Siriraj Medical Journal

1-4

Authors: Ekawee Sripariwuth, M.D., Sutatip Pongcharoen, M.D., Ph.D.

Objective: Chronic hepatitis B virus infection (CHB) is involved in a deviated immune response to clear the virus. The disease process is caused by CD8+ T cell response. The mechanisms underlying different clinical manifestations of CHB are not clearly known. The present study investigated CD4+ and CD8+ T cell responses to hepatitis B virus (HBV) infection, in terms of cell proliferation and CD69, IL-4, IFN-γ, perforin and granzyme B expression. Methods: A HBV peptide, FLLTRILTI and ionomycin/phorbol myrister acetate and phytohemagglutinin were used to stimulate peripheral blood mononuclear cells (PBMC) from patients with chronic HBV infection. The expression of CD69, IL-4, IFN-γ, perforin and granzyme B as well as cell proliferation was assessed. Results: All subjects had similar CD69 expression and cell proliferation. However, the number of IL-4+ CD4 T cells increased in hepatitis B e-antigen (HBeAg)-positive CHB patients with increased alanine aminotransferase (ALT), HBV carriers, and HBeAg-positive CHB patients with normal ALT. IFN-γ+ CD4 T cells increased in HBeAg-positive and -negative CHB patients with increased ALT and also in HBV carriers. However, granzyme B-positive CD8+ T cells decreased in HBeAg-negative and -positive CHB patients with normal ALT. Conclusion: The present study demonstrated that the different CD4 and CD8 T cell responses may underlie the hepatitis outcomes of CHB.

11-14

Authors: Kanokvalai Kulthanan, M.D., Sumruay Pinkaew, M.Sc., Leena Chularojanamontri, M.D., Araya Manapajon, M.D., Kanchalit Thanomkitti, M.D., Kumpol Aiempanakit, M.D., Rasthawathana Desomchoke, M.D., Kowit Jongjarearnprasert, M.Pharm.

Background: Non-steroidal anti-in ammatory drugs (NSAIDs) are over-the-counter drugs which are widely used. In Thailand, cutaneous reactions to nonsteroidal anti-in ammatory drugs were frequently angioedema and urticaria. However, there are many limitations of the diagnostic investigations, so the diagnosis is still based on history and clinical manifestation. In 2007, there was a study in Italy, which reported that an autologous plasma skin test (APST) could detect autoreactive state in patients with multiple intolerances to NSAIDs. Objective: We aimed to investigate whether APST is positive in single and multiple NSAID reactors in the Thai population or not. Methods: The patients with recent history of urticaria and/or angioedema following the administration of NSAIDs were prospectively recruited. Individuals were classi ed into two groups (single or multiple NSAID reactors) based on history, clinical manifestation and/or laboratory investigation and then APST was done after at least a month free of symptoms. Results: Of all sixty-eight patients, thirteen (19.1%) were men and fty- ve (80.9%) were women. The mean age was 42.7 ± 15.0 years (range 17-77 years). In our study, single NSAID reactors (69.1%) were more common than multiple NSAID reactors (30.9%). Multiple NSAID reactors tended to have a personal and family history of atopy (p = 0.030 and 0.012, respectively) than single reactors. APST was positive 19.0% and 10.6% in multiple and single NSAID reactors, respectively. However, there was no statistically signi cant relationship between positive APST and multiple NSAID reactivity (p = 0.442). Conclusion: This study showed no statistically signi cant association between APST positivity and multiple NSAID reactors in Thai patients. However, our study revealed signi cantly higher proportions of personal and family history of atopic diathesis in multiple NSAID reactors.

21-24

Authors: Sukhum Jiamton, M.D., Ph.D., Rujee Phuardchantuk, M.D., Chanisada Wongpraparut, M.D., Leena Chularojmontri, M.D., Narumol Silpa-archa, M.D., Pranee Kasemsarn, M.D., Kanokvalai Kulthanan, M.D., Puan Suthipinittharm, M.D.

Background: Nail abnormalities are common in psoriasis. The relationship between nail abnormalities and disease severity or impact on quality of life has scarcely been reported. Objectives: The aims of this study were to nd the proportion and types of nail abnormalities among Thai psoriasis patients and to assess the association between nail abnormalities, disease severity and the quality of life. Methods: A retrospective medical record review of 1,027 psoriasis patients who attended the dermatology clinic from Fe- bruary 2005 to May 2008 was performed. Demographic data, type of nail abnormalities and severity of psoriasis as well as the dermatology life quality index (DLQI) were recorded. Results: Nail abnormalities in Thai psoriasis patients were diagnosed in 63.4% of them. The most common type was ony- cholysis (45.9%) followed by nail pittings (42.8%). Nail abnormalities were signi cantly associated with higher psoriasis area severity index (PASI) with adjusted odds ratio of 2.45 (95% CI 1.86-3.23, p<0.001) and associated with DLQI with adjusted odds ratio of 1.61 (95% CI 1.00-2.58, p=0.05). Conclusion: Nail abnormalities in psoriasis are common and associated with disease severity and quality of life of patients.