Additional active tuberculosis cases detected and costs incurred by a second household contact investigation.

In routine contact investigation in Myanmar, basic health staff conduct home visits and symptom screening among household contacts before investigation. We supplemented this with follow-up telephone calls by programme nurses inviting all contacts to be screened. The staff identified 376 contacts, 4 with symptoms, 3 of whom presented, including 1 with tuberculosis (TB). Due to the second intervention, 264 of the remaining 373 contacts received screening and 17 additional cases were detected. The additional cost incurred by the second intervention was 4.3 times higher than that of the conventional method, but TB yield was increased by a factor of 17.

Dans la recherche de routine des contacts au Myanmar, le personnel de santé de base fait des visites à domicile et du dépistage de symptômes parmi les contacts familiaux avant l'investigation. Nous avons complété cette méthode avec un suivi par téléphone par les infirmiers du programme invitant tous les contacts à se faire dépister. Le personnel a identifié 376 contacts, dont 4 avaient des symptômes, 3 se sont présentés et 1 avait une tuberculose. Grâce à cet initiative complémentaire, 264 des 373 contacts restants ont été dépistés et 17 cas supplémentaires ont été détectés. Le coût additionnel lié à cette intervention supplémentaire a multiplié par 4,3 celui de la méthode conventionnelle mais le rendement a été multiplié par 17.

En la investigación corriente de los contactos de pacientes con tuberculosis (TB) en Myanmar, los trabajadores de salud básica visitan los hogares y realizan el tamizaje de síntomas en los contactos domiciliarios antes de remitirlos para investigación. Este método se complementó con llamadas telefónicas de seguimiento por parte de personal de enfermería del programa, que invitaban a todos los contactos a participar en la detección sistemática. Con la investigación corriente se encontraron 376 contactos, cuatro presentaban síntomas y en tres de ellos se diagnosticó la TB. Al poner en práctica la iniciativa complementaria, se practicó la detección sistemática a 264 de los 373 contactos restantes y se diagnosticaron otros 17 casos de TB. El costo de la intervención adicional fue 4,3 veces más alto que el costo del método habitual, pero el rendimiento diagnóstico se multiplicó por 17.

Factors related to diagnostic delay of oral squamous cell carcinoma in southern Thailand: Revisited.

OBJECTIVES: To evaluate the impact of more open access to health services by Thailand's universal health coverage (UHC) on diagnostic delay of oral squamous cell carcinomas (OSCC) by comparing results with our previous study prior to the UHC. Reasons for delay in attending healthcare professional (HCP) consultation were also investigated. METHODS: A structure questionnaire was employed to interview 154 OSCC consecutive patients. Variables were included for Cox proportional regression models to conclude the hazard ratio of each delay. RESULTS: Regarding patient delay, those who had more than 12-year education showed less delay (HR 0.46, 95% CI: 0.21-1.01) while longer delay was found in farmers (HR 1.49, 95% CI: 1.05-2.11). Compared with the previous study, there was no association between herbal medication and patient delay, herbal medication and total delay, nor religion and total delay. Professional delay showed no association with any variable. Only half of the patients received initial proper HCP management in both studies. Patient delay was mostly (89.9%) due to unawareness of the lesion severity. CONCLUSIONS: Open access to the healthcare system had an influence on diagnostic delay. Public education and precise clinical acumen by HCPs in OSCC diagnosis are needed for early detection.

A population-based study of prevalence of Down syndrome in Southern Thailand.

BACKGROUND: Down syndrome (DS) is the most common chromosomal disorder that causes mental retardation. In 2009, a population-based birth defects study was implemented in three provinces in southern Thailand. This study aimed to determine the prevalence of DS in the studied regions, and the proportion of DS fetuses detected by prenatal screening. METHODS: Data were obtained from a population-based surveillance study undertaken during 2009-2013. Entries in the birth defects registry included live births, stillbirths after 24 weeks gestational age, and terminations of pregnancy following prenatal diagnosis. Infants with clinical characteristics of DS had a chromosomal study to make a definite diagnosis. RESULTS: Of the total 186 393 births recorded during the study period, 226 DS cases were listed, giving a prevalence of 1.21 per 1000 births [95% confidence interval (CI) 1.05-1.37]. The median maternal age was 36.5 years with a percentage of maternal age ≥35 years of 60.6%. Seventy-seven cases (34.1% of all cases) were diagnosed prenatally and these pregnancies were terminated. The prevalence of DS per 1000 births was significantly higher in older women, from 0.47 (95% CI 0.28-0.67) in mothers aged <30 years to 0.88 (95% CI 0.59-1.17) in mothers 30-<35 years (P<0.01), and to 4.74 (95% CI 3.95-5.53) in mothers ≥35 years (P<0.001). CONCLUSIONS: The prevalence of DS significantly increased with maternal age. About 35% of DS cases were detected prenatally and later terminated. Hence, examining only registry live births will result in an inaccurate prevalence rate of DS.

Financial burden on the families of patients with hepatitis B virus-related liver diseases and the role of public health insurance in Yunnan province of China.

OBJECTIVE: To investigate the financial burden of patients who had various stages of hepatitis B virus-related diseases and the level of alleviation from financial burden by health insurance schemes in Yunnan province of China. STUDY DESIGN: A cross-sectional survey. METHODS: Patients' information was consecutively recorded at the First Affiliated Hospital of Kunming Medical University, from December 2012 to June 2013. Consecutive cases of hepatitis B virus (HBV) (520), compensated cirrhosis (91), decompensated cirrhosis (198) and hepatocellular carcinoma (HCC) (131) were recruited from the outpatient and inpatient departments. The total direct costs, hospital charge, outpatient costs, hospitalization fees being reimbursed and household catastrophic health expenditure were estimated for each disease group. RESULTS: The average annual direct costs for each disease group were 19,496 RMB for HBV, 28,466 RMB in compensated cirrhosis, 46,061 RMB for decompensated cirrhosis, and 33,044 RMB for HCC patients. Catastrophic health expenditure occurred in all four groups. Health insurance reimbursement released the financial burden incurred by medical expenses of patients under a high level of household economic status. Public health insurance schemes helped the patients to various extents. CONCLUSIONS: Among these patient groups, direct costs represent a significant economic burden. Health expenditure and financing systems must be considered to prevent the increase of household catastrophe, particularly among the poor.

Expression of oral cytokines in HIV-infected subjects with long-term use of antiretroviral therapy.

OBJECTIVES: The objectives of this study were to determine (i) the expression of oral pro-inflammatory cytokines in HIV-infected subjects compared with non-HIV individuals, (ii) the cytokine expression in the subjects with antiretroviral therapy (ART) compared with those without ART, and (iii) factors associated with the expression of the cytokines. MATERIALS AND METHODS: Oral examination was performed and saliva samples were collected and analyzed for the expression of pro-inflammatory cytokines using ELISA. Logistic regression analysis was performed to determine the association between HIV/ART status and the cytokine expression. RESULTS: One hundred and fifty-seven HIV-infected subjects with and without ART, and 50 non-HIV individuals were enrolled. TNF-α and IL-6 in saliva were significantly decreased, while IL-8 was significantly increased in HIV infection (P < 0.05). Changes in the expression of IL-8 were also observed between HIV-infected subjects who were and were not on ART (P < 0.05). Duration of HIV infection and smoking was significantly associated with the expression of pro-inflammatory cytokines in saliva (P < 0.05). CONCLUSION: Oral innate immunity is affected by HIV infection and use of ART. IL-8 may be the useful biomarker to identify subjects at risk of infection and malignant transformation due to HIV infection and long-term use of ART.

Changes in oral cytokeratin expression in HIV-infected subjects with long-term use of HAART.

OBJECTIVES: The objectives of this study were to determine (i) the expression of oral cytokeratins (CKs) among human immunodeficiency virus (HIV)-infected subjects compared with non-HIV controls, (ii) the oral CK expression in the subjects with highly active antiretroviral therapy (HAART) compared with those without HAART, and (iii) factors associated with the expression of oral CKs. MATERIALS AND METHODS: Oral tissues from buccal mucosa were obtained by punched biopsy in HIV-infected subjects with and without HAART, and non-HIV individuals. The samples were processed for immunohistochemical studies of CK1, CK13, CK14, CK16, and involucrin. The staining intensity was scored and recorded. Logistic regression analysis and multi-way ANOVA test were performed. RESULTS: The expression of CK13, CK14, and CK16 was found to be significantly different between HIV-infected subjects and non-HIV individuals (P < 0.05). The expression of those CKs was also significantly different between those who were and were not on HAART (P < 0.05). No significant difference between the groups was observed regarding CK1 and involucrin. CONCLUSIONS: Oral epithelial cell differentiation as marked by the CK expression is affected by HIV infection and use of HAART. CKs may be the useful biomarkers to identify HIV-infected subjects who are at risk of malignant transformation of the oral mucosa because of HIV infection and HAART.

Cancer survival in Songkhla, Thailand, 1990-1999.

The Songkhla registry, besides being hospital-based, has population-based cancer registration data available since 1990. Cancer registration is done by active methods. The registry is contributing data on survival for 36 cancer sites or types registered during 1990-1999. Follow-up has been carried out by passive and active methods with median follow-up ranging from 3-71 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged between 52-100%; death certificate only (DCO) cases comprised 0-34%; 54-93% of total registered cases were included for survival analysis. Complete followup at five years ranged from 50-85% for different cancers. Five-year age-standardized relative survival rates of common cancers were cervix (59%), lung (7%), breast (59%), thyroid (86%), oesophagus (11%), liver (2%), nonmelanoma skin (75%), colon (45%) and oral cavity (33%). Five-year relative survival by age group did not reveal any pattern or trend and was fluctuating. A majority were diagnosed with regional spread of disease, and survival decreased with increasing clinical extent of disease.

Sensitivity of pooled serum testing for screening antibody of schistosomiasis japonica by IHA in a mountainous area of Yunnan, China.

Pooled sample testing (PST) as a strategy for avoiding testing the majority of individual negative samples has been proposed for screening of diseases in low prevalence areas. There has been no standard guideline for PST in screening of Schistosoma japonicum infection of Yunnan, China. To document the optimum pool size with acceptable sensitivity of PST for screening of Schistosoma japonicum infection in this setting, an experimental pooling of each of 31 positive sera by IHA with various numbers of 24 negative sera was done. The results were used to create a statistical model which was subsequently used for simulation to predict sensitivity of the pooled serum tests in the population with varying prevalence and pool size. We found that to keep the sensitivity of PST above 90%, 1:05 should be the maximum dilution, that is, the optimum pool size should not be greater than 6. Antigen will have rather little interference if the prevalence of infection is low e.g. 1% or the antigen:antibody ratio is 1:100 or below. Pooled serum testing by IHA is an acceptable sensitive method for detecting antibody for Schistosoma japonicum infection in this area.

A randomized clinical trial of chlorhexidine in the maintenance of oral candidiasis-free period in HIV infection.

OBJECTIVE: To determine if chlorhexidine can be used as an intervention to prolong the time to relapse of oral candidiasis. SUBJECTS AND METHODS: A double-blinded randomized clinical trial was performed in 75 HIV/AIDS subjects with oral candidiasis. Clotrimazole troche was prescribed, and the subjects were re-examined every 2 weeks until the lesions were completely eradicated. The subjects were then randomly divided into two groups; 0.12% chlorhexidine (n = 37, aged 22-52 years, mean 34 years) and 0.9% normal saline (n = 38, aged 22-55 years, mean 38 years). They were re-examined every 2 weeks until the next episode was observed. RESULTS: The time to recurrence of oral candidiasis between the chlorhexidine and the saline group was not statistically significant (P > 0.05). The following variables were significantly associated with the time of recurrence; frequency of antifungal therapy (P = 0.011), total lymphocyte (P = 0.017), alcohol consumption (P = 0.043), and candidiasis on gingiva (P = 0.048). The subjects with lower lymphocyte showed shorter oral candidiasis-free periods (P = 0.034). CONCLUSIONS: Chlorhexidine showed a small but not statistically significant effect in maintenance of oral candidiasis-free period. This lack of significance may be due to the small sample size. Further study should be performed to better assess the size of the effect, or to confirm our findings.

Expression of p53 in oral squamous cell carcinoma and its association with risk habits in southern Thailand.

Tobacco smoking and alcohol drinking are the principal factors associated with p53 expression in oral squamous cell carcinomas (OSCC) in the west, whereas betel quid chewing and smokeless tobacco are important factors in the east. Variable results of p53 expression have been reported and it has been proposed that ethnic difference and a variation in the indigenous oral habit may be responsible for the finding. This study, therefore, investigated p53 expression among 106 OSCC patients from a southern Thailand population in which all four risk behaviours, tobacco smoking, alcohol drinking, betel quid chewing and use of smokeless tobacco, are practised. The associations of p53 expression with lifetime exposure to each risk behaviour were explored. Multivariate modelling showed that lifetime exposure to alcohol drinking was significantly positively associated with p53 expression (likelihood ratio P value 0.01). Betel quid chewing and tobacco smoking habit showed a trend of decreasing risk of p53 expression with increased lifetime exposure (OR 0.62, 95% CI 0.39-1.00 and OR 0.50, 95% CI 0.26-0.98, respectively). No significant association was found between p53 expression and clinico-pathological parameters. Further investigations are needed to study (1) the molecular alteration of p53 in each risk habit and (2) other possible pathways of oral carcinogenesis in betel quid- and tobacco smoking-associated OSCC in these group of patients.

Social attitudes toward shaving for cranial neurosurgery.

Unshaved cranial neurological surgery has been successfully performed at Songklanagarind Hospital. However, within the Buddhist community, shaving is one of the traditional procedures for cleanliness and purification, and the unshaved method may have a cultural effect on social beliefs. Knowledge of social attitudes toward shaving or not shaving for cranial neurological surgery has implications for informed consent process prior to cranial operation. The attitudes of shaving were surveyed in the communities of Songkhla Province where Songklanagarind Hospital is situated. Of 1128 respondents, the female to male ratio was 3:2, their age was mostly under 40 years old and 91% were Buddhist. Sixty per cent of the respondents were in favour of shaving. After knowing the equivalent result of surgery either by shaved or unshaved method, the group favouring unshaved cranial surgery increased from 12 to 37%. Statistical analysis, through ordinal and multinomial logit, identified the young age, female and more educated who needed to socialize, and frequently meet many people were the groups who preferred or were ready to change their choice to the unshaved method. The neurosurgeon should give an advice to the patient not only the indications and results of surgery, but also a choice of shaved or unshaved cranial neurological surgery.

Factors related to advanced stage oral squamous cell carcinoma in southern Thailand.

A critical factor that indicates a poor prognosis of oral squamous cell carcinoma (OSCC) is advanced stage disease. This study, therefore, aimed to identify the factors related to advanced stage (TNM staging III, IV) OSCC in Thailand. There were 161 patients with squamous cell carcinoma of the oral cavity and lip (ICD-9 140, 141, 143-5), included in the study. Sixty-two per cent of the patients presented with advanced stage disease. Information on demographic characteristics, risk habits, health-seeking behaviour prior to health care professional (HCP) consultation, tumour characteristics and patient and professional delay was obtained by questionnaire-based interview of the patients. These variables were included as initial variables in a logistic regression to calculate the odds ratio (OR) of advanced versus early stage OSCC. Having traditional herbal medication before HCP consultation significantly increased the risk of advanced stage OSCC (OR 5.77; 95% C.I. 1.25-26.62). Floor of mouth location of tumour was associated with a lower risk of advanced stage disease (OR 0.27; 95% C.I. 0.09-0.82) as was having an ulcer (OR 0.43, 95% C.I. 0.02-0.89). The findings indicate that having traditional herbal medication before HCP consultation increased the risk of advanced stage disease. The lower risk of advanced stage OSCC associated with ulcerative tumours and those on the floor of the mouth may be due to their being more readily detected by the patients.

The clinical course of Hashimoto's thryoiditis in children and adolescents: 6 years longitudinal follow-up.

Forty-six children and adolescents with Hashimoto's thyroiditis were followed up for 5.9 +/- 0.3 years. The mean age at diagnosis was 12.4 +/- 1.7 years (range 9-15.4 yr). The patients were divided into three groups according to thyroid function: group 1 (n = 28) included patients who had normal concentrations of free thyroxine (FT4) and thyrotropin (TSH); group 2 (n = 8) included patients who had normal FT4 and elevated TSH, consistent with compensated hypothyroidism; group 3 (n = 10) included patients who had low FT4 and elevated TSH consistent with overt hypothyroidism. After 5.9 years of follow-up, four out of eight patients with compensated hypothyroidism had normal thyroid function and the other four patients developed overt hypothyroidism. Thyroxine therapy was administered in patients with overt hypothyroidism including the four patients with compensated hypothyroidism who later presented with overt hypothyroidism. All patients in both euthyroid and hypothyroid groups had normal growth and puberty. Final adult height was 0.43 +/- 0.80 SDS which was 1.58 +/- 3.03 cm above mid-parental height. The mean age at menarche (n = 43) was 12.4 +/- 1.1 years, which was not different from normal children. The goiter remained the same size in most of the patients with euthyroidism without thyroxine therapy, but decreased in patients with overt hypothyroidism after thyroxine therapy.

Genetic and environmental interactions on oral cancer in Southern Thailand.

Many countries are interested in understanding the relationship between genetic susceptibility and their prevalent environmental cancers for disease prevention. In Thailand we conducted a population-based case-control study of 53 matched pairs to assess the risk of oral cancer in relation to genetic polymorphism of the glutathione-S-transferase genes (GSTM1 and GSTT1) in cigarette smokers, alcohol drinkers, and betel quid chewers. Interaction of the genes with other potential risk factors such as local bean consumption were also elucidated. Homozygous deletion of GSTM1 has a frequency of 56.6% (n = 30 over 53) among the patients and 30.2% (16/53) among the controls. This gene is associated with a 2.6-fold higher risk for development of oral cancer (95% CI 1.04-6.5). Among the null GSTM1 individuals, those who smoke, consume alcohol, and/or chew betel quid have a significantly increased risk for oral cancer with an odd ratio (OR) = 4.0 (95% CI = 1.2-13.7), OR = 7.2 (95% CI = 1.5-33.8), and OR = 4.4 (95% CI = 1.1-17.8), respectively. Interactions between any two of the lifestyle habits for oral cancer risk, however, are not found. The frequency of the GSTT1 null genotype is 34.0% (18/53) among the patients and 47.2% (25/53) among our controls. There is no association between the GSTT1 null allele and oral cancer risk. In conclusion, our study provides data to indicate that individuals who have homozygous deletion of the GSTM1 gene have increased risk for oral cancer. The risk increases further when these individuals are exposed to environmental toxicants such as chemicals in cigarette smoke, alcohol, and betel quid. These baseline data can be applied to a larger population-based study, both to verify the observation and to conduct mechanistic investigations.

Factors related to delay in diagnosis of oral squamous cell carcinoma in southern Thailand.

The factors related to patient, professional and total delay in 161 oral squamous cell carcinoma (OSCC) patients attending for treatment at a university hospital in southern Thailand were investigated. About 42 and 20% of these patients had a patient delay of more than 1 month and 3 months, respectively. About half of the patients received proper management from health care professionals (HCPs) on their first consultation. Traditional herbal medication use was significantly associated with prolonged patient delay (hazard ratio [HR] 0.46, 95% C.I. 0.28-0.76). None of the variables investigated had a significant association with professional delay. Traditional herbal medication use also significantly prolonged total delay (HR 0.45, 95% C.I. 0.27-0.74). Buddhists had shorter total delay than Muslims (HR 0.68, 95% C.I. 0.49-0.95). The present study indicates that both patients and HCPs are responsible for the diagnostic delay. A health education campaign about OSCC and the use of traditional herbal medication is recommended to shorten patient delay. Continuing education on oral cancer and precancer for HCPs and clarification of the referral system are needed to effect a major reduction in professional delay.

The usefulness of serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) for evaluation of children with short stature.

The diagnostic value of serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was studied in 24 growth hormone deficient (GHD) and 36 normal variant short stature (NVSS) children. The serum IGF-1 and IGFBP-3 concentrations were markedly below the 5th centile for chronological age in all 24 GHD children, but were in the low normal range for age in most of the NVSS children. The concentrations of IGF-1 and IGFBP-3 significantly correlated with peak GH concentration, height age, and bone age. To account for the age- and sex-dependency, IGF-1 and IGFBP-3 levels were transformed to standard deviation score (SDS). Using the -2 SDS as a cut-off level to differentiate between GHD and NVSS, the diagnostic value of IGF, as well as IGFBP-3, showed sensitivity 100 per cent, specificity 66.7 per cent, and accuracy 80 per cent. The combined use of IGF-1 and IGFBP-3 < -2 SDS improved the diagnostic value with sensitivity 100 per cent, specificity 77.8 per cent, and accuracy 86.7 per cent. We concluded that the serum concentrations of IGF-1 and IGFBP-3 could reflect endogenous GH secretion and could be used as a screening evaluation of GH status in short children.

p53 protein expression in cutaneous squamous cell carcinoma.

BACKGROUND: p53 is a nucleoprotein encoded by a tumor suppressor gene. It's mutations are implicated in the genesis of a wide variety of malignant neoplasia including skin cancers. OBJECTIVE: To study the expression of the p53 protein in cutaneous squamous cell carcinoma (SCCs) and evaluate the relationships between this expression and sites, varying degrees of differentiation and amounts of apoptotic cells. METHOD: Sixty-seven tissue samples of SCCs from Songklanagarind Hospital obtained from January 1991 to December 1996 were examined by immunohistochemistry using polyclonal anti p53-CM1. (Novocastra Laboratories, Newcastle, England, dilution 1:700) RESULT: p53 Immunoreactivity was demonstrated in 26.87 per cent of SCCs. This was observed in 15/51 of sun-exposed cases and 3/16 of sun-protected cases (p = 0.401). The more differentiated the tumor, the less p53 staining was observed (p = 0.043). There was no association between p53 positivity and the amounts of apoptotic cells. CONCLUSION: The p53 expression is not related to the sun exposure. It does not represent a commitment to apoptosis. However, it may indicate the differentiation and/or proliferative status of the tumor cells.

Delay in breast cancer care: a study in Thai women.

BACKGROUND: Breast cancer is the second most common cause of cancer death in Thai women. Cancer registry data reveal a high prevalence of late-stage disease at diagnosis. The factors resulting in delay in Thailand have not yet been investigated. OBJECTIVES: To determine the extent of, and the factors contributing to, delay in breast cancer care. DESIGN: Women with breast cancer who were first treated at Songklanagarind Hospital between June 1994 and June 1996 were interviewed with retrospective chart audits of care. MEASURES: Dependent variables included patient delay (symptom recognition to first care) and system delay (first care to treatment). Independent variables tested included demographic factors, help-seeking behavior, and cancer knowledge. Nonparametric rank sum tests were used for univariate analysis, and Cox regression was used for multivariate analysis. RESULTS: Ninety-four cases were included in the study. The median patient and system delays were 4 weeks; 26.6% and 24.4% of patients, respectively, experienced patient and system delay >12 weeks. Only marital status (unmarried compared with married women) was significantly associated with patient delay (hazard ratio [HR] 2.78, 95% CI 1.23-6.25). Contacting a provincial hospital instead of a university hospital as first medical care (hazard ratio 2.50, 1.23-5.26), being given a diagnosis rather than being told nothing (HR 2.04, 1.14-3.57) and being given treatment rather than being immediately referred (HR 4.55, 2.22-9.09) were associated with system delay. CONCLUSIONS: Patient delay and system delay in breast cancer care are important weaknesses of disease control in Thailand. Educational programs should target unmarried women, who are at higher risk of delay. System delay in hospitals outside the university needs to be improved by a good referral system.

A clinical checklist for fragile X syndrome: screening of Thai boys with developmental delay of unknown cause.

The aim of this study was to determine a cost-effective clinical checklist for fragile X syndrome (FXS) screening in a Thai male pediatric population with developmental delay of unknown cause. We studied 179 non-FXS male patients and 27 FXS patients from 18 families (age < or = 15 years). A six-item clinical checklist was used including family history (FH), long and narrow face (F), prominent and large ears (E), attention deficit/hyperactivity (AH), autistic-like behavior (AT) and testicular volume (T). These were scored as 0 if absent, 1 if borderline, and 2 if present. All patients were tested by using PCR and/or southern blot for the FMR1 gene. We used a logistic regression model from a computer program to analyze the data (Stata, version 5.0). We used logistic regression with cluster in the same family (average score) to eliminate bias from the related FXS cases. We found that a five-item checklist, 2FH + F + 0.5E + 2AH + T = total score, was the best model. When we used this clinical checklist with a threshold of total score of 4, 78.7 per cent of the screened cases with total scores < or = 4 could be eliminated as negative cases. In addition, all positive FXS cases had total scores > 4. We propose this five-item model for FXS screening in clinical pediatric practice, particularly from Asian population settings.

Serum insulin-like growth factor-1 (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) in healthy Thai children and adolescents: relation to height, weight, and body mass index.

The objective of this study was to evaluate the correlation between serum concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3) and growth parameters (height, weight, and body mass index) in 260 healthy children and adolescents aged 5-20 years. The subjects were divided into 2 groups according to the age achieving final height. Group 1 included children with active growth consisting of girls aged under 14 years (N = 80) and boys aged under 16 years (n = 74). Group 2 included adolescents who achieved final height consisting of females aged at and over 14 years (n = 82), and males aged at and over 16 years (n = 24). In group 1, the serum concentrations of IGF-1 and IGFBP-3 were significantly positive correlated with all growth parameters. In group 2, although the correlation was insignificant, the concentrations of IGF-1 and IGFBP-3 seemed to be greater in individuals who were relatively taller and had lean body mass than those who were relatively short and over average body mass.