Nakhon Ratchasima, Thailand
Nakhon Ratchasima, Thailand

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Khananurak K.,Chulalongkorn University | Vutithanachot V.,Chumphae Hospital | Simakachorn N.,Maharat Nakhon Ratchasima Hospital | Theamboonlers A.,Chulalongkorn University | And 2 more authors.
Infection, Genetics and Evolution | Year: 2010

Rotaviruses are the most common cause of severe diarrhea among infants and young children worldwide, especially in developing countries. In Thailand, rotavirus has presented a major public health problem causing severe diarrhea in infants and young children. It was responsible for about one-third of diarrheal diseases in hospitalized patients. In this study, we have analyzed the distribution and performed molecular characterization of rotaviruses circulating in infants and young children with diarrhea admitted to the city and rural hospitals in Thailand between July 2007 and May 2009. Group A human rotavirus was detected in 158 (28.4%) of 557 fecal specimens by RT-PCR. The peak incidence of infection was found in the winter months between December and March. The G1P[8] strain was identified as the most prevalent (49.4%) followed by G9P[8] (22.2%), G2P[4] (20.2%) and G3P[8] (0.6%). The uncommon strains G12P[8], G12P[6] and G3P[9] were also detected. Phylogenetic analysis of selected G and P genotypes isolated in this study was performed to compare with the reference strains from different countries. Emergence of G12 in the northern part of Thailand was observed and phylogenetic analysis demonstrated close relation between Thai isolates and strains from India. The present study reveals the recurring changing genotypes of rotavirus circulating in Thailand. The genetic association between isolates from Thailand and other countries ought to be considered with regard to local and global dissemination of rotavirus as it is crucial for prevention especially, with respect to vaccine implementation. © 2010 Elsevier B.V.


Kitiyodom S.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2015

Background: Adolescent pregnancy is risky with multiple complications during pregnancy and the delivery period. Adolescent pregnancy among students is more risky because the mothers did not intend to get pregnant, have poor relationship with the husband and do not take care of their child themselves as in other occupations. Objective: The decisions of adolescent mothers towards antenatal care (ANC) attendance and their postpartum adaptation; comparing students with other occupations Material and Method: This retrospective hospital-based study used data from the records of 777 adolescent mothers who attended the adolescent postpartum clinic at Maharat Nakhon Ratchasima Hospital from January 2012 to December 2013. The data were classified into students and other occupation groups. Their decisions for ANC attendance, spousal relationship, pregnancy intentions, family acceptance and postpartum adaptation (contraceptive decision, decision for taking care of baby and returning to study) from both groups were compared and analyzed. Results: The prevalence of student mothers was 63.3% of all adolescent pregnancies. The following factors were more common in student mothers with statistical significance, odd ratio (95% confidence interval): unintended pregnancy 3.66 (2.45-5.47), family non-acceptance 1.71 (1.03-2.93), poor ANC (no ANC and ANC after 12 weeks) 22.82 (14.33-37.34). Other factors including no ANC attendance, decision for taking care of the baby, contraceptive decision (before and after deliveries), and the contraceptive method was no different between the groups. After delivery, adolescents decided to return to their studies; 58.7% for students and 33.3% for other occupation groups. Conclusion: Students account for 63.3% of all adolescent pregnancies. None of them was married so the majority did not intend to be pregnant and not be accepted by their families, leading to poor ANC attendance. Half of them decided to return to their studies. Further studies should be prospectively performed at schools to see the true prevalence of pregnancy and the related factors such as pregnancy termination, withdrawal from school and the continuation of their studies. © 2015, Medical Association of Thailand. All rights reserved.


Suksathien Y.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

The patient who suitable for short stem THA must has good neck quality for initial stable fixation. In Thailand, the majority of patients are end stage osteonecrosis and have relatively narrow neck diameter so it's may be increased risk of intraoperative femoral fractures and leading to stem failure. Evaluate the initial clinical and radiographic results of short stem THA over a maximum follow-up period of about 24 months, paying special attention to early problem. The case series of 50 patients receiving short stem THA during March 2010 to September 2011. There were 15 cases of Mayo stem and 35 cases of Metha stem. The appearance of bone trabeculae development and radiolucent line at 1 year postoperative was reviewed using Gruen's classification. The Harris hip score was recorded at 6 months, 12 months and 24 months postoperative for evaluated the clinical results. In Mayo stem group, the mean age of patient was 44.2 years (range, 19-58) with the mean BMI of 20.9 (range, 16.9-28.1). There were 2 cases of intraoperative fractures and were treated with cerclage wires, 1 case had 3 mm subsidence with radiolucent line in zone 1, 2. Bone trabeculae was developed at zone 2 (60%), 6 (86.7%), 7 (53.3%) and radiolucent line was observed at zone 1 (6.7%) and zone 2 (6.7%). In Metha stem group, the mean age of patient was 43.9 years (range, 24-59) with the mean BMI of 22.2 (range, 16.5-32.3). There was 1 case of intraoperative fracture and was treated with cerclage wire, no further subsidence was observed. Bone trabeculae was developed at zone 1 (15.4%), 3 (79.9%), 6 (100%), 7 (92.3%) and no radiolucent line was observed. The mean Harris hip score was significantly improved from 44.9 (range, 22.7-59.7) preoperatively to 95.9 (range, 87-100) at 6 months (p < 0.01) in both stem design. The clinical results of short stem THA are generally satisfactory. The short-term results are promising and the learning curve acceptable. Its design enable preservation of the bone stock and the bone trabeculae appears to confirm the assumption of proximal force transmission. It is a promising option for young and active patients.


Insiripong S.,Maharat Nakhon Ratchasima Hospital
The Southeast Asian journal of tropical medicine and public health | Year: 2013

The ratio of hematocrit (Hct) to hemoglobin (Hb) in the people with normal red blood cell (RBC) morphology is generally three to one. We studied Hct/Hb ratios among patients with alpha-thalassemias (Hb H, H-CS, AEBart, AEBart-CS, EFBart and EFBart-CS diseases) diagnosed by high performance liquid chromatography, and compared them with normal subjects and with patients having anemia due to chronic kidney disease (CKD). The Hct and Hb levels were derived by automated analyzer. The means +/- SD of the Hct/Hb ratios were 3.5 +/- 0.2 (range 3.3 - 4.1), 3.0 +/- 0.1 (range 2.9 - 3.2) and 3.0 +/- 0.1 (range 2.8 - 3.2) in the alpha-thalassemia, normal and CKD groups, respectively. The mean Hct/Hb ratio in subjects with alpha-thalassemia was higher than the mean in normal subjects and in those with CKD. The Hct/Hb ratios for each genotype of the alpha-thalassemia were not different from each other. The underlying mechanisms for the higher Hct/Hb ratio among those with alpha-thalassemia are theorized to be less density and/or more hydration of a-thalassemia RBCs, more entrapment of plasma in the spun RBC, the high percent of nucleated RBC and WBC interference. A ratio of 3.5 +/- 0.2 may be helpful in cases of moderate anemia when typing only shows Hb A and E, to consider investigation for alpha-thalassemia, or in cases of alpha-thalassemia with acute blood loss, if the Hct is less than 35%, in the decision to transfuse.


Suksathien R.,Maharat Nakhon Ratchasima Hospital | Suksathien Y.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2010

Background: Knee and elbow flexion contractures are a frequent cause of ambulation and function problems that often require extensive rehabilitation. Traditional methods are of limited benefit in severe and fixed contracture. A new static progressive splint was developed from daily-use knee and elbow orthosis and a newly invented gradual telescopic rod, which is designed to provide low load, and gradual and prolonged stretching. Material and Method: The splint was used in ten cases (11 knees) of knee flexion contracture and three cases of elbow flexion contracture. There were multiple etiologies of contracture such as burn scar contractures, intra-articular fractures, septic arthritis, juvenile rheumatoid arthritis, and immobilization. The average timing of the contracture before splinting was 14.6 months (range, 2 to 36) in the knee group and 16.7 months (range, 6 to 30) in the elbow group. Results: The average initial extension was-53.6 degrees (range,-30 to-85) in the knee group and-70 degrees (range-65 to-80) in the elbow group. The average post treatment extension was-15 degrees (range, 0 to-30) in the knee group and-38.3 degrees (range,-30 to-45) in the elbow group. The average duration of treatment was 9.2 weeks (range, 4 to 16) in the knee group and 14 weeks (range, 11 to 20) in the elbow group. The most dramatic result was found in the patient who had burn scar flexion contractures of both knees for 20 months. The knee extensions increased from-60 and-85 degrees to full extension in four and 14 weeks after treatment, respectively. There were no recurrences or complications from the use of this splint. The patients were able to easily adjust the gradual telescopic rod themselves to provide the appropriate force for stretching. Conclusion: The static progressive splint is a new, effective, and low cost method for treatment of knee and elbow flexion contracture from multiple etiologies. The excellent result was found in extra articular contracture.


Kitiyodom S.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2015

Objective: To compare the adequacy of endometrium and the post-procedural pain between the manual vacuum aspiration (MVA) and metal curettage method. Material and Method: The present research was a clinical experiment. A randomized controlled trial study was done with older than 35-year old females with abnormal intrauterine bleeding who attended the out-patient gynecology department of Maharat Nakhon Ratchasima Hospital between December 1, 2013 and April 30, 2014. Patients were allocated with simple randomization technique into two groups, the experimental group was using MVA and the control group was using conventional metal uterine curettage. Pain levels were assessed according to the visual analogue scale. All tissue samples were examined by pathologists. Statistics used were percentage and Chi-square. Results: Percentages of tissue adequacy for pathological examination of control and experiment groups were 87.88 and 90.91, respectively. There was no significant difference between the two methods (p-value = 0.572). The patients with severe pain in the experiment group were less than that of the control group. The relative risk is 0.47 (95% CI = 0.30-0.72). Conclusion: MVA caused less pain than the metal curette method, while both provided the same rate of adequacy of endometrial tissue sampling for pathological diagnosis. The MVA offered more humanized health care for gynecological patients who required such procedure. Further researches focusing on the cost-effectiveness or medical complications could benefit a practice guideline and the health care system for this patient group. © 2015, Medical Association of Thailand. All rights reserved.


Insiripong S.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2010

A granulocytosis in dengue hemorrhagic fever has not been mentioned, it may probably be included under the term of leucopenia. Here is the case of a 14-year Thai boy presenting with fever and diarrhea for 3 days. He was diagnosed as dengue hemorrhagic fever, grade I because he had hemoconcentration, thrombocytopenia without bleeding and positive IgM dengue antibody. On the 5th day, he developed agranulocytosis and was treated with G-CSF and empirical antibiotics. His leucocyte count was successfully normalized within 1 day and persistently sustained until discharge.


Sudprasert W.,Maharat Nakhon Ratchasima Hospital | Kunakornsawat S.,Lerdsin General Hospital
Journal of the Medical Association of Thailand | Year: 2012

Objective: A retrospective study was performed in case with three and four levels degenerative cervical spondylosis that underwent anterior cervical discectomy and fusion (ACDF) with polyetheretherketone (PEEK) cages and anterior cervical plate to evaluate the efficacy and outcome. Material and Method: Clinical and radiographic results of 16 patients (6 women and 10 men) between January 2006 and June 2009 with follow-up more than 24 months were evaluated. Spinal curvature, segmental sagittal angulations, construct height and the radiographic fusion success rate were measured. Odom's criteria, visual analog scale (VAS), Nurick and modified JOA (Japanese Orthopedic Association) score were used to assess the clinical results. Results: There was significant difference between pre- and post-operative in degree of lordosis, segmental Cobb angle and clinical outcomes (p < 0.01). Clinical outcomes were classified as 'excellent' or 'good' according to Odom's criteria in 14 patients (success rate: 87.5%). Mean follow-up period was 36 months. Flexion and extension lateral radiographs showed 100% fusion rate. The construct height and sagittal alignment were maintained on the final follow-up observations. No cage failure, subsiding or dislodgement was showed on follow-up radiographs. Conclusion: Interbody fusion with PEEK cages packed with bone substitute and aspirated bone marrow which additions of cervical plate eliminate the complications of graft harvest and is a good option for the treatment of patients with three and four levels degenerative cervical spondylosis.


Mekawichai P.,Maharat Nakhon Ratchasima Hospital | Choeikamhaeng L.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2013

Objective: To evaluate the prevalence and the associated factors of dementia in Thai Parkinson's disease (PD) patients at Maharat Nakhon Ratchasima Hospital (MNRH), Nakhon Ratchasima Province, Thailand. Material and Method: A cross sectional study in consecutive PD patients at the neurological clinic, MNRH between January and August 2011 was performed. The baseline characteristics such as age, sex, duration and severity of disease, education level, and medications were collected. Dementia was assessed according to Thai Mini Mental State Examinations (TMSE). The data were analyzed for determining the prevalence and factors that might correlate with dementia in patients with PD. Results: One hundred forty three PD patients with mean age of 65.8±10.5 years and 49% males were enrolled in the present study. The prevalence of dementia was 35.0% in all subjects and 39.4% with education level adjustment. Dementia was found in any severity of PD. The advanced age and the later age at PD onset were the associated factors that had influenced on developing of dementia. Conclusion: The prevalence of dementia in PD patients at MNRH with education level adjustment was 39.4% and could be found in any stage of disease. The advanced age and later age at PD onset were the significant associated factors for this condition. TMSE with cut-off score below 24 points was suitable for using to define dementia in Thai PD patients.


Wiwatworapan W.,Maharat Nakhon Ratchasima Hospital | Ratanajaratroj N.,Maharat Nakhon Ratchasima Hospital | Sookananchai B.,Maharat Nakhon Ratchasima Hospital
Journal of the Medical Association of Thailand | Year: 2012

Background: The inferior vena cava (IVC) diameter is often used to estimate central venous pressure (CVP); however, the correlation and the cutoff of IVC compared with CVP have not yet been described in a Thai-population. Material and Method: A cross-sectional study evaluated the critically ill patients in the medical intensive care unit who had a central venous catheter inserted. The correlation between CVP and IVC diameter measured by a 2-dimensional, long-axis subxiphoid view at the end-expiratory phase with bedside ultrasonography were evaluated. Results: Forty-seven patients with a mean age of 60 + 16 years (range, 18 to 91) were studied. Correlation (r) between endexpiration IVC diameter and CVP was 0.75 (95% CI 0.59-0.85; p < 0.0001). An IVC diameter of ≤ 10 mm predicted CVP of 10 cmH 2O (sensitivity 77% and specificity 91%) and IVC diameter of ≥ 15 mm predicted CVP of 15 cmH 2O (sensitivity 90% and specificity 89%). Conclusion: The present study indicate that the measurement of the IVC diameter has a good correlation with CVP in Thaipopulation and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

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