Zeitschriften und Ausgaben

Volumen 16 (2022): Heft 3 (June 2022)

Volumen 16 (2022): Heft 2 (April 2022)

Volumen 16 (2022): Heft 1 (February 2022)

Volumen 15 (2021): Heft 6 (December 2021)

Volumen 15 (2021): Heft 5 (October 2021)

Volumen 15 (2021): Heft 4 (August 2021)

Volumen 15 (2021): Heft 3 (June 2021)

Volumen 15 (2021): Heft 2 (April 2021)

Volumen 15 (2021): Heft 1 (February 2021)

Volumen 14 (2020): Heft 6 (December 2020)

Volumen 14 (2020): Heft 5 (October 2020)

Volumen 14 (2020): Heft 4 (August 2020)

Volumen 14 (2020): Heft 3 (June 2020)

Volumen 14 (2020): Heft 2 (April 2020)

Volumen 14 (2020): Heft 1 (February 2020)

Volumen 13 (2019): Heft 6 (December 2019)

Volumen 13 (2019): Heft 5 (October 2019)

Volumen 13 (2019): Heft 4 (August 2019)

Volumen 13 (2019): Heft 3 (June 2019)

Volumen 13 (2019): Heft 2 (April 2019)

Volumen 13 (2019): Heft 1 (February 2019)

Volumen 12 (2018): Heft 6 (December 2018)

Volumen 12 (2018): Heft 5 (October 2018)

Volumen 12 (2018): Heft 4 (August 2018)

Volumen 12 (2018): Heft 3 (June 2018)

Volumen 12 (2018): Heft 2 (April 2018)

Volumen 12 (2018): Heft 1 (February 2018)

Volumen 11 (2017): Heft 6 (December 2017)

Volumen 11 (2017): Heft 5 (October 2017)

Volumen 11 (2017): Heft 4 (August 2017)

Volumen 11 (2017): Heft 3 (June 2017)

Volumen 11 (2017): Heft 2 (April 2017)

Volumen 11 (2017): Heft 1 (February 2017)

Volumen 10 (2016): Heft 6 (December 2016)

Volumen 10 (2016): Heft 5 (October 2016)

Volumen 10 (2016): Heft 4 (August 2016)

Volumen 10 (2016): Heft 3 (June 2016)

Volumen 10 (2016): Heft 2 (April 2016)

Volumen 10 (2016): Heft s1 (December 2016)

Volumen 10 (2016): Heft 1 (February 2016)

Volumen 9 (2015): Heft 6 (December 2015)

Volumen 9 (2015): Heft 5 (October 2015)

Volumen 9 (2015): Heft 4 (August 2015)

Volumen 9 (2015): Heft 3 (June 2015)

Volumen 9 (2015): Heft 2 (April 2015)

Volumen 9 (2015): Heft 1 (February 2015)

Volumen 8 (2014): Heft 6 (December 2014)

Volumen 8 (2014): Heft 5 (October 2014)

Volumen 8 (2014): Heft 4 (August 2014)

Volumen 8 (2014): Heft 3 (June 2014)

Volumen 8 (2014): Heft 2 (April 2014)

Volumen 8 (2014): Heft 1 (February 2014)

Volumen 7 (2013): Heft 6 (December 2013)

Volumen 7 (2013): Heft 5 (October 2013)

Volumen 7 (2013): Heft 4 (August 2013)

Volumen 7 (2013): Heft 3 (June 2013)

Volumen 7 (2013): Heft 2 (April 2013)

Volumen 7 (2013): Heft 1 (February 2013)

Volumen 6 (2012): Heft 6 (December 2012)

Volumen 6 (2012): Heft 5 (October 2012)

Volumen 6 (2012): Heft 4 (August 2012)

Volumen 6 (2012): Heft 3 (June 2012)

Volumen 6 (2012): Heft 2 (April 2012)

Volumen 6 (2012): Heft 1 (February 2012)

Volumen 5 (2011): Heft 6 (December 2011)

Volumen 5 (2011): Heft 5 (October 2011)

Volumen 5 (2011): Heft 4 (August 2011)

Volumen 5 (2011): Heft 3 (June 2011)

Volumen 5 (2011): Heft 2 (April 2011)

Volumen 5 (2011): Heft 1 (February 2011)

Volumen 4 (2010): Heft 6 (December 2010)

Volumen 4 (2010): Heft 5 (October 2010)

Volumen 4 (2010): Heft 4 (August 2010)

Volumen 4 (2010): Heft 3 (June 2010)

Volumen 4 (2010): Heft 2 (April 2010)

Volumen 4 (2010): Heft 1 (February 2010)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 4 (2010): Heft 3 (June 2010)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

20 Artikel
access type Uneingeschränkter Zugang

The role of metabolic acidosis in chronic kidney diseases

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 367 - 372

Zusammenfassung

Abstract

Background and objectives: This review focuses on three areas, basic acid-base physiology especially concerning hydrogen ion balance, development of acidosis in chronic kidney disease (CKD), and the consequences of acidosis. We highlight what is well established, what is less certain, and what is unknown. Method and results: The literature on acidosis in CKD were searched from 2004 to 2010 utilizing PubMed, Google Scholar, and Ovid to augment the classic work on acid base physiology over the past three decades. The original research in endogenous acid production and net acid excretion were reviewed. Touching upon the development of metabolic acidosis in CKD, we focused on the consequences of chronic metabolic acidosis on growth and other important variables. Finally, we recognize the significant issue of patients’ medical non-compliance and presented treatment strategy to counter this problem. Conclusion: The correction of acidosis in chronic kidney disease needs no advocacy. The case is made conclusively. Patient non-compliance because of the medication that needs to be taken several times a day is a problem, requiring due diligence.

Schlüsselwörter

  • Bicarbonate therapy
  • chronic kidney disease
  • growth retardation
  • metabolic acidosis
  • net acid balance
  • non-compliance
access type Uneingeschränkter Zugang

Ataxia telangiectasia mutated nuclear localization in head and neck cancer cells is PPP2R2B-dependent

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 373 - 383

Zusammenfassung

Abstract

Background: Protein phosphatase 2A (PP2A) has been implicated in radiation-induced activation of cellular responses, likely by its ability to regulate the autophosphorylation of the ataxia telangiectasia mutated (ATM) protein, a key molecule involved in the DNA damage response initiated by double-stranded DNA breaks. Interestingly, a hereditary defect in the PPP2R2B gene, which encodes the beta isoform of PP2A regulatory subunit B, causes autosomal dominant spinocerebellar ataxia 12, a clinical condition resembling that of ataxia telangiectasia patients. Moreover, PPP2R2B is significantly down-regulated in many human cancers, including head and neck squamous cell carcinomas (HNSCCs). Objective: Examine whether PPP2R2B regulates ATM function, thereby contributing to tumor progression due to the resulting defective DNA repair. Methods: The roles of PPP2R2B were evaluated in irradiated HNSCC cell lines, siRNAPPP2R2B cells and okadaic acid treated cells. Expression of PPP2R2B was measured by microarray, Western blot analysis and real time quantitative rtPCR. ATM quantity and localization, ATM phosphorylation and γ-H2AX were determined by Western blot analysis and/or immunofluorescence assay. Clonogenic cell survival assay was performed to determine ionizing radiation sensitivity. Results: PPP2R2B expression is reduced in multiple tumor types, including HNSCCs. Indeed, HNSCC cell lines that have lower PPP2R2B mRNA expression and siRNAPPP2R2B cells lower basal and radiation-induced levels of phosphorylated ATM and the consequent reduction in the levels of phosphorylation of the downstream ATM target, γ-H2AX. Depletion of PPP2R2B and inhibition of PP2A with okadaic acid resulted in limited ATM nuclear localization. Finally, siRNAPPP2R2B cells displayed enhanced sensitivity to death after radiation. Conclusion: In HNSCCs, ATM nuclear localization is PPP2R2B dependent, and decreased PPP2R2B expression may result in limited ATM activation by preventing its nuclear accumulation and ATM-chromatin interaction. Therefore, decreased PPP2R2B expression in HNSCCs may contribute to genomic instability, cancer development and radiation sensitivity by limiting ATM functions.

Schlüsselwörter

  • ATM
  • head
  • neck
  • nuclear localization
  • PPP2R2B
  • PP2A
  • SCA12
  • squamous cell carcinoma
access type Uneingeschränkter Zugang

Association of high sensitivity C-reactive protein concentrations and metabolic syndrome among Thai adults

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 385 - 393

Zusammenfassung

Abstract

Background: Limited information is available regarding associations of metabolic syndrome with C-reactive protein (CRP) concentrations among Asian populations. Objective: Investigate the association of high sensitivity CRP (hsCRP) concentrations and metabolic syndrome among Thai adults. Methods: This cross-sectional study was comprised of 467 Thai participants (209 men and 258 women) receiving annual health check-up. Spearman’s rank correlation coefficients were used to assess the associations between metabolic parameters (age, waist circumference, blood pressure, triglycerides, HDL-C, fasting plasma glucose, fasting insulin and uric acid) with hsCRP concentrations for men and women, respectively. Multivariable logistic regression procedures were used to estimate the risk (odds ratios (OR), and 95% confidence intervals (CI) of metabolic syndrome according to low, moderate, and high hsCRP concentrations (<1.0, 1.0-3.0, and >3.0 mg/L, respectively). Results: Measures of adiposity and fasting insulin were positively and significantly correlated with hsCRP concentrations among women with and without metabolic syndrome. Similar associations were observed among men without metabolic syndrome. After controlling for confounders, moderately elevated hsCRP concentrations were associated with a 2.38-fold increased risk of metabolic syndrome (OR=2.38, 95%CI=1.20-4.72) among men. Men with high hsCRP concentrations had a 5.45-fold increased risk of metabolic syndrome (OR=5.45, 95%CI=2.24- 13.27) when compared with those who had low hsCRP concentrations. The corresponding OR for women with moderately elevated and high hsCRP concentrations were 4.92 (OR=4.92, 95%CI=2.34-10.35) and 11.93 (OR=11.93, 95%CI=5.54-25.72), respectively. Conclusions: These findings are consistent with the literature suggesting a role of hsCRP as a biomarker for metabolic syndrome.

Schlüsselwörter

  • C-reactive protein
  • inflammation
  • metabolic syndrome
  • obesity
access type Uneingeschränkter Zugang

Quality and patient safety in anesthesia service: Thai survey

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 395 - 401

Zusammenfassung

Abstract

Background: The Royal College of Anesthesiologists of Thailand (RCAT) performed large-scale epidemiologic study of anesthesia-related complications and national incidents study in 2004 and 2007, respectively. Objectives: Evaluate the anesthesia service in Thailand with regard to status of quality and patient safety. Material and methods: A pre-planned structured questionnaire regarding demographic, administrative, preanesthetic, intraoperative postanesthetic variables and complications were requested to be filled in by nurse anesthetists attending the refresher course lecture of RCAT in February 2008. Descriptive statistics was used. Results: Three hundred fifty questionnaires were given and 341 respondents (97%) returned the questionnaires. Most of the respondents (90%) worked in government section. Thirty percent of respondents practiced in hospital without medical doctor anesthesiologist and 58% of nurse anesthetists worked in hospitals that have been accredited. Forty-six percent of respondents reported unavailability of a 24-hour recovery room. The questionnaires revealed of inadequacy of anesthesia personnel (64%), inadequate supervision during emergency condition (53%), inadequacy of patient information regarding anesthesia (57-69%), and low opportunity for patient to choose choice of anesthesia (19%). The commonly used monitoring were pulse oximeter (92% of respondents) and electrocardiography (63%). One-third (32%) of respondents had to provide of anesthesia for patients with insufficient NPO (non per oral) time. Common problems that the respondents experienced were miscommunication (49%), intraoperative cardiac arrest during the past year (35%), error related to infusion pump (24%) and medication error (8%). Fifty-five percent of respondents had to monitor at least one patient per month receiving spinal anesthesia. Conclusion: Suggested strategies for quality and patient safety improvement in anesthesia service are increasing personnel, increasing 24-hour recovery room, improvement of supervision, improvement of communication, compliance to guidelines and improvement of nurse anesthetist’s training regarding monitoring patient receiving spinal anesthesia and cardiopulmonary resuscitation.

Schlüsselwörter

  • Anesthesia
  • cardiac arrest
  • guidelines
  • patient information
  • quality
  • safety
access type Uneingeschränkter Zugang

Three-dimensional imaging of living transplanted kidney vasculature by 3D color Doppler ultrasonography

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 403 - 411

Zusammenfassung

Abstract

Background: It is of clinical importance to display the vasculature of transplanted kidney in three-dimensional (3D) and in non-invasive way. 3D color Doppler ultrasonographic imaging (3D-CDUI) is a non-invasive technique to display the 3D vasculature of living organs. Objective: Probe into characteristics of 3D vasculature of living transplanted kidney by 3D-CDUI, and evaluate the clinical value of 3D-CDUI on monitoring complications after operation of renal transplant. Methods: Nine patients who received allogeneic transplantation of kidney were monitored with 3D-CDUI. The instruments used included ACUSON Sequoia 512 and TomTec computer station of 3D-CDUI. Using magnetic positioning free-hand scanning, the 3D reconstruction and display of renal tissue structure and blood flow were performed off-line. Results: All patients underwent 3D-CDUI examinations without any side effect or complication. When acute rejection occurred, the 3D distribution change of renal blood flow signal could be observed clearly. During treatment of acute necrosis of renal tubules, changes of renal blood flow signal in 3D color Doppler images could be detected earlier compared with 2D color Doppler images. The position of embolized vassels could be diagnosed accurately by 3D-CDUI. Conclusion: The 3D-CDUI was helpful to improve diagnosis level of ultrasonography by monitoring complications after renal transplantation.

Keyword

  • Color Doppler
  • post-operative complication
  • renal vasculature
  • 3D-ultrasonography
  • transplanted kidney
access type Uneingeschränkter Zugang

Endovascular aortic stent for thoracic and abdominal aortic aneurysm: imaging consequences and complications

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 413 - 420

Zusammenfassung

Abstract

Background: Endovascular stent-graft implantation has been used as an alternative to conventional open surgery in treatment of aortic aneurysm. Computed tomographic angiography (CTA) has been requested for follow-up and evaluation of aortic stent complications. Objective: Find the incidence of endovascular aortic stent complications and analyze the CTA features of postendovascular aortic stent consequences. Methods: Two radiologists reviewed CTA images of 635 patients who attended King Chulalongkorn Memorial Hospital between Sep 1, 2003 and Aug 31, 2008. Thirty-eight patients had endovascular aortic stent installation with 95 CTA images. The incidence of endovascular aortic stent complications, the image appearances including consequences and time-interval of endoleak were analyzed. Results: There were 23 thoracic aortic stents, 10 abdominal aortic stents and five combined stents for thoracic and abdominal aortic aneurysms. Twenty-eight cases had aortic stent complications (73.7%). Two cases had immediately post procedural complication of groin hematomas (7.1%). Ten patients had more than one finding. Findings of the stent-graft complications were as follows: 19 endoleaks, 15 stent thrombosis, five stents without covered-dissection, two stent kinkings, two iatrogenic focal aortic dissection, two air within aneurysm after stent installation and one spreading infected aortitis. The most common complication was endoleaks (53.6%), which could progress, be persistent or resolvable. Time-interval to detect endoleak was between 1 and 464 days. Conclusion: CTA can be used as modality of choice in demonstration of stent location, consequences, and complications. The stent complication was still high in the first five-year experience.

Schlüsselwörter

  • Aortic stent complication
  • computed tomographic angiography (CTA)
  • endoleak
  • endovascular aortic stent
access type Uneingeschränkter Zugang

Effects of Bungarus candidus (Malayan krait) venom on general circulation and renal hemodynamics in experimental animals

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 421 - 428

Zusammenfassung

Abstract

Background: Many studies have reported the occurrence of lethal acute renal failure after snakebites. Bungarus candidus (Malayan krait) is a medically important venomous snake distributed widely throughout Southeast Asia. The best known features of systemic envenoming by B. candidus are neurotoxic. Objective: Obtain more information on effects of B. candidus venom on changes in systemic and renal hemodynamics in experimental animals. Methods: Twelve adult male New Zealand white rabbits were used to study the effect of B. candidus venom on general circulation and renal hemodynamics. An anesthetized animal was intravenously injected with B. candidus venom at a dosage of 50μg/kg bodyweight. All changes of parameters were observed after initial post venom injection and recorded at 30 min intervals until 150 minutes after envenomation. Results: After envenomation, cardiovascular responses showed a marked decrease in mean arterial pressure within two minutes, afterwards gradually returning closely to baseline values. There were stepwise decreases in heart rate and cardiac output, while total peripheral resistance was slightly increased. The renal hemodynamics significantly decreased by glomerular filtration rate, effective renal plasma flow and effective renal blood flow, while the filtration fraction significantly increased. Envenomed animals showed a reduction in renal fraction, while renal vascular resistance stepwise increased. The plasma potassium level tended to increase. Animals showed stepwise decreases in urinary excretion of Na+, K+ and Cl-. A marked decrease in plasma calcium level was apparent at 120 minutes, while plasma creatine phosphokinase and lactate dehydrogenase levels increased at 30-120 minutes. Conclusion: A significant drop in blood pressure was attributed to a sustained fall in cardiac output, which would be associated with a reduction in heart rate. Sustained hypotension would contribute to reduction of renal blood flow, which results in decreased GFR.

Schlüsselwörter

  • Animal experiment
  • Bungarus candidus
  • general circulation
  • renal hemodynamics
  • snake venom
access type Uneingeschränkter Zugang

Stapes fixation surgery: stapedectomy versus stapedotomy

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 429 - 434

Zusammenfassung

Abstract

Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest.

Keyword

  • Otosclerosis
  • stapedectomy
  • stapedotomy
  • stapes
access type Uneingeschränkter Zugang

Awareness and risk factors associated with barbers in transmission of hepatitis B and C from Pakistani population: barber’s role in viral transmission

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 435 - 442

Zusammenfassung

Abstract

Background: In Pakistan, most patients with Hepatitis B and C have history of facial and armpit shaving from barbers. Objective: Evaluate the awareness and risk factors associated with barbers in transmission of Hepatitis B and C. Subjects and methods: A cross sectional survey was conducted in Rawalpindi and Islamabad, the twin capital cities of Pakistan between January and July 2009. Five hundred and eight barbershops were surveyed. Results: Out of 508 barber shops, 99.8% and 98.2% were washing their razor with water and water plus antiseptic solution, respectively, while 99.8% were using new blades. Only 39.6% knew that hepatitis B virus (HBV) and hepatitis C virus (HCV) were viral diseases, 26.6% knew that it can lead to cancer, 90.7% thought that hepatitis could be transferred by blade sharing, 47.8% knew that a vaccine for HBV was available, and 43.0% had education beyond the primary level. None of the barbers used a new or washed apron/towel on every customer. Conclusion: In Pakistan, a small number of barbers are shaving clients with an old style razor with a permanent blade. There is moderate awareness about the various modes of transmission of hepatitis among the barbers, and most of them don’t know about vaccination. A predominant number of them are considering interferon treatment as a vaccine for hepatitis B and C.

Schlüsselwörter

  • Awareness
  • barbers
  • hepatitis
  • razor
access type Uneingeschränkter Zugang

Safety and efficacy of a new imidazole fungicide, Sertaconazole, in the treatment of fungal vulvo-vaginitis: a comparative study using Fluconazole and Clotrimazole

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 443 - 448

Zusammenfassung

Abstract

Background: Sertaconazole is a new imidazole fungicide introduced for vulvo-vaginal candidiasis. It has an azole group with benzothiophene that inhibits biosynthesis of ergosterol and brings about a massive leak of cytoplasm with consequent fungal cell death. Objective: Assess the safety and efficacy of Sertaconazole in the treatment of fungal vulvo-vaginitis for comparison with Fluconazole and Clotrimazole. Subjects and methods: One-hundred eighty-eight outpatients with fungal vulvo-vaginitis were recruited at Siriraj Hospital, Thailand between August 31, 2004 and January 30, 2006. The patients were given Sertaconazole, Fluconazole, or Clotrimazole, and received vaginal swab and culture for fungus at seventh and 28th days after treatment. Results: Out of 188 cases, 177 cases were followed-up completely. Sertaconazole group included 66 cases where 35 cure, 20 fail, and 7 recurrent cases. Fluconazole group included 60 cases and had 37 cure, six fail, and 20 recurrence cases. Clotrimazole group included 55 cases and had 32 cure, nine fail and 11 recurrent cases. There were risk factors of fungal vulvo-vaginitis, including frequent micturition and small toilet shower flushing. Conclusion: Sertaconazole had similar effectiveness and less side-effect as compared with Fluconazole and Clotrimazole. It appeared to work well with lowest recurrence.

Schlüsselwörter

  • Clotrimazole
  • efficacy
  • Fluconazole
  • fungal vulvo-vaginitis
  • recurrence
  • risk factors
  • Sertaconazole
access type Uneingeschränkter Zugang

Pasteurella multocida infections in cancer patients

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 449 - 455

Zusammenfassung

Abstract

Background: Pasteurella multocida is a small, gram-negative coccobacillus, which most commonly causes soft tissue infections due to animal bites or scratches, mainly from cats and dogs. Immunocompromised hosts, such as cancer patients, are more likely to develop systemic complications as a result of P. multocida infections. Objective: Retrospectively analyze the medical records of four afflicted patients being managed at Moffitt Cancer Center, Tampa, USA between 1999 and 2009, and careful study for additional 32 cases of P. multocida infection among cancer patients with variegated histology found in the current medical literature. Methods: Of 36 subjects, 67% of the patients had been diagnosed with a solid organ cancer, whereas 33% had a hematologic malignancy. Clinical scenarios described fever as the most frequent initial presentation and bacteremia as the most prevalent mode of infection. Results: Forty-seven percent of the patients had experienced some sort of animal contact and 41% showed evidence of skin or soft tissue infection. The status of the white blood cell count, was available in 22 patients (of 36 patients), and 27% demonstrated neutropenia. The survival percentage of the patients with known clinical outcome was 77%. Conclusion: Medical management mostly involved antibiosis with beta-lactams. Atypical scenario of Pasteurella multocida infection may involve bites or scratches (specifically from cats or dogs) in a cancer patient presenting with sepsis and accompanied by skin or soft tissue or respiratory tract infection. A high level of suspicion for P. multocida as a possible pathogen in cancer patients would facilitate an amelioration in morbidity ameliorating, and timely initiation of specific antibiotics.

Schlüsselwörter

  • Beta-lactams
  • infections
  • malignancy
  • Pasteurella multocida
access type Uneingeschränkter Zugang

Postoperative opacification of polymethylmethacrylateintraocular lens

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 457 - 462

Zusammenfassung

Abstract

Background: Opacification of ophthalmic devices has been previously reported in silicone scleral buckle, Molteno implant, and intraocular lens opacification. However, there is no report on polymethyl methacrylate (PMMA) intraocular lens (IOL) calcification. Objective: Report the clinical feature, histopathologic and spectrophotometer analysis of opacified three-piece PMMA IOL. Method: A 60-year-old diabetic patient reported decreased visual acuity in her right eye, which had undergone phacoemulsification with PMMA IOL implantation. The ophthalmic examination revealed a white homogeneous opacification of posterior surface of the IOL. The explanted IOL was analyzed using scanning electron microscopy, energy dispersive spectroscopy, and alizarin red staining. Results: The scanning electron microscope analysis showed granular deposits on posterior surface of the IOL. Using energy dispersive spectroscopy analysis, calcium and phosphate peaks were revealed, which was confirmed by positive for alizarin red staining. Conclusion: This case report provided evidence of PMMA IOL calcification caused by calcium and phosphate deposits. The possible etiologies were extrinsic and/or intrinsic factors.

Schlüsselwörter

  • Calcification
  • intraocular lens
  • polymethylmethacrylate
access type Uneingeschränkter Zugang

A benign liver tumor mimics hepatic metastasis from colon cancer

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 463 - 467

Zusammenfassung

Abstract

Background: Liver is the most common distant metastasized organ in advanced colon cancer. Surgical resection of metastatic lesions would offer the best chance of a long-term survival. An accurate diagnosis and evaluation of extent of disease is crucial in the management of liver metastasis. Objective: Report a benign hepatic condition mimicking liver metastasis in a colon cancer patient. Case presentation: A 53-year-old male with an early stage sigmoid colon cancer was treated with sigmoidectomy followed by adjuvant chemotherapy consisting of 5-FU, leucovorin, and oxaliplatin for six months. Annual computerized tomography of abdomen at two years after the surgery revealed three hypervascular nodules in the liver. Investigations including MRI of the liver and whole body FDG-F18 PET/CT demonstrated evidence consistent with non-metastatic liver nodules. Liver biopsy of one of the lesions led to the diagnosis of “focal nodular hyperplasia”. Conclusion: The possible etiology, diagnosis, and further management of this benign liver tumor, the focal nodular hyperplasia became clear.

Schlüsselwörter

  • Colonic carcinoma
  • focal nodular hyperplasia
  • liver metastasis
  • oxaliplatin
access type Uneingeschränkter Zugang

Arsenic and amputations in Cambodia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 469 - 474

Zusammenfassung

Abstract

Background: Elevated levels of arsenic in drinking water in Cambodia were first identified in 1999. The first cases of suspected arsenicosis were identified by the WHO in 2002, and the first laboratory confirmed cases were found in 2006. Objective: Present three patients with ulcerating tumors of the legs who came from two different districts in Cambodia. Results: Cutaneous lesions characteristic of chronic arsenicosis were exhibited, and squamous cell carcinomas requiring amputation had developed. The clinical features of chronic arsenicosis and its surgical management were examined, in addition to its impact in Cambodia and current preventive strategies Conclusion: There will be an increased incidence of these problems in the future. Medical practitioners in the Mekong River Basin should be aware of them, so as to recognize them early, and treat them appropriately.

Schlüsselwörter

  • Amputation
  • arsenicosis
  • Cambodia
  • drinking water
  • squamous cell carcinoma
access type Uneingeschränkter Zugang

Salivary clearance of sugar before and after insertion of fixed partial dentures

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 475 - 478

Zusammenfassung

Abstract

Background: The development of carious lesions is dependent on the presence of acid-producing microflora in the mouth. The activity of these plaque bacteria is dependent on sugar, which diffuses from the saliva following carbohydrate intake. The sugar serves as a substrate for fermentation, producing organic acids that demineralize tooth enamel. Elimination of the sugar from the mouth is accomplished by dilution with newly secreted saliva, a process generally referred to as sugar clearence. Objectives: Determine if fixed partial prosthodontic treatment affects the length of salivary sugar clearance. Materials and methods: Fifteen male subjects age between 21 and 32, and requiring 10 porcelain fixed partial dentures were included in this study. Before receiving their dentures, the subjects, rinsed with a 10% sucrose solution for 30 seconds then gave saliva samples. The prpcedure was repeated one month after the dentures were put in place. The length of sugar clearance was calculated. Results: Salivary sugar was cleared in 14.89±0.89 minutes before the denture application and in 18.86± 0.90 minutes after denture treatment. The initial sucrose concentration was 113.63±1.29 mmol/L before the dentures and 142.99±10.82 mmol/L after the dentures. Conclusion: The use of fixed partial dentures does not affect the time required to clear salivary sugar or the level of the initial sucrose concentration.

Schlüsselwörter

  • Fixed partial dentures
  • oral sugar clearance
  • saliva
access type Uneingeschränkter Zugang

Provider-initiated HIV counseling and testing of out patients at community hospitals in Thailand: an economic evaluation using the Markov model

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 479 - 484

Zusammenfassung

Abstract

Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS control efforts. However, in Thailand, the cost-effectiveness of this program is unknown. Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand compared with the current practice. Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires on their household expenditure and quality of life using the visual analog scale. Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for all cases of 13-64 year old if the ceiling threshold equaled three times of GDP. Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective than the current practice and should be implemented in health care setting in Thailand.

Schlüsselwörter

  • Community hospital
  • economic evaluation
  • HIV/AIDS
  • provider-initiated testing
  • quality of life
  • Markov model
access type Uneingeschränkter Zugang

Time duration to safety sitting in parturient receiving spinal anesthesia for cesarean section with 0.5% Bupivacaine and morphine

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 485 - 489

Zusammenfassung

Abstract

Background: Spinal anesthesia has been used for cesarean section for a long time. However, the proportion of post-cesarean paturients who were able to sit at the fourth hour still remains unclear. Objective: Investigate the proportion of post-cesarean paturients that were able to sit at the fourth hour following spinal anesthesia with 0.5% hyperbaric bupivacaine and morphine. Furthermore, investigate the optimum time to encourage ambulation, and the risk factors delaying time duration to sit. Methods: A prospective observational study was conducted in 240 patients with American Society of Anesthesiologists physical status classification I and II, and single pregnancy parturients undergoing cesarean section. The patients who had body mass index (BMI) >35, estimated blood loss >1000 mL, needed postoperative bed rest, or received postoperative sedation were excluded. Hyperbaric bupivacaine 8-11 mg and morphine 0.2-0.3 mg were used. The patients were evaluated at the fourth hour until they could sit without adverse events or complete the sixth hour. All patients were evaluated for risk factors delaying the time duration to sit. Results: Out of 240 patients, 77.0%, 90.9%, and 98.4% were able to sit at the fourth, fifth, and sixth hour, respectively. The risk factors that delayed time to sit were Bromage scale >1 and pain score >3 by the univariate analysis, and were Bromage scale >1 and pain score >3 by the multivariate analysis. Conclusion: Seventy-seven percent of the patients could sit at the fourth hour, and most patients (98%) could sit at the sixth hour. The risk factors that delayed the time duration to sit were Bromage score >1 and pain score >3.

Schlüsselwörter

  • Ambulation
  • cesarean section
  • spinal anesthesia
access type Uneingeschränkter Zugang

Treatment outcome of hepatocellular carcinoma patients with high-risk vascular invasion: a retrospective analysis

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 491 - 496

Zusammenfassung

Abstract

Background: Invasion of major hepatic vessels in hepatocellular carcinoma (HCC) generally prohibits the surgical treatment. Objective: Analyze outcomes of non-surgical approaches in this group of HCC. Methods: Retrospective review of medical records of 648 HCC admitted to King Chulalongkorn Memorial Hospital between January 2003 and December 2005 was carried out to select only patients who had unresectable HCC with vascular invasion and hepatic functions-Child-Pugh class-A. Vascular invasion was defined as involvement of portal vein, inferior vena cava (IVC), or their branches identified by imaging techniques. Non-surgical treatments were either transarterial chemoembolization (TACE) or systemic chemotherapy (SCT) in addition to general supportive care. Treatment outcomes of the patients were analyzed. Results: Out of 71 unresectable HCC patients enrolled, 57patients were treated with TACE, while 14 received SCT. In the TACE group, 39 (68%), 7 (12%) and 11 (19%) patients had portal vein, IVC, and both vessels invasion, respectively. In the SCT group; 11 (78%), 1 (7%) and 2 (14%) had invasion of portal vein, IVC, and both vessels, respectively. Median overall survival in both groups was 158 days. Univariate analysis demonstrated that AFP level <1000 ng/mL, tumor size <10 cm, and SCT treatment significantly influenced survival. Additional multivariate analysis confirmed that diameters of tumor, and SCT were independent prognostic factors for good survival. A survival analysis showed longer survival in the SCT group than that of TACE (210 vs. 149 days, p=0.03) group. Conclusion: Survival of HCC patients with major vessels invasion was better when treated with SCT compared to TACE. Future prospective study in larger populations to test the hypothesis is warranted.

Schlüsselwörter

  • Hepatocellular carcinoma
  • systemic chemotherapy
  • transarterial chemoembolization
access type Uneingeschränkter Zugang

Broadening our perspectives as physicians: one world-one medicine-one health

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 497 - 498

Zusammenfassung

Abstract

There are no passengers on spaceship earth. We are all crew ! (Marshall Mcluhan). Understanding the emergence of new zoonotic agents requires knowledge of pathogen biodiversity in wildlife, human-wildlife interactions, anthropogenic pressures on wildlife populations, and changes in society and human behavior [1].

Schlüsselwörter

  • Human-wildlife interaction
  • one-health
  • zoonoses
access type Uneingeschränkter Zugang

News from other pages

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 499 - 500

Zusammenfassung

20 Artikel
access type Uneingeschränkter Zugang

The role of metabolic acidosis in chronic kidney diseases

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 367 - 372

Zusammenfassung

Abstract

Background and objectives: This review focuses on three areas, basic acid-base physiology especially concerning hydrogen ion balance, development of acidosis in chronic kidney disease (CKD), and the consequences of acidosis. We highlight what is well established, what is less certain, and what is unknown. Method and results: The literature on acidosis in CKD were searched from 2004 to 2010 utilizing PubMed, Google Scholar, and Ovid to augment the classic work on acid base physiology over the past three decades. The original research in endogenous acid production and net acid excretion were reviewed. Touching upon the development of metabolic acidosis in CKD, we focused on the consequences of chronic metabolic acidosis on growth and other important variables. Finally, we recognize the significant issue of patients’ medical non-compliance and presented treatment strategy to counter this problem. Conclusion: The correction of acidosis in chronic kidney disease needs no advocacy. The case is made conclusively. Patient non-compliance because of the medication that needs to be taken several times a day is a problem, requiring due diligence.

Schlüsselwörter

  • Bicarbonate therapy
  • chronic kidney disease
  • growth retardation
  • metabolic acidosis
  • net acid balance
  • non-compliance
access type Uneingeschränkter Zugang

Ataxia telangiectasia mutated nuclear localization in head and neck cancer cells is PPP2R2B-dependent

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 373 - 383

Zusammenfassung

Abstract

Background: Protein phosphatase 2A (PP2A) has been implicated in radiation-induced activation of cellular responses, likely by its ability to regulate the autophosphorylation of the ataxia telangiectasia mutated (ATM) protein, a key molecule involved in the DNA damage response initiated by double-stranded DNA breaks. Interestingly, a hereditary defect in the PPP2R2B gene, which encodes the beta isoform of PP2A regulatory subunit B, causes autosomal dominant spinocerebellar ataxia 12, a clinical condition resembling that of ataxia telangiectasia patients. Moreover, PPP2R2B is significantly down-regulated in many human cancers, including head and neck squamous cell carcinomas (HNSCCs). Objective: Examine whether PPP2R2B regulates ATM function, thereby contributing to tumor progression due to the resulting defective DNA repair. Methods: The roles of PPP2R2B were evaluated in irradiated HNSCC cell lines, siRNAPPP2R2B cells and okadaic acid treated cells. Expression of PPP2R2B was measured by microarray, Western blot analysis and real time quantitative rtPCR. ATM quantity and localization, ATM phosphorylation and γ-H2AX were determined by Western blot analysis and/or immunofluorescence assay. Clonogenic cell survival assay was performed to determine ionizing radiation sensitivity. Results: PPP2R2B expression is reduced in multiple tumor types, including HNSCCs. Indeed, HNSCC cell lines that have lower PPP2R2B mRNA expression and siRNAPPP2R2B cells lower basal and radiation-induced levels of phosphorylated ATM and the consequent reduction in the levels of phosphorylation of the downstream ATM target, γ-H2AX. Depletion of PPP2R2B and inhibition of PP2A with okadaic acid resulted in limited ATM nuclear localization. Finally, siRNAPPP2R2B cells displayed enhanced sensitivity to death after radiation. Conclusion: In HNSCCs, ATM nuclear localization is PPP2R2B dependent, and decreased PPP2R2B expression may result in limited ATM activation by preventing its nuclear accumulation and ATM-chromatin interaction. Therefore, decreased PPP2R2B expression in HNSCCs may contribute to genomic instability, cancer development and radiation sensitivity by limiting ATM functions.

Schlüsselwörter

  • ATM
  • head
  • neck
  • nuclear localization
  • PPP2R2B
  • PP2A
  • SCA12
  • squamous cell carcinoma
access type Uneingeschränkter Zugang

Association of high sensitivity C-reactive protein concentrations and metabolic syndrome among Thai adults

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 385 - 393

Zusammenfassung

Abstract

Background: Limited information is available regarding associations of metabolic syndrome with C-reactive protein (CRP) concentrations among Asian populations. Objective: Investigate the association of high sensitivity CRP (hsCRP) concentrations and metabolic syndrome among Thai adults. Methods: This cross-sectional study was comprised of 467 Thai participants (209 men and 258 women) receiving annual health check-up. Spearman’s rank correlation coefficients were used to assess the associations between metabolic parameters (age, waist circumference, blood pressure, triglycerides, HDL-C, fasting plasma glucose, fasting insulin and uric acid) with hsCRP concentrations for men and women, respectively. Multivariable logistic regression procedures were used to estimate the risk (odds ratios (OR), and 95% confidence intervals (CI) of metabolic syndrome according to low, moderate, and high hsCRP concentrations (<1.0, 1.0-3.0, and >3.0 mg/L, respectively). Results: Measures of adiposity and fasting insulin were positively and significantly correlated with hsCRP concentrations among women with and without metabolic syndrome. Similar associations were observed among men without metabolic syndrome. After controlling for confounders, moderately elevated hsCRP concentrations were associated with a 2.38-fold increased risk of metabolic syndrome (OR=2.38, 95%CI=1.20-4.72) among men. Men with high hsCRP concentrations had a 5.45-fold increased risk of metabolic syndrome (OR=5.45, 95%CI=2.24- 13.27) when compared with those who had low hsCRP concentrations. The corresponding OR for women with moderately elevated and high hsCRP concentrations were 4.92 (OR=4.92, 95%CI=2.34-10.35) and 11.93 (OR=11.93, 95%CI=5.54-25.72), respectively. Conclusions: These findings are consistent with the literature suggesting a role of hsCRP as a biomarker for metabolic syndrome.

Schlüsselwörter

  • C-reactive protein
  • inflammation
  • metabolic syndrome
  • obesity
access type Uneingeschränkter Zugang

Quality and patient safety in anesthesia service: Thai survey

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 395 - 401

Zusammenfassung

Abstract

Background: The Royal College of Anesthesiologists of Thailand (RCAT) performed large-scale epidemiologic study of anesthesia-related complications and national incidents study in 2004 and 2007, respectively. Objectives: Evaluate the anesthesia service in Thailand with regard to status of quality and patient safety. Material and methods: A pre-planned structured questionnaire regarding demographic, administrative, preanesthetic, intraoperative postanesthetic variables and complications were requested to be filled in by nurse anesthetists attending the refresher course lecture of RCAT in February 2008. Descriptive statistics was used. Results: Three hundred fifty questionnaires were given and 341 respondents (97%) returned the questionnaires. Most of the respondents (90%) worked in government section. Thirty percent of respondents practiced in hospital without medical doctor anesthesiologist and 58% of nurse anesthetists worked in hospitals that have been accredited. Forty-six percent of respondents reported unavailability of a 24-hour recovery room. The questionnaires revealed of inadequacy of anesthesia personnel (64%), inadequate supervision during emergency condition (53%), inadequacy of patient information regarding anesthesia (57-69%), and low opportunity for patient to choose choice of anesthesia (19%). The commonly used monitoring were pulse oximeter (92% of respondents) and electrocardiography (63%). One-third (32%) of respondents had to provide of anesthesia for patients with insufficient NPO (non per oral) time. Common problems that the respondents experienced were miscommunication (49%), intraoperative cardiac arrest during the past year (35%), error related to infusion pump (24%) and medication error (8%). Fifty-five percent of respondents had to monitor at least one patient per month receiving spinal anesthesia. Conclusion: Suggested strategies for quality and patient safety improvement in anesthesia service are increasing personnel, increasing 24-hour recovery room, improvement of supervision, improvement of communication, compliance to guidelines and improvement of nurse anesthetist’s training regarding monitoring patient receiving spinal anesthesia and cardiopulmonary resuscitation.

Schlüsselwörter

  • Anesthesia
  • cardiac arrest
  • guidelines
  • patient information
  • quality
  • safety
access type Uneingeschränkter Zugang

Three-dimensional imaging of living transplanted kidney vasculature by 3D color Doppler ultrasonography

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 403 - 411

Zusammenfassung

Abstract

Background: It is of clinical importance to display the vasculature of transplanted kidney in three-dimensional (3D) and in non-invasive way. 3D color Doppler ultrasonographic imaging (3D-CDUI) is a non-invasive technique to display the 3D vasculature of living organs. Objective: Probe into characteristics of 3D vasculature of living transplanted kidney by 3D-CDUI, and evaluate the clinical value of 3D-CDUI on monitoring complications after operation of renal transplant. Methods: Nine patients who received allogeneic transplantation of kidney were monitored with 3D-CDUI. The instruments used included ACUSON Sequoia 512 and TomTec computer station of 3D-CDUI. Using magnetic positioning free-hand scanning, the 3D reconstruction and display of renal tissue structure and blood flow were performed off-line. Results: All patients underwent 3D-CDUI examinations without any side effect or complication. When acute rejection occurred, the 3D distribution change of renal blood flow signal could be observed clearly. During treatment of acute necrosis of renal tubules, changes of renal blood flow signal in 3D color Doppler images could be detected earlier compared with 2D color Doppler images. The position of embolized vassels could be diagnosed accurately by 3D-CDUI. Conclusion: The 3D-CDUI was helpful to improve diagnosis level of ultrasonography by monitoring complications after renal transplantation.

Keyword

  • Color Doppler
  • post-operative complication
  • renal vasculature
  • 3D-ultrasonography
  • transplanted kidney
access type Uneingeschränkter Zugang

Endovascular aortic stent for thoracic and abdominal aortic aneurysm: imaging consequences and complications

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 413 - 420

Zusammenfassung

Abstract

Background: Endovascular stent-graft implantation has been used as an alternative to conventional open surgery in treatment of aortic aneurysm. Computed tomographic angiography (CTA) has been requested for follow-up and evaluation of aortic stent complications. Objective: Find the incidence of endovascular aortic stent complications and analyze the CTA features of postendovascular aortic stent consequences. Methods: Two radiologists reviewed CTA images of 635 patients who attended King Chulalongkorn Memorial Hospital between Sep 1, 2003 and Aug 31, 2008. Thirty-eight patients had endovascular aortic stent installation with 95 CTA images. The incidence of endovascular aortic stent complications, the image appearances including consequences and time-interval of endoleak were analyzed. Results: There were 23 thoracic aortic stents, 10 abdominal aortic stents and five combined stents for thoracic and abdominal aortic aneurysms. Twenty-eight cases had aortic stent complications (73.7%). Two cases had immediately post procedural complication of groin hematomas (7.1%). Ten patients had more than one finding. Findings of the stent-graft complications were as follows: 19 endoleaks, 15 stent thrombosis, five stents without covered-dissection, two stent kinkings, two iatrogenic focal aortic dissection, two air within aneurysm after stent installation and one spreading infected aortitis. The most common complication was endoleaks (53.6%), which could progress, be persistent or resolvable. Time-interval to detect endoleak was between 1 and 464 days. Conclusion: CTA can be used as modality of choice in demonstration of stent location, consequences, and complications. The stent complication was still high in the first five-year experience.

Schlüsselwörter

  • Aortic stent complication
  • computed tomographic angiography (CTA)
  • endoleak
  • endovascular aortic stent
access type Uneingeschränkter Zugang

Effects of Bungarus candidus (Malayan krait) venom on general circulation and renal hemodynamics in experimental animals

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 421 - 428

Zusammenfassung

Abstract

Background: Many studies have reported the occurrence of lethal acute renal failure after snakebites. Bungarus candidus (Malayan krait) is a medically important venomous snake distributed widely throughout Southeast Asia. The best known features of systemic envenoming by B. candidus are neurotoxic. Objective: Obtain more information on effects of B. candidus venom on changes in systemic and renal hemodynamics in experimental animals. Methods: Twelve adult male New Zealand white rabbits were used to study the effect of B. candidus venom on general circulation and renal hemodynamics. An anesthetized animal was intravenously injected with B. candidus venom at a dosage of 50μg/kg bodyweight. All changes of parameters were observed after initial post venom injection and recorded at 30 min intervals until 150 minutes after envenomation. Results: After envenomation, cardiovascular responses showed a marked decrease in mean arterial pressure within two minutes, afterwards gradually returning closely to baseline values. There were stepwise decreases in heart rate and cardiac output, while total peripheral resistance was slightly increased. The renal hemodynamics significantly decreased by glomerular filtration rate, effective renal plasma flow and effective renal blood flow, while the filtration fraction significantly increased. Envenomed animals showed a reduction in renal fraction, while renal vascular resistance stepwise increased. The plasma potassium level tended to increase. Animals showed stepwise decreases in urinary excretion of Na+, K+ and Cl-. A marked decrease in plasma calcium level was apparent at 120 minutes, while plasma creatine phosphokinase and lactate dehydrogenase levels increased at 30-120 minutes. Conclusion: A significant drop in blood pressure was attributed to a sustained fall in cardiac output, which would be associated with a reduction in heart rate. Sustained hypotension would contribute to reduction of renal blood flow, which results in decreased GFR.

Schlüsselwörter

  • Animal experiment
  • Bungarus candidus
  • general circulation
  • renal hemodynamics
  • snake venom
access type Uneingeschränkter Zugang

Stapes fixation surgery: stapedectomy versus stapedotomy

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 429 - 434

Zusammenfassung

Abstract

Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest.

Keyword

  • Otosclerosis
  • stapedectomy
  • stapedotomy
  • stapes
access type Uneingeschränkter Zugang

Awareness and risk factors associated with barbers in transmission of hepatitis B and C from Pakistani population: barber’s role in viral transmission

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 435 - 442

Zusammenfassung

Abstract

Background: In Pakistan, most patients with Hepatitis B and C have history of facial and armpit shaving from barbers. Objective: Evaluate the awareness and risk factors associated with barbers in transmission of Hepatitis B and C. Subjects and methods: A cross sectional survey was conducted in Rawalpindi and Islamabad, the twin capital cities of Pakistan between January and July 2009. Five hundred and eight barbershops were surveyed. Results: Out of 508 barber shops, 99.8% and 98.2% were washing their razor with water and water plus antiseptic solution, respectively, while 99.8% were using new blades. Only 39.6% knew that hepatitis B virus (HBV) and hepatitis C virus (HCV) were viral diseases, 26.6% knew that it can lead to cancer, 90.7% thought that hepatitis could be transferred by blade sharing, 47.8% knew that a vaccine for HBV was available, and 43.0% had education beyond the primary level. None of the barbers used a new or washed apron/towel on every customer. Conclusion: In Pakistan, a small number of barbers are shaving clients with an old style razor with a permanent blade. There is moderate awareness about the various modes of transmission of hepatitis among the barbers, and most of them don’t know about vaccination. A predominant number of them are considering interferon treatment as a vaccine for hepatitis B and C.

Schlüsselwörter

  • Awareness
  • barbers
  • hepatitis
  • razor
access type Uneingeschränkter Zugang

Safety and efficacy of a new imidazole fungicide, Sertaconazole, in the treatment of fungal vulvo-vaginitis: a comparative study using Fluconazole and Clotrimazole

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 443 - 448

Zusammenfassung

Abstract

Background: Sertaconazole is a new imidazole fungicide introduced for vulvo-vaginal candidiasis. It has an azole group with benzothiophene that inhibits biosynthesis of ergosterol and brings about a massive leak of cytoplasm with consequent fungal cell death. Objective: Assess the safety and efficacy of Sertaconazole in the treatment of fungal vulvo-vaginitis for comparison with Fluconazole and Clotrimazole. Subjects and methods: One-hundred eighty-eight outpatients with fungal vulvo-vaginitis were recruited at Siriraj Hospital, Thailand between August 31, 2004 and January 30, 2006. The patients were given Sertaconazole, Fluconazole, or Clotrimazole, and received vaginal swab and culture for fungus at seventh and 28th days after treatment. Results: Out of 188 cases, 177 cases were followed-up completely. Sertaconazole group included 66 cases where 35 cure, 20 fail, and 7 recurrent cases. Fluconazole group included 60 cases and had 37 cure, six fail, and 20 recurrence cases. Clotrimazole group included 55 cases and had 32 cure, nine fail and 11 recurrent cases. There were risk factors of fungal vulvo-vaginitis, including frequent micturition and small toilet shower flushing. Conclusion: Sertaconazole had similar effectiveness and less side-effect as compared with Fluconazole and Clotrimazole. It appeared to work well with lowest recurrence.

Schlüsselwörter

  • Clotrimazole
  • efficacy
  • Fluconazole
  • fungal vulvo-vaginitis
  • recurrence
  • risk factors
  • Sertaconazole
access type Uneingeschränkter Zugang

Pasteurella multocida infections in cancer patients

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 449 - 455

Zusammenfassung

Abstract

Background: Pasteurella multocida is a small, gram-negative coccobacillus, which most commonly causes soft tissue infections due to animal bites or scratches, mainly from cats and dogs. Immunocompromised hosts, such as cancer patients, are more likely to develop systemic complications as a result of P. multocida infections. Objective: Retrospectively analyze the medical records of four afflicted patients being managed at Moffitt Cancer Center, Tampa, USA between 1999 and 2009, and careful study for additional 32 cases of P. multocida infection among cancer patients with variegated histology found in the current medical literature. Methods: Of 36 subjects, 67% of the patients had been diagnosed with a solid organ cancer, whereas 33% had a hematologic malignancy. Clinical scenarios described fever as the most frequent initial presentation and bacteremia as the most prevalent mode of infection. Results: Forty-seven percent of the patients had experienced some sort of animal contact and 41% showed evidence of skin or soft tissue infection. The status of the white blood cell count, was available in 22 patients (of 36 patients), and 27% demonstrated neutropenia. The survival percentage of the patients with known clinical outcome was 77%. Conclusion: Medical management mostly involved antibiosis with beta-lactams. Atypical scenario of Pasteurella multocida infection may involve bites or scratches (specifically from cats or dogs) in a cancer patient presenting with sepsis and accompanied by skin or soft tissue or respiratory tract infection. A high level of suspicion for P. multocida as a possible pathogen in cancer patients would facilitate an amelioration in morbidity ameliorating, and timely initiation of specific antibiotics.

Schlüsselwörter

  • Beta-lactams
  • infections
  • malignancy
  • Pasteurella multocida
access type Uneingeschränkter Zugang

Postoperative opacification of polymethylmethacrylateintraocular lens

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 457 - 462

Zusammenfassung

Abstract

Background: Opacification of ophthalmic devices has been previously reported in silicone scleral buckle, Molteno implant, and intraocular lens opacification. However, there is no report on polymethyl methacrylate (PMMA) intraocular lens (IOL) calcification. Objective: Report the clinical feature, histopathologic and spectrophotometer analysis of opacified three-piece PMMA IOL. Method: A 60-year-old diabetic patient reported decreased visual acuity in her right eye, which had undergone phacoemulsification with PMMA IOL implantation. The ophthalmic examination revealed a white homogeneous opacification of posterior surface of the IOL. The explanted IOL was analyzed using scanning electron microscopy, energy dispersive spectroscopy, and alizarin red staining. Results: The scanning electron microscope analysis showed granular deposits on posterior surface of the IOL. Using energy dispersive spectroscopy analysis, calcium and phosphate peaks were revealed, which was confirmed by positive for alizarin red staining. Conclusion: This case report provided evidence of PMMA IOL calcification caused by calcium and phosphate deposits. The possible etiologies were extrinsic and/or intrinsic factors.

Schlüsselwörter

  • Calcification
  • intraocular lens
  • polymethylmethacrylate
access type Uneingeschränkter Zugang

A benign liver tumor mimics hepatic metastasis from colon cancer

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 463 - 467

Zusammenfassung

Abstract

Background: Liver is the most common distant metastasized organ in advanced colon cancer. Surgical resection of metastatic lesions would offer the best chance of a long-term survival. An accurate diagnosis and evaluation of extent of disease is crucial in the management of liver metastasis. Objective: Report a benign hepatic condition mimicking liver metastasis in a colon cancer patient. Case presentation: A 53-year-old male with an early stage sigmoid colon cancer was treated with sigmoidectomy followed by adjuvant chemotherapy consisting of 5-FU, leucovorin, and oxaliplatin for six months. Annual computerized tomography of abdomen at two years after the surgery revealed three hypervascular nodules in the liver. Investigations including MRI of the liver and whole body FDG-F18 PET/CT demonstrated evidence consistent with non-metastatic liver nodules. Liver biopsy of one of the lesions led to the diagnosis of “focal nodular hyperplasia”. Conclusion: The possible etiology, diagnosis, and further management of this benign liver tumor, the focal nodular hyperplasia became clear.

Schlüsselwörter

  • Colonic carcinoma
  • focal nodular hyperplasia
  • liver metastasis
  • oxaliplatin
access type Uneingeschränkter Zugang

Arsenic and amputations in Cambodia

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 469 - 474

Zusammenfassung

Abstract

Background: Elevated levels of arsenic in drinking water in Cambodia were first identified in 1999. The first cases of suspected arsenicosis were identified by the WHO in 2002, and the first laboratory confirmed cases were found in 2006. Objective: Present three patients with ulcerating tumors of the legs who came from two different districts in Cambodia. Results: Cutaneous lesions characteristic of chronic arsenicosis were exhibited, and squamous cell carcinomas requiring amputation had developed. The clinical features of chronic arsenicosis and its surgical management were examined, in addition to its impact in Cambodia and current preventive strategies Conclusion: There will be an increased incidence of these problems in the future. Medical practitioners in the Mekong River Basin should be aware of them, so as to recognize them early, and treat them appropriately.

Schlüsselwörter

  • Amputation
  • arsenicosis
  • Cambodia
  • drinking water
  • squamous cell carcinoma
access type Uneingeschränkter Zugang

Salivary clearance of sugar before and after insertion of fixed partial dentures

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 475 - 478

Zusammenfassung

Abstract

Background: The development of carious lesions is dependent on the presence of acid-producing microflora in the mouth. The activity of these plaque bacteria is dependent on sugar, which diffuses from the saliva following carbohydrate intake. The sugar serves as a substrate for fermentation, producing organic acids that demineralize tooth enamel. Elimination of the sugar from the mouth is accomplished by dilution with newly secreted saliva, a process generally referred to as sugar clearence. Objectives: Determine if fixed partial prosthodontic treatment affects the length of salivary sugar clearance. Materials and methods: Fifteen male subjects age between 21 and 32, and requiring 10 porcelain fixed partial dentures were included in this study. Before receiving their dentures, the subjects, rinsed with a 10% sucrose solution for 30 seconds then gave saliva samples. The prpcedure was repeated one month after the dentures were put in place. The length of sugar clearance was calculated. Results: Salivary sugar was cleared in 14.89±0.89 minutes before the denture application and in 18.86± 0.90 minutes after denture treatment. The initial sucrose concentration was 113.63±1.29 mmol/L before the dentures and 142.99±10.82 mmol/L after the dentures. Conclusion: The use of fixed partial dentures does not affect the time required to clear salivary sugar or the level of the initial sucrose concentration.

Schlüsselwörter

  • Fixed partial dentures
  • oral sugar clearance
  • saliva
access type Uneingeschränkter Zugang

Provider-initiated HIV counseling and testing of out patients at community hospitals in Thailand: an economic evaluation using the Markov model

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 479 - 484

Zusammenfassung

Abstract

Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS control efforts. However, in Thailand, the cost-effectiveness of this program is unknown. Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand compared with the current practice. Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires on their household expenditure and quality of life using the visual analog scale. Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for all cases of 13-64 year old if the ceiling threshold equaled three times of GDP. Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective than the current practice and should be implemented in health care setting in Thailand.

Schlüsselwörter

  • Community hospital
  • economic evaluation
  • HIV/AIDS
  • provider-initiated testing
  • quality of life
  • Markov model
access type Uneingeschränkter Zugang

Time duration to safety sitting in parturient receiving spinal anesthesia for cesarean section with 0.5% Bupivacaine and morphine

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 485 - 489

Zusammenfassung

Abstract

Background: Spinal anesthesia has been used for cesarean section for a long time. However, the proportion of post-cesarean paturients who were able to sit at the fourth hour still remains unclear. Objective: Investigate the proportion of post-cesarean paturients that were able to sit at the fourth hour following spinal anesthesia with 0.5% hyperbaric bupivacaine and morphine. Furthermore, investigate the optimum time to encourage ambulation, and the risk factors delaying time duration to sit. Methods: A prospective observational study was conducted in 240 patients with American Society of Anesthesiologists physical status classification I and II, and single pregnancy parturients undergoing cesarean section. The patients who had body mass index (BMI) >35, estimated blood loss >1000 mL, needed postoperative bed rest, or received postoperative sedation were excluded. Hyperbaric bupivacaine 8-11 mg and morphine 0.2-0.3 mg were used. The patients were evaluated at the fourth hour until they could sit without adverse events or complete the sixth hour. All patients were evaluated for risk factors delaying the time duration to sit. Results: Out of 240 patients, 77.0%, 90.9%, and 98.4% were able to sit at the fourth, fifth, and sixth hour, respectively. The risk factors that delayed time to sit were Bromage scale >1 and pain score >3 by the univariate analysis, and were Bromage scale >1 and pain score >3 by the multivariate analysis. Conclusion: Seventy-seven percent of the patients could sit at the fourth hour, and most patients (98%) could sit at the sixth hour. The risk factors that delayed the time duration to sit were Bromage score >1 and pain score >3.

Schlüsselwörter

  • Ambulation
  • cesarean section
  • spinal anesthesia
access type Uneingeschränkter Zugang

Treatment outcome of hepatocellular carcinoma patients with high-risk vascular invasion: a retrospective analysis

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 491 - 496

Zusammenfassung

Abstract

Background: Invasion of major hepatic vessels in hepatocellular carcinoma (HCC) generally prohibits the surgical treatment. Objective: Analyze outcomes of non-surgical approaches in this group of HCC. Methods: Retrospective review of medical records of 648 HCC admitted to King Chulalongkorn Memorial Hospital between January 2003 and December 2005 was carried out to select only patients who had unresectable HCC with vascular invasion and hepatic functions-Child-Pugh class-A. Vascular invasion was defined as involvement of portal vein, inferior vena cava (IVC), or their branches identified by imaging techniques. Non-surgical treatments were either transarterial chemoembolization (TACE) or systemic chemotherapy (SCT) in addition to general supportive care. Treatment outcomes of the patients were analyzed. Results: Out of 71 unresectable HCC patients enrolled, 57patients were treated with TACE, while 14 received SCT. In the TACE group, 39 (68%), 7 (12%) and 11 (19%) patients had portal vein, IVC, and both vessels invasion, respectively. In the SCT group; 11 (78%), 1 (7%) and 2 (14%) had invasion of portal vein, IVC, and both vessels, respectively. Median overall survival in both groups was 158 days. Univariate analysis demonstrated that AFP level <1000 ng/mL, tumor size <10 cm, and SCT treatment significantly influenced survival. Additional multivariate analysis confirmed that diameters of tumor, and SCT were independent prognostic factors for good survival. A survival analysis showed longer survival in the SCT group than that of TACE (210 vs. 149 days, p=0.03) group. Conclusion: Survival of HCC patients with major vessels invasion was better when treated with SCT compared to TACE. Future prospective study in larger populations to test the hypothesis is warranted.

Schlüsselwörter

  • Hepatocellular carcinoma
  • systemic chemotherapy
  • transarterial chemoembolization
access type Uneingeschränkter Zugang

Broadening our perspectives as physicians: one world-one medicine-one health

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 497 - 498

Zusammenfassung

Abstract

There are no passengers on spaceship earth. We are all crew ! (Marshall Mcluhan). Understanding the emergence of new zoonotic agents requires knowledge of pathogen biodiversity in wildlife, human-wildlife interactions, anthropogenic pressures on wildlife populations, and changes in society and human behavior [1].

Schlüsselwörter

  • Human-wildlife interaction
  • one-health
  • zoonoses
access type Uneingeschränkter Zugang

News from other pages

Online veröffentlicht: 13 Apr 2018
Seitenbereich: 499 - 500

Zusammenfassung

Planen Sie Ihre Fernkonferenz mit Scienceendo