Nirush Lertprasertsuk

Cytomegalovirus-associated manifestations involving the digestive tract in children with human immunodeficiency virus infection.

Objective To study the clinical manifestations of gastrointestinal cytomegalovirus disease in children with human immunodeficiency virus infection. Methods Review of clinical records of eight human immunodeficiency virus–infected children and histopathologically confirmed gastrointestinal cytomegalovirus disease from 1995 to 2001. Results Six of the eight children were younger than 1 year. The most common clinical presentations were fever and chronic diarrhea. Lower gastrointestinal hemorrhage and bowel perforation were noted in four and three patients, respectively. The colon was the most commonly affected site, followed by the small bowel and esophagus. The diagnosis was established by histopathology, obtained during endoscopy and surgery. Mucosal edema, erythema, and ulcer comprised the most common endoscopic findings. Two patients with fever, chronic diarrhea, and lower gastrointestinal bleeding developed remission after being treated with a 14-day course of ganciclovir. Conclusion Gastrointestinal cytomegalovirus disease can result in serious life-threatening complications, such as bowel perforation and massive gastrointestinal bleeding. Patients with chronic diarrhea and fever of unidentified cause might benefit from gastrointestinal endoscopy for early diagnosis and treatment. Although ganciclovir does not eradicate the infection and relapses are frequent, this treatment can prevent complications and reduce morbidity.

Predominant mucosal IL-8 mRNA expression in non-cagA Thais is risk for gastric cancer.

AIM To study gastric mucosal interleukine-8 (IL-8) mRNA expression, the cytotoxin-associated gene A (cagA) mutation, and serum pepsinogen (PG) I/II ratio related risk in Thai gastric cancer. METHODS There were consent 134 Thai non-cancer volunteers who underwent endoscopic narrow band imaging examination, and 86 Thais advance gastric cancer patients who underwent endoscopic mucosal biopsies and gastric surgery. Tissue samples were taken by endoscopy with 3 points biopsies. The serum PG I, II, and Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody for H. pylori were tested by enzyme-linked immunosorbent assay technique. The histopathology description of gastric cancer and non-cancer with H. pylori detection was defined with modified Sydney Score System. Gastric mucosal tissue H. pylori DNA was extracted and genotyped for cagA mutation. Tissue IL-8 and cyclooxygenase-2 (COX-2) mRNA expression were conducted by real time relative quantitation polymerase chain reaction. From 17 Japanese advance gastric cancer and 12 benign gastric tissue samples, all were tested for genetic expression with same methods as well as Thai gastric mucosal tissue samples. The multivariate analysis was used for the risk study. Correlation and standardized t-test were done for quantitative data, P value < 0.05 was considered as a statistically significant. RESULTS There is a high non cagA gene of 86.8 per cent in Thai gastric cancer although there are high yields of the East Asian type in the positive cagA. The H. pylori infection prevalence in this study is reported by combined histopathology and H. pylori IgG antibody test with 77.1% and 97.4% of sensitivity and specificity, respectively. The serum PG I/II ratio in gastric cancer is significantly lower than in the non-cancer group, P = 0.045. The serum PG I/II ratio of less than 3.0 and IL-8 mRNA expression ≥ 100 or log10 ≥ 2 are significant cut off risk differences between Thai cancer and non-cancer, P = 0.03 and P < 0.001, respectively. There is a significantly lower PGI/II ratio in Japanese than that in Thai gastric cancer, P = 0.026. Serum PG I/II ratio at cut off less than 3.0 and IL-8 mRNA expression Raw RQ > 100 or log10 > 2 are significantly difference between Thai cancer group when compared to non-cancer group, P = 0.013 and P < 0.001, respectively. In the correlation study, low PG I/II ratio does not associate with chronic atrophic gastritis severity score in Thais non-cancer cases. However, there is a trend, but not significant convert correlation between IL-8 mRNA expression level and low PG I/II ratio in Thai positive H. pylori infection. The high expression of IL-8 gene demonstrates a poorer prognosis by stage and histology. CONCLUSION Predominant gastric mucosal IL-8 mRNA expression level, H. pylori infection, and low PG I/II ratio are relative risks for Thai gastric cancer without correlation with cagA mutation.

Toxicity evaluation of standardized extract of Gynostemma pentaphyllum Makino

ETHNOPHARMACOLOGICAL RELEVANCE To evaluate the safety of standardized extract of Gynostemma pentaphyllum in rats. MATERIALS AND METHODS The water extract of Gynostemma pentaphyllum was prepared and standardized, the dry powder yielded 6% gypenosides. In the acute oral toxicity test, the single oral dose of 5000 mg/kg of Gynostemma pentaphyllum extract was given to female Sprague-Dawley rats. In subchronic toxicity test, the oral dose of 1000 mg/kg/day of the extract was given to rats in treatment and satellite groups for 90 days. Satellite groups of both sexes were kept for additional 28 days after 90-day treatment. Control rats received distilled water. RESULTS Standardized extract of Gynostemma pentaphyllum did not cause death or any toxic signs in rats. The daily administration of the extract for 90 days did not produce lethal or harmful effects. Although certain hematological and blood chemistry values (i.e., neutrophil, monocyte, glucose, and serum alkaline phosphatase levels) were found to be statistically different from the control group, however; these values were within the ranges of normal rats. CONCLUSION Standardized extract of Gynostemma pentaphyllum did not produce mortality or any abnormality in rats.

Aflatoxin–albumin adduct formation after single and multiple doses of aflatoxin B1 in rats treated with Thai medicinal plants

The objective was to conduct an assessment of the ability of two Thai medicinal plants, Cymbopogon citratus Stapf and Murdannia loriformis, to modulate levels of serum aflatoxin-albumin (AF-albumin) adducts following aflatoxin B(1) (AFB(1)) exposure in rats. The influence of the plant extracts on AF-albumin adduct formation after a single exposure to 250 microg/kg body weight (bw) AFB(1) was measured over a 48-h period. Rats received M. loriformis extract (3 g/kg bw) or C. citratus Stapf extract (5 g/kg bw) daily for the week prior to the AFB(1) administration. In control rats, maximum adduct levels were observed 12 h post-AFB(1) treatment but in the animals receiving Murdannia extract, maximum levels occurred earlier, at 4 h post-treatment. No such effect was observed with the Cymbopogon extract. Daily treatment of rats with AFB(1) at 250 microg/kg bw for 3 weeks caused serum AF-albumin adduct levels to accumulate over a 10-14 day period and reach plateau levels 4.4-fold higher than observed after a single dose. Treatment with Murdannia extract for 1 week before and then throughout the AFB(1) exposure period resulted in a slight decrease in the AF-albumin adduct levels in the first week of the intervention. After that time, however, the reduction in adduct levels in the Murdannia extract group did not differ significantly from controls. No significant alteration in the biomarker levels was seen with the Cymbopogon extract treatments compared to control rats.

Juvenile Polyp in Thai Children—Clinical and Colonoscopic Presentation

BackgroundThe aim of this prospective study was to describe the clinical characteristics of colorectal polyp in Thai children.MethodsFrom December 2002 to February 2005, children under 15 years of age presenting with rectal bleeding were prospectively enrolled. Demographic, clinical, and laboratory information was recorded. Location, number, characteristics, and histopathology of the polyps were noted.ResultsThere were 32 patients with a mean age of 6.5 years. The most common presenting symptom was hematochezia, followed by prolapsing rectal mass and diarrhea. In 20 patients there was a single polyp, 6 had 2–4 polyps, and 6 were diagnosed with polyposis coli. Most of the polyps were located exclusively at the rectum and sigmoid colon. In only 7 cases were the polyps proximal to the rectosigmoid region. This included 6 patients who had polyps beyond the splenic flexure. All were juvenile polyps without evidence of adenomatous changes. Compared to those with isolated polyps, the patients with polyposis coli had a statistically significant incidence of right-sided polyps (P <0.001) and a history of prolapse of the rectal mass (P = 0.006).ConclusionsBecause of the high prevalence of right-sided polyps and the concern about malignant transformation, colonoscopy should be considered as the initial evaluation in children with rectal bleeding.

Impact of gastrointestinal endoscopy on HIV‐infected children

Objective:  To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems.

Abstract 3834: Difference of host immunity and mucosal defense to H. pylori infection caused Asian paradox on incidence of gastric cancer: Correlation with mucosal mRNA expression of IL-8, pepsinogenI/II ratio, and H. pylori cagA gene mutation in Thai and Japanese gastric cancer

Proceedings: AACR 101st Annual Meeting 2010‐‐ Apr 17‐21, 2010; Washington, DC Background: Recent in vitro studies showed the association between mucosal mRNA expression of IL-8 with cagA, East Asian type in gastric cancer that frequently found in Japanese. In Thais, not only gastric cancer, but also gastroduodenal ulcer incidences are opposite to those in Japanese. We hypothesized that an associations difference between Thais and Japanese stomach mucosal tissue cytokine response to H. pylori infection may lead us to find key role of host defense in gastric carcinogenesis. Method: There were 143 non-cancer volunteers in Thais, and 110 Thai and Japanese gastric cancer patients who underwent endoscopy and gastric surgery. IL-8 cytokine mRNA expression was conducted by real time RT-PCR. Histopathology, serum IgG antibody for H. pylori, pepsinogen I and II were tested. Tissue H. pylori DNA extracted from antral position in stomach was genotyped for cagA mutation. p value <0.05 was considered as a statistically significant. Result: No distribution difference by sex, age, and stage of advance cancer in both nations. H. pylori positivity in Thai gastric cancer was 70.5% (55/78). There is a significant lower PGI/II ratio in Japanese than in Thai gastric cancer, p = 0.026. Thai gastric cancer patients had significantly lower level of PGII/II ratio at means of 3.3±1.7 than in normal one, p =0.042, and of other non-chronic active gastritis (CAG), p =0.002. Means level of IL-8 mRNA expression in Thai cancer and Japanese cancer were 8511.36±5.22 and 174.54±329.51, respectively. Means level of IL-8 mRNA expression in Thai cancer group is also higher than in non-cancer group, p = 0.058. In subgroup analysis, we could not see a significantly differences of IL-8 mRNA expression or PGI/II ratio in positivity and true negativity H. pylori infection. However, in positive cases with less than 2.0 of PGI/II low ratio showed a significant higher level of IL-8 expressions than with PGI/II ratio over 3.0, p < 0.05. In Thai non-cancer, cagA genotype yield of 33 per cent each of Eastern, Western, and Mix type. Low PGI/II ratio did not associate to CAG severity score in Thais. There was only 32/55 (58%) who had positive H. pylori by PCR and pathology with a rising up of H. pylori IgG antibody. In the 6-year followed up of Thai CAG group with H. pylori cagA, Eastern infection, no one develop to be cancer. Conclusion: In this vivo study, we postulated that IL-8 cytokine expression is a predictive marker for poor prognosis incidence in gastric cancer. There is also association to low PGI/II ratio. The opposite result on IL-8 mRNA expression between both nations reflex to individualized host stomach mucosal defense. High level IL-8 mRNA expression in Thais showed mucosal defense in gastric cancer carcinogenesis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3834.

Case of eosinophilic granulomatous enterocolitis caused by Strongyloides stercoralis infection with marked hypoalbuminemia and ascites

We report a 10‐year‐old boy presenting with generalized pitting edema, ascites, abdominal pain, and chronic mucous diarrhea for 4 weeks. He had underlying diseases of hemoglobin E and juvenile rheumatoid arthritis and had been treated with immunosuppressive agents for a long period of time, including prednisolone and methotrexate. After extensive investigations, Strongyloides stercoralis infection, leading to protein‐losing enteropathy and eosinophilic granulomatous enterocolitis, was diagnosed. In the present report, we demonstrate early colonoscopic findings, revealing patchy erythema and small raised mucosal nodules with erosions at the cecum. Histopathological study showed open ulceration with cryptitis, intense infiltration of eosinophils and histiocytes with granuloma formation, in which Strongyloides stercoralis larvae were noted.