Tom 8 (2014): Zeszyt 3 (June 2014)

Background: There is no consensus in the literature on the role of human herpes virus-6 (HHV-6) in multiple sclerosis (MS) onset or progression.

Objective: We evaluated a possible role for HHV-6 in MS onset and progression.

Methods: We conducted a literature search of PubMed and Google scholar with the following search terms: (“multiple sclerosis” OR “MS”) and (“Human Herpes Virus-6” OR “HHV-6”).

Results: A total 21 publications were retrieved, of which 19 case-control studies were included. A further 25 articles were retrieved for background information.

Conclusion: There was insufficient evidence to support a role of HHV-6 in MS onset and progression.

Background: There are several species of mosquitoes that readily attack people, and some are capable of transmitting microbial organisms that cause human diseases including dengue, malaria, and Japanese encephalitis. The mosquitoes of major concern in Malaysia belong to the genera Culex, Aedes, and Armigeres.

Objective: To study the host-seeking behavior of four Malaysian mosquitoes commonly found in urban residential areas in Kuala Lumpur.

Methods: The host-seeking behavior of Aedes albopictus, Armigeres kesseli, Culex quinquefasciatus, and Culex vishnui was conducted in four urban residential areas in Fletcher Road, Kampung Baru, Taman Melati, and University of Malaya student hostel. The mosquito biting frequency was determined by using a bare leg catch (BLC) technique throughout the day (24 hours). The study was triplicated for each site.

Results: Biting activity of Ae. albopictus in urban residential areas in Kuala Lumpur was detected throughout the day, but the biting peaked between 0600-0900 and 1500-2000, and had low biting activity from late night until the next morning (2000-0500) with biting rate ≤1 mosquito/man/hour. Biting behavior of Ar. kesseli was distinctly crepuscular, which exhibited two peaks of activity at 0600-0700 and 1900-2000, while Culex quinquefasciatus and Cx. vishnui were nocturnal feeders with multiple biting peaks throughout the night.

Conclusion: This study recommends optimal time for fogging to be conducted in Malaysia and neighboring countries according to the peak biting peak obtained.

Background: Overuse of abortive medication is a common factor contributing to an increase in headache frequency in patients with migraine. Whether or not chronic exposure to dihydroergotamine (DHE) can lead to this transformation remains uncertain.

Objective: To determine the effect of acute and chronic DHE exposure on development of cortical spreading depression (CSD) and trigeminal nociception.

Methods: The study comprised two experiments, namely acute and chronic exposure. In the acute experiment, a single dose of DHE (100 μg/kg) was given to male Wistar rats after successful induction of CSD. In the chronic experiment, DHE was given daily for the period of 0, 7, 14, and 28 days. CSD was induced 30 minutes after the final injection and the cortical field potential was recorded. Expression of c-Fos in caudal brainstem was used as an indicator of trigeminal nociception.

Results: Acute exposure to DHE attenuated the expression of c-Fos in the caudal brainstem without change in CSD response. By contrast, chronic exposure (14 and 28 days) to DHE increased the area under the curve of CSD waveforms. In parallel with the change in the CSD, there was significant increase of c-Fos expression within 14 days exposure to DHE and the expression remained significantly elevated for up to the 28 days examined.

Conclusion: Our study demonstrated that chronic DHE administration can increase cortical excitability and increase c-Fos expression in caudal brainstem. Our preclinical evidence suggests the possible adverse effect of chronic DHE use in causing chronification of headache.

Background: Human embryonic stem (hES) cells are pluripotent, and can differentiate into three germ layers. Traditionally, cultures of hES cells are maintained in a system containing mouse embryonic fibroblasts as a feeder layer for support of undifferentiated growth. However, contamination by animal cells limits the use of hES cells.

Objective: We evaluated the use of human dental pulp stem cells (hDPSCs) as a feeder layer for hES cell culture. It should be possible to obtain a new source of human mesenchymal stem cells for feeder cells to maintain undifferentiated growth of hES cells.

Methods: hDPSCs from removed impacted wisdom teeth (third molars) were extracted, cultured, and characterized for mesenchymal stem cell properties. Furthermore, hDPSCs were used as a feeder layer for culturing Chula2 and Chula5 hES cell lines. Finally, hES cell lines grown on hDPSCs feeders were examined embryonic stem cell properties.

Results: We found that hDPSCs, which have mesenchymal properties, can support undifferentiated growth of hES cell lines. After prolonged culture (passage 17), these hES cell lines still maintain ES cell properties including typical morphology seen in hES cells, the expression of pluripotency markers (Oct4, Sox2, Nanog, Rex1, SSEA-3, SSEA-4, TRA-1-60, and TRA-1-81), embryoid body formation and retention of a normal karyotype.

Conclusion: hDPSCs, derived from the pulp tissue of impacted third molars, are a potential source of human feeder cells for the culture of undifferentiated hES cells.

Background: Because of the limited number of patient-controlled analgesia (PCA) pumps in our developing country, we proposed a technique of modified nurse-controlled analgesia (NCA) to relieve postoperative pain in pediatric patients.

Objective: We assessed efficacy, safety, compliance by nurses, and satisfaction including parent satisfaction of a modified NCA protocol compared with fixed-dose analgesia conventionally used for postoperative pain relief in pediatric patients.

Methods: A prospective study design was conducted in pediatric patients who underwent major surgery in a university hospital. In the pre-NCA phase, patients received a conventional fixed-dose opioid after surgery. In the NCA phase, nurses could initiate two additional small doses autonomously, as prescribed, if the initial bolus was inadequate. Outcome measures were the number of moderate to severe pain scores, respiratory depression, compliance by nurses, and parent satisfaction.

Results: There were 117 and 113 patients in the pre-NCA and NCA phases, respectively. Detection of moderate to severe pain ≥2 episodes in 24 h after surgery was significantly higher in the NCA phase especially in moderate to severe pain procedures. Respiratory depression was not found in either phase. The majority of nurses showed positive attitudes to routine use of a modified NCA protocol. Parent satisfaction was high in both groups.

Conclusion: The attitude of nurses toward the modified NCA protocol was positive and it significantly increased detection of episodes of moderate to severe postoperative pain, which accordingly increased patient care and pain relief without severe untoward effects.

Background: As part of their innate immune response to changes in the central nervous system environment, normally quiescent microglia become activated and increase expression of pattern recognition receptors, scavenger receptors, and production of inflammatory cytokines, proteinases, reactive oxygen species (ROS), and free radicals. These molecules have been implicated in the pathogenesis and progression of several neurodegenerative disorders including Alzheimer disease (AD).

Objective: We compared patterns of microglial innate immune responses elicited by nonfibrillar amyloid β peptide (nfAβ_1-42) to those elicited by lipopolysaccharide (LPS).

Methods: Murine BV-2 microglial cells were exposed to either nfAβ_1-42 or LPS for 12 h. Then, total RNA from each condition was isolated and expression levels of Toll-like receptor (TLR)-4, scavenger receptor class A (SRMARCO) and class B (SR-BI), CD36, and matrix metalloproteinase (MMP)-9 were determined by reverse transcription-quantitative real-time polymerase chain reaction. The amount of hydrogen peroxide (H2O2) and nitric oxide (NO) in the cell-free supernatant at 24 h were determined using 10-acetyl-3,7-dihydroxyphenoxazine (Amplex Red) and Griess reagent, respectively.

Results: nfAβ_1-42 and LPS significantly increased expression of TLR-4, SR-MARCO, CD36, and MMP-9 and production of H2O2 and NO in BV-2 microglial cells compared with that of unstimulated cells. However, expression of SR-BI was significantly induced only when the cells were exposed to nfAβ1-42.

Conclusion: These findings indicate that pattern of microglial innate immune responses elicited by nfAβ_1-42 overlap with that elicited by LPS and suggest a specific role of microglial SR-BI expression in AD pathogenesis.

Background: The validity and agreement of the New Numbers Contrast Sensitivity Chart with the original Mars chart have been found to be good. The two charts can be used interchangeably; however, evidence of the repeatability of the new chart remains to be sought. This study was to assess the repeatability of the New Numbers Contrast Sensitivity Chart.

Objectives: We assessed the repeatability of the Numbers Contrast Sensitivity Chart.

Methods: Two hundred subjects from the ophthalmic clinic of the King Chulalongkorn Memorial Hospital, who were able to communicate and read Arabic numerals were recruited. The contrast sensitivity (CS) scores were collected by reading the same Numbers Contrast Sensitivity Chart in the same environment with each eye and both eyes ten minutes apart. The repeatability of the CS score was assessed by Bland-Altman plot analysis.

Results: The visual acuity of subjects with variety in diagnoses ranged from 20/480 to 20/20. The mean differences were -0.006, -0.008, -0.002 log CS and the coefficients of repeatability were 0.155, 0.141, and 0.093 for the right eye, left eye, and both eyes, respectively. The plots showed a narrow range of 95% limit of agreement, which were (+0.146, -0.159) in the right eye, (+0.130, -0.147) in the left eye, and (+0.089, -0.093) in both eyes.

Conclusions: The New Numbers Contrast Sensitivity Chart has good repeatability. With proven good validity and repeatability, this easy and convenient numbers chart is beneficial for practical use in a clinical setting where English is not used as the primary language.

Background: Diabetes is a leading cause of end stage renal disease (ESRD), which impacts on treatment costs and patients’ quality of life. Microalbuminuria screening in patients with diabetes as an early intervention is beneficial in slowing the progression of diabetic nephropathy.

Objectives: We aimed to assess the cost-effectiveness of annual microalbuminuria screening in type 2 diabetic patients.

Methods: We compared screening by urine dipsticks with a “do nothing” scenario. To replicate the natural history of diabetic nephropathy, a Markov model based on a simulated cohort of 10,000 45-year-old normotensive diabetic patients was utilized. We calculated the cost and quality of life gathered from a cross-sectional survey. The costs of dialysis were derived from The National Health Security Office (NHSO). We also calculated the incremental cost-effectiveness ratio (ICER) for lifetime with a future discount rate of 3%.

Results: The ICER was 3,035 THB per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses showed that all ICERs were less than the Thai Gross Domestic Product (GDP) per capita (150,000 THB in 2011) based on World Health Organization’s suggested criteria.

Conclusions: Annual microalbuminuria screening using urine dipsticks in type 2 diabetic patients is very costeffective in Thailand based on World Health Organization’s recommendations. This finding has corroborated the benefit of this screening in the public health benefit package.

Background: Wearing a face veil (niqab) was found to have a negative effect on the ventilatory function of Saudi adult women, which may challenge their functional exercise capacity.

Objectives: To investigate the effect of physical activity on a 6-minute walked distance (6-MWD) among young adult niqab-wearing healthy Saudi women.

Materials and Methods: Forty healthy young Saudi women were recruited for this study. The study participants (aged 22.8 ± 2.5 years) were selected from students and administrative staff at King Saud University. They were normotensive, nonsmokers, and of normal or mildly overweight. They were divided into 2 groups on basis of niqab wearing. A 6- minute walk test was implemented as measure of the participant’s functional exercise capacity. Their physical activity level was expressed as low, moderate, or high levels using the International Physical Activity Questionnaire-Short Form. Comparisons between the basal physiological characters of the 2 groups, 6-MWD, and physical activity level were conducted. A two-way independent ANOVA was used to study the interaction of niqab wearing and the physical activity level on the 6-MWD for niqab wearing women.

Results: Women in the niqab wearing group had a significantly higher physical activity level and longer 6-MWD than those in the niqab nonwearing group (370.7 ± 62.95 and 510.0 ± 81.75 m (mean ± SD) respectively).

Conclusion: A physically active lifestyle improves and preserves the functional exercise capacity reflected by longer 6-MWD among the physically active niqab-wearing Saudi adult healthy women compared with less active women who did not wear the niqab.

Background: Serum glycated albumin (GA) is a marker of glycemic control in diabetic renal patients, but studies were limited by the use of few random glucose values to define glycemic control.

Objectives: To determine whether GA correlated with self blood glucose monitoring is better than HbA1c in hemodialyzed diabetic patients taking erythropoietin.

Methods: This was a cross-sectional study of diabetic patients on hemodialysis with and without erythropoietin. GA was measured by ELISA and HbA1c by ion-exchange HPLC. GA was reported as the GA/albumin ratio where albumin was measured using bromocresol green. The average capillary blood glucose level over the preceding three months (CBG) was calculated from self-reported daily prebreakfast, prelunch, and prebed glucose meter readings.

Results: Thirty-four patients were recruited; 18 were taking erythropoietin (6000 units per week) and 16 had never received erythropoietin. HbA1c correlated poorly with CBG in patients taking erythropoietin (r = -0.014, P = 0.96) compared with patients without erythropoietin (r = 0.579, P = 0.02). The correlation of GA/albumin ratio with CBG in the erythropoietin group (r = 0.612, P = 0.007) was similar to the nonerythropoietin group (r = 0.854, P < 0.001). The slope for HbA1c versus CBG was 2.8-fold greater in patients without erythropoietin compared with those taking erythropoietin. There was no significant difference in the slopes for GA/albumin ratio versus CBG between the two patient groups (P > 0.05).

Conclusion: In diabetic patients on hemodialysis and taking low doses of erythropoietin, GA/albumin is a better marker of glycemic control than HbA1c.

Background: Animal bites are one of the leading causes of visits to an emergency room (ER) in Thailand. Rabies is an almost invariably fatal disease.

Objectives: We evaluated the appropriateness of rabies vaccination in clinical practice following the World Health Organization (WHO) guidelines.

Methods: All patients who visited the ER at Ramathibodi Hospital of Mahidol University because of mammal bites and received rabies vaccination by the WHO rabies postexposure regimen were enrolled. Data were retrieved from medical records. Wound categories were classified by WHO guidelines both in real practice and by the investigators on subsequent investigation.

Results: The agreement between clinical practice and the WHO guidelines was calculated and reported as kappa statistics. There were 372 eligible patients. The mean age was 36 years and 172 patients were male. The agreement between clinical practice and the WHO guidelines was a disturbing 26.9% with a kappa statistic of -0.02, P = 0.56.

Conclusion: Even in a referral and teaching hospital, rabies postexposure vaccination in Thailand was not appropriate according to WHO guidelines.

Background: Trisomy 21 or Down syndrome (DS) is the most common aneuploidy disorder. Fetal karyotypic analysis remains the criterion standard for prenatal diagnosis of DS, although the method is time consuming and requires skilled personnel. Real-time quantitative polymerase chain reaction (qPCR) can be used to determine a difference in the amount of gene copy by calculation of the difference between the cycle threshold (ΔCT) of a tested gene and a reference gene.

Objectives: To develop a rapid qPCR diagnostic method for trisomy 21.

Methods: Ten DS patients with the known karyotype of trisomy 21 were enrolled. Their parents were included as controls. D21S11 locus on chromosome 21 and SM locus on chromosome 16 from each subject were amplified by qPCR. The D21S11/SM ΔCT and 2^-ΔΔCT values were compared between DS patients and their parents.

Results: The D21S11/SM ΔCT values of the DS patients were higher than their respective controls except for one family. The mean 2^-ΔΔCT value between patients and mothers was 1.88 ± 0.95 (95% CI 1.20-2.56), and between fathers and mothers as controls was 1.06 ± 0.68 (95% CI 0.58-1.54).

Conclusion: The diagnostic method of trisomy 21 by using qPCR is feasible, although false negative results may occur. Using more index genes is recommended to increase the sensitivity and specificity.

Background: The world is entering the post-outbreak period of the 2009 A H1N1 strain of the influenza virus. The strain is expected to continue spreading, as seasonal influenza viruses do each year. The majority of children have relatively low immunity and engage in activities at school where opportunities abound for exposure to and spreading of diseases.

Objectives: We compared the effectiveness of influenza prevention by using non-pharmaceutical measures in primary schools.

Methods: This study was conducted at two medium-sized primary schools in Nakhon Phanom province, Thailand. Multistage sampling was used to select students from Grades 4 to 6. The study group consisted of 230 students from the 2 schools and the control group 224 students from the 2 schools. The research included (a) 8 h of instruction on influenza-like illnesses and their prevention integrated into health promotion and physical education classes and (b) building understanding among parents and in the community. Data were analyzed for frequencies, percentages, and multiple logistic regression.

Results: Non-pharmaceutical influenza interventions reduced the rate of influenza-like illnesses by 77% (AOR = 0.23, 95% CI: 0.15"0.36). Students who did not receive the influenza-like prevention and control training had a morbidity of 54.9%; whereas those who received the training had a morbidity of 23.5%. Overall, the group receiving the educational model saw a 57% reduction in its morbidity compared with the control group. The students in the intervention group who washed their hands for 20 seconds three or more times per day had a morbidity of 38.9%, which resulted in an overall reduction in morbidity of 36.4%. The morbidity rate of students who missed school because they were ill was 39.5%. When comparing training methods, the hand-washing group saw morbidity reduced by 34.7%, while simply receiving news and information from public health officials resulted in only a 29.2% reduction in morbidity. Overall, the group receiving the disease prevention and control training was able to reduce morbidity by 58.7%.

Conclusion: Influenza prevention education among students was integrated into the health education curriculum. Children were taught hand-washing and respiratory etiquette (i.e., covering the nose and face when sneezing, coughing, and nose-blowing). Cartoon media were used as visual teaching aids. The results from this program helped to decrease the number of cases of influenza-like illness and morbidity among students and families.

Background: Gadolinium diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) is a developed agent with preferential uptake by hepatocytes. A rapid and specific hepatocyte uptake with biliary excretion was observed of approximately 50% of the injected dose. The amount of contrast uptake is thought to be related to reserve liver function.

Objectives: To evaluate correlation between liver signal intensity in the hepatobiliary phase of Gd-EOB-DTPA and reserved liver function by using the model score for end-stage liver disease (MELD).

Methods:All patients who underwent magnetic resonance (MR) imaging with Gd-EOB-DTPA were retrospectively collected. The patients with serum creatinine level higher than 1.5 mg/dL or patients without available data to estimate MELD score were excluded. Thirty-six patients were enrolled. A signal-to-noise ratio (SNR) in the liver parenchyma on a fat-suppressed three dimensional fast spoiled-gradient recalled echo sequence images before and 20 minutes after contrast injection were measured and calculated on PACS by two radiologists. The MELD score was determined and interobserver reliability was estimated.

Results: Among 36 patients, we found a negative relationship between the percentage enhancement and the MELD score (P < 0.01, r = 0.545). The SNR at 20 minutes after Gd-EOB-DTPA injection also had a negative relationship with the MELD score with statistical significance (P < 0.01, r = 0.460). Interobserver reliability was 0.675.

Conclusion: The percentage enhancement in hepatobiliary phase of Gd-EOB-DTPA can predict reserved liver function.

Background: Overactive bladder (OAB) is a symptom-based condition, difficult to evaluate and impairs human related quality of life. A questionnaire is essential for the diagnosis and evaluation of treatment outcomes. The Overactive Bladder Symptom Score (OABSS) questionnaire has been mentioned previously as a useful tool for quantifying symptoms, severity, and treatment outcomes.

Objectives: To examine the psychometric properties of the OABSS in Thai women with overactive bladder.

Methods: Sixty women aged over 18 years, diagnosed with overactive bladder syndrome were recruited. They visited in two sessions at a two-week intervals using an OABSS questionnaire translated into Thai by a group of translators comprised of bilingual doctors and native speakers. OABSS in Thai preserves the original format using seven questions.

Results: Sixty woman aged over 18 years with overactive bladder symptoms were recruited (mean age 56; SD17.8). Content validity revealed a high score of symptoms. Internal consistency of the questionnaire from both visits showed a Cronbach alpha at 0.80 and 0.82 respectively. There was a strong association between the seven-item OABSS score at visit 1 and visit 2 with an intraclass correlation coefficient (ICC) of 0.96 (95% CI 0.947-0.981).

Conclusion: The OABSS Thai version is valid, and easily evaluates symptoms and severity of OAB. It could be used not only by urologists, but also by other healthcare providers as a screening tool for OAB in Thailand.

Background: Primary granulocytic sarcoma (GS) only rarely presents with an ovarian mass classified as extramedullary myeloid progenitor tumor cells. Few patients with cases of primary GS survive after systemic chemotherapy.

Objective: To present a case of primary GS treated with complete course of chemotherapy. The patient is currently in complete remission.

Methods: Retrospective review of medical records and comparison with previous case reports.

Results: A 41-year-old woman presented with an ovarian mass of 6 months duration. There was no previous history of hematologic disease or presence of leukemic cells in other organs at the time of diagnosis. Immunohistochemistry confirmed the diagnosis. She received complete course of chemotherapy, after which complete remission was achieved.

Conclusion: A case of primary granulocytic sarcoma of the ovary was successfully treated with chemotherapy. This disease needs careful diagnosis and appropriate treatment for a good outcome.

British scientist Sir Wilfrid Le Gros Clark was one of the most distinguished anatomists, neuroscientists and physical anthropologists of the twentieth century. He spent most of his career at the University of Oxford as the Chair of the Anatomy Department. This paper focuses on Le Gros Clark’s early career and provides a historical account of the three years he spent as a Principal Medical Officer in Sarawak, which was then a British controlled state on the island of Borneo. At Sarawak he carried out numerous medical, administrative, and educational duties, making significant improvements to the local health system. His success as the Principal Medical Officer came not only as a result of his medical knowledge and organizational skills, but also because of his extensive knowledge and understanding of the local cultures. Interested in the natural history of the country, Le Gros Clark also collected specimens of the local fauna. These would provide material for some of his most significant research carried out when he took an academic position in England. Years in Sarawak enriched Le Gros Clark not only as a scientist and medical practitioner, but also had a deep influence on his general outlook on life and personal development.