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Biomedical subjects

Henry Wilde

Publications and source records attributed to Henry Wilde.

53 records · Page 3Linked to original sources
PubMed2003

Clinical spectrum of hepatic tuberculosis: comparison between immunocompetent and immunocompromised hosts.

BACKGROUND: Hepatic tuberculosis has been reported in normal and immunocompromised hosts. However, no published comparisons between these two groups of subjects with hepatic tuberculosis have been found. The aim of this study was to compare the clinical manifestations, biochemical tests, radiologic features and pathological findings of hepatic tuberculosis in immunocompromised and immunocompetent patients. METHOD: The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted between January 1993 and October 2000 to Chulalongkorn University Hospital, Thailand. There were 12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE) male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations, biochemical tests, radiologic features and pathological findings were compared between these 2 groups. The diagnosis of Mycobacterium tuberculosis (M. tb) was the combination of a demonstrated organism in hemo- or specimen culture, histopathology (positive acid fast bacilli) and rapid identification of M. tb from nested polymerase chain reaction (nPCR) assay based on amplification of the IS 6110 insertion sequences. RESULTS: The clinical features were similar in both groups with fever, weight loss and hepatomegaly as the main manifestations. The biochemical findings were also similar but the alkaline phosphatase (ALP) was significantly higher in the immunocompromised group (p < 0.001). Hepatomegaly and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found more commonly in the immunocompetent subjects, although the differences were not statistically significant. Non-caseating granuloma without detection of acid fast bacilli was a common finding in both groups. The nested PCR assay increased the sensitivity from 49 per cent to 86 per cent compared to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was significantly higher in immunocompetent patients (p < 0.05) due to the extreme age and severe coexisting diseases. CONCLUSION: Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and reverse A/G ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was significantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and specificity in the diagnosis of this disease.

Adolescent↗
PubMed2003

Medical residency training in the US: important considerations.

The United States attracts medical scholars from abroad. However, the previously open-armed welcome extended to medical residents in America no longer exists for a variety of reasons. A series of barriers based on high educational standards and a rigid system of testing scientific and clinical skills and communication abilities, now tend to eliminate many applicants. Added to this is that American medical colleges now produce a near adequate number of new graduates and that foreign trained residents are often relegated to less desirable programs. These may not provide the level of training expected by the applicant. Less attractive programs are also less likely to enhance the scholar's chances of gaining an academic career and professional recognition on returning home. Applicants for residencies in the US should now be aware that only the best are likely to gain entrance to highly desired posts and to quality fellowships after completing a residency in America. All of this should be weighed against the stress and high costs that are now entailed in obtaining postgraduate medical training in America. This study endeavors to summarize what a young doctor should know about the application process for an American residency position and what he might expect from it.

Clinical Competence↗
PubMed2002

Management of rabies in humans.

Rabies is a fatal disease in humans, and, to date, the only survivors of the disease have received rabies vaccine before the onset of illness. The approach to management of the rabies normally should be palliative. In unusual circumstances, a decision may be made to use an aggressive approach to therapy for patients who present at an early stage of clinical disease. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon-alpha, and ketamine. Corticosteroids should not be used. As research advances, new agents may become available in the future for the treatment of human rabies.

Adrenal Cortex Hormones↗
PubMed2002

Prospective immunogenicity study of multiple intradermal injections of rabies vaccine in an effort to obtain an early immune response without the use of immunoglobulin.

The present study sought to determine whether increasing and accelerating rabies vaccine administration would result in earlier protective levels of neutralizing antibody. Results indicated that the 8-site and double-dose Thai Red Cross intradermal regimens produced higher antibody titers by day 14 but not significantly higher titers by days 5 and 7. Administration of rabies immunoglobulin into and around bite wounds on the first day of rabies prophylaxis should remain the optimal postexposure treatment.

Adult↗
PubMed2002

Rabies intradermal post-exposure vaccination of humans using reconstituted and stored vaccine.

Thailand's northern Petchabun province is endemic for canine rabies. There were 27 reported human rabies deaths between 1989 and 1998. A rabies control plan was formulated in 1997 between medical and veterinary public health officials. It started an intense education program and an ongoing dog vaccination campaign. Economic constraints and the high cost of biological were the main reasons for inadequate human post-exposure management (PET). It was therefore decided to use the economical Thai Red Cross Intradermal Vaccine Regimen (TRC-ID) throughout the province. The original TRC-ID method is only suitable for clinics that see more than one PET patient daily. TRC-ID was therefore modified by storing the reconstituted vaccine in a refrigerator for the same patient's next two visits. Data on a total of 8157 PET patients were collected. An additional modification of TRC-ID also eliminated the 90 day booster. There were no treatment failures and no human rabies deaths in 1999, 2000 and 2001. The modified TRC-ID method induces adequate levels of neutralizing antibodies, protects humans bitten by rabid dogs and results in significant savings in vaccine and travel costs.

Animals↗
PubMed2002

Potency, sterility and immunogenicity of rabies tissue culture vaccine after reconstitution and refrigerated storage for 1 week.

The economical Thai Red Cross intradermal (TRC-ID) post-exposure rabies treatment schedule is now widely used in Asia. However, directives from WHO and manufacturers mandated that the vaccine be used within 8h after reconstitution of the freeze-dried product. This limits the use of TRC-ID to large animal bite clinics that see several rabies exposed patients daily. This study demonstrated that refrigerated purified chick embryo and Vero cell rabies vaccines can be stored safely for up to 7 days after reconstitution; allowing use of this treatment regimen in clinics that see few rabies exposed subjects. A large project applying this method in a Northern Thai canine rabies endemic province is now in place.

Animals↗
PubMed2002

Post-exposure rabies treatment in pigs.

A rabid dog invaded a Thai pig farm and severely mauled 11 adult pigs. This offered an opportunity to study efficacy of a human type post-exposure vaccine regimen with and without rabies immunoglobulin. A commercial veterinary tissue culture rabies vaccine and equine rabies immune globulin were used. All pigs survived for 1 year following the exposure. All animals developed detectable rabies neutralizing antibodies on day 7 and levels over 0.5IU/ml on day 14. This small study suggests that post-exposure rabies treatment using a proven human regimen, applied to valuable farm animals, can be safe and effective.

Animals↗
PubMed2002

Postexposure treatment of rabies infection: can it be done without immunoglobulin?

The last remaining international manufacturer of equine rabies immunoglobulin (ERIG) discontinued production in 2001. However, ERIG remains an essential biological that has no substitute other than human rabies immunoglobulin (HRIG), which is in short supply and virtually unaffordable in developing countries. Physicians in regions where canine rabies is endemic and neither ERIG nor HRIG is available are providing less-than-optimal treatment to patients exposed to rabies. If no immunoglobulin is available, they have only 1 therapy option: use of a vaccine schedule that produces the highest and, hopefully, earliest neutralizing antibody response. However, treatment failures must still be expected. Early, aggressive wound cleansing and more intensive efforts at canine control and are ever more important. Countries that have the resources to manufacture their own rabies immunoglobulins must be encouraged to do so.

Animals↗
PubMed2002

Risk of rabies after mammal bites in Thai children.

The data were collected by questionnaire at the Outpatient Department of Chulalongkorn University Hospital, Bangkok Thailand. This study revealed that 52 per cent of children had pet mammals in their home of which 67 per cent were dogs. 23.6 per cent of these children gave at least one history of a mammal bite inside (53.4%) or outside (46.6%) their house. Mammal bites of children could be found at all ages. However, most were in the age group of 10-14 years (42.3%), and 5-9 years (39.7%). The most common site of injury was on the legs (56.6%) and hands (30.7%). 31.7 per cent and 68.3 per cent of the bitten children incurred WHO category II and III potential rabies exposures (moderate and severe). 61.9 per cent had performed wound cleansing on each bite injury site and 34 per cent did not. 72 per cent of the children who had mammal bites received no post-exposure rabies treatment and 85.7 per cent did not make any effort to capture or observe the animal who had bitten them. Only 10.6 per cent observed the animals for 10 days or more. It was concluded that children are at considerable risk of mammal bites and that they are not receiving optimal care in this canine rabies endemic region and that 50 per cent of human rabies cases in Thailand were in children under 15 years of age.

Adolescent↗
PubMed2002

Streptococcus suis infection in Thailand.

This is a retrospective study of Streptococcus suis infection in humans submitted to the National Streptococcal Referrence Center of Thailand from 1994 to 2001. There were 11 men and 6 women whose mean age was 46.24 years (range 1 month to 75 years). Among the men, two had known occupational and behavioral exposure to pork or meat products. Among the women, one was a butcher and three were housewives. Half of the patients had underlying diseases. One patient had congenital hydrocephalus, three patients had rheumatic heart disease and three were alcoholics. Two of these patients had a history of skin injury before infection. Nine patients had evidence of acute bacterial meningitis, four patients had infective endocarditis, two had the sepsis syndrome and two suffered from pneumonia and spontaneous bacterial peritonitis. The authors suspected that many cases are not reported particularly where pig-rearing or pork consumption are common. In the absence of an effective vaccine, prevention by public health surveillance is important. Prompt treatment of any cuts and wounds among pork-handlers is a sensible precaution. Furthermore, a high index of suspicion and early detection in order to identify and apply effective antimicrobial agents is necessary to successfully treat S. suis infection.

Adolescent↗
PubMed2001

Use of rabies vaccines after reconstitution and storage.

Storing freshly reconstituted purified chick embryo rabies vaccine at 4 degrees C for 1 week allowed use of <1 ampoule of 1.0 mL for 1 patient for day 0, 3, and 7 immunizations, representing considerable savings in vaccine and also possibly allowing use of this cost-saving regimen in centers that see <1 rabies-exposed patient daily. The 90-day booster dose mandated in the current intradermal regimen may not be necessary if the day 28 dose is doubled, eliminating 1 clinic visit at no additional cost in vaccine.

Drug Stability↗
PubMedDate not supplied

Expatriate clinics and medical evacuation companies are a growth industry worldwide.

Globalization and the growth of tourism, which now includes "adventure" visits to very remote regions, has created new employment but also new problems. For example, elderly tourists break their hips where there is no competent orthopedic surgeon, a traveler gets bitten by a cobra in rural Cambodia where there is not even an "Ambu" bag to keep him oxygenated, and a tour guide develops high-altitude cerebral edema on a remote Nepalese mountain. What would we do without organizations that are capable of removing such victims rapidly and safely to a place able to provide appropriate medical care? Fortunately, several well-staffed and well-equipped air ambulance companies stand ready almost worldwide to help 24 hours a day. Medical assistance firms, which sell their own travel insurance and/or act as agents of large insurance companies, are also at hand and have offices in major cities worldwide. They have 24-hour telephone numbers and are prepared to advise a sick or injured traveler where he or she should go to obtain competent medical care. Most of these firms have regional medical advisors in strategic locations who maintain a network of contacts. They can ensure that an ill traveler is receiving appropriate care and will act as quality controllers. They are also able to advise whether medical evacuation to a higher level of care is needed and where the traveler should be evacuated to.

Ambulatory Care Facilities↗