Siriraj Medical Journal

187-190

Authors: Wanchai Wongkornrat, M.D., Somchai Sriyoscharti, M.D., Pansak Laksanabunsong, M.D., Teeravit Phanchaipetch, M.D.,Thaworn Subtaweesin, M.D., Punnarerk Thongchareon, M.D., Pranya Sakiyalak, M.D., Worawong Slisatkorn, M.D.,Nisarat Opartkiattikul, M.D.

Background: Aspirin used after coronary artery bypass graft surgery (CABG) improved patient survival and reduced graft thrombosis. However, individual variations in the antiplatelet effect of aspirin have been reported among CABG patients. Objective: To compare the intensity of platelet aggregation between patients receiving low and high aspirin dosage in post CABG patients. Methods: We prospectively studied the effect of aspirin dosage on platelet aggregation in 100 CABG patients. Oral aspirin was discontinued prior to CABG and re-started within 12 hours after CABG. Blood samples were collected and transferred to a laboratory prior to surgery then again on postoperative days two and eight for platelet aggregation test and platelet count within three hours after venipuncture. Results: One hundred patients (sixty five male and thirty five female patients) post coronary artery bypass graft (CABG) were evaluated for eligibility to enter the trial. The percentage of platelet aggregation was compared between low dose (<100 mg/ day), and high dose (>100 mg/day) aspirin, at postoperative CABG days 2 and 8, which showed no significant difference for the platelet aggregation (p = 0.161 post CABG day 2 and p = 0.098 post CABG day 8). Conclusion: Low dosage aspirin should be used in post CABG patients because the intensity of platelet aggregation between patients post CABG receiving low and high aspirin dosage were not different, while the prophylactic effect of the low aspirin dosage in reducing the risk of cardiovascular events proved equally as effective as the high aspirin dosage.

196-199

Authors: Khemchat Wangtawesap, M.D., Arunotai Siriussawakul, M.D. Onuma Chaiwat, M.D., Tipa Chakorn, M.D.,Rapeepan Nuntabut, M.D., Daranee Kusakunniran, M.D., Sudta Parakkamodom, RN, Panisara Saengsung, RN,Thanawin Chawaruechai, RN, Wasinee Methapraphamorn, RN, Chulaluk Komoltri, DrPH (Biostatistics)

Objective: To survey the times to critical actions (defibrillator and doctor presence, initiation of chest compression) of inhospital simulated cardiopulmonary resuscitation (CPR). Methods: A 1-year retrospective simulated audit 2009 in a 2,400-bed university hospital in Thailand. Results: A total of 57 adult wards (around a third of all wards in the hospital), including intensive care units, critical wards, procedural units, general wards and out-patient units were audited. Overall, the median time of initiation of chest compression and defibrillator presence among CPR teams were 1.27 (0.35-7.19) and 1.16 (0.00-26.00) minutes, respectively. The median time of the first doctor presence was 3.45 (0.00-15.15) minutes. However, there were significant differences in time to defibrillator and doctor presence among wards. The longer time of these critical managements were recorded in non-monitored areas (general wards and out-patient units) (p = 0.004 and 0.007, respectively). Conclusion: In our CPR simulated survey, delayed initiation of critical managements commonly occurred in non-monitored areas. Better management should be concerned for favorable outcomes.

205-206

Authors: Adune Ratanawichitrasin, M.D., Somsri Ratanawichitrasin, M.D.

No abstract available.

210-214

Authors: Ananya Pongpaibul, M.D.

No abstract available.

143-146

Authors: Saifon Chawanpaiboon, M.D., Sujin Kanokpongsakdi, M.D.

Objective: To determine the preterm birth rate, neonatal birth weight and causes of early neonatal death at Siriraj Hospital over a 9-year period (2002-2010). Methods: The medical records of preterm birth, threatened preterm labor and neonatal birth weight at Siriraj Hospital from 2002 to 2010 were retrospectively collected and reviewed. The data was analyzed by SPSS version 13. Results: During a 9-year period, 2002-2010, the birth rate decreased steadily from 2002 to 2006, but increased suddenly from 2007 to 2010. The rate of preterm birth was increased steadily from 2004 to 2010 (9.44%-13.70%). The rate of threatened preterm labor was constantly between 6.0 and 8.9%. Among preterm births, low birth weight infants were mostly found except in the year 2003. Early neonatal death was mostly caused from fetal abnormality. The trend of neonatal death from prematurity had continuously declined and there was no early neonatal death from 2008 to 2010. Conclusion: Regarding this 9-year review, the preterm birth rate increased from 2007 to 2010 while premature babies mostly survived.

151-156

Authors: Chaicharoen Tantanate, M.D., Metinee Teyateeti, M.D., Panutsaya Tientadakul, M.D.

Background: Plasma interference is a problem for coagulation analyzers using a photo-optical detection method. Sysmex® CS-2100i is a fully-automated coagulation analyzer which has been developed to reduce this problem. Objective: To evaluate the influence of interferences on prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen analyzed by Sysmex® CS-2100i. The performance of this analyzer was also assessed in this study. Methods: Pooled plasma samples spiked with interfering substances including hemoglobin, bilirubin and lipid were used in the interference study. Real patients’ samples with these interferences were also tested. Control materials and pooled samples were used for precision, comparison, and carryover studies. Results: The PT, APTT, and fibrinogen could be analyzed in both plasma samples with interference added and real abnormal patients’ plasma samples. The deviation of PT, APTT, and fibrinogen levels was not obvious, except for an upward trend of fibrinogen level with increased hemoglobin. The highest % CV of PT, APTT, and fibrinogen were 1.24, 3.18, and 4.31, respectively for within-run and 2.32, 2.11, and 6.06, respectively for between-run precision analysis. The correlation coefficients of PT, APTT, and fibrinogen between Sysmex® CS-2100i and Sysmex® CA-1500 were 0.99, 0.99, and 0.98 with intra-class correlation coefficients of 0.99, 0.99, and 0.98 respectively. No significant carryover of specimen was observed. Conclusion: Sysmex® CS-2100i could analyze both samples with artificial interfering substance added and real abnormal patients’ samples. This machine also had an acceptable performance by our evaluation.

163-167

Authors: Pantip Sangprasert, RN, MNS, NP, APN

Objective: This action research used a one group pre-post test design in 75 samples and used both quantitative and qualitative methods. The study was designed to develop knowledge and basic skill practice in a hypertension program among 240 healthcare volunteers obtained as samples randomly chosen from four communities. Methods: The instrumentation employed comprised of the hypertension knowledge questionnaires, observational guide form and group discussion. All these aspects of knowledge were good quality for all volunteers in terms of discrimination = 0.48 ± 0.18, difficulty =.0.72 ± 0.49 and reliability Kuder-Richarson 20 = 0.74 with split-half = 0.81. Results: Following participation in the program, the quantitative data were the knowledge of the volunteers was increased with statistical significance (p<.001) and which was positively correlated with the level of education, but was negatively correlated with age (r = 0.224, p<.01 and r = -0.289 respectively). The qualitative data were peopleัs problems, needs and preferences for eating foods high in sodium and cholesterol, forgetting or refusing to take medication, lack of awareness about the severity of the disease and no motivation to exercise especially for elderly patients. Conclusion: This program should be useful for other healthcare volunteers in monitoring, supervising and supporting the teamwork in collaboration with community network development.

171-173

Authors: Chumpol Anamnart, M.D., Niphon Poungvarin, M.D., FRCP, FRI.

Chronic migraine (CM) is an important cause of chronic daily headache (CDH), a common severe headache syndrome. Patients with CM are significantly disabled from employment and overuse pain relieving medications. CM is a difficult condition to treat. Overuse of abortive medications and limited benefit from oral preventive medications are an important problem in managing this condition. Recent randomized controlled trials evaluating the efficacy of botulinum toxin A (BoNT-A) have confirmed its efficacy for CM prophylaxis. BoNT-A is a safe drug with no systemic reactions in clinical trials for headache.

177-184

Authors: Teerin Liewluck, M.D., Tumptip Sangruchi, M.D.

Sporadic inclusion body myositis (SIBM) is the most common idiopathic inflammatory myopathy in Caucasians over the age of 50 years. The prevalence of SIBM in the Asian population was initially thought to be very low, although the recent study showed that the prevalence of SIBM in Japan is in fact similar to the prevalence in Australia and the USA. SIBM is a refractory myositis with associated myodegenerative features mimicking the neuropathology of Alzheimer’s disease. The diagnosis of definite SIBM requires the typical clinical features and the presence of an autoaggressive inflammatory reaction, rimmed vacuoles, and congophilic deposits or tubulofilamentous inclusions. About one-fourth of patients with the typical clinical features of SIBM did not fulfill the pathological criteria of the definite SIBM. These canonical biopsy features may be absent in the early stage of the disease. Here we review the typical findings and the diagnostic pitfalls of the muscle biopsy in SIBM.

111-114

Authors: Supannee Suwanrattanadech, M.D., Tripop Lertbunnaphong, M.D., Dittakarn Boriboonhirunsarn, M.D., M.P.H., Ph.D.

Objective: To determine the prevalence and explore the knowledge, attitude and practice of using feminine hygiene products in Thai women. Methods: A survey was conducted between May and August 2009 in 400 Thai women between the ages of 20-35 who attended at Siriraj Gynecological clinic. Questionnaires dealing with knowledge, attitudes and practice were completed and data were collected and analyzed. Results: The mean age of participants was 28.5 ± 4.2 years. The prevalence of participants who have ever used feminine wash and vaginal douche were 70.5% and 14.25%, respectively. To get rid of an unpleasant odor, and feeling clean and fresh were the most common reasons for using both products. The most common timing of using feminine wash was after period, after bath and when having unpleasant odor, whereas having leucorrhea and unpleasant odor were noted in vaginal douche group. Significant association between use of vaginal douche and an experience of sexual intercourse was observed (P < 0.05). Conclusion: Use of feminine hygiene products, especially feminine wash, was quite popular in Thai women. To get rid of unpleasant odor as well as to feel clean and fresh were common reasons for using this product. Recommendations by gynecologists about appropriate use of feminine hygiene products should be carefully considered in daily practice.

119-122

Authors: Wilawan Thirapatarapong, M.D., Rungrudda Sribun, B.NS., Umaporn Atichadmanee, B.Sc. (PT)

Objective: The primary purpose of the study was to determine the incidence of abnormal electrocardiograms (ECGs) which affected the changes of exercise programs. The secondary purpose was to study types of ECG abnormality and the time of detecting the abnormality. Methods: The study was retrospective design. The studied population was selected from the followed up patients at our outpatient cardiac rehabilitation clinic from October 1, 2008 to May 31, 2009. The inclusion criteria were patients who had to follow up at our outpatient cardiac rehabilitation clinic and were monitored for ECG telemetry. The medical and ECG telemetry records of the patients were reviewed. The incidence of abnormal ECGs was reported as the percentage of patients with abnormal ECGs. The patients with abnormal ECGs were classified as the ECG changing group and those without abnormal ECGs were classified as the non-ECG changing group. The comparison of both groups was performed by Chi-square test for categorical data and the independent samples t-test for the quantitative data. The median survival time was carefully estimated by KaplanMeier method of Survival Analysis. The factors associated with time of detecting abnormal ECGs were analyzed by using Cox proportional hazards model. The data analysis was performed with statistical significant difference of the p-value < 0.05. Results: Five hundred and forty patients, 378 males and 162 females, were enrolled. There were 151 from 540 patients (28%) in the ECG changing group and 389 patients (72%) in the non-ECG changing group. The comparison between two groups indicated that there were no significant differences regarding gender, age, body mass index, diseases and co-morbidities (such as coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, dyslipidemia and chronic obstructive lung disease), left ventricular ejection fraction and status of cardiac surgery. The two most common types of ECG abnormality in the ECG changing group were tachyarrhythmia and bradyarrhythmia, respectively. The Cox proportional hazards model revealed that there was no factor associated with time of detecting abnormal ECGs. From the Kaplan-Meier method of Survival Analysis, the median survival time of detecting abnormal ECGs was 61 months (95% CI: 47.6, 74.9). Conclusion: The incidence of abnormal ECGs which affected the changes of exercise programs in our outpatient cardiac rehabilitation clinic was 28%. The most common type of abnormality was tachyarrhythmia. The median survival time for detecting abnormal ECGs was 61 months after cardiac hospital discharge. There was no associated factor with the time of detecting abnormal ECGs.

128-131

Authors: Rungnapha Khiewchaum, M.N.S., A.P.N.*, Orapan Thosingha, D.N.S.**, Prangtip Chayaput, Ph.D. (Nursing)**,

Background: After sustaining severe traumatic brain injury (TBI), most patients suffer both physical and mental disabilities. Caregivers of those critically ill patients have to deal with crises not only from unexpected injury, but also from difficult situations in giving care to them. The preparation program (PP) which assists caregivers to cope by enhancing the participation in care during intensive episode is needed. Objective: To examine differences between mean coping scores of TBI patientsั caregivers who received the PP and those receiving the usual nursing care. Methods: A quasi-experimental research design was conducted. The sample included 40 caregivers of ICU patients with severe TBI, 20 for a control group and 20 for an experimental group, was recruited. The Preparation Program (PP) implemented in the experimental group was developed based on an extensive review of related literature. The Thai version of the Coping and Adaptation Processing ScaleShort Form (TCAP-SF) was administered before and after the training of caregivers with PP to determine their coping abiility. Data were analyzed using Chi-square and t-test. Results: Caregivers who received the PP had a higher mean of coping score (x= 98.50, SD = 8.32) than those receiving the usual care did (x = 79.55, SD = 12.20) at p <.001. Conclusion: Caregivers were able to cope better after receiving the PP. The PP facilitated them to deal with a crisis episode of a family member with TBI in the ICU by getting more participation in their care. However, the coping of caregivers after patient discharge from the ICU to ward and after returning home should be evaluated.

139-142

Authors: Kosit Sribhen, M.D., Choosri Sribhen, Dr.sci.agr.

No abstract available.

73-75

Authors: Thos Harnroongroj, M.D., Jittisak Timjang, M.D., Rongras Damrongwatanasuk, M.D. Thossart Harnroongroj, M.D.

Objective: To compare the post-reduction service time between using a narcotic and combination of a narcotic with sedative drugs for reduction of acute anterior shoulder dislocation. Methods: Between 2004-2010, medical records and radiographs of patients who sustained acute anterior shoulder dislocation and obtained the successful reduction under sedation were reviewed. The patients were divided into 2 groups. Group 1, reduction was done under either intravenous morphine or pethidine and group 2, under either intravenous morphine or pethidine combined with diazepam. Post-reduction service times were recorded. The statistically significant difference was considered at p ≤ 0.05. Results: 42 patients were divided to 2 groups (21 patients in each group). The mean post-reduction service time of group 1 was 62.10 (SD = 31.42) and group 2 was 87.57 (SD = 32.07) minutes. The statistical analysis showed that group 1 significantly spent 25.47 minutes less post-reduction service time than group 2 (p = 0.013). Conclusion: Reduction of acute anterior shoulder dislocation under a narcotic significantly uses shorter post-reduction service time than under a combination of a narcotic with sedative drug in the emergency room.

81-84

Authors: Preechaya Wongkrajang, M.D., Wimol Chinswangwatanakul, M.D., Ph.D., Panutsaya Tientadakul, M.D.,Nisarat Opartkiattikul, M.D., Ph.D.

Objective: To collect the necessary data for a perspective of Whole Blood Clotting Time (WBCT) practice in Thailand. Methods: In March 2007, 124 questionnaires were sent to laboratory members of the Thailand National External Quality Assessment Scheme (Thailand NEQAS) to obtain essential information about the WBCT practice. Results: From a dispatch of 124 questionnaires, 120 (96.77%) were returned. There were 101 (84.1%) hospitals performing WBCT in the laboratories and the mean number of WBCTs performed was 16.17 times/month. Eighty nine laboratories (88.11%) used the modified Lee-White methods. Seventy four laboratories (73.26%) used snake bite and other animal bites as the indication for WBCT. Thirty three laboratories (34.37%) had problems performing the WBCT. Conclusion: The WBCT methods among the practice of the Thailand NEQAS laboratory members were as various as problems concerning WBCT throughout Thailand. Their practice needs to be improved and standardized by proper education. It also emphasizes the need for an appropriate guidelines for WBCT in Thailand.

89-91

Authors: Teerasak Chuxnum, M.D., Prawit Choomkasien, M.D., Prasert Thongcharoen, M.D.

In Thailand, rabies remains an important zoonotic disease due to its lethality in humans. Although the numbers of human rabies cases have been steadily decreasing over the past ten years, the epidemiological situation has started to change. Assessment of human rabies was based on the national infectious disease surveillance system from B.E. 2546-2550. There were 106 cumulative cases distributed in all four regions of Thailand. The highest mortality rates were found in the Central and Southern regions. Dogs were the main reservoir with the highest percentage found in puppies younger than 3 months (45%). Most of the causal dogs, and 61% of the dogs with owners had not received Rabies vaccination each year. The data strongly revealed that most of the human rabies cases did not receive rabies vaccine after the animal contact or bite. Prevention and control strategies should focus especially on the regions and provinces which had the highest number of cases, or on those regions which continue to have incident cases each year. It is also essential to set up a better control of the animal population which can potentially infect humans.

94-96

Authors: Saifon Chawanpaiboon, M.D.

No abstract available.

102-105

Authors: Therdsak Prammananan, Dr. rer. biol. hum.

No abstract available.

38-41

Authors: Chairat Leelaphattanadit, M.D., Saifon Chawanpaiboon, M.D., Siripong Sawasdimongkol, M.D.

Objective: To determine the prevalence of ovarian cancer, staging, presenting symptoms, gestational age of diagnoses, screening and diagnostic methods and pregnancy outcomes during pregnancy at Siriraj Hospital over a 13-year period (1998-2010). Methods: Medical records of pregnant women diagnosed with ovarian cancer at Siriraj Hospital from 1998 to 2010 were reviewed. Results: During the 13-year period, 1998-2010, eight cases of pregnant women with ovarian cancer were detected. Six cases of ovarian cancer stage I and 2 cases of ovarian cancer stage II were recorded. All of the patients presented with the symptom of abdominal mass. Two cases presented with abdominal pain. Ultrasonography was performed in all cases to confirm the diagnosis. Two patients with stage II ovarian cancer which was diagnosed in early pregnancy, subsequently had abortions. Five cases from 6 cases of those patients with stage I ovarian cancer underwent caesarean delivery while one case had a normal vaginal delivery. Conclusion: Regarding to this 13-year review, the prevalence of ovarian cancer in pregnancy was low. The management of pregnant patients with ovarian cancer depended on the gestational age and the staging of malignancy.

47-51

Authors: Kullathorn Thephamongkhol, M.D., M.Sc., Kanyanee Laebua, M.D., Pittaya Dankulchai, M.D., Janjira Petsuksiri, M.D., Chumpot Kakanaporn, M.Sc., Lalida Tuntipumiamorn, M.Sc., Porntip Iampongpaiboon, M.Sc., Yaowalak Chansilpa, M.D.,Pittayapoom Pattaranutraporn, M.D.

Objective: Setup verification is the critical part to make sure of the accuracy for Intensity-modulated radiotherapy in nasopharyngeal cancer patients. This pilot study was designed to answer whether and how much the kV-CBCT in addition to 2DkV is more accurate than 2DkV alone in terms of verification parameters. Methods: Images acquisition: Offline images were displayed in the matched position between reference images. 2D and 3D matches: The bony matches were done by using the location of the tumor in the nasopharyngeal and upper neck regions. The distances displaced from the isocenter were recorded in x-y-z directions. Analysis: The distance of the isocenter shift in each direction (X, Y, Z) were presented as point estimations. The alignment between the two methods was assessed with Pearson’s and Spearman’s correlation. The 3 mm difference within 90% is considered as an acceptable range of non-inferiority of 2DkV, compared with CBCT. Results: 11 nasopharyngeal cancer patients were included into this study. The correlation between 2DkV and kV-CBCT were 0.46, 0.11 and 0.16 for Superior-inferior (SI), Anterior-posterior (AP) and Left-right (LR) directions, respectively. The central value for the kV-CBCT; SI, AP and LR directional shift were 0.07, 0.06 and 0.03 cm, respectively, whereas the central value for 2DkV; SI, AP and LR directional shift were 0.05, 0.07 and 0.04 cm. For the difference shift < 3 mm, the results > 90% were within acceptable value: 100% and 96.96% for SI and LR directions whereas the AP direction was 87.87%. Conclusion: Compared with kV-CBCT by using our criteria, 2DkV images are accurate enough for treatment verification in nasopharyngeal cancer patients.

58-59

Authors: Prapat Wanitpongpan, M.D., Kusol Russameecharoen, M.D., Tuenjai Chuangsuwanich, M.D.,Buraya Phattanachindakun, M.D.

A rare mirror syndrome (Ballantyne syndrome) was seen in a woman who carried a hydropic fetus caused by fetal atrio-ventricular septal defect (AVSD). Diagnosis was made with confidence after ruling out cardiogenic pulmonary edema and preeclampsia. Placental pathology demonstrated multifocal villous edema and accelerated maturation of trophoblasts which may support the earlier reports about potential etiologic roles of the placenta to trigger the disease.

64-67

Authors: Sopon Iamsirithaworn, M.D., Ph.D., Pasakorn Akarasewi, M.D., Thitipong Yingyong, M.D., Suthanun Suthachana, M.Sc.,Chakrarat Pittayawonganon, M.D., M.P.H., Kumnuan Ungchusak, M.D., M.P.H.

No abstract available.