Bangkok, Thailand
Bangkok, Thailand

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Anannamcharoen S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Determine the relationship between vascular endothelial growth factor (VEGF) expression and microvascular density (MVD) in primary colorectal cancer specimens including the prognostic value by evaluating the correlation between various common reported prognostic histopathologic indictors and these two angiogenic parameters. The Inter-observer reliability on VEGF and MVD measurement was also determined. Anti-VEGF and anti-factor CD34 monoclonal antibodies immunohistochemical staining was performed in 40 randomly selected formalin-fixed paraffin-embedded colorectal cancer specimens of non-stage-IV patients who underwent curative resection using. Immunoreactive in 25% or more carcinoma cells was categorized as positive. The intensity of VEGF expression was graded in a semiquantitative fashion, ranging from 0 to 2 Tumor MVD was determined by counting any endothelial cells stained with CD34 per two randomly selected fields at x200 magnification in each slide. The correlation between VEGF expression and MVD was evaluated. Inter-observer agreement was assessed by comparing the results of VEGF and MVD measurements made by two pathologists. A moderate correlation was found between the percentage of positive immunoreactive cells and the intensity of VEGF immunoreactive staining (correlation value of 0.436, p < 0.05). MVD was found having no correlation with both the percentage of positive immunoreactive cells and intensity of VEGF immunoreactive staining (the correlation value of -0.056, p = 0.732 and 0.108, p = 0.506, respectively). Neither MVD nor VEGF expression in primary colorectal cancer tissue was found having a significant correlation with any common reported prognostic histopathologic indictors. In counting CD34-stained endothelial cells, this study revealed a high intra-observer correlation coefficient of 0.886 (95% CI: 0.715-0.955) for the first pathologist and 0.913 (95% CI: 0.782-0.965) for the second. High inter-observer reliability was found in both MVD and VEGF measurement with a substantial agreement (agreement: 95%, kappa = 0.643) between the two pathologists. In primary colorectal cancer tissues, there was no significant relationship between MVD and VEGF expression. This study revealed a high intra and inter-observer reliability on VEGF and MVD measurement. Neither MVD nor VEGF expression provided predictive value of advanced or aggressiveness of disease. Further studies on larger sample size would help validate these results.


Srisuwan P.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand | Year: 2013

Background: Dementia will inevitably increase in the aging world. Moreover, there is no cure for dementia. Therefore, primary prevention is very important. There are several factors possibly and/or certainly influencing dementia risk including non-modifiable and modifiable risk factors. There are evidences that the risk of developing dementia may be reduced by modifiable risk factors. Lifestyle factors: The strategies are to encourage regular physical and mental exercise in midlife and in late-life. Those include cognitive activity and higher education, mentally demanding occupations or participation in mentally challenging leisure activities, being more socially active, a diet that is low in saturated fat, a diet with lots of fruits and vegetables, smoking cessation, and prevention of head injury, with loss of consciousness Chronic disease factors: The strategies are to prevent high blood pressure, especially at midlife, diabetes, high serum cholesterol, especially at midlife, and depression or high depressive symptoms. Conclusion: It is important to develop a systematic public-health strategy and research specific to primary prevention of dementia in Thailand with the evidence-based medicine.


Chuengchitraks S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To demonstrate the incidence of catheter-related blood stream infection (CRBSI) of patients in the pediatric intensive care unit (PICU) after implementing the new guideline to prevent CRBSI. All patients who were admitted to PICU at Phramongkutklao Hospital between January and December 2006 and had central venous catheter (CVC) inserted from the operation room before admission or CVC placed in the PICU were included in a cohort study with longitudinal assessment of an overall catheter care policy targeted at the reduction of vascular access infection. The guideline included five key components (hand hygiene, maximal barrier precautions, povidine skin antiseptic, optimal catheter site selection, daily review of line necessity with prompt removal of unnecessary lines) called "central line bundle". All nursing staffs in the PICU were asked to attend an educational meeting in order to review the scientific data on vascular access insertion, device use and care. Data regarding age, underlying disease, location of insertion, duration, and complication were recorded. A total of 61 patients were recruited. Average duration of catheterization was 8.7 days. Complications were found in 8 cases (13.1%). Hematoma was the most common complication (6.6%) followed by infection (3.3%). Rate of CRBSI was reduced from 2.6 per 1000 catheter days to 2.4 per 1000 catheter days after implementing the new practice guideline. Rate of CRBSI was reduced after implementing the new "central line bundle" guideline to prevent CRBSI.


Sutthavong S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

Dental caries remains a public health problem even though it is preventable. There are several risk factors that relate to dental caries, especially in children in suburban and rural areas, where they normally receive their first dental examination in primary schools by teachers or health care personnel. Their oral health depends primarily on their parents' awareness. To identify prevalence and severity of dental caries and their risk factors among children in public education centers in Phranakornsriayudhya, Thailand. A cross-sectional total study was conducted among children attending public education centers in Koh-Rean Subdistrict, Phranakornsriayudhya District, Phranakornsriayudhya Province, Thailand including a day care center, 2 kindergartens and 2 elementary schools, during the academic year of 2005. All children were invited to attend a dental health survey including general oral examination and a face to face interview for the participants' parents as well as children attending grade 1-6. Standardized questionnaires were used to identify the participants' oral health care behaviors. There were 157 (99.4%) from 158 children aged 2-12 years participated in the survey, 152 (96.8%) students had dental caries. The prevalence of dental caries among pre-school children was 95.4%. The overall average Decay Missing Filling for primary teeth (dmft) was 7.4 (+/- 4.6) and the overall average Decay Missing Filling for permanent teeth (DMFT) was 3.7 (+/- 1.8). The dmft among pre-school children was 9.1 (+/- 5.2). The prevalence of gingivitis was 95.5%. The independence risk factors for dental caries for primary teeth were brushing under supervision of teacher when compared with the parents (Odds ratio = 12.1 (95% CI, 2.6-55.4)), and not brushing after breakfast (Odds ratio = 3.7 (95% CI, 1.1-12.1). There were no significant risk factors of dental caries for permanent teeth. A relatively high prevalence of dental caries was observed among children in suburban area in Thailand, especially in early childhood. It was shown that having the parents supervising their tooth brushing and having tooth brushing after breakfast may protect the dental caries for primary teeth. The public health interventions among this population are therefore urgently needed.


Surangsrirat S.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To assess the association between Blastocystis infection and irritable bowel syndrome (IBS) in Thai patients, Phramongkutklao Hospital. A case-control study was conducted at Phramongkutklao Hospital, Bangkok, Thailand during 2007-2008. A total of 126 subjects were enrolled into the study. Sixty-six persons were enrolled in the IBS group and 60 persons were enrolled in the control group. Intestinal parasitic infections were determined using wet preparation and formalin-ethyl acetate concentration. Short-term in vitro culture was performed to detect Blastocystis sp. Additionally, stool specimens were cultured for pathogenic bacteria. Patients' history and physical examination were also recorded. Of 66 IBS patients, 61 (92.4%) had abdominal pain, 50 (78.1%) had diarrhea, and 14 (21.9%) had constipation. In vitro cultivation revealed that 10.0% and 16.7% were positive for Blastocystis sp. in the control and IBS group, respectively. There was no significant difference of the prevalence of Blastocystis infection between these 2 groups (p = 0.203). Blastocystis infection was a common parasitic infection which was predominant in both IBS and control group. The presence of Blastocystis sp. in stool did not imply gastrointestinal symptoms in the IBS patients. Further study of subtype characterization of Blastocystis sp. in a larger sample size of the case-control study might reveal a possible relationship between Blastocystis sp. and IBS patients.


Satirapoj B.,Phramongkutklao Hospital
Advances in Experimental Medicine and Biology | Year: 2013

The most common cause of end stage renal disease (ESRD) requiring dialysis is diabetes. Both environmental and genetic factors have been postulated as the risk factors of Diabetic Nephropathy (DN). Hyperglycemia-induced metabolic and hemodynamic pathways are recognized to be mediators of kidney injury. Multiple biochemical pathways have been postulated that explain how hyperglycemia causes tissue damage: Non-enzymatic glycation that generates advanced glycation end products, activation of protein kinase C, acceleration of the polyol pathway and oxidative stress. Three major histologic pathological changes occur in DN: Mesangial expansion, OBM thickening, and glomerular sclerosis. It now seems clear in targeting a therapeutic regimen to achieve blood glucose, blood pres sure and proteunuric goals, dietary protein and salt restriction, weight reduction, aggressive lipid lowering, smoking cessation and exercise. Multiple inten sive interventions reduce cardiovascular events as well as nephropathy by about half when compared with conventional multifactorial treatment. © 2012 Landes Bioscience and Springer Science+Business Media.


Phavichitr N.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Dyspepsia is a common form of chronic abdominal pain in children and adolescents. Although it is usually functional or non-organic in origin, it disturbs daily activities, school attendance and the child's wellbeing. The authors evaluated prevalence and factors associated with dyspepsia among schoolchildren by comparing life-style of dyspeptic children with their asymptomatic peers. Total 1181 schoolchildren (mean age 14.7 +/- 1.8 years) were recruited from three schools in Bangkok. Data on dyspeptic symptoms were collected by using a questionnaire based on Rome III classification system. Potential precipitating factors for dyspepsia and life-style related to dyspepsia were also explored in the questionnaire. Dyspepsia was reported in 24.0% of the subjects. Prevalence was significantly higher in girls than in boys (27.0% vs. 20.0% p = 0.006). There was no difference between the comparison groups in terms of school test scores, past medical illness, parental marital status, parental income, number of siblings,frequency of stool and spicy food, carbonated beverage or dairy product consumption. The dyspepsia group had higher percentage of family history of peptic ulcer (odds ratio [OR] = 2.5 [95% CI = 1.7 to 3.7]), history of taking medicine (OR 1.7 [1 .0 to 2.9]), alcohol consumption (OR 2.4 [1.0 to 5.7]), severe stress (OR = 3.4 [1.2 to 9.9]) and extreme stress (OR = 3.9 [1.3 to 12.0]). Prevalence of self-reported dyspepsia among schoolchildren in this survey was similar to those previously reported; with family history of peptic ulcer, history of taking medicine, alcohol consumption, stresses in life as potential risk factors.


Sansanayudh N.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

To compare changes of body water measured by using bioelectrical impedance analysis (BIA), between lercanidipine and amlodipine therapy. This is a prospective randomized open-label study in hypertensive outpatients. Eighty patients were randomized into two groups; 1) amlodipine 5 mg/d and 2) lercanidipine 10 mg/d. Patients were assessed for changes in total body water (TBW), extracellular water (ECW) and intracellular water (ICW) at week 4 and 8 after treatment. At baseline body water in both groups were similar. After treatment, both groups did not have significant changes in body water from baseline. Seven patients in amlodipine group (17.5%) and none of lercanidipine group developed edema; p = 0.012. Among those seven patients, TBW, ECW and ICW all increased significantly from baseline. BIA did not detected changes of body water in most patients. However, in patients who developed edema, TBW, ECW and LCW significantly increased from baseline with the greatest changes seen in extracellular compartment.


Chaichamnan K.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

Malignant proliferating trichilemmal tumors (MPTT) are rare neoplasm arising from outer root sheath of hair follicle, the diagnosis of which is base essentially on histological features resulting in occasionally misdiagnosis of squamous cell carcinoma. In difficult cases, however evaluation of additional parameters may be needed to differentiate benign proliferating trichilemmal tumor from MPTT or differentiate PTT and MPTT from squamous cell carcinoma. We report two cases of MPTT on which, in addition to histologic features, we have determined p53 immunohistochemical expression pattern, proliferative fraction, and CD34 expression. For comparison, concurrent proliferating trichilemmal tumors (PTT) and trichilemmal cysts (TC) as well as well-differentiated squamous cell carcinoma (SCC) were studied. The two MPTTs show expression of p53 with increased proliferative index as well as all three SCC. The PTTs and TCs stained negative and few basal cells for p53 and Ki-67, respectively. MPTTs exhibit CD34 immunoreactivity, indicating trichilemmal differentiation. The contrast p53 and Ki-67 expression pattern in MPTT and PTT may be helpful in the diagnosis of MPTT. Expression of CD34 may be an additional feature to distinguish MPTT from SCC.


Wacharasint P.,Phramongkutklao Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

To evaluate the effectiveness and accuracy of three dynamic indices, currently available in intensive care monitoring devices, which are pulse pressure variation (PPV), stroke volume variation (SVV) and pulse oximetry plethysmographic waveform variation (POPV) in septic patients. This prospective clinical trial was conducted in 20 deeply sedated septic patients 18 years of age and older who had invasive blood pressure monitoring with an intraarterial cannula. PPV, SVV and POPV (%) were calculated using five consecutive snapshots from every patient's monitor. Statistical analysis compared using linear regression, paired t-test or student t-test, and receiver operating characteristic (ROC) curve analysis. The authors found that, strong correlation existed of PPV for the detection of percent cardiac index change (r2 = 0.794, p < 0.001). A respiratory variation in POPV exceeding 14% (sensitivity of 72%, specificity of 90%), SVV exceeding 11% (sensitivity 90%, specificity 92%) allowed detection of PPV exceeding 12% (sensitivity 84%, specificity 96%). Comparing of PPV, SVV and POPV, PPV is the most correlate with percent change in cardiac index and the most effective dynamic index for predict fluid responsiveness in adult septic critically ill patients who are on controlled mechanical ventilator, followed by SVV and POPV.

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