Tertiary Care Hospital In Thailand Research Articles

Long-term outcomes and predictors of survival after cardiopulmonary resuscitation for in-hospital cardiac arrest in a tertiary care hospital in Thailand.

BackgroundThere are limited data available regarding long-term survival and its predictors in cases of in-hospital cardiac arrest (IHCA) in which patients receive cardiopulmonary resuscitation.PurposeThe objectives of this study were to determine the 1-year survival rates and predictors of survival after IHCA.Patients and methodsData were retrospectively collected on all adult patients who were administered cardiopulmonary resuscitation from January 1, 2013 to December 31, 2014 in Srinagarind Hospital (Thailand). Clinical outcomes of interest and survival at discharge and 1 year after hospitalization were reviewed. Descriptive statistics and survival analysis were used to analyze the outcomes.ResultsOf the 202 patients that were included, 48 (23.76%) were still alive at hospital discharge and 17 (about 8%) were still alive at 1 year post cardiac arrests. The 1-year survival rate for the cardiac arrest survivors post hospital discharge was 72.9%. Prearrest serum HCO3<20 meq/L, asystole, urine <800 cc/d, postarrest coma, and absence of pupillary reflex were predictors of death.ConclusionOnly 7.9% of patients with IHCA were alive 1 year following cardiac arrest. Prearrest serum HCO3<20 meq/L, asystole, urine <800 cc/d, postarrest coma, and absence of pupillary reflex were the independent factors that predicted long-term mortality.

Influencing of Family Management in Families with Thalassemic Children on Health Related Quality of Life and Family Functioning: SEM approach

Purpose: To predicate the way in which families incorporate the work of managing a child with thalassemia within family life and its outcomes. Methods: A correlational design with a structural equation modeling (SEM) approach was used. A total of 309 parents of children with thalassemia from 4 tertiary care hospitals in Thailand completed our questionnaires. Results: Family life difficulties had a negative influence on the child’s health-related quality of life (HRQOL) (b = -2.23, p &lt; 0.05) and family functioning (b = -0.27, p &lt; 0.05), whereas the child’s daily life (b = 5.06, p &lt; 0.05) and condition management ability (b = -1.86, p &lt; 0.05) had a negative influence on the child’s HRQOL. In the final model, 3 variables including the child’s daily life, condition management ability, and family life difficulty could explain 33 % of variance in the child’s HRQOL (R2 = 0.33). This model showed that only family life difficulty could explain 2 % of variance of family functioning (R2 = 0.02). Conclusions: The study suggests that nurses should design interventions to support families in managing their child’s conditions in order to achieve a good child and family outcomes.

Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand.

ObjectiveTo determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and associated factors.MethodsA total of 431 pregnant women who were indicated for emergency cesarean delivery were included. Clinical information and timing of process after decision until delivery and pregnancy outcomes were evaluated.ResultsMean age was 30 years, and 59.4% were nulliparous. Mean gestational age at delivery was 37.9 weeks. The decision was made during normal office hour in 33.2%. Median decision-to-operating room interval, decision-to-incision interval, and DDIs were 45, 70, and 82 minutes, respectively. Only 3.5% of patients had DDI ≤30 minutes, while 52.0% had DDI >75 minutes. During after office hours, every time interval was significantly shorter and 4.9% had DDI ≤30 minutes compared to 0.7% in normal office hours (P=0.001). Compared to other indications, time intervals were significantly shorter in those with non-reassuring fetal heart rate (FHR), and DDI ≤30 minutes was achieved in 18.8% vs. 0.8% (P<0.001). Shortest DDI was observed among those with non-reassuring FHR during after office hours. Neonatal outcomes were comparable between different DDIs.ConclusionOnly 3.5% of emergency cesarean delivery had a DDI ≤30 minutes (median 82 minutes). Significant shorter time intervals were observed in those with non-reassuring FHR during after office hours.

Abstract 21348: The Difference of Antiplatelet Prescription Between Gender and the 1-Year Mortality in Patients With STEMI in Developing Country

Introduction: There were inequalities in treatments prescribing to women resulted in poorer outcome in woman compare to men in many conditions include ST-elevation myocardial infarction (STEMI). Hypothesis: This study aims to described the difference of dual antiplatelet therapy (DAPT) prescription between gender and its effect on outcome. Methods: We conducted a retrospective study of consecutive patients presented with STEMI who underwent primary percutaneous coronary intervention at a tertiary care hospital in Thailand from January 2011 to December 2015. Patients’ baseline characteristics, usage of antiplatelet and mortality were collected. Chi-square and Log-rank were used to analyze. Results: Total of 755 patients (74.8% male) were included. Women were significantly older (68.1 ± 13.4 vs 57.6 ± 12.7, p &lt;0.005), had lower hemoglobin at baseline (12 ± 1.9 vs 14.3 ± 2, p &lt;0.005) and had more comorbidities include diabetes mellitus (46.6% vs 26.2%, p&lt;0.005), hypertension (76.8% vs 49.2%, P&lt;0.005) and chronic kidney disease (7.6% vs 3%, p=0.009). At the time of discharge, aspirin and clopidogrel were less commonly prescribed in women (86% vs 92.7%, p = 0.015 and 85.5% vs 91.1%, p=0.049, respectively) but the usage of DAPT was not statistically different between female and male (85.3% vs 90.9%, p=0.061) (Table). The 1-year survival is lower in women (79.5% vs 88.6%, p = 0.001). Patients who were discharged with DAPT had lower 1-year mortality than those without DAPT (2.6% vs 16.7%, p=0.003). Men, but not women, who were discharged with DAPT have the 1-year survival rate higher than those without DAPT. Conclusions: In conclusion, aspirin and clopidogrel but not DAPT were less commonly prescribed for women. The 1-year mortality was high in female which reflects the same disparity in outcomes that was found in western countries. There may be different effect of DAPT on males and female.

Health-Related Quality of Life and Functional Ability of Patients with Rheumatoid Arthritis: A Study from a Tertiary Care Hospital in Thailand

ObjectivesTo assess the health-related quality of life and functional ability of patients with rheumatoid arthritis (RA) using the Thai EuroQol five-dimensional questionnaire (EQ-5D) and the Thai Health Assessment Questionnaire (HAQ), and to analyze correlations between the scores from both questionnaires. MethodsThis cross-sectional study was conducted among 221 patients with RA aged 18 years or older at a tertiary care hospital in Thailand. Data collection methods included individual patient interviews and data gathering from medical records. The correlations between the EQ-5D and HAQ scores were analyzed using Spearman’s rank correlation coefficients. ResultsMost patients were female (78.3%), aged 41 to 60 years (57.0%), having had RA for 12 to 60 months (43.0%), and being in an active disease state (60.6%). From the EQ-5D, most patients reported no problems in each dimension, except for mobility and pain/discomfort. For the HAQ, most patients reported no difficulty for almost all activities, except for arising. The medians (interquartile ranges) for the EQ-5D utility, EuroQol visual analogue scale (EQ VAS), and HAQ scores were 0.65 (0.55–0.73), 70 (50–80), and 0.25 (0.00–0.81), respectively. The Spearman’s rank correlation coefficients were 0.42 for the EQ-5D utility and EQ VAS scores (P = 0.01), −0.65 for the EQ-5D utility and HAQ scores (P < 0.001), and −0.39 for the EQ VAS and HAQ scores (P < 0.001). ConclusionsThe health-related quality of life and functional ability of most patients in our study were partially affected by the disease. The EQ-5D and HAQ scores significantly correlated at a moderate to strong level.

A Prognostic Scoring Tool for Cesarean Organ/Space Surgical Site Infections: Derivation and Internal Validation.

Organ/space surgical site infections (SSIs) are serious complications after cesarean delivery. However, no scoring tool to predict these complications has yet been developed. This study sought to develop and validate a prognostic scoring tool for cesarean organ/space SSIs. Data for case and non-case of cesarean organ/space SSI between January 1, 2007 and December 31, 2012 from a tertiary care hospital in Thailand were analyzed. Stepwise multivariable logistic regression was used to select the best predictor combination and their coefficients were transformed to a risk scoring tool. The likelihood ratio of positive for each risk category and the area under receiver operating characteristic (AUROC) curves were analyzed on total scores. Internal validation using bootstrap re-sampling was tested for reproducibility. The predictors of 243 organ/space SSIs from 4,988 eligible cesarean delivery cases comprised the presence of foul-smelling amniotic fluid (four points), vaginal examination five or more times before incision (two points), wound class III or greater (two points), being referred from local setting (two points), hemoglobin less than 11 g/dL (one point), and ethnic minorities (one point). The likelihood ratio of cesarean organ/space SSIs with 95% confidence interval among low (total score of 0-1 point), medium (total score of 2-5 points), and high risk (total score of ≥6 points) categories were 0.11 (0.07-0.19), 1.03 (0.89-1.18), and 13.25 (10.87-16.14), respectively. Both AUROCs of the derivation and validation data were comparable (87.57% versus 86.08%; p = 0.418). This scoring tool showed a high predictive ability regarding cesarean organ/space SSIs on the derivation data and reproducibility was demonstrated on internal validation. It could assist practitioners prioritize patient care and management depending on risk category and decrease SSI rates in cesarean deliveries.

Prevalence of methicillin resistance and macrolide–lincosamide–streptogramin B resistance in Staphylococcus haemolyticus among clinical strains at a tertiary-care hospital in Thailand

Staphylococcus spp. is a major cause of nosocomial infection and sepsis. However, increasing drug resistance is becoming a challenge to microbiologists. The purpose of this study was to identify and determine antimicrobial resistance phenotypes and drug resistance genes of clinical coagulase-negative staphylococci (CoNS) isolates at Mae Sot Hospital in Tak province, Thailand. A total of 229 CoNS isolates were collected from clinical specimens during two periods in 2014 and in 2015. Staphylococcus haemolyticus was the most prevalent species (37.55%), followed by S. epidermidis (21.83%), S. saprophyticus (11.79%) and S. hominis (11.35%) respectively. The remaining 17.48% of the organisms comprised S. capitis, S. arlettae, S. cohnii, S. equorum, S. xylosus, S. warneri, S. sciuri, S. pettenkoferi, S. kloosii and S. lugdunensis. Methicillin-resistant CoNS (MRCoNS), containing the mecA gene, were detected in 145 of 229 isolates, mostly found in S. haemolyticus and S. epidermidis. In addition, the differentiation of their macrolide–lincosamide–streptogramin B (MLSB) resistance phenotypes was determined by the D-test and corresponding resistance genes. Among 125 erythromycin-resistant CoNS, the prevalence of constitutive type of MLSB, inducible clindamycin resistance and macrolide–streptogramin B resistance phenotypes were 72, 13.60 and 14.40% respectively. These phenotypes were expressed in 80% of MRCoNS strains. In addition, the ermC gene (79.20%) was found to be more prevalent than the ermA gene (22.40%), especially among MRCoNS. These results indicate that CoNS may play an important role in spreading of drug resistance genes. More attention to these organisms in surveillance and monitoring programs is needed.

Changes in the Patch Test Population Over a Ten-Year Period at the Contact Dermatitis Clinic, Siriraj Hospital: A University-Based Tertiary Care Hospital in Thailand

Background: There are several factors which have an impact on patch test results. In the past, comparing the populations between different institutes, without appropriate indicators was difficult. Thus, the MOAHLFA index (Male, Occupational, Atopic dermatitis, Hand dermatitis, Leg dermatitis, Face dermatitis and Age above 40 years) was developed. However, the study of this index in Thailand is limited. Objective: To investigate the MOAHLFA index in patch testing population in the Contact Dermatitis Clinic at Siriraj Hospital. Methods : The clinical parameters of patients who underwent patch testing at Contact Dermatitis Clinic, Siriraj Hospital during 10 years were studied. Results: Our patch test population showed a statistically significant increase in the proportion of male patients aged above 40 years while a statistical decrease was found in those with occupational skin diseases with a history of atopic dermatitis, and lesions on the hands during a decade. Conclusion: This study revealed patch-test population attending Siriraj contact dermatitis clinic changed in 10-years period. According to MOAHLFA index, the changes were increasing of male, aged >40 years but decreasing of atopic, occupational-related contact allergy patients.

A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand

Abstract Background Classic symptoms of illness are often absent in older adults, delaying diagnosis and management, and resulting in unfavorable outcomes. Objectives To determine the prevalence of atypical presentations by older Thai adults with infections in the emergency department (ED) of a tertiary care hospital, and to identify factors associated with atypical presentations in such patients. Methods We performed a secondary analysis of a retrospective cohort observational study of atypical presentations of patients aged ≥65 years in the ED using a subset of data first reported in the Archives of Gerontology and Geriatrics in 2015; 62:97-102. Results The prevalence of atypical presentations was 35% of those with infectious diseases (64 of 183 cases). Pneumonia was the most common (30%). We identified 4 associated risk factors: complicated urinary tract infection (UTI) (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.75,11. 78; P = 0.002), cancer (OR 2.64; 95% CI 1.07, 6.53; P = 0.04), dementia (OR 6.66; 95% CI 1.47, 30.11; P = 0.01), and pulse rate &gt;90 beats/min (OR 2.06; 95% CI 1.01, 4.22; P = 0.04). Infective diarrhea was protective (OR 0.27; 95% CI 0.09, 0.8; P = 0.02). Conclusions Atypical presentations of infectious diseases by older Thai patients in the ED accounted for about one third of those with infectious disease. Associated risk factors were complicated UTI, cancer, dementia, and increased pulse rate. Older patients with these factors who have uncertain diagnoses should be considered for hospitalization because the absence of classic symptoms does not exclude life-threatening infections.

In Vitro Synergistic Activity of Biapenem Combination with Sulbactam, Colistin, and Fosfomycin Sodium Against Multidrug-resistant Acinetobacter baumannii Isolates from Tertiarycare Hospitals in Thailand

Background Acinetobacter baumannii has become a major cause of nosocomial infections worldwide due to highly resistance to various groups of antibacterial agents. This in vitro study was determine the MICs for sulbactam, colistin, fosfomycin sodium individually and synergistic activity of both in combination with biapenem against multidrug-resistant A. baumannii.MethodsThe MICs and synergistic interaction of sulbactam, colistin, fosfomycin sodium and biapenem were determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (2016) by the chequerboard technique. 40 clinical MDR-Acinetobacter baumannii isolates from 13 tertiarycare hospitals in Thailand were tested. The synergistic effect was evaluated by the fractional inhibitory concentration index (FICI).ResultsThe MICs for MDR- Acinetobacter baumannii results of biapenem and other agents are shown in Figure 1. The FICI results showed all 40 strains (100%) had an FICI ≤ 0.5, suggesting a synergistic effect of colistin in combination with biapenem (Table 1). MICs of mostly strains were decreased two to four doubling dilutions for both antibacterial agents. Moreover, 95% of isolates have MICs to colistin and fosfomycin sodium lower than sensitivity breakpoint when combined with biapenem. The result showed no data on the antagonistic effect (FICI ˃4) of all biapenem-based combination.ConclusionThe combination of colistin or fosfomycin sodium with biapenem show synergistic pattern and MICs improvement for all strains. For that reason, the use of colistin, fosfomycin sodium combined with biapenem could be a promising treatment option for MDR- Acinetobacter baumannii.FIGURE 1.MIC for multidrug resistant Acinetobacter baumannii biapenem (n = 63), sulbactam (n = 40), colistin (n = 40), and fosfomycin sodium(n = 40).TABLE 1.Synergistic effect of sulbactam, colistin, and fosfomycin sodium with biapenem against MDR A. baumannii (n = 40) by using the checkerboard assayEffectNumber of Isolates (%)Sulbactam + BiapenemColistin + BiapenemFosfomycin sodium + BiapenemSynergy (FICI≤0.5)30 (75)40 (100)33 (82.5)Partial synergy (FICI>0.5-<1)9 (20)07 (17.5)Additive (FICI=1)1 (5)00Indifference (FICI>1-≤4)000Antagonism (FICI>4)000Disclosures J. Houngsaitong, Thai Meiji Co.,Ltd: No relationship, Research grant

Efficacy of the Ovesco Clip for Closure of Endoscope Related Perforations.

Aim. To study the efficacy and other treatment outcomes of Ovesco clip closure of iatrogenic perforation. Methods. Retrospective study from 3 tertiary-care hospitals in Thailand. Patients with iatrogenic perforation who underwent immediate endoscopic closure by Ovesco clip were included. Patients' demographic data, perforation size, number of Ovesco clips used, fasting day, length of hospital stay, success rates, and complication rate were recorded. Technical success was defined as closure achievement during endoscopic procedure and clinical success was defined as the patient can be discharged without the need of additional surgical or radiological intervention. Results. There were 6 iatrogenic perforations in 2 male and 4 female patients. The median age was 59 years (range 39–78 years). The locations of perforation were 5 duodenal walls and 1 rectosigmoid junction. The median perforation size was 13 mm (range 10–40 mm). The technical success was 100% and the clinical success was 83.3%. The success rates per locations were 100% in colon and 80% in duodenum, respectively. The median fasting time was 5 days (range 1–10 days) and the median length of hospital stay was 10 days (range 2–22 days). There was no mortality in any. Conclusion. Ovesco clip seems to be an effective and safe tool for a closure of iatrogenic perforation.

Survival Outcomes of Advanced and Recurrent Cervical Cancer Patients Treated with Chemotherapy: Experience of Northern Tertiary Care Hospital in Thailand.

Chemotherapy is the primary treatment for advanced and recurrent cervical cancer. To evaluate the survival outcomes of chemotherapy and the prognostic factors in this setting, we conducted a retrospective study by reviewing the medical records of advanced and recurrent cervical cancer patients treated with systemic chemotherapy at our institute between January, 2008 and December, 2014. One hundred and seventy-three patients met the criteria with a mean age of 50.9 years. 4.1% of them were HIV positive. The most common initial stage was stage IVB (30.1%) and the most common histology was squamous cell carcinoma (68.6%). Ninety-two (53.2%) patients were previously treated with concurrent chemoradiation with 53% developing combined sites of recurrence. The median recurrence free interval was 16.7 months. Cisplatin + 5 fluorouracil (5FU) (53.2%) was the most frequent first line chemotherapy followed by carboplatin + paclitaxel (20.2%) with an objective response of 39.3%. Seventy-two patients received subsequent chemotherapy. The median overall survival of all studied patients was 13.2 months. Only a recurrence free interval of less than 12 months was an independent prognostic factor for survival outcome. In conclusion, chemotherapy treatment for advanced and recurrent cervical cancer patients showed modest efficacy with a shorter recurrence free survival less than 12 months as a significant poor prognosis factor.

Creutzfeldt-Jakob Disease in a Tertiary Care Hospital in Thailand: A Case Series and Review of the Literature

Creutzfeldt-Jakob Disease (CJD) is an incurable and inevitably fatal neurodegenerative disorder. Although CJD has a worldwide distribution, there are no official statistics on CJD in Thailand. A diagnosis of CJD is suspected when a patient develops rapidly progressive dementia with myoclonus. However, CJD may be mistaken for a variety of illnesses because its initial presentation frequently consists of non-specific symptoms. Here, we examined cases of sporadic CJD (sCJD) from Thammasat University Hospital (a tertiary care hospital in Thailand) between January 1, 2012 and December 31, 2014. Three cases of probable and possible sCJD were collected. All cases presented with rapidly progressive cognitive dysfunction accompanied by spontaneous myoclonus. Classical electroencehalography changes and typical abnormal MRI features were observed. All of the cases died within a period of 8 months. None of the patients underwent brain biopsy. Our findings raise questions about the prevalence of CJD in Thailand, which needs further study.

Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real-life cohort in Thailand.

BackgroundElevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of cardiovascular disease or mortality; however, the LDL-C goal for therapy in acute coronary syndrome (ACS) patients is controversial and varies among guidelines. This study aimed to assess the effect of reaching an LDL-C goal of <70 mg/dL (<1.8 mmol/L) on first composite cardiovascular outcomes in routine clinical practice in Thailand.MethodsA retrospective cohort study was conducted using medical charts and the electronic hospital database of patients diagnosed with ACS and treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death). Cox proportional hazard models adjusted for potential confounders were used.ResultsOf 405 patients, mean age was 65 years (60% males). Twenty-seven percent of the patients attained an LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL, and 35% had LDL-C ≥100 mg/dL. Forty-six patients experienced a composite cardiovascular outcome. Compared with patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were associated with a reduced composite cardiovascular outcome (adjusted hazard ratio [HR]=0.42; 95% confidence interval [CI]=0.18–0.95; P-value=0.037), but patients with an LDL-C between 70 and 99 mg/dL had a lower composite cardiovascular outcome, which was not statistically significant (adjusted HR=0.73; 95% CI=0.37–1.42; P-value=0.354).ConclusionACS patients who received statins and achieved an LDL-C of <70 mg/dL had significantly fewer composite cardiovascular outcomes, confirming “the lower the better” and the benefit of treating to LDL-C target in ACS patient management.

Statin therapy in patients with acute coronary syndrome: low-density lipoprotein cholesterol goal attainment and effect of statin potency.

BackgroundElevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of coronary artery disease. Current guidelines recommend an LDL-C target of <70 mg/dL (<1.8 mmol/L) for acute coronary syndrome (ACS) patients, and the first-line treatment to lower lipids is statin therapy. Despite current guidelines and the efficacious lipid-lowering agents available, about half of patients at very high risk, including ACS patients, fail to achieve their LDL-C goal. This study assessed LDL-C goal attainment according to use of high and low potency statins in routine practice in Thailand.MethodsA retrospective cohort study was performed by retrieving data from medical records and the electronic hospital database for a tertiary care hospital in Thailand between 2009 and 2011. Included were ACS patients treated with statins at baseline and with follow-up of LDL-C levels. Patients were divided into high or low potency statin users, and the proportion reaching the LDL-C goal of <70 mg/dL was determined. A Cox proportional hazard model was applied to determine the relationship between statin potency and LDL-C goal attainment. Propensity score adjustment was used to control for confounding by indication.ResultsOf 396 ACS patients (60% males, mean age 64.3±11.6 years), 229 (58%) were treated with high potency statins and 167 (42%) with low potency statins. A quarter reached their target LDL-C goal (25% for patients on high potency statins and 23% on low potency statins). High potency statins were not associated with increased LDL-C goal attainment (adjusted hazards ratio 1.22, 95% confidence interval 0.79–1.88; P=0.363).ConclusionThere was no significant effect of high potency statins on LDL-C goal attainment. Moreover, this study showed low LDL-C goal attainment for patients on either low or high potency statins. The reasons for the low LDL-C goal attainment rate warrants further investigation.

Brief communication (Original). Prevalence and risk factors for deep vein thrombosis in hospitalized high-risk patients at a tertiary care hospital in Thailand

Abstract Background: Deep vein thrombosis (DVT) is a silent killer in hospitalized patients. Its prevalence in Thai population may be different from Western countries. Objective: To evaluate recognized risk factors for DVT in high-risk Thai patients according to the American College of Chest Physicians (ACCP). Methods: Hospitalized patients were prospectively enrolled at the Department of Medicine, Khon Kean Hospital. The study period was January 2010 to March 2011. Inclusion criteria were patients who were admitted with either (1) heart or respiratory failure or (2) one of the following conditions: cancer, sepsis, acute stroke, or inflammatory bowel disease. The admission length was at least four days. Patients were excluded if the hospitalization was because of venous thromboembolism or if there was a requirement for heparin therapy. Results: One hundred patients met the study criteria during the study. Of those, 5 patients (5%) had evidence of DVT by ultrasonography. None of these patients had pulmonary embolisms by computed tomographic angiography. In the multiple logistic regression analysis, only acute stroke was significantly associated with DVT. The adjusted odds ratio (OR) was 19.72; (95% confidence interval (CI) 1.37, 284.37). DVT was the only significant factor associated with death during admission with adjusted OR of 30.76 (95% CI: 2.02, 469.03). Conclusions: The prevalence of DVT in hospitalized high-risk patients by ACCP criteria was low. Admission because of acute stroke may increase the risk of DVT and having DVT may result in high mortality.

Prevalence and risk factors for deep vein thrombosis in hospitalized high-risk patients at a tertiary care hospital in Thailand

Background: Deep vein thrombosis (DVT) is a silent killer in hospitalized patients. Its prevalence in Thai population may be different from Western countries. Objective: To evaluate recognized risk factors for DVT in high-risk Thai patients according to the American College of Chest Physicians (ACCP). Methods: Hospitalized patients were prospectively enrolled at the Department of Medicine, Khon Kean Hospital. The study period was January 2010 to March 2011. Inclusion criteria were patients who were admitted with either (1) heart or respiratory failure or (2) one of the following conditions: cancer, sepsis, acute stroke, or inflammatory bowel disease. The admission length was at least four days. Patients were excluded if the hospitalization was because of venous thromboembolism or if there was a requirement for heparin therapy. Results: One hundred patients met the study criteria during the study. Of those, 5 patients (5%) had evidence of DVT by ultrasonography. None of these patients had pulmonary embolisms by computed tomographicangiography. In the multiple logistic regression analysis, only acute stroke was significantly associated with DVT. The adjusted odds ratio (OR) was 19.72; (95% confidence interval (CI) 1.37, 284.37). DVT was the onlysignificant factor associated with death during admission with adjusted OR of 30.76 (95% CI: 2.02, 469.03). Conclusions: The prevalence of DVT in hospitalized high-risk patients by ACCP criteria was low. Admission because of acute stroke may increase the risk of DVT and having DVT may result in high mortality. Keywords: CT angiogram, deep venous thrombosis, high risk, pulmonary embolism, Thai

Diabetic Foot Problems in Tertiary Care Diabetic Clinic in Thailand

Foot problems in patients with diabetes cause substantial morbidity and may lead to lower extremity amputations. These risks may be reduced by appropriate screening and intervention measures. Effective screening assigns the patient to a risk category and dictates both the type and frequency of appropriate foot interventions. Less than half of diabetic patients in tertiary care hospital in Thailand received annual foot examination and there are limited data available on the nature of foot problems in such setting. This study reported a cross-sectional data of 438 diabetic patients attend tertiary diabetic clinic in the university hospital in Northern Thailand. Neuropathy manifestations as skin dryness, limitation of joint mobility and insensate to monofilament was the most common manifestation of diabetic foot problems in this setting. Most patients were not protected by proper footwear. More effort is needed to educate diabetic patients about foot care and improve their choice and selection of footwear.

Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

IntroductionLimited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.ObjectiveTo determine the diagnostic indicators of peptic ulcer perforation.Material and methodsA cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients’ final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR) estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX).ResultsThe study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06), tenderness (RR = 1.94, 95% CI 1.17–3.21), and guarding (RR = 1.52, 95% CI 1.05–2.20); X-ray with free air (RR = 2.80, 95% CI 2.08–3.77); and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82).ConclusionFive diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer.

Statins utilisation pattern: a retrospective evaluation in a tertiary care hospital in Thailand

To determine statin usage pattern and evaluate whether new generation statins are actually needed by the patients receiving them. This retrospective cohort included patients receiving first-time statins at a tertiary care hospital in Thailand. Using electronic medical records from 2005, its indication was determined based on history of coronary heart disease (CHD) and CHD-risk equivalents. The lipid profiles tested within 30 days prior to the first date of statins prescription were analysed. Each patient was assessed as to whether statin was needed based on low-density lipoprotein cholesterol (LDL-C) reduction capacity and lipid goals. A total of 2479 first-time statin users was included. Ninety percent of the users received simvastatin, while 8% and 2% received atorvastatin and pravastatin respectively. More than half (58.0%) used statins for primary prevention, although all usage of atorvastatin was considered not needed. Considering the use of statin for secondary prevention to achieve the LDL-C goal of <130mg/dl (3.37mmol/l), more than 80% of atorvastatin users could be switched to simvastatin. Only 8% of simvastatin usage would not be able to achieve this target. When the LDL-C goal was <70mg/dl (1.81mmol/l), 40.2% simvastatin users was considered appropriate, while 58.6% needed atorvastatin to be prescribed. A substantial proportion of patients did not need statins therapy, particularly for primary prevention. In addition, atorvastatin use is mostly not needed except in patients requiring statins for secondary prevention to achieve the LDL-C goal of <70mg/dl (1.81mmol/l). The findings should prompt hospital policy makers to develop measures to ensure the proper use of statins in their clinical settings.