Veera Tepsumethanon, Boonlert Lumlertdacha and Channarong Mitmoonpitak
Background: Rabies is a fatal disease. However, dogs are the principal vehicle for rabies transmission of human. A little information about pre-morbid behavior in rabid dogs could be found in the literature. Objective: Assess the value of history taking in predicting rabies diagnosis in dogs, and identify the percentage of rabies positives by history taking in a prospective study. Materials and methods: Studies were conducted at the Rabies Diagnostic Unit, Queen Saovabha Memorial Institute, Thai Red Cross Society between 2002 and 2008. Historical data were collected prospectively from 153 live rabies suspected dogs on admission to the diagnostic facility. Results: Rabies was found in 14% to 80% of dogs with completed questionnaires except for dogs less than one month old, not sick or sick for more than 10 days. Conclusion: History taking does not help in decision-making for rabies post-exposure prophylaxis of humans.
Background: Data regarding the natural history and outcome of treatment of chronic hepatitis B (CHB) patients in Thailand remain inconclusive.
Objective: We aimed to examine the natural history and outcome of therapy in Thai CHB patients treated with nucleoside analogues (NAs) monotherapy or interferon (IFN) monotherapy.
Method: CHB patients without clinical evidence of cirrhosis and alanine aminotransferase (ALT) levels >1.5 times of normal for at least 6 months were enrolled from 6 hospitals (2002 to 2005). Treatment included NAs and IFN. Treatment response was defined as ALT normalization and an HBV DNA level <10,000 copies/ml (or <2,000 IU/ml) and/or HBeAg seroconversion at the end of follow up. The study was approved by the institutional review board of each hospital.
Result: A total of 567 patients with mean age of 46.8 ± 11.9 y were included. The ratio of HBeAg positive to HBeAg negative patients was 1.3:1. Nineteen percent of patients had no HBeAg status. There were 262 HBeAg positive patients (46%) and 197 HBeAg negative patients 35%. Sixty-one percent received NAs while 20% received IFN as a first line treatment and the remaining 19% received no specific medication. For the HBeAg positive patients, HBeAg seroconversion and undetectable HBV-DNA were achieved in 32.8% and 50.5%, respectively in NAs group (on therapy), and HBeAg seroconversion and undetectable HBV-DNA were achieved in 24.3% and 21.4%, respectively in the IFN-treated group (off treatment). For the HBeAg negative patients, undetectable levels of HBV-DNA occurred in 68.8% in the NAs group while undetectable levels of HBV-DNA occurred in 37.5% of patients in the IFN-treated group. HBsAg loss was not found in the NAs group, but 2.8% of patients in IFN group had HBsAg loss. HBV DNA reappeared in the IFN group (off treatment) and NAs groups (on therapy) in 26.6% and 24.3% of patients, respectively. Minor adverse events of therapy were found in 9% of patients. Five percent of patients progressed to Child A cirrhosis and one patient in the NAs group (0.18%) died from causes unrelated to liver disease, during a 3-year follow-up.
Conclusion: The treatment response of Thai CHB patients from multicenter study showed the results similar to previous studies. However, higher durability of treatment with lower rate of reappearance of HBV DNA was observed in Thai CHB patients.
British scientist Sir Wilfrid Le Gros Clark was one of the most distinguished anatomists, neuroscientists and physical anthropologists of the twentieth century. He spent most of his career at the University of Oxford as the Chair of the Anatomy Department. This paper focuses on Le Gros Clark’s early career and provides a historical account of the three years he spent as a Principal Medical Officer in Sarawak, which was then a British controlled state on the island of Borneo. At Sarawak he carried out numerous medical, administrative, and educational duties, making significant improvements to the local health system. His success as the Principal Medical Officer came not only as a result of his medical knowledge and organizational skills, but also because of his extensive knowledge and understanding of the local cultures. Interested in the natural history of the country, Le Gros Clark also collected specimens of the local fauna. These would provide material for some of his most significant research carried out when he took an academic position in England. Years in Sarawak enriched Le Gros Clark not only as a scientist and medical practitioner, but also had a deep influence on his general outlook on life and personal development.