Maha Chakri Sirindhorn Medical Center Research Articles

The Comparative Study on the Mental Index and Panoramic Mandibular Index in Thai Osteoporotic, Osteopenic, and Non-osteoporotic Patients: A Cross-sectional Study

Background Osteoporosis is one of the clinical problems in the elderly. Many previous studies focused on the index obtained from dental radiography as an adjunctive tool, which is considered beneficial for the screening of osteoporosis. Objective The purpose of this study was to compare the Mental Index (MI) and Panoramic Mandibular Index (PMI) acquired from panoramic radiographs in osteoporotic, osteopenic, and non-osteoporotic patients. Methods This research was approved by the Ethics Committee for Human Research, Srinakharinwirot University (certification number SWUEC-061/2562E). This study compared 150 osteoporotic patients undergoing treatment at the HRH Princess Maha Chakri Sirindhorn Medical Center with age-sex matched to 150 non-osteoporotic patients undergoing dental treatment at the Dental Hospital, Faculty of Dentistry, Srinakharinwirot University, using digital panoramic radiographs. MI and PMI were collected and analyzed using an independent T-test and Pearson correlation. Results The mean age of the 300 participants in the study was 57.82±12.25 years, while the mean age of the osteoporotic and non-osteoporotic patients was 57.95±12.30 years and 57.69±12.19 years, respectively. The mean MI for osteoporotic patients and non-osteoporotic patients was 0.314±0.088 cm and 0.3840±0.073 cm, respectively. Similarly, the mean PMI for osteoporotic patients and non-osteoporotic patients was 0.302±0.092 and 0.342±0.064, respectively. A significant difference in MI and PMI was observed between osteoporotic and non-osteoporotic patients (p=0.00). Conclusion Osteoporosis has a statistically significant effect on MI and PMI (p<0.05).

Prognostic Value of The Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Platelet Count for Platinum-Sensitive Recurrent Epithelial Ovarian Cancer.

To study the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet count in patients with platinum-sensitive recurrent epithelial ovarian cancer (PS-ROC). This was a retrospective study on a database of platinum-sensitive recurrent epithelial ovarian cancer patients who received treatment at HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) between January 2010 and December 2020. The patients' demographic data, surgical factors, pathological factors, laboratory findings, and response to treatment were reviewed from the patients' medical records. Survival analysis was conducted using the Kaplan-Meier survival estimate and Cox regression model. In total, 56 patients were recruited in this study. The median overall survival (OS) and progression-free survival (PFS) were 33 (95%CI 23-43) and 11 (95%CI 8-16) months, respectively. Survival analysis showed a high PLR was associated with decreased OS compared with low value but no significant difference in PFS. High NLR was associated with poor OS and PFS. There was no association between the platelet count and survival outcome (OS and PFS). In the multivariable Cox regression analysis, the NLR, PLR, and platelet count were not significant prognostic factors for survival outcome. However, low hemoglobin and a decreased disease-free interval were significantly associated with poor PFS. A white blood cell count (WBC) ≥ 8,000 cells/mm3 was a poor prognostic factor for overall survival (Adjusted HR 7.64; 95%CI: 2.21-26.42; p-value = 0.001). The NLR, PLR, and platelet count were not associated with both the OS or PFS in patients with PS-ROC. However, the WBC level is an easy, readily available, and economical way to predict survival outcomes in PS-ROC patients and may help physicians to tailor therapeutic interventions in the future.

Outcomes and Prognostic Factors of Patients with Platinum- Resistant or Refractory Epithelial Ovarian Cancer, Fallopian Tube Cancer and Peritoneal Cancer.

To determine the survival outcomes and prognostic factors of the patients with recurrent platinumresistant and refractory epithelial ovarian cancer (EOC), tubal, and peritoneal cancer. Women with recurrent platinum-resistant and refractory EOC, tubal and peritoneal cancer who received treatment at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) between January 2010 and December 2019 were included. Demographic data, serum marker, surgical factors, pathological factors and response of treatment were reviewed. Kaplan-Meier was used to calculate survival outcome. Forty patients were recruited in this study (platinum-resistant 24 patients and refractory 16 patients). The median survival times were 19 and 21 months in and platinum-resistant and platinumrefractory patients, respectively. There were no significant differences in overall survival according to age, comorbidity, tumor grading, primary treatment, and secondary surgery. However, histology of clear cell carcinoma may associate with increased risk of death. The median overall survival of patients with clear cell carcinoma, serous carcinoma, and others were 14.4, 22.9, and 32.2, respectively (p = 0.003). Almost 10 years, the survival rate of the patients in these group has not increased despite new treatments option. Novel strategies should be considered in National policy of the treatment for ovarian cancer in our country.

Accuracy of CCL20 expression level as a liquid biopsy-based diagnostic biomarker for ovarian carcinoma.

The study aimed to investigate the potentiality of chemokines, including MCP-1, CCL15, CCL20, and CXCL14, as biomarkers for differential diagnosis between benign tumors and ovarian cancer (OC). A cross-sectional study was conducted in women aged >18 years who had adnexal masses treated with elective surgery at the HRH Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between 2020 and 2021. The preoperative MCP-1, CCL15, CCL20, and CXCL14 serum levels were measured using a sandwich enzyme-linked immunosorbent assay. Preoperative diagnosis was defined according to the risk of malignancy index. The histological diagnosis and cancer subtype were confirmed using pathological specimens. Ninety-eight participants were preoperatively diagnosed with malignant tumors. The pathological diagnosis confirmed OC in 33 patients and disclosed 27 misdiagnosed cases, of which endometriotic cyst was the most common (44.44%). CCL20 and CA125 serum levels were significantly higher in the patients with cancer than in those with benign. In addition, CCL20 level could differentiate between benign and early-stage malignancy. Furthermore, only CCL20 levels could distinguish endometriotic cysts from OC, whereas CA125 levels could not. Concordant with the serum protein level, the increased mRNA level of CCL20 was observed in ovarian cancers comparing with that in benign tissues. We found that CCL20 levels could differentiate between benign tumors and OC with 60.61% sensitivity and 75.44% specificity at the optimal cutoff value of 38.79 pg/ml. Finally, the logistic regression model integrating CCL20, CA125, and menopause status promoted diagnostic accuracy by increasing the specificity to 91.23%. Our study revealed the potential usefulness of CCL20 level as a biomarker for diagnosing early-stage OC with endometriosis differentiation. We recommend further studies to confirm the accuracy of CCL20 levels with the current diagnosis in a large patient sample.

In Vitro Activity of Ceftolozane-Tazobactam and Other Antibiotics against Pseudomonas aeruginosa Infection-Isolates from an Academic Medical Center in Thailand.

(1) Background: Resistant Pseudomonas aeruginosa (PA) infections have limited treatment options. Data on the activity of ceftolozane-tazobactam (C-T) against PA in Thailand are limited. Objectives: The objective of this study was to identify the in vitro activity of C-T against general and resistant PA isolates from patients with real clinical infections from the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) compared to other antibiotics and to study the resistant molecular patterns of those PA strains which were resistant to C-T. (2) Materials and Methods: This was an in vitro susceptibility study of 100 PA isolates plus an additional seven resistant PA isolates collected from MSMC patients. All PA isolates were tested with susceptibility broth (Sensititre™) and C-T minimal inhibitory concentration (MIC) test strips (Liofilchem, Roseto degli, Abruzzi, Italy). The C-T-resistant PA isolates were analyzed for six β-lactamase genes (blaCTX-M, blaNDM, blaIMP, blaVIM, blaOXA-23 and blaOXA-48) and the mcr-1 gene. (3) Results: A total of 100 PA isolates were collected between January 2020 and January 2021 and between February 2021 and September 2021 for the additional 7 resistant isolates. There were 18 resistant PA isolates (6 MDR, 11 XDR and 1 pan-drug resistant isolate). The overall susceptibility of the initial 100 PA isolates and the 18 resistant PA isolates was 94% and 44.5%, respectively, for C-T. The C-T susceptibility rates for isolates non-susceptible to ceftazidime, piperacillin-tazobactam, carbapenems and antipseudomonal β-lactams were 65.5%, 69.7%, 50% and 44.5%, respectively. Among the 10 isolates which were resistant to C-T, there were only 3 isolates found to have the resistant gene, which included 1 for blaIMP, 1 for blaVIM and 1 for blaNDM. (4) Conclusions: Although C-T was the best susceptibility antibiotic overall for PA isolates and MDR PA isolates at the MSMC, most of the XDR PA isolates and the PDR PA isolate were not susceptible to C-T. The mechanisms for C-T resistance involved multiple factors including the presence of blaIMP, blaVIM and blaNDM.

COVID-19 Distribution Predicting in Nursing Caring Office Room: A Case Study at Princess Maha Chakri Sirindhorn Medical Center

The risk of spreading the virus largely depends on the airflow behavior and the change in direction caused by the air supply and location of the exhaust air. The generated particles may travel long during sneezing, adversely affecting human bodies to defend against COVID-19 infectious diseases. This paper examines airflow path and airborne pollutant distribution in the nursing caring office room for COVID-19 patients ward at Princess Maha Chakri Sirindhorn Medical Center, Nakhornnayok province by computational fluid dynamics modeling and field measurement. Fifteen dummies of nursing staff stay in the room, and only one dummy (Patient) generated COVID-19. It is found that the generated particles during sneezing may travel a long distance as compared with the normal respiration and the ventilation system can effectively remove contaminants from the room and distribution in the room. From the obtained results, the keeping a social distancing should be more than 1.5 m for preventing the spread of the COVID-19 from person to person.

Correlation between Carbapenem Consumption and Carbapenems Susceptibility Profiles of Acinetobacter baumannii and Pseudomonas aeruginosa in an Academic Medical Center in Thailand.

The emergent issue of carbapenem-resistant Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) is a major problem in Thailand. The wide use of carbapenems can increase selective pressure of bacterial resistance. The objective of this study was to determine the relationship between carbapenem consumption and the susceptibility rates of A. baumannii and P. aeruginosa, including multi-drug resistance (MDR) strains. This was a retrospective study. Carbapenem consumption and susceptibility profiles were collected from 2007 to 2013 at the Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Thailand. We found that the susceptibility rate of A. baumannii to imipenem and meropenem from the sputum and the bronchoalveolar lavage (BAL) specimens was significantly decreased during the study period, but no significant change was found in the P. aeruginosa data. The relationship between carbapenem consumption and the susceptibility rate of A. baumannii had a clear association with the use of ertapenem. We found a statistically significant negative correlation between ertapenem consumption and the susceptibility rate of A. baumannii to imipenem (r = −0.91; p = 0.004) and meropenem (r = −0.97; p = 0.000) in the data from the non-ICU wards. In addition, imipenem use had a moderate negative correlation with the MDR P. aeruginosa data but no statistical significance (r = −0.714; p > 0.05). In conclusion, our study suggested there is an association between carbapenem use and the susceptibility of A. baumannii and P. aeruginosa. Notwithstanding this, information on ecological factors should be considered for further study. These findings showed the need to optimize the carbapenem prescription policy. Avoiding carbapenem overuse and rethinking the appropriate initial therapy might decrease the rate of resistant organisms.

Prevalence of Allergen Sensitization from Allergen Skin Prick Test Reactivities of Allergic Rhinitis Patients in the MSMC

Background: Allergic rhinitis is commonly found in Thailand and its prevalence seems to be higher in each area with the commonly found allergens and different characteristics of the population. Objective: To study the prevalence of each type of allergen from a skin prick test carried out among patients with allergic rhinitis in HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Nakhon Nayok Province, Thailand. Materials and Methods: The study was conducted using a descriptive cross-sectional study design. Retrospective data were collected from the medical records of all patients with allergic rhinitis who took a skin prick test at the Department of Otolaryngology, MSMC between 1 April 2016 and 31 March 2021. The results of the prevalence of allergens were reported in terms of numbers and percentages. Skin prick tests giving positive results among patients with allergic rhinitis were compared to the test results of patients with allergic rhinitis and asthma. Results: In total, 304 subjects diagnosed with allergic rhinitis who took a skin prick test met the criteria for inclusion in the present study, 207 were female (68.09%). Their mean age was 39.65+12.32 years old. The study found that 198 (65.13%) patients had positive results from of the test. The standardized mite mix was the most common allergen (55.92%), followed by American cockroach (37.82%), Johnson grass (5.59%), mixed Aspergillus (3.95%), and dog epithelium (1.32%). The patients with allergic rhinitis and asthma had a higher incidence of positive results than the patients with allergic rhinitis alone (risk difference was 13.36%, 95% CI 5.06 to 21.66, p-value = 0.005). Conclusion: The present study revealed that the prevalence of a positive skin prick test response was 65.13% of patients diagnosed with allergic rhinitis. The standardized mite mix was the most frequently found allergen, followed by American cockroach, Johnson grass, mixed Aspergillus, and dog epithelium. Keywords: Skin test; Allergens; Allergic rhinitis; Prevalence

Patient Acceptability of Universal Transvaginal Cervical Length Screening Program Implementation at HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand

Background: Preterm birth is a significant problem. It is a leading cause of early neonatal death. Transvaginal ultrasonography for cervical length measurement during second trimester could predict preterm labor. Vaginal progesterone reduced preterm birth incidence in pregnant women with short cervical length. Objective: To evaluate the acceptance rate of a universal transvaginal cervical length (TCL) screening program implementation. Materials and Methods: A retrospective cohort study of universal TCL before 24 weeks of gestation at the time of anatomical scan between 18 to 23+6 weeks from single center from July, 2017 through July, 2018. Pregnant woman with cervical length (CL) <20 millimeters (mm) were diagnosed cervical shortening and were offered treatment as protocol. Incidence of cervical shortening was assessed. Acceptance rates and factors for declining TCL screening were analyzed. The incidence of preterm birth before 34 weeks and 37 weeks were reported. Results: Three hundred forty-one Thai pregnant women were enrolled. Of those, 294 (86.2%) accepted TCL screening. Three pregnant woman (1.1%) had a CL <20 mm. Employed women and women who had income >10,000 Baht per month were likely to accept TCL screening (OR, 2.13; 95% CI, 1.14 to 3.98 and OR, 2.85; 95% CI, 1.37 to 5.95, respectively). The incidence of preterm birth was accounted for 8.9 percent in the acceptance and 2.1 percent in denial group. Conclusion: The universal transvaginal cervical length screening program at HRH Princess Maha Chakri Sirindhorn Medical Center was successfully implemented at 86.2% of acceptance rate. Keywords: Cervical length; Universal screening; Acceptability; Preterm birth; Prevention

The Study of Content Validity, Construct Validity, Reliability of the Relational Ethics Scale (RES) in the Thai Version

Objective: To assess content validity, construct validity, and reliability of Relational Ethics Scale (RES) in Thai version. Materials and Methods: The researcher translated RES into Thai and then translated back into English. Then, RES in Thai version was given to 120 patients aged between 18 to 60 years in Department of Psychiatry, HRH Princess Maha Chakri Sirindhorn Medical Center. Content validity was measured by item-objective congruence index (IOC). Construct validity was measured by confirmatory factor analysis (CFA), referred from the Root Mean Square Error of Approximation (RMSEA) and loading factor. Cronbach’s alpha coefficient was used for reliability measurement. Results: IOC of RES in Thai version was 0.86, RMSEA was 0.06, the loading factor of all questions >0.30, and overall internal consistency of RES was 0.96. Conclusion: RES in Thai version contained content validity and construct validity. If it is developed further to determine predictive, concurrent validity and determine sensitivity and specificity, it can be used for evaluation and treatment planning accurately in psychological intervention. Keywords: Relational ethics scale; Thai version; Vertical relationship; Horizontal relationship

A Study of Red Blood Cell Disorders in Chronic Obstructive Pulmonary Disease Patients

Background: Chronic obstructive pulmonary disease (COPD) is a disease that affecting body systems especially the respiratory system, circulatory system and also hematopoietic system. Objectives: The primary objective of the present study was to determine the prevalence of anemia and polycythemia in COPD patients. The secondary objectives was to determine factors associated with anemia and polycythemia. Materials and Methods: The present study was a retrospective study. All medical records of COPD patients visiting the lung diseases clinic of HRH Princess Maha Chakri Sirindhorn Medical Center between January 1, 2016, and December 31, 2019, were reviewed. Complete blood count, biochemistry laboratory results, lung function test, 6-minute walking distance, frequency of exacerbations and admission were recorded. Results: One hundred twenty-five patients were enrolled. Patients in GOLD stage 1, 2, 3 and 4 were 41.2%, 47%, 9.8% and 2% respectively. Most of the patients were in group A (50.4%). In our study, the prevalence of anemia in COPD patients was 39.2% and none of the patients had polycythemia. There was no association between GOLD classification or group of COPD and anemia. When analyzed by multiple logistic regression, we found that the higher BMI showed a significantly lower risk of anemia than lower BMI (OR 0.877; 95% CI: 0.795 to 0.967) and the frequency of acute exacerbation correlated with anemic condition statistically significant (OR 1.402, 95% CI: 1.142 to 1.721). Anemia and frequency of exacerbation had  very low level of positive correlation (r=0.282) at the significance level. Conclusion: Anemia was common comorbidity in COPD patients. Lower body mass index and frequency of exacerbation were significantly related to anemia. Keywords: Chronic obstructive pulmonary disease; Anemia; Polycythemia; Hemoglobin

Evaluation of the techniques and steps of intranasal corticosteroid sprays administration.

BackgroundIntranasal corticosteroid (INCS) is one of the most effective treatments for allergic rhinitis (AR). To achieve optimum efficiency while avoiding adverse effects (AEs), patients must comply with and follow the drug administration instructions.ObjectiveTo evaluate INCS administration techniques and steps and the association between inaccurate drug administration and AEs.MethodsA descriptive cross-sectional study was performed in patients diagnosed with AR who had used an INCS for more than 1 month at the HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhon Nayok, Thailand between September 2020 and August 2021. Patient information was collected, evaluate the accuracy of the application techniques and the steps they followed for INCS administration and the occurrence of any associated AEs.ResultsIn total, 150 subjects diagnosed with AR met the criteria. Only 6 patients (4%) correctly performed all 12 steps of INCS administration, while 44 patients (29.33%) correctly performed the 5 recommended essential steps. AEs were found in 23 patients (15.33%), with not pointing the tip slightly outward away from the septum significantly associated with a 3.6 times higher risk of AEs in patients (odds ratio, 3.6; 95% confidence interval, 1.3–9.4; p = 0.012).ConclusionInvestigations into INCS use in patients with AR revealed that only 4% of patients correctly performed all the administration techniques and steps, while 30% of patients at least followed the 5 recommended essential steps perfectly. Not pointing the tip slightly outward away from the septum was found to result in the most AEs.Trial RegistrationThai Clinical Trials Registry: TCTR-20210718003

The effect of frenotomy on long-term breastfeeding in infants with ankyloglossia

IntroductionThe World Health Organization has issued guidelines suggesting exclusive breastfeeding for at least six months for all infants. However, one of the main factors interfering with successful breastfeeding is ankyloglossia. Frenotomy may help improve breastfeeding, but evidence on the long-term effects on breastfeeding is lacking. Therefore, this study was conducted to evaluate the effect of frenotomy on breastfeeding and identify factors associated with receiving exclusive breastfeeding for six months. MethodsThis was a cross-sectional descriptive study conducted using retrospective chart review. Infants diagnosed with anterior ankyloglossia who underwent frenotomy at HRH Princess Maha Chakri Sirindhorn Medical Center between April 1, 2013 and March 31, 2019 were included. Data on both the mothers and the infants were collected. The length and types of feeding at 2, 4, 6, and 12 months were recorded. ResultsIn total, 526 infants were included in the study; 322 (61.22%) were male. Their median age on the day of surgery was 2 days (minimum 1 day, maximum 30 days). In total, 7.03% did not receive breastfeeding, whereas 17.96% and 75.01% had received breastfeeding for fewer than and more than six months, respectively. The prevalence of infants exclusively breastfed decreased over time from 81.37% to 55.70%, 33.46%, and 4.38% at 2, 4, 6, and 12 months, respectively. The study did not show any independent factors of neonatal and maternal characteristics associated with being exclusively breastfed for six months. ConclusionAmong infants with anterior ankyloglossia who received frenotomy, 33.46% were exclusively breastfed for six months. The study did not show any independent factors of neonatal and maternal characteristics associated with being exclusively breastfed for six months.

Prevalence of Abacavir Hypersensitivity Reaction and Cost-Effectiveness of HLA-B*5701 Screening: A Ten-Year Experience in The HRH Princess Maha Chakri Sirindhorn Medical Center

Background: Recently, the authors had reported a case with abacavir hypersensitivity reaction (ABC-HSR), the first diagnosed patient at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC). There was no data regarding the incidence or prevalence of ABC-HSR previously reported in Thailand. Objective: To study the prevalence of ABC-HSR, the abacavir use pattern and the cost effectiveness for the routine human leukocyte antigen (HLA)-B*5701 screening before abacavir use by analyses of the MSMC data. Materials and Methods: All patients at the MSMC who were prescribed abacavir from October 1, 2010 to September 30, 2020 were retrospectively reviewed for ABC-HSR and the abacavir use pattern at the time when abacavir was started. The cost-effectiveness analysis was applied by analyzing the cost between the routine HLA-B*5701 screening before abacavir use and the HLA-B*5701 confirmation for ABC-HSR. The cost for the prevention of a case of ABC-HSR was defined. Results: There were total of 54 patients who were prescribed abacavir and only one ABC-HSR case diagnosed. The prevalence of ABC-HSR was 1.85%. The main reason for the abacavir prescription was a substitution for tenofovir (TDF) because of the TDF adverse effects (81.13%). The HLA-B*5701 screening before abacavir use was done in 26.42% at the MSMC. If all eligible patients were routinely screened for the HLA-B*5701 allele before abacavir use, the cost would be 54,000 Baht. The cost for the diagnosis and the management of the ABC- HSR case was 7,230 Baht. The cost for the prevention of a case of ABC-HSR was 46,770 Baht. Conclusion: The prevalence of ABC-HSR was low. The main reason for abacavir use was a substitution for TDF. The cost for the prevention for a case of ABC-HSR was 46,770 Baht which would be less if the cost for the HLA-B*5701 test was reduced. Keywords: Abacavir; Hypersensitivity reaction; Prevalence; HLA-B*5701

Neutrophil to Lymphocyte Ratio as a Marker in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy in HRH Princess Maha Chakri Sirindhorn Medical Center

Background: Non anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy. usually associated with systemic vasculopathy disease and has variable visual outcomes. The mechanism of NAION is not fully understood and there is no treatment have been proven to be standard treatment. Objective: To evaluate Neutrophil to Lymphocyte Ratio in Non-arteritic Anterior Ischemic Optic Neuropathy patients in HRH Princess Maha Chakri Sirindhorn Medical Center. Design: Retrospective crossectional study. Materials and Methods: 90 patients in the present study were categorized equally into three groups. Group one was those who were diagnosed with NAION. Group two and three as control groups were those who were diagnosed with cataract with and without systemic diseases respectively. The complete blood count was examined at the first visit of NAION or at the pre-operative day. NLR in each group was calculated and compared. Results: The average of NLR in the group one was 2.25, in the group two and group three were 1.69 and 1.74 respectively. The comparison of mean continuous variable between 3 groups using Oneway ANOVA was analysed. NLR in group one was higher with statistical significance (p<0.05) when compared with group two but there was no statistical significance between group one and group three or group two and group three. The level of NLR has the negative correlation with the improvement of BCVA at 3 months. Conclusion: NLR ratio is one of the marker that can be found elevated when there is an inflammatory reaction, in the present study there is a significant higher of NLR ratio in NAION group and has negative correlation with vision at three months, NLR could be used as a prognostic indicator for the prediction of Visual outcome. Keywords: Non arteritic anterior ischemic optic neuropathy; Neutrophil lymphocyte ratio (NLR); Prognostic indicator; Prediction; Visual outcome

The Study of Maternal and Neonatal Complications in Teenage Pregnancy

Background: Pregnancy in adolescents is the important health problem around the world, especially for developing countries including Thailand. Objective: To define the prevalence of teenage pregnancy at HRH Princess Maha Chakri Sirindhorn Medical Center as well as its complication in both maternal and neonatal aspects. Materials and Methods: The present study is a prospective cohort study conducted in HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhon Nayok, Thailand. The data was collected between August 2016 and May 2017. Participants were divided into 2 groups consisted of pregnant adolescents (age 10 to 19 years old) and pregnant adults (age 20 to 34 years old). Clinical information of newborns were collected at the age of 3 days. Results: There were 1,258 pregnancies in total including 198 adolescent pregnancies, so the prevalence of adolescent pregnancy in our study was 15.7%. Adolescent pregnancy was associated with lower education level, anemia, and higher rate of vaginal delivery. The neonatal complication of teenage pregnancy found in the present study consisted of anemia (22.7%) and meconium-stained amniotic fluid (9.1%). In contrast, the gestational diabetes (1.5%) and neonatal hypoglycemia (6.6%) were lower in adolescent pregnancy, compared to adult pregnancy. Conclusion: Teenage pregnancy showed the negative impact on both maternal and neonatal health, particularly for anemia in pregnant women and neonates as well as meconium-stained amniotic fluid. Keywords: Teenage pregnancy; Maternal complication; Neonatal complication, Anemia, Meconium-stained amniotic fluid

Anesthetic related Adverse Events by Incidence Report in HRH Princess Maha Chakri Sirindhorn Medical Center

Objective: The objective of the present study was to evaluate the incidence of all complications and contributing factors after receiving anesthesia within HRH Princess Maha Chakri Sirindhorn Medical Center. Materials and Methods: This prospective descriptive study included 2,285 patients who received anesthesia services from the Department of Anesthesiology. Data was collected from August 2019 to January 2020 and analyzed with STATA software version 15. Results: In 2,285 patients who received anesthesia services, there were a total of 1,180 complications, which represented in an incidence rate of 51.64%. More than half of these complication were preventable. 93.42% were minor adverse events. The majority of the population was adult age over 18 years old, with average age of 47.8 years old. Most were female (59.17%), ASA class 2 (43.19%) and received general anesthesia technique (48.89%). The most common anesthetic complications were hypotension, sore throat, nausea/vomiting and shivering respectively. The most common major anesthetic complication was cardiac arrhythmia. Conclusion: The incidence rate of anesthetic complication was 51.64%. The most common complications were hypotension, nausea/vomiting and shivering. Factors that contributed to anesthetic complications were female gender, age >65, pregnancy, long operative time, and positions other than supine. Factors that minimized the risk were minor operation, TIVA and other anesthesia techniques and supervision. Keywords: Anesthesiology; Safety; Complications; Postoperative; Perioperative; Operation; Patient

A Comparison of Mean Platelet Volume between Viral Hepatitis and Non-Viral Hepatitis in Liver Cirrhosis

Background: A high level of mean platelet volume (MPV) is associated with platelet activation, which occurs in chronic inflammatory disease. Several studies have demonstrated that a high MPV is associated with chronic viral hepatitis and hepatic fibrosis. However, the role of MPV in patients with cirrhosis is unclear. Objectives: To evaluate the MPV in patients with cirrhosis, and to compare the MPV between viral hepatitis and non-viral hepatitis groups. Moreover, the correlation of MPV and factors was also explored. Materials and Methods: The medical records of 420 cirrhosis outpatients from 2010 to 2017 at Her Royal Highness (HRH) Princess Maha Chakri Sirindhorn Medical center were reviewed and analyzed as a retrospective study. The MPV was expressed as mean±SD. The correlation between MPV values and cirrhosis parameters including mortality outcomes were evaluated. Results: According to retrospective data, the mean age was 56.23 (SD 12.77). Two-hundred and ninety-two patients were males (69.5%), and one-hundred and twenty-eight patients were females (30.5%). Child-Pugh scores A, B, and C were found in 286 (68.1%), 132 (31.4%), and 2 (0.5%) cases, respectively. There was a significant difference of MPV between the group of viral hepatitis and non-viral hepatitis cirrhosis (10.79±1.05 vs. 10.54±1.00; 95% CI, 0.06 to 0.45), respectively. The median time of follow-up in this study was 40.06 months (range, 0.07 to 121.41). The mortality rate was 18.3%. Elevated MPV was found inversely correlated with albumin and platelet counts, and positive correlation with levels of prothrombin time, and INR in all causes of cirrhosis especially chronic viral hepatitis. However, there was no correlation of MPV and long-term mortality outcomes in all causes of cirrhosis (r=-0.066, 95% CI -0.165 to 0.035) and viral hepatitis causes (r=-0.035, 95% CI -0.158 to 0.095). Conclusion: The difference of MPV between viral hepatitis and non-viral hepatitis groups causing liver cirrhosis was identified in our study. The MPV was not correlated with long-term mortality outcomes in cirrhotic patients. Keywords: Platelet volume; Liver cirrhosis; Viral hepatitis; Mortality

Comparative Study on DNA Amplification Methods for Detection of Carbapenem-Resistant Enterobacteriaceae (CRE)

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a resistant group of gram-negative bacteria that produces carbapenemase destroying carbapenem molecules causing drug resistances. Among them, the incidence of New Delhi metallo-beta-lactamases (blaNDM-1), a metallocarbapenemases or class B carbapenemases or metallo-β-lactamases (MBL), are increasing worldwide. Objective: To focused on comparative study on DNA amplification methods for detection of CRE in terms of analytical sensitivity and specificity. Materials and Methods: CRE strains (Escherichia coli, Escherichia cloacae, Citrobacter freudii, and Klebsiella pneumonia) were collected from HRH Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand. All specimens were initially screened for CRE isolates by using carbapenem disks inhibition test. The polymerase chain reaction (PCR), loop mediated isothermal amplification (LAMP) and recombinant polymerase amplification (RPA) assays were further employed for identification of drug resistance blaNDM-1 gene among CRE isolates. The analytical sensitivity and specificity of the three amplification assays were compared and analyzed. Results: The analytical sensitivity test of PCR, LAMP and RPA assays revealed that the limit of detection were 0.74 ng/μL, 7.4 pg/μL, and 0.74 ng/μL, respectively. Specificity test demonstrated that all three assays showed no cross hybridization to the other 15 related bacterial isolates. Conclusion: The data pointed out that LAMP assay was 100 times more sensitive than PCR and RPA, which could be suitable for application as early detection test for carbapenem resistant bacteria. Hence, the physician can select the proper antibiotics to treat the CRE infectious bacteria, which can reduce morbidity and mortality rates in patients. In the future, LAMP will be combined with lateral flow dipstick (LFD) to improve the efficacy of the assay as not only the early detection test with high sensitivity and specificity for carbapenem resistant bacteria, but also as the convenient and rapid screening test. Keywords: Enterobacteriaceae; Carbapenem; Carbapenem-resistant Enterobacteriaceae (CRE); New Delhi metallo-beta-lactamase (blaNDM-1)

Comparison of the Performance of Existing Nutritional Screening Tools against Subjective Global Assessment in Cirrhotic Patients

Background: Malnutrition in cirrhosis has a significant negative impact on morbidity and mortality. There is no agreed gold standard of the screening tool. Study comparing the diagnostic properties of nutritional assessment tools in cirrhotic patients is limited. The Subjective Global Assessment (SGA) is one of the global assessment tools. It is used to assess nutritional status in different patient populations. Objective: To evaluate the diagnostic properties of different nutritional screening tools compared with SGA in cirrhotic patients. Materials and Methods: A cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center. All cirrhotic patients were enrolled. The nutritional status was evaluated by the SGA, the Royal Free Hospital Subjective Global Assessment (RFH-SGA), the Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST), the Malnutrition Universal Screening Tool (MUST), the Prognostic Nutritional Index (PNI-O), the Nutritional Risk Index (NRI), the Spanish Society of Parenteral, the Enteral Nutrition (SENPE), and the Controlling Nutritional Status (CONUT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate RFH-SGA, RFH-NPT, LDUST, MUST, PNI-O, NRI, SENPE, and CONUT compared with SGA. Results: Ninety-four cirrhotic patients were included. The mean age was 60.82 (SD 10.11) years. Patients with cirrhosis Child Turcotte Pugh (CTP) A, B, and C were 62, 21, and 11, respectively. Twenty-five patients (28.7%) were malnourished according to SGA, five with CTP A cirrhosis, twelve with CTP B cirrhosis, and ten with CTP C cirrhosis. The present study also showed that NRI had the highest sensitivity (100%) and LDUST had the highest specificity (94%). Conclusion: NRI is an effective tool with high sensitivity for identifying malnutrition in early stage of cirrhosis. Keywords: Nutritional screening; Cirrhosis; Subjective Global Assessment; SGA; Nutritional Risk Index; NRI