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ABSTRACT: Background Carbamazepine (CBZ) is broadly used for the treatment of epilepsy, neuropathic pain and other neurological diseases, owing to its effectiveness and low price. CBZ can induce Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). There are several studies that found an association between HLA-B*1502 and CBZ-induced SJS/TEN, especially in people of Thai origin. In Thailand the prevalence of HLA-B*1502 was found to be in the range 8.1-14 %. Objective This study aimed to determine if screening for HLA-B*1502 in Thai patients who were to receive CBZ is cost effective. Setting Srinagarind Hospital, Khon Kaen University, Thailand. Method A comparison between treatment cost of CBZ induced SJS/TEN and the HLAB*1502 screening costs in the Thai population. Main outcome measure Comparison of the costs of treatment of CBZ induced SJS/TEN and costs of HLA-B*1502 screening test. Results When persons having the HLA-B*1502 allele receive CBZ, the chance of developing SJS/TEN is as high as 88.1 %, while persons without the HLA-B*1502 allele do not develop SJS/TEN. Therefore, a model was calculated to compare the cost of treatment between HLA-B*1502 testing before giving CBZ and if the patients were not tested for HLAB*1502. It was found that screening 100 patients before giving CBZ would save an amount of 98,549.94 baht per 100 cases of CBZ-prescribed patients. Conclusion The screening for HLA-B*1502 allele before giving carbamazepine is cost effective. The results of the present study may also apply to other populations if the HLA-B*1502 frequency is high enough.
International journal of clinical pharmacy. 05/2013;
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ABSTRACT: PURPOSE: The prevalence of both hypertension and obstructive sleep apnea (OSA) are increased in patients with age greater than 60 years. We studied the clinical differences of OSA in hypertensive patients with age greater or less than 60 years. In addition, rate of OSA-induced hypertension in Thai population is limited. METHODS: We retrospectively reviewed medical records of patients treated at the hypertension/sleep clinic at Srinagarind Hospital, Khon Kaen University, between 2010 and 2011. The inclusion criteria used were hypertensive patients who had at least one symptom of OSA and had been tested for the sleep study. Rate and clinical features of OSA were studied and categorized by age of 69 years. Factors associated with likelihood of having OSA in hypertensive patients age over 60 years were identified by multiple logistic regression analysis. RESULTS: During the study period, 49 patients met the criteria. Of those, 42 patients (85.71 %) had an apnea-hypopnea index (AHI) of more than 5/h. The average AHI was 22.22 ± 13.86 times/h. The common symptoms of OSA were snoring (100 %), daytime sleepiness (28.57 %), unexplained nocturia (28.57 %), and gastroesophageal reflux disease (28.57 %). The numbers of patients with age less than 60 years and more than 60 years were 20 and 22 cases, respectively. Most patients (88.10 %) had well-controlled blood pressure level. Only BMI was significantly associated with OSA-induced hypertension in patients aged over or equal to 60 years. The adjusted odds ratio was 0.743 (0.560, 0.985). CONCLUSIONS: OSA is very common in Thai hypertensive patients aged 40-70 years who have at least one symptom of OSA. Lower BMI is a predictor of obstructive sleep apnea in elderly Thai hypertensive patients.
Sleep And Breathing 02/2013; · 1.84 Impact Factor
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ABSTRACT: Caregivers of persons with epilepsy (PWEs) in developing countries do not always have access to correct information related to the affliction of the patients they are entrusted to care for. Epilepsy can be difficult to manage for all those involved, whether it is a family member, the PWEs themselves, or the caregiver. Misconceptions are common about epilepsy, especially in undeveloped countries where a majority of the population have lower educational levels. This study aims to acquire baseline data about caregivers of PWEs related to their knowledge, attitudes, and methods of giving care to PWEs. A cross-sectional survey was administered to 83 PWE caregivers at a university epilepsy clinic in northeastern Thailand. The caregivers believed that knowledge about epilepsy was paramount; however, they felt that their own knowledge of the condition was insufficient. Educational level, relationship to the PWEs, and sex were correlated to various aspects related to epilepsy knowledge and attitudes in caregivers. A slight negative correlation was found between caregiver knowledge and attitudes toward epilepsy with Pearson's correlation coefficient (r=-0.38, P-value 0.001). Education and improved epilepsy information need to be provided to the caregivers of PWEs in northeastern Thailand.
Epilepsy & Behavior 02/2013; · 2.34 Impact Factor
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ABSTRACT: BACKGROUND: Pineal calcification and low melatonin have been shown to be risk factors for stroke in animal studies; however, there are limited clinical data on the association of pineal calcification and stroke in humans. METHODS: All computed tomographic (CT) scans of the brains of patients >15 years of age during the year 2011 at a university teaching hospital were retrospectively reviewed. Patient medical charts were used to obtain the risk factors for stroke, including diabetes, hypertension, dyslipidemia, age, and sex. Cerebral infarction was identified by having clinical syndromes of stroke and a positive CT scan. Patients with embolic or hemorrhagic stroke were excluded. Pineal calcification was evidenced by the CT scans. The association of various stroke risk factors and cerebral infarction were calculated using logistic regression analysis. RESULTS: A total of 1614 patients were included, and symptomatic cerebral infarction was identified in 620 patients (38.4%). Regarding stroke risk factors in symptomatic cerebral infarction patients, the majority of patients were male (356 [57.4%]), >50 years of age (525 [84.7%]), and had hypertension (361 [58.2%]); some had diabetes (199 [32.1%]) and dyslipidemia (174 [28.1%]). Pineal calcification was found in 1081 patients (67.0%), with a male:female ratio of 1.5:1. Significant factors related to cerebral infarction by univariate logistic regression were age >50 years, hypertension, diabetes, dyslipidemia, and pineal calcification. Pineal calcification as a risk factor for cerebral infarction had an adjusted odds ratio of 1.35 (95% confidence interval 1.05-1.72). CONCLUSIONS: Pineal calcification may be a potential new contributor to cerebral infarction.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 02/2013;
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ABSTRACT: Abstract Blastocystis hominis is a foodborne protozoan found in the human feces worldwide. One hundred and ninety-nine individuals with stool samples positive for B. hominis were identified from a pool of 14,325 patient stools collected between 2003 and 2010 from Srinagarind hospital in Thailand. The medical records of patients were reviewed for demographic and clinical data. Of the 85 patients (42.7%) who had B. hominis infection with no co-infections, 42.5% experienced gastrointestinal symptoms. Abdominal pain is the most frequently observed symptom followed by diarrhea. Strongyloides stercolaris and Opisthorchis viverrini were the predominant parasitic co-infections in blastocystosis patients. The infection rates of B. hominis were high during the rainy season. Most B. hominis-infected patients (94%) had underlying diseases; malignancy and chronic diseases were equally top ranked (35.3%) which indicated that B. hominis is an opportunistic protozoan.
Foodborne Pathogens and Disease 10/2012; · 2.26 Impact Factor
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ABSTRACT: Background: Tuberculosis is a common health problem in developing countries including Thailand. The association between occupation and recent onset of tuberculosis is unclear. Objective: We studied the association of job types and tuberculin conversion or recent onset latent tuberculosis in healthcare workers in an endemic area of tuberculosis. Design and Sample: A case-control study was done at Srinagarind Hospital, Thailand. Cases were subjects with tuberculin conversion, while controls were subjects with negative results of tuberculin skin test (TST) in two consecutive years. Results: One thousand twenty five subjects completed two consecutive TST between 2001 and 2009. The rate of tuberculin conversion was 19.8% or 203 subjects. In a multivariate model, the only three significant factors for tuberculin conversion were male gender, having a BCG scar, and job type. Only nurses, nurse assistants, and ward workers were significantly associated with tuberculin conversion with adjusted odds ratio [95% confidence interval] of 2.3 [1.3-4.1], 2.3 [1.3-4.7], and 3.0 [1.8-5.0], respectively. Conclusion: Being male, having a BCG scar, and certain job types increase the risk of latent tuberculosis in healthcare workers. Tuberculosis infection control program should emphasize job types for healthcare workers who are at increased risk.
Asian biomedicine 08/2012; 6:535-539. · 0.33 Impact Factor
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ABSTRACT: A chronic physical/mental disease not only has direct consequences for the chronically-ill older adults but can also alter the caregiver's life. The objectives of this study were to identify burdens of community-dwelling older adults, characteristics of caregivers, severity of caregiver burden, and to develop supportive strategies. Caregivers of community-dwelling older adults were randomly interviewed between February and March 2012. Information on baseline characteristics and caregiver burden using Zarit Burden Inventory (ZBI) was collected. One hundred-fifty caregivers were interviewed. The mean ZBI was 20.8 + 11.3 [95 % CI 19.0, 22.7]. The majority of caregiver burden was classified as no burden (52 %). The age of caregivers, self-reported health status and duration of care had a positive relationship with ZBI scores while self-reported income had a negative one. Caregiver burden among Thai community-dwelling elder persons was small as most of those cared for had uncomplicated illness but this might be underestimated. Caregiver-dependent factors were more strongly associated with high burden than patient characteristics. Healthcare providers should consider these factors for interventions to alleviate burden.
Journal of Community Health 06/2012; · 1.28 Impact Factor
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ABSTRACT: Mini-mental-State Examination (MMSE) is a widely used tool for dementia screening. However, several limitations are found and the Rowland Universal Dementia Assessment Scale (RUDAS) appears to be an alternative test. The objective in this study was to compare the performance of MMSE-Thai 2002 and RUDAS-Thai for dementia screening, and to determine their performances and identify their optimal cut-off points. The participants were older patients from a Geriatric and Neurology Outpatient Clinic, Srinagarind Hospital, Khon Kaen University. The RUDAS-Thai and the MMSE-Thai 2002 were administered to each participant. Subsequently, a specialist physician assessed each participant for dementia. Results showed the area under receiver operating characteristic curve for both RUDAS-Thai (81.0%; 95%CI, 74.8-87.2) and MMSE-Thai 2002 (81.2%; 95%CI, 74.9-87.4) were equal. A score of 24 or lower provided an optimal cut-off point. Our finding supports that the RUDAS-Thai can be an effective alternative test for dementia screening. For both test scores, a score of 24 or lower is an optimal cut-off point to provide an indication of developing dementia.
American Journal of Alzheimer s Disease and Other Dementias 05/2012; 27(4):254-9. · 1.45 Impact Factor
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ABSTRACT: Treating persons with epilepsy (PWE) in developing countries may be different from elsewhere. Knowledge and attitudes of PWE are known to be associated with seizure control. This study aims to evaluate factors related with the knowledge and attitudes of PWE in northeastern Thailand. A cross-sectional survey using questionnaires and interviews was undertaken at the Khon Kaen University epilepsy clinic. The questionnaire comprised 22 questions (14 knowledge questions and 8 attitude questions). Two hundred three PWE participated in the study with a mean age of 36.5 years. Four factors were significantly associated with the knowledge about epilepsy, which included education level, age, epilepsy duration, and a history of experiencing antiepileptic medication side effects. In addition, there were four factors significantly associated with the attitudes about epilepsy, which included seizure control, education level, epilepsy duration, and marital status. There is a need to provide more education, preferably community based, to help PWE obtain more accurate information.
Epilepsy & Behavior 04/2012; 24(1):23-9. · 2.34 Impact Factor
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ABSTRACT: Background and aims: Dementia is prevalent in the elderly but it is usually unrecognized. The Rowland Universal Dementia Assessment Scale (RUDAS) appears to be a good screening tool for dementia detection. The objectives are to validate RUDAS-Thai for detecting dementia according to Diagnostic and Statistical Manual of Mental Disorders- IV-Text Revised (DSM-IV-TR) criteria in a geriatric outpatient setting and to determine its optimal cut point. Methods: This is a cross-sectional study in which the target population is patients from a Geriatric and Neurology Outpatient Clinic, Srinagarind Hospital, Khon Kaen University who were at the age of 60 years or above. The content validity and test-retest reliability of the RUDAS-Thai were performed initially. It was administered to each participant. Then a specialist physician assessed each participant for dementia. Results: Eighty-nine (44.5%) subjects had dementia, 89 (44.5%) had normal cognition and 22 (11%) had mild cognitive impairment. The area under the Receiver operating characteristic (ROC) curve was 0.82(0.75-0.87). The optimal cut point was 24/30; it provided sensitivity and specificity of 78.7% and 61.8%, respectively. It was not influenced by age and gender but by educational level. Conclusions: The RUDAS-Thai is a good screening tool for dementia detection in a geriatric outpatient setting. It is portable, short time consuming and avoids some limitations of the Mini- Mental State Examination (MMSE). However, education does affect the scores. The scores of 24 or lower is an optimal cut point for an indication of developing dementia.
Aging - Clinical and Experimental Research 03/2012;
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ABSTRACT: Neuropsychiatric lupus (NPL) can present with a wide variety of clinical manifestations secondary to major organ involvement. These are often difficult to diagnose and treat with a high mortality.
This study aims to describe the prevalence, clinical features and predictive factors for NPL patients.
Patients with SLE were retrospectively reviewed for 5 years, between January 2000 and August 2005. The prevalence, clinical features and predictive factors for NPL patients were studied. Neuropsychiatric (NP) syndromes were defined using the American College of Rheumatology (ACR) nomenclature and case definitions.
750 patients with SLE were studied; 13 patients were excluded due to incomplete data. The mean age was 35 +/- 11.7 years and 95.2% were female. The mean SLE disease duration was 6.9 +/ 5.6 years. Eleven of the 19 ACR NP syndromes were identified and NP manifestations occurred in 97 patients (13%) with a total of 103 NP events. Central nervous system (CNS) manifestations accounted for 87% (84 patients), while involvement of the peripheral nervous system (PNS) 13% (13 patients). The three most frequent manifestation were seizures (31.1%), followed by psychoses (223%), and cerebrovascular disease (22.3%). CNS involvement was strongly associated with hematologic and gastrointestinal involvements. The mortality rate in patients with NPSLE was 18.8%.
Seizures, psychoses and cerebrovascular disease were the three most common NP features in SLE patients. CNS involvement was strongly associated with hematologic and gastrointestinal involvement.
Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand 03/2012; 30(1):55-60. · 0.65 Impact Factor
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ABSTRACT: The recommended treatment of otosyphilis is intravenous penicillin therapy. The response rate varied between 23% and 31%. This treatment needs hospitalisation and is costly, inconvenient and time consuming. Oral doxycycline was tested for its efficacy in otosyphilis.
The authors reviewed 19 patients diagnosed as having otosyphilis with hearing loss at the outpatient unit between 2004 and 2008 by oral doxycycline 400 mg/day for 21 days.
Of those enrolled patients, 12 patients were male and the mean age is 69.4 years. The hearing was improved in nine patients (47.3%) and the audiogram of seven patients (36.8%) showed improvement. There was no serious side effect of doxycycline.
The data suggest that doxycycline may be an effective alternate regimen for otosyphilis.
Sexually transmitted infections 01/2012; 88(3):177-8. · 2.18 Impact Factor
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ABSTRACT: Brain metastasis from cholangiocarcinoma (CCA) is a rare but fatal event. To the best of our knowledge, only few cases have been reported. Herein, we report the incident rate and a first case series of brain metastases from CCA.
Between January 2006 and December 2010 5,164 patients were treated at Srinagarind hospital, Khon Kaen University; of those, 8 patients developed brain metastasis. Here we reviewed clinical data and survival times.
The incident rate of brain metastases from CCA was 0.15%. The median age of the patients was 60 years. Tumor subtypes were intrahepatic in 6 and hilar in 2 patients. All suffered from symptoms related to brain metastasis. Three patients were treated with whole-brain radiation therapy (WBRT), one of whom also underwent surgery. The median survival after the diagnosis of brain metastasis was 9.5 weeks (1-28 weeks). The longest survival observed in a patient in RPA class I with two brain lesions and received WBRT.
This is a first case series of brain metastases from CCA with the incident rate of 0.15%. It is rare and associated with short survival time.
Asian Pacific journal of cancer prevention: APJCP 01/2012; 13(5):1995-7. · 0.66 Impact Factor
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ABSTRACT: Background: Delirium is a frequent complication associated with hospitalization of older adults leading to serious complications but it is potentially preventable. The overall data regarding admission rates and its impact in Thai geriatrics are limited. Objective: To identify admission, mortality rates of older persons with delirium and its consequences. Material and Method: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in delirious patients. Results: Delirium occurred in 11,410 of all admissions; contributing admission and mortality rates of 155.4 and 6.4/100,000 older persons. These figures increased with age. The average length of stay in persons with and without delirium were 22.3 and 5.4 days and the average hospital charges were 53,174 and 18,230.8 Baht, respectively. Conclusion: The admission rate of patients with delirium was lower than prior reports; underdetection and underreport should be considered. Admission and mortality rates rose with age. There was an increase in length of stay and hospital charges.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 01/2012; 95(Suppl 7):224-228.
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ABSTRACT: Gnathostoma spinigerum and Angiostrongylus cantonensis are human parasites that can cause neurological symptoms. The human diseases produced by these parasites can usually be differentiated by clinical symptoms. The aim of this study was to report neuroimaging abnormalities detected with computed tomography (CT) and MR in patients with gnathostomiasis and angiostrongyliasis. We enrolled 15 and 12 patients with serologically proven gnathostomiasis and angiostrongyliasis, respectively, who had brain or spinal imaging done. The neuro-gnathostomiasis group had significantly more patients with intracerebral hemorrhage and myelitis patterns. The angiostrongyliasis group had no specific findings and most patients had normal CT brain images. The variety of neuroimaging findings is shown here. This study emphasizes that neuroimaging studies may be useful to differentiate gnathostomiasis and angiostrongyliasis particularly in patients with indistinct clinical presentations.
Neurological Sciences 11/2011; 33(4):893-8. · 1.32 Impact Factor
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ABSTRACT: Meningitic angiostrongyliasis (MA), caused by Angiostrongylus cantonensis, is often diagnosed by clinical criteria alone, because the confirmative serologic tests are not always available in the rural endemic areas. In this study, we evaluated the relationship between various clinical parameters of MA and the sero-positivity to sort out the predictive parameters to ensure the diagnosis. We enrolled consecutive adults in whom MA had been clinically diagnosed, who had serologic results for A. cantonensis, and negative serologic results for Gnathostoma spinigerum. There were 75 eligible patients; 26 (34.7%) and 49 (65.3%) patients who had negative and positive serologic tests for A. cantonensis, respectively. Baseline characteristics and laboratory results were comparable between sero-positive and -negative groups. Only the cerebrospinal fluid (CSF) eosinophil counts of 40% or higher was significantly predictive for positive serologic test with the adjusted odds ratio of 4.970 (95% confidence interval of 1.337-18.477). In diagnostic facilities in the endemic areas with the limited availability of serologic tests, clinicians can ensure the diagnosis of MA by using CSF eosinophil level.
Vector borne and zoonotic diseases (Larchmont, N.Y.) 09/2011; 12(1):73-5. · 2.61 Impact Factor
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ABSTRACT: Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients.
Consecutive patients who had influenza-like illness less than seven days and had been tested for H1N1 by the real-time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests.
There were 6494 patients had flu-like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09-7·40), 6·25 (1·42-27·49), 1·69 (1·08-2·66), and 0·31 (0·12-0·79), respectively.
Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource-limited health care facilities.
Influenza and Other Respiratory Viruses 08/2011; 5(6):e558-62. · 4.16 Impact Factor
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ABSTRACT: Angiostrongylus cantonensis and Gnathostoma spinigerum are the two most common causative parasites of eosinophilic meningitis (EOM). Serological tests are helpful tools for confirming the identity of the pathogen. Recent reports determined the specificity of such tests by using normal healthy controls. There have been limited studies done to rule out the cross-reactivity between these two causative parasites of EOM. This study aims to assess the specificity of the serological test in EOM by using each condition as a control for the other. Thirty-three patients with a diagnosis of EOM were enrolled. Sera from 22 patients with a positive 29-kDa antigenic diagnostic band of A. cantonensis were tested for the 21 and 24-kDa antigenic bands of G. spinigerum. Similarly, sera of 11 gnathostomiasis patients were tested for the 29-kDa diagnostic band for A. cantonensis. Only one patient in the angiostrongyliasis group had a positive result for the 21 and 24-kDa antigenic bands of G. spinigerum, while no gnathostomiasis patients showed a positive result for the 29-kDa antigenic band of A. cantonensis. The specificity of the 21 and 24-kDa antigenic bands for gnathostomiasis and the 29-kDa antigenic band for A. cantonensis was 95.5% and 100%, respectively. The antigenic bands for the diagnosis of gnathostomiasis and angiostrongyliasis in EOM were highly specific.
Memórias do Instituto Oswaldo Cruz 08/2011; 106(5):570-2. · 2.15 Impact Factor
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ABSTRACT: BACKGROUND: We studied the association of causes and stroke outcome of stroke in the young in Thailand. METHODS: A retrospective study was performed at Srinagarind Hospital, Khon Kaen University, Thailand. All patients under 45 years of age who were diagnosed with stroke between 1996 and 2010 and who had complete workups for causes of stroke in the young were enrolled. Stroke outcome was defined as favorable or nonfavorable at approximately 1 year of follow-up. If the patient had normal functional ability or mild disability but the patient was fully employed, the outcome was classified as favorable. Clinical features of strokes and the potential stroke risk factors were compared between the favorable and nonfavorable groups. RESULTS: Eighty-five patients were enrolled. About half of patients were male (47 patients; 55.3%). The mean age (SD) was 35.9 (6.2) years. Three-fourths of male patients had a stroke after 30 years of age, while female patients developed stroke in all age ranges equally. More than half of patients (45 patients; 52.9%) had cardiac causes of stroke. Rheumatic mitral stenosis accounted for 68% (31 patients), and 45% (14 patients) had atrial fibrillation. There were 64 patients (79%) who had a favorable outcome. Cardiac causes, particularly mitral stenosis and alcohol intake, were significantly associated with a nonfavorable outcome. CONCLUSIONS: Stroke in the young generally has a favorable outcome. Factors associated with a nonfavorable outcome of stroke in the young were cardiac abnormalities and alcohol intake. A prospective study to evaluate the association of causes and outcome is needed.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 07/2011;
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ABSTRACT: This article presents the appropriate neuroimaging for persons with epilepsy (PWE) in resource-limited facilities. PWE from the Epilepsy Clinic, Srinagarind Hospital between November 1, 2003 and January 30, 2005 were enrolled. The inclusion criteria were PWE aged more than 15 years who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. We compared the abnormal neuroimaging findings by both imaging modalities. A total of 180 out of 370 PWE met the inclusion criteria, comprising 101 men (56.1%) and 79 women (43.9%). There were 75 PWE who underwent only CT imagings, 85 PWE who underwent only MRI and 20 PWE who underwent both CT and MRI studies. CT scan significantly detected brain abnormalities more than MRI in PWE (P = 0.0131). It was also found that CT scan was superior than MRI in detecting stroke and cysticercosis in PWE, whereas MRI was significantly better in the diagnosis of hippocampal sclerosis. Clinicians should be able to choose appropriate brain imaging for PWE, particularly in resource-limited countries. MRI should be preserved for particular brain lesion owing to availability and cost effectiveness.
Neurological Sciences 06/2011; 32(5):969-71. · 1.32 Impact Factor
