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 9 (2015): Heft 6 (December 2015)

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

Suche

13 Artikel

Editorial

Uneingeschränkter Zugang

Building a healthy public policy and reorienting health services towards control of chronic diseases

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 725 - 726

Zusammenfassung

Review article

Uneingeschränkter Zugang

Long-acting injectable antipsychotics in patients with schizophrenia: systematic review and mixed treatment meta-analysis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 741 - 750

Zusammenfassung

Abstract

Long-acting injectable antipsychotics (LAIs) are recommended for schizophrenic patients who cannot adhere to oral medication. We systematically reviewed randomized controlled trials of 6 LAIs available in Thailand including fluphenazine, flupentixol, haloperidol, zuclopenthixol, paliperidone, and risperidone in PubMed/ MEDLINE and the Cochrane library (1955-Nov 2013). Inclusion was limited to studies of schizophrenia ≥24 weeks duration published in English. We selected 17 of 1,245 articles including 1,904 patients. The number of patients ranged from 19 to 747 per study (median 54). Mean study duration was 52.3 weeks (24-96 weeks) and median quality score using a Jadad scoring method was 4 (2-5). We applied a Bayesian model with a mixed treatment comparison approach for 3 competing risk outcomes including relapse, and discontinuation because of adverse events or other reasons. Based on the random effect model preferred by a goodness of fit analysis, risperidone had the lowest 52 week probability of relapse (mean ± SD, 0.26 ± 0.321) followed by paliperidone (0.30 ± 0.314). Zuclopenthixol had the lowest probability of discontinuation because of an adverse event (0.07 ± 0.159) or other reasons (0.26 ± 0.295). Risperidone had the highest probability of preventing relapse (0.35 ± 0.476) or discontinuation for other reasons (0.31 ± 0.461). Zuclopenthixol had the highest probability of preventing discontinuation because of adverse effects (0.31 ± 0.464). All 6 LAIs tended to have a lower risk of relapse compared with placebo. Differences between LAIs preventing any treatment discontinuation or relapse were seen, but limited in our analysis.

Schlüsselwörter

  • Competing risk outcomes
  • long acting injectable antipsychotics
  • meta-analysis
  • mixed treatment comparison
Uneingeschränkter Zugang

Intrauterine infection as a possible trigger for labor: the role of toll-like receptors and proinflammatory cytokines

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 727 - 739

Zusammenfassung

Abstract

The mechanisms underlying the initiation of premature uterine contractions during pregnancy are not fully understood. It is now widely accepted that proinflammatory cytokines are key mediators of the inflammatory signaling pathways in term or preterm labor. However, the exact triggers for inflammation-induced labor remain to be identified.

We review the published literature and summarize the possible pathophysiological mechanisms underlying the initiation of uterine contractions with a particular emphasis on intrauterine infection.

Term and preterm labor are associated with inflammation-induced infiltration of leukocytes into the myometrium, cervix, decidua, and fetal membranes. During labor, peripheral leukocytes invade uterine tissues and secrete bactericidal mediators such as proinflammatory cytokines, resulting in initiation of uterine activity and labor. When these pathophysiological mechanisms occur too early in pregnancy, they may lead to preterm labor. The initiation of inflammatory cascades within the myometrium or intrauterine compartments must be tightly regulated to prevent premature activation of the inflammatory signals and to prevent premature uterine activation.

Labor in humans and rodents is associated with inflammation and the increased uterine contractions during labor are regulated by a complex of signaling pathways between pro- and antiinflammatory cytokines and between mother and fetus. Labor can be triggered from different sources including maternal, fetal and general infection. Therefore it is vital for pregnant women to avoid infection-related pathology and seek medical advice immediately to avoid premature uterine contractions or perhaps abortion.

Schlüsselwörter

  • Cytokines
  • infection
  • intrauterine
  • labor
  • myometrium
  • TLRs
  • uterus

Original article

Uneingeschränkter Zugang

Aspirin responsiveness and 6-month clinical outcome observed in a cohort study of patients with unstable angina pectoris

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 751 - 759

Zusammenfassung

Abstract

Whether patients with coronary heart disease (CHD) and resistance to aspirin found by in vitro tests are at a greater risk of major adverse cardiovascular events (MACEs) is controversial.

To identify any association between resistance to aspirin found by in vitro tests and MACEs in patients with unstable angina pectoris (UAP).

Previously we demonstrated that 38 of 104 patients admitted to hospital with UAP showed resistance to aspirin using whole blood aggregometry (WBA). In the present study, the same cohort was observed during a 6-month follow-up. The primary end points were MACEs, including cardiovascular death, nonfatal myocardial infarction, revascularization, stroke/transient ischemic attack, or worsening UAP that required the patient to be readmitted to hospital.

During the course of 6 months, only 1 patient in the aspirin-sensitive group was lost in follow-up, and MACEs occurred in 24 patients. Patients with resistance to aspirin found by WBA did not apparently have a higher risk of MACEs compared with patients who were aspirin-sensitive (29% vs 20%, P > 0.05). Cox regression analysis showed that resistance to aspirin found by WBA appeared to have no significant correlation with 6-month clinical outcome (HR 1.56, 95% CI 0.70-3.48, P > 0.05).

Aspirin resistance, as defined by WBA, was not associated with an increased risk of MACEs in patients with UAP in a 6-month follow-up. Clarification of the clinical significance of aspirin responsiveness detected by platelet function tests requires further investigation in larger longitudinal studies.

Schlüsselwörter

  • Aggregometry
  • antiplatelet
  • aspirin responsiveness
  • major adverse cardiovascular events
  • unstable angina pectoris

Brief communication (Original)

Uneingeschränkter Zugang

The prevalence of inappropriate blood tests in pediatric patients scheduled for elective surgery in Thailand: a retrospective chart review

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 809 - 815

Zusammenfassung

Abstract

Laboratory blood tests rarely detect any abnormalities in apparently healthy patients. Moreover, unnecessary testing may not only upset pediatric patients and their parents, but may harm patients because of overtreatment of borderline or false-positive results.

To determine the prevalence and factors correlated with inappropriate preoperative testing of pediatric patients scheduled for elective surgery.

We conducted a 6-month retrospective chart review of all children <15 years of age who underwent elective surgery at Siriraj Hospital in Bangkok, Thailand. Demographic and clinical data were recorded, including age, sex, physical status class according to the American Society of Anesthesiologists (ASA), underlying diseases, diagnosis, operation, service unit, and grade of surgery. The requested preoperative laboratory tests were based on the surgeon’s decision. We assessed whether each test was appropriate based on the recommendations for preoperative testing from our Department of Anesthesiology.

We included data from 130 patients. The overall prevalence of inappropriate preoperative testing was 55%. Grade of surgery and service unit significantly affected inappropriate testing (P = 0.01 and P = 0.001 respectively). The highest prevalence of inappropriate test requests was for a complete blood count (37%), and all the risk factors, including ASA class I (P = 0.015), minor operation (P < 0.001), and nonpediatric surgery unit (P < 0.001), were significantly associated with this test.

The prevalence of inappropriate preoperative testing was high, especially for healthy patients who underwent minor operations. Therefore, we recommend that surgical staff be educated to request laboratory tests only when indicated.

Schlüsselwörter

  • Healthy pediatric patients
  • inappropriate preoperative order
  • minor surgery
  • pediatric anesthesia
  • preoperative testing
Uneingeschränkter Zugang

Prevalence of attention deficit hyperactivity disorder in children with epilepsy in a Thai Hospital

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 803 - 807

Zusammenfassung

Abstract

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental and behavioral disorder commonly prevalent in school-aged children. ADHD can be a comorbid diagnosis in those with epilepsy. However, the relationship between ADHD and epilepsy is complex and not entirely known.

To compare the prevalence of ADHD between children with epilepsy at Prapokklao Hospital and healthy children in Chantaburi province, Thailand.

We recruited 73 children with epilepsy at Prapokklao Hospital and 73 age- and sex-matched healthy children at a local school in Chantaburi. The parents of all children rated their child’s behavior using ADHD rating scales. In those with higher scores, a child psychiatrist at Prapokklao Hospital then diagnosed ADHD based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Children with epilepsy appeared to be from families with a lower socioeconomic status than their counterparts. Furthermore, those with epilepsy tended to have a greater probability of diagnosis with ADHD than healthy controls (19% versus 3%, P < 0.001). However, this finding was not significant after data were controlled for the socioeconomic status of the children.

There was an interesting trend towards a greater probability of ADHD diagnosis in those children with epilepsy than in healthy children. As such, epilepsy may increase the risk of these children developing ADHD. To document the prevalence of ADHD in children with epilepsy and healthy controls, both groups of children should be matched not only based on age and sex, but also socioeconomic status.

Schlüsselwörter

  • ADHD
  • attention deficit hyperactivity disorder
  • epilepsy
  • prevalence
  • seizures
Uneingeschränkter Zugang

Relationship between cervical swab culture and placental histological evidence of amniotic fluid infection in preterm labor

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 797 - 801

Zusammenfassung

Abstract

Histopathology shows that 49.8% of women with preterm labor between 23–32 weeks of gestation had histological chorioamnionitis (HCA), but there is poor correlation between HCA and clinical diagnosis of chorioamnionitis. Cervical swab culture is used as a standard tool for evidence of infection.

To determine the relationship between cervical swab culture and placental histological evidence of amniotic fluid infection in preterm labor.

Retrospective observational review of cervical swab culture and placental pathology of women presenting to labor rooms of King Chulalongkorn Memorial Hospital.

We identified 104 patients with preterm labor and intact membranes from January 2012 to May 2013. Amniotic fluid infection detected by placental pathology was present in 10 patients, while a positive cervical culture was present in 12. There was only one patient that showed a positive result for both cervical swab culture and HCA. In patients with HCA, acute chorioamnionitis was present in 7 of 10 cases. Fetal inflammatory response was noted in only one case. There was no significant correlation between cervical swab culture and evidence of amniotic fluid infection in placental pathology (P = 0.87, odds ratio 0.84, 95% confidence interval 0.1 to 7.27).

There was no significant relationship between evidence of amniotic fluid infection in placental pathology and cervical swab culture or clinical signs of chorioamnionitis in preterm labor with intact membrane. However, because of some limitations in this study, the role of cervical swab culture in preterm labor remains inconclusive and more study is needed for clarification.

Schlüsselwörter

  • Cervical swab culture
  • histological chorioamnionitis
  • preterm labor
Uneingeschränkter Zugang

Smell discrimination and identification scores in Thai adults with normosmia

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 789 - 795

Zusammenfassung

Abstract

Olfactory function can be assessed using quantitative or qualitative tests. The phenyl ethyl alcohol (PEA) olfactory threshold test is a useful quantitative test by which to detect olfactory thresholds and to classify them into normosmia, hyposmia, and anosmia. Qualitative tests of olfaction include the smell discrimination and identification tests, which are helpful in diagnosing several neurological diseases.

To identify normal values of smell discrimination and identification scores as references for Thai adults.

We prospectively recruited 128 healthy participants with normosmia as measured by the PEA olfactory threshold test and tested them for smell discrimination and identification scores.

The participants included 64 men and 64 women with age ranging from 18 to 60 years and a mean age of 35.9 years. Median score (interquartile range) of smell discrimination was 16 (13.5-16.0) and mean score (± standard deviation) of smell identification was 8 ± 1.5. The ability of women to discriminate and identify smells was significantly better than that of men as shown by a lower olfactory threshold and higher discrimination and identification scores.

Our study provides normal values for smell discrimination and identification scores in Thai adults, which may be used as references in clinical practice and research. The ability to identify smells may be influenced by individual experience and cultural backgrounds.

Schlüsselwörter

  • Normosmia
  • PEA test
  • phenyl ethyl alcohol olfactory threshold
  • smell discrimination test
  • smell identification test
Uneingeschränkter Zugang

The burden of Clostridium difficile infection in Thais: nationwide survey

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 783 - 788

Zusammenfassung

Abstract

Data on the incidence and burden of Clostridium difficile infection (CDI) in Asia is limited.

To evaluate the incidence and burden of CDI in Thailand.

We used 2010 Nationwide Hospital Admission Data, which included the diagnosis of digestive disorders from various causes coded using the ICD-10. Patients with a diagnosis of Clostridium difficile (ICD10-A07) aged >18 years, were included. Their baseline characteristics, clinical outcomes, and risk factors for CDI were analyzed. Length of hospital stay (LOS), mortality rate, and hospital expenses were used as indicators to evaluate the burden of CDI in Thailand.

Of 4,863,935 admissions in 2010, 554 patients in 570 admissions (0.01%) were diagnosed with CDI. Of these, 106 (19.1%) died during the index hospitalization, and 98.1% had at least one comorbidity. The mean LOS for patients with CDI was longer than with other colitis (P < 0.001) and was also significantly longer for those who died during the index admission, compared with those who survived during the index admission (P = 0.04). The hospital expense for those who died was significantly higher than for those who survived (P < 0.001). From a multivariate analysis, age ≥85 years old, comorbidity, and sepsis were risk factors for mortality during admission with adjusted odds ratios of 2.40, 7.4, and 5.14, respectively.

The calculated burden of CDI in Thais is high; although the incidence of CDI is lower in Thailand than in Western countries. The mortality relates to the elderly age-group and comorbidity, especially sepsis.

Schlüsselwörter

  • Burden
  • Clostridium difficile infection
  • nationwide study
  • Southeast Asia
  • Thailand
  • epidemiology
Uneingeschränkter Zugang

Foreign medical practitioners: requirements for medical practice and postgraduate training in Thailand under ASEAN Economic Community liberalization in 2015

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 777 - 782

Zusammenfassung

Abstract

The ten member states that currently comprise the Association of Southeast Asian Nations (ASEAN) agreed to cooperate to become the ASEAN Economic Community (AEC). The first targets of the AEC are free flow of goods, services, investment, capital, and skilled labor. The eventual goal is “a single market and production base”. The ASEAN Mutual Recognition Arrangement (MRA) for medical practitioners has been formulated to facilitate cooperation and the mobility of medical practitioners within the AEC.

We reviewed the requirements of the Medical Council of Thailand (TMC) and the Thai Ministry of Public Health for medical practice and postgraduate training of foreign medical practitioners.

In Thailand a foreign medical practitioner (FMP), holding a valid medical license from their country of graduation, will be recognized as a legal medical practitioner only after obtaining either a temporary or permanent medical licensure from TMC. To acquire a permanent Thai medical license, the FMP needs to register as a member of the TMC, have graduated from a TMC recognized medical school, but also having passed all 3 parts of the National Licensing Examination of Thailand. A Thai medical license is also required for clinical postgraduate medical training. Thai language proficiency is mandatory for registration. There is now only one formal international postgraduate medical training program in Thailand. Participants as observers may be exempted from some or all of these regulations.

The current status of medical licensure in the Kingdom of Thailand presents hurdles that may have to be surmounted.

Schlüsselwörter

  • ASEAN
  • foreign medical practitioners
  • medical licensing and reciprocity
  • medical practice
  • medical training
Uneingeschränkter Zugang

Prevalence of radiosensitive organ shielding in patients undergoing computed tomography examinations: an observational service audit in Ahvaz, Iran

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 771 - 775

Zusammenfassung

Abstract

Radiation exposure from computed tomography (CT) is associated with deleterious effects. In-plane bismuth shields (IBS) have been suggested as an effective method to reduce radiation exposure to radiosensitive organs during CT.

To explore the availability and usage of modern shielding tools (IBS) and conventional radiation shields for patients undergoing CT exams in five hospitals in Ahvaz, Iran.

Six radiological technology students were sent to five different hospitals of Ahvaz as observers. Data of the availability and usage of shielding tools for patients undergoing CT exams were collected.

In the five hospitals evaluated, there were no IBS found. In each X-ray room at least one lead apron was available. A gonad shield and thyroid collar were available in 70% and 62% of X-ray rooms, respectively. Also there was no available lens shield. Shielding the eyes and thyroid gland were often neglected. Gonads and breasts were shielded occasionally.

Patients have received avoidable doses of radiation and this is a reason for concern and call for action. Adherence to safety guidelines is recommended. The provision and routine use of IBS to radiosensitive organs as well as lead-shields to the organs outside the field being scanned should be mandatory.

Schlüsselwörter

  • Bismuth shield
  • computed tomography
  • radiation protection
  • shielding tools
Uneingeschränkter Zugang

Engaging local governments in health promotion and chronic disease prevention activities: the case of Local Health Security Funds in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 761 - 770

Zusammenfassung

Abstract

Health care systems should use community-driven activities to promote health and prevent disease to address the challenges from noncommunicable diseases (NCDs) such as diabetes mellitus and high blood pressure. In Thailand, Local Health Security Funds (LHSF) are an initiative to encourage local governments to play a more active role in promoting health. Universal Health Coverage provides funding for this initiative. However, the effectiveness of such initiatives has not been fully assessed.

To investigate the effectiveness of LHSFs in conducting activities to promote health and prevent disease related to diabetes and hypertension.

We administered a questionnaire to local governments responsible for LHSFs in April 2014 to survey information about their communities, leadership, and activities to promote health.

Complete answers to our questionnaire were provided by 1,144 respondents (98.4%). About 94% of those surveyed had already joined LHSFs. Most LHSFs implemented a variety of community activities to promote health, and prevent diabetes and hypertension. We classified these activities into 5 main areas according to the Ottawa Charter. LHSFs most commonly strengthened community action, while building a local health policy was least common. Only 20.8% of the LHSFs had implemented activities in all 5 areas. A number of factors were associated with the activities, including the development of networks and personal skills.

LHSFs are useful for engaging local governments in promoting health, and preventing diabetes and hypertension in their communities. Good relationships between local government leaders and public health officers are linked to more effective LHSFs.

Schlüsselwörter

  • Community
  • health promotion
  • local governments
  • Thailand
  • NCDs

Clinical vignette

Uneingeschränkter Zugang

A rare presentation of myxoma, pediculated and originating from the fornix of the conjunctiva

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 817 - 819

Zusammenfassung

Abstract

Myxoma is a rare benign tumor of the connective tissue. It is the most common type of benign heart tumor, but may occur elsewhere.

To report a case of ocular fornix conjunctiva with involvement of myxoma.

A 50-year-old male patient was admitted to our clinic with the complaint of a growing ovoid mass in his left lower eyelid fornix conjunctiva for over a year. The mass contained a hemorrhagic ulcer and was solid, painless, purple-red, and clinging to the inferior fornix by thin pedicle tissue. Examination of both eyes found that they were otherwise normal.

The mass was diagnosed as myxoma on the basis of histopathology including vimentin and CD34, but not S100 immunoreactivity, and fusiform-stellar-shaped cells in loose myxoid stroma stained with Alcian blue.

Myxoma should be considered in the differential diagnosis of ocular tissue masses and that it can mimic other types of tumors.

Schlüsselwörter

  • Fornix of conjunctiva
  • myxoma
  • pediculated
13 Artikel

Editorial

Uneingeschränkter Zugang

Building a healthy public policy and reorienting health services towards control of chronic diseases

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 725 - 726

Zusammenfassung

Review article

Uneingeschränkter Zugang

Long-acting injectable antipsychotics in patients with schizophrenia: systematic review and mixed treatment meta-analysis

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 741 - 750

Zusammenfassung

Abstract

Long-acting injectable antipsychotics (LAIs) are recommended for schizophrenic patients who cannot adhere to oral medication. We systematically reviewed randomized controlled trials of 6 LAIs available in Thailand including fluphenazine, flupentixol, haloperidol, zuclopenthixol, paliperidone, and risperidone in PubMed/ MEDLINE and the Cochrane library (1955-Nov 2013). Inclusion was limited to studies of schizophrenia ≥24 weeks duration published in English. We selected 17 of 1,245 articles including 1,904 patients. The number of patients ranged from 19 to 747 per study (median 54). Mean study duration was 52.3 weeks (24-96 weeks) and median quality score using a Jadad scoring method was 4 (2-5). We applied a Bayesian model with a mixed treatment comparison approach for 3 competing risk outcomes including relapse, and discontinuation because of adverse events or other reasons. Based on the random effect model preferred by a goodness of fit analysis, risperidone had the lowest 52 week probability of relapse (mean ± SD, 0.26 ± 0.321) followed by paliperidone (0.30 ± 0.314). Zuclopenthixol had the lowest probability of discontinuation because of an adverse event (0.07 ± 0.159) or other reasons (0.26 ± 0.295). Risperidone had the highest probability of preventing relapse (0.35 ± 0.476) or discontinuation for other reasons (0.31 ± 0.461). Zuclopenthixol had the highest probability of preventing discontinuation because of adverse effects (0.31 ± 0.464). All 6 LAIs tended to have a lower risk of relapse compared with placebo. Differences between LAIs preventing any treatment discontinuation or relapse were seen, but limited in our analysis.

Schlüsselwörter

  • Competing risk outcomes
  • long acting injectable antipsychotics
  • meta-analysis
  • mixed treatment comparison
Uneingeschränkter Zugang

Intrauterine infection as a possible trigger for labor: the role of toll-like receptors and proinflammatory cytokines

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 727 - 739

Zusammenfassung

Abstract

The mechanisms underlying the initiation of premature uterine contractions during pregnancy are not fully understood. It is now widely accepted that proinflammatory cytokines are key mediators of the inflammatory signaling pathways in term or preterm labor. However, the exact triggers for inflammation-induced labor remain to be identified.

We review the published literature and summarize the possible pathophysiological mechanisms underlying the initiation of uterine contractions with a particular emphasis on intrauterine infection.

Term and preterm labor are associated with inflammation-induced infiltration of leukocytes into the myometrium, cervix, decidua, and fetal membranes. During labor, peripheral leukocytes invade uterine tissues and secrete bactericidal mediators such as proinflammatory cytokines, resulting in initiation of uterine activity and labor. When these pathophysiological mechanisms occur too early in pregnancy, they may lead to preterm labor. The initiation of inflammatory cascades within the myometrium or intrauterine compartments must be tightly regulated to prevent premature activation of the inflammatory signals and to prevent premature uterine activation.

Labor in humans and rodents is associated with inflammation and the increased uterine contractions during labor are regulated by a complex of signaling pathways between pro- and antiinflammatory cytokines and between mother and fetus. Labor can be triggered from different sources including maternal, fetal and general infection. Therefore it is vital for pregnant women to avoid infection-related pathology and seek medical advice immediately to avoid premature uterine contractions or perhaps abortion.

Schlüsselwörter

  • Cytokines
  • infection
  • intrauterine
  • labor
  • myometrium
  • TLRs
  • uterus

Original article

Uneingeschränkter Zugang

Aspirin responsiveness and 6-month clinical outcome observed in a cohort study of patients with unstable angina pectoris

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 751 - 759

Zusammenfassung

Abstract

Whether patients with coronary heart disease (CHD) and resistance to aspirin found by in vitro tests are at a greater risk of major adverse cardiovascular events (MACEs) is controversial.

To identify any association between resistance to aspirin found by in vitro tests and MACEs in patients with unstable angina pectoris (UAP).

Previously we demonstrated that 38 of 104 patients admitted to hospital with UAP showed resistance to aspirin using whole blood aggregometry (WBA). In the present study, the same cohort was observed during a 6-month follow-up. The primary end points were MACEs, including cardiovascular death, nonfatal myocardial infarction, revascularization, stroke/transient ischemic attack, or worsening UAP that required the patient to be readmitted to hospital.

During the course of 6 months, only 1 patient in the aspirin-sensitive group was lost in follow-up, and MACEs occurred in 24 patients. Patients with resistance to aspirin found by WBA did not apparently have a higher risk of MACEs compared with patients who were aspirin-sensitive (29% vs 20%, P > 0.05). Cox regression analysis showed that resistance to aspirin found by WBA appeared to have no significant correlation with 6-month clinical outcome (HR 1.56, 95% CI 0.70-3.48, P > 0.05).

Aspirin resistance, as defined by WBA, was not associated with an increased risk of MACEs in patients with UAP in a 6-month follow-up. Clarification of the clinical significance of aspirin responsiveness detected by platelet function tests requires further investigation in larger longitudinal studies.

Schlüsselwörter

  • Aggregometry
  • antiplatelet
  • aspirin responsiveness
  • major adverse cardiovascular events
  • unstable angina pectoris

Brief communication (Original)

Uneingeschränkter Zugang

The prevalence of inappropriate blood tests in pediatric patients scheduled for elective surgery in Thailand: a retrospective chart review

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 809 - 815

Zusammenfassung

Abstract

Laboratory blood tests rarely detect any abnormalities in apparently healthy patients. Moreover, unnecessary testing may not only upset pediatric patients and their parents, but may harm patients because of overtreatment of borderline or false-positive results.

To determine the prevalence and factors correlated with inappropriate preoperative testing of pediatric patients scheduled for elective surgery.

We conducted a 6-month retrospective chart review of all children <15 years of age who underwent elective surgery at Siriraj Hospital in Bangkok, Thailand. Demographic and clinical data were recorded, including age, sex, physical status class according to the American Society of Anesthesiologists (ASA), underlying diseases, diagnosis, operation, service unit, and grade of surgery. The requested preoperative laboratory tests were based on the surgeon’s decision. We assessed whether each test was appropriate based on the recommendations for preoperative testing from our Department of Anesthesiology.

We included data from 130 patients. The overall prevalence of inappropriate preoperative testing was 55%. Grade of surgery and service unit significantly affected inappropriate testing (P = 0.01 and P = 0.001 respectively). The highest prevalence of inappropriate test requests was for a complete blood count (37%), and all the risk factors, including ASA class I (P = 0.015), minor operation (P < 0.001), and nonpediatric surgery unit (P < 0.001), were significantly associated with this test.

The prevalence of inappropriate preoperative testing was high, especially for healthy patients who underwent minor operations. Therefore, we recommend that surgical staff be educated to request laboratory tests only when indicated.

Schlüsselwörter

  • Healthy pediatric patients
  • inappropriate preoperative order
  • minor surgery
  • pediatric anesthesia
  • preoperative testing
Uneingeschränkter Zugang

Prevalence of attention deficit hyperactivity disorder in children with epilepsy in a Thai Hospital

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 803 - 807

Zusammenfassung

Abstract

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental and behavioral disorder commonly prevalent in school-aged children. ADHD can be a comorbid diagnosis in those with epilepsy. However, the relationship between ADHD and epilepsy is complex and not entirely known.

To compare the prevalence of ADHD between children with epilepsy at Prapokklao Hospital and healthy children in Chantaburi province, Thailand.

We recruited 73 children with epilepsy at Prapokklao Hospital and 73 age- and sex-matched healthy children at a local school in Chantaburi. The parents of all children rated their child’s behavior using ADHD rating scales. In those with higher scores, a child psychiatrist at Prapokklao Hospital then diagnosed ADHD based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Children with epilepsy appeared to be from families with a lower socioeconomic status than their counterparts. Furthermore, those with epilepsy tended to have a greater probability of diagnosis with ADHD than healthy controls (19% versus 3%, P < 0.001). However, this finding was not significant after data were controlled for the socioeconomic status of the children.

There was an interesting trend towards a greater probability of ADHD diagnosis in those children with epilepsy than in healthy children. As such, epilepsy may increase the risk of these children developing ADHD. To document the prevalence of ADHD in children with epilepsy and healthy controls, both groups of children should be matched not only based on age and sex, but also socioeconomic status.

Schlüsselwörter

  • ADHD
  • attention deficit hyperactivity disorder
  • epilepsy
  • prevalence
  • seizures
Uneingeschränkter Zugang

Relationship between cervical swab culture and placental histological evidence of amniotic fluid infection in preterm labor

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 797 - 801

Zusammenfassung

Abstract

Histopathology shows that 49.8% of women with preterm labor between 23–32 weeks of gestation had histological chorioamnionitis (HCA), but there is poor correlation between HCA and clinical diagnosis of chorioamnionitis. Cervical swab culture is used as a standard tool for evidence of infection.

To determine the relationship between cervical swab culture and placental histological evidence of amniotic fluid infection in preterm labor.

Retrospective observational review of cervical swab culture and placental pathology of women presenting to labor rooms of King Chulalongkorn Memorial Hospital.

We identified 104 patients with preterm labor and intact membranes from January 2012 to May 2013. Amniotic fluid infection detected by placental pathology was present in 10 patients, while a positive cervical culture was present in 12. There was only one patient that showed a positive result for both cervical swab culture and HCA. In patients with HCA, acute chorioamnionitis was present in 7 of 10 cases. Fetal inflammatory response was noted in only one case. There was no significant correlation between cervical swab culture and evidence of amniotic fluid infection in placental pathology (P = 0.87, odds ratio 0.84, 95% confidence interval 0.1 to 7.27).

There was no significant relationship between evidence of amniotic fluid infection in placental pathology and cervical swab culture or clinical signs of chorioamnionitis in preterm labor with intact membrane. However, because of some limitations in this study, the role of cervical swab culture in preterm labor remains inconclusive and more study is needed for clarification.

Schlüsselwörter

  • Cervical swab culture
  • histological chorioamnionitis
  • preterm labor
Uneingeschränkter Zugang

Smell discrimination and identification scores in Thai adults with normosmia

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 789 - 795

Zusammenfassung

Abstract

Olfactory function can be assessed using quantitative or qualitative tests. The phenyl ethyl alcohol (PEA) olfactory threshold test is a useful quantitative test by which to detect olfactory thresholds and to classify them into normosmia, hyposmia, and anosmia. Qualitative tests of olfaction include the smell discrimination and identification tests, which are helpful in diagnosing several neurological diseases.

To identify normal values of smell discrimination and identification scores as references for Thai adults.

We prospectively recruited 128 healthy participants with normosmia as measured by the PEA olfactory threshold test and tested them for smell discrimination and identification scores.

The participants included 64 men and 64 women with age ranging from 18 to 60 years and a mean age of 35.9 years. Median score (interquartile range) of smell discrimination was 16 (13.5-16.0) and mean score (± standard deviation) of smell identification was 8 ± 1.5. The ability of women to discriminate and identify smells was significantly better than that of men as shown by a lower olfactory threshold and higher discrimination and identification scores.

Our study provides normal values for smell discrimination and identification scores in Thai adults, which may be used as references in clinical practice and research. The ability to identify smells may be influenced by individual experience and cultural backgrounds.

Schlüsselwörter

  • Normosmia
  • PEA test
  • phenyl ethyl alcohol olfactory threshold
  • smell discrimination test
  • smell identification test
Uneingeschränkter Zugang

The burden of Clostridium difficile infection in Thais: nationwide survey

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 783 - 788

Zusammenfassung

Abstract

Data on the incidence and burden of Clostridium difficile infection (CDI) in Asia is limited.

To evaluate the incidence and burden of CDI in Thailand.

We used 2010 Nationwide Hospital Admission Data, which included the diagnosis of digestive disorders from various causes coded using the ICD-10. Patients with a diagnosis of Clostridium difficile (ICD10-A07) aged >18 years, were included. Their baseline characteristics, clinical outcomes, and risk factors for CDI were analyzed. Length of hospital stay (LOS), mortality rate, and hospital expenses were used as indicators to evaluate the burden of CDI in Thailand.

Of 4,863,935 admissions in 2010, 554 patients in 570 admissions (0.01%) were diagnosed with CDI. Of these, 106 (19.1%) died during the index hospitalization, and 98.1% had at least one comorbidity. The mean LOS for patients with CDI was longer than with other colitis (P < 0.001) and was also significantly longer for those who died during the index admission, compared with those who survived during the index admission (P = 0.04). The hospital expense for those who died was significantly higher than for those who survived (P < 0.001). From a multivariate analysis, age ≥85 years old, comorbidity, and sepsis were risk factors for mortality during admission with adjusted odds ratios of 2.40, 7.4, and 5.14, respectively.

The calculated burden of CDI in Thais is high; although the incidence of CDI is lower in Thailand than in Western countries. The mortality relates to the elderly age-group and comorbidity, especially sepsis.

Schlüsselwörter

  • Burden
  • Clostridium difficile infection
  • nationwide study
  • Southeast Asia
  • Thailand
  • epidemiology
Uneingeschränkter Zugang

Foreign medical practitioners: requirements for medical practice and postgraduate training in Thailand under ASEAN Economic Community liberalization in 2015

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 777 - 782

Zusammenfassung

Abstract

The ten member states that currently comprise the Association of Southeast Asian Nations (ASEAN) agreed to cooperate to become the ASEAN Economic Community (AEC). The first targets of the AEC are free flow of goods, services, investment, capital, and skilled labor. The eventual goal is “a single market and production base”. The ASEAN Mutual Recognition Arrangement (MRA) for medical practitioners has been formulated to facilitate cooperation and the mobility of medical practitioners within the AEC.

We reviewed the requirements of the Medical Council of Thailand (TMC) and the Thai Ministry of Public Health for medical practice and postgraduate training of foreign medical practitioners.

In Thailand a foreign medical practitioner (FMP), holding a valid medical license from their country of graduation, will be recognized as a legal medical practitioner only after obtaining either a temporary or permanent medical licensure from TMC. To acquire a permanent Thai medical license, the FMP needs to register as a member of the TMC, have graduated from a TMC recognized medical school, but also having passed all 3 parts of the National Licensing Examination of Thailand. A Thai medical license is also required for clinical postgraduate medical training. Thai language proficiency is mandatory for registration. There is now only one formal international postgraduate medical training program in Thailand. Participants as observers may be exempted from some or all of these regulations.

The current status of medical licensure in the Kingdom of Thailand presents hurdles that may have to be surmounted.

Schlüsselwörter

  • ASEAN
  • foreign medical practitioners
  • medical licensing and reciprocity
  • medical practice
  • medical training
Uneingeschränkter Zugang

Prevalence of radiosensitive organ shielding in patients undergoing computed tomography examinations: an observational service audit in Ahvaz, Iran

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 771 - 775

Zusammenfassung

Abstract

Radiation exposure from computed tomography (CT) is associated with deleterious effects. In-plane bismuth shields (IBS) have been suggested as an effective method to reduce radiation exposure to radiosensitive organs during CT.

To explore the availability and usage of modern shielding tools (IBS) and conventional radiation shields for patients undergoing CT exams in five hospitals in Ahvaz, Iran.

Six radiological technology students were sent to five different hospitals of Ahvaz as observers. Data of the availability and usage of shielding tools for patients undergoing CT exams were collected.

In the five hospitals evaluated, there were no IBS found. In each X-ray room at least one lead apron was available. A gonad shield and thyroid collar were available in 70% and 62% of X-ray rooms, respectively. Also there was no available lens shield. Shielding the eyes and thyroid gland were often neglected. Gonads and breasts were shielded occasionally.

Patients have received avoidable doses of radiation and this is a reason for concern and call for action. Adherence to safety guidelines is recommended. The provision and routine use of IBS to radiosensitive organs as well as lead-shields to the organs outside the field being scanned should be mandatory.

Schlüsselwörter

  • Bismuth shield
  • computed tomography
  • radiation protection
  • shielding tools
Uneingeschränkter Zugang

Engaging local governments in health promotion and chronic disease prevention activities: the case of Local Health Security Funds in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 761 - 770

Zusammenfassung

Abstract

Health care systems should use community-driven activities to promote health and prevent disease to address the challenges from noncommunicable diseases (NCDs) such as diabetes mellitus and high blood pressure. In Thailand, Local Health Security Funds (LHSF) are an initiative to encourage local governments to play a more active role in promoting health. Universal Health Coverage provides funding for this initiative. However, the effectiveness of such initiatives has not been fully assessed.

To investigate the effectiveness of LHSFs in conducting activities to promote health and prevent disease related to diabetes and hypertension.

We administered a questionnaire to local governments responsible for LHSFs in April 2014 to survey information about their communities, leadership, and activities to promote health.

Complete answers to our questionnaire were provided by 1,144 respondents (98.4%). About 94% of those surveyed had already joined LHSFs. Most LHSFs implemented a variety of community activities to promote health, and prevent diabetes and hypertension. We classified these activities into 5 main areas according to the Ottawa Charter. LHSFs most commonly strengthened community action, while building a local health policy was least common. Only 20.8% of the LHSFs had implemented activities in all 5 areas. A number of factors were associated with the activities, including the development of networks and personal skills.

LHSFs are useful for engaging local governments in promoting health, and preventing diabetes and hypertension in their communities. Good relationships between local government leaders and public health officers are linked to more effective LHSFs.

Schlüsselwörter

  • Community
  • health promotion
  • local governments
  • Thailand
  • NCDs

Clinical vignette

Uneingeschränkter Zugang

A rare presentation of myxoma, pediculated and originating from the fornix of the conjunctiva

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 817 - 819

Zusammenfassung

Abstract

Myxoma is a rare benign tumor of the connective tissue. It is the most common type of benign heart tumor, but may occur elsewhere.

To report a case of ocular fornix conjunctiva with involvement of myxoma.

A 50-year-old male patient was admitted to our clinic with the complaint of a growing ovoid mass in his left lower eyelid fornix conjunctiva for over a year. The mass contained a hemorrhagic ulcer and was solid, painless, purple-red, and clinging to the inferior fornix by thin pedicle tissue. Examination of both eyes found that they were otherwise normal.

The mass was diagnosed as myxoma on the basis of histopathology including vimentin and CD34, but not S100 immunoreactivity, and fusiform-stellar-shaped cells in loose myxoid stroma stained with Alcian blue.

Myxoma should be considered in the differential diagnosis of ocular tissue masses and that it can mimic other types of tumors.

Schlüsselwörter

  • Fornix of conjunctiva
  • myxoma
  • pediculated

Planen Sie Ihre Fernkonferenz mit Scienceendo