Pausawasdi N.,Mahidol University |
Ratanachu-ek T.,Rajavithi Hospital
Digestive Endoscopy | Year: 2017
Incidental pancreatic cysts have become gradually more recognized in clinical practice as a result of increased use of transabdominal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). These lesions consist of inflammatory cysts (pseudocysts) and pancreatic cystic neoplasms (PCN) which have been classified as benign, premalignant and malignant. The diagnosis and management strategy of incidentally discovered pancreatic cysts can be challenging as the majority of them are PCN and CT or MRI alone may not be sufficient to provide an accurate diagnosis. Endoscopic ultrasound (EUS)-guided fine-needle aspiration provides a method to obtain cyst fluid for analysis and the recently developed EUS-based technology including contrast-enhanced ultrasound, cystoscopy and needle-based confocal laser endomicroscopy allows endosonographers to gain additional useful information. The current data suggest that EUS evaluation of pancreatic cysts offers some benefits especially in cases of inconclusive CT or MRI. © 2017 Japan Gastroenterological Endoscopy Society
Thu Thuy P.T.,Medic Medical Center |
Bunchorntavakul C.,Rajavithi Hospital |
Bunchorntavakul C.,University of Pennsylvania |
Tan Dat H.,Medic Medical Center |
Rajender Reddy K.,University of Pennsylvania
Journal of Hepatology | Year: 2012
Background & Aims: Genotype 6 chronic hepatitis C (HCV) is encountered predominantly in Southeast Asia and data on optimal treatment strategy is limited. This study was aimed at assessing the rate and predictors of sustained virological response (SVR) in genotype 6 chronic HCV following 48 and 24 weeks of pegylated interferon and ribavirin therapy. Methods: This investigator-initiated, open-label randomized trial was conducted in Vietnam between 2008 and 2010. One hundred and five treatment-naïve HCV genotype 6 patients were randomized to either 48-week (N = 70) or 24-week (N = 35) duration of pegylated interferon (PEG-IFN) alfa-2a 180 mcg/week and ribavirin (RBV) 15 mg/kg/day; 92 patients completed the study (63 in the 48-week and 29 in the 24-week group, respectively). Primary outcome was sustained virological response (SVR) as intention-to-treat analysis. Results: There was no statistical difference in SVR between 48-week and 24-week treated groups (71% vs. 60%, respectively; p = 0.24). In the 48-week and 24-week treatment groups, 81% and 80% of cases achieved rapid virological response (RVR) (p = 0.86), and 86% and 80% achieved complete early virological response (p = 0.45). Among those patients with RVR, SVR was in 86% (48-weeks), and 75% (24-weeks) of cases, whereas following non-RVR, only 8% of cases had an SVR with 48-week treatment duration. Conclusions: Overall, RVR was achieved in the majority of genotype 6 patients and, in those patients, similar and high rates of SVR were noted following 24-week and 48-week therapy. This observation, however, needs validation in a larger study to demonstrate non-inferiority of the shorter duration therapy. In non-RVR patients, even 48-week therapy achieved low SVR rates. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Bunchorntavakul C.,Rajavithi Hospital |
Reddy K.R.,University of Pennsylvania
Alimentary Pharmacology and Therapeutics | Year: 2015
Background The treatment of hepatitis C virus (HCV) has evolved dramatically after the introduction of direct acting anti-virals. NS5A protein plays an important role in HCV replication and is an attractive target for drug development. Aim To review clinical studies on the efficacy and safety of direct-acting anti-virals regimens containing daclastavir, an NS5A inhibitor, in the treatment of chronic hepatitis C. Methods A Medline search was undertaken to identify relevant literature using search terms including 'daclatasvir', 'HCV treatment' and 'NS5A inhibitors'. Furthermore, we scanned abstracts presented at the recent international meetings in liver disease, viral hepatitis and infectious disease, as well as the reference lists of the review articles to identify publications not retrieved by electronic searches. Results Daclatasvir is the first-in-class HCV NS5A inhibitor that has been demonstrated in Phase I-III trials to have a potent anti-viral effect and clinical efficacy across multiple HCV genotypes (GT). Daclastavir is generally safe and well tolerated, with a low barrier to resistance and low potential for drug-drug interaction. When Daclastavir is added to PEG-IFN/RBV platform, sustained virological response (SVR) rates are increased significantly compared with PEG-IFN/RBV alone. The all-oral combination of Daclastavir/asunaprevir (ASV; protease inhibitor) has high SVR rates against GT1b, but less activity against GT1a. Dual combination of Daclastavir/Sofosbuvir (SOF; nucleotide polymerase inhibitor) and triple combination of Daclastavir/ASV/beclabuvir (BCV; non-nucleoside polymerase inhibitor) have demonstrated >90% SVR rates in both treatment naïve and treatment-experienced patients with GT1. Furthermore, Daclastavir/SOF combination has also demonstrated up to 90% SVR rates in patients with GT3, and in those with human immunodeficiency virus coinfection, cirrhosis and post-transplant HCV recurrence with any GT. Daclastavir/ASV/BCV has primarily demonstrated near 100% SVR rates in patients with GT4. Conclusion Daclastavir-containing regimens, with or without PEG-IFN, have shown promising results in clinical trials, and present an excellent treatment option for those with chronic HCV and for multiple genotypes. © 2015 John Wiley & Sons Ltd.
Plewma P.,Rajavithi Hospital
Journal of the Medical Association of Thailand | Year: 2013
Objective: The aim of the present study was to identify the prevalence of exclusive breast-feeding after 2,4, and 6 months in Rajavithi Hospital. The present study evaluated the factors associated with discontinuing breast-feeding before the first two months of life in order to target early nursing interventions to encourage and support continued breast-feeding and increase the exclusive breast-feeding rate.Material and Method: From September 2010 to May 2011, mothers were interviewed prior to hospital discharge from the maternity ward and follow-up phone calls were made after 2,4 and 6 months postpartum. Results: The prevalence of exclusive breast-feeding after 2, 4 and 6 months was 57.9% (252 out of 435), 32.0% (139 out of 435) and 4.8% (21 out of 435) respectively. At 2 months postpartum, multivariate analysis was carried out to identify whether maternal obesity and breast-feeding intervals of more than 3 hours had a statistically significant association with cessation of breast-feeding. The most common reason for cessation of exclusive breast-feeding by mothers was their return to work. Conclusion: The prevalence of exclusive breast-feeding at 2, 4, and 6 months was 57.9%, 32.0% and 4.8%, respectively. Maternal obesity, and maternal breast-feeding for intervals of more than 3 hours prior to hospital discharge were risk factorsof early breast-feeding cessation at 2 months postpartum. This is an area on which we would target nursing interventions to prevent early unintended weaning.
Thongkoom P.,Rajavithi Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012
From 1999 to 2009, a total of 10,470 clinical enterococcal strains from patients in Rajavithi Hospital were isolated. Of these, 201 (1.9%) vancomycin-resistant enterococci (VRE) including 199 (99.0%) Enterococcus faecium and 2 (1.00%) Enterococcus faecalis were found. The incidence of VRE was 1.8% in 1999, 3.3% in 2000, 5.1% in 2001, 1.0% in 2002, 0.0% in 2003 and 2004, 1.1% in 2005, 4.7% in 2006, 1.9% in 2007, 2.2% in 2008 and 0.9% in 2009. Seventy-one VRE isolates were classified to VanA phenotype (69 VanA E. faecium and 2 VanA E. faecalis) and 130 were classified to VanB phenotype (VanB E. faecium). The rate of inpatient departments (IPD)-associated VRE (199 (99.0%) VRE isolates) was significantly greater than the incidence of outpatient departments (OPD)-VRE (2 (1.0%) VRE isolates). VRE were found in medical (33.7%), ICUs (15.6%) and surgical (15.1%) wards. VRE were mostly found in urine, 64.2%, following in pus, blood, genital and sputum specimens, 21.9%, 9.0%, 3.5% and 1.4%, respectively. VRE, especially vancomycin resistant E. faecium, were multidrug-resistant (resistance to ampicillin, tetracycline, norfloxacin, ciprofloxacin, erythromycin and gentamicin). All strains of VRE were fully susceptible to linezolid.
Ku G.,Sloan Kettering Cancer Center |
Tan I.B.,National Cancer Center Singapore |
Yau T.,University of Hong Kong |
Boku N.,Kanagawa University |
And 5 more authors.
The Lancet Oncology | Year: 2012
Colon cancer is seen with increasing frequency in the Asia-Pacific region, and it is one of the most important causes of cancer mortality worldwide. This article reviews the available evidence for optimum management of colon cancer-in particular, with respect to screening and early detection of colon cancer, laparoscopic surgical treatment, adjuvant treatment of individuals with high-risk stage II and stage III cancer, palliative treatment of patients with metastatic disease, and management of resectable and potentially resectable metastases-and how these strategies can be applied in Asian countries with different levels of health-care resources and economic development, stratified by basic, limited, enhanced, and maximum resource levels. © 2012 Elsevier Ltd.
Piampring P.,Rajavithi Hospital
Journal of the Medical Association of Thailand | Year: 2016
Background: Complete dentures are used to restore masticatory function, improve esthetics, enhance phonetic functionality, and facilitate social communication for edentulous patients. After long-term use, problems can arise because of changes in the patients’ condition and because of denture attrition. Objective: To survey problems encountered while using complete dentures, and to evaluate related factors after 3-8 years of use. Material and Method: One hundred and fourteen participants aged between 56 and 97 years who wore complete dentures supplied by Rajavithi Hospital between 2007 and 2012 were included in the survey. Data were collected via telephone interviews. Details were recorded for baseline characteristics of patients, how and when they used their dentures, how they maintained them, their perception of the condition of their dentures, and the problems that they encountered while using them. Descriptive statistics were used to evaluate patient characteristics and Chi-square/Fisher’s exact/Student t-tests were used to evaluate correlations between condition of dentures and patient factors. A p-value of less than 0.05 was considered statistically significant. Results: Half of all participants had problems in using complete dentures, and the most frequent difficulty was denture looseness, which affected about one-third of all patients. Marital status, whether or not participants had children, and time of wearing dentures were significantly related to having problems (p = 0.007, 0.039, and 0.003, respectively). Conclusion: Many complete denture patients had problems with denture looseness and dentists should recall these patients in a timely manner to help them achieve a better quality of life. © 2016, Medical Association of Thailand. All rights reserved.
Nuntagowat C.,Mahidol University |
Leelawat K.,Mahidol University |
Leelawat K.,Rajavithi Hospital |
Tohtong R.,Mahidol University
Clinical and Experimental Metastasis | Year: 2010
We studied the role of Neutrophil Gelatinase-associated Lipocalin (NGAL, lipocalin 2) in regulating the invasiveness of a cholangiocarcinoma cell line, RMCCA-1. RMCCA-1 cells expressed multiple forms of 25, 40, 75 and 115/135 kDa NGAL which were detected in the conditioned medium, whereas only the 25 kDa form was detected in the cell lysates. NGAL expression was induced by serum deprivation. NGAL downregulation by siRNA suppressed NGAL mRNA and protein expression by about 70-80%, concommittant with a significant reduction of in vitro invasiveness, migration and pro-MMP-9 activity, but not cell proliferation. Suppression of pro-MMP-9 activity paralleled a reduction of NGAL/MMP-9 complex in the conditioned medium, although MMP-9 mRNA expression was unaffected. Our data suggest that NGAL promotes the invasiveness of the cholangiocarcinoma cells by forming complex with MMP-9, stabilizing its activity and rendering the cancer cells to be more invasive. © 2010 Springer Science+Business Media B.V.
Atsawarungruangkit A.,Rajavithi Hospital
Medical Education Online | Year: 2015
Objectives: To evaluate the relationship between the pass rate of the American Board of Internal Medicine (ABIM) certifying exam and the characteristics of residency programs. Methods: The study used a retrospective, cross-sectional design with publicly available data fromthe ABIM and theFellowship andResidency Electronic InteractiveDatabase. All categorical residency programs with reported pass rates were included. Using univariate andmultivariate, linear regression analyses, I analyzed how69 factors (e.g., location, general information, number of faculty and trainees, work schedule, educational environment) are related to the pass rate. Results:Of 371 programs, only one region had a significantly different pass rate from the other regions; however, as no other characteristics were reported in this region, I excluded program location from further analysis. In the multivariate analysis, pass rate was significantly associated with four program characteristics: ratio of full-time equivalent paid faculty to positions, percentage of osteopathic doctors, formal mentoring program, and on-site child care (OCC). Numerous factors were not associated at all, including minimum exam scores, salary, vacation days, and average hours per week. Conclusions: As shown through the ratio of full-time equivalent paid faculty to positions and whether there was a formal mentoring program, a highly supervised training experience was strongly associated with the pass rate. In contrast, percentage of osteopathic doctors was inversely related to the pass rate. Programs with OCC significantly outperformed programs without OCC. This study suggested that enhancing supervision of training programs and offering parental support may help attract and produce competitive residents. © 2015 Amporn Atsawarungruangkit.
Bonnel A.R.,Baylor College of Medicine |
Bunchorntavakul C.,Rajavithi Hospital |
Rajender Reddy K.,University of Pennsylvania
Liver Transplantation | Year: 2014
The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to relieve the signs and symptoms of portal hypertension in patients with liver disease. The most common indications for placement are refractory ascites and variceal hemorrhage. In properly selected candidates, TIPS placement can serve as a bridge to liver transplantation. Expertise in TIPS placement after transplantation has significantly increased, which has allowed the procedure to become a viable option for retransplant candidates suffering the consequences of recurrent portal hypertension due to portal vein thrombosis, recurrent liver disease, or hepatic venous outflow obstruction (HVOO). However, TIPSs in liver transplant recipients are associated with a lower clinical response rate and a higher rate of complications in comparison with patients with native liver disease, and they are, therefore, generally reserved for patients with a Model for End-Stage Liver Disease (MELD) score ≤ 15 and ≤ 12 in patients with HCV. The role of TIPS placement in nonliver transplant recipients has been well studied in large trials, and it translates well into clinical applicability to candidates for orthotopic liver transplantation (OLT). However, the experience with OLT recipients is heterogeneous and restricted to small series. Thus, we focus here on reviewing the current literature and discussing the proper use of TIPSs in liver transplant recipients. © 2013 American Association for the Study of Liver Diseases.