Browsing by Author "Sitthi-amorn, Chitr"
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Item Importance of delayed perfusion with primary angioplasty on short-term mortality in acute myocardial infarction patients.(2007-12-05) Kruthkul, Khanat; Srimahachota, Suphot; Udayachalerm, Wasan; Budhari, Wacin; Charipromprasit, Jarkarun; Suitthichayakul, Taworn; Sitthi-amorn, ChitrBACKGROUND: Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain. OBJECTIVE: The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI. MATERIAL AND METHOD: The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI. RESULTS: Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction < 40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809). CONCLUSION: The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.Item Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.(2005-03-27) Suttajit, Siritree; Wagner, Anita K; Tantipidoke, Ruangthip; Ross-Degnan, Dennis; Sitthi-amorn, ChitrUpper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand. Based on recorded diagnoses and symptoms, 91% of the patients probably had viral URIs; 60% of viral and 89% of bacterial URI patients were prescribed an antibiotic. Compliance with the national treatment guideline was 36.4% for treatment of viral URIs and only 1.7% for treatment of bacterial URIs. Amoxicillin was the most frequently prescribed antibiotic regardless of diagnosis. Among viral URI patients, those who were young, male, and self-paying were more likely to receive antibiotics; part-time physicians were more likely to prescribe antibiotics for these patients. Among patients with bacterial URIs, those who paid for drugs by themselves were more likely to receive antibiotics compared to patients covered by the national health insurance plan. We used these formative results as input to the design of health center and community interventions to encourage more appropriate prescribing for URI among adults.Item Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.(2005-07-22) Laosee, Orapin C; Pathanapornpandh, Nopporn; Sitthi-amorn, Chitr; Khiewyoo, Jiraporn; Somrongthong, Ratana; Dulyavoranun, NamthipThe Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).Item Sexual behaviors and opinions on sexuality of adolescents in a slum community in Bangkok.(2003-06-16) Somrongthong, Ratana; Panuwatsuk, Panee; Amarathithada, David; Chaipayom, Orapin; Sitthi-amorn, ChitrThis study was a survey research aiming to investigate sexual behaviors and opinions on sexuality of adolescents in a slum community. The study group comprised of 377 adolescents aged 12-22 years in a slum community in Bangkok randomly selected, and data were collected using self-administered questionnaires. Results indicated that 18.8% of the adolescents were sexually experienced with the average age of 15 years old at first intercourse. 63.1% of the adolescents had unprotected sexual intercourse with lovers or friends. Almost one-third of the population believed that premarital sexual activity was acceptable. One-sixth of the adolescents agreed that having sexual intercourse with a lover is safe, assuming that they had trustworthy partners and that having sexual intercourse was the best way to prevent their lover from having sexual activities with other partners. In addition, gender and age range were found to be the factors that significantly related to the adolescents' opinions that premarital sexual activity was acceptable and having sexual intercourse with a lover was safe (p < 0.05), whereas the relationship between the opinions and education level was statistically insignificant. It is recommended that familial, academic, community and public health support are necessary in educating the adolescents on reproductive health and family planning in order to reduce high risk behaviors associated with acquiring HIV and other STDs.