Pub Date : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13763
Objective: To evaluate whether a visual inspection of ischemic changes in brain computed tomography (CT) images, which is very practical in clinical settings, could predict neurological outcomes in post-cardiac arrest survivors. Materials and Methods: The authors retrospectively reviewed medical records and brain CT images of 62 patients who remained comatose after surviving cardiac arrest and had undergone a CT scan within 24 hours to seven days. Neurological outcomes at one month were assessed using the Cerebral Performance Category (CPC). The CPC scores of 1-2 and 3-5 referred to good and poor neurological outcomes, respectively. Findings from the inspection of the images were graded into grade 1 for absence of acute ischemic change, grade 2 for decreased attenuation of the grey matter in some brain region(s), and grade 3 for diffused loss of grey-white matter differentiation or apparent brain swelling. An experienced neurologist and a consensus group of four pre-clerkship medical students, blinded to the neurological outcomes, evaluated the grade of ischemic changes in CT images. Results: Positive correlations were observed between CPC and CT grading by both the neurologist (ρ=0.76, 95% CI 0.63 to 0.90, p<0.001) and medical students (ρ=0.57, 95% CI 0.38 to 0.77, p<0.001). The CT grading of 2 or more by the neurologist could predict poor neurological outcomes with specificity of 1.00, sensitivity of 0.89, and receiver operating characteristic (ROC) AUC of 0.94 (95% CI 0.89 to 1.00). The evaluation by medical students showed an ROC AUC of 0.80 (95% CI 0.64 to 0.96). Conclusion: The simple visual inspection of ischemic changes in brain CT images showed a high diagnostic accuracy and could be a practical method for predicting neurological outcomes in post-cardiac arrest survivors. Keywords: Cardiac arrest; Post-cardiac arrest ischemic brain injury; Neurological outcomes; Computerized tomography
目的:评估在临床中非常实用的脑计算机断层扫描(CT)图像中缺血性改变的视觉检查是否可以预测心脏骤停后幸存者的神经预后。材料和方法:作者回顾性地回顾了62例心脏骤停存活后仍处于昏迷状态的患者的医疗记录和脑CT图像，并在24小时至7天内进行了CT扫描。使用脑功能分类(CPC)评估1个月时的神经学预后。CPC得分为1-2分和3-5分分别表示神经预后良好和较差。影像学检查结果分为1级(未见急性缺血性改变)，2级(部分脑区灰质衰减减少)，3级(弥漫性灰质分化丧失或明显脑肿胀)。一位经验丰富的神经科医生和四名见习前医学院学生组成的共识小组，对神经学结果不知情，评估CT图像中缺血性变化的等级。结果:神经内科医生(ρ=0.76, 95% CI 0.63 ~ 0.90, p<0.001)和医学生(ρ=0.57, 95% CI 0.38 ~ 0.77, p<0.001)的CPC评分与CT评分呈正相关。神经科医生的CT评分为2级或以上，可预测神经预后不良，特异性为1.00，敏感性为0.89，受试者工作特征(ROC) AUC为0.94 (95% CI 0.89至1.00)。医学生评价的ROC AUC为0.80 (95% CI 0.64 ~ 0.96)。结论:简单的视觉检查脑CT图像的缺血性改变具有较高的诊断准确性，可作为预测心脏骤停后幸存者神经预后的实用方法。关键词:心脏骤停;心脏骤停后缺血性脑损伤;神经系统的结果;电脑断层摄影术
{"title":"Assessment of Brain Computed Tomography as a Practical Way to Predict Neurological Outcomes in Post-Cardiac Arrest Survivors","authors":"","doi":"10.35755/jmedassocthai.2023.05.13763","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13763","url":null,"abstract":"Objective: To evaluate whether a visual inspection of ischemic changes in brain computed tomography (CT) images, which is very practical in clinical settings, could predict neurological outcomes in post-cardiac arrest survivors.\u0000\u0000Materials and Methods: The authors retrospectively reviewed medical records and brain CT images of 62 patients who remained comatose after surviving cardiac arrest and had undergone a CT scan within 24 hours to seven days. Neurological outcomes at one month were assessed using the Cerebral Performance Category (CPC). The CPC scores of 1-2 and 3-5 referred to good and poor neurological outcomes, respectively. Findings from the inspection of the images were graded into grade 1 for absence of acute ischemic change, grade 2 for decreased attenuation of the grey matter in some brain region(s), and grade 3 for diffused loss of grey-white matter differentiation or apparent brain swelling. An experienced neurologist and a consensus group of four pre-clerkship medical students, blinded to the neurological outcomes, evaluated the grade of ischemic changes in CT images.\u0000\u0000Results: Positive correlations were observed between CPC and CT grading by both the neurologist (ρ=0.76, 95% CI 0.63 to 0.90, p<0.001) and medical students (ρ=0.57, 95% CI 0.38 to 0.77, p<0.001). The CT grading of 2 or more by the neurologist could predict poor neurological outcomes with specificity of 1.00, sensitivity of 0.89, and receiver operating characteristic (ROC) AUC of 0.94 (95% CI 0.89 to 1.00). The evaluation by medical students showed an ROC AUC of 0.80 (95% CI 0.64 to 0.96).\u0000\u0000Conclusion: The simple visual inspection of ischemic changes in brain CT images showed a high diagnostic accuracy and could be a practical method for predicting neurological outcomes in post-cardiac arrest survivors.\u0000\u0000Keywords: Cardiac arrest; Post-cardiac arrest ischemic brain injury; Neurological outcomes; Computerized tomography","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79105416","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13788
Background: Caring for terminal cancer patients is a heavy burden and complex. Caregivers take the important roles in caring. If caregivers could not adapt to the changing roles, this could negatively affect their health and they could be unable to continue taking care of the patients. Objective: To investigate the factors affecting the psychological well-being of terminal cancer patient caregivers. Materials and Methods: A descriptive study of terminal cancer patient caregivers in Muang Uttaradit District, Uttaradit Province was performed in the present study. The caregivers were selected using a systematic random sampling technique. Data was collected between June and September 2021. The data was analyzed using descriptive statistics, and stepwise multiple regression analysis. Results: Two hundred fifty participants were included in the present study. The results showed that the participants had an overall moderate level of psychological well-being. Support from public health personnel, spouse, neighbors, and community, underlying diseases of caregivers, and resilience were predictive of psychological well-being. Five variables could predict the psychological well-being of terminal cancer patient caregivers by 60.2%. Conclusion: Terminal cancer patient caregivers need support and assistance for enhancing psychological well-being according to predictable variables, which are concrete forms of activity. Keywords: Terminal cancer patient caregivers; Psychological well-being; Social support; Resilience
{"title":"Factors Affecting the Psychological Well-Being of Terminal Cancer Patient Caregivers in Muang District Uttaradit Province","authors":"","doi":"10.35755/jmedassocthai.2023.05.13788","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13788","url":null,"abstract":"Background: Caring for terminal cancer patients is a heavy burden and complex. Caregivers take the important roles in caring. If caregivers could not adapt to the changing roles, this could negatively affect their health and they could be unable to continue taking care of the patients.\u0000\u0000Objective: To investigate the factors affecting the psychological well-being of terminal cancer patient caregivers.\u0000\u0000Materials and Methods: A descriptive study of terminal cancer patient caregivers in Muang Uttaradit District, Uttaradit Province was performed in the present study. The caregivers were selected using a systematic random sampling technique. Data was collected between June and September 2021. The data was analyzed using descriptive statistics, and stepwise multiple regression analysis.\u0000\u0000Results: Two hundred fifty participants were included in the present study. The results showed that the participants had an overall moderate level of psychological well-being. Support from public health personnel, spouse, neighbors, and community, underlying diseases of caregivers, and resilience were predictive of psychological well-being. Five variables could predict the psychological well-being of terminal cancer patient caregivers by 60.2%.\u0000\u0000Conclusion: Terminal cancer patient caregivers need support and assistance for enhancing psychological well-being according to predictable variables, which are concrete forms of activity.\u0000\u0000Keywords: Terminal cancer patient caregivers; Psychological well-being; Social support; Resilience","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82877299","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13734
Background: Acinetobacter baumannii bacteremia is a hospital-acquired infection with a high mortality rate. Up to 80% of hospital-acquired A. baumannii infections are caused by carbapenem-resistant Acinetobacter baumannii (CRAB) strains. Objective: To determine the overall 30-day mortality rate, factors associated with mortality, and antibiotic drug susceptibility patterns of CRAB isolates among children with hospital-acquired CRAB bloodstream infections. Materials and Methods: A retrospective review was conducted among hospitalized pediatric patients between January 2017 and September 2022 at King Chulalongkorn Memorial Hospital, Bangkok. The inclusion criteria were CRAB bacteremia in children under 18 years of age. Thirty-day mortality after CRAB bacteremia was analyzed using Kaplan-Meier estimates. Associated factors were analyzed by Poisson regression. Antibiotic susceptibility patterns of nine antimicrobial agents were summarized. Results: Fifty-eight patients with 66 episodes of CRAB bacteremia were identified. The median age was 7.5 months (IQR 0.8 to 60.0), and 86.4% of the patients were admitted to the intensive care unit. Central line-associated bloodstream infections (CLABSI) were identified in 90.9% of cases. Most patients (74.2%) received colistin combination with sulbactam regimen. The 30-day mortality rate was 19.7% (95% CI 10.9 to 31.3). Associated factors for mortality rate were septic shock (aRR 7.6, 95% CI 2.3 to 25.0) and underlying congenital heart disease (aRR 3.4, 95% CI 1.0 to 11.7). Drug susceptibility of colistin and tigecycline were 93% and 48%, respectively. Sulbactam was not susceptible. Conclusion: One-fifth of children with CRAB bacteremia died within 30 days. Associated factors with mortality were septic shock and congenital heart disease. Colistin had the highest in vitro drug susceptibility rate. The common regimen used in the present study was colistin combination with sulbactam therapy. Keywords: Acinetobacter baumannii; Bacteremia; Carbapenem resistance; Susceptibility; Mortality; Pediatrics
背景:鲍曼不动杆菌菌血症是一种高致死率的医院获得性感染。高达80%的医院获得性鲍曼不动杆菌感染是由耐碳青霉烯类鲍曼不动杆菌(CRAB)菌株引起的。目的:了解医院获得性血液感染患儿的总体30天死亡率、与死亡率相关的因素以及CRAB分离株的抗生素药敏模式。材料和方法:对2017年1月至2022年9月在曼谷朱拉隆功国王纪念医院住院的儿科患者进行回顾性研究。纳入标准为18岁以下儿童的CRAB菌血症。用Kaplan-Meier估计法分析CRAB菌血症后30天死亡率。用泊松回归分析相关因素。总结了9种抗菌药物的药敏规律。结果:共鉴定出58例66例螃蟹菌血症。中位年龄为7.5个月(IQR为0.8 ~ 60.0)，86.4%的患者入住重症监护病房。90.9%的病例中发现了中心线相关血流感染(CLABSI)。大多数患者(74.2%)采用粘菌素联合舒巴坦方案。30天死亡率为19.7% (95% CI 10.9 ~ 31.3)。死亡率的相关因素是感染性休克(aRR 7.6, 95% CI 2.3 ~ 25.0)和潜在的先天性心脏病(aRR 3.4, 95% CI 1.0 ~ 11.7)。粘菌素和替加环素的药敏率分别为93%和48%。舒巴坦不敏感。结论:1 / 5的螃蟹菌血症患儿在30天内死亡。与死亡率相关的因素是感染性休克和先天性心脏病。粘菌素体外药敏率最高。本研究中常用的治疗方案是粘菌素联合舒巴坦治疗。关键词:鲍曼不动杆菌;菌血症;碳青霉烯耐药;磁化率;死亡率;儿科
{"title":"Clinical Outcomes and Associated Factors for Mortality among Pediatric Patients with Carbapenem-Resistant Acinetobacter baumannii","authors":"","doi":"10.35755/jmedassocthai.2023.05.13734","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13734","url":null,"abstract":"Background: Acinetobacter baumannii bacteremia is a hospital-acquired infection with a high mortality rate. Up to 80% of hospital-acquired A. baumannii infections are caused by carbapenem-resistant Acinetobacter baumannii (CRAB) strains.\u0000\u0000Objective: To determine the overall 30-day mortality rate, factors associated with mortality, and antibiotic drug susceptibility patterns of CRAB isolates among children with hospital-acquired CRAB bloodstream infections.\u0000\u0000Materials and Methods: A retrospective review was conducted among hospitalized pediatric patients between January 2017 and September 2022 at King Chulalongkorn Memorial Hospital, Bangkok. The inclusion criteria were CRAB bacteremia in children under 18 years of age. Thirty-day mortality after CRAB bacteremia was analyzed using Kaplan-Meier estimates. Associated factors were analyzed by Poisson regression. Antibiotic susceptibility patterns of nine antimicrobial agents were summarized.\u0000\u0000Results: Fifty-eight patients with 66 episodes of CRAB bacteremia were identified. The median age was 7.5 months (IQR 0.8 to 60.0), and 86.4% of the patients were admitted to the intensive care unit. Central line-associated bloodstream infections (CLABSI) were identified in 90.9% of cases. Most patients (74.2%) received colistin combination with sulbactam regimen. The 30-day mortality rate was 19.7% (95% CI 10.9 to 31.3). Associated factors for mortality rate were septic shock (aRR 7.6, 95% CI 2.3 to 25.0) and underlying congenital heart disease (aRR 3.4, 95% CI 1.0 to 11.7). Drug susceptibility of colistin and tigecycline were 93% and 48%, respectively. Sulbactam was not susceptible.\u0000\u0000Conclusion: One-fifth of children with CRAB bacteremia died within 30 days. Associated factors with mortality were septic shock and congenital heart disease. Colistin had the highest in vitro drug susceptibility rate. The common regimen used in the present study was colistin combination with sulbactam therapy.\u0000\u0000Keywords: Acinetobacter baumannii; Bacteremia; Carbapenem resistance; Susceptibility; Mortality; Pediatrics","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90445618","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13786
Background: During lockdown in 2020 from the outbreak of coronavirus disease 2019 (COVID-19), rhegmatogenous retinal detachment (RRD) has been affected in several aspects including prevalence alteration, delayed presentations, and poorer treatment outcomes. These effects are unknown after lockdown by comparing with the preceding year. Objective: To determine the impact of the COVID-19 pandemic on the number, clinical characteristics, type of surgical procedure, and anatomical outcome of primary RRD during and after lockdown compared with those parameters in the same periods of the previous year. Materials and Methods: In the present retrospective cohort study, the medical records of patients with primary RRD underwent retinal surgery at Mettapracharak Hospital during and after the first lockdown in 2020 and the corresponding period in 2019 were reviewed. These four periods had an equal number of days as the first lockdown period. The following data were analyzed, baseline demographics, initial clinical presentations, type of surgical procedure, and outcome. Results: Four hundred fifty-five patients, for 455 eyes, underwent surgery for primary RRD. One hundred seven patients were treated during lockdown, 106 patients after lockdown, whereas 117 patients and 125 patients were treated in identical periods in the previous year, respectively. A decrease of 8.5% of RRD cases during lockdown and of 15.2% of RRD cases post-lockdown were documented. No significant differences were found with respect to demographic features, clinical characteristics, type of surgical procedure, or the anatomical single surgery success rate of RRD patients among all time periods. However, a significantly lower prevalence of right-eye involvement and shorter waiting time for surgery after lockdown were documented. Conclusion: The authors revealed the impact of the COVID-19 pandemic on the reduction in the number of surgical procedures for primary RRD during and after lockdown. Our findings could aid redefinition of a strategic plan for RRD management after the COVID-19 pandemic had subsided. Keywords: Rhegmatogenous retinal detachment; COVID-19; Pandemic; Lockdown; Tertiary hospital; Eye
{"title":"Impact of the COVID-19 Pandemic on the Number, Clinical Characteristics, Surgical Types, and Anatomical Outcome of Patients with Primary Rhegmatogenous Retinal Detachment during and after COVID-19 Lockdown in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.05.13786","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13786","url":null,"abstract":"Background: During lockdown in 2020 from the outbreak of coronavirus disease 2019 (COVID-19), rhegmatogenous retinal detachment (RRD) has been affected in several aspects including prevalence alteration, delayed presentations, and poorer treatment outcomes. These effects are unknown after lockdown by comparing with the preceding year.\u0000\u0000Objective: To determine the impact of the COVID-19 pandemic on the number, clinical characteristics, type of surgical procedure, and anatomical outcome of primary RRD during and after lockdown compared with those parameters in the same periods of the previous year.\u0000\u0000Materials and Methods: In the present retrospective cohort study, the medical records of patients with primary RRD underwent retinal surgery at Mettapracharak Hospital during and after the first lockdown in 2020 and the corresponding period in 2019 were reviewed. These four periods had an equal number of days as the first lockdown period. The following data were analyzed, baseline demographics, initial clinical presentations, type of surgical procedure, and outcome.\u0000\u0000Results: Four hundred fifty-five patients, for 455 eyes, underwent surgery for primary RRD. One hundred seven patients were treated during lockdown, 106 patients after lockdown, whereas 117 patients and 125 patients were treated in identical periods in the previous year, respectively. A decrease of 8.5% of RRD cases during lockdown and of 15.2% of RRD cases post-lockdown were documented. No significant differences were found with respect to demographic features, clinical characteristics, type of surgical procedure, or the anatomical single surgery success rate of RRD patients among all time periods. However, a significantly lower prevalence of right-eye involvement and shorter waiting time for surgery after lockdown were documented.\u0000\u0000Conclusion: The authors revealed the impact of the COVID-19 pandemic on the reduction in the number of surgical procedures for primary RRD during and after lockdown. Our findings could aid redefinition of a strategic plan for RRD management after the COVID-19 pandemic had subsided.\u0000\u0000Keywords: Rhegmatogenous retinal detachment; COVID-19; Pandemic; Lockdown; Tertiary hospital; Eye","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88188176","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13754
Background: Understanding the prevalence and associated factors of accessibility to palliative care among non-cancer patients can promote the quality of life. However, data in this area of Thailand are limited. Objective: To investigate the prevalence and associated factors of non-cancer patients’ access to palliative treatment. Materials and Methods: A cross-sectional study was performed by a retrospective medical chart review of non-cancer patients admitted and later pronounced dead at Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Thailand. The accessibility to the palliative care system was collected using the authors’ modification of the Supportive and Palliative Care Indicators Tool (SPICT). All data were analyzed by using the chi-square test and the binary logistic regression model, respectively. Results: The prevalence of accessibility to palliative care among non-cancer patients was 15.69%. Non-cancer patients with renal and liver failure were significantly associated with accessibility to palliative care (adjusted OR 4.742, p=0.002 and 6.159, p=0.011, respectively). Conclusion: Prevalence of access to palliative care in non-cancer patients was 15.69%. Organ failure in non-cancer patients with renal and hepatic systems can boost accessibility to palliative treatment. There were few palliative patients without cancer that accessed palliative care service. Additionally, it is critical for healthcare professionals to be educated on the fundamentals of palliative care. Keywords: Non-cancer patients; Prevalence; Accessibility; Palliative care
{"title":"Accessibility to Palliative Care for Non-Cancer Patients Near the End of Life: The Obstacles and Opportunities","authors":"","doi":"10.35755/jmedassocthai.2023.05.13754","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13754","url":null,"abstract":"Background: Understanding the prevalence and associated factors of accessibility to palliative care among non-cancer patients can promote the quality of life. However, data in this area of Thailand are limited.\u0000\u0000Objective: To investigate the prevalence and associated factors of non-cancer patients’ access to palliative treatment.\u0000\u0000Materials and Methods: A cross-sectional study was performed by a retrospective medical chart review of non-cancer patients admitted and later pronounced dead at Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Thailand. The accessibility to the palliative care system was collected using the authors’ modification of the Supportive and Palliative Care Indicators Tool (SPICT). All data were analyzed by using the chi-square test and the binary logistic regression model, respectively.\u0000\u0000Results: The prevalence of accessibility to palliative care among non-cancer patients was 15.69%. Non-cancer patients with renal and liver failure were significantly associated with accessibility to palliative care (adjusted OR 4.742, p=0.002 and 6.159, p=0.011, respectively).\u0000\u0000Conclusion: Prevalence of access to palliative care in non-cancer patients was 15.69%. Organ failure in non-cancer patients with renal and hepatic systems can boost accessibility to palliative treatment. There were few palliative patients without cancer that accessed palliative care service. Additionally, it is critical for healthcare professionals to be educated on the fundamentals of palliative care.\u0000\u0000Keywords: Non-cancer patients; Prevalence; Accessibility; Palliative care","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81438433","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13845
Objective: To evaluate dynamic contrast-enhanced (DCE), dynamic susceptibility contrast (DSC), and arterial spin labeling (ASL)-derived perfusion magnetic resonance imaging (MRI) parameters as a non-invasive technique for differentiating between high-grade gliomas (HGGs) and low-grade gliomas (LGGs), and to determine the diagnostic value of each parameter. Materials and Methods: Twenty-four patients with histopathologically confirmed HGGs or LGGs underwent DCE-, DSC-, and ASL-magnetic resonance perfusion (MRP). Retrospective qualitative and quantitative assessment of MRP-derived parameters, including DCE-Ktrans, DCE-Ve, DCE-Vp, DSC-rCBV, DSC-rCBF, and ASL-rCBF were performed, and the diagnostic value of each parameter was determined using ROC analysis. Results: Of the 24 patients enrolled in the present study, which included 10 LGGs and 14 HGGs, DCE-derived Vp showed the best diagnostic performance for differentiating between HGGs and LGGs (AUC 0.833, cutoff >0.0002 mL/100 g, p=0.018, 100% sensitivity, 28.6% specificity), followed by DCE-derived Ktrans (AUC 0.75, cutoff >0.024 min⁻¹, p=0.011, 58.3% sensitivity, 100% specificity) and DSC-derived normalized rCBV (AUC 0.75, p=0.021, cutoff >1.15, 100% sensitivity, 37.5% specificity). The ASL-derived normalized rCBF showed no statistically significant difference between HGGs and LGGs (AUC 0.457, p=0.757). Conclusion: DCE-derived Vp, DCE-derived Ktrans, and DSC-derived rCBV are helpful perfusion MRI parameters for differentiating HGGs and LGGs, with DCE-derived Vp showing the best diagnostic performance in the present study. Keywords: DCE; DSL; ASL; Perfusion MR; Glioma
{"title":"Diagnostic Value of Dynamic Contrast-Enhanced (DCE), Dynamic Susceptibility Contrast (DSC) and Arterial Spin Labeling (ASL) Perfusion MRI for Differentiation of High-Grade and Low-Grade Gliomas","authors":"","doi":"10.35755/jmedassocthai.2023.05.13845","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13845","url":null,"abstract":"Objective: To evaluate dynamic contrast-enhanced (DCE), dynamic susceptibility contrast (DSC), and arterial spin labeling (ASL)-derived perfusion magnetic resonance imaging (MRI) parameters as a non-invasive technique for differentiating between high-grade gliomas (HGGs) and low-grade gliomas (LGGs), and to determine the diagnostic value of each parameter.\u0000\u0000Materials and Methods: Twenty-four patients with histopathologically confirmed HGGs or LGGs underwent DCE-, DSC-, and ASL-magnetic resonance perfusion (MRP). Retrospective qualitative and quantitative assessment of MRP-derived parameters, including DCE-Ktrans, DCE-Ve, DCE-Vp, DSC-rCBV, DSC-rCBF, and ASL-rCBF were performed, and the diagnostic value of each parameter was determined using ROC analysis.\u0000\u0000Results: Of the 24 patients enrolled in the present study, which included 10 LGGs and 14 HGGs, DCE-derived Vp showed the best diagnostic performance for differentiating between HGGs and LGGs (AUC 0.833, cutoff >0.0002 mL/100 g, p=0.018, 100% sensitivity, 28.6% specificity), followed by DCE-derived Ktrans (AUC 0.75, cutoff >0.024 min⁻¹, p=0.011, 58.3% sensitivity, 100% specificity) and DSC-derived normalized rCBV (AUC 0.75, p=0.021, cutoff >1.15, 100% sensitivity, 37.5% specificity). The ASL-derived normalized rCBF showed no statistically significant difference between HGGs and LGGs (AUC 0.457, p=0.757).\u0000\u0000Conclusion: DCE-derived Vp, DCE-derived Ktrans, and DSC-derived rCBV are helpful perfusion MRI parameters for differentiating HGGs and LGGs, with DCE-derived Vp showing the best diagnostic performance in the present study.\u0000\u0000Keywords: DCE; DSL; ASL; Perfusion MR; Glioma","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80475881","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13846
Background: Use of high flow nasal cannula (HFNC) has been widely accepted as non-invasive respiratory support in children suffering from lower respiratory tract infections (LRI). Patients who use HFNC still need respiratory care from health personnel in ICU or intermediate care wards. Without the weaning protocol, the authors had noticed prolonged HFNC use, which affected the length of hospital stay (LOS). As such, a pediatric patient care team (PCT) created the weaning protocol and collected data whether the weaning protocol would shorten weaning time. Objective: To compare HFNC weaning times among children suffering from LRI, before and after using the weaning protocol. Materials and Methods: A pre- and post-intervention study of 1-month-old to 5-year-old children who received HFNC therapy for LRI at Panyananthaphikkhu Chonprathan Medical Center between August 2018 and July 2020, the one year before and after the protocol was implemented in August 2019, were carried out. Demographic data and severity of respiratory illness according to Respiratory Assessment Score (RAS) were recorded. Multivariate linear regression, adjusted for age, gender, weight, RR, HR, SpO₂, and RAS before using HFNC, was used to compare between the pre- and post-weaning protocol groups according to total HFNC time, duration of weaning time, and LOS. Results: There were 25 patients in each group. The mean age in the post-weaning protocol group was lower, but there was no difference in severity. Multivariate linear regression demonstrated that the post-weaning protocol group had a significantly shorter weaning time at 49.5±37.0 hours versus 84.2±62.8 hours (p=0.034). Moreover, total HFNC time was also significantly shorter in the post-weaning protocol group at 71.53±36.7 hours versus 119.6±78.2 hours (p=0.019). There was no difference in vital signs during weaning between the two groups. Conclusion: Implementing the weaning protocol reduce weaning time and total HFNC time, without affecting clinical outcomes. Keywords: High flow nasal cannula; Weaning protocol; Lower respiratory tract infection; Length of stay
{"title":"The Weaning Protocol of High Flow Nasal Cannula Reduce Duration of Weaning in Lower-Respiratory Tract Infection in Children Who Used High Flow Nasal Cannula: Single Center Experience in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.05.13846","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13846","url":null,"abstract":"Background: Use of high flow nasal cannula (HFNC) has been widely accepted as non-invasive respiratory support in children suffering from lower respiratory tract infections (LRI). Patients who use HFNC still need respiratory care from health personnel in ICU or intermediate care wards. Without the weaning protocol, the authors had noticed prolonged HFNC use, which affected the length of hospital stay (LOS). As such, a pediatric patient care team (PCT) created the weaning protocol and collected data whether the weaning protocol would shorten weaning time.\u0000\u0000Objective: To compare HFNC weaning times among children suffering from LRI, before and after using the weaning protocol.\u0000\u0000Materials and Methods: A pre- and post-intervention study of 1-month-old to 5-year-old children who received HFNC therapy for LRI at Panyananthaphikkhu Chonprathan Medical Center between August 2018 and July 2020, the one year before and after the protocol was implemented in August 2019, were carried out. Demographic data and severity of respiratory illness according to Respiratory Assessment Score (RAS) were recorded. Multivariate linear regression, adjusted for age, gender, weight, RR, HR, SpO₂, and RAS before using HFNC, was used to compare between the pre- and post-weaning protocol groups according to total HFNC time, duration of weaning time, and LOS.\u0000\u0000Results: There were 25 patients in each group. The mean age in the post-weaning protocol group was lower, but there was no difference in severity. Multivariate linear regression demonstrated that the post-weaning protocol group had a significantly shorter weaning time at 49.5±37.0 hours versus 84.2±62.8 hours (p=0.034). Moreover, total HFNC time was also significantly shorter in the post-weaning protocol group at 71.53±36.7 hours versus 119.6±78.2 hours (p=0.019). There was no difference in vital signs during weaning between the two groups.\u0000\u0000Conclusion: Implementing the weaning protocol reduce weaning time and total HFNC time, without affecting clinical outcomes.\u0000\u0000Keywords: High flow nasal cannula; Weaning protocol; Lower respiratory tract infection; Length of stay","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74029429","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13809
Objective: To compare the pulsatile index (UA-PI), resistance index (UA-RI), and systolic/diastolic ratio (UA-S/D) of the umbilical artery between pregnant women with advanced maternal age (AMA) and normal maternal age. Materials and Methods: Participants were pregnant women who attended antenatal care at the maternal-fetal medicine unit at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. The present study was conducted between February and December 2022. Participants who met inclusion criteria were classified as study for the patients aged 35 years and older, and control groups for the patients younger than 35 years old. All participants underwent ultrasonography for umbilical artery Doppler velocimetry measurement including UA-PI, UA-RI, and UA-S/D. Demographic characters of both study and control groups were included for statistical calculation. Results: Five hundred pregnant women with gestational age between 18 and 24 weeks were enrolled. The mean age of the study and the control group were 37.9 and 26.0 years, respectively. Participants in the study group have higher BMI than the control group. The study and the control group had comparable diastolic and systolic blood pressure. The mean (standard deviation) of UA-PI, UA-RI, and S/D ratio of the study/control group were 1.33±0.21/1.27±0.22, 0.77±0.1/0.74±0.09, and 4.24±0.98/3.95±0.97, respectively, with statistical significance. The study group had a significantly higher number of large for gestational age (LGA), pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM) than the control group. Conclusion: AMA pregnancy had higher UA-PI, UA-RI, UA-S/D, incidence of PIH, GDM, and LGA than those age less than 35 years. Keywords: Advanced maternal age; Umbilical artery Doppler indices; Second trimester
{"title":"A Comparison of the Umbilical Artery Doppler Indices between Pregnancies with Advanced and Normal Maternal Age in the Second Trimester","authors":"","doi":"10.35755/jmedassocthai.2023.05.13809","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13809","url":null,"abstract":"Objective: To compare the pulsatile index (UA-PI), resistance index (UA-RI), and systolic/diastolic ratio (UA-S/D) of the umbilical artery between pregnant women with advanced maternal age (AMA) and normal maternal age.\u0000\u0000Materials and Methods: Participants were pregnant women who attended antenatal care at the maternal-fetal medicine unit at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. The present study was conducted between February and December 2022. Participants who met inclusion criteria were classified as study for the patients aged 35 years and older, and control groups for the patients younger than 35 years old. All participants underwent ultrasonography for umbilical artery Doppler velocimetry measurement including UA-PI, UA-RI, and UA-S/D. Demographic characters of both study and control groups were included for statistical calculation.\u0000\u0000Results: Five hundred pregnant women with gestational age between 18 and 24 weeks were enrolled. The mean age of the study and the control group were 37.9 and 26.0 years, respectively. Participants in the study group have higher BMI than the control group. The study and the control group had comparable diastolic and systolic blood pressure. The mean (standard deviation) of UA-PI, UA-RI, and S/D ratio of the study/control group were 1.33±0.21/1.27±0.22, 0.77±0.1/0.74±0.09, and 4.24±0.98/3.95±0.97, respectively, with statistical significance. The study group had a significantly higher number of large for gestational age (LGA), pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM) than the control group.\u0000\u0000Conclusion: AMA pregnancy had higher UA-PI, UA-RI, UA-S/D, incidence of PIH, GDM, and LGA than those age less than 35 years.\u0000\u0000Keywords: Advanced maternal age; Umbilical artery Doppler indices; Second trimester","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73929403","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13764
Objective: To propose an innovative head-tracking device integrated into a standard postoperative eye shield to improve the care of gas-filled eye patients. The present study aims to evaluate the satisfaction and compliance from the users of this device. Materials and Methods: Five healthy volunteers were assigned to use the innovative eye shield for three days at their home and instructed to maintain facedown positioning at all times. Subjects graded their satisfaction and safety scores. Twenty-four hours of positioning data were obtained from the phone devices connected to the eye shield by Bluetooth® system. During the study, an application in the phone will alarm if the participant’s head is in the wrong position (more than 15 degrees of the reference). Participants were interviewed about their satisfaction concerning the issue on the third day of the study. Results: Of the five subjects, four were males, and one was female. The mean age was 51.8 years old. From the questionnaires, the majority of subjects were satisfied with the appearance, weight, audio-vibrating level, wearing comfort, and easy instruction (median 5, 5, 5, 4, and 5, respectively, range from 1 to 5). For head positioning compliance, participants maintained their head positioning better in the daytime versus nighttime. The third day had worse compliance compared to the first and second days. For the safety issue, none of the participants reported the blackout of the instrument, short circuit, or skin burn event. Mild irritation from the medical tape was reported from one subject. Conclusion: The innovative eye shield is safe and improves patient compliance in maintaining head positioning after gas-filled intraocular surgery. Keywords: Retinal detachment; Macular hole; Vitrectomy; Intraocular gas/oil; Post-operative head position; Tracking device
{"title":"The Safety and Satisfaction of an Innovative Eye Shield Detecting Head Position for Post-Operative Intraocular Surgery","authors":"","doi":"10.35755/jmedassocthai.2023.05.13764","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13764","url":null,"abstract":"Objective: To propose an innovative head-tracking device integrated into a standard postoperative eye shield to improve the care of gas-filled eye patients. The present study aims to evaluate the satisfaction and compliance from the users of this device.\u0000\u0000Materials and Methods: Five healthy volunteers were assigned to use the innovative eye shield for three days at their home and instructed to maintain facedown positioning at all times. Subjects graded their satisfaction and safety scores. Twenty-four hours of positioning data were obtained from the phone devices connected to the eye shield by Bluetooth® system. During the study, an application in the phone will alarm if the participant’s head is in the wrong position (more than 15 degrees of the reference). Participants were interviewed about their satisfaction concerning the issue on the third day of the study.\u0000\u0000Results: Of the five subjects, four were males, and one was female. The mean age was 51.8 years old. From the questionnaires, the majority of subjects were satisfied with the appearance, weight, audio-vibrating level, wearing comfort, and easy instruction (median 5, 5, 5, 4, and 5, respectively, range from 1 to 5). For head positioning compliance, participants maintained their head positioning better in the daytime versus nighttime. The third day had worse compliance compared to the first and second days. For the safety issue, none of the participants reported the blackout of the instrument, short circuit, or skin burn event. Mild irritation from the medical tape was reported from one subject.\u0000\u0000Conclusion: The innovative eye shield is safe and improves patient compliance in maintaining head positioning after gas-filled intraocular surgery.\u0000\u0000Keywords: Retinal detachment; Macular hole; Vitrectomy; Intraocular gas/oil; Post-operative head position; Tracking device","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77245473","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 : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13850
Objective: 1) To compare the outcomes of fetal heart rate monitoring using a newly-designed elastic cardiotocograph (CTG) bandage and a conventional ultrasound transducer bandage, and 2) to evaluate the satisfaction of the participants and labor staff using the newly-designed elastic CTG bandage compared to those using the conventional ultrasound transducer bandage. Materials and Methods: The researchers invented the newly-designed elastic CTG bandage and conducted a quasi-experimental study with thirty-four pregnant women gestational age under 37 weeks using both the newly-designed elastic CTG bandage and the conventional ultrasound transducers. A comparison of the outcomes of fetal heart rate monitoring between the two methods was done using Wilcoxon signed-rank test. Then, two instruments (the CTG band satisfaction questionnaire for women, and the CTG band satisfaction questionnaire and fetal heart rate graph absence record for the labor staff) were administered to the respective participants. They were adapted for the study based on the diffusion of innovation model, which postulated that an innovation was generally adopted when five main factors (compatibility, complexity, trial-ability, observability, and relative advantage) were met. Results: The median score of signals of fetal heart rate loss when solely using the newly-designed elastic CTG bandage was only 1.0 times and the conventional ultrasound transducer bandage was 3.0 times. There was a significant difference (p<0.001). Most members of the labor staff were satisfied with the suitability of the newly-designed elastic CTG bandage. Conclusion: The newly-designed elastic CTG bandage improved the quality of fetal heart rate assessment compared to the conventional ultrasound transducer bandage, resulting in the reduction of errors during examinations and the labor staff’s workloads while providing the ability to continuously assess the fetal heart rate. Keywords: Cardiotocograph; Fetal heart rate; Intrapartum fetal monitoring
{"title":"Comparison of a Newly-Designed and Conventional Strap Used for Cardiotocograph Recoding in Preterm Labor","authors":"","doi":"10.35755/jmedassocthai.2023.05.13850","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13850","url":null,"abstract":"Objective: 1) To compare the outcomes of fetal heart rate monitoring using a newly-designed elastic cardiotocograph (CTG) bandage and a conventional ultrasound transducer bandage, and 2) to evaluate the satisfaction of the participants and labor staff using the newly-designed elastic CTG bandage compared to those using the conventional ultrasound transducer bandage.\u0000\u0000Materials and Methods: The researchers invented the newly-designed elastic CTG bandage and conducted a quasi-experimental study with thirty-four pregnant women gestational age under 37 weeks using both the newly-designed elastic CTG bandage and the conventional ultrasound transducers. A comparison of the outcomes of fetal heart rate monitoring between the two methods was done using Wilcoxon signed-rank test. Then, two instruments (the CTG band satisfaction questionnaire for women, and the CTG band satisfaction questionnaire and fetal heart rate graph absence record for the labor staff) were administered to the respective participants. They were adapted for the study based on the diffusion of innovation model, which postulated that an innovation was generally adopted when five main factors (compatibility, complexity, trial-ability, observability, and relative advantage) were met.\u0000\u0000Results: The median score of signals of fetal heart rate loss when solely using the newly-designed elastic CTG bandage was only 1.0 times and the conventional ultrasound transducer bandage was 3.0 times. There was a significant difference (p<0.001). Most members of the labor staff were satisfied with the suitability of the newly-designed elastic CTG bandage.\u0000\u0000Conclusion: The newly-designed elastic CTG bandage improved the quality of fetal heart rate assessment compared to the conventional ultrasound transducer bandage, resulting in the reduction of errors during examinations and the labor staff’s workloads while providing the ability to continuously assess the fetal heart rate.\u0000\u0000Keywords: Cardiotocograph; Fetal heart rate; Intrapartum fetal monitoring","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75042974","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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