Comparisons of clinical characteristics between adult patients with 2009 H1N1 influenza and those with seasonal influenza during the 2009 epidemic in Thailand.

Clinical presentations of patients with 2009 H1N1 influenza are generally similar to those of patients with seasonal influenza. A cross-sectional study was conducted among adults at an outpatient clinic in a university hospital setting during the 2009 epidemic. Infections in all patients were confirmed by real-time reverse transcription-polymerase chain reaction.

Simultaneous detection and subtyping of H274Y-positive influenza A (H1N1) using pyrosequencing.

Introduction: We investigated the frequency of H274Y-positive swine-origin 2009 A (H1N1) influenza virus outbreak in Thailand during May-August 2009. 

Methodology: This study sought to find Oseltamivir resistance mutation H274Y by using pyrosequencing.

Results: From 8,710 real-time RT-PCR swine-origin 2009 A(H1N1) influenza virus-positive specimens, 100 randomly selected samples identified one such virus with H274Y mutation  using pyrosequencing.

Invasive pneumococcal disease in Phramongkutklao Hospital 2004-2008: clinical data, serotype distribution and antimicrobial resistance patterns.

Objective: To describe the clinical course, serotype distribution and antimicrobial resistance patterns of invasive pneumococcal disease (IPD) cases in a public hospital.

Material And Method: Retrospective review of IPD cases occurring from January 2004 through December 2008 was performed. Antibiotic susceptibility testing and serotyping were performed for available isolates.

HIV-1 drug resistance mutations in children who failed non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy.

Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens have recently been used in HIV-1 infected children in resource-limited settings. Treatment failure with this regimen has become more common. A second regimen needs to be prepared for the Thai national program.

A patient with penicillin-resistant viridans group streptococcal endocarditis and unusual reactions to vancomycin.

There is a paucity of data regarding the treatment of endocarditis caused by penicillin-resistant viridans group streptococci (PR-VGS). We report a 16-year-old girl who had native-valve endocarditis due to PR-VGS which was identified as Streptococcus mitis. She also had unusual reactions to vancomycin.

Evidence-based medicine in clinical curriculum.

Introduction: The teaching of evidence-based medicine (EBM) has now been incorporated as an integral part of medical curriculum at the Faculty of Medicine, Ramathibodi Hospital but there is little research into the effectiveness of the course. The purpose of this report is to evaluate the EBM skills of medical students and competency of the faculty member.

Materials And Methods: The EBM course was created by the EBM Working Group at the Faculty of Medicine, Ramathibodi Hospital for 3rd- to 6th-year medical students.

Four novel and three recurrent mutations of the BTK gene and pathogenic effects of putative splice mutations.

X-linked agammaglobulinemia is caused by mutations in the human BTK gene, leading to recurrent pyogenic infections. We describe four novel and three known BTK-mutations in seven patients from seven (six Thai and one Burmese) families. All but one were sporadic cases.

A bedside prediction-scoring model for late-onset neonatal sepsis.

Objective: Insufficient tools for bedside prediction of late-onset neonatal sepsis (LNS) initiated this study. The objective was to develop and validate a simple prediction-scoring model for LNS defined as culture-proven sepsis occurring 72 hours after birth.

Methods: The study was performed at a university hospital in Bangkok.

Invasive Chromobacterium violaceum infection in children: case report and review.

A 3.3-year-old boy developed Chromobacterium violaceum abscesses of lungs, liver and spleen and was successfully treated. He had chronic granulomatous disease (CGD).

Vertical dengue infection: case reports and review.

Two vertical dengue infection cases are presented, and 15 others are reviewed. Twelve mothers had fever 0-9 (median, 2) days antepartum. The fevers of 17 neonates occurred at 1-11 (median, 4) days of life and lasted for 1-5 (median, 3) days.

Hemophagocytic syndrome and Burkholderia cepacia splenic microabscesses in a child with chronic granulomatous disease.

Hemophagocytic syndrome, splenic microabscesses and pulmonary cavitary lesions were presented in a 17-month-old boy with prolonged fever, hepatosplenomegaly and a history of tuberculous lymphadenitis. Clinical course mimicked tuberculosis. Blood cultures were negative.

Detection of the impairment of CD80 expression on circulating monocytes in HIV-infected Thai children.

The mechanism of progressive anergic response in HIV-infected children has yet to be adequately described. One possibility is inappropriate delivery of an essential second signal for T-cell activation due to the inappropriate presentation of co-stimulatory molecules. To determine whether the ligand for the secondary signal is impaired in pediatric AIDS, we compared the level of CD80 expression by circulating monocytes in HIV-infected and-noninfected children (15 mild/asymptomatic, 13 symptomatic and 12 HIV seronegative children).

Antimicrobial resistance in countries with limited resources: unique challenges and limited alternatives.

The haphazard use of antimicrobial agents has caused these essential drugs to lose their effectiveness. In the resource-poor parts of the world, the problem is complex, involving inadequate access to antimicrobial agents in the poorest countries along with an excessive variety of drugs in middle-income countries that have inadequate capability to use them well or to control the unnecessary emergence of resistant microbes. Both circumstances may result in the rapid dissemination of antimicrobial resistance.

Elective cesarean delivery plus short-course lamivudine and zidovudine for the prevention of mother-to-child transmission of human immunodeficiency virus type 1.

Objective: The purpose of this study was to evaluate the effect of elective cesarean delivery plus a lamivudine-zidovudine prophylaxis regimen on non-breastfeeding mothers with human immunodeficiency virus type 1 and their infants.

Study Design: Forty-six antiretroviral-naïve, pregnant women with human immunodeficiency virus type 1 were included. The prophylactic regimen was a lamivudine-zidovudine tablet (150 mg/300 mg) twice daily from week 34 of pregnancy until cesarean delivery at week 38 of gestation, preoperative intravenous zidovudine, and neonatal zidovudine syrup for 4 weeks.

Mother-to-child transmission of cryptococcus neoformans.

Cryptococcal meningitis was diagnosed in a 92-day-old boy who was not HIV-1-infected and who survived after treatment, although with hydrocephalus. The mother was HIV-1-infected, delivered prematurely, had peripartum cryptococcal meningitis and died 14 days postpartum. There was no other possible source for cryptococcal infection in this infant.

Pediatric invasive pneumococcal disease in a teaching hospital in Bangkok.

Background: Increased problems with drug-resistant Streptococcus pneumoniae (SP) and the dearth of epidemiologic and clinical information on invasive pneumococcal disease in children in Asia formed the basis for this study.

Methods: A periodic retrospective review of the records of 0-15-year-old patients was conducted at a teaching hospital in Bangkok, during 1971-2000.

Results: Infections with penicillin-non-susceptible SP (PNSSP) strains rapidly increased after they first appeared in 1988, and they accounted for 71% (29/41) of the total cases during 1996-2000.

Utilization of restricted antibiotics in a university hospital in Thailand.

Antibiotic resistance, a major negative consequence of antibiotic overuse, is an important problem worldwide. Various means have been used to control antibiotic usage including the use of an antibiotic order form (AOF), restricted antibiotic formularies and provision of educational information. The present study was designed to evaluate the use of antimicrobials in a 1,000-bed university hospital.

Norfloxacin and azithromycin for treatment of nontyphoidal salmonella carriers.

There has been inadequate evaluation of an antibiotic for eradication of nontyphoidal salmonellae (NTS) in asymptomatic carriers. In a randomized, placebo-controlled trial, such efficacy was evaluated using 2 five-day regimens (norfloxacin, 400 mg twice per day, and azithromycin, 500 mg once per day) compared with placebo. The study included 265 food workers in an area of Thailand where NTS are endemic who were asymptomatic NTS carriers.

Prevalence of HIV-1 drug resistance in antiretroviral-naive pregnant Thai women.

HIV-1 drug resistance may limit the use of antiretrovirals when attempting to reduce the vertical transmission rate. Establishing the prevalence of the HIV-1 mutations associated with antiretroviral resistance in pregnant women will enable clinicians to maximize the chances of preventing vertical transmission. In order to determine the prevalence of HIV-1 resistant strains among antiretroviral-naive pregnant Thai women, the nucleotide sequences of the HIV-1 polymerase (pol) gene were evaluated.

Neonatal tuberculosis associated with shock, disseminated intravascular coagulation, hemophagocytic syndrome, and hypercalcemia: a case report.

We report on a female infant with disseminated tuberculosis who presented with clinical sepsis and disseminated intravascular coagulation starting at 14 days of age. Parenteral ofloxacin combined with streptomycin were used because the enteral route was not possible and intravenous isoniazid and rifampicin were not available. Rare complications including infection-associated hemophagocytic syndrome, hypercalcemia, and adrenal insufficiency were detected and successfully managed.