Nakhonsawan, Thailand
Nakhonsawan, Thailand

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PubMed | Maharaj Nakhonsithammarat Hospital, Chonburi Hospital, Sawanpracharak Hospital, Princess MahaChakriSirindhorn Medical Center Hospital and 7 more.
Type: Journal Article | Journal: Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association | Year: 2016

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.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.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.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.


PubMed | Rajavithi Hospital, Chonburi Hospital, Princess Maha Chakri Sirindhorn Medical Center Hospital, Sawanpracharak Hospital and 7 more.
Type: Journal Article | Journal: Journal of gastroenterology and hepatology | Year: 2016

Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB.During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis.A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS2 and FRS1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization.In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB.


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.


Pongpan S.,Chiang Mai University | Pongpan S.,Phrae Hospital | Patumanond J.,Thammasat University | Wisitwong A.,Sawanpracharak Hospital | And 2 more authors.
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.


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.


Tungpakorn N.,Sawanpracharak Hospital
Journal of Venomous Animals and Toxins Including Tropical Diseases | Year: 2010

Snakebites are endemic in some parts of Thailand, being associated with several complications. Ocular disturbances are uncommon, except in cases of corneal or conjunctival injury, when the eye is directly exposed to the snake venom. The present study presents a case of combined ophthalmic artery occlusion and transient central retinal artery occlusion with macular ischemia after a Russell's viper bite. © CEVAP 2010.


Wiboonchutikul S.,Mahidol University | Sungkanuparph S.,Mahidol University | Kiertiburanakul S.,Mahidol University | Chailurkit L.-O.,Mahidol University | And 4 more authors.
Journal of the International Association of Physicians in AIDS Care | Year: 2012

Vitamin D plays role in bone health and the regulation of the immune system. A cross-sectional study of serum 25-hydroxyvitamin D (25[OH]D) levels was conducted among HIV-1-infected Thai patients to determine the prevalence and associated factors of low vitamin D levels (25[OH]D <30 ng/mL) in tropical setting. 25-Hydroxyvitamin D was measured by liquid chromatography/tandem mass spectrometry. Of 178 patients, 58% received antiretroviral therapy at median (interquartile range [IQR]) duration of 7.4 (5.9-8.5) years. The prevalence of 25(OH)D deficiency (<20 ng/mL) and insufficiency (20-29.9 ng/mL) was 26.8% and 44.9%, respectively. Multivariate analysis showed that receiving efavirenz (EFV) was significantly associated with low vitamin D status (odds ratio = 3.60; 95% confidence interval, 1.06-12.15, P <.05). The mean (±standard deviation) level of 25(OH)D in patients receiving and not receiving EFV was 22.9 (6.6) and 28.6 (10.7) ng/mL, respectively, (P <.05). Low vitamin D status is common and needs to be assessed among HIV-infected patients including tropical residents especially when EFV is used. © SAGE Publications 2011.


Weraphong J.,Naresuan University | Pannarunothai S.,Naresuan University | Luxananun T.,Sawanpracharak Hospital | Junsri N.,Sawanpracharak Hospital | Deesawatsripetch S.,Sawanpracharak Hospital
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2013

This study explored the burden of household out-of-pocket health expenditure on urban inhabitants with different socio-economic status and health insurance schemes in Nakhon Sawan Municipality. This study employed a cross sectional survey by using a structured questionnaire. Health personnel from six primary care units interviewed a representative of the sampled households. Sampled households were selected by a two-stage random sampling technique. Descriptive statistics were used to describe general household characteristics, and Mantel-Haenszel odds ratio was used to explain the relationships between factors and catastrophic health expenditure. From 406 sampled households, there were 1,421 household members and 340 individuals who reported illness within the last month. The poor and non-poor groups reported hypertension, diabetes, and the common cold as the most common ailments. Most patients sought care at a regional hospital and then primary care units, drug stores, and private hospitals, respectively. Household out-of-pocket medical costs were most frequently paid to drug stores and to private clinics. The direct non-medical costs were mostly paid for transportation and food. Factors related to catastrohpic health expenditure were the Civil Servant Medical Benefit Scheme (CSMBS) cardholder, use of public hospital, private hospital, and clinic. Furthermore, catastrophic expenditures were related to non-medical costs and time loss for indirect cost. Catastrophic rates of the poor were 12.5 and 30.4% from direct and non-medical cost, respectively. The rates for the non-poor were lower.


Pawasuttikul C.,Sawanpracharak Hospital | Chantharasap T.,Sawanpracharak Hospital
Journal of the Medical Association of Thailand | Year: 2014

Objective: To determine the clinical results of patients with comminuted fractures of the distal femur treated by open biological reduction using an indirect reduction technique and locking compression plate (LCP) without primary bone grafting. Material and Method: Prospective observation was conducted with 40 patients (24 males and 16 females), average age 48.7 years (range 20-81), with distal femoral fractures AO/OTA types A2 (5), A3 (17), C2 (8) and C3 (10) who were treated using an open indirect reduction technique and fixation with LCP between May 2010 and December 2013. Among the 40 patients, 28 were closed fractures and 12 were open fractures. Clinical results were evaluated using the Neer score six months after surgery. Follow-up periods ranged from 12 to 36 months (average 18.35). Results: Thirty eight (95%) of the fractures healed completely without a secondary procedure. The average time to union was 14.45 weeks (range 12-24). The average knee range of motion was 2° (0-5) to 110° (20-140). Two patients had an implant failure which required revision and secondary iliac bone grafting. There were no varus or valgus deformities, no limb shortening and no deep infections. Neer scores were excellent in 18 cases (45%), good in 14(35%), fair in 6 (15%) and poor in 2 (5%). The mean Neer score was 83.60 (range 50-100). Conclusion: The indirect reduction technique for the treatment of comminuted distal femoral fractures provides satisfactory results when combined with LCP fixation. © 2014, Medical Association of Thailand. All rights reserved.


PubMed | Sawanpracharak Hospital
Type: Journal Article | Journal: Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2012

Traumatic brain injury is one of the major problems and leading cause of death worldwide. The present study was aimed to identify factors responsible for mortality by comparing survivors and nonsurvivors in patients that had a low probability of mortality.A nested case-control study was conducted at Sawanpracharak Hospital from January 1, 2007 to December 31, 2007. All head injury deaths that had TRISS-PS greater than 0.5 were enrolled as the case patients. Head injured patients with TRISS-PS greater than 0.5 and that survived were chosen as the control patients. The number of controls per case was 2:1. Patients with ages < 15 were excluded from the present study.Six factors associated with increased mortality are age > or = 45 years (OR = 1.61, 95% CI = 1.1-2.3), alcohol intoxication (OR = 3.11, 95% CI = 1.4-6.9), admission GCS 3-8 (OR = 4.16, 95% CI = 2.4-7.2), arrival GCS-M < or = 4 (OR = 1.46, 95% CI = 1.0-2.0), Head-AIS > or = 4 (OR = 3.31, 95% CI = 1.3-8.3), and admission SBP < 90 mmHg (OR = 13.36, 95% CI = 3.2-56.3).Head injury continues to be a substantial public health problem. Deaths that met criteria for low probability of mortality, especially in those without associated risk factors should be analyzed for errors that may be preventable.

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