Volume 9 (2015): Issue 3 (June 2015)

Melioidosis is an infection caused by Burkholderia pseudomallei. The bacteria are able to grow as planktonic and biofilm phenotypes. There is as yet no vaccine available for B. pseudomallei. The infection is common in northern parts of Thailand.

To summarize current knowledge regarding B. pseudomallei and its biofilm growth phenotype.

A literature search using MEDLINE (PubMed), SCOPUS, and OVID/LWWW databases.

The virulence factors of B. pseudomallei are important in biofilm formation. The properties to produce biofilms promote pathogenesis of disease.

Biofilm formation is a virulence factor and plays a significant role in the pathophysiology of melioidosis. The relationship of biofilms to relapse needs more study.

Basic fibroblast growth factor (bFGF) plays a crucial role in various biological processes, including cell growth, survival, migration, and differentiation. In stem cell biology, bFGF is employed to maintain stemness and regulate differentiation.

To review the role of bFGF in the behavior of stem cells, focusing particularly on human dental tissue-derived mesenchymal stem cells (DMSCs).

The articles from January 1, 1990 to March 25, 2015 in the PubMed database were searched with assigned key words (dental stem cells and (bFGF or FGF2)). Titles and abstracts of the retrieved articles were evaluated to identify inclusion criteria.

Sixty-five articles were identified from the PubMed database using the assigned keywords. Eighteen articles met the inclusion criteria including: (1) articles published in English, (2) articles describing the effects of endogenous and exogenous bFGF in cell culture and animal studies, and (3) the cell model used in the study was derived from dental-related tissues, and were employed as the main articles discussed in the present narrative review.

bFGF supplementation enhances stem cell marker expression in DMSCs. However, the role of bFGF on osteogenic differentiation by DMSCs remains controversial.

Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) infections among women and girls may be symptomatic or asymptomatic.

To survey and identify C. trachomatis, N. gonorrhoeae, and HPV infections in symptomatic and asymptomatic women and girls in Bangkok and surrounding neighborhoods using molecular techniques, evaluate the use of doxycycline treatment for clinically symptomatic patients infected with C. trachomatis, and identify possible genetic mutations associated with persistence and/or drug resistance.

We enrolled 150 women and girls with inflamed urogenital tracts and 134 asymptomatic controls, both without a history of HIV infection or cervical cancer in this prospective study. Genomic DNAs were extracted, and C. trachomatis, N. gonorrhoeae, and HPV infections were detected using established PCR primers and protocols. PCR controls included no confirmatory template controls or human β-globin. Patients infected with C. trachomatis were treated with doxycycline and re-examined after treatment. C. trachomatis major outer membrane (ompA) and tryptophan synthesis A (trpA) genes were sequenced to identify possible genetic mutations associated with persistence and/or drug resistance.

C. trachomatis, N. gonorrhoeae, and HPV were detected in 22%, 6%, and 48% of symptomatic, and in 3%, 16%, and 10% of asymptomatic women and girls, respectively. Coinfection with C. trachomatis and HPV were frequent in the 15-34 year age group, and associated with upper urogenital tract symptoms. Doxycycline was not considered effective for C. trachomatis infection. Several nonconserved amino acid changes were detected in C. trachomatis ompA and trpA.

We found different distributions of these pathogens among symptomatic and asymptomatic patients. We also found doxycycline treatment failures, and mutated trpA supported persistent C. trachomatis infections.

Dermatophytosis is a superficial infection caused by filamentous fungi belonging to the following three genera: Microsporum, Trichophyton and Epidermophyton. Arbitrarily primed PCR (AP-PCR) is a rapid and sensitive procedure for the diagnosis of the fungal species.

To identify various dermatophyte species as rapidly and precisely as possible.

Fifty-two clinical dermatophyte isolates from ten species were recovered from samples obtained the Department of Medical Mycology and patients in different parts of Iran. All 52 dermatophyte isolates tested belonged to any of Trichophyton, Microsporum, or Epidermophyton genera. Four random primers, OPAA11, OPU15, OPAA17, and OPD18, were used in this study.

The results indicated that all 10 dermatophyte species displayed distinct DNA band patterns after amplification with the random primers OPAA11 and OPU15. Nine species of dermatophytes were distinguished with the random primer OPAA17 using a different DNA band pattern. AP-PCR amplified different PCR products using primer OPD18.

AP-PCR offers a convenient solution to the problems encountered in the recognition of morphological features of dermatophyte species in comparison with conventional morphological methods. This approach represents technological progress in identification of dermatophytosis.

Patients with urolithiasis usually have increased urinary protein excretion.

To compare the urinary protein, including albumin, excretion by patients with urolithiasis and their children, and identify the urinary proteins that are excreted more than they are by the normal population.

We recruited 28 patients with urolithiasis after stone removal (G1) and their nonstone-forming children (G2), and 30 healthy volunteers who lived in the same region (G3) and their children (G4). Medical history and 24 h urine were analyzed. Total urinary proteins and albumin were measured, and the urine proteome analyzed by two-dimensional SDS–polyacrylamide gel electrophoresis and mass spectrophotometry.

Age, sex, body mass index, and amount of smoking and alcohol drinking were not different between G1 and G3, or G2 and G4. G1 patients had more prevalent underlying diseases than participants in the other groups. Urinary protein and albumin levels were highest in G1 participants, and were higher in G2 compared with G4. Preliminary proteomics showed elevated urinary Tamm–Horsfall protein, albumin, κ- and λ-2 light chain immunoglobulin excretion.

Patients with urolithiasis and their children had elevated excretion of urinary protein, including albumin, compared with the normal population, even though the levels were not clinically important. Leakage of these proteins suggest a tubular cell reabsorption defect that might associate with the pathogenesis of stone formation.

Acute stroke is a common neurological disorder. Intravenous recombinant tissue-type plasminogen activator (rt-PA) treatment is recommended for treatment of patients with acute ischemic stroke. A major side effect of rt-PA is intracerebral hemorrhage (ICH). Studies of the risks for ICH after rt-PA treatment in Asian populations are limited.

To determine risk factors for intracerebral hemorrhage after treatment of acute ischemic stroke with rt-PA and create online tool to calculate the risk.

We reviewed all patients with acute ischemic stroke who received treatment with rt-PA within 4.5 hours of stroke onset at the stroke fast track unit, Srinagarind Hospital, Khon Kaen University, Thailand. The study period was between November 2008 and September 2011. Factors associated with ICH after rt-PA treatment were analyzed by multivariate logistic regression.

There were 162 patients with acute ischemic stroke who received rt-PA treatment within 4.5 hours. Of those, 12 patients (7.41%) developed ICH. Only baseline modified Rankin scale score was significantly associated with ICH. The adjusted odds ratio was 1.733 (95% CI 1.008 to 2.982). An online tool to calculate the risk is available at http://202.28.94.20/research/.

Intracerebral hemorrhage after rt-PA treatment of patients with acute stroke was low at 7.41% and related to baseline functional status.

Antihistamines are used to treat allergic rhinitis. Whether better pharmacokinetic and pharmacodynamic properties confer higher clinical effectiveness is not known.

To compare the effectiveness of original fexofenadine, original levocetirizine, and locally-manufactured fexofenadine for treating persistent allergic rhinitis.

Patients with persistent allergic rhinitis were enrolled during June 2010 to December 2013. Patients were allocated to receive original fexofenadine, original levocetirizine, or locally-manufactured fexofenadine for one week. Daily symptoms were self-assessed. Disease specific quality of life, allergen induced wheal and flare size, peak nasal inspiratory flow, and any adverse events were reported at one week.

We enrolled 69 patients. There was no significant difference in reduction of mean total symptom score between original fexofenadine, original levocetirizine, and locally-manufactured fexofenadine (mean (95% CI); 5.52 (3.98, 7.06), 4.32 (2.43, 6.21), 4.45 (2.51, 6.40)) respectively. Improvement in otolaryngic symptoms (P = 0.51), nonotolaryngic symptoms (P = 0.59), work and study performance (P = 0.42), exertion (P =0.81), sleep disturbance (P = 0.76), social disturbance (P = 0.16), emotional disturbance (P = 0.66), overall general health (P =0.55), allergen induced wheal (P = 0.44) and flare suppression (P = 0.90), and peak nasal inspiratory flow (P =0.85) were not significantly different between the 3 groups. All groups similarly reported minor adverse events.

There is no difference in effectiveness between fexofenadine and levocetirizine in treating persistent allergic rhinitis. Locally-manufactured and original fexofenadine similarly improve symptoms, nasal air flow, and quality of life. No major drug-related adverse events were reported.

Ephedrine has vasoconstrictive and mild β-adrenergic agonist effects that may be able to decrease intraoperative core temperature hypothermia. However, its efficacy is still unclear.

To determine the efficacy of ephedrine given during induction to maintain core temperature during plastic and breast surgery under general anesthesia.

A prospective, randomized, double-blinded study was approved by our Institutional Review Board and registered with the Thai Clinical Trials Registry as TCTR20141212002. We randomly assigned 30 patients to receive mixture of propofol and ephedrine (ephedrine group, n = 15) or a mixture of propofol and normal saline (control group, n = 15) for induction of general anesthesia. The tympanic temperature (core temperature before intubation), esophageal temperature (core temperature after intubation), index temperature (peripheral temperature), systolic and diastolic blood pressure were compared between groups and baselines.

During surgery, patients in ephedrine group showed better esophageal temperature maintenance than those in the control group. Whereas systolic blood pressure in ephedrine group was significantly higher than in the control group in early phase after induction.

A bolus dose of ephedrine given during induction can decrease core temperature loss during plastic and breast surgery under general anesthesia.

Contrast-enhanced magnetic resonance angiography (CE-MRA) is an accurate and noninvasive method used to screen for renal artery stenosis (RAS). Color Doppler ultrasonography (CDUS) and noncontrast enhanced magnetic resonance angiography (NC-MRA) are considered noninvasive imaging modalities, which require no contrast medium injection.

To compare NC-MRA with CDUS for screening for RAS using CE-MRA as a reference standard.

The study was approved by our institutional review board with written informed consent was obtained from all patient participants. We prospectively enrolled 42 consecutive patients who were suspected of having RAS. All patients underwent CDUS, NC-MRA, and CE-MRA of renal arteries. The attending radiologist interpreted the CDUS after scanning the patient. CE-MRA and NC-MRA were separately interpreted by consensus between two radiologists. Data including (1) number of visualized renal arteries, (2) agreement between CDUS and NC-MRA compared with CE-MRA, and (3) time taken for examination, were evaluated.

We included 102 renal arteries and 306 renal artery segments in the study. NC-MRA visualized significantly more renal artery segments (258 segments) than CDUS (286 segments, P = 0.0004). NC-MRA and CDUS were in good agreement with CE-MRA when determining the degree of stenosis (K_w = 0.71 and K_w = 0.66, respectively). NC-MRA took a significantly shorter time for examination (21.2 minutes) than CDUS (47.5 minutes, P <0.0001).

NC-MRA is comparable to CDUS for screening for renal artery stenosis. However, NC-MRA can visualize more renal artery segments and require shorter examination time than CDUS.

Bisphenol A (BPA), a xenoestrogenic monomer, is one of the most common industrial chemicals used in epoxy coatings for canned food and other consumer items. There is only limited information regarding the potential health risks from BPA exposure in children and adolescents from Asian countries.

To detect and determine urinary BPA concentrations, and identify possible association between urinary BPA levels, demographic characteristics, and BPA exposure risks in Thai children and adolescents.

A cross-sectional study was conducted in 376 children and adolescents aged 3–18 years from kindergarten, elementary, and middle schools in Bangkok, Thailand. Urinary concentrations of total BPA were determined by liquid chromatography tandem mass spectrometry (LC–MSMS). Anthropometric data and questionnaires regarding BPA exposure risks were collected.

BPA was detected in 283 of 376 urine samples (75.3%) with a median adjusted BPA 0.53 μg/g creatinine (range 0.04–1.12). Thirty-one participants (9%) were overweight and 39 (11%) were obese. The BPA detection rate was significantly higher in obese children (OR 3.42, 95% confidence interval (CI) 1.18–9.95, P = 0.02) compared with children of normal weight. BPA was detected more often in younger children (3-6 years) when compared with children (6–10 years) and adolescents (10–18 years). There were no significant association between BPA levels and other demographic data or BPA exposure risks.

BPA exposure in Thai children and adolescents may be lower than exposure in children from the United States, some European nations, and other Asian countries. Obese and younger children were significantly associated with BPA detection.

The impact of hepatitis B or C virus (HBV or HCV) coinfection on the progression of liver diseases in patients infected with human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) has not been fully studied in resource-limited settings.

To examine the seroprevalence of HBV or HCV coinfection and its effect on hepatic function in HIV-infected Thai patients receiving HAART.

A single-center cross-sectional study was conducted from October 2011 to January 2013 in Thai patients infected with HIV (n = 211). Combination ART was received by 94.3% of the patients (median duration, 32.1 (range, 0–95.3) months). The patients were screened for HBV and HCV infection and examined for transaminitis, defined as levels of aspartate aminotransferases (AST) and/or alanine aminotransferase (ALT) increased above the upper normal limits, and ARV-associated hepatotoxicity. Regression analyses were performed to determine risks for transaminitis in the studied group.

Prevalence of HBV or HCV coinfection in the HIV-infected patients was 11.4% and 7.6%, respectively and the rate of transaminitis was 26.5%, with only one patient developing severe grade 3 hepaticity. Univariate and multivariate analyses indicated that predictive risk factors for transaminitis in this study group were seropositivity for HCV (OR 12.3, 95% CI 3.0-50.1, P < 0.001), but not for HBV, together with age difference, sex, and CD4⁺ cell count.

Coinfection with HCV is a potentially more important risk for transaminitis than coinfection with HBV, leading to chronic liver diseases in HIV-infected Thai patients with ongoing HAART.

Polymorphisms in the P. falciparum gene for ATPase6 (pfATPase6) have been proposed as markers for artemisinin resistance, though the precise artemisinin binding pocket has not yet been comprehensively investigated in cases of treatment failure from along the Thai-Cambodian border.

To investigate the specific regions of pfATPase6 in adequate clinical and parasitological response and treatment failures from Thai-Cambodian border.

We examined polymorphisms in pfATPase6 by sequence analysis in parasites collected from 164 patients with uncomplicated malaria showing variable clinical phenotypes (13 cases of treatment failure and 151 adequate clinical and parasitological response) from adjacent areas on either side of the Thai-Cambodian border during the period 2005-2007. We investigated potential correlations between putative binding pocket polymorphisms with clinical response.

The majority of DNA sequences coding for the proposed artesunate binding pocket (M3, M5, and M7 helices) and the regions around Ser769 were conserved in parasite populations collected from patients in both study sites, regardless of clinical outcome.

The previously proposed areas of pfATPase6 did not appear to vary based on clinical outcome in a large number of patients from Southeast Asia, suggesting these regions are unlikely to be useful as molecular markers of resistance in clinical specimens from the Southeast Asian region.

Assessing the maturational status and pubertal growth spurt of a patient has considerable influence on diagnosis, treatment planning, and the outcome of orthodontic treatment.

To assess the usefulness of panoramic radiographs as a tool to estimate the growth and to ascertain the importance of tooth calcification stages as an indicator of maturity by using digital panoramic radiographs.

We compared the dental maturity assessed by calcification of mandibular canine, first premolar, second premolar, and second molars using digital panoramic radiographs and skeletal maturity assessed by cervical vertebral maturation stages using lateral cephalograms and hand-wrist radiographs. Skeletal maturity was assessed using a cervical vertebrae maturation technique; hand-wrist maturity was evaluated using Fishman skeletal maturity indicators. Dental maturity was estimated according to guidelines of Demirjian. Spearman rank-order correlation coefficients were used to determine the correlation between tooth calcification stages and skeletal maturity assessed on panoramic radiographs, lateral cephalograms, and hand-wrist radiographs of 60 patient participants, including 45 boys and 15 girls.

The panoramic radiograph is a reliable tool with which to estimate of growth and development of boys.

The relationship between tooth calcification stages and the skeletal maturity indicators in boys allows clinicians to identify the stage of the pubertal growth from panoramic radiographs. It is appropriate to put these skeletal and dental maturation relationships into daily orthodontic diagnostic practice.

Congenital limb defects (CLDs) are a significant cause of morbidity and depending upon the severity, result in varying degrees of disability. Data on CLDs is scarce for South Asian populations.

To obtain insight into the spectrum of CLDs in the population of the interior Sindh region Pakistan.

A cross-sectional study was conducted in seven districts of interior Sindh and individuals or families were recruited from various hospitals and through door-to-door surveys.

We recruited 165 independent individuals or families with certain type of CLDs during 2010-2013. The CLDs were categorized into 10 broad categories, and the five major types witnessed were: polydactyly, syndactyly, reduction deformities, musculoskeletal defects, and brachydactyly. CLDs depicted great phenotypic variability, but collectively, upper limbs were more commonly involved than lower limbs, right arms more than the left, left legs more than the right, and distal limb segments more than proximal segments. The pattern of malformations was not different between Muslims and Hindus.

These data established detailed distributions of CLDs across the vital sociodemographic attributes of the studied population, and are helpful in quantifying the impact of CLDs on the study population. Future molecular analyses of this cohort are anticipated to improve the clinical classifications and would also be of tremendous help to the affected individuals or families in risk estimation and genetic counseling.

Many reports from developing and developed countries have shown increased resistance against macrolides and other antibiotics among Streptococcus pyogenes or group A streptococci (GAS).

To study the current resistance pattern of S. pyogenes in Pakistan to commonly prescribed antibiotics.

Altogether, 85 (53%) of S. pyogenes strains were isolated and collected from 160 various clinical specimens from patients in Pakistan.

Among other strains, 51 (32%) group D streptococci, 15 (9%) group B streptococci, 7 (4%) group G streptococci, and 2 (1%) group C streptococci were also identified. Predominantly, S. pyogenes were isolated from throat swabs (55%), followed by pus (17%), tissues (12%), and blood or wound swabs (7%). The majority of the S. pyogenes isolates were collected during the rainy season (55%) followed by cool season (40%), while merely 5% strains were isolated during the hot season, indicating a correlation of GAS incidence with seasonal changes. The highest rate of resistance was observed against clindamycin (29%), followed by macrolides (20%), and ciprofloxacin (14%). However, all strains of GAS were sensitive to penicillin and co-amoxiclav.

The emergence of lincosamide and macrolide resistance among GAS is a major problem worldwide which is probably due to misuse of antibiotics, self-medication, or frequent use of these antibiotics.

The use of mosquito coils is a common method of protection against mosquito bites and mosquito borne diseases. These coils are widely marketed and used by households in Malaysia to prevent mosquito associated problems.

To determine the bioefficacy of commercial d-allethrin and d-trans allethrin spatial repellents against the dengue vector Aedes aegypti.

We evaluated the knockdown and mortality effects of spatial repellents containing d-allethrin (0.3% w/w) and d-trans allethrin (0.1% and 0.15% w/w) on Ae. aegypti in a Peet Grady Chamber, relative to a reference product (0.2% w/w d-allethrin).

The spatial repellent containing 0.3% d-allethrin had the shortest knockdown times (KT₅₀ and KT₉₀) and these were significantly different from the other products including the reference coil except the 0.15% d-trans allethrin coil. The spatial repellent containing 0.3% d-allethrin elicited a mortality response of 96%, which was significantly different from the mortality response to the other coils, except for the 0.15% d-trans allethrin formulation.

Spatial repellents containing 0.3% d-allethrin or 0.15% d-trans allethrin had higher efficacies against Ae. aegypti than repellents containing 0.2% w/w d-allethrin or 0.1% d-trans allethrin and their use by households could offer better relief from Ae. aegypti.

Proximal interphalangeal joint (PIPJ) dislocation is a common injury. Current management of instability after closed reduction is repair of the torn ligament followed by immobilization. Important sequels after prolonged immobilization include stiffness. On the other hand, early motion exercise may cause rerupture. Buddy taping has been used to partially stabilize the injured finger which also allows early gentle motion. However, this technique cannot be applied to collateral ligament injury of a border finger such as the radial collateral ligament of the index or ulnar collateral ligament of the little finger.

To describe functional outcomes after application of a frame improvised from a standard disposable syringe in cases of index radial collateral ligament injury.

We constructed adjustable, customized, mobile frames improvised from standard disposable syringe barrels for stabilizing collateral ligaments of the PIPJ to improve motion and protect the repaired ligament. Two patients with radial collateral ligament injury of the index finger were treated with the improvised frame for 4 weeks after an initial 3-week immobilization with Kirschner wire and a static splint.

The average range of motion of PIPJ after treatment was 0-105 with good radioulnar stability. The lifetime of the improvised frame is approximately 8 days, but it can be replaced easily and inexpensively in most medical facilities.

We introduce an improvised frame, which we call a “Sriracha frame”, as a novel, inexpensive, easy to produce, and effective device that yields good, early joint motion and stability.