Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13837
Background: Valgus knee is a challenge of ligament balance in total knee arthroplasty (TKA). A lateral release is often recommended to achieve symmetric extension gaps in valgus deformity, due to the traditional requirements of tight lateral gap. However, the gap pattern valgus osteoarthritis knee has not been studied. Materials and Methods: The present study was a retrospective study on navigated TKA with 89 valgus osteoarthritis knees. The gap measurement, bone cut, and component rotation values were collected from navigation and the data were analyzed. Results: Only 6.70% of valgus knees in the present series had a narrower lateral flexion gap than medial flexion gap and 7.90% had narrower lateral extension gap than medial extension gap. Conversely, most of valgus cases were seen in bigger lateral flexion gaps than medial flexion gaps at 76.4%. This was consistent with the extension gap patterns of 80.9%. The degree of valgus deformity positively correlated with all gaps, except for flexion lateral gap. The present study demonstrated a mean external rotation of 2.25±2.09° in the femoral component rotation and the degree of valgus deformity had no significant correlation with femoral rotation. Conclusion: The lateral distal femoral condyle hypoplasia might have more important role in the extension gap than the ligament tension. The lateral ligament might influence the lateral flexion gap more than the lateral femoral condyle deficiency. Lateral structural release for correction of valgus deformity during extension could lead to instability in flexion especially for gap patterns with a lateral flexion gap that is wider than the medial flexion gap. Keywords: Valgus knee; Navigated TKA; Gap pattern
{"title":"Gap Pattern in Valgus Knee: An Assessment with TKA Navigation","authors":"","doi":"10.35755/jmedassocthai.2023.04.13837","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13837","url":null,"abstract":"Background: Valgus knee is a challenge of ligament balance in total knee arthroplasty (TKA). A lateral release is often recommended to achieve symmetric extension gaps in valgus deformity, due to the traditional requirements of tight lateral gap. However, the gap pattern valgus osteoarthritis knee has not been studied.\u0000\u0000Materials and Methods: The present study was a retrospective study on navigated TKA with 89 valgus osteoarthritis knees. The gap measurement, bone cut, and component rotation values were collected from navigation and the data were analyzed.\u0000\u0000Results: Only 6.70% of valgus knees in the present series had a narrower lateral flexion gap than medial flexion gap and 7.90% had narrower lateral extension gap than medial extension gap. Conversely, most of valgus cases were seen in bigger lateral flexion gaps than medial flexion gaps at 76.4%. This was consistent with the extension gap patterns of 80.9%. The degree of valgus deformity positively correlated with all gaps, except for flexion lateral gap. The present study demonstrated a mean external rotation of 2.25±2.09° in the femoral component rotation and the degree of valgus deformity had no significant correlation with femoral rotation.\u0000\u0000Conclusion: The lateral distal femoral condyle hypoplasia might have more important role in the extension gap than the ligament tension. The lateral ligament might influence the lateral flexion gap more than the lateral femoral condyle deficiency. Lateral structural release for correction of valgus deformity during extension could lead to instability in flexion especially for gap patterns with a lateral flexion gap that is wider than the medial flexion gap.\u0000\u0000Keywords: Valgus knee; Navigated TKA; Gap pattern","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87257526","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13835
Background: Stroke is the second cause of Thai death after cancer. Therefore, stroke patients need to change their healthcare behavior (HB) for sustainable recovery. Objective: To study the effectiveness of mindfulness and self-regulation program (MSRP) on the HB and to analyze the interaction between family social support (FSS), and MSRP on HB of stroke patients. Materials and Methods: The randomized controlled trials (RCTs) were designed to test the program’s effectiveness. Fifty-eight stroke patients at the Neurological Institute participated in this trial. This was calculated by using G*Power 3.1 at power 0.85. Random assignment was used to allocate 28 participants in the experimental and 30 in the control group. The data were collected from the Likert rating scale with a Cronbach’s reliability of 0.934 to 0.989. The MSRP ran for five weeks with five activities between April and December 2021. T-tests and two-way ANOVA were used for data analyses. Results: After participation, stroke patients had a mean HB of 5.32 (SD 0.423) and were at a high level. The MSRP was effective, significantly enhancing HB. Additionally, the experimental group had a higher HB than the control group and higher than before participation in the intervention (p<0.05). The present study found that the interaction between FSS and the MSRP affected HB. Conclusion: This MSRP should be used to initiate promoting the HB of stroke patients. Keywords: Mindfulness; Self-regulation; Strokes; Healthcare; Health behavior; Health Program
{"title":"Effectiveness of Mindfulness and Self-Regulation Program on Healthcare Behaviors among Stroke Patients: A Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.04.13835","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13835","url":null,"abstract":"Background: Stroke is the second cause of Thai death after cancer. Therefore, stroke patients need to change their healthcare behavior (HB) for sustainable recovery.\u0000\u0000Objective: To study the effectiveness of mindfulness and self-regulation program (MSRP) on the HB and to analyze the interaction between family social support (FSS), and MSRP on HB of stroke patients.\u0000\u0000Materials and Methods: The randomized controlled trials (RCTs) were designed to test the program’s effectiveness. Fifty-eight stroke patients at the Neurological Institute participated in this trial. This was calculated by using G*Power 3.1 at power 0.85. Random assignment was used to allocate 28 participants in the experimental and 30 in the control group. The data were collected from the Likert rating scale with a Cronbach’s reliability of 0.934 to 0.989. The MSRP ran for five weeks with five activities between April and December 2021. T-tests and two-way ANOVA were used for data analyses.\u0000\u0000Results: After participation, stroke patients had a mean HB of 5.32 (SD 0.423) and were at a high level. The MSRP was effective, significantly enhancing HB. Additionally, the experimental group had a higher HB than the control group and higher than before participation in the intervention (p<0.05). The present study found that the interaction between FSS and the MSRP affected HB.\u0000\u0000Conclusion: This MSRP should be used to initiate promoting the HB of stroke patients.\u0000\u0000Keywords: Mindfulness; Self-regulation; Strokes; Healthcare; Health behavior; Health Program","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89117573","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13771
Objective: Acute ischemic stroke treatment costs are a concerning issue in developing countries. The objective of the present study was to determine cost and health-care resource utilization in patients with acute ischemic stroke in Thailand. Materials and Methods: The present study was a retrospective cohort study. The authors reviewed data from the electronic medical records of acute ischemic stroke patients. Data on resource utilization and healthcare costs (HCCs) were collected. Cost data, patient characteristics, and disease severity were described. Analyses were conducted using generalized linear regression models with a log-link and gamma distribution. Results: Two thousand two hundred seventy-eight patients had been diagnosed with ischemic stroke. The mean total costs per patient were 1,244.40 (±594.81) USD. Medical equipment was the most significant cost for acute ischemic stroke patients. Patients suffering from moderateto- severe stroke had higher HCCs than those suffering from minor stroke. Multivariate generalized linear modeling presented age, gender, most comorbidities, and the Barthel index score on admission to affect total cost in patients with acute ischemic stroke. Conclusion: HCCs in patients with acute ischemic stroke were significantly associated with age, gender, some comorbid conditions, and the Barthel index score at admission. HCCs are rising as a result of the severity of strokes. Keywords: Acute ischemic stroke, Healthcare resource utilization, Healthcare costs, Thailand
{"title":"Costs and Healthcare Resource Utilization of Inpatients with Acute Ischemic Stroke","authors":"","doi":"10.35755/jmedassocthai.2023.04.13771","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13771","url":null,"abstract":"Objective: Acute ischemic stroke treatment costs are a concerning issue in developing countries. The objective of the present study was to determine cost and health-care resource utilization in patients with acute ischemic stroke in Thailand.\u0000\u0000Materials and Methods: The present study was a retrospective cohort study. The authors reviewed data from the electronic medical records of acute ischemic stroke patients. Data on resource utilization and healthcare costs (HCCs) were collected. Cost data, patient characteristics, and disease severity were described. Analyses were conducted using generalized linear regression models with a log-link and gamma distribution.\u0000\u0000Results: Two thousand two hundred seventy-eight patients had been diagnosed with ischemic stroke. The mean total costs per patient were 1,244.40 (±594.81) USD. Medical equipment was the most significant cost for acute ischemic stroke patients. Patients suffering from moderateto- severe stroke had higher HCCs than those suffering from minor stroke. Multivariate generalized linear modeling presented age, gender, most comorbidities, and the Barthel index score on admission to affect total cost in patients with acute ischemic stroke.\u0000\u0000Conclusion: HCCs in patients with acute ischemic stroke were significantly associated with age, gender, some comorbid conditions, and the Barthel index score at admission. HCCs are rising as a result of the severity of strokes.\u0000\u0000Keywords: Acute ischemic stroke, Healthcare resource utilization, Healthcare costs, Thailand","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77503090","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13832
Background: Medication-related osteonecrosis of the jaw (MRONJ) could disturb the quality of life of the patients. In Thailand, published data reporting the prevalence of MRONJ is scarce. Objective: To analyze the current situation regarding the occurrence of osteonecrosis of the jaw in osteoporotic patients taking antiresorptive drugs at Pranangklao Hospital in Nonthaburi Province, Thailand. Materials and Methods: Data regarding osteoporotic patients received antiresorptive drugs were collected retrospectively from the electronic medical records between January 2014 and June 2020. Data were analyzed using descriptive statistics. Results: The hospital database revealed that there were 1,188 patients that received antiresorptive drugs during the specified period. One thousand twenty-nine (86.62%) were prescribed with only one antiresorptive drug. Alendronate was the main drug among the four medications prescribed, which was used by 592 patients (49.83%). Mean antiresorptive drug exposure time was 1.52 years (SD 1.54) and median was 0.85 years. Among 49 patients who had tooth extraction after receiving oral bisphosphonate, two MRONJ cases were reported. Therefore, the prevalence of MRONJ among the 1,188 patients receiving antiresorptive drugs in the present study was 0.17%, and the prevalence of MRONJ among the 677 obtaining oral bisphosphonates was 0.295%. About 89% had comorbid diseases. The most common comorbid diseases were hypertension, followed by dyslipidemia, and diabetes mellitus. Furthermore, 17% had a history of corticosteroid drug administration. Conclusion: MRONJ cases were found in osteoporotic patients receiving oral bisphosphonates. The prevalence of MRONJ and contributing factors gave information essential for managing this unwanted condition. Keywords: Medication related osteonecrosis of the jaw; Prevalence; Osteoporosis; Comorbidity; Corticosteroid
{"title":"Prevalence of Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients Treated with Antiresorptive Drugs at Pranangklao Tertiary Care Hospital in Nonthaburi Province, Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.04.13832","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13832","url":null,"abstract":"Background: Medication-related osteonecrosis of the jaw (MRONJ) could disturb the quality of life of the patients. In Thailand, published data reporting the prevalence of MRONJ is scarce.\u0000\u0000Objective: To analyze the current situation regarding the occurrence of osteonecrosis of the jaw in osteoporotic patients taking antiresorptive drugs at Pranangklao Hospital in Nonthaburi Province, Thailand.\u0000\u0000Materials and Methods: Data regarding osteoporotic patients received antiresorptive drugs were collected retrospectively from the electronic medical records between January 2014 and June 2020. Data were analyzed using descriptive statistics.\u0000\u0000Results: The hospital database revealed that there were 1,188 patients that received antiresorptive drugs during the specified period. One thousand twenty-nine (86.62%) were prescribed with only one antiresorptive drug. Alendronate was the main drug among the four medications prescribed, which was used by 592 patients (49.83%). Mean antiresorptive drug exposure time was 1.52 years (SD 1.54) and median was 0.85 years. Among 49 patients who had tooth extraction after receiving oral bisphosphonate, two MRONJ cases were reported. Therefore, the prevalence of MRONJ among the 1,188 patients receiving antiresorptive drugs in the present study was 0.17%, and the prevalence of MRONJ among the 677 obtaining oral bisphosphonates was 0.295%. About 89% had comorbid diseases. The most common comorbid diseases were hypertension, followed by dyslipidemia, and diabetes mellitus. Furthermore, 17% had a history of corticosteroid drug administration.\u0000\u0000Conclusion: MRONJ cases were found in osteoporotic patients receiving oral bisphosphonates. The prevalence of MRONJ and contributing factors gave information essential for managing this unwanted condition.\u0000\u0000Keywords: Medication related osteonecrosis of the jaw; Prevalence; Osteoporosis; Comorbidity; Corticosteroid","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85711435","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13822
Background: An esophageal stricture is the most frequent complication after surgical correction for esophageal atresia (EA) patient, resulting in hospitalization or surgical intervention. Objective: To describe the characteristics of EA with a stricture and assess the factors influencing the postoperative esophageal stricture. Materials and Methods: All children after surgical correction between 1999 and 2014 were included. All complications at one and five years were recorded and predicting factors for esophageal stricture were analyzed. Results: Forty-seven patients were recorded. Thirty-one EA patients were divided into two groups as stricture and non-stricture. Stricture had 18 patients and non-stricture had 13 patients. Median follow-up time of EA with esophageal stricture was 10 years (3,690.5 days), and 5.7 years (2082.0 days) for EA without stricture. Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association was found in 38% and 58.1% had anastomotic stricture. The waiting time from birth to surgical repair was significantly longer in the stricture group at 15 versus 3 days (p=0.009). The median esophageal stricture time was about five years (1,829 days). The most common clinical presentation of EA with stricture was dysphagia following with recurrent pneumonia. Respiratory pneumonia was more common in the stricture group (p=0.033). Conclusion: Primary repairs should not be delayed in EA patients. Anastomotic strictures can be found beyond the fifth year after surgery. A multidisciplinary follow-up plan should be continued for longer than five years to enable the detection of further late stricture formation. Keywords: Esophageal atresia; Tracheoesophageal fistula; Congenital esophageal atresia; Postoperative esophageal stricture
{"title":"Factors Predicting Postoperative Esophageal Stricture after Repaired Tracheoesophageal Malformation in Children with Esophageal Atresia","authors":"","doi":"10.35755/jmedassocthai.2023.04.13822","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13822","url":null,"abstract":"Background: An esophageal stricture is the most frequent complication after surgical correction for esophageal atresia (EA) patient, resulting in hospitalization or surgical intervention.\u0000\u0000Objective: To describe the characteristics of EA with a stricture and assess the factors influencing the postoperative esophageal stricture.\u0000\u0000Materials and Methods: All children after surgical correction between 1999 and 2014 were included. All complications at one and five years were recorded and predicting factors for esophageal stricture were analyzed.\u0000\u0000Results: Forty-seven patients were recorded. Thirty-one EA patients were divided into two groups as stricture and non-stricture. Stricture had 18 patients and non-stricture had 13 patients. Median follow-up time of EA with esophageal stricture was 10 years (3,690.5 days), and 5.7 years (2082.0 days) for EA without stricture. Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association was found in 38% and 58.1% had anastomotic stricture. The waiting time from birth to surgical repair was significantly longer in the stricture group at 15 versus 3 days (p=0.009). The median esophageal stricture time was about five years (1,829 days). The most common clinical presentation of EA with stricture was dysphagia following with recurrent pneumonia. Respiratory pneumonia was more common in the stricture group (p=0.033).\u0000\u0000Conclusion: Primary repairs should not be delayed in EA patients. Anastomotic strictures can be found beyond the fifth year after surgery. A multidisciplinary follow-up plan should be continued for longer than five years to enable the detection of further late stricture formation.\u0000\u0000Keywords: Esophageal atresia; Tracheoesophageal fistula; Congenital esophageal atresia; Postoperative esophageal stricture","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89486031","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13732
Objective: To describe imaging findings on contrast enema of Hirschsprung disease at King Chulalongkorn Memorial Hospital. Materials and Methods: The present study was a retrospective study, approved by the present institute ethic Committee. The requirement for informed consent was waived. Between January 2002 and March 15, 2021, the imaging, medical, and histopathologic information of 48 cases with histopathologically proven Hirschsprung disease were evaluated. Results: Forty cases out of 48 (83.33%) that met the inclusion criteria were male. Neonate and infant patients made up 42 cases. According to histopathologic data, there were diseases in the short segment in 60.42% of the study cases, the long segment in 12.50%, and the entire colon in 14.58%. The common symptoms were abdominal distention, delayed passing meconium, constipation, and poor feeding. The transitional zone in 40 out of 48 (83.33%) was the most often observed imaging finding. Out of the 48 patients, additional imaging findings for 17 (35.41%) was reverse rectosigmoid ratio, for nine (18.75%) was serration, for three (6.25%) was microcolon, and for one (2.08%) was short colon. The transitional zone was also most common among cases of short and long segment diseases. In the cases of total colonic disease, transitional zone and non-diagnostic imaging were equal. Conclusion: The transitional zone, reverse rectosigmoid ratio, and serration are common imaging findings for Hirschsprung disease on contrast enema at King Chulalongkorn Memorial Hospital. Non-diagnostic findings were uncommon but frequently observed in total colonic aganglionosis with variety of patterns. Therefore, if a diagnosis is clinically suspected, a biopsy may be required to confirm it. Keywords: Contrast enema; Hirschsprung disease
{"title":"Imaging Findings on Contrast Enema of Hirschsprung Disease","authors":"","doi":"10.35755/jmedassocthai.2023.04.13732","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13732","url":null,"abstract":"Objective: To describe imaging findings on contrast enema of Hirschsprung disease at King Chulalongkorn Memorial Hospital.\u0000\u0000Materials and Methods: The present study was a retrospective study, approved by the present institute ethic Committee. The requirement for informed consent was waived. Between January 2002 and March 15, 2021, the imaging, medical, and histopathologic information of 48 cases with histopathologically proven Hirschsprung disease were evaluated.\u0000\u0000Results: Forty cases out of 48 (83.33%) that met the inclusion criteria were male. Neonate and infant patients made up 42 cases. According to histopathologic data, there were diseases in the short segment in 60.42% of the study cases, the long segment in 12.50%, and the entire colon in 14.58%. The common symptoms were abdominal distention, delayed passing meconium, constipation, and poor feeding. The transitional zone in 40 out of 48 (83.33%) was the most often observed imaging finding. Out of the 48 patients, additional imaging findings for 17 (35.41%) was reverse rectosigmoid ratio, for nine (18.75%) was serration, for three (6.25%) was microcolon, and for one (2.08%) was short colon. The transitional zone was also most common among cases of short and long segment diseases. In the cases of total colonic disease, transitional zone and non-diagnostic imaging were equal.\u0000\u0000Conclusion: The transitional zone, reverse rectosigmoid ratio, and serration are common imaging findings for Hirschsprung disease on contrast enema at King Chulalongkorn Memorial Hospital. Non-diagnostic findings were uncommon but frequently observed in total colonic aganglionosis with variety of patterns. Therefore, if a diagnosis is clinically suspected, a biopsy may be required to confirm it.\u0000\u0000Keywords: Contrast enema; Hirschsprung disease","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73886029","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13839
Background: Endotracheal tube intubation can be associated with laryngeal edema, which may present as post-extubation stridor (PES). PES may prolong length of stay in pediatric intensive care unit, particularly if reintubation was necessary. Objective: To evaluate the efficacy of laryngeal ultrasonography and percent leak volume (PLV) in predicting PES in pediatric patients. Materials and Methods: A prospective study of 43 pediatric patients admitted to pediatric intensive care unit was conducted. Laryngeal ultrasonography was performed to measure air column width (ACW) within 24 hours after intubation. Within four hours before extubation, laryngeal ultrasonography was repeated. Air column width ratio (ACWR) was calculated by ACW before extubation divided by ACW after intubation. PLV was calculated by the difference between inspiratory and expiratory tidal volume divided by inspiratory tidal volume. Both of ACWR and PLV were analyzed to determine the optimal cut-off value for predicting PES. Results: Twenty-two patients (51%), developed PES. Receiver operating characteristics curve (ROC) analysis showed that ACWR at cut-off point ≤0.94 had a sensitivity of 72.7%, specificity of 61.9%, positive predictive value (PPV) of 66.7%, and accuracy of 67.4% in predicting PES. A cut-off point of PLV of less than 9.74% had 59.1% sensitivity, 57.1% specificity, 59.1% PPV, and 58.1% accuracy in predicting PES. ACWR and PLV had an area under the ROC curve (AUC) of 0.722 (p=0.013, 95% CI 0.56 to 0.87) and 0.602 (p=0.253, 95% CI 0.43 to 0.77), respectively. Conclusion: ACWR measured by laryngeal ultrasonography of 0.94 or less may be helpful in predicting PES. ACWR is more accurate than PLV in predicting PES. Keywords: Laryngeal ultrasonography; Percent leak volume; Post-extubation stridor
背景:气管插管可伴有喉部水肿，其表现为拔管后喘鸣(PES)。PES可能会延长儿童重症监护病房的住院时间，特别是如果需要重新插管。目的:探讨喉超声及喉漏率(PLV)对小儿PES的预测价值。材料与方法:对43例儿科重症监护患者进行前瞻性研究。插管后24小时内进行喉超声检查，测量气管气柱宽度(ACW)。拔管前4小时复查喉部超声检查。气柱宽度比(ACWR)用拔管前的ACW除以插管后的ACW计算。PLV由吸气和呼气潮气量之差除以吸气潮气量计算。对ACWR和PLV进行分析，确定预测PES的最佳临界值。结果:22例(51%)发生PES。受试者工作特征曲线(ROC)分析显示，ACWR在截断点≤0.94时预测PES的敏感性为72.7%，特异性为61.9%，阳性预测值(PPV)为66.7%，准确率为67.4%。当PLV小于9.74%时，预测PES的敏感性为59.1%，特异性为57.1%，PPV为59.1%，准确度为58.1%。ACWR和PLV的ROC曲线下面积(AUC)分别为0.722 (p=0.013, 95% CI 0.56 ~ 0.87)和0.602 (p=0.253, 95% CI 0.43 ~ 0.77)。结论:喉超声测得的ACWR值小于等于0.94有助于预测PES。ACWR对PES的预测比PLV更准确。关键词:喉超声;泄漏体积百分比;拔喘鸣
{"title":"Laryngeal Ultrasonography and Percent Leak Volume in Predicting Post-Extubation Stridor in The Pediatric Intensive Care Unit Patients","authors":"","doi":"10.35755/jmedassocthai.2023.04.13839","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13839","url":null,"abstract":"Background: Endotracheal tube intubation can be associated with laryngeal edema, which may present as post-extubation stridor (PES). PES may prolong length of stay in pediatric intensive care unit, particularly if reintubation was necessary.\u0000\u0000Objective: To evaluate the efficacy of laryngeal ultrasonography and percent leak volume (PLV) in predicting PES in pediatric patients.\u0000\u0000Materials and Methods: A prospective study of 43 pediatric patients admitted to pediatric intensive care unit was conducted. Laryngeal ultrasonography was performed to measure air column width (ACW) within 24 hours after intubation. Within four hours before extubation, laryngeal ultrasonography was repeated. Air column width ratio (ACWR) was calculated by ACW before extubation divided by ACW after intubation. PLV was calculated by the difference between inspiratory and expiratory tidal volume divided by inspiratory tidal volume. Both of ACWR and PLV were analyzed to determine the optimal cut-off value for predicting PES.\u0000\u0000Results: Twenty-two patients (51%), developed PES. Receiver operating characteristics curve (ROC) analysis showed that ACWR at cut-off point ≤0.94 had a sensitivity of 72.7%, specificity of 61.9%, positive predictive value (PPV) of 66.7%, and accuracy of 67.4% in predicting PES. A cut-off point of PLV of less than 9.74% had 59.1% sensitivity, 57.1% specificity, 59.1% PPV, and 58.1% accuracy in predicting PES. ACWR and PLV had an area under the ROC curve (AUC) of 0.722 (p=0.013, 95% CI 0.56 to 0.87) and 0.602 (p=0.253, 95% CI 0.43 to 0.77), respectively.\u0000\u0000Conclusion: ACWR measured by laryngeal ultrasonography of 0.94 or less may be helpful in predicting PES. ACWR is more accurate than PLV in predicting PES.\u0000\u0000Keywords: Laryngeal ultrasonography; Percent leak volume; Post-extubation stridor","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78197723","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 : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13842
Objective: To compare the diagnostic performance of breast magnetic resonance imaging (MRI) and mammography with ultrasonography for detection of local recurrent breast cancer among female patients with post-breast conserving therapy (BCT). Materials and Methods: The authors retrospectively enrolled 190 post-BCT female patients who underwent post-operative surveillance by breast MRI and mammography with ultrasonography at King Chulalongkorn Memorial Hospital between January 1, 2008 and July 1, 2019. Two radiologists reviewed the images from the two surveillance modalities, independently. The information including radiological and histopathological data were blinded during the review process. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were then estimated to reflect the diagnostic performance of the two modalities for detection of local recurrent breast cancer. Results: Of the 190 patients, 52 (27.4%) were diagnosed as local recurrent breast cancer. Sensitivity, specificity, PPV, and NPV were 98.1%, 92%, 82.3%, 99.2%, respectively, for breast MRI, and 88.5%, 62.3%, 46.9%, 93.5%, respectively, for mammography with ultrasonography. The findings that could be better evaluated by breast MRI than by mammography with ultrasonography included post-operative change and benign mass (p<0.001), suspicious mass (p<0.001), and suspicious calcification (p<0.003). Conclusion: Breast MRI is superior to mammography with ultrasonography for detection of local recurrent breast cancer after BCT. Furthermore, MRI can help clinicians avoid unnecessary biopsy and surgical interventions due to its ability to differentiate post-treatment change from local recurrent breast cancer. Keywords: Breast conserving therapy; Magnetic resonance imaging; Breast MRI; Mammography with ultrasonography; Local recurrent breast cancer
{"title":"Comparison of Diagnostic Performance between MRI and Mammogram with Ultrasound in Surveillance for Local Recurrent Breast Cancer after BCT","authors":"","doi":"10.35755/jmedassocthai.2023.04.13842","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13842","url":null,"abstract":"Objective: To compare the diagnostic performance of breast magnetic resonance imaging (MRI) and mammography with ultrasonography for detection of local recurrent breast cancer among female patients with post-breast conserving therapy (BCT).\u0000\u0000Materials and Methods: The authors retrospectively enrolled 190 post-BCT female patients who underwent post-operative surveillance by breast MRI and mammography with ultrasonography at King Chulalongkorn Memorial Hospital between January 1, 2008 and July 1, 2019. Two radiologists reviewed the images from the two surveillance modalities, independently. The information including radiological and histopathological data were blinded during the review process. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were then estimated to reflect the diagnostic performance of the two modalities for detection of local recurrent breast cancer.\u0000\u0000Results: Of the 190 patients, 52 (27.4%) were diagnosed as local recurrent breast cancer. Sensitivity, specificity, PPV, and NPV were 98.1%, 92%, 82.3%, 99.2%, respectively, for breast MRI, and 88.5%, 62.3%, 46.9%, 93.5%, respectively, for mammography with ultrasonography. The findings that could be better evaluated by breast MRI than by mammography with ultrasonography included post-operative change and benign mass (p<0.001), suspicious mass (p<0.001), and suspicious calcification (p<0.003).\u0000\u0000Conclusion: Breast MRI is superior to mammography with ultrasonography for detection of local recurrent breast cancer after BCT. Furthermore, MRI can help clinicians avoid unnecessary biopsy and surgical interventions due to its ability to differentiate post-treatment change from local recurrent breast cancer.\u0000\u0000Keywords: Breast conserving therapy; Magnetic resonance imaging; Breast MRI; Mammography with ultrasonography; Local recurrent breast cancer","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76051059","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 : 2023-03-15DOI: 10.35755/jmedassocthai.2023.03.13799
Objective: To assess the quality of life (QOL) and related factors in psoriatic patients. Materials and Methods: A cross-sectional study was conducted of 145 out-patients with psoriasis in Rajavithi Hospital. SF-36 mean scores were recorded for eight dimensions, physical function (PF), role limitations due to physical problems (RP), role limitations due to emotional problems (RE), vitality (VT); bodily pain (BP), general health (GH), social function (SF), and mental health (MH). The relationships between factors and QOL were explored using Pearson’s correlation coefficient. Results: The mean age was 46.27±16.25 years, and 55.2% were male. Average BMI was 25.40±5.45 kg/m², and the mean duration of psoriasis was 48 months. The median PASI score was 10, and 62% had a PASI score of 10 or less. The main areas of involvement were skin (77.2%), scalp (59.3%), and nails (44.8%). The QOL scores ranged from 35.67 to 72.00 with the highest score for bodily pain (72.00±21.86), followed by physical role (71.90±36.67), and emotional role (67.82±37.56). Female, smoking, underlying diseases, and area of involvement were associated with QOL. Conclusion: Demographic, behavioral, and psoriasis-specific factors are associated with QOL. Keywords: Psoriasis; Quality of life; SF-36
{"title":"Quality of Life of Psoriatic Patients Assessed by SF-36 in Rajavithi Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.03.13799","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.03.13799","url":null,"abstract":"Objective: To assess the quality of life (QOL) and related factors in psoriatic patients.\u0000\u0000Materials and Methods: A cross-sectional study was conducted of 145 out-patients with psoriasis in Rajavithi Hospital. SF-36 mean scores were recorded for eight dimensions, physical function (PF), role limitations due to physical problems (RP), role limitations due to emotional problems (RE), vitality (VT); bodily pain (BP), general health (GH), social function (SF), and mental health (MH). The relationships between factors and QOL were explored using Pearson’s correlation coefficient.\u0000\u0000Results: The mean age was 46.27±16.25 years, and 55.2% were male. Average BMI was 25.40±5.45 kg/m², and the mean duration of psoriasis was 48 months. The median PASI score was 10, and 62% had a PASI score of 10 or less. The main areas of involvement were skin (77.2%), scalp (59.3%), and nails (44.8%). The QOL scores ranged from 35.67 to 72.00 with the highest score for bodily pain (72.00±21.86), followed by physical role (71.90±36.67), and emotional role (67.82±37.56). Female, smoking, underlying diseases, and area of involvement were associated with QOL.\u0000\u0000Conclusion: Demographic, behavioral, and psoriasis-specific factors are associated with QOL.\u0000\u0000Keywords: Psoriasis; Quality of life; SF-36","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75286867","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 : 2023-03-15DOI: 10.35755/jmedassocthai.2023.03.13806
Objective: To study the feasibility of magnetic resonance elastography (MRE) for the evaluation of myoma uteri in Thai patients. Materials and Methods: A prospective descriptive study was conducted between September 2020 and October 2021. Twenty-six myoma uteri patients were performed in a 3.0-Tesla MRI scanner, added with a pneumatic system generating mechanical waves. For the MRE assessment, the number of acquired slices, mean stiffness with standard deviation (SD), minimum, and maximum stiffnesses (kPa) were recorded. Results: The mean stiffness of the myoma uteri was 3.02 kPa (range 1.83 to 5.06, SD 0.79). Their volume ranged from 56.24 to 716.35 cm³ (mean 237.74, SD 187.63. The proportion of lesions ranged from 31.87% to 74.36% of the whole uterus (mean 44.94, SD 16.98). Conclusion: Uterine MRE is a feasible diagnostic tool for studying the tissue stiffness of the myoma uteri, which is higher than normal uterine tissue. The mean stiffness of Thai patient myoma uteri was lower than other ethnicities. Keywords: Myoma uteri; Uterine fibroid; Uterine leiomyoma; MRE; Tissue stiffness
{"title":"Myoma Uteri: Stiffness from MR Elastography in Thai Patients: A Pilot Study","authors":"","doi":"10.35755/jmedassocthai.2023.03.13806","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.03.13806","url":null,"abstract":"Objective: To study the feasibility of magnetic resonance elastography (MRE) for the evaluation of myoma uteri in Thai patients.\u0000\u0000Materials and Methods: A prospective descriptive study was conducted between September 2020 and October 2021. Twenty-six myoma uteri patients were performed in a 3.0-Tesla MRI scanner, added with a pneumatic system generating mechanical waves. For the MRE assessment, the number of acquired slices, mean stiffness with standard deviation (SD), minimum, and maximum stiffnesses (kPa) were recorded.\u0000\u0000Results: The mean stiffness of the myoma uteri was 3.02 kPa (range 1.83 to 5.06, SD 0.79). Their volume ranged from 56.24 to 716.35 cm³ (mean 237.74, SD 187.63. The proportion of lesions ranged from 31.87% to 74.36% of the whole uterus (mean 44.94, SD 16.98).\u0000\u0000Conclusion: Uterine MRE is a feasible diagnostic tool for studying the tissue stiffness of the myoma uteri, which is higher than normal uterine tissue. The mean stiffness of Thai patient myoma uteri was lower than other ethnicities.\u0000\u0000Keywords: Myoma uteri; Uterine fibroid; Uterine leiomyoma; MRE; Tissue stiffness","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86551180","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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