Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago

BACKGROUND

The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T.

METHODS

The SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed.

RESULTS

Thus far, thanks to implementation of the SEUSA program in Trinidad and Tobago 175, healthcare professionals have been exposed to training programs in the organ donation field. The Living Kidney Program was reinforced and the structure of the Deceased Donation (DD) network was defined. Since 2010, 485 potential organ donors have been detected, and 9 have become actual organ donors; 74 patients have received a kidney transplant (59 from living and 15 from deceased donors).

CONCLUSIONS

This project results demonstrate that the application of the SEUSA program is an efficient methodology to develop DD programs that increase and consolidate transplant programs in the Caribbean region.

Risk factors for Opisthorchis viverrini Infection in Nong Khai Province, Thailand

BACKGROUND

Opisthorchis viverrini (OV) infection is the main risk factor for cholangiocarcinoma and is often found in Northeastern Thailand. The prevalence of OV infection and the incidence of cholangiocarcinoma are major public health problems in this region.

OBJECTIVES

The objectives of this study were to identify factors associated with OV infection among people in Nong Khai Province in order to develop a prevention programme in the community.

MATERIALS AND METHODS

The data were collected in July 2013. Stool specimens were examined for intestinal parasites within hours after collection using a normal saline wet preparation and the modified Kato- Katz technique. A case-control study was conducted to collect information about demographic data, the habit of eating unsafely prepared fish, the safe disposal of waste food, and the practice of defaecating in fields. Structured questionnaires were used to interview 351 participants (117 cases and 234 controls) in a random selection of 30 villages across Nong Khai Province. Multiple logistic regression was used to identify risk factors for OV infection.

RESULTS

In the multivariate analysis, the results showed that the factors which had a statistically significant association with OV infection were the habit of consuming unsafely prepared fish (ORadj=5.17, 95%CI=2.49- 10.74), the similar habit of family members (ORadj=3.25, 95%CI=1.63-6.49) , a history of O. viverrini infection (ORadj=5.64, 95%CI=2.10-15.18), a history of taking praziquantel (ORadj=5.66, 95%CI=3.11-10.29), and the unsafe disposal of waste food (ORadj=2.1, 95%CI=1.10-3.80).

CONCLUSIONS

The findings of this study highlight the features on which a community programme should focus in order to reduce the prevalence of opisthorchiasis and incidence of bile duct cancer.

Prevalence and Factors Associated with Oral Pre-Malignant Lesions in Northeast Thailand

BACKGROUND

Oral cavity cancer (OCC) is one of the most common cancers worldwide. No studies have reported on the prevalence and epidemiologic risk factors of oral premalignant lesions (OPLs) in Thailand. The purpose of this study was to investigate the prevalence of OPLs and associated factors in Roi Et Province, Thailand.

MATERIALS AND METHODS

To investigate the prevalence of OPLs, a cross-sectional descriptive study was conducted in which 2,300 subjects over 40 years of age were recruited and screened for the prevalence of OPLs. To identify factors associated with OPLs, a matched case-control study was used in which the subjects were 102 cases with OPL and 102 matched controls without OPLs. The studies were conducted in Roi Et Province during the period 1 February, 2014, to 30 April, 2014, and the data were collected by the use of a structured interview questionnaire and by extraction of information from medical records. Data analyses involved the use of descriptive statistics, McNemar's test, and conditional logistic regression.

RESULTS

The overall prevalence of OPLs was 3.8%, and no-one was diagnosed with more than one type of OPL. The factors found to be associated with a statistically significant higher risk of an OPL were betel nut chewing, smoking, and alcohol consumption. The associations with these factors were strong, especially for betel nut chewing and smoking.

CONCLUSIONS

The habits of betel nut chewing, smoking, and alcohol use are confirmed as factors associated with OPLs in a population of Roi Et Province, Thailand. Campaigns to reduce such risk healthy behaviour are needed, but whether any actual decrease will prevent the eventual transformation of an OPL into an OCC remains an open question.

Measurement of the Target-Normal Single-Spin Asymmetry in Quasielastic Scattering from the Reaction (3)He(↑)(e,e')

We report the first measurement of the target single-spin asymmetry, A(y), in quasielastic scattering from the inclusive reaction (3)He(↑)(e,e') on a (3)He gas target polarized normal to the lepton scattering plane. Assuming time-reversal invariance, this asymmetry is strictly zero for one-photon exchange. A nonzero A(y) can arise from the interference between the one- and two-photon exchange processes which is sensitive to the details of the substructure of the nucleon. An experiment recently completed at Jefferson Lab yielded asymmetries with high statistical precision at Q(2)=0.13, 0.46, and 0.97  GeV(2). These measurements demonstrate, for the first time, that the (3)He asymmetry is clearly nonzero and negative at the 4σ-9σ level. Using measured proton-to-(3)He cross-section ratios and the effective polarization approximation, neutron asymmetries of -(1-3)% were obtained. The neutron asymmetry at high Q(2) is related to moments of the generalized parton distributions (GPDs). Our measured neutron asymmetry at Q(2)=0.97  GeV(2) agrees well with a prediction based on two-photon exchange using a GPD model and thus provides a new, independent constraint on these distributions.

Health Vulnerability of Households in Flooded Communities and Their Adaptation Measures

Floods adversely affect community well-being and health. This study aims to assess the present health vulnerability of households to floods in a rural flood-prone area of northeastern Thailand, as well as their adaptation measures. The participants were the representatives of 312 randomly selected households, and data were collected using an interview questionnaire. Health vulnerability was assessed in terms of flood exposure, flood sensitivity, and flood adaptive capacity. The data were analyzed with descriptive statistics. The results showed that 47.1% of the households had a low level of health vulnerability to flooding, while in 21.2% the level was high. Households had been adapting themselves to cope with the health impacts from flood. Their coping practices included special arrangements for the protection of property, food management, the provision of water supply and waste disposal, the elimination of sources of vector-borne diseases, family health care, the protection of family livelihood, and communication and transportation.

Factors affecting cervical cancer screening uptake by Hmong hilltribe women in Thailand

BACKGROUND

Cervical cancer is relatively common in Thai women, but the proportion of females receiving Pap smear screening is still low.

OBJECTIVE

The purpose of this cross-sectional study was to study factors related to cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province.

MATERIALS AND METHODS

Interview data were collected from 547 of these women aged 30-60 years living in the study area and analyzed using multiple logistic regression.

RESULTS

The results showed that 64.9% of the study sample had received screening, and that 47.2% had attended due to a cervical screening campaign. The most common reason given for not receiving screening was lack of time (21.4%). The factors found to be positively associated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56, 95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20, 95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), and perceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67).

CONCLUSIONS

To promote the uptake of cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancer screening, and access to screening services should be provided in conjunction with existing everyday services, such as family planning and routine blood pressure monitoring or diabetes services.

Measurement of double-polarization asymmetries in the quasielastic (3)He[→](e[→],e(')d) process

We present a precise measurement of double-polarization asymmetries in the ^{3}He[over →](e[over →],e^{'}d) reaction. This particular process is a uniquely sensitive probe of hadron dynamics in ^{3}He and the structure of the underlying electromagnetic currents. The measurements have been performed in and around quasielastic kinematics at Q^{2}=0.25(GeV/c)^{2} for missing momenta up to 270  MeV/c. The asymmetries are in fair agreement with the state-of-the-art calculations in terms of their functional dependencies on p_{m} and ω, but are systematically offset. Beyond the region of the quasielastic peak, the discrepancies become even more pronounced. Thus, our measurements have been able to reveal deficiencies in the most sophisticated calculations of the three-body nuclear system, and indicate that further refinement in the treatment of their two-and/or three-body dynamics is required.

Relationship between the body mass index and abnormal pap smears

This cross-sectional analytic study aimed to investigate any relationship between the body mass index (BMI) and an abnormal Pap smear. The subjects were 7,720 women aged 30-69 years who lived in Khon Kaen Province, Thailand, and had been recruited as participants in the Khon Kaen Cohort Study during 1990-2001. All had received Pap smear screening for cervical cancer. The data were analyzed using descriptive and inferential statistics. Multiple logistic regression was used to determine the relationship between body mass index and an abnormal Pap smear. The mean BMI was 24.53 kg/m(2) (SD =3.98), and 2.14% had abnormal Pap smears. Compared with the reference group of women with a BMI ≤ 22.9 kg/m(2), those with a body mass index of 23.0- 24.9 kg/m(2) had a reduced risk of an abnormal smear (OR(adj) = 0.92, 95%CI: 0.57-1.47), but women with a BMI 25.0-29.9 kg/m(2) were found to have an approximately 1.24 times higher risk (OR(adj) = 1.24, 95%CI: 0.86-1.80), and those with a BMI ≥ 30.0 kg/m2 had an approximately 1.63 times higher risk (OR(adj)=1.63, 95%CI: 0.98-2.69). The results indicated that the risk of Pap smear abnormalities is increased in women who have a higher than normal body mass index, but this finding was not statistically significant. Nevertheless, public health personnel should encourage women to maintain their BMI in the normal range to reduce the possible future risk of cervical cancer.

Prevalence of OV infection in Yasothon Province, Northeast Thailand

A liver fluke, Opisthorchis viverrrini (OV), is the major cause of the high incidence of cholangiocarcinoma in Thailand. The prevalence of OV infection remains high in various parts of the country, especially in Northeast Thailand and particularly in wetland rural areas where a large proportion of the community work in agriculture and continue the traditional practice of eating raw or undercooked cyprinoid fish products. The national control program seems to have had little impact in many of these areas, and it has been difficult to make precise assessments of the overall effectiveness of the program. This paper is the first report of prospective research project designed to monitor the impact of the national control program in rural communities located in a northeastern province and at high risk of OV infection. The participants in this initial survey were 1,569 villagers, aged 20-65 years, living in two subdistricts of Yasothon Province. Stool examinations showed that 38.68% were infected with OV. Males were slightly more likely to be infected than females, but the difference was not statistically significant. Infection was found to be positively associated with age in both males and females. The preliminary data indicate that the population selected for study is suitable for the purpose of the monitoring project.

Effectiveness of aromatherapy with light thai massage for cellular immunity improvement in colorectal cancer patients receiving chemotherapy

BACKGROUND

Patients with colorectal cancer are usually treated with chemotherapy, which reduces the number of blood cells, especially white blood cells, and consequently increases the risk of infections. Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by, for example, increasing the numbers of natural killer cells and peripheral blood lymphocytes. However, there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer. The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer, who have received chemotherapy, can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects.

MATERIALS AND METHODS

Sixty-six patients with colorectal cancer in Phichit Hospital, Thailand, were enrolled in a single-blind, randomised-controlled trial. The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period. The control group received standard supportive care only. Assessments were conducted at pre-assessment and at the end of one week of massage or standard care. Changes from pre-assessment to the end of treatment were measured in terms of white blood cells, neutrophils, lymphocytes, CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores.

RESULTS

The main finding was that after adjusting for pre-assessment values the mean lymphocyte count at the post-assessment was significantly higher (P=0.04) in the treatment group than in the controls. The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11%. The secondary outcomes were that at the post assessment the symptom severity scores for fatigue, presenting symptom, pain and stress were significantly lower in the massage group than in the standard care controls.

CONCLUSIONS

Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms.

Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma

Diarrhea is a major cause of morbidity and discomfort for patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT). There are multiple causes of diarrhea in patients undergoing transplantation including antineoplastic chemotherapy, antimicrobials and infection, including Clostridium difficile as the most common pathogen involved. The purpose of this study was to determine the incidence of C. difficile-associated diarrhea (CDAD) 1 week before and 30 days after APBSCT, and to identify risk factors for the development of CDAD including diagnosis. Two hundred and forty-two patients underwent APBSCT for multiple myeloma and lymphoma between October 1996 and October 2001 in two teaching hospitals. Diarrhea was reported in 157 (64.9%) subjects. One hundred and thirty-five out of the 157 subjects were tested for the presence of C. difficile toxin A. These subjects constitute the study group. The incidence of CDAD was 15%. Two thirds of the patients who developed CDAD had multiple myeloma and one third had lymphoma; this difference did not attain statistical significance. The use of cephalosporins (P = 0.03) and the use of intravenous vancomycin (P = 0.02) were the only identified risk factors associated with the development of CDAD. Patients treated with paclitaxel as part of the mobilization regimen had a lower incidence of CDAD than patients who received hematopoietic growth factor only (P = 0.01).

Silver deposition and tissue staining associated with wound dressings containing silver

Argyria is the general term used to denote a clinical condition in which excessive administration and deposition of silver causes a permanent irreversible gray-blue discoloration of the skin or mucous membranes. The amount of discoloration usually depends on the route of silver delivery (ie, oral or topical administration) along with the body's ability to absorb and excrete the administered silver compound. Argyria is accepted as a rare dermatosis but once silver particles are deposited, they remain immobile and may accumulate during the aging process. Topical application of silver salts (eg, silver nitrate solution) may lead to transient skin staining. To investigate their potential to cause skin staining, two silver-containing dressings (Hydrofiber and nanocrystalline) were applied to human skin samples taken from electively amputated lower limbs. The potential for skin discoloration was assayed using atomic absorption spectroscopy. When the dressings were hydrated with water, a significantly higher amount of silver was released from the nanocrystalline dressing compared to the Hydrofiber dressing (P <0.005), which resulted in approximately 30 times more silver deposition. In contrast, when saline was used as the hydration medium, the release rates were low for both dressings and not significantly different (silver deposition was minimal). Controlling the amount of silver released from silver-containing dressings should help reduce excessive deposition of silver into wound tissue and minimize skin staining.

Anterior uveitis and congenital fibrosis of the extraocular muscles in a patient with Noonan syndrome

We describe a patient with Noonan syndrome who presented with Human Leukocyte Antigen B27-associated recurrent acute anterior uveitis and manifestations of congenital fibrosis of the extraocular muscles, which has not been reported before.

Time and PSA threshold model prognosticates long-term overall and disease-specific survival in prostate cancer patients as early as 3 months after external beam radiation therapy

The specific aim of this analysis was to evaluate the capability of a time and prostate-specific antigen (PSA) threshold model to prognosticate overall survival (OS) and disease-specific survival (DSS) based on early PSA kinetics after radiotherapy for prostate cancer by retrospective review of outcomes in 918 patients. Crossing below analyzed PSA thresholds at specific defined time points reduced disease-specific death hazard ratios to relative to the cohort above threshold. The time and PSA threshold model demonstrates the ability to prognosticate OS and DSS as early as 3 months post-radiotherapy for prostate cancer.

Granisetron vs ondansetron for prevention of nausea and vomiting in hematopoietic stem cell transplant patients: results of a prospective, double-blind, randomized trial

The serotonin type-3 (5-HT3) antagonists represent a significant advance in the prevention of acute nausea and vomiting (N/V) from highly emetogenic chemotherapy. We sought to determine if any differences in efficacy or adverse effects exist between two such agents, ondansetron and granisetron, during conditioning therapy for hematopoietic stem cell transplantation (HSCT). Patients were randomized to receive either ondansetron 0.15 mg/kg intravenously every 8 h or granisetron 10 microg/kg intravenously daily. Additionally, all patients received scheduled dexamethasone and lorazepam. Prophylaxis was continued until 24 h after completion of chemotherapy. Nausea and distress were measured subjectively with visual analog scales and emetic episodes were quantified. Of the 110 randomized patients, 96 were evaluable for efficacy and safety. No significant differences in efficacy were observed between the ondansetron- and granisetron-treated patients, evaluated by comparing the degree of nausea and distress, number of emetic episodes and overall control of emesis. The adverse effects were also comparable and no patients were removed from study because of severe toxicities. This trial demonstrates that ondansetron and granisetron are equally effective at preventing acute N/V associated with conditioning therapy frequently used for HSCT. The agent of choice should be based on drug acquisition cost or preference.

Neutralizing human monoclonal antibodies to conformational epitopes of human T-cell lymphotropic virus type 1 and 2 gp46

Ten human monoclonal antibodies derived from peripheral B cells of a patient with human T-cell lymphotropic virus (HTLV)-associated myelopathy are described. One monoclonal antibody recognized a linear epitope within the carboxy-terminal 43 amino acids of HTLV gp21, and two monoclonal antibodies recognized linear epitopes within HTLV type 1 (HTLV-1) gp46. The remaining seven monoclonal antibodies recognized denaturation-sensitive epitopes within HTLV-1 gp46 that were expressed on the surfaces of infected cells. Two of these antibodies also bound to viable HTLV-2 infected cells and immunoprecipitated HTLV-2 gp46. Virus neutralization was determined by syncytium inhibition assays. Eight monoclonal antibodies, including all seven that recognized denaturation-sensitive epitopes within HTLV-1 gp46, possessed significant virus neutralization activity. By competitive inhibition analysis it was determined that these antibodies recognized at least four distinct conformational epitopes within HTLV-1 gp46. These findings indicate the importance of conformational epitopes within HTLV-1 gp46 in mediating a neutralizing antibody response to HTLV infection.

Evaluation of the conventional stretcher as a support surface

The conventional wood and canvas stretcher was evaluated with regard to comfort and risk of pressure and ischaemic damage. Sixty subjects were evaluated and results were found to be similar to other support surfaces. A mean sacral interface pressure of 40.7 mmHg was noted. Subjects found the stretchers cold and uncomfortable, particularly over the heels and lower back.

Pressure effects from the military stretcher

Attention is drawn to a possible deficiency in the folding pole canvas stretcher. Canvas tensioning and uniformity of support in the variety of stretcher where the canvas is attached by screws and metal strips was noted to be defective. High interface pressures were found on this type of stretcher, a problem not encountered in stretchers where the canvas tensioning is with regularly spaced tacks. Patients supported on the screw and strip variety may be at a higher risk of pressure necrosis.

Spastic ataxia associated with human T-cell lymphotropic virus type II infection

Human T-cell lymphotropic virus type one (HTLV-1) is associated with tropical spastic paraparesis or HTLV-I--associated myelopathy. We report 2 women with a spastic ataxic illness similar to HTLV-I--associated myelopathy infected solely with HTLV-II. Identification of HTLV-II infection was made serologically, by polymerase chain reaction, and by viral culture (in 1 woman). One woman, treated with 200 mg of danazol orally, three times daily, had pronounced improvement in ambulation, nocturnal spasticity, and nighttime urinary frequency. It appears that infection with HTLV-II may cause an illness similar to HTLV-I--associated myelopathy, but distinguished by the presence of ataxia.

Human T-cell leukemia virus type II infection frequently goes undetected in contemporary US blood donors

Serologic screening for human T-cell leukemia virus type I (HTLV-I) infection was begun in US blood banks with the licensure of enzyme-linked immunosorbent assays (ELISA) in December 1988. We examined the donation histories of the first 60 Western blot (WB)-confirmed HTLV-I/II positive donors to one blood center and found 8 had made 16 previous donations that scored negative on the screening ELISA. All 16 donations had ELISA absorbance below the cutoff for a positive assay, but still well above that of the average donation (17.6% +/- 5.7% of the cutoff). In a more extensive study, 17 donations from a total of 61,752 at six blood centers were both ELISA-positive and WB-positive for HTLV-I (4) or HTLV-II (13), and 218 samples had ELISA absorbance greater than 50% of the ELISA cutoff. One hundred seventy-eight of the 218 were tested further by WB and 11 were found positive. All 11 positives were confirmed by polymerase chain reaction; 10 had HTLV-II and 1 had HTLV-I. Thus, the HTLV-I-based screening ELISA missed at least 10 of 23, or 43% (95% confidence interval, 23% to 66%), of HTLV-II infections, compared with 1 of 5, or 20%, of HTLV-I infections.

Human monoclonal antibodies to human cytomegalovirus

Human monoclonal antibodies (HMAbs) to human cytomegalovirus (HCMV) have been developed by using electric field-induced cell fusion of human B lymphocytes to the human-mouse cell line SBC-H20. By this procedure, multiple hybridomas have been produced that secrete IgG 1 HMAbs with distinct patterns of indirect immunofluorescence on HCMV-infected cells. HMAbs Z01 and X20 immunoprecipitated a major protein at 64 kDa. HMAb Z02 immunoprecipitated a major protein of 48-50 kDa. HMAb Z10 identified a single protein at 65 kDa and HMAb X16 identified proteins at 100, 65, and 36-38 kDa. The HMAbs demonstrated varying degrees of virus-neutralizing activity. The production of HMAbs to HCMV provides an important approach to studying the human host response to HCMV by elucidating biologically relevant antigens and epitopes. In addition, HMAbs are a potentially unlimited source of relevant human antibodies for treating life-threatening HCMV infection.