The Prediction Factors of Pre-XDR and XDR-TB among MDR-TB Patients in Northern Thailand

Background: Molecular diagnosis based on the detection of mutations conferring genetic drug resistance is useful for early diagnosis and treatment of Pre-XDR and XDR-TB patients. However, the study of mutation as a marker to predict Pre-XDR and XDR-TB is rare. Methods: Thirty-four Mycobacterium tuberculosis (MTB) isolates from MDR, Pre-XDR and XDR-TB patients in the upper north of Thailand, who had been identified for drug susceptibility using the indirect agar proportion method from 2005-2012, were examined for genetic site mutations of katG, inhA, and ahpC for isoniazid (INH) drug resistance, rpoB for rifampicin (RIF) drug resistance, gyrA for ofloxacin (OFX), and rrs for kanamycin (KAN). Associations between resistant genes and Pre-XDR and XDR-TB in the MDR patients were performed using exact probability tests. Univariable logistic regression was used to quantify the strength of association between the gene mutation with Mycobacterium tuberculosis and the prevalence of Pre-XDR and XDR-TB in the MDR patients. Results: The mutations in the region of the rpoB gene at codon 445 (C445T) in the Pre-XDR or XDR-TB patients were significantly 20.6 times more prevalent among the MDR-TB patients. The inhA gene mutation at codon 114 (T114G) was also significantly 8.1 times more prevalent. Conclusion: The findings can be used to predict the odds of Pre-XDR and XDR-TB in MDR-TB patients, as a guide for prevention and treatments.

Correlations between Gene Resistant Markers and Second-Line Anti-TB Drug Resistance in Pre-XDR and XDR-TB Patients

Background: Extensively drug resistant tuberculosis (XDR-TB) is a serious problem in public health and XDR-TB patients usually develop from multi-drug resistance tuberculosis (MDR-TB) and pre-XDR-TB. The rapid molecular test for drug susceptibility testing (DST) can be used for early detection to prevent XDR-TB. Methods: We examined 34 clinical Mycobacterium tuberculosis (M. tuberculosis) isolates from MDR/XDR-TB patients in the upper north of Thailand that were identified with drug susceptibility profiles by indirect agar proportion method from 2005-2012. Our study investigated the genetic mutations in gyrA for ofloxacin resistance and rrs for kanamycin resistance. The genetic mutations and drug susceptibility test results were analyzed using the exact test. Results: The majority of the ofloxacin resistance was detected in gyrA 21, gyrA 70, gyrA 87, gyrA 102, gyrA 162, and gyrA 187 were at 0%, 12.5%, 37.5%, 0%, 50.0% and 25.0% sensitivity, respectively, and at 96.2, 96.2%, 20.1%, 96.2%, 57.7% and 61.5% specificity, respectively. Kanamycin resistance was found in rrs 512, rrs 241, rrs 223, rrs 414 and rrs 408 at 16.7%, 0%, 0%, 16.7% and 16.7% sensitivity, respectively, and at 96.4%, 92.9%, 82.1%, 82.1% and 71.4% specificity, respectively. This study found no significant correlation between gyrA mutations and ofloxacin resistance and also no correlation between the rrs gene and kanamycin resistance. Conclusion: These primer sequences and PCR products in our study such as gyrA and rrs might be unsuitable to detect ofloxacin and kanamycin resistance in the upper north of Thailand.

The development and validation of a risk score for predicting microalbuminuria in type 2 diabetic patients

Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.

Adverse pregnancy outcomes in women with high pre-pregnancy body mass index

Background/Aims: Obesity along with high prepregnancy body mass index (PP-BMI) is known to cause many adverse pregnancy outcomes. In Thailand, there is not much study showing both the prevalence and complications of these conditions. The objectives of this study were to estimate the prevalence of prepregnancy overweight and obesity and their impacts on adverse pregnancy outcomes. Methods: This study was a cross sectional study. Data were collected retrospectively from hospital electronic database along with manual retrieval from medical charts and labor records. Data of all delivery women from 1st February 2011 to 31st August 2012 were collected. When excluded cases with incomplete data and those without PP-BMI, 5420 cases were into analysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: The proportion of pregnant women with overweight and obesity were 11.1% and 3.9%. After multiple logistic regression analysis was done, women in obesity group were correlated with having 1, 2 and 3 complications. They were also correlated with preeclampsia, gestational diabetes, cesarean section, higher birth weight group and long neonatal length. Conclusions: This Thai prevalence of obesity in pregnancyshould alarm health care providers to be more prepared, for a future health problem of the country. Many complications that come with obese pregnant women that were reported in western countries also happen in Thai population. Decreasing body weight before conception, giving correct health education, well planned pregnancy;antenatal lifestyle intervention and even gestational weight gain restricttion could help avoiding these uneventful morbidities.

High pre-delivery body mass index also caused adverse pregnancy outcomes

Background/Aims: It is known that high pre-preg-nancybody mass index (BMI) and high gestational weight gain both can cause many adverse pregnancy outcomes. High pre-delivery BMI (PD-BMI), though theoretically could do similar effects, is rarely been studied. The objectives of this study were to show the distribution of PD-BMI of the delivery women and to identify its correlation with adverse pregnancy outcomes. Methods: This study was a cross sectional study. Data were collected retrospectively from hospital electronic database of Lampang Regional Hospital (LPH) along with manual retrieval from medical charts and labor records. Data of all pregnant women who delivered at labor room were collected from 1st February 2011 to 31st August 2012. After preterm and multifetal pregnancies were excluded, 4999 cases were into the analysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: In this group of women, 93.9% were in the PD-BMI range of 20.0 -34.9 kg/m2. After multivariate analysis was used, higher PD-BMI was shown to be correlated with higher cesarean section, neonates weighing ≥3500 gmand long neonatal length with relative risk (RR) and 95% confidence interval (95% CI) of 1.11 (1.09 - 1.13), 1.15 (1.12 - 1.17) and 1.07 (1.05 - 1.09), respectively. Conclusions: High PD-BMI was correlated with multiple adverse pregnancy outcomes. Interestingly, their effect sizes were much smaller comparing to high pre-pregnancy BMI and high gestational weight gain. It confirmed the current recommendations to monitor pre-pregnancy BMI and gestational weight gain to avoid unwanted morbidities.

Risk of high gestational weight gain on adverse pregnancy outcomes

Background/Aims: Excessive gestational weight gain was known to be associated with adverse pregnancy outcomes. It increased the complications during pregnancy, delivery and postpartum period. Nevertheless, there are studies reporting the incompliance of pregnant women with recommendations of weight gain. The objectives of this study were to estimate the prevalence of high gestational weight gain and to identify the increased adverse pregnancy outcomes in these women. Methods: This was a cross sectional study. Data were collected retrospectively from hospital electronic database of Lampang Regional Hospital (LPH) along with manual retrieval from medical charts and labor records. Data of all pregnant women who delivered at labor room of LPH were collected from 1st February 2011 to 31st August 2012. After preterm and multifetal pregnancies were excluded, 4747 cases were brought to the study. This study used the new weight gain recommendation from the Institute of Medicine and National Research Council to classify pregnant women by pre-pregnancy body mass index. Data were analyzed by univariate and multivariate analysis. Results: The proportions of pregnant women with different level of weight gain were 28.4%, 38.5% and 33.1% for low, normal and high weight gain. After multivariate analysis was done to control the confounders, women with high weight gain were significantly correlated with having preeclampsia, higher birth weight group, cesarean section and long neonatal length with relative risk (RR) and 95% confidence interval (95% CI) of 4.84 (2.31 - 10.16), 3.94 (3.24 - 4.79), 2.12 (1.82 - 2.47) and 2.33 (1.90 - 2.86). Conclusions: There were more than half of pregnant women that were prone to have inappropriate weight gain. Many complications from high weight gain that have been reported from aboard also occurred in Thai pregnant women. This should alert corresponding health institute to establish a new guideline to avoid high gestational weight gain.