Chulalongkorn Research Articles

Association between Vitamin D Receptor Single-Nucleotide Polymorphisms and Colorectal Cancer in the Thai Population: A Case-Control Study.

Vitamin D and its cognate intracellular nuclear receptor, namely, vitamin D receptor (VDR), are involved in the regulation of a variety of body metabolic processes, immune function, and oncogenesis. A large number of studies demonstrated the association of low vitamin D levels and variations in five common single nucleotide polymorphisms (SNPs), FokI, BsmI, Tru9I, ApaI, and TaqI, with the risk of several cancers, including colorectal cancers. However, these associations vary among different populations. This case-control study was aimed at analysing whether common single-nucleotide polymorphisms (SNPs) and haplotypes of the vitamin D receptor (VDR) gene contribute to colorectal carcinogenesis in the Thai population. We enrolled 364 Thai participants from King Chulalongkorn Memorial Hospital between 2014 and 2015. Half of the participants underwent colonoscopy and showed a normal colon without polyps (control group) and another half were newly diagnosed patients with colorectal cancer (CRC) by colonoscopy during the index period, were under treatment, or were followed up at the outpatient clinic (case group). Differences in allele and genotype frequencies of five common VDR SNPs, between the case and control groups, were the primary outcome measures. Differences in haplotype frequencies of the five SNPs between the case and control groups were the secondary outcome measures. Among the 364 participants, baseline characteristics were not significantly different between the case and control groups, except for the higher proportion of males in the CRC group. The mean vitamin D level was also not significantly different between the case and control groups (24.6 ± 9.1 vs. 25.3 ± 10.6 ng/mL, p = 0.52). None of the five VDR SNPs was associated with CRC development (p > 0.05). However, haplotype analysis of these polymorphisms demonstrated that the AGGT haplotype was associated with a decreased risk of CRC (odds ratio 0.24, 95% confidence interval 0.07-0.81, p = 0.01). The AGGT haplotype was associated with a lower risk of CRC in the Thai population. This genetic linkage might support the role of vitamin D in colorectal carcinogenesis. However, this finding requires further study within a larger population and a multivariate analysis of other established risk factors.

Clinical features and immunohistochemistry profile of biopsy-proven gastric gastrointestinal stromal tumor (GIST): a description of 5 years case series and literature review of GIST

Abstract Background Gastrointestinal stromal tumor (GIST) was the most common mesenchymal tumor of the gastrointestinal tract predominately occurring in the stomach. Although GIST was a rare disease, it was considered to be a life-threatening malignancy. Objective To explore the current status of gastric GIST in Thai patients. Method The medical records of patients who were diagnosed with histologically proven gastric GIST from 2012 to 2016 in King Chulalongkorn Memorial Hospital were reviewed. Results Of 22 patients, there were 14 (63.6%) females and 8 (36.4%) males with the mean age of 62.6 ± 14.8 years. The average duration before the first presentation was 12 weeks. The initial symptoms were upper gastrointestinal bleeding (50.0%) followed by abdominal pain (31.8%). Tumor mostly located at the proximal part (fundus and cardia) in 20 (90.9%) patients. At the time of the diagnosis, three patients (13.6%) had distant metastasis. Of this group, 77.3% underwent surgical treatment. Discussion Although gastric GIST was an uncommon disease, early diagnosis and prompt treatment could save the lives of many patients.

876-P: Accuracy of Continuous Glucose Monitoring Compared with Capillary Blood and Venous Plasma Glucose Measurements in Medical Intensive Care Unit Patients

Objective: To assess the accuracy of the subcutaneous continuous glucose monitoring (CGM) sensor by comparing to the capillary blood glucose (CBG) and venous plasma glucose (VPG) measurements in the medical intensive care unit (MICU) patients. Subjects and Methods: In a prospective study in patients in the MICUs, Medtronic Enlite sensor was inserted in the abdominal area. Paired sensor glucose readings with reference glucose values (CBG and VPG) were collected from MICU patients receiving intravenous insulin infusion therapy. The accuracy was assessed using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plot. Results: Twelve patients completed the study (age 69.3 ± 11.6 years; BMI 21.6 ± 2.9 kg/m2; APACHE II score 21.8 ± 6.3 and duration of CGM use 108.7 ± 41.1 hours). A total of 353 paired CGM and CBG glucose readings and 125 paired CGM and VPG readings were included in the analysis. Using CBG as the reference, MARD was 7.2%. The modified Bland-Altman plot showed 95% of the limit of agreement (LoA) was -18.4% to 19.2%. The SEG analysis showed that 100% of paired glucose values were within zones A or B. No clinically significant difference in the accuracy was seen between subgroups of vasopressor use (MARD 6.1% in the vasopressor group vs. 6.8% in the non-vasopressor group, p = NS). Using VPG as the reference, the MARD was 8.8%. The modified Bland-Altman plot showed 95% LoA of - 22.6% to 28.2%. The SEG analysis showed 95.2% of glucose readings were within zones A or B. Conclusion: The accuracy of the subcutaneous CGM sensor in MICU patients was comparable to that observed in non-critical care settings, with no device-related adverse events. The sensor accuracy remained within the similar range when using VPG as the references compared to using CBG as the references. No differences in terms of accuracy between the vasopressor and non-vasopressor groups were found in this study. Disclosure N. Laichuthai: None. P. Buranasupkajorn: None. W. Khovidhunkit: Speaker’s Bureau; Self; Amgen, AstraZeneca. Funding Quality Improvement Fund; King Chulalongkorn Memorial Hospital; Thai Red Cross Society (1-62-30101-A-11)

Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) for Prediction of Persistent AKI and Major Adverse Kidney Events

We aimed to determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) can accurately predict persistent AKI, major adverse kidney events at 30 days (MAKE30) and 365 days (MAKE365) in hospitalized AKI patients. This is a retrospective study of adult patients who were admitted at King Chulalongkorn Memorial Hospital. We performed multivariable logistic regression for persistent AKI, MAKE30, and MAKE365. We developed equations for predicting MAKE30 and MAKE365 and divided the dataset into derivation and validation cohorts. uNGAL performance and predictive models were assessed using the area under the receiver operating characteristic curve (AROC). Among 1,322 patients with AKI, 76.9%, 45.1%, and 61.7% had persistent AKI, MAKE30, and MAKE365. The AROC were 0.75 (95% confidence interval[CI] 0.70–0.80), 0.66 (95%CI 0.61–0.71), and 0.64 (95%CI 0.59–0.70) for prediction of persistent AKI, MAKE30, and MAKE365 by uNGAL. The AROC in the validation dataset combining uNGAL with clinical covariates were 0.74 (95%CI 0.69–0.79) and 0.72 (95%CI 0.67–0.77) for MAKE30 and MAKE365. We demonstrated an association between uNGAL and persistent AKI, MAKE30, and MAKE365. Prediction models combining uNGAL can modestly predict MAKE30 and MAKE365. Therefore, uNGAL is a useful tool for improving AKI risk stratification.

Comparison of Removable Rigid Dressing and Elastic Bandage for Residual Limb Maturation in Transtibial Amputees: A Randomized Controlled Trial

ObjectiveTo determine the effect of a removable rigid dressing (RRD) on the time to residual limb maturation compared with elastic bandage (EB) in transtibial amputees. DesignExperimental single-blinded (assessor-blinded) randomized controlled trial. SettingDepartment of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. ParticipantsTranstibial amputees (N=25) with immature residual limb. InterventionParticipants were allocated to use RRD or EB to achieve residual limb maturation, and all participants in both groups were trained with the same preprosthetic program. Main Outcome MeasuresThe time to residual limb maturation, patient satisfaction, and complications were compared between the 2 groups. ResultsMedian time to residual limb maturation was significantly lower in the RRD group (median, 28d [interquartile range, 17-51d]) than in the EB group (median, 54d [interquartile range, 30-77d]; P=.020). After accounting for time since amputation, maturation time remained significantly lower in the RRD group (adjusted hazard ratio, 3.32; 95% CI, 1.08-10.20; P=.036). There was no significant difference in complications or patient satisfaction. ConclusionIn postoperative management of transtibial amputation, the use of RRD had a significantly shorter period to residual limb maturation when compared with the EB group.

Cost effectiveness analysis of additional NK-1 receptor antagonist to olanzapine, ondansetron, and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving high-dose cisplatin.

e19398 Background: NK-1 receptor antagonist (NK1RA) is a standard anti-emetic agent in chemotherapy-induced nausea and vomiting (CINV) prevention in patients receiving high-dose (HD) cisplatin. However, in limited-resource settings, three-drug regimen including olanzapine, ondansetron and dexamethasone is affordable and effective in CINV prevention in these patients. Objectives: To evaluate cost effectiveness of additional NK1RA for CINV prevention in Thai patients receiving HD cisplatin in 3-cycle horizon, societal perspective. Methods: During January to December 2019, 20 patient receiving HD cisplatin were prospectively enrolled to receive standard three-drug regimen at King Chulalongkorn Memorial Hospital. Total medical resource utility, non-medical cost and clinical outcomes were actually collected and used for establishing decisional-tree model and cost-effectiveness analysis. Three arms decisional-tree model was constructed. First, standard strategy, a real-world practice in Thailand, patients received three-drug regimen in all cycles of chemotherapy. Second, NK1RA-rescue strategy, patients received three-drug regimen in the first cycle and additional NK1RA in subsequent cycles if the patients experienced CINV. Third, NK1RA upfront strategy, patients received four drug NK1RA-containing regimen in all cycles. Complete response (CR) rate was assumed to be 92.5% in NK1RA-containing regimen based on clinical trials. The study endpoint is to compare cost and QALYs in term of incremental cost-effectiveness ratio (ICER). Results: CR rates were 90% and 71% in first and second cycle in patients receiving standard regimen. The NK1RA upfront strategy produced greatest QALYs of 0.0351, followed by 0.0328 and 0.0292 in NK1RA-rescue strategy and standard strategy respectively. Mean total costs were 10420.46, 3332.19 and 2841.30 Thai baht (THB) respectively. The ICER of NK1RA-rescue strategy relative to standard strategy was 135,774 THB per QALY and the ICER of NK1RA upfront strategy relative to NK1RA-rescue strategy was 3,096,654 THB per QALY. Therefore, the ICER of NK1RA-rescue strategy but not NK1RA upfront strategy is considered to be cost effective at the willingness-to-pay level of 160,000 THB per QALY. Conclusions: Our findings suggested that the additional NK1RA as a rescue strategy is cost-effective in patients receiving HD cisplatin in Thai health care.

Effect of Anodal Transcranial Direct Current Stimulation at the Right Dorsolateral Prefrontal Cortex on the Cognitive Function in Patients With Mild Cognitive Impairment: A Randomized Double-Blind Controlled Trial

ObjectivesTo study the effect of anodal transcranial direct stimulation (atDCS) of the right dorsolateral prefrontal cortex (DLPFC) on cognitive function and side effects in patients with mild cognitive impairment. DesignExperimental double-blind randomized, sham-controlled trial. SettingDepartment of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital ParticipantsVolunteers (N=45) with mild cognitive impairment. InterventionsNot applicable. Main Outcome MeasuresThe atDCS group (n=23) were stimulated at 2 mA for 20 minutes with the anode on the right DLPFC and the cathode on the left supraorbital area. The control group (n=22) received placebo stimulation. Baseline cognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery test. Participants were treated 3 times per week for 4 weeks (12 sessions). Cognitive function and side effects were assessed immediately after the first stimulation, the last session, and 4 weeks after treatment. ResultsCambridge Neuropsychological Test Automated Battery results revealed a significant improvement in the accuracy of the visual sustained attention (VSA) in the atDCS group at all 3 time points, the spatial working memory and visual memory (VM) immediately after the first stimulation, and a decreased VM reaction time after 12 sessions. A long-lasting effect on VSA and VM were found 4 weeks after treatment. ConclusionsAnodal tDCS over the right DLPFC enhanced the VSA, spatial working memory, and VM accuracy after the first stimulation and reduced the reaction time of VM after 12 sessions. A long-lasting effect on VSA and VM was found 4 weeks after treatment. This study corroborated atDCS as a safe technique to improve cognitive function.

SAT-171 Adrenocortical Carcinoma in Thailand: A 10-Year Retrospective Review in a Single Tertiary Center

Background: Adrenocortical carcinoma (ACC) is a rare and fatal endocrine malignancy. This retrospective review aims to investigate treatment outcomes and clinical characteristics of 18 patients diagnosed with ACC at King Chulalongkorn Memorial Hospital from 2009 to 2018. Methods: We reviewed medical records regarding the presenting symptoms, hormonal investigations, imaging results, staging, modalities of treatment and outcomes. Results: Of the 18 patients, 14 patients were female (77%). The median age at diagnosis was 47.5 years [interquartile range (IQR) 39.5-58.2]. Mass effects and/or hormonal hypersecretion were the most common presentation, documented in 7 (38%) and 6 (33%) patients respectively. Autonomous adrenal hormone excess was found in 10 patients (56%). Cushing’s syndrome and elevated dehydroepiandrosterone sulphate (DHEAS) were documented in 9 (50%) and 7 patients (41%) respectively. Mineralocorticoid excess was found in 1 patient (6%). At initial staging, 9 patients (50%) were in advance or metastatic stage. Surgery was performed in 17 patients (94%) and 13 patients (76%) were in remission. However, recurrence was observed in 6 patients (33%), with the median disease-free interval of 13.5 months (IQR 12.0-25.0 months). In patients with stage 2 disease, open surgery resulted in longer disease-free interval despite larger tumor size, compared with laparoscopic surgery. Final outcomes revealed that 8 patients (44%) had remission, 2 patients (11%) had persistent disease and 6 patients (33%) died. Combination therapy (adrenalectomy, radiation, medications and local control such as metastatectomy, radiofrequency ablation and transarterial chemoembolization) was documented in 11 patients (61%). All patients with remission received complete tumor resection and presented at early stages of cancer, with the majority of them having non-functioning tumors. The median follow-up time was 34 months (IQR 9-73). Conclusions: ACC is a rare and fatal disease with high mortality rates. Diagnosis is time-sensitive and requires multimodality approach.

Hospital epidemiology and antimicrobial susceptibility of isolated methicillin-resistant Staphylococcus aureus: a one-year retrospective study at a tertiary care center in Thailand

ABSTRACT Background: Increased rates of Staphylococcus aureus resistance and its morbidity and mortality have raised concern about the strategy of antibiotic use. Objectives: This study aimed to determine the prevalence of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) isolates among Thai patients with S. aureus infection and to identify risk factors and appropriate antibiotics for these resistant strains. Methods: Data of culture-proven S. aureus isolates from clinical specimens during 2017 in King Chulalongkorn Memorial Hospital, Thailand, were retrospectively collected and classified as methicillin-sensitive S. aureus or MRSA by cefoxitin screening and oxacillin minimum inhibitory concentration by the Vitek 2 system. Each isolate was also tested for susceptibility to teicoplanin, erythromycin, clindamycin, linezolid, trimethoprim/sulfamethoxazole, ciprofloxacin, moxifloxacin, tetracycline, doxycycline, and vancomycin by Vitek 2. Demographic information and comorbidities from medical records were reviewed to identify risk factors for S. aureus infection. Results: MRSA isolates were identified in 147 (17%) of 890 patients with no different ratio in adults or children. A higher proportion of MRSA in hospital-acquired settings was observed (27% vs. 12%; p < 0.001). Comorbidities significantly associated with MRSA were chronic lung, cardiovascular, and neurological diseases. Atrial fibrillation, dementia, and benign prostatic hyperplasia were independently associated with MRSA isolation. Vancomycin was still susceptible to all kinds of infection. One VRSA isolate was from colonization. Conclusion: The prevalence of MRSA in our facility seemed to be comparatively low. Vancomycin is still an appropriate option for MRSA coverage since all S. aureus isolates in our center were sensitive to vancomycin. However, careful attention is warranted since one colonization isolate was VRSA.

Husband\u2019s willingness-to-pay for HIV and syphilis screening at antenatal care clinic under the Thai universal coverage scheme

BackgroundScreening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to determine the husband’s willingness-to-pay (WTP) for his HIV and syphilis screening tests and potential factors affecting STI screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand.MethodsA pilot open-ended interview was conducted among 50 participants to estimate the mean and standard deviation of WTP prices for HIV and syphilis screening tests. A questionnaire was developed to obtain demographics, STI knowledge and screening history, as well as two contingent valuation methods (bidding and payment scale), using the mean WTP prices identified from the pilot study as a starting WTP with ¼SD step-up/down. The survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. Descriptive statistics and logistic regression were used for data analysis.ResultsDuring the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27–36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP prices for HIV and syphilis screening tests were US$14.5 (IQR 12.4–14.5) and US$9.7 (IQR 10–12), respectively. The payment scale method suggested approximately three-quarters of the WTP prices from the bidding method.ConclusionsThe husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.

The Significance of the Inao during the reign of King Chulalongkorn; A transitional period in the Thai Panji tradition

There are two main versions of the Panji story in the Thai literary tradition, entitled Inao and Dalang respectively. Both versions were first composed at the Thai court in roughly the eighteenth century and have provided inspiration for Thai arts ever since. Of the two stories, the Inao has become much more popular than the Dalang. The most influential Inao work was composed by King Rama II (r. 1809-1824) and his reign is widely accepted as the heyday of Inao. There was also another period of time in which the Inao theme was popular: the reign of King Chulalongkorn (r. 1868-1910). This article is an examination of the presentation of the Inao story during the reign of King Chulalongkorn and also presents an assessment of the significance of these Inao works to the Inao tradition. The findings of this article reveal that, during this period, the Inao story was presented in an increasingly diversified number of art and cultural works in both traditional and new styles. These Inao works marked a significant turning-point in the Inao culture and indicate that not only was the reign of King Chulalongkorn “a Golden Age” of the Inao in Thailand, but it was also “a transitional period” in the Thai Panji tradition.

Proatlas anomalies in craniofacial malformations: 5-year experience in King Chulalongkorn Memorial Hospital

To review the prevalences of proatlas anomalies in craniofacial malformations and evaluate the relation between craniofacial malformation and proalast anomalies. The 221 patients with craniofacial malformation who underwent CT facial bone and 3D brain in King Chulalongkorn Memorial Hospital (KCMH). Then, the craniofacial malformed patients are classified into six groups composed of craniosynostosis, cephalocele, midface anomaly, facial and branchial arch syndrome, facial cleft face, and others. Reviewing image finding by the researcher and the radiologist advisor was done separately and gave the consensus in the case with disagreement. Qualitative analysis of the prevalence of proatlas anomalies was achieved. In addition, assessment of the relationship between craniofacial malformation and proatlas anomalies was conducted using Pearson's chi-square test to determine statistical significance. The proatlas anomalies were presented in 26 patients of 221 craniofacial malformed patients. Details of frequentative proatlas anomalies consist of pre-basioccipital arch in eight patients, os odontoideum in five patients, bony mass along the margin of foramen magnum in three patients, atlas assimilation in two patients, hypertrophic occipital condyle in one patient, third occipital condyle in one patient, and mixed characteristic of proatlas anomalies in six patients. These results represented pre-basioccipital arch and os odontoideum as the two most common presentations among proatlas anomalies and also showed significant existence of proatlas diseases in craniofacial malformation (p value = 0.006). Our results emphasize the existence of proatlas anomalies which should be carefully looked for, particularly in craniofacial malformed patients due to significant statistical correlation.

Prevalence of neuropsychiatric symptoms in patients with mild cognitive impairment at King Chulalongkorn Memorial Hospital (P. 133)

Prevalence of neuropsychiatric symptoms in patients with mild cognitive impairment at King Chulalongkorn Memorial Hospital (P. 133)

Prevalence of vitamin D deficiency in patients with schizophrenia at King Chulalongkorn Memorial Hospital (P. 159)

Prevalence of vitamin D deficiency in patients with schizophrenia at King Chulalongkorn Memorial Hospital (P. 159)

Incidence and Risk Factors of Postcontrast Acute Kidney Injury in Patients with Acute Ischemic Stroke.

Background Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. Goal. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT. Methods We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase. Result Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate (eGFR) ≤ 30 mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI. Conclusion The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR ≤ 30 mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.

A Potential Biomarker from Diffusion Weighted Imaging and Parametric Response Map Analysis for Treatment Response Prediction in Nasopharyngeal Cancer

Diffusion-weighted imaging (DWI) is an MRI technique which provides functional information of tissue by detecting microscopic motion of water molecules. The change of apparent diffusion coefficient (ADC) derived from DWI was used as an imaging biomarker for treatment response prediction in cancers [1]. However, it was based on whole-tumor analysis which did not reflect heterogeneity within the tumor. To overcome this limitation, a new method called parametric response map (PRM) analysis was proposed to evaluate response by quantifying voxel-wise changes in ADC [2]. Here we investigated the use of PRM analysis on ADC from DWI as an imaging biomarker for treatment response prediction in nasopharyngeal cancer (NPC) patients. We collected thirteen patient datasets including ten complete response (CR) patients and three partial response (PR) patients at King Chulalongkorn Memorial Hospital where one patient dataset consisted of DWI and ADC data acquired before (i.e. pre-treatment) and at five weeks after (i.e. mid-treatment) initiation of chemoradiation therapy. For each dataset, we compared pre-treatment ADC image with co-registered mid-treatment ADC image, and calculated the percentage of voxels with increased ADC values with respect to total voxels within the tumor ROI, defined as PRM+. To validate the feasibility of the PRM biomarker, we computed the mean and standard deviation (SD) of percentage change in tumor volume (%AVol ) and in ADC (%AADC) and PRM+ across CR and PR patients, where tumor response was from 6-month follow-up data using RECIST1.1 guideline. The results showed that %AVol as well as %AADC between both groups was not significantly different. In contrast, PRM+ was significantly different between both groups (p < 0.05, 82.7±7.8% in CR vs 66.7±6.5% in PR). Our results implied that the proposed PRM+ biomarker could be a potential biomarker for early treatment response prediction in NPC patients.

Measurement of the Whole Body, Eye Lens and Extremity Occupational Doses in Nuclear Medicine Staff at King Chulalongkorn Memorial Hospital

Nuclear medicine staff have handled several radionuclides of gamma and beta emitters which result in obtaining occupational radiation risk. In 2018, the Government of Thailand announced the reduction of the eye lens dose limit from 150 to 20 mSv per year for the consecutive 5 years as of ICRP No. 118 in 2011. In Thailand, the personal effective dose to whole body, Hp(10) and the personal equivalent dose to the extremity, Hp(0.07) have been measured using optically stimulated luminescence dosimeter (OSLD) in nuclear medicine staffs while the personal equivalent dose to the eye lens, Hp(3) has never been measured. The objective is to measure Hp(10), Hp(3), and Hp(0.07) using OSLD in nuclear medicine staff who dispense high activity of radionuclides at King Chulalongkorn Memorial Hospital (KCMH). The correlations between the Hp(10), Hp(3) and Hp(0.07) were analyzed. The personal occupational dose has been measured in 10 nuclear medicine staff. Three sets of OSLD are attached at whole body, finger, and eye lens (left and right) of each personnel arranged by Thailand Institute of Nuclear Technology (TINT). As some radionuclides emit beta and gamma, most staff perform best practice in routine work, the short exposure time and the short range of beta rays to reach eye dosimeters which result in the estimated annual whole body, eye lens and extremity were less than the annual dose limit. The correlations between Hp(3) and Hp(10), Hp(0.07) and Hp(10), Hp(3) and Hp(0.07) had been recorded, while Hp(3) could be estimated from Hp(10).

Sleep Quality of Hospitalized Patients, Contributing Factors, and Prevalence of Associated Disorders.

Background Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission. Methods An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality. Results Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; p < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; p = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively. Conclusions This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.

Sleep quality and associated factors of patients with mild cognitive impairment at King Chulalongkorn Memorial Hospital (P. 3)

Sleep quality and associated factors of patients with mild cognitive impairment at King Chulalongkorn Memorial Hospital (P. 3)

Combination of Euro-Collins and University of Wisconsin Solution: An Effective and Economic Substitute for Organ Procurement

PurposeMany types of preservation fluid were used in liver procurement. Undoubtedly, the gold standard is the University of Wisconsin (UW) solution. But the solution is expensive. The aim of this study was to evaluate the results of combined acetated Ringer solution, Euro-Collins solution, and UW solution. Materials and MethodsAll patients undergoing adult liver transplantation from cadaveric donor during January 2013 to December 2017 in King Chulalongkorn Memorial Hospital were included in this study. Donor and recipient characteristics, preservation fluid, operative data, and postoperative outcomes were recorded. ResultsA total of 102 patients receiving liver transplants were enrolled into the study. The mean age of donors was 34.2 years. The mean total ischemic time was 420.93 minutes. In recipients, posttransplantation complications were the following: (1) primary nonfunction in 1 patient (0.98%); (2) early allograft dysfunction in 23 patients (22.5%); (3) hepatic artery thrombosis in 3 patients (2.7%); (4) hepatic venous outflow obstruction in 2 patients (1.96%); (5) biliary leakage in 1 patient (0.98%); (6) biliary anastomosis stenosis in 4 patients (3.92%); and (7) biliary nonanastomosis stenosis in 1 patient (0.98%). No inhospital mortality was occurred. Overall mortality rate is 7.8% (8/102). One-, 3-, and 5-year survival were 95.9%, 91.5%, and 88.4%, respectively. ConclusionsThe combination of acetated Ringer solution, Euro-Collins solution, and UW solution is effective and economic for liver preservation. Further study should be conducted.