Volume 5 (2011): Edition 2 (April 2011)

Background and Objective: Although perinatal depression is a worldwide problem, most of the studies related to this issue have been conducted in Western countries. This paper summarizes the literature on the prevalence as well as associated factors among Asian countries where the cultural attitudes, customs, and norms are considerably different from those in Western countries.

Methods: We conducted a literature search using MEDLINE (PubMed) from 1968, PsychINFO from 1970, and SCOPUS database from 1982 using keywords “depression”, “antenatal”, “antepartum”, “pregnancy”, “postnatal”, “postpartum”, “perinatal”, “after childbirth” and “Asia”. Only the articles published in English were included.

Results: The overall prevalence of depression during pregnancy and postnatal period are about 20% and 21.8%, respectively. The factors related to perinatal depression can be grouped into the following categories, individual characteristics, husband/marital relationship, pregnancy-related, infant-related, and other psychosocial issues. While there is considerable overlap between Asian and Western countries with respect to risk factors for perinatal depression, premarital pregnancy, conflict with mother in-law, and dissatisfaction with infant’s gender are more specific to Asian cultures.

Conclusions: Studies conducted in Asian countries suggest that the prevalence of perinatal depression is slightly higher than in Western countries. There are several unique culturally related issues that clinicians treating pregnant and postpartum Asian women should be aware as they contribute to an increased risk of depression in these women.

Background: Retinal ganglion cells (RGCs) are protected in rats with acute elevated intraocular pressure (IOP) by Erigeron breviscapus (vant.) hand-mazz (EBHM). However, it is unclear whether EBHM has neuroprotective effect on RGCs in animal with chronic elevated IOP.

Objective: Investigate the protective effect of EBHM extract on RGCs in rabbits with chronic elevated IOP.

Methods: Unilateral chronic elevated IOP was produced in rabbits by repeated injection of 2% methylcellulose into the anterior chamber. Secondary degeneration was measured with and without EBHM extract treatment for 60 days. At 60 days, the cells density of the RGCs layer, the thickness of retinal nerve fiber layer (RNFL), and the optic nerve axons were observed and analyzed using an image analysis system. The ultrastructural changes of RGCs and optic nerve axons were observed using transmission electron microscopy.

Results: Compared with their contralateral control eyes with normal IOP, in the retinas of 3-4 mm from the optic disc, the cells density of the RGCs layer in the eyes with chronic elevated IOP was 23.2±6.5 cells (n = 6) and 36.0±8.9 cells (n = 10) per three 400x fields at 60 days in untreated and EBHM-treated group, respectively. The RNFL thickness in eyes with chronic elevated IOP was 3.4±0.4 μm (n = 6) and 5.0±1.0 μm (n = 10) at 60 days in untreated and EBHM-treated group, respectively. The axons number per 15057.8 μm² in eyes with chronic elevated IOP was 370.4±41.0 (n = 6) and 439.0±50.8 (n = 10) at 60 days in untreated and EBHM-treated group, respectively. The number of the organelles in RGCs plasm appeared decreased and mitochondrion vacuolated in the elevated IOP eyes of EBHM-treated group, while some dispersive mitochondrion and rough surfaced endoplasmic reticulum and ribosome still existed in the RGCs plasm. The myelin sheath plates condensed and degenerated, and the microfilaments and microtubules decreased or disappeared in the elevated IOP eyes, but the axons degeneration in the chronic elevated IOP with EBHM treatment was less than that in the chronic elevated IOP without treatment.

Conclusion: EBHM extract provided a neuroprotective effect on retinal ganglion cells in rabbits with chronic elevated IOP.

Background: Secondary brain edema is a serious complication of hepatic encephalopathy (HE). Recently, it has been reported that proinflammatory cytokines are involved in the pathogenesis of brain edema during HE.

Objectives: Observe the dynamic expressions of brain and plasma proinflammatory cytokines in encephalopathy rats, and evaluate the relationship between proinflammatory cytokines and brain edema.

Methods: Acute HE rats were induced by intraperitoneal injection of thioacetamide (TAA) in 24 hours intervals for two consecutive days. Then, clinical symptom and stages of hepatic encephalopathy, motor activity counts, index of liver function, and brain water content were observed. The dynamic expressions of IL-1β, IL-6, and TNF-α in plasma and brain tissues were measured with enzyme-linked immunosorbent assay.

Results: Typical clinical performances of hepatic encephalopathy were occurred in all TAA-administrated rats. The TAA rats showed lower motor activity counts and higher the index of alanine aminotransferase, aspartate aminotransferase, total bilirubin and ammonia than those in control rats. Brain water content was significantly enhanced in TAA rats compared with the control. The expressions of IL-1β, IL-6, and TNF- α in plasma and brain significantly increased in TAA rats. In addition, the expressions of cerebral proinflammatory cytokines were positively correlated with brain water content but negatively correlated with motor activity counts.Conclusion: Inflammation was involved in the pathogenesis of brain edema during TAA-induced HE.

Background: Human plasma paraoxonase1 (PON1) is an esterase catalyzing the hydrolysis of organophosphorus pesticides and other xenobiotics. The aims of this study were to develop a rapid method to determinate PON1 activity, evaluate some interference, and study the influence of storage temperature on PON1 activity assay.

Methods: Measurement of PON1 activity was performed for 369 samples by measuring the hydrolysis of paraoxon using a spectrophotometric method adapted on konelab 30 ⃞.

Results: The developed method facilitates the determination of PON1 activity at the rate of more than 200 samples per hour, and it is linear between 2 and 900 IU/L. Intra and inter-assay imprecision coefficients of variation were 2% and 5% respectively. PON1 activity in serum was correlated with those in heparinized plasma (r = 0.994, p < 0.001) and in plasma/EDTA (r = 0.962, p < 0.001). The mean inhibition of the PON1 activity was, by EDTA/K₃, 41 ± 10 %. There was not significant PON1 activity variation after 40 days of storage at -20°C or at +4 ⃞ C. There were no substantial interferences from haemoglobin, jaundice and hyperlipidemia.

Conclusion: The developed method is reliable, reproducible, and suitable. It can also be performed on heparinized plasma for the determination of PON1 activity. Hence, it may be useful for assaying PON1 activity in several intoxications such as organophosphorus, sarin, and soman nerve agents.

Background: Luteinizing hormone-releasing hormone (LHRH) is a naturally occurring hormone that controls sex hormones in both men and women. In general, LHRH is poorly absorbed through the gastrointestinal tract due to its large molecular size, high polarity, and loss from enzymatic degradation.

Objective: Prepare and develop LHRH in a dry power formulation with stability and biological activity.

Methods: Mannitol (M) and glycine (G) were chosen as ingredients to stabilize and protect LHRH during the freeze drying processes and during storage. The physicochemical properties of LHRH dry powders were examined by capillary electrophoresis, fluorescence spectrophotometry, scanning electron microscopy, and photon correlation spectroscopy. The release of LHRH from the dry powder was carried out in dissolution apparatus. In addition, a rat model was employed to study the bioactivity of LHRH in the dry powder form.

Results: The LHRH dry powder formulations using M and G in the ratios of 6:4 and 7:3 were more stable than other formulations. LHRH colloids containing M:G showed no aggregation after storage at 4°C for one month. The concentration of LHRH in the dry powder form was more stable than that of LHRH in solution form. All the LHRH dry powder formulations were instantly dissolved within 10 seconds in an aqueous medium. After the LHRH dry powder (13 mg) was reconstituted and administered intraperitoneally to male rats during a one-month period, the testosterone level in the plasma was significantly decreased compared with an untreated group (15.0±1.0 ng/mL, 15.0±1.0 ng/mL and 20.0±2.0 ng/mL for LHRH containing M:G; 6:4, 7:3, and 8:2, respectively, compared to the control of 35±2 ng/mL, p<0.05).

Conclusion: The LHRH dry powder formulations had good physicochemical properties and bioactivity.

Background: Pneumatic reduction has become a therapeutic method for intussusception instead of surgery. It is more successful than barium reduction, but it depends on how much the operator is familiar with the method and equipment.

Objective: Determine success rate and recurrent rate of intussusception and factors affecting outcome of pneumatic reduction in Thailand.

Materials and methods: Fifty-eight children with 73 numbers of intussusception who underwent pneumatic reduction at Songklanagarind Hospital, Thailand between January 2002 and March 2007 were retrospectively reviewed. Age, sex, clinical parameters, physical examination, imaging findings, and reduction technique were evaluated.

Results: Overall success rate was 54 out of the 73 episodes and recurrent rate was 10 out of 58 patients with intussusception. Long duration of symptom, rectal bleeding, dehydration, and leukocytosis significantly affected poor outcome. Radiographic findings of gut obstruction and ascites as well as sonographic findings of thickened colonic wall, trapped fluid between intussusceptum and intussuscipien, and small bowel obstruction could also predict the poor outcome.

Conclusion: Many factors from clinical presentation, plain radiographic, and sonographic findings affect poor outcome of pneumatic reduction. However, it can be performed unless peritonitis and sepsis/shock are present.

Background: Papillary lesions of the breast cause diagnostic problem because papillary structures are found in benign and malignant processes. Core needle biopsy is important to make an initial diagnosis, but it still has potential pitfalls. Comparison between core needle biopsy and excisional biopsy can predict the possibility of malignant change in atypical papillary lesions.

Objective: Evaluate the concordance between core needle biopsy and excisional results in atypical papillary lesions of the breast.

Materials and methods: The pathology database of University of Texas Medical Branch at Galveston, USA was searched for patients with atypical papillary lesions at core needle biopsy who subsequently underwent surgical excision. Pathology reports from the excisional biopsies was also examined to assign each case to one of three categories, downgrade to benign papilloma, no change (remained atypical papillary lesion), and upgrade to carcinoma. The mammograms and ultrasounds were reviewed for each case. They characterized the lesions according to multiple imaging criteria.

Results: Twenty-four patients with atypical papillomas at core biopsy subsequently underwent surgical excision. The lesions were downgraded to benign papilloma in 25%, remained atypical papillary lesion in 33%, and upgraded to carcinoma in 42%. On mammographic presentations (n = 23), masses were in 61%, architectural distortion in 4.3%, mass with calcifications in 9%, mass with architectural distortion and calcifications in 4.3%, calcifications alone in 17.4%, and architectural distortion and calcifications in 4.3%. On ultrasound findings (n = 21), solid masses were in 90%, intracystic masses in 10%, peripheral in locations in 81%, and subareolar in location in 19%.

Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy.

Background: The use of combination antiretroviral therapy (cART) has become a standard of care in the treatment of HIV infection. However, antiretroviral drug resistance occurs in a substantial number of patients. In resource-limited settings, genotypic resistance assay using a commercial kit is costly.

Objective: Focus on the validation of an in-house HIV-1 specific genotypic drug resistance assay in Thai patients failing cART.

Materials and methods: Results of HIV-1 genotypic drug resistance assay was evaluated by comparing an inhouse method to a commercial test. The TRUGENE HIV-1 genotyping kit was used in 79 plasma specimens (49 from HIV patients failing cART therapy and 30 from proficiency testing panels).

Results: The results from the in-house assay were comparable to those obtained from the TRUGENE HIV-1 genotyping kit with >99.0% codon-to-codon agreement. The lower limit of detection by the in-house assay was approximately 100 copies/mL of HIV-1 RNA. In addition, this in-house assay would allow testing of samples from patients infected with HIV-1 subtype other than B.

Conclusion: The in-house HIV-1 genotypic drug resistance assay may be used as an alternative to commercial kits, particularly in resource limited settings.

Background: Many microarray experiments have been conducted during recent years, and scores of gene expression data have been archived in public databases. The use of data from multiple experiments can provide valuable information. However, there is a lack of convenient tools to compare datasets in this manner.

Objective: Implement software, called CU-DREAM, to compare the datasets of two microarray experiments. CUDREAM is easy to use and compatible with Gene Expression Omnibus (GEO).

Subjects and methods: Five experiments were used to demonstrate the functionality of CU-DREAM. These are GSE6791, GSE7803, GSE5816, GSE4246, and GSE13638 for studies of cancers and RNA interference.

Results: All six showcases demonstrated the validity of the CU-DREAM approach. One showcase could confirm the regulation of genes identified in two independent experiments on cervical cancer. The statistical significance was lower compared with cervical and lung cancers. In addition, CU-DREAM could identify isoform changes in lung cancer. The last showcase demonstrated that Dicer- and Ago2-depleted cells or Dicer-depleted HeLa and HEK293 cells shared the same gene regulation pathways. CU-DREAM had seven main functions: 1) to identify genes that are up- and down-regulated in an experiment, 2) to validate significantly regulated genes using data from another experiment, 3) to determine if two different diseases have a similar effect on gene regulation, 4) to identify isoform-changed genes, 5) to determine if cells share gene regulation mechanisms, 6) to identify common gene regulation pathways even when comparing two different cell types, and 7) to identify down-stream genes that are regulated by the conditions of the analyzed experiments.

Conclusion: CU-DREAM is an effective tool for the pre-screening of drugs, substances or environmental insults or the identification of the genetic changes that are associated with pathological conditions (CU-DREAM can be downloaded from: http://pioneer.netserv.chula.ac.th/~achatcha/cu-dream).

Background: De Quervain’s tenosynovitis is a common disease among the patients who performed unaccustomed repetitive movement of the thumb side of the wrist. A neoprene thumb stabilizer splint is often used to restrict thumb movement. However, because of its cost, usage of an elastic bandage made of cheaper materials is proposed.

Objective: Compare the effectiveness between the elastic bandage and the neoprene thumb stabilizer splint in acute De Quervain’s tenosynovitis.

Methods: Forty participants with acute De Quervain’s tenosynovitis were divided into two groups (20 participants each). The first group used the elastic bandage, and the second group used the neoprene thumb stabilizer splint. Visual Analog Scale (VAS) pain, lateral and palmar pinch strength were measured before and after using the bandage and the splint for one or two weeks.

Results: The average ages in the bandage and the splint group were 53.15±10.42 and 48±11.7 years, respectively. The VAS pain score of the bandage and splint group over week 0, 1, and 2 were 58.50, 33.90 and 19.55, and 51.60, 35.85 and 25.20, respectively. The bandage and splint group had the lateral pinch strength over the time of 9.40, 10.70 and 11.25 lbs, and 8.90, 9.88 and 10.57 lbs, respectively. Furthermore, they had the palmar pinch strength of 3.63, 4.68 and 5.28 lbs, and 3.07, 3.92 and 4.29 lbs, respectively.

Conclusion: The pain and strength were not significantly different between the bandage and the splint group in acute De Quervain tenosynovitis. Using the bandage may be more cost-effectiveness than using the splint.

Background: Tramadol is a centrally acting analgesic drug. Rectal administration of tramadol is useful in the treatment of post-operative pain or malignant pain in cases where it cannot be administered orally. In Thailand, tramadol is available only as a capsule for oral use and as a solution for injection.

Objective: Develop tramadol hydrochloride rectal suppositories and rectal gel preparations.

Methods: Tramadol rectal suppository and rectal gel were prepared. Physicochemical properties (viscosity, gel strength, mucoadhesive force) and the in vitro release of tramadol hydrochloride were investigated from different bases (Witepsol H15, polyethylene glycol, poloxamer, and hydroxyethylcellulose). The analgesic activity of rectal tramadol hydrochloride using the hot plate test was evaluated in rats.

Results: Tramadol hydrochloride rectal gel using poloxamer was more mucoadhesive to the rectal mucous membrane than was the gel with the hydroxyethylcellulose base. Tramadol hydrochloride was released rapidly in vitro from both the Witepsol H15 and polyethylene glycol bases. It was completely released from the polyethylene glycol suppository base within 15 minutes. The amount of tramadol hydrochloride release from the Witepsol H15 suppository base was about 93% at 120 minutes. When using poloxamer or hydroxyethylcellulose as a rectal base, tramadol hydrochloride was released from both bases rapidly and completely released within 15 minutes. Administration of a tramadol hydrochloride suppository in rats exhibited a more pronounced analgesic effect with the polyethylene glycol base than with the Witepsol H15-based suppositories. The rectal gel had a less pronounced analgesic effect when made with the hydroxyethylcellulose base than with the poloxamer base.

Conclusion: Tramadol hydrochloride suppositories and rectal gels with different bases showed rapid and almost complete drug release from the bases, prolonging the latency of a nociceptive response in in vivo experiments.

Background: Oxidative stress induces renal dysfunction in diabetes, in which renal mitochondrial disturbance was implicated. Vitamin C (VC) supplementation may ameliorate the renal dysfunction in diabetics. However, it is not clear whether VC supplementation is effective for renal mitochondrial disturbances in diabetes.

Objective: Investigate whether long-term continuous VC supplementation could ameliorate the renal mitochondrial disturbances in streptozotocin (STZ)-induced diabetic rats.

Methods: Thirty-five male Sprague-Dawley rats were used, and diabetes was induced by an injection of STZ. The rats were divided into three groups: control rats (CON), STZ-induced diabetic rats (STZ), and diabetic rats supplemented by vitamin C (STZ-VC). The CON and STZ rats were given tap water, while STZ-VC rats received VC (1 g/L) every day for eight, 24 and 52 weeks. The kidney was isolated and homogenized. Oxygen comsumption (Vo₂) was measured in mitochondria homogenate using an oxygen consumption monitor. Based on Vo₂ tracings, the respiration control index (RCI) and P/O ratio (= ADP/ O ratio) were measured at week 8, 24 and 52.

Results: At week eight, using either glutamate plus malate (for site I) or succinate (for site II) as substrates, both RCI and P/O ratio were not significantly different among three groups. The P/O ratio in STZ and STZ-VC rats increased from eight to 52 weeks after VC supplementation. At week 24, the P/O ratio at site II was normalized in STZ-VC rat. The increased P/O ratio (only site I) and the increased RCI (only site II) of STZ-VC rats were slower than those of STZ rats.

Conclusion: Short-term VC supplementation might not influence the renal mitochondrial activity. The long-term VC supplementation could ameliorate the mitochondrial disturbances induced in STZ-induced diabetic rats.

Background: Ultrasonography is an important imaging tool in detection of small breast cancers, particularly in younger women with dense breasts. Among the ultrasonographic characteristics for the malignancy, it is unclear which are common or more predictive.

Objective: Analyze breast ultrasonograms and determine the common and predictive characteristics of the BIRADS 4/5 small breast lesions that were correlated with histology-proved carcinoma among Thai patients.

Methods: Data were collected retrospectively between November 2006 and September 2007 at King Chulalongkorn Memorial Hospital. Forty-five BI-RADS 4 or 5 small breast lesions from 41 patients were reviewed for ultrasonographic characteristics and for correlation between each of these features and histology-proved malignancy.

Results: There were 15 out of 30 lesions of BI-RADS 4 and 14 out of 15 of BI-RADS 5 that were histologically proven breast carcinoma. The lesion dimension ranged from 0.27 cm to 1.5 cm (mean: 0.98 cm). The malignant signs that were common consisted of irregular shapes (70%) and posterior shadowing (35.6%). However, the most correlating signs for malignancy were vascularity of the lesion 100%, and spiculated margins 100%. The other characteristics for malignancy, in descending order, were marked hypoechoicity 88.9%, microcalcifications within mass 85.7%, echogenic halo 83.3%, shadowing 81.3%, branched pattern 77.8%, duct extension 75%, irregular shape72.2%, and taller than wide orientation 70%.

Conclusion: Irregular shape and shadowing were the two most common malignant signs that characterized BI-RADS 4, 5 small breast lesions by ultrasonography. However, the most predictive signs were increases in vascularity and spiculated margins.

Background: Eye injuries, especially open globe injuries, cause visual morbidities and socioeconomic burden. It is an urgent task to require good database and stakeholder involvement for open globe injuries.

Objectives: Investigate the epidemiology and predictive factors of visual outcome in open globe injuries in an industrial area in Thailand.

Methods: Consecutive cases of in-patient open globe injuries in Mettapracharak Eye Centre between February 2009 and January 2010 were examined. Patients were interviewed at first visit and followed-up for six months. The Birmingham Eye Trauma Terminology was used to classify types of injuries. Demographic data, cost of treatment, length of stay, and predictive factors (initial visual acuity, presence of relative afferent pupillary defect, hyphema, vitreous hemorrhage, intraocular foreign bodies, retinal detachment, time-duration to surgery, and wound length) were assessed.

Results: Fifty-two out of 60 eyes were included. Most (82.7%) of patients were men and average age was 34.1 years (range: 8-68 years). About half (51.9%) were graduated from primary school and 65.3% were laborers. Most patients had not used protective devices. The endophthalmitis rate was 13.5%, and panophthalmitis rate was 5.8%. The enucleation rate was 9.6%. The median length of stay was nine days. Poor initial visual acuity and intraocular foreign bodies were significant predictive factors (p <0.05).

Conclusion: Open globe injuries caused visual morbidity especially in young adult male, laborers with low education. Initial visual acuity and intraocular foreign bodies were significant predictive factors.

Background: Currently, there is a considerable variation concerning the provision of preanesthetic-risk information, especially potential detrimental adverse outcomes.

Objective: Determine the effects of printed anesthetic-risk information before surgery including patients’ anxiety, refusal of surgery, knowledge perception of adverse events and factors affecting anxiety.

Methods: Patients in a university hospital, a tertiary care hospital, a secondary care hospital, and a neurological institute in Thailand, undergoing low-to-moderate risk surgery were randomly allocated to control group (C) and study group (S), where group C received printed general information in anesthesia, and group S received printed incidences of five anesthetic adverse events as sore throat, nausea/vomiting, tooth loss, not waking up after surgery, cardiac arrest. Spielberger State-Trait Anxiety Inventory Scale (STAIS, STAIT) for anxiety and Visual Analog Scale (VAS) for knowledge perception were recorded before and after information, and after surgery. Numbers of patients who refused surgery and needed anesthetic-risk information in the next surgery were also recorded. STAIS >45 were considered “high anxiety”.

Results: Eight-hundred and twenty-four patients were analyzed (group C: 414, group S: 410). There was no difference in age, sex, ASA physical status, salary, education level, habitat, anesthetic experience and operative risk between groups. STAIS and STAIT, proportion of patients with high anxiety, proportion of patients who refused surgery were not different between groups. Patients in control group needed anesthetic-risk information in the next surgery more than study group (p <0.001). VAS for knowledge about five adverse events in study group were significantly higher than control group (p <0.001). Risk factors by the multivariate analysis included patients with high baseline trait anxiety and low income of less than 10,000 Baht/month.

Conclusion: Printed anesthetic-risk information did not increase anxiety, but increased knowledge perception of the patients.