Siriraj Medical Journal

262-266

Authors: Paiboon Tummarintra, M.Sc., Phakrop Kaewbundit, Rasda Boonprasert, M.Sc., Teera Kolladarungkri, M.D.

Objective: To study the effect of temperature on phenytoin concentration in serum and to determine the sample were kept at 2-8°C and 35°C. Methods: Serum samples of patients, who had been treated with phenytoin. had their phenytoin level determined on the first day. The sample was stored for seven days and analyzed on days three, five and seven of the study and divided into three storage concentrations from 2.5-10, 10.1-20 and 20.1-30 µg/ml compared using 50 samples per group. Results: Phenytoin level was found to have increased over time to three days at a temperature of 35°C and five days at 2-8°C. It increased in the level of statistical significance at p<0.05. This study’s data were all well correlated at r2 = 0.9981-0.9999. Conclusion: Collected samples for analysis of phenytoin level must be stored at 2-8°C and stored for at least five days, to prevent degradation of protein which cannot bind to the drug. The phenytoin levels in serum increased to make the diagnosis of dosage mistakes.

273-279

Authors: Suppachai Poolsuppasit, M.D., Poom Tritrakarn, M.D., Shusee Visalyaputra, M.D., Nuchsaroch Pechpaisit, M.D.,Roungsin Choavaratana, M.D., Ladda Phuampolprasert, B.Sc., Pathipa Suksopee, B.Sc.

Objective: Total intravenous anesthesia for uterine curettage with propofol is common in practice. Narcotics are used to decrease movement due to pain during the procedure. But narcotics may cause hypotension, hypoventilation, bradycardia, desaturation and apnea. We hypothesized that the use of ketamine instead of fentanyl can reduce the incidence of patients’ movement and other complications mentioned above. Methods: Eighty-four patients were enrolled into the study. The patients were randomized in to 2 groups: Fentanyl group (Propofol+Fentanyl) and Ketamine group (Propofol+Ketamine). Low dose of ketamine (0.3 mg/kg) or fentanyl (1 mcg/kg) was injected, followed by propofol 1.5 mg/kg, then uterine curettage was started along with propofol infusion of 5 mg/kg/hr. Patients’ movement, respiratory rate, blood pressure, and O2 saturation were recorded every minute. After the procedure, the emergence duration and surgeon’s satisfaction were recorded. The incidence of nausea/vomiting, dizziness and any other complaints were recorded for 24 hours postoperatively. Results: There was no significant difference in patient’s movement, surgeon’s satisfaction and emergence duration between the two groups. Patients in ketamine group significantly showed lower incidences of respiratory depression as shown by less requirement of airway manipulation with assisted ventilation, and lower incidences of hypotension than patients in the fentanyl group (2.4% vs. 19%, p=0.029 and 7.2% vs. 52.4%, p<0.01, respectively). Conclusion: The use of low dose ketamine with propofol in patients having uterine curettage can cause less hypotension and less respiratory depression than using fentanyl with propofol, without any difference in patients’ movements and emergence from anesthesia.

285-291

Authors: Tawatchai Apidechkul, Dr.P.H. (Epidemiology), Sauwaluck Pongwiriyakul, M.Sc., Mitra Cassely, M.D.,Chomnard Pojanamart, Ph.D.

Objective: To identify the risk factors of HIV/ HBV coinfection among HIV persons. Methods: 356 newly diagnosed HIV positive patients had their blood tested for HBV serological markers: HBsAg, HBsAb and HBcAb by immunochromatographic and ELISA methods. Cases were those positive for one or more of the HBV markers, and controls were negative for all HBV markers. All completed questionnaires designed to identify risk factors. Logistic regression statistical method was used to find the associations between demographic and behavioural parameters and the coinfection status. Results: A total of 122 out of 356 cases were suitable for analysis. Fifty percent were male, 40.3% were aged 30-39 years old, 62.9% were married, 18.6% were illiterate, and 10.5% were unemployed. After controlling for possible confounding factors the multiple logistic regression identified two factors associated with HIV/HBV co-infection namely number of years in school and CD4 cell count. The “no education” group had a greater risk of 7.07 times (OR=7.07, 95% CI=1.77-28.24) than the “≥13 years” group. CD4 “≤ 200 cells/mm3” was a protective factor protect for HIV and HBV coinfection when compared to “≥ 200 cells/mm3” group (OR=0.35, 95% CI=0.13-0.94). Conclusion: The study suggests that a good education may reduce HIV/HBV co-infection. A practical approach would be a provision of wide accessibility to quality general and sex education on the risk and prevention of HIV, HBV, and a promotion of HBV immunization.

296-300

Authors: Prapun Aanpreung, M.D., Ananya Pongpaibul, M.D.

Benign recurrent intrahepatic cholestasis (BRIC) is an autosomal recessive cholestatic liver disease. Recurrent self-limited episodes of jaundice and severe pruritus are leading clinical manifestations. We report a 16-year-old Thai boy with three recurrent episodes of cholestasis. The first episode occurred at 30 months old. The subsequent recurrent episodes were at 13 and 16 years, respectively. Investigations including viral study, autoimmune hepatitis markers, abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) were negative. Diagnosis of BRIC was made based on specific criteria. He was treated with cholestyramine and ursodeoxycholic acid when the first and second episodes occurred which resulted in good recovery. However, for the last recurrent episode, treatment with ursodeoxycholic acid failed to improve his condition, so his treatment was changed to rifampicin, which resulted in dramatic response. Although BRIC is a rare disease, it should be taken into account in all cases with recurrent cholestasis with normal or minimally elevated GGT level. Currently, genetic study for the mutation of ATP8B1 and ABCB11 genes are crucial for making a definite diagnosis