Tantiniramai S.,Prapokklao Hospital |
Lukkanapichonchut P.,Ratchaburi Hospital
Journal of the Medical Association of Thailand | Year: 2011
Objective: To study the health related quality of life (HRQOL) among Thai unilateral lower limb amputees and determine the factors associated with a good HRQOL. Material and Method: A postal survey with the WHOQOL-BREF-Thai questionnaire (26 items) to 1,300 people with LLA who received a lower limb prostheses from Siriraj Hospital, Prapokklao Hospital, and Ratchaburi Hospital between 2001and 2005 was conducted. Descriptive statistics were used to report the level of HRQOL. Chi-Square, independent Sample t-test and multivariate analysis by stepwise logistic regression were used to determine the factors associated with a good QOL. Results: Three hundred and nine questionnaires were completed from the 321 returned questionnaires (response rate 24.7%). Among these, 278 people were with unilateral LLA.They were 221males and 57 females with mean age 46.9 + 13.9 years old. The number of people with LLA who had poor, fair, and good QOL were 14 (5%), 241 (86.7%), and 23 (8.3%), respectively. Demographically, the people with LLA who had long duration of amputation (p = 0.001), higher education (p = 0.005), and had been employed after amputation (p < 0.001) had significantly better HRQOL. The amputees who had good wearing comfort (p = 0.04) after wearing the prostheses, had no phantom pain (p = 0.02), used no gait aids (p = 0.01), and had no body image anxiety (p = 0.01) had significantly better HRQOL. The factors associated with the good HRQOL were higher education (OR 3.2), having been employed after amputation (OR 2.1), and having good prosthetic wearing comfort (OR 1.3). Conclusion: Thai people with unilateral LLA reported primarily fair HRQOL. Having higher education, having been employed after amputation, and having good prosthetic wearing comfort were associated with the good HRQL.
Phumethum V.,Mount Sinai Hospital |
Phumethum V.,Prapokklao Hospital |
Jamal S.,St Michaels Hospital |
Johnson S.R.,Mount Sinai Hospital |
And 2 more authors.
Journal of Rheumatology | Year: 2011
Objective. Biologic agents are increasingly used in the rheumatic diseases. Their role in patients with systemic sclerosis (SSc) is uncertain. Our aim was to evaluate the effectiveness and safety of biologic agents in SSc. We review the evidence for the use of biologic agents to improve inflammatory arthritis, disability, and skin score, and we review adverse effects with biologic agents in patients with SSc. Methods. A systematic literature review was performed to identify studies evaluating the use of biologic agents in SSc. Medline, Embase, CINAHL, and Cochrane Database of Systematic Reviews were searched. A standardized abstraction form was used to extract biologic agent, study design, sample size, treatment effect, and adverse effects. Results. A total of 23 studies from 1413 citations were evaluated. Three studies evaluated infliximab, 3 evaluated etanercept, 3 evaluated antithymocyte globulin, 3 evaluated imatinib, 6 evaluated rituximab, and 1 study each evaluated interferon-γ (IFN-γ), IFN-α, relaxin, delipidated, deglycolipidated Mycobacterium vaccae, human anti-transforming growth factor β1 antibody, and oral type I collagen. Studies of etanercept and infliximab suggest improvements in inflammatory arthritis and Health Assessment Questionnaire Disability Index (HAQ-DI). None of the other biologic agents demonstrated reproducible, statistically significant improvements in joint count, HAQ-DI, or skin score. Conclusion. Anti-tumor necrosis factor-a agents may improve inflammatory arthritis and disability in SSc. The effect on skin score is uncertain. Adequately powered trials are needed to evaluate efficacy, and longitudinal studies are needed to evaluate longterm safety of these agents in SSc. The Journal of Rheumatology Copyright © 2011. All rights reserved.
Kongsap P.,Prapokklao Hospital |
Kongsap P.,Chulalongkorn University
Clinical Ophthalmology | Year: 2012
Purpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS) performed by third-year residents. Design: A randomized, controlled trial. Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75) or retrobulbar anesthesia (group 2, n = 75). Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS), operative time, and injection and operative complications. Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9) min vs 47.7 (10.9) min, and a median (interquartile range) pain score of 40 (range, 20-70) vs 40 (range, 20-50) were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3%) compared to the retrobulbar group (1.3%). The operative complication rate between groups was not different (P. 0.05). Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program. © 2012 Kongsap, publisher and licensee Dove Medical Press Ltd.
Omair M.A.,University of Toronto |
Phumethum V.,Prapokklao Hospital |
Johnson S.,University of Toronto
Clinical and Experimental Rheumatology | Year: 2012
Objectives: To assess the long-term safety and effectiveness of tumour necrosis factor (TNF) inhibitors in the treatment of systemic sclerosis (SSc) patients with inflammatory arthritis. Methods: SSc patients who fulfilled the ACR criteria and had inflammatory arthritis followed in The Scleroderma Programme at the Mount Sinai and Toronto Western Hospitals, Toronto, Canada who received a TNF inhibitors for 12 months or more were retrospectively reviewed. Safety outcomes included development of TNF inhibitor related side effects, malignancy and death. Effectiveness outcomes included swollen joint count, tender joint count, skin score, and self-reported pain score at 12 months, compared to baseline. Results: Ten SSc patients were identified: 7 (70%) were female and 6 (60%) had diffuse disease with a median skin score of 6. Six patients (60%) had ILD. At 12 months, the median swollen joint count and tender joint count significantly decreased from 10 to 0 (p<0.01) and 15 to 3 (p=0.02), respectively. The median pain score decreased from 6 to 3.5 (p=0.10). The median skin score remained unchanged at 6 months. The FVC and DLCO changed from 86% and 65% respectively, to 80% and 75% respectively. One patient developed uncomplicated herpes zoster. After 30 months, 3 patients (30%) developed malignancy. No death or other adverse events were observed. Conclusion: TNF inhibitors appear to be effective in the treatment of SSc-associated inflammatory arthritis. Skin score and lung function did not change significantly with therapy. However, malignancy occurred in one third of patients. Further studies are required to confirm these findings. © Clinical and Experimental Rheumatology 2012.
Katchamart W.,University of Toronto |
Katchamart W.,Mahidol University |
Johnson S.,University of Toronto |
Lin H.-J.L.,University of Toronto |
And 4 more authors.
Arthritis Care and Research | Year: 2010
Objective. To summarize the potential predictors of remission in patients with rheumatoid arthritis (RA). Methods. We performed a systematic review of prognostic studies that identified the predictors of remission in RA patients. Studies were identified in Medline, EMBase, and the Cochrane Registry, and by hand search. We included only studies performing multivariate analysis. Results. A total of 18 studies from 2,062 citations were included. The following variables were found to be the independent predictors of RA remission: male sex; young age; late-onset RA; short disease duration; nonsmoker; low baseline disease activity; mild functional impairment; low baseline radiographic damage; absence of rheumatoid factor and anti - citrullinated peptide; low serum level of acute-phase reactant, interleukin-2, and RANKL at baseline; MTHFR 677T alleles and 1298C alleles in the methotrexate (MTX) - treated patients; magnetization transfer ratio 2756A allele ± either the SLC 19A180A allele or the TYMS 3R-del6 haplotype in the MTX plus sulfasalazine combination - treated patients; early treatment with nonbiologic disease-modifying antirheumatic drug (DMARD) combinations; the use of anti - tumor necrosis factor (anti-TNF); the concurrent use of DMARDs in anti-TNF - treated patients; and moderate or good response to treatments at the first 6 months. The magnitude of the association in the individual predictor was diverse among the studies depending on the patient characteristics, the study characteristics, and the variables used to adjust for in the models. Conclusion. A number of independent predictors of remission, i.e., baseline clinical and laboratory characteristics and genetic markers, were summarized. The predictive value of prognostic factors recently identified needs to be confirmed. © 2010, American College of Rheumatology.
Prasarnphanich T.,Prapokklao Hospital
Journal of Pediatric Infectious Diseases | Year: 2010
There is a lack of data assessing the accuracy of clinical diagnosis of influenza in children. This study aimed to identify the clinical predictors of influenza infections and to validate the use of clinical criteria of influenza-like illness definition for the diagnosis of influenza in children. Virological influenza surveillance was conducted by collecting throat swab specimens for viral culture and clinical data from febrile children with acute respiratory tract infection at Prapokklao Hospital from July 2005 to September 2007. The criteria of influenza-like illness definition was modified for children and defined by the presence of fever > 38°C plus two of the following three symptoms: headache, cough and sore throat. Two hundred and four of 838 specimens (24%) yielded positive results for influenza virus isolates. Influenza A virus infections were more common than influenza B virus infections. In the multivariate analysis positive predictors of influenza infections were cough [odds ratio (OR)=2.07 95% confidence interval (CI)= 1.26-3.39] and age > 5 years old (OR=2.30, 95% CI=1.66-3.19), whereas diarrhea was inversely associated with influenza (OR=0.29, 95% CI=0.12-0.69). Both the World Health Organization criteria (OR=1.82, 95% CI=1.04-3.18) and the modified criteria for children (OR=1.86, 95% CI=1.38-2.56) showed a positive association with influenza infections. World Health Organization criteria showed high sensitivity and negative predictive value but low specificity and positive predictive value. The modified criteria for children showed fair sensitivity and specificity, high negative predictive value but low positive predictive value. According to the average proportion of positive isolates of 24%, influenza should be recognized as an important cause of acute respiratory tract infections in children especially in the endemic season, but the diagnosis of pediatric influenza cannot be established on clinical criteria alone. © 2010 - IOS Press and the authors. All rights reserved.
Kongsap P.,Prapokklao Hospital
International Journal of Ophthalmology | Year: 2010
AIM: To report the short-and medium-term outcomes of sutureless large-incision manual cataract extraction using the Kongsap (SLIMCE-K) technique. METHODS: This prospective study included 73 eyes of 73 patients who underwent cataract surgery performed by using the SLIMCE-K technique. The postoperative visualacuity , intraoperative and postoperative complications, and endothelial cell loss were evaluated. A follow-up visit, at least 6 months after the surgery , was included in the study . RESULTS: All patients had improved visual acuity after surgery . Uncorrected visual acuity (UCVA) was 6/18 or better in 55 eyes (75.3 %) at 1 week postoperatively and in 64 eyes (87.6%) at 6 weeks postoperatively (P=0.09). The best corrected visual acuity (BCVA) was 6/18 or better in 67 eyes (91.8%) at 1 week postoperatively and in 70 eyes (95.9%) at 6 weeks postoperatively . The results remained stable at 3 months and 6 months postoperatively . No significant intraoperative complications were encountered. The endothelial cell loss was 4.8% at the 3 -month follow -up examination. CONCLUSION: When performed by an experienced surgeon, SLIMCE-K is a safe and effective procedure that can be perform ed independent of phacoem ulsification machines. It can be used in any nuclear grading of cataract hardness that is common in developing countries. © International Journal of Ophthalmology Press.
Kongsap P.,Prapokklao Hospital
International Journal of Ophthalmology | Year: 2011
AIM: To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery (MSICS). METHODS: This was a prospective, non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision, i. e., the Blumenthal technique (group 1, n = 64) or a temporal scleral tunnel incision, i. e., the Ruit technique (group 2, n = 65). MSICS and intraocular lens implantation were performed through an unsutured 6.5- to 7.0-mm scleral tunnel incision. Uncorrected and corrected visual acuity, intraoperative and postoperative complications, and surgically induced astigmatism calculated by simple subtraction were compared. Patients were examined 1 day, 1 week, 1 month, and 3 months after surgery. RESULTS: Both groups achieved good visual outcomes with minor complications. Three months after surgery, the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group (P = 0.29). The average (SD) postoperative astigmatism was 0.87 (0.62) diopter (D) for the Blumenthal group and 0.86 (0.62) D for the Ruit group. The mean (SD) surgically induced astigmatism was 0.55 (0.45) D and 0.50 (0.44) D for the Blumenthal and Ruit groups, respectively (P = 0.52). Common complications were minimal hyphema and corneal edema. There was no statistically significant difference in the complication rate between the groups (P > 0.05). CONCLUSION: In MSICS, both the Blumenthal and Ruit techniques achieve good visual outcomes, with low complication rates.
Kongsap P.,Prapokklao Hospital
International Journal of Ophthalmology | Year: 2015
Aim: To assess the results of a modified technique for scleral fixation of a posterior chamber intraocular lens (IOL) in eyes which had deficient of posterior capsular support. Methods: This retrospective study was comprised of ten patients with deficient posterior capsular support who underwent one-haptic fixation of posterior chamber IOLs, between February 2010 and October 2011. IOL as implanted with one haptic supported on the capsular remnant and the other haptic drawn into the sulcus by anchoring suture without a knot. All patients were evaluated for pre- and postoperative visual acuity, lens centration, intra-and postoperative complications. Results: A knotless, one-haptic fixation of posterior chamber IOLs has successfully been performed on ten eyes. All cases had inadequate capsular support (i.e. a capsular tear ranged from 5 to 7 clock hours). The average age was 74.25±8.87y (SD). The average postoperative uncorrected visual acuity was 0.51 logMAR. Complications included hyphema in one eye, a mild inflammatory reaction in the anterior chamber in two eyes, and a transient rise in IOP in one eye. Neither IOL tilt nor dislocation was observed and there were no later complications. Conclusion: In the presence of insufficient capsular support, a knotless, one-haptic fixation of posterior chamber IOLs is a safe and viable option which reduces the operation time, and minimizes postoperative suture-related complications. © 2015, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.
Kongsap P.,Prapokklao Hospital
Clinical Ophthalmology | Year: 2010
Objective: To present a new surgical approach for the management of posteriorly dislocated lens by using a combination of 20-gauge (20G) and 23-gauge (23G) pars plana vitrectomy. Design: An interventional case series Methods: This technique was performed on six patients (five men, one woman; mean age, 66.67 years; range, 66-72 years). Two 23G trans-conjunctival sclerotomy ports were created for infusion and illumination along with a 20G sclerotomy port for introducing the vitrectomy probe or fragmatome. Results: This procedure was successfully performed on six eyes. On postoperative day one, the media were clear and the retina could be seen by indirect ophthalmoscopy. Hyphema developed in one eye and resolved within a week. There were no observed cases of retinal tear, wound leakage, hypotony, or endophthalmitis. The post-operative follow-up period ranged from three to twelve months (mean, 8.1 months). By the final visit, two patients had achieved a visual acuity of 20/40 or better, three patients, 20/70, and one patient, 20/200. Conclusion: The combination of 20G and 23G pars plana vitrectomy is an efficacious and safe procedure for management of posteriorly dislocated lens. ©2010 Kongsap, publisher and licensee Dove Medical Press Ltd.