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PubMed | Nan Hospital, The Queen Sirikit National Institute of Child Health and Khon Kaen University
Type: Journal Article | Journal: World journal of microbiology & biotechnology | Year: 2016

Carbapenemase-producing Enterobacteriaceae (CPE) isolates have now emerged worldwide. We therefore modified the phenotypic Carba NP test by use of a filter paper strip for easily and rapidly identifying CPE in routine laboratory. A collection of 56 CPE and carbapenemase-producing Pseudomonas spp. isolates (including 28 NDM-1, 11 IMP-14a, 1 IMP-1, 1 IMP-4, 1 IMP-9, 1 IMP-15, 4 VIM-2, 1 VIM-1, 1 IMP-14a with VIM-2, 3 OXA-48, 3 OXA-181 and 1 KPC-2 producers) and 41 non-CPE isolates (including 19 ESBL, 7 pAmpC, 3 AmpC, 9 ESBL with pAmpC and 3 non-ESBL & non-AmpC producers) as confirmed by the PCR methods were tested by the paper strip method using pharmaceutical imipenem/cilastatin as a substrate. Bacterial colonies of each isolate were applied directly on filter paper strips dropped with either imipenem-phenol red (test strip) or phenol red solution alone (control strip). The reaction was read within 5min. This test failed to detect 3 OXA-181, 2 OXA-48 and 3 IMP-14a producers (85.7% sensitivity), whereas no false positives were seen (100% specificity). Further evaluation of the paper strip test in 267 CPE screening-positive isolates from three hospitals by their medical technologists showed 92.0% sensitivity (100% for NDM producers) and 100% specificity compared with the PCR methods. Because of its ease, rapidness and cost effective, the paper strip test has a potential for routine CPE testing in low-resource laboratories particularly in areas with high prevalence of NDM enzymes, leading to appropriate antimicrobial therapy and infection control strategy.


PubMed | Ajou University, LG Corp, Eulji University, Catholic University of Korea and 7 more.
Type: Journal Article | Journal: Diabetes, obesity & metabolism | Year: 2016

Gemigliptin is a new dipeptidyl peptidase-IV inhibitor. We investigated the efficacy and safety of initial combination therapy with gemigliptin and metformin compared with monotherapy with either drug in patients with type 2 diabetes (T2D).A total of 433 T2D patients with a glycosylated haemoglobin (HbA1c) level of 7.5% to 11.0% and a fasting plasma glucose (FPG) concentration <270 mg/dL were randomly assigned to 3 groups: (1) gemigliptin 50 mg qd + metformin 1000 to 2000 mg qd (titrated individually), (2) gemigliptin 50 mg qd, or (3) metformin 1000 to 2000 mg qd. The primary end-point was the change in HbA1c level after 24 weeks. Secondary end-points were the changes in FPG, insulin, proinsulin and C-peptide levels. The percentages of responders who achieved an HbA1c level <7% (or <6.5%) were compared between treatment groups.Baseline HbA1c levels were 8.7% in all groups. The mean changes in HbA1c level from baseline to week 24 were -2.06%, -1.24% and -1.47% in the combination, gemigliptin monotherapy and metformin monotherapy groups, respectively. The 95% confidence intervals for between-group differences in HbA1c changes were -1.02 to -0.63 in the combination group vs the gemigliptin group and -0.82 to -0.41 vs the metformin group, which confirmed the superiority of combination therapy. A significantly higher percentage of patients in the combination therapy group reached the target HbA1c level <7% (or <6.5%) compared with the monotherapy groups. No severe side effects were observed.In T2D patients, the initial combination of gemigliptin and metformin had superior efficacy without safety concerns compared with monotherapy with either drug.


Srisawat N.,Chulalongkorn University | Srisawat N.,University of Pittsburgh | Praditpornsilpa K.,Chulalongkorn University | Patarakul K.,Chulalongkorn University | And 22 more authors.
PLoS ONE | Year: 2015

AKI is one of the most serious complications of leptospirosis, an important zoonosis in the tropics. Recently, NGAL, one of the novel AKI biomarkers, is extensively studied in various specific settings such as sepsis, cardiac surgery, and radiocontrast nephropathy. In this multicenter study, we aimed to study the role of NGAL as an early marker and an outcome predictor of leptospirosis associated AKI. Patients who presented with clinical suspiciousness of leptospirosis were prospectively enrolled in 9 centers from August 2012 to November 2014. The first day of enrollment was the first day of clinical suspicious leptospirosis. Blood and urine samples were serially collected on the first three days and day 7 after enrollment. We used three standard techniques (microscopic agglutination test, direct culture, and PCR technique) to confirm the diagnosis of leptospirosis. KDIGO criteria were used for AKI diagnosis. Recovery was defined as alive and not requiring dialysis during hospitalization or maintaining maximum KDIGO stage at hospital discharge. Of the 221 recruited cases, 113 cases were leptospirosis confirmed cases. Thirty seven percent developed AKI. Median uNGAL and pNGAL levels in those developing AKI were significantly higher than in patients not developing AKI [253.8 (631.4) vs 24.1 (49.6) ng/ml, p < 0.001] and [1,030 (802.5) vs 192.0 (209.0) ng/ml, p < 0.001], respectively. uNGAL and pNGAL levels associated with AKI had AUC-ROC of 0.91, and 0.92, respectively. Both of urine NGAL and pNGAL level between AKI-recovery group and AKI-non recovery were comparable. From this multicenter study, uNGAL and pNGAL provided the promising result to be a marker for leptospirosis associated AKI. However, both of them did not show the potential role to be the predictor of renal recovery in this specific setting. © 2015 Srisawat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | Banglamung Hospital, Dokkhamtai Hospital, Chiang Mai University, Wangyang Hospital and 3 more.
Type: Journal Article | Journal: Pediatric dentistry | Year: 2015

To directly compare the survival rates of three incomplete caries removal techniques that differed in the amount of caries removal and the base material used.Ninety-six primary molars with asymptomatic deep caries or reversible pulpitis were randomly assigned to three groups: (1) indirect pulp treatment (IPT); (2) minimal caries removal with both resin-modified glass ionomer base material and luting cement (MCRB/L); and (3) minimal caries removal with only resin-modified glass ionomer luting cement (MCRL). The treatments were followed clinically and radiographically for two years.The two-year survival probabilities in the IPT, MCRB/L, and MCRL groups were 0.90 (95 percent confidence interval [CI] equals 0.73 to 0.97), 0.93 (95 percent CI equals 0.76 to 0.98), and 0.77 (95 percent CI equals 0.58 to 0.89), respectively. There was no significant difference in the two-year survival probabilities of the three studied groups (generalized Wilcoxon P=.07).Following two years, neither the amount of caries removal nor the base material affected the success of incomplete caries removal treatment. However, minimal caries removal with MCRB/L presented the highest survival rate among the tested groups and resulted in no incidence of pulp exposure.


PubMed | Krasang hospital, Maharaj Nakhon Si Thammarat hospital, Mahasarakarm hospital, Roiet hospital and 6 more.
Type: Journal Article | Journal: PloS one | Year: 2015

AKI is one of the most serious complications of leptospirosis, an important zoonosis in the tropics. Recently, NGAL, one of the novel AKI biomarkers, is extensively studied in various specific settings such as sepsis, cardiac surgery, and radiocontrast nephropathy. In this multicenter study, we aimed to study the role of NGAL as an early marker and an outcome predictor of leptospirosis associated AKI. Patients who presented with clinical suspiciousness of leptospirosis were prospectively enrolled in 9 centers from August 2012 to November 2014. The first day of enrollment was the first day of clinical suspicious leptospirosis. Blood and urine samples were serially collected on the first three days and day 7 after enrollment. We used three standard techniques (microscopic agglutination test, direct culture, and PCR technique) to confirm the diagnosis of leptospirosis. KDIGO criteria were used for AKI diagnosis. Recovery was defined as alive and not requiring dialysis during hospitalization or maintaining maximum KDIGO stage at hospital discharge. Of the 221 recruited cases, 113 cases were leptospirosis confirmed cases. Thirty seven percent developed AKI. Median uNGAL and pNGAL levels in those developing AKI were significantly higher than in patients not developing AKI [253.8 (631.4) vs 24.1 (49.6) ng/ml, p < 0.001] and [1,030 (802.5) vs 192.0 (209.0) ng/ml, p < 0.001], respectively. uNGAL and pNGAL levels associated with AKI had AUC-ROC of 0.91, and 0.92, respectively. Both of urine NGAL and pNGAL level between AKI-recovery group and AKI-non recovery were comparable. From this multicenter study, uNGAL and pNGAL provided the promising result to be a marker for leptospirosis associated AKI. However, both of them did not show the potential role to be the predictor of renal recovery in this specific setting.


Techasena W.,Nan Hospital | Wongwacharapiboon P.,Nan Hospital | Terawanich S.,Phrae Hospital | Pattamadilok S.,National Health Research Institute
Journal of the Medical Association of Thailand | Year: 2011

The authors have added the second dose of measles vaccine to children aged 18 months since 1997 because of the measles outbreaks in Nan province in 1993-1994. Objective: To compare measles antibody level between two doses vaccination at 9, 18 months and single dose at 9 months in children at the age of 4 to 6 years old. Material and Method: A cross sectional serological study in children 4 to 6 years old was performed between August 2008 and August 2009 at three hospitals in Nan and Phrae provinces. The subjects were divided into two groups, 1) 100 children in Nan provincial hospital received two doses of measles vaccination at the age of 9 and 18 months and 2) 91 children received single dose measles vaccination at the age of 9 months, 41 from Phrae provincial hospital and 50 from Weingsa district hospital. Blood samples were drawn for measles antibody measurement by ELISA assays at Virus Research Institute, National Institute of Health, Thailand. Results: The mean measles antibody level in children 4 to 6 years old in both groups was a satisfactory high level, 1,887.67 and 1,621.02 mIU/ml in single and two doses vaccination respectively, which were not statistically significant (p = 0.431). The higher level in single dose group could be explained by the average age being younger than the two doses group by one year (4 years 2 months vs. 5 years 4 months). Therefore, the waning immunity in younger age group is suspected to be less than the older age group. The rate of protective measles antibody level (≥ 255 mIU/ml) was significantly higher in the two doses group than the single dose, 87% compared to 76% (p = 0.046), which represented primary vaccine failure at the age 4 to 6 years of 13% and 24%, respectively. Conclusion: The authors suggest that a second dose of measles vaccine at the age of 18 months be administered to decrease the number of primary vaccine failure from 24% to 13%. Further studies in the same age group and in different areas are required to confirm these findings.


Witoonpanich R.,Mahidol University | Vichayanrat E.,Mahidol University | Tantisiriwit K.,Nan Hospital | Wongtanate M.,Nan Hospital | And 9 more authors.
Clinical Toxicology | Year: 2010

Introduction. Botulism is a rare presynaptic neuromuscular junction disorder caused by potent toxins produced by the anaerobic, spore-forming, Gram-positive bacterium Clostridium botulinum. Food-borne botulism is caused by the ingestion of foods contaminated with botulinum toxin. In March 2006, there was a large outbreak of food-borne botulism associated with the ingestion of home-canned bamboo shoots in Thailand. The survival analyses for respiratory failure in these patients were studied and are reported here. Methods. A prospective observational cohort study was conducted on this outbreak. The primary outcome of interest was the time to respiratory failure. The secondary outcome was the time to weaning off ventilator. The prognostic factors associated with respiratory failure and weaning off ventilator are presented. Results. A total of 91 in-patients with baseline clinical characteristics were included. Most cases first presented with gastrointestinal symptoms followed by neurological symptoms, the most striking of which being difficulty in swallowing. Common clinical features included ptosis, ophthalmoplegia, proximal muscle weakness, pupillary abnormality, and respiratory failure. Forty-two patients developed respiratory failure requiring mechanical ventilation and the median duration on ventilator was 14 days. The median length of hospital stay for all patients was 13.5 days. Difficulty in breathing, moderate to severe ptosis, and dilated and fixed pupils were associated with respiratory failure. Among patients who were on ventilators, a short incubation period and pupillary abnormality were associated with a longer period of mechanical ventilation. All patients had antitoxin injection and there was no mortality in this outbreak. Conclusion. The history of difficult breathing and the findings of moderate to severe ptosis and pupillary abnormality were associated with severe illness and respiratory failure. A long incubation time was associated with a better prognosis. Although botulism is a potentially fatal disease, there was no mortality in this outbreak. All patients had antitoxin injection and good intensive care that resulted in good clinical outcomes. Copyright © Informa UK, Ltd.


PubMed | Naresuan University and Nan Hospital
Type: Journal Article | Journal: Indian journal of clinical biochemistry : IJCB | Year: 2015

Severe hemolytic anemia in -thalassemia major and -thalassemias/HbE (-TM) patients requires giving blood transfusions. Chronic blood transfusions lead to iron overload consequence with organs damage and risk of alloantibody-formation. This study evaluates the prevalence of red cell alloimmunization and estimates the risk of alloantibody-formation in chronic transfusion-dependent -TM patients. This cross sectional study was conducted on 143 -TM patients receiving regular transfusions. We tried to determine the frequency, types and factors influencing red cell alloimmunization in these transfusion-dependent -TM patients. Median age of 25 (17.5%) alloantibody-formation -TM patients was 19.0years (inter quartile 15.5-24.0years). The alloantibodies were Anti-Rh (E) (13.1%), Anti-Rh (D) (0.7%). Thirty-four patients (23.8%) of the sample had splenectomies of which 10 (29.4%) had alloantibody-formation. The interval from first transfusion to antibody development varied from 1.5 to 14years. Alloantibody-formation correlated with splenectomy and splenectomy correlated with number of transfusion (p<0.005). In multiple logistic regression used to estimate the risk of alloantibodies formation with splenectomy; OR and 95% CI were 2.88 (1.07-7.80), p=0.037 after adjusting for other co-variates. The rate of red cell alloimmunization was 17.5% and splenectomy associated with increased alloantibody-formation in these transfusion-dependent -TM patients.


PubMed | Nan Hospital
Type: Comparative Study | Journal: Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2011

The authors have added the second dose of measles vaccine to children aged 18 months since 1997 because of the measles outbreaks in Nan province in 1993-1994.To compare measles antibody level between two doses vaccination at 9, 18 months and single dose at 9 months in children at the age of 4 to 6 years old.A cross sectional serological study in children 4 to 6 years old was performed between August 2008 and August 2009 at three hospitals in Nan and Phrae provinces. The subjects were divided into two groups, 1) 100 children in Nan provincial hospital received two doses of measles vaccination at the age of 9 and 18 months and 2) 91 children received single dose measles vaccination at the age of 9 months, 41 from Phrae provincial hospital and 50 from Weingsa district hospital. Blood samples were drawn for measles antibody measurement by ELISA assays at Virus Research Institute, National Institute of Health, Thailand.The mean measles antibody level in children 4 to 6 years old in both groups was a satisfactory high level, 1,887.67 and 1,621.02 mIU/ml in single and two doses vaccination respectively, which were not statistically significant (p = 0.431). The higher level in single dose group could be explained by the average age being younger than the two doses group by one year (4 years 2 months vs. 5 years 4 months). Therefore, the waning immunity in younger age group is suspected to be less than the older age group. The rate of protective measles antibody level (> or = 255 mIU/ml) was significantly higher in the two doses group than the single dose, 87% compared to 76% (p = 0.046), which represented primary vaccine failure at the age 4 to 6 years of 13% and 24%, respectively.The authors suggest that a second dose of measles vaccine at the age of 18 months be administered to decrease the number of primary vaccine failure from 24% to 13%. Further studies in the same age group and in different areas are required to confirm these findings.

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