Pub Date : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13792
The author has informed the editor to correct the affliliation in the article as follow: Incorrect affliliation in the article: Sopatip Rerkmoung MD¹ Pornpun Angyureekul MD² Kwanyupa Sukonthamarn MD¹ ¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand ² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Correct affliliation: Sopatip Rerkmoung, MD¹,² Pornpun Angyureekul, MD² Kwanyupa Sukonthamarn, MD¹,² ¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand ² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
{"title":"Correction to: Developmental Outcomes after Rehabilitation in Pediatric Patients with Global Developmental Delay: A Retrospective Case-Control Study","authors":"","doi":"10.35755/jmedassocthai.2023.02.13792","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13792","url":null,"abstract":"The author has informed the editor to correct the affliliation in the article as follow:\u0000\u0000Incorrect affliliation in the article:\u0000Sopatip Rerkmoung MD¹\u0000Pornpun Angyureekul MD²\u0000Kwanyupa Sukonthamarn MD¹\u0000\u0000¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand\u0000² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand\u0000\u0000Correct affliliation:\u0000Sopatip Rerkmoung, MD¹,²\u0000Pornpun Angyureekul, MD²\u0000Kwanyupa Sukonthamarn, MD¹,²\u0000\u0000¹ Thai Red Cross Rehabilitation Center, Samut Prakan, Thailand\u0000² Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85805365","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13775
Background: Chronic limb-threatening ischemia (CLTI) represents the late stage of atherosclerotic peripheral arterial disease (PAD). Similar to atherosclerosis in other vascular beds, it is preceded by a long-standing early disease and pre-disposing conditions. Thus, the care of this patient population is theoretically best delivered by a multidisciplinary team. The authors studied the outcomes of a multidisciplinary, well-structured, and evidence-based protocol that might influence better outcomes for CLTI patients. Materials and Methods: The present study was a retrospective study done in a single center. Between January 2018 and December 2020, data were reviewed from CLTI patients that received the multidisciplinary, well-structured, and evidence-base protocol for the treatment of CLTI. The primary outcome was the perioperative clinical outcome of the patients. The secondary outcomes were the 1-year clinical outcome and the admission cost for vascular operation. Results: Two hundred thirty CLTI cases between January 2018 and December 2020 were retrospectively reviewed. Of the 230 cases, 87.9% were elderly (older than 60-years-old) with significant comorbidities including diabetes (74.3%) and hypertension (74.8%). The protocol implementation resulted in clinical outcomes in terms of both major adverse cardiac event (MACE) and major adverse limb event (MALE) at 1.3% and 6.52%, respectively. The survival rates at 1-and 2-years post-revascularization were 84.3% and 74.1%, and the 1-year follow-up MACE and MALE were 6.08% and 12.2%, respectively. Moreover, the protocol statistically improved the quality of life as measured by EuroQoL group-5 Dimensions-5 Levels (EQ-5D-5L) utility score. The median 1-year mean EQ-5D-5Q score increased from 0.332 to 0.863. The cost of the treatments was significantly higher with the increasing severities of CLTI. Conclusion: A multidisciplinary, well-structured, and evidence-based protocol may potentially be effective in improving the quality of care among CLTI patients, both in terms of clinical outcomes and overall health status. Keywords: Peripheral arterial disease (PAD); Chronic limb-threatening ischemia (CLTI); Multidisciplinary and evidence-based protocol
{"title":"Outcomes of Multidisciplinary and Evidence-Based Management of Chronic Limb Threatening Ischemia Patients: The Impacts of Protocol-Based Care Processes","authors":"","doi":"10.35755/jmedassocthai.2023.02.13775","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13775","url":null,"abstract":"Background: Chronic limb-threatening ischemia (CLTI) represents the late stage of atherosclerotic peripheral arterial disease (PAD). Similar to atherosclerosis in other vascular beds, it is preceded by a long-standing early disease and pre-disposing conditions. Thus, the care of this patient population is theoretically best delivered by a multidisciplinary team. The authors studied the outcomes of a multidisciplinary, well-structured, and evidence-based protocol that might influence better outcomes for CLTI patients.\u0000\u0000Materials and Methods: The present study was a retrospective study done in a single center. Between January 2018 and December 2020, data were reviewed from CLTI patients that received the multidisciplinary, well-structured, and evidence-base protocol for the treatment of CLTI. The primary outcome was the perioperative clinical outcome of the patients. The secondary outcomes were the 1-year clinical outcome and the admission cost for vascular operation.\u0000\u0000Results: Two hundred thirty CLTI cases between January 2018 and December 2020 were retrospectively reviewed. Of the 230 cases, 87.9% were elderly (older than 60-years-old) with significant comorbidities including diabetes (74.3%) and hypertension (74.8%). The protocol implementation resulted in clinical outcomes in terms of both major adverse cardiac event (MACE) and major adverse limb event (MALE) at 1.3% and 6.52%, respectively. The survival rates at 1-and 2-years post-revascularization were 84.3% and 74.1%, and the 1-year follow-up MACE and MALE were 6.08% and 12.2%, respectively. Moreover, the protocol statistically improved the quality of life as measured by EuroQoL group-5 Dimensions-5 Levels (EQ-5D-5L) utility score. The median 1-year mean EQ-5D-5Q score increased from 0.332 to 0.863. The cost of the treatments was significantly higher with the increasing severities of CLTI.\u0000\u0000Conclusion: A multidisciplinary, well-structured, and evidence-based protocol may potentially be effective in improving the quality of care among CLTI patients, both in terms of clinical outcomes and overall health status.\u0000\u0000Keywords: Peripheral arterial disease (PAD); Chronic limb-threatening ischemia (CLTI); Multidisciplinary and evidence-based protocol","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84127586","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13779
Objective: To collect and describe the clinical presentations of early-onset schizophrenia in a clinical setting. In addition, the authors aimed to compare the clinical presentations of early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS). Materials and Methods: A 10-year retrospective chart review of early-onset schizophrenia participants, both inpatients and outpatients, who received psychiatric treatments at Ramathibodi Hospital, Bangkok, Thailand between January 2011 and December 2020. Subjects were divided into two groups by age of onset symptoms, 1) EOS with onset between 13- to 18-years-old, and 2) VEOS with onset before 13-years-old. Descriptive statistics in term of frequency and percentage were used to describe clinical characteristics. Regarding the comparisons between groups, the differences were considered as statistically significant at the level of a p-value of less than 0.05. Results: Forty-one participants were analyzed. The VEOS subgroup included nine participants (22%) and EOS subgroup included 32 participants (78%). The age of symptom onset ranged from 7.9 to 17.7 years old, with a mean of 14.2 years old (SD 2.5 years). The diagnostic stability was 82.9%. Thirty-seven (90.2%) and 39 participants (95.1%) demonstrated delusion and auditory hallucination, respectively. Only 13 participants (31.7%) reported visual hallucination. Moreover, there were statistically significant differences between EOS and VEOS on gender, other psychiatric comorbidities apart from depressive disorders, and the number of other psychotropic medication classes apart from antipsychotic medications. The female predominance demonstrated in VEOS subgroup, while the male predominance was found in EOS subgroup. Conclusion: Although EOS was rare, the diagnostic stability of EOS was high. Auditory hallucination was the most common psychotic presentation reported in this population. The female predominance was demonstrated in the VEOS subgroup, while the male predominance was found in the EOS subgroup. Keywords: Early-onset schizophrenia; Childhood; Adolescence; Clinical presentations
{"title":"Clinical Presentations of Early-Onset Schizophrenia: A 10-Year Retrospective Chart Review","authors":"","doi":"10.35755/jmedassocthai.2023.02.13779","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13779","url":null,"abstract":"Objective: To collect and describe the clinical presentations of early-onset schizophrenia in a clinical setting. In addition, the authors aimed to compare the clinical presentations of early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS).\u0000\u0000Materials and Methods: A 10-year retrospective chart review of early-onset schizophrenia participants, both inpatients and outpatients, who received psychiatric treatments at Ramathibodi Hospital, Bangkok, Thailand between January 2011 and December 2020. Subjects were divided into two groups by age of onset symptoms, 1) EOS with onset between 13- to 18-years-old, and 2) VEOS with onset before 13-years-old. Descriptive statistics in term of frequency and percentage were used to describe clinical characteristics. Regarding the comparisons between groups, the differences were considered as statistically significant at the level of a p-value of less than 0.05.\u0000\u0000Results: Forty-one participants were analyzed. The VEOS subgroup included nine participants (22%) and EOS subgroup included 32 participants (78%). The age of symptom onset ranged from 7.9 to 17.7 years old, with a mean of 14.2 years old (SD 2.5 years). The diagnostic stability was 82.9%. Thirty-seven (90.2%) and 39 participants (95.1%) demonstrated delusion and auditory hallucination, respectively. Only 13 participants (31.7%) reported visual hallucination. Moreover, there were statistically significant differences between EOS and VEOS on gender, other psychiatric comorbidities apart from depressive disorders, and the number of other psychotropic medication classes apart from antipsychotic medications. The female predominance demonstrated in VEOS subgroup, while the male predominance was found in EOS subgroup.\u0000\u0000Conclusion: Although EOS was rare, the diagnostic stability of EOS was high. Auditory hallucination was the most common psychotic presentation reported in this population. The female predominance was demonstrated in the VEOS subgroup, while the male predominance was found in the EOS subgroup.\u0000\u0000Keywords: Early-onset schizophrenia; Childhood; Adolescence; Clinical presentations","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86824265","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13750
Background: Pregnancy-induced hypertension is one of the major causes of both maternal and fetal death. Calcium can be prescribed to prevent the development of pre-eclampsia among the population with low calcium intake. However, there are only a few research studies on the effect of calcium alone, the impact of calcium co-administrated with other medications, and the timing of prescription during pregnancy. Materials and Methods: The authors conducted a randomized, single-blind, controlled trial to evaluate the efficacy of high-dose calcium carbonate (CaCO₃) co-administrate with aspirin in women with moderate to high risk of developing pre-eclampsia in reducing the incidence of pre-eclampsia. All pregnant women at 12 to 28 weeks of gestation having a moderate to high risk of developing pre-eclampsia were randomly assigned to receive aspirin with CaCO₃ (3,750 mg/day), or aspirin with standard dose calcium carbonate (1,250 mg/day) until delivery or developed pre-eclampsia. Results: One hundred thirty women underwent randomization with 64 women in the CaCO₃ group and 66 women in the standard dose group. The incidence of pre-eclampsia was six cases in the high-dose group and eight cases in the controlled group (OR 0.8, 95% CI 0.3 to 2.6). The percentage of participants having adverse events related to high-dose and standard dose calcium carbonate did not differ significantly between the groups. Conclusion: The use of CaCO₃ at 3,750 mg/day, co-administrate with low-dose aspirin of 81 mg/day, starting at 12 to 28 weeks of gestation, resulted in a non-significantly difference in the incidence of pre-eclampsia with severe features. Keywords: Calcium carbonate; Pre-eclampsia; Prevention
{"title":"Calcium and Aspirin Supplementation for Prevention of Pre-eclampsia in Moderate to High-Risk Pregnancy: A Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.02.13750","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13750","url":null,"abstract":"Background: Pregnancy-induced hypertension is one of the major causes of both maternal and fetal death. Calcium can be prescribed to prevent the development of pre-eclampsia among the population with low calcium intake. However, there are only a few research studies on the effect of calcium alone, the impact of calcium co-administrated with other medications, and the timing of prescription during pregnancy.\u0000\u0000Materials and Methods: The authors conducted a randomized, single-blind, controlled trial to evaluate the efficacy of high-dose calcium carbonate (CaCO₃) co-administrate with aspirin in women with moderate to high risk of developing pre-eclampsia in reducing the incidence of pre-eclampsia. All pregnant women at 12 to 28 weeks of gestation having a moderate to high risk of developing pre-eclampsia were randomly assigned to receive aspirin with CaCO₃ (3,750 mg/day), or aspirin with standard dose calcium carbonate (1,250 mg/day) until delivery or developed pre-eclampsia.\u0000\u0000Results: One hundred thirty women underwent randomization with 64 women in the CaCO₃ group and 66 women in the standard dose group. The incidence of pre-eclampsia was six cases in the high-dose group and eight cases in the controlled group (OR 0.8, 95% CI 0.3 to 2.6). The percentage of participants having adverse events related to high-dose and standard dose calcium carbonate did not differ significantly between the groups.\u0000\u0000Conclusion: The use of CaCO₃ at 3,750 mg/day, co-administrate with low-dose aspirin of 81 mg/day, starting at 12 to 28 weeks of gestation, resulted in a non-significantly difference in the incidence of pre-eclampsia with severe features.\u0000\u0000Keywords: Calcium carbonate; Pre-eclampsia; Prevention","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73865282","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13772
The authors reported a rare case of ectopic atrial tachycardia (EAT) with reversible myocardial dysfunction associated with enterovirus 71 (EV71) infection. A previously healthy 11-year-old boy presented with progressive heart failure. An initial ECG revealed a regular narrow QRS tachycardia with abnormal P wave morphology. Echocardiography showed severely impaired left ventricular function (LVEF 20%). Viral study (PCR) in stool was positive for EV71. Treatment with inotropic support, amiodarone, and carvedilol resulted in gradual restoration of sinus rhythm over 10 days. Cardiac function returned to normal within three months. EV71 can cause EAT along with other complications and should be considered in patients with persistent tachycardia and cardiac dysfunction. Recognizing this arrhythmia led to proper management to control ventricular rate, then termination of the tachycardia and gradual restoration of ventricular function to normal. Keywords: Enterovirus 71; Ectopic atrial tachycardia; Myocardial dysfunction; Myocarditis; Heart failure
{"title":"Ectopic Atrial Tachycardia and Reversible Myocardial Dysfunction in a Child with Enterovirus 71 Infection: A Case Report","authors":"","doi":"10.35755/jmedassocthai.2023.02.13772","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13772","url":null,"abstract":"The authors reported a rare case of ectopic atrial tachycardia (EAT) with reversible myocardial dysfunction associated with enterovirus 71 (EV71) infection. A previously healthy 11-year-old boy presented with progressive heart failure. An initial ECG revealed a regular narrow QRS tachycardia with abnormal P wave morphology. Echocardiography showed severely impaired left ventricular function (LVEF 20%). Viral study (PCR) in stool was positive for EV71. Treatment with inotropic support, amiodarone, and carvedilol resulted in gradual restoration of sinus rhythm over 10 days. Cardiac function returned to normal within three months. EV71 can cause EAT along with other complications and should be considered in patients with persistent tachycardia and cardiac dysfunction. Recognizing this arrhythmia led to proper management to control ventricular rate, then termination of the tachycardia and gradual restoration of ventricular function to normal.\u0000\u0000Keywords: Enterovirus 71; Ectopic atrial tachycardia; Myocardial dysfunction; Myocarditis; Heart failure","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85447706","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13784
P. Chongtrakool, P. Wangleotsakulchai, T. Tabboon, H. Thuncharoon, C. Pummangura, D. Samretwit, T. Yungyuen, P. Khowwigkai, T. Suttisaewan, S. Srifuengfung
Objective: The impact of COVID-19 on the number and antibiogram profile of Salmonella was studied between January 2018 and December 2021. The present time period included years before the COVID-19 pandemic, which are 2018 and 2019, and during the pandemic, which are 2020 and 2021. Materials and Methods: Salmonella infections were classified into eight distinct serogroups using slide agglutination with specific antisera (A, B, C, D, E, F, G, and I). The susceptibility to antimicrobial agents were evaluated by the standard disk diffusion method. Results: Four hundred fifty-one isolates were detected (139 in 2018, 119 in 2019, 102 in 2021, and 91 in 2021). Salmonella infection decreased by 25.2% from 258 isolates in 2018 and 2019 to 193 in 2020 and 2021. When comparing Salmonella infections in different age groups (0 to 10, 11 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and older than 70 years), before and during COVID-19, statistical significance was noted only in patients aged 11 to 20 (p=0.016). For clinical specimens (stool, blood, urine, pus, etc.), statistical significance was found only in blood specimens (p=0.036). The four most predominant Salmonella serogroups were B (31.1%), C (30.6%), E (15.7%), and D (11.4%). S. Typhi was present in 2.1% (4/193) of Salmonella isolates during COVID-19. The findings of a susceptibility test using the disk diffusion method for four commonly used drugs in treatment of severe salmonellosis as ampicillin, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, before and during COVID-19 demonstrated statistical significance only in Salmonella serogroup D (p=0.028). Overall, drug susceptibility of Salmonella serogroup B, C, D, and E was ampicillin (range 15.1% to 55.9%), cefotaxime (range 66.7% to 100%), ciprofloxacin (range 18.8% to 59.1%), and trimethoprim/sulfamethoxazole (range 70.0% to 93.8%). Conclusion: The present study results suggested the importance of monitoring the prevalence of Salmonella at a hospital in Bangkok. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment. Keywords: Salmonella; COVID-19 pandemic; Thailand
{"title":"Isolation and Antibiotic Susceptibility Profile of Salmonella spp. from Patients in a Tertiary Care Hospital in Thailand","authors":"P. Chongtrakool, P. Wangleotsakulchai, T. Tabboon, H. Thuncharoon, C. Pummangura, D. Samretwit, T. Yungyuen, P. Khowwigkai, T. Suttisaewan, S. Srifuengfung","doi":"10.35755/jmedassocthai.2023.02.13784","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13784","url":null,"abstract":"Objective: The impact of COVID-19 on the number and antibiogram profile of Salmonella was studied between January 2018 and December 2021. The present time period included years before the COVID-19 pandemic, which are 2018 and 2019, and during the pandemic, which are 2020 and 2021.\u0000\u0000Materials and Methods: Salmonella infections were classified into eight distinct serogroups using slide agglutination with specific antisera (A, B, C, D, E, F, G, and I). The susceptibility to antimicrobial agents were evaluated by the standard disk diffusion method.\u0000\u0000Results: Four hundred fifty-one isolates were detected (139 in 2018, 119 in 2019, 102 in 2021, and 91 in 2021). Salmonella infection decreased by 25.2% from 258 isolates in 2018 and 2019 to 193 in 2020 and 2021. When comparing Salmonella infections in different age groups (0 to 10, 11 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and older than 70 years), before and during COVID-19, statistical significance was noted only in patients aged 11 to 20 (p=0.016). For clinical specimens (stool, blood, urine, pus, etc.), statistical significance was found only in blood specimens (p=0.036). The four most predominant Salmonella serogroups were B (31.1%), C (30.6%), E (15.7%), and D (11.4%). S. Typhi was present in 2.1% (4/193) of Salmonella isolates during COVID-19. The findings of a susceptibility test using the disk diffusion method for four commonly used drugs in treatment of severe salmonellosis as ampicillin, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, before and during COVID-19 demonstrated statistical significance only in Salmonella serogroup D (p=0.028). Overall, drug susceptibility of Salmonella serogroup B, C, D, and E was ampicillin (range 15.1% to 55.9%), cefotaxime (range 66.7% to 100%), ciprofloxacin (range 18.8% to 59.1%), and trimethoprim/sulfamethoxazole (range 70.0% to 93.8%).\u0000\u0000Conclusion: The present study results suggested the importance of monitoring the prevalence of Salmonella at a hospital in Bangkok. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment.\u0000\u0000Keywords: Salmonella; COVID-19 pandemic; Thailand","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73383143","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13782
Objective: To investigate the efficacy and safety of pharmacoinvasive (PI) strategy compared to primary percutaneous coronary intervention (PPCI) in the setting of a real-world ST-elevation myocardial infarction (STEMI) network where streptokinase (SK) is predominantly prescribed. Materials and Methods: The authors analyzed 325 STEMI patients who participated in The Siriraj STEMI network between July 2015 and October 2020. The primary efficacy endpoint was the incidence of cumulative major adverse cardiovascular and cerebrovascular events (MACCE) at one month, which were the composite of death, myocardial infarction, stroke, and non-coronary artery bypass graft (CABG)-related thrombolysis in myocardial infarction (TIMI) major or minor bleeding. The safety endpoint was non-CABG-related TIMI major or minor bleeding during the index hospitalization. Cox regression was performed for survival analysis. The authors applied propensity score matching to reduce the bias of the confounding variables. Results: Two hundred four patients received fibrinolytic therapy, 191 (93.6%) obtained SK, and 121 participants underwent PPCI. After propensity score matching analysis, the incidence of cumulative MACCE at one-month follow-up was not significantly different between the PI and the PPCI group (p=0.726) as well as the incidence of bleeding endpoint (p=0.446). In the subgroup analysis of the 191 patients who received SK (SK-PI), there was no statistical difference in the occurrence of cumulative MACCE compared to PPCI (p=0.136). Killip classification class III (hazard ratio [HR] 7.50, 95% confidence interval [CI] 3.25 to 17.31, p<0.001), and class IV (HR 9.78, 95% CI 4.31 to 22.21, p<0.001) were independent risk factors for developing MACCE. Conclusion: The streptokinase-based pharmacoinvasive strategy is non-statistically different in terms of efficacy and safety compared to PPCI. This evidence supports the utilization of the SK-PI approach in low- to middle-income countries where the availability of fibrin-specific fibrinolytic agents is often limited. Keywords: Revascularization strategy; Acute coronary syndrome; Fibrinolytic therapy
{"title":"Streptokinase-Based Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention: A Propensity Score Matching Analysis from the Siriraj STEMI Network","authors":"","doi":"10.35755/jmedassocthai.2023.02.13782","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13782","url":null,"abstract":"Objective: To investigate the efficacy and safety of pharmacoinvasive (PI) strategy compared to primary percutaneous coronary intervention (PPCI) in the setting of a real-world ST-elevation myocardial infarction (STEMI) network where streptokinase (SK) is predominantly prescribed.\u0000\u0000Materials and Methods: The authors analyzed 325 STEMI patients who participated in The Siriraj STEMI network between July 2015 and October 2020. The primary efficacy endpoint was the incidence of cumulative major adverse cardiovascular and cerebrovascular events (MACCE) at one month, which were the composite of death, myocardial infarction, stroke, and non-coronary artery bypass graft (CABG)-related thrombolysis in myocardial infarction (TIMI) major or minor bleeding. The safety endpoint was non-CABG-related TIMI major or minor bleeding during the index hospitalization. Cox regression was performed for survival analysis. The authors applied propensity score matching to reduce the bias of the confounding variables.\u0000\u0000Results: Two hundred four patients received fibrinolytic therapy, 191 (93.6%) obtained SK, and 121 participants underwent PPCI. After propensity score matching analysis, the incidence of cumulative MACCE at one-month follow-up was not significantly different between the PI and the PPCI group (p=0.726) as well as the incidence of bleeding endpoint (p=0.446). In the subgroup analysis of the 191 patients who received SK (SK-PI), there was no statistical difference in the occurrence of cumulative MACCE compared to PPCI (p=0.136). Killip classification class III (hazard ratio [HR] 7.50, 95% confidence interval [CI] 3.25 to 17.31, p<0.001), and class IV (HR 9.78, 95% CI 4.31 to 22.21, p<0.001) were independent risk factors for developing MACCE.\u0000\u0000Conclusion: The streptokinase-based pharmacoinvasive strategy is non-statistically different in terms of efficacy and safety compared to PPCI. This evidence supports the utilization of the SK-PI approach in low- to middle-income countries where the availability of fibrin-specific fibrinolytic agents is often limited.\u0000\u0000Keywords: Revascularization strategy; Acute coronary syndrome; Fibrinolytic therapy","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73309909","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13773
Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly. Objective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard. Materials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared. Results: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67). Conclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy. Keywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria
{"title":"Accuracy of Peguero-Lo Presti ECG Criteria for Left Ventricular Hypertrophy Diagnosis in Elderly Thai Patients Using Cardiovascular Magnetic Resonance as a Gold Standard","authors":"","doi":"10.35755/jmedassocthai.2023.02.13773","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13773","url":null,"abstract":"Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly.\u0000\u0000Objective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard.\u0000\u0000Materials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared.\u0000\u0000Results: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67).\u0000\u0000Conclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy.\u0000\u0000Keywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81223871","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 : 2023-02-15DOI: 10.35755/jmedassocthai.2023.02.13776
Background: Admission hypothermia (AH) is one of the key indicators in quality care of preterm infants. Unfortunately, AH rate in the authors’ institution was rather high. Therefore, the authors had set up quality improvement initiatives to improve rate of AH in the authors’ institution. The present study aimed to assess the effectiveness of the authors’ quality improvement initiatives (QI) to reduce admission hypothermia (AH) in infants less than 2,000 g. Materials and Methods: The present study was a retrospective evaluation of the authors’ QI program. The enrolled infants were inborn with birthweight less than 2,000 g, admitted in the NICU directly after birth. The QI consisted of increasing resuscitation area temperature (RT), use of heat protective measures, and transported with prewarmed transport incubator. To assess effectiveness, rate of admission hypothermia and admission temperature (AT) were selected as QI outcomes. The outcomes were compared between pre-QI period and post-QI period. Results: There were 117 and 133 infants in pre-QI and post-QI period, respectively. RT were 24.7±1.48℃ and 24.8±1.04℃,AT increased from 36.4±0.85℃ to 36.7±0.60℃ and incidence of hypothermia were decreased from 50.4% to 30.8%, in pre and post QI period (p-value<0.05). Conclusion: The authors’ QI effectively reduced AH in infants under 2,000 g. Keywords: Preterm; Hypothermia; Quality improvement
{"title":"Prevention of Admission Hypothermia in Low-Birth- Weight Infants Through PDSA Cycle of Quality Improvement Initiative","authors":"","doi":"10.35755/jmedassocthai.2023.02.13776","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.02.13776","url":null,"abstract":"Background: Admission hypothermia (AH) is one of the key indicators in quality care of preterm infants. Unfortunately, AH rate in the authors’ institution was rather high. Therefore, the authors had set up quality improvement initiatives to improve rate of AH in the authors’ institution. The present study aimed to assess the effectiveness of the authors’ quality improvement initiatives (QI) to reduce admission hypothermia (AH) in infants less than 2,000 g.\u0000\u0000Materials and Methods: The present study was a retrospective evaluation of the authors’ QI program. The enrolled infants were inborn with birthweight less than 2,000 g, admitted in the NICU directly after birth. The QI consisted of increasing resuscitation area temperature (RT), use of heat protective measures, and transported with prewarmed transport incubator. To assess effectiveness, rate of admission hypothermia and admission temperature (AT) were selected as QI outcomes. The outcomes were compared between pre-QI period and post-QI period.\u0000\u0000Results: There were 117 and 133 infants in pre-QI and post-QI period, respectively. RT were 24.7±1.48℃ and 24.8±1.04℃,AT increased from 36.4±0.85℃ to 36.7±0.60℃ and incidence of hypothermia were decreased from 50.4% to 30.8%, in pre and post QI period (p-value<0.05).\u0000\u0000Conclusion: The authors’ QI effectively reduced AH in infants under 2,000 g.\u0000\u0000Keywords: Preterm; Hypothermia; Quality improvement","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84483153","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 : 2023-01-15DOI: 10.35755/jmedassocthai.2023.01.13728
K. Foofuengmonkolkit, A. Susupaus, J. Udomkusonsri, T. Songdechakraiwut, J. Namchaisiri, P. Sakiyalak
Background: Acute respiratory distress syndrome (ARDS) is an undesirable outcome of severe coronavirus disease 2019 (COVID-19). Although venovenous extracorporeal membrane oxygenation (VV-ECMO) has been widely accepted as a rescue therapy for severe ARDS, its use in COVID19-associated ARDS is still debated. Objective: To compare the clinical outcomes of COVID-19 patients treated with VV-ECMO or conventional ventilator support. Materials and Methods: The authors conducted a retrospective study in Bangkok Heart Hospital, Thailand, between March and September 2021. Patients were divided into ECMO and non-ECMO or conventional ventilator support groups. The primary outcome was in-hospital mortality, and the secondary outcomes were complications, length of ICU stay, recovery time after extubation, and total length of hospital stay. Results: Of the 3,053 COVID-19 patients, 36 (1.18%) developed severe ARDS, which 12 were treated with VV-ECMO and 24 with a conventional ventilator. In-hospital mortality was non-significantly lower in the ECMO group at 58.3% versus 83.3% (p=0.126). Upper gastrointestinal bleeding was non-significantly more common in the ECMO group at 41.7% versus 25.0% (p=0.306) but there were no cases of deep vein thrombosis in the ECMO group at 0% versus 20.8% (p=0.088). There were no significant differences in any other complications. Six patients, including four in the ECMO group and two in the non-ECMO group underwent cytokine removal via HA330 hemoperfusion, but interleukin-6 did not decrease in these patients. Conclusion: VV-ECMO in COVID-19-associated ARDS patients did not significantly decreased mortality compared to conventional ventilator therapy. A multidisciplinary team should develop an optimal treatment plan for each COVID-19-associated ARDS patient. Keywords: SARS-CoV-2; Intensive care unit, Artificial respiration
{"title":"Extracorporeal Membrane Oxygenation versus Conventional Ventilator Support in COVID-19 Patients with Acute Respiratory Distress Syndrome","authors":"K. Foofuengmonkolkit, A. Susupaus, J. Udomkusonsri, T. Songdechakraiwut, J. Namchaisiri, P. Sakiyalak","doi":"10.35755/jmedassocthai.2023.01.13728","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.01.13728","url":null,"abstract":"Background: Acute respiratory distress syndrome (ARDS) is an undesirable outcome of severe coronavirus disease 2019 (COVID-19). Although venovenous extracorporeal membrane oxygenation (VV-ECMO) has been widely accepted as a rescue therapy for severe ARDS, its use in COVID19-associated ARDS is still debated.\u0000\u0000Objective: To compare the clinical outcomes of COVID-19 patients treated with VV-ECMO or conventional ventilator support.\u0000\u0000Materials and Methods: The authors conducted a retrospective study in Bangkok Heart Hospital, Thailand, between March and September 2021. Patients were divided into ECMO and non-ECMO or conventional ventilator support groups. The primary outcome was in-hospital mortality, and the secondary outcomes were complications, length of ICU stay, recovery time after extubation, and total length of hospital stay.\u0000\u0000Results: Of the 3,053 COVID-19 patients, 36 (1.18%) developed severe ARDS, which 12 were treated with VV-ECMO and 24 with a conventional ventilator. In-hospital mortality was non-significantly lower in the ECMO group at 58.3% versus 83.3% (p=0.126). Upper gastrointestinal bleeding was non-significantly more common in the ECMO group at 41.7% versus 25.0% (p=0.306) but there were no cases of deep vein thrombosis in the ECMO group at 0% versus 20.8% (p=0.088). There were no significant differences in any other complications. Six patients, including four in the ECMO group and two in the non-ECMO group underwent cytokine removal via HA330 hemoperfusion, but interleukin-6 did not decrease in these patients.\u0000\u0000Conclusion: VV-ECMO in COVID-19-associated ARDS patients did not significantly decreased mortality compared to conventional ventilator therapy. A multidisciplinary team should develop an optimal treatment plan for each COVID-19-associated ARDS patient.\u0000\u0000Keywords: SARS-CoV-2; Intensive care unit, Artificial respiration","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83202185","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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