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Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among people living with HIV (PLWH) due to comorbidities and factors related to HIV infection. This study aimed to identify clinical predictors of significant fibrosis among PLWH with MASLD. Materials and Methods: A retrospective cohort study was conducted with PLWH having CD4 counts =200, enrolled between April and October 2023 at two tertiary hospitals. The primary outcome was identifying the clinical predictors of significant fibrosis (F=2) defined by TE=8 kPa. Secondary outcomes included MASLD prevalence and characteristics. Results: Among 96 PLWH, 52 (54.2%) had MASLD. The mean age was 49.7±8.0 years, 63.5% were male, and the mean BMI was 25.8±4.1 kg/m². Obesity, diabetes, and dyslipidemia were present in 17.3%, 19.2%, and 46.2% of participants, respectively. The mean CAP and TE were 285±36 dB/m and 8.7±7.8 kPa, respectively. Significant fibrosis was present in 24 patients (46.2%). Fibrosis scoring systems (FIB-4, APRI, NFS) demonstrated good accuracy (AUROCs: 0.84, 0.85, 0.76, respectively). Multivariate analysis identified predictors of significant fibrosis: higher BMI (aOR 1.24, p=0.042), dyslipidemia (aOR 3.96, p=0.038), and higher AST (aOR 1.19, p=0.011). The AGA pathway using two steps (FIB-4 and TE) improved reclassification of significant fibrosis risk, reducing the number of individuals at indeterminate risk, 12 out of 52 in the first step to 7 out of 52 in the second step. Conclusion: MASLD is highly prevalent in PLWH, with about half experiencing significant fibrosis. Predictors of significant fibrosis include dyslipidemia, higher BMI, and elevated AST levels. Fibrosis scoring systems accurately predict significant fibrosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Melioidosis is an infectious disease caused by Burkholderia pseudomallei, and it has a wide range of clinical symptoms. It is endemic in tropical areas, including Southeast Asia. Despite the availability of effective treatment, the mortality rate is still high, especially in patients presenting with septic shock. The aim of this study was to determine and explore clinical characteristics, microbiology, treatment outcomes, and factors associated with in-hospital mortality which could predict prognosis and provide a guide for future treatment. Materials and Methods: The population in this retrospective cohort study included all 262 patients with a diagnosis of melioidosis who were hospitalized at Surin Hospital, Surin, Thailand, from April 2014 to March 2017. We included patients older than 15 years with a positive culture for B. pseudomallei. Data regarding the clinical characteristics, microbiology, and treatment outcomes of the patients were collected and analyzed. The patients were divided into two groups dependent on outcome, specifically non-survival and survival. Logistic regression was performed to determine the risk factors associated with in-hospital mortality. Results: Out of the 262 patients with melioidosis during the study period, 117 (44.7%) patients died. The mean age was 57.2 ± 14.4 years, and 193 (73.7%) patients were male. The most common comorbidity was diabetes (123, 46.9%), followed by chronic kidney disease (35, 13.4%) and chronic liver disease (31, 11.8%). Four risk factors were found to be associated with in-hospital mortality, including age (adjusted odds ratio (aOR) 1.04, 95%CI: 1.01–1.07), respiration rate (aOR 1.18, 95%CI: 1.06–1.32), abnormal chest X-ray finding (aOR 4.79, 95%CI: 1.98–11.59), and bicarbonate levels (CO2) (aOR 0.92, 95%CI: 0.85–0.99). Conclusions: Our study identified age, respiration rate, abnormal chest X-ray finding, and CO2 levels are predictive factors associated with in-hospital mortality in melioidosis patients. Physicians should be aware of these factors, have access to aggressive treatment options, and closely monitor patients with these risk factors. [ABSTRACT FROM AUTHOR]

Objective: Imipenem/cilastatin, a broad-spectrum antibacterial, is reserved for treatment of serious infections caused by multidrug-resistant Gram-negative bacteria. The present study was aimed to compare the effectiveness and adverse events of generic and original imipenem/cilastatin. Materials and Methods: A retrospective, multicenter, cohort, non-inferiority study of generic imipenem/cilastatin (Sianem®), and original imipenem/cilastatin (Tienam®) was carried on between November 2017 and September 2020. The centers included Srinagarind Hospital, Taksin Hospital, Nakornping Hospital, Nakhonpathom Hospital, and King Chulalongkorn Memorial Hospital. The clinically relevant data were retrieved from the medical records on day 3, 7, and 14 after enrollment. A sample size of 260 patients per arm was needed. Results: There were 214 and 227 medical and surgical patients enrolled in generic and original imipenem/cilastatin groups, respectively. Baseline characteristics of the two groups were not significantly different. Most patients were male and elderly. Comorbidity was observed in 86.6%. The average length of hospital stay was 17 days. At day 14 after enrollment, the favorable outcome in generic and original imipenem/cilastatin groups were 83.1% and 90.0%, respectively, with no statistical difference. The mortality rates were 3.4% and 2.0% in generic and original imipenem/ cilastatin groups, respectively, with no statistic difference. Serious adverse events were also not significantly different between the two groups at 0.9% and 0.4%. Conclusion: The generic imipenem/cilastatin was non-inferior to the original imipenem/cilastatin in terms of effectiveness and adverse events for the treatment of serious bacterial infections in hospitalized adult patients. [ABSTRACT FROM AUTHOR]

Background To date, cases of extraintestinal micro-sporidiosis have been increasingly reported in both otherwise healthy and immunocompromised individuals. Among them, microsporidial myositis is very rare. To the best of our knowledge, this is the first report of microsporidial myositis caused by Trachipleistophora hominis in a patient with human immunodeficiency virus (HIV) in Thailand. Case report A Thai man with HIV presented with fever and muscle pain at both anterior thighs and left arm for 3 months. Muscle biopsy was performed, and pathology exhibited neutrophil infiltration and focal aggregations of microsporidial spores. The 18S ribosomal RNA sequence revealed the species of this microsporidium as T hominis , and albendazole of 800mg/day was initiated. He gradually improved, and was discharged home 6 weeks after hospitalization. Conclusions To the best of our knowledge, this is the first report of microsporidial myositis caused by Trachipleistophora hominis in a person with HIV in Thailand. [ABSTRACT FROM AUTHOR]

Microsporidia are obligate intracellular eukaryotes of broad host range (1). At least 15 species have been implicated in human infections. Although few microsporidiosis cases have been reported, they have emerged [...]

Background: The efficacy and safety of Andrographis paniculata (Burn.f.) Wall. ex Nees in the treatment of acute nonspecific upper respiratory tract infection (NS-URI) are still less clear due to the diversity of herbal preparations, dosages, and few large clinical trials. The authors aimed to investigate the therapeutic efficacy and safety of the crude extract from A. paniculata in acute NS-URI. Materials and Methods: Patients aged 18 to 60 years old from government hospitals, with acute NS-URI were enrolled between January 2018 and August 2019. Drug allocation was randomized in block of six. The crude extract of A. paniculata was packed in capsules containing 20 mg of andrographolide and given thrice daily for four days. The placebo capsules were physically identical. Ten tablets of paracetamol were also given as symptom-rescue drug. They were followed at days 4 to 7, and 14 to 30. Results: Eight hundred sixty-two patients were enrolled between January 2018 and August 2019. Thirty-three patients withdrew from the study, therefore, 829 patients remained in the final analysis. Four hundred nineteen cases (50.5%) received the crude extract, and 410 cases (49.5%) received the placebo. The demographic data, clinical manifestation, and laboratory findings at the enrollment were similar in both groups. At the first follow-up, the rates of severity of each and combined symptoms decreased similarly, and almost all patients felt much better or recovered on day 7. Paracetamol was used by 205 (48.9%) and 185 (45.1%) patients in the experimental and control groups, respectively, and about three tablets taken in each group. Patient satisfaction rates were also similar in both groups. Adverse effects were mild and self-limited in 18 (4.3%) and 9 (2.2%) patients in the experimental and control groups, respectively. Conclusion: The therapeutic efficacy of the crude extract or active ingredient from A. paniculata for acute NS-URI was not confirmed. Both groups showed similarly mild and few adverse drug reactions. Trial registration: The present study protocol was registered at the Thai Clinical Trials Registry (TCTR 20170329002; date: March 26, 2017). [ABSTRACT FROM AUTHOR]

To the Editor: Over the past 2 decades, human pythiosis has emerged as an important parafungal disease; Thailand reports the most cases (1,2). Given the rarity of this infection in [...]