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Permpalung N.,Columbia University | Wongrakpanich S.,Queen Savang Vadhana Memorial Hospital | Korpaisarn S.,Mahidol University | Tanratana P.,Mahidol University | And 2 more authors.
Vaccine | Year: 2013

Rabies is a fatal infectious disease. Because prevention is the key management for rabies, many vaccination regimens have been developed and used worldwide. The aims for developing rabies vaccination regimens include decreasing the number and amount of dosages, decreasing the duration and the number of clinical visits, and reducing cost. Interestingly, some intradermal (ID) regimens have proved to be as effective as the standard intramuscular (IM) regimens, and have been increasingly used in developing countries because they are less expensive. In this article, we reviewed rabies vaccines based on results obtained from clinical trials and international treatment guidelines for post-exposure prophylaxis, pre-exposure prophylaxis for the high risk group, and booster vaccination. © 2013 Elsevier Ltd.

Puthanakit T.,HIV Netherlands Australia Thailand Research Collaboration | Puthanakit T.,Red Cross | Saphonn V.,National Center for Dermatology and STDs | Ananworanich J.,HIV Netherlands Australia Thailand Research Collaboration | And 30 more authors.
The Lancet Infectious Diseases | Year: 2012

Background: The optimum time to start antiretroviral therapy for children diagnosed with HIV infection after 1 year of age is unknown. We assessed whether antiretroviral therapy could be deferred until CD4 percentages declined to less than 15% without affecting AIDS-free survival. Methods: In our multicentre, randomised, open-label trial at nine research sites in Thailand and Cambodia, we enrolled children aged 1-12 years who were infected with HIV and had CD4 percentages of 15-24%. Participants were randomly assigned (1:1) by a minimisation scheme to start antiretroviral therapy at study entry (early treatment group) or antiretroviral therapy to start when CD4 percentages declined to less than 15% (deferred treatment group). The primary endpoint was AIDS-free survival (based on US Centers for Disease Control and Prevention category C events) at week 144, assessed with the Kaplan-Meier analysis and the log-rank approach. This study is registered with ClinicalTrials.gov, number NCT00234091. Findings: Between March 28, 2006, and Sept 10, 2008, we enrolled 300 Thai and Cambodian children infected with HIV, with a median age of 6·4 years (IQR 3·9-8·4). 150 children were randomly allocated early antiretroviral therapy (one participant was excluded from analyses after withdrawing before week 0) and 150 children were randomly allocated deferred antiretroviral therapy. Median baseline CD4 percentage was 19% (16-22%). 69 children (46%) in the deferred treatment group started antiretroviral therapy during the study. AIDS-free survival at week 144 in the deferred treatment group was 98·7% (95% CI 94·7-99·7; 148 of 150 patients) compared with 97·9% (93·7-99·3; 146 of 149 patients) in the early treatment group (p=0·6). Interpretation: AIDS-free survival in both treatment groups was high. This low event rate meant that our study was underpowered to detect differences between treatment start times and thus additional follow-up of study participants or future studies are needed to answer this clinical question. Funding: US National Institutes of Health, Division of AIDS; National Institute of Allergy and Infectious Diseases; National Institute of Child Health and Human Development; and National Institute of Mental Health. © 2012 Elsevier Ltd.

Khanasuk Y.,Queen Savang Vadhana Memorial Hospital | Tanavalee A.,Chulalongkorn University
Journal of the Medical Association of Thailand | Year: 2015

Background: Low urine output (LUO) for six hours is defined as the stage that is at risk of acute renal failure. Major surgeries with a bloodless field, such as total knee arthroplasty (TKA), may be associated with LUO; however, there has been no study addressing this point. The present study evaluated the incidence of LUO and the effect of fluid balance on LUO in TKA patients during the first 24 hours after surgery. Material and Method: The authors retrospectively evaluated 257 uncomplicated patients undergoing unilateral TKA during the first 24 hours after surgery. Patients’ demographic data, intra-operative intravenous (IV) fluid replacement, postoperative IV fluid replacement, oral fluid intake, total fluid intake, postoperative urine output, blood collected from the drain, and the total visible fluid output during the first 24 hours after surgery were collected and evaluated. Results: The incidence of LUO was 19.1% (49/257) in the studied group. There were no significant differences in patients’ demographic data between the LUO and normal urine output (NUO) groups. Comparing the LUO and NUO groups, the LUO group had a lower volume of intra-operative fluid replacement, with statistical significance. There were no differences in postoperative IV fluid replacement and postoperative oral fluid intake between groups. Although 80.5% of the studied group had IV fluid replacement at a less than ideal level, at discharge there was no patient suffering from renal complications related to LUO. Discussion and Conclusion: Urine output is one of the common monitoring parameters of fluid balance in the perioperative period; it should be ≥0.5 mL/kg/h. Prolonged low urine output for six hours and for 12 hours are categorized as causing risk and injury to the kidney, respectively. The incidence of LUO at our institution during the first 24 hours after TKA is not uncommon and is significantly related to intra-operative fluid replacement. Fortunately, all LUO patients had further fluid replacement, resulting in no renal complications at discharge. As eighty percent of patients had less than ideal fluid replacement, and patients having LUO during the first 24 hours had a significantly lower volume of intra-operative fluid replacement, the authors propose reconsidering perioperative fluid replacement in TKA patients, especially intra-operative IV fluid to avoid LUO. © 2015, Medical Association of Thailand. All rights reserved.

Kanchanatawan W.,Lerdsin General Hospital | Arirachakaran A.,Police General Hospital | Chaijenkij K.,Mahidol University | Prasathaporn N.,Queen Savang Vadhana Memorial Hospital | And 3 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: To compare the clinical outcomes of osteoarthritis indices (WOMAC and Lequesne scores) and adverse events in the treatment of osteoarthritis (OA) of the knee with platelet-rich plasma (PRP) versus hyaluronic acid (HA) or placebo. Methods: A systematic review and meta-regression were performed to compare outcomes between PRP injections versus HA or placebo. Relevant randomized control trials were identified from Medline and Scopus from date of inception to 13 August 2015. Results: Nine of 551 studies were eligible; 6, 5, 5, 5, 2, 2, 2 and 7 studies were included in pooling of WOMAC total, pain, stiffness and function scores, Lequesne score, IKDC score, EQ-VAS score and adverse events in OA knee patients, respectively. The PRP injections had −15.4 (95 % CI −28.6, −2.3, p = 0.021), lower mean WOMAC total scores, and 8.83 (95 % CI 5.88, 11.78, p < 0.001), 7.37 (95 % CI 4.33, 10.05, p = 0.021) higher mean IKDC and EQ-VAS scores when compared to HA injections. However, PRP injections had no significant differences in WOMAC pain, stiffness and function scores, as well as Lequesne score and adverse events when compared to HA or placebo. Conclusion: In short-term outcomes (≤1 year), PRP injection has improved functional outcomes (WOMAC total scores, IKDC score and EQ-VAS) when compared to HA and placebo, but has no statistically significant difference in adverse events when compared to HA and placebo. This study suggests that PRP injection is more efficacious than HA injection and placebo in reducing symptoms and improving function and quality of life. It has the potential to be the treatment of choice in patients with mild-to-moderate OA of the knee who have not responded to conventional treatment. Level of evidence: I. © 2015, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).

Akawatcharangura P.,Queen Savang Vadhana Memorial Hospital | Taechakraichana N.,Chulalongkorn University | Osiri M.,Chulalongkorn University
Lupus | Year: 2016

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects most women of reproductive age. The prevalence of premature ovarian failure (POF) in SLE patients is higher than that in the general population. However, the data on this condition are limited in Asian countries. Objectives: To determine the prevalence and associated factors of POF in SLE patients who received immunosuppressive therapy. Methods: Women aged 18-40 years who were diagnosed with SLE according to the 1997 revised criteria for the classification of SLE or patients with biopsy-proven lupus nephritis were evaluated. All patients had received at least one of the following immunosuppressive agents: cyclophosphamide (CYC), azathioprine, mycophenolate mofetil, chlorambucil or cyclosporine for more than six months. POF was diagnosed in those who had sustained amenorrhea for more than six consecutive months, with a level of estradiol ≤ 110 pmol/L (30 pg/mL) and follicle stimulating hormone ≥40 IU/L. Results: Ninety two SLE patients were included in this study. Mean age at enrollment was 30 ± 6.9 years and disease duration was 103 ± 67.5 months. The mean Systemic Lupus International Collaborating Clinics/ American College of Rheumatology (SLICC/ACR) damage index was 1.7 ± 1.7. Seventy five patients (82%) had lupus nephritis. Sixty four patients (70%) received CYC. Eleven patients (12%) with POF were observed. For the binary logistic regression model, CYC cumulative dosage of more than 10 g was the only independent risk factor of POF (hazard ratio 17.0, 95%CI 1.96-147.72, p = 0.01). Conclusions: From our data, 12% of SLE patients developed POF. A cumulative dose of CYC of more than 10 g was the only risk factor for POF. To prevent these events, systematic evaluation and early recognition of POF should be promoted in the care of SLE patients. © The Author(s) 2015.

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