Paradigm Shift from Open Surgery to Minimally Invasive Surgery in Three Approaches for Radical Prostatectomy: Comparing Outcomes and Learning Curves

Objective: Radical prostatectomy (RP) can be performed by several approaches, such as open retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic prostatectomy (RALP). This study investigated and shared the differences in the surgical techniques, learning curves, and outcomes of each approach of RP. Materials and Methods: The data of patients who received RP given by one of the authors between January 2002 to June 2016 were retrospectively reviewed. We compared perioperative and postoperative outcomes among approaches, searched for predictors of a positive surgical margin (PSM), and assess the learning curves of the two minimally invasive approaches. Results: 527 patients underwent RP during January 2002 to June 2016 including 42 RRP, 198 LRP, and 327 RALP. RALP had the highest negative surgical margin (68.8%) and lowest multifocal positive surgical margin (10.7%). PSM predictors were the Gleason score and pathological T staging. The learning curve showed that RALP needed one-hundred-cases experience to achieve the lowest PSM rate and 200 cases to master bleeding control. In the first 100 cases in each group, the PSM rate in LRP was lower than in RALP. Conclusion: Minimally invasive approach in radical prostatectomy showed significant improvements over RRP, especially the RALP approach. RALP would take a surgeon 100 and 200 cases to reach the plateau on the learning curve for achieving the desired oncologic and perioperative outcome efficiencies, respectively. However, LRP and RRP are still feasible in a service setting and for training purposes

Positivity and Intensity of Gnathostoma spinigerum Infective Larvae in Farmed and Wild-Caught Swamp Eels in Thailand

From July 2008 to June 2009, livers of the swamp eels (Monopterus alba) were investigated for advanced third-stage larvae (AL3) of Gnathostoma spinigerum. Results revealed that 10.2% (106/1,037) and 20.4% (78/383) of farmed eels from Aranyaprathet District, Sa Kaeo Province and those of wild-caught eels obtained from a market in Min Buri District of Bangkok, Thailand were infected, respectively. The prevalence was high during the rainy and winter seasons. The infection rate abruptly decreased in the beginning of summer. The highest infection rate (13.7%) was observed in September and absence of infection (0%) in March-April in the farmed eels. Whereas, in the wild-caught eels, the highest rate (30.7%) was observed in November, and the rate decreased to the lowest at 6.3% in March. The average no. (mean±SE) of AL3 per investigated liver in farmed eels (1.1±0.2) was significantly lower (P=0.040) than those in the caught eels (0.2±0.03). In addition, the intensity of AL3 recovered from each infected liver varied from 1 to 18 (2.3±0.3) in the farmed eels and from 1 to 47 (6.3±1.2) in the caught eels, respectively. The AL3 intensity showed significant difference (P=0.011) between these 2 different sources of eels. This is the first observation that farmed eels showed positive findings of G. spinigerum infective larvae. This may affect the standard farming of the culture farm and also present a risk of consuming undercooked eels from the wild-caught and farmed eels

Screening Practices for Infectious Diseases among Burmese Refugees in Australia

Helicobacter pylori and Strongyloides spp. infections were the most common conditions found

Blastocystis hominis and Endolimax nana Co-Infection Resulting in Chronic Diarrhea in an Immunocompetent Male

Blastocystis hominis and Endolimax nana exist as two separate parasitic organisms; however co-infection with the two individual parasites has been well documented. Although often symptomatic in immunocompromised individuals, the pathogenicity of the organisms in immunocompetent subjects causing gastrointestinal symptoms has been debated, with studies revealing mixed results. Clinically, both B. hominis and E. nana infection may result in acute or chronic diarrhea, generalized abdominal pain, nausea, vomiting, flatulence and anorexia. We report the case of a 24-year-old immunocompetent male presenting with chronic diarrhea and abdominal pain secondary to B. hominis and E. nana treated with metronidazole, resulting in symptom resolution and eradication of the organisms. Our case illustrates that clinicians should be cognizant of both B. hominis and E. nana infection as a cause of chronic diarrhea in an immunocompetent host. Such awareness will aid in a timely diagnosis and possible parasitic eradication with resolution of gastrointestinal symptoms

Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented.We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90$189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68$109 per life-year gained) compared with several molecular diagnostic options.For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone

Clonal diversity of the glutamate dehydrogenase gene in Giardia duodenalis from Thai Isolates: evidence of genetic exchange or Mixed Infections?

Background: The glutamate dehydrogenase gene (gdh) is one of the most popular and useful genetic markers for the genotypic analysis of Giardia duodenalis (syn. G. lamblia, G. intestinalis), the protozoan that widely causes enteric disease in humans. To determine the distribution of genotypes of G. duodenalis in Thai populations and to investigate the extent of sequence variation at this locus, 42 fecal samples were collected from 3 regions of Thailand i.e., Central, Northern, and Eastern regions. All specimens were analyzed using PCR-based genotyping and recombinant subcloning methods. Results: The results showed that the prevalence of assemblages A and B among these populations was approximately equal, 20 (47.6%) and 22 (52.4%), respectively. Sequence analysis revealed that the nucleotide diversity of assemblage B was significantly greater than that in assemblage A. Among all assemblage B positive specimens, the allelic sequence divergence within isolates was detected. Nine isolates showed mixed alleles, ranged from three to nine distinct alleles per isolate. Statistical analysis demonstrated the occurrence of genetic recombination within subassemblages BIII and BIV was likely. Conclusion: This study supports increasing evidence that G. duodenalis has the potential for genetic exchange

Transmission cycles of Giardia duodenalis in dogs and humans in Temple communities in Bangkok—A critical evaluation of its prevalence using three diagnostic tests in the field in the absence of a gold standard

The prevalence and associated risk factors for Giardia duodenalis in canine and human populations in Temple communities of Bangkok, Thailand were determined by evaluating three common diagnostic methods utilised to detect Giardia, namely zinc sulphate flotation and microscopy, an immunofluoresence antibody test and nested polymerase chain reaction (PCR) based on the SSU-rDNA gene. The diagnostic sensitivity and specificity together with the negative and positive predictive values of each test were evaluated in the absence of a gold standard using a Bayesian approach. The median estimates of the prevalence of infection with G. duodenalis in dogs and humans in Thailand were 56.8% (95% PCI, 30.4%, 77.7%) and 20.3% (95% PCI, 7.3%, 46.3%) respectively. PCR and immunofluorescence antibody tests (IFAT) were the most accurate tests overall with diagnostic sensitivity and specificity of 97.4% (95% PCI, 88.5%, 99.9%) and 56.2% (95% PCI, 40.4%, 82.9%) for the PCR and 61.8% (95% PCI, 40.8%, 99.1%) and 94.7% (95% PCI, 87.4%, 99.1%) for IFAT respectively Three cycles, anthroponotic, zoonotic and dog-specific cycles of G. duodenalis were shown to be operating among the human and canine populations in these Temple communities in Bangkok, supporting the role of the dog as a potential reservoir for Giardia infections in humans

Detection of Cryptosporidium oocysts in green mussels (Perna viridis) from shell-fish markets of Thailand

Mussels filter large volumes of water and can concentrate pathogenic organisms, which may act as potential vehicles of transmission to the consumer. A survey study was carried out to investigate the presence of Cryptosporidium protozoan parasites in green mussels (Perna viridis), the smussles pecies most destined for consumption in Thailand. In total, 56 samples were examined from Bangkok (n = 24) and Samut Prakan (n = 32) a wholesale shell-fish markets located at the mouth of the Chao Phraya River. The market for green mussels was closed to the mussel culture placed along the coastal line and this localization may have significant economical impact if the mussels’ cultures are found contaminated. Cryptosporidium spp. oocysts were detected by the immunofluorescence antibody method (IFA) in 12.5% of the samples examined. The detection of Cryptosporidium oocysts in green mussels’ population of Samut Prakan was higher (15.6%) than in Bangkok market (8.3%). These differences in positive samples from the two locations may be caused by physical, ecological and anthropogenic conditions. This could relay to different contamination levels of marine water by Cryptosporidium oocysts and consequently to contamination of harvested shellfish populations. The results demonstrate that the Cryptosporidium spp. oocysts were found indigenous in mussels from the coastal line of Thailand, indicating that mussels may act as a reservoir of Cryptosporidium foodborne infections for humans