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Chiang Mai, Thailand

Sriwongpan P.,Chiang Mai University | Krittigamas P.,Nakornping Hospital | Kantipong P.,Chiang Rai Prachanukroh Hospital | Kunyanone N.,Chiang Rai Prachanukroh Hospital | And 2 more authors.
Risk Management and Healthcare Policy

Background: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices. Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement), and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression. Results: A total of 526 patients were classified into nonsevere (n = 357), severe (n = 100), and deceased (n = 69). The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45-0.74, P < 0.001), increased pulse rate (OR = 1.03, 95% CI = 1.01-1.05, P < 0.001), presence of crepitation (OR = 3.25, 95% CI = 1.52-6.96, P =0.001) increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95-0.98, P = 0.001), increased aspartate aminotransferase (every 10 IU/L) (OR = 1.04, 95% CI = 1.02-1.06, P=0.001), increased serum albumin (OR = 0.47, 95% CI = 0.27-0.80, P = 0.001), increased serum creatinine (OR = 1.83, 95% CI = 1.50-2.24, P < 0.01), and increased levels of positive urine albumin (OR = 1.43, 95% CI = 1.17-1.75, P< 0.001). Conclusion: Patients suspicious of scrub typhus with low body temperature, rapid pulse rate, presence of crepitation, low percentage of lymphocyte, low serum albumin, elevated aspartate aminotransferase, elevated serum creatinine, and positive urine albumin should be monitored closely for severity progression. © 2013 Sriwongpan etal. Source

Jirawison C.,Nakornping Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet

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. Source

Inchai J.,Chiang Mai University | Liwsrisakun C.,Chiang Mai University | Theerakittikul T.,Chiang Mai University | Chaiwarith R.,Chiang Mai University | And 2 more authors.
Journal of Infection and Chemotherapy

Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii remains a significant cause of morbidity and mortality. Increasing antimicrobial resistance influences the selection of antibiotic treatment especially pandrug-resistant A.baumannii. A retrospective cohort study was conducted in the Medical Intensive Care Unit to identify the risk factors of VAP caused by multidrug-resistant A.baumannii (MDR-AB), extensively drug-resistant A.baumannii (XDR-AB) and pandrug-resistant A.baumannii (PDR-AB). All 337 adult patients with confirmed A.baumannii VAP were included. The incidence of MDR-AB, XDR-AB and PDR-AB were 72 (21.4%), 220 (65.3%) and 12 (3.6%), respectively. The risk factor for MDR-AB was prior use of carbapenems (OR 5.20; 95% CI 1.41-19.17). Risk factors for XDR-AB were the prior use of carbapenems (OR, 6.30; 95% CI, 1.80-21.97) and a high Sequential Organ Failure Assessment (SOFA) score (OR 1.35; 95% CI 1.07-1.71). In PDR-AB, the risk factors were the prior use of colistin (OR, 155.95; 95% CI, 8.00-3041.98), carbapenems (OR, 12.84; 95% CI, 1.60-103.20) and a high Simplified Acute Physiology Score (SAPS II) (OR 1.10; 95% CI 1.01-1.22). In conclusion, previous exposure to antibiotics and severity of VAP were risk factors of drug-resistant A. baumannii. Judicious use of carbapenems and colistin is recommended to prevent the antimicrobial-resistant strains of this organism. © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Source

Intaraphet S.,Chiang Mai University | Kasatpibal N.,Chiang Mai University | Siriaunkgul S.,Chiang Mai University | Sogaard M.,Aarhus University Hospital | And 4 more authors.
Asian Pacific Journal of Cancer Prevention

Background: Clarifying the prognostic impact of histological type is an essential issue that may influence the treatment and follow-up planning of newly diagnosed cervical cancer cases. This study aimed to evaluate the prognostic impact of histological type on survival and mortality in patients with cervical squamous cell carcinoma (SCC), adenocarcinoma (ADC) and small cell neuroendocrine carcinoma (SNEC). Materials and Methods: All patients with cervical cancer diagnosed and treated at Chiang Mai University Hospital between January 1995 and October 2011 were eligible. We included all patients with SNEC and a random weighted sample of patients with SCC and ADC. We used competing-risks regression analysis to evaluate the association between histological type and cancer-specific survival and mortality. Results: Of all 2,108 patients, 1,632 (77.4%) had SCC, 346 (16.4%) had ADC and 130 (6.2%) had SNEC. Overall, five-year cancer-specific survival was 60.0%, 54.7%, and 48.4% in patients with SCC, ADC and SNEC, respectively. After adjusting for other clinical and pathological factors, patients with SNEC and ADC had higher risk of cancer-related death compared with SCC patients (hazard ratio [HR] 2.6; 95% CI, 1.9-3.5 and HR 1.3; 95% CI, 1.1-1.5, respectively). Patients with SNEC were younger and had higher risk of cancer-related death in both early and advanced stages compared with SCC patients (HR 4.9; 95% CI, 2.7-9.1 and HR 2.5; 95% CI, 1.7-3.5, respectively). Those with advanced-stage ADC had a greater risk of cancer-related death (HR 1.4; 95% CI, 1.2-1.7) compared with those with advanced-stage SCC, while no significant difference was observed in patients with early stage lesions. Conclusion: Histological type is an important prognostic factor among patients with cervical cancer in Thailand. Though patients with SNEC were younger and more often had a diagnosis of early stage compared with ADC and SCC, SNEC was associated with poorest survival. ADC was associated with poorer survival compared with SCC in advanced stages, while no difference was observed at early stages. Further tailored treatment-strategies and follow-up planning among patients with different histological types should be considered. Source

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. Source

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