High prevalence of drink-driving in Thailand

This study was conducted to measure the prevalence of drivers with a blood alcohol concentration (BAC) over 50 mg/dl and to identify predictors for such an outcome. A cross-sectional study was conducted during March to August 1995 in eight provinces in Thailand. In each province, with the collaboration of the police, one checkpoint in a suburban area and one on a highway were used to collect data on drivers of 20 motorcycles, 20 4-wheel and 20 6+-wheel motor vehicles, during 1300-1500h, 1700-1900h and 2200-2400h. For each subject, a breath test for alcohol was undertaken using standard breath testing instruments. Four thousand, six hundred and seventy-five male drivers were tested. The crude prevalence of high BAC was 12.6% (range 4.5-23.7%). The differences in prevalence between the suburban area (8.7%) and the highway (8.4%) and between drivers tested on weekdays (9.8%) and on holidays (7.5%) were not statistically significant. The crude prevalences were 3.4-3.8% and 3.8-3.9% at 1300-1500h and 1700-1900h, respectively. During 2200-2400h the prevalence rose to 19.2%, 16.0% and 11.9% among the motorcyclists, the 4-wheel vehicle drivers and the 6+-wheel vehicle drivers, respectively. High BAC among Thai drivers in the study period was very common, especially at night. Efforts should be focused on these high-risk groups and this time period.     

Continuous warm blood cardioplegia: A randomized prospective clinical comparison

Seventy-eight patients undergoing isolated coronary artery bypass grafting (CABG) were randomized to receive one of two myocardial preservation techniques. Control patients (C) (n=38) had myocardial protection by moderate systemic hypothermia, topical cold saline, and myocardial arrest with antegrade dilute blood/cold potassium cardioplegia with subsequent intermittent retrograde solution every 10–15 minutes during the period of aortic cross-clamping. The experimental group (warm blood, WB) (n=40) had myocardial protection at systemic normothermia, myocardial arrest with antegrade high potassium, and warm blood cardioplegia with subsequent continuous retrograde low potassium warm blood cardioplegia throughout aortic cross-clamping. The two groups were similar preoperatively. After aortic declamping, all WB patients developed a spontaneous rhythm. Only three (7.5%) required intraoperative defibrillation compared with 23 (61%) C patients,p<0.0001. The cross-clamp time per graft was greater with WB,p=0.003. The postoperative need for inotropes, cardiac pacing, incidence of ventricular dysrhythmia, chest tube drainage, and hospital stay did not differ between groups. Perioperative myocardial infarction occurred in 2 WB and 0 C patients (p=0.25). Mortality was not different between groups (WB=1, C=2,p=0.89). It is possible to perform CABG with continuous warm blood cardioplegia with low morbidity and mortality. However, no clear advantage was demonstrated over standard techniques that allow the technical ease of a bloodless field. The metabolic and physiologic significance of spontaneous resumption of sinus rhythm upon aortic declamping remains to be elucidated.     

Effects of curcuminoids on frequency of acute myocardial infarction after coronary artery bypass grafting

It is well established that myocardial infarction (MI) associated with coronary artery bypass grafting (CABG) predicts a poor outcome. Nevertheless, cardioprotective therapies to limit myocardial injury after CABG are lacking. Previous studies have shown that curcuminoids decrease proinflammatory cytokines during cardiopulmonary bypass surgery and decrease the occurrence of cardiomyocytic apoptosis after cardiac ischemia/reperfusion injury in animal models. We aimed to evaluate whether curcuminoids prevent MI after CABG compared to placebo. The 121 consecutive patients undergoing CABG were randomly allocated to receive placebo or curcuminoids 4 g/day beginning 3 days before the scheduled surgery and continued until 5 days after surgery. The primary end point was incidence of in-hospital MI. The secondary end point was the effect of curcuminoids on C-reactive protein, plasma malondialdehyde, and N-terminal pro-B-type natriuretic peptide levels. Baseline characteristics were comparable between the curcuminoid and placebo groups. Mean age was 61 ± 9 years. On-pump CABG procedures were performed in 51.2% of patients. Incidence of in-hospital MI was decreased from 30.0% in the placebo group to 13.1% in the curcuminoid group (adjusted hazard ratio 0.35, 0.13 to 0.95, p = 0.038). Postoperative C-reactive protein, malondialdehyde, and N-terminal pro-B-type natriuretic peptide levels were also lower in the curcuminoid than in the placebo group. In conclusion, we demonstrated that curcuminoids significantly decreased MI associated with CABG. The antioxidant and anti-inflammatory effects of curcuminoids may account for their cardioprotective effects shown in this study.     

Geometry of the Clavicle and Reliability of Measurement using PACS

Purpose

To investigate the geometry of the clavicle and to assess the reliability of Picture Archiving Communication System (PACS) for its measurement.

Methods

One hundred pairs of dry clavicles from 78 males and 22 females were measured on radiographs using PACS. Measurements included all of the following parameters: length, width, medial and lateral angulation. The intraclass correlation coefficient (ICC) for the inter-observer and intra-observer reliability was calculated.

Results

The mean left clavicle length among males and females was 149.25 ± 9.64 and 133.30 ± 8.32 mm, respectively. The respective mean right clavicle length among the males and females was 147.77 ± 9.99 and 132.08 ± 6.92 mm. The clavicles from male cadavers were significantly longer, wider and thicker than those from females, on both the left and right (P < 0.05). Among both the male and female clavicles, the left side was significantly longer than the right (P < 0.05). There was good to excellent intra-observer reliability (ICC > 0.70) for all parameters. Inter-observer reliability was also found good to excellent for all parameters except for medial clavicular angulation; for which there was fair reliability (ICC = 0.697).

Conclusion

The geometry of the clavicle is influenced by sex and side. Use of PACS as a measurement tool is reliable. Data from this study will be useful for pre-contouring plate or improving future designs of the anatomical plate of the clavicle.     

Factors influencing survival in patients after bidirectional Glenn shunt

Clinical characteristics, echocardiographic values, and catheterization data of 45 patients with a functional univentricular heart who had a bidirectional Glenn shunt instituted between November 1994 and October 2006 were retrospectively reviewed. Median age at operation was 20 months (range, 9 months to 19 years). Median follow-up time after the bidirectional Glenn operation was 4 years (range, 1 day to 11 years). The early mortality rate was 4/45 (8.9%); overall mortality was 24.4%. Actuarial survival after a bidirectional Glenn shunt was 73% +/- 8% at 5 years and 55% +/- 17% at 10 years. In multivariate Cox proportional hazards analysis, heterotaxy syndrome and systemic right ventricle were independent predictors of mortality after the bidirectional Glenn shunt. Age at operation, oxygen saturation, previous surgery, a pulsatile Glenn shunt, cardiopulmonary bypass, postoperative pulmonary artery pressure, bilateral superior venae cavae, and Nakata index were not predictive of mortality. The presence of heterotaxy syndrome and systemic right ventricle in patients with a functional univentricular heart should lead to aggressive investigation and management strategies.     

Intra-tendon sheath injection for trigger finger: the randomized controlled trial.

The most common technique used for non-surgical treatment of trigger fingers is the direct injection of steroids into the flexor tendon sheath over the metacarpal head. However, this method causes more pian to the patient and can result in tendon rupture due to insertion of needle into the tendon. Carlson and Curtis described the mid-axial injection technique which is simple and relatively painless. We aim to compare the pain result from the injection between these two methods. The prospective randomised control trial study was designed. There were 103 trigger fingers included in the study which were divided into two groups: the conventional technique of injection (CI technique) and the mid-axial injection technique (MAI technique). The visual analogue scale for pain score had been recorded at the time of injection: one, three and six weeks. The complication after injection and the recurrent symptoms within one year were also recorded. The Student's t-test, Chi-squared and Fisher-exact analysis were used for statistical testing. The results showed that the mean VAS pain scores immediately after needle insertion were 40.19 +/- 23.3 and 48.39 +/- 26.5 in the MAI and CI technique groups, respectively. The MAI technique was less painful than the CI technique (p < 0.05). There were no complications from the injections in both methods. However, the recurrent rate seems to be higher in the conventional technique (p = 0.23). We concluded that the MAI injection technique provided less pain result than the CI technique and there were no complications from this injection technique.     

Prediction of idiopathic respiratory distress syndrome by the stable microbubble test on gastric aspirate

We evaluated the usefulness and accuracy of the stable microbubble test (SMT) performed on gastric aspirates of neonates to predict idiopathic respiratory distress syndrome (IRDS) and compared the results with those of the shake test, using the clinical characteristics of IRDS as the gold standard for the diagnosis of IRDS. One hundred forty paired samples of gastric aspirates, obtained within 1 hour of delivery from neonates with gestational ages between 27 and 42 weeks (mean, 36.6 ± 3.5 weeks) and birth weights between 800 and 4,090 grams (mean 2,571 ± 826 grams) were evaluated. The sensitivity and specificity of the SMT with a predefined cut-off value of less than 20 bubbles/mm² were 94.7% and 95%, respectively, with a positive and negative predictive value of 75% and 99.1%, respectively. The positive predictive value and specificity were increased to 100% in premature neonates. These values, especially the positive predictive value and specificity, were much higher than those obtained with the shake test. We conclude that the SMT on gastric aspirates obtained within 1 hour of delivery is a rapid and simple procedure to identify those neonates who will develop IRDS and who may benefit from prophylactic exogenous surfactant replacement. Pediatr Pulmonol. 1998; 25:383–389. © 1998 Wiley-Liss, Inc.     

Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients

The objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200-250 mL/min and an ultrafiltrate flow rate of 800-1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71 ± 0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73 ± 0.21 L/h or 12.11 ± 3.50 mL/min) constituted 49.4 ± 20.8% of total vancomycin clearance (1.59 ± 0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9 ± 104.0 mg). The volume of distribution was 24.69 ± 11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08 ± 0.05 h⁻¹ and 12.02 ± 7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50% of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500-750 mg every 12 h to provide a steady-state trough concentration of 15-20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.     

Allozyme analysis of the temporal populations of Echinostoma revolutum collected from domestic ducks in Khon Kaen Province, Thailand

Four temporal populations of Echinostoma revolutum (ER1, ER2, ER3, ER4) were collected from domestic ducks in Khon Kaen Province, Thailand during February-October 2008. The ER1, ER2, ER3 and ER4 were collected in February, April, June and October, respectively. The 12 enzymes encoding 15 loci were examined. Two loci were found in each of 3 enzymes, namely glucose-6-phosphate dehydrogenase (G6PD), malic enzyme (ME) and peptidase valine-leucine (PEPA). Of these, three loci, namely, G6pd-1, Me-1 and PepA-2, were polymorphic. Genotypes were assigned for the specific allelic profiles detected at these three polymorphic loci. Twenty-eight genotypes were observed in the 4 temporal populations of E. revolutum. Three genotypes, Er22, Er23 and Er25, were found in all populations. The Er6 genotype occurred had the highest frequency of all the populations. These 28 genotypes were clustered into 3 groups with genetic differences of 2-12% among the loci. A cluster of genotypes (Er1, Er3, Er9 and Er12) showed the greatest genetic difference among the genotypes (12% difference). These results show intraspecific variation exists in E. revolutum populations in domestic ducks from Khon Kaen Province, Thailand.     

Health status of diabetes type 2 patients in Thailand contradicts their perception and admitted compliance

A nationwide data set about the health status of diabetes mellitus type 2 (DM) patients and a questionnaire of a sub-sample of the DM patients about their know-how, behavior and perception about health care had been re-assessed. Laboratory results revealed that in average 70% of the patients had been over nourished, over 50% had abnormal cholesterol-, over 55% had high triglyceride levels and 51% had high density lipid (HDL) values below 45 mg/dl. Sixty percent of patients had glycated hemoglobin (HbA1c) levels over 7%. About 60% of study participants answered a questionnaire. In contrast to the laboratory findings about 90% claimed to take the medicine as the doctor advised, 60% said that they adjusted their food intake as advised and more than 80% said that they know well how to take care of themselves. They were only superficially informed about the complications of DM. Almost 95% were satisfied with the health service they receive and over 70% were satisfied with their health status. The results are discussed in connection with the need to control DM on the basis of primary health care (PHC). It is argued that the assessment of health programs solely through questionnaires might be misleading, if the findings are not confirmed by clinical and biochemical parameters.