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Buriram, Thailand

Pheerawong P.,Buriram Hospital | Songmuang S.B.,Chulalongkorn University | Lertsuwunseri V.,Chulalongkorn University | Satitthummanid S.,Chulalongkorn University | Srimahachota S.,Chulalongkorn University
Journal of the Medical Association of Thailand | Year: 2015

Background: In patient with non-valvular atrial fibrillation (AF), over 90% of thrombus accumulation originates in the left atrial appendage (LAA). Warfarin significantly reduces risk of stroke. However, long-term anticoagulant therapy is associated with a significant risk of major bleeding, particularly in elderly. Transcatheter occlusion of left atrial appendage with Watchman device has proved to be non-inferior to warfarin in preventing stroke in non-valvular AF patients. No previous report of transcatheter occlusion of LAA was found in Thailand. Objective: To evaluate short-term results of left atrial appendage closure with the Watchman® device in patient with non-valvular AF performed at King Chulalongkorn Memorial Hospital (KCMH). Material and Method: Between November 2012 and December 2014, 12 consecutives patients underwent percutaneous transcatheter left atrial appendage closure. Data included patient’s characteristics, embolic risk factors, bleeding risk score, procedural finding, complications, in-hospital outcomes, and antithrombotic management were retrospectively reviewed. Results: Percutaneous LAA occlusion was successfully performed in all 12 patients. The mean age was 71.2±8.1 years. The history of previous bleeding was seen in four patients (33%). All patients had good left ventricular systolic function. The mean CHADS2score was 3.2±1.3, the mean CHA2DS2-VASc score was 4.8±1.6 and the mean HAS-BLED score was 2.5±0.9. The average LAA orifice diameter was 21.7±3.4 mm, and the median implant size was 27.0 mm. The compression ratio was 15.2±6.2%. Three patients (25%) were performed under general anesthesia, nine patients (75%) were performed with local anesthesia. The average procedure time was 61.2±18.5 minutes. The average fluoroscopy time was 6.8±3.3 minutes. There was no device embolization or pericardial effusion. There was no periprocedural cerebral event, assess site bleeding, or death during hospital admission. Mild peridevice leak was observed in three patients (25%), and all had disappeared on TEE performed at the 45-day follow-up. The median length of stay was two days. Conclusion: The result of the present study showed that percutaneous LAA occlusion with the Watchman device was feasible and safe. The successfulness of the procedures and periprocedural complications were similar to standard in literature. © 2015, Medical Association of Thailand. All rights reserved.

Hsu S.C.,University of California at Los Angeles | Sears R.L.,University of California at Los Angeles | Lemos R.R.,University of Santiago de Compostela | Lemos R.R.,Federal University of Pernambuco | And 58 more authors.
Neurogenetics | Year: 2013

Familial idiopathic basal ganglia calcification (IBGC) or Fahr's disease is a rare neurodegenerative disorder characterized by calcium deposits in the basal ganglia and other brain regions, which is associated with neuropsychiatric and motor symptoms. Familial IBGC is genetically heterogeneous and typically transmitted in an autosomal dominant fashion. We performed a mutational analysis of SLC20A2, the first gene found to cause IBGC, to assess its genetic contribution to familial IBGC. We recruited 218 subjects from 29 IBGC-affected families of varied ancestry and collected medical history, neurological exam, and head CT scans to characterize each patient's disease status. We screened our patient cohort for mutations in SLC20A2. Twelve novel (nonsense, deletions, missense, and splice site) potentially pathogenic variants, one synonymous variant, and one previously reported mutation were identified in 13 families. Variants predicted to be deleterious cosegregated with disease in five families. Three families showed nonsegregation with clinical disease of such variants, but retrospective review of clinical and neuroimaging data strongly suggested previous misclassification. Overall, mutations in SLC20A2 account for as many as 41 % of our familial IBGC cases. Our screen in a large series expands the catalog of SLC20A2 mutations identified to date and demonstrates that mutations in SLC20A2 are a major cause of familial IBGC. Non-perfect segregation patterns of predicted deleterious variants highlight the challenges of phenotypic assessment in this condition with highly variable clinical presentation. © 2013 Springer-Verlag Berlin Heidelberg.

Choubtum L.,Mahidol University | Witoonpanich P.,Mahidol University | Hanchaiphiboolkul S.,Prasat Neurological Institute | Bhidayasiri R.,Chulalongkorn University | And 5 more authors.
BMC Neurology | Year: 2015

Background: About 50% of Thai patients with adult-onset spinocerebellar ataxia (SCA) was Machado-Joseph disease (MJD), SCA1, SCA2 and SCA6. The author investigated further on less common SCAs in the patients without any known mutations. Methods: DNA samples of 82 index patients who were genetically excluded MJD, SCA1, SCA2, SCA6, SCA7 and dentatorubro-pallidoluysian atrophy (DRPLA) were examined. Analysis of SCA8, SCA10, SCA12, SCA17 and SCA19 genes were comprehensively performed. Normal range of trinucleotide repeat expansion sizes of TATA-box-binding protein gene (TBP) were also determined in 374 control subjects. Results: Eight patients carried ≥42 CAG/CAA repeat allele in the TBP consistent with SCA17. The pathological repeat alleles ranged from 42 to 57 repeats. All patients had significant degree of cognitive dysfunction. Other non-ataxic phenotypes comprised of parkinsonism, chorea, dystonia and myoclonus. A sporadic patient carried a heterozygous 41-repeat allele developed chronic progressive cerebellar degeneration commenced at the age of 28years. Whilst, 2% of the control subjects (8/374) carried the 41-repeat allele. Five of the carriers were re-examined, and revealed that four of them had parkinsonism and/or cognitive impairment without cerebellar signs. Analysis of other types of SCAs was all negative. Conclusions: This is the first study of SCA8, SCA10, SCA12, SCA17 and SCA19 in Thais. SCA17 appears to be an important cause of ataxia in Thailand. Although, the pathological cut-off point of the TBP repeat allele remains unclear, the finding suggests that the 41-repeat may be a pathological allele resulting late-onset or mild phenotype. Apart from ataxia, cognitive impairment and parkinsonism may be clinical presentations in these carriers. © 2015 Choubtum et al.

Pheerawong P.,Buriram Hospital | Plienthaisong B.,Buriram Hospital
Journal of the Medical Association of Thailand | Year: 2014

Objective: To study clinical outcomes of recombinant tissue plasminogen activator (alteplase) as primary fibrinolytic drug in patients with acute STEMI in Buriram Hospital.Material and Method: Data on demographics, medications, in-hospital outcomes, and angiography were collected from a prospective registry of STEMI patients admitted by STEMI fast track from January 1, 2011 to December 31, 2013.Results: During the 3-year period, 97 consecutive patients with STEMI who received alteplase were enrolled. The mean age was 64.3 year and 75.3% were male. There were high prevalence of dyslipidemia and current smoking. Median time from symptom onset to hospital presentation was 170 minutes. Median door to needle time was 30 minutes. Thrombolytic therapy was started in 30 minutes in 55.7% of cases. Overall bleeding was 19.6%. Intracranial hemorrhage was 1.0% of patients. ST-segment resolution was found in 79.4% of patients. In-hospital mortality was 11.3%. Angiographic data (n = 45) in patients with clinical reperfusion (n = 32), TIMI flow grade 2 and 3 combined was 90.6% and TIMI flow grade 3 was 56.3%. Revascularization was performed in 90.6%.Conclusion: Alteplase in acute STEMI provided good clinical reperfusion with minimal major bleeding complication. Most of patients with clinical reperfusion required additional percutaneous coronary intervention to fix residual stenosis of infarct related artery. © 2014 Medical Association of Thailand. All rights reserved.

Rattanawong P.,Mahidol University | Vutthikraivit W.,Buriram Hospital | Charoensri A.,Buriram Hospital | Jongraksak T.,Buriram Hospital | And 5 more authors.
Annals of Noninvasive Electrocardiology | Year: 2016

Background Brugada syndrome (BrS) is defined as presenting of type-1 Brugada pattern (BrP). BrS can also be induced by fever. This study demonstrated a highest prevalence of fever-induced BrS ever reported. Method During May 2014, febrile (oral temperature ≥ 38 °C) and nonfebrile patients underwent standard and high leads (V1 and V2 at 2nd intercostal space) electrocardiogram. Risk factor and cardiac symptoms were recorded. Patients with a persistent of type-1 BrP after fever had subsided were excluded. The prevalence of BrS, type-2 BrP and early repolarization pattern (ERP) were demonstrated. Results A total of 401 patients, 152 febrile, and 249 nonfebrile, were evaluated. BrS was identified in six febrile patients (five males and one female) and two males in nonfebrile patients. The study demonstrated higher prevalence of BrS in febrile group compared to nonfebrile group (4.0% vs 0.8%, respectively, P = 0.037). Among fever-induced BrS patients, three patients (50.0%) experienced cardiac symptoms before and at the time of presentation and two patients (33.3%) had history of first-degree relative sudden death. No ventricular arrhythmia was observed. All of type-1 BrP disappeared after fever had subsided. We found no difference in prevalence of type-2 BrP in febrile and nonfebrile group (2.0% vs 2.8%, respectively, P > 0.05) as well as ERP (3.3% vs 6.4%, respectively, P > 0.05). Conclusions Our study showed a highest prevalence of fever induced BrS ever reported. A larger study of prevalence, risk stratification, genetic test and management of fever-induced BrS should be done, especially in an endemic area. © 2015, Wiley Periodicals, Inc.

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