Vajira Medical Journal: Journal of Urban Medicine

1-10

Authors: Nontawat Benjakul, Sira Laohathai, Chalermpak Supakatitham

Background: Since 2018, the global incidence of lung cancer had increased to 2.1 million causing lung cancer to be a major leading cause of cancer-related mortality in worldwide, with 29 percent mortality rate. This is causing by an increasing tobacco consumption rate, especially in developing countries. For other risk factors that associate with lung cancer were sex, age and metropolitan people. Aim: To study clinical characteristics and pathologic profiles correlation of primary lung cancer in Thailand’s metropolitan medical center Method: A retrospective study in Vajira hospital. The study population with diagnosed with primary lung cancer between January 2016, and May 2021. The information was collected: sex, age, pathologic profile, and stage. Results: A total of 110 primary lung cancer patients were found at Vajira Hospital from January 2013 to June 2021, consisting of 52 males (47.3%) and 58 females (52.7%). The mean age for patients at the time of diagnosis was 62.93 years. Most common histologic type of lung cancer in both metropolitan and non-metropolitan residents were invasive adenocarcinoma (81.8% in total) with 41.8% and 40%, respectively. Most presentation of lung cancer staging were diagnosed at early stage. Conclusions: This study revealed a growing incidence of adenocarcinoma, an increasing rate of female cases in both metropolitan and non-metropolitan nonsmoker female patients. However, further studies on risk factors of primary lung cancers emphasis on nonsmoker women are recommended.

21-34

Authors: Chayanee Dechosilpa, Natthapong Hongku

Background: Department of Orthopedics Faculty of Medicine Vajira Hospital, Navamindradhiraj University has introduced the temporarily new working system consistent with social distancing protocols during the COVID-19 pandemic situation. We would assess the effect of adjusting this system from the corporate perspective such as the attending staffs and residents to estimate satisfaction after implementation. Moreover, the system may be used again in the case of prolong COVID-19 pandemic periods or having a new wave in the future. Materials and Methods: The organizational survey research was conducted in the Department of Orthopedic, Vajira hospital. Two researchers collected the questionnaire data from the attending staffs and residents in June, 2020 for assessing their satisfaction of the new working system in 3 aspects, operational (12 questions), academic (4 questions), and daily life (4 questions). Results: 13 attending staffs and 16 residents were recruited in the study. The average satisfaction score was 61.06 (from 80 points). There is no statistically significant difference in terms of the satisfaction score between attending staffs and residents. In terms of the efficacy of the new working system, the resident’s monthly examination results demonstrated that the scores in March and April were 18.56 and 20.25 out of full 40 scores, respectively. The average score was increasing by 1.68 points. However, this increase was no statistically significant difference. Conclusion: The COVID-19 pandemic remains widely prevalent and without an antiretroviral medication or effective vaccine. We have introduced a novel working system which was demonstrated an effective scheme for medical personnel. It may serve as a model to use in the case of a long-term prevalence or a new wave of the COVID-19 pandemic occurs.

45-58

Authors: Suphawe Wasuanankun, Uraporn Phumisantiphong, Taweewong Tantracheewathorn

Objective: To determine the bacterial pathogens and susceptibility patterns causing ventilator associated pneumonia (VAP) in neonatal intensive care unit (NICU) Methods: Retrospective descriptive study, collected data from microbiology department and medical records of newborn diagnosed as VAP at Faculty of Medicine Vajira Hospital, Navamindradhiraj University since January 1, 2016 to October 31, 2020. Results: Forty four of specimens from sputum were diagnosed with VAP. The major pathogens were gram negative bacteria (93.2%) which included S. maltophilia (36.4%), P. aeruginosa (34.1%), A. baumannii (9.1%), Acinetobacter spp. (6.8%), E. coli, K. pneumoniae and Klebsiella spp. (2.3% each equally). A gram positive bacterium was S. aureus 6.8% which sensitive to methicillin 100% . All S. maltophilia isolates were sensitive to ceftazidime, ciprofloxacin, imipenem and piperacillin/tazobactam. A.baumannii isolates were 100% sensitive to colistin and tigecycline, 50% sensitive to amikacin, cefoperazone/sulbactam, ceftazidime, ciprofloxacin, gentamicin, imipenem, meropenem and piperacillin/tazobactam. P. aeruginosa isolates were 100% sensitive to amikacin, cefoperazone/sulbactam, gentamicin and piperacillin/tazobactam, 92.9% sensitive to ceftazidime and meropenem, 88.9%, 86.7% and 85.7% were sensitive to ciprofloxacin, imipenem and colistin, respectively. E. coli was ESBL 100% that all susceptible to amikacin, ceftazidime, carbapenems and piperacillin/tazobactam. Conclusion: The bacterial pathogens causing VAP in NICU at Faculty of Medicine Vajira Hospital were S. maltophilia, P. aeruginosa, A. baumannii, Acinetobacter spp., E .coli. The empirical antibiotic of choice is piperacillin/tazobactam or ceftazidime or carbapenems. Combination with aminoglycosides or ciprofloxacin is crucial for severe case and cloxacillin for suspected S. aureus. In case of carbapenem resistant A. baumannii (CRAB) and not improve with other empirical antibiotics, consider tigecycline plus colistin.

69-76

Authors: Wiraporn Kanchanasuttirak

Objective: To determine the positive predictive value (PPV) of breast imaging reporting and data systems (BI-RADS) category 5 in the diagnosis of breast cancer. Materials and methods: A retrospective study of consecutive women who underwent mammogram and ultrasound at the Diagnostic Breast Cancer Center, Vajira Hospital from January 1, 2015 to December 31, 2019 was performed. Women who were categorized as BI-RADS category 5 (BI-RADS 5) and had pathological diagnosis were enrolled. Clinical information, mammographic and ultrasonographic findings, method of tissue diagnosis, and pathological results were retrospectively reviewed. The PPV of BI-RADS 5 was analyzed. Results: Of 14,427 women who underwent mammography in the institution during the study period, 208 categorized as BI-RADS 5 and had pathological diagnosis were included. Mean age was 58.9 years (range 34–91 years). Mass was the most common imaging finding in 49% of the 208 women. Breast cancer was found in 202 women (97.1%) and benign pathology in 6 (2.9%). Invasive ductal carcinoma was the most common malignant pathology (85.6%), whereas fibroadenoma was the most common benign pathology (33.3%). The PPV of breast cancer in BI-RADS 5 was 97.1%. Conclusion: The PPV of breast cancer in BI-RADS 5 was 97.1%. Although the probability of malignancy is very high, preoperative tissue diagnosis before definite treatment is still recommended.