Inadvertent Platelet Transfusion from Monkeypox Virus-Infected Donor to Recipient, Thailand, 2023.

In Thailand, platelet product from a blood donor was transfused to a recipient who had dengue. Two days later, the donor was confirmed to have monkeypox virus infection. Monkeypox virus DNA was undetectable in recipient specimens up to 2 weeks after transfusion. The recipient remained asymptomatic at 4 weeks of monitoring.

Anti-D alloimmunization by Asia type DEL red blood cell units in a D-negative Thai patient.

BACKGROUND: DEL phenotype is a rare Rh variant that cannot be detected by routine serological typing, and DEL individuals are thus typed D-negative (D-). Anti-D alloimmunization has been reported in "true" D- patients receiving DEL red blood cells (RBCs). CASE PRESENTATION: A 17-year-old, D- Thai male patient suffering from immunodeficiency syndrome with negative antibody screening received RBC units from 17 serological D- donors over a period of seven months due to acute respiratory failure with anemia. Before the 12th transfusion, anti-D production was detected. He was later transfused with RBCs from six other apparent D- donors. In order to elucidate anti-D production, all 17 blood donors were investigated by replicative serological testing and molecular analysis to identify potential RHD gene variants. All donors were confirmed D- by routine method, but as many as 12/17 were positive by adsorption-elution testing. Molecular analysis showed that five donors, including four whose blood was transfused before anti-D production occurred, carry the Asia type DEL allele, and are thus predicted to express a DEL phenotype. These data clearly suggest that 1/ the alloimmunized D- patient was exposed to D antigen, 2/ our adsorption-elution test is currently defective to identify DEL RBCs, and 3/ molecular analysis is highly valuable for Asia type DEL allele screening. CONCLUSION: For the first time in Thailand, we report anti-D alloimmunization in a serological D- patient transfused by Asia type DEL RBC units. This work definitely supports the implementation of a dedicated policy for DEL blood management including molecular testing.

Serologically D-negative blood donors in Thailand: molecular variants and diagnostic strategy.

BACKGROUND: Discriminating individuals with "Asian type DEL" from those who are "true D-negative" (D-) among serologically D- donors/patients in Asia would be very valuable, as clinical outcomes are different in these groups. Here we investigated the molecular basis of D-negativity in Thai blood donors, designing a specific strategy for this purpose. MATERIALS AND METHODS: After routine testing, a total of 1,270 serologically D- blood donors originating from Central, Northeastern and South Thailand underwent analysis of the RHD gene by (i) quantitative multiplex polymerase chain reaction of short fluorescent fragments (QMPSF); (ii) direct sequencing of exon 9 to identify the c.1227G>A variant defining the Asian type DEL allele; and (iii) direct sequencing of the other exons. RESULTS: The most common observation was whole deletion of the gene (i.e. RHD*01N.01; allele frequency: 86.81%), followed by the Asian type DEL allele (RHD*01EL.01; 7.60%) and a D-negative hybrid allele (RHD*01N.03; 3.46%). Four novel alleles, including one with a 13.1 kilobase-deletion, were identified and characterized. All but one RHD*01EL.01 allele carriers (183/184) were C-positive (C+), suggesting that this latter subset may be screened specifically when investigating the c.1227G>A variant, which can be identified with 100% accuracy by a specific Tm-shift genotyping assay. DISCUSSION: On the basis of our extensive molecular findings, we have designed a dedicated diagnostic strategy based on Rh C antigen typing followed by a genotyping test. Implementation of this method in all or selected groups of serologically D- donors/patients will contribute to improve the management of transfusion and pregnancy in Thailand.

Dynamics of Cytokine, SARS-CoV-2-Specific IgG, and Neutralizing Antibody Levels in COVID-19 Patients Treated with Convalescent Plasma.

Coronavirus disease 2019 (COVID-19) is a contagious illness worldwide. While guidelines for the treatment of COVID-19 have been established, the understanding of the relationship among neutralizing antibodies, cytokines, and the combined use of antiviral medications, steroid drugs, and convalescent plasma therapy remains limited. Here, we investigated the connection between the immunological response and the efficacy of convalescent plasma therapy in COVID-19 patients with moderate-to-severe pneumonia. The study included a retrospective analysis of 49 patients aged 35 to 57. We conducted clinical assessments to determine antibody levels, biochemical markers, and cytokine levels. Among the patients, 48 (98%) were discharged, while one died. We observed significantly higher levels of anti-nucleocapsid, anti-spike, and neutralizing antibodies on days 3, 7, and 14 after the transfusion compared to before treatment. Serum CRP and D-dimer levels varied significantly across these four time points. Moreover, convalescent plasma therapy demonstrated an immunoregulatory effect on cytokine parameters, with significant differences in IFN-ß, IL-6, IL-10, and IFN-α levels observed at different sampling times. Evaluating the cytokine signature, along with standard clinical and laboratory parameters, may help to identify the onset of a cytokine storm in COVID-19 patients and determine the appropriate indication for anti-cytokine treatment.

Dynamics of Neutralizing Antibodies and Binding Antibodies to Domains of SARS-CoV-2 Spike Protein in COVID-19 Survivors.

Neutralizing antibody level is used to predict immune protection against SARS-CoV-2 infection. Spike protein of SARS-CoV-2 is a major target for virus-neutralizing antibody. A number of neutralizing epitopes were mapped on receptor binding domain (RBD) and N-terminal domain (NTD) of S1 subunit of the spike. Anti-SARS-CoV-2 antibody usually decreases over time after recovery. Level of neutralizing antibody and binding antibody to several domains from COVID-19 recovered patients was observed longitudinally in this study. Sequentially collected serum samples from 35 patients demonstrated both similar and different trends of neutralizing antibodies versus binding antibodies to each domain. Twenty-three individuals showed similarly decreasing pattern of neutralizing titer, binding antibodies to RBD, NTD, fusion protein (S2), and nucleocapsid (NP). Interestingly, eight individuals had stably high neutralizing titer (≥320) for 3-12 months, whereas their binding antibodies to RBD, NTD, and NP rapidly decreased. Moreover, their binding antibodies to S2 were stable over time similar to the persistence of neutralizing antibody levels. The long-lasting antibody to S2 suggested an anamnestic response to cross-reactive epitopes from previous infections with other related coronaviruses. These data indicate a difference in kinetics and longevity of antibodies to various domains and epitopes of the SARS-CoV-2 proteins. A better understanding in this difference may help improve vaccine design to induce long-lasting immunity to COVID-19.

Long-term persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein-specific and neutralizing antibodies in recovered COVID-19 patients.

Understanding antibody responses after natural severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can guide the coronavirus disease 2019 (COVID-19) vaccine schedule, especially in resource-limited settings. This study aimed to assess the dynamics of SARS-CoV-2 antibodies, including anti-spike protein 1 (S1) immunoglobulin (Ig)G, anti-receptor-binding domain (RBD) total Ig, anti-S1 IgA, and neutralizing antibody against wild-type SARS-CoV-2 over time in a cohort of patients who were previously infected with the wild-type SARS-CoV-2. Between March and May 2020, 531 individuals with virologically confirmed cases of wild-type SARS-CoV-2 infection were enrolled in our immunological study. Blood samples were collected at 3-, 6-, 9-, and 12-months post symptom onset or detection of SARS-CoV-2 by RT-PCR (in asymptomatic individuals). The neutralizing titers against SARS-CoV-2 were detected in 95.2%, 86.7%, 85.0%, and 85.4% of recovered COVID-19 patients at 3, 6, 9, and 12 months after symptom onset, respectively. The seropositivity rate of anti-S1 IgG, anti-RBD total Ig, anti-S1 IgA, and neutralizing titers remained at 68.6%, 89.6%, 77.1%, and 85.4%, respectively, at 12 months after symptom onset. We observed a high level of correlation between neutralizing and SARS-CoV-2 spike protein-specific antibody titers. The half-life of neutralizing titers was estimated at 100.7 days (95% confidence interval = 44.5-327.4 days, R2 = 0.106). These results support that the decline in serum antibody levels over time in both participants with severe disease and mild disease were depended on the symptom severity, and the individuals with high IgG antibody titers experienced a significantly longer persistence of SARS-CoV-2-specific antibody responses than those with lower titers.

Long-term specific IgG response to SARS-CoV-2 nucleocapsid protein in recovered COVID-19 patients.

This study monitored the long-term immune response to severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection in patients who had recovered from coronavirus disease (COVID)-19. Anti-nucleocapsid immunoglobulin G (anti-N IgG) titer in serum samples collected at a single (N = 302) or multiple time points (N = 229) 3-12 months after COVID-19 symptom onset or SARS-CoV-2 detection in respiratory specimens was measured by semiquantitative chemiluminescent microparticle immunoassay. The 531 patients (966 specimens) were classified according to the presence or absence of pneumonia symptoms. Anti N IgG was detected in 87.5% of patients (328/375) at 3 months, 38.6% (93/241) at 6 months, 23.7% (49/207) at 9 months, and 26.6% (38/143) at 12 months. The anti-N IgG seropositivity rate was significantly lower at 6, 9, and 12 months than at 3 months (P < 0.01) and was higher in the pneumonia group than in the non-pneumonia/asymptomatic group at 6 months (P < 0.01), 9 months (P = 0.04), and 12 months (P = 0.04). The rate started to decline 6-12 months after symptom onset. Anti-N IgG sample/cutoff index was positively correlated with age (r = 0.192, P < 0.01) but negatively correlated with interval between symptom onset and blood sampling (r = - 0.567, P < 0.01). These findings can guide vaccine strategies in recovered COVID-19 patients.

Do Heberden and Bouchard nodes affect finger dexterity in elderly?

Elderly often have Heberden nodes (HN) and Bouchard nodes (BN) that may affect finger dexterity. The aim of this cross-sectional study was to assess an effect of HN and BN on finger dexterity of the elderly. The nine-hole peg test was used for dexterity measurement in 200 elderly with HN and/or BN. Mean age was 68.6 +/- 5.39 years. Average performance of each hand was compared between elderly with or without nodes. HN and BN were found in 75 right hands (37.5%) and 73 left hands (36.5%). Nodes were found in females more often than males (p < 0.001). Average right hand dexterity in elderly with and without nodes was 21.6 +/- 3.16 and 21.4 +/- 3.16 s. Average left hand dexterity in elderly with and without nodes was 23.3 +/- 3.13 and 23.3 +/- 3.67 s. There was no significant difference between elderly with or without nodes (p >/= 0.05). In conclusion, HN and BN in elderly hands do not affect finger dexterity. Therapist may use the same training program to prevent deterioration of finger dexterity in elderly with or without nodes.

Medical complications during inpatient stroke rehabilitation in Thailand: a prospective study.

OBJECTIVE: To identify the incidence and risk factors of medical complications during inpatient stroke rehabilitation. MATERIAL AND METHOD: Stroke patients (n = 118) admitted to the Thai Red Cross Rehabilitation Center between August 2006 and January 2007 were prospectively evaluated throughout inpatient rehabilitation to identify incidence of complications. RESULTS: Eighty-three patients (70.3%) experienced at least one complication. The common complications were post-stroke depression (56.6%), musculoskeletal pain (28%), urinary tract infection (UTI) (17.8%), and complex regional pain syndrome (CRPS) type I (15.3%). Others were pneumonia (4.2%), cardiovascular complications (4.2%), falls (4.2%), upper GI bleeding (3.2%), seizure (2.5%), and pressure ulcer (1.7%). Fourteen patients (11.8%) were referred to the acute care hospital because of severe medical complications. History of myocardial infarction, low admission Barthel ADL Index, urinary incontinence, indwelling catheterization, and dysphagia were risk factors of complications (p < 0.05). There were no specific risk factors of post-stroke depression. The risk factor of UTI was indwelling catheterization (RR 78.86, p < 0.001), CRPS type I was limited shoulder range of motion (RR 3.13, p = 0.035), pneumonia was aspiration (RR 145.33, p < 0.001), and cardiovascular complication was history of myocardial infarction (RR 7.70, p = 0.037). CONCLUSION: The incidence of medical complication is 70.3%. Post-stroke depression, musculoskeletal pain, UTI and CRPS type I are the common complications. The risk factors of complications are low admission BAI, history of myocardial infarction, urinary incontinence, indwelling catheterization, and dysphagia. Awareness and screening of risk factors should be implemented to lower the incidence.

SARS-CoV-2 RNA shedding in recovered COVID-19 cases and the presence of antibodies against SARS-CoV-2 in recovered COVID-19 cases and close contacts, Thailand, April-June 2020.

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although Thailand has been fairly effective at controlling the spread of COVID-19, continued disease surveillance and information on antibody response in recovered patients and their close contacts remain necessary in the absence of approved vaccines and antivirals. Here, we examined 217 recovered COVID-19 patients to assess their viral RNA shedding and residual antibodies against SARS-CoV-2. We also evaluated antibodies in blood samples from 308 close contacts of recovered COVID-19 patients. We found that viral RNA remained detectable in 6.6% of recovered COVID-19 cases and up to 105 days. IgM, IgG, and IgA antibodies against SARS-CoV-2 were detected in 13.8%, 88.5%, and 83.4% of the recovered cases 4-12 weeks after disease onset, respectively. Higher levels of antibodies detected were associated with severe illness patients experienced while hospitalized. Fifteen of the 308 contacts (4.9%) of COVID-19 cases tested positive for IgG antibodies, suggesting probable exposure. Viral clearance and the pattern of antibody responses in infected individuals are both crucial for effectively combating SARS-CoV-2. Our study provides additional information on the natural history of this newly emerging disease related to both natural host defenses and antibody duration.

Foot disorders and falls in older persons.

BACKGROUND: Fall rates are high among older people even in the healthy population. An aging foot may affect ambulatory function and increase the risk of fall(s). OBJECTIVE: To study foot musculoskeletal disorders, falls and associated factors in healthy elderly subjects. METHODS: Healthy volunteers aged 60-80 years who were independent in self-care and walking were recruited from urban Bangkok. Trained physicians evaluated health status, foot problems, and fall(s) history of all subjects. Walking performance was assessed using the 'Timed Get Up & Go' test and 6-m walking speed. Footprints were taken from the standing position. Foot dimensions and footwear were also measured by certified orthotists. Associated factors of foot disorders and falls were analyzed. RESULTS: There were 213 subjects: 108 men, 105 women with a mean age of 68.6 +/- 5.4 years. Foot deformities presented in 87% and were not significantly associated with walking performance or falls. Foot pain was found in 14% with a male:female sex ratio of 1:4. The causes of pain were plantar fasciitis, hallux valgus, callus, metatarsalgia, and inappropriate footwear. Subjects with foot pain had slower walking speed (1.14 +/- 0.12 vs. 1.19 +/- 0.12 m/s, p = 0.056). Falls were reported in 29.5% of women and 12.9% of men (p = 0.004). Multivariate analyses demonstrated that fall risk factors were female gender (OR = 2.4, 95% CI = 1.13-5.12), plantar fasciitis (OR = 6.8, 95% CI = 1.52-31.02), and knee osteoarthritis (OR = 3.6, 95% CI = 1.71-7.59). Subgroup analyses revealed that visual deficit was associated with falls in women (OR = 4.7, 95% CI = 1.75-12.73), and impaired foot protective sensation was associated with falls in men (OR = 5.1, 95% CI = 1.46-18.38). CONCLUSIONS: Aging foot deformities presented different characteristics among genders and were mostly asymptomatic. Foot pain, especially from plantar fasciitis, increased risk of falls in healthy older persons. Foot assessment, foot pain management, and proper footwear play important roles in fall prevention.

Lumbar disc degeneration in Thai elderly: a population-based study.

OBJECTIVE: Determine the prevalence and related factors of lumbar disc degeneration in the Thai elderly. MATERIAL AND METHOD: A population-based study was done at Rom Klao community, Bangkok. Seven hundred and ninety-two cases (306 males, and 486 females) out of 1166 elderly people aged > or =50 (mean age of 61.07 +/- 7.8 years) were assessed. The lateral spinal radiographs were interpreted as spondylosis grade 0-3 according to the degree of severity. RESULTS: Males had more prevalence of grade 2-3 spondylosis than females (58.8% vs. 52.9%), but females had higher prevalence of spinal listhesis (14.4% vs. 8.8%). Age was a strong predicting factor for disc degeneration (OR = 1.088, 95% CI = 1.065-1.111, p = 0.000). Females had more risk to develop spinal listhesis (OR = 1.84, 95% CI = 1.11-3.05, p = 0.020) and low back pain (OR = 1.82, 95% CI = 1.29-2.56, p = 0.001). BMI was a predicting factor for spondylosis (OR = 1.066, 95% CI = 1.02-1.10, p = 0.000). About 27% of the cases reported moderate-severe low back pain and had lower Barthel ADL index (p = 0.018). CONCLUSION: Lumbar disc degeneration and low back pain were highly prevalent among the Thai elderly. Therefore, they need proper health care for disability prevention.

Electrodiagnosis and recovery of facial paralysis at King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study electrodiagnostic findings and recovery patterns of patients with facial nerve paralysis. MATERIAL AND METHOD: Seventy-six medical records of patients who had a facial paralysis and had their electrodiagnosis performed in a 2-year period were reviewed. Patients were invited for re-evaluation. The patients would be evaluated according to House-Brackmann Facial Nerve Grading Scale (HBFNGS), residual impairment, disability, emotional and social consequences. RESULTS: Complete data were obtained from 50 patients whose mean age was 47.0 +/- 17.9 years. Seventy-two percent were diagnosed as Bell's palsy. There was significant correlation between %CMAP amplitude and HBFNGS (grade I-VI) at r = 0.5; p < 0.01. All cases of Bell's palsy with CMAP amplitude > or = 70% of normal side regained full recovery. Patients with CMAP amplitude > or = 30% had good recovery. Bell's palsy with CMAP amplitude < 10% and with other causes had poor outcome. Nine patients had synkinesis. Most of them were of traumatic cause and had severe nerve degeneration. No evidence showed that electrical stimulation was a factor inducing synkinesis. CONCLUSION: Percent CMAP amplitude could moderately predict the outcome of Bell's palsy better than other causes of facial palsy. The paralysis from traumatic cause with low %CMAP amplitude had more chance to develop synkinesis.

Falls among stroke patients in Thai Red Cross rehabilitation center.

OBJECTIVE: To determine the incidence and risk factors of falls among stroke patients. MATERIAL AND METHOD: A prospective cohort study was designed to study the stroke patients who were admitted to the Thai Red Cross Rehabilitation Center from February 2004 to July 2005. Related variables offaller and non-faller groups were compared. RESULTS: Of 151 patients, 24 (15.9%) experienced at least one fall. The incidence rate was 3.44/1000 patients/ day. Most of the falls (71.4%) occurred during the daytime, in the bathroom (37.1%), and by the bedside (22.9%). Falls frequently occurred while transferring (22.9%) and walking (20%). Barthel ADL Index (BAI) score was the variable that significantly differentiated the fallers from the non-fallers (p = 0.013). Patients with BAI score of > or = 12 had 3 times more risk to fall. CONCLUSION: About 16% of stroke patients fell during rehabilitation. More attention should be paid during the transfer and ambulation. Furthermore, a safety area should be provided in every bathroom and by the bedside.

Effects of imagery-weight exercise.

OBJECTIVE: To study the effects of imagery-weight exercise on muscle strength. MATERIAL AND METHOD: Preliminary study of a before and after designed experiment was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, from June to September 2004. Fifteen healthy sedentary volunteers: 5 males, 10 females, mean age 28.7 +/- 3.5 years were enrolled The participants were instructed to perform imagery-weight exercise training with their non-dominant arms. The program consisted of 3 sets of 10 repetitions of elbow flexion, 3 days/week, for 8 weeks. The arm muscles strength were assessed with computerized isotonic machine. One-Repetition Maximum (1-RM) at before and after the training program, was compared RESULTS: The mean 1-RM of elbow flexors increased by 44.9% (from 6.78 +/- 2.10 kg to 9.83 +/- 2.32 kg, p = 0.000). The mean 1-RM of elbow extensors increased by 32.0% (from 4.03 +/- 1.98 kg to 5.33 +/- 2.32 kg, p = 0.000). CONCLUSION: Imagery-weight exercise is another effective technique of low impact strength training.

Star excursion balance training: effects on ankle functional stability after ankle sprain.

OBJECTIVES: To study the effects of Star Excursion Balance training on functional stability of athletes with ankle sprain. MATERIAL AND METHOD: Thirty-two male athletes with grade 2 ankle sprain, aged 15-22 years old were enrolled. They were random sampling into training group (n=15) and control group (n=17). All received conventional physical therapy program for 4 weeks. The training group also underwent the Star Excursion Balance training 3 days per week for 4 weeks. Single leg stance time (SLST) was assessed at pre- and post-training. Re-injuries were recorded during 3 months follow-up. RESULTS: After the program, subjects from both groups demonstrated significant improvement in SLST The training group gained SLST of the injured sides 2 times more than the control group (p = 0.002 tested with eyes closed, p = 0. 007 tested with eyes open), and also improved the SLST during eyes closed of the normal sides (p = 0.015). Re-injuries were found in 1/15 of the training group and 2/17 of the control group. CONCLUSION: Star Excursion Balance training is more effective than the conventional therapy program in improving functional stability of the sprained ankle.

Incidence of vertebral fractures in Thai women and men: a prospective population-based study.

BACKGROUND: Vertebral fracture is the most common but the least well-investigated osteoporotic fracture. A population-based prospective study was conducted to determine incidence of vertebral fracture in Thai older adults. METHODS: Lateral thoracic and lumbar spine radiographs obtained in 1997 and 2002 of 322 participants were evaluated morphometrically. Incidence of fracture was considered if the vertebra was determined as normal at baseline and any of the anterior, central, posterior vertebral heights on the follow-up film showed a decrease of at least 20% or 4 mm compared with baseline height. RESULTS: Incidences of vertebral fracture in women and men were 32.1/1000 and 54.5/1000 person-year, respectively. Incident rates in men were higher than those in women in all age groups. Incidence increased with age, ranging from 27.4/1000 person-year at ages 50-59 years to 46.1/1000 person-year at ages of 70 years or more for women, and 42.3/1000 person-year at ages 50-59 years to 66.7/1000 person-year at ages of 70 years or more in men. The incidence was markedly high compared with other studies conducted in white older adults. Thai older adults with incidental vertebral fractures had a much higher proportion of having multiple-level fractures compared with white older adults. CONCLUSIONS: This study showed a remarkably high incidence of vertebral fractures in a Thai population, particularly in men. The main contributing factor for incidental vertebral fracture was likely to be trauma or micro-trauma associated with strenuous physical activity or work rather than osteoporosis, particularly among the younger age group and men.

Proper shoe sizes for Thai elderly.

BACKGROUND: Problems from improper shoe fitting are common, but there are limited foot data for the older Thai population. OBJECTIVES: To study foot dimensions and determine proper shoe sizes for Thai elderly. METHODS: Healthy older people: 108 men, 105 women, aged 60-80 years, who were independent in walking, were recruited. Thirteen foot dimensions and current shoes used were measured. Side-to-side, gender difference, and correlations of main foot measurements were analyzed. RESULTS: About 50% women and 34% men wore too narrow shoes, and this was found to be associated with foot pain. At the same foot length (FL), men had larger foot width (FW) and toe depth. Foot width=2.39+(0.29 x FL), r=0.50, p=0.001 for women and=2.48+(0.31 x FL), r=0.56, p=0.002 for men. Arch length=1.0+(0.7 x FL), r=0.93, p=0.001 for both genders. Toe depth had constant values in all shoe sizes of each gender. Correlations of other foot parameters were reported. CONCLUSIONS: These anthropometric data is essential for proper shoe fitting in order to provide foot ergonomics and prevent foot problems for older Thai people.