Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13878
Background: Tacrolimus (Tac) has been widely used with other immunosuppressive agents to prevent graft rejection post-kidney transplantation. However, the usage of Tac has depended on experience rather than evidence-based methods. In the present study, the authors investigated the Tac usage patterns and outcomes in kidney-transplanted patients at a transplant center located in the North of Vietnam. Materials and Methods: A retrospective cross-sectional study was conducted. Patients were included if they underwent renal transplantation, received Tac as part of the immunosuppressive therapy, and had been followed up in Viet Duc Hospital during the period between February 2009 and February 2019. Excluded patients were those who did not use Tac or switched to another drug during treatment. Results: The number of followed up patients steadily decreased from 342 cases in the first six months to 281 cases in the second year, 217 in the third year, 185 in the fourth year, and 152 in the fifth year post-transplanted. Only 17 cases had a ten-year follow-up. The number of transplants from deceased donors at 9.6% was much lower than live donors at 90.4%. Three patients died through the five years of the follow-up due to causes unrelated to kidney transplantation. Ten cases were ABO-incompatible transplantations. The mean blood concentration of Tac was highest in the first six months with 10.6 ng/mL, then gradually dropped to the lowest value at 6.3 ng/mL in the fifth year. Seven cases were identified as graft rejection with no clear outcome. Conclusion: Although there were a lack of standard tests and facilities for taking care of kidney transplant patients, the intra-patient variability and Tac concentration of included patients in the author’s center were close to the international studies in developed countries in five years follow-up. Keywords: Tacrolimus; Transplantation; Kidney; Vietnam
{"title":"Experience of Tacrolimus Usage in Kidney Transplant Vietnamese Patients","authors":"","doi":"10.35755/jmedassocthai.2023.08.13878","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13878","url":null,"abstract":"Background: Tacrolimus (Tac) has been widely used with other immunosuppressive agents to prevent graft rejection post-kidney transplantation. However, the usage of Tac has depended on experience rather than evidence-based methods. In the present study, the authors investigated the Tac usage patterns and outcomes in kidney-transplanted patients at a transplant center located in the North of Vietnam.\u0000\u0000Materials and Methods: A retrospective cross-sectional study was conducted. Patients were included if they underwent renal transplantation, received Tac as part of the immunosuppressive therapy, and had been followed up in Viet Duc Hospital during the period between February 2009 and February 2019. Excluded patients were those who did not use Tac or switched to another drug during treatment.\u0000\u0000Results: The number of followed up patients steadily decreased from 342 cases in the first six months to 281 cases in the second year, 217 in the third year, 185 in the fourth year, and 152 in the fifth year post-transplanted. Only 17 cases had a ten-year follow-up. The number of transplants from deceased donors at 9.6% was much lower than live donors at 90.4%. Three patients died through the five years of the follow-up due to causes unrelated to kidney transplantation. Ten cases were ABO-incompatible transplantations. The mean blood concentration of Tac was highest in the first six months with 10.6 ng/mL, then gradually dropped to the lowest value at 6.3 ng/mL in the fifth year. Seven cases were identified as graft rejection with no clear outcome.\u0000\u0000Conclusion: Although there were a lack of standard tests and facilities for taking care of kidney transplant patients, the intra-patient variability and Tac concentration of included patients in the author’s center were close to the international studies in developed countries in five years follow-up.\u0000\u0000Keywords: Tacrolimus; Transplantation; Kidney; Vietnam","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87484183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13877
Background: Neonatal seizure is an emergency condition that affects neurodevelopment and mortality. The appropriate treatment and seizure termination is crucial. Previous studies determined the efficacy of different types of antiseizure medications (ASMs), but there is no consensus toward second-line ASMs in neonatal seizure. Objective: To compare the efficacy of second-line ASMs in neonatal seizure, compared between levetiracetam and phenytoin. Materials and Methods: The present study was a retrospective study. The author recruited patients with diagnosis of neonatal seizure admitted at Maharat Nakhon Ratchasima Hospital, Thailand, between January 1, 2018 and December 31, 2020. Patients who had clinical seizure refractory and were given first-line ASM (intravenous phenobarbital) and received second-line ASMs as intravenous levetiracetam or intravenous phenytoin were included. Etiologies of seizure, seizure types, and other demographic data were recorded. The efficacy of levetiracetam and phenytoin were determined by comparing the duration of seizure, the need for third-line ASMs, and morbidity as developmental outcome, diagnosis of cerebral palsy, and mortality rate. Results: Twenty-five patients (68% male) were recruited. Sixty-four percent were diagnosed with hypoxic ischemic encephalopathy (HIE). The most common seizure type was subtle seizure at 56%. Levetiracetam was given to 56% and phenytoin was given to 44% as second-line ASMs. The duration of seizure was significantly different at 28.12 minutes in levetiracetam and 42.72 minutes in phenytoin (p=0.01). The drug adherence was higher in the levetiracetam group. Regarding third-line ASMs, 28.7% of the levetiracetam group and 45.45% of phenytoin group needed third-line ASMs, but this was not statistically significant. Mortality was 20% and 48% were diagnosed as cerebral palsy. There was no significant difference in mortality and morbidity between the two groups. Conclusion: Levetiracetam had no superior efficacy than phenytoin in neonatal seizure. Keywords: Neonatal seizure; Levetiracetam; Phenytoin; Efficacy
{"title":"Efficacy of Levetiracetam versus Phenytoin in Neonatal Seizure in Rural Area of Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.08.13877","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13877","url":null,"abstract":"Background: Neonatal seizure is an emergency condition that affects neurodevelopment and mortality. The appropriate treatment and seizure termination is crucial. Previous studies determined the efficacy of different types of antiseizure medications (ASMs), but there is no consensus toward second-line ASMs in neonatal seizure.\u0000\u0000Objective: To compare the efficacy of second-line ASMs in neonatal seizure, compared between levetiracetam and phenytoin.\u0000\u0000Materials and Methods: The present study was a retrospective study. The author recruited patients with diagnosis of neonatal seizure admitted at Maharat Nakhon Ratchasima Hospital, Thailand, between January 1, 2018 and December 31, 2020. Patients who had clinical seizure refractory and were given first-line ASM (intravenous phenobarbital) and received second-line ASMs as intravenous levetiracetam or intravenous phenytoin were included. Etiologies of seizure, seizure types, and other demographic data were recorded. The efficacy of levetiracetam and phenytoin were determined by comparing the duration of seizure, the need for third-line ASMs, and morbidity as developmental outcome, diagnosis of cerebral palsy, and mortality rate.\u0000\u0000Results: Twenty-five patients (68% male) were recruited. Sixty-four percent were diagnosed with hypoxic ischemic encephalopathy (HIE). The most common seizure type was subtle seizure at 56%. Levetiracetam was given to 56% and phenytoin was given to 44% as second-line ASMs. The duration of seizure was significantly different at 28.12 minutes in levetiracetam and 42.72 minutes in phenytoin (p=0.01). The drug adherence was higher in the levetiracetam group. Regarding third-line ASMs, 28.7% of the levetiracetam group and 45.45% of phenytoin group needed third-line ASMs, but this was not statistically significant. Mortality was 20% and 48% were diagnosed as cerebral palsy. There was no significant difference in mortality and morbidity between the two groups.\u0000\u0000Conclusion: Levetiracetam had no superior efficacy than phenytoin in neonatal seizure.\u0000\u0000Keywords: Neonatal seizure; Levetiracetam; Phenytoin; Efficacy","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80370707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13817
Background: Ameloblastoma is a benign, locally aggressive neoplasm eliciting frequent relapse and morbidity. Based on many updates, there is an introduction of the World Health Organization (WHO) 2017 Classification in which the terminology has been modified and re-categorized. Objective: To study natural courses, the clinicopathological characteristics, and rate of recurrence of ameloblastoma patients in Siriraj Hospital. Materials and Methods: The H&E stained slides of 122 patients diagnosed with ameloblastoma between 2006 and 2019 at Siriraj Hospital were reviewed and re-classified according to the WHO 2017 Classification. The natural course of disease and the clinicopathological characteristics were analyzed. A descriptive statistical analysis was used to calculate the frequency and percentages of different variables. Results: There were 86.9% of the cases being conventional ameloblastomas, whilst the predominant histologic pattern being the follicular pattern. The treatment of choice is excision. Recurrence of ameloblastoma is thought to be the consequence of several risk factors, clinicoradiological characteristics of the tumor, anatomical locations, treatments of choice, tumoral behavior, and tumor subtypes in particular. Thirty cases presented with recurrence, of which 83.3% were conventional ameloblastomas. Most of the cases were treated with radical treatment and have free surgical resection margins. Conclusion: The clinicopathological characteristics and natural course of ameloblastoma patients in Siriraj Hospital corresponds to the WHO Classification. The present study demonstrated a high recurrence rate in patients treated with conservative surgery. Thus, the authors agree with the WHO 2017 Classification that radical surgery is recommended for patients with a history of recurrence and some specific subtypes of ameloblastomas. Keywords: Ameloblastoma; Mandible; Neoplasm; Odontogenic tumors; Oral pathology
{"title":"Ameloblastoma in Siriraj Hospital: A 14-Year Retrospective Analysis of Clinicopathological Characteristics Correlating to the WHO 2017 Classification","authors":"","doi":"10.35755/jmedassocthai.2023.08.13817","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13817","url":null,"abstract":"Background: Ameloblastoma is a benign, locally aggressive neoplasm eliciting frequent relapse and morbidity. Based on many updates, there is an introduction of the World Health Organization (WHO) 2017 Classification in which the terminology has been modified and re-categorized.\u0000\u0000Objective: To study natural courses, the clinicopathological characteristics, and rate of recurrence of ameloblastoma patients in Siriraj Hospital.\u0000\u0000Materials and Methods: The H&E stained slides of 122 patients diagnosed with ameloblastoma between 2006 and 2019 at Siriraj Hospital were reviewed and re-classified according to the WHO 2017 Classification. The natural course of disease and the clinicopathological characteristics were analyzed. A descriptive statistical analysis was used to calculate the frequency and percentages of different variables.\u0000\u0000Results: There were 86.9% of the cases being conventional ameloblastomas, whilst the predominant histologic pattern being the follicular pattern. The treatment of choice is excision. Recurrence of ameloblastoma is thought to be the consequence of several risk factors, clinicoradiological characteristics of the tumor, anatomical locations, treatments of choice, tumoral behavior, and tumor subtypes in particular. Thirty cases presented with recurrence, of which 83.3% were conventional ameloblastomas. Most of the cases were treated with radical treatment and have free surgical resection margins.\u0000\u0000Conclusion: The clinicopathological characteristics and natural course of ameloblastoma patients in Siriraj Hospital corresponds to the WHO Classification. The present study demonstrated a high recurrence rate in patients treated with conservative surgery. Thus, the authors agree with the WHO 2017 Classification that radical surgery is recommended for patients with a history of recurrence and some specific subtypes of ameloblastomas.\u0000\u0000Keywords: Ameloblastoma; Mandible; Neoplasm; Odontogenic tumors; Oral pathology","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86558346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13880
Background: Children with poor reading ability may be at risk of early mental health problems. Objective: To determine an association between poor reading ability and generalize anxiety, school avoidance and depression among pupils in early school years. Materials and Methods: The cross-sectional study was conducted in 1,038 pupils studying in Grade 2 in 8 primary schools in Thailand. All pupils were individually assessed in their reading abilities by the Thai Standard Reading Tests. Generalized anxiety disorder and significant school avoidance were screened by using the Thai version of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Depression was screened by using the Thai version of the Short Mood and Feelings Questionnaire (SMFQ). Results: A total of 877 pupils completed the tests. The mean age was 7.0 years (SD 0.4 years). The prevalence of generalized anxiety disorder, significant school avoidance, and depression were 18.4% (95% CI 15.8 to 20.9), 32.2% (95% CI 29.1 to 35.3), and 36.0% (95% CI 32.9 to 39.2), respectively. Poor reading ability was significantly associated with school avoidance with the odds ratio of 2.2 (95% CI 1.5 to 3.3, p<0.001) and depression with the odds ratio of 1.8 (95% CI 1.2 to 2.6, p=0.005), but was not significantly associated with generalized anxiety disorder. Conclusion: Poor reading ability was associated with school avoidance and depression in early school years. Emotional problems should be screened early in those with poor reading ability. Keywords: Poor reading ability; Anxiety; Depression; School avoidance; Mental health
背景:阅读能力差的儿童可能存在早期心理健康问题的风险。目的:探讨学龄期小学生阅读能力差与泛化焦虑、逃学和抑郁的关系。材料与方法:以泰国8所小学的1038名二年级学生为研究对象进行横断面研究。所有学生的阅读能力都通过泰国标准阅读测试进行了单独评估。使用泰国版儿童焦虑相关情绪障碍筛查(SCARED)对广泛性焦虑障碍和显著的学校回避进行筛查。使用泰国版的简短情绪和感觉问卷(SMFQ)筛选抑郁症。结果:共有877名学生完成了测试。平均年龄7.0岁(SD 0.4岁)。广泛性焦虑障碍、明显的逃学和抑郁的患病率分别为18.4% (95% CI 15.8至20.9)、32.2% (95% CI 29.1至35.3)和36.0% (95% CI 32.9至39.2)。阅读能力差与逃学显著相关，比值比为2.2 (95% CI 1.5 ~ 3.3, p<0.001)，与抑郁显著相关，比值比为1.8 (95% CI 1.2 ~ 2.6, p=0.005)，但与广泛性焦虑障碍无显著相关。结论:阅读能力差与学龄期学生逃避学校和抑郁有关。阅读能力差的孩子应该及早发现情绪问题。关键词:阅读能力差;焦虑;抑郁症;学校回避;心理健康
{"title":"Depression, Generalize Anxiety Disorder, and School Avoidance in Early School Years in Pupils with Poor Reading Ability","authors":"","doi":"10.35755/jmedassocthai.2023.08.13880","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13880","url":null,"abstract":"Background: Children with poor reading ability may be at risk of early mental health problems.\u0000\u0000Objective: To determine an association between poor reading ability and generalize anxiety, school avoidance and depression among pupils in early school years.\u0000\u0000Materials and Methods: The cross-sectional study was conducted in 1,038 pupils studying in Grade 2 in 8 primary schools in Thailand. All pupils were individually assessed in their reading abilities by the Thai Standard Reading Tests. Generalized anxiety disorder and significant school avoidance were screened by using the Thai version of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Depression was screened by using the Thai version of the Short Mood and Feelings Questionnaire (SMFQ).\u0000\u0000Results: A total of 877 pupils completed the tests. The mean age was 7.0 years (SD 0.4 years). The prevalence of generalized anxiety disorder, significant school avoidance, and depression were 18.4% (95% CI 15.8 to 20.9), 32.2% (95% CI 29.1 to 35.3), and 36.0% (95% CI 32.9 to 39.2), respectively. Poor reading ability was significantly associated with school avoidance with the odds ratio of 2.2 (95% CI 1.5 to 3.3, p<0.001) and depression with the odds ratio of 1.8 (95% CI 1.2 to 2.6, p=0.005), but was not significantly associated with generalized anxiety disorder.\u0000\u0000Conclusion: Poor reading ability was associated with school avoidance and depression in early school years. Emotional problems should be screened early in those with poor reading ability.\u0000\u0000Keywords: Poor reading ability; Anxiety; Depression; School avoidance; Mental health","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88108959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13875
Objective: The preferred choice of anesthesia for cesarean delivery is spinal block, which has a failure rate of 0.5% to 17.0%. The present study investigated the incident rate of second choice of anesthesia following a failed block, as well as the factors influencing the anesthesiologist’s selection. Materials and Methods: A single-center, retrospective cross-sectional study was conducted using electronic medical records of parturients who had experienced a failed spinal block for cesarean deliveries between 2014 and 2019. Each rate of repeated spinal block and the conversion to general anesthesia were calculated. Factors associated with the decision-making were examined, and maternal and neonatal outcomes were reviewed. Results: Three hundred four women were recruited. The rates of repeated block and conversion to general anesthesia were 81.2% and 18.8%, respectively. Dural puncture with more than one attempt (p=0.022) and anesthesia level at the thoracic dermatome (p<0.001) were associated with a lower decision to repeat the block. Maternal in the repeated block group had a higher incidence of hypotension at 59.5% (p<0.001) and shivering at 16.2% (p=0.008). Neonates in the repeat block group had a lower incidence of any complications than those in the conversion to general anesthesia group at 4% versus 29.8% (p<0.001). Conclusion: Following an unsuccessful spinal block for cesarean section, the repeated block was still preferred. The level of anesthesia and the spinal attempts were the significant factors in this choice. Keywords: Cesarean delivery; Conversion to general anesthesia; Failed spinal block; Maternal and neonatal outcomes; Repeat block
{"title":"The Choice of Anesthesia after First Failed Spinal Block and Its Impact on Maternal and Neonatal Outcomes in Cesarean Delivery: A Cross-Sectional Study","authors":"","doi":"10.35755/jmedassocthai.2023.08.13875","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13875","url":null,"abstract":"Objective: The preferred choice of anesthesia for cesarean delivery is spinal block, which has a failure rate of 0.5% to 17.0%. The present study investigated the incident rate of second choice of anesthesia following a failed block, as well as the factors influencing the anesthesiologist’s selection.\u0000\u0000Materials and Methods: A single-center, retrospective cross-sectional study was conducted using electronic medical records of parturients who had experienced a failed spinal block for cesarean deliveries between 2014 and 2019. Each rate of repeated spinal block and the conversion to general anesthesia were calculated. Factors associated with the decision-making were examined, and maternal and neonatal outcomes were reviewed.\u0000\u0000Results: Three hundred four women were recruited. The rates of repeated block and conversion to general anesthesia were 81.2% and 18.8%, respectively. Dural puncture with more than one attempt (p=0.022) and anesthesia level at the thoracic dermatome (p<0.001) were associated with a lower decision to repeat the block. Maternal in the repeated block group had a higher incidence of hypotension at 59.5% (p<0.001) and shivering at 16.2% (p=0.008). Neonates in the repeat block group had a lower incidence of any complications than those in the conversion to general anesthesia group at 4% versus 29.8% (p<0.001).\u0000\u0000Conclusion: Following an unsuccessful spinal block for cesarean section, the repeated block was still preferred. The level of anesthesia and the spinal attempts were the significant factors in this choice.\u0000\u0000Keywords: Cesarean delivery; Conversion to general anesthesia; Failed spinal block; Maternal and neonatal outcomes; Repeat block","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79010189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13865
Background: Institutionalized older adults tend to experience higher levels of impaired health conditions compared to older persons living in the community. Healthy ageing is a global objective, however, there is limited knowledge about promoting healthy ageing specifically among older persons in social welfare homes. Objective: To examine the prevalence and factors associated with healthy ageing among institutionalized older adults in government social welfare home for older persons (GSWHOP) in the complex societies of the Southern region of Thailand. Materials and Methods: The present study was an analytical cross-sectional study that included 126 older participants aged 60 years or older capable of self-help activities. The present study defined healthy ageing as having independent physical function, good mental health status with no depression, normal nutrition status, and good quality of life. Results: Approximately 33.3% of the older residents who were capable of self-help activities achieved healthy ageing. There was no significant difference in the prevalence of healthy ageing between men at 36.2% and women at 30.9% (p>0.05). After controlling for other covariates, the present study found that factors such as length of institutional stay, knowledge of health promotion behavior (HPB), perceived stress, received HPB related information, and exercise were significantly associated with healthy ageing (p<0.05 to p<0.001). Conclusion: The present study revealed that approximately one in three institutionalized older residents in southern Thailand met the criteria for healthy ageing. The findings indicate the importance of social welfare staff, administrators, and policymakers in implementing effective solutions. These include providing practical knowledge of HPBs, promoting regular exercise, and implementing stress management strategies for institutionalized older adults. Targeting individuals after their first year of institutional stay is crucial. These measures can improve the health and well-being of institutionalized older adults in the region. Keywords: Healthy ageing; Institutionalized older adults; Health promotion behaviors; Educational and ecological factors; Quality of life; Southern Thailand
{"title":"Healthy Ageing and Associated Factors among the Older Adults Living in Government Social Welfare Home for Older Persons in Southern Thailand: An Analytical Cross-Sectional Study","authors":"","doi":"10.35755/jmedassocthai.2023.08.13865","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13865","url":null,"abstract":"Background: Institutionalized older adults tend to experience higher levels of impaired health conditions compared to older persons living in the community. Healthy ageing is a global objective, however, there is limited knowledge about promoting healthy ageing specifically among older persons in social welfare homes.\u0000\u0000Objective: To examine the prevalence and factors associated with healthy ageing among institutionalized older adults in government social welfare home for older persons (GSWHOP) in the complex societies of the Southern region of Thailand.\u0000\u0000Materials and Methods: The present study was an analytical cross-sectional study that included 126 older participants aged 60 years or older capable of self-help activities. The present study defined healthy ageing as having independent physical function, good mental health status with no depression, normal nutrition status, and good quality of life.\u0000\u0000Results: Approximately 33.3% of the older residents who were capable of self-help activities achieved healthy ageing. There was no significant difference in the prevalence of healthy ageing between men at 36.2% and women at 30.9% (p>0.05). After controlling for other covariates, the present study found that factors such as length of institutional stay, knowledge of health promotion behavior (HPB), perceived stress, received HPB related information, and exercise were significantly associated with healthy ageing (p<0.05 to p<0.001).\u0000\u0000Conclusion: The present study revealed that approximately one in three institutionalized older residents in southern Thailand met the criteria for healthy ageing. The findings indicate the importance of social welfare staff, administrators, and policymakers in implementing effective solutions. These include providing practical knowledge of HPBs, promoting regular exercise, and implementing stress management strategies for institutionalized older adults. Targeting individuals after their first year of institutional stay is crucial. These measures can improve the health and well-being of institutionalized older adults in the region.\u0000\u0000Keywords: Healthy ageing; Institutionalized older adults; Health promotion behaviors; Educational and ecological factors; Quality of life; Southern Thailand","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86255348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13876
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. Keywords: Effectiveness; Safety; Adverse events; Generic drug; Imipenem/cilastatin
{"title":"Effectiveness and Adverse Events of Generic and Original Imipenem/Cilastatin in Hospitalized Patients: The First Multicenter Non-Inferiority Study in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.08.13876","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13876","url":null,"abstract":"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.\u0000\u0000Materials 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.\u0000\u0000Results: 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%.\u0000\u0000Conclusion: 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.\u0000\u0000Keywords: Effectiveness; Safety; Adverse events; Generic drug; Imipenem/cilastatin","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85981842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13874
Background: Massive blood loss is the primary cause of immediate death in trauma patients. In prehospital care, where laboratory and investigation resources are limited, a massive blood transfusion (MBT) scoring system could activate blood bank preparation of blood components and facilitate EMS decision-making regarding the appropriate trauma center destination. This is particularly significant in urban environments where motor vehicle accidents are highly prevalent. Materials and Methods: A retrospective cohort study was conducted using data from prehospital trauma patients. Predictive parameters, including vital signs, mechanism of injury, and serious injury body parts, were analyzed, and the significant parameters identified by a multivariable analysis were used to develop a clinical scoring system. Discrimination was evaluated by the area under the receiver operating characteristic (AuROC) curve, calibration was demonstrated with the Hosmer-Lemeshow goodness of fit test, and internal validation was performed. Results: Among 511 trauma patients, 72 (14.1%) received MBT. The prehospital factors that significantly predicted massive MBT included hypotension with a SBP of less than 90 mmHg, penetrating object injuries, serious injuries to the face, thorax, abdomen, extremities including the pelvis, and the use of life-saving interventions such as advanced airway management and pelvic binding. The AuROC was 0.943 (95% CI 0.914 to 0.972, p<0.001). The probability of receiving massive transfusion was 94.79% in patients with score of 5 or higher. Conclusion: The prehospital MBT score demonstrates good performance and discrimination for predicting MBT using simple and rapidly obtainable parameters in a prehospital setting. Keywords: Massive transfusion; Massive bleeding; Prehospital care
背景:大量失血是创伤患者立即死亡的主要原因。在实验室和调查资源有限的院前护理中，大规模输血(MBT)评分系统可以激活血库准备血液成分，促进EMS对合适的创伤中心目的地的决策。这在机动车事故非常普遍的城市环境中尤为重要。材料和方法:采用院前创伤患者的资料进行回顾性队列研究。对生命体征、损伤机制、严重损伤部位等预测参数进行分析，并通过多变量分析识别出显著性参数，建立临床评分系统。采用受试者工作特征曲线下面积(AuROC)评价鉴别性，采用Hosmer-Lemeshow拟合优度检验进行标定，并进行内部验证。结果:511例外伤患者中，72例(14.1%)接受了MBT治疗。院前因素可显著预测大面积MBT，包括收缩压低于90 mmHg的低血压、穿透性物体损伤、面部、胸部、腹部、四肢(包括骨盆)的严重损伤，以及使用挽救生命的干预措施，如先进的气道管理和骨盆捆绑。AuROC为0.943 (95% CI 0.914 ~ 0.972, p<0.001)。5分及以上患者接受大量输血的概率为94.79%。结论:院前MBT评分在预测院前MBT方面具有良好的性能和判别性，使用简单、快速获得的参数。关键词:大量输血;大量出血;院前护理
{"title":"Development of Prehospital Factors for Predicting Massive Blood Transfusion in Trauma Patients","authors":"","doi":"10.35755/jmedassocthai.2023.08.13874","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13874","url":null,"abstract":"Background: Massive blood loss is the primary cause of immediate death in trauma patients. In prehospital care, where laboratory and investigation resources are limited, a massive blood transfusion (MBT) scoring system could activate blood bank preparation of blood components and facilitate EMS decision-making regarding the appropriate trauma center destination. This is particularly significant in urban environments where motor vehicle accidents are highly prevalent.\u0000\u0000Materials and Methods: A retrospective cohort study was conducted using data from prehospital trauma patients. Predictive parameters, including vital signs, mechanism of injury, and serious injury body parts, were analyzed, and the significant parameters identified by a multivariable analysis were used to develop a clinical scoring system. Discrimination was evaluated by the area under the receiver operating characteristic (AuROC) curve, calibration was demonstrated with the Hosmer-Lemeshow goodness of fit test, and internal validation was performed.\u0000\u0000Results: Among 511 trauma patients, 72 (14.1%) received MBT. The prehospital factors that significantly predicted massive MBT included hypotension with a SBP of less than 90 mmHg, penetrating object injuries, serious injuries to the face, thorax, abdomen, extremities including the pelvis, and the use of life-saving interventions such as advanced airway management and pelvic binding. The AuROC was 0.943 (95% CI 0.914 to 0.972, p<0.001). The probability of receiving massive transfusion was 94.79% in patients with score of 5 or higher.\u0000\u0000Conclusion: The prehospital MBT score demonstrates good performance and discrimination for predicting MBT using simple and rapidly obtainable parameters in a prehospital setting.\u0000\u0000Keywords: Massive transfusion; Massive bleeding; Prehospital care","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83435044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13873
Objective: Cancer and stroke are leading causes of morbidity and mortality in Thailand. The objectives of the present study were 1) to determine the incidence of ischemic stroke in cancer patients in Thailand, 2) to identify the cancer subtypes most associated with ischemic stroke, and 3) to compare the etiology of stroke in two groups of patients, those who had conventional risk factors for stroke and those without conventional risk factors or cryptogenic stroke. Materials and Methods: The present study was a retrospective descriptive study. The authors collected data on cancer patients hospitalized between 2008 and 2020 according to International Classification of Disease and Related Health Problem Tenth Revision (ICD-10) and identified the number of ischemic stroke patients and the cancer subtype for each patient. Risk factors for stroke were identified as conventional risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, smoking, and imaging evidence of atherosclerosis) and cryptogenic risk factors (none of the conventional risk factors). Results: Sixteen thousand six hundred forty-seven cancer patients were included in the present study and 85 of these patients were diagnosed with ischemic stroke. Therefore, the incidence of ischemic stroke in cancer patients was 0.51%. The cancer subtypes most often associated with ischemic stroke were thoracic as predominantly lung, lower gastrointestinal tract, and hepatobiliary cancer. Most patients (88.24%) had at least one conventional risk factor. Hypertension was the most common conventional risk factor. Cryptogenic stroke was found in 5.88% of the patients and 5.88% of the patients had insufficient data on risk factors. Conclusion: The incidence of ischemic stroke in Thai cancer patients is low. Lung cancer is the cancer type most associated with ischemic stroke. Most cancer patients with ischemic stroke had multiple vascular risk factors. Keywords: Stroke; Cancer; Incidence
{"title":"The Incidence of Ischemic Stroke in Cancer Patients in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.08.13873","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13873","url":null,"abstract":"Objective: Cancer and stroke are leading causes of morbidity and mortality in Thailand. The objectives of the present study were 1) to determine the incidence of ischemic stroke in cancer patients in Thailand, 2) to identify the cancer subtypes most associated with ischemic stroke, and 3) to compare the etiology of stroke in two groups of patients, those who had conventional risk factors for stroke and those without conventional risk factors or cryptogenic stroke.\u0000\u0000Materials and Methods: The present study was a retrospective descriptive study. The authors collected data on cancer patients hospitalized between 2008 and 2020 according to International Classification of Disease and Related Health Problem Tenth Revision (ICD-10) and identified the number of ischemic stroke patients and the cancer subtype for each patient. Risk factors for stroke were identified as conventional risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, smoking, and imaging evidence of atherosclerosis) and cryptogenic risk factors (none of the conventional risk factors).\u0000\u0000Results: Sixteen thousand six hundred forty-seven cancer patients were included in the present study and 85 of these patients were diagnosed with ischemic stroke. Therefore, the incidence of ischemic stroke in cancer patients was 0.51%. The cancer subtypes most often associated with ischemic stroke were thoracic as predominantly lung, lower gastrointestinal tract, and hepatobiliary cancer. Most patients (88.24%) had at least one conventional risk factor. Hypertension was the most common conventional risk factor. Cryptogenic stroke was found in 5.88% of the patients and 5.88% of the patients had insufficient data on risk factors.\u0000\u0000Conclusion: The incidence of ischemic stroke in Thai cancer patients is low. Lung cancer is the cancer type most associated with ischemic stroke. Most cancer patients with ischemic stroke had multiple vascular risk factors.\u0000\u0000Keywords: Stroke; Cancer; Incidence","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85107123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13881
Background: Diabetes Type 2 is chronic disease that can progress from simple hyperglycemia to severe complications. Many behavioral risks have been discovered for blood sugar prediction. Objective: To develop a simple behavioral risk scoring to predict well-controlled HbA1c level in diabetes type 2 patients. Materials and Methods: A total of 140 diabetes type 2 patients were recruited. Patients were interviewed about behavioral factors affecting blood sugar in three months retrospectively. To develop the risk score, risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk scoring scheme was developed from behavioral predictors: eating desserts and soft drinks, regular exercise and strict medication intake. The scoring scheme was applied in bootstrap internal validity test to test the model performance. Results: The scheme explained, by area under the receiver operating characteristic curve (AuROC), 91.6% (95% CI 0.87 to 0.96) of being good diabetic control (HbA1c ≤7%) with good calibration (Hosmer-Lemeshow χ²=3.61; p=0.61). The likelihood ratio of being good diabetic control (scores greater than or equal to 1) and poor diabetic control (score lower than 1) were 3.83 (95% CI 2.69 to 5.46) and 0.11 (95% CI 0.05 to 0.21), respectively. When applied in bootstrap internal validity test, the score showed good performance with AuROC 88.7% (95% CI 0.81 to 0.93). Conclusion: A simple and non-invasive scoring scheme of three predictors provides good prediction indices for being good and poor diabetic control patients. This scheme may help clinicians in order to take further appropriate action for diabetic control. Keywords: Diabetes type 2; HbA1c controlling level; Prediction; Risk scoring
背景:2型糖尿病是一种慢性疾病，可以从单纯的高血糖发展到严重的并发症。许多行为风险已被发现用于预测血糖。目的:建立一种简单的行为风险评分方法来预测2型糖尿病患者控制良好的HbA1c水平。材料与方法:共招募140例2型糖尿病患者。回顾性随访3个月，了解影响血糖的行为因素。为编制风险评分，采用logistic回归方法构建招聘时测量的风险指标。回归系数被转换成项目得分，并加起来成为总分。根据行为预测因素制定了风险评分方案:吃甜点和软饮料，定期锻炼和严格的药物摄入。将该计分方案应用于bootstrap内部效度检验，检验模型的性能。结果:通过受试者工作特征曲线下面积(AuROC)，该方案解释了91.6% (95% CI 0.87 ~ 0.96)的糖尿病控制良好(HbA1c≤7%)，校准良好(Hosmer-Lemeshow χ²=3.61;p = 0.61)。糖尿病控制良好(评分≥1)和糖尿病控制不良(评分低于1)的似然比分别为3.83 (95% CI 2.69 ~ 5.46)和0.11 (95% CI 0.05 ~ 0.21)。应用bootstrap内部效度检验时，得分的AuROC为88.7% (95% CI 0.81 ~ 0.93)。结论:简单、无创的三种预测指标评分方案为糖尿病控制好坏患者提供了较好的预测指标。该方案可以帮助临床医生采取进一步适当的措施来控制糖尿病。关键词:2型糖尿病;HbA1c控制水平;预测;风险评分
{"title":"Behavioral Risk Score for Predicting Well-Controlled HbA1c Level in Diabetes Type 2 Patients","authors":"","doi":"10.35755/jmedassocthai.2023.08.13881","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13881","url":null,"abstract":"Background: Diabetes Type 2 is chronic disease that can progress from simple hyperglycemia to severe complications. Many behavioral risks have been discovered for blood sugar prediction.\u0000\u0000Objective: To develop a simple behavioral risk scoring to predict well-controlled HbA1c level in diabetes type 2 patients.\u0000\u0000Materials and Methods: A total of 140 diabetes type 2 patients were recruited. Patients were interviewed about behavioral factors affecting blood sugar in three months retrospectively. To develop the risk score, risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk scoring scheme was developed from behavioral predictors: eating desserts and soft drinks, regular exercise and strict medication intake. The scoring scheme was applied in bootstrap internal validity test to test the model performance.\u0000\u0000Results: The scheme explained, by area under the receiver operating characteristic curve (AuROC), 91.6% (95% CI 0.87 to 0.96) of being good diabetic control (HbA1c ≤7%) with good calibration (Hosmer-Lemeshow χ²=3.61; p=0.61). The likelihood ratio of being good diabetic control (scores greater than or equal to 1) and poor diabetic control (score lower than 1) were 3.83 (95% CI 2.69 to 5.46) and 0.11 (95% CI 0.05 to 0.21), respectively. When applied in bootstrap internal validity test, the score showed good performance with AuROC 88.7% (95% CI 0.81 to 0.93).\u0000\u0000Conclusion: A simple and non-invasive scoring scheme of three predictors provides good prediction indices for being good and poor diabetic control patients. This scheme may help clinicians in order to take further appropriate action for diabetic control.\u0000\u0000Keywords: Diabetes type 2; HbA1c controlling level; Prediction; Risk scoring","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78480752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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