Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment.

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants included 74 Thai PLWH: 38 met Frascati criteria for ANI and 36 were cognitively normal (CN). Participants completed Thai language versions of the MoCA (MoCA-T) and IHDS, and a validated neurocognitive battery. We examined between-group differences for MoCA-T and IHDS total scores, and scale subcomponents. We also conducted receiver operating characteristic (ROC) analyses to determine the ability of the MoCA-T and IHDS to discriminate between CN and ANI groups, and compared their area under the curve (AUC) values. Results revealed lower MoCA-T total score, as well as the Visuospatial/Executive and Delayed Recall subtask scores, in the ANI relative to CN group. Groups did not differ on the IHDS. For ROC analyses, the MoCA-T, but not the IHDS, significantly differentiated the ANI from CN group, and there was a significant difference in AUC values between the MoCA-T (AUC = .71) and IHDS (AUC = .56). Sensitivity and specificity statistics were poor for both screening measures. These data indicate while the MoCA-T functions better than the IHDS in detecting Thai PLWH with ANI, the mildest form of HAND, neither cognitive screener, showed strong utility. Our findings reflect the limited efficacy of common screening measures in detecting subtler cognitive deficits among Thai PLWH, and highlight the need for better screening tools.

A Randomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound.

Necrotizing fasciitis (NF) is a high morbidity and mortality disease and also demands high economic resources. The standard treatment of NF is surgical debridement and proper dressing for wound bed preparation. The efficacy of silver alginate dressing can inhibit the growth of microorganisms and keep the environment clean for wound bed preparation. However an optimal dressing to manage such wounds has yet to emerge. NF patients who were admitted between April 2013 and May 2016 were randomized to have wound dressing using either silver dressing (Ag group) or normal saline solution gauze (NSS group). The 4 main outcomes for comparison between the 2 groups were the duration of wound bed preparation, total cost during hospital stay, the duration of hospital stay, and the pain score. Thirty-nine patients were included in the study: 19 patients in the NSS group and 20 patients in the Ag group. The mean duration of wound bed preparation in the NSS group was 31.87 days, and in Ag group it was 21.39 days, but this trend was not statistically significant ( P = .057). The mean cost of treatment in the NSS and Ag groups was not significantly different ( P = .434; US$3308.83 and US$2647.82, respectively). The duration of hospital days in the 2 groups was not significantly different either (29.19 days [NSS group] and 20.99 days [Ag group]; P = .222). The pain score was significantly lower in the Ag group than those in the NSS group. Although silver dressing seems to be expensive, the cost of total treatment during hospital stay and the duration of hospital stay were not significantly different between groups. However, the mean duration of wound bed preparation seems to trend favoring toward the silver dressing group.

The risk factors of low birth weight infants in the northern part of Thailand.

BACKGROUND: The incidence of low birth weight (LBW) in Chiang Mai University Hospital was high. OBJECTIVE: Determined the incidence and risk factors of low birth weight infants. MATERIAL AND METHOD: The present study included pregnant women between 1989 and 1990 who attended the antenatal clinics (ANC) having a gestational age less than or equal to 24 weeks. During that period, up to delivery, clinical and other potential data namely demographic and biomedical factors, maternal status, socioeconomic factors, and nutritional factors were included. The birth weight at birth less than 2,500 gm was considered LBW. RESULTS: Two thousand one hundred eighty four pregnant subjects who delivered live born and were still eligible, were used for analysis in the present study. The incidence of LBW was 9.2% (201/2,184). Women with body mass index (BMI) at first antenatal clinics (ANC) less than 18.5 Kg/m2 and weight gain during the second trimester less than 300 grams/week was the strongest independent risk factor for LBW (odds ratio 11.25, 95% confidence interval (CI) 5.77-21.94). The number of antenatal care less than 4, monilial vaginitis, the infestation of hookworm and strongyloides, and pregnancy-induced hypertension were independent risk factors (odds ratio 11.04, 3.14, 4.93 and 4.02 respectively). CONCLUSION: The present study showed that low initial BMI, low weight gain in the second trimester, and low attendance at ANC are associated to the occurrence of LBW. The development of a scoring system for detecting high-risk of LBW in pregnant women based on a combination of antenatal factors should be pursued.

Sex difference in composition of plaques of patients undergoing carotid endarterectomy.

Our study aimed to examine the hypothesis that women have more stable plaques (a lower proportion of lipid component and a higher proportion of fibrous tissue) compared to men. Plaque specimens of 141 consecutive carotid endarterectomy patients (60 females and 81 males) were studied. Medical histories were recorded and the plasma concentrations of cholesterol and inflammatory markers were measured. We found that plaques from females had significantly less lipid than those from males (p = .01): the mean percentage of plaque lipid for women and men was 47.8% and 58.2%, respectively. Plaques from females had more fibrous tissue than those from men (p = .02): the mean percentage of fibrous tissue for women and men was 38.8% and 29.8%, respectively. This study concluded that the histology of carotid artery plaques from women appears to be more stable than that of those from men.

Left retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysms (AAAs) repair.

OBJECTIVE: The purpose of this prospective randomized study was to compare the left retroperitoneal approach (RPA) with the midline transperitoneal approach (TPA) for infrarenal abdominal aortic aneurysms (AAAs) repair with operative details, postoperative complications, and total cost comparision. MATERIAL AND METHOD: Between January 2000 and December 2003, 36 patients undergoing elective surgery for infrarenal AAAs were included in the prospective comparison of transperitoneal approach (TPA) with retroperitoneal approach (RPA). Thirty-six patients were analyzed, with 18 in group 2 (TPA) and 18 in group I (PRA). There was no significant differences between the groups in patient demographics. (p value > 0.05) RESULTS: There was no significant differences in the aortic cross clamp time, operative time, estimated blood loss and intraoperative blood transfusion between the two groups (p value > 0.05); however, significantly more intraoperative fluid needs and bowel function onset had a statistically longer return in group 11 (TPA) than in group I (RPA). Statistically reduction in postoperative ileus (>4 days) and total length of hospital stay was observed in group I (RPA) (p value < 0.05). Postoperative cardiopulmonary complications were statistically significantly more increased in group II (TPA) than in group I (RPA). Wound complications were more in group I (RPA) (1 hematoma, 4 abdominal wall hernia, and 4 chronic wound pain) than in group II (TPA) (2 chronic wound pain). Total cost payment was not significantly different in both groups. CONCLUSION: The left retroperitoneal approach for infrarenal AAAs repair, with fewer cardiopulmonary complications and shorter hospital stay has more unsatisfactory postoperative wound complications than the midline transperitoneal approach.