Queen Sirikit National Institute of Child Health

Bangkok, Thailand

Queen Sirikit National Institute of Child Health

Bangkok, Thailand
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Daengsuwan T.,Queen Sirikit National Institute of Child Health | Watanatham S.,Queen Sirikit National Institute of Child Health
Asian Pacific Journal of Allergy and Immunology | Year: 2017

Introduction: Severe asthma attacks are life-threatening, and require serious medical attention. Intravenous MgSO4 is an efficient medication, proven to improve outcomes. To date, most research has focused on administration of nebulized MgSO4 in adults with critical asthma. However, its benefits for treating childhood asthma has been little investigated. This study compared the clinical efficacy and adverse effects of nebulized MgSO4 and intravenous MgSO4 in the treatment of children with severe acute asthma. Method: A prospective, open-label, randomized, controlled pilot study was conducted in children with severe asthma exacerbation admitted at the Queen Sirikit National Institute of Child Health. Twenty-eight patients were randomized to receive three intermittent doses of nebulized or intravenous MgSO4. The Modified Wood’s Clinical Asthma Score was determined prior to, and at 20, 40, 60, 120, 180 and 240 minutes after treatment administration. The length of hospital stay was also recorded. Results: Fifteen patients received nebulized isotonic MgSO4 and 13 were administered intravenous MgSO4. There were no differences in the baseline characteristics of the two groups, including their initial asthma severity scores (4.87 ± 0.92 vs. 5.0 +0.82; p = 0.69). No statistically significant differences between the two groups were identified at 60 minutes (2.47 ± 0.83 vs. 2.77 ± 0.93; p = 0.37) until 240 minutes. The length of hospital stay for both groups was also similar (4.0 ±1.2 vs. 4.54 ± 2.7; p = 0.51). No adverse effects from MgSO4 administration were observed among the participants. Conclusions: In this small sample size we demonstrated that nebulized MgSO4 and intravenous MgSO4 are both clinically beneficial and safe for Thai children suffering from severe asthma exacerbation. © 2017, Allergy and Immunology Society of Thailand. All rights reserved.


Punpanich W.,Queen Sirikit National Institute of Child Health | Punpanich W.,Rangsit University | Chotpitayasunondh T.,Queen Sirikit National Institute of Child Health | Chotpitayasunondh T.,Ministry of Public Health
International Journal of Infectious Diseases | Year: 2012

Objectives: The objective of this review is to provide updated information on the clinical spectrum and natural history of human influenza, including risk factors for severe disease, and to identify the knowledge gap in this area. Methods: We searched the MEDLINE database of the recent literature for the period January 2009 to August 17, 2011 with regard to the abovementioned aspects of human influenza, focusing on A(H1N1)pdm09 and seasonal influenza. Results: The clinical spectrum and outcomes of cases of A(H1N1)pdm09 influenza have been mild and rather indistinguishable from those of seasonal influenza. Sporadic cases covering a wide range of neurological complications have been reported. Underlying predisposing conditions considered to be high-risk for A(H1N1)pdm09 infections are generally similar to those of seasonal influenza, but with two additional risk groups: pregnant women and the morbidly obese. Co-infections with bacteria and D222/N variants or 225G substitution of the viral genome have also been reported to be significant factors associated with the severity of disease. The current knowledge gap includes: (1) a lack of clarification regarding the relatively greater severity of the Mexican A(H1N1)pdm09 influenza outbreak in the early phase of the pandemic; (2) insufficient data on the clinical impact, risk factors, and outcomes of human infections caused by resistant strains of influenza; and (3) insufficient data from less developed countries that would enable them to prioritize strategies for influenza prevention and control. Conclusions: Clinical features and risk factors of A(H1N1)pdm09 are comparable to those of seasonal influenza. Emerging risk factors for severe disease with A(H1N1)pdm09 include morbid obesity, pregnancy, bacterial co-infections, and D222/N variants or 225G substitution of the viral genome. © 2012 International Society for Infectious Diseases.


Bautista E.,National Institute of Respiratory Diseases | Chotpitayasunondh T.,Queen Sirikit National Institute of Child Health | Gao Z.,Peking University | Harper S.A.,Centers for Disease Control and Prevention | And 12 more authors.
New England Journal of Medicine | Year: 2010

As of March 2010, illness caused by the 2009 H1N1 virus had occurred in almost all countries, with more than 16,000 deaths from laboratory-confirmed cases reported to the World Health Organization (WHO). The United States saw an estimated 59 million pandemic H1N1 illnesses, 265,000 hospitalizations, and 12,000 deaths. This review by WHO experts summarizes the virologic, epidemiologic, and clinical data on the 2009 H1N1 virus and assesses future directions. Copyright © 2010 Massachusetts Medical Society.


Capeding M.R.,Institute of Tropical Medicine | Tran N.H.,Pasteur Institute Ho Chi Minh City | Hadinegoro S.R.S.,University of Indonesia | Ismail H.I.H.M.,Kuala Lumpur Hospital | And 21 more authors.
The Lancet | Year: 2014

Background An estimated 100 million people have symptomatic dengue infection every year. This is the fi rst report of a phase 3 vaccine effi cacy trial of a candidate dengue vaccine. We aimed to assess the effi cacy of the CYD dengue vaccine against symptomatic, virologically confi rmed dengue in children.Methods We did an observer-masked, randomised controlled, multicentre, phase 3 trial in fi ve countries in the Asia- Pacifi c region. Between June 3, and Dec 1, 2011, healthy children aged 214 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratifi ed by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective effi cacy against symptomatic, virologically confi rmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine effi cacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281.Findings We randomly assigned 10 275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confi rmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 565% (95% CI 438664) effi cacy. We recorded 647 serious adverse events (402 [62%] in the vaccine group and 245 [38%] in the control group). 54 (1%) children in the vaccine group and 33 (1%) of those in the control group had serious adverse events that happened within 28 days of vaccination. Serious adverse events were consistent with medical disorders in this age group and were mainly infections and injuries.Interpretation Our fi ndings show that dengue vaccine is effi cacious when given as three injections at months 0, 6, and 12 to children aged 214 years in endemic areas in Asia, and has a good safety profi le. Vaccination could reduce the incidence of symptomatic infection and hospital admission and has the potential to provide an important public health benefi t.Funding Sanofi Pasteur. © © 2014 Elsevier Ltd.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-TP | Phase: HEALTH-2007-2.3.3-4 | Award Amount: 4.17M | Year: 2008

RANGER addresses the HEALTH-2007-2.3.3-4: Innovative point-of-care (POC) diagnostic tests for influenza call by providing a innovative solution to the immediate need for a rapid, robust, cost effective & user friendly POC diagnostic for influenza. We will develop the following real-time PCR system: 1) A robust, portable system allowing testing at the POC anywhere in the world 2) Raw sample to result automation of the entire test process including sample preparation 3) Parallel processing of multiple samples & different sample types (aspirates & swabs) in a modular, user-friendly system 4) RAPID & simple positive/negative result to the end user 5) No need for an external computer or laboratory equipment 6) Low cost consumable & reagents with a target cost of < 10 per test 7) Sample preparation & freeze dried reagents pre-packaged into an ambient stable consumable to eliminate cold storage chains 8) High confidence PCR results providing sensitivity & specificity equivalent to reference laboratory assays a. Suitable for the diagnosis of early stage infections where viral titres can be low b. Applicable to late surveillance & can be used to confirm the results from lower cost, low performance screen tests such as antibody assays that have low sensitivity and specificity. c. Simultaneous identification of specific influenza strains & viral subtypes using multiplexing real-time PCR assays will also allow exclusion of related respiratory diseases 9) Surveillance Management software & geographical data using GPS, allowing health authorities to manage early stage epidemics. The RANGER consortium includes WHO reference sites for human influenza diagnostics & world leading companies to develop and validate a POC influenza diagnostic system within 2 years. This system will allow health systems to be better prepared for epidemics by enabling early identification of infection and thus timely implementation of containment/treatment strategies.


Sukswai P.,Queen Sirikit National Institute of Child Health
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2011

To evaluate the clinical features, causative pathogens and outcomes-related to acute hematogenous osteomyelitis and septic arthritis in pediatric patients. The authors conducted a retrospective cohort study of patients under 15 years of age with diagnosis of acute hematogenous osteomyelitis (AHO) and/or septic arthritis (SA), treated at Queen Sirikit National Institute of Child Health from 1996 to 2006. Demographic data, clinical characteristics, bacterial spectrum, and outcomes were collected. Potential risk factors for osteoarticular sequelae in the patients who had more than 2 years of follow-up were analyzed. One hundred and twenty-nine patients met the diagnostic criteria which included 51 cases with SA, 35 cases with AHO and 37 cases with both SA and AHO. The patient's age ranged between 1 day and 13 years 4 months, comprising 37 (28.6%) of newborns, 28 (21.7%) of > 1-12 months, 18 (14%) of > 1-3 years and 46 (35.7%) of > 3-15 years. Causative bacteria were found in 103 of 129 patients (80%), the two most common pathogens were methicillin-sensitive Staphylococcus aureus (MSSA) in 48 (46.6%) and methicillin-resistant Staphylococcus aureus (MRSA) in 18 (17.5%) cases. The initial temperature on admission day was high (> 37.5 degrees C) in only one-third of newborns, one-half of infants and two-thirds of the older group. The duration of antibiotic administration ranged between 21 and 56 days (mean 42 days). Arthrotomy or drainage and bone or joint aspiration underwent in 62% and 17% of cases respectively. Outcomes of 79 patients who had more than 2 years of follow-up identified osteoarticular sequelae in 23 patients (29%) that consisted of avascular necrosis of epiphysis, limb-length discrepancy and pathologic fractures. Univariate analysis for potential risk factors compared between sequelae and without sequelae groups demonstrated significant association with more than 1 week duration of presenting symptoms, newborn age group, hip joint infection, infection with MRSA and more than 3 days delayed treatment with appropriate antibiotics. MSSA was the most common bacterial pathogen causing pediatric osteoarticular infections in all age groups but was second to MRSA in the newborn group. Osteoarticular sequelae were avascular necrosis of epiphysis, limb length discrepancy, and pathologic fracture which were significantly related to longer duration of presenting symptoms, newborn age group, hip joint involvement, MRSA infection and delayed administration of appropriate antibiotics.


Kalayanarooj S.,Queen Sirikit National Institute of Child Health
Tropical Medicine and Health | Year: 2011

Dengue is one of the m Mosetd iimcipnoertant mosquito-borne viral illnesses. The first DHF outbreak was reported from the Philippines in 1953. Initially it was endemic only in Southeast Asia and the Western Pacific regions. After about 50 years from the first outbreak, it spread globally to almost every continent including North and South America, Australia and Africa. The majority of cases during the 50s to 80s were children, but today the disease affects both children and adults of all age groups. The disease is caused by dengue viruses that have four serotypes: dengue 1, dengue 2, dengue 3 and dengue 4. Primary infection usually results in milder illness, while more severe disease occurs in cases of repeated infection with different serotypes. In this paper clinical manifestations and management of dengue/DHF/DSS are summarized. © 2011 by The Japanese Society of Tropical Medicine.


Wutthiworawong B.,Queen Sirikit National Institute of Child Health
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2011

To assess a new method the "Combine Treatment" consisted of diode laser photocoagulation and intravitreal bevacizumab for treatment of AP-ROP. These retrospective and non-comparative case series study in twelve premature infants (7 Male, 5 Female) from ROP clinic with diagnosis of aggressive posterior retinopathy of prematurity (AP-ROP) based on indirect ophthalmoscopic examination were included in the present study. The "Combine Treatment" consisted of one treatment session in which diode laser photocoagulation was applied in the avascular zone (anterior and posterior to the presumed ridge include vascular nets up to the clear retina) followed by intravitreal injection of Bevacizumab (Avastin). Fundus photographs were obtained before and after the treatment using a wide-field digital pediatric imaging system (RetCam). Twenty-three eyes were treated with the "Combine Treatment". The rest were treated with only laser abrasion. All patients got favorable anatomical outcomes of all treated eyes. Proliferative tissue started regress 2 weeks after treatment and completed regress about 4.92 weeks (range; 3-7 weeks). There was neither progression of disease nor serious ocular or systemic complications. No further treatments were needed. In the present study, one session of the "Combine Treatment" leads to favorable anatomical outcomes for patients with AP-ROP. This new approach prevents aggressive progression and offers hope of good future vision to patients. The authors hope that this new approach will be another choice of treatment to prevent aggressive progression of the disease and gain good vision in the future.


Pukrushpan P.,Chulalongkorn University | Tulvatana W.,Chulalongkorn University | Pittayapongpat R.,Queen Sirikit National Institute of Child Health
Journal of AAPOS | Year: 2014

We report the clinical and pathological findings of a rare case of congenital uveal melanoma. A 7-week-old girl presented with history of a black area at the inner corner of her left eye since birth. Examination revealed an enlarged globe with an area of visible uveal pigment nasal to the cornea, an iris mass, and shallow anterior chamber in the left eye. Magnetic resonance imaging revealed an intraocular mass. Enucleation was performed when the girl was 2 months of age. Pathologic examination confirmed a malignant melanoma epithelioid cell type with extraocular extension. She was treated with chemotherapy and subtotal exenteration.


Thamkunanon V.,Queen Sirikit National Institute of Child Health
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2011

Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery. Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue surgery had been observed in these study groups of patients. Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6-12 months after operation. Analyzing GMFCS change was performed by statistics. Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group (92 month old), was a trend difference in statistic (p = 0.032). Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more benefit than older children.

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