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BACKGROUND: The increasing rate of treatment failure with penicillin and other beta-lactam antibiotics in pharyngotonsillitis caused by group A beta-hemolytic streptococci (GABHS) has prompted the search for alternative antimicrobials. Both clindamycin and amoxicillin/clavulanic acid have excellent clinical activity in pharyngotonsillitis. OBJECTIVE: This study compared the clinical and bacteriologic efficacy and tolerability of oral clindamycin with those of oral amoxicillin/clavulanic acid in the outpatient treatment of acute recurrent GABHS pharyngotonsillitis. METHODS: This was an international, multicenter, randomized, investigator-blinded, prospective study in patients with acute recurrent pharyngotonsillitis. Recurrence was defined as > or =2 episodes of documented pharyngeal and/or tonsillar infection within the 12 months before the study. A rapid diagnostic test for GABHS was performed before initiating therapy, and positive results were confirmed by pharyngotonsillar culture. Patients were randomly assigned to receive oral clindamycin 300 mg BID or oral amoxicillin/clavulanic acid 1 g BID for 10 days. Culture was repeated on day 12. The primary study end points were clinical and bacteriologic efficacy assessed on day 12, and clinical and bacteriologic recurrence rates assessed at a visit taking place up to 3 months after the completion of treatment. Tolerability was the secondary end point. RESULTS: Seven hundred seventy-four patients with acute, recurrent GABHS pharyngotonsillitis were enrolled in the study (mean age, 28 years; age range, 12-60 years). Five hundred forty-two patients (272 clindamycin, 270 amoxicillin/clavulanic acid) were clinically evaluable at day 12. Four hundred ninety-four patients were bacteriologically evaluable, and the safety population included 772 patients. There were no significant differences between groups at baseline. In terms of clinical efficacy at day 12, 252/272 (92.6%) patients in the clindamycin group and 230/270 (85.2%) patients in the amoxicillin/clavulanic acid group were considered cured (P < 0.003). At day 12, bacteriologic eradication was achieved in 237/242 (97.9%) and 238/252 (94.4%) patients in the respective treatment groups (P = NS). No clinical response was observed in the absence of bacteriologic eradication. At 3-month follow-up, clinical cure was achieved in 267/280 (95.4%) patients in the clindamycin group and 267/280 (95.7%) patients in the amoxicillin/clavulanic acid group (P = NS); bacteriologic eradication was observed in 235 (99.2%) and 237 (99.6%) of the respective treatment groups (P = NS). Both treatments were well tolerated. Adverse events were reported in 53/384 (13.8%) patients in the clindamycin group and 41/390 (10.5%) patients in the amoxicillin/clavulanic acid group. The most commonly reported adverse events involved the digestive system (mainly diarrhea), occurring in 33 (8.6%) and 22 (5.6%) patients in the respective treatment groups. CONCLUSIONS: In this study in patients with acute recurrent GABHS pharyngotonsillitis, oral clindamycin 300 mg BID and oral amoxicillin/clavulanic acid 1 g BID achieved comparable rates of bacteriologic eradication at 12 days and 3 months and comparable clinical cure rates at 3 months. Patients who received clindamycin had significantly greater clinical cure rates at 12 days. Both regimens were well tolerated. [ABSTRACT FROM AUTHOR]

Background: The Epworth Sleepiness Scale (ESS), Sleep Apnea Scale of Sleep Disorders Questionnaire (SA-SDQ), and Pittsburgh Sleep Quality Index (PSQI) are widely used in English speaking countries for sleep problem screening. However, there is no officially validated Thai-version of sleep questionnaires available., Objective: To provide standard Thai version of three sleep questionnaires and find cut-off level to screening sleep problems in Thai population., Material and Method: We used Mapi Research Institute Methods for translation from original language to Thai questionnaire. Then, test-retest reliability analysis was performed. Finally, we collected data from patients who underwent polysomnography in Phramongkutklao Sleep Lab Centre between June and August 2011. Cut-off value to screen population at risk for sleep-related disorder was researched., Results: The questionnaires were translated with very good inter-rater agreement. Cut-off of ESS, SA-SDQ, and PSQI suggested sleep disorders would be 9, 27, and 6.5 respectively., Conclusion: Sleep disorder questionnaires including ESS, SA-SDQ, and PSQI were translated into Thai with high validity, reliability, and accuracy.

Background: Nowadays, there are many methods to reduce microorganisms in the air, such as dehumidifier, air purifier or humidity and temperature controller. The Precise Climate Controller is an instrument for controlling humidity and temperature, a concept that is demonstrated., Objective: To determine the efficacy of this device, in order to reduce the quantity of the fungi and bacteria in the closed system., Methods: This study is a perspective experimental study and is conducted as follows - the air sample in the closed system, a 42-cubic-meter room, is collected before the installation of the Precise Climate Controller. Next, the room is fumed with Aspergillus flavus and closed for 2 days. Then the instrument is in use in order to keep the relative humidity (RH) and the temperature constant at 55% RH and 25 degrees Celsius (℃). The air samples are collected every 3 days for 5 times during the period of 15 days to identify the type and calculate the quantity of the microorganisms., Results: Before the Precise Climate Controller has been installed. Three species of bacteria are found in the air samples, but none of the fungus exists in the testing room. Once the room has been fumed with a large amount of A. flavus and the instrument is in use for 3 days, nine colonies of A. flavus are identified, but later on when the instrument is in use for 6, 9, 12, and 15 days, the air samples contain neither fungus nor bacteria., Conclusion: After keeping the RH and temperature of the closed system constant at 55% RH and 25℃ by using the Precise Climate Controller, it is found that the efficaciousness in controlling the quantity and species of fungi and bacteria is clinically significant.

Objective: The present study aimed to evaluate the efficacy of tonsillectomy with UPPP and tongue base surgery in the treatment of moderate to severe OSA., Study Design: The present study employed a cross sectional design among 18 OSA patients undergoing surgery by a single surgeon from 2005 to 2009. The follow-up period was 25 to 37 months. Data included BMI, ESS and full night PSG recorded to compare pre- and post-operation., Results: In all, 14 of 18 patients (77.8%) carried out the reduction of AHI 50% or lower than 20, postoperatively, defined as the success group. Mean ESS was decreased from 11.11 to 4.77 (p < 0.001). Most patients were satisfied with their postoperative results and reduction of subjective symptoms., Conclusion: A combined surgery in moderate and severe OSA had a surgical success rate of 77.8% in short and long term pos-toperation.

Objective: To compare two-hour daytime polysomnography (DPSG) and overnight polysomnography (ONPSG) (as the gold standard) in screening for high risk snorers., Study Design: Descriptive study (diagnostic test)., Setting: Snoring Clinic, Phramongkutklao Hospital., Material and Method: The present study was carried out among patients attending the Snoring clinic at Phramongkutklao hospital from September 2005 to February 2006 who had high risk of sleep apnea (pre-test) and scheduled for overnight PSG. Additionally, subjects were willing to take a two-hour daytime polysomnography. Both tests were performed less than two months apart. Each case was assessed using the Epworth sleepiness scale (ESS) > or = 8/24 and/or BMI > or = 27.5 kg/sqm as criteria to define as high risk snorer. After performing polysomnography, the subjects were categorized as high risk obstructive sleep apnea syndrome (OSAS, AHI > or = 20/hour) and low risk OSAS (AHI < 20/hour). Regarding snoring sound, subjects were divided into three groups: mild, moderate and severe., Results: Fifty subjects, 33 males and 17females, were enrolled in the present study. Two males were excluded due to a daytime PSG recording less than two hours. The mean age was 48.3 +/- 10.64 years (22-65), mean BMI was 27.69 +/- 3.95 kg/sqm (22.5-36.9) and ESS 10.56 +/- 2.25/24. The mean AI and AHI for daytime PSG vs. overnight PSG were 24.31 +/- 21.36, 28.30 +/- 21.44 vs. 22.39 +/- 20.43 and 25.30 +/- 20.91 respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of daytime PSG compared with overnight PSG were 92%, 91.3%, 92% and 91.3% respectively. The agreement of snoring during day and night (K-value) was 0.716 +/- 0.1 (p = 0.03)., Conclusion: Sleep parameters (AI, AHI) for daytime PSG had high sensitivity, specificity, PPV and NPV compared with standard overnight PSG. These can be used as reliable screening tests for high risk snorers and also be used to assess the outcome of OSAS patients undergoing surgical intervention.

Objectives: This study was undertaken to seek the correlation between tonsillar core and tonsillar crypt cultures and study the incidence of beta- lactamase producing bacteria (BLPB) in chronic tonsillitis patients., Material and Method: The study was carried out in Department of Otolaryngology from Feb 2000 to Dec 2001. Patients with chronic tonsillitis who underwent tonsillectomy were enrolled, and culture results from tonsillar crypts were compared with tonsillar core., Results: The tonsil were removed from 61 patients. Age ranging from 2-14 years (n=21) and 15-50 years (N= 40); H. influenza (25.2%), S. aureus (23.4%), and S. viridian (11.3%) were isolated from tonsillar core, while 25.9% and 24% of organisms isolated from tonsillar crypt were H. influenza and S. aurieus, respectively. Correlations between tonsillar core and tonsillar crypt culture were 100% specificity for Group A beta hemolytic streptococcocus (GABHS), 86.2% for H. influenza and 81.5% for S. aureus. Regarding beta-lactamase production, 29.2% of H. influenza were beta lactamase producing bacteria (BLPB), while 88.9% of S. aureus were BLPB., Conclusion: The present study demonstrates a high correlation in cultures obtained from tonsillar crypt and tonsillar core. The difference in isolated technique may account for the higher correlation when compared to previous studies. The incidence of beta- lactamase producing bacteria in chronic tonsillitis was high.

The aim of this study was to determine the aeroallergen sensitivity of allergic rhinitis patients. A total of 100 cases (female: 59, male: 41, aged between 10-59 years, mean age 27.9 years) who were diagnosed with allergic rhinitis by history and clinical presentation, underwent a prick skin test with 30 aeroallergens, and the important sensitizing allergens were assessed. Skin test reactivity showing > or = 3 mm wheal with erythema as the positive skin test, was recorded. The results of patients with positive skin tests follow. TREES: acacia 19%, mango 16%, coconut 12%. GRASSES: bermuda 17%, johnson 21%, timothy 16%, bahia 16% orchard 18%. WEEDS: pigweed 16%, kochia 14%. MOLDS: alternaria 11%, cladosporium 11%, aspergillus 12%, penicillium 16%, helminthosporium 16%, botrytis 15%, rhodotorula 20%, fusarium 26%, curvularia 26%, smut mix 11%, rust 9%. EPIDERMALS: cat 29%, dog 28%, feathers 37%. INDOOR ALLERGENS: house dust 72%, D. pteronyssinus 76%, D. farinae 79%, American cockroach 60%, German cockroach 41%, kapok 30%. Eighty-five percent of patients sensitive to house dust mites were positive to both D. pteronyssinus and D. farinae, indicating substantial cross-reactivity. The study shows that the house dust mite and the cockroach are important aeroallergen sensitizers among the Thai population, since more than half the patients were skin-test positive to the house dust mite and the cockroach.

Mucocillary clearance of nasal mucosa was evaluated with the saccharin test. A total of 140 subjects was divided into 4 groups: smokers, allergic rhinitis patients, sinusitis patients, and a normal control group. The mean mucociliary transit time for the normal control group (n = 40) was 12 minutes, while allergic rhinitis patients (n = 40) had a mean of 14.6 minutes. The smoker group (n = 40) could be further divided into the following subcategories: (a) those who had been smoking for less than 5 years (n = 10) had a mean of 15.2 minutes, (b) those who had been smoking for more than 5 years at less than one-pack a day (n = 11) had a mean of 14 minutes, and (c) those who had been smoking for more than 5 years at more than one-pack a day (n = 19) had a mean of 16.5 minutes. For the sinusitis patients (n = 20) the mean was 16.6 minutes. The study shows that sinusitis patients, along with those smokers who had been smoking for more than 5 years at more than one-pack a day, had a mucocillary transit time that was considered to be prolonged when compared to the normal control group (p < 0.05).