Adrenocorticotropin stimulation test in congenital adrenal hyperplasia: comparison between standard and low dose test.

The aim of the study was to compare the response between the standard and low dose adrenocorticotropin (ACTH) test for patients with congenital adrenal hyperplasia (CAH). The authors employed a 2-by-2 crossover design and enrolled 16 patients, 14 girls and 2 boys, aged between 1.4 months and 15 years. Steroid treatment was stopped 24 hours before each test was conducted. The standard ACTH (250 microg) test was performed followed by the low dose test (1 microg) in eight patients; the other eight underwent the low dose ACTH test first followed by the standard one. The cortisol and 17-hydroxyprogesterone (17-OHP) levels in each patient varied unpredictably between the two tests. The cortisol responses to the low dose ACTH at 30 and 60 minutes were lower than at time zero; in contrast to the 60-minute peak cortisol response to the standard dose. The serum 17-OHP in all specimens was more than 10,000 ng/dl (300 nmol/L), with the peak response at 60 minutes in both groups. Both the low dose and standard dose ACTH test indicated adrenal insufficiency and the high 17-OHP levels were diagnostic of 21- hydroxylase (21-OH) deficiency. If the low dose ACTH test becomes the "standard" ACTH test, the diagnosis of 21-OH deficiency would probably not be missed.

Comparison between the antimicrobial susceptibility of Burkholderia pseudomallei to trimethoprim-sulfamethoxazole by standard disk diffusion method and by minimal inhibitory concentration determination.

Melioidosis, an infection caused by Burkholderia pseudomallei, usually occurs in immunocompromised patients and requires prolonged antibiotic therapy. Previously, oral trimethoprim-sulfamethoxazole (TM/SM), an inexpensive and effective drug has been used as a maintenance therapy. The susceptibility of B. pseudomallei to TM/SM by the standard disk diffusion method is very low. However, some patients who were treated with TM/SM as a maintenance therapy despite the in vitro resistance showed good clinical responses. There were no data comparing the susceptibility of B. pseudomallei by the standard disk diffusion method with other quantitative susceptibility tests. The objective of this study was to determine the agreement between the antimicrobial susceptibility of B. pseudomallei to TM/SM by standard disk diffusion and minimal inhibitory concentration determination (MIC). We performed the susceptibility test of 144 strains of B. pseudomallei to TM/SM by both the standard disk diffusion and microbroth dilution MIC. The sensitivity results were 53.5 per cent and 84.0 per cent respectively. The agreement between the 2 tests was very poor (Kappa = 0.14; 95% CI = -0.01 to 0.29). The false resistant rate by the standard disk diffusion test was 67.9 per cent. Further in vitro susceptibility and clinical study are needed to define the interpretive criteria that correlate with clinical response.

Cefoperazone/sulbactam + co-trimoxazole vs ceftazidime + co-trimoxazole in the treatment of severe melioidosis: a randomized, double-blind, controlled study.

A prospective randomized, double-blind, controlled study of cefoperazone/sulbactam (cefoperazone 25 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) vs ceftazidime (100 mg/kg/day) + co-trimoxazole (trimethoprim 8 mg/kg/day) in the treatment of severe melioidosis was conducted at Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, from July 1995 to September 1996. A total of 84 patients were enrolled in the study. Forty of them (48%) had culture-proven melioidosis and were randomly assigned to one of the two treatment groups, each group with 20 patients. Two cases (one in each treatment group) were excluded from the final analysis due to incomplete data. There was no significant difference in the mortality rate between the two groups-16 per cent (3/19) in the cefoperazone/sulbactam group vs 21 per cent (4/19) in the ceftazidime group (p > 0.05). Bacteriological responses of successfully treated patients were similar in both groups, and both treatment regimens were well tolerated. Cefoperazone/sulbactam + co-trimoxazole can therefore be used as an alternative treatment for severe melioidosis. However, to further support this conclusion, a study with a larger patient population is needed.

Working and living conditions of construction workers: comparison between large and small construction sites in northeastern Thailand.

This study examined differences in working and living conditions of construction workers in large and small construction sites in Northeastern Thailand. Data were collected by questionnaires, through observation and interviewing. A total of 812 construction workers from 20 large sites and 24 small sites were studied. Working and living conditions among the construction workers were generally poor. However, they were better at the large sites than the small ones. The data suggest an urgent need to improve sanitation and safety conditions on the construction sites and camp sites, including personal protective devices and improved welfare for the workers and their families.

Methodological issues in conducting a survey of construction workers in northeastern Thailand.

Social and health problems among the construction workers in Thailand were studied in a multicenter cross-sectional survey. This paper documents methodological issues related to conducting the survey in the northeastern Thailand. These issues include defining suitable sampling frames for building sites and workers and collecting data. A number of practical problems and the approaches to solve them are discussed.