Journal of the Medical Association of Thailand = Chotmaihet thangphaet最新文献

{"title":"The Comparison of Efficacy between Intrathecal Morphine Combined with Either Intravenous Selective COX-II Inhibitor or Acetaminophen and Intrathecal Morphine Alone for Analgesia after Cesarean Section: A Double-Blinded Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.07.13870","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13870","url":null,"abstract":"Background: Spinal anesthesia is a popular anesthetic of choice for cesarean section but inadequate analgesia may result in delayed ambulation and healing after surgery. Multimodal analgesia is currently applied to decrease the adverse effect of each medication, enhance analgesic efficacy and promote Enhanced Recovery After Surgery (ERAS). Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are recommended for enhanced recovery after cesarean section (ERAC).\u0000\u0000Objective: To compare the analgesic efficacy of a combination of acetaminophen or selective COX-II inhibitors with intrathecal morphine and intrathecal morphine alone after cesarean section.\u0000\u0000Materials and Methods: Eighty-eight parturients undergoing cesarean section were divided into three groups. Acetaminophen group: intrathecal morphine 0.1 mg and intravenous acetaminophen 1 gram every 6 hours. Parecoxib group: intrathecal morphine 0.1 mg and intravenous parecoxib every 12 hours. Control group: intrathecal morphine 0.2 mg only. The primary outcome was total morphine consumption in the first 24 hours postoperatively. The secondary outcomes were pain intensity, vomiting episodes, and time to first dose of opioid.\u0000\u0000Results: The parecoxib group showed total morphine reduction in the first 24 hours of 10.655 mg (95% CI –15.04 to –6.27, p<0.001) compared with the control group. The pain intensity at rest and movement decreased in the parecoxib group compared to the control group at 4, 8, and 12 hours postoperatively (at rest: p=0.020, 0.001, and 0.002, at movement: p=0.002, 0.002, and 0.002). The acetaminophen group showed reduction of the pain intensity at 4 hours postoperative compared with the control group (p=0.011). Vomiting episodes and total ondansetron consumption were lower in the parecoxib group and the acetaminophen group. The parecoxib group also showed prolonged time to first dose of opioid usage.\u0000\u0000Conclusion: Parecoxib decreased total opioid consumption, decreased postoperative vomiting episodes and increased time for first dose opioid requirement. Acetaminophen also reduced the pain intensity and vomiting at 4 hours postoperative. The alternative and multimodal concepts in intraoperative and postoperative pain medications are the easiest ERAC components to improve outcome for the anesthesiologist.\u0000\u0000Keywords: Acetaminophen; Cesarean section; COX-II inhibitor; Intrathecal morphine","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"117 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84931383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Thrombocytopenia and Coagulopathy in Cardiac Surgery with Cardiopulmonary Bypass: Incidence and Outcomes after Non-Red Cell Blood Product Transfusion","authors":"","doi":"10.35755/jmedassocthai.2023.07.13862","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13862","url":null,"abstract":"Background: Cardiopulmonary bypass (CPB) activates inflammatory and fibrinolytic pathways, potentially disrupting hemostasis. Transfusion of non-red cell blood product is a conventional method of restoring hemostasis and treating coagulopathy and thrombocytopenia, the two common adverse outcomes of CPB.\u0000\u0000Objective: To determine the incidence and outcomes of postoperative thrombocytopenia and coagulopathy in adult Thai cardiac surgery patients with CPB receiving non-red cell blood product transfusions.\u0000\u0000Materials and Methods: The present study included patients aged 18 years and older that underwent cardiac surgery with CPB at Siriraj Hospital between January 2017 and June 2018. Enrolled patients were divided into four groups, no non-red cell blood products in Group 1, platelets (PLT) only in Group 2, fresh frozen plasma (FFP) and/or cryoprecipitate (cryo) in Group 3, and PLT, FFP and/or cryo in Group 4. Patients, clinical status and histories, intraoperative outcomes, and perioperative outcomes were collected and assessed for all groups. Postoperative thrombocytopenia was defined by PLT counts less than 100,000 cells/mm³. Coagulopathy was defined by prothrombin time (PT) or activated partial thromboplastin time (aPTT) greater than 1.5 of its institutional reference values. Non-red cell blood product transfusions for cardiac patients were determined by their attending physician.\u0000\u0000Results: Of the 360 patients included, 61.7% were male, with a mean (±SD) age of 65.3±11.7 years, and BMI of 24.1±4.0 kg/m². Most patients were classified as ASA-PS class 3 (71.9%), had elective surgeries (96.4%), history of antiplatelet use (65.8%), and coronary artery bypass graft (CABG) surgical procedure (56.9%). Postoperative thrombocytopenia was significantly more prevalent in Group 1 at 11.6%, followed by Group 3 at 9.5%, Group 4 at 3.7%, and Group 2 at 0% (p=0.010). Post-operative coagulopathy was more prevalent in Group 3 at 4.8%, followed by Group 2 at 4.1%, Group 1 at 3.9%, and Group 4 at 0.7%. Group 4 had a significantly greater incidence of anticoagulant use at 17.8% (p=0.007) and significantly longer CPB durations compared to the other groups at 146.6±74.7 minutes (p<0.01).\u0000\u0000Conclusion: The researchers’ study confirmed that preoperative antithrombotic use prior to cardiac surgical procedures and longer CPB duration influences physicians’ decision to transfuse. The present study recommended prohibiting prophylactic administration of FFP and PLT as well as implementing restrictive non-red cell blood product transfusion strategies.\u0000\u0000Keywords: Thrombocytopenia; Coagulopathy; Non-red Cell Blood Product Transfusion; Cardiopulmonary Bypass; Cardiac Surgery","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74860950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasoalveolar Rhabdomyosarcoma Presenting as Traumatic Nasal Injury: A Rare Case Report Mimicking Organized Hematoma","authors":"","doi":"10.35755/jmedassocthai.2023.07.13866","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13866","url":null,"abstract":"The nasoalveolar region is an uncommon area of all rhabdomyosarcoma (RMS) cases. RMS has a bimodal distribution in children, occurring in those aged two to four years and 12 to 16 years. The authors presented an unusual case of alveolar RMS that presented at a young age, in an uncommon region, with an atypical presentation, and imaging findings mimicking organized hematoma and complicated nasoalveolar cyst. Confounding as a result of the presence of trauma can delay diagnosis and treatment.\u0000\u0000Keywords: Nasoalveolar; Rhabdomyosarcoma; Hematoma","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91196858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Thyroid Cancer Using the American Thyroid Association Guidelines and American College of Radiology-Thyroid Imaging Reporting and Data System","authors":"","doi":"10.35755/jmedassocthai.2023.07.13780","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13780","url":null,"abstract":"Objective: To compare the American Thyroid Association (ATA) classification system of 2015 with the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) of 2017 to determine the superior system to predict cancer risk in thyroid nodules.\u0000\u0000Materials and Methods: The present study was a retrospective study that included patients with thyroid nodule(s) referred to the department of radiology for fine-needle aspiration (FNA) between February 2019 and March 2021. The authors assessed the ability of either system to predict malignancy based on FNA cytology results. Sensitivity, specificity, negative predictive values (NPV), and positive predictive values (PPV) were calculated.\u0000\u0000Results: One hundred sixty-five nodules were reviewed based on the ATA guideline of 2015 and ACR-TI-RADS of 2017. The sensitivity, specificity, PPV, and NPV of the ATA guidelines were 95.45%, 65.04%, 29.58%, and 98.94%, respectively, while that of the ACR-TI-RADS were 95.45%, 62.24%, 28%, and 98.89%, respectively.\u0000\u0000Conclusion: The ATA guidelines of 2015 and the ACR-TI-RADS of 2017 have comparable sensitivity and NPV for thyroid carcinoma diagnosis with moderate specificity for both systems. These results confirm a high probability of both systems rejecting malignancy.\u0000\u0000Keywords: Thyroid; FNA; ATA guideline; ACR-TI-RADs","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77195695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of a Thai Herbal Remedy in Patients with Mild Chronic Plaque Psoriasis: An Observer-Blinded Randomized, Standard Treatment-Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.07.13864","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13864","url":null,"abstract":"Background: Psoriasis is a chronic non-infectious inflammatory skin disease caused by genetic and environmental predispositions. There is a Thai herbal remedy for psoriasis recorded in Wat Pho’s marble inscriptions, consisting of Dictyophora indusiate Fisch, Psilocybe cubensis (Earle) Sing, and sesame oil.\u0000\u0000Objective: To compare the efficacy and safety of a Thai herbal remedy as an alternative treatment to the standard treatment of 0.1% triamcinolone lotion in patients with mild chronic plaque psoriasis.\u0000\u0000Materials and Methods: A randomized, split-body controlled design was conducted in 30 mild chronic plaque-type psoriasis patients with symmetrically distributed psoriasis rashes. Each patient was randomized to apply a Thai herbal remedy on a rash on one side of the body and 0.1% triamcinolone lotion on the other side, using the same dosage of twice daily for eight weeks. Efficacy was assessed at week 1, 2, 4, and 8 by the Targeted Area Score (TAS). The Self-Assessment Score (SAS) at week 8 was compared to the baseline. Safety was assessed through the interviews at each visit. Product satisfaction was evaluated by the visual analog scale (VAS).\u0000\u0000Results: The TAS and SAS for erythema, desquamation, and induration decreased in both treatment groups, with no significant difference. However, product satisfaction in color (p=0.012), odor (p=0.013), and absorption (p=0.003) were significantly higher in the 0.1% triamcinolone lotion group.\u0000\u0000Conclusion: The present study showed that the Thai herbal remedy was safe and efficacious in treating chronic plaque-type psoriasis, therefore, can be used as an alternative treatment.\u0000\u0000Keywords: Thai herbal remedy; Psoriasis; Dictyophora indusiate Fisch; Psilocybe cubensis (Earle) Sing; Sesame oil","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80506101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors and Impact of Secondary Pulmonary Infection on Mortality in Patients with Hypoxemic COVID-19 Pneumonia: A Retrospective Cohort Study","authors":"","doi":"10.35755/jmedassocthai.2023.07.13765","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13765","url":null,"abstract":"Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19.\u0000\u0000Objective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients.\u0000\u0000Materials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI.\u0000\u0000Results: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p<0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p<0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients.\u0000\u0000Conclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients.\u0000\u0000Keywords: COVID-19; Secondary pulmonary infection; Mortality; Risk factors","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73041356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Snoring in Pregnancy and Its Maternal-Fetal Outcomes at Vajira Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.07.13869","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13869","url":null,"abstract":"Background: Snoring is an important symptom that is associated with obstructive sleep apnea and increases the risk of adverse pregnancy outcomes. In Thailand, the prevalence of snoring during pregnancy is uncertain. Determining the prevalence and characteristics may reduce the prevalence of snoring and improve pregnancy outcomes.\u0000\u0000Objective: The primary outcome was to determine the prevalence of snoring in Thai pregnant women in the third trimester, including pregnancy and chronic onset. The secondary outcome was to investigate the associations between pregnancy outcome and habitual snorer or those identified as high risk by the Thai Berlin Questionnaire.\u0000\u0000Materials and Methods: Three hundred eighty-two singleton pregnant women aged at least 18 years and at least 33 weeks of gestational age were recruited from the antenatal care clinic at Vajira Hospital, Navamindradhiraj University, between November 2021 and September 2022 and filled out the Thai Berlin Questionnaire. The 382 pregnant women were identified the presence of snoring or high risk of OSA in the previous month. Medical records, including demographic information and pregnancy outcomes, were collected, and analyzed.\u0000\u0000Results: The prevalence of snoring was 31.4% in the third trimester of pregnancy of which 27% were pregnancy onset snoring and 4.4% were chronic onset snoring. Habitual snoring was significantly different from non-snoring in regard to the requirement for positive-pressure ventilation in newborns (aOR 6.67, 95% CI 1.2 to 35.54). The high risk group had significantly more pregnancy induced hypertension than the low risk group (aOR 5.96, 95% CI 2.15 to 16.5), gestational hypertension (aOR 13.6, 95% CI 2.1 to 86.8), preeclampsia (aOR 4.07, 95% CI 1.09 to 15.2), severe preeclampsia (aOR 4.9, 95% CI 1.15 to 20.93), preterm birth (aOR 6.21, 95% CI 1.58 to 24.42), and low birth weight of newborn (aOR 6.09, 95% CI 2.5 to 14.87).\u0000\u0000Conclusion: The prevalence of snoring among Thai pregnant women was comparable to previous Western studies. Screening pregnant women at risk of the symptom may provide an early chance to lower the prevalence of snoring and adverse pregnancy outcomes.\u0000\u0000Keywords: Snoring; Snoring in pregnancy; Pregnancy outcomes","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75426169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of COVID-19 Self-Risk Assessment Tool for Infection Prevention among Working-Age Population","authors":"","doi":"10.35755/jmedassocthai.2023.06.13860","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13860","url":null,"abstract":"Background: Given the ongoing impact of the COVID-19 pandemic, self-risk assessment tools are crucial for individuals, particularly the working-age group, to evaluate their infection risk. There is a lack of such tools as of early 2021.\u0000\u0000Objective: To develop and evaluate the effectiveness of the self-assessment test application named Thai Save Thai (TST) for determining individuals’ risk level of COVID-19 infection before entering premises.\u0000\u0000Materials and Methods: The present research consisted of two phases between April 2021 and July 2022. In the first phase, factory workers from all regions of the country were recruited using population allocation sampling. TST was used for self-assessment three times within two-week period to determine risk levels. The second phase evaluated the sensitivity, specificity and predictive value of TST among 320 subjects underwent reverse transcription polymerase chain reaction (RT-PCR) testing.\u0000\u0000Results: TST showed varying percentages for each risk level: normal, 44.4%, 38.8%, 29.2%; low, 54.3%, 60.8%, 70.5%; high, 0.2%, 0.02%, 0.1%; very high, 1.1%, 0.36%, 0.21%; and infection results, 0.02%, 0%, 0.05%. TST indicated a sensitivity of 95.7% (95% CI 87.3 to 104.0), a specificity of 75.0% (95% CI 63.2 to 86.8) for detecting infection. Sensitivity for very high-risk level was 85.7% (95% CI 59.8 to 111.6) with 63.9% specificity (95% CI 51.9 to 76.0). The high-risk level had a sensitivity of 75% (95% CI 32.6 to 117) with specificity of 28.1% (95% CI 20.6 to 35.5), while the low-risk level had sensitivity of 90% (95% CI 71.4 to 109.0) with specificity of 27.1% (95% CI 19.8 to 34.3). The negative predictive value (NPV) were the same value as 97.5% at all results.\u0000\u0000Conclusion: TST application is a self-risk screening tool that effectively discriminates between different risk levels and provides sensitivity for detecting infection with NPV for all assessment results. This application can enable individuals to assess their risk level of COVID-19 infection before entering any premises.\u0000\u0000Keywords: Self-risk assessment; COVID-19; Infection; Verify of entry; Working-age","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91009966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest Radiograph Findings Monitoring with Time Course of COVID-19 Pediatrics Patients","authors":"Na","doi":"10.35755/jmedassocthai.2023.06.13854","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13854","url":null,"abstract":"Objective: To study image findings in covid pediatric patients, both in the first diagnosis images and follow-up images to see disease progression over time.\u0000\u0000Materials and Methods: The present research was conducted in all pediatric patients aged 0 to 18 years diagnosed as Covid-19 infection and admitted at Phramongkutklao Hospital during the study period. Image findings were retrospectively reviewed by an experienced pediatric radiologist and Brixia score was given. The maximum severity score and timing to reach this score were calculated and recorded in all patients.\u0000\u0000Results: During the study period, 428 films were collected from 170 patients. Most patients were male with a mean age of 9.89 years. Most common presenting symptom was fever. One-fourth of the studied patients had underlying illnesses. Most patients were symptomatic patients with 156 out of 170 (91.8%). The first X-ray showed abnormalities in 64.7% of symptomatic group and 42.9% in asymptomatic group. Common lobes of lungs involved were middle and lower lobes, which was slightly right-side predominate. Mean Brixia score was 2.79 (0 to 12) and 2.97 (0 to 14) in asymptomatic and symptomatic patients, respectively, which was not statistically significant. Time to reach maximum severity score was phase 1 (0 to 4 days) for symptomatic patients and phase 2 (5 to 8 days) for asymptomatic ones. For patients with normal first X-ray, abnormalities could be detected on later films, mostly in phase 1 and 2.\u0000\u0000Conclusion: Screening X-ray at the first diagnosis had high rates of abnormality detection regardless of symptom. For patients with normal first X-ray, abnormalities could be detected on later films, mostly in phase 1 and 2. Therefore, even with the fear of unnecessary exposure to radiation in children, X-ray should be performed at the first diagnosis regardless of symptom. Appropriate timing to follow-up X-ray was phase 2, at day 5 to 8 of disease.\u0000\u0000Keywords: Covid 19 X-ray; Covid in children; X-ray of pediatric covid","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84747842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Pulmonary Arterial Hypertension and Risk Factors in End Stage Renal Disease Patients with Peritoneal Dialysis and Hemodialysis","authors":"","doi":"10.35755/jmedassocthai.2023.06.13858","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13858","url":null,"abstract":"Background: Pulmonary arterial hypertension (PAH) is associated with high mortality and frequent complications in end stage renal disease patients. Epidemiological data for this disorder across the spectrum of end stage renal disease in Thai patients is limited.\u0000\u0000Objective: To compare the prevalence and risk factors of PAH in hemodialysis and peritoneal dialysis in end stage renal disease among the Thai patients.\u0000\u0000Materials and Methods: The authors retrospectively studied in patients with end stage renal disease at Pranangklao Hospital between January 2016 and December 2021.\u0000\u0000Results: A total of 201 patients were enrolled. The average age of patients was 55.57±16.22 years (47.3% male). Most patients had hypertension. Most patients had been prescribed folic acid. The number of patients with mean pulmonary artery pressure >20 mmHg was 81 (77.1%) in the hemodialysis group and 52 (54.2%) in the peritoneal dialysis group (p<0.001). PAH in hemodialysis was higher than peritoneal dialysis (OR 2.86, 95% CI 1.56 to 5.24, p<0.001). The following were factors associated with PAH: history of coronary artery disease (OR 2.77, 95% CI 1.29 to 5.94, p<0.009), history of beta-blocker use (OR 2.09, 95% CI 1.15 to 3.79, p<0.015), left ventricular ejection fraction by Simpson’s method (OR 0.95, 95% CI 0.92 to 0.98, p<0.001). The variable associated with PAH (peritoneal dialysis group) in multivariate logistic regression was Hemodialysis (adjusted OR 3.16, 95% CI 1.66 to 6.03, p<0.001).\u0000\u0000Conclusion: End stage renal disease in Thai patients undergoing hemodialysis carry a three-fold risk of pulmonary hypertension than peritoneal dialysis patients.\u0000\u0000Keywords: Pulmonary hypertension; Hemodialysis; Peritoneal dialysis","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83168141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}