The relationship between creamatocrit and cumulative percentage of total milk volume: a cross-sectional study in mothers of very preterm infants in Bangkok, Thailand.

BACKGROUND: Human hindmilk contains higher concentrations of fat than foremilk and is more desirable for growth in preterm infants who can tolerate limited volumes of breastmilk. There is currently no clear demarcation between foremilk and hindmilk. This study characterized the change in breastmilk's fat content from the start to end of milk flow and defined this demarcation. METHODS: Mothers of infants born at ≤ 32 weeks gestational age and ≥ 14 days after childbirth in a University hospital in Bangkok, Thailand between July, 2011, and April, 2012 were included in this cross-sectional study. Breastmilk samples were sequentially collected from the start to end of milk flow in 5-mL aliquots using breast pumps. The fat content of each aliquot from each breast was determined through creamatocrit. The average creamatocrit of foremilk and hindmilk were compared in predefined foremilk to hindmilk ratios of 20:80, 25:75, 33:67, and 50:50. Creamatocrit of the first and last aliquots were compared for mothers who expressed low- (≤ 25-mL per breast) and high-volumes (> 25-mL per breast) of breastmilk. RESULTS: Of the 25 mothers enrolled, one was excluded due to unsuccessful creamatocrit measurement. The last aliquot of breastmilk had a significantly higher creamatocrit than the first from the same breast (median [interquartile range] of 12.7% [8.9%, 15.3%] vs. 5.6% [4.3%, 7.7%]; test statistic 1128, p < 0.001). Mean creamatocrit in hindmilk portions (9.23%, 9.35%, 9.81%, and 10.62%, respectively) was significantly higher than foremilk portions (6.28%, 6.33%, 6.72%, and 7.17%, respectively) at all predefined ratios. Creamatocrit increased by 1% for every 10% incremental increase in expressed breastmilk volume until the breast was emptied. Low-volume mothers had a significantly higher creamatocrit in the first aliquot compared with high-volume mothers (U = 437, p = 0.002). No significant difference in breastmilk volume was observed between mothers with and without breastfeeding experience. CONCLUSIONS: Fat content in breastmilk increased on an incremental basis. More fluid definitions of foremilk and hindmilk should be adopted. Mothers should prepare their breastmilk into aliquots based on the required feeding volume of their infant. Hindmilk aliquots can be prioritized over foremilk aliquots to ensure infants obtain optimal caloric intake.

Distinguishing SARS-CoV-2 Infection and Non-SARS-CoV-2 Viral Infections in Adult Patients through Clinical Score Tools.

This study aimed to determine distinguishing predictors and develop a clinical score to differentiate COVID-19 and common viral infections (influenza, respiratory syncytial virus (RSV), dengue, chikungunya (CKV), and zika (ZKV)). This retrospective study enrolled 549 adults (100 COVID-19, 100 dengue, 100 influenza, 100 RSV, 100 CKV, and 49 ZKV) during the period 2017−2020. CKV and ZKV infections had specific clinical features (i.e., arthralgia and rash); therefore, these diseases were excluded. Multiple binary logistic regression models were fitted to identify significant predictors, and two scores were developed differentiating influenza/RSV from COVID-19 (Flu-RSV/COVID) and dengue from COVID-19 (Dengue/COVID). The five independent predictors of influenza/RSV were age > 50 years, the presence of underlying disease, rhinorrhea, productive sputum, and lymphocyte count < 1000 cell/mm3. Likewise, the five independent predictors of dengue were headache, myalgia, no cough, platelet count < 150,000/mm3, and lymphocyte count < 1000 cell/mm3. The Flu-RSV/COVID score (cut-off value of 4) demonstrated 88% sensitivity and specificity for predicting influenza/RSV (AUROC = 0.94). The Dengue/COVID score (cut-off value of 4) achieved 91% sensitivity and 94% specificity for differentiating dengue and COVID-19 (AUROC = 0.98). The Flu-RSV/COVID and Dengue/COVID scores had a high discriminative ability for differentiating influenza/RSV or dengue infection and COVID-19. The further validation of these scores is needed to ensure their utility in clinical practice.

Laparoscopic versus open hepatectomy for large hepatocellular carcinoma: a single center propensity-score-matching comparative analysis of perioperative outcomes and long-term survival.

BACKGROUND: Although the benefits of laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) in most circumstances are evident, the benefits for large HCC are contentious. This study aimed to compare the perioperative outcomes and survival after LH versus open hepatectomy (OH) in large HCC patients. METHODS: An analysis of prospectively maintained database included 215 hepatectomies for large HCC (diameter ≥ 5 cm). The operative and survival outcomes were compared between the LH group (n = 109) and the OH group (n = 106). Propensity score matching (PSM) 1:1 included 70 patients in each group. The entire cohort multivariable analyses were performed to identify the factors associated with surgical complications and suboptimal recurrence-free survival (RFS). RESULTS: After PSM, baseline characteristics and the extent of liver resection were similar in both groups. The LH group had a shorter hospital stay than the OH group (7 vs 9.5 days, p = 0.001). The R0 resection rate, complication rate, overall survival, and RFS were similar between the groups. The multivariate analyses revealed two independent factors predicting surgical complication (major resection; p < 0.001 and large volume blood loss; p = 0.042), and 3 independent factors predicting suboptimal RFS including R1 resection (p = 0.011), multifocal HCC (p = 0.005), and microvascular invasion (p = 0.001). LH was not associated with surgical complication and suboptimal RFS. CONCLUSION: Our study highlights the benefits of LH by improving the perioperative outcomes, without long-term survival inferiority in selected large HCC patients compared with conventional OH. LH can be an attractive option for large HCC treatment.

Association between adenoid bacteriology and clinical characteristics of adenoid-related diseases in children.

INTRODUCTION: The aim of this research is to find the association between the pathogenic bacteria obtained from the adenoid culture and clinical characteristics of adenoid-related diseases in children. METHODS: In this retrospective study, we reviewed the medical records of children who had adenoidectomy for adenoid-related diseases. Demographic data, diagnoses, indications for adenoidectomy and bacterial culture results were collected. The adenoid size was measured in the lateral skull X-ray as adenoid-nasopharyngeal ratio. Associations between the culture results and the demographic data, adenoid size, and the diagnoses were analyzed. RESULTS: There were 407 children who had adenoidectomy for obstructive sleep-disordered breathing (75.2%), otitis media with effusion (19.2%), and chronic sinusitis (5.6%). Median age was 5.9 years. Common pathogenic bacteria in the adenoid were Haemophilus influenzae (26.2%), Staphylococcus aureus (23.5%), Streptococcus pneumoniae (18.2%), and Moraxella catarrhalis (12%). The patient's age had significant association with the prevalence of pathogenic bacteria. S. pneumoniae was most prevalent in young children up to 7 years. S. aureus was more common in children over 7 years. H. influenzae had similar prevalence in all age groups. Size of the adenoid and type of adenoid-related diseases had no association with the outcome of bacterial culture. CONCLUSION: Age of the patients was the significant factor associated with the bacteriological findings of the adenoid while size and types of adenoid-related diseases were not associated with the outcome of bacterial culture.

Ivermectin Accelerates Circulating Nonstructural Protein 1 (NS1) Clearance in Adult Dengue Patients: A Combined Phase 2/3 Randomized Double-blinded Placebo Controlled Trial.

BACKGROUND: Dengue is the most significant mosquito-borne viral disease; there are no specific therapeutics. The antiparasitic drug ivermectin efficiently inhibits the replication of all 4 dengue virus serotypes in vitro. METHODS: We conducted 2 consecutive randomized, double-blind, placebo-controlled trials in adult dengue patients to evaluate safety and virological and clinical efficacies of ivermectin. After a phase 2 trial with 2 or 3 days of 1 daily dose of 400 µg/kg ivermectin, we continued with a phase 3, placebo-controlled trial with 3 days of 400 µg/kg ivermectin. RESULTS: The phase 2 trial showed a trend in reduction of plasma nonstructural protein 1 (NS1) clearance time in the 3-day ivermectin group compared with placebo. Combining phase 2 and 3 trials, 203 patients were included in the intention to treat analysis (100 and 103 patients receiving ivermectin and placebo, respectively). Dengue hemorrhagic fever occurred in 24 (24.0%) of ivermectin-treated patients and 32 (31.1%) patients receiving placebo (P = .260). The median (95% confidence interval [CI]) clearance time of NS1 antigenemia was shorter in the ivermectin group (71.5 [95% CI 59.9-84.0] hours vs 95.8 [95% CI 83.9-120.0] hours, P = .014). At discharge, 72.0% and 47.6% of patients in the ivermectin and placebo groups, respectively had undetectable plasma NS1 (P = .001). There were no differences in the viremia clearance time and incidence of adverse events between the 2 groups. CONCLUSIONS: A 3-day 1 daily dose of 400 µg/kg oral ivermectin was safe and accelerated NS1 antigenemia clearance in dengue patients. However, clinical efficacy of ivermectin was not observed at this dosage regimen.

Clinical Characteristics of Sarcoidosis in Asian Population: A 14-year Single Center Retrospective Cohort Study from Thailand.

BACKGROUND: Little is known about epidemiology and clinical characteristics of sarcoidosis in Asian population. OBJECTIVES: This study aimed to examine the epidemiology and clinical characteristics of Thai patients with sarcoidosis, using databases of a tertiary care medical center. METHODS: Potential cases of sarcoidosis were identified from two sources, the medical record-linkage system and the pathology database of Siriraj Hospital, Mahidol University in Bangkok, Thailand. Patients with ICD-10-CM codes for sarcoidosis were identified and retrieved from the medical record-linkage system from 2005 to 2018. Patients with histopathology positive for non-caseating granuloma were identified and retrieved from the pathology database from the same time period. All potential cases underwent individual medical record review to confirm the diagnosis of sarcoidosis which required compatible clinical pictures supported by presence of non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis and exclusion of other granulomatous diseases. RESULTS: From 2005 to 2018, 89 confirmed cases of sarcoidosis were identified. 80.9% of them were female and mean age at diagnosis was 46.8 years (standard deviation (SD) 13.9 years). The majority of patients had intrathoracic disease (81 cases; 91.0%) but less than half had respiratory symptoms (34 cases; 41.9%). Extrathoracic disease was common in this cohort that pulmonary sarcoidosis was accompanied by extrathoracic involvement in 53 patients (65.4%). Sarcoid uveitis was the most common extrathoracic disease (35 cases; 39.3%), followed by cutaneous sarcoidosis (24 cases; 26.9%), extrathoracic lymphadenopathy (18 cases; 22.5%) and sarcoid arthropathy (4 cases; 4.5%). CONCLUSION: The current study examined clinical characteristics of sarcoidosis in an Asian population and found high prevalence of uveitis and marked female predominance. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020011).

Cut-off values for positive bronchodilator response in healthy Thai preschool children using forced oscillation technique.

BACKGROUND: Forced oscillation technique (FOT) requires minimal patient cooperation and is particularly useful in young children. Bronchodilator test is a valuable tool for wheezy and asthmatic patients. The cut-off value for bronchodilator response by FOT in healthy Thai children has not been reported. OBJECTIVE: To determine the cut-off values for positive bronchodilator response in healthy Thai preschool children using pseudorandom FOT. METHODS: FOT was used to measure respiratory function at baseline and after 400 mcg MDI salbutamol in healthy Thai children aged 3-6 years. Respiratory resistance (Rrs) and reactance (Xrs) at 6, 8, and 10 Hz were collected. Pre- and post-bronchodilator tests were compared using paired t-test. Absolute and percent changes after bronchodilator were calculated and their cut-off values were defined as mean ± 1.96 SD. Correlation between each of those and baseline data was analyzed using Pearson's correlation coefficient. RESULTS: Of the 150 enrolled children, FOT measurement at baseline and after bronchodilator was successfully completed in 111 children (51 boys). The mean ± standard deviation age, height, and arm span was 5.2 ± 1.1 years, 109.3 ± 8.7 cm, and 107.2 ± 9.1 cm, respectively. No correlation was observed between any absolute or percent changes in bronchodilator response and gender, age, height, or arm span. The cut-off values established for bronchodilator response by percent change were, as follows: Rrs6: -23%, Rrs8: -20%, Rrs10: -20%, Xrs6: 36%, Xrs8: 60%, and Xrs10: 43%. CONCLUSIONS: The cut-off values identified in this study will be useful for evaluating bronchodilator response by FOT in wheezy and asthmatic young children.

Ten-year survival and factors associated with increased mortality in patients admitted for acute decompensated heart failure in Thailand.

INTRODUCTION: Data on the long-term outcomes of Asian patients admitted for acute decompensated heart failure is scarce. The objectives of this study were to determine short-term, intermediate-term and long-term survival among patients admitted for acute decompensated heart failure in Thailand, and to identify factors independently associated with increased mortality. METHODS: Patients who were admitted with a primary diagnosis of heart failure were enrolled in the Thai Acute Decompensated Heart Failure Registry (ADHERE) from 18 hospitals located across Thailand during 2006. Medical record data was collected according to ADHERE protocol. Mortality data was collected from death certificates on file at the Thailand Bureau of Registration Administration. RESULTS: A total of 1,451 patients were included. The mean age of the patients was 63.7 ± 14.4 years, and 49.7% were male. One-year, five-year and ten-year mortality rates in Thai patients admitted for acute decompensated heart failure were 28.0%, 58.2% and 73.3%, respectively. Independent predictors of increased mortality were identified. There were more cardiovascular-related deaths than non-cardiovascular-related deaths (54.6% vs. 45.4%, respectively). CONCLUSIONS: The ten-year mortality rate in Thai patients admitted for acute decompensated heart failure was 73.3%. Many factors were found to be independently associated with increased mortality, including left ventricular ejection fraction.

Accuracy of Tumour-Associated Circulating Endothelial Cells as a Screening Biomarker for Clinically Significant Prostate Cancer.

Even though more than 350,000 men die from prostate cancer every year, broad-based screening for the disease remains a controversial topic. Guidelines demand that the only commonly accepted screening tool, prostate-specific antigen (PSA) testing, must be followed by prostate biopsy if results are elevated. Due to the procedure's low positive predictive value (PPV), however, over 80% of biopsies are performed on healthy men or men with clinically insignificant cancer-prompting calls for new ways of vetting equivocal PSA readings prior to the procedure. Responding to the challenge, the present study investigated the diagnostic potential of tumour-associated circulating endothelial cells (tCECs), which have previously been described as a novel, blood-based biomarker for clinically significant cancers. Specifically, the objective was to determine the diagnostic accuracy of a tCEC-based blood test to detect clinically significant prostate cancer (defined as Gleason score ≥ 3 + 4) in high-risk patients. Performed in a blinded, prospective, single-centre set-up, it compared a novel tCEC index test with transrectal ultrasound-guided biopsy biopsy as a reference on a total of 170 patients and found that a tCEC add-on test will almost double the PPV of a standalone PSA test (32% vs. 17%; p = 0.0012), while retaining a negative predictive value above 90%.

The rate of patients at high risk for cardiovascular disease with an optimal low-density cholesterol level: a multicenter study from Thailand.

BACKGROUND: Hypercholesterolemia is a major risk factor for cardiovascular events in patients with established atherosclerotic disease (EAD) and in those with multiple risk factors (MRFs). This study aimed to investigate the rate of optimal low-density lipoprotein (LDL) cholesterol level in a multicenter registry of patients at high risk for cardiovascular events. METHODS: A multicenter registry of EAD and MRF patients was conducted. Demographic data, medical history, cardiovascular risk factors, anthropometric data, laboratory data, and medications were recorded and analyzed. We classified patients according to target LDL levels based on recommendation by the European Society of Cardiology (ESC) 2011 into Group 1 which is EAD and diabetes or chronic kidney disease (CKD)-target LDL below 70 mg/dL, and Group 2 which is MRF without diabetes or CKD-target LDL below 100 mg/dL. The rate of optimal LDL level in patients with Group 1 and Group 2 was analyzed and stratified according to the treatment pattern of lipid-lowering medications. RESULTS: A total of 3100 patients were included. Of those, 51.7% were male. Average age was 65.8 ± 9.7 years. Average LDL level was 96.3 ± 32.6 mg/dL. A vast majority (92.7%) received statin and 9.3% received ezetimibe. Optimal LDL level was achieved in 20.3% of patients in Group 1 (LDL < 70 mg/dL), and in 46.6% in Group 2 (LDL < 100 mg/dL). The overall rate of optimal LDL control was 23% since 89.6% of study population belongs to Group 1. The rate of optimal LDL was not different between high and low potency statin. Factors that were associated with optimal LDL control were older age, the presence of coronary artery disease or peripheral artery disease. CONCLUSIONS: The rates of optimal LDL level were unacceptably low in this study population. As such, a strategy to improve LDL control in high-risk population should be implemented.

A Comparison of Pediatric Weight Estimation Methods for Emergency Resuscitation.

OBJECTIVES: Obtaining accurate pediatric weight is necessary during emergency resuscitation. Although several weight estimation methods exist, the most precise method has not been conclusively determined. This study aimed to evaluate the validity, reliability, and practicality of these tools. METHODS: A prospective observational study was conducted in healthy Thai children aged 6 months to 12 years. Correlations between estimated and actual weights were tested. Validity was assessed by mean bias (estimated weight minus actual weight) and accuracy (10% error). Practicality was evaluated by time usage and data derived from user questionnaires. RESULTS: Four hundred thirty participants with mean age of 6.7 years and mean weight of 26 kg were enrolled. A strong correlation between estimated weight and actual weight in all methods was demonstrated. Parental estimation was the most accurate tool in all age groups, with the lowest overall mean error (ME) of -0.83 kg and the highest accuracy of 88.7%. The Broselow tape was the second most accurate tool in ages younger than 1 year and 1-to-5-year age groups (ME = 0.23 and 0.50 kg; accuracy = 55.3% and 54.1%, respectively). The Mercy method was the second most accurate tool in the 6-to-10-year and 11-to-12-year age groups (ME = -2.47 and -2.77; accuracy = 54.6% and 67.9%, respectively). The Broselow tape had the highest score for practicality of use. CONCLUSIONS: Parental estimation was the most accurate method in every age group. The next best alternative is the Broselow tape in children aged 5 years or younger and the Mercy method in children aged older than 5 years.

Bacterial leakage and marginal adaptation of various bioceramics as apical plug in open apex model.

AIM: The aim of the present study was to investigate bacterial leakage and marginal adaptation of bioceramic apical plugs. METHODS: Extracted human mandibular premolars were prepared to simulate open apex using No. 4 Peeso reamer in retrograde direction. In total, 150 specimens were divided into 10 groups by obturation with five bioceramics in two thicknesses. Groups 1, 3, 5, 7, and 9 were obturated with ProRootMTA, Biodentine, TotalFill BC RRM paste, TotalFill BC RRM putty, and RetroMTA at 3 mm, and groups 2, 4, 6, 8, and 10 were obturated with the same materials at 4 mm. Ten specimens in each group were evaluated for bacterial leakage of Enterococcus faecalis for 75 days. Five specimens from each group were sectioned to investigate the gap area under scanning electron microscope. RESULTS: The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited less bacterial leakage and lower mean percentage of gap area than those of the other groups. TotalFill BC RRM paste showed the highest leakage for both the 3- and 4-mm groups. CONCLUSION: The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited the best sealing ability and marginal adaptation of apical plugs.

Treatment outcome differences between pass and fail scores and correlation between cephalometric changes and cast-radiograph evaluation of the American Board of Orthodontics.

OBJECTIVE: Using the cast-radiograph evaluation (CRE) score of the American Board of Orthodontics (ABO), the purpose of this study was 1) to find the post-treatment discrepancies that contributed to low-quality outcomes and 2) to identify if there might be any correlation between cephalometric changes and post-treatment discrepancies. MATERIALS AND METHODS: About 200 records submitted for the Thai Board of Orthodontics examination were analyzed. Overall, 23 parameters of the CRE scores and 12 cephalometric changes were collected. Based on the total CRE score, the cases were classified into three categories: pass (score <20), undetermined (score 20-30), and fail (score >30). Kruskall-Wallis was used to analyze the differences of mean CRE scores among these three categories. In addition, the cases were further classified into fixed appliance, two-phase and orthognathic surgery groups. Correlation tests were carried out to determine if there might be any association between cephalometric changes and CRE parameters. RESULTS: Significant differences of mean CRE scores were found for all CRE components except interproximal contacts. Significant correlation coefficients with the total CRE scores were found for all parameters except interproximal contacts. Significant moderate association was found between lower incisor changes and CRE scores in the two-phase and orthognathic surgery group. CONCLUSIONS: In order to improve treatment outcome quality, the top four parameters that orthodontists should pay attention to are occlusal contacts, occlusal relationship, marginal ridges, and alignment and rotations. Cephalometric changes were not suitable as weighting factors for total CRE scores.

Predictive performance of a multivariable difficult intubation model for obese patients.

BACKGROUND: A predictive model of scores of difficult intubation (DI) may help physicians screen for airway difficulty to reduce morbidity and mortality in obese patients. The present study aimed to set up and evaluate the predictive performance of a newly developed, practical, multivariate DI model for obese patients. METHODS: A prospective multi-center study was undertaken on adults with a body mass index (BMI) of 30 kg/m2 or more who were undergoing conventional endotracheal intubation. The BMI and 10 preoperative airway tests (namely, malformation of the teeth in the upper jaw, the modified Mallampati test [MMT], the upper lip bite test, neck mobility testing, the neck circumference [NC], the length of the neck, the interincisor gap, the hyomental distance, the thyromental distance [TM] and the sternomental distance) were examined. A DI was defined as one with an intubation difficulty scale (IDS) score ≥ 5. RESULTS: The 1,015 patients recruited for the study had a mean BMI of 34.2 (standard deviation: 4.3 kg/m2). The proportions for easy intubation, slight DI and DI were 81%, 15.8% and 3.2%, respectively. Drawing on the results of a multivariate analysis, clinically meaningful variables related to obesity (namely, BMI, MMT, and the ratio of NC to TM) were used to build a predictive model for DI. Nevertheless, the best model only had a fair predictive performance. The area under the receiver operating characteristic curve (AUC) was 0.71 (95% confidence interval 0.68-0.84). CONCLUSIONS: The predictive performance of the selected model showed limited benefit for preoperative screening to predict DI among obese patients.

Surveillance of Otitis Media With Effusion in Thai Children With Cleft Palate: Cumulative Incidence and Outcome of the Management.

OBJECTIVE: To study the incidence and outcome of management of otitis media with effusion in Thai children with cleft palate. DESIGN: Retrospective cohort study in the tertiary care center. PATIENTS: Ninety-five children with cleft palate were referred for ear evaluation, from June 1997 to January 2015. Fifteen children (15.8%) had associated craniofacial syndromic anomalies. MAIN OUTCOME MEASURES: Cumulative incidence of otitis media with effusion, rate of ventilation tube insertion, duration of indwelling tubes, hearing outcome, and complications of ventilation tubes. RESULTS: Ear examinations were done every 8 to 12 weeks throughout the study. Cumulative incidence of otitis media with effusion was 53.7% in children within 12 months of age and 81.1% within 24 months of age. At the end of the study, all of the patients had at least 1 episode of otitis media with effusion. Eighty-eight children (92.6%) had palatoplasty, and there was no significant difference in the incidence of otitis media before and after palatoplasty. The mean hearing level at recruitment was 40.8 ±18.4 dB. Ventilation tube insertion was done in 76 patients (80%). The median time for indwelling tubes was 11.7 months. Rate of ventilation tube insertion was 0.5/year. The mean hearing level at last follow-up was 23.5 ± 14 dB. Otorrhea through tube was found in 24 cases (31.6%). CONCLUSION: Otitis media with effusion was common in Thai children with cleft palate. Surveillance of middle ear effusion and ventilation tube insertion contributed to a favorable hearing outcome.

Prevalence and Clinical Correlation of Superficial Fungal Foot Infection in Thai Naval Rating Cadets.

BACKGROUND: Superficial fungal foot infection is one of the most important dermatological diseases currently affecting military personnel. Many Thai naval rating cadets are found to suffer from superficial fungal foot infections and their sequels. OBJECTIVE: To investigate prevalence, potent risk factors, responding pathogens and clinical correlation of superficial fungal foot infection in Thai naval rating cadets training in Naval rating school, Sattahip, Thailand. MATERIALS AND METHODS: This cross-sectional study was performed in August 2015. Validated structured questionnaire was used regarding information about behaviors and clinical symptoms. Quality of life was assessed by Dermatology Quality of Life Index (DLQI) questionnaire and clinical presentation demonstrated by Athlete's foot severity score (AFSS). Laboratory investigations including direct microscopic examination and fungal culture were performed and recorded. All of the participants were informed and asked for their consent. RESULTS: A total of 788 Thai naval rating cadets with a mean age of 19 yr were enrolled. There were 406 (51.5%) participants suspected of fungal skin infection from questionnaire screening. After clinical examination, 303 participants (38.5%) were found to have foot lesions (AFSS ≥1). Superficial fungal foot infection was diagnosed with microscopic examination and fungal culture in 57 participants, giving a point prevalence of 7.2%. Tinea pedis was diagnosed in 54 participants with the leading causative organism being Trichophyton mentagrophytes (52.8%). Other 3 participants were diagnosed as cutaneous candidiasis. Wearing combat shoes more than 8 h was found to be a predisposing factor (p = 0.029), taking a shower less than two times a day (p = 0.008), and wearing sandals during shower (p = 0.055) was found to be protective against infection. Most fungal feet infection cases noticed their feet abnormalities (p < 0.001) including scales (p < 0.001), vesicles (p = 0.003) and maceration at interdigital web spaces (p < 0.001). Mean DLQI in superficial fungal foot infection cases was 3.35. Participants who had foot lesions (AFSS ≥1) were concerned of their foots unpleasant odor demonstrated significantly higher mean DLQI than those without odor (4.2 vs. 2.28; p < 0.001). CONCLUSION: Superficial fungal foot infection is found as 7.2% of naval rating cadets. Wearing combat shoes more than 8 h was found to be a predisposing factor. In addition to skin manifestations including scales, vesicles, and maceration, superficial fungal foot infection also exhibited an unpleasant foot odor which affected quality of life. Self-foot-examination and life style modification should be promoted to prevent fungal infection.

Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review.

BACKGROUND: Despite widely recommended usage of cyclosporine A (CsA) in chronic spontaneous urticaria (CSU), there is no meta-analysis concerning its efficacy and safety. OBJECTIVE: To meta-analyze and review the efficacy and safety of CsA in CSU. METHODS: Efficacy was assessed by the relative change in urticaria activity score at 4 weeks and response rates at 4, 8, and 12 weeks. Safety was assessed by analyzing the number of patients with 1 or more adverse event. RESULTS: Eighteen studies (909 participants) including 2 randomized controlled trials were included, with 125, 363, and 266 patients with CSU receiving very low (<2 mg/kg/d), low (from 2 to< 4 mg/kg/d), and moderate (4-5 mg/kg/d) doses of CsA, respectively. After 4 weeks, the mean relative change in urticaria activity score of CsA-treated patients was -17.89, whereas that of controls was -2.3. The overall response rate to CsA treatment with low to moderate doses at 4, 8, and 12 weeks was 54%, 66%, and 73%, respectively. No studies of very low-dose CsA evaluated response rates at 4, 8, and 12 weeks. Among patients treated with very low, low, and moderate doses of CsA, 6%, 23%, and 57% experienced 1 or more adverse event, respectively. CONCLUSIONS: Given the limited number and quality of studies, our results should be interpreted with caution. CsA is effective at low to moderate doses. Adverse events appear to be dose dependent and occur in more than half the patients treated with moderate doses of CsA. We suggest that the appropriate dosage of CsA for CSU may range from 1 to 5 mg/kg/d, and 3 mg/kg/d is a reasonable starting dose for most patients.

Detection of cardiac iron overload with native magnetic resonance T1 and T2 mapping in patients with thalassemia.

BACKGROUND: To investigate the diagnostic performance of native cardiac magnetic resonance (CMR) T1 and T2 mapping for cardiac iron overload (CIO) in thalassemia patients. METHODS: All thalassemia patients who underwent CMR were enrolled on a clinical 1.5T scanner. Native T1 mapping with the Modified Look-Locker Inversion recovery (MOLLI) technique, T2 mapping using a black-blood multi-echo spin-echo technique, and conventional T2* mapping using multi-echo gradient-echo techniques were performed. CIO was defined by a T2* of <20ms; while severe CIO was considered as <10ms. RESULTS: A total of 200 patients were enrolled in the study (23.9±14.6years old [mean±SD], 102 male). Among these, 8 patients (4.0%) had CIO. Both native T1 and T2 times were significant different among patients with no CIO, mild-to-moderate CIO, and severe CIO (1012.7±57.7 vs. 846.4±34.4 vs 601.3±34.6ms for T1, p<0.05; 59.6±6.5 vs. 48.7±2.5 vs. 32.8±1.2ms for T2, p<0.05). The best cut-off values for detection of CIO were 887 and 52ms for T1 and T2, respectively. This yielded a sensitivity, specificity and area under the curve (AUC) of 100%, 98.4% and 0.997 respectively for T1, in comparison to 100%, 88.8% and 0.961 respectively for T2. CONCLUSIONS: Native T1 mapping can differentiate between severe, mild-to-moderate, and no CIO, which appears to be a promising technique for detection and assessment of myocardial iron.

Long-term outcome following regenerative periodontal treatment of intrabony defects.

This study aimed to evaluate the long-term outcome of the regenerative periodontal therapy of an intrabony defect in terms of tooth survival and clinical attachment level (CAL) stability. The association between failure and patient as well as tooth variables was assessed. Treatment records of the patients who received regenerative surgery and re-evaluation at 1-year post-surgery were screened. Patient and tooth variables, defect characteristics, and types of treatments were collected. Periodontal parameters were retrieved before regenerative surgery (baseline), 1-year post-surgery, and every visits of supportive periodontal treatment (SPT) until failure, including tooth loss or CAL loss ≥2 mm was found. In this study, treatment records from 89 patients were included. These patients continued SPT from 0.5-11.16 years. Of these patients, 92.1 % survived from tooth loss, while 61.8 % survived from CAL loss ≥2 mm compared to 1-year post-surgery. At the sites with residual pocket depth <5 mm, patients attending SPT >80 % had a significantly less percentage of teeth with CAL loss ≥2 mm compared to 1-year post-surgery than those attending SPT <80 %. However, at the sites with residual pocket depth ≥5 mm, no significant difference in the percentage of teeth with CAL loss ≥2 mm was found between patients attending SPT >80 % or <80 %. Smoking, patient's compliance, and residual pocket depth after regenerative surgery were significantly associated with tooth loss. However, these factors were not significantly associated with CAL loss compared to baseline or 1-year post-surgery.