Buddhachinaraj Medical Journal
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Item A Case Report: Methemoglobinemia(Buddhachinaraj Medical Journal, 2007-02-01) Sirirat CharoensawanOBJECTIVE: To report a case of methemoglobinemia after exposure to antiseptic solution, cetrimide (savlon\®) in Buddhachinaraj Phitsanulok Hospital. METHOD: A case report. A 9-year-old Thai girl, with a history of chronic constipation had a rectal biopsy planned for histological diagnosis. Intraoperatively, the examination revealed impact feces so the rectum was evacuated and irrigated with antiseptic solution, savlon. At the recovery room, she had good consciousness, good vital signs except the presence of central cyanosis. Her monitored percutaneous oxygen saturation (SpO₂) was 89-90% which did not respond to 100% oxygen therapy. After exclusion of other cardiopulmonary problems of hypoxemia, acquired methemoglobinemia from savlon exposure was suspected. She was rectally reirrigated with normal saline solution to remove the remaining toxin. RESULTS: She dramatically responded to intravenous methylene blue. She was extubated safely and discharged 3 days later. CONCLUSIONS: Hypoxemia is a life threatening condition. Clinicians must be aware to unusual causes of hypoxemia which do not respond to ordinary therapy. Methylene blue is the treatment of choice for methemoglobinemia. Oxygen therapy alone probably does not get enough response. Avoidance of the oxidizing agent, probably savlon as in this case, is prudent.Item Stroke Rehabilitation(Buddhachinaraj Medical Journal, 2007-02-01) Krisana KaewmoonOBJECTIVE: To study the rehabilitation of stroke patients in Srisangwornsukhothai Hospital.METHOD: One-year retrospective descriptive study from medical records of stroke patients was conducted fromOctober 1, 2005 to September 30, 2006. The data was analyzed and presented in frequency, mean and percentage.RESULTS: One hundred and eighty nine stroke patients received the rehabilitation program at the Department of Rehabilitation Medicine, Srisangwornsukhothai Hospital. There were 112 males (59.3%) and 77 females (40.7%). The mean age was 62.58 years (12-88 years). Cerebral infarction and cerebral hemorrhage were found in 55% and 36%, respectively. Right and left hemiplegic patients were equally found in 43.9%. Hypertension, dyslipidemia and diabetes mellitus were the main risk factors. The mean onset to rehabilitation time was 20 days after stroke, with mean duration of therapy 7.52 days. One hundred and ten patients (58.2%) had decreased activity of daily living problems but only 48 (25.4%) were discharge due to achieving set goals.CONCLUSIONS: Rehabilitation is necessary for stroke patients to improve their daily living ability and quality of life. Duration of therapy, discharge planning and follow up loss are the major problems of stroke rehabilitation in Srisangwornsukhothai Hospital.Item Unstable Mental Health Weakens the Immune System(Buddhachinaraj Medical Journal, 2007-02-01) . .Item Using Real Time Ultrasound in Prediction of Intrauterine Fetal Weight by Fetal Abdominal Circumference and Biparietal Diameter(Buddhachinaraj Medical Journal, 2007-02-01) Supachai NathongchaiOBJECTVE: To develope the predictive intrauterine fetal weight equation by using real time ultrasound to measure fetal abdominal circumference and biparietal diameter. METHOD: A prospective descriptive study was conducted during July 3, 2005 to February 9, 2006 in single pregnant wemen in the labour room of Somdej Prachoataksinmaharaj Hospital. Data analysis used the software for frequency, percentage, mean, standard deviation, t–test and regression analysis with significant level at 0.01. RESULTS: Eighty nine pregnant wemen were included in the study. The predictive intrauterine fetal weight equation was 52.073+(1.003xgrams of ultrasound estimate fetal weight) (p \< 0.001). This predictive equation had 68.5% prediction of fetal weight. The mean fetal weight from the equation was 2997.57 grams while the mean real fetal weight was 2997.98 grams. CONCLUSIONS: Using real time ultrasound for fetal abdominal circumference and biparietal diameter measurement has high accuracy for prediction of intrauterine fetal weight as compared with other current methods.Item Clinical Outcome after Application of CPG for Sepsis(Buddhachinaraj Medical Journal, 2007-02-01) Pornpit Treebupachatsakul; Nataya Kamsawang; Panya TuandeangOBJECTIVE: To compare clinical outcome before and after application of clinical practice guideline (CPG) for sepsis. METHOD: The study was an observational study with historical control. The data of pre-guideline period collected by retrospective review of medical records during August 1st to October 30th 2005 were compared to those of post-guideline period collected during February 1st to April 30th 2006. The primary outcome was in-hospital mortality and the secondary outcome were organ failure, ICU length of stay and hospital length of stay. Data analysis used the computer’s package for chi-square, and Fisher’s exact test with significant level at 0.05. RESULTS: One hundred and seventy three patients with sepsis or septic shock were included; 90 patients in pre-CPG period and 83 patients in post-CPG period. Baseline characteristics of patients in pre-CPG and post-CPG periods were comparable. The common causes of sepsis were pneumonia, urinary tract infection, gastrointestinal and intra-abdominal infection, consecutively. Hospital mortality rate was significantly reduced from 73.3% in pre-CPG period to 54.2% in post-CPG period (p=0.01). With regard to organ failure, acute respiratory distress syndrome was significantly increased from 26.7% to 44.9% (p=0.02) during the same period. Meanwhile, proportion of acute tubular necrosis and disseminated intravascular coagulopathy were found to be greater after introduction of the guideline. Furthermore, the length of ICU stay and total hospital stay trended longer in post-CPG period. CONCLUSIONS: The CPG for sepsis is effective in reducing in-hospital mortality. The reciprocal increase in morbidity, acute respiratory distress syndrome indicates that the CPG implementation might imperfect and requires further improvement.Item ชวนอ่านหนังสือ(Buddhachinaraj Medical Journal, 2007-02-01) . .Item Reduction the Cost of Blood Preparation for Transfusion in Surgical Patients by Type and Screen(Buddhachinaraj Medical Journal, 2007-02-01) Mujarin Tiloklurs; Ganokwan Klunklin; Jutharak YimsabaiOBJECTIVE: To compare the cost of blood preparation in low transfusion rate surgical patients by type and screen (T\&S) and crossmatching technique and study the rate of blood transfusion in those patients at Buddhachinaraj Phitsanulok Hospital. METHOD: Descriptive retrospective study of blood preparation by T\&S technique for surgical patients in obstetric, gynecology, and ear nose throat wards was performed between January and May, 2006. All data were compared the cost of blood preparation by T\&S and crossmatching. RESULTS: In obstetric, gynecology, and ear nose throat wards; 718 recipients (1,510 units) were requested for bloood. The supplied blood units were 3.3, 15.1 and 20.0 percent of the requested amount, in each ward respectively. T\&S technique was used instead of crossmatching for 1,393 units which decreased the expense by 206,800 baht. CONCLUSIONS: T\&S reduces the cost of blood preparation as compared to crossmatching. It enables flexible utilisation of blood stock and reduces blood wastage due to ageing. Moreover, it decreases the workload of blood bank staff and yields better transfusion management.Item Item Male Contaception: No Complication and Action as Quick as a Flash(Buddhachinaraj Medical Journal, 2007-02-01) . .Item Item Drug Delivery by Mail(Buddhachinaraj Medical Journal, 2007-02-01) Yongyos JariyawitayawatItem Fetal Birthweight Prediction by Multiplication of Intrapartum Symphysio-Fundal Height and Abdominal Girth at Umbilical Level(Buddhachinaraj Medical Journal, 2007-02-01) Khachonsilp PongsawatkulOBJECTIVE: To predict the fetal birthweight by using the multiplication of intrapartum symphysio–fundal height and abdominal girth at the umbilical level.METHOD: A prospective descriptive study of 1,000 pregnant women who attended antenatal care and delivered at Phayao Hospital from November, 2000 to August, 2005. Tape measurement was carried out at the levels mentioned above and then multiplication was done to obtain the estimated fetal weight in grams, compared to the actual fetal weight after delivered within half an hour. Software data analysis was done for frequency, percentage, mean, standard deviation, and regression analysis to determine the relationship between these factors with significant level at 0.05.RESULTS: The mean value of the subjects was expressed as followed: the maternal age, body weight, height and gestational age were 26.48±6.073 years, 63.80±8.710 kg, 154.75±5.426 cm, 38.6±1.319 weeks respectively. Moreover, the average height of symphysio–fundal and abdominal girth were 33.74±2.673 cm and 91.26+6.754 cm respectively. The mean actual fetal weight at birth was 3,125.18+396.789 grams. By using the regression analysis, the predicting component had graphic linear statistically significant relationship with the actual one (p \< 0.001). The estimated fetal weight was 1,884.099+0.383 (HFxAC), R²=0.366. The mean estimated fetal weight was 3,132±511.580 grams.CONCLUSIONS: These results indicate the usefulness of tape measurement in estimating fetal weight in utero as compared to the actual one.Item Item ‘Cumin’: An Eldery Miracle in Improving Memory and Alleviate Arthritis(Buddhachinaraj Medical Journal, 2007-02-01) . .Item Diagnostic Laparoscopy in Patients with Chronic Pelvic Pain(Buddhachinaraj Medical Journal, 2007-02-01) Suntorn IntapiboolOBJECTIVE: To study the diagnostic laparoscopy in patients with chronic pelvic pain. METHOD: A retrospective descriptive study of patients with chronic pelvic pain in Srisangwornsukhothai Hospital from January, 2000 to December, 2005 was conducted. Patients’ characteristics and diagnostic laparoscopy were reviewed and analyzed. RESULTS: Eighty-nine patients were enrolled in this study. The mean age was 32 years old (range 19-47 years). Forty-nine (55.1%) patients had endometriosis, twenty-one (23.6%) patients had pelvic adhesion, six (6.7%) patients had ovarian cyst, four (4.5%) patients had myoma uteri, three (3.4%) patients had pelvic inflammatory disease, two (2.3%) patients had tubal occlusion and one (1.1%) patient had adenomyosis. Although three (3.4%) patients had normal finding. CONCLUSION: The most common cause of chronic pelvic pain in this study is pelvic endometriosis. Diagnostic laparoscopy is an important tool for identifying the causes and proper management in these patients.Item The Results of Medical Services for Prevention and Care of Diabetes Mellitus Type 2 Patients at Primary Care Unit under Universal Coverage System(Buddhachinaraj Medical Journal, 2007-02-01) Thongpool Taesombot; Sriwan Tichaphan; Orathai Keawcharoen; Pornthip ReangmeeOBJECITVE: To study the results of medical services for prevention and care of diabetes mellitus type 2 patients at primary care unit.METHOD: A descriptive study was conducted from October to December, 2005. The main components of the study were budget for screening, drugs for diabetes mellitus treatment, processes of medical services for prevention and care such as screenings, treatments, referral, home visits, and health education and the results composed of fasting blood sugar, comorbidities: cholesterol, body mass index, blood pressure and behavior of diabetes mellitus patients. The data were gathered from routine reports and questionnaires with twelve providers, and 326 type 2 diabetes patients at primary care unit in 3 contracting units for primary care: Watbot, Bangkratum, and Nernmaprang. The subjects were selected by purposive sampling. The data were analyzed by descriptive statistics such as frequency, percentage, average and standard deviation.RESULTS: Expenditure for screening and patient care was 14.4% of the whole budget for prevention and promotion. Drugs such as sulphonylurea and biguanide were inadequate in some primary care units but this problem could be solved. Screening, follow-up, referral, and home visits did not perfectly follow the universal coverage guidelines for diabetes mellitus care. 35.6% patients were well controlled. Only 0.9% of the patients showed appropriate self-care behavior. Diabetes mellitus screening in 66.3% population over 40 years of age was done. However, only 65.9% of the suspected cases were confirmed, that did not meet the criteria.CONCLUSIONS: The medical services for diabetes mellitus prevention and care does not perfectly follow the universal coverage guidelines. It may be due to lack of clarity in resource allocation and standard medical services guidelines for prevention and care of diabetes mellitus.Item Pathology of Breast Lesions in Rachaburi Regional Hospital, 2004-2006(Buddhachinaraj Medical Journal, 2007-02-01) Sunee ChiewshanprisriOBJECTIVE: To study pathology of breast lesions from 2004 to 2006 pathological records in Rachaburi Regional Hospital. METHOD: The retrospective descriptive study was conducted from pathological records in Rachaburi Regional Hospital for 3 years (2004-2006). These tissues were obtained from core needle biopsy, incisional biopsy, excisional biopsy or lumpectomy, mastectomy with axillary node dissection and accompanying sentinel node biopsy. Cytological study by fine needle aspiration and study for hormone receptor (ER, PR) and HER-2 status evaluation were also included. RESULTS: Six hundred and fifty three breast lesions were found (5.2%) from the total of 12,486 specimens. Two hundred and forty five cases were malignant breast lesions (37.5% of 653 breast lesions), which 94% were ductal carcinoma. Nineteen sentinel node biopies were done and 7 cases were positive for malignancy. One thousand and six fine needle aspiration were performed with 5 cases positive for malignancy (0.5%). One hundred and twenty cases had performed hormone receptor (ER, PR) and 104 cases for HER-2 status evaluation. CONCLUSIONS: Pathological diagnosis plays an important role in early detection and treatment of breast cancer which will prolong survival and improve quality of life.Item Gifts from Labor Room(Buddhachinaraj Medical Journal, 2007-02-01) Suchat PorncharoenpongItem ข่าววิชาการ(Buddhachinaraj Medical Journal, 2007-02-01) . .Item Living Will: Not Mercy Killing(Buddhachinaraj Medical Journal, 2007-02-01) Sawaeng Boonchalermvipas-