Vajira Medical Journal: Journal of Urban Medicine

Number 2, 2022

85-94
Clinical Characteristics and Outcomes of Acute Myeloid Leukemia in Vajira Hospital-a 9-year Single Center Retrospective Study

Authors: Dusit Jit-ueakul

Abstract

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Objective: To collect demographic data, management patterns and outcomes of acute myeloid leukemia (AML) patients in a tertiary hospital. Methods: We collected data of newly diagnosed AML patients from 2008 to 2016, including clinical presentation and characteristics at the time of diagnosis. Survivals and factors affecting outcomes were evaluated. Results: There were 106 patients enrolled in the study. More than half of the patients were in the younger age group, which had a median age 56.5 years (41.5-73.5). Initial symptoms at presentation were anemia, fever and bleeding tendency. The younger age group had a good performance status presented by Eastern Cooperative Oncology Group (ECOG) score of less than two. Intensive chemotherapy was utilized in treatment of most patients in the younger group (85.7%) as compared with the elderly group (18%). Better intensive chemotherapy significantly improved median survival (256 vs 79 days; p < 0.001). Conclusion: AML patients who had received intensive chemotherapy had a survival advantage irrespective of age.

95-102
Treatment Outcomes after Breast Conserving Therapy in Breast Cancer Patients in Faculty of Medicine, Vajira Hospital: a 10-Year Retrospective Stud

Authors: Kanisa Rongsriyam, Kamonrat Sueangamiam, Thanatip Tantivatana

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Objective: To study the 5 and 10-year survival rate and prognosis factors in breast cancer patients receiving breast conservative treatment (BCT). Methods: A retrospective descriptive analysis of BCT patients who were treated in Radiation Oncology unit, Department of Radiology, Faculty of Medicine Vajira Hospital between 2009 and 2019. The Kaplan-Meier method was used for survival analysis. The authors analyzed association of patients and tumor characteristics with survival using the log-rank test and Cox models. Results: A total of 158 BCT patients were included. Five-year overall and disease-free survivals were 100% and 97.8%, respectively, with 10-year overall survival and disease-free survival were 100% and 95.7%, respectively. Numbers of positive nodes more than 4 (HR of 10.25; 95% CI:1.66-63.18) are significantly prognostic factors related to recurrence. Conclusions: Breast cancer patients who were treated with BCT had a favorable long-term survival outcome. Survival rates did not change much between 5 and 10 years. The important prognostic factor affecting disease-free survival was axillary lymph node metastasis.

103-114
Diagnostic Accuracy of the Liver Imaging Reporting and Data System (LI-RADS 2018) in Diagnostic of Hepatocellular Carcinoma in Cirrhosis Patients, Chronic Hepatitis B Carrier Patient, Prior Hepatocellular Carcinoma Patient and Treated Hepatocellular Carcinoma Patient Compared with Histopathological Report

Authors: Monthanee Puengphong, Krongkan Kanchanarat

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Objective: To evaluate the accuracy of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 category 5 in magnetic resonance imaging (MRI) for the diagnosis of hepatocellular carcinoma Methods: This retrospective study included patients who underwent liver MRI and had proven pathological lesion. From 2012 to 2021, 45 patients (52 observations including 29 HCCs) met the inclusion criteria. Two radiologists independently reviewed hepatic observation and assessed the LI-RADS version 2018 category. The diagnosis performances of LI-RADS 3, LI-RADS 4, and LI-RADS 5 were calculated using the generalized estimating equation method. Results: A total of 45 patients (mean age, 59.8) with 52 lesions, including 26 men and 19 women met the inclusion criteria. Most lesions were HCC ,29 (55.8%). The highest sensitivity of the major feature for HCC diagnosis was non-rim arterial enhancement (93%). The highest specificity of the major feature for HCC diagnosis was capsule appearance (100%). The highest accuracy of the major feature for diagnosis was non-rim peripheral washout (86.6%). The inter-observer agreement between the two readers in the classification of lesions was perfect for the Liver Imaging Reporting and Data System (LI-RADS) classification (k= 0.868) and almost perfect for LI-RADS with AF classification (k= 0.872). The LI-RADS 5 sensitivities were 82.8% and 79.3% (as R1, R2) with the same value when combined with ancillary findings. The accuracy of L5 of LI-RADS 2018 was 87.5% (same value with ancillary findings) and 83.3% (same value with ancillary findings) in R1 and R2, respectively. Conclusion: The LI-RADS version 2018 category 5 has high sensitivity, specificity, and accuracy in the diagnosis of HCC.

115-124
Efficacy and Adverse Effects of Sodium Phosphate and Polyethylene Glycol When Used in Bowel Preparation prior to Colonoscopy among Patients Admitted at Vajira Hospital

Authors: Thanacom Thapananon, Rangsima Thiengthiantham

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Objective: Bowel preparation is an important process before colonoscopy. Sodium phosphate (NaP) and polyethylene glycol (PEG) are the drugs mainly used in bowel preparation at Vajira Hospital. Since NaP is an osmotic laxative, it may cause dehydration and electrolyte imbalance. Hence, PEG is commonly utilized in patients admitted to the hospital. The fragile patients need to admitted for bowel preparation for colonoscopy. Thus, the current study aimed to compare the efficacy of NaP and PEG and their effect on electrolyte levels in these patients. Methods: Datas were collected from admitted patients who received either NaP or PEG for bowel preparation at Vajira Hospital from January 1, 2016, to December 31, 2016. Results: NaP and PEG did not significantly differ in terms of efficacy. However, compared with PEG, NaP significantly increased serum Na levels (+1.737 mmol/L) and decreased serum K levels (-0.517 mmol/L). Nevertheless, there was no remarkable difference in the changes in serum Na and K levels based on clinical data. Conclusion: Thus, NaP can be used with caution in bowel preparation among admitted patients as it has minimal side effects on electrolyte levels.

125-136
The Correlation between Thai Cardiovascular Risk Score and the Multi-Ethnic Study of Atherosclerosis (MESA) Risk Score in Thai Populations

Authors: Kunlatuch Chopchai, Chaisiri Wanlapakorn, Suwara Issaragrisil, Teetouch Ananwattanasuk, Padoemwut Teerawongsakul

Abstract

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Objective: The purpose of this study was to examine the relationship between the Thai cardiovascular risk score (TCVRS) and the Multi-Ethnic Study of Atherosclerosis (MESA) risk score and predictors of high CAC score in Thai adults without a history of atherosclerotic cardiovascular disease. Methods: This is a cross-sectional study assessing chest computed tomography scan patients without established atherosclerotic disease in Vajira Hospital, Thailand from July to December 2018. The TCVRS, MESA, and CAC scores were analyzed to estimate coronary heart disease risk. The predictive factors for the high CAC score were assessed by using univariate and multivariable analysis. Results: The total of 84 patients were enrolled (mean age, 55.1 years and female, 65.5%), mostly zero CAC (46.4%). The correlation of TCVRS and MESA risk score was stronger than FRS and MESA risk score by r = 0.818; p<0.001 and r = 0.747; p< 0.001, respectively. The agreements were acceptable with mean difference = -0.73, SD = 0.242 and -3.78, SD = 0.539, respectively. In multivariate analysis, diabetes mellitus (odds ratio [OR]: 28.39, 95% CI:1.92-420.09; p = 0.015) and age ≥ 60 years (OR: 38.26, 95% CI:13.76-389.49; p = 0.002) were independent risk factors to predict high CAC. Conclusion: There is a strong correlation between TCVRS and MESA risk score in Thai populations, but the MESA risk score may have a lower estimated coronary heart disease risk in Thai patients, especially in patients with multiple risk factors for coronary heart disease. Diabetes mellitus was the strongest predictor of high CAC.

137-148
Risk Factors of Blood Transfusion in Knee Arthroplasty

Authors: Pruk Chaiyakit, Weeranate Umpanpong, Tawipat Watcharotayangkoon

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Background: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient who underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were included in a multivariable analysis. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level and surgical technique. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggested that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.

149-160
Comparison of the Speech Performance of Thai Adults with Apraxia of Speech and Thai Adults with Normal Speech by Using the Apraxia Test for Thai Adults

Authors: Pitcharpa Dejket, Jeamjai Jeeraumporn, Sumalee Dechongkit, Montip Tiensuwan

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Objective: To measure and analyze the speech performance score of adults with apraxia of speech (AOS) and adults with normal speech and to compare the speech performance scores of both groups. Methods: The study was conducted at the Speech Clinic in Ramathibodi Hospital. Participants were divided into two groups. The measurements of speech performance were obtained by using the Apraxia Test for Thai Adults. The test results were analyzed by using descriptive statistics and a Mann-Whitney U test for a comparison of the speech performance scores of both groups. Results: The results showed that the group of adults with normal speech had higher scores on all subtests than the group of adults with apraxia of speech (AOS). The results also showed that the group of adults with normal speech had statistically significant differences (p-value < .05) on subtests I, II, III, IV, and some tasks in subtests V, VI, and VII. The group of adults with AOS had more difficulties with both speech and nonspeech tasks than the group of adults with normal speech. Conclusion: Adults with AOS showed the adverse effects of the impairment on their speech performance scores. They had more difficulties in moving their articulators to produce speech sounds while adults with normal speech did not have impaired movements of their articulators or restricted speech production.

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Outcome of Self-Efficacy Enhancement Program on Knowledge and Confidence of Foot Ulcers Prevention Behavior in the Diabetic Elderly of the Puranawat Temple Elderly Club, Bangkok

Authors: Kunnika Jermtienchai, Prapaiwan Danpradit

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Objectives: To study and compare knowledge of foot ulcer prevention before and after program implementation and to compare foot ulcers prevention behavior before program implementation and confidence of foot ulcers prevention behavior after program implementation in the diabetic elderly of the Puranawat Temple Elderly Club, Bangkok. Method: The research was quasi experimental research with one group pre-post-test design. The purposively selected samples were thirty Diabetic elderly of the Puranawat Temple Elderly Club, Bangkok. The research tool was the modified program of the Self-Efficacy Theory of Bandura. Data were collected from questionnaire for the period of 3 days. Data were analyzed by percentage, mean, standard deviation and paired t-test. Results: Before and after program implementation, the diabetic elderly had good and very good level of knowledge about foot ulcers prevention respectively. After program implementation, the knowledge about foot ulcer prevention of the samples were statistical significantly higher than before the program (p < 0.01). Results of the compare the foot ulcers prevention behavior before program implementation. The samples had average level of behavior before program implementation. After program implementation, they had high level of confidence which was higher than the level of behavior before program implementation with statistical significance (p < 0.01) in overall and in each aspect. The aspect with the highest confidence was foot examination and the aspect with the least confidence was foot cleaning. Conclusion: The Self-Efficacy Enhancement Program on knowledge and confidence of foot ulcers prevention behavior in the diabetic elderly of the Puranawat Temple Elderly Club showed significant improvement of knowledge and confidence in the diabetic elderly. The program was designed for health teams, village health volunteers and other interested groups to enhance foot care self-efficacy and help the diabetic elderly in communities to prevent foot ulcers and leg amputation.