Phetchabun Medical Journal

Comparison of the Efficacy of Syphilis Screening Using Traditional and Reverse Algorithms in Pregnant Women and Their Sexual Partners at Wichianburi Hospital, Phetchabun Province, Thailand

2024-08-15T10:07:42+07:00

Syphilis was a sexually transmitted disease that caused severe complications, including neurosyphilis and congenital syphilis in infants born to infected mothers. Two primary screening approaches for detecting syphilis were the traditional and reverse algorithms. This research aimed to compare the efficacy of these algorithms in pregnant women and their sexual partners at Wichianburi Hospital between March and October 2023, covering 880 cases. In the traditional algorithm, blood samples were initially tested using the Rapid Plasma Reagin (RPR) test, and if reactive, a titer test followed. The reverse algorithm began with the Anti-TP test (initial TT) using an automatic analyzer that provided results based on the Cut-Off Index (C.O.I). If positive, the RPR test was conducted, and if reactive, a titer test was performed; if the result was negative, the TPHA test (second TT) was carried out. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and the comparison of RPR titer with C.O.I. values were analyzed. The study revealed that the reverse algorithm demonstrated superior sensitivity at 100% compared to the traditional algorithm's 77.8%, while both methods shared a specificity of 99.9%. The reverse algorithm's PPV, NPV, and LR+ were higher, at 94.7%, 100.0%, and 862.0, respectively, compared to 93.3%, 99.5%, and 670.4 for the traditional method. Out of 18 patients diagnosed with syphilis, the reverse algorithm detected all cases, whereas the traditional algorithm identified only 14, resulting in 4 false negatives. Among 862 non-syphilitic patients, one false positive occurred with the reverse algorithm. The false negatives in the traditional method corresponded to cases with C.O.I. values below 30, while patients with an RPR titer of 1:32 had C.O.I. values exceeding 100. In conclusion, the reverse algorithm was shown to be more effective than the traditional method, detecting more infected individuals and offering better diagnostic opportunities. Thus, it is recommended for syphilis screening to reduce risks of misdiagnosis, missed treatment opportunities, and congenital disabilities.

Evaluation of the Melioidosis Surveillance System at Satuek Hospital, Buriram Province, Thailand, 2023

2024-10-19T10:34:14+07:00

This study aimed to evaluate the operational procedures of the melioidosis surveillance system, including both quantitative and qualitative characteristics, and to provide recommendations for improving the surveillance system at Satuk Hospital. The study employed a cross-sectional design using both qualitative and quantitative methods. For qualitative outcomes, in-depth interviews were conducted using semi-structured questionnaires designed by the researcher, and data were analyzed through content analysis. For the quantitative aspect, patient records from Satuk Hospital were reviewed for the period from January 1 to December 31, 2023, involving 965 patients, based on specific ICD-10 codes related to melioidosis. Data analysis was performed using Microsoft Excel, with results presented as frequencies and percentages. The findings revealed that most staff members accepted the reporting system as straightforward and adaptable to changes in disease definitions. Additionally, the reporting process was efficient, with good substitutability among reporters. Regarding the surveillance system's evaluation based on the Epidemiology Division’s definitions, sensitivity was found to be 25% (2/8), and positive predictive value was 22.2% (2/9). When evaluated according to Satuk Hospital's criteria, sensitivity was 10.16% (6/59), and the positive predictive value was 66.7% (6/9). The completeness of data for key variables such as gender, age, and patient’s address during illness was 100% accurate (9/9). However, discrepancies were found in the data for the onset date of illness and diagnostic codes, with errors at 55.5% (5/9) and 22.2% (2/9), respectively. Timely reporting within 7 days was achieved at 77.7% (7/9). Overall, the study identified limitations in the reporting system’s coverage, as well as in sensitivity and positive predictive value. Recommendations include continuous monitoring and follow-up of patients, as well as regular data reviews to ensure accurate reporting and enhance the effectiveness of the surveillance system.

Prediction of Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke, Phetchabun Hospital

2024-11-18T09:44:03+07:00

This study aimed to develop a clinical prediction score for forecasting intracerebral hemorrhage (ICH) following intravenous thrombolysis (rt-PA) in patients with acute ischemic stroke at Phetchabun Hospital. A retrospective cohort study was conducted among patients with acute ischemic stroke who received rt-PA treatment at the stroke unit of Phetchabun Hospital between January 1, 2018, and June 30, 2024. Post-treatment complications were classified into three groups: 1) no complications, 2) asymptomatic intracerebral hemorrhage, and 3) symptomatic intracerebral hemorrhage with worsening neurological deficits. Data analysis was performed using ordinal logistic regression to identify factors associated with the occurrence of ICH, and the Area Under the Receiver Operating Characteristic Curve (AuROC) was used to assess the predictive accuracy of the model. The study included 317 patients, classified into three groups: 1) no complications (260 patients, 82.0%), 2) asymptomatic ICH (15 patients, 4.8%), and 3) symptomatic ICH with neurological deterioration (42 patients, 13.2%). The Symptomatic Intracerebral Hemorrhage (sICH) score was derived from six variables associated with ICH: age over 60 years, blood glucose levels higher than 200 mg/dL, history of aspirin use, NIHSS score greater than 20, platelet count lower than 250,000 cells/mm³, and the use of antihypertensive medication during rt-PA administration. The score ranged from 0 to 7.5, with a cut-off point at 2.5. The AuROC for the prediction score was 0.74 (95%CI: 0.70-0.80). Future studies should include a more diverse patient population with varying clinical characteristics, as well as employ longitudinal study designs to improve the predictive accuracy of the score and facilitate its broader clinical application.

Outbreak Investigation of Acute Hemorrhagic Conjunctivitis Caused by Coxsackievirus A24 Among Wrestling Event Participants in Mueang District, Phetchabun Province, Thailand, June 2023

2024-12-17T16:37:19+07:00

On June 25, 2023, the Epidemiology Unit of Phetchabun Hospital was notified of an outbreak of conjunctivitis among participants in a wrestling competition in Mueang District, Phetchabun Province. A surveillance and rapid response team, in collaboration with relevant authorities, conducted an investigation from June 25 to June 30, 2023, to confirm the diagnosis and outbreak, describe the epidemiological characteristics, identify associated factors, and provide recommendations for controlling and preventing further spread. A descriptive epidemiological study defined suspected cases as individuals who participated in the wrestling competition and exhibited conjunctival inflammation between June 17 and June 30, 2023. Conjunctival swabs and water samples were collected to identify pathogens and assess chlorine residues. An unmatched case-control study was conducted, with logistic regression used to analyze the associated factors. The investigation identified 50 patients, with a male-to-female ratio of 2.8:1 and a mean age of 15 years (SD = 4.5). The predominant symptom was conjunctival redness (100%), followed by discharge (68%) and eye irritation (44%). The first cases were reported on June 21, with the peak occurring on June 25. Conjunctival swab tests confirmed Coxsackievirus A24 as the causative agent, and the water chlorine concentration was found to be 0.2 mg/L. Multivariate analysis revealed significant associated factors for the outbreak, including training in the same group (Adjusted OR = 8.26, 95% CI: 2.36–29.98, P-value < 0.001) and sharing meals (Adjusted OR = 17.14, 95% CI: 2.16–136.05, P-value = 0.01). The outbreak was attributed to Coxsackievirus A24, likely introduced from outside the area, with close contact, such as training together and sharing meals, as major contributing factors. Screening symptomatic individuals and isolating patients from the general population are essential measures to prevent future outbreaks.

Investigation of a Scabies Outbreak in a Nursing Home in Mueang District, Nonthaburi Province, Thailand, August 2023 to April 2024

2024-11-27T11:37:17+07:00

On February 8, 2024, the Division of Epidemiology was notified of a scabies outbreak at a nursing home in Mueang District, Nonthaburi Province. An investigation team was deployed to confirm the diagnosis and outbreak, describe its epidemiological features, identify the source, and provide proper control measures. A descriptive study was conducted, with active case finding using a structured questionnaire. Suspected cases were defined as individuals with at least one rash lesion between August 1, 2023, and April 30, 2024. Probable cases were those diagnosed by a dermatologist, while confirmed cases had laboratory confirmation. Environmental surveys and laboratory testing were performed. A total of 19 cases were identified, including 1 confirmed case, with an attack rate of 54.3%. The cases included 8 males and 11 females (male-to-female ratio: 1:1.4), with a median age of 64 years (range: 17–89). Among the cases, 11 were residents and 8 were staff members, distributed across both floors of the facility. The index case, a staff member, developed symptoms on September 14, 2023, after sharing a room with a trainee who had itchy rashes. Sarcoptes scabiei was confirmed in one laboratory sample. The outbreak was likely linked to caregiving processes, as staff rotated rooms and had direct physical contact with residents. In conclusion, the investigation confirmed a scabies outbreak involving both residents and staff, with no severe cases or fatalities. The outbreak was likely introduced by an infected individual without prior screening. It is recommended that new staff undergo scabies screening before starting work to prevent future outbreaks.