Wongtriratanachai P.,Chiang Mai University |
Luevitoonvechkij S.,Chiang Mai University |
Sribunditkul S.,Nakornping Hospital |
Leerapun T.,Chiang Mai University |
And 2 more authors.
Journal of Clinical Densitometry | Year: 2013
Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50. yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1to 2.4), with a mean age of 76.7. yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70. yr or older. The highest incidence of hip fracture was observed in patients older than 85. yr (1239). At 6. mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75. yr. In patients older than 84. yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed. © 2013 The International Society for Clinical Densitometry.
Bunupuradah T.,Red Cross |
Duong T.,MRC Clinical Trials Unit |
Compagnucci A.,French Institute of Health and Medical Research |
McMaster P.,North Manchester General Hospital |
And 11 more authors.
AIDS | Year: 2013
BACKGROUND: Excess risks for death/opportunistic disease in adults randomized to CD4-driven planned treatment interruption (PTI) in the Strategies for Management of Antiretroviral Therapy (SMART) trial remained after antiretroviral therapy (ART) re-initiation. Risks for children following PTI were evaluated in long-term follow-up of children in the PENTA 11 trial. METHODS: Children with HIV RNA below 50 copies/ml and CD4 at least 30% (2-6 years) or at least 500 cells/μl (7-15 years) were randomized to continuous ART (cART) or PTI in PENTA 11 (ISRCTN 36694210). After the end of the trial, all were recommended to resume ART. Data were collected annually and analysed up to the second year of visit. RESULTS: One hundred and one (51 cART, 50 PTI; median baseline age 9.2 years) children had median overall follow-up 4.6 (range 3.7-5.0) years. During 2-year post-trial period, there were no deaths or new Centers for Disease Control and Prevention (CDC) stage B/C events. Rate of clinical grade of at least two events was similar between PTI and cART [relative risk (RR) 1.03; 95% confidence interval (CI) 0.43, 2.50; P=0.94]. At 2 years, difference in absolute CD4% between PTI and cART was -1.6% (-4.5%; 1.3%; P=0.27), and proportions with HIV RNA below 50 copies/ml were 82 versus 86% (P=0.57), respectively; no differences in growth or fasting lipids were observed. Key predictors of greater CD4% recovery after re-initiating ART were higher CD4% at baseline (P<0.001) and longer time since ART re-initiation (P<0.001). During overall follow-up, 4 (8%) PTI versus 5 (10%) CT children switched ART for failure (P=0.75) and 9 (18%) versus 1 (2%) (P=0.008) substituted ART for simplification. CONCLUSIONS: No adverse clinical, immunological or virological consequences of PTI were observed 2 years after the end of PENTA 11 trial. Although ART interruption is not generally recommended, it may be an acceptable option for children, particularly when there is high risk of unplanned treatment interruptions. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Estopinal C.B.,Exempla St Joseph Hospital |
Estopinal C.B.,University of California at San Francisco |
Estopinal C.B.,Vanderbilt University |
Ausayakhun S.,Chiang Mai University |
And 4 more authors.
Ophthalmic Epidemiology | Year: 2013
Purpose: The World Health Organization (WHO) recommends that Southeast Asian countries have ≥1 ophthalmologist per 100,000 persons, equally distributed in urban and rural areas. However, regional patterns of eye care have been poorly characterized. This study investigates the distribution of ophthalmologists in Thailand and provides regional estimates of access to ophthalmologists. Methods: We geocoded the work address of ophthalmologists listed in the 2008 directory of the Royal College of Ophthalmologists of Thailand. We determined the number of ophthalmologists per 100,000 persons at the national, provincial, and district levels using data from the 2000 Thai Population Census, and assessed demographic factors associated with meeting the WHO recommendation of ≥1 ophthalmologist per 100,000 persons. Results: In 2008, Thailand had 1.52 ophthalmologists per 100,000 persons; however, only 20 of 76 provinces (26%) and 134 of 926 districts (14%) met the WHO recommendation of ≥1 ophthalmologist per 100,000 persons. District factors associated with not meeting the WHO recommendation included a high proportion of children, a high proportion of elderly, and a high proportion of rural residents. Conclusion: Thailand meets the WHO's goal for access to ophthalmologic care, but the distribution of ophthalmologists is uneven, with less access to ophthalmologic care in rural areas. © Informa Healthcare USA, Inc.
Inchai J.,Chiang Mai University |
Pothirat C.,Chiang Mai University |
Liwsrisakun C.,Chiang Mai University |
Deesomchok A.,Chiang Mai University |
And 2 more authors.
Japanese Journal of Infectious Diseases | Year: 2015
We conducted a retrospective cohort study in the medical intensive care unit of Chaing Mai University Hospital to describe the epidemiology of ventilator-associated pneumonia (VAP) and identify prognostic indicators of 30-day VAP mortality. A total of 621 patients diagnosed with VAP between January 2005 and December 2011 were included. The overall 30-day mortality rate was 44.4z. The major causative pathogens were Acinetobacter baumannii (54.3z), Pseudomonas aeruginosa (35.2z), and methicillin-resistant Staphylococcus aureus (15.1z). Most A. baumannii (90.2z) comprised drug-resistant strains. Identified prognostic indicators were co-morbid malignancy (hazard ratio [HR] ＝ 1.60; 95z confidence interval [CI] 1.02–2.42; P ＝ 0.040), septic shock (HR ＝ 2.51; 95z CI, 1.60–4.00; P ＜ 0.001), Simplified Acute Physiology Score II ＞45 (HR ＝ 1.62; 95z CI, 1.03–2.56; P ＝ 0.041), Sequential Organ Failure Assessment score ＞5 (HR ＝ 3.40; 95z CI 2.00–5.81; P ＜ 0.001), and delayed inappropriate empirical antibiotic treatment (HR ＝ 2.23; 95z CI, 1.12–4.45; P ＝ 0.022). VAP was associated with high mortality. The major causative pathogen was drug-resistant A. baumannii. Therefore, early detection of VAP by surveillance in mechanically ventilated patients leading to earlier treatment may improve patient outcomes. Guidelines for prescribing appropriate empirical antibiotics to cover drug-resistant bacteria could be established using local epidemiological data. © 2015 National Institute of Health. All rights reserved.
Khamrin P.,Chiang Mai University |
Malasao R.,Chiang Mai University |
Chaimongkol N.,Chiang Mai University |
Ukarapol N.,Chiang Mai University |
And 5 more authors.
Infection, Genetics and Evolution | Year: 2012
Human bocavirus (HBoV) is a newly identified human parvovirus that associated with respiratory and gastrointestinal diseases. Epidemiological surveillance of HBoV was conducted on fecal specimens collected from hospitalized children with diarrhea in Chiang Mai, Thailand in 2011. Among a total of 222 fecal specimens tested, 17 (7.7%) were positive for HBoV by PCR. Of the 17 HBoV positive samples, double- or triple-infections together with other enteric viruses were found in 10 (58.8%) pediatric patients, while monoinfection with HBoV alone was detected in seven (41.2%) cases. Mixed infection among HBoV with norovirus GII was frequently observed in this population. The partial VP1 nucleotide sequences of all 17 HBoV strains demonstrated that all four species of HBoV were found in the specimens tested. Eleven strains were HBoV1. Other three strains showed the sequence identity with HBoV2, which were most closely related to the HBoV2A. In addition, other two HBoV strains showed the highest level of nucleotide sequence identity with the HBoV3. It was surprisingly to observe that one Thai HBoV strain showed a unique characteristic similar to the HBoV4, a rare species of HBoV found in acute gastroenteritis patients. In summary, this study presents the genetic background information of HBoV circulated in acute gastroenteritis children in Chiang Mai, Thailand and it was clearly demonstrated that HBoVs circulated in this area were genetically diverse as all four species of HBoVs (HBoV1-4) were detected in the fecal specimens collected from pediatric patients admitted to the hospitals in this area. © 2012 Elsevier B.V..
Jirawison C.,Nakornping Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012
To study the role of intravitreal injection of bevacizumab (Avastin) at the end of vitrectomy for prevention of postoperative vitreous hemorrhage in diabetic eye disease. The authors conducted a retrospective, comparative, nonrandomized study comparing patients with diabetic eye disease who received a 1.25 mg bevacizumab injection at the end of vitrectomy to a group with diabetic eye disease who underwent vitrectomy but did not receive this injection. For statistical analysis, each patient was assigned to one of four groups according to the hemostatic modalities used (group 1, none; group 2, only long acting gas; group 3, only intraoperative intravitreal bevacizumab; group 4, both long acting gas and intraoperative intravitreal bevacizumab). The primary outcome measure was the incidence of early and late postoperative vitreous hemorrhage (POVH). The secondary outcome measure was visual acuity (VA) at 1 and 6 months. The present study included 87 eyes from 78 patients. The 87 eyes were categorized in the four groups described above. The incidence of early postoperative VH was lowest in group 3 (50%), followed by group 1 and group 4 (130%) and group 2 (16%) (p = 0.49). No eyes in group 1 or group 4 had late postoperative VH. Group 3 had the lowest incidence of VA below 20/200 (11%) in the first postoperative month, followed by group 1 (22%), group 4 (33%) and group 2 (50%) (p = 0.44). Group 3 also had the best visual recovery (VA above 20/50) with 38% at the end of six months compared with 13% in group 1, 7% in group 4 and no eyes in group 2 (p = 0.03). Patients with intravitreal injection of 1.25 mg bevacizumab at the end of diabetic vitrectomy had the lowest incidence of early postoperative vitreous hemorrhage with no statistical significance. However they had significantly the best visual recovery at the end of six months.
Suntornlimsiri W.,Nakornping Hospital
Journal of the Medical Association of Thailand | Year: 2010
Objective: To evaluate the histopathology of women who had "atypical squamous cells of undetermined significance" (ASC-US) on cervical cytology in a region with high incidence of cervical cancer. Material and Method: Retrospective case-record review of 254 women with ASC-US cytology undergoing colposcopic examination at Nakornping Hospital between October 2003 and September 2007. Results: Of the 254 patients who had ASC-US smears underwent colposcopic and histopathologic evaluation. The mean age was 45.3 years (range,18-72 years). The histologic diagnoses, obtained from colposcopically directed biopsy or endocervical curettage or loop electrosurgical excision procedure or cold knife conization after initial colposcopy, showed that 47 (18.5%) women had histologically confirmed high-grade lesions and 20 (7.9%) women had invasive cancers. There was no statistically significant difference in the incidence of high-grade or invasive lesions between who were 50 years old or more and those who were younger (50.0% and 50.5%, respectively, p = 0.39). Conclusion: Reporting ASC-US cytology in our population is obviously associated with significant cervical pathology, particularly invasive cancer that is possible at a rate higher than previously reported. Women who have ASC-US smears should therefore be referred for immediate colposcopy regardless of age.
Suriya C.,Chiang Mai University |
Kasatpibal N.,Chiang Mai University |
Kunaviktikul W.,Chiang Mai University |
Kayee T.,Nakornping Hospital
Clinical and Experimental Gastroenterology | Year: 2011
Introduction: Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death. Objective: To determine the diagnostic indicators of peptic ulcer perforation. Material and methods: A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients' final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR) estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX). Results: The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14-2.06), tenderness (RR = 1.94, 95% CI 1.17-3.21), and guarding (RR = 1.52, 95% CI 1.05-2.20); X-ray with free air (RR = 2.80, 95% CI 2.08-3.77); and referral from other hospitals (RR = 1.37, 95% CI 1.03-1.82). Conclusion: Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer. © 2011 Suriya et al, publisher and licensee Dove Medical Press Ltd.
Suriya C.,Chiang Mai University |
Kasatpibal N.,Chiang Mai University |
Kunaviktikul W.,Chiang Mai University |
Kayee T.,Nakornping Hospital
Clinical and Experimental Gastroenterology | Year: 2012
Objective: To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP). Methods: A case-control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P ≥ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems. Results: A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal antiinflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0-6.0 and the total score ranged from 0-34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores < 10.5), moderate risk (scores 11-21), and high risk (scores ≥ 21.5) patients was 0.13, 11.44, and 1.95, respectively. Conclusion: This scoring system is an effective diagnostic indicator for identifying the complex cases of PUP. It is a simple system and can help guide clinicians, providing them with a more efficient way to accurately subgroup patients while also reducing potential biases. © 2012 Suriya et al, publisher and licensee Dove Medical Press Ltd.
PubMed | Chiang Mai University and Nakornping Hospital
Type: | Journal: Journal of intensive care | Year: 2016
Ventilator-associated pneumonia (VAP) caused by drug-resistant Acinetobacter baumannii is associated with high mortality in critically ill patients. We identified the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP.A retrospective cohort study was conducted in the Medical Intensive Care Unit at Chiang Mai University Hospital, Thailand. All adult patients diagnosed with A. baumannii VAP between 2005 and 2011 were eligible. Univariable and multivariable Coxs proportional hazards regression were performed to identify the prognostic factors of 30-day mortality.A total of 337 patients with microbiologically confirmed A. baumannii VAP were included. The proportion of drug-sensitive (DS), MDR, XDR, and PDR A. baumannii were 9.8%, 21.4%, 65.3%, and 3.6%, respectively. The 30-day mortality rates were 21.2%, 31.9%, 56.8%, and 66.7%, respectively. The independent prognostic factors were SOFA score >5 (hazard ratio (HR)=3.33, 95% confidence interval (CI) 1.94-5.72, P<0.001), presence of septic shock (HR=2.66, 95% CI 1.71-4.12, P<0.001), Simplified Acute Physiology Score (SAPS) II >45 (HR=1.58, 95% CI 1.01-2.46, P=0.045), and inappropriate initial antibiotic treatment (HR=1.53, 95% CI 1.08-2.20, P=0.016).Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high mortality rate. Septic shock, high SAPS II, high SOFA score, and inappropriate initial antibiotic treatment were independent prognostic factors for 30-day mortality.