Journal of Charoenkrung Pracharak Hospital

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    Accuracy Detection of Mycobacterium Tuberculosis DNA,using Polymerase Chain Reaction by Granulomatous Lesion in Tissue Section
    (Journal of Charoenkrung Pracharak Hospital, 2010-09-30) NIsarat Dhanarak; Somboon Keelawat
    Objective : to correlation the relationships of histopathology presenting of granuloma with TB-PCR method and calculated the sensitivity and specificity. Materials and Methods : Descriptive retrospectively study, selected 209 patients, during 2007-2008 at King Chulalongkorn Memorial Hospital, who were clinically suspected to have tuberculosis and had a history of previously tissue sampling from various organs for light microscopic examination. Two pathologists reviewed their histopathological features independently again. The presence and absence of granulomatous formation was assessed. All of these tissues were analysed by using the positive results of TB-PCRResults : 97 cases (46%) had microscopically granulomatous formation and the other 112 cases (54%) were diagnosed as chronic inflammation without granulomas. In the former 97 patients with chronic granulomatous inflammation, 24 cases (25%) were TB-PCR positive and 73 cases (75%) were TB-PCR negative. Whereas the results of 112 patients having only chronic inflammation, 27 cases (24%) were positive for TB-PCR and the remaining 85 cases (76%) were negative. Collected data, including presence or absence of granulomas, results of TB-PCR and acid fast stain was evaluated their relationships and calculated the sensitivity and specificity of granulomatous cases (75%) were TB-PCR negative. Whereas the results of 112 patients having only chronic inflammation, 27 cases (24%) were positive and the remaining 85 cases (76%) were negative. Base on definite results of TB-PCR, granulomatous formation had a sensitivity of 47% (24/51) and a specificity of 54% (85/158). The positive predictive value for granulomas was 25% (24/97) and its negative predictive value was 76% (85/112).Conclusion : Granulomators formation is not a sensitive method for investigate Mycobacterium tuberculosis in paraffinembedded tissue, probably in small pieces of specimens or immunocompromised patients that granulomas are rarely formed.
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    Diffuse alveolDiffuse alveolar damage in four months infant with bronchopneumo ia together with history of receicombined DPT and HBV vaccineved
    (Journal of Charoenkrung Pracharak Hospital, 2010-09-30) sirisanpang yodavadh; suparach suwattanapim
    A four months Thai male infant with history combined DPT-HBV vaccine and oral polio vaccine from Health Center one day before admission in Charoenkrung Pracharak Hospital, presenting with fever and convulsion two hours before admission. CPR and endotracheal intubation were done but not successfully. Autopsy revealed diffuse alveolar damage in and some foci of bronchopneumonia in all lobes of lung. Also demonstrated was tiny abscess in left kidney with evidence of acute tubular necrosis. The brain autopsy displayed hypoxic change without any specific neuropathology. This was the first case ofthe autopsy in infant in Charoenkrung Pracharak Hospital, exhibiting acute lung injury (ALI) associated with an underlying sepsis.Combined DPT-HPV vaccine and oral polio vaccine was not associated to the cause of death.
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    Prostaglandins and Hypotensive Lipids
    (Journal of Charoenkrung Pracharak Hospital, 2010-09-30) Worawan Tantitemit
    The prostaglandin-related agents, or hypotensive lipids, are a relatively new class of ocular hypotensive agents. Four agents have been approved for clinical use in the United States: two prostaglandin analoques (latanoprost: 1996, travoprost:2001), prostamide (bimatooprost: 2001) and docosanoid (unoprostone: 2000). Latanoprost, which was the first prostaglandinagent for glaucoma treatment, has undergone extensive clinical trials for efficacy, drug interaction and side effects and also has the most extensive clinical experience. The mechanism of action is that these drugs increase uveoscleral outflow by remodeling the extracellular matrix in the uveosscleral outflow pathway which results in increased spaces between the muscle fascicles.Whether there are other mechanisms of action of these drug is not fully understood. The efficacy of latanoprost, travoprost and bimatoprost, that are used once a day, is superior to topical beta-blockers. The drift in effectiveness of intraocular pressure lowering (tachyphylaxis) have not been observed in this drug class, and there is no peak and trough effect. They have mild extraocular irritation, and virtually no systemic side effect.
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    The Relationships between Transformational Leadership, Job Involvement and Role of Professional Nurses in Primary Care
    (Journal of Charoenkrung Pracharak Hospital, 2010-09-30) Pattama Pupipatphol
    Objective : To study role of professional nurses and to determine the relationship between transformational leadership, jobinvolvement, and role of professional nurses primary care units, under the Jurisdiction of Bangkok Metropolitan Administration.Meterial and Method : The descriptive research was the designed to study the role of professional nurses and determinethe leadership between transformational leadership, job involvement, and role of professional nurses primary care units, underthe Jurisdiction of Bangkok Metropolitan Administration. The sample was 250 professional nurses, randomly selected throughsimple random sampling technique. Research instrument were questionnaires consisting of four parts; personal factor,transformational leadership, job involvement, and role of professional nurses primary care units. They were judged for theirvalidities and reliabilities. The Cronbach, s alpha coefficients were 0.88, 0.72 and 0.86 respectively. The data were analyzed bypercentage, mean, standard deviation, and Pearson, s product moment correlation coefficients.Results : The major findings were as follows: 1)The role of professional nurses primary care units, under the jurisdiction ofBangkok Metropolitan Administration, at the middle level. (X = 4.01 SD = .39) 2)Transformational leadership was positivelyrelated to the role of professional nurses primary care units, under the jurisdiction of Bangkok Metropolitan Administration, atthe middle level (r = .59) with the significant at the 0.05 level.3)Job involvement was positively related to the role of professionalnurses primary care units, under the jurisdiction of Bangkok Metropolitan Administration, at the high level (r = .70) with thesignificant at the 0.05 level.Conclusion : Role of professional nurses primary care units, under the Jurisdiction of Bangkok Metropolitan Administrationwas a middle level and positive correlation with transformational leadership and job involvement