Inhibitory effect of Zingiber cassumunar Roxb. (Phlai) on nasal cytokine productions and eosinophilic recruitment in patients with allergic rhinitis.

BACKGROUND: Zingiber cassumunar Roxb. (Phlai) has been used for the treatment of allergies including allergic rhinitis (AR). Although the anti-histamine effects have been reported, assessment of nasal cytokine and eosinophil production had not been investigated. OBJECTIVE: This study aimed to examine the effect of Phlai on alterations in nasal pro-inflammatory cytokine levels and eosinophil counts in nasal mucosa. METHODS: This was a randomized, double-blind, three-way crossover study. Nasal concentrations of cytokines, namely interleukin (IL)-4, IL-5, IL-13 and interferron-gamma (IFN-γ), nasal smear eosinophilia as well as total nasal symptom score (TNSS) were evaluated before and after a 4 weeks treatment with 200 mg Phlai capsules or placebo in 30 AR patients. RESULTS: We observed significant (p < 0.05) reduction in IL-5, IL-13 as well as the number of eosinophils in subjects given Phlai. The degree of improvement of TNSS after Phlai treatment was initially manifested in week 2 with the greatest effect in week 4. In contrast, there were no significant differences in all nasal cytokines, eosinophil counts or TNSS between before and after receiving placebo. CONCLUSIONS: These findings provided the first evidence for the anti-allergic effect of Phlai which possibly involved inhibition of nasal pro-inflammatory cytokines production and eosinophilic recruitment. Phlai thus represents a promising herbal medicine for alleviating inflammation and AR symptoms.

Diagnostic accuracy of atopy patch test in children with cow's milk allergy.

BACKGROUND: The accuracy of an atopy patch test (APT) for fresh cow's milk allergy is controversial. Few studies have focused on commercial extract solutions. We aimed to evaluate the diagnostic performance of the APT in cow's milk allergic children using fresh cow's milk and commercial extracts of cow's milk and its components including casein, α-lactalbumin, and ß-lactoglobulin. METHODS: A prospective study was carried out in children with a history of cow's milk allergy. Children underwent the skin prick test (SPT) and APT with fresh cow's milk, powdered cow's milk, and commercial extracts of cow's milk, casein, α-lactalbumin, and ß-lactoglobulin. Oral food challenge (OFC) was confirmed in all children. RESULTS: A total of 37 patients participated (mean age 13.14 ± 7.26 months). Only 5 (13.51%) patients had positive OFC to cow's milk. The sensitivity of the APT using fresh cow's milk was 40%, specificity was 65.6%, PPV was 15.4%, and NPV was 87.5%. The sensitivity of the APT using powdered cow's milk was 40%, 60.7% for specificity, 15.4% for PPV, and 58% for NPV. The sensitivity and PPV of the APT using commercial solutions of cow's milk, casein, α-lactalbumin, and ß-lactoglobulin were zero. The specificities were 90.6%, 93.8%, 100%, and 100% for α-lactalbumin, cow's milk, casein, and ß-lactoglobulin, respectively. CONCLUSIONS: APT using commercial solutions showed higher specificity than fresh milk. The specificity increased using a protein component allergen.

Efficacy, patients' perception, and cost of medication in allergic rhinitis with subcutaneous immunotherapy.

BACKGROUND: Allergic rhinitis (AR) is the allergic inflammation of nasal mucosa. Treatment of AR includes pharmacotherapy and allergen immunotherapy. Subcutaneous immunotherapy (SCIT) is indicated in inadequate disease control, patient's preference, or impossible allergen avoidance. SCIT is an effective treatment but its cost is comparatively high. Efficacy, patient perception, and cost of medication are rarely explored in Asia. OBJECTIVE: To study efficacy, patient perception, and cost-benefit of SCIT in AR. METHODS: We performed a descriptive cross-sectional study at Thammasat University Hospital, Thailand. AR patients who had been receiving SCIT were interview. Current and recall of AR total symptom score (TSS), quality of life, and perception were scored. Cost of medications before SCIT and current cost were reviewed from the medical records. RESULTS: A total of 142 patients were enrolled. Sixty-eight patients (47.9%) received single allergen; house dust mite was the most common allergen. The median of maintenance phase was 47 months, range 15-142 months. The mean of current TSS was significantly lower than mean TSS before SCIT. Forty-two patients (29.6%) had discontinued SCIT on the day of the interview. After discontinuation of SCIT, TSS was still lower than TSS before SCIT. The average cost of medications including SCIT was lower than that of before SCIT with an average difference of 254.2 USD/year. Sixteen patients (11.3%) experienced systemic reaction, 8 of which had reaction during rush immunotherapy. CONCLUSIONS: SCIT is an effective, cost-saving and safe treatment option for AR. Rush immunotherapy can reduce duration of build-up phase but increase the risk of systemic reaction.

Outcomes of young children hospitalized with acute wheezing.

BACKGROUND: Wheezing in preschool children is a common symptom. OBJECTIVE: The study aimed to determine an incidence of recurrent wheezing among young children who had been hospitalized with acute wheezing after 12 months. Factors associated with recurrent wheezing were explored. METHODS: A longitudinal study was conducted among 236 children, aged between 6 months and 5 years, who were hospitalized with acute wheezing in 4 hospitals located in Bangkok and adjacent provinces, Thailand. Demographics, house environments and clinical characteristic data were collected at entry. Serum specific IgE levels against common food and inhalant allergens and serum 25-hydroxyvitamin D (25OHD) concentrations were measured. RESULTS: At entry, the mean age was 24.4 months (SD = 15.7 months). Of 236 hospitalized children with acute wheezing, ninety-four cases (39.8%) were the first wheezing episode of life. By laboratory results, 197 (83.5%) and 56 (23.7%) children were atopic and had vitamin D insufficiency respectively. There were 195 cases completely followed for 12 months. One-year risk of emergency visits and hospitalization due to recurrent wheezing were 49.7% and 23.1% respectively. By multivariable analysis, being the second born child or more, vitamin D insufficiency, "ever wheeze", and allergic rhinitis were significantly associated with recurrent wheezing within 12 months with adjusted odds ratios of 2.5 (95% confidence interval: 1.3-5.3), 2.3 (95% confidence interval: 1.1-4.4), 1.9 (95% confidence interval: 1.2-3.5), and 1.6 (95% confidence interval: 1.3-2.9) respectively. CONCLUSIONS: Being the second born child or more, vitamin D insufficiency, ever wheeze, and allergic rhinitis were significant risks of recurrent wheezing.

A randomized controlled study comparing the efficacy of soap versus soap-plus-microwave disinfection for irrigation device in children with acute rhinosinusitis.

BACKGROUND: Nasal irrigation is an effective component of sino-nasal disease management. Nonetheless, bacterial contamination is worrisome. OBJECTIVE: To study bacterial colonization incidence using squeeze-bottle nasal irrigation devices, after disinfection with soap or soap-plus-microwave technique, in pediatric acute rhinosinusitis. METHODS: A randomized, prospective, controlled study was conducted on acute rhinosinusitis children, aged 2-15 years. Each participant was randomized into a soap-cleaning or soap-plus- microwave group. For a two-week period, participants irrigated their nostrils with NSS twice daily and cleaned the bottle after each use. In the end, bottles were sent to a microbiological laboratory for bacterial identification. RESULTS: The mean 5S Score and satisfaction score gradually improved in both groups with no significant differences between groups. Bacterial identification frequency in the soap group was slightly higher than in the soap-plus-microwave one, without statistical significance. For safety and tolerability, all participants reported 100% adherence to nasal irrigation. The soap-plus-microwave group reported more minor adverse outcomes than the soap-cleaning one. No thermal deformation of irrigation bottles was observed. CONCLUSIONS: Regular cleaning of nasal irrigation devices is needed to minimize bacterial contamination. Only soap or soap plus microwave disinfection appeared simple and safe for disinfection. Both techniques can equally minimize the rate of bacterial contamination. Although no gross thermal deformation at optimal power and duration, chemical irritants after high power or long microwave durations may be a concern.

Concordance of skin test reactivity between indoor inhalant allergens among children with allergic respiratory disease.

BACKGROUND: In vitro studies have demonstrated cross-reactivity among indoor allergen proteins in children with allergic respiratory diseases. However, there are only few studies evaluating in vivo response. A skin prick test (SPT) with commercial indoor solutions is widely used in clinical practice. We aimed to evaluate SPT agreement in children with allergic respiratory disease between pairs of common indoor allergens. METHODS: We reviewed SPT results of children 2 to 18 years old, diagnosed with respiratory allergic disease. Results from house dust mite (Dermatophagoides farinae, Dermatophagoides pteronyssinus), cockroach (Periplaneta americana, Blatella germanica), cat and dog were collected. Sensitization was defined as ≥ 3 mm in wheal diameter. Kappa coefficient (κ) was used to analyze sensitization concordance for each allergen pair. RESULTS: The charts of 300 children, 187 (62.33%) males, were reviewed. Mean age was 7.43 ± 3.29 years with 183 (61%), 140 (46.67%), 45 (15%), 30 (10%) sensitizations to house dust mite (HDM), cockroach, cat and dog, respectively. Sensitization concordance between HDM and cockroach was moderate: κ = 0.53 (95% CI: 0.42-0.64). Moderate agreement occurred between dog and cat: κ = 0.41 (95%CI: 0.30-0.52). HDM-sensitized children showed poor concordance with both cat κ = 0.17 (95%CI: 0.09-0.24) and dog κ = 0.09 (95%CI: 0.03-0.14). There was also poor concordance between cockroach-sensitized children to cat κ = 0.19 (95%CI; 0.11-0.28) and dog κ = 0.11 (95%CI; 0.04-0.18). CONCLUSION: We demonstrated moderate agreement of SPT response between HDM and cockroach as well as dog and cat. This may be due to cross-reactivity. Component-resolved diagnosis should be considered in children with co-sensitization of these allergen pairs.

Associations between the infant and young child feeding index and nutritional status.

BACKGROUND: The infant and child feeding index (ICFI) is a single summary World Health Organization influenced index to assess feeding quality in infants and young children aged 6-36 months. This study aimed to demonstrate any associations between ICFI and nutritional status in a single Thai center. METHODS: The demographic data and feeding practices of healthy infants and children aged 6-36 months were collected from questionnaires given to 304 parents/caregivers; anthropometric measurements were taken. Associations between ICFI and weight-for-age Z scores (WAZ), length/height for age Z scores (LAZ/HAZ), weight-for-length/height Z scores (WLZ/WHZ), and body mass index-for-age Z scores (BAZ) were examined. RESULTS: The mean ICFI was 6.14 ± 1.63 and was lowest in the 6-8 months age group. Breastfed infants had significantly higher ICFI scores than those not breastfed. Factors influencing ICFI were infant age and milk volume intake. The ICFI was negatively associated with WAZ, WLZ/WHZ, and BAZ (ß = -0.13, P = 0.037; ß = -0.17, p = 0.01; ß = -0.15, P = 0.026, respectively). Breastfeeding was also negatively associated with WAZ, LAZ/HAZ, WLZ/WHZ, and BAZ. CONCLUSIONS: This study demonstrated a negative association between the ICFI and nutritional status. Breastfeeding may have obscured some positive effects from appropriate feeding practices, while dairy consumption may have hidden negative outcome from inappropriate ones. Despite the ICFI appearing to reflect infant and young child feeding behaviors, using the ICFI alone may not accurately reveal nutritional status.

Predictors of severe adverse outcomes in febrile neutropenia of pediatric oncology patients at a single institute in Thailand.

Febrile neutropenia in pediatric oncology patients may lead to severe infection, with adverse events including septic shock or death. The aim of the study was to investigate the prevalence of severe adverse outcomes and to determine the associated risk factors. This is a retrospective cohort study of pediatric oncology patients with febrile neutropenia from October 2013 to September 2017 at Thammasat University Hospital, Thailand. Clinical assessment and time-to-event of severe outcomes were analyzed. There were 95 febrile neutropenic episodes; severe adverse outcomes were documented in 11 (11.5%), with no infection-associated mortalities. Those with severe outcomes were older, received prophylactic granulocyte-colony stimulating factor (G-CSF), and had documented infection, lower initial ANC, and central venous catheter insertion. The proportional hazard regression model revealed age ≥ 10 years (hazard ratio [HR], 5.96; p = 0.005), prophylactic G-CSF (HR, 4.52; p = 0.028), and microbiologically documented infections (HR, 12.53; p = 0.017) independently predicted severe adverse outcomes. Although severe adverse outcomes occurred in only 11.5% of our febrile neutropenic episodes, we identified a few risk factors that may help predict those at highest risk.

Prevalence and severity of asthma, rhinoconjunctivitis and eczema in children from the Bangkok area: The Global Asthma Network (GAN) Phase I.

BACKGROUND: As noted in the reports of ISAAC phase I and III, allergic diseases are very common in Thailand, especially among younger children. OBJECTIVE: The objectives of this project are to study the prevalence and severity of the most common allergic diseases. i.e. asthma, rhinoconjunctivitis and eczema among children living in Bangkok. METHODS: A cross-sectional multi-centers survey using GAN Core questionnaires on asthma, rhinoconjunctivitis and eczema symptoms were completed by parents of children aged 6-7 years and children aged 13-14 years. RESULTS: The total of 6,291 questionnaires were eligible for the analysis. The cumulative vs. 12-month period prevalence of the three conditions for all children were: 24.4% vs. 13.5% for wheezing, 51.1% vs. 43.6% for rhinitis and 15.8% vs. 14.2% for eczema, respectively. The period prevalence of wheezing for younger children (14.6%) was higher than for older children (12.5%). Prevalences of severe wheeze and exercise wheeze were more common among older children (2.9% and 14.8%). The 12-month prevalences of rhinitis (43.6%) and rhinoconjunctivitis (16.3%) were higher in both age groups. Eczema, as the same to the other conditions, occurred more frequently in both groups (period prevalence of 14.3% and 14.0%) comparing to ISAAC phase III. CONCLUSION: Allergic conditions are very common diseases among children residing in Bangkok. There is an urgent need for an in-depth study to define epidemiological factors responsible for this increase.

Prevalence and risk factors of allergic rhinitis in children in Bangkok area.

BACKGROUND: Allergic rhinitis (AR) is a disease with a high global disease burden and significant morbidity and expense. Risk factors are not well understood. OBJECTIVE: The objective of our project is to study the prevalence and risk factors of AR in children living in the Bangkok area. METHODS: A cross-sectional, multi-center survey using new GAN core questionnaires on current AR and risk factors was completed by 3,074 parents of children aged 6-7 years and by 3,217 children aged 13-14 years, directly. RESULTS: The prevalence of current AR in children aged 6-7 years and 13-14 years was 15.0% (95% confidence interval [CI]:13.8-16.3%) and 17.5% (95% CI: 16.2-18.8%), respectively. The prevalence of severe AR in children aged 6-7 years and 13-14 years was 1.0% (95% CI: 0.6-1.3%) and 1.9% (95% CI: 1.4-2.4%), respectively. Co-morbidity with asthma and eczema was 27.1% and 24.6%, respectively. Significant factors associated with AR include parental history of asthma (p = 0.025), parental history of AR (p < 0.001), parental history of eczema (p < 0.001), lower respiratory tract infection in the first year of life (p < 0.001), breastfeeding (p = 0.019), current use of paracetamol (p < 0.001), exercise (p < 0.001), current cat exposure (p = 0.008), and truck traffic on the street of residence (< 0.001). CONCLUSION: AR is a common disease among children residing in Bangkok. This study confirms that a family history of atopy (asthma, AR, and eczema), antibiotics given in the first year of life, current paracetamol use, exercise, current cat exposure, and truck traffic on the street of residence are important and significant risk factors for AR symptoms.

Improved participants' understanding of research information in real settings using the SIDCER informed consent form: a randomized-controlled informed consent study nested with eight clinical trials.

PURPOSE: This study aimed to test the applicability and effectiveness of the principles and informed consent form (ICF) template proposed by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER) across multiple clinical trials involving Thai research participants with various conditions. METHODS: A single-center, randomized-controlled study nested with eight clinical trials was conducted at Thammasat University Hospital, Thailand. A total of 258 participants from any of the eight clinical trials were enrolled and randomly assigned to read either the SIDCER ICF (n = 130) or the conventional ICF (n = 128) of the respective trial. Their understanding of necessary information was assessed using the post-test questionnaire; they were allowed to consult a given ICF while completing the questionnaire. The primary endpoint was the proportion of the participants who had the post-test score of ≥80%, and the secondary endpoint was the total score of the post-test. RESULTS: The proportion of the participants in the SIDCER ICF group who achieved the primary endpoint was significantly higher than that of the conventional ICF group (60.8 vs. 41.4%, p = 0.002). The total score of the post-test was also significantly higher among the participants who read the SIDCER ICF than those who read the conventional ICF (83.3 vs. 76.0%, p < 0.001). CONCLUSIONS: The present study demonstrated that the SIDCER ICF was applicable and effective to improve Thai research participants' understanding of research information in diverse clinical trials. Using the SIDCER ICF methodology, clinical researchers can improve the quality of ICFs for their trials.

Metabolic Syndrome in Thai Women Previously Diagnosed with Gestational Diabetes.

Background: The study of metabolic syndrome after delivery and its relationship to gestational diabetes (GDM) in Thai is lacking. Objective: To compare the prevalence and risk factors of metabolic syndrome after delivery in GDM and normal pregnant Thai women. Material and Method: A case-control study was performed at Thammasat University Hospital. Women with previous history of GDM (n = 56) and normal pregnant women (n = 51) delivered during 2007-2013 were enrolled. All of them underwent metabolic profile evaluation and 75 gm oral glucose tolerance test in 2013-2014. Risk factors of metabolic syndrome were assessed by logistic regression model. Results: Women were recruited a mean of 2.97±)1.15 years after delivery. Compared to the control group, the mean current age, median body mass index (BMI) before pregnant, current BMI, waist/height ratio and systolic blood pressure were significantly higher in GDM group. Metabolic syndrome was more in the GDM group (26.8% (15/56) vs. 7.8% (4/51), OR 4.3, 95% CI: 1.32-13.99). Only a BMI ≥25 kg/m2 before index pregnancy was a significant independent factor for this condition (OR 7.18, 95% CI 1.79-28.80; p = 0.005). After delivery, GDM group had more insulin resistance, assessed by HOMA-IR, less insulin sensitivity assessed by Masuda index and QUICKI score and less insulin secretion assessed by HOMA-B, comparing to control group without metabolic syndrome. Conclusion: Previously diagnosed GDM women have higher prevalence of metabolic syndrome after delivery. Obesity before pregnant is a strong independent risk factor for this condition.

Economic Burden of Hospitalization with Acute Wheezing in Preschool Children: A Multi-Center Study.

Background: Wheezing is an important health problem in Thailand especially among preschool age. Objective: The aim of this study was to estimate costs of wheezing for hospitalization in preschool children under patient, provider, and societal perspectives. Material and Method: Two hundred and thirty-four participants who were admitted with acute wheezing at 4 hospitals including Thammasat University Hospital, Saraburi Hospital, Bhumibol Adulyadej Hospital and King Chulalongkorn Memorial Hospital during July 2014 to June 2015 were included in the present study. Data from hospital financial database and caregivers' expenses were collected. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care costs were determined by human capital approach. Results: The means of patient, provider and societal costs per admission were 3,020 THB (SD = 6,632 THB), 18,126 THB (SD = 16,898 THB), and 20,269 THB (SD = 20,537 THB) respectively. The main cost component in provider and societal perspective were accommodation costs during admission. Informal care cost was a major cost component for direct nonmedical costs. The economic burden of acute wheezing admission of preschool children in Thailand was estimated as 759 million THB per year. Conclusion: These costs of illness analysis provided an evidence of economic burden and costs of preschool wheezing in hospitalization in Thailand.

Effect of allergic rhinitis and asthma on the quality of life in young Thai adolescents.

BACKGROUND: Despite an increasing recognition that both asthma and allergic rhinitis are serious health disorders in Thailand, their combined effects on patients' quality of life in the Thai population has not been reported. OBJECTIVE: The study aimed to evaluate the impacts of allergic rhinitis and asthma on the quality of life of young adolescents in Thailand. METHODS: A total of 1,440 pupils, aged 12-14 years, were randomly recruited from 4 schools located in Bangkok and Pathum Thani Province. Allergic rhinitis and asthmatic symptoms were identified by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. The Pediatric Quality of Life Inventory (PedsQL) questionnaire was used to evaluate their quality of life. RESULTS: There were 1,230 completed questionnaires for analysis. The prevalence of allergic rhinitis alone, asthma alone and diseases co-occurrence was 32.8%, 7.2%, and 12.7% respectively. Pupils with respiratory allergy had significantly lower PedsQL mean scores than healthy pupils, for all dimensions (p < 0.006). The greatest reduction of the PedsQL mean score was for emotional functioning. Among pupils with allergic rhinitis, those who were also affected with asthma had significantly lower mean scores, for all quality of life domains (all p < 0.001). Compared to allergic rhinitis, asthma significantly reduced PedsQL mean scores in almost all domains (p < 0.001), except for physical health. CONCLUSIONS: Allergic rhinitis and asthma have a significant influence on the quality of life in young Thai adolescents, in particular regarding emotional functioning. Asthma has stronger negative effects on life quality than allergic rhinitis, especially regarding psychosocial health.

Health-related quality of life in Thai children with allergic respiratory diseases.

BACKGROUND: Childhood asthma and allergic rhinitis (AR) are major chronic respiratory diseases affecting health-related quality of life (HRQOL). Few school-based studies have reported the HRQOL of individuals with asthma or AR. OBJECTIVE: The study measured HRQOL among primary school pupils with asthma, AR and both diseases combined in Thailand. MATERIAL AND METHOD: Two thousand and eight school pupils, aged 6-9 years, from six primary schools were randomly studied. The self-reported Pediatric Quality of Life Inventory Core Scales (PedsQL) questionnaires were used to evaluate pupils' HRQOL in their classrooms. The parent-reported PedsQL questionnaires and the parent-reported International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire were sent to their parents to evaluate pupils' HRQOL and identify asthma and AR respectively. RESULTS: One thousand nine hundred and twenty-four of 2,008 (95.8%) pupils completed the self-reported PedsQL questionnaire and 1,789/2,008 (89.1%) parent-reported questionnaires were returned for analysis. By child self-reports, asthmatic pupils with or without AR had significant impairment in all domains of PedsQL questionnaire (p ≤ 0.049) compared to healthy pupils. Pupils with combined asthma and AR had significantly lower summary (p = 0.015) and emotional functioning mean scores (p = 0.001) than pupils with AR alone. By parent-reports, pupils with asthma alone, AR alone, and combined diseases had significant impairment in emotional functioning (p ≤ 0.047), compared to healthy pupils. CONCLUSION: Allergic respiratory diseases significantly reduced HRQOL in Thai school pupils, especially for emotional functioning. AR alone minimal impairs HRQOL while asthma with or without AR significantly reduce HRQOL in all domains.

Urinary Leukotriene E4 Level in Non-Allergic Thai Young Children.

BACKGROUND: Urinary leukotriene E4 (uLTE4) concentration represents body leukotriene synthesis. The level increases especially in respiratory allergic diseases. Researches of leukotriene production role in children with respiratory allergic diseases required the normal levels in non-allergic children as references. OBJECTIVE: The study was to assess the reference values of uLTE4 in non-allergic Thai children measured by competitive enzyme-linked immunosorbent assay (ELISA) technique. MATERIAL AND METHOD: Children who were admitted for elective surgery, aged 6 months to 5 years, were included in the study. Subjects who had acute illness, respiratory allergy (allergic rhinitis and asthma), and chronic diseases were excluded. Morning urine (5 ml) was collectedfor uLTE4 analysis by competitive ELISA technique. RESULTS: There were 36 urinary samples from 36 subjects aged 6-60 months with 26 boys and 10 girls. The mean of uLTE4 concentration was 619.73 ± 701.32 pg/ml and the mean of uLTE4 concentration adjustedfor urinary creatinine concentrations was 1,328 ± 788.54 pg/mg creatinine. The mean of uLTE4 concentration in boys and girls were 1,349 ± 817.10 pg/mg creatinine and 1,275 ± 747.79 pg/mg creatinine respectively. The mean of uLTE4 concentration adjusted for urinary creatinine concentrations were 1,363 ± 886.65, 1,384 ± 771.81 and 1,223 ± 773.16 pg/mg creatinine for children with the age of 6-18, 19-36 and 37-60 months respectively. CONCLUSION: The concentrations of uLTE4 and uLTE4 per creatinine were presented by age group in Thai very young children with non-respiratory disease. The concentrations were elevated in younger age group.

Correlations between gross motor functions and health-related quality of life in Thai children with spastic diplegia.

BACKGROUND: The motor disorders of cerebral palsy (CP) may not only affect children sfunctional capacities, but also their health-related quality of life (HR QOL). OBJECTIVE: The purpose ofthis study is to examine the correlation between gross motor functions andHRQOL of Thai children with spastic diplegia. MATERIAL AND METHOD: Fifty children with spastic diplegia were recruited from an outpatient department of Thammasat University Hospital and Rajanukul Hospital. All participants were measured for gross motor functions by the gross motor function measure (GMFM-66) and their HRQOL by reports of the Pediatric Quality of Life Inventory 4.0 (PedsQL). Spearman's rank correlation coefficients were used to determine the correlations between dimensional scores of GMFM-66 and PedsQL. RESULTS: Forty-five of 50 children with spastic diplegia were completely undertaken for both GMFM-66 and PedsQL mea- sures. The total HRQOL scale score had a fairly significant degree of relationship with the total GMFMscore (r = 0.48, p<0.001). The physical health summary score had a notably moderate to good degree of relationship with the total GMFM score (r = 0. 52, p<0.001). The psychosocial health summary score had afair degree relationship with the total GMFMscore (r = 0.27,p = 0.076). CONCLUSION: The gross motor function tended to correlate with HRQOL in children with spastic diplegia, especially with regard to the physical aspects of the HRQOL.

The efficacy of hospital-based food program as galactogogues in early period of lactation.

OBJECTIVE: Galactogogue food has been frequently used among lactating women without reported efficacy data. The present study was aimed to address the outcome of hospital-based food programs as defined by the onset of lactation and infant's weight loss. MATERIAL AND METHOD: A Quasi-experimental design was done to compare the maternal breast fullness/heaviness and infants' body weight among 106 women in galactogogue group and 127 controls. Data was gathered daily from the 1st day of postpartum through the date discharged regarding timing of first breast feeding, nursing frequency, LATCH score, nonbreast-milk fluid, breast fullness/hardness, leakage of colostrum/breast milk, let-down reflex and infants' body weight. RESULTS: Maternal report of breast fullness/heaviness within the first 48 hours in galactogogue group was significantly more than control (71.7% and 56.7%, respectively; p < 0.001). Proportion of infant who had an excessive weight loss, as defined by weight loss more than 7% within the first 48 hours, in galactogogue group was significantly lower than controls (15.1% and 24.4%, respectively; p = 0.043). CONCLUSION: The use of traditional food as hospital-based food program had some efficacies in the early period of lactation, regarding presence of breast fullness and reduction of infant's weight loss. However the efficacy in maintaining breast milk production should be further studied. Likewise, frequent breastfeeding and thorough emptying of breasts definitely result in increased milk production and should be evaluated in all lactating women.

The efficacy of 2% chlorhexidine gluconate in 70% alcohol compared with 10% povidone iodine in reducing blood culture contamination in pediatric patients.

BACKGROUND: Blood culture is the gold standard for diagnosis of septicemia. However; false-positive blood cultures are associated with increased health care costs due to unnecessary treatment. OBJECTIVE: To evaluate the efficacy of 2% chlorhexidine gluconate in 70% alcohol compared with 10% povidone iodine in reducing blood culture contamination inpediatricpatients. MATERIAL AND METHOD: This is a prospective study of pediatric patients who were admitted at a tertiary-care hospital. Pediatric patients who neededpercutaneous blood cultures were recruitedfrom two general pediatric wards and the pediatric intensive care unit. The authors used 10% povidone iodine as an antiseptic in odd months and 2% chlorhexidine gluconate in 70% alcohol as an antiseptic in even months in obtaining the blood culture samples. RESULTS: There were 1,269 blood culture specimens taken from 821 patients. 654 specimens used 10%povidone iodine as an antiseptic and 619 specimens used 2% chlorhexidine gluconate in 70% alcohol as an antiseptic. The 10% povidone iodine group and the 2% chlorhexidine gluconate in 70% alcohol group had the risk of blood culture contamination of 3.21% (95%CI: 2.00%-4.87%) and 2.28% (95% CI: 1.25%-3.79%) respectively. The risk difference ofblood culture contamination was 0.93% (95% confidence interval: 0. 86-2.72%) with p = 0.31. The most common contamination organism was Coagulase negative staphylococci (68.57%). No adverse skin reactions were observed in both antiseptic solutions groups. CONCLUSION: Use of2% chlorhexidine gluconate in 70% alcohol as an antiseptic seems to reduce the risk of blood culture contamination compared to use of 10% povidone iodine. In addition, neither of the antiseptic solutions resulted in adverse skin reactions.

Quality of life of elementary school students with sleep-disordered breathing and allergic rhinitis: A population-based study in Thailand.

BACKGROUND: Sleep-disordered breathing (SDB) and allergic rhinitis (AR) are common problems that can lead to worsening quality of life (QOL) in children with these conditions. There is scarce evidence on the QOL of children with SDB outside of the hospital setting with inconsistent evidence on the association of AR and QOL concerning the SDB in children. Thus, the primary objective of this study is to determine the QOL concerning the SDB of elementary school students by using OSA-18. We also aim to provide the relationship of allergic rhinitis to the QOL. METHODS: A cross-sectional study was conducted on all elementary school students, aged 6-12 years, from 10 elementary schools. The QOL of all participants was evaluated by the Thai version of the caregiver-administered OSA-18 questionnaire. The simple and multiple linear regression models were used to determine the effect of allergic rhinitis on the OSA-18 total scores. RESULTS: A total of 3,053 children were included in the final analysis, 50.1% male. At least a moderate impact on QOL from SDB was observed in 9.4% of the population. Children with AR had significantly higher mean total OSA- 18 scores than the children without AR (47.5 ± 15.0 VS 38.5 ± 13.1, p < 0.001). After the adjustment for age, gender, body mass index, household income, and history of asthma, the point estimate of the adjusted beta regression coefficient on the OSA-18 total score in children with AR was 7.82 (95% CI: 6.00-9.65, p < 0.001). Significant associations were observed between AR and all domains except for emotional distress. CONCLUSIONS: A substantial number of elementary school children had at least a moderate impact on the QOL from SDB, especially those with AR. Thus, effective screening of SDB in children with AR should be done to improve the QOL of these children.