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Open access

Wilawan Somsong, Saranath Lawpoolsri, Yuthichai Kasetjaroen, Weerawat Manosuthi and Jaranit Kaewkungwal

Abstract

Background

Elderly patients with pulmonary tuberculosis are less likely to achieve treatment success than younger patients, and patients aged ≥60 years have a substantial increase in mortality.

Objectives

To compare treatment outcomes over 2 periods during the transition of Thai national tuberculosis (TB) reporting systems and determine treatment success rates and mortality for elderly patients in TB treatment-care settings in Thailand.

Methods

Retrospective cohort study of all records of elderly patients extracted from 2 national TB databases in Thailand: the TB Case Management (TBCM) database of the National TB Program (2014–2015) and the database of the National Health Security Office (NHSO; 2010–2011).

Results

There were 8,301 elderly patients with TB in the TBCM cohort and 11,869 in the NHSO cohort. Overall treatment success rates were 78.5% for patients in the TBCM cohort and 87.5% for patients in the NHSO cohort. High success rates for treatment were found for those aged 60–69 years: 91.1% in 2010–2011 and 85.0% in 2014–2015. High mortality was reported for patients aged ≥90 years: 34.6% in 2010–2011 and 50.0% in 2014–2015.

Conclusions

Compared with the NHSO historical cohort, success rates for treatment were lower and death rates were higher in the TBCM cohort. Because NHSO enforced intensive case monitoring and follow-up while TBCM has no such mechanism, the estimates from the TBCM database may be less accurate for TB circumstances in Thailand. Frequent routine home visits may ensure more complete treatment-care information and support, and increase the treatment success rate in the elderly.

Open access

Tulaya Potaros and Suwimon Yeephu

Abstract

Background

Tramadol is classified as a pharmacist-only (restricted) medicine by the Food and Drug Administration of Thailand (Thai FDA). Because of concern about its abuse, in September 2013 the Thai FDA announced a policy to control the distribution of tramadol in community pharmacies.

Objectives

To identify tramadol dispensing practices by community pharmacists in Bangkok, their recognition of tramadol abuse and the Thai FDA control policy announcement; and opinions about the tramadol control policy.

Methods

This descriptive cross-sectional study was conducted in community pharmacies located in Bangkok. Pharmacists on duty were interviewed from September 2015 to April 2016.

Results

Data from 305 pharmacists working in 305 pharmacies revealed that tramadol, both single (tramadol alone) and combination (tramadol plus acetaminophen) formulations, was available in 185 pharmacies (60.7%). Most pharmacists dispensed tramadol to supply regular medicine along with previous prescriptions (74%). Among 305 pharmacists, 304 (99.7%) recognized tramadol abuse in combination with cold–cough remedies and carbonated beverages can create euphoria. Most (97.7%) knew about the announcement of the tramadol control policy, and most (82.6%) thought that the policy was practical. Approximately 43% of pharmacists agreed that the policy was effective in reducing the tramadol abuse problem, whereas 36.7% disagreed. Moreover, 60.3% disagreed with rescheduling tramadol as a prescription-only medicine. In their opinion, tramadol should still be available in pharmacies, to be dispensed by community pharmacists to patients with medical necessity.

Conclusions

Further studies nationwide in Thailand are likely to be useful to represent and compare information in different parts of the country.

Open access

Passisd Laoveeravat, Nicha Wongjarupong, Chonlada Phathong, Cameron Hurst, Sombat Treeprasertsuk, Rungsun Rerknimitr and Roongruedee Chaiteerakij

Abstract

Background

Cirrhotic patients are susceptible to drug toxicity, which presents frequently with antituberculosis drug (ATD) treatment. Previous studies of ATD-induced liver injury (ATDILI) in cirrhotics have been limited to patients with early-stage cirrhosis.

Objectives

To describe characteristics and determine risk factors for ATDILI in cirrhotic patients.

Methods

We included 64 cirrhotic patients treated with ATDs between 2006 and 2016 in a tertiary referral university teaching hospital in Bangkok, Thailand. Cirrhosis was diagnosed by radiological features, including small-sized nodular liver and/or caudate lobe hypertrophy or evidence of portal hypertension (collateral vessels, varices, and/or splenomegaly). Clinical information was retrospectively abstracted. Characteristics of patients with ATDILI vs. those without ATDILI were compared.

Results

Six (9.4%) patients developed ATDILI with the median duration from ATD initiation of 14 days (range: 6–66). All the 6 patients who developed ATDILI received 3 hepatotoxic ATDs (isoniazid, rifampin, and pyrazinamide) and had Child–Turcotte–Pugh class B cirrhosis. The patients with ATDILI were found to have a higher percentage of human immunodeficiency virus (HIV) infection than patients without ATDILI (50% vs. 8.6%; P = 0.02).

Conclusions

Cirrhotic patients, particularly those with underlying HIV infection, are at risk of developing ATDILI. Pyrazinamide should be used cautiously in cirrhotic patients due to the significantly increased risk of ATIDLI. This study supports the current recommendation for the use of ATD in patients with cirrhosis; however, the ATD regimen should be carefully selected, particularly for cirrhotic patients with HIV infection.

Open access

Jarmmaree Sornboot, Wichai Aekplakorn, Pongrama Ramasoota, Surat Bualert, Somying Tumwasorn and Wiroj Jiamjarasrangsi

Abstract

Background

Long-term surveillance of airborne bioaerosols in health care facilities is required to protect the health of patients and health care workers. Feasible methods to measure airborne bioaerosol concentrations and determine associated environmental factors may help to avoid nosocomial tuberculosis (TB).

Objectives

To describe the concentrations and size of airborne bioaerosols and to identify the potential contributors to indoor airborne bioaerosols in TB high-risk areas in health care facilities.

Methods

We conducted a cross-sectional study in 7 large health care facilities located in Bangkok and nearby in central Thailand using a 6-stage Andersen cascade impactor to collect viable airborne bioaerosols that were quantified using culture techniques. Environmental parameters were determined using a tracer gas technique with an indoor air quality meter. Other potential factors were assessed using a questionnaire.

Results

The mean indoor airborne bacterial and fungal concentrations were 596.1 and 521.2 colony-forming units (cfu)/m3, respectively, and the mean outdoor airborne bacterial and fungal concentrations were 496.5 and 650.1 cfu/m3, respectively. The majority of airborne bioaerosols were in respirable sizes. The indoor-to-outdoor ratios were 1.2 for bacteria and 0.8 for fungi. Air change rate was inversely correlated with indoor airborne bioaerosol concentrations, whereas emergency department central-type air conditioners and relative humidity were positively correlated with the indoor airborne bioaerosol concentrations (P < 0.05).

Conclusions

High indoor bioaerosol concentrations found in the health care facilities suggest that it is imperative to improve the indoor air quality. Improved air change rate and avoiding use of central-type air-conditioning systems may reduce bioaerosol concentrations.

Open access

Effat Hatefnia, Kobra Alizadeh and Mostafa Ghorbani

Abstract

Background

Hypertension is the leading preventable cause of premature deaths worldwide. Physical activity reduces the levels of blood lipids and blood pressure in people suffering from hypertension.

Objectives

To apply the theory of planned behavior (TPB) to determine factors associated with physical activity by women with hypertension who were referred to health care centers in Kiashahr in 2016.

Methods

The present observational study was conducted in a cross-section of 215 women diagnosed with hypertension who had records in health care centers in Kiashahr and who were recruited through census from August to September 2016. The data collection tool was a custom-designed questionnaire based on the TPB, and the collected data were analyzed using descriptive and analytical statistical methods.

Results

The mean scores of knowledge, attitudes, subjective norms, perceived behavioral control, and intention to undertake physical activity were significantly (P < 0.01) higher among women who performed regular physical activity than in those without regular physical activity. Constructs including behavioral intention (P < 0.001, odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61) and attitude (P = 0.004, OR 1.27, 95% CI 1.08, 1.50) were significant predictors for undertaking physical activities.

Conclusions

Attitude and behavioral intention were predictors for undertaking physical activities. We recommended the design of interventional programs based on these 2 factors for women with hypertension living in rural areas of Iran.

Open access

Pakkapon Rattanachaisit, Paweena Susantitaphong, Kessarin Thanapirom, Roongruedee Chaiteerakij, Piyawat Komolmit, Pisit Tangkijvanich and Sombat Treeprasertsuk

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is one of the major causes of chronic liver disease. The primary treatment of NAFLD by statins has not been clearly elucidated.

Objectives

To evaluate the effectiveness of statin use in patients with biopsy-proven NAFLD or non-alcoholic steatohepatitis on the change in liver histology.

Methods

We searched MEDLINE, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials for clinical trials and observational studies investigating the effects of statins on histological change regardless of type or dosage from inception to December 2015. Random-effect model meta-analyses were used to compute changes in outcomes of interest. The study protocol was registered in advance with the International Prospective Register of Systematic Reviews (PROSPERO 2016 CRD42016033132).

Results

We identified 6 studies (111 patients), representing 5 cohort studies and 1 randomized controlled clinical trial. There was significant decrease in steatosis grading with a standardized mean difference of –2.580 (95% confidence interval [CI] –4.623 to –0.536; P = 0.013) and NAFLD activity score standardized mean difference of –1.488 (95% CI –2.506 to –0.471; P = 0.004). However, there was no significant change in fibrosis stage (0.156; 95% CI –0.553 to 0.865; P = 0.667).

Conclusions

Statin use can possibly reduce the extent of steatohepatitis but not the stage of fibrosis. Further randomized controlled studies to assess histological evidence with adequate sample size and duration are required in order to establish the role of statin as a primary treatment of NAFLD.

Open access

Songkran Nakbun, Pramote Thongkrajai and Choosak Nithikathkul

Abstract

Background

Opisthorchiasis caused by Opisthorchis viverrini is a serious health issue in the Mekong basin region, resulting in a high prevalence of cholangiocarcinoma. Nakhon Phanom province had the highest prevalence of O. viverrini infection in Thailand at 60% of the surveyed population in 2009, despite the attempted control of opisthorchiasis for >50 years. Knowing risk factors for O. viverrini infection in Nakhon Phanom may lead to improved control and prevention of opisthorchiasis.

Objectives

To determine risk factors for O. viverrini infection in Nakhon Phanom.

Methods

We conducted a cross-sectional survey in Nakhon Phanom province from February to March 2014. The community was selected using a stratified random sampling method, and then, participants were selected by systematic random sampling. Individuals ≥15 years old were included. Knowledge of O. viverrini infection, and attitudes and practice to avoid it were assessed using a questionnaire. O. viverrini infection was determined by stool examination with a formalin–ether concentration method. Factors associated with the infection were determined using multivariate logistic regression analysis.

Results

Of the 134 participants, 75 (56%) were infected with O. viverrini. In the multivariate logistic regression analysis, 3 independent factors were associated with O. viverrini infection: age ≥ 55 years, odds ratio (OR) adjusted 6.36 (95% confidence interval (CI) 1.28–31.66); consumption of chopped raw-fish salad (koi pla), OR adjusted 28.74 (95% CI 3.59–230.24); and perceived susceptibility, OR adjusted 0.15 (95% CI 0.03–0.74).

Conclusions

Age ≥ 55 years, consuming koi pla, and perceived susceptibility were independently associated with O. viverrini infection in Nakhon Phanom.

Open access

Thinley Dorji, Pempa Lhamo, Tshering Tshering, Lungten Zangmo, Kencho Choden, Deki Choden and Kesang Namgyal

Abstract

Background

The burden of diabetes has increased rapidly with an increasing cost of treatment.

Objectives

To describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin.

Methods

This cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) <7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar <180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist.

Results

We studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P < 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe.

Conclusions

Glycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.