Vajira Medical Journal: Journal of Urban Medicine

369-380

Authors: Tayatorn Sudsuansee, Wiriya Nilprapa, Worawan Rojanawong

Objective: Neck circumference (NC) is becoming useful for various diseases in adults but not children. Due to a lack of normalized data. This study uses the normalized NC to compare with a patient’s NC as a percentage (%NC) in habitually snoring children to distinguish obstructive sleep apnea (OSA) cases. The ratio of NC and adenoid thickness (NCAR) is hypothetically less in non-overweight OSA children. We proposed this ratio as a parameter to identify OSA in non-overweight children. Methods: Habitually snoring children who underwent overnight pulse oximetry (overnight SpO2)/polysomnography (PSG) were eligible. Data gathering included an assessment of participants’ body sizes and AT (from radiographs). Results: Overall, there were 73 children (65% boys, median age 10.6 y (IQR 7.4-12.7), 52.1% of whom tested positive by either test. In addition, 58.9% of children underwent overnight SpO2, and 20.9% tested positive. Among 30 children tested by PSG, confirmation of OSA diagnosis of varying severity was 96.7%. The positive and non-positive groups did not have statistically significant differences in %NC. In overweight children (n=40), there were no statistically significant differences of %NC between positive (n=27) and non-positive (n=13) results [94.9 (88.3-104.1) vs. 93.4 (89.3-104.4), p-value 0.669]. But the non-overweight group, positive children (n=19) had a statistically smaller median NCAR compared to non-positive children (n=11); 14.3 (12.7-14.9) vs. 16.2 (14.7-20.3), p-value=0.006. The proposed cut-off NCAR value in predicting non-positive tests in non-overweight children is more than 13.95, with a 47.4% sensitivity and 100% specificity. The positive predictive value is 100%, and the negative predictive value is 68.6%. Conclusion: There was no statistically significant difference in %NC of the overall OSA vs. non-OSA children and the overweight OSA vs. non-OSA children. In the non-overweight group, NCAR was significantly smaller in positive children.

389-396

Authors: Pruk Chaiyakit, Ittiwat Onklin, Weeranate Ampunpong

Objective: Soft tissue release and gap balancing in varus knee deformity following total knee arthroplasty (TKA) are important issues that lack conclusive results. Various techniques including posteromedial capsule (PMC) and superficial medial collateral ligament (sMCL) release have been used for varus knee correction and flexion gap balance. Methods: We retrospectively reviewed data from patients who had undergone TKA with computer-assisted surgery measurement and the use of PMC and sMCL release by the preservation of anterior attachment of pes anserine at our institute from November 2015 to February 2016. Gaps and alignment were measured and recorded by computer-assisted surgery measurement. Results: Twenty-one patients were enrolled. The mean age was 68.0 (48.0-78.0) years with a mean preoperative hip-knee-ankle angle of 8.1 (3.5-16.0) degrees and a mean flexion contracture (FC) of 11.3 (3.5-16.0) degrees. The mean corrections for varus deformity after PMC and sMCL release were 4.9 ± 2.8 and 3.4 ± 1.7 degrees, respectively, with the mean FC after PMC and sMCL release correction of 5.6 ± 3.5 and 1.3 ± 2.9 degrees. The mean medial extension gap changes after PMC and sMCL release were 1.8 ± 1.4 and 1.7 ± 1.0 millimetres, respectively, with mean medial flexion gap after PMC and sMCL release changes of 0.7 ± 0.9 and 5.1 ± 2.1 millimetres, respectively. There was no significant change in lateral gaps after PMC and sMCL release. No instability of the knee was found. Conclusion: The sMCL released with the preservation of the anterior attachment of pes anserinus in total knee arthroplasty has an additional effect on varus knee correction and flexion gap balance after PMC release without the creation of knee instability.

407-414

Authors: Pharanai Sukhumungoon, Sunisa Dangsriwan, Pattamarat Rattanachuay

Objective: To investigate the capability of methicillin-resistant Staphylococcus aureus (MRSA) and mecA-carrying Staphylococcus aureus (MCSA) transfer from hospital to community through foods due to the mecA gene is responsible for various antimicrobials resistance. Methods: We investigated four MRSA from patients and healthy carriers and one mecA-carrying S. aureus (MCSA) from food, whether they were capable of surviving through acidic condition and simulated gastrointestinal system. All bacterial strains were examined in green papaya salad’s liquid portion (GPL), pH 2.0 and pH 3.0 to test their toleration ability in acidic food. Bacterial toleration to gastrointestinal system was investigated using 0.3% (w/v) pepsin-supplemented phosphate buffer saline (PBS) (pH 2.0 and pH 3.0), and different concentrations bile salt-supplemented tryptic soy broth (TSB). T-test was used to compare the bacterial survival rates at room temperature and 4ºC, before exposure to GPL, pH 2.0 and pH 3.0. Results: The results revealed that MRSA and MCSA could tolerate in GPL, pH 3.0 and pH 2.0 for 2 h and 1 h, respectively. Bacterial exposure to 4ºC for 3 h before incubated in GPL, pH 2.0, significantly prolonged bacterial survival (P < 0.05). Toleration to simulated gastrointestinal system demonstrated that clinical MRSA strain PSU20 well tolerated to simulated gastric juice, pH 3.0 [0.3% (w/v) pepsin] for at least 1 h with the bacterial survival populations of 4.40 log CFU/ml. In addition, this PSU20 well tolerated to all concentrations of bile salts. Conclusion: This study suggests that clinical MRSA has potential to transfer from hospital to community through foods and is able to break the gastrointestinal innate immunity establishing infection in human. This is crucial for public health stand point.

427-436

Authors: Meedee Meepolprapai, Taweewong Tantracheewathorn

Objective: To determine clinical presentations related to pulmonary tuberculosis in children. Methods: A retrospective descriptive study was conducted in children less than 15 years old who were diagnosed with pulmonary tuberculosis at the Department of Pediatrics, Faculty of Medicine Vajira Hospital between January 1st, 2009 - January 1st, 2021. The quantitative data were analyzed into mean and standard deviation and compared between groups by unpaired t-test. The qualitative data were reported by percentage and compares between groups by Chi-square test. Results: A total of 96 patients were included. The average age was 10.3 ± 4.6 years (6 months to 15 years old); 36.5% of patients were male and 63.5% were female, while 84.4% of the patients presented with 2 or more clinical features. Signs and symptoms described in the Thai CPG for Tuberculosis in Children 2019 that were found in this study were cough ≥ 2 weeks (58.3%), fever ≥ 7 days (57.3%), anorexia (42.7%), weight loss (25.0%), inactivity (8.3%), and poor weight gain (1%). Signs and symptoms not included in the Thai CPG for Tuberculosis in Children 2019 were afebrile (34.4%), cough < 2 weeks (28.1%), fatigue (28.1%), hemoptysis (19.8%), night sweat (15.6%), no cough (13.5%), dyspnea (12.5%), chest pain (9.4%), tachypnea (9.4%), fever < 7 days (8.3%), lymphadenopathy (8.3%), chronic vomiting and diarrhea (1%), and asymptomatic (2.1%). Ninety-two patients (95.8%) always had at least 1 clinical feature that was described in the Thai Tuberculosis CPG 2019. However, 4 patients (4.2%) in this study only presented with clinical features not included in the Thai Tuberculosis CPG 2019, including 1 patient who presented with only chest pain, 1 patient who presented with only hemoptysis, and 2 asymptomatic patients. Conclusion: Most of the pediatric patients with pulmonary tuberculosis presented with 2 or more clinical features and almost always had at least 1 symptom that was described in the Thai Tuberculosis CPG 2019.