RESUMEN
BACKGROUND: A study was undertaken to evaluate the diagnostic value of pleural fluid concentrations of interferon gamma (IFN-gamma) as a marker of tuberculosis. METHODS: Patients admitted to King Chulalongkorn Memorial Hospital between April 1997 and January 1998 with a lymphocytic exudative pleural effusion were enrolled into the study. The pleural fluids were examined for cytology, staining for acid fast bacilli, and mycobacterial culture. Pathological examination and mycobacterial culture were performed on each pleural biopsy specimen. The diagnosis of tuberculosis was made when one of the following criteria was met: (1) Mycobacterium tuberculosis was isolated from either the pleural fluid or pleural tissue; (2) granulomas were demonstrated in the pleural tissue which stained positive for acid fast bacilli (AFB); or (3) in the presence of granulomas negative on staining for AFB in pleural tissue there was a response to antituberculous treatment on follow up. All pleural fluid samples were stored at -70 degrees C and the IFN-gamma level was measured by immunoassay. Analysis was made using sensitivity, specificity, and likelihood ratio for a positive test result. The best cut off point was determined by the highest likelihood ratio and receiver operating characteristic curve. RESULTS: A total of 66 patients were enrolled and tuberculosis was confirmed in 39 of them. The diagnoses in the non-tuberculous group included malignancy (15), paramalignancy (11), and chronic pleuritis secondary to infective endocarditis (1). The mean (SE) IFN-gamma level in the pleural fluid was significantly higher in the tuberculous group than in the non-tuberculous group (1493.3 (131.3) pg/ml versus 80.1 (50.4) pg/ml, p<0.001). The overlap between the two groups was minimal. At the cut off value of 240 pg/ml the sensitivity was 94.9% (95% CI 86.6 to 100), the specificity was 96.3% (95% CI 89.2 to 100), and the likelihood ratio for a positive test result was 25.6. CONCLUSIONS: The pleural fluid concentration of IFN-gamma is a good and useful diagnostic marker of tuberculosis presenting as a lymphocytic exudative pleural effusion.
Asunto(s)
Interferón gamma/análisis , Derrame Pleural/química , Tuberculosis Pleural/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Biomarcadores/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
This prospective study of assessing the efficacy and safety of lyophilized cryoprecipitate (LC), which was heat-treated at 60 degrees C for 25 hours, was conducted in 23 patients with hemophilia A (severe 13, moderate 9, mild 1) at the International Hemophilia Training Center, Bangkok from 1997 to 1998. A total of 223 infusions of LC were given. The status of the patients could be classified into 4 groups: group I, non-bleeding (n = 13); group II, severe bleeding requiring hospitalization (n = 9); group III, appendectomy (n = 1) and group IV, early bleeding controlled by modified home treatment (n = 200). Pharmacokinetic studies were conducted in groups I and II. The mean in vivo half-life of factor VIII clotting activity (F VIII:C) was 12.6 hours and the mean in vivo incremental recovery at baseline was 2.1 per cent/unit/kg. The mean clearance was 3.22 ml/kg/h. There was no statistically significant difference in these parameters between groups I and II (p > 0.05). The hemostasis was successfully achieved and 1 to 2 small urticarial wheals were observed in only 2 infusions. In addition, 9 out of 23 patients received LC exclusively for 1 year. None of them developed inhibitor to F VIII:C nor did any contract additional transfusion-transmitted infection except one who developed anti-hepatitis C virus seroconversion after receiving 16 bottles of LC in 4 months. Therefore, the more efficient virus-inactivation in the preparation of LC should be established.
Asunto(s)
Factor VIII/uso terapéutico , Hemofilia A/terapia , Adolescente , Adulto , Niño , Preescolar , Liofilización , Humanos , Lactante , Estudios Prospectivos , Activación ViralRESUMEN
Due to improvements in socio-economic and sanitation conditions, Thailand has undergone a change from hyperendemicity to intermediate endemicity for hepatitis A virus infection, leaving a large part of the adult population without immunity. At the same time, the country is still highly endemic for hepatitis B and especially in the northeast, hepatitis C virus infection both of which when acquired during infancy or early childhood exhibit a strong tendency to turn towards chronic liver disease, although in particular with hepatitis B virus the asymptomatic carrier state is also rather common. As no cross-immunity exists between any of these viruses, double or triple infections do occur, a situation where previously acquired immunity to HAV becomes crucial as double infections have been shown to take a more severe or even fatal course. In the present study, we investigated 820 HBV- and/or HCV-related chronic liver disease (CLD) patients and 195 blood donors, both groups divided by 10-year age intervals, for the prevalence of anti-HAV. The results showed the same age dependence of immunity for all groups tested as can be expected for an area of intermediate endemicity, in that approximately 50% of those between 21 and 30 years of age had acquired anti-HAV. These findings indicate the immune response to HAV infection not to be altered by chronic infection with either HBV or HCV. Hence, vaccination against HAV should be considered, particularly in anti-HAV-negative patients with CLD.
Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Portador Sano , Susceptibilidad a Enfermedades/etiología , Hepatitis A/etiología , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Cirrosis Hepática/complicaciones , Adulto , Distribución por Edad , Anciano , Portador Sano/epidemiología , Estudios de Casos y Controles , Enfermedad Crónica , Susceptibilidad a Enfermedades/sangre , Susceptibilidad a Enfermedades/epidemiología , Susceptibilidad a Enfermedades/inmunología , Enfermedades Endémicas/estadística & datos numéricos , Femenino , Hepatitis A/sangre , Hepatitis A/epidemiología , Hepatitis A/inmunología , Hepatitis A/transmisión , Anticuerpos de Hepatitis A , Anticuerpos Antihepatitis/sangre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Socioeconómicos , Tailandia/epidemiologíaRESUMEN
According to the International Committee for Standardization in Haematology (ICSH), we determined the reference values for reticulocytes using an automated blood cell analyzer Technicon H*3 RTC in 200 healthy adult blood donors, aged between 17 and 60 years, 100 of whom were male and 100 female. The parameters included reticulocyte count, and its corpuscular indices; mean reticulocyte corpuscular volume (MCVr), mean reticulocyte corpuscular hemoglobin concentration (CHCMr), mean reticulocyte hemoglobin content (CHr), reticulocyte distribution width (RDWr), reticulocyte hemoglobin distribution width (HDWr) and reticulocyte corpuscular hemoglobin concentration distribution width (CHDWr). The reference ranges were established by setting the reference limits at two standard deviations from the arithmetic reference mean.
Asunto(s)
Índices de Eritrocitos , Recuento de Reticulocitos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , TailandiaRESUMEN
One hundred and twenty two patients who were presenting with chronic persistent cough for more than 3-4 weeks were studied. Using anatomical and stepwise approach, we could identify the cause of chronic cough in 96% of the patients. The most common causes were due to postnasal drip syndrome (PND) (45%) and bronchial asthma (26%). We also demonstrated the important role of methacholine inhalation challenge in the diagnostic work up. The procedure could identify the patients who had bronchial hyperresponsiveness (BHR) in 52% of the cases. The severity degree of the BHR was classified into three levels. Mild or nonspecific BHR was defined as PC20 16-25 mg/ml. This could be found in many diseases such as PND and bronchiectasis. Moderate degree of BHR (PC20 8-16 mg/ml) was found in patients with PND and asthma. PC20 of less than 8 mg/ml was considered to be the most severe degree and it seemed to be specific for the diagnosis of asthma (positive predictive value 100%). Other condition that caused chronic cough were drug-induced, especially angiotensin-converting enzyme inhibitors, gastroesophageal reflux disease (GERD), idiopathic pulmonary fibrosis, subgottic cancer and idiopathic cough. These conditions may require invasive diagnostic work up, such as fiberoptic bronchoscopy and tissue biopsy. The treatment of chronic cough was according to the etiology. Thus, the patients presenting with chronic cough should be investigated to identify the cause, and it was not just only the administration of cough suppressant drugs in these patients.
Asunto(s)
Asma/diagnóstico , Tos/diagnóstico , Cloruro de Metacolina , Administración por Inhalación , Adulto , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Cloruro de Metacolina/administración & dosificación , Persona de Mediana EdadRESUMEN
The polymorphism of the human leucocyte antigen HLA-DR2 and the heterogeneity of HLA-DR2 class II-related haplotypes (HLA-DRB1-DRB5-DQA1-DQB1) were investigated in four populations of east and south-east Asia (SEA) and five Melanesian populations using TaqI restriction fragment length polymorphism (RFLP) analysis, and the polymerase chain reaction (PCR) amplification-based techniques PCR-RFLP and sequence-specific oligonucleotide (SSO) typing. The haplotype DRB1*1502-DRB5*0101-DQA1*0102-DQB1*0601 was common in Malaysians, Javanese, Thursday Islanders, Madang, Goroka and the Australian Aborigines, while DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502 was common in the Thai and Thursday Islanders. DRB1*1501-DRB5*0101-DQA1*0102-DQB1*0602 was present at a high frequency in Northern Chinese, Goroka, Watut and Australian Aborigines. The study describes four rare or unusual haplotypes: HLA-DRB1*1501-DRB5*0101-DQA1*0101-DQB1*0601, DRB1*1502-DRB5*0101-DQA1*0101-DQB1*0502, DRB1*1502-DRB5*0102-DQA1* 0102-DQB1*0502 and DRB1*1501-DRB5*0101-DQA1*0101/2-DQB1*0503; the latter two were confirmed by segregation in two Javanese families. A new DR2 allele, initially detected by PCR-RFLP and confirmed by DNA sequencing as DRB1*16022 (previously designated DRB1*16Madang), was seen in a Madang individual. A new HLA-DR2 TaqI RFLP subtype, locally designated as DR15U, is also described. This RFLP subtype segregated in a Javanese family and correlated with a typically SEA haplotype, DRB1*1502-DRB5*0102-DQA1*0101-DQB1*0501. The allele HLA-DR16Thai, determined by TaqI DRB RFLP, was found by PCR-RFLP and SSO typing to correlate with a unique SEA haplotype, HLA-DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502, and was observed in the Thai, Malaysian, Thursday Islander, Javanese and Northern Chinese populations.
Asunto(s)
Alelos , Antígenos HLA-DQ/clasificación , Antígenos HLA-DR/clasificación , Antígeno HLA-DR2/clasificación , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo de Longitud del Fragmento de Restricción , Asia Sudoriental , Australia , Secuencia de Bases , China , ADN , Variación Genética , Antígenos HLA-DQ/genética , Cadenas alfa de HLA-DQ , Cadenas beta de HLA-DQ , Antígenos HLA-DR/genética , Antígeno HLA-DR2/genética , Cadenas HLA-DRB1 , Cadenas HLA-DRB5 , Haplotipos , Humanos , Datos de Secuencia Molecular , PoblaciónRESUMEN
The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.
Asunto(s)
Servicios Médicos de Urgencia , Grupo de Atención al Paciente , Calidad de la Atención de Salud , Adulto , Anciano , Femenino , Mortalidad Hospitalaria , Hospitales de Distrito , Humanos , Tiempo de Internación , Persona de Mediana Edad , TailandiaRESUMEN
Of 782,190 volunteer blood donors in Bangkok and nearby areas, who were screened for infection with human immunodeficiency type 1 (HIV-1) from January 1988 through December 1992, 3,219 tested positive on both enzyme immuno assay and Western blot assay. The identification variables of the donor were collected. The majority of HIV seropositive blood donors were male. The average age (median) of HIV seropositive was 26-29 years all through 1988-2992. The prevalence of HIV seropositive in male donors was higher than that in females. HIV seropositivity was confirmed in blood donations from first-time male donors in this study during 1988-1992. This rate has increased progressively from 0.87/1,000 in 1988 to 15.95/1,000 in 1992 with much higher rates in repeat donors. The repeat male donors increased from 0.77/1,000 in 1988 to 5.26/1,000 in 1991 and since then showed a decreased rate to 3.93/1,000 in 1992. Female donors were infected with HIV more frequently with the prevalence by sex ratio M:F rising from 27:1 in 1988 to 6.6:1 in 1992. Comparing the seropositive rate between first time and repeat female donors, the results showed an increase in rate from 0.11/1,000 in 1990 to 2.02/1,000 in 1992, but essentially the same rate in report donors. A majority of HIV seropositive blood donors (1990-1992) lived in Bangkok (42-49%) and among those who lived in one eastern province (Samut Prakan), 90-93% lived in the industrial areas. Of those who lived in Chon Buri Province, 73-88% lived in Sattaheep District, which is a naval base.
Asunto(s)
Donantes de Sangre , Seropositividad para VIH/epidemiología , VIH-1 , Adulto , Western Blotting , Ensayo de Inmunoadsorción Enzimática , Femenino , VIH-1/aislamiento & purificación , Humanos , Masculino , Prevalencia , Características de la Residencia , Distribución por Sexo , Tailandia/epidemiologíaRESUMEN
One hundred and forty three among five hundred and twenty-six cases of bacterial pneumonia in adults (27.2%) who had pleural effusion (parapneumonic effusion) admitted to Chulalongkorn Hospital during the period January 1987 to December 1991 were analyzed. There were 40 cases with effusion that was less than 10 mm thick on chest decubitus film, 44 cases of uncomplicated exudative phase, 40 cases of complicated exudative phase (early empyema) and 19 cases of empyema. Most patients in our study required thoracocentesis (72%), had early empyema and emyema (41.3%) as well as high incidence of positive organisms on Gram stain in pleural fluid. This indicates that our patients may have had a prolonged clinical course before coming to the hospital. About half of our patients had pleuitic chest pain or signs of pleural effusion. Among the various stages of parapneumonic effusion, the empyema group had the most delayed response to treatment and needed intercostal drainage for twice the duration of the early empyema group (15.69 vs 7.55 days). The overall mortality was 22.4 per cent. Factors associated with death were advanced age, hospital acquired and broncho-pneumonia, abnormal host, no pleuritic chest pain, no signs of consolidation, respiratory failure, shock and complications of assisted ventilation.
Asunto(s)
Derrame Pleural/complicaciones , Neumonía Bacteriana/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Derrame Pleural/epidemiología , Neumonía Bacteriana/epidemiología , Pronóstico , Tailandia/epidemiologíaRESUMEN
Five hundred and twenty-six cases of bacterial pneumonia in adults admitted to Chulalongkorn Hospital during the period January 1987 to December 1991 were studied, comparing the elderly aged > or = 60 years (241 cases) with the nonelderly < 60 years of age (285 cases). The study indicates that there was a significantly increased number of community and hospital-acquired pneumonia in the elderly than previously reported. Pneumonia in the elderly might present with no fever, no cough no signs of parenchymal infiltration, but significant mental changes. There was a higher incidence of pleural involvement, but lower incidence of septic shock in the non-elderly than the elderly, which suggests that the nonelderly had better systemic resistance against bacterial infection than the elderly. There was no significant difference in complete blood count between the two groups. However, sputum specimens to be collected through endotracheal tube and Gram-negative bacilli on Gram stain were found more in the elderly than the non-elderly. The elderly had more respiratory failure requiring mechanical ventilation, septic shock, and had higher mortality than the non-elderly. They also required longer duration of treatment and hospitalization. There were parameters which indicated the high-risk factors for mortality among the elderly. These included hospital-acquired pneumonia, bronchopneumonia, Gram-negative pneumonia, abnormal status of host, sputum specimens requiring collection by suction, respiratory failure and septic shock.
Asunto(s)
Neumonía Bacteriana , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/mortalidad , Neumonía Bacteriana/fisiopatología , Pronóstico , Factores de Riesgo , TailandiaRESUMEN
In Thailand, the prevalence of HIV infection in the general population and in donor blood (DB) has sharply increased since 1987. The HIV seropositive rate in DB was increased from 0.0065 per cent in 1987 to 0.95 per cent in 1993 (150 times in 6 years). Heterosexual transmission is the major route of spreading. Therefore, HIV seronegative blood (SNB) poses significant hazard to the recipients because of the risk of viraemia during the window period of early HIV infection. In Thailand HIV Ab screening in all units of blood was started in 1987 and was compulsory nationwide in early 1989. Donor self exclusion (DSE) has been implemented since 1990. It is not fully effective in the prevention of transfusion associated AIDS (TAA) because of many limiting factors. However, DSE should be promoted to practice in every blood bank particularly those that can not do HIV Ag screening. During 1990-1992, there were 30 reported cases of TAA by SNB. The study of risk figure (HIV Ag positive-neutralization with HIV Ab negative) in DB was 1:3,400 and 1:10,000 in two reports in 1991. Under all these circumstances, the national AIDS committee has documented the policy to do HIV Ag screening in every unit of blood from August 1991 and allocated a 10 million baht budget (year 1992) for Ag testing. Several hospitals and NBC reported the risk figures which varied from 1:3,400 to 1:25,000. A certain amount of blood is processed to 2-4 blood components given to 2-4 patients which will increase the number of TAA by SNB.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: In Thailand, the human immunodeficiency virus (HIV) seropositivity rate in donated blood increased 150 times from 1987 to 1993, from 0.0065% to 0.95%. Although the National Blood Center and large hospitals initiated HIV antibody screening of all blood in 1987, HIV seronegative blood can pose a serious hazard to recipients because of the risk of viremia during the window period of early HIV infection. Transfusion-associated acquired immunodeficiency syndrome (AIDS) from seronegative blood was first reported in Thailand in 1990 in three thalassemic children. To reduce this risk, HIV P24 Ag screening has been mandatory since 1990 and is estimated to prevent about 180 cases of transfusion-associated HIV transmission from seronegative blood per year. Less effective, yet recommended, is donor self-exclusion. Other preventive measures recommended include exclusion of donors from high-risk groups, public education, sensitive and early detection of IgM antibodies, promotion of autologous blood transfusion, and the use of blood substitutes or blood stimulating factors.
Asunto(s)
Donantes de Sangre , Infecciones por VIH/transmisión , Seronegatividad para VIH , Reacción a la Transfusión , Infecciones por VIH/epidemiología , Humanos , Tailandia/epidemiología , Factores de TiempoRESUMEN
Prevention of transfusion associated AIDS (TAA) in Thailand began in 1986 when the HIV infection started to be sharply increased among the general population. The retrospective anti-HIV screening in various blood donor populations by The National Blood Center (NBC) revealed a seroconverted prisoner. Then the use of prisoners, prisoners' blood was not recommended from 1986. In April 1987, the first case of TAA was disclosed. Five months later, anti-HIV screening in all units of blood was firstly introduced at Ramathibodi Hospital (RH) and NBC. From 1989, anti-HIV screening in all units of blood is mandatory nationwide by Ministry of Public Health. Despite the anti-HIV screening, TAA cases transmitted by seronegative blood were gradually reported. Among many Medical Centers, there were 9 and 18 cases of TAA recorded from Chiang Mai and Bangkok areas respectively, since 1985. In addition, several new seroconverters were observed among voluntary blood donors. All of this evidence indicates the existence of blood donation during the early stage of infection, the so-called "window period". At present, HIV-P24 antigen ELISA seems to be the only available technique for mass screening. In 1990, NBC successfully performed a retrospective study on HIV-Ag ELISA screening by obtaining the prevalence of 1/10,000 units of blood. At the same period of time, in RH prospective study, a unit of blood with HIV-Ag only was detected when 3432 units of blood were screened. The HIV-Ag ELISA screening was then performed on every unit of blood routinely since Aug 12, 1991 at RH.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/etiología , Seronegatividad para VIH , Reacción a la Transfusión , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Humanos , Vigilancia de la Población , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Tailandia/epidemiologíaRESUMEN
Among 182 episodes with ARF (PaCO2 > 50 torr) in 400 episodes of COPD patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986, despite conservative treatment, 66 developed severe acute respiratory failure requiring assisted ventilation. Patients with a history of chronic cough, pneumonia as a precipitating factor and more severe ARF on admission, as indicated by palpitation, headache, cyanosis, alteration of consciousness, cor-pulmonale and decompensated acidosis (pH < 7.30), were likely to require mechanical ventilation. Indications for mechanical ventilation were carbon dioxide narcosis (43 episodes), severe hypoxemia despite on a high FIO2 (one episode), various combination parameters of respiratory muscle fatigue, cardiovascular instability (22 episodes). The major complications of mechanical ventilation were pneumonia, sepsis, pneumothorax, UGI bleeding of 16, 8, 5 and 9 episodes, respectively. The average duration of assisted ventilation and hospitalization were 15.8 and 19.02 days, respectively. The mortality rate was 50 per cent in the mechanical ventilation group compared with 9.8 per cent in the non-mechanical ventilation group. Increased mortality rate was found in those with pneumonia as the precipitating factor (68.4 vs 14.3%, respectively, in comparing the two groups). Complications of mechanical ventilation, which included pneumonia, sepsis, fluid overload, hyponatremia and persistent acidosis, were high-risk factors for the non-surviving group.
Asunto(s)
Enfermedades Pulmonares Obstructivas/terapia , Respiración Artificial , Insuficiencia Respiratoria/terapia , Anciano , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Persona de Mediana Edad , Respiración Artificial/efectos adversos , Insuficiencia Respiratoria/etiologíaRESUMEN
There were 34 episodes of pneumothorax out of 400 episodes of COPD (i.e. 8.5% of the total) among patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986; the episodes of pneumothorax occurred among 22 males and one female, with the average age on admission being 64.0 +/- 8.5 years. All patients had a long history of smoking (average 40 years) with a history of recurrent pneumothorax (47.8%) and two episodes of pneumothorax per patient. Since only about one third of our patients had chest pain or positive signs of pneumothorax on physical examination, the possibility of pneumothorax should be considered in every patient who develops sudden and increasing shortness of breath, especially during mechanical ventilation, or even in association with other obvious precipitating factors, e.g. URI. With regard to complications, there were eight, four, two, two and five episodes of severe respiratory failure requiring assisted ventilation, tension pneumothorax, bilateral simultaneous pneumothorax, pneumomediastinum with subcutaneous emphysema, and plural effusion, respectively. The death rate was 23.5 per cent. Patients who had a pneumothorax requiring assisted ventilation or who developed a pneumothorax during assisted ventilation had a grave prognosis because of multiple complications from mechanical ventilation. Two episodes with minimal pneumothoraxes achieved re-expansion after conservative treatment. The treatment required 3.3 days for the lung to fully expand, 9.6 days when the air-leak stopped and the duration of tube drainage was 10.8 days. Our study indicates that the longer the duration of lung collapse the longer the time required for re-expansion of the lung.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedades Pulmonares Obstructivas/complicaciones , Neumotórax/etiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumotórax/diagnóstico , Neumotórax/terapia , Recurrencia , Respiración ArtificialRESUMEN
The immunogenicity of heat-inactivated plasma derived hepatitis B vaccines were studied in one hundred and eighty-two adult blood donor volunteers whose HBV markers (HBsAg, anti-HBs) were negative. They were randomized for four regimens of 3 micrograms intramuscular Hepaccine-B vaccine at the schedules of 0, 1, 2, 9 months, 0, 1, 3, 9 months, 0, 2, 6, 12 months, 0, 1, 6, 12 months and another regimen of 5 micrograms Hevac-B Pasteur vaccine at 0, 1, 2, 9 months. Blood specimens, tested for serological marker (anti-HBs), were drawn at 1, 3, 6, 9, 12 and 15 months following the initial injection. The outcome revealed that the Hepaccine-B vaccinated group in the schedules of 0, 2, 6, 12 and 0, 1, 6, 12 months yielded seroconversion rates of 48.7% and 56.8%, respectively one month after vaccination. After that, the immune response (anti-HBs titer) regularly increased every three months until it reached 100% with a geometric mean (GMT) of 135 and 130 mIU/ml respectively in the fifteenth month. Taking the Hepaccine-B and the Hevac-B Pasteur with the same schedule (0, 1, 2, 9 months) into consideration, we found that the former yielded the higher seroconversion rate, one month after the initial injection, which increased to the highest rate of 95.8% in the ninth month. After that it was steady until the fifteenth month with higher GMT (584 mIU/ml) than that of Hevac-B Pasteur (323 mIU/ml). The seroconversion rate of Hevac-B Pasteur in the first month was lower than that of Hepaccine-B but it yielded the highest rate of 100% in the sixth month. After that, it gradually decreased and again increased to 100% in the fifteenth month.
Asunto(s)
Formación de Anticuerpos/inmunología , Vacunas contra Hepatitis Viral/uso terapéutico , Adolescente , Adulto , Donantes de Sangre , Femenino , Anticuerpos contra la Hepatitis B/sangre , Vacunas contra Hepatitis B , Humanos , Esquemas de Inmunización , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Tailandia , Vacunas contra Hepatitis Viral/administración & dosificación , Vacunas contra Hepatitis Viral/inmunologíaRESUMEN
Four hundred episodes of COPD among patients admitted to Chulalongkorn Hospital between 1982 and 1986 were analyzed. There were 193 males and 45 females with 325 and 75 episodes of admission, respectively; the average age on admission was 68.4 +/- 0.5 years. The most significant associated underlying factor was cigarette smoking in 94 per cent of the cases, with the patients smoking an average of 1.15 packs of cigarettes per day for 43 years. In our study, 26.8 per cent of the patients had a cough, with the average age at onset being 47.4 +/- 2.1 years. The most common clinical manifestation was dyspnea with 58.5, 35.2 and 0.5 per cent having dyspnea functional class II, III, IV and with the average age at onset being 61.1 +/- 0.7, 66.6 +/- 0.7 and 71.0 +/- 1.0 years, respectively. An important manifestation on admission was dyspnea functional class III and IV, which were present in of 89 per cent of the cases. The main precipitating factors which led to the patients' admission were upper respiratory tract infection, pneumonia, bronchospasms and congestive heart failure, which accounted for 48.0, 10.0, 8.5, 31.8 and 18.3 per cent of the cases, respectively. With regard to these complications, there were 16.5, 48.3, 31.1 and 12.5 per cent of the patients who suffered respiratory failure requiring assisted ventilation, corpulmonale, polycythemia and peptic ulcer, respectively. Arterial blood gas on admission revealed a pH level of 7.36 +/- 0.1, pCO2 of 53.3 +/- 23.7 torr, and PO2 of 54.2 +/- 19.9 torr.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedades Pulmonares Obstructivas , Anciano , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/epidemiología , Enfermedades Pulmonares Obstructivas/etiología , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Pronóstico , Factores de Riesgo , Tailandia/epidemiologíaRESUMEN
An analysis and comparison of 286 adult patients involving 560 episodes of status asthmaticus admitted to the Medical Service of Chulalongkorn Hospital during the years 1984 through 1988 were examined. There were 58 patients who required mechanical ventilation 75 times compared with 228 patients with 485 episodes of attack who did not require the use of mechanical ventilation. The increased risk factors for status asthmaticus among those who required assisted ventilation were as follows: younger age at onset of asthma, younger age of severe attack, chronic asthma (especially unstable asthma), previous history of intubation and mechanical ventilation, shorter duration of severe attack and extremely severe attack in the sitting position before arriving at the emergency room, receiving beta 2 adrenergic inhaler, mistakenly taking beta blockers, high fever (over 38 degrees C) as a result of respiratory tract infection, increased initial pulse rate (over 125 beats/minute) and white blood cell count of over 16,000/mm3, and pneumothorax on admission. Simple asthma and history of taking franol or tedral in status asthmaticus indicated a low risk for mechanical ventilation. The taking of glucocorticoids did not pose a risk to status asthmaticus requiring mechanical ventilation.
Asunto(s)
Respiración Artificial , Estado Asmático/terapia , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Asmático/fisiopatologíaRESUMEN
The relationships between pleural fluid pH and PO2 to pleural fluid PO2, amylase, protein, glucose, white cell count were examined in 110 cases of tuberculous and 140 cases of malignant pleural effusions. Pleural fluid amylase concentrations of 200 or more units/ml indicated malignant effusions rather than tuberculous effusions with a specificity of 92.7 per cent and sensitivity of 27.1 per cent. There was evidence which suggested that the increasing pleural fluid amylase concentrations were due to the excessive leakage of serum amylase into the pleural cavity secondary to the break-down of capillaries by tuberculosis and malignancy as well as the production of amylase by tumor cells invading the pleura. The decreasing pleural fluid pH and increasing pleural fluid PCO2 had a significant linear relationship with decreasing fluid PO2, increasing pleural fluid protein and decreasing fluid glucose. These indicated a leakage of serum protein into the pleural cavity and the over-utilization of glucose relative to the transport defect of low pleural fluid glucose concentrations in the acidotic fluid of tuberculous and malignant effusions. No relationship between pleural fluid pH and PCO2 to pleural fluid and white cell count was found in the present study.