Vajira Medical Journal: Journal of Urban Medicine

S15-S26

Authors: Patcharin Uttasri, Lakkana Boonyagars, Apisada Suthepwanon

Background: Serious neutropenia is a common complication of chemotherapy and radiation among HIV-infected patients with malignancy leading to morbidities and deaths. This study was intended to investigate the prevalence and risk factors associated with neutropenia in HIV-infected patients with malignancy receiving chemotherapy and/or radiotherapy. Methods: A retrospective cohort study was conducted by extensive reviewing patients’ medical records. Cancer patients with HIV infection who received medical attendances at Vajira hospital from January 1, 2013 to December 31, 2017 were participated. Clinical data including demographics, cancer types, stages and treatment, and HIV-related factors were collected and analyzed. Results: There were 39 eligible patients, 20 had AIDS-defining cancers and 19 had non-AIDS-defining ones. The prevalence of all grade neutropenia was 58.9% (23 of 39). Slightly more common in females (61.5%). The median age was 50.53 (IQR 40.92-60.14). Median CD4 cell count prior to cancer diagnosis was 304.9 cells/µL (IQR 175 – 387). Nighty percent of lymphoma patients and all breast cancer patients developed neutropenia after chemotherapy. On the other hand, neutropenia did not occur among HIV-infected cancer patients receiving radiotherapy. Independent risk factors associated with neutropenia included those who aged more than 55 years and had hematologic malignancies. There was no statistically significant association with sex, body mass index, ECOG performance status, comorbidities, prophylactic treatment against opportunistic infection, CD4 count, HIV viral load, and specific type of anti-retroviral drugs. Conclusion: The prevalence of neutropenia among cancer patients with HIV infection was 58.9%. Most occurred among patients with lymphoma and breast cancer.

S39-S52

Authors: Piyawan Thongsrinuch, Sirinan Junthong

Objectives: first objectives were to determine the prevalence of early hearing detection and intervention newborn in Vajira hospital. Secondary objectives were to study correlation of risk factors for hearing loss in newborn and to study the process of early hearing detection and intervention in Vajira hospital. Methods: A Prospective descriptive cross-sectional study, data collected from newborns in Vajira hospital between August 2018 to July 2019. Newborns were screened with TEOAE at wards and the results were documented in medical records. The newborns who failed (“refer”) the first screening test were asked to return for repeat screening by audiologists to confirm pathological results. The total results were documented in medical records. A detailed case history, the high risk factors based on JCIH 2007, hearing screening and intervention process were obtained. Results: Among 1,979 live births between August 2018 to July 2019, 1,946 newborns were screened with TEOAE before 1 month old and before discharge from hospital. Prevalence of early hearing screening (before 1 month old) was 1,932 newborns (97.6%). The total hearing screening referral rate was 280 newborns (14.4%). A total of newborns who failed (“refer”) the first screening test underwent complete diagnostic hearing assessment within 3 months old was 192 newborns (68.6%). Before 3 months old, 5 newborns were diagnosed with hearing loss. After being diagnosed hearing loss, they obtained an appointment to follow-up the hearing and development before 6 months old. This study did not find the hearing loss newborns who received the hearing aids or cochlear implant. We found that the overall hearing loss newborns were admitted in NICU more than 5 days and received ototoxic medications. The other risk factor was craniofacial anomalies. Conclusions: The prevalence of early hearing detection (before 1 month old) was 97.6%. The overall prevalence of hearing loss in newborn in Vajira hospital was found to be 2.5 per 1,000 live births. This study found that total newborns who diagnosed with hearing loss were high risk group base on JCIH 2007. The prevalence of hearing intervention after diagnosis was 0%. When the results of the study were compared with indicators of JCIH 2007 and recommendation of Thailand, the efficacy of the early hearing detection and intervention newborn in Vajira hospital could almost reached all indicators. Some indicators were inferior to JCIH indicators due to many underlying factors causing the results of this study to be lower than the fact.

S63-S74

Authors: Neeranat Simasingha, Pich Paholpak, Swangjit Suraamornkul

Background: Diabetes is the most common chronic non-communicable disease in Thailand and leads to both small and large vascular complications. Lack of risk assessment to provide preventive advice and proper care of diabetic foot. There will be a chance of diabetic foot ulcers, foot infections, amputation and eventual disability. Objective: The aims of this study were to collect the prevalence of diabetic foot ulcers and relationship between the risk factors of diabetic foot ulcers. Method: The cross-sectional descriptive study in type 2 diabetics patients was conducted. Baseline characteristics, foot assessment with monofilament test and ankle-brachial index were collected to stratify risk, according to the International working group on the diabetic foot risk classification system (IWGDF risk classification). The relationship of risk factor also were also analysed. Result: Three hundred and twenty-four type 2 diabetes patients were studied. The average parameter consists of duration of diabetes 12.95 ± 10.14 years, fasting blood glucose level 161.56 ± 60.68 mg/dL, HbA1C level 8.31 ± 3.39%, eGFR 78.46 ± 25.97 ml/min/1.73m2. According to the International working group on the diabetic foot risk classification system (IWGDF risk classification), category 0 is divided into 299 patients (92.3 percent), category 1 has 21 patients(6.5 percent), category 2 has 2 patients (0.6 percent), category 3 has 2 patients (0.6 percent). There were association between the risk of developing diabetic foot ulcers and the duration of diabetes (p= 0.029), hypertension (p= 0.001), stroke (p= 0.004), creatinine raising (p= 0.044), decreased eGFR (p= 0.001). Conclusion: The prevalence according to IWGDF risk classification is 92.3% for a very low risk category, while 6.5, 0.6 and 0.6 % for low, moderate and high risk category, respectively. The factors associated to risk stratification of diabetic foot were duration of diabetes, hypertension, stroke, and chronic kidney disease.

S91-S100

Authors: Sirichan Chunhakan

Objectives: To study the association of hepcidin and erythroferrone (ERFE) levels with hemoglobin levels in systemic lupus erythematosus (SLE) patients. Methods: Forty-two serum samples collected from SLE patients were categorized into anemia and without anemia using hemoglobin levels. Forty blood donors were included as control group, all serum was collected from leftover specimen. Hepcidin and ERFE were measured in patients and control group using enzyme-linked immunosorbent (ELISA) kit. Results: Hepcidin and ERFE showed the highest levels in anemic SLE patients and were statistically significantly higher than in non-anemic SLE patients and control group, while hepcidin and ERFE were statistically significantly higher in non-anemic SLE patients than control group. In SLE patients, hepcidin and erythroferrone were statistically negatively correlated with hemoglobin. There was no statistically significant correlation between hepcidin and erythroferrone levels. Conclusion: Elevated serum hepcidin and erythroferrone levels were associated with anemia in SLE patients. Whereas hepcidin and erythroferrone were independent of each other in causing anemia and both values were not appropriate to be used as markers of anemia status in SLE patients.

S117-S124

Authors: Sirikarn Tangcheewinsirikul

Chikungunya infection (CI) is caused by the chikungunya virus, which is spread by Aedes mosquitos. CI has been reported in both pediatric and adult patients with a range of clinical phenotypes, notably musculoskeletal (MSK) symptoms. In young children, particularly in the newborn age, the symptoms are frequently severe. Thailand, which is located in the tropical tropics, has had several outbreaks of CI. As a result, pediatricians and general practitioners should be aware of the disease’s natural course as well as management guidelines. This article aims to inform pediatricians and general practitioners on the clinical characteristics particularly MSK complaints, diagnostic criteria, differential diagnosis, laboratory investigations and treatment guidelines for pediatric patients with chikungunya infection from rheumatology’s point of view.