Frank Peter Schelp

A reliable screening protocol for thalassemia and hemoglobinopathies in pregnancy: an alternative approach to electronic blood cell counting.

Primary screening for thalassemia and hemoglobinopathies usually involves an accurate blood count using an expensive electronic blood cell counter A cheaper alternative method was tested by using a modified osmotic fragility (OF) test and a modified dichlorophenolindophenol (DCIP) test. Altogether 423 pregnant Thai women participated in this project. Hemoglobin patterns and globin genotypes were determined using an automated high-performance liquid chromatography analyzer and polymerase chain reaction analysis of alpha- and beta-globin genes. Among the 423 subjects, 264 (62.4%) carried thalassemia genes. The combined OF and DCIP tests detected all pregnant carriers of the 3 clinically important thalassemias, ie, alpha0-thalassemia, beta-thalassemia, and hemoglobin E with a sensitivity of 100.0%, specificity of 87.1%, positive predictive value of 84.5%, and negative predictive value of 100.0%, which show more effectiveness than these values for the standard method based on RBC counts. A combination of modified OF and DCIP tests should prove useful and applicable to prenatal screening programs for thalassemia and hemoglobinopathies in communities with limited facilities and economic resources.

Relationship of tobacco smoking with serum vitamin B12, folic acid and haematological indices in healthy adults.

OBJECTIVES To investigate the effects of tobacco smoking on serum vitamin B12, folic acid and haematological parameters in healthy Thai smokers and non-smokers. DESIGN Cross-sectional study of smokers and non-smokers in a military unit in Bangkok, Thailand. SETTING A military unit in Thailand. SUBJECTS One hundred and twenty-three male smokers from a military unit in Bangkok, who participated voluntarily in the study, were investigated. Sixty-six male non-smokers from the same unit were selected as controls. Fasting blood samples were collected for investigation of vitamin B12, folic acid and haematological variables. RESULTS The serum folic acid concentration of smokers was lower than that of non-smokers, but was not statistically significantly different. Haemoglobin was lower in smokers than in non-smokers; 16.3% of smokers were anaemic compared with only 3.0% of non-smokers. Anaemia was not related to folate deficiency. The white blood cell count was found to be higher in smokers than in non-smokers. CONCLUSION The results of this study suggest that there were low serum folic acid concentrations in smokers compared with non-smokers, which might contribute to the development of vascular and cardiovascular diseases. The higher white blood cell count might be indicative alterations in the immune functions of smokers.

Serum Homocysteine, B12 and Folic Acid Concentration in Thai Overweight and Obese Subjects

This study investigated levels of serum homocysteine, vitamin B12, folic acid, vitamin B6 and vitamin C, in 37 male and 112 female overweight and obese Thai volunteers (body mass index; BMI > or = 25.00), and 23 male and 90 female normal-weight Thai volunteers, who came for a physical check-up at the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok from March to October of 2000. Data included anthropometric measurements and waist/hip ratios. All anthropometric variables, except height, were significantly higher for the overweight subjects than for the normal subjects. Statistically significantly higher levels of serum homocysteine were found in the overweight subjects. Serum homocysteine concentrations in overweight and obese males were significantly higher than in overweight and obese females. Serum folic acid and vitamin C in the overweight and obese were found to be statistically significantly lower than in the control subjects. No statistically significant difference in vitamin B12 was found in the overweight and obese subjects compared with the normal control subjects. The medians of serum folic acid and vitamin C concentrations for the overweight and obese males were significantly lower than those of the overweight and obese females. A negative correlation was found between serum folic acid and homocysteine concentrations in all overweight and obese subjects. A significant negative correlation between serum folic acid and vitamin B6 was observed in both male and female overweight and obese subjects. The results of the investigation suggest that homocysteine levels in overweight and obese subjects seem to be caused by insufficient dietary folic acid intake and probably not by B12 deficiency.

Adherence to Antiretroviral Therapy (ART) among People Living With HIV (PLHIV): a cross-sectional survey to measure in Lao PDR

RationaleSince 2001, antiretroviral therapy (ART) for people living with HIV (PLHIV) has been available in the Lao People’s Democratic Republic (PDR). A key factor in the effectiveness of ART is good adherence to the prescribed regimen for both individual well-being and public health. Poor adherence can contribute to the emergence of drug resistant strains of the virus and transmission during risky behaviors. Increased access to ART in low-income country settings has contributed to an interest in treatment adherence in resource–poor contexts. This study aims to investigate the proportion of adherence to ART and identify possible factors related to non-adherence to ART among people living with HIV (PLHIV) in Lao PDR.MethodsA cross-sectional study was conducted with adults living with HIV receiving free ART at Setthathirath hospital in the capital Vientiane and Savannakhet provincial hospitals from June to November 2011. Three hundred and forty six PLHIV were interviewed using an anonymous questionnaire. The estimation of the adherence rate was based on the information provided by the PLHIV about the intake of medicine during the previous three days. The statistical software Epidata 3.1 and Stata 10.1 were used for data analysis. Frequencies and distribution of each variable were calculated by conventional statistical methods. The chi square test, Mann–Whitney test and logistic regression were used for bivariate analyses. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. A p-value < 0.05 was considered to indicate statistical significance.ResultsOf a total of 346 patients, 60% reported more than 95% adherence to ART. Reasons for not taking medicine as required were being busy (97.0%), and being forgetful (62.2%). In the multivariate analysis, educational level at secondary school (OR=3.7, 95% CI:1.3-10.1, p=0.012); illicit drug use (OR=16.1, 95% CI:1.9-128.3, p=0.011); dislike exercise (OR=0.6, 95% CI:0.4-0.9, p=0.028), and forgetting to take ARV medicine during the last month (OR=2.3, 95% CI:1.4-3.7, p=0.001) were independently associated with non-adherence.ConclusionsNon-adherence to ART was associated with individual factors and exposure to ART. Priority measures to increase adherence to ART should aim to intensify counseling and comprehensive interventions, such as guidance for PLHIV on medication self-management skills, tailoring the regimen to the PLHIV life style, and improving adherence monitoring and health care services.

Infection and re-infection rates of opisthorchiasis in the Water Resource Development Area of Nam Pong Project, Khon Kaen Province, northeast Thailand

A one-year investigation on re-infection rates of opisthorchiasis was carried out in three villages in the Nam Pong Water Resource Development Project, Thailand. In the two villages where selective population chemotherapy was combined with improvements in sanitation and health education aimed at changing food habits, the mean monthly re-infection rate was 2.0% and the annual cumulative rate was 21.5%. In the third village, where only selective population chemotherapy was carried out, the monthly re-infection rate was 5.0% and the annual cumulative rate was 55.5%. Studies on new infections in initially negative individuals were also carried out in the three villages, with inconclusive results.

Activity, dietary intake, and anthropometry of an informal social group of Thai elderly in Bangkok

Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60-94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.

Serum Leptin and Lipid Profiles in Thai Obese and Overweight Subjects

The weight, height, body mass index (BMI), waist/hip ratio, serum leptin and lipid profiles of 48 overweight (BMI > or = 25.00). Thai males and 166 overweight Thai females, compared with 26 males and 81 females in a control group (BMI = 18.5-24.9 kg/m2), were investigated. Subjects for the study were those persons who turned up regularly for physical check-ups at the out-patient department, general practice section of the Rajvithi Hospital, Bangkok. The study was conducted between March-October, 1998. Statistically significantly higher levels of serum leptin, cholesterol, LDL-C, LDL-C/HDL-C ratio and triglyceride were found in the overweight compared with the control subjects. The median serum leptin concentration in overweight subjects was 19.6 (2.0-60.0 ng/ml) compared with 9.0 (range 1.0-30.0 ng/ml) in the control subjects (p < 0.001). The median values of leptin serum concentrations in the overweight and obese males were significantly higher than those of the overweight and obese females. A total of 66.7% (32 out of 48) of the overweight and obese males had elevated leptin levels, while elevated leptin levels were found in 87.3% (145 out of 166) of the overweight and obese females. A total of 18.8% and 21.1% of the overweight and obese males and females respectively had cholesterol concentrations of > or = 6.48 mmol/l. However, the prevalence of low HDL-C (HDL-C < or = 0.91 mmol/l) was found to be 41.7% in the overweight and obese males and 4.2% in the overweight and obese females. Statistically significant associations were found between weight, height, BMI, waist, hip, waist/hip ratio, HDL-C, and serum leptin in both overweight male and female subjects. A negative correlation was found between serum leptin and LDL-C/HDL-C ratio in both the overweight and obese subjects.

Iodine deficiency disorder—an old problem tackled again: a review of a comprehensive operational study in the northeast of Thailand

Abstract Between 1991 and 1996 attempts were made to control iodine deficiency disorder (IDD) in the Northeast of Thailand. The project was conducted within the framework of an intervention project with emphasis on women’s health in the reproductive age. IDD was found to be highly prevalent in the project area. The goitre rate of the women was 50,6%. In school children it was between 27 to 93%. The use of iodinated water was not successful. In the project area, iodinated fish sauce was favoured over iodinated salt. This was because the local population mostly use fish sauce instead of salt in their cooking. The results of two independent intervention trials, one with females and another with school children, indicated that iodinated fish sauce could be the best means to control IDD in the area. The experiences gained in the trials were used to control IDD in the whole project area. From 1991 to 1996 the goitre rate of females in the reproductive age decreased to about 20%.

Tobacco Smoking in Relation to the Phenotype of Alpha-1-Antitrypsin and Serum Vitamin C Concentration

Purpose: To investigate the effects of tobacco smoking on serum alpha-1-antitrypsin (AT) concentrations in relation to the Pi types of AT (MM and non-MM phenotypes) and vitamin C concentrations in the serum of Thai smokers and non-smokers. Design: Cross-sectional study of smokers and non-smokers in a military unit in Bangkok, Thailand. Materials and Methods: 123 male smokers and 66 male non-smokers were randomly selected from a military unit in Bangkok. Venous blood was analysed by rocket immunoelectrophoresis for AT concentrations. AT phenotype and vitamin C status were determined by iso-electrofocusing (IEF) and spectro-photometric methods. Co-variance analysis was used to determine whether smoking directly influences AT levels. Results: There were statistically significantly higher levels of serum AT and thiocyanate concentrations in smokers than in non-smokers. The thiocyanate level correlated with the duration and quantity of cigarette smoking. However, vitamin C, an antioxidant, was found with stati...

Relationship between alpha-2-macroglobulin, anthropometric parameters and lipid profiles in Thai overweight and obese in Bangkok

The aim of this study was to assess anthropometric variables and the lipid pattern in relation to alpha-2-macroglobulin in normal- and over-nourished Thai individuals, to further support the hypothesis that alpha-2-macroglobulin plays a beneficial role in the determination of nutritional status. The study sample comprised of 48 male and 166 female overweight and obese Thai volunteers and 26 male and 81 female normal subjects. The overweight individuals had statistically significant lower alpha-2-macroglobulin (A2M) serum levels. The total serum cholesterol, low density lipoprotein-cholesterol (LDL-C) and triglycerides were significantly higher and high density lipoprotein-cholesterol (HDL-C) lower in the over-nourished group as compared with the normal subjects. The LDL/HDL ratio was slightly but significantly higher in the over-nourished group, but still well below the value of 5 for both groups. In using a stepwise multiple linear regression, the model, which best explained the variation of A2M for all individuals including age, HDL-C, BMI, and gender. The relationship of A2M to the variables under study differed between males and females. For males, a model which includes cholesterol and BMI explained best the variation of the proteinase inhibitor. For the females, the best model includes age, HDL-C and BMI. The role of protease inhibitors has hardly been explored in human epidemiological studies despite its relationship to important public health issues including nutrition, smoking, cancer and cardiovascular diseases. The results of this study further support the hypothesis, that A2M might play a role in the interrelationship of the nutritional status with the occurrence and the prevention of diseases.