Biomedical subjects

Issarang Nuchprayoon

Publications and source records attributed to Issarang Nuchprayoon.

At least 19 recordsLinked to original sources

PubMed2007

Characterization of a novel deletion causing (deltabeta)0-thalassemia in a Thai family.

A novel deletion of the human beta-globin gene cluster associated with the increased level of fetal hemoglobin (Hb F) in adult life has been demonstrated in a Thai family. A Thai girl who was mistakenly diagnosed as beta-thalassemia/HbE is found to be the compound heterozygote of this mutation and Hb E. The heterozygous father had mild hypochromic and microcytic red blood cells and a high level of Hb F (23.2%). Polymorphic restriction sites in the beta-globin gene cluster identified the homozygous alleles, which localized the deletion region between the psibeta-globin and the 3' beta-globin genes. DNA polymerase that can amplify a long DNA template was employed to examine DNA fragment encompassing this deletion. A 11.3 kilobases (kb) of DNA deletion, beginning approximately 3.1 kb 5' to the delta-globin gene and end in the intron 2 of the beta-globin gene was detected. DNA analysis revealed that this is a case of (deltabeta)(0)-thalassemia with a novel mutation, which can lead to a mild form of beta-thalassemia upon interaction with Hb E.

Adult↗

PubMed2006

Rosai-Dorfman disease and juvenile xanthogranuloma in a Thai boy: report of a case.

A 3-year-old Thai boy suffered from two histiocytoses, Rosai-Dorfman disease (RDD) and juvenile xanthogranuloma (JXG). The patient first presented with massive cervical lymphadenopathy at the age of one year. Biopsy revealed typical RDD; abnormally large CD68- and S-100 protein-positive histiocytes with occasional emperipolesis filled up the sinuses. Two years later, he developed polyuria and polydypsia. Skull film demonstrated osteolytic lesions at the occiput and left parietal region. Enlargement of the pituitary stalk was found on the magnetic resonance imaging. Despite the clinical impression of Langerhans cell histiocytosis, biopsy of the occipital lesion disclosed numerous large histiocytes with foamy cytoplasm. Several Touton giant cells with wreath-like arrangement of the nuclei were also observed. The abnormal cells expressed CD68 and factor XIIIa, but were non-reactive with S-100 protein and CD1a. Biopsy of the pituitary stalk was not performed According to the authors' literature search, this represents the first report of RDD and JXG affecting the same person.

Histiocytes↗

PubMed2006

Diffuse Neonatal Hemangiomatosis: report of 5 cases.

Diffuse Neonatal Hemangiomatosis (DNH) is a rare, life-threatening condition associated with a few to hundreds of small, cutaneous and visceral hemangiomas. The authors reported 5 cases of DNH in which hepatic hemangioma were the most common visceral involvement. Response to prednisolone in these cases was not good, one died and four required second line therapy. Of these four cases, one case with embolisation; one with interferon and two with vinblastine. Response to vinblastine was good, but long-term follow-up of the side effects are needed.

Angiomatosis↗

PubMed2005

G6PD Viangchan (871G>A) is the most common G6PD-deficient variant in the Cambodian population.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common hereditary enzymopathy among Southeast Asians. We studied G6PD mutations in 108 migrant Cambodian laborers in Chanthaburi province and cord blood samples from 107 Cambodian newborns at Buriram Hospital. Thirty-one (26.1%) of 119 Cambodian males and three of 96 (3.1%) females were G6PD deficient and were assayed for G6PD mutations. G6PD Viangchan (871G>A) was identified in most G6PD-deficient Cambodians (28 of 34; 82.4%); G6PD Union (1360C>T) and G6PD Coimbra (592C>T) was found in one case each. We concluded that G6PD Viangchan (871G>A) was the most common mutation among Cambodians. This finding is similar to G6PD-deficient Thais and Laotians, suggesting a common ancestry of people from these three countries.

Cambodia↗

PubMed2005

Hospital-based epidemiologic survey of malignancies in children infected with human immunodeficiency virus in Thailand.

To determine the incidence and spectrum of malignancies in human immunodeficiency virus-infected children, we surveyed 48 hospitals in Thailand between 1996 and 2000. There were 23 children (14 boys and 9 girls; average age at diagnosis of malignancy, 4.2 years), and the incidence rate was 0.6 per 1000 person-years. The most common malignancy was lymphoma (87.0%). The prognosis was poor.

AIDS-Related Opportunistic Infections↗

PubMed2005

Mucocutaneous findings in febrile neutropenic children with acute leukemias.

Febrile neutropenia is common in children with leukemia. Mucous membrane and skin are most common portals of entry for microorganisms in these patients. The aim of the present study was to find the prevalence of mucocutaneous findings infebrile neutropenic leukemic children. The authors prospectively examined children with fever with neutropenia in acute leukemia, aged 1-15 years, who were admitted to the Department of Pediatrics, King Chulalongkorn Memorial Hospital, between September 2000 and August 2001. During the study period, 46 children had 116 admissions, 51 of which were due to febrile neutropenia. Their cancer diagnoses were ALL (76%) and ANLL (24%). The prevalence of mucocutaneous findings was 86% (61% were from infections, 22% from mucositis and 4% from chemical phlebitis). Other detected sites of infection were lower respiratory tract (36%), urinary tract (32%), upper respiratory tract (11%), septicemia (11%) and unidentified (35%). Thirty-four percent of the patients had more than one site of infection. Gram-negative septicemia was the most common infection (15cases/71%) followed by gram positive (4cases/19%) and candida (2cases/10%). The prevalence of infection was found in severe neutropenia (absolute neutrophil count, ANC less than 500 cell/cu mm), moderate neutropenia (ANC, 500-1000 cell/cu mm) and mild neutropenia (ANC, 1001-1500 cell/cu mm) was 72%, 9% and 5%, respectively. Infection in patients in the severe neutropenia group was significantly more common than in moderate mild neutropenia groups (p < 0.01). Seven patients (15%) died, all of them had severe and prolonged neutropenia, for more than 7 days. Daily physical examination of skin and mucous membrane are suggested for proper and prompt diagnosis and treatment of febrile neutropenic children with acute leukemia to reduce mortality and morbidity in these patients. A Guideline for the use of antimicrobial agents in neutropenic patients with acute leukemia is proposed In conclusion, infection was commonly found in severe neutropenia. Mucocutaneous infection was the most common site of infection infebrile neutropenia in children with leukemia.

Adolescent↗

PubMed2005

Thai medical graduates in the United States residency training programs: 1988-2003.

In the past 2 decades, international medical graduates (IMG) were needed to fill graduate medical education (GME) positions in the United States (U.S.). The author built a database of Thai medical graduates in accredited U.S. residency systems between 1988-2003, and analyzed the trend and opportunity for Thai IMG. During the 16-year study period, there were 281 Thai medical graduates who successfully entered residency in the U.S., with a rising trend that reached a peak between 1993-1994, and subsequently declined to about 10-15 per year Thai physicians entered U.S. residency program 4.2 +/- 3.3 years after medical school graduation. Thai IMGs were mostly in internal medicine (N=153, 54.4%) and pediatric residency programs (N=76, 27.1%), with much fewer in psychiatry (N=10), surgery (N=9), neurology (N=8), anesthesiology (N=7), and other specialties (N=18). Thai medical graduates tended to be clustered in a few residency programs. Half of the Thai graduates in the U.S. internal medicine residency were accepted in 9 programs; the largest were Texas Tech (Lubbock, N=18), Albert Einstein University (Philadelphia, N=14), and University of Hawaii (Honolulu, N=13). For pediatric residency, about half of the Thai graduates (56.6%) were in 6 programs; the largest were Christ Hospital (Oaklawn, N=11), University of Illinois at Chicago (N=11), and Jersey City Medical Center (N=9). After residency training, most Thais (94.5%) chose to do subspecialty training. The most popular medical subspecialties were cardiology, nephrology, and hematology-oncology. The most popular pediatric subspecialties were allergy-immunology, endocrinology, and cardiology. In conclusion, there are too few Thais in the U.S. residency system. This information may be helpful for Thai medical graduates who seek residency abroad.

Foreign Medical Graduates↗

PubMed2005

Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin.

Assessing the risk of developing severe hyperbilirubinemia, based on a nomogram has been recommended by the American Academy of Pediatrics. The objectives of this study were: 1) To develop an hour-specific nomogram, using transcutaneous bilirubin level (TCB, Bilicheck, SpecRx, Inc, Norcross, GA, USA), in Thai newborn infants and 2) To determine the risk zones that will predict the development of severe hyperbilirubinemia. Three hundred and ninety two (392) healthy neonates, born by C-section, were recruited from November 2003 to May 2004. One hundred and eight (108) infants were excluded from the nomogram development due to hemolytic diseases (ABO incompatibility 51, G6PD deficiency 34, combined ABO incompatibility and G6PD deficiency 3) and requirement of phototherapy (20). Nomogram, using daily hour-specific TcB for 4 days, of 284 neonates was constructed Plotting all 392 infants, TcB on the nomogram, the risk zones in relation to the requirement of phototherapy was determined. The 90th percentile (P90) was designated as high risk track with the sensitivity of 96.9%, specificity 78.8%, positive and negative predictive values 29.1% and 99% respectively, and LR 4.6. P10 was labeled as very low risk track, area between P10-P25 as low risk zone, P25-P90 as intermediate zone with P25-P50 as low intermediate and P50-P90 as high intermediate. In conclusion, an hour-specific TcB nomogram, can be used to identify the risk of subsequent development of severe hyperbilirubinemia. Recognizing the infants risk enables awareness of the problem and prompt intervention which should reduce severe hyperbilirubinemia and chance to develop bilirubin encephalopathy.

Bilirubin↗

PubMed2005

Comparison of two transcutaneous bilirubinometers--Minolta AirShields Jaundice Meter JM103 and Spectrx Bilicheck--in Thai neonates.

Transcutaneous bilirubin (TcB) has been reported to have a high correlation with serum bilirubin. The objectives of this study were: (1) to compare the accuracy of two transcutaneous bilirubinometer (Minolto AirShields Jaundice Meter, JM103 (JM) and SpectRx, Bilicheck (BC) in estimating total serum bilirubin (TSB) levels; and (2) to assess the predictive ability of transcutaneous bilirubin in relation to specific selected TSB levels. A total of 154 measurements of TcB, using JM and BC, and TSB were recruited from 134 term and near-term infants. Postnatal ages ranged from 19 to 160 hours (x = 64.7, SD = 25.6). TSB levels ranged from 4.5 to 17.5 mg/dl (x = 10.4, SD = 2.5). The correlation coefficients between TcB (JM and BC) and TSB measurements were significant and similar (r 0.80 and 0.82, respectively). The errors of distribution were, for TSB and TcB-JM, the mean difference of 0.7 mg/dl (SD 1.6 mg/dl and 95% confidence interval of the mean (CI) 0.4 and 1.0]; and, for TSB and TcB-BC, the mean difference of -0.6 mg/dl (SD 1.5 mg/dl and 95% CI -0.4 and -0.8). TcB-JM had a tendency to underestimate TSB levels, and TcB-BC had a tendency to overestimate TSB levels. The sensitivity of BC was higher, but specificity was lower, than JM in corresponding to different TSB levels, except at a TSB level of 15 mg/dl when both instruments yielded 100% sensitivity. The accuracy of JM in predicting TSB was higher than BC at all TSB levels. Operating the JM was simple and uncomplicated. It would be suitable for clinical use when a number of personnel perform the measurement.

Bilirubin↗

PubMed2005

Resolution of eosinophilia after treatment of cutaneous gnathostomiasis.

The present study was to investigate the dynamics of eosinophil in peripheral blood of patients with cutaneous gnathostomiasis before and after worm removal. The total of 28 proven cases of cutaneous gnathostomiasis treated by albendazole were included in the present study. The absolute eosinophil count (AEC) was higher than 500/ul during infestation in almost all the patients, the positive rate was 89%, and significantly decreased to normal level after receiving albendazole and worm removal within 3 months in 96%. In conclusion, an increas of AEC is another important hallmarks of cutaneous gnathostomiasis and this parameter could be the earlier indicator for responsiveness to treatment.

Adolescent↗

PubMed2005

Computer-assisted instruction in parasitology: a cross-over design.

We report here the results of the study using CAI compared to the hard copy for study of lessons in parasitology. We evaluated the CAI compared to hard copy lessons in 60 students, attending the third-year parasitology course at Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. The students were randomly divided into two groups (30 each). The lessons tested were Ascaris lumbricoides and Enterobius vermicularis, which were prepared as CAI and hard copy form. Using a cross-over design, the first group was provided CAI form on the topic of A. lumbricoides, then switched to hard copy form on the topic of E. vermicularis. The second group was provided hard copy form on the topic of A. lumbricoides, then switched to CAI form on the topic of E. vermicularis. After 30 minute reading, the 10-multiple choice question test was provided for each topic. There was no significant difference of the scores between 2 groups. The most students (91.67%) had more satisfaction when using CAI compared to hard copy in terms of easy to use, convenient to use, less time consuming, more understandable, more attractive to read, and less stress for study. There were 32.8% students complaining that reading hard copy was boring. Other comments were stress when reading (2%), more difficult (17.2%) and more time needed to search specific information (17.2%), and wasting papers (17.2%). However 58.6% still complained problems when using CAL. About 25% had physical discomfort (e.g. Headache, eye pain), and 25% had difficulty to access to use CAI (e.g. no computers available, problems with computer or network error). We suggested that instructors should create and improve CAI lessons in biomedical sciences both in quantity and quality (e.g. content with details, pictures, narrations).

Computer-Assisted Instruction↗

PubMed2004

Noninvasive transcutaneous bilirubin as a screening test to identify the need for serum bilirubin assessment.

Hyperbilirubinemia is a common problem in the newborn infant. It can progress to develop kernicterus unless intervention is initiated. Severity and decision for management are usually based on serum bilirubin (TsB) which needs blood sampling. Transcutaneous bilirubin measurement is a noninvasive technique and the result correlates closely with TsB. A new transcutaneous bilirubinometer, Minolta AirShields Jaundice Meter, JM103, has been introduced The objectives of this study were: 1) To evaluate the accuracy of transcutaneous bilirubin (TcB) measured by JM 103, when compared to TsB, used clinically in a hospital setting (Leica Unistat Bilirubinometer) and 2) To develop a cut-off point of TcB level which indicated the need for serum bilirubin assessment. Three hundred and eighty eight term and near-term newborn infants with 460 paired TcB-TsB specimens were studied from August to November 2003. Birth weight was 3117.57 +/- 424.82 grams. TsB ranged from 4 to 19.6 mg/dL (x 10.5, SD 2.46). The correlation coefficient between TcB and TsB was significant (r 0.8, p < 0.001). TcB showed a tendency to underestimate TsB, with mean difference of 0.7 mg/dL, SD 1.6 mg/dL, and 95% confidence interval 0.85 and 0.55 mg/dL. TcB values of 8, 9, 10, 12 mg/dL were chosen as cut-off points that indicated the need for blood sampling for TsB (corresponded to hour-specific levels of 10, 12, 13 and 15 mg/dL, respectively when phototherapy should be initiated). In conclusion, noninvasive TcB assessment demonstrates significant accuracy, compared to TsB. It can be used as a screening test to identify the need for blood sampling for serum bilirubin level.

Bilirubin↗

PubMed2004

Endothelial injury and altered hemodynamics in thalassemia.

Increased activated circulating endothelial cells, enhanced von Willebrand factor (vWF:Ag) and adhesion molecules (sVCAM-1) are observed in patients with beta-thalassemia/hemoglobin E. Such evidences of endothelial cell injury are associated with altered intrarenal hemodynamics with a significant reduction in renal plasma flow. Altered renal functions (namely depleted creatinine clearance) and abnormal tubular function test, which is reflected by abnormally increased fractional excretion of magnesium (FE Mg), are also delineated. The increased FE Mg implies tubulointerstitial injury which may relate to the microvascular endothelial injury and chronic ischemia.

Case-Control Studies↗

PubMed2004

Pneumocystis pneumonia: an update.

Pneumocystis pneumonia is a major cause of illness and death in immunocompromised hosts. The numbers of pneumocystis pneumonia cases in Thailand have increased each year from 1992 to 2000 and peaked in 2000 at 6,255 cases. The microbe that causes pneumocystis pneumonia in humans is called Pneumocystis jirovecii. Pneumocystis sp. was discovered nearly a century ago, but the knowledge of Pneumocystis sp. remained poorly understood, until the molecular biology techniques help scientists verify it fungus nature. In the past, Pneumocystis sp. was misclassified as protozoan due to its morphologic features. Later, it was reclassified as fungus due to DNA analysis. Cotrimaxazole, the combination of trimethoprim-sulfamethoxazole, is the drug of choice for treatment and prophylaxis of pneumocystis pneumonia. However, increasing evidence of mutations in the enzyme dihydropteroate synthase (DHPS), the target of sulfa drugs represent emergence of sulfa resistance.

Animals↗

PubMed2003

Study of specific IgG subclass antibodies for diagnosis of Gnathostoma spinigerum.

Gnathostoma spinigerum infection is endemic in Thailand and many Asian countries. Current diagnosis is the skin test and enzyme-linked immunosorbent assay (ELISA) for IgG antibody against the G. spinigerum third-stage larvae (L3), but cross-reactivity is common. We evaluated the sensitivity and specificity of anti-G. spinigerum L3 IgG subclass antibodies for diagnosis of 43 patients with gnathostomiasis. The majority of patients with gnathostomiasis (91%) had eosinophilia. While the anti-G. spinigerum L3 IgG1 antibody provided the highest sensitivity (98%), the anti-G. spinigerum L3 IgG2 antibody had the highest specificity (88%). The ELISA that detected anti-G. spinigerum L3 IgG1 antibody could be a reliable laboratory screening test, while anti-G. spinigerum L3 IgG2 antibody could be used to confirm the diagnosis.

Adolescent↗

PubMed2003

Expression of the FAT10 gene is highly upregulated in hepatocellular carcinoma and other gastrointestinal and gynecological cancers.

The ubiquitin-like modifier (UBL) family has recently generated much interest in the scientific community, as it is implicated to play important regulatory roles via novel protein-protein modification. FAT10 (diubiquitin) belongs to this family of proteins, comprising two ubiquitin-like moieties fused in tandem, and has been implicated to be involved in the maintenance of spindle integrity during mitosis. As FAT10 may play a role in the regulation of genomic stability, we examined if there is an association between FAT10 expression and hepatocellular carcinoma (HCC) or other cancers. Northern blot analyses revealed upregulation of FAT10 expression in the tumors of 90% of HCC patients. In situ hybridization as well as immunohistochemistry utilizing anti-FAT10 antibodies localized highest FAT10 expression in the nucleus of HCC hepatocytes rather than the surrounding immune and non-HCC cells. FAT10 expression was also found to be highly upregulated in other cancers of the gastrointestinal tract and female reproductive system. In conclusion, we demonstrated upregulation of FAT10 expression in various gastrointestinal and gynecological cancers. Its overexpression is unrelated to the general increase in protein synthesis or a general immune/inflammatory response to cancer. Rather, FAT10 may modulate tumorigenesis through its reported interaction with the MAD2 spindle-assembly checkpoint protein.

Carcinoma, Hepatocellular↗

PubMed2003

Red cell indices and therapeutic trial of iron in diagnostic work-up for anemic Thai females.

Anemia is common among Thai females. Thalassemia and iron deficiency are highly prevalent in the Thai population. A therapeutic trial of iron has been used to differentiate between the two conditions, however, no previous study on its usefulness in a Thai population has been reported. Otherwise healthy persons who had complete blood count (CBC) as routine 'check-up' and found to be anemic (Hb < 12 g/dl) at a preventive medicine clinic were tested for hemoglobin typing, serum ferritin, serum iron, and were given oral iron sulfate (120 mg elemental iron per day for at least 2 months) and a repeat CBC on a follow-up visit. Sixty-six individuals, all females, with pre-treatment hemoglobin (Hb) level of 9.5 +/- 1.7 g/dl (mean +/- SD), had complete data for analysis. Final diagnoses were isolated iron deficiency in 23 (34.8%), iron deficient thalassemia traits in 6 (9.1%) and iron-sufficient thalassemia syndromes in 29 (43.9%) anemic subjects. After a therapeutic trial of iron, Hb rose to 12.8 +/- 1.0 g/dl (n = 16, p = 2 x 10(-8)) among the iron deficient group, but not in thalassemia. The authors have identified that the most useful red cell indices that will discriminate between iron deficiency and thalassemia is a combination of red blood cell counts (RBC) > 4.4 x 10(6)/microl and mean corpuscular volume (MCV) < 69 fl. High RBC (> 4.4 x 10(6)/microl) and very low MCV (< 69 fl) is a sensitive (92.9%) and highly specific (100%) criteria for diagnosis of mild thalassemia diseases (Hemoglobin H (HbH), Hemoglobin H-Constant Spring (HbH-CS), and homozygous Hemoglobin E (HbEE)). Conversely, a low RBC (> 4.4 x 10(6)/microl) and/or low to normal MCV (69-85 fl) is highly sensitive (91.3%) but not specific (60%) for the diagnosis of iron deficiency. The authors conclude that a therapeutic trial of iron is useful as a diagnostic test in anemic females except those with high RBC (> 4.4 x 10(6)/microl) and very low MCV (< 69 fl), a subgroup which most likely has thalassemia and are least likely to benefit from iron treatment.

Adult↗

PubMed2003

Efficacy and safety of meropenem as an empirical treatment for febrile neutropenia in children with cancer.

Meropenem is a promising carbapenem antibiotic as an empirical monotherapy in patients with febrile neutropenia (FN). With the limited data of the therapy in pediatric patients, the authors conducted this study to evaluate the efficacy and safety of meropenem as empirical antibiotic therapy in 30 pediatric cancer patients with FN (mean age = 7.5 years), who were admitted to King Chulalongkorn Memorial Hospital from May 2000 to December 2001. Meropenem 60 mg/kg/day was given intravenously every 8 hours. The efficacy of meropenem was assessed as successful, inconclusive and failure on days 3 and 5 of the therapy and compared to that of other empirical antibiotics used from January 1997 to April 2000. The study showed that six blood culture specimens (20%) grew organisms, half of which were considered to be contaminants, and six urine culture specimens (20%) grew gram negative rod bacteria. On day 3 and 5 of the therapy, the success rate of meropenem was higher than that of comparatives (30.0% vs 17.6% on day 3, 50.0% vs 39.3% on day 5). The use of meropenem appeared safe, with minimal side effects. In conclusion, the present study showed that meropenem was safe and tolerable in children. The efficacy as an empirical monotherapy in pediatric cancer patients with FN was satisfactory, with a failure rate of 23.3 per cent on day 5 of treatment.

Adolescent↗