Organophosphates (OPs) are widely used for pest and weed control in many countries including Thailand. In addition to causing environmental pollution, OPs affect human health by overstimulating neurotoxicants, and OP exposure during pregnancy can lead to adverse health effects of mothers and their fetuses. Using gas chromatography-mass spectrometry with a dedicated extraction protocol to identify OPs in meconium of newborn babies ( = 68) from hospitals in Amnat Charoen, Kanchanaburi and Nakhon Sawan provinces, agricultural regions of Thailand, among ten OP types analyzed, eight were detected in 98% of meconium samples (chlorpyrifos (median ± interquartile range (IQR) 0.08 ± 0.03-0.16 μg/g) in 32% of samples, demeton-s-methyl (0.35 ± 0.26-0.49 μg/g) in 73%, dichlorvos (0.67 ± 0.58-0.71 μg/g) in 38%, dimethoate (0.43 ± 0.09-1.56 μg/g) in 50%, ethion (0.21 ± 0.19-0.26 μg/g) in 12%, malathion (0.28 ± 0.15-0.52 μg/g) in 50%, omethoate (5.63 ± 4.85-8.57 μg/g) in 34%, and tolclofos-methyl (0.08 ± 0.03-0.10 μg/g) in 41%). There are no significant differences in these parameters from babies whose mothers did and did not work in the agricultural or who lived near (within one km) and distant from farmland. The findings should be of benefit in developing programs to protect pregnant women and newborn babies from exposure to OP pesticides.

A prediction model for pretreatment HIV RNA level ≤100,000 copies/ml would provide a useful tool for selection of abacavir (ABC) or rilpivirine (RPV) in the first-line regimen in a resource-limited setting. Factors associated with pre-treatment HIV RNA ≤100,000 copies/ml were determined from a cohort of 1,223 patients divided into a derivation (n = 873) and the remaining in a validation group. Their median [interquartile range (IQR)] age was 36.3 (30.5-42.9) years, CD4 count 122 (39-216) cells/mm3 and pre-treatment HIV RNA level 100,000 (32,449-229,777) copies/ml. Factors associated with pretreatment HIV RNA ≤100,000 copies/ml were non-anemia [odds ratio (OR)= 2.05; 95% confidence interval (CI): 1.28-3.27, p= 0.003], CD4 count ≥200 cells/mm3 (OR= 3.00; 95% CI: 2.08-4.33, p<0.001) and non-heterosexual HIV exposure (OR= 1.61; 95% CI: 1.07-2.43, p= 0.021). The area under a receiver operating characteristic curve was 0.66 (95% CI: 0.62-0.69), but specificity was 97.3%. The prediction model identified a set of readily available clinical data but lacked the requisite predictive performance to fulfill its purpose.

Stigma and discrimination experienced by nurses infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) potentially undermine their positions. The aim of this study was to determine the factors associated with nurses’ attitudes towards accepting co-workers with HIV, HBV, or HCV. The study design was descriptive and cross-sectional. Four hundred Vietnamese nurses participated in this study using stratified random sampling at two public hospitals in Hanoi, Vietnam. A self-administrated questionnaire was used to obtain data. Descriptive statistics and multivariable logistic regression was performed to analyze data. Nine percent of nurses had experienced a needle-stick or sharps injury (NSI) from a patient infected with HIV, and 15.8% of respondents reported having a previous NSI from a patient infected with HBV or HCV. Some nurses reported that they could not accept contact between patients and nurses infected with HIV (25.2%) and HBV or HCV (12.7%). Older age and a belief that colleagues should disclose their infection status were associated with positive attitudes towards HIV-, HBV-, or HCV-positive colleagues. Fear of transmission was associated with negative attitudes towards HIV-positive co-workers. Infected employees disclosure of their status may help their colleagues to be more accepting by providing appropriate workplace adjustments for infected employees. HIV is generally a more stigmatized infection, and therefore attitudes towards HIV-positive co-workers might be affected by fear of transmission. Providing education to recognize infectious risk may be effective in improving nurses’ attitudes in Vietnam, as elsewhere.

Sexually transmitted infections (STI) remain an important public health issue globally, particularly among the young population. Despite being preventable and curable, STI continue to spread. Lack of access to treatment is an important factor in many developing and underdeveloped nations. Lack of awareness and knowledge is another important factor. This study assessed the awareness, knowledge, and misconceptions among secondary school students on STI. Overall, awareness was poor but better among male students and those in the Pure Science academic streaming. Similarly, the knowledge level of STI was also poor: low level (63.0%), moderate level (34.4%), and high level (2.6%). Male students (p=0.014) and Pure Science academic streaming students (p<0.001) scored better. There were misconceptions, but poor knowledge was predominant. Common sources of information were teachers, health professionals, Internet, parents and TV programs. Based on our study, more needs to be done to improve the awareness and knowledge level of STI, and detailed inclusion into the educational curriculum may be a consideration.

A large number of migrants have move to cities in Thailand seeking employment. These people may be at increased risk for environmental health problems. We studied the health status, environmental living conditions and microbial indoor air quality (IAQ) among selected groups of migrant workers and their households in Mueang District, Samut Sakhon, central Thailand. We conducted a cross sectional study of 240 migrant workers and their households randomly selected by multistage sampling. The person responsible for hygiene at each studied household was interviewed using a structured questionnaire. Two indoor air samples were taken from each household (480 indoor air samples) to determine bacterial and fungal counts using a Millipore air tester; 240 outdoor air samples were collected for comparison. Ninety-nine point six percent of study subjects were Myanmar, 74.2% were aged 21-40 years, 91.7% had a primary school level education or lower and 53.7% had stayed in Thailand less than 5 years. Eight point three percent had a history of an underlying disease, 20.8% had a recent history of pulmonary tuberculosis in a family member within the previous year. Forty-three point eight percent had a current illness related to IAQ during a previous month. Twenty-one point three were current cigarette smokers, 15.0% were current alcohol consumers, and 5.0% exercises ≥3 times per week. Forty-nine point two percent never opened the windows of their bedrooms or living rooms for ventilation, 45% never cleaned their window screens, and 38.3% never put their pillows or mattresses in the sunlight. The mean(±SD) air bacterial count was 230(±229) CFU/m3 (outdoor air = 128±82 CFU/ m3), and the mean fungal count was 630(±842) CFU/m3 (outdoor air = 138±94 CFU/ m3). When the bacterial and fungal counts were compared with the guidelines of the American Conference of Governmental Industrial Hygienists, the bacterial counts in 6.5% of houses surveyed and the fungal counts in 28.8% of house surveyed were higher than the recommended levels (<500 CFU/m3). Bacterial and fungal counts in the sample households were not significantly correlated with household hygiene practice scores (p>0.05). There was a positive correlation between bacterial counts and fungal counts in household air samples, r=0.28, p<0.001.

This research aimed at exploring the development of the capacitybuilding process in environmental and health impact assessment, including the consideration of subsequent, capacity-building achievements. Data were gathered through questionnaires, participatory observations, in-depth interviews, focus group discussions, and capacity building checklist forms. These data were analyzed using content analysis, descriptive statistics, and inferential statistics. Our study used the components of the final draft for capacity-building processes consisting of ten steps that were formulated by synthesis from each respective process. Additionally, the evaluation of capacity building levels was performed using 10-item evaluation criteria for nine communities. The results indicated that the communities performed well under these criteria. Finally, exploration of the factors influencing capacity building in environmental and health impact assessment indicated that the learning of community members by knowledge exchange via activities and study visits were the most influential factors of the capacity building processes in environmental and health impact assessment. The final revised version of capacitybuilding process in environmental and health impact assessment could serve as a basis for the consideration of interventions in similar areas, so that they increased capacity in environmental and health impact assessments.

Haemophilus influenzae was isolated from 556 different patients, mostly 10 years or under, at a tertiary referral hospital in Bangkok, Thailand during 2012 - 2015. Peak period of detection was from January to March. Thirty-nine percent of the isolates were β-lactamase positive. β-Lactamase-negative ampicillin-resistant H. influenzae (BLNAR) constituted 2% of β-lactamase-negative cases. H. influenzae was susceptible to ampicillin (58%), amoxicillin/clavulanate (99%), cefotaxime (100%), ceftriaxone (100%), cefuroxime (99%), ciprofloxacin (99%), chloramphenicol (86%), tetracycline (75%), and trimethoprim-sulphamethoxazole (52%). β-Lactamase-producing isolates (72%) showed high minimal inhibitory concentration (MIC) to ampicillin (128-516 μg/ml) and all BLNAR isolates low ampicillin MIC (2-16 μg/ml). These findings indicate that the level of ampicillin resistance in H. influenzae depended on differences in resistance mechanism.

We analyzed data of Staphylococcus aureus isolated from patients attending Thammasat University Hospital, Thailand from August 2012 to July 2015. In total, 232/502 (46%) S. aureus isolates were methicillin-resistant S. aureus (MRSA). There was a declining trend of proportion of MRSA infection, but the prevalence of MRSA in the last year of study remained high (38%). All 32 MRSA-infected outpatients had history of exposure to healthcare facilities during the previous two months and thus were not considered as having community-associated MRSA. In addition, all these strains were negative for pvl, suggesting that these strains were hospital-associated MRSA. All MRSA stains were susceptible to linezolid, teicoplanin and vancomycin, but resistance to erythromycin and clindamycin were nearly 100%. Fifty-two percent and 87% of MRSA strains were susceptible to tetracycline and trimethoprim-sulfamethoxazole, respectively. These results emphasize the necessity of long-term surveillance and monitoring of antimicrobial susceptibility pattern of MRSA.

This study aimed to explore the impact of personality trait and professional identity on work-related depression, anxiety, irritation among Chinese nurses. Hospital nurses are known to work in stressful environment, which may lead to depression, anxiety and irritation symptoms. Few studies have been done to address this problem from the perspective of personality trait and professional identity in Chinese nurses. This was a cross sectional study. Data were collected from twenty hospitals of Hunan Province, in central China. The instruments used in this study were Eysenck Personality Questionnaire Short Scale, Professional Identity Questionnaire, and Work-Related Depression, Anxiety and Irritation Scale. Extraversion and professional identity negatively correlated with and predicted work-related depression, anxiety and irritation; Neuroticism and Psychoticism positively correlated with and predicted work-related depression, anxiety and irritation. Strengthening the nurses’ professional identity may be helpful toward reducing work-related depression, anxiety and irritation. Administrative and psychological interventions of these work-related emotion problems should take the difference in personality trait into account.

Diabetes mellitus type 2 (DM) is associated with oral diseases. Some studies indicated that patients who seek dental treatment could have undiagnosed hyperglycemic condition. The aim of this study was to assess the prevalence of undiagnosed hyperglycemia and selected associated factors among Thai dental patients. Dental patients without a history of hyperglycemia were recruited from the Special Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand and His Majesty the King’s Dental Service Unit, Thailand. The patients were randomly selected and a standardized questionnaire was used to collect demographic data from each patient. Blood pressure, body mass index (BMI), and waist circumference were recorded for each subject. The number of missing teeth, periodontal status, and salivary flow rate were also investigated. HbA1c was assessed using a finger prick blood sample and analyzed with a point-of-care testing machine. Hyperglycemia was defined as a HbA1c ≥5.7%. The prevalence of hyperglycemia among participants was calculated and multivariate logistic regression analysis was used to identify risk factors. A total of 724 participants were included in the study; 33.8% had hyperglycemia. On multiple logistic regression analysis, older age, family history of DM, being overweight (BMI ≥23 kg/m2), having central obesity and having severe periodontitis were significantly associated with hyperglycemia. The high prevalence of hyperglycemia in this study of dental patients suggests this setting may be appropriate to screen for patients with hyperglycemia.

Early childhood caries (ECC) can cause pain and interfere with healthy nutrition affecting a child growth. The aim of this study was to determine if there is an association between dental caries and body mass index (BMI) among Thai children aged 3 to 5 years. We randomly selected 100 students attending Suan Missakawan School, Bangkok, Thailand. We examined each child to determine the number of decayed, missing and filled teeth (DMFT) giving a DMFT score. We also measured the height and weight for each subject and calculated their body mass index (BMI) as weight in kilograms divided by height in meter squared. Parents or guardians were asked to complete a questionnaire asking general information and the diet of the child. Data from the questionnaire were analyzed using the Kruskal-Wallis test. Associations between caries and variables were examined using the Spearman’s correlation with significance set at p<0.05. The mean (±SD) age of the subject, the mean (±SD) DMFT score of the subject and the mean (±SD) BMI for the subjects were 4.21(±0.71) years old, 5.27(±4.78) and 16.46(±2.56) kg/ m2, respectively. Seventy-one percent of subjects had a normal BMI, 25% were overweight and 4% were underweight. Eighteen percent had no caries (DMFT score=0), 32% had a few caries (DMFT score=0.1-3.0), 14% had many caries (DMFT scores=3.1-6.9), and 36% had very many caries (DMFT≥7). The DMFT score was not significantly associated with a history of sugar consumption or BMI. The DMFT score was significantly negatively associated with estimated fat consumption and estimated iron consumption based on the diet reported by the parents or guardians. Further studies are needed to determine if these reported diets reflect actual consumption and if the associations are still significant.

Dentists can offer their patients who smoke tobacco assistance with smoking cessation. We conducted this study to assess dental patient knowledge about the effects of smoking and perceptions and attitudes regarding the role of dentists in smoking cessation counselling. We conducted this study to inform tobacco cessation programs that could potentially include dentists. We conducted a cross-sectional study using a self-administered questionnaire among 375 patients. The mean age of subjects was 33.4 years; females comprised 51.5%. Participants were divided into 3 groups: those who never smoked (n = 263, 70.7%), smokers (n = 92, 24.7%), and ex-smokers (n = 17, 4.5%). Significantly more participants (p = 0.046) who never smoked (92.9%) knew smoking can cause bad breath than smokers (86.9%). Significantly more participants (p = 0.002) who never smoked (74.8%) knew smoking can cause periodontal disease than smokers (57.6%). Significantly more participants (p < 0.001) who never smoked (84.5%) knew smoking can cause oral cancer than smokers (66.7%). Significantly more participants (p < 0.001) who never smoked (86.7%) knew smoking can cause lung cancer than smokers (69.7%). Significantly more participants who never smoked (85.5%) felt dentists should be interested in the smoking status of their patients (p = 0.004) than smokers (72.6%). Significantly more participants (p = 0.08) who never smoked (69.6%) stated dentists should give smoking cessation advice than smokers/ex-smokers (59.0%). Smoker/ ex-smokers had less knowledge about the effects of smoking on oral and general health than non-smokers. Both smokers/ex-smokers and non-smokers felt dentists should provide smoking cessation advice.

The purpose of this study was to investigate the short-term effects of xylitol chewing gum and maltitol spray on the concentration of salivary mutans streptococci (MS) and on the plaque index. Eighty-one second, third and fourth year dental and dental assistant students with a salivary MS concentration > 103 CFU/ml cultured on mitis salivarius bacitracin (MSB) agar were included in the study. The age range of subjects was 18-23 years. The participants were divided into 3 groups: control, xylitol chewing gum and maltitol spray groups. Each subject brushed their teeth with fluoridated toothpaste (1,000 ppm). Each subject in the xylitol chewing gum group was told to chew 2 pieces, 6 times a day (total xylitol dose=7.3 g/day) for 4 weeks. Each subject in the maltitol spray group was told to spray one puff twice daily (morning and evening) for 4 weeks. A dental examination and saliva samples to determine the salivary MS concentration were collected at baseline and at 2 and 4 weeks after experiment initiation. The nonparametric Mann–Whitney U test was used to analyze differences among groups. The mean ages in the control, xylitol chewing gum and maltitol spray groups were 22±1, 20±1 and 20±1 years, respectively. The mean MS concentrations at the beginning of the study and after 2 weeks in the control, and xylitol chewing gum and moltitol oral spray groups were not significantly different from each other. There was a significantly lower MS concentration in the moltitol oral spray group than in the control group by 4 weeks (p=0.045) but no significant difference between the control group and the xylitol gum group by 4 weeks. There were no significant differences in the mean plaque index at baseline among the control group, the xylitol chewing gum group and the moltitol oral spray group. The plaque index was significantly lower in the xylitol chewing gum group than the control group (p=0.003) at 2 weeks but not 4 weeks. There was no significant difference in the mean plaque index between the control group and the moltitol oral spray group at any time. Using the maltitol spray significantly reduced the MS level in the saliva by 4 weeks use but using the xylitol gum did not. However, using the xylitol chewing gum did reduce the mean plaque by 2 weeks use but the effect did not last; by 4 weeks there was no difference from control. The moltitol spray provided no benefit over the control in reducing the mean plaque index.

Fluoride dentifrice is effective in preventive dental caries but may cause fluorosis, especially in young children. Reducing the concentration of fluoride from the regular concentration of 1,000 parts per million (ppm) to 500 ppm can reduce the risk for fluorosis but increases the risk of caries. Adding tricalcium phosphate (TCP) to the dentifrices may improve the efficacy of remineralization possibly allowing for a lower concentration of fluoride to reduce the risk of fluorosis. We studied this to inform future caries prevention efforts in children. We immersed 40 sound primary incisors into demineralizing solution (pH=4.4) for 96 hours at 37°C to create demineralized lesions. The 40 teeth were then divided into 4 groups of 10 teeth each. Group A: control (treated with deionized water only); Group B: treated with fluoride dentifrice at a concentration of 1,000 ppm; Group C: treated with fluoride dentifrice at a concentration of 500 ppm and 500 ppm TCP, and Group D: treated with fluoride dentifrice at a concentration of 1,000 ppm and 500 ppm TCP. The teeth were each subjected to 7 days of pH-cycling and the studied dentifrice was applied for one minute, 3 times daily during the 7 day period. After the 7 day period the teeth were each sectioned and examined with polarized light microscopy. The depths of demineralized areas were measured using Image-Pro plus software. A pair t-test was used to compare lesion depths before and after dentifrice treatment. Differences in mean lesion depths within each group were analyzed using the One-way ANOVA and LSD tests; a 95% confidence intervals were calculated. The mean lesion depths in all the groups before dentifrice treatment were not significantly different (p=0.143). The mean demineralized lesion depths after dentifrice treatment were significantly different by group (p=0.00). The mean demineralized lesion depth in Group A significantly deeper than the other groups (p=0.00). Group D had the shallowest depth, significantly shallower than the other groups (p=0.006). There was no significant difference in the mean demineralized lesion depth between Groups B and C (p=0.478). The mean demineralized lesion depth changed significantly after dentifrice treatment in all the groups (p=0.00). Group A was significantly deeper (p=0.00) and groups B, C and D were all significantly shallow. Group D had the greatest reduction in mean demineralized lesion depth (p<0.05). The 1,000 ppm fluoride plus TCP dentifrice gave superior remineralization than the 500 ppm fluoride plus TCP and the 1,000 ppm fluoride dentifrice. The 500 ppm fluoride plus TCP gave the same remineralizing effect as the 1,000 ppm fluoride dentifrice. TCP enhances remineralization on primary enamel when added to fluoride dentifrice. Our results show if TCP is added to fluoride dentifrice a lower concentration of fluoride is needed to provide the same benefit as fluoride dentifrice with a higher concentration of fluoride, reducing the risk of fluorosis in children.

Partner notification (PN) is an important strategy to control sexually transmitted infections. The objective of this study was to assess the outcomes of PN in order to improve control of sexually transmitted infections. We retrospectively reviewed heterosexual male gonorrhea cases who presented for treatment to Bangrak Hospital during 2008 to determine the percent PN, the percent of successful partner management (SPM) and the factors associated with both. We used univariate and multivariate analyses to determine significant associations between characteristics of index cases and PN outcomes. We reviewed the medical records of 418 index cases. The median age of the subjects reviewed was 30 years old (range: 14-63). Six hundred ninety-two partners were identified. Of those, 367 partners (53.0%) were notified by 311 index cases; 95 partners (25.9% of the notifications) of the 89 index cases presented for treatment. The medical records of 92 partners were available to review: 61 (66%) had gonorrhea, chlamydia, or genital herpes infections. The median period from being notified to seeking care was 2.5 days (range: 0-92); 80% sought care within 9 days of notification. Spouses and girlfriends were the major partners being notified and had greater SPM. On multivariate analysis, a greater notification rate was found among index cases who were government workers or had a steady relationship. A higher SPM rate was associated with index cases who were aged ≥25 years, married or had a steady relationship. The PN rate among the studied index cases was inadequate. Further studies are needed to develop successful methods to improve PN rates and SPM rates in order to improve sexually transmitted infection control in the study population.

We describe a clinical course of idiopathic chyluria in a previously healthy 8-year-old Thai boy, with a 1-year history of cloudy white urine undergoing antibiotic treatment. The patient was investigated for the causes but they all proved negative. Cystoscopy and retrograde pyelography demonstrated a renolymphatic fistula of the right kidney. The patient was refractory to a mediumchain triglyceride-rich diet. Ultimately, sclerotherapy with 1% povidone iodine was employed twice, which resulted in a resolution of the disorder. We emphasize that chyluria, even though a very rare condition of chylous disorders, but ultimately can be initially managed by providing a medium-chain triglyceride-rich diet and is curable by sclerotharapy. Importantly, medium-chain triglyceride-rich diet can be applied to treat other types of chylous disorders.

Millions of people, worldwide, struggle with being overweight or obese. Medical students, who will eventually become physicians, should be good role models for patients; however, some medical students are themselves overweight or obese. The aim of this study was to evaluate the efficacy of a weight-loss program for medical students in Thailand. A six-month weight reduction program was designed consisted of three full-day sections that were scheduled, as follows: Day One, End of Week One, and End of Week Eight. The interventions incorporated various behavior modification strategies. Participant anthropometric measurements were recorded. Obesity-related knowledge, perception, attitude, and inappropriate weight-loss behaviors were obtained by validated questionnaire. At the end of the study, statistically significant weight loss was demonstrated (median 2.70 kg, p<0.05) compared to baseline. Moreover, participant knowledge significantly increased and inappropriate weight-loss behaviors significantly decreased (p<0.05 and p<0.05, respectively) compared to baseline. Given the demonstrated modest effectiveness of this low-intensity weight reduction program, this intervention should be considered as an effective education tool for medical students.

Local Thai and imported Malaysian beef in southern Thailand area carry several Shiga toxin-producing Escherichia coli (STEC) serotypes. STEC O104 is an important pathogen capable of causing outbreaks with considerable morbidity and mortality. This study investigated the presence of E. coli O104 from local Thai and imported Malaysian beef obtained from markets in Hat Yai City, Songkhla Province during August 2015 - February 2016. Thirty-one E. coli O104 strains were isolated from 12 beef samples (16% and 23% Thai and imported Malaysian, respectively). Thirty strains possessed aggA (coding for a major component of AAF/I fimbriae), a gene associated with enteroaggregative E. coli (EAEC) pathotype, and all strains carried fimH (encoding Type 1 fimbriae). Thirty strains belonged to phylogenetic group B1 and one strain (from Malaysian beef) to group A. Agglutination of yeast cells was observed among 29 E. coli O104 strains. Investigation of stx2 phage occupancy loci demonstrated that sbcB was occupied in 12 strains. Antimicrobial susceptibility assay revealed that 7 strains were resistant to at least one antimicrobial agent and two were multi-drug resistant. One strain carried extended spectrum β-lactamase gene blaCTX-M and three carried blaTEM. PFGE-generated DNA profiling showed identical DNA pattern between that of one EAEC O104 strain from Thai beef and another from Malaysian beef, indicating that these two strains originated from the same clone. This is the first report in Thailand describing the presence of EAEC O104 from both Thai and imported Malaysian beef and their transfer between both countries. Thorough surveillance of this pathogen in fresh meats and vegetables should help to prevent any possible outbreak of E. coli O104.

Measurement of exhaled carbon monoxide (ECO) has been used to confirm self-reported tobacco smoking. There is little data regarding ECO levels among Thai tobacco smokers by age. The objectives of this study were to determine ECO cutoff level to confirm tobacco smoking and to assess whether the cutoff level varies by age. During 2009 we evaluated 875 Thai volunteers aged 16-70 years, residing in Pathum Thani (central Thailand) and Khon Kaen (northeastern Thailand). Among the 875 volunteers, there were 584 non-smokers and 291 smokers. Each subject was interviewed and had their ECO level measured. The mean ECO level was 11.24 ppm among smokers and 2.25 ppm among non-smokers. The best ECO cutoff level to distinguish 291smokers from 584 non-smokers was 5 ppm (sensitivity 79.0%, specificity 89.9%).The optimal ECO cutoff level varied by age-group. For subjects aged 16-25 years, the best ECO cutoff level was 4 ppm (sensitivity 85.2%, specificity 77.5%) and for subject aged 26-70 years, the best ECO cutoff level was 5 ppm (sensitivity 79.4%, specificity 91.2%).These levels by age should be used among Thai subjects to determine smoking.

Tuberculosis (TB) is a cause of death from a single infectious agent Mycobacterium tuberculosis (MTB), leading to approximately 2.5 million deaths annually worldwide. Information regarding prevalence and pattern of drug resistance among TB patients in Pakistan remains inadequate due to the country’s limited resources. This study compared conventional diagnostic techniques with a PCRbased assay targeting IS6110 sequence. In addition, MTB drug resistant profiles against four first-line drugs (ethambutol, isoniazid, rifampin, and streptomycin) from new and retreatment cases of TB. From 101 sputum samples microscopic examination of Ziehl-Neelsen-stained smears and culturing on Lowenstein Jensen medium resulted in 96% and 100% positives, compared to 98% by PCR. Prevalence of MDR-MTB was 41.5% and 58.5% among new (n = 51) and retreatment (n = 50) cases, but 10% of the former group were sensitive to all four first-line anti-TB drugs. Thus, MDR-MTB is highly prevalent among TB patients in Punjab Province, Pakistan (where the study was conducted) and, although PCR amplification of MTB-specific IS6110 sequence was rapid, it lacked the sensitivity of the culture assay.

The Smoking Cessation Clinic (SCC) at Thammasat University Hospital had only 27 patients from October 2013 to September 2014 and a quit rate of only 3.7%. A new smoking cessation program was implemented at the end of 2014 to improve success rates. This new program is an interdisciplinary program that includes several health care specialists. The study aimed to examine the characteristics of the smokers and the outcomes after implementing the new program with an interdisciplinary approach at the SCC in order to gain data to improve the efficacy of the SCC. This prospective descriptive study was conducted by the SCC from December 2014 to December 2015. During the study period 111 patients attended the SCC under the new program and all were included in the survey; 100 (90.1%) were men. The mean (±SD) age of these patients was 56.5±13.5 years. The mean (±SD) age of onset of smoking was 18.5±5.5 years. Smoking cessation in the program was checked by measuring the exhaled carbon monoxide levels at 6 months after reporting smoking cessation. A level less than 10 parts per million was considered not to be a smoker. Of the 111 patients, 14 (12.6%) had reported smoking cessation and had an exhaled carbon monoxide level less than 10 parts per million. The new smoking cessation program was attended by more patients and had a higher success rate than the previous smoking cessation program, although the smoking cessation success rate was still low. Further studies are needed to determine which factors improved cessation rates and to determine other factors associated with successful smoking cessation in the study population.