Vajira Medical Journal
Permanent URI for this collection
Browse
Recent Submissions
Item The Effectiveness of Life-style Health Behavior Improvement Program for the Diabetes Mellitus Patients of Huayploo Hospital, Nakornpathom(Vajira Medical Journal, 2010-01-13) Wattanachai Apirukkhit; Kayul BoontasanaAbstract The Effectiveness of Life-style Health Behavior Improvement Program for the Diabetes Mellitus Patients of Huayploo Hospital, Nakornpathom Wattanachai Apirukkhit MD* Kayul Boontasana Certificate in Nursing and Midwifery** * Health Services Department, Hauyploo Hospital ** Nursing Department, Hauyploo Hospital Objective: To evaluate the effectiveness of life-style health behavior improvement program for the diabetes mellitus patients of Huayploo hospital, Amphur Nakornchaisri, Nakornpathom province. Study design: Quasi-experimental research. Subjects: A total of 69 patients with diabetes mellitus of Huayploo hospital, Amphur Nakornchaisri, Nakornpathom province were enrolled. Methods: The 6-month life-style health behavior improvement program was applied to the subjects. The data were collected before, during and after the program. Main outcome measures: Fasting blood sugar before and after the program. Results: The fasting blood sugar before and after the program were 158.1 ± 45.8 mg/dl and 145.2 ± 31.4 mg/dl respectively. After attending the program regularly, the fasting blood sugar was decreased statistically significant (p-value \< .05). Conclusion: The life-style health behavior improvement program could decrease the fasting blood sugar level significantly in diabetes mellitus patients of Huayploo hospital, Amphur Nakornchaisri, Nakornpathom province. Vajira Med J 2007 ; 51 : 205 - 210Item Peripheral Arterial Disease of Lower Extremities, PAD(Vajira Medical Journal, 2010-01-13) Burapa Kanchanabat; Waigoon Stapanavatr; Yoothapong Sangpayup; Pong KanchanasuttirakAbstract Peripheral Arterial Disease of Lower Extremities, PAD Burapa Kanchanabat MD Waigoon Stapanavatr MD Yoothapong Sangpayup MD Pong Kanchanasuttirak MD Peripheral arterial disease (PAD) commonly affects lower Extremities. The main cause is atherosclerosis. There is no available incidence data in Thai population. It is a major cause of lower limb amputation. PAD could be categorized as chronic arterial occlusion, presenting with chronic ulcer, gangrene or rest pain and acute arterial occlusion which leading to rapid limb loss. PAD is easily diagnosed by history taking, physical examination and measurement of ankle/brachial index (ABI). Treatment options are depends on its severity and the patient's condition. Risk factors modification, antiplatelets, anti-coagulants, thrombolytics and arterial bypass surgery may consider for appropriate patients. Vajira Med J 2007 ; 51 : 217 - 225Item Off-pump Coronary Artery Bypass Grafting in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-13) Suksan Kanoksin; Suphakarn Techapongsatorn; Petchsree Charoensombatamorn; Siriwan TankittiwatAbstract Off-pump Coronary Artery Bypass Grafting in BMA Medical College and Vajira Hospital Suksan Kanoksin MD, FICST* Suphakarn Techapongsatorn MD, FICST* Petchsree Charoensombatamorn BS (nursing)** Siriwan Tankittiwat BN, MSc (nursing administration)** * Department of Surgery, BMA Medical College and Vajira Hospital ** Nursing Department, BMA Medical College and Vajira Hospital Objective: To compare the results between off-pump and on-pump coronary artery bypass grafting. Study design: Cross-sectional study. Subjects: A total of sixty-two patients with coronary heart disease underwent coronary bypass at the Department of Surgery, Bangkok Metropolitan Administrtion Medical College and Vajira Hospital during November 2003 to April 2005 were enrolled. Methods: Hospital records and operative note records were collected and analyzed. Main outcome measures: Preoperative risk factors, intra-operative clinical markers and postoperative outcomes. Results: From the study, the differences between both groups in terms of age, sex, blood pressure, hyperlipidemia and diabetic mellitus were not significant. But there were statistically significant differences between both groups in terms of chronic obstructive pulmonary disease, renal disease, heart failure and number of vessel disease. According to result from intraoperative clinical markers, there was statistically significant differences between both groups in terms of numbers of bypass grafts. From the result of postoperative outcomes, on-pump coronary artery bypass group had more mortality rate, stroke incidence, wound infection rate, reoperation rate for stop bleeding, blood transfusion, drainage volume, rising of cardiac enzyme, longer period of ICU stay, longer ventilator dependence period, and longer hospital admission period. Conclusion: The outcomes of off-pump coronary artery bypass grafting was better than on-pump coronary artery bypass grafting for treatment of coronary heart disease patients. This procedure can reduce the post-operative blood transfusion, post-operative ventilation usage, post-operative ICU stay, and hospital stay. Vajira Med J 2007 ; 51 : 171 - 177Item Prevalence of Snoring and Effect on General Health Status of Personnel in Bangkok Metropolitan Administration Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-13) Pichai Puapermpulsiri; Ronayooth Boonchoo; Nittaya YuangdetklaAbstract Prevalence of Snoring and Effect on General Health Status of Personnel in Bangkok Metropolitan Administration Medical College and Vajira Hospital Pichai Puapermpulsiri MD* Ronayooth Boonchoo MD* Nittaya Yuangdetkla MD** * Department of Otolaryngology, BMA Medical College and Vajira Hospital ** Department of Preventive and Social Medicine, BMA Medical College and Vajira Hospital Objectives: To study the prevalence of snoring and effect on general health status of personnel in BMA Medical College and Vajira Hospital. Study design: A cross-sectional study. Subjects: A total of 390 personnel of BMA Medical College and Vajira Hospital were randomly selected in December 2005. Methods: Self-administered questionnaires about snoring and general health status (Thai SF-36) were distributed to the subjects. Main outcome measures: Prevalence of snoring, associated factor and general health status. Results: The response rate was 76.6 %. The prevalence of primary snoring was 36.1%. Concerning about severity, the prevalence of habitual snoring, simple snoring and obstructive sleep apnea were 15.4 %, 20.7 % and 3.7% respectively. Snoring was significantly associated with age, gender, BMI, smoking, alcoholic consumption, diabetes mellitus, hypertension and heart disease. The difference in mean score of general health status between snorers and non-snorers was not significant. Conclusions: The prevalence of primary snoring was 36.1%. The general health status between snorers and non-snorers were not different. Vajira Med J 2007 ; 51 : 195 - 203Item Risk Factors associated with Inguinal Hernia in Adult Male: A Case-control Study(Vajira Medical Journal, 2010-01-13) Anan Manomaipiboon; Sawit Ampornareekul; Vasin Chotivanich; Nataphon SantrakulAbstract Risk Factors associated with Inguinal Hernia in Adult Male: A Case-control Study Anan Manomaipiboon MD, MSc (Clinical Epidemiology)* Sawit Ampornareekul MD** Vasin Chotivanich MD* Nataphon Santrakul MD* * Department of Surgery, BMA Medical College and Vajira Hospital ** Department of Surgery, Phrapinklao Hospital Objective: To determine the association between heavy object lifting and occurrence of inguinal hernia in adult male and to identify the other risk factors of inguinal hernia in adult male Study design: A case-control study. Subjects: Two hundred and nineteen patients in two tertiary care hospitals - BMA Medical College and Vajira Hospital and Phrapinklao Hospital were enrolled in this study during June 2002 to March 2003, 73 patients as cases and 146 patients as controls. Cases were defined as newly diagnosed inguinal hernia in adult male with the duration of symptoms less than one year. The corrected diagnoses were confirmed from operative report. Previously surgical repairs of inguinal hernia were excluded. Controls were male in-patients during the same periods as cases. Controls were approximately age-matched within five years interval to cases. In-patients with urological, colo-rectal and cardio-thoracic diseases were not recruited as controls. Methods: Both cases and controls were asked to answer the same questions on their demographic background, past history of heavy object lifting, smoking, urinary outflow tract obstruction, constipation, chronic cough. Their height and estimated body weights before occurrence of the diseases and previous appendectomy via right lower abdominal incision were recorded. Results: In univariate and multivariate analysis, no association between all exposure variables and inguinal hernia were found. The adjusted odds ratio for inguinal hernia in relation to past history of heavy object lifting was 1.1 (95% CI, 0.6-2.2). The adjusted odds ratio in relation to smoking, increased intra-abdominal pressure, previous appendectomy and obesity were 1.0 (95% CI, 0.6-1.9), 1.1 (95% CI, 0.6-1.9), 1.3 (95% CI, 0.4-3.7) and 0.7 (95% CI, 0.3-1.3) respectivel Conclusion: This study did not suggest an inverse effect between past history of heavy object lifting, smoking, urinary outflow tract obstruction, constipation, chronic cough, previous appendectomy and inguinal hernia. Vajira Med J 2007 ; 51 : 179 - 187Item Placenta Percreta with Bladder Wall Invasion: A Case Report(Vajira Medical Journal, 2010-01-13) Wisist KhorsuwandeeAbstract Placenta Percreta with Bladder Wall Invasion: A Case Report Wisist Khorsuwandee BSc (Med), MD Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Placenta percreta was a very rare condition in the past. However, it is becoming more common in view of the increasing rates of cesarean section and advanced maternal age pregnancy. This condition could be life-threatening for both mother and infant, due to the consequences of disseminated intravascular coagulation (DIC) as well as its penetration into the adjacent organs such as intestine or urinary bladder. The treatment of placenta percreta can be done by either peripartum hysterectomy or medical therapy with conservation of the uterus and placenta. In this case report, a 43-year-old pregnant woman, gravida 3, was prenatally diagnosed as having placenta percreta with bladder wall invasion by an ultrasonographic study. She underwent a cesarean section with subtotal hysterectomy. Her infant was a normal male infant weighing 2,700 grams. The Apgar scores at 1 and 5 min were 10 and 10 respectively. Immediately post hysterectomy, the estimated blood loss was 2,000 ml. After that, there was a serious event of DIC causing further bleeding about 2,000 ml. This resulted in a necessarily blood and blood components replacement, so that such complication could be overcome. Postoperatively, both mother and infant were admitted for 11 days. At 1-month follow-up, they were in good condition. Vajira Med J 2007 ; 51 : 211 - 216Item Effect of Punica granatum Linn. Peel Extracts on the Growth of Common Bacteria Causing Infection in Burn Patients(Vajira Medical Journal, 2010-01-13) Poth ThirakhuptAbstract Effect of Punica granatum Linn. Peel Extracts on the Growth of Common Bacteria Causing Infection in Burn Patients Poth Thirakhupt MD Department of Surgery, BMA Medical College and Vajira Hospital Objective: To study the effect of Punica granatum Linn. peel extracts on the growth of common bacteria causing infection in burns patients. Study design: Experimental study. Materials: Punica granatum Linn. peel extracts and common bacteria causing infection in burn patients. These bacteria consisted of Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acenitobacter baumannii, Klebsiellla pneumoniae prepared from microbiology laboratory, BMA Medical College and Vajira Hospital during May to August 2007. Methods: The extract was prepared by solvent extraction technique using hexane and methanol. Then, the extract was dissolved in distilled water to make a concentration of 300 mg/ml. for testing. Each bacteria was prepared in three agar plates. Paper disc with the extracts was laid in the culture plate of the bacteria and incubated at 37 for 24 hours. Main outcome measure: The diameter of inhibition zone (clear zone) was recorded in cm. Results: There were clear zones only in Staphylococcus aureus and MRSA plates. The average diameter of clear zones were 2.1 ± 0.1 and 2.0 ± 0.2 cm. On the contrary, there were no clear zones in Pseudomonas aeruginosa, Acenitobacter baumannii, Klebsiellla pneumoniae plates. Conclusion: Punica granatum Linn peel extract at the concentration of 300 mg/ml inhibited the growth of Staphylococcus aureus and MRSA. Vajira Med J 2007 ; 51 : 189 - 194Item Results of Laparoscopic Myomectomy in Bangkok Metropolitan Administration Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-13) Sarwinee Ratchanon; Prateep Hanidhikul; Anusorn Triwitayakorn; Budsaba WiriyasirivajAbstract Results of Laparoscopic Myomectomy in Bangkok Metropolitan Administration Medical College and Vajira Hospital Sarwinee Ratchanon MD, MSc (Reproductive Biology) * Prateep Hanidhikul MD ** Anusorn Triwitayakorn MD * Budsaba Wiriyasirivaj MD, MSc (Epidemiology), MSc (Clinical Embryology) * * Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital ** Special Instructor of Endoscopic Surgery, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objective: To study baseline characteristics, operative time, operative blood loss, conversion rate, complications and duration of postoperative hospital stay in patients underwent laparoscopic myomectomy. Study design: Descriptive study. Subjects: A total of fourty-four patients underwent laparoscopic myomectomy from January 2003 to December 2006 were enrolled. Methods: Patients' characteristics, intra-operative data, complications and hospital stay were collected from hospital records and hospital database. Main outcome measures: Age, presenting symptoms, indication for surgery, amount and size of myoma, operative time, operative blood loss, conversion rate, complications and duration of postoperative hospital stay. Results: The average age of study population was 34.8 ± 4.8 years. The two most common indications for surgery were hypermenorrhea and infertility. The operative time and operative blood loss were 232.6 ± 71.4 minutes and 358.2 ± 51.3 ml, respectively. The major complication, profuse bleeding from myomectomy site during operation leading to conversion, was 4.5%. There was no injury to urinary bladder, ureter or bowel. Minor complication rate was 56.8%. The duration of postoperative hospital stay was 2.4 ± 0.2 days. Conclusion: Laparoscopic myomectomy was a useful surgery due to short postoperative hospital stay and less blood loss. Although minor complications were still high but major complications were too low. There was no injury to urinary bladder, ureter or bowel. Vajira Med J 2007 ; 51 : 163 - 170Item Effect of Planned Instruction and Modeling on Knowledge, Practice, and Control of Blood Glucose Levels of Diabetic Patients(Vajira Medical Journal, 2010-01-08) Pansa Panjasri; Prapaiwan Danpradith; Chuenjit PotisupsukAbstract Effect of Planned Instruction and Modeling on Knowledge, Practice, and Control of Blood Glucose Levels of Diabetic Patients Pansa Panjasri MNS* Prapaiwan Danpradith Ed (nursing), MEd** Chuenjit Potisupsuk DrPH*** * Department of Family Medicine and Coummunity, Rongkwang Hospital, Phrae ** Faculty of Nursing, Naresuan University *** School of Nursing, Sukhothai Thammathirat Open University Objective: To examine the effect of planned instruction and modeling on knowledge, practice and the control of blood glucose level of diabetic patients Study design: Quasi experimental research. Subjects: Fifty two patients with type 2 diabetes mellitus attending Rongkwang Primary Care Unit, Phrae province during October 2006 - March 2007 were selected by purposive sampling into 2 groups: 26 in the experimental group and 26 in the control group. Methods: The experimental group was provided with the designed planned instruction and modeling in six sessions during 17-week period. The planned instruction and modeling were directed to diabetes self care diet, exercise and drug therapy. Participants of the experimental group had regular educational meetings, discussed and exchanged of information related to glycemic control experiences, demonstration of diabetic foods and exercise. The control group had regular education program. Knowledge and practice were evaluated by questionnaires while glucose control were evaluated by level of fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) Main outcome measures: Pre and Post test about knowledge of diabetes mellitus, practice of diet intake, exercise, drug compliance, level of FBS and HbA1c in the experimental and the control group. Results: Knowledge of diabetes mellitus and level of HbA1c after planned instruction and modeling of the experimental group were significantly improved while knowledge and practice of diet intake, exercise and drug compliance before and after intervention were not different. HbA1c level after intervention of the experimental group was significantly lower than the control group while knowledge and practice of food intake exercise and drug compliance after intervention were not different. Conclusion: Only knowledge of diabetes mellitus and level of HbA1c after planned instruction and modeling of the experimental group were significantly improved. Vajira Med J 2008 ; 52 : 57 - 65Item Factors Associated with Spouse Physical Abuse(Vajira Medical Journal, 2010-01-08) Peeranuch Rohitsatian; Supranee Angkeaw; Varuna KolkijkovinAbstract Factors Associated with Spouse Physical Abuse Peeranuch Rohitsatian MD* Supranee Angkeaw MD* Varuna Kolkijkovin MD** *Department of Preventive and Social Medicine, BMA Medical College and Vajira Hospital **Department of Psychiatry, BMA Medical College and Vajira Hospital Objective: To determine the causes, characteristics, severity and factors associated with severity of spouse physical abuse. Study design: Descriptive study. Subjects: A total of 272 physical abused wives visiting at one stop crisis center, BMA Medical College and Vajira Hospital during January 2003 to December 2005 were enrolled. Methods: The personnel and family characteristics, data of physical abuse and its severity, classified into minor and major violence, were gathered from hospital records and analyzed. Main outcome measures: Association between studied factors and severity of spouse physical abuse. Results: Concerning about severity of physical abuse, 83.1% were classified as major violence. The most common act and cause of physical abuse were punching and drunken responsible for 37.9% and 39.7% respectively. Moreover, repeated physical abuse occurred in 68.7%. The wife's low education, history of physical abuse and husband's narcotic usage were significantly associated with major violence of wife's physical abuse. Conclusion: The wife's education, history of physical abuse and husband's narcotic usage were associated with major violence of wife's physical abuse. Vajira Med J 2008 ; 52 : 31 - 38Item Alveolar Osteitis(Vajira Medical Journal, 2010-01-13) Netnapis ChanasongkramAbstract Alveolar Osteitis Netnapis Chanasongkram DDM Dental Section, BMA Medical College and Vajira Hospital Alveolar osteitis, condition known as a "dry socket" is the most common complication following dental extraction. Its precise etiology and effective prevention remain unclear. There are many risk factors that contribute to the development of alveolar osteitis such as trauma, coagulopathies, smoking, preexisting oral infection, female, oral contraceptive pills, oral bacteria etc. Some preventions suggested to be the guideline in reducing its incidence consist of using systemic antibiotic orally after extraction or surgery (metronidazole, clindamycin) and perioperative antiseptic mouth rinsing. Concerning about its management, pain relieving and wound healing stimulation are the main purposes. Vajira Med J 2007 ; 51 : 67 - 71Item "Diabesity": The 21st Century Epidemic(Vajira Medical Journal, 2010-01-08) Swangjit Sura-amornkulAbstract "Diabesity": The 21st Century Epidemic Swangjit Sura-amornkul MD, FRCP(T), MSc (clinical investigation) Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Diabetes and obesity are twin interrelated epidemics which threaten to engulf the world's healthcare systems over the next two decades. The prevalences of both are increasing at an alarming rate with up to 400 million people likely to develop diabetes, largely type 2, in the next 15 to 20 years unless action is taken. Indeed, much of this increase in diabetes prevalence is directly attributable to the epidemic of obesity. Both diabetes and obesity are associated with significant mortality and morbidity from macrovascular disease such as heart attack, stroke and peripheral vascular disease. In addition, diabetes carries the extra burden from the specific microvascular complications of retinopathy, nephropathy and neuropathy. The costs of these conditions, both personal and economic, are enormous. Vajira Med J 2008 ; 52 : 77 - 82Item Neurocysticercosis(Vajira Medical Journal, 2010-01-13) Areeporn ChonhenchobAbstract Neurocysticercosis Areeporn Chonhenchob MD Department of Surgery, BMA Medical College and Vajira Hospital Neurocysticercosis is the common neurosurgical disease in Thailand. It is the leading cause of hydrocephalus and late-onset epilepsy in adults. The development of techniques in neuroimaging and immunological studies contribute the accurate and rapid diagnosis. Moreover, successful medical treatment has been established by new medical treatment. Albendazole or praziquantel are two effective medicines that can reduce the course of treatment to 8 days and to 1 day respectively. These medicines are inexpensive and convenient especially in endemic areas because most affected patients are in low socioeconomic status. Vajira Med J 2007 ; 51 : 135 - 139Item Antimicrobial Susceptibility of Gentamicin-impregnated Polymethylmethacrylate Beads after Resterilization(Vajira Medical Journal, 2010-01-13) Mason Porramatikul; Damrong Tapanakulsak; Siri SirimanapongAbstract Antimicrobial Susceptibility of Gentamicin-impregnated Polymethylmethacrylate Beads after Resterilization Mason Porramatikul MD* Damrong Tapanakulsak MD* Siri Sirimanapong MD* *Department of Orthopaedics Surgery, BMA Medical College and Vajira Hospital Objective: To compare the antimicrobial susceptibility to Staphylococcus aureus of Gentamicin-impregnated polymethylmethacrylate beads (GPMMA beads) before and after resterilization with ethylene oxide gas. Study design: Experimental study (laboratory research). Materials: A total of twenty four pieces of GPMMA bead were selected in this study. This study was conducted at Department of Orthopaedics Surgery, BMA Medical College and Vajira Hospital. Methods: All GPMMA beads were equally divided into two groups: control and experimental groups. The experimental group was sterilized again with ethylene oxide gas before testing. The antimicrobial susceptibility was identified by diffusion method of Kirby-Bauer for both groups. Diameter of zone of inhibition was recorded and compared. Results: In control group, the diameters of zone of inhibition at 24, 72 and 168 hrs were 27.3 ± 1.5, 29.2 ± 1.2, and 29.5 ± 1.2 mm respectively. In experimental group, the diameters of zone of inhibition at 24, 72 and 168 hrs were 29.5 ± 1.2, 30.3 ± 1.4 and 30.8 ± 1.0 mm respectively. Statistical analysis demonstrated significant differences between two groups. Conclusion: The antimicrobial susceptibility to Staphylococcus aureus of GPMMA beads after resterilization with ethylene oxide gas was not less than the new GPMMA beads. Vajira Med J 2007 ; 51 : 103 - 109Item Insect Bite Itching Score as a New Tool for Evaluating Severity of Itching(Vajira Medical Journal, 2010-01-13) Sumanas Bunyaratvej; Vinij Pongparit; Wangchai Leesanguankul; Supinda KeattipunAbstract Insect Bite Itching Score as a New Tool for Evaluating Severity of Itching Sumanas Bunyaratvej MD* Vinij Pongparit MD** Wangchai Leesanguankul MD** Supinda Keattipun MD*** * Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University ** Department of Medicine, BMA Medical College and Vajira Hospital *** Department of Family Medicine, BMA Medical College and Vajira Hospital Objective: To study the correlation between insectbite itching score as a new tool for evaluating severity of itching and visnal analog scale. Study design: Cross-sectional study. Subjects: One hundred and ten patients presenting with itching as a chief complaint at Dermatological Clinic, Department of Medicine, BMA Medical College and Vajira Hospital during November to December 2004 were enrolled. Methods: Severity of itching was assessed by three methods consisting of visual analog scale and two insect bite itching scores (mosquito bite itching score and ant bite itching score). The correlation and satisfaction for these three methods were evaluated. Main outcome measures: Severity of itching, satisfaction of these methods. Results: The correlation between VAS and both insect bite itching scores (mosquito bite itching score and ant bite itching score) were 0.717 and 0.620 (p-value \< 0.001). The satisfactory score of insect bite itching score and VAS were 3.4 ± 0.8 and 3.1 ± 0.9. Conclusion: The newly developed insect bite itching scores correlated well with VAS. Moreover, subjects satisfied this method more than VAS. Vajira Med J 2007 ; 51 : 19 - 24Item Incidence and Risk Factors of Post-phototherapy Neonatal Bilirubin Rebound(Vajira Medical Journal, 2010-01-13) Manutham Manavathongchai; Payon Boonyarittipong; Ariya Sanguanwongthong; Kannikar Booranavanich; Siwiluck KanchanabatAbstract Incidence and Risk Factors of Post-phototherapy Neonatal Bilirubin Rebound Manutham Manavathongchai MD* Payon Boonyarittipong MD* Ariya Sanguanwongthong MD* Kannikar Booranavanich MD* Siwiluck Kanchanabat MD* Vip Viprakasit MD, PhD** * Department of Pediatrics, BMA Medical College and Vajira Hospital **Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University Objectives: To determine the incidence and risk factors of post-phototherapy neonatal bilirubin rebound. Study design: Cross-sectional study. Subjects: A total of two hundred and two term newborns with hyperbilirubinemia received phototherapy at Department of Pediatrics, BMA Medical College and Vajira Hospital during May to December 2006 were recruited. Bilirubin level at 24 hours after the phototherapy was assessed in all patients. Methods: Demographic data, bilirubin level and all possible risk factors associated with rebound hyperbilirubinemia were collected and analyzed. Main outcome measures: Incidence and risk factors of post-phototherapy neonatal bilirubin rebound. Results: A total of 10 neonates (4.9%) developed significantly rebound hyperbilurubinemia. All of them were treated with phototherapy again. An initial age of phototherapy (less than 48 hrs.) was the only significant risk factor contributing to rebound hyperbilirubinemia (odds ratio 6.3, 95% CI: 1.6-25.2). Conclusion: Rebound hyperbilirubinemia after complete phototherapy session was not common in term neonates. However, newborns having an early onset of jaundice within 48 hrs. requiring immediate phototherapy had more chance to develop rebound phenomenon. Vajira Med J 2007 ; 51 : 25 - 32Item The Causes of Unreceipted Unnatural Death Report in BMA Medical College and Vajira Hospital(Vajira Medical Journal, 2009-12-30) Charoonsak NualchaemAbstract The Causes of Unreceipted Unnatural Death Report in BMA Medical College and Vajira Hospital Charoonsak Nualchaem MD Department of Forensic Medicine, BMA Medical College and Vajira Hospital Objectives: To study the prevalence and causes of unnatural death reports being unreceipted in BMA Medical College and Vajira Hospital. Study design: Descriptive study. Subjects: The death reports from unnatural causes in BMA Medical College and Vajira Hospital and the inquiry officials at Samsen police station. Methods: Data from the unnatural death reports during January 1996 - December 2005 and the records in which the inquiry officials had signed upon the receipt of death reports were searched for the unreceipted reports. Qualitative data to evaluate the knowledge and recognition of the importance of a death report was obtained from 12 inquiry officers from Samsen police station by an in-depth interview. Results: From 1,935 unnatural deaths of the five causes, the most common cause was unknown (48.5 %). The rate of unreceipted death reports was 74.4%. The most common type of unnatural causes with the highest prevalence of unreceipted death reports was also the unknown cause (98.5%). From the interview with the inquiry officials, most of them had good knowledge in forensic medicine, but 83.3% had insufficient time. The recognition of the inquiry officials regarding the importance of death reports was fair. The problems in the receiving of the death reports was marked. The main problem was the working process of the inquiry officials themselves especially their insufficient working hours. Conclusion: The rate of unreceipted death reports was 74.4%. The most important cause of unreceipted death reports was insufficient working hours of the inquiry officials. Vajira Med J 2008 ; 52 : 209-218Item Results of Total Laparoscopic Hysterectomy for Benign Diseases in Bangkok Metropolitan Administration Medical College and Vajira Hospital(Vajira Medical Journal, 2010-01-08) Sarwinee Ratchanon; Prateep Hanidhikul; Pongthorn Virojchaiwong; Anusorn Triwitayakorn; Budsaba WiriyasirivajAbstract Results of Total Laparoscopic Hysterectomy for Benign Diseases in Bangkok Metropolitan Administration Medical College and Vajira Hospital Sarwinee Ratchanon MD, MSc (Reproductive Biology) * Prateep Hanidhikul MD ** Pongthorn Virojchaiwong MD, MSc (Health Economic) * Anusorn Triwitayakorn MD * Budsaba Wiriyasirivaj MD, MSc (Epidemiology), MSc (Clinical Embryology) * * Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital ** Special instructor of Endoscopic Surgery, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital Objective: To study baseline characteristics, operative time, operative blood loss, conversion rate, complications and duration of postoperative hospital stay in patients who underwent total laparoscopic hysterectomy for benign diseases and to compare operative time and operative blood loss in overweight and obese patients to normal-weight patients. Study design: Descriptive study. Subjects: A total of 125 women who underwent total laparoscopic hysterectomy for benign diseases at BMA Medical College and Vajira Hospital from January 2000 to December 2006 were enrolled. Methods: Patients' characteristics, intra-operative data, complications and hospital stay were collected from hospital records. Main outcome measures: Age, diagnosis or indications for surgery, operative time, operative blood loss, conversion rate, complications and duration of postoperative hospital stay. Results: The average age of the study population was 42.8 ± 8.5 years, ranged from 10 to 63 years. The most common diagnoses or indications for surgery were myoma uteri, myoma uteri with adenomyosis and adenomyosis. The operative time and operative blood loss were 267.8 ± 74.4 minutes and 302.7 ± 287.3 ml, respectively. Six of all were converted to total abdominal hysterectomy with conversion rate of 4.8%. Only one case (0.8%) had major complication of urinary bladder injury. The minor complication rate was 38.4%. The duration of postoperative hospital stay was 3.9 ± 2.0 days. Operative time and operative blood loss were more in overweight and obese patients compared to normal-weight patients, but without statistical significance. Conclusion: Total laparoscopic hysterectomy for benign diseases can be done successfully with low major complication, although minor complications were high. Overweight and obesity patients had longer operative time and more operative blood loss, but without statistical significance. Vajira Med J 2008 ; 52 : 5 - 13Item Pilates Exercise(Vajira Medical Journal, 2010-01-13) Wanida SunantarodAbstract Pilates Exercise Wanida Sunantarod BSc (Physiotherapy) Department of Rehabilitation, BMA Medical College and Vajira Hospital Pilates exercise is a new modernist exercise. This exercise is composed of muscle contraction, breathing and mind. It can increase strengthening, endurance and flexibility of core muscles. So, it is useful for applying with physical therapy. Vajira Med J 2007 ; 51 : 141 - 148Item Pulmonary Tuberculosis among Heroin Addicts in Bangkok Metropolitan Administration Narcotic Clinics(Vajira Medical Journal, 2010-01-13) Kovit YongvanitjitAbstract Pulmonary Tuberculosis among Heroin Addicts in Bangkok Metropolitan Administration Narcotic Clinics Kovit Yongvanitjit MD Drug Abuse Prevention and Treatment Division, Health Department, Bangkok Metropolitan Administration Objective: To determine the epidemiological characteristics, the rate of pulmonary TB, HIV prevalence and factors associated with pulmonary TB among heroin addicts. Study design: Cross-sectional study. Subjects: A total of 622 heroin addicts attending narcotic clinics of Health Department, BMA during October 2005 to March 2006 were enrolled. Method: Data from all records of heroin addicts at 18 narcotic clinics of Health Department, BMA were collected and analyzed. Main outcome measure: Numbers and morbidity rate of pulmonary TB and HIV prevalence among heroin addicts. HIV prevalence among heroin addicts with pulmonary TB. Result: There were 564 males (90.7%) and 58 females (9.3%). The average age was 34.7 ± 8.6 year. (15-67 year). According to the diagnosis of pulmonary TB, 507 from 622 clients (81.5%) received chest x-ray, 19 from 507 clients (3.8%) were diagnosed of pulmonary TB and 8 from 507 clients (1.58%) had positive for AFB. For HIV study, 477 clients (76.7%) received HIV voluntary counseling and testing and 196 (41.1%) were HIV positive. From 19 heroin addicts with pulmonary TB, 13 clients (76.5%) were HIV + ve. HIV infection was significantly associated with pulmonary TB among heroin addicts (p-value \< 0.05). Age, marital status, education, career, treatment history, period of heroin usage and past history of treatment were not associated with pulmonary TB. Conclusion: High pulmonary TB rate was found among heroin addicts in Bangkok. The crude pulmonary TB rate and pulmonary TB with positive AFB were 3.8% (all type) and 1.6%. HIV infection was the only significant risk factor for pulmonary TB in this study. Vajira Med J 2007 ; 51 : 95 - 101