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

Suche

Volumen 9 (2015): Heft 4 (August 2015)

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

Suche

15 Artikel

Editorial

access type Uneingeschränkter Zugang

A possible alternative to multivariate models for cardiovascular risk estimates

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 439 - 440

Zusammenfassung

Review article

access type Uneingeschränkter Zugang

Hyperactive and hypoactive psychomotor subtypes of delirium in demented and nondemented elderly patients with hip fractures: systematic review and meta-analysis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 441 - 453

Zusammenfassung

Abstract

The occurrence of delirium superimposed on dementia (DSD) in patients with hip fracture may have many life-threatening complications, especially if unrecognized and untreated.

To estimate the prevalence and outcomes of DSD in hospitalized elderly adults with dementia and hip fracture, and clinical symptoms of delirium with and without dementia.

The review process followed guidelines consisting of 5 steps suggested for systematic reviews. Relevant studies between January 2000 to December 2014 were obtained from electronic databases, and 2 trained reviewers independently analyzed them. Comprehensive Meta-Analysis software (Biostat) was used to assess and combine the data across studies.

We identified 15 articles for meta-analysis. Prevalence of DSD after hip fracture was 69.7% (95% confidence interval [CI] = 60.4%-77.7%). People with dementia after hip fracture had a 6.03 times higher likelihood of sustaining delirium than those without dementia (95% CI = 3.63%-10.04%). The symptoms of delirium in a person without dementia was more often any hyperactivity (ES = 2.27, 95% CI = 1.17-4.41, P = 0.015), but those lacking dementia were more often hypoactive (ES = 2.22, 95% CI = 1.15-4.56, P = 0.018). There was limited evidence of publication bias, and there was substantial selective reporting bias in articles.

The review demonstrates the high prevalence of DSD and highlights the differences in motor subtypes of delirium between delirium with and without dementia, but there is concern about these results given the high risk of bias.

Schlüsselwörter

  • Delirium
  • dementia
  • hip fracture

Original article

access type Uneingeschränkter Zugang

Antiaging phenotype in skeletal muscle after endurance exercise is associated with the oxidative phosphorylation pathway

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 455 - 471

Zusammenfassung

Abstract

Performing regular exercise may be beneficial to delay aging. During aging, numerous biochemical and molecular changes occur in cells, including increased DNA instability, epigenetic alterations, cell-signaling disruptions, decreased protein synthesis, reduced adenosine triphosphate (ATP) production capacity, and diminished oxidative phosphorylation.

To identify the types of exercise and the molecular mechanisms associated with antiaging phenotypes by comparing the profiles of gene expression in skeletal muscle after various types of exercise and aging.

We used bioinformatics data from skeletal muscles reported in the Gene Expression Omnibus repository and used Connection Up- and Down-Regulation Expression Analysis of Microarrays to identify genes significant in antiaging. The significant genes were mapped to molecular pathways and reviewed for their molecular functions, and their associations with molecular and cellular phenotypes using the Database for Annotation, Visualization and Integrated Discovery and Kyoto Encyclopedia of Genes and Genomes informatics resources, and GeneCards databases, respectively.

The results showed that endurance exercise has an antiaging potential (Pearson χ2, P < 0.01) by upregulating genes coding for components of the oxidative phosphorylation pathway (Benjamini false discovery rate Q < 0.05). We found that numerous genes coding for components of other pathways were also upregulated (Pearson χ2 P < 0.01) as a chronic adaptation to endurance exercise, including ATP5C1, involved in ATP synthesis, CYCS, involved in electron transfer in the mitochondrial respiratory chain, and GSTK1, involved in cellular detoxification.

Endurance exercise may be the best type to promote antiaging phenotypes by increasing mitochondrial biogenesis and ATP production capacity.

Schlüsselwörter

  • Aging
  • endurance exercise
  • mitochondrial biogenesis
  • mitochondrial dysfunction
  • oxidative phosphorylation
  • skeletal muscle

Brief communication (Original)

access type Uneingeschränkter Zugang

Incidence of significant extravascular findings in patients undergoing computed tomographic angiography of the whole aorta or abdominal aorta

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 551 - 557

Zusammenfassung

Abstract

A high prevalence of significant extravascular findings is reported in patients who underwent computed tomographic angiography (CTA) of the pulmonary artery, abdominal aorta, and lower extremities for suspected vascular pathology.

To determine the incidence of significant extravascular findings in patients who underwent CTA of the whole aorta or abdominal aorta, and to determine the common clinical symptoms of patients who underwent CTA of aorta in whom these significant extravascular findings were usually found.

We retrospectively reviewed the cases of 187 patients who underwent CTA of whole aorta and 37 patients who underwent of CTA of abdominal aorta at King Chulalongkorn Memorial Hospital from January 2011 to December 2012. We measured the prevalence of significant extravascular findings and placed these findings into 3 categories. We reviewed the clinical history, further investigation, and also pathologic result of these extravascular findings.

Of 336 extravascular findings in 210 (95%) patients, 41 (12%) provided a an alternative explanation for symptoms of acute chest pain and acute abdominal pain, including axial skeletal fracture, pneumohemothorax, and hemopericardium associated with trauma, 85 (25%) were incidental extravascular findings that required radiological follow-up or further investigation including indeterminate lung nodules or lesions, liver masses, significantly enlarged lymph nodes, adrenal nodules, and mediastinal lesions, and 210 (63%) were extravascular findings that required less urgent or no follow-up. Nine (12%) patients received diagnoses of previously unknown malignancy.

Radiologists and referring clinicians should be aware of the frequency of significant extravascular findings.

Schlüsselwörter

  • CTA of abdominal aorta
  • CTA of whole aorta
  • significant extravascular findings
access type Uneingeschränkter Zugang

Development of a Thai version of the neutropenia subscale for the Functional Assessment of Cancer Therapy–Neutropenia questionnaire

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 543 - 549

Zusammenfassung

Abstract

There is a need for a validated translation of the neutropenia subscale (NS) of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) questionnaire used to assess neutropenia-specific concerns and health-related quality of life for Thai patients receiving cancer chemotherapy.

To translate the NS of the FACT-N questionnaire into Thai and examine the psychometric properties of the Thai version.

The 19 item NS was translated into Thai in accordance with the guidelines of the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology. The psychometric properties of the translated version were then tested. We randomly selected 260 patient participants with hematological malignancies from four hospitals in Thailand. All participants completed the Thai version of FACT-N at the time of expected neutropenia (7-14 days after receiving chemotherapy). The Thai NS content validity was evaluated by a panel of 5 experts. The construct validity of the Thai NS was tested by confirmatory factor analysis (CFA). The internal consistency of the Thai NS was tested with Cronbach’s α coefficients.

The Thai version of the NS was semantically equivalent to the English version. The content validity index was good at 0.95. The CFA of the Thai NS indicated acceptable construct validity. All 19 items on the Thai NS had significant estimated factor loadings (P < 0.05). Cronbach’s α coefficient was 0.82.

The Thai NS, as part of FACT-N, is appropriate in terms of translation and psychometric properties for assessing specific neutropenia-related concerns in Thai patients undergoing cancer chemotherapy

Schlüsselwörter

  • FACT-N
  • health-related quality of life
  • hematological malignancies
  • neutropenia subscale
  • scale translation
  • scale validation
access type Uneingeschränkter Zugang

Multidrug resistance by biofilm-forming clinical strains of Proteus mirabilis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 535 - 541

Zusammenfassung

Abstract

Biofilm formation on indwelling devices is one of the most important mechanisms playing a role in device-related urinary tract infections caused by Proteus mirabilis. Increasing antibiotic resistance of microorganisms has raised questions concerning the relationship between biofilm formation and drug resistance.

To determine clinical prevalence, antibiotic resistance of, and biofilm formation by P. mirabilis strains.

We studied the susceptibilities of various P. mirabilis strains isolated from different clinical materials by a disc-diffusion method. Biofilm formation was determined by a crystal violet binding assay.

Two (13%) of 15 P. mirabilis strains were found to be strong biofilm formers (SBF). Both SBF P. mirabilis strains were isolated from urine samples from children less than 15 years old in a pediatric emergency unit. Cefixime, cefazolin, ceftriaxone, amikacin, and piperacillin/tazobactam were the most effective antibiotics against 15 P. mirabilis strains (100%), whereas SBF P. mirabilis strains were multidrug resistant or (resistant to 5 different antimicrobial classes). Both of the SBF P. mirabilis strains, but neither of the weak biofilm forming P. mirabilis strains were resistant to ampicillin and ceftazidime among β-lactam antibiotics, or tobramycin and gentamicin among aminoglycoside antibiotics used in the present study.

Children comprise the only patients infected with SBF P. mirabilis strains and both SBF P. mirabilis strains displayed high antimicrobial resistance in our setting.

Schlüsselwörter

  • Biofilm formation
  • device-related infections
  • multidrug resistance
  • Proteus mirabilis
  • urinary tract infection
access type Uneingeschränkter Zugang

Prevalence of thalassemia carriers among the Lahu hill tribe population, Chiang Rai, Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 527 - 533

Zusammenfassung

Abstract

Current data on the prevalence of hemoglobinopathies among Lahu in northern Thailand are limited.

To investigate the prevalence of thalassemia carriers among Lahu hill tribe people in Chiang Rai Province, Thailand.

We conducted a cross-sectional study in 2 phases. The first retrospectively analyzed data from antenatal clinics attended by Lahu women between January 2011 and June 2012. The second phase was prospective and included the husbands of Lahu women. In the second phase, 116 Lahu adults were administered a questionnaire and blood tests for osmotic fragility (OFT) and dichlorophenol indophenol precipitation (DCIP). The hemoglobin (Hb) type of those positive for either or both tests was identified by HPLC and PCR.

Data from 358 Lahu women in the first phase showed a mean age of 23.2 y (range 13-46 y, SD 6.83), 68.5% were primigravida. Fifty-eight had abnormal mean corpuscular volume (MCV), 87 positive OFT, 18 positive DCIP test, and 3.0% positive results in both tests. Eight of 83 participating husbands had abnormal MCV, 8 positive OFT and 2 positive DCIP test. In the second phase, 52.2% of 116 participants were women, mean age of 33.7 y (range 18-68 y, SD 11.2), 38 positive OFT, 10 positive DCIP test, and 3.7% positive results in both tests. Hb typing showed 5 participants with HbE, 1 β-thalassemic, 1 HbE homozygous, and no α-thalassemia-1 (SEA) was identified.

Provision of a thalassemia screening in health care settings in remote areas of Thailand is an ongoing need.

Schlüsselwörter

  • Hill tribe
  • Lahu
  • pregnant women
  • prevalence
  • thalassemia carrier
access type Uneingeschränkter Zugang

Fibroglandular tissue and quantitative background parenchymal enhancement on magnetic resonance breast images are inversely correlated with menopause in Thai women

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 519 - 526

Zusammenfassung

Abstract

There are limited data regarding background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) for Asian women.

To determine relationships between the amount of fibroglandular tissue (FGT) and BPE in breast MRI.

A retrospective review identified 95 MRI examinations of women with normal breasts between March 2012 to July 2014 for inclusion in this study. BPE and MRI-FGT were assessed on precontrast T1-weighted fat-suppressed images by consensus and described according to the American College of Radiology Breast Imaging Reporting and Data System. We analyzed BPE, including early and peak enhancement (Eearly, Epeak), and the signal enhancement ratio (SER). Spearman rank correlations between MRI-FGT and BPE and menopausal status were compared using Mann-Whitney U tests.

Fourteen premenopausal and 81 postmenopausal women had scattered and heterogeneous FGT (74%) and minimal to mild BPE (84%). There was a significant correlation between age and amount of MRI-FGT (r = -2.63; P = 0.01), but not BPE or enhancement kinetics. There was no significant correlation between FGT, BPE, and enhancement kinetics. There was a significant inverse relationship between menopause and the amount of FGT, BPE, and Epeak (P < 0.001, = 0.001, and = 0.04, respectively). There was no significant difference between pre and postmenopausal Eearly and SER (P > 0.05).

There is no significant correlation between the amount of FGT and BPE in either premenopausal or postmenopausal women. The amount of FGT, degree of BPE, and Epeak were higher in premenopausal women.

Schlüsselwörter

  • Background parenchymal enhancement (BPE)
  • breast MRI correlation
  • fibroglandular tissue (FGT)
  • menstruation
  • Thai women
access type Uneingeschränkter Zugang

Cross-sex hormone use does not increase cardiovascular risk in young male-to-female transsexuals: a study of self-medication by healthy Thai cabaret dancers

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 511 - 518

Zusammenfassung

Abstract

Cross-sex hormone (CSH) use is widespread among transsexuals in Thailand. CSHs are used by male-to-female (MtF) transsexuals for feminization.

To determine effects of self-medication with CSH on cardiovascular risk biomarkers, C-reactive protein (CRP) and fibrinogen (Fb), in Thai MtF transsexuals.

Data were collected from healthy MtF transsexual cabaret dancers in Pattaya city, Thailand, using a questionnaire and descriptive interview. Blood samples were collected to determine lipid profile, CRP, Fb, and sex hormone levels. ANOVA, Pearson correlation, and logistic regression were analyzed for effects of CSH on biomarkers; comparing CSH users with non-using controls.

We grouped 102 MtF transsexual participants (average age 28 years) as CSH (n = 66) and non-hormone using controls (n = 36). Several female and antimale hormonal products were used in CSH self-medication, with an average 12.5-year exposure. In the CSH group, significantly higher HDL with lower CRP levels and a negative correlation between total cholesterol, LDL, and 17β-estradiol were observed. Risk prevalence analysis exhibited lower prevalence of disease susceptibility in the CSH group. Logistic regression accordingly revealed the effect of CSH on CRP levels with odds ratios of 0.26 (CI 0.1-0.68) and 0.34 (CI 0.13-0.93) in crude and adjusted models, respectively.

Moderate exposure to low doses of CSH use showed no serious risk or health problems in healthy MtF transsexuals in terms of cardiovascular risk biomarkers

Schlüsselwörter

  • C-reactive protein
  • cardiovascular
  • estrogen
  • fibrinogen
  • male-to-female transsexuals progesterone
  • testosterone
access type Uneingeschränkter Zugang

Subtelomeric aberrations in Thai patients with idiopathic mental retardation and autism detected by multiplex ligation-dependent probe amplification

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 501 - 509

Zusammenfassung

Abstract

Chromosomal rearrangements involving telomeres account for approximately 1%-30% of causes of mental retardation (MR). It is therefore recommended that all cases of undiagnosed MR be screened for subtelomeric aberration. Nevertheless, resolution of a standard karyotyping using the G-banding technique is limited. Therefore, an additional technique with higher resolution should be performed to detect this type of anomaly.

To screen for subtelomeric aberration in Thai patients with mental retardation and autism.

Multiplex ligation-dependent probe amplification (MLPA), was used to screen 114 Thai patients with idiopathic MR and 15 patients with autism. All positive results were confirmed by using a different set of MLPA probes or real-time PCR.

We identified 5 patients with submicroscopic aberration in patients with MR. One patient had a submicroscopic deletion at the 1p36.33 region, which was confirmed by real-time PCR. There were 2 patients with subtelomeric duplication at the 15q11.2 and 11p15.5 regions sequentially. Two patients had the same duplication at the Xp22.33. region.

The present study shows that the incidence of a subtelomeric aberration in Thai patients with idiopathic MR is approximately the same reported previously (3.9%). Identifying these submicroscopic aberrations requires an advanced method with higher resolution than standard karyotyping. Although microarray techniques may be a more informative, they are costly and require an array facility, which are not widely available, especially in developing countries. Thus, MLPA in a routine cytogenetic test for MR patients with normal karyotypes in this setting can help to increase diagnostic yield.

Schlüsselwörter

  • Autism
  • mental retardation
  • MLPA
  • subtelomere
access type Uneingeschränkter Zugang

Coronary artery events in Thai patients with psoriasis using Framingham and Ramathibodi–Electricity Generating Authority of Thailand risk scores

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 495 - 500

Zusammenfassung

Abstract

soriasis is an independent risk factor for cardiovascular disease. Several tools such as Framingham score (FRS) and Ramathibodi-Electricity Generating Authority of Thailand (RAMA-EGAT) score have been developed to predict the 10-year risk of coronary artery disease (CAD) and death. However, there are only few studies determine CAD risk using FRS and RAMA-EGAT score in Asian patients with psoriasis.

To investigate the risk of CAD events using the FRS and RAMA-EGAT score in Thai patients with psoriasis.

Predictive factors that associated with intermediate and high risk (≥10%) of CAD events within 10-year were determined. Variables, including age, sex, blood pressure, cholesterol, high-density lipoprotein, diabetes mellitus, waist circumference, smoking, and alcohol intake were used to calculate scores.

Of 145 patients with psoriasis and a mean age of 48.1 ± 14.1 years, 72 patients were men. Using FRS and RAMA-EGAT, 25% and 13% of the patients, respectively had a ≥10% risk of developing CAD events. A higher risk of CAD was predicted when severe psoriasis was considered. The duration of disease and treatment were associated with an increased risk of CAD using the FRS and RAMA-EGAT score by multivariate analysis.

A substantial portion of our patients had a CAD risk ≥10%, with significant relationship with duration of disease and treatment. Early screening of CAD and appropriate treatments of psoriasis may be helpful for preventing CAD in patients with psoriasis.

Schlüsselwörter

  • Coronary artery diseases
  • Framingham score
  • psoriasis
  • RAMA-EGAT score
  • Thai
access type Uneingeschränkter Zugang

Unsedated transnasal esophagoscopy: a sensitive and safe outpatient screening tool

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 491 - 494

Zusammenfassung

Abstract

Unsedated transnasal esophagoscopy is an emerging screening tool for head and neck cancer evaluation. It has been popular because of its acceptance and cost-effectiveness in an office setting.

To evaluate indications, outcomes, and complications of unsedated transnasal esophagoscopy among patients at our hospital.

A retrospective, descriptive review of data recorded from patients who underwent transnasal esophagoscopy (TNE) without sedation at ENT department. Demographic data, indication, and clinical record were collected.

We retrospectively reviewed the records of 58 patients. Their mean age was 57.4 years (range 18-84 years), and the cohort comprised 43 men and 15 women. Indications for TNE (total 72) were second primary cancer surveillance 34/72 (47%), swallowing problem 27/72 (38%), head and neck clinical staging 8/72 (11%), and voice problem 3/72 (4%). Tissue biopsy positive for esophageal cancer was found in 5/58 patients (9%). Two patients (3%) had major complications.

Transnasal esophagoscopy is a safe and practical screening tool for detecting esophageal cancer. This procedure allows otolaryngologists early detection of cancer in an office setting.

Schlüsselwörter

  • Dysphagia
  • esophageal cancer
  • head and neck cancer
  • second primary cancer
  • swallowing
  • transnasal esophagoscopy
access type Uneingeschränkter Zugang

Prognostic factors associated with poor outcomes among multiethnic patients with acute exacerbation of chronic obstructive pulmonary disease

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 481 - 490

Zusammenfassung

Abstract

Acute exacerbation is the most common cause of hospitalization for patients with chronic obstructive pulmonary disease (COPD).

To investigate prognostic factors associated with poor outcomes after acute exacerbation of COPD.

A retrospective study of patients with a diagnosis of acute exacerbation of COPD (AECOPD) admitted to hospital in Penang over 5-year periods between January 2007 and December 2011 were conducted. We analyzed survival data using a Kaplan-Meier curves, and Cox regression was used to identify prognostic factors for mortality and readmission.

The study included 259 patients with a median age of 70 years (interquartile range = 59.7-76.7 years), and men comprised 92.7% of the cohort. Mortality after 1, 3, and 5 years was 26.3%, 49.8%, and 59.5% respectively. Older age (hazard ratio (HR), 2.53; 95% confidence interval (CI), 1.29-4.92) and long-term oxygen therapy (LTOT) at discharge (HR, 2.78; 95% CI, 1.54-5.02) were identified as independent prognostic factors associated with a higher risk of mortality after discharge. The risk of hospital readmission was 34% for 1 year, 43.2% for 3 years, and 48.6% for 5 years. Older age (HR, 1.78; 95% CI, 1.12-2.85), LTOT at discharge (HR, 3.63; 95% CI, 1.89-6.95), frequency of admissions in the previous year (HR, 2.92; 95% CI, 1.47-5.80), and being ventilated (HR, 0.19; 95% CI, 0.08-0.47) were identified as prognostic factors associated with readmission.

Patients surviving AECOPD were prone to poor outcomes. Older patients and those discharged with LTOT were at higher risk of mortality and readmission at any time.

Schlüsselwörter

  • COPD
  • exacerbation
  • mortality
  • patient readmission
  • prognosis
access type Uneingeschränkter Zugang

Human Leukocyte Antigen-G (HLA-G) 14-bp deletion polymorphism is associated with decreased risk of pulmonary fibrosis in Indonesian Javanese patients with multidrug-resistant tuberculosis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 473 - 479

Zusammenfassung

Abstract

Human leukocyte antigen-G (HLA-G) is a nonclassical HLA class I antigen with immunomodulatory activity that usually inhibits immune responses. The role of the HLA-G polymorphism in multidrug-resistant tuberculosis (MDR-TB) is unknown.

To analyze clinical data from Indonesian Javanese patients with MDR-TB to find an association between the HLA-G polymorphism and MDR-TB.

Fifty-seven Indonesian Javanese patients with MDR-TB were enrolled and monitored from May 2012 to Jan 2014. Non-TB individuals and non-MDR-TB individuals were recruited as controls. The HLA-G polymorphism status of each patient was determined by polymerase chain reaction. Patient clinical data were analyzed against polymorphism status. The presence of an association was estimated with an odds ratio (OR) and 95% confidence interval (CI) calculated via logistic regression.

Nineteen (33.3%), 30 (52.6%), and 8 (14.1%) MDR-TB patient participants carried a homozygous deletion (D/D), heterozygous deletion (I/D), and homozygous insertion (I/I) genotypes, respectively. Among control participants, D/D genotype carriers less frequently had a history of TB infection (OR 0.4, 95% CI 0.179-0.981, P = 0.043). The deletion allele for MDR-TB patients was associated with a decreased likelihood of developing pulmonary fibrosis (adjusted OR 0.1, 95% CI 0.014-0.639, P = 0.016).

D/D genotype carriers are less susceptible to TB, and MDR-TB patients with a deletion allele are less likely to develop pulmonary fibrosis.

Schlüsselwörter

  • HLA-G
  • Indonesia
  • MDR-TB
  • polymorphism
  • tuberculosis

Clinical report

access type Uneingeschränkter Zugang

A cluster of probable primary toxoplasmic lymphadenitis in a Thai family: case reports and a review of the literature

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 559 - 563

Zusammenfassung

Abstract

Primary toxoplasmosis is frequently asymptomatic in immunocompetent adults. To our knowledge, a cluster of primary toxoplasmosis in Thailand has not been previously reported.

To report a cluster of primary toxoplasmosis in a Thai family.

Physical examination, complete blood count, liver function tests, blood chemistry, chest radiography, and lymph node histopathology.

A previously healthy 39-year-old man presented with painless bilateral cervical lymphadenopathy for one month. Simultaneously, his 6-year-old son had painless cervical lymphadenopathy. Lymph node histopathology of the man showed the classic triad of characteristics of toxoplasmic lymphadenitis. Both patients were doing well when last seen two months after symptomatic and supportive treatment.

Patients with toxoplasmic lymphadenitis can survive without specific antiparasitic treatment. Normal hosts may have a benign clinical presentation.

Schlüsselwörter

  • Immunocompetent hosts
  • primary toxoplasmosis
  • toxoplasma
  • toxoplasmic lymphadenitis
  • toxoplasmosis
15 Artikel

Editorial

access type Uneingeschränkter Zugang

A possible alternative to multivariate models for cardiovascular risk estimates

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 439 - 440

Zusammenfassung

Review article

access type Uneingeschränkter Zugang

Hyperactive and hypoactive psychomotor subtypes of delirium in demented and nondemented elderly patients with hip fractures: systematic review and meta-analysis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 441 - 453

Zusammenfassung

Abstract

The occurrence of delirium superimposed on dementia (DSD) in patients with hip fracture may have many life-threatening complications, especially if unrecognized and untreated.

To estimate the prevalence and outcomes of DSD in hospitalized elderly adults with dementia and hip fracture, and clinical symptoms of delirium with and without dementia.

The review process followed guidelines consisting of 5 steps suggested for systematic reviews. Relevant studies between January 2000 to December 2014 were obtained from electronic databases, and 2 trained reviewers independently analyzed them. Comprehensive Meta-Analysis software (Biostat) was used to assess and combine the data across studies.

We identified 15 articles for meta-analysis. Prevalence of DSD after hip fracture was 69.7% (95% confidence interval [CI] = 60.4%-77.7%). People with dementia after hip fracture had a 6.03 times higher likelihood of sustaining delirium than those without dementia (95% CI = 3.63%-10.04%). The symptoms of delirium in a person without dementia was more often any hyperactivity (ES = 2.27, 95% CI = 1.17-4.41, P = 0.015), but those lacking dementia were more often hypoactive (ES = 2.22, 95% CI = 1.15-4.56, P = 0.018). There was limited evidence of publication bias, and there was substantial selective reporting bias in articles.

The review demonstrates the high prevalence of DSD and highlights the differences in motor subtypes of delirium between delirium with and without dementia, but there is concern about these results given the high risk of bias.

Schlüsselwörter

  • Delirium
  • dementia
  • hip fracture

Original article

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Antiaging phenotype in skeletal muscle after endurance exercise is associated with the oxidative phosphorylation pathway

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 455 - 471

Zusammenfassung

Abstract

Performing regular exercise may be beneficial to delay aging. During aging, numerous biochemical and molecular changes occur in cells, including increased DNA instability, epigenetic alterations, cell-signaling disruptions, decreased protein synthesis, reduced adenosine triphosphate (ATP) production capacity, and diminished oxidative phosphorylation.

To identify the types of exercise and the molecular mechanisms associated with antiaging phenotypes by comparing the profiles of gene expression in skeletal muscle after various types of exercise and aging.

We used bioinformatics data from skeletal muscles reported in the Gene Expression Omnibus repository and used Connection Up- and Down-Regulation Expression Analysis of Microarrays to identify genes significant in antiaging. The significant genes were mapped to molecular pathways and reviewed for their molecular functions, and their associations with molecular and cellular phenotypes using the Database for Annotation, Visualization and Integrated Discovery and Kyoto Encyclopedia of Genes and Genomes informatics resources, and GeneCards databases, respectively.

The results showed that endurance exercise has an antiaging potential (Pearson χ2, P < 0.01) by upregulating genes coding for components of the oxidative phosphorylation pathway (Benjamini false discovery rate Q < 0.05). We found that numerous genes coding for components of other pathways were also upregulated (Pearson χ2 P < 0.01) as a chronic adaptation to endurance exercise, including ATP5C1, involved in ATP synthesis, CYCS, involved in electron transfer in the mitochondrial respiratory chain, and GSTK1, involved in cellular detoxification.

Endurance exercise may be the best type to promote antiaging phenotypes by increasing mitochondrial biogenesis and ATP production capacity.

Schlüsselwörter

  • Aging
  • endurance exercise
  • mitochondrial biogenesis
  • mitochondrial dysfunction
  • oxidative phosphorylation
  • skeletal muscle

Brief communication (Original)

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Incidence of significant extravascular findings in patients undergoing computed tomographic angiography of the whole aorta or abdominal aorta

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 551 - 557

Zusammenfassung

Abstract

A high prevalence of significant extravascular findings is reported in patients who underwent computed tomographic angiography (CTA) of the pulmonary artery, abdominal aorta, and lower extremities for suspected vascular pathology.

To determine the incidence of significant extravascular findings in patients who underwent CTA of the whole aorta or abdominal aorta, and to determine the common clinical symptoms of patients who underwent CTA of aorta in whom these significant extravascular findings were usually found.

We retrospectively reviewed the cases of 187 patients who underwent CTA of whole aorta and 37 patients who underwent of CTA of abdominal aorta at King Chulalongkorn Memorial Hospital from January 2011 to December 2012. We measured the prevalence of significant extravascular findings and placed these findings into 3 categories. We reviewed the clinical history, further investigation, and also pathologic result of these extravascular findings.

Of 336 extravascular findings in 210 (95%) patients, 41 (12%) provided a an alternative explanation for symptoms of acute chest pain and acute abdominal pain, including axial skeletal fracture, pneumohemothorax, and hemopericardium associated with trauma, 85 (25%) were incidental extravascular findings that required radiological follow-up or further investigation including indeterminate lung nodules or lesions, liver masses, significantly enlarged lymph nodes, adrenal nodules, and mediastinal lesions, and 210 (63%) were extravascular findings that required less urgent or no follow-up. Nine (12%) patients received diagnoses of previously unknown malignancy.

Radiologists and referring clinicians should be aware of the frequency of significant extravascular findings.

Schlüsselwörter

  • CTA of abdominal aorta
  • CTA of whole aorta
  • significant extravascular findings
access type Uneingeschränkter Zugang

Development of a Thai version of the neutropenia subscale for the Functional Assessment of Cancer Therapy–Neutropenia questionnaire

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 543 - 549

Zusammenfassung

Abstract

There is a need for a validated translation of the neutropenia subscale (NS) of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) questionnaire used to assess neutropenia-specific concerns and health-related quality of life for Thai patients receiving cancer chemotherapy.

To translate the NS of the FACT-N questionnaire into Thai and examine the psychometric properties of the Thai version.

The 19 item NS was translated into Thai in accordance with the guidelines of the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology. The psychometric properties of the translated version were then tested. We randomly selected 260 patient participants with hematological malignancies from four hospitals in Thailand. All participants completed the Thai version of FACT-N at the time of expected neutropenia (7-14 days after receiving chemotherapy). The Thai NS content validity was evaluated by a panel of 5 experts. The construct validity of the Thai NS was tested by confirmatory factor analysis (CFA). The internal consistency of the Thai NS was tested with Cronbach’s α coefficients.

The Thai version of the NS was semantically equivalent to the English version. The content validity index was good at 0.95. The CFA of the Thai NS indicated acceptable construct validity. All 19 items on the Thai NS had significant estimated factor loadings (P < 0.05). Cronbach’s α coefficient was 0.82.

The Thai NS, as part of FACT-N, is appropriate in terms of translation and psychometric properties for assessing specific neutropenia-related concerns in Thai patients undergoing cancer chemotherapy

Schlüsselwörter

  • FACT-N
  • health-related quality of life
  • hematological malignancies
  • neutropenia subscale
  • scale translation
  • scale validation
access type Uneingeschränkter Zugang

Multidrug resistance by biofilm-forming clinical strains of Proteus mirabilis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 535 - 541

Zusammenfassung

Abstract

Biofilm formation on indwelling devices is one of the most important mechanisms playing a role in device-related urinary tract infections caused by Proteus mirabilis. Increasing antibiotic resistance of microorganisms has raised questions concerning the relationship between biofilm formation and drug resistance.

To determine clinical prevalence, antibiotic resistance of, and biofilm formation by P. mirabilis strains.

We studied the susceptibilities of various P. mirabilis strains isolated from different clinical materials by a disc-diffusion method. Biofilm formation was determined by a crystal violet binding assay.

Two (13%) of 15 P. mirabilis strains were found to be strong biofilm formers (SBF). Both SBF P. mirabilis strains were isolated from urine samples from children less than 15 years old in a pediatric emergency unit. Cefixime, cefazolin, ceftriaxone, amikacin, and piperacillin/tazobactam were the most effective antibiotics against 15 P. mirabilis strains (100%), whereas SBF P. mirabilis strains were multidrug resistant or (resistant to 5 different antimicrobial classes). Both of the SBF P. mirabilis strains, but neither of the weak biofilm forming P. mirabilis strains were resistant to ampicillin and ceftazidime among β-lactam antibiotics, or tobramycin and gentamicin among aminoglycoside antibiotics used in the present study.

Children comprise the only patients infected with SBF P. mirabilis strains and both SBF P. mirabilis strains displayed high antimicrobial resistance in our setting.

Schlüsselwörter

  • Biofilm formation
  • device-related infections
  • multidrug resistance
  • Proteus mirabilis
  • urinary tract infection
access type Uneingeschränkter Zugang

Prevalence of thalassemia carriers among the Lahu hill tribe population, Chiang Rai, Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 527 - 533

Zusammenfassung

Abstract

Current data on the prevalence of hemoglobinopathies among Lahu in northern Thailand are limited.

To investigate the prevalence of thalassemia carriers among Lahu hill tribe people in Chiang Rai Province, Thailand.

We conducted a cross-sectional study in 2 phases. The first retrospectively analyzed data from antenatal clinics attended by Lahu women between January 2011 and June 2012. The second phase was prospective and included the husbands of Lahu women. In the second phase, 116 Lahu adults were administered a questionnaire and blood tests for osmotic fragility (OFT) and dichlorophenol indophenol precipitation (DCIP). The hemoglobin (Hb) type of those positive for either or both tests was identified by HPLC and PCR.

Data from 358 Lahu women in the first phase showed a mean age of 23.2 y (range 13-46 y, SD 6.83), 68.5% were primigravida. Fifty-eight had abnormal mean corpuscular volume (MCV), 87 positive OFT, 18 positive DCIP test, and 3.0% positive results in both tests. Eight of 83 participating husbands had abnormal MCV, 8 positive OFT and 2 positive DCIP test. In the second phase, 52.2% of 116 participants were women, mean age of 33.7 y (range 18-68 y, SD 11.2), 38 positive OFT, 10 positive DCIP test, and 3.7% positive results in both tests. Hb typing showed 5 participants with HbE, 1 β-thalassemic, 1 HbE homozygous, and no α-thalassemia-1 (SEA) was identified.

Provision of a thalassemia screening in health care settings in remote areas of Thailand is an ongoing need.

Schlüsselwörter

  • Hill tribe
  • Lahu
  • pregnant women
  • prevalence
  • thalassemia carrier
access type Uneingeschränkter Zugang

Fibroglandular tissue and quantitative background parenchymal enhancement on magnetic resonance breast images are inversely correlated with menopause in Thai women

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 519 - 526

Zusammenfassung

Abstract

There are limited data regarding background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) for Asian women.

To determine relationships between the amount of fibroglandular tissue (FGT) and BPE in breast MRI.

A retrospective review identified 95 MRI examinations of women with normal breasts between March 2012 to July 2014 for inclusion in this study. BPE and MRI-FGT were assessed on precontrast T1-weighted fat-suppressed images by consensus and described according to the American College of Radiology Breast Imaging Reporting and Data System. We analyzed BPE, including early and peak enhancement (Eearly, Epeak), and the signal enhancement ratio (SER). Spearman rank correlations between MRI-FGT and BPE and menopausal status were compared using Mann-Whitney U tests.

Fourteen premenopausal and 81 postmenopausal women had scattered and heterogeneous FGT (74%) and minimal to mild BPE (84%). There was a significant correlation between age and amount of MRI-FGT (r = -2.63; P = 0.01), but not BPE or enhancement kinetics. There was no significant correlation between FGT, BPE, and enhancement kinetics. There was a significant inverse relationship between menopause and the amount of FGT, BPE, and Epeak (P < 0.001, = 0.001, and = 0.04, respectively). There was no significant difference between pre and postmenopausal Eearly and SER (P > 0.05).

There is no significant correlation between the amount of FGT and BPE in either premenopausal or postmenopausal women. The amount of FGT, degree of BPE, and Epeak were higher in premenopausal women.

Schlüsselwörter

  • Background parenchymal enhancement (BPE)
  • breast MRI correlation
  • fibroglandular tissue (FGT)
  • menstruation
  • Thai women
access type Uneingeschränkter Zugang

Cross-sex hormone use does not increase cardiovascular risk in young male-to-female transsexuals: a study of self-medication by healthy Thai cabaret dancers

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 511 - 518

Zusammenfassung

Abstract

Cross-sex hormone (CSH) use is widespread among transsexuals in Thailand. CSHs are used by male-to-female (MtF) transsexuals for feminization.

To determine effects of self-medication with CSH on cardiovascular risk biomarkers, C-reactive protein (CRP) and fibrinogen (Fb), in Thai MtF transsexuals.

Data were collected from healthy MtF transsexual cabaret dancers in Pattaya city, Thailand, using a questionnaire and descriptive interview. Blood samples were collected to determine lipid profile, CRP, Fb, and sex hormone levels. ANOVA, Pearson correlation, and logistic regression were analyzed for effects of CSH on biomarkers; comparing CSH users with non-using controls.

We grouped 102 MtF transsexual participants (average age 28 years) as CSH (n = 66) and non-hormone using controls (n = 36). Several female and antimale hormonal products were used in CSH self-medication, with an average 12.5-year exposure. In the CSH group, significantly higher HDL with lower CRP levels and a negative correlation between total cholesterol, LDL, and 17β-estradiol were observed. Risk prevalence analysis exhibited lower prevalence of disease susceptibility in the CSH group. Logistic regression accordingly revealed the effect of CSH on CRP levels with odds ratios of 0.26 (CI 0.1-0.68) and 0.34 (CI 0.13-0.93) in crude and adjusted models, respectively.

Moderate exposure to low doses of CSH use showed no serious risk or health problems in healthy MtF transsexuals in terms of cardiovascular risk biomarkers

Schlüsselwörter

  • C-reactive protein
  • cardiovascular
  • estrogen
  • fibrinogen
  • male-to-female transsexuals progesterone
  • testosterone
access type Uneingeschränkter Zugang

Subtelomeric aberrations in Thai patients with idiopathic mental retardation and autism detected by multiplex ligation-dependent probe amplification

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 501 - 509

Zusammenfassung

Abstract

Chromosomal rearrangements involving telomeres account for approximately 1%-30% of causes of mental retardation (MR). It is therefore recommended that all cases of undiagnosed MR be screened for subtelomeric aberration. Nevertheless, resolution of a standard karyotyping using the G-banding technique is limited. Therefore, an additional technique with higher resolution should be performed to detect this type of anomaly.

To screen for subtelomeric aberration in Thai patients with mental retardation and autism.

Multiplex ligation-dependent probe amplification (MLPA), was used to screen 114 Thai patients with idiopathic MR and 15 patients with autism. All positive results were confirmed by using a different set of MLPA probes or real-time PCR.

We identified 5 patients with submicroscopic aberration in patients with MR. One patient had a submicroscopic deletion at the 1p36.33 region, which was confirmed by real-time PCR. There were 2 patients with subtelomeric duplication at the 15q11.2 and 11p15.5 regions sequentially. Two patients had the same duplication at the Xp22.33. region.

The present study shows that the incidence of a subtelomeric aberration in Thai patients with idiopathic MR is approximately the same reported previously (3.9%). Identifying these submicroscopic aberrations requires an advanced method with higher resolution than standard karyotyping. Although microarray techniques may be a more informative, they are costly and require an array facility, which are not widely available, especially in developing countries. Thus, MLPA in a routine cytogenetic test for MR patients with normal karyotypes in this setting can help to increase diagnostic yield.

Schlüsselwörter

  • Autism
  • mental retardation
  • MLPA
  • subtelomere
access type Uneingeschränkter Zugang

Coronary artery events in Thai patients with psoriasis using Framingham and Ramathibodi–Electricity Generating Authority of Thailand risk scores

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 495 - 500

Zusammenfassung

Abstract

soriasis is an independent risk factor for cardiovascular disease. Several tools such as Framingham score (FRS) and Ramathibodi-Electricity Generating Authority of Thailand (RAMA-EGAT) score have been developed to predict the 10-year risk of coronary artery disease (CAD) and death. However, there are only few studies determine CAD risk using FRS and RAMA-EGAT score in Asian patients with psoriasis.

To investigate the risk of CAD events using the FRS and RAMA-EGAT score in Thai patients with psoriasis.

Predictive factors that associated with intermediate and high risk (≥10%) of CAD events within 10-year were determined. Variables, including age, sex, blood pressure, cholesterol, high-density lipoprotein, diabetes mellitus, waist circumference, smoking, and alcohol intake were used to calculate scores.

Of 145 patients with psoriasis and a mean age of 48.1 ± 14.1 years, 72 patients were men. Using FRS and RAMA-EGAT, 25% and 13% of the patients, respectively had a ≥10% risk of developing CAD events. A higher risk of CAD was predicted when severe psoriasis was considered. The duration of disease and treatment were associated with an increased risk of CAD using the FRS and RAMA-EGAT score by multivariate analysis.

A substantial portion of our patients had a CAD risk ≥10%, with significant relationship with duration of disease and treatment. Early screening of CAD and appropriate treatments of psoriasis may be helpful for preventing CAD in patients with psoriasis.

Schlüsselwörter

  • Coronary artery diseases
  • Framingham score
  • psoriasis
  • RAMA-EGAT score
  • Thai
access type Uneingeschränkter Zugang

Unsedated transnasal esophagoscopy: a sensitive and safe outpatient screening tool

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 491 - 494

Zusammenfassung

Abstract

Unsedated transnasal esophagoscopy is an emerging screening tool for head and neck cancer evaluation. It has been popular because of its acceptance and cost-effectiveness in an office setting.

To evaluate indications, outcomes, and complications of unsedated transnasal esophagoscopy among patients at our hospital.

A retrospective, descriptive review of data recorded from patients who underwent transnasal esophagoscopy (TNE) without sedation at ENT department. Demographic data, indication, and clinical record were collected.

We retrospectively reviewed the records of 58 patients. Their mean age was 57.4 years (range 18-84 years), and the cohort comprised 43 men and 15 women. Indications for TNE (total 72) were second primary cancer surveillance 34/72 (47%), swallowing problem 27/72 (38%), head and neck clinical staging 8/72 (11%), and voice problem 3/72 (4%). Tissue biopsy positive for esophageal cancer was found in 5/58 patients (9%). Two patients (3%) had major complications.

Transnasal esophagoscopy is a safe and practical screening tool for detecting esophageal cancer. This procedure allows otolaryngologists early detection of cancer in an office setting.

Schlüsselwörter

  • Dysphagia
  • esophageal cancer
  • head and neck cancer
  • second primary cancer
  • swallowing
  • transnasal esophagoscopy
access type Uneingeschränkter Zugang

Prognostic factors associated with poor outcomes among multiethnic patients with acute exacerbation of chronic obstructive pulmonary disease

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 481 - 490

Zusammenfassung

Abstract

Acute exacerbation is the most common cause of hospitalization for patients with chronic obstructive pulmonary disease (COPD).

To investigate prognostic factors associated with poor outcomes after acute exacerbation of COPD.

A retrospective study of patients with a diagnosis of acute exacerbation of COPD (AECOPD) admitted to hospital in Penang over 5-year periods between January 2007 and December 2011 were conducted. We analyzed survival data using a Kaplan-Meier curves, and Cox regression was used to identify prognostic factors for mortality and readmission.

The study included 259 patients with a median age of 70 years (interquartile range = 59.7-76.7 years), and men comprised 92.7% of the cohort. Mortality after 1, 3, and 5 years was 26.3%, 49.8%, and 59.5% respectively. Older age (hazard ratio (HR), 2.53; 95% confidence interval (CI), 1.29-4.92) and long-term oxygen therapy (LTOT) at discharge (HR, 2.78; 95% CI, 1.54-5.02) were identified as independent prognostic factors associated with a higher risk of mortality after discharge. The risk of hospital readmission was 34% for 1 year, 43.2% for 3 years, and 48.6% for 5 years. Older age (HR, 1.78; 95% CI, 1.12-2.85), LTOT at discharge (HR, 3.63; 95% CI, 1.89-6.95), frequency of admissions in the previous year (HR, 2.92; 95% CI, 1.47-5.80), and being ventilated (HR, 0.19; 95% CI, 0.08-0.47) were identified as prognostic factors associated with readmission.

Patients surviving AECOPD were prone to poor outcomes. Older patients and those discharged with LTOT were at higher risk of mortality and readmission at any time.

Schlüsselwörter

  • COPD
  • exacerbation
  • mortality
  • patient readmission
  • prognosis
access type Uneingeschränkter Zugang

Human Leukocyte Antigen-G (HLA-G) 14-bp deletion polymorphism is associated with decreased risk of pulmonary fibrosis in Indonesian Javanese patients with multidrug-resistant tuberculosis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 473 - 479

Zusammenfassung

Abstract

Human leukocyte antigen-G (HLA-G) is a nonclassical HLA class I antigen with immunomodulatory activity that usually inhibits immune responses. The role of the HLA-G polymorphism in multidrug-resistant tuberculosis (MDR-TB) is unknown.

To analyze clinical data from Indonesian Javanese patients with MDR-TB to find an association between the HLA-G polymorphism and MDR-TB.

Fifty-seven Indonesian Javanese patients with MDR-TB were enrolled and monitored from May 2012 to Jan 2014. Non-TB individuals and non-MDR-TB individuals were recruited as controls. The HLA-G polymorphism status of each patient was determined by polymerase chain reaction. Patient clinical data were analyzed against polymorphism status. The presence of an association was estimated with an odds ratio (OR) and 95% confidence interval (CI) calculated via logistic regression.

Nineteen (33.3%), 30 (52.6%), and 8 (14.1%) MDR-TB patient participants carried a homozygous deletion (D/D), heterozygous deletion (I/D), and homozygous insertion (I/I) genotypes, respectively. Among control participants, D/D genotype carriers less frequently had a history of TB infection (OR 0.4, 95% CI 0.179-0.981, P = 0.043). The deletion allele for MDR-TB patients was associated with a decreased likelihood of developing pulmonary fibrosis (adjusted OR 0.1, 95% CI 0.014-0.639, P = 0.016).

D/D genotype carriers are less susceptible to TB, and MDR-TB patients with a deletion allele are less likely to develop pulmonary fibrosis.

Schlüsselwörter

  • HLA-G
  • Indonesia
  • MDR-TB
  • polymorphism
  • tuberculosis

Clinical report

access type Uneingeschränkter Zugang

A cluster of probable primary toxoplasmic lymphadenitis in a Thai family: case reports and a review of the literature

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 559 - 563

Zusammenfassung

Abstract

Primary toxoplasmosis is frequently asymptomatic in immunocompetent adults. To our knowledge, a cluster of primary toxoplasmosis in Thailand has not been previously reported.

To report a cluster of primary toxoplasmosis in a Thai family.

Physical examination, complete blood count, liver function tests, blood chemistry, chest radiography, and lymph node histopathology.

A previously healthy 39-year-old man presented with painless bilateral cervical lymphadenopathy for one month. Simultaneously, his 6-year-old son had painless cervical lymphadenopathy. Lymph node histopathology of the man showed the classic triad of characteristics of toxoplasmic lymphadenitis. Both patients were doing well when last seen two months after symptomatic and supportive treatment.

Patients with toxoplasmic lymphadenitis can survive without specific antiparasitic treatment. Normal hosts may have a benign clinical presentation.

Schlüsselwörter

  • Immunocompetent hosts
  • primary toxoplasmosis
  • toxoplasma
  • toxoplasmic lymphadenitis
  • toxoplasmosis

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