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Methawasin K.,Srinakharinwirot UniversityNakhon Nayok | Suwanwela N.C.,Chulalongkorn University | Phanthumchinda K.,Chulalongkorn University
Journal of the Medical Association of Thailand | Year: 2015

Objective: The risk of recurrent ischemic stroke and acute coronary syndrome increased in the large artery atherosclerotic subtype. The purpose of this study was to compare 2-year outcomes between the ischemic stroke patients with intracranial arterial stenosis without significant extracranial carotid stenosis and the patients with extracranial carotid stenosis. Material and Method: This study prospectively compared 123 ischemic stroke patients: 71 patients with intracranial arterial stenosis without significant extracranial carotid stenosis and 52 patients with extracranial carotid stenosis. Neurologic and radiologic investigations were performed at the beginning of the study. All of them were treated as regular outpatients of the neurology unit with a mean follow-up of 24 months. Recurrent stroke, myocardial infarction, and death were recorded. Results: Fifteen patients of the extracranial carotid stenosis group and eighteen patients of the intracranial arterial stenosis without significant extracranial carotid stenosis group developed recurrent stroke during follow-up (p = 0.40). Acute coronary syndrome occurred in eight patients of the extracranial carotid stenosis group and only one of the intracranial arterial stenosis without significant extracranial carotid stenosis group (p = 0.004). Causes of death were end stage cancers, stroke and related conditions, and acute coronary syndrome. The multivariate analysis showed that symptomatic extracranial carotid stenosis is an important risk factor of the acute coronary syndrome (p = 0.03, OR = 10.81, 95% CI 1.23-94.77). Conclusion: There was no significant difference of recurrent ischemic stroke and recurrent stroke between patients with intracranial arterial stenosis without extracranial carotid stenosis and patients with extracranial carotid stenosis. On the other hand, patients with extracranial carotid stenosis had more incidences of acute coronary syndrome significantly than patients with intracranial arterial stenosis. © 2015, Medical Association of Thailand. All rights reserved.


Upapan P.,Srinakharinwirot UniversityNakhon Nayok
Journal of the Medical Association of Thailand | Year: 2015

Erysipelothrix rhusiopathiae infection in humans may not be as rare as previously thought. In most cases, the disease is acquired from animals through work-related exposure. Human infection has been reported since the early 1900’s up to the present. Unsolved issues associated with this organism include inadequate disease control in animals, difficulty in identification and isolation of the bacteria, diagnostic delay due to unawareness of this uncommon disease or unfamiliarity with the increasingly diverse clinical manifestations, and inappropriate antibiotic use due to misdiagnosis, as well as drug resistance. In this review, we attempt to address the unsolved issues related to human Erysipelothrix infection and suggest possible solutions. © 2015, Medical Association of Thailand. All rights reserved.


Chuchuen U.,Srinakharinwirot UniversityNakhon Nayok | Parnpiansil P.,In Buri Hospital | Busarakumtragul P.,Srinakharinwirot University
Journal of the Medical Association of Thailand | Year: 2015

Background: Laughing is a kind of well known alternative medicine used to treat stressful persons or depressive patients to relax. The laughing program used in this study was initially designed by Thai psychiatrists. It consists of deep diaphragmatic breathing exercises, voice expression, facial expression exercises and aerobic exercises, which are expected to promote good health. Objective: To evaluate the effects of the laughing training on stress levels in Thai private office workers. Material and Method: Thirty-eight subjects whose age 25-60 years were recruited to enroll in this program. They were randomly divided into two groups: 20 people for the experimental group and 18 persons for the control group. The experimental subjects participated in laughing program for 3 days/week, 60 minutes/day for 8 consecutive weeks. The program took place from June to July 2013. The level of stress was assessed using the Suanprung stress test-60 (SPST-60). The data were analyzed by descriptive statistics, t-test dependent and t-test independent with p<0.05 considered significant. Results: After they joined the laughing program, no significant difference was found in the mean scores of the level of stress between the control and experimental groups. However, the sensitivities to the arousal events in the experimental group had a tendency to decrease. Conclusion: Laughing training may be used as a tool to promote better health. There was no significant difference in the stress levels after the program was ended except a decrement tendency in the sensitivities to the arousal events. For further study, duration and intensity of the course may be adjusted for a more effective training program. © 2015, Medical Association of Thailand. All rights reserved.


Tantisiriwat W.,Srinakharinwirot UniversityNakhon Nayok | Santiwattanakul S.,Srinakharinwirot University
Journal of the Medical Association of Thailand | Year: 2015

Objective: To identify the epidemiology of candida isolations in HRH Princess Maha Chakri Sirindhorn Medical Center and the sensitivity of all candida species to fluconazole. Material and Method: Two hundred of Candida albicans and other Candida species from clinical specimens were collected from microbiological department between January 2010 and April 2012. All Candida were identified by standard methods and the sensitivity of fluconazole was tested by using fluconazole E test test. Results: There were 8 species of Candida in this study including: C. albicans (n = 94), C. tropicalis (n = 66), C. glabrata (n = 11), C. guilliermondii (n = 10), C. parapsilosis (n = 9), C. zeylanoides (n = 4), C. keyfr (C. pseudotropicalis) (n = 2), C. lusitaniae (n = 1), Candida species (n = 3). The percentage of non-albicans Candida spp. was slightly higher than C. albicans (53% vs. 47%). C. tropicalis was identified as the highest percentage of all non-albicans Candida spp. Fluconazole resistant strains were detected among C. albicans (35.71%), C. tropicalis (13.85%), C. guilliermondii (20.0%), and C. zeylanoides (50.0%). The common spp. with highest percentage of resistant strain was C. albicans. Conclusion: Fluconazole could be used as the first-line antifungal for candidiasis at HRH Princess Maha Chakri Sirindhorn Medical Center. Empirical treatment with amphotericin B and stepping down to fluconazole when sensitivity suggested might be the recommendation for severe cases in our setting. © 2015, Medical Association of Thailand. All rights reserved.


Benjasuwantep B.,Srinakharinwirot UniversityNakhon Nayok | Rattanamongkolgul S.,Srinakharinwirot UniversityNakhon Nayok | Ramsay M.,McGill University
Journal of the Medical Association of Thailand | Year: 2015

Objective: To standardize and evaluate the psychometric properties of the Thai version of the Montreal Children’s Hospital Feeding Scale (MCH-FS). Material and Method: The MCH-FS was translated and the cultural effects of the Thai version (Thai.MCH-FS) were reviewed. Caregivers of 200 children between the age of 12 and 48 months were interviewed and completed the Thai.MCH-FS. In addition to demographic information, each child had a physical exam and anthropometric measures were taken. Each child was classified with or without feeding problems by at least two of three pediatricians who were blind to the results of the feeding scale. Results: Internal consistency for reliability was high (Cronbach’s alpha at 0.835). The area under the ROC curve was 0.864. With a discrimination score of 40, both sensitivity (72%) and specificity (80.67%) were at acceptable levels. Factor analysis resulted in three factors accounting for 52.3%. Of the 200 children, 150 children were classified with no feeding problems and 50 with feeding problems. There were no significant differences in the characteristics of the two groups; however, the Thai.MCH-FS scores were significantly different for the two groups. Conclusion: The Thai version of the MCH-FS has been shown to be a valid and reliable short scale for detecting feeding problems in a pediatric care setting. © 2015, Medical Association of Thailand. All rights reserved.

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