Queen Saovabha Memorial Institute

Rabies is a fatal zoonosis caused by the rabies virus (RABV) that has afflicted humans for thousands of years. RABV infection leads to neurological symptoms and death; however, its pathogenesis in the brain is unclear, which complicates patient care. Given that no treatment exists for symptomatic cases, there is an urgent need for effective antiviral drugs. In this study, we aimed to investigate the pathogenic mechanism of RABV in the brain and screen for potential anti-RABV drugs. Protein samples were extracted from the brains of RABV-positive and RABV-negative dogs, and proteomic and phosphoproteomic analyses were conducted. The results showed that the synaptic vesicle cycle is critical to RABV pathogenesis. The kinases involved in the phosphorylation of proteins in the synaptic vesicle cycle were identified and examined as potential drug targets. Casein kinase 2 and protein kinase C were found to be key kinases for RABV replication, and five inhibitors of these enzymes were tested for their anti-RABV properties. Pretreating cells with the kinase inhibitor sunitinib significantly reduced the viral yield after RABV infection. Our findings suggest that RABV interferes with synaptic communication, which leads to rabies, and that inhibiting a vital kinase can reduce viral production. Hence, our findings have implications for the development of rabies treatment regimes.

Abstract Background Necrotizing fasciitis (NF) is a rare and fatal soft tissue infection that requires immediate diagnosis and management. Data on microbiological aspects, clinical features, and outcomes of NF remain unexplored, particularly in certain global regions. With its high mortality rate, comprehensive understanding of NF is crucial.Figure 1.Inclusion Flow Diagram of Patients Diagnosed with Necrotizing Fasciitis between 2022-2023 Methods All NF cases diagnosed at a tertiary care center in Eastern Thailand between January 2022 - December 2023 were retrospectively reviewed. Patient’s demographic, comorbidities, clinical presentations, laboratory data, treatment modalities, and clinical outcomes were evaluated.Table 1.Microbial Profile and Organism Distribution in Necrotizing Fasciitis Cases Results Among 99 NF cases identified, the mean age was 54.85 years (SD = 13.5), and 52.5% were males. Most common comorbidities were hypertension (48.5%), diabetes (44.4%), and dyslipidemia (38.4%). Wound cultures revealed 52.7% monomicrobial, 14% polymicrobial, and 33.3% no growth, with Streptococcus pyogenes being the most prevalent (28.6%). Average number of debridements per case was 3.06, and 53.5% of the patients underwent vacuum dressing with an average duration of 24.07 days (SD = 18.8). Significantly fewer patients underwent debridement within 24 hours if the initial diagnosis was cellulitis prior to being diagnosed with NF (21/43 (48%) versus 44/56 (78.5%), p = 0.002). The most common antibiotic regimen was ceftriaxone plus clindamycin (78.8%). Mortality occurred in 8 cases (8.08%), while 11 cases (11.1%) had amputations and 26 cases (26.3%) experienced severe sepsis.Table 2.Treatment Modalities and Their Attributes in Patients Diagnosed with Necrotizing Fasciitis Conclusion Our cohort exhibits a notably low mortality rate, compared to existing literature. Here, we present the first study exploring NF characteristics in Eastern Thailand. With findings indicating delayed debridement among patients initially diagnosed with cellulitis, this emphasizes the significance for prompt diagnosis of NF.Table 3.Clinical Outcomes in Study Cohort of 99 patients with Necrotizing Fasciitis Disclosures All Authors: No reported disclosures

Extensor indicis proprius (EIP) opponensplasty is one of the commonly used techniques to restore thumb abduction and opposition in patients with thenar muscle dysfunction from various causes of median nerve palsy. However, its subcutaneous route around the distal ulna may not represent a straight line of pull, and part of the extensor hood sometimes has to be harvested along with the EIP tendon to gain adequate length to reach the insertion. The purpose of the study is to present the alternative method of EIP opponensplasty and report the clinical outcomes. The modified EIP opponensplasty was performed on 16 patients with severe carpal tunnel syndrome. At the final follow-up examination, all patients were able to regain their desired level of activities. The Kapandji score, abduction angle, and the disabilities of the arm, shoulder, and hand score improved in all patients. There were no complications related to harvesting the EIP tendon. Two patients developed finger stiffness, which improved after rehabilitation. This technique is safe and effective for restoring thumb function and can solve the insufficient tendon length problem of the original EIP opponensplasty.

We describe a new species of karst-dwelling pitviper from Chumphon Province of Peninsular Thailand, in the Isthmus of Kra, based on morphological and molecular data (2427 bp from cyt b, ND4 and 16S rRNA mitochondrial DNA genes). Morphologically, Trimeresurus kraensis sp. nov. is distinguished from other congeners by the following combination of morphological characters: a dark/bottle-green dorsum with reddish-brown or purple crossbands; pale green venter lacking dark dots; stripes present on the lateral sides of the ventrals; internasals generally in contact; one large supraocular scale on each side of the head; iris pale copper; tail brown with dark purplish-brown crossbars; dorsal scales in 21–21–15 rows; ventral scales 167 in a single male, 169–171 in females; subcaudal scales 62 in a single male, 52–54 in females, all paired. White vertebral spots present in males, located on approximately every two or four dorsal scales; dark brown spots forming discontinuous pattern present on 1–3 lateral dorsal scale rows; males with reddish-brown postocular stripe with jagged edges. The new species differs from the morphologically similar species Trimeresurus venustus s. str. by a notable divergence in cytochrome b mitochondrial DNA gene sequences (p = 5.9%).

A preliminary report from a single institution, noninferiority, prospective randomized controlled trial is conducted to determine the effectiveness of interlaminar endoscopic lumbar discectomy (IELD) versus microscopic lumbar discectomy (MLD) for the treatment of L5-S1 lumbar disc herniation (LDH). This prospective, noncrossover, randomized controlled trials was conducted at a single neurosurgical center. Patients with symptomatic radiculopathy or intermittent neurogenic claudication caused by LDH were enrolled from July 2016 to July 2021. The study compared the effectiveness of microscopic and full-endoscopic discectomy procedures. Outcome measures included visual analogue scale (VAS) scores for back and leg pain, Oswestry Disability Index scores, radiologic measurements, endurance time of walking, and satisfaction rate. Of 37 assessed patients, both IELD and MLD groups demonstrated significant improvements in VAS scores for pain over time, with no significant difference between them. For secondary outcomes, the IELD group had a shorter hospital stay and reduced blood loss but a longer operation time than the MLD group. Radiographic evaluations showed no change compared to preoperative data. Patient satisfaction and recovery rates were slightly higher for the MLD group, but both groups were comparable in most evaluations, with complications being minimal. The IELD was noninferior in improving the intensity of back and leg pain and functional disability, compared to the MLD. Additionally, the IELD showed no difference in clinical outcomes for patients in terms of radiographic results and patient satisfaction rates. The results of this research preliminarily demonstrate that the IELD could be considered an effective alternative to MLD for L5-S1 central or paracentral LDH.

Abstract We describe a new species of pitvipers from Trang Province of Thailand, near the Thailand–Malaysian border, based on morphological and molecular (2427 bp from cyt b, ND4, and 16S rRNA mitochondrial DNA genes) lines of evidence. Morphologically, Trimeresurus ciliarissp. nov. is distinguished from its congeners by the following combination of morphological characters: a long papillose hemipenis; first supralabial and nasal scale fused; three to four small supraocular scales; internasals not in contact; small scale between nasal and the scale formed by the fused second supralabial and loreal present; dorsal scales in 17–17–15 rows across the body; ventral scales 172–175 in males, 171 in female; subcaudal scales 59–63 in males, 61 in female, all paired; in life an emerald-green dorsum with reddish-brown bands; creamy-white venter lacking dark dots or stripes on the lateral sides of the ventrals; white vertebral spots present in both sexes on every two or three dorsal scales; dark brown spots forming discontinuous pattern present on 1–3 lateral dorsal scale rows; males with reddish-brown postocular stripe. The new species forms a distinct clade on the phylogenetic tree of the genus Trimeresurus and differs from the morphologically similar species T. venustus by a significant divergence in cytochrome b mitochondrial DNA gene sequences (p = 12.5%). The new species is currently known from a small karstic area in the Nakawan Range spanning the border of Thailand and Malaysia, in particular in limestone forests in Trang and Satun provinces (Thailand); it likely also occurs in the adjacent parts of Perlis State (Malaysia). Our study also suggests that the taxonomy of T. kanburiensis species complex requires further studies; in particular our study suggests that the status of populations from Chumphon Province of Thailand and Pulau Langkawi Island of Malaysia should be re-assessed.

Background: After the implementation of the deinstitutionalization policy, the role of family caregivers has grown in importance and the caring responsibilities have shifted onto their shoulders. This study sought to better understand the Thai family caregivers’ needs for readiness to care for people with psychosis.