Chiang Mai Medical Journal

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GAIT PARAMETERS, ENERGY CONSERVATION AND PERCEIVED EXERTION IN CHILDREN WITH CEREBRAL PALSY WHEN WALKING WITH THE DEVELOPING POSTERIOR WALKER
(Chiang Mai Medical Journal, 2009-09-21) Pattrawarin Saivarin; Sirintra Anusri; Somchai Pattana; Sainatee Pratanaphon
In Thailand, children with cerebral palsy have little access to the posterior walker. This study developed the posterior walker for children with cerebral palsy (CP) and studies its efficacy on gait parameters, energy expenditure and perceived exertion. The walker was designed and constructed according to stability, safety and foldability. Five children with CP participated. They had received a practice period of 1-month to familiarize themselves with both types of posterior walker (commercial posterior walker and new walker). Spatiotemporal gait was evaluated by GAITRite analysis, and energy expenditure determined according to the method described by Schlough et al. (2005) at pre and post practice once a week for 4 weeks. Rate of perceived exertion was also measured using the method described by Mattsson (1997). The new 4-wheeled posterior walker was constructed with dimensions of 57 cm x 67 cm x 48 cm and it weighed 6 kg. When ambulating with the new walker, the gait parameters, energy expenditure and perceived exertion of the children with cerebral palsy were comparable with using the commercial posterior walker in each period of measuring. There was also no time effect on those variables after training with either the commercial or new walker. These results indicated that the new walker could be used as an ambulation aid for children with cerebral palsy. However, the training program should be intensified to yield more benefit on those parameters.
EATING AND PHYSICAL EXERCISE BEHAVIOR OF CHILDREN IN ELEMENTARY SCHOOL
(Chiang Mai Medical Journal, 2010-10-22) Tharntip Mahawana; Varaporn Sirisawang,
Objective To discover the eating and physical exercise behavior of 4th to 6th academic year students at seven elementary government schools in Muang district, Chiang Mai province. Method A total of 940 students were interviewed for their eating and physical exercise behavior. Frequency, percentage, average and standard deviation were used for analysis. Results Overall behavior of the students was at a fair level (mean/average of 13.45). Having breakfast and physical exercise were at good levels (mean of 2.53 and 2.51 respectively). Most students (56.7%) had breakfast regularly. Drinking milk was at a middle level, with only 39.57% taking it regularly and 57.79% from time to time. For beverages, only 7.02% took them regularly and 89.47% periodically. For crispy cookies, 27.35% ate them daily and 70.96% sometimes. Fruit was eaten by 22.8% daily and 74.68% periodically. The students bought beverages and crispy cookies from shops near their house and in school. A minority bought from shops in front of the schools. For physical exercises, 56.70% exercised regularly, most frequent by playing (73.37%). The number of grade 4 students drinking milk was statistically higher than that in grade 5 and 6. Discussion Student behavior was at a fair level. When items were analyzed, eating breakfast and exercise were at good levels, but consuming crispy cookies was at a poor level. Correction of behavior should be inspired so that students will behave properly in the future. There was no relationship between education level and eating behavior such as eating crispy cookies, drinking beverages, eating fruit or physical exercise. No relationship was found between knowledge and other behavior. Chiang Mai Med Bull 2005;44(2):65-71.
ANTIPROLIFERATIVE EFFECT ON COLON CANCER CELL LINES BY AQUEOUS EXTRACT FROM THE BARK OF MILLINGTONIA HORTENSIS
(Chiang Mai Medical Journal, 2007-11-30) Siwapong Tansuwanwong; Hiroyuki Yamamoto; Kohzoh Imai; Usanee Vinitketkumnuen
Millingtonia hortensis is a traditional medicinal plant widely used in South-East Asia. This study focused on the antiproliferative effect when comparing between aqueous extract and ethanol extract from the bark of M. hortensis using human colon cancer cell lines, DLD-1, HCT15, SW48 and SW480. In in vitro experiments, the MTT method was used to determine the antiproliferative effect of M. hortensis extract on colon cancer cells. An aqueous extract of M. hortensis significantly reduced the proliferation rate of colon cancer cell lines in a dose-dependent manner. However, no antiproliferative effect was observed by ethanol extract of M. hortensis. This finding indicated that only aqueous extract from the bark of M. hortensis is able to inhibit colon cancer cell proliferation, and its mechanism is now under investigation.
COMPARATIVE BIOAVAILABILITY STUDY OF TWO MELOXICAM PREPARATIONS
(Chiang Mai Medical Journal, 2010-10-26) Noppamas Rojanasthien; Panawan Thummati; Boonyium Kumsorn
Objective To evaluate the relative bioavialability of two oral formulations of 15-mg of meloxicam tablets. Methods The study was conducted as an open label, two-way, crossover design with a washout period of 2-weeks. Twelve healthy male volunteers were given either one tablet of the test formulation or the same dose of the innovator after fasting. Blood samples were collected at 96 h postdose. The plasma was separated and the concentrations of meloxicam were determined by the HPLC method. Results The mean Cmax (ng/mL) was 1,509.80 and 1,379.94, while the mean AUC 0-∞ (ng.h/ mL) was 62,770.29 and 57,752.81 for the test and reference, respectively. The average Tmax (h) and half-life (h) of the test (6.25, 25.44) were slightly longer than those of the reference (5.33, 23.42). The relative bioavailability (%) with respect to the Cmax and AUC 0-∞ was 109.60 and 108.18, while, the mean (90% CI) after logarithmical (ln) transformation was 1.09 (0.97- 1.22) and 1.07 (1.02-1.13), respectively. No significant differences in pharmacokinetic parameters between the two formulations were found. Therefore, the study concluded that the bioavailability of the two meloxicam formulations are bioequivalent in terms of rate and extent of absorption. Chiang Mai Med Bull 2005;44(3):91-100.
Satisfaction with peer educators among HIV infected persons
(Chiang Mai Medical Journal, 2010-02-15) Jiraporn Suwanteerangkul; Suwat Chariyalertsak; Peninnah Oberdorfer; Darawan Thapinta; Albert W Wu; Avina Sarna; Philip Guest
Background An insuffi cient number of health personnel and excessive workload havebeen common barriers for the provision of adequate HIV care in Thailand. HIV patients areoften discouraged when they experience medication side effects as they commence highlyactive antiretroviral therapy (HAART). Peer educators present a potential solution to thisproblem. This report focuses on patient satisfaction with the activities of peer educators.Method Two hundred and twenty three people living with HIV/AIDS (PLHA) wereenrolled into this study following initiation of HAART. A structured interview was used.Complete data of 219 participants at month 4, and 211 at month 12 after initiation ofHAART were collected. Focus group discussions were held in 4 selected hospitals.Descriptive statistical analyses were performed. Paired t-tests were carried out to comparesatisfaction difference between month 4 and month 12. Content analyses of qualitativedata were done.Result The mean age of participants was 35 (range: 18-73 years) and 53% of them weremale. Their need for home visits by peer educators was higher at month 4 than at month12. Participants expressed a high satisfaction rate with peer educators (time provided;willingness to listen; ability to explain; convenience in making contact when necessary;client comfort in talking to them; attentive to the condition; and provision of help, adviceand encouragement in taking anteretroviral (ARV) medications at month 4 as well as month12.Conclusion Peer educator intervention could be successfully deployed to support PLHAand help them adhere to antiretroviral medication. Chiang Mai Medical Journal2009;48(3):95-104.
OUTCOMES IN PATIENTS WITH EXTRAHEPATIC CHOLANGIOCARCINOMA WHO UNDERWENT PALLIATIVE BILIARY DRAINAGE AT SAWANPRACHARAK HOSPITAL
(Chiang Mai Medical Journal, 2009-09-21) Borirak Chareonsil; Choosak Hongladaromp
Objective: The aim of the study was to evaluate the therapeutic results of palliative biliary drainage in patients with extrahepatic cholangiocarcinoma (EHCC) at Sawanpracharak Hospital. Material and method: A retrospective study of EHCC patients, who were diagnosed by endoscopic cholangiopancreatography (ERCP), was performed between 2000 and 2007. The patients were divided in to 2 groups according to the majority of procedures: “Pre-stenting” group (2000-2003) comprising 29 patients and “Stenting” group (2004-2007) consisting of 92 patients. The efficiency of biliary drainage was evaluated by serum bilirubin and alkaline phosphatase. Remote results of treatment were assessed by mean survival time. Results: There were 121 patients with EHCC; mean age 65.9 years; location of tumor - 80.2% hilar, 18.2% middle and distal 1.6%. The therapy consisted of endoscopic stenting and surgery. Jaundice was significantly relieved in all patients who underwent biliary drainage (p \< 0.05). There were 3 (21.4%) operative deaths in the “Pre-stenting” group, while no procedure-related complications occurred in the “Stenting” group. There was no significant difference of mean survival time after biliary drainage in either surgical or endoscopic approaches (p \< 0.05). Conclusion: Most patients with EHCC were Klatskin tumor and presented with advanced stage that was unsuitable for curative surgical resection. Palliation has become the mainstay in management for the relief of biliary obstruction. Endoscopic biliary drainage is an effective procedure for palliating obstructive jaundice without procedure-related mortality or major complications.
TRENDS OF PEPTIC ULCER DISEASES AND HELICOBACTER PYLORI INFECTION IN NORTHERN THAILAND
(Chiang Mai Medical Journal, 2010-09-27) Ong-ard Praisontarangkul; Pises Pisespongsa; Sith Hongsongkiat
Background Hp PUD is increasing. This study aimedto determine the trends of PUD andHp infection, and exposure to nonsteroid anti-infl ammatorydrugs and aspirin (NSAIDs/ASA), their association with upper gastrointestinal (UGI) bleeding, andcomparison to previous data.Methods Hp infection to previous data of 1992 to show their trends.Results Hp infection in each group was 38.18%, 42.86%, and 33.33%,respectively.Hp related ulcers had less UGI bleeding than NSAIDs/ASA related. When comparedto previous data, the proportion of DU had decreased, GU and combined ulcers had increased, andtheHp infection rate in all 3 groups had decreased.Conclusions Hp, non-NSAIDs/ASA related ulcers were diagnosed. NSAIDs/ASA related ulcers have morechances of bleeding.Chiang Mai Medical Journal 2010;49(2):41-48.While the prevalence of PUD and Hp was decreasing, more NSAIDs/ASA related andnon-A total of 98 cases were included; gastric ulcer (GU) in 55, duodenal ulcer (DU) in 28, and15 cases of combined ulcers. TheAll PUD patients with complete records of Hp status and NSAIDs/ASA exposure in 2008were included for analysis of prevalence and their association with UGI bleeding. We comparedpresent data of PUD andThe decline in global prevalence of Helicobacter pylori (Hp) and peptic ulcer disease(PUD) has been recognized, while the prevalence of non-
ETHICS-LEARNING EXPERIENCE ARRANGEMENT : CMU MEDICAL STUDENTS'VIEW
(Chiang Mai Medical Journal, 2010-01-15) Pannee Sirivatanapa; Acharawan Yampochai; Ubol Liewpreecha
The first character of Chiang Mai medical graduate is moral and ethical character. To achieve that objective, the various learning experiences should be arranged with regard to the teacher's and learner's view. This study was conducted to demonstrate the Chiang Mai medical students' view on ethics-learning experience arrangement by using the questionaire. The results showed that the most effective learning experience arrangement in their view was the teacher's role model. Consequently, the institute should stress on the teacher's realization of their own role model which effect upon the medical student's ethics-learning experience. Chiang Mai Med Bull 2002;41(4):215-222.
MUTAGENICITY AND ANTIMUTAGENICITY OF MEDICINAL PLANTS, NOM NANG, SUN SOKE AND STEVIA, EXTRACTS IN AMES TEST
(Chiang Mai Medical Journal, 2010-01-15) Usanee Vinitketkumnuen; Rawewan Puatanachokchai; Arunya Manosroi; Jiradet Manosroi
Abstract Aqueous and 80% alcohol crude extracts of three medicinal plants, i.e., Nom Nang , Sun Soke and Stevia showed non-genotoxicity in Ames test in the presence or absencc of metabolic enzymes activation. However, the aqueous and 80% alcoholic extracts of Sun Soke or Nom Nang showed antimutagenicity against pyrolysate mutagens, IQ and Trp-P-1, hepatocarcinogen, aflatoxin B1 and a carcinogenic, AF-2. But co-mutagenicity to Trp-P-1 was observed in 80% alcoholic extract of Nom Nang and to AFB1 was in aqueous extract of Sun Soke. Chiang Mai Med Bull 2001;40:(3):147-153.
PROLONGED EFFECT OF CHILDREN AND FAMILY BASED INTERVENTION ON TREATING CHILDHOOD OBESITY
(Chiang Mai Medical Journal, 2009-09-21) Sainatee Pratanaphon; Nittaya Pun-Ai; Samatchai Chamnongkich
The effects of modest lifestyle modifications in growing obese children using a children and family based intervention were interesting. This study was aimed to investigate the long term effect of intervention on the BMI percentile change and anthropometric measure change in obese/overweight children, compared with normal weight children. Three hundred and twelve children aged 6-7 years participated in this study. They were defined as normal weight, overweight, and obese, based on the BMI criterion from the International Obesity Task Force (IOTF). The obese/overweight children and their parents enrolled in a 1-day seminar including education and behavioral modification, and group discussion. In addition, an interview and suggestions were made for each family 4 times a year via the telephone. The anthropometric data such as BMI and WC value as well as the changes in BMI percentile of all children were examined at pre- and post- 1 year intervention. The results showed that, at follow-up, the BMI percentile change of the obese/overweight children had not altered, which compared with normal weight children (odds ratio, 1.69 : 95% CI, 0.71-4.02; p = 0.17). Similarly, the mean change in BMI and WC values of obese/overweight children remained significantly higher than that of normal weight children (p \< 0.001). Thus, long-term intervention that focused on dietary education and behavioral modification, including a follow-up 3 times a year, did not provide any advantages on the BMI percentile change, or BMI and WC values of the obese/overweight children.
CENTELLA ASIATICA EXTRACT INDUCES CELL CYCLE ARREST IN CACO-2 HUMAN COLON CANCER CELLS
(Chiang Mai Medical Journal, 2009-12-22) Piyawan Bunpo; Keiko Kataoka; Hideki Arimochi; Haruyuki Nakayama; Tomomi Kuwahara; Yoshinari Ohnishi; Usanee Vinitketkumnuen
Centella asiatica is traditionally a medicinal plant frequently employed in the practice of Thai folk medicine. This study examined the anti-tumor activity of the crude water extract of C. asiatica using human colon adenocarcinoma-derived Caco-2 cells. C. asiatica extract reduced the proliferation rate of Caco-2 cells significantly in a concentration- and time-dependent manner. The mechanism of cancer cell growth inhibition was shown to occur via cell cycle arrest. The extract induced S and G2-M arrest in Caco-2 cells accompanied apoptosis induction. The extract also increased the accumulation of cyclin B1 protein in the cells. These findings indicate that C. asiatica extract inhibited cell proliferation of Caco-2 cells through modification of the cell cycle events and this cell cycle arrest is associated, at least in part, with increased accumulation of cyclin B1 protein. Chiang Mai Med Bull 2005;44(1):21-28.
FUNGAL INFECTION OF THE BREAST: TWO REPORTED CASES DIAGNOSED BY FINE NEEDLE ASPIRATION (FNA) CYTOLOGY
(Chiang Mai Medical Journal, 2009-09-21) Neelaya Sukhamwang; Benjaporn Chaiwun; Hongsin Trakultivakorn
Objective: To report two cases of fungal infection, zygomycosis and aspergillosis, of the breast, diagnosed by fine needle aspiration (FNA) cytology. In most reports, these fungal species are not frequently encountered in immunocompetent hosts. Both of our patients were in healthy condition. Materials and methods: All breast FNA cases obtained over a 5 year period in Maharaj Nakorn Chiang Mai Hospital were reviewed. Only two cases of fungal infections were found. The FNA and histologic slides were reviewed. Results: Case 1: A 42-year-old healthy woman presented with a 1.5 cm ill-defined mass at the left breast. FNA showed fungal hyphae, morphologically consistent with zygomycosis. The histologic study of a subsequent biopsy revealed fungal hyphae with broad and irregular branching, identified by Gomori methenamine silver and Periodic Acid Schiff stains. Case 2: A 59-year-old woman with a history of intraductal carcinoma and treated with post-lumpectomy and chemotherapy, seven years before, presented with newly developed mass at the right breast. The cytology revealed multiple septate hyphae with dichotomous branching; a feature of aspergillus. The patient was treated by wide excision. Histologic examination showed abscesses containing septate hyphae. Conclusion: Fungal infection of the breast is uncommon even in patients with immunocompromised status. Both of our patients were healthy, though one was previously diagnosed as having breast cancer and treated seven years before. Our study also emphasized the usefulness of FNA study in diagnosing fungal infection of the breast.
CT FINDINGS OF ACUTE PANCREATITIS IN MAHARAJ NAKORN CHIANG MAI HOSPITAL
(Chiang Mai Medical Journal, 2007-11-30) Anchalee Wongnai; Wittanee Na-Chiang Mai
Purpose: To retrospectively review etiologies, CT findings, complications and correlation between the CT severity index (CTSI) and length of hospital stay (LOS) in the patients with acute pancreatitis in Maharaj Nakorn Chiang Mai Hospital. Materials and methods: Ninety one patients with a diagnosis of acute pancreatitis were recruited from the Maharaj Nakorn Chiang Mai Hospital database from October 2003 to June 2005. The etiologies of acute pancreatitis were collected from medical records. Fifty patients underwent CT scans in the hospital. The CT findings were analyzed. All patients were grouped into mild, moderate and severe pancreatitis using the currently accepted CTSI, developed by Bathazar et al. Correlation between CTSI and LOS was calculated by ANOVA and Sheffe methods using the SPSS program. Result: The most common etiology of acute pancreatitis was alcohol ingestion, which presented in 30 patients (60%). By using the currently accepted CTSI, we graded the severity of acute pancreatitis as mild in 30 (60%), moderate in 16 (32%) and severe in 4 (8%) of the 50 patients. The most common extrapancreatic abnormality was pleural effusion; which accounted for 29 (58%) of the 50 patients. Complications of pancreatitis were as follows; pancreatic abscess in 6 patients (12%), infected pancreatic necrosis in 2 (4%), pancreatic pseudocyst in 4 (8%), venous thrombosis in 8 (16%) and splenic infarction in 1 patient (2%). When comparing LOS between groups, there was a significant difference in LOS between the mild and moderate pancreatitis groups (p=0.04) and between the mild and severe pancreatitis groups (p=0.001), but there was no significant difference in LOS between the moderate and severe pancreatitis groups (p=0.078). Conclusion: The most common etiology of acute pancreatitis in Maharaj Nakorn Chiang Mai Hospital is alcohol ingestion. Most of the patients with acute ancreatitis are in the mild group. The most common complication is venous thrombosis. The grading of pancreatitis could be graded in mild and severe acute pancreatitis groups, which correlated well with patient outcome.
ECTOPIC PELVIC KIDNEY AND INGUINAL OVARY IN A 37-YEAR-OLD WOMAN: AN EXTREMELY RARE CASE
(Chiang Mai Medical Journal, 2010-09-27) Phitsanu Mahawong
Pelvic kidney is the most common type of renal ectopia. It can occur unilaterally orbilaterally and may present with ureteropelvic junction obstruction or vesicoureteral refl ux. Themost striking feature is the association of genital anomalies in patients with renal ectopia. The authorreports, here in a case of right pelvic kidney with ipsilateral inguinal ovary, which was detectedduring surgical treatment of a renal pelvic stone.Chiang Mai Medical Journal 2010;49(2):75-79.
OUTCOMES OF DIFFERENTIATED THYROID CARCINOMA (DTC) PATIENTS AT MAHARAJ NAKORN CHIANG MAI HOSPITAL (MNCM)
(Chiang Mai Medical Journal, 2007-11-30) Supawan Buranapin; Laddawan Limpijarnkit; Natapong Kosachunhanun; Jongkol Vachiranakorn; Ampica Mangklabruks
Objective: To compare the outcome of DTC patients treated at MNCM with various types of therapy. End point measurements were cancer recurrence and cancer death. Materials and methods: A retrospective review of all available medical records of DTC patients from January 1988 to December 1998 was performed. Some patients, who were diagnosed DTC long before 1988 and had continued to follow-up, were included in this study. There were 292 patients (225 female and 67 male) comprising 54.5% papillary cell carcinoma, 39.7% follicular cell carcinoma and 5.8% mixed papillary and follicular cell carcinoma. Results: The mean age at diagnosis was 43.6±0.86 years. The female to male ratio was 3:1 and mean tumor size 3.8 cm. The outcomes among 4 types of therapy were compared: surgery alone, surgery combined with thyroid hormone suppression (THS), surgery combined with THS and I131 remnant ablation started within 1 year after surgery, and surgery combined with THS and I131 remnant ablation started more than 1 year after surgery. There were no significant differences among the groups of therapy regarding sex, tumor size, cell type, local tumor invasion and cervical node metastasis, but age at diagnosis and distant metastasis were significantly different. The mean survival time for each treatment group was 8.04, 10.67, 23.97 and 12.11 years, respectively (p=0.03). Disease free interval in each treatment groups was 6.72, 8.72, 19.94 and 9.53 years, respectively, (p=0.003). Factors that influenced cancer death were cervical node metastasis, distant metastasis and thyroid remnant ablation. Factors that influenced cancer recurrence were age at diagnosis, cervical node metastasis, distant metastasis and thyroid remnant ablation. Conclusion: This study suggested that thyroid remnant ablation is effective in decreasing cancer recurrence and cancer death in DTC patients.
GOLDMANN APPLANATION TONOMETRY AFTER LASER IN SITU KERATOMILEUSIS FOR MYOPIA
(Chiang Mai Medical Journal, 2010-01-15) Winai Chaidaroon; Nawat Watanachai
Abstract Purpose : To evaluate the change of intraocular pressure (IOP) using Goldmann applanation tonometry (GAT) and to determine the relationship between IOP and the central corneal thickness (CCT) after laser in situ keratomileusis (LASIK).Methods: Data from 65 patients, who had undergone bilateral LASIK, were included in a retrospective study. Three-month follow-up data were reviewed. IOP was measured by GAT preoperatively and 3 months after LASIK. The change from baseline (preoperative) IOP and the correlation between IOP and the central corneal thickness (CCT) were evaluated. Results: At 3 months, the mean IOP decreased, compared to preoperative values. The significant mean change in IOP was 2.14±0.90 mm Hg (range, 0 to 5 mm Hg) (p=0.0001), and the mean reduction of CCT after LASIK was 90.46±30.62 μm (range 25 to 167 μm). There was no correlation between change in CCT (μm) and IOP (mm Hg) (r=-0.09; p=0.334).Conclusion : LASIK lowered IOP measurement by GAT. The reduction in IOP measurement was probably caused by a change in the corneal thickness (central stromal thinning). This decrease may the delay recognition and treatment of future glaucoma that may develop after LASIK for myopia.Chiang Mai Med Bull 2001;40(4):163-166.
THE BREAST IMAGING REPORTING AND DATA SYSTEM- BI-RADS: POSITIVE PREDICTIVE VALUE OF CATEGORY 4 AND 5 LESIONS
(Chiang Mai Medical Journal, 2010-10-15) Malai Muttarak; Kanchana Srivichai; Benjaporn Chaiwun; Neelaya Sukhamwang
Objective Materials and methods fi ndings, and pathological results were recorded. The positive predictive value (PPV) ofBI-RADS categories 4 and 5 were analyzed.Results fi cations, was the most common imaging abnormality. Fibroadenoma and fi brocysticchange were the most common benign lesions leading to biopsy. The most common histologicdiagnosis of malignancy was invasive carcinoma. The most common biopsy method wasfi ne-needleaspiration.Conclusion fi cations, had a high chance of malignancy. Preoperative biopsy shouldbe performed before defi nite treatment in all suspicious mammographic fi ndings because ofthe overlap in mammographic appearances of benign and malignant breast lesions. Fine needleaspiration biopsy (FNAB) was the most common method used in this study.Chiang Mai MedicalJournal 2010;49(3):111-116.The BI-RADS categorization is useful in predicting the chance of malignancy. Breastmass, with or without calciThe PPV for BI-RADS 4 was 26.6% and BI-RADS 5 89.5%. Mass, with or withoutmicrocalciInstitutional Reviewed Board approval was obtained. From 12,284 women,who underwent screening and diagnostic mammography at our institution, 236 were categorized asBI-RADS 4 and 144 as BI-RADS 5 between January 2006 and December 2008. Biopsy methods,imagingTo determine the positive predictive value of BI-RADS categories 4 and 5.
COMPARISON OF METHODS USED IN MEASURING NONADHERENCE AND THE BARRIERS AGAINST ADHERENCE TO ANTIPSYCHOTIC DRUGS IN OUTPATIENTS WITH SCHIZOPHRENIA
(Chiang Mai Medical Journal, 2010-10-15) Sirijit Suttajit; Sutrak Pilakanta
Background Methods Results Conclusion Chiang Mai Medical Journal 2010;49(3):97-103.Subjective methods such as self-reporting and psychiatrist rating might underestimatenonadherence to antipsychotic drugs. Objective methods such as the pill count should be added toevaluate nonadherence. Furthermore, barriers against adherence in Thailand may differ in someaspects from those in western countriesOf the 75 participants in the previous study, four were lost to follow-up. In this study theprevalence of nonadherence reported by the 71 remaining patients and psychiatrists was only 5.1%and 16.9%, respectively, while that measured by pill count was 46.5%. The three most commonbarriers reported by patients with schizophrenia were memory problems, stigma, and adverse drugreactions.A prospective study was conducted at Chiang Mai University Hospital, Thailand, in which75 patients with schizophrenia were followed up from a pervious study for three months to evaluatetheir adherence to antipsychotic drugs measured by self-reporting, psychiatrist rating and pill count.The nine domains of barriers against adherence were assessed, and risk factors associated with highbarriers were analyzed using the chi-square and independent t-tests.Although patient self-reporting was the method used most commonly to measureadherence to antipsychotic drugs in schizophrenia, it may underestimate the degree of nonadherence.In addition, little is known about barriers against adherence in patients with schizophrenia inThailand.
BREAST SELF-EXAMINATION IN WOMEN RECEIVING HORMONE REPLACEMENT THERAPY AT THE MENOPAUSE CLINIC, MAHARAJ NAKORN CHIANG MAI HOSPITAL
(Chiang Mai Medical Journal, 2010-01-15) Narisa Sribanditmongkol
This descriptive study was conducted to investigate the breast self- examination practice in 200 women receiving hormone replacement therapy and had received education about breast cancer and breast self- examination from nurses at Menopause Clinic Maharaj Nakorn Chiang Mai hospital. Data were collected by researcher, using breast self- examination questionnaire. The results showed that breast self-examination score of the group was at a medium level with mean of 15.07 and SD of 6.70 (possible score 0-28) and majority of the subject (67.5%) had breast self-examination score at medium level, only 16.5% had score at good level and 16% had low level score. The results of this study indicated that women receiving hormone replacement therapy had practiced breast self-examination ineffectively. The appropriate educational program and media needed to be adjusted and considered in order to encourage the performance of breast self-examination in the women. Chiang Mai Med Bull 2004;43(1):9-13.
RUPTURED VASA PREVIA: REPORT OF FOUR CASES
(Chiang Mai Medical Journal, 2007-11-30) Vorapin Gomutbutra
The author reported 4 cases of ruptured Previa with a fatal perinatal outcome of two dead fetus in utero, two still births and a neonatal death. No definite prenatal diagnosis could be made in any of them. After experiencing two cases, every risk case needed awareness especially in unexplainable severe fetal distress after small bloody aminotic fluid. However, two more fetal deaths occurred with Ruptured Vasa Previa. Antenatal diagnosis and elective cesarean section may reduce mortality and morbidity. The purpose of this report was to postulate whether some special devices may soon be able to detect this abnormality in a high index of suspicious cases.

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