Rivista e Edizione

Volume 16 (2022): Edizione 3 (June 2022)

Volume 16 (2022): Edizione 2 (April 2022)

Volume 16 (2022): Edizione 1 (February 2022)

Volume 15 (2021): Edizione 6 (December 2021)

Volume 15 (2021): Edizione 5 (October 2021)

Volume 15 (2021): Edizione 4 (August 2021)

Volume 15 (2021): Edizione 3 (June 2021)

Volume 15 (2021): Edizione 2 (April 2021)

Volume 15 (2021): Edizione 1 (February 2021)

Volume 14 (2020): Edizione 6 (December 2020)

Volume 14 (2020): Edizione 5 (October 2020)

Volume 14 (2020): Edizione 4 (August 2020)

Volume 14 (2020): Edizione 3 (June 2020)

Volume 14 (2020): Edizione 2 (April 2020)

Volume 14 (2020): Edizione 1 (February 2020)

Volume 13 (2019): Edizione 6 (December 2019)

Volume 13 (2019): Edizione 5 (October 2019)

Volume 13 (2019): Edizione 4 (August 2019)

Volume 13 (2019): Edizione 3 (June 2019)

Volume 13 (2019): Edizione 2 (April 2019)

Volume 13 (2019): Edizione 1 (February 2019)

Volume 12 (2018): Edizione 6 (December 2018)

Volume 12 (2018): Edizione 5 (October 2018)

Volume 12 (2018): Edizione 4 (August 2018)

Volume 12 (2018): Edizione 3 (June 2018)

Volume 12 (2018): Edizione 2 (April 2018)

Volume 12 (2018): Edizione 1 (February 2018)

Volume 11 (2017): Edizione 6 (December 2017)

Volume 11 (2017): Edizione 5 (October 2017)

Volume 11 (2017): Edizione 4 (August 2017)

Volume 11 (2017): Edizione 3 (June 2017)

Volume 11 (2017): Edizione 2 (April 2017)

Volume 11 (2017): Edizione 1 (February 2017)

Volume 10 (2016): Edizione 6 (December 2016)

Volume 10 (2016): Edizione 5 (October 2016)

Volume 10 (2016): Edizione 4 (August 2016)

Volume 10 (2016): Edizione 3 (June 2016)

Volume 10 (2016): Edizione 2 (April 2016)

Volume 10 (2016): Edizione s1 (December 2016)

Volume 10 (2016): Edizione 1 (February 2016)

Volume 9 (2015): Edizione 6 (December 2015)

Volume 9 (2015): Edizione 5 (October 2015)

Volume 9 (2015): Edizione 4 (August 2015)

Volume 9 (2015): Edizione 3 (June 2015)

Volume 9 (2015): Edizione 2 (April 2015)

Volume 9 (2015): Edizione 1 (February 2015)

Volume 8 (2014): Edizione 6 (December 2014)

Volume 8 (2014): Edizione 5 (October 2014)

Volume 8 (2014): Edizione 4 (August 2014)

Volume 8 (2014): Edizione 3 (June 2014)

Volume 8 (2014): Edizione 2 (April 2014)

Volume 8 (2014): Edizione 1 (February 2014)

Volume 7 (2013): Edizione 6 (December 2013)

Volume 7 (2013): Edizione 5 (October 2013)

Volume 7 (2013): Edizione 4 (August 2013)

Volume 7 (2013): Edizione 3 (June 2013)

Volume 7 (2013): Edizione 2 (April 2013)

Volume 7 (2013): Edizione 1 (February 2013)

Volume 6 (2012): Edizione 6 (December 2012)

Volume 6 (2012): Edizione 5 (October 2012)

Volume 6 (2012): Edizione 4 (August 2012)

Volume 6 (2012): Edizione 3 (June 2012)

Volume 6 (2012): Edizione 2 (April 2012)

Volume 6 (2012): Edizione 1 (February 2012)

Volume 5 (2011): Edizione 6 (December 2011)

Volume 5 (2011): Edizione 5 (October 2011)

Volume 5 (2011): Edizione 4 (August 2011)

Volume 5 (2011): Edizione 3 (June 2011)

Volume 5 (2011): Edizione 2 (April 2011)

Volume 5 (2011): Edizione 1 (February 2011)

Volume 4 (2010): Edizione 6 (December 2010)

Volume 4 (2010): Edizione 5 (October 2010)

Volume 4 (2010): Edizione 4 (August 2010)

Volume 4 (2010): Edizione 3 (June 2010)

Volume 4 (2010): Edizione 2 (April 2010)

Volume 4 (2010): Edizione 1 (February 2010)

Dettagli della rivista
Formato
Rivista
eISSN
1875-855X
Pubblicato per la prima volta
01 Jun 2007
Periodo di pubblicazione
6 volte all'anno
Lingue
Inglese

Cerca

Volume 11 (2017): Edizione 1 (February 2017)

Dettagli della rivista
Formato
Rivista
eISSN
1875-855X
Pubblicato per la prima volta
01 Jun 2007
Periodo di pubblicazione
6 volte all'anno
Lingue
Inglese

Cerca

11 Articoli

Editorial

Accesso libero

Development of practice guidelines relevant to patient characteristics and local imperatives

Pubblicato online: 31 Aug 2017
Pagine: 1 - 1

Astratto

Review Article

Accesso libero

Nanoparticles in therapeutic applications and role of albumin and casein nanoparticles in cancer therapy

Pubblicato online: 31 Aug 2017
Pagine: 3 - 20

Astratto

Abstract

Nanoparticles are widely used for various therapeutic treatments. Proteins have the advantage of being naturally occurring, with relative lack of toxicity and antigenicity, but easy biodegradability and potent ability to bind other compounds. Proteins have been produced in nanoformulations, which have been made by various methods including desolvation and precipitation. Biopolymeric nanoparticles including proteins are used in delivery of genes and drugs, and in tissue engineering. Protein nanoparticulate drug delivery systems are used to treat several diseases because of their high drug-binding capacity, biocompatibility, nutritional value, stability, and potent site-specific action. Among the various proteins, casein and albumin nanoparticles are used widely as nanocarriers for various therapeutic drugs.

To review the types of nanoparticles and their role in therapeutic applications, and the important role of casein and albumin nanoparticles in cancer therapy.

A literature search based on nanoparticles, their types, and their roles in medical applications was conducted using websites including Google Scholar, SpringerLink, ResearchGate, and the U.S. National Institutes of Health’s National Library of Medicine’s National Center for Biotechnology Information PubMed database including PubMed Central covering from 2000 to 2016.

Nanoparticles, especially albumin and casein had been found effective drug delivery systems.

Protein based nanoparticles such as albumin and casein nanoparticles are widely used for targeting cancers and can be used as effective vehicles for the delivery of various anticancer drugs.

Parole chiave

  • Albumin nanoparticles
  • casein nanoparticles
  • coacervation
  • nanoprecipitation
  • protein nanoparticles

Original article

Accesso libero

Perioperative and Anesthetic Adverse events in Thailand (PAAd Thai) incident reporting study: anesthetic profiles and outcomes

Pubblicato online: 31 Aug 2017
Pagine: 21 - 32

Astratto

Abstract

The Royal College of Anesthesiologists of Thailand initiated registry and reporting of anesthesia service incidents and outcomes in 2005.

The Perianesthetic Anesthetic Adverse Events in Thailand (PAAd Thai) study aimed to investigate patient, surgical, and anesthetic profiles, and suggest strategies for prevention of adverse events.

A prospective descriptive study was conducted in 22 hospitals across Thailand. Each hospital was invited to report, on an anonymous basis, any perianesthetic adverse incident during 12 months (between January 1 and December 31, 2015). A standardized incident report form was completed to determine the type of incident, and where, when, how, and why it occurred using closed and open-ended questionnaires. Data regarding main anesthetic techniques were also reported monthly. Descriptive statistics were used.

For 333,219 cases, 2,206 incident reports with 3,028 critical incidents were reported. The incidents commonly occurred in male patients (52.0%), aged <10 y (13.0%) and >70 y (18.2%). The incidence of adverse events included cardiac arrest within 24 h (15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal intubation (8.5:10,000), difficult intubation (8.0:10,000), and malignant hyperthermia (1:200,000). General, cardiothoracic, neurological, and otorhinolaryngological surgical specialties posed a high risk of incidents. Operating and recovery rooms were common locations for incidents.

In the past decade, there were dramatic reductions of perioperative cardiac arrests and difficult intubations. Common factors related to critical incidents were inexperience, emergency, inadequate preanesthetic evaluation, inappropriate decisions, lack of vigilance, and inexperienced assistants. Suggested corrective strategies are compliance with guidelines, additional training, and improvement of supervision and quality assurance.

Parole chiave

  • Adverse events
  • anesthesia
  • incidents
  • incident report
  • patient safety

Brief communication

Accesso libero

Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study: hospital characteristics and methods

Pubblicato online: 31 Aug 2017
Pagine: 33 - 39

Astratto

Abstract

Safety in anesthesia can be improved through monitoring and analysis of anesthetic complications. We conducted the present Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study to determine the current frequency distribution of incidents related to the anesthetic complications, factors contributing to the incidents, and corrective strategies.

To describe the characteristics of the hospitals participating in this study and methods used.

A multicenter prospective observational study was conducted in hospitals across Thailand in 2015. The participating hospitals were asked to anonymously report incidents of anesthesia-related adverse events and management. Three peer reviewers reviewed the completed record forms describing the incidents including possible mechanisms, contributing factors, appropriate management, and preventive strategies to achieve agreement by consensus.

Twenty-two hospitals across Thailand participated in this study. Fourteen (64%) were nonuniversity (service directed) hospitals, while 8 (36%) were university (academic teaching) hospitals. Most hospitals were involved in residency training and teaching medical students (77%), while just more than half (57%) were involved in training nurse anesthetists. The ratio of anesthesiologists to an operating room was 0.67:1 and the ratio of nurse anesthetists to an operating room was 2.03:1.

A critical incident analysis of each reported adverse event is helpful for proposing a corrective or preventive strategy to ameliorate perioperative care and improve patient safety in the Thai health care system.

Parole chiave

  • Adverse events
  • anesthesia
  • incident report
  • perioperative

Brief communication (Original)

Accesso libero

Genotype distributions of CYP2C9 and VKORC1 in southern Thais and their association with warfarin maintenance dose in patients with cardiac surgery

Pubblicato online: 31 Aug 2017
Pagine: 81 - 87

Astratto

Abstract

Pharmacodynamics of warfarin are influenced by genetic polymorphisms of its metabolic enzymes.

To determine CYP2C9 and VKORC1 genotypes in a population in southern Thailand, and their association with warfarin maintenance doses.

We genotyped CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910), VKORC1 (rs9923231 and rs9934438) from the blood DNA of 210 healthy controls, and determined the association of 2 polymorphic markers (CYP2C9*3 and rs9923231) in 154 patients with aortic valve protheses, with warfarin maintenance dose and coagulopathy.

CYP2C9*3 was detected in 17/210 controls; all were heterozygous variants (-*1*3). No CYP2C9*2 polymorphisms were detected. The 2 VKORC1 polymorphisms were in complete linkage disequilibrium. The genotype distribution of VKORC1 (rs9923231) was 118:72:20 for AA:AG:GG. The warfarin maintenance dose in patients with CYP2C9*1*3 (20.7 mg/week) was significantly less than in patients with CYP2C9*1*1 (31.7 mg/week; P < 0.01). In VKORC1 patients, the warfarin maintenance dose increased significantly with minor variants (AA:AG:GG; 23.8:35.3:47.3 mg/week). The incidence of prolonged prothrombin time (INR > 5) was significantly higher in the VKORC1-AA group (45/76) than the AG (22/64) or GG (3/16) groups. The median time to achieve a stable INR was highest for patients with a GG genotype (342 days) compared with 20 days for those with AA, and 160 days for those with AG. Other factors associated with warfarin maintenance dose were body surface area, age (>45 years), and concomitant drug use.

Polymorphisms of CYP2C9*3 and VKORC1 are present in southern Thais. We recommend pharmacogenetic studies of these markers as a component of warfarin therapy.

Parole chiave

  • Pharmacogenetics
  • Thai patients
  • warfarin
Accesso libero

Frequency of hepatitis B envelope antigen-negative chronic hepatitis B virus infection in untreated patients from three cities in Pakistan

Pubblicato online: 31 Aug 2017
Pagine: 73 - 79

Astratto

Abstract

Hepatitis B envelope antigen (HBeAg)-negative chronic hepatitis B virus (CHB) infection is a clinical entity refractory to treatment and has implications for disease outcome.

To determine the frequency of HBeAg-negative CHB in untreated hepatitis B surface antigen (HBsAg)-positive patients.

We conducted this cross-sectional study of untreated HBsAg-positive patients from 3 cities in Pakistan for more than 6 months.

Of495 patients, 276 (47.7%) had detectable hepatitis B virus (HBV) DNA (mean 5.3 ± 1.96 log10 copies/mL), 81 (16.4%) were HBeAg positive and 414 (83.6%) were HBeAg negative. All 81 (100%) HBeAg-positive patients had detectable HBV DNA. Frequency of HBeAg-negative CHB infection was 155 (31.3%) among HBsAg-positive patients. One hundred and sixteen (74.8%) of the HBeAg-negative patients with CHB infection were in the age range of 15–35 years.

HBeAg-negative patients constitute a considerable proportion of patients with CHB infection. HBsAg-positive patients, especially with younger age, should be thoroughly investigated for this entity to avoid the devastating long-term complications of this disease.

Parole chiave

  • Chronic hepatitis B
  • hepatitis
  • hepatitis B surface antigen
  • Pakistan
Accesso libero

Economic impact of investment in maternal and newborn health care under the National Health Security Scheme of Thailand

Pubblicato online: 31 Aug 2017
Pagine: 65 - 72

Astratto

Abstract

Evidence for the impact of health care spending in the area of maternal, newborn and child health (MCH) in developing countries is limited.

To examine the investment and medical care expenses for MCH under Universal Health Coverage (UHC) in Thailand.

A prevention–appraisal–failure (PAF) cost element method was applied. Using a payer perspective, data related to PAF elements of MCH were collected from the Universal Coverage Scheme (UCS) inpatient claim database, UCS liability claims, the health-budget administration and health resource databases of the Ministry of Public Health, and the population census of The National Statistical Office in fiscal years 2007–2011. The main outcome measures included payments and budgets for MCH at a provincial level.

Investment and medical care costs of antenatal care to prevent and manage complications increased from US$7.77 per person per year (PPPY) in 2007 to US$11.69 PPPY in 2011. The payments to support quality-focused activities ranged from US$0.60 to US$1.19 PPPY, whereas failure costs resulting from postpartum complications and UHC liability claims were US$1.92, 2.24, 2.35, 2.48, and 2.56 PPPY. Univariate regression analyses of year-on-year changes in prevention and appraisal costs for providing MCH and changes in the failure costs showed significant negative associations between 3 of 4 pairs of years

Increased year-on-year costs of preventing MCH problems were associated with a reduction in year-on-year costs incurred for correcting problems. Despite increasing trends for all the costs, this finding indicated improvements in allocation of resources to address MCH challenges in Thailand.

Parole chiave

  • Cost-identification and effectiveness analysis
  • maternal
  • newborn and child health
  • Thailand
  • universal health coverage
Accesso libero

Utility of body mass index and neck circumference to screen for metabolic syndrome in Thai people

Pubblicato online: 31 Aug 2017
Pagine: 55 - 63

Astratto

Abstract

Anthropometric indices have been studied as tools with which to detect metabolic syndrome (MetS). Few data are available from Southeast Asian populations where ethnic differences are an issue.

To compare the performance of body mass index (BMI) and neck circumference (NC) in predicting MetS, determine the correlation between waist circumference (WC), BMI and NC, and identify optimal cut-off points in older Thai people.

We prospectively recruited participants aged ≥50 years to the Healthy Ageing Khon Kaen University Campus Project from March 2012 to April 2015 and collected their baseline characteristics, anthropometric measures, and metabolic profiles. MetS was recognized using International Diabetes Foundation criteria.

We enrolled 586 participants as part of a wider study (Limpawattana P, Manjavong M, Sopapong R. Endocr Prac 2016; 22:8-15). BMI and NC had positive correlations with WC in both sexes (P < 0.001). For women, the area under the receiver operating characteristic curve (AUC) for BMI was 0.88 (95%CI 0.84, 0.91) and for NC was 0.79 (95%CI 0.75, 0.84). For men, the AUC for BMI was 0.91 (95%CI 0.87, 0.95) and for NC was 0.84 (95%CI 0.79, 0.90). BMI ≥24.5kg/m2 in either sex, and NC ≥33 cm in women or ≥39 cm in men indicated MetS.

BMI and NC are good anthropometric indices for predicting MetS. BMI was better than NC. A BMI of 24.5kg/m2 in either sex and NCs of 33 cm in women and 39 cm in men are recommended as the optimal cutoff points to indicate MetS.

Parole chiave

  • Abdominal obesity
  • anthropometric indices
  • cardiometabolic risk factors
  • central obesity
  • upper body obesity
  • sensitivity and specificity
  • diagnostic accuracy
  • predictive
  • area under the ROC curve
Accesso libero

Echinocytes in the peripheral blood of patients infected with dengue virus may be a predictor of disease severity

Pubblicato online: 31 Aug 2017
Pagine: 49 - 53

Astratto

Abstract

Echinocytes have been demonstrated as sequelae to serum high-density lipoprotein decreases in patients with liver disease, but not to our knowledge in dengue virus infection.

To investigate any association between echinocytosis and dengue infection.

We retrospectively studied a cross-section of patients at Mahasarakham University Hospital infected with dengue in August 2015. Infection was diagnosed clinically, and by rapid immunochromatography when nonstructural protein 1 antigen, or IgM or IgG antibodies were detected in the serum. We used World Health Organization 2009 and 2011 criteria to define dengue severity. We examined peripheral blood smears made before and after defervescence.

Two patients had warning signs, 6 did not, 1 had dengue hemorrhagic fever (DHF), and 7 had uncomplicated dengue fever (DF). The ages of patients with and without warning signs was not significantly different (P > 0.99). Patients with warning signs had a mean (SD) alanine transaminase (ALT) level of 354.50 (291.91) IU/L, while the level was 29.67 (20.61) IU/L in those without. The lowest mean platelet count in the patients with warning signs was 35.5 (21.9) × 103 cells/mm3, while the count was 98 (66.1) × 103 cells/mm3 in those without. There was no significant difference in mean ALT level (P = 0.28) or the platelet count (P = 0.09) between patients with and without warning signs. Echinocytes were significantly associated with DWS (P = 0.04), but did not differ significantly between the DHF and DF patients (P = 0.13).

Echinocytosis may be associated with severe disease.

Parole chiave

  • Dengue hemorrhagic fever
  • echinocyte
  • peripheral blood smear
  • hepatitis
  • predictor
Accesso libero

Clinical and laboratory findings and outcomes of classic organic acidurias in children from north-eastern Thailand: a 5-year retrospective study

Pubblicato online: 31 Aug 2017
Pagine: 41 - 47

Astratto

Abstract

Classic organic acidurias, including isovaleric aciduria (IVA), propionic aciduria (PA) and methylmalonic aciduria (MMA), are rare inherited metabolic disorders caused by deficiencies of enzymes in catabolic pathways.

To report clinical and laboratory findings and outcomes of classic organic acidurias in children north-eastern Thailand and their outcomes over the past 5 years.

During 2010-2014, twelve patients were identified as having classic organic acidurias confirmed by urine organic acids analysis.

Classic organic acidurias were identified as follows; 5 patients with IVA, 4 patients with PA, and 3 patients with MMA. Ten patients had neonatal-onset and 9 cases were diagnosed during the neonatal period with clinical signs and symptoms of altered consciousness, poor feeding, respiratory distress, abnormal odor, and shock. Common laboratory findings included metabolic acidosis with an elevated anion gap, hyperammonemia, hypocalcemia, and cytopenia. Ammonia levels could be extremely high, especially in PA. Three patients with neonatal-onset of acidurias died during their first catabolic crisis, and one patient died later. One patient with MMA had exfoliative erythema after excessive dietary restriction. Four of 8 surviving patients had IVA and had better neurodevelopmental outcomes than those with PA and MMA.

Neonatal-onset classic organic acidurias are more common than late-onset cases and usually mimic neonatal sepsis. Laboratory findings that include hematologic abnormalities should raise suspicion. Close monitoring of biochemical parameters, growth and neurodevelopmental outcomes is necessary in a long-term follow-up.

Parole chiave

  • Isovaleric aciduria
  • methylmalonic aciduria
  • neutropenia
  • organic acidurias
  • propionic aciduria

Clinical vignette

Accesso libero

Polycythemia vera concomitant with renal angiomyolipoma: case report and clinical outcome

Pubblicato online: 31 Aug 2017
Pagine: 89 - 92

Astratto

Abstract

Polycythemia vera has been found in a wide range of hematopoietic tissue disorders, but rarely concomitant with renal abnormality. To our knowledge there is only one available report of a patient with polycythemia vera concomitant with renal angiomyolipoma, and the report does not cover the clinical course of this rare finding.

To report the presentation and clinical course of a patient with polycythemia vera concomitant with right renal angiomyolipoma.

We retrospectively reviewed the medical records of a patient with polycythemia vera who presented with renal angiomyolipoma.

Our patient presented with a right renal mass and polycythemia vera diagnosed by a point mutation in the gene for Janus kinase 2. The mass was diagnosed as renal angiomyolipoma on histopathology. After partial nephrectomy, she was prescribed a low dosage of hydroxyurea without the return of erythrocytosis for a year.

Polycythemia vera responded well to low dosage hydroxyurea, which controlled erythrocytosis after removing the renal mass.

Parole chiave

  • Clinical outcome
  • polycythemia vera
  • presenting clinical
  • renal angiomyolipoma
11 Articoli

Editorial

Accesso libero

Development of practice guidelines relevant to patient characteristics and local imperatives

Pubblicato online: 31 Aug 2017
Pagine: 1 - 1

Astratto

Review Article

Accesso libero

Nanoparticles in therapeutic applications and role of albumin and casein nanoparticles in cancer therapy

Pubblicato online: 31 Aug 2017
Pagine: 3 - 20

Astratto

Abstract

Nanoparticles are widely used for various therapeutic treatments. Proteins have the advantage of being naturally occurring, with relative lack of toxicity and antigenicity, but easy biodegradability and potent ability to bind other compounds. Proteins have been produced in nanoformulations, which have been made by various methods including desolvation and precipitation. Biopolymeric nanoparticles including proteins are used in delivery of genes and drugs, and in tissue engineering. Protein nanoparticulate drug delivery systems are used to treat several diseases because of their high drug-binding capacity, biocompatibility, nutritional value, stability, and potent site-specific action. Among the various proteins, casein and albumin nanoparticles are used widely as nanocarriers for various therapeutic drugs.

To review the types of nanoparticles and their role in therapeutic applications, and the important role of casein and albumin nanoparticles in cancer therapy.

A literature search based on nanoparticles, their types, and their roles in medical applications was conducted using websites including Google Scholar, SpringerLink, ResearchGate, and the U.S. National Institutes of Health’s National Library of Medicine’s National Center for Biotechnology Information PubMed database including PubMed Central covering from 2000 to 2016.

Nanoparticles, especially albumin and casein had been found effective drug delivery systems.

Protein based nanoparticles such as albumin and casein nanoparticles are widely used for targeting cancers and can be used as effective vehicles for the delivery of various anticancer drugs.

Parole chiave

  • Albumin nanoparticles
  • casein nanoparticles
  • coacervation
  • nanoprecipitation
  • protein nanoparticles

Original article

Accesso libero

Perioperative and Anesthetic Adverse events in Thailand (PAAd Thai) incident reporting study: anesthetic profiles and outcomes

Pubblicato online: 31 Aug 2017
Pagine: 21 - 32

Astratto

Abstract

The Royal College of Anesthesiologists of Thailand initiated registry and reporting of anesthesia service incidents and outcomes in 2005.

The Perianesthetic Anesthetic Adverse Events in Thailand (PAAd Thai) study aimed to investigate patient, surgical, and anesthetic profiles, and suggest strategies for prevention of adverse events.

A prospective descriptive study was conducted in 22 hospitals across Thailand. Each hospital was invited to report, on an anonymous basis, any perianesthetic adverse incident during 12 months (between January 1 and December 31, 2015). A standardized incident report form was completed to determine the type of incident, and where, when, how, and why it occurred using closed and open-ended questionnaires. Data regarding main anesthetic techniques were also reported monthly. Descriptive statistics were used.

For 333,219 cases, 2,206 incident reports with 3,028 critical incidents were reported. The incidents commonly occurred in male patients (52.0%), aged <10 y (13.0%) and >70 y (18.2%). The incidence of adverse events included cardiac arrest within 24 h (15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal intubation (8.5:10,000), difficult intubation (8.0:10,000), and malignant hyperthermia (1:200,000). General, cardiothoracic, neurological, and otorhinolaryngological surgical specialties posed a high risk of incidents. Operating and recovery rooms were common locations for incidents.

In the past decade, there were dramatic reductions of perioperative cardiac arrests and difficult intubations. Common factors related to critical incidents were inexperience, emergency, inadequate preanesthetic evaluation, inappropriate decisions, lack of vigilance, and inexperienced assistants. Suggested corrective strategies are compliance with guidelines, additional training, and improvement of supervision and quality assurance.

Parole chiave

  • Adverse events
  • anesthesia
  • incidents
  • incident report
  • patient safety

Brief communication

Accesso libero

Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study: hospital characteristics and methods

Pubblicato online: 31 Aug 2017
Pagine: 33 - 39

Astratto

Abstract

Safety in anesthesia can be improved through monitoring and analysis of anesthetic complications. We conducted the present Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study to determine the current frequency distribution of incidents related to the anesthetic complications, factors contributing to the incidents, and corrective strategies.

To describe the characteristics of the hospitals participating in this study and methods used.

A multicenter prospective observational study was conducted in hospitals across Thailand in 2015. The participating hospitals were asked to anonymously report incidents of anesthesia-related adverse events and management. Three peer reviewers reviewed the completed record forms describing the incidents including possible mechanisms, contributing factors, appropriate management, and preventive strategies to achieve agreement by consensus.

Twenty-two hospitals across Thailand participated in this study. Fourteen (64%) were nonuniversity (service directed) hospitals, while 8 (36%) were university (academic teaching) hospitals. Most hospitals were involved in residency training and teaching medical students (77%), while just more than half (57%) were involved in training nurse anesthetists. The ratio of anesthesiologists to an operating room was 0.67:1 and the ratio of nurse anesthetists to an operating room was 2.03:1.

A critical incident analysis of each reported adverse event is helpful for proposing a corrective or preventive strategy to ameliorate perioperative care and improve patient safety in the Thai health care system.

Parole chiave

  • Adverse events
  • anesthesia
  • incident report
  • perioperative

Brief communication (Original)

Accesso libero

Genotype distributions of CYP2C9 and VKORC1 in southern Thais and their association with warfarin maintenance dose in patients with cardiac surgery

Pubblicato online: 31 Aug 2017
Pagine: 81 - 87

Astratto

Abstract

Pharmacodynamics of warfarin are influenced by genetic polymorphisms of its metabolic enzymes.

To determine CYP2C9 and VKORC1 genotypes in a population in southern Thailand, and their association with warfarin maintenance doses.

We genotyped CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910), VKORC1 (rs9923231 and rs9934438) from the blood DNA of 210 healthy controls, and determined the association of 2 polymorphic markers (CYP2C9*3 and rs9923231) in 154 patients with aortic valve protheses, with warfarin maintenance dose and coagulopathy.

CYP2C9*3 was detected in 17/210 controls; all were heterozygous variants (-*1*3). No CYP2C9*2 polymorphisms were detected. The 2 VKORC1 polymorphisms were in complete linkage disequilibrium. The genotype distribution of VKORC1 (rs9923231) was 118:72:20 for AA:AG:GG. The warfarin maintenance dose in patients with CYP2C9*1*3 (20.7 mg/week) was significantly less than in patients with CYP2C9*1*1 (31.7 mg/week; P < 0.01). In VKORC1 patients, the warfarin maintenance dose increased significantly with minor variants (AA:AG:GG; 23.8:35.3:47.3 mg/week). The incidence of prolonged prothrombin time (INR > 5) was significantly higher in the VKORC1-AA group (45/76) than the AG (22/64) or GG (3/16) groups. The median time to achieve a stable INR was highest for patients with a GG genotype (342 days) compared with 20 days for those with AA, and 160 days for those with AG. Other factors associated with warfarin maintenance dose were body surface area, age (>45 years), and concomitant drug use.

Polymorphisms of CYP2C9*3 and VKORC1 are present in southern Thais. We recommend pharmacogenetic studies of these markers as a component of warfarin therapy.

Parole chiave

  • Pharmacogenetics
  • Thai patients
  • warfarin
Accesso libero

Frequency of hepatitis B envelope antigen-negative chronic hepatitis B virus infection in untreated patients from three cities in Pakistan

Pubblicato online: 31 Aug 2017
Pagine: 73 - 79

Astratto

Abstract

Hepatitis B envelope antigen (HBeAg)-negative chronic hepatitis B virus (CHB) infection is a clinical entity refractory to treatment and has implications for disease outcome.

To determine the frequency of HBeAg-negative CHB in untreated hepatitis B surface antigen (HBsAg)-positive patients.

We conducted this cross-sectional study of untreated HBsAg-positive patients from 3 cities in Pakistan for more than 6 months.

Of495 patients, 276 (47.7%) had detectable hepatitis B virus (HBV) DNA (mean 5.3 ± 1.96 log10 copies/mL), 81 (16.4%) were HBeAg positive and 414 (83.6%) were HBeAg negative. All 81 (100%) HBeAg-positive patients had detectable HBV DNA. Frequency of HBeAg-negative CHB infection was 155 (31.3%) among HBsAg-positive patients. One hundred and sixteen (74.8%) of the HBeAg-negative patients with CHB infection were in the age range of 15–35 years.

HBeAg-negative patients constitute a considerable proportion of patients with CHB infection. HBsAg-positive patients, especially with younger age, should be thoroughly investigated for this entity to avoid the devastating long-term complications of this disease.

Parole chiave

  • Chronic hepatitis B
  • hepatitis
  • hepatitis B surface antigen
  • Pakistan
Accesso libero

Economic impact of investment in maternal and newborn health care under the National Health Security Scheme of Thailand

Pubblicato online: 31 Aug 2017
Pagine: 65 - 72

Astratto

Abstract

Evidence for the impact of health care spending in the area of maternal, newborn and child health (MCH) in developing countries is limited.

To examine the investment and medical care expenses for MCH under Universal Health Coverage (UHC) in Thailand.

A prevention–appraisal–failure (PAF) cost element method was applied. Using a payer perspective, data related to PAF elements of MCH were collected from the Universal Coverage Scheme (UCS) inpatient claim database, UCS liability claims, the health-budget administration and health resource databases of the Ministry of Public Health, and the population census of The National Statistical Office in fiscal years 2007–2011. The main outcome measures included payments and budgets for MCH at a provincial level.

Investment and medical care costs of antenatal care to prevent and manage complications increased from US$7.77 per person per year (PPPY) in 2007 to US$11.69 PPPY in 2011. The payments to support quality-focused activities ranged from US$0.60 to US$1.19 PPPY, whereas failure costs resulting from postpartum complications and UHC liability claims were US$1.92, 2.24, 2.35, 2.48, and 2.56 PPPY. Univariate regression analyses of year-on-year changes in prevention and appraisal costs for providing MCH and changes in the failure costs showed significant negative associations between 3 of 4 pairs of years

Increased year-on-year costs of preventing MCH problems were associated with a reduction in year-on-year costs incurred for correcting problems. Despite increasing trends for all the costs, this finding indicated improvements in allocation of resources to address MCH challenges in Thailand.

Parole chiave

  • Cost-identification and effectiveness analysis
  • maternal
  • newborn and child health
  • Thailand
  • universal health coverage
Accesso libero

Utility of body mass index and neck circumference to screen for metabolic syndrome in Thai people

Pubblicato online: 31 Aug 2017
Pagine: 55 - 63

Astratto

Abstract

Anthropometric indices have been studied as tools with which to detect metabolic syndrome (MetS). Few data are available from Southeast Asian populations where ethnic differences are an issue.

To compare the performance of body mass index (BMI) and neck circumference (NC) in predicting MetS, determine the correlation between waist circumference (WC), BMI and NC, and identify optimal cut-off points in older Thai people.

We prospectively recruited participants aged ≥50 years to the Healthy Ageing Khon Kaen University Campus Project from March 2012 to April 2015 and collected their baseline characteristics, anthropometric measures, and metabolic profiles. MetS was recognized using International Diabetes Foundation criteria.

We enrolled 586 participants as part of a wider study (Limpawattana P, Manjavong M, Sopapong R. Endocr Prac 2016; 22:8-15). BMI and NC had positive correlations with WC in both sexes (P < 0.001). For women, the area under the receiver operating characteristic curve (AUC) for BMI was 0.88 (95%CI 0.84, 0.91) and for NC was 0.79 (95%CI 0.75, 0.84). For men, the AUC for BMI was 0.91 (95%CI 0.87, 0.95) and for NC was 0.84 (95%CI 0.79, 0.90). BMI ≥24.5kg/m2 in either sex, and NC ≥33 cm in women or ≥39 cm in men indicated MetS.

BMI and NC are good anthropometric indices for predicting MetS. BMI was better than NC. A BMI of 24.5kg/m2 in either sex and NCs of 33 cm in women and 39 cm in men are recommended as the optimal cutoff points to indicate MetS.

Parole chiave

  • Abdominal obesity
  • anthropometric indices
  • cardiometabolic risk factors
  • central obesity
  • upper body obesity
  • sensitivity and specificity
  • diagnostic accuracy
  • predictive
  • area under the ROC curve
Accesso libero

Echinocytes in the peripheral blood of patients infected with dengue virus may be a predictor of disease severity

Pubblicato online: 31 Aug 2017
Pagine: 49 - 53

Astratto

Abstract

Echinocytes have been demonstrated as sequelae to serum high-density lipoprotein decreases in patients with liver disease, but not to our knowledge in dengue virus infection.

To investigate any association between echinocytosis and dengue infection.

We retrospectively studied a cross-section of patients at Mahasarakham University Hospital infected with dengue in August 2015. Infection was diagnosed clinically, and by rapid immunochromatography when nonstructural protein 1 antigen, or IgM or IgG antibodies were detected in the serum. We used World Health Organization 2009 and 2011 criteria to define dengue severity. We examined peripheral blood smears made before and after defervescence.

Two patients had warning signs, 6 did not, 1 had dengue hemorrhagic fever (DHF), and 7 had uncomplicated dengue fever (DF). The ages of patients with and without warning signs was not significantly different (P > 0.99). Patients with warning signs had a mean (SD) alanine transaminase (ALT) level of 354.50 (291.91) IU/L, while the level was 29.67 (20.61) IU/L in those without. The lowest mean platelet count in the patients with warning signs was 35.5 (21.9) × 103 cells/mm3, while the count was 98 (66.1) × 103 cells/mm3 in those without. There was no significant difference in mean ALT level (P = 0.28) or the platelet count (P = 0.09) between patients with and without warning signs. Echinocytes were significantly associated with DWS (P = 0.04), but did not differ significantly between the DHF and DF patients (P = 0.13).

Echinocytosis may be associated with severe disease.

Parole chiave

  • Dengue hemorrhagic fever
  • echinocyte
  • peripheral blood smear
  • hepatitis
  • predictor
Accesso libero

Clinical and laboratory findings and outcomes of classic organic acidurias in children from north-eastern Thailand: a 5-year retrospective study

Pubblicato online: 31 Aug 2017
Pagine: 41 - 47

Astratto

Abstract

Classic organic acidurias, including isovaleric aciduria (IVA), propionic aciduria (PA) and methylmalonic aciduria (MMA), are rare inherited metabolic disorders caused by deficiencies of enzymes in catabolic pathways.

To report clinical and laboratory findings and outcomes of classic organic acidurias in children north-eastern Thailand and their outcomes over the past 5 years.

During 2010-2014, twelve patients were identified as having classic organic acidurias confirmed by urine organic acids analysis.

Classic organic acidurias were identified as follows; 5 patients with IVA, 4 patients with PA, and 3 patients with MMA. Ten patients had neonatal-onset and 9 cases were diagnosed during the neonatal period with clinical signs and symptoms of altered consciousness, poor feeding, respiratory distress, abnormal odor, and shock. Common laboratory findings included metabolic acidosis with an elevated anion gap, hyperammonemia, hypocalcemia, and cytopenia. Ammonia levels could be extremely high, especially in PA. Three patients with neonatal-onset of acidurias died during their first catabolic crisis, and one patient died later. One patient with MMA had exfoliative erythema after excessive dietary restriction. Four of 8 surviving patients had IVA and had better neurodevelopmental outcomes than those with PA and MMA.

Neonatal-onset classic organic acidurias are more common than late-onset cases and usually mimic neonatal sepsis. Laboratory findings that include hematologic abnormalities should raise suspicion. Close monitoring of biochemical parameters, growth and neurodevelopmental outcomes is necessary in a long-term follow-up.

Parole chiave

  • Isovaleric aciduria
  • methylmalonic aciduria
  • neutropenia
  • organic acidurias
  • propionic aciduria

Clinical vignette

Accesso libero

Polycythemia vera concomitant with renal angiomyolipoma: case report and clinical outcome

Pubblicato online: 31 Aug 2017
Pagine: 89 - 92

Astratto

Abstract

Polycythemia vera has been found in a wide range of hematopoietic tissue disorders, but rarely concomitant with renal abnormality. To our knowledge there is only one available report of a patient with polycythemia vera concomitant with renal angiomyolipoma, and the report does not cover the clinical course of this rare finding.

To report the presentation and clinical course of a patient with polycythemia vera concomitant with right renal angiomyolipoma.

We retrospectively reviewed the medical records of a patient with polycythemia vera who presented with renal angiomyolipoma.

Our patient presented with a right renal mass and polycythemia vera diagnosed by a point mutation in the gene for Janus kinase 2. The mass was diagnosed as renal angiomyolipoma on histopathology. After partial nephrectomy, she was prescribed a low dosage of hydroxyurea without the return of erythrocytosis for a year.

Polycythemia vera responded well to low dosage hydroxyurea, which controlled erythrocytosis after removing the renal mass.

Parole chiave

  • Clinical outcome
  • polycythemia vera
  • presenting clinical
  • renal angiomyolipoma

Pianifica la tua conferenza remota con Sciendo