Vajira Medical Journal: Journal of Urban Medicine

433-440

Authors: Adjima Soongsatitanon, Sasiwan Suthasmalee

Objective: To determine risk factors associated with birth asphyxia in pregnancies. Methods: A case control study was conducted by including 578 newborns delivered at Vajira Hospital between January 2018 and March 2020. Cases were 289 women who delivered the baby with Apgar score ≤ 7 at 1 minute, while the controls were 289 women who delivered the baby with Apgar score > 7 at 1 minute. The data was collected from medical records. Antepartum factors, intrapartum factors and newborn factors were analyzed with univariate analysis and binary logistic regression analysis. Results: Factors significantly associated with birth asphyxia included breech presentation (OR 3.18, 95% CI 1.10-9.22), vacuum extraction (OR 10.06, 95% CI 2.00-50.45), cesarean section (OR 2.53, 95% CI 1.59-4.03), preterm delivery (OR 6.62, 95% CI 3.26-13.46) and birthweight < 2500 grams (OR 3.49, 95% CI 1.54-7.90). Conclusion: The statistically significant risk factors associated with birth asphyxia were breech presentation, vacuum extraction, cesarean section, preterm delivery and birthweight < 2500 grams.

455-468

Authors: Natwipa Wanicharoen

Objective: To explore the health-related quality of life (HRQoL) of children with language impairment (LI), and to identify the factors that affect HRQoL in children with LI. Methods: This study was a cross-sectional descriptive study. The participants were 100 children with LI including specific language impairment (SLI), global developmental delay (GDD), autistic spectrum disorder (ASD), down syndrome (DS), and intellectual disability (ID), aged 2-7 years attending the Division of Developmental and Behavioral Pediatrics, Faculty of Medicine Vajira Hospital between November 2019 and October 2020. The HRQoL was assessed by the PedsQLTM 4.0– Thai version, parent proxy-report. Data were analyzed using the descriptive and inferential statistics. Results: Most of the children with LI were male (59%) with mean age of 3.96 ± 1.72 years old. Most of them were diagnosed with SLI, GDD, and ASD, accounting for 65%, 24%, and 24% respectively. The HRQoL of the children with LI were at high levels, accounting for 54% (67.87±14.53). The highest HRQoL score was in social functioning (69.25±18.94). The lowest score was in school functioning (58.90±22.44). Factor associated with HRQoL of the children with LI was behavior problems. Conclusion: Language impairment affects children’s HRQoL, especially in school functioning. Measuring HRQoL could serve as one of the methods used to provide the most appropriate and holistic care for children with LI.

479-484

Authors: Thitawat Wongampornpat, Bhapapak Na-songkla

Background: Laparoscopic living donor nephrectomy was performed in 2010 substituted open living donor nephrectomy in Vajira hospital. This study aims to present result of surgery. Method: A retrospective descriptive study was conducted. Eighty eight donors were performed laparoscopic living donor nephrectomy and 88 kidneys were transplanted to recipients between 2010 to 2020. Donor demographic data, number of renal vessels, operative time, warm ischemic time, operative blood loss, length of hospital stay, complication, serum creatinine after nephrectomy, serum creatinine of recipients and delay graft function were retrospectively review from medical record. Result: Mean operative time was 219±38 minutes, mean warm ischemic time was 192.2±39.8 seconds. Mean intraoperative blood loss was 66±56 milliliter, mean hospital stay length was 5.4±2.4 days. Complication rate of donor was 3.4%. There was no vascular or ureteral complication to recipients in this study. Conclusion: Laparoscopic living donor nephrectomy in Vajira hospital is safe and feasibility. Result of kidney function of the recipients at one year of follow up stilled good.

501-512

Authors: Nontawat Benjakul, Supasan Sripodok, Tanapong Tungjitsirisun, Pattara Pattaravoratham, Thararat Soiphet

Background: The Bethesda system for reporting thyroid cytopathology (TBSRTC) is a standardized and reproducible system. It is used worldwide to interpret fine-needle aspiration cytology (FNAC) of thyroid. A crucial issue of thyroid FNA is its accuracy comparing with the final histologic outcomes. This may vary on many factors e.g., nature of lesion, quality of the cytologic specimen, pathologist’s experience, etc. Aim: To evaluate the accuracy of TBSRTC from FNAC. Nature of lesion which may impact the accuracy was also studied. Method: A retrospective study evaluating data of TBSRTC in our hospital during January 2013 to June 2021 were reviewed and compared to its final histologic outcomes to determine diagnostic accuracy. Results: 3714 FNA procedures were done at Vajira Hospital from January 2013 to June 2021, consisting of 3,266 (87.94%) females and 448 (12.06%) males. The female: male incidence ratio was approximately 7:1. The age at diagnosis was ranged from 14 to 86 years (median 53 years). A total of 527 patients (461 female; 87.5%, and 66 male; 12.5%) underwent surgical resection with available histopathology evaluation. From those cases, the FNAC reports revealed 172 (32.6%) cases as non-diagnostic/unsatisfactory (ND/US), 216 (41.0%) cases as benign, 87 (16.5%) cases as atypical of undetermined significant or follicular lesion of undetermined significance (AUS/FLUS), 4 (0.8%) cases as follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 36 (6.8%) cases as suspicious for malignancy (SM), and 12 (2.3%) cases as malignant. The risk of malignancy (ROM) in operated thyroid specimen was 15.7%, 15.3%, 33.3%, 0%, 91.7%, and 91.7%, respectively Conclusions: The accuracy of thyroid FNAC at our hospital was high in malignant groups including category V and VI. However, the ROM in categories I, II, III, and V exceeded the suggested limit in TBSRTC. We strongly encourage medical practitioners in all professions to use TBSRTC because it is an international standard that shares a common understanding and helps guide patient management.