonstrated significant correlations between hyperfibrinolysis and following bleeding in advanced cirrhotic patients. Objectives: Estimate the prevalence of hyperfibrinolysis in cirrhotic patients at stable conditions and to assess its role in predicting subsequent hemorrhage. Methods: The prospective cohort study included 58 consecutive cirrhotic patients at the Liver Clinic, Chulalongkorn Hospital. Assays for liver functions, PT, APTT, fibrinogen, fibrin degradation products (FDPs) and euglobulin lysis time (ELT) were performed at baseline. The subjects were followed-up for 10 months to observe clinical hemorrhage and survival. Results: The mean age was 56.4 years and 47% were male. The etiologies of liver diseases were virus (62.1%), alcohol (24.1%) or unknown (8.6%). Hyperfibrinolysis as reflected by ELT<120 minutes or FDPs>10 μg/mL was present in 32.8% and 74.1%, respectively. Fibrinolytic activity was significantly correlated with platelet counts and coagulation times, but not as much with liver function tests. By 10 months, 13 cases (22.4%) showed hemorrhagic episodes and 7 (12.1%) were expired, including 2 from bleeding. The significant predictors for death were Child class B or C, presence of ascites, hyperbilirubinemia, hypoalbuminemia, and prolonged APTT. However, none of the clinical, biochemical, or hemostatic factors was associated with clinical bleeding. Conclusion: Hyperfibrinolysis is common in cirrhotic outpatients. However, it cannot predict subsequent hemorrhage or survival. Novel hemostatic tests are required to assess the probability of bleeding in this disorder.

Schlüsselwörter

  • Bleeding
  • cirrhosis
  • euglobulin lysis time
  • hyperfibrinolysis
  • survival
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Lytic replication of Epstein-Barr virus in human peripheral T-lymphocytes

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 207 - 214

Zusammenfassung

Abstract

Background: There are few reports about the interactions of EBV with peripheral T-cells, especially during the early phase of infection. Objective: Demonstrate the capability of EBV to infect and replicate in human peripheral T-cells in vitro. Methods: After treating with EBV, the susceptibility of in vitro EBV infection into T-cells was confirmed using electron microscopy, the expression of EBV mRNA using RT-PCR, and the expression of EBV proteins using Western blot analysis. The expression of CD19 and CD21 mRNA was determined using RT-PCR. The induction of cell death was measured using trypan blue exclusion assay. Results: The susceptibility of in vitro EBV infection was confirmed by the presence of virus particles in the cytoplasm. The entering to lytic infection was confirmed by detection the expression of EBV lytic (BZLF1) mRNA, and the expression of late lytic proteins (VCA and gp350/220). The expression of CD19 and CD21 were not observed using RT-PCR. The interactions of EBV with T-cells leaded to induction of T-cell death. Conclusion: Peripheral T-cells are a direct target of EBV infection. At the beginning of infection by EBV, EBV infection of T-cells leads to the entering into lytic virus replication. EBV binds to these cells through a receptor distinct from the CD21.

Schlüsselwörter

  • CD21
  • entry
  • Epstein-Barr virus (EBV)
  • lytic replication
  • T-lymphocytes
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Magnetic resonance imaging in the evaluation of meniscal tear

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 215 - 222

Zusammenfassung

Abstract

Background: Magnetic resonance imaging (MRI) has been recognized as the imaging method for non-invasive evaluation of knee pathology, particular meniscus and ligaments. Objective: Compare the sensitivity, specificity, and accuracy of MRI in the detection of meniscal tears with arthroscopy. Material and methods: Twenty-seven patients who were diagnosed as meniscal tear on arthroscopy with preoperative MRI were included in this study between January 2003 and June 2008. MRI was performed with a 1.5 Tesla Signa Horizon Echospeed MRI for eight patients between January 2003 and June 2005 and a 1.5 Tesla Signa Excited HD MRI for nineteen patients between July 2005 and June 2008. The location of meniscal tear was evaluated by studying three areas: anterior horn, body and posterior horn. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the anterior horn, body, posterior horn and overall meniscus were calculated. Results: The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn, and overall medial meniscus was 42.9%, 87.5%, 94.1%, and 81.3%, respectively. The specificity was 95.0%, 84.2%, 81.8%, and 88.0%, respectively. The accuracy was 81.5%, 85.2%, 89.3%, and 85.4%, respectively. The PPV was 75.0%, 70.0%, 88.9%, and 81.2%, respectively. The NPV was 82.6%, 94.1%, 90.0%, and 88.0%, respectively. The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn and overall lateral meniscus was 0%, 100%, 85.7%, and 80.0%, respectively. The specificity was 100%, 100%, 90.5% and 97.2%, respectively. The accuracy was 96.0%, 100%, 90.5%, and 97.2%, respectively. The PPV was 100%, 75% and 80%, respectively. The NPV was 96.3%, 100%, 95.0%, and 97.2%, respectively. Conclusion: MRI is a helpful technique to detect meniscal tear with different sensitivity and accuracy on the meniscal location.

Schlüsselwörter

  • Arthroscopy
  • magnetic resonance imaging
  • meniscal tears
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Serum vascular endothelial growth factor per platelet count in patients with biliary atresia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 223 - 229

Zusammenfassung

Abstract

Background: Biliary atresia (BA) is a progressive, sclerosing, inflammatory process resulting in complete obliteration of the extrahepatic bile ducts. The obstruction of bile flow engenders worsening cholestasis, hepatic fibrosis, and cirrhosis, which lead to portal hypertension and a decline in hepatic synthetic function. Hepatic stellate cells, which play roles in hepatic fibrogenesis, are an important source of various inflammatory mediators including vascular endothelial growth factor (VEGF) in the injured liver. Objectives: Investigate the level of serum VEGF and serum VEGF per platelet count in patients with BA and its relation to clinical characteristics. Methods: Peripheral blood samples were taken from 70 BA patients and 15 healthy control children. Serum VEGF was measured by enzyme-linked immunosorbent assay. We compared serum VEGF and serum VEGF per platelet count in BA patients with the respective results obtained in healthy control children. The relation of serum VEGF per platelet count with clinical variables of BA patients was investigated. Results: Serum VEGF levels and serum VEGF per platelet count in BA patients were not significantly different from those in normal controls (289.64±230.01 pg/mL vs. 312.36±189.05 pg/mL; p=0.72 and 1.72±1.21x106 vs. 1.57±0.97x106; p=0.66). Significant differences were observed among BA patients when VEGF per platelet count was categorized by the presence of esophageal varice (p=0.03). Only in BA patients was the serum level of VEGF correlated with the number of platelets (r=0.53, p<0.001). Conclusion: A high serum VEGF per platelet count is a useful marker for the development of portal hypertension in BA patients, especially for esophageal varice. Serum VEGF per platelet count may be useful for monitoring disease course in BA after hepatic portoenterostomy.

Schlüsselwörter

  • Biliary atresia
  • platelet
  • vascular endothelial growth factor
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Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 243 - 251

Zusammenfassung

Abstract

Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.

Schlüsselwörter

  • Bupivacaine
  • craniotomy
  • intra-operative analgesia
  • post-operative analgesia scalp
  • nerve block
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Distribution of hepatitis C virus genotypes, hepatic steatosis and their correlation with clinical and virological factors in Pakistan

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 253 - 262

Zusammenfassung

Abstract

Background: Due to the inherently unstable nature of HCV, various genotypes have been identified. Steatosis is a histological feature in the progression of HCV-associated liver disease and has been shown to alter the host lipid metabolism. Objective: Assess the distribution of HCV genotypes in the two provinces of Pakistan, and determine the association of hepatic steatosis with altered clinical and virological factors in chronic HCV patients. Methods: One hundred twenty six chronic HCV patients (steatosis in 49 patients) were enrolled for qualitative analysis by PCR. Out of 126 ELISA and PCR positive samples, 119 (48 with hepatic steatosis) chronic HCV patients (mean age 42.0±13.3 years, mean body mass index (BMI) 24.2±4.1) were proved positive after PCR-based detection. Biochemical and virological factors such as HCV genotype, or glucose, in 119 CHC patients were determined and compared between patients with and without hepatic steatosis. Results: Out of 126 samples, 119 were HCV positive, where 58 (48.7%) were genotype 3a, 24 (20.2%) were 3b, 12 (10.1%) were 1a, eight (6.7%) were 2a, six (5.0%) were 1b, and one (0.8%) was 4. Furthermore, seven (5.9%) had a co-infection and three (2.5%) were untypable. BMI (p=0.004), genotype 3a (p<0.001), and triglycerides (p=0.002) were significantly associated with steatosis. It is noteworthy that cholesterol (p=0.281), glucose (p=0.305), lowdensity lipoprotein (p=0.101), high-density lipoprotein (p=0.129), alanine amino transferase (p=0.099), aspartate transaminase (p=0.177), bilirubin (p= 0.882), and age (p=0.846) showed non-significant association. Conclusion: Genotype 3a is the predominant genotype in Pakistan. Hepatic steatosis is quite frequent feature in HCV patients and strongly correlates with BMI, genotype 3a, and triglyceride contents in patients infected with HCV.

Schlüsselwörter

  • Clinical parameters
  • genotypes
  • hepatitis C virus
  • steatosis
  • subtype 3a
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Novel genetic marker in TGFB2 gene associated with expression of TGF-β2 in leukocyte and SLE susceptibility

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 263 - 269

Zusammenfassung

Abstract

Background: TGF-β2 has a role in immune regulation, and genetic variance within the gene might contribute to systemic lupus erythematosus (SLE) pathogenesis. The TGFB2 gene is one candidate gene within the major SLE genetic susceptibility loci. Objective: Investigate the TGFB2 gene located on chromosome 1q41 as a SLE susceptibility gene. Materials and methods: One hundred fifty three SLE patients and 133 healthy controls participated in this study. Four markers selected in two haplotype blocks that have a minor allele frequency greater than 5% in Thai population were genotyped and analyzed in the association study. Results: There was no significant association between SLE susceptibility and the polymorphism in the promoter area (+67_68insACAA) and +89835 (A/G) at the intron 5 of TGFB2 gene. Instead, minor allele of the two new genetic markers at the intron 1 (+720) (corrected p-value = 0.024, OR = 0.4141, 95%CI = 0.22-0.80) and intron 6 (+94399_94400) (corrected p-value = 0.000143, OR = 0.3367, 95%CI = 0.20-0.58) were independently associated as a protective factor to SLE. Additionally, the real time RT-PCR results showed that patients with the protective allele (minor allele) at the +94399_94400 position have higher TGF-β2 mRNA level in leukocytes than patients with the risk allele (p=0.011). Conclusion: Two new genetic markers at intron1 (+720) and intron 6 (+94399_94400) were independently associated with SLE. The observed results have to be confirmed in other populations with a large sample size.

Schlüsselwörter

  • Gene polymorphism
  • TGFB2
  • SLE
  • Thai population
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Effects of N(2-propylpentanoyl)urea on hippocampal amino acid neurotransmitters in spontaneous recurrent seizure rats

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 271 - 279

Zusammenfassung

Abstract

Background: N(2-propylpentanoyl) urea (VPU) is a new valproic acid (VPA) analog with higher anticonvulsant activity than its parent compound in various animal models including seizure acutely induced by pilocarpine. Objective: Investigate its effects on hippocampal amino acid neurotransmitters in spontaneous recurrent seizure (SRS) rats. Methods: Pilocarpine hydrochloride was used to induce status epilepticus (SE). Animals were visually observed for two hours/day for an episode of SRS for six weeks. Microdialysis experiment was performed to detect hippocampal amino acid neurotransmitters on those rats that developed SRS. Results: In comparison to normal rats, hippocampal glutamate, gamma-aminobutyric acid (GABA), and glycine, significantly increased in SRS rats. Occurrence of SRS in the faces of increased level of inhibitory neurotransmitters suggests the key role played by glutamate in the genesis and control of SRS. Based on the observation in pilocarpine-induced SE, the level of glutamate in SRS rats significantly decreased by a clinically effective anticonvulsant, VPA (300 and 600 mg/kg, i.p). Similar profile on hippocampal glutamate was also exhibited by VPU (50 and 100 mg/kg, i.p.). Conclusion: The possible role of VPU in controlling seizure in SRS rats and subsequently human temporal lobe epilepsy as VPA was suggested.

Schlüsselwörter

  • N-(2-propylpentanoyl)urea
  • valproic acid
  • pilocarpine
  • spontaneous recurrent seizure
  • amino acid neurotransmitters
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Stem cell factor in gingival crevicular fluid in periodontal health and disease

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 281 - 287

Zusammenfassung

Abstract

Background: Stem cell factor is a pleiotropic cytokine produced by several cell types including fibroblasts, bone marrow stromal cells, mast cells, and endothelial cells. In addition, stem cell factor is an important hematopoietic growth factor, which binds to and activates the ligand for the tyrosine kinase-type receptor c-kit. Objectives: Analyze concentration of stem cell factor within gingival crevicular fluid (GCF) in both periodontal health and disease and to determine the correlation of stem cell factor in GCF and inflammatory status of periodontal tissues. Materials and methods: Forty-five subjects (aged 24 to 75 years) were classified into the following three groups according to their periodontal tissue status as group I (clinically healthy gingiva with no loss of attachment), group II (gingivitis with no attachment loss), and group III (periodontitis). GCF samples collected from each patient were examined for stem cell factor level using enzyme-linked immunosorbant assay. Results: The maximum level of stem cell factor in GCF was obtained for group III (71.8±7.8 pg/g protein), and the lowest mean stem cell factor concentration in GCF was observed for group I (22.1±7.3 pg/g protein). The GCF stem cell factor level of patients in group III was statistically higher than that in group II (p <0.04) and group I (p <0.001). In addition, the mean GCF levels of stem cell factor in group II (48.1±7.5 pg/g protein) were significantly higher than those in group I (p <0.02). There was a positive correlation between stem cell factor in GCF and gingival inflammation index (r=0.59, p <0.001) Conclusion: GCF levels of stem cell factor increased in parallel with the severity of periodontal disease. Its levels in GCF could be potentially useful as a biochemical marker of periodontal inflammation and the host response.

Schlüsselwörter

  • Gingival crevicular fluid
  • gingivitis
  • inflammation
  • periodontitis
  • stem cell factor
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Efficacy of a 3-day artesunate-mefloquine combination in the treatment of uncomplicated falciparum malaria in Kanchanaburi province of Thailand

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 289 - 295

Zusammenfassung

Abstract

Background: In Kanchanaburi province located on the Thai-Myanmar border, Plasmodium falciparum parasites have developed significant resistance to commonly-used anti-malarials. For use against falciparum malaria, 2-day artesunate-mefloquine combination (MAS2) has recently been replaced by a 3-day artesunate-mefloquine combination (MAS3) that is an artemisinin-based combination therapy regimen recommended by the WHO. Objective: Investigate the efficacy and safety of MAS3 in the treatment of uncomplicated falciparum malaria in patients of Kanchaburi province. Methods: The study was conducted at Bongtee sub-district, Sai Yok district, Kanchanaburi province between June and November 2009. Fifty-one uncomplicated falciparum malaria patients were enrolled. Inclusion, exclusion and study method followed the WHO protocol for assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Patients received a MAS3 and were followed for 42 days. Results: All patients clinically recovered, but four patients were again parasitaemic on day 21, (1 patient) 28 (2 patients) and 42 (1 patient), respectively. Molecular analyses suggested that all recurrences were caused by recrudescence. There were no severe adverse events, but complaints of headache, gastrointestinal upset, nausea, and vomiting. Delay in parasite clearance was found. Proportion of parasite clearance on day 1, 2, 3 and 7 were 17.7%, 62.7%, 80.4%, and 100%, respectively. Conclusion: MAS3 is comparable to MAS2, and meet the WHO efficacy criteria for use against falciparum malaria, but the effect on parasite clearance was inferior to that of MAS2. Close monitoring evaluation is required.

Schlüsselwörter

  • Artesunate-mefloquine combination
  • efficacy study
  • falciparum malaria
  • Kanchanaburi province
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Co-expression of human malaria parasite Plasmodium falciparum orotate phosphoribosyltransferase and orotidine 5’-monophosphate decarboxylase as enzyme complex in Escherichia coli: a novel strategy for drug development

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 297 - 306

Zusammenfassung

Abstract

Background: Human malaria parasite Plasmodium falciparum operates de novo pyrimidine biosynthetic pathway. The fifth and sixth enzymes of the pathway form a heterotetrameric complex, containing two molecules each of orotate phosphoribosyltransferase (OPRT) and orotidine 5’-monophosphate decarboxylase (OMPDC). Objective: Define the function of OPRT-OMPDC enzyme complex of P. falciparum by co-expressing the enzymes in Escherichia coli. Methods: The constructed plasmids containing either P. falciparum OPRT or OMPDC were cloned in E. coli by co-transformation. Both genes were co-expressed as OPRT-OMPDC enzyme complex and the complex was purified by chromatographic techniques, including N2+-NTA affinity, Hi Trap Q HP anion-exchange, uridine 5’- monophosphate affinity, and Superose 12 gel-filtration columns. Physical and kinetic properties of the enzyme complex were analyzed for its molecular mass. Results: Co-transformation of PfOPRT and PfOMPDC plasmids in E. coli were achieved with a clone containing DNA ratio of 1:2, respectively. Both plasmids remained stable and were functionally expressed in the E. coli cell for at least 20 weeks. The P. falciparum OPRT-OMPDC enzyme complex were co-expressed and the complex was co-eluted in all chromatographic columns during purification and physical analysis. The molecular mass of the complex was 130 kDa, whereas the PfOPRT and PfOMPDC component were 35.6 and 41.5 kDa, respectively. The enzymatic activities of the complex were competitively inhibited by their products of each enzyme component. Conclusion: P. falciparum OPRT and OMPDC in E. coli as an enzyme complex were co-transformed and functionally co-expressed. These have similar properties to the native enzyme purified directly from P. falciparum, and this character is different from that of the human host organism. The enzyme complex would be suitable as new target to research selective inhibitors as suitable drugs to better control this disease.

Schlüsselwörter

  • Co-expression
  • co-transformation
  • enzyme complex
  • orotate phosphoribosyltransferase (OPRT)
  • orotidine 5’-monophosphate decarboxylase (OMPDC)
  • Plasmodium falciparum
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Association between angiotensin II type-1 receptor A1166C polymorphism and the presence of angiographically-defined coronary artery disease in an Iranian population

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 307 - 314

Zusammenfassung

Abstract

Background: There are reported associations between a polymorphism of the angiotensin II type 1 receptor (AT1R/A1166C) gene and coronary artery disease (CAD), hypertension, and myocardial infarction in some populations. Objective: Investigate the association between A1166C polymorphism and CAD in an Iranian population. Methods: Four hundred and thirteen patients with suspected CAD were recruited. Based on coronary angiography, the patients were classified into CAD+ (n=315) and CAD- (n=98) groups defined as >50% and <50% stenosis of any major coronary artery, respectively. One hundred and thirty-five healthy subjects were also recruited as the control group. The AT1R polymorphism was assessed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) based method. Results: A higher frequency of the AC and CC genotypes and lower frequency of the AA genotype was observed in both CAD+ and CAD- groups, compared with the control group (p <0.05). CAD+ and CAD- groups also had a higher frequency of the C allele than controls (p <0.01). There was no significant difference in genotype and allele frequencies between hypertensive and non-hypertensive patients (p > 0.05). In addition, the AT1R genotype frequencies did not differ significantly among different subgroups of CAD+ patients, based on the number of affected coronary vessels (p >0.05). Conclusion: The frequency AT1R/A1166C polymorphism was higher among patients with some degrees of coronary stenosis who are candidates of coronary angiography.

Schlüsselwörter

  • Angiography
  • angiotensin receptor
  • coronary artery disease
  • hypertension
  • polymorphism
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Correlation of microvascular density and proliferation index in undifferentiated nasopharyngeal carcinoma

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 315 - 321

Zusammenfassung

Abstract

Background: Undifferentiated nasopharyngeal carcinoma is a highly malignant tumor with an endemic distribution. Several histologic parameters have been studied to provide prognostic information for patient management. Both proliferation index and microvascular density are commonly determined on such tumors, but the relationship between these two parameters has not been studied fully. Objectives: Determine the association between microvascular density and cellular proliferation in undifferentiated nasopharyngeal carcinoma. Methods: A series of 60 cases were studied in patients of Southeast Asian origin. Cellular proliferation was determined using Ki67 immunostaining, and vessel proliferation using CD31 immunostaining in terms of areas of increased staining (‘hot spots’). Ki67 results were scored on a scale of 0-4+ and CD31 results as a microvascular density/mm2. Results: The mean of the microvascular density was 22/mm2 in the Ki67-negative group (25 cases). In the Ki67- positive group (35 cases), the mean was 35/mm2. The difference between the positive and negative group was statistically significant (p <0.001). Microvascular density significantly increased as the Ki67 score increased (p<0.001). However, the ‘hot spots’ for microvascular density in tissue sections did not correspond to areas of increased cellular proliferation. Conclusion: Pathologists usually determine only one of these two prognostic factors when dealing with undifferentiated nasopharyngeal carcinoma. The proliferation index is suggested because it is easier to perform and can be done on small biopsies not to contain enough surface area for microvascular density determination.

Schlüsselwörter

  • CD31
  • Ki67
  • microvascular density
  • morphometry
  • nasopharyngeal carcinoma
  • proliferation index
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Intranasal location of lacrimal sac in Thai cadavers

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 323 - 327

Zusammenfassung

Abstract

Background: Many current literatures have described that the lacrimal sac is located just anterior to the anterior attachment (axilla) of the middle turbinate. However, there was no data on the exact boundary of the sac, especially the distance related with a permanent landmark such as the middle turbinate attachment. Objective: Determine the intranasal location of the lacrimal sac related to the middle turbinate attachment in Thai fresh cadavers. Methods: The study was performed in 26 Thai fresh cadavers, donated to Khon Kaen University, Thailand between July 2006 and July 2007. The height and width of the lacrimal sac were recorded, as well as the distances from the upper, lower, anterior and posterior border of the lacrimal sac to the axilla of the middle turbinate were measured. Results: The mean height and width of 52 lacrimal sacs were 11.2 and 6.2 mm. The mean distances from the upper, lower, anterior, and posterior border of lacrimal sac to the axilla of the middle turbinate were 4.9 mm (95%CI=4.4-5.4), 5.6 mm (95%CI=5.1-6.1), 3 mm (95%CI=2.4-3.6), and 2.9 mm (95%CI=2.3-3.5), respectively. The upper border of all lacrimal sacs were located superior to the axilla of the middle turbinate (95%CI=93.1-100), and posterior border of 44 sacs (85%, 95%CI=72.5-92.0) were located posterior to the axilla. Additionally, the anterior wall did not extend anterior to the anterior attachment of the middle turbinate in 21% of the sac. Conclusion: This study revealed the more exact intranasal location of lacrimal sacs. This is useful for surgeons to perform adequate endoscopic dacryocystorhinostomy to prevent postoperative lacrimal sump syndrome.

Schlüsselwörter

  • Anatomy
  • lacrimal sac
  • dacryocystorhinostomy
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The apolipoprotein E (APOE) gene and the risk of diabetic nephropathy (DN): a meta-analysis in East Asian populations

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 329 - 335

Zusammenfassung

Abstract

Background: Several studies have examined the association between DN and the APOE gene, but the results have been inconsistent. Objective: Determine whether APOE is a risk factor for DN by a meta-analysis. Methods: A meta-analysis was performed using all findings of 16 similar case-control studies in East Asian to evaluate the effect of APOE as a risk factor for DN. Several electronic databases were searched for relevant articles up to 2009. After data collection, a meta-analysis was used to assess heterogeneity, combine results and evaluate variations by using software STATA SE 9.0. Publication bias was examined by the Egger’s linear regression test and fail-safe number. Results: The meta-analysis showed that the ε2 allele almost doubled the risk of DN in East Asians (pooled ORs [95% CI]: 1.85 [1.49-2.29]). In contrast, studies relating the ε4 allele to DN risk were very heterogeneous and the pooled ORs were 1.05 [95% CI: 0.72-1.52]. In the subgroup meta-analysis, ε4 was substantially related to an increased risk for DN in studies conducted in China (pooled ORs [95% CI]: 1.51 [1.11-2.06]), which was different from previous results. However, the higher risk of DN associated with ε4 was not found in Japanese or Korean populations (pooled ORs [95% CI]: 0.46 [0.27-0.80] and 0.58 [0.09-3.55], respectively). Conclusion: The ε2 allele conferred a higher risk of DN in East Asians, and no significant result was obtained with the ε4 allele.

Schlüsselwörter

  • Apolipoprotein E
  • diabetic nephropathy
  • meta-analysis
  • polymorphism
  • type 2 diabetic
  • mellitus
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Effect of omeprazole, rabeprazole, and rebamipide on the accuracy of urea breath test in patients with Helicobacter pylori infection

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 337 - 342

Zusammenfassung

Abstract

Background: The urea breath test (UBT) has been widely used for H. pylori eradication after treatment. The breath test could be adversely affected by various factors including proton pump inhibitors (PPIs) that are also used in the therapy for H. pylori infection. Objective: Determine the effect of omeprazole, rabeprazole and the mucoprotective agent rebamipide, on the UBT. Methods: Fifty-six patients with dyspepsia and positive for H. pylori by rapid urease test were enrolled. They were classified into three groups: Group 1 (n=25) received omeprazole 20 mg once daily, group 2 (n=13) received rabeprazole 20 mg once daily, and group 3 (n=18) received rebamipide 100 mg three times a day. All patients received a 14-day course of their medications. UBT was performed on day 0 as a baseline and on day 14 in all patients. In patient with negative results of UBT on day 14, the UBT was performed in consecutive week until the test became positive. Results: Fifty-six patients (20 men and 36 women) participated in the study. Their mean age was 46.77±14.3 years. False negative rate after 14-day treatment in omeprazole, rabeprazole and rebamipide group were 20.0%, 30.8%, and 0% respectively. There was a significant difference between 13C level in patients with negative and positive UBT results (2.7±0.7 vs.22.9±3.7/mL, p=0.025). The reversal of false negative to true positive tests occurred within two weeks after discontinuation of omeprazole and rabeprazole. Conclusion: Proton pump inhibitors had an effect on the accuracy of H. pylori detection using UBT. Rabeprazole revealed a higher false negative rate in the UBT than omeprazole. The mucoprotective drug, rebamipide, did not influence negative results in the UBT.

Schlüsselwörter

  • Helicobacter pylori
  • rabeprazole
  • rebamipide
  • urea breath test
access type Uneingeschränkter Zugang

Prescribing pattern of higher generation antibiotics in the out-patient setting in Bhutan hospitals

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 349 - 353

Zusammenfassung

Abstract

Background: The emergence of antibiotic resistance is a complex problem contributed by the interplay of various parties such as prescribers, patients or health settings. In particular, prescribers play a vital role in the use of antibiotics both in rational prescribing of drugs and influencing patients on the appropriate use. Objectives: Determine the appropriateness of the higher generation antibiotics (cephalosporin and flouroquonolone groups) in the out-patient setting of Bhutan hospitals. Materials and method: A cross-sectional study was conducted in three referral hospitals of Bhutan where the prescriptions were collected from the pharmacy. All prescriptions containing higher generation antibiotics were selected based on the appropriateness using a modified Medication Appropriateness Index. Three hundred thirty three prescriptions containing higher generation antibiotics were analyzed. Results: The use of antibiotics was common with 37.1% of the prescriptions containing antibiotics out of which 14% were higher generation antibiotics. When assessed on the appropriateness of the prescription, 55.9% of the prescriptions containing higher generation antibiotics were prescribed inappropriately. In addition, only 47.1% of the prescriptions had appropriate indications for higher generation antibiotics. Conclusion: There is a widespread inappropriate use of higher generation antibiotics in Bhutan.

Schlüsselwörter

  • Antibiotics
  • Bhutan
  • medication appropriateness index
  • prescribing pattern
  • rational use
access type Uneingeschränkter Zugang

Modeling tuberculosis incidence in Nepal

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 355 - 360

Zusammenfassung

Abstract

Background: Tuberculosis (TB) constitutes a large burden of infectious disease in Nepal. Objective: Model incidence of TB between 2003 and 2008 in Nepal. Methods: A retrospective study was conducted in Nepal of tuberculosis incidence by gender and location over the six years period. Data were obtained for 198,719 tuberculosis cases from the Nepal Tuberculosis Center (NTC). A negative binomial model with two multiplicative components as predictors was used and provided a good fit. Results: The model extracted a decreasing trend during the first five years followed by a drop in 2008.The overall incidence of TB was 1.31 cases per 1,000 population with a male to female incidence rate ratio of 1.86. There were pronounced spatial variations with higher rates occurring in the Terai region, followed by the Hill, and Mountain regions. Conclusion: Tuberculosis incidence showed a steady decreasing trend, but the number of cases was still very high. Gender differences existed in TB incidence in Nepal. Higher rates were observed in the Terai Region and urban areas. These findings highlight the need for the tuberculosis control measures to remain on a sustained and long-term basis for the high TB burden rate of Nepal.

Schlüsselwörter

  • Modeling
  • negative binomial model
  • tuberculosis

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