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Nakhonsawan, Thailand

Lowprukmanee N.,Sawanpracharak Hospital
Journal of the Medical Association of Thailand | Year: 2013

Objective: To study the relationship of factors associated with clinical outcome in surgical groups of spontaneous intracerebral hematoma patients (SICH). Material and Method: The data were retrospectively collected from surgically treated SICH patients who had surgery at Sawanpracharak Hospital between October 2006 and September 2009. Risk factors (heart disease, previous stroke, hypertension, diabetes mellitus (DM), hyperlipidemia, obesity, smoking, alcoholic consumption, and family history), Glasgow Coma Scale (GCS), hematoma volume, midline shift (MS), intraventricular bleeding (IVH), hydrocephalus, convulsion, tracheostomy, pneumonia, rebleeding, operating time, and intraoperative blood loss were studied. Results: Throughout the study period, 380 patients with SICH underwent surgical treatment. Factors that were statistically significant related to outcome of SICH were age (p<0.001), diabetes mellitus (p<0.001), smoking (p = 0.003), alcoholic consumption (p = 0.001), Glasgow Coma Scale (p<0.001), hematoma volume (p<0.001), midline shift (p<0.001), intraventricular bleeding (p<0.001), hydrocephalus (p<0.001), pneumonia (p<0.001), rebleeding (p = 0.006), operating time (p<0.001), and intraoperative blood loss (p = 0.008). After logistic regression analysis was done, factors that were statistically significantly related were Glasgow Coma Scale 3 to 8 [OR 6.03 (3.09-11.75); p<0.001], Glasgow Coma Scale 9 to 12 [OR 3.29 (1.87-5.77); p<0.001], intraventricular bleeding [OR 2.33 (1.37-3.98); p = 0.002], pneumonia [OR 1.62 (1.00-4.23); p = 0.049], rebleeding [OR 2.30 (1.04-5.08); p = 0.040], operating time greater than two hours [OR 3.05 (1.11-8.34); p = 0.030], and midline shift greater than 10 mm [OR 2.07 (1.04-3.57); p = 0.038]. Conclusion: Outcome of surgical treatment of SICH in the present study were related to age, diabetes mellitus, smoking, alcoholic consumption, Glasgow Coma Scale 3 to 8 and 9 to 12, hematoma volume, midline shift greater than 10 mm, intraventricular bleeding, hydrocephalus, pneumonia, rebleeding, operating time greater than two hours, and intra operative blood loss. Source


Pongpan S.,Chiang Mai University | Patumanond J.,Thammasat University | Wisitwong A.,Sawanpracharak Hospital | Tawichasri C.,Clinical epidemiology society at chiang Mai | Namwongprom S.,Chiang Mai University
Risk Management and Healthcare Policy | Year: 2014

Objective: To validate a simple scoring system to classify dengue viral infection severity to patients in different settings. Methods: The developed scoring system derived from 777 patients from three tertiary-care hospitals was applied to 400 patients in the validation data obtained from another three tertiary-care hospitals. Percentage of correct classification, underestimation, and overestimation was compared. The score discriminative performance in the two datasets was compared by analysis of areas under the receiver operating characteristic curves. Results: Patients in the validation data were different from those in the development data in some aspects. In the validation data, classifying patients into three severity levels (dengue fever, dengue hemorrhagic fever, and dengue shock syndrome) yielded 50.8% correct prediction (versus 60.7% in the development data), with clinically acceptable underestimation (18.6% versus 25.7%) and overestimation (30.8% versus 13.5%). Despite the difference in predictive performances between the validation and the development data, the overall prediction of the scoring system is considered high. Conclusion: The developed severity score may be applied to classify patients with dengue viral infection into three severity levels with clinically acceptable under- or overestimation. Its impact when used in routine clinical practice should be a topic for further study. © 2014 Pongpan et al. Source


Chairat R.,Chiang Mai University | Puttisri A.,Sawanpracharak Hospital | Pamarapa A.,Uttaradit Hospital | Wongrach N.,Lampang Hospital | And 4 more authors.
Journal of the Medical Association of Thailand | Year: 2014

Objective: To describe the pattern of disease progression and to describe locoregional recurrence, distant recurrence, and death rates in breast cancer patients after complete treatment.Material and Method: Medical records of women diagnosed with breast cancer at two university affiliated tertiary care hospitals in the Northern Thailand that had complete treatments between 2006 and 2010 were traced. Extracted key information included patient clinical profiles and documented recurrence of cancer. The causes of death were verified from breast cancer case registration database, death certificates through The Ministry of Internal Affairs’ civil registration, by direct telephone contact, or by distributed prepaid postcards.Results: Medical records of 829 women diagnosed with breast cancer without prior evidence of distant metastasis, and had complete recommended treatment were included. Six hundred thirty seven women had not experienced any events up to the end of the follow-up (76.8%). The first occurring events were focused and categorized into three distinct types, locoregional recurrence (n = 83, median follow-up time = 34.2 months), distant recurrence (n = 78, median follow-up time = 35.4 months), and death without any evidences of locoregional or distant recurrences (n = 12, median follow-up time = 36.7 months). Distant recurrence after locoregional recurrence was reported (n = 33). There were109 patient who had died (breast cancer related death) up to the end of the follow-up (13.2%). The three types of consecutively occurring deaths were death after locoregional recurrence without any distant recurrences (n = 15), death after distant recurrence with locoregional recurrence (n = 21), and death after documented distant recurrence without any locoregional recurrences (n = 61).Conclusion: The trend was that the rate of the first occurring locoregional recurrence was slightly higher than that of distant recurrence. The death rate in patients without any recurrences was much lower than in those experiencing prior recurrences. The rates of disease progression from local recurrence to distant recurrence and to death were approximately 5 to 7 times faster in patients who had experienced earlier progressions. © 2014, Medical Association of Thailand. All rights reserved. Source


La-Orkhun V.,Chulalongkorn University | Supachokchaiwattana P.,Sawanpracharak Hospital | Lertsapcharoen P.,Chulalongkorn University | Khongphatthanayothin A.,Chulalongkorn University
Annals of Tropical Paediatrics | Year: 2011

Background: Various minor cardiac rhythm abnormalities have been reported in patients with dengue virus infection. Previous studies have used only random electrocardiograms (ECG) to assess the incidence of cardiac arrhythmias, and the time when the ECGs were undertaken was not systematically defined. Objectives: To evaluate cardiac arrhythmias and heart rate variability in children with dengue virus infection during the convalescent stage using Holter monitoring. Methods: Overnight 18-24-hour Holter monitoring was performed in 35 children [mean (SD) age 11.7 (2.3) y] at least 24 hours after defervescence (on the last day of admission). In 17 patients, time- and frequency-domain shortterm (5 minutes) heart rate variability (HRV) during the convalescent stage was also compared with the value obtained during the follow-up visit (at least 14 days after defervescence). Results: During the convalescent stage, cardiac rhythm abnormalities were found in ten patients (29%), including sinus pause (1), first-degree (2) and Mobitz type I second-degree AV block (Wenckebach) (3) and atrial (4) and ventricular ectopic beats (5). There was no relationship between the clinical severity of dengue virus infection (DF, DHF without shock and DSS) and the incidence of cardiac arrhythmia. There was no significant difference in the averaged RR interval, the time-domain HRV (SDNN, RMSSD, pNN 50) or frequency-domain HRV (LF, HF, LF/HF ratio) between the convalescent stage and at follow-up. Conclusion: Various benign bradyarrhythmias and ectopic beats are detected in patients with dengue virus infection during the convalescent stage. © W. S. Maney & Son Ltd 2011. Source


Thanapirom K.,Chulalongkorn University | Ridtitid W.,Chulalongkorn University | Rerknimitr R.,Chulalongkorn University | Thungsuk R.,Sawanpracharak Hospital | And 12 more authors.
Saudi Journal of Gastroenterology | Year: 2016

Background/Aim: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. Patients and Methods: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case-control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed. Result: Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow-Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization. Conclusion: In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay. © 2016 Saudi Journal of Gastroenterology (Official journal of The Saudi Gastroenterology Association) Published by Wolters Kluwer - Medknow. Source

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