Active screening of gastrointestinal helminth infection in migrant workers in Thailand

Objective

This study aimed to detect gastrointestinal helminth infection in migrant workers in Thailand.

Methods

A cross-sectional survey study was conducted in 403 migrant workers in the factories of Nakhon Ratchasima Province, northeastern Thailand during October 2016 to June 2017. Gastrointestinal helminth infections were detected by the formalin ether acetate concentration technique and microscopy. The data were analyzed using the χ²-test and logistic regression.

Results

The rate of gastrointestinal helminth infection was 24.07%. The most common species involved in infection was Opisthorchis viverrini (11.91%), followed by hookworm (5.46%), Trichuris trichiura (5.21%), Strongyloides stercoralis (0.5%), Ascaris lumbricoides (0.5%), and Taenia spp. (0.5%). The majority of infections were found in men aged ≥40 years, married participants, uneducated participants, laborers, those who worked for 1 year, and those who had an income of 9000 to 12,000 THB.

Conclusions

Gastrointestinal helminth infection is still found in migrant workers. Therefore, active surveillance is required in this large group for investigating and eradicating this type of infection.

Detection of Risk Groups for Carcinogenic Liver Fluke Infection by Verbal Screening Questionnaire Using a Mobile Application

The carcinogenic liver fluke, Opisthorchis viverrini, is a serious health problem in Southeast Asia where infection is associated with cholangiocarcinoma, a major cause of death in Thailand. This cross-sectional study aimed to screen for O. viverrini infection among a Thai rural population of 560 individuals from Nakhon Ratchasima, Khonkaen, and Chaiyaphum provinces with a verbal screening test with a mobile application (OvApp). Faecal samples were also processed with a mini-parasep sf parasite faecal concentrator. The infection rate of O. viverrini was found to be 2.86%. The majority of infections were detected in males aged 41–50, with primary school being their highest education level, and who were engaged in agricultural occupations. In screening for O. viverrini infection, the OvApp had a high sensitivity (87.5%), specificity (94.6%), negative predictive value (98.9%), and accuracy (98.6%). The positive predictive value was 70.0% for the OvApp. The observed agreement was substantial for this application (k-value = 0.64) indicated that it is a potentially useful tool for decreasing the cost of large-scale O. viverrini screening.

Opisthorchis viverrini infection among migrant workers in Nakhon Ratchasima province, Thailand, indicates continued need for active surveillance

Opisthorchis viverrini is a serious problem in Thailand, Cambodia, the Lao People's Democratic Republic and Vietnam. Active surveillance and eradication of O. viverrini is required. A cross-sectional study of 403 immigrant workers was conducted between October 2016 and June 2017 in Nakhon Ratchasima, Thailand. Stool samples were analysed via the formalin-ether concentration technique, with subsequent data analysis performed using descriptive statistics and logistic regression. Overall infection was 24.1% and the results reveals an O. viverrini infection rate was 11.9%. O. viverrini infection was identified in 25.6% of Cambodians, 15.3% of Laotians and 3.6% workers from Myanmar sampled. The majority of infections were found in males, aged e"40 years and working as labourers. Raw or undercooked cyprinoid fish consumption was associated with an elevated risk for O. viverrini infection (OR_adj = 2.2, 95% CI = 1.2-4.0). Other intestinal helminthic infections were hookworm (5.5%), Trichuris trichiura (5.2%), Strongyloid stercoralis (0.5%), Ascaris lumbricoides (0.5%) and Taenia spp. (0.5%), respectively. This is the first study to report O. viverrini among immigrant workers in Thailand; therefore, active surveillance is needed among migrant workers to identify and treat O. viverrini infection.

Detection of a carcinogenic liver fluke among migrant workers by three coprological concentration methods

Opisthorchis viverrini is a major health problem in many part of Southeast Asia. Therefore, this study aimed to detect Opisthorchis viverrini infection among migrant workers in Thailand by using three coprological concentration methods. A cross-sectional study was conducted among 147 migrant workers in Thailand. Fecal samples were processed by the modified formalin ether concentration technique, the Kato Katz thick smear, and the miniparasep solvent free parasite fecal concentrator. Specificities, sensitivities, negative predictive values, positive predictive values, Kappa indexes were analyzed with SPSS version 22. The infection rate with opisthorchiasis was 27.2%. The parameters measured for the modified formalin ether concentration technique, Kato Katz thick smear, and mini-parasep solvent free parasite fecal concentrator methods respectively were as follows: infection rates (23.1%, 12.9%, and 22.4%), sensitivities (85.0%, 47.5%, and 82.5%), specificities (100%, 100%, and 100%), positive predictive values (100%, 100%, and 100%), and negative predictive values (94.7%, 83.6%, and 93.9%). The kappa index value of diagnostic agreement between formalin ether concentration technique and mini-parasep solvent free parasite fecal concentrator showed substantial agreement for O. viverrini. In conclusion, the calculated analytical sensitivity, and negative predictive values indicate that modified formalin ether concentration technique and mini-parasep solvent free parasite fecal concentrator are more accurate in detecting O. viverrini infections. The study indicates that the mini-parasep solvent free parasite fecal concentrator method was the method with high potential to be used in routine laboratory and community diagnosis for opisthorchiasis.

Role of the Mdm2 SNIP 309 Polymorphism in Gastric Mucosal Morphologic Patterns of Patients with Helicobacter pylori Associated Gastritis

BACKGROUND

The tumor suppressor p53 is as a regulator of cell proliferation, apoptosis and many other biological processes as well as external and internal stress responses. Mdm2 SNIP309 is a negative regulator of 53. Therefore, this study aimed to determine the role of the Mdm2 SNIP 309 polymorphism in the gastric mucosal morphological patterns in patients with Helicobacter pylori associated gastritis.

MATERIALS AND METHODS

A prospective cross-sectional study was carried out from November 2014 through November 2015. Biopsy specimens were obtained from patients and infection was proven by positive histology. Gastric mucosa specimens were sent to the Molecular Genetics Unit, Institute of Medicine, Suranaree University of Technology where they were tested by molecular methods to detect the patterns of Mdm2 SNIP 309 polymorphism using the real-time PCR hybridization probe method. The results were analyzed and correlated with gastric mucosal morphological patterns by using C-NBI endoscopy.

RESULTS

A total of 300 infected patients were enrolled and gastric mucosa specimens were collected. In this study the percentage of Mdm2 SNIP 309 T/T homozygous and Mdm2 SNIP309 G/T heterozygous was 78% and 19 % respectively whereas Mdm2 SNIP309 G/G homozygous was 3%. Mdm2 SNIP 309 T/T homozygous and Mdm2 SNIP309 G/T heterozygosity correlated with type 1 to type 3 gastric mucosal morphological patterns (P<0.01) whereas Mdm2 SNIP309 G/G homozygous correlated with type 4 and type 5 (P<0.01).

CONCLUSIONS

Our study finds the frequency of Mdm2 SNIP309 G/G in a Thai population is very low, and suggests that this can explain ae Thailand enigma. Types 1 to type 3 are the most common gastric mucosal morphological patterns according to the unique genetic polymorphism of MDM2 SNIP 309 in the Thai population.

Helicobacter Species are Possible Risk Factors of Cholangiocarcinoma

Several infectious agents are considered to be causes of cancer in human, mainly hepatitis B and C viruses, high-risk human pailloma viruses, Helicobacter pylori, Clonorchis sinensis, and Opisthorchis viverrini. Here we described the evident research and the association between Helicobacter spp. and biliary tract cancer particularly cholangiocarcinoma (CCA). Global epidemiological studies have suggested that Helicobacter spp. are possible risk factors for biliary tract diseases. Molecular studies support a linkage of Helicobacter spp. with CCA development. H. pylori, H. bilis, and H. hepaticus, are found in CCA, but the most common species are H. pylori and H. bilis. The type of CCA are associated with Helicobacter spp. include extrahepatic CCA, and common bile duct cancer. Up to the present, however, the results from different regions, materials and methods, sub-sites of cancer, and controls have not been consistent, thus introducing heterogeneity. Therefore, a comparison between co-Helicobacter spp.-CCA in the countries with low and high incident of CCA is required to settle the question. Furthermore, clarifying variation in the role of Helicobacter species in this CCA, including pathogenesis of CCA through enhanced biliary cell inflammation and proliferation, is necessary.

Detection of the Carcinogenic Liver Fluke Opisthorchis viverrini Using a Mini Parasep SF Faecal Parasite Concentrator

The Mini Parasep SF fecal parasite concentrator (MPSFC) is a new modification of the closed concentration system, which can easily be adopted in any routine clinical pathology laboratory. Here we describe our experience with the system in diagnosing Opisthorchis viverrini. A total of 199 fecal samples was submitted for routine examination in the clinical pathology laboratory of Suranaree University of Technology hospital, Nakhon Ratchasima province, Thailand, during August to October 2015. Out of all samples examined, 10 (5.03%) were positive with intestinal parasites including O. viverrini (2.01%), followed by Strongyloided stercoralis (1.51%), Hookworm (0.5%), Taenia spp. (0.5%), and Entamoeba coli (0.5%). Regarding the distribution of intestinal parasites in relation to the methods used, and found that 4 samples (2.01%) were positive using the direct wet smear method while 10 (5.03%) were positive with the Mini Parasep SF method; the difference was statistically significant (X2-test = 116.506, p-value =0.001). Mean time for processing using the Parasep system was 6.03 min/ sample, the conventional direct wet smear method at 0.3 min/sample. Cost per test, conventional direct wet smear method costing less than the Parasep method at USD 0.74/sample versus USD 1.47/sample. This first report of O. viverrini detection using MPSFC indicates that Parasep concentration test is useful in the routine laboratory, increasing the yield of parasites as compared to direct microscopy, but with greater processing time and cost. Further comparisons between the Parasep concentration test and common methods for O. viverrini detection are required, particularly concerning use in epidemiological surveys.

Helicobacter Pylori Associated Gastritis Increases Risk of Colorectal Polyps: a Hospital Based-Cross-Sectional Study in Nakhon Ratchasima Province, Northeastern Thailand

BACKGROUND

Colorectal polyps are common in Thailand, particularly in the northeastern region. The present study aimed to determine any correlation between Helicobacter pylori-associated gastritis and colorectal polyps in the Thai population.

MATERIALS AND METHODS

A total of 303 patients undergoing esophagogastroduodenoscopy with colonoscopy for investigation of chronic abdominal pain participated in this study from November 2014 to October 2015. A diagnosis of Helicobacter pylori associated gastritis was made if the bacteria were seen on histopathological examination and a rapid urease test was positive. Colorectal polyps were confirmed by histological examination of colorectal biopsies. Patient demographic data were analyzed for correlations.

RESULTS

The prevalence of colorectal polyps was 77 (25.4%), lesions being found more frequently in Helicobacter pylori infected patients than non-infected subjects [38.4% vs. 12.5%; Odds Ratio (OR) (95% CI): 2.26 (1.32 - 3.86), p < 0.01]. Patients with Helicobacter pylori - associated gastritis were at high risk of having adenomas featuring dysplasia [OR (95% CI): 1.15 (1.16 - 7.99); P = 0.02]. There was no varaition in location of polyps, age group, sex and gastric lesions with respect to Helicobacter pylori status.

CONCLUSIONS

This study showed that Helicobacter pylori associated gastritis is associated with an increased risk of colorectal polyps, especially adenomas with dysplasia in the Thai population. Patients with Helicobacter pylori-associated gastritis may benefit from concurrent colonoscopy for diagnosis of colorectal polyps as a preventive and early treatment for colorectal cancer.

Improved Detection of Helicobacter pylori Infection and Premalignant Gastric Mucosa Using "Site Specific Biopsy": a Randomized Control Clinical Trial

BACKGROUND

Helicobacter pylori infection and premalignant gastric mucosa can be reliably identified using conventional narrow band imaging (C-NBI) gastroscopy. The aim of our study was to compare standard biopsy with site specific biopsy for diagnosis of H. pylori infection and premalignant gastric mucosa in daily clinical practice.

MATERIALS AND METHODS

Of a total of 500 patients who underwent gastroscopy for investigation of dyspeptic symptoms, 250 patients underwent site specific biopsy using C-NBI (Group 1) and 250 standard biopsy (Group 2). Sensitivity, specificity, and positive and negative predictive values were assessed. The efficacy of detecting H. pylori associated gastritis and premalignant gastric mucosa according to the updated Sydney classification was also compared.

RESULTS

In group 1 the sensitivity, specificity, positive and negative predictive values for predicting H. pylori positivity were 95.4%, 97.3%, 98.8% and 90.0% respectively, compared to 92.9%, 88.6%, 83.2% and 76.1% in group 2. Site specific biopsy was more effective than standard biopsy in terms of both H. pylori infection status and premalignant gastric mucosa detection (P<0.01).

CONCLUSIONS

Site specific biopsy using C-NBI can improve detection of H. pylori infection and premalignant gastric mucosa in daily clinical practice.

Primary Care Intervention to Prevent and Control Cholangiocarcinoma: Lesson from Nakhon Ratchasima, Thailand

BACKGROUND

Cholangiocarcinoma (CCA) is a bile duct cancer. It includes intra-and extra-hepatic bile duct. It is most commonly found in Thailand particularly in the northeast and north region. Those regions have been reported as the highest of incident of the world.

OBJECTIVE

Primary car interven in the risk areas of CCA among population in Nakhon Ratchasima province,Thailand.

MATERIAL AND METHOD

A community-based study was conducted among three districts of Nakhon Ratchasima province, Thailand including Bua Yai, Chum Phuang, and Mueang Yang district between July and December 2015. Mix method was used in this study that included cross-sectional survey, action research, and application of Geographic Information System. The study was composed of five steps, develop Korat CCA network, CCA screening by using Korat CCA verbal screening test, detection of liver fluke and CCA in the population at risk by using Kato Katz thick smear technique and ultrasonography, health behavior modification, and development of Geographic Information System for CCA database.

RESULTS

Three hundred fifty five participants were tested for liver fluke infection and the infection rate was found to be 2.25%. Eight cases from 88 participants at risk had a dilated bile duct. Populations at risk in each district were selected for health modification briefing that used the social engagement model. Seven community rules were agreed, cooked fish consumption, stop under-cooked fish, hygienic defecation, CCA campaign, food safety club, annual health check, an ongoing monitoring by village health volunteer and local public health officer.

CONCLUSION

Infection in Nakhon Ratchasima is high. A community briefing and rules were agreed. A geovisual display of the population at risk for CCA is now available.

Analysis of Risk Areas of Opisthorchis viverrini in Rural Communities by Using SUT-OV-001

BACKGROUND

Opisthorchis viverrini is still a serious problem in rural areas of Thailand particularly Northeastern and Northern region. Active surveillance is required to determine the update data for further prevention and control planning.

OBJECTIVE

To determine the population at risk and analyze the risk areas for O. viverrini in rural communities of Nakhon Ratchasima province, Thailand.

MATERIAL AND METHOD

A cross-sectional survey was conducted between October 2015 and March 2016 at Kang Sanam Nang district, Nakhon Ratchasima province, Thailand. The population at risk for O. viverrini was screened by SUT-OV-001 with Cronbach’ alpha coefficient, 0.724. O. viverrini infection was examined by using Kato thick smear. The risk areas were analyzed by using geographic information system.

RESULTS

Three hundred ninety seven people were recruited for this study. The majorities were female (53.15%), age group 41 to 50 years old (35.01%), educated with primary school (59.45%), agriculture (85.64%), and of income of 2,000 baht (47.36%). The majorities of them were high-risk (49.62%), followed by moderate risk (36.02%), and low-risk (7.3%). Risk areas were classified as very-high-risk areas, found in Beng Samrong (11.44 km(2)), followed by Keang Sanam Nang (5.21 km(2)). High-risk areas were found in Bueng Phalai sub-district (70.16 km(2)), followed by Bueng Samrong (30.45 km(2)), and Non Samran (27.33 km(2)). O. viverrini infection was 3.02%, and distributed in the moderate risk areas (four cases), high-risk areas (three cases), low-risk areas (three cases), and very-high-risk areas (two cases).

CONCLUSION

The present study indicates the population at risk for O. viverrini and risk areas in the rural communities by using SUT-OV-001 and GIS. These tools are useful to display the risk areas for further prevention and control planning and monitor.

Correlation between Patterns of Mdm2 SNIP 309 and Histopathological Severity of Helicobacter pylori Associated Gastritis in Thailand

BACKGROUND

The commonly held view of the tumor suppressor p53 is as a regulator of cell proliferation, apoptosis and many other biological processes as well as external and internal stress responses. Mdm2 SNIP309 is a negative regulator of p 53. Therefore, this study aimed to determine the correlation between the patterns of Mdm2 SNIP 309 and the inflammation grading of Helicobacter pylori associated gastritis in a Thai population.

MATERIALS AND METHODS

A cross-sectional study was carried out from November 2014 through June 2015. Biopsy specimens were obtained from infected patients and infection was proved by positive histology. The gastric mucosa specimens were sent to the Molecular Genetic Unit, Institute of Medicine, Suranaree University of Technology where they were tested by molecular methods to detect the patterns of Mdm2 SNIP 309 using the real-time PCR hybridization probe method. The results were analyzed and compared with the Updated Sydney classification.

RESULTS

A total of 100 infected patients were interviewed and gastric mucosa specimens were collected. In this study the percentage of Mdm2 SNIP 309 T/T homozygous and Mdm2 SNIP309 G/T heterozygous was 78% and 19 % respectively whereas Mdm2 SNIP309 G/G homozygous was 3%. Mdm2 SNIP 309 T/T homozygous and Mdm2 SNIP309 G/T heterozygous correlated with mild to moderate inflammation (P<0.01) whereas Mdm2 SNIP309 G/G homozygous correlated with severe inflammation (P<0.01).

CONCLUSIONS

Our study found the frequency of Mdm2 SNP309 G/G in our Thai population to be very low, and suggests that this can explain to some extent the low incidence of severe inflammation and gastric cancer changes in the Thai population. Mild to moderate inflammation are the most common pathologic gradings due to the unique genetic polymorphism of Mdm2 SNIP 309 in the Thai population.

Genetic Polymorphism of MDM2 SNP309 in Patients with Helicobacter Pylori-Associated Gastritis

BACKGROUND

Helicobacter pylori plays an important role in gastric cancer, which has a relatively low inciduence in Thailand. MDM2 is a major negative regulator of p53, the key tumor suppressor involved in tumorigenesis of the majority of human cancers. Whether its expression might explain the relative lack of gastric cancer in Thailand was assessed here.

MATERIALS AND METHODS

This single-center study was conducted in the northeast region of Thailand. Gastric mucosa from 100 patients with Helicobacter pylori associated gastritis was analyzed for MDM2 SNP309 using real-time PCR hybridization (light-cycler) probes.

RESULTS

In the total 100 Helicobacter pylori associated gastritis cases the incidence of SNP 309 T/T homozygous was 78 % with SNP309 G/T heterozygous found in 19% and SNP309 G/G homozygous in 3%. The result show SNP 309 T/T and SNP 309 G/T to be rather common in the Thai population.

CONCLUSIONS

Our study indicates that the MDM2 SNP309 G/G homozygous genotype might be a risk factor for gastric cancer in Thailand and the fact that it is infrequent could explain to some extent the low incidence of gastric cancer in the Thai population.

Review and Current Status of Opisthorchis viverrini Infection at the Community Level in Thailand

Opisthorchis viverrini is remains a public health problem in Thailand, particularly in the northeast and north regions which have the highest incidences of chonalgiocarcinoma (CCA). O. viverrini causes the disease opithorchiasis, and its has been classified as a group 1 biological carcinogen. Humans, dogs, and cats become infected with O. viverrini by ingesting raw or undercooked fish containing infective metacercariae. The first human cases of O. viverrini infection were reported in Thailand 100 years ago, and it's still a problem at the community level. Based on data for the year 2009, more than 6 million people were infected with O. viverrini. Associated medical care and loss of wages in Thailand costs about $120 million annually. This review highlights the current status of O. viverrini infection in communities of Thailand through active surveillance for the five years period from 2010 and 2015. A total of 17 community-based surveys were conducted, most in the northeast region. Some 7 surveys demonstrated a high prevalence over 20%, and the highest was 45.7%. Most commonly infection was found in age group of 35 years and older, males, and agricultural workers. Although, the national prevalence may be decreasing but the results show that the O. viverrini infection is still high in communities of the northeast region. Therefore, the focus in populations living in northeast Thailand should be screening of infection and changing their eating behavior.

Surveillance of Populations at Risk of Cholangiocarcinoma Development in Rural Communities of Thailand Using the Korat-CCA Verbal Screening Test

Cholangiocarcinoma (CCA) is a serious problem in Thailand, particularly in the northeastern region. Active surveillance in rural communities with an appropriat low-cost screening tool is required to facilitate early detection. Therefore, this study aimed to investigate the population at risk of CCA in Bua Yai district, Nakhon Ratchasima province, Northeastern Thailand using the Korat-CCA verbal screening test (KCVST) during June to October 2015. Reliability of KCVST demonstrated a Cronbach alpha coefficient=0.75 Stepwise-multiple regression showed that alcohol consumption was important for CCA screened, followed by agriculture and pesticide use, under-cooked cyprinoid fish consumption, praziquantel use, naïve northeastern people, opisthorchiasis, family relatives with CCA, and cholangitis or cholecystitis or gallstones, respectively. Population at risk for CCA was classified to low risk (63.4%), moderate risk (33.7%), and high risk (1.32%) for CCA. When CCA was screened using ultrasonography, 4 of 32 high risk participants had an abnormal biliary tract with dilated bile ducts. This study indicates that KCVST is a potential useful too which decrease the cost of large scale CCA screening.

Distribution of the Population at Risk of Cholangiocarcinoma in Bua Yai District, Nakhon Ratchasima of Thailand Using Google Map

BACKGROUND

Cholangiocarcinoma (CCA), a major problem of health in Thailand, particularly in Northeastern and Northern regions, is generally incurable and rapidly lethal because of presentation in stage 3 or 4. Early diagnosis of stage 1 and 2 could allow better survival. Therefore, this study aimed to provide a distribution map of populations at risk for CCA in BuaYai district of Nakhon Ratchasima province, Northeast Thailand.

MATERIALS AND METHODS

A cross-sectional survey was carried out in 10 sub-districts and 122 villages, during June and November 2015. The populations at risk for CCA were screened using the Korat CCA verbal screening test (KCVST) and then risk areas were displayed by using Google map (GM).

RESULTS

A total of 11,435 individuals from a 26,198 population completed the KCVST. The majority had a low score of risk for CCA (1-4 points; 93.3%). High scores with 6, 7 and 8 points accounted for 1.20%, 0.13% and 0.02%. The population at risk was found frequently in sub-district municipalities, followed by sub-district administrative organization and town municipalities, (F=396.220, P-value=0.000). Distribution mapping comprised 11 layers: 1, district; 2, local administrative organization; 3, hospital; 4, KCVST opisthorchiasis; 5, KCVST praziquantel used; 6, KCVST cholelithiasis; 7, KCVST raw fish consumption; 8, KCVST alcohol consumption; 9, KCVST pesticide used; 10, KCVST relative family with CCA; and 11, KCVST naive northeastern people. Geovisual display is now available online.

CONCLUSIONS

This study indicated that the population at high risk of CCA in Bua Yai district is low, therefore setting a zero model project is possible. Key success factors for disease prevention and control need further study. GM production is suitable for further CCA surveillance and monitoring of the population with a high risk score in this area.

Re-Examination of Opisthorchis viverrini in Nakhon Ratchasima Province, Northeastern Thailand, Indicates Continued Needs for Health Intervention

Opisthorchis viverrini infection is associated with cholangiocarcinoma particularly in the cases of chronic or re-infection. This presents a serious health problem in northeastern and northern Thailand. A community base approach is required for surveillance. Therefore, in a pilot project, re-examination of O. viverrini infection was conducted in the 3 districts of Nakhon Ratchasima province, Thailand, during June and October 2015. A total of 355 participants from a 194,152 population, was selected through multi-stage sampling. O. viverrini infection was determined using modified Kato Katz thick smear technique. Participants were 229 males and 126 females, and aged ≥30 years old. Prevalence of O. viverrini infection was 2.25% (8/355 participants). O. viverrini infection was slightly higher in females (3.17%), and age group between 41-50 years (4.49%). Mueang Yang district had a highest of O. viverrini infection rate (2.82%), and followed by Bua Yai (2.48%), and Chum Phuang (1.84%), respectively. O. viverrini infection rate was increased from year 2012 to 2015 particularly in Bua Yai and Mueang Yang. These re-examinion results indicate that opisthorchiasis is still problem in community of Nakhon Ratchasima province, therefore, the provincial-wide scale is need required. Furthermore health education is need intervened in the infected group, and screening of cholangiocarcinoma is urgently concerned.

Overweight Relation to Liver Fluke Infection among Rural Participants from 4 Districts of Nakhon Ratchasima Province, Thailand

A cross-sectional survey was conducted among 730 participants from 4 rural districts of Nakhon Ratchasima province, Thailand, with a reported high incidence of liver fluke infection. This study was aimed to examine and evaluate the nutritional status in relation to Opisthorchis viverrini infection. Participants were purposive selected from Chum Phuang, Mueang Yang, Bua Yai, and Kaeng Sanam Nang districts. Stool samples were prepared by Kato Katz technique and then assessed by microscopy. Anthropometry was evaluated according to the body mass index from weight and height. Descriptive statistics and Spearman rank correlation coefficients were used to evaluate the association between the nutritional status and O. viverrini infection. Of 1.64% infected with O. viverrini the highest proportions were found in age groups ≥61 and 41-50 years old, Mueang Yang district. The majorities of participants had normal weight (32.2%), followed by class II obesity (28.1%), class I obesity (21.8%), underweight (10.3%), and class III obesity (8.63%). Nutritional status with class II obesity (rS=0.639, <0.01) and class I obesity (rS=0.582, <0.05), had moderately statistical significant correlations with O. viverrini infection. Meanwhile, normal weight (rS=0.437, <0.05) and class III obesity (rS=0.384, <0.05) demonstrated lower statistical significance. These findings raise the possibility that infection with O. viverrini may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand whether O. viverrini contributes directly to fat deposition and possible mechanisms.

Behavioral Modification Regarding Liver Fluke and Cholangiocarcinoma with a Health Belief Model Using Integrated Learning

This study aimed to modify behavior regarding liver fluke and cholangiocarcinoma prevention in Chumphuang district, Nakhon Ratchasima province, Thailand through integrated learning. A total of 180 participants were included through purposive selection of high-risk scores on verbal screening. Participants attended the health education program which applied the health belief model included family based, knowledge station based, academic merit based and community based learning. Data were collected using a questionnaire composed of 4 parts: 1) personal information, 2) knowledge, 3) perceived susceptibility, severity, benefits, and barriers, 4) practice regarding liver fluke and cholangiocarcinoma prevention. The result revealed that the majority were female (79.9%), age ≥60 years old (33.2%), primary school educational level (76.1%), and agricultural occupation (70.1%). The mean scores of knowledge, perception, and practice to liver fluke and cholangiocarcinoma prevention, before participated the integrative learning were low, moderate, and low, respectively. Meanwhile, the mean score of knowledge, perceived susceptibility, severity, benefits, and barriers, and practice regarding liver fluke and cholangiocarcinoma prevention, were higher with statistical significance after participation in the integrated learning. This finding indicates that health education programs may successfully modify health behavior in the rural communities. Therefore they may useful for further work behavior modification in other epidemic areas.

TLR1 Polymorphism Associations with Gastric Mucosa Morphologic Patterns on Magnifying NBI Endoscopy: a Prospective CrossSectional Study

BACKGROUND

Helicobacter pylori is now recognized as a causative factor of chronic gastritis, gastroduodenal ulcers, gastric cancer and mucosaassociated lymphatic tissue lymphoma. Tolllike receptors are important bacterial receptors in gastric epithelial cell signaling transduction and play critical roles in gastric carcinogenesis.

MATERIALS AND METHODS

A total of 400 patients undergoing esophagogastroduodenoscopy for investigation of chronic abdominal pain were genotyped for singlenucleotide polymorphisms (SNPs) in TLR1 (rs4833095) using TagMan SNPs genotyping assay by realtime PCR hybridization. Relationships with susceptibility to H. pylori infection and premalignant gastric mucosa morphological patterns, classified by magnifying NBI endoscopy, were investigated.

RESULTS

The percentages of TLR1 rs4833095, CC homozygous, CT heterozygous and TT homozygous cases were 34, 46.5 and 19%, respectively. CC showed statistical differences between H. pylori positive and negative cases (P<0.001). CT and TT correlated with type 1 and type 2 gastric mucosal morphological patterns (P<0.01) whereas CC correlated with types 3 and 4 (P<0.01).

CONCLUSIONS

This study demonstrated good correlation of TLR1 rs4833095 genotype with severity of inflammation in H. pylori infected gastric mucosa according to gastric mucosal morphologic patterns with magnifying NBI endoscopy.

Opisthorchis viverrini Infection Among People in the Border Areas of Three Provinces, Northeast of Thailand

Opisthorchis viverrini is still a serious problem in Northeastern and Northern Thailand. Active surveillance is required to determine updated data for further prevention and control planning. Therefore, this study aimed to examine the prevalence and risk factors for O. viverrini in three provinces, Northeastern Thailand. A cross- sectional survey was conducted during October 2015 to March 2016 at Kaeng Sanam Nang district of Nakhon Ratchasima province, Waeng Noi district of Khon Kaen province, and Khon Sawan district of Chaiyaphum province, Thailand. Stool samples were examined by using a modified Kato-Katz Thick smear technique. From a total of 978 participants screened, O. viverrini infection was found in 1.74%, the majority opf positive cases being male (6.62%), age group 51-60 years old (4.21%), educated at primary school (8.43%), occupied with agriculture (9.62%),having an income <4,000 baht per month (4.82%), and living in Khon Sawan district (8.43%). Participants had a high knowledge level (42.43%), good attitude level (34.76%), and fair level (38.04%). The present study indicates the O. viverrini infection rate is low, but elderly males with primary school education involved in agriculture are still frequently effected particularly in Khon Sawan district. Therefore, this risk group requires behavior modification and continued monitoring.

Endoscopic ultrasound-guided hepaticogastrostomy for hilar cholangiocarcinoma: the first trial in Thailand

BACKGROUND

There are many palliative treatments for patients with unresectable malignant biliary obstruction, e.g. endoscopic retrograde cholangiopancreatography (ERCP) with stents, percutaneous transhepatic biliary drainage (PTBD) or surgery. We propose a new technique by using endoscopic ultrasound (EUS) with fluoroscopy to perform hepaticogastrostomy for palliative drainage far from the site of tumor to avoid tumor obstruction.

MATERIAL AND METHOD

Between December 2005 and June 2006, two patients with severe jaundice by hilar cholangiocarcinoma were treated with this new procedure. The first case was a 44-year female post partial resection of tumor and Roux en Y hepaticojejunostomy and the second case was a 48-year male post ERCP and right hepatic stent. We used an electronic convex curved linear-array echo-endoscope with fluoroscope guided to drain left dilated intrahepatic duct to the stomach by inserting 8 Fr 60 mm metallic wallstent via lesser curvature. We performed under general anesthesia and followed-up every two weeks.

RESULTS

There were former two patients failed to place the stents. Hepaticogastrotomy of both patients were our first successful trial but stent site of the first case was not good because the insertion was at esophagogastric junction. Total bilirubin of first and second case fell from 38.4 mg/dl to 27.3 mg/dl and 22.0 mg/dl to 3.4 mg/ dl in two weeks, respectively. No immediate complication was found and oral diet was well succeeded on the next day after procedure in both cases. The first case was dead after 32 days of operation from sepsis and hepatic failure. The second case was clinically much improved after 3 months and died from liver failure after 6 months and 10 days.

CONCLUSION

This new interventional EUS-guided hepaticogastrostomy is safe, feasible and may provide an alternative to surgery or PTBD or failed ERCP. It can improve the palliative treatment in hilar lesions because it's internal drainage and far from tumor site that promote fast recovery. However, long term study is still necessary to evaluate the results and cost-effectiveness of this technique.

Experimental comparative study of the efficacy and side effects of Cissus quadrangularis L. (Vitaceae) to Daflon (Servier) and placebo in the treatment of acute hemorrhoids

OBJECTIVE

To investigate efficacy and side effects of Cissus quadrangularis L. and micronised purified flavanoid fraction (MPFF) in treatment of hemorrhoids.

MATERIAL AND METHOD

A prospective double blind randomized study was designed in acute hemorrhoidal patients from three hospitals. In each hospital, eighty patients received the flavanoid mixture, C. quadrangularis, or placebo (3 x 2 p.c. for 4 days and then 2 x 2 p.c. for 3 days). Patients were evaluated on bleeding, pain, discharge, pruritis, erythema, and direct patient interviews. Each symptom was scored on a graded severity scale from 0 to 3 on the first day and the seventh day. Blood tests and monitoring of treatment-related side effects were conducted.

RESULTS

Five hundred seventy patients (299 females, 271 males) were enrolled. No significant difference regarding age, gender, occupation, and history of disease was recorded. Mostly acute bleeding ceased at the second day in all groups. Analysis on all groups revealed improvement in all symptoms with non-significant difference. No adverse events, no blood chemistry changes were reported.

CONCLUSION

The therapeutic efficacy of flavanoid mixture, C. quadrangularis L. and placebo are not different indicating that they play no role in improving early hemorrhoidal symptoms. Long-term studies should be conducted for effects in preventive and curative action.

Risk factors for gallstone disease in a Thai population

Background

Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors.

Methods

We conducted a case–control study of 407 participants comprising 207 cases with GSD and 200 controls without GSD, as confirmed by ultrasonography. The participants completed a questionnaire and underwent physical and ultrasonographic examination. The risk factors examined were age, sex, BMI, use of oral contraceptives, diabetes mellitus, cirrhosis, thalassemia, dyspepsia, family history of gallstone disease, smoking status, alcohol consumption, and dietary history.

Results

BMI, fat content of dietary meat, and smoking were associated with GSD. When compared to participants with a BMI below 25, participants with a BMI of 25 or higher had a multivariate relative risk of 4.1 (95% CI, 2.5–6.7). Participants who consumed meat with moderate fat content or high fat content had respective relative risks of 2.5 and 2.9 (95% CI, 1.5–4.2 and 1.5–5.6), when compared to those who consumed meat with a low fat content. Also, the multivariate relative risk for former smokers, as compared to never smokers, was 2.4 (95% CI, 1.1–5.2).

Conclusions

High BMI, consumption of high-fat meat, and smoking were associated with gallstone disease.

Endoscopic management of cystic duct stump leakage after cholecystectomy

BACKGROUND/AIMS

Cystic duct stump leakage (CDL) is a rare and serious complication after cholecystectomy. Since laparoscopic cholecystectomy has been gold standard treatment of gallstone disease, this complication is found more frequently. Endoscopic management is now highly recommended and more appropriate than surgical correction, that would be evaluated.

METHODOLOGY

From January 1994 to December 2004, sixteen consecutive cases of patients with CDL after cholecystectomy were managed by endoscopic retrograde cholangiopancreatography (ERCP) in our unit. Endoscopic sphincterotomy (EST), stone extraction, stenting and nasobiliary tube drainage were selected to manage each patient with appropiate indication. Failed cannulation cases were corrected by open choledochojejunostomy. We also reviewed the time from cholecystectomy to presentation, presenting symptoms, treatment procedures and outcome.

RESULTS

A total of 16 patients; 9 women, 7 men average age 57.7 years with CDL after cholecystectomy were studied, 12 had undergone laparoscopic, and 4 had open cholecystectomy. Median time of presenting symptoms after cholecystectomy was 10.3 days (range 3-25 days). Symptoms included abdominal distension 100%, pain 87.5%, jaundice 62.5% and fever 37.5%. Diagnostic and therapeutic ERCP was successful in 14 cases comprising EST 2, EST+stone extraction 2, EST+ stone extraction +stent 2, EST+stone extraction + nasobiliary tube 1 and only plastic stent 7. Failed connulation in 2 cases, underwent open choledochojejunostomy. Median follow up time was 18.2 months (range 1-96 months) in 13 cases with no mortality.

CONCLUSIONS

CDL is a serious complication, more frequently after LC than OC. ERCP with combined endoscopic procedure is the treatment of choice to resolve the bile leakage.

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

AIM: To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP: 600 cases per year). All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood (in cholangitis) and clinical cholangitis were recorded.

RESULTS: Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n = 26). During ERCP, stones were found in 22 patients, malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis (relative risk = 0.71; 95% CI = 0.14-3.65; p = 0.88). Bacterobilia was found in 27 (56.3%) out of 48 patients. E. coli and Streptococcus viridans were the most common organisms.

CONCLUSION: Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.

Complications of laparoscopic cholecystectomy and their management

BACKGROUND/AIMS

Of all the complications of laparoscopic cholectecystomy, bile duct injury and bile leak are the most serious complications. The purpose of this study is to present our data of incidence of the complications and our experience in the management of complications during and after laparoscopic cholecystectomy.

METHODOLOGY

Retrospective study was performed on 348 patients, 102 males and 246 females with mean age of 52 years who underwent laparoscopic cholecystectomies during the period from 1 January 1996 to 31 December 1998 in the Department of Surgery, Rajavithi Hospital, Bangkok, Thailand. All complications were diagnosed and their management was recorded.

RESULTS

The complications included common bile duct injury in one case (0.29%) then we converted to exploratory laparotomy with cholecystectomy and Roux-en-Y choledochojejunostomy. One case that had cystic stump leakage (0.29%) and retained common bile duct stones was diagnosed later, we corrected by endoscopic retrograde cholangiopancreatography & ES, removed stones and placed a stent. One case had port wound infection (0.29%) which we treated by drainage and antibiotics. All of these had satisfactory results.

CONCLUSIONS

The complications of laparoscopic cholecystectomy can be prevented by adequate surgical experiences, carefulness and case selection. The results of their management also depend on the facilities and cooperation with the endoscopists.

Pulse dye laser lithotripsy for large biliary tract stones

From 1997 to 1998 the first series of 21 patients with large biliary tract stones (1.5-4.0 cm with average 2.5 cm in diameter) who underwent endoscopic stone extraction by using combination of ERCP and EST with automatic stone-tissue detection pulse dye laser was carried out. Male = 8, Female = 13, average age = 57.5 years (32-83) most of the stones were primary stones (71.4%). Laser fibers were controlled by balloon catheter with fluoroscope (blind technique) in 16 cases and by mother-babyscope system in 5 cases. The result in successful fragmentation of stones was 87.5 per cent with the blind technique and 100 per cent with the mother-babyscope technique. Temporary stents were used in the patients who had severe cholangitis and those who required more than one session of lithotripsy (19%). Complications consisted of controllable cholangitis in 2 cases (9.5%) and there was no mortality. We conclude that stone-tissue detection lithotripsy is very safe and effective in patients with large biliary tract stones and high surgical risk especially via the direct mother-babyscope system.