Vajira Medical Journal: Journal of Urban Medicine

Number 1, 2023

439-447
The Study of Pathological Findings in MedicoLegal Cases Positive for Urinary Methamphetamine in Thai Postmortem Cases

Authors: Peerayuht Phuangphung, Wichai Wongchanapai

Abstract

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OBJECTIVE: This study aims to study pathological findings in Thai postmortem cases who were positive for methamphetamine in urine and compare these findings to the control group which was negative for drugs of abuse. METHODS: Retrospective study was conducted from autopsy reports and toxicological data of Thai postmortem cases between January 2018 and March 2020. The data were categorized into two groups including methamphetamine group and control group based on the detection of methamphetamine in urine. Sex, age and pathological findings were recorded in both groups. Chi-square test, Mann-Whitney U test and multiple comparisons with Games-Howell post-hoc test were performed where appropriate. RESULTS: There were 85 methamphetamine cases with 170 in the negative control group. All study subjects were male. Average ages of these two groups were 46.71 and 45.38 years old. Heart weight in the methamphetamine group was significantly greater than in the control group (p<0.05). Histologically, the methamphetamine group showed significant myocardial hypertrophy and interstitial fibrosis compared with the control group (p<0.01). The presence of alveolar hemosiderin-laden macrophages in the methamphetamine group was significantly higher than in the control group (p<0.001). Coronary artery stenosis was considered adjusted with age. In the methamphetamine group, the stenosis of the left anterior descending artery (LAD) at greater than 50% was significantly detected in younger ages than in the control group (p<0.05). CONCLUSION: Methamphetamine had an association with increased heart weight and LAD stenosis greater than 50% in younger age in Thai male cadavers.

448-454
Rate and Predictors of Postoperative Respiratory Complications Following Adenotonsillectomy in Children with Obstructive Sleep Apnea

Authors: Woravipa Israsena Na Ayudhya, Worawan Rojanawong

Abstract

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OBJECTIVE: This study aimed to determine the rate and risk factors of postoperative respiratory complications in children with obstructive sleep apnea (OSA) who underwent adenotonsillectomy. METHODS: A retrospective study was conducted on the date of children with OSA who underwent adenotonsillectomy between April 2013 and July 2021. Data on demographics, medical history, tonsil grading, polysomnography parameters, and postoperative respiratory complications including cough, position, airway intervention, and desaturation were collected. Chi-square test or Fisher’s exact test was performed to evaluate risk factors. RESULTS: Seventy-one children with OSA who underwent adenotonsillectomy were included in this study. The overall rate of postoperative respiratory complications was 32/71 (45.1%) and that of minor respiratory complications was 37/52 (71.2%), including desaturation, supplement oxygen, reposition, and cough. Statistically significant association with postoperative respiratory complications was observed for obese versus non-obese (p < 0.001), severe apnea–hypopnea index (AHI) (p = 0.001), and severe lowest oxygen saturation (p = 0.001). CONCLUSION: Despite the high rate of minor respiratory complications, postoperative respiratory complications are frequent after adenotonsillectomy among children with OSA. Obese versus non-obese and severity of AHI and lowest oxygen saturation are associated with postoperative respiratory complications following adenotonsillectomy.

455-462
A Study of Hand Dermatitis and Associated Factors During The COVID-19 Pandemic

Authors: Wanjarus Roongpisuthipong, Aishwarya Pattnaik, Siwaporn Rungrojthanakit, Suppachai Lawanaskol, Theerawut Klangjareonchai

Abstract

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OBJECTIVE: This study was conducted to determine the associated factors of hand dermatitis during a COVID-19 pandemic versus a non-COVID pandemic year by comparing the frequency of outpatient clinic visits. METHODS: This retrospective study used data from the dermatology department from January 2019 to December 2020. As an epidemiological assessment of increased dermatologic clinic visits of hand dermatitis patients, the Poisson mean difference model with generalized estimating equation regression was used. RESULTS: The study comprised a total of 16,506 outpatient dermatological clinic visits, including 793 hand dermatitis visits. After controlling the confounders such as demographic data, occupation, and corticosteroid use, hand dermatitis visits increased by 30% during the pandemic period compared to the pre-pandemic period. The average age of patients was 55.2 ± 16.4 years. Females mainly composed 70.6% and 62.8% of the subjects during the pandemic and pre-pandemic periods, respectively (P = 0.022). Patients reported significantly less hand cream usage (P = 0.013) and foot dermatitis diagnosed (P = 0.009) during the pandemic period than during the pre-pandemic period. Furthermore, patients were prescribed topical corticosteroids with low to moderate potency more frequently during the pandemic period (P = 0.019), whereas the use of topical corticosteroids with moderate to high potency and systemic corticosteroids did not differ between the two time periods. CONCLUSION: The COVID -19 pandemic had an impact on hand dermatitis in increasing outpatient dermatologic clinic visits. Emollient use is an important preventive factor in hand dermatitis. More hand cream use might help prevent hand dermatitis during COVID-19 pandemic and other infectious pandemics in the future.

463-470
Antibody Response after ChAdOx1 nCoV-19 Vaccination in Patients with Type 2 Diabetes at Vajira Hospital

Authors: Orawan Jedsadatud, Swangjit Suraamornkul

Abstract

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Number of views: 16

OBJECTIVE: A question exists as to whether people with diabetes can respond effectively to the COVID-19 vaccine. This study aimed to evaluate antibody response after COVID-19 vaccination in patients with type 2 diabetes. METHODS: This was a cross-sectional analytical study. Two hundred and twelve type 2 diabetes patients were enrolled after receiving a second dose of the ChAdOx1nCoV-19vaccine 3 months previously. Demographic data, medical history, and blood drawn were collected. Antibodies against receptor binding domain (anti-RBD) was investigated in the laboratory department. Other factors that could affect anti-RBD level, i.e. age, gender, BMI, glycemic control, duration of diabetes, and comorbidity, were collected and analyzed. RESULTS: Among 212 patients with type 2 diabetes 3 months after receiving a second dose of the ChAdOx1nCoV-19 vaccine, the anti-RBD level mean was 989.56 U/ml. Patients with type 2 diabetes, with or without cardiovascular disease as a comorbidity, had median anti-RBD levels equal to 258 U/ml and 442 U/ml, respectively. The median of anti-RBD levels between groups had statistically significant differences (p-value = 0.021). Age, gender, BMI, duration of diabetes, glycemic control, and other comorbidities showed no statistically significant differences in the median anti-RBD levels. CONCLUSION: Only patients with type 2 diabetes with cardiovascular disease as a comorbidity showed statistically significant differences in Anti-SARS-CoV-2 response 3 months after receiving a second dose of the ChAdOx1nCoV-19 vaccine. Therefore, patients with diabetes and cardiovascular disease require earlier revaccination to ensure protection against COVID-19 infection.

471-480
Prevalence of Thiamine Deficiency in Cirrhotic Patients

Authors: Pacharakorn Techaratanayuenyong, Charnarong Trisuwanwat

Abstract

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OBJECTIVE: This study aimed to evaluate the prevalence of thiamine deficiency in outpatient cirrhosis and compare thiamine deficiency between alcoholic cirrhosis and non-alcoholic cirrhosis, whether there are any factors or clinical outcomes associated with thiamine deficiency, and short-term follow-up after vitamin B1 replacement. METHODS: This cross-sectional study included patients who were diagnosed with cirrhosis at the Gastrointestinal and Hepatology Division of Vajira Hospital in outpatient settings. All patient data characteristics were collected and also baseline laboratory and erythrocyte transketolase activity (ETKA), which is a standard test for the diagnosis of thiamine deficiency. Patients who were diagnosed with thiamine deficiency were identified as ETKA ≥ 1.25. Thiamine deficiency patients were tested for clinical outcomes; ophthalmoplegia, nystagmus, ataxia, and Adult ADHD self-report scale v.1.1 and all of them underwent replacement with vitamin B1 for 3 months. RESULTS: From January 2020 to December 2020, 121 eligible cirrhotic patients were enrolled. Alcoholic cirrhosis comprised 41/121 (33.9%), and non-alcoholic cirrhosis amounted to 80/121 (66.1%). The comparison of prevalence in alcoholic and non-alcoholic cases was 14.6% vs. 11.2% (P=0.59). Neither the severity of disease nor baseline nutritional status was related to thiamine deficiency. The prevalence of hepatocellular carcinoma (HCC) was higher in the thiamine deficiency group compared to the others (46.7% vs. 12.3%; p=0.003). In univariate analysis, HCC was the only factor related to thiamine deficiency. Almost all thiamine deficiency status cases did not have either neurologic abnormality or any attention deficit. CONCLUSION: Thiamine deficiency was found in end-stage liver disease, irrespective of cirrhotic etiology. HCC was considered an associated factor of the thiamine deficiency. The occurrence of HCC may be emphasized as a proxy for the condition of thiamine deficiency

481-488
Remote Ischemic Preconditioning to Prevent Contrast-Associated Kidney Injury in Elective Coronary Angiogram: A Randomized Controlled Trial

Authors: Papatsiri Suntavaruk, Solos Jaturapisanukul, Sathit Kurathong, Wanjak Pongsittisak

Abstract

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Number of views: 14

OBJECTIVE: Remote ischemic preconditioning (RIPC) is a new strategy to prevent organ injury from oxidative stress and ischemic reperfusion injury, particularly for the kidney, heart, and brain. Contrast-associated acute kidney injury (CA-AKI) is a complication of coronary angiography (CAG). Based on previous studies, whether RIPC prevents CA-AKI post-CAG remains unclear. Therefore, this study aims to compare the efficacy of standard (std) management and standard management with RIPC to prevent CA-AKI post-CAG. METHODS: This study was an open-label 1:1 randomized controlled trial. The elective CAG patients with an estimated glomerular filtration rate of 15–45 mL/min/1.73 m2 were enrolled. For the RIPC group, patients performed RIPC starting from inflating manual cuff pressure to 200 mmHg for 5 min on an extremity and then deflating 5 min alternate to four times before coronary angiogram at least 1 hr. All patients had received the usual standard management of pre-CAG. The AKI outcomes were evaluated at 48 hrs and 1 week post-CAG. The adverse events were also assessed. RESULTS: A total of 27 patients (RIPC group = 14, std group = 13) were enrolled in this study. Baseline characteristics were comparable between both groups except for male gender was higher in the RIPC group (std group 7 [53.85%] and RIPC group 11 [78.57%]), in part of the amount of contrast media volume and procedure duration was higher in the std group (mean contrast volume are 140 [120] mL in the std group and 40.00 [31.25] mL in the RIPC group). No AKI event was observed in the RIPC group. By contrast, AKI in the std group at 48 hrs included two (15.4%) participants and one (7.7%) participant at 1 week. Serious adverse events were not observed in both groups. CONCLUSION: RIPC may be implemented as a systematic strategy to prevent CA-AKI post-CAG. Some researchers tend to improve CA-AKI. Further studies in a larger number of participants may verify the benefit of RIPC and provide definite conclusion.