Prevalence of concomitant angioedema in chronic spontaneous urticaria: A systematic review and meta-analysis.

BACKGROUND: Angioedema (AE) is a condition associated with considerable morbidity and mortality that can significantly affect quality of life. AE often occurs in patients with CSU although the true prevalence remains unknown. Therefore, we conducted this systematic review and meta-analysis to summarize the available data. OBJECTIVE: This study is conducted with the aim of retrieving data from all published studies and create the pooled prevalence of AE in CSU patients. METHODS: Narrative reviews of AE and CSU, a systematic review, and a meta-analysis were conducted. The Ovid Medline and Embase databases were systematically searched per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Studies were eligible if they were in English and measured the prevalence of AE in CSU in adults or children. Two reviewers independently extracted data and appraised each study's quality. Estimated prevalence and 95% confidence interval (CI) values were pooled using random-effects meta-analysis. RESULTS: Seventeen studies from 16 countries were included. The pooled prevalence of AE in patients with CSU was 36.5% (95%CI, 30.9-42.5%; I2 = 96%). The pooled estimated prevalence of AE in patients with CSU was 44.0% (95%CI, 34.1-54.5%) in Europe, 44.5% (95%CI, 28.5-61.8%), America, and 29.4% (95%CI, 24.7-34.7%) in Asia. CONCLUSIONS: Our systematic review and meta?analysis showed that AE affects over one-third of CSU patients, although the prevalence from individual study varied considerably, ranging from 5 to 67 percent. Subgroup-analysis found that AE is more prevalent in Europe and America than in Asia.

The cost of community outreach HIV interventions: a case study in Thailand.

BACKGROUND: There was an estimated 440,000 people living with HIV in Thailand in 2018. New cases are declining rapidly thanks to successful prevention programs and scaling up of anti-retroviral therapy (ART). Thailand aims to achieve its commitment to end the HIV epidemic by 2030 and implemented a cascade of HIV interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program. METHODS: This study focused on community outreach HIV interventions implemented by Non-Governmental Organizations (NGOs) under the RRTTR program in 27 provinces. We calculated unit cost per person reached for HIV interventions targeted at key-affected populations (KAPs) including men who have sex with men/ transgender (MSM/TG), male sex workers (MSW), female sex workers (FSW), people who inject drugs (PWID) and migrants (MW). We studied program key outputs, costs, and unit costs in variations across different HIV interventions and geographic locations in Thailand. We used these estimates to determine costs of HIV interventions and evaluate economies of scale. RESULTS: The interventions for migrants in Samut Sakhon was the least costly with a unit cost of 21.6 USD per person to receive services, followed by interventions for migrants in Samut Prakan 23.2 USD per person reached, MSM/TG in Pratum Thani 26.5USD per person reached, MSM/TG in Nonthaburi 26.6 USD per person reached and, MSM/TG in Chon Buri with 26.7 USD per person. The interventions yielded higher efficiency in large metropolitan and surrounding provinces. Harm reduction programs were the costliest compare with other interventions. There was association between unit cost and scale of among interventions indicating the presence of economies scale. Implementing HIV and TB interventions jointly increased efficiency for both cases. CONCLUSION: This study suggested that unit cost of community outreach HIV and TB interventions led by CSOs will decrease as they are scaled up. Further studies are suggested to follow up with these ongoing interventions for identifying potential contextual factors to improve efficiency of HIV prevention services in Thailand.

Clinical manifestations and progression, seasonal variation, and environmental factors associated with Paederus dermatitis among patients attending the outpatient dermatology clinic of Thailand's largest national tertiary referral center: a prospective cohort study.

INTRODUCTION: Paederus dermatitis (PD) is a skin reaction to a chemical substance called paederin, which emanates from a beetle of Paederus spp. This study's objective was to investigate the clinical manifestations and progression, seasonal variation, and environmental factors associated with PD among patients attending the outpatient dermatology clinic of Siriraj Hospital. METHODS: This prospective cohort study included patients who were diagnosed with PD at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the October 2017 to July 2018 study period. Sociodemographic and environmental data were collected by questionnaire. RESULTS: Twenty-five PD patients (16 females, 9 males) were included with a mean age of 40.9 years (range 17-69 years). The most common sites were the upper and lower extremities. Erythema, linear, and kissing lesions (where two skin surfaces contact) were found in 100%, 32%, and 28% of patients, respectively. Seventy-six percent of patients demonstrated more than one lesion. Eighty percent of patients lived in Bangkok, and 44% of patients had a home near a farm or forest. Fluorescent lighting was used in the homes of 24 patients. All 25 patients were treated with topical steroid, and some received other supportive regimens. Two patients had post-inflammatory hyperpigmentation as a complication; only 7 of 25 patients attended the scheduled follow-up visit. CONCLUSION: In Thailand, PD presents throughout the year, but the most active month is December. Skin lesions vary from mild irritant dermatitis to severe dermatitis, and the average time to complete cure is 12 days. History and clinical manifestation are essential for accurate diagnosis.

WILLINGNESS TO PAY, QUALITY OF LIFE, AND KNOWLEDGE ON HERPES ZOSTER AMONG THAI PATIENTS PRIOR ZOSTER VACCINE ERA.

Herpes zoster is a devastating condition affecting patients' wellbeing. Policy on zoster vaccine in developing countries needs more data on the disease burden. This study was designed to assess willingness to pay, quality of life, and the patients' knowledge on herpes zoster disease. All of the patients were asked to complete questionnaires about the willingness to pay for zoster treatment using the Dermatology Life Quality Index (DLQI) questionnaires in Thai version and basic knowledge about herpes zoster. The demographic and clinical data were all recorded. Eighty-two from one hundred and eighteen patients in this study were female (69.5%), and the mean (SD) age was 57.6 (14.9) years. The median of their willingness to pay for zoster treatment was THB500 (range of THB50-10,000) or only 4.2% of median income per month. The mean of total DLQI score (SD) was 10.7 (6.2), which indicated moderate to severe impact on quality of life. From multiple linear regression analysis, three factors were related to inferior patients' quality of life including facial involvement (regression coefficients, b=4.789, p=0.001), presence of zoster complications (b=5.018, p=0.001) and advanced pain score (b=0.883, p<0.001). Moreover, more than half of them still had mistaken knowledge about the disease.

PREVALENCE AND CLINICAL MANIFESTATIONS OF MALE PATIENTS WITH ANOGENITAL WARTS ATTENDING A SEXUALLY TRANSMITTED DISEASE CLINIC PRIOR HPV VACCINE RECOMMENDATION.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide among men who have sex with men (MSM). A quadrivalent HPV vaccine has been recommended for men in the United States since 2011. We conducted a retrospective study to determine the male anogenital wart burden and patient characteristics at a sexually transmitted disease (STD) clinic to provide baseline data regarding HPV infection. We reviewed the charts of male patients who attended a STD clinic between January 2007 and December 2011 and were diagnosed with having anogenital warts by clinical examination. A total of 181 patients were included in the study. The mean age of patients was 31.1 years, of which 22.7% were MSM and 14.9% had human immunodeficiency virus (HIV) infection. The prevalences of anogenital warts were 22.6% among MSM and 15.1% among HIV infected patients. The prevalence of anogenital warts increased between 2007 and 2011. Compared with patients without anogenital warts at the same STD clinic, patients with anogenital warts were significantly younger and more likely to have multiple sexual partners. Among the HIV infected patients, 63% were MSM; they had a significantly higher anogenital wart recurrence rate. Male anogenital warts posed a significant burden at the STD clinic. A preventive program is needed for anogenital warts, especially among MSM.

Total IgE, mosquito saliva specific IgE and CD4+ count in HIV-infected patients with and without pruritic papular eruptions.

BACKGROUND: Pruritic Papular Eruption (PPE) is a skin disorders found in HIV infected patients. However, the exact etiology of PPE is not documented. It has been suggested that PPE might result from arthropod bites. OBJECTIVE: The aim of this study was to investigate those factors in the HIV patient contributing to the occurrence of PPE, including specific IgE against mosquito saliva allergens, total IgE, CD4 cell counts and their associations. METHODS: Specific IgE against saliva allergens of Cx. quinquefasciatus mosquito was measured in 25 HIV patients with PPE and in 60 HIV without PPE by a time-resolved fluorescence immunoassay (TRIFA). The total IgE levels and CD4cell counts were also determined. RESULTS: Among the HIV patients with PPE, 84% (21/25) had CD4 cell counts less than 200 cells/µl in contrast to 30% (18/60) of the HIV without PPE patients. These differences were statistically significant (p =0.0005, χ2 test). The total IgE scores for the HIV patients with PPE were significantly higher than for those without PPE. A comparison of the mean arbitrary scores of the specific IgE in HIV patients, with and without PPE, was non-significant (p = 0.152). However, 44% (11/25) of the HIV patients with PPE had an arbitrary score above the mean score of mosquito bite allergic subjects, as compared to only 3.3% (2/60) of HIV patients without PPE. CONCLUSIONS: It may be concluded that the etiology of PPE in the HIV patient may be heterogeneous or multi-causal with allergic responses to the mosquito saliva allergen being only partially responsible.

Clinical and epidemiological characteristics of patients with syphilis: 5 year-case study from Thailand.

BACKGROUND: Syphilis has been increasing dramatically worldwide since 2000, especially among men who have sex with men (MSM), and in those with human immunodeficiency virus (HIV) infection. However most previous reports studied about prevalence and riskfactors ofsyphilis in MSMpopulation without statistical comparison with non-MSMpopulation. OBJECTIVE: The present study aimed to describe epidemiological trends, clinical manifestations, laboratory investigation, treatment, and HIV co-infection in patients diagnosed with syphilis, including statistical evaluation these data between MSMand non-MSM as well as HIV and non-HIVpopulations. MATERIAL AND METHOD: This was a retrospective medical records review ofpatients diagnosed with syphilis who attended Sexual Transmitted Diseases (STD) clinic between January 2008 and December 2012. Demographic data, clinical manifestations, HIVstatus, VDRL titer; and treatment regimens were collected. RESULTS: Of the 922 patients that attended the STD clinic, 143 syphilis patients were recruited with an overall prevalence of 15.5%. Twenty-six patients were MSM and 31 were HIV infected patients. Prevalence rate of syphilis in MSMand HIV infected patients were 2.8% and 3.4%, respectively. Prevalence had upward trend that startedfrom 2008 and reachedpeak in 2011. When taking MSMinto account, MSMsignificantly had younger age than non-MSM Early stage ofsyphilis, VDRL titer higher than 1:32 at diagnosis, and MSMpopulation were significantly associated with HIV-positivity among syphilis patients. Regarding treatment ofsyphilis, median time to cure syphilis was 117 days (95% confidence interval = 93-141). Treatment regimen, MSM and HIVco-infection did not significantly show influence on duration to cure. CONCLUSION: Prevalence ofsyphilis has been continuously increasing. MSM with syphilis significantly associated with younger age. Moreover, early stage of syphilis, VDRL titer higher than 1:32, and MSMpopulation were significantly related with HIVinfection. Treatment regimen, MSM and HIVco-infection did not significantly show influence on duration to cure.

Utilization of Primary Health Care Under National Health Insurance in Samarinda Municipality, East Kalimantan Province, Indonesia.

Aim: In Indonesia, basic community health services are provided to all citizens through Primary Health Care (PHC) settings under the National Health Insurance (NHI) scheme. The insurance is compulsory and provides basic community health needs. Based on a gatekeeper concept, the PHC is deemed to be the first contact point for all basic healthcare needs. Despite the commencement of services through PHC settings in 2014 under this concept, utilization in PHC settings remains lower than in hospital settings. This study aimed to assess factors associated with utilization of PHC under National Health Insurance in Samarinda Municipality, East Kalimantan Province, Indonesia. Materials and Methods: The research examined the utilization of services over six months. It employed a cross-sectional method and included 382 NHI participants in 10 districts of Samarinda Municipality. Each district was divided into urban and semi-urban areas based upon local government indicators representing the whole research area. A two-stage random sampling and purposive sampling approach was implemented to select the sample. The participants were interviewed using a structured questionnaire. Chi-square and multiple logistic regressions were conducted to determine the impact of factors on the utilization of PHC. Results: Only 17.3% of participants used PHC services regularly. Three constitutive factors, type of NHI participants (Adj. OR: 2.62; p<0.005), accommodation (Adj. OR: 2.18; p<0.005) and awareness (Adj. OR: 3.27; p<0.005) most profoundly influenced the under-utilization of PHC by NHI participants. Conclusion: The study found that the type of NHI participant and the utilization factors of accommodation and awareness significantly influenced the degree of utilization of PHC facilities by NHI participants and that the differences arose from variations in knowledge and experience. Strengthening these factors will rely upon an expanded role of government and community collaboration, emphasizing the needs of NHI participants.

Clinical features and aggravating factors in nummular eczema in Thais.

BACKGROUND: Nummular eczema is an idiopathic inflammatory skin disease that mostly has a chronic and relapsing course. Many factors are thought to be responsible for this condition, such as atopic dermatitis, dry skin, emotional stress or seasonal variation. OBJECTIVE: The purpose of the study was to assess clinical findings and aggravating factors of nummular eczema and to evaluate characteristics, severity of disease and quality of life of patients. METHODS: One hundred patients aged from 18 years old diagnosed as nummular eczema were asked about general data, characteristics and clinical findings of nummular eczema, and completed the Thai version of the Dermatology Life Quality Index (DLQI) questionnaires. They also underwent a physical examination. CONCLUSIONS: Clinical features and possible aggravating factors of nummular eczema were reported. The result confirmed the chronic course of the disease. The nummular eczema affected quality of life of patients and itching caused the most impairment. RESULTS: Mean (SD) age was 42.1 (18.4) years and two-thirds were women. Fourteen percent had history of atopic dermatitis and half had history of atopy or contact dermatitis. From patch tests, the most common allergen was found to be nickel. Ninety percent of lesions located in lower extremities and two-thirds had a co-existing dryness of the skin. Emotional stress and drinking alcohol aggravated the disease. Those who had exacerbation in summer or skin dryness tended to have persisting disease. Mean(SD) total DLQI score among our patients was 9.2(6.8). Quality of life of the patients was significantly impaired in younger life, office workers, those with trunk-distributed lesions and those having extensive lesions. CONCLUSIONS: Clinical features and possible aggravating factors of nummular eczema were reported. The result confirmed the chronic course of the disease. The nummular eczema affected quality of life of patients and itching caused the impairment.

Opinions and perceptions on acne: a community-based questionnaire study in Thai students.

OBJECTIVE: To evaluate the opinions and perceptions on acne and the effect of acne on the quality of life in Thai teenagers. MATERIAL AND METHOD: Five hundred ninety seven students of five high schools in Bangkok were administered a self-reported questionnaire about acne. Of these, 537 students were further examined by dermatologists to grade acne severity. RESULTS: The study population consisted of 392 (65.7%) female and 205 (34.3%) male. More than half believed that inadequate sleep, stress, sweat/exercise/hot weather; cosmetics, pre-menstrual period, oily food, and sun exposure aggravated their acne. Regarding Dermatology life quality index (DLQI), the question concerning embarrassment had the highest mean DLQI score, which reflect the most impact by acne. CONCLUSION: Some of the Thai adolescents still had misconceptions about the disease. Even mild acne can have an extremely large effect on their quality of life.

The factors affecting quality of life in Thai psoriasis patients.

OBJECTIVE: To identify the factors that affect quality of life in Thai psoriasis patients. MATERIAL AND METHOD: Data collected from 326 psoriasis patients that visited dermatology clinic at Siriraj Hospital, Bangkok, Thailand between 2001 and 2007 was used. Dermatology Life Quality Index (DLQI) was used to measure quality of life. Severity was evaluated by Psoriasis Area and Severity Index (PASI). RESULTS: Overall, psoriasis had moderate to very large negative effect on the patient's life. There was a tendency that elderly patients had a slightly better quality of life than younger adult and middle-age patients. However other demographic variables (i.e., gender, occupation, and income) had no influence on quality of life. This study also identified a linear trend of increased overall DLQI with greater PASI. CONCLUSION: Only older age and lesser severity of disease had association with few burdens in Thai psoriasis patients.

Enrollment of dengue patients in a prospective cohort study in Umphang District, Thailand, during the COVID-19 pandemic: Implications for research and policy.

Background and Aims: Dengue is endemic in Thailand and imposes a high burden on the health system and society. We conducted a prospective cohort study in Umphang District, Tak Province, Thailand, to investigate the share of dengue cases with long symptoms and their duration. Here we present the results of the enrollment process during the COVID-19 pandemic with implications and challenges for research and policy. Methods: In a prospective cohort study conducted in Umphang District, Thailand, we examined the prevalence of persistent symptoms in dengue cases. Clinically diagnosed cases were offered free laboratory testing, We enrolled ambulatory dengue patients regardless of age who were confirmed through a highly sensitive laboratory strategy (positive NS1 and/or IgM), agreed to follow-up visits, and gave informed consent. We used multivariate logistic regressions to assess the probability of clinical dengue being laboratory confirmed. To determine the factors associated with study enrollment, we analyzed the relationship of patient characteristics and month of screening to the likelihood of participation. To identify underrepresented groups, we compared the enrolled cohort to external data sources. Results: The 150 clinical cases ranged from 1 to 85 years old. Most clinical cases (78%) were confirmed by a positive laboratory test, but only 19% of those confirmed enrolled in the cohort study. Women, who were half as likely to enroll as men, were underrepresented in the cohort. Conclusions: The Thai physicians' clinical diagnoses at this rural district hospital had good agreement with laboratory diagnoses. By identifying underrepresented groups and disparities, future studies can ensure the creation of statistically representative cohorts to maximize their scientific value. This involves recruiting and retaining underrepresented groups in health research, such as women in this study. Promising strategies for meaningful inclusion include multi-site enrollment, offering in-home or virtual services, and providing in-kind benefits like childcare for underrepresented groups.

Cutaneous reactions to proton pump inhibitors: a case-control study.

BACKGROUND: Even though proton pump inhibitors (PPIs) are commonly used in clinical practice, a limited number of studies are available about cutaneous adverse reactions from PPIs, and most of these are case reports. OBJECTIVE: To demonstrate the pattern of cutaneous reactions related to PPI usage and to evaluate the risk of developing PPI drug eruptions among adult patients. METHODS: We reviewed the spontaneous reports of any adverse events associated with PPI use, as reported from January 2005 through May 2010 to the Adverse Drug Reaction Center at Siriraj Hospital in Thailand. Each control was sampled from 15 patients who had consecutive hospital numbers from each study case. RESULTS: The prevalence of cutaneous reactions to PPIs varied, ranging from three to 20 per 100,000 of the treated population. Sixty-four patients with a history of reaction to PPIs, and 65 controls were enrolled. Most cutaneous reactions were attributed to omeprazole (n=50; 78.1%), and the most frequently observed cutaneous reaction was maculopapular rash (43.8%). None of the patients experienced a cross-reaction between individual PPIs. CONCLUSION: Cutaneous adverse reactions to PPIs range from minor drug rashes to a severe, life-threatening reaction. Individuals with a history of adverse drug reaction have an increased risk of cutaneous reaction to PPIs.

Clinical characteristics of Thai patients with psoriasis.

OBJECTIVE: To reveal the clinical manifestations, aggravating factors, factor associated with severity, and treatment of psoriasis in Thai patients. MATERIAL AND METHOD: The data of psoriasis patients who had been visited Dermatologic outpatient clinic, Siriraj Hospital between July 2002 and July 2008 were retrospectively reviewed. RESULTS: One thousand eighty two patients were studied. The male to female ratio was 1.2:1 and the peak age of onset was in the 40 to 49 year-old age group. The most common aggravating factor was stress (50%), followed by trauma (39%) and weather condition (35%). The majority of patients had plaque type (72.8%). Male gender, smoking, alcohol intake, and nail abnormalities were related to severe psoriasis (PASI > 10). CONCLUSION: The present study demonstrated the demographic data of Thai psoriasis patients in a large number of population. These data would be beneficial for national public health development of Thailand in order to provide the better care for Thai psoriasis patients.

Characteristics of HIV/sexually transmitted infections among men who have sex with men and women in Bangkok, Thailand.

BACKGROUND: Men who have sex with men (MSM) are a key HIV target population in Thailand. An important subgroup is men who have sex with men and women (MSMW) as they can sexually transmit infections between individuals with different gender identities. This study compared the sexually transmitted infection risk behavior of different types of men in Thailand. METHODS: We retrospectively reviewed the medical records of 839 consecutive male patients who visited an STI clinic in Bangkok, Thailand, between 2014 and 2020. RESULTS: Men who have sex with women only (MSWO) predominated (58.0%), followed by men who have sex with men only (MSMO, 32.2%) and MSMW (9.8%). MSMW and MSMO shared similar sexual risk behaviors, such as significantly higher median numbers of sex partners (10 and 8, respectively) than MSWO (5; Kruskal-Wallis, p < 0.001). MSMW had the highest prevalence of concurrent sexual partnerships (91.4%), significantly different from MSWO (61.2%) and MSMO (76.7%; chi-squared, p < 0.001). HIV and syphilis prevalence was significantly higher for MSMO (48.9% and 51.1%) and MSMW (42.7% and 48.8%) than MSWO (12.3% and 20.9%; chi-squared, p < 0.001). CONCLUSIONS: MSMW exhibited similar sexual risk behavior and high HIV/STI prevalence comparable to MSMO.

Retrospective study of psoriasis in people living with HIV: Thailand's experience.

Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/µl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.

Do Antinuclear Antibodies Influence the Clinical Features of Chronic Spontaneous Urticaria?: A Retrospective Cohort Study.

Background: Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives: To compare clinical features of CSU patients who are positive and negative for ANA. Methods: This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t-test and the Mann-Whitney U test for quantitative variables. The chi-squared test or Fisher's exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed via Kaplan-Meier survival analysis. Results: Of 323 CSU patients, 31% had positive ANA. There were no significant differences in disease severity or impairment in quality of life. Patients with a positive ANA test had significantly lower prevalence of allergic rhinitis (p = .048) and significantly higher level of erythrocyte sedimentation rate (p = 0.007). Kaplan-Meier survival analysis showed that 2% of ANA positive CSU patients achieved remission status after one year and 28% did so after five years. There was no statistically significant difference in time to remission and time to relapse between ANA-positive and negative groups. Conclusion: Positive ANA in CSU patients could not indicate the differences in main disease characteristics from the ANA-negative CSU patients. Investigation for ANA may be useful in CSU patients who are suspected of having autoimmune diseases.

Efficacy and Safety of Clinacanthus nutans Lindau Cream vs. Podophyllin for the Treatment of Adults with Condyloma Acuminata.

Human papillomavirus (HPV) infection causes condyloma acuminata (CA). Podophyllin is the standard treatment. Clinacanthus nutans Lindau (C. nutans), a medicinal plant, has potent anti-inflammatory and antiviral effects. C. nutans cream is widely used in Thailand to treat the herpes simplex virus. We proposed that C. nutans might also induce CA clearance. There are no studies of C. nutans treatment of CA. This randomized controlled trial at Siriraj Hospital, Thailand, was conducted between January 2018 and December 2019. CA samples were obtained from 10 men with at least two CAs 1 centimeter apart. Each wart was randomized to a 4-week treatment with either C. nutans or podophyllin. The participants were 24 to 72 years old. Most HPV types were low-risk HPVs (HPV 11, HPV 6). Median CA clearance with podophyllin was a 97% CA clearance with podophyllin and 82% with C. nutans. C. nutans may be an alternative treatment for CA.

Factors associated with the effectiveness of diabetes care at primary care settings.

OBJECTIVE: To assess the effectiveness of diabetes care and the factors associated with the effectiveness at primary care settings. MATERIAL AND METHOD: Data were obtained from reviewing of 1,795 medical patient files of patients with type 2-DM treated at forty-eight primary care settings. Information recorded included characteristics, body mass index, co-morbidity, fasting blood glucose (FBG) and HbA1c levels and health personnel mix types (physicians, pharmacists, nurses, health technical officers and community health workers). HbA1c level of diabetes in 542 of 1,795 medical patient files were analyzed. Glycemic controllability of diabetes patients was defined using FBG and HbA1c levels as the effectiveness indicators of diabetes care. RESULTS: Of 1,795 patients, 40.8% were able to control their FBG levels and 22.7% of the 542 patients who have HbA1c data could control their HbA1c levels. Multivariate analysis confirmed that age and health personnel mix types are significant factors for glycemic controllability as measured by FBG level (p < 0.01). By measuring HbA1c level, age was also significant factor in diabetes care effectiveness (p = 0.012). CONCLUSION: Age was a significant factor in controlling both FBG and HbA1c levels in type 2 diabetes whereas health personnel, physicians and pharmacists, are significant factors in increasing effectiveness of diabetes care. The policy makers should consider distributing these health personnel to primary care settings and this would be a challenge for the policy makers to develop such a strategy and to implement this policy.

Expression Pattern of Genes in Condyloma Acuminata Treated with Clinacanthus nutans Lindau Cream versus Podophyllin.

Clinacanthus nutans Lindua (C. nutans), a strong antiviral traditional medicine, can be used to treat condyloma acuminata (CA) caused by the human papillomavirus (HPV). However, its molecular mechanism for CA elimination is unknown. Herein, we conducted a randomized clinical trial to evaluate the effectiveness of C. nutans and its molecular mechanism compared with podophyllin, the gold standard treatment. Using a randomized block design, six patients were treated with C. nutans and podophyllin for four weeks. Efficacy of drugs was assessed by size reduction of the warts and HPV viral load quantification using droplet digital PCR. The gene expression profiling of CA was analyzed using NanoString Technology. After the podophyllin and C. nutans treatments, CA lesion sizes were reduced to 97.0% and 84.4% clearance, and the HPV viral loads were reduced by 74.0% and 46.6%, respectively. The gene expression pattern of immune profiling showed that 23 genes (i.e., HLA-DPB, CCL3, CXCL2, CXCR2, and OSM) were significantly differentially expressed by podophyllin, whereas 2 genes (IFNL1 and IRF2) were remarkably expressed by C. nutans. In inflammatory profiling, 108 genes (i.e., CXCL2, IL8, and STAT3) were highly expressed by podophyllin, but none of genes were observed to change expression by C. nutans. These results suggested that podophyllin may reduce the HPV infection through a mechanism related to proinflammatory response. In addition, C. nutans was found to suppress the HPV infection through mechanism related to the activation of immune response. This study shows novel therapeutic mechanisms of podophyllin and C. nutans. It is suggested that C. nutans might be used as an alternative treatment for CA treatment.