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Chiang Rai, Thailand

Panyasai S.,University of Phayao | Thongsuk P.,Chiang Rai Prachanukroh Hospital | Pornprasert S.,Chiang Mai University
Hemoglobin | Year: 2016

Hb Agenogi [β90(F6)Glu→Lys (GAG>AAG) HBB: c.271G>A)] is a very rare β-globin chain variant. We report for the first time this hemoglobinopathy in a pregnant 20-year-old Thai woman. She was seen by an obstetrician at her 14th week of gestation. She was pale and had an inflammatory lesion of her lower left leg. The hemoglobin (Hb) analysis by high performance liquid chromatography (HPLC) and low pressure liquid chromatography (LPLC) showed a peak of abnormal Hb at the C window. On capillary electrophoresis (CE), the abnormal Hb peak was observed at electrophoretic zone 4 that corresponded to the Hb E (HBB: c.79G>A) peak. Direct DNA sequencing revealed a GAG>AAG mutation at codon 90 of the β-globin gene. Thus, even though Hb Agenogi is very rare, it can be found in Thai people. The knowledge and understanding of this hemoglobinopathy will be used to assist in diagnosis, management and counseling for patients. © 2016 Taylor & Francis. Source


Wiwattanawarang N.,Chiang Rai Prachanukroh Hospital
Journal of the Medical Association of Thailand | Year: 2014

Total knee replacement is an effective procedure for severely diseased knee joints; however, one of the major problems resulting in failure of arthroplasty is periprosthetic joint infection. Fungal infection is rarely found perprosthetic joints infection, but the incidence may be increased in high risk patients. Progression of the disease and definitive treatment guidelines have not yet been established. In two cases of fungal periprosthetic joint infection the organism was identified from cultures as Candida spp. Those patients had developed symptoms of pain and local knee inflammation six years after total knee replacement. A two-stage operation was carried out. The first operation removed the prosthesis, the polyethylene surface, the cement mantle and the infected tissue. After identification of the organism, the correct antibiotic was administered until the infection was controlled. A second operation was carried out to re-implant the prosthesis after the infection had subsided. A summary of reports in the literature regarding treatment of fungal periprosthetic infections as well as an algorithm for treatment decision making are presented. © 2014, Medical Association of Thailand. All rights reserved. Source


Cressey T.R.,Chiang Mai University | Cressey T.R.,Harvard University | Cressey T.R.,CIRAD - Agricultural Research for Development | Best B.M.,University of California at San Diego | And 13 more authors.
British Journal of Clinical Pharmacology | Year: 2013

Aim: To describe the pharmacokinetics and safety of indinavir boosted with ritonavir (IDV/r) during the second and third trimesters of pregnancy and in the post-partum period. Methods: IMPAACT P1026s is an on-going, prospective, non-blinded study of antiretroviral pharmacokinetics (PK) in HIV-infected pregnant women with a Thai cohort receiving IDV/r 400/100mg twice daily during pregnancy through to 6-12 weeks post-partum as part of clinical care. Steady-state PK profiles were performed during the second (optional) and third trimesters and at 6-12 weeks post-partum. PK targets were the estimated 10th percentile IDV AUC (12.9μgml-1h) in non-pregnant historical Thai adults and a trough concentration of 0.1μgml-1, the suggested minimum target. Results: Twenty-six pregnant women were enrolled; thirteen entered during the second trimester. Median (range) age was 29.8 (18.9-40.8) years and weight 60.5 (50.0-85.0) kg at the third trimester PK visit. The 90% confidence limits for the geometric mean ratio of the indinavir AUC(0,12h) and Cmax during the second trimester and post-partum (ante:post ratios) were 0.58 (0.49, 0.68) and 0.73 (0.59, 0.91), respectively; third trimester/post-partum AUC(0,12h) and Cmax ratios were 0.60 (0.53, 0.68) and 0.63 (0.55, 0.72), respectively. IDV/r was well tolerated and 21/26 women had a HIV-1 viral load < 40 copies ml-1 at delivery. All 26 infants were confirmed HIV negative. Conclusion: Indinavir exposure during the second and third trimesters was significantly reduced compared with post-partum and ∼30% of women failed to achieve a target trough concentration. Increasing the dose of IDV/r during pregnancy to 600/100mg twice daily may be preferable to ensure adequate drug concentrations. © 2013 The Authors. Source


Duong T.,Institute Of Recherche Pour Le Developpement Ird Umi 174 | Duong T.,London School of Hygiene and Tropical Medicine | Jourdain G.,Institute Of Recherche Pour Le Developpement Ird Umi 174 | Jourdain G.,Chiang Mai University | And 17 more authors.
PLoS ONE | Year: 2012

Background: Data on determinants of long-term disease progression in HIV-infected patients on antiretroviral therapy (ART) are limited in low and middle-income settings. Methods: Effects of current CD4 count, viral load and haemoglobin and diagnosis of AIDS-defining events (ADEs) after start of combination ART (cART) on death and new ADEs were assessed using Poisson regression, in patient aged ≥18 years within a multi-centre cohort in Thailand. Results: Among 1,572 patients, median follow-up from cART initiation was 4.4 (IQR 3.6-6.3) years. The analysis of death was based on 60 events during 6,573 person-years; 30/50 (60%) deaths with underlying cause ascertained were attributable to infections. Analysis of new ADE included 192 events during 5,865 person-years; TB and Pneumocystis jiroveci pneumonia were the most commonly presented first new ADE (35% and 20% of cases, respectively). In multivariable analyses, low current CD4 count after starting cART was the strongest predictor of death and of new ADE. Even at CD4 above 200 cells/mm3, survival improved steadily with CD4, with mortality rare at ≥500 cells/mm3 (rate 1.1 per 1,000 person-years). Haemoglobin had a strong independent effect, while viral load was weakly predictive with poorer prognosis only observed at ≥100,000 copies/ml. Mortality risk increased following diagnosis of ADEs during cART. The decline in mortality rate with duration on cART (from 21.3 per 1,000 person-years within first 6 months to 4.7 per 1,000 person-years at ≥36 months) was accounted for by current CD4 count. Conclusions: Patients with low CD4 count or haemoglobin require more intensive diagnostic and treatment of underlying causes. Maintaining CD4≥500 cells/mm3 minimizes mortality. However, patient monitoring could potentially be relaxed at high CD4 count if resources are limited. Optimal ART monitoring strategies in low-income settings remain a research priority. Better understanding of the aetiology of anaemia in patients on ART could guide prevention and treatment. © 2012 Duong et al. Source


Sriwongpan P.,Chiang Mai University | Krittigamas P.,Nakornping Hospital | Kantipong P.,Chiang Rai Prachanukroh Hospital | Kunyanone N.,Chiang Rai Prachanukroh Hospital | And 2 more authors.
Risk Management and Healthcare Policy | Year: 2013

Background: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices. Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement), and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression. Results: A total of 526 patients were classified into nonsevere (n = 357), severe (n = 100), and deceased (n = 69). The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45-0.74, P < 0.001), increased pulse rate (OR = 1.03, 95% CI = 1.01-1.05, P < 0.001), presence of crepitation (OR = 3.25, 95% CI = 1.52-6.96, P =0.001) increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95-0.98, P = 0.001), increased aspartate aminotransferase (every 10 IU/L) (OR = 1.04, 95% CI = 1.02-1.06, P=0.001), increased serum albumin (OR = 0.47, 95% CI = 0.27-0.80, P = 0.001), increased serum creatinine (OR = 1.83, 95% CI = 1.50-2.24, P < 0.01), and increased levels of positive urine albumin (OR = 1.43, 95% CI = 1.17-1.75, P< 0.001). Conclusion: Patients suspicious of scrub typhus with low body temperature, rapid pulse rate, presence of crepitation, low percentage of lymphocyte, low serum albumin, elevated aspartate aminotransferase, elevated serum creatinine, and positive urine albumin should be monitored closely for severity progression. © 2013 Sriwongpan etal. Source

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