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C Dejthevapor A Vibhagool A Thakkinstian S Sirinavi M Vorachit 《The Southeast Asian journal of tropical medicine and public health》2000,31(4):679-683
To identify risk factors for acquisition of penicillin-resistant Streptococcus pneumoniae (PRSP) in patients in Bangkok, using a case-control study, the study included patients with clinical specimens which grew S. pneumoniae during January to December 1997, treated at a teaching hospital in Bangkok. Penicillin susceptibility was determined by E-test and strains with MIC of > 0.1 microg/ml were considered resistant. Cases were the patients who had PRSP, and patients who had penicillin-susceptible S. pneumoniae (PSSP) were controls. The study variables included age 15 years or younger, immunocompromised status, ventilatory support, and antibiotic use or hospitalization within the previous 3 months. There were 73 cases and 51 controls. Their ages were 0 to 87 years, with median age of cases 4 and controls 49 years. Pneumonia was the most common type of infection, being 47% in cases and 45% in controls. Univariate analysis revealed significant association of PRSP acquisition with previous antibiotic use (p<0.0001), age < or = 15 years (p=0.001) and previous hospitalization (p=0.002). Logistic regression analysis in order to adjust for confounding effects showed that the only significant risk factor was previous antibiotic use (OR 18.4; 95% CI 6.2-54.6). The major risk factor for acquisition of PRSP in this study population is recent antibiotic use. Decreased antibiotic use would reduce risk of acquisition of PRSP. 相似文献
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Pornsuriyasak P Charoenpan P Vongvivat K Thakkinstian A 《Respirology (Carlton, Vic.)》2005,10(4):520-524
OBJECTIVE: The aim of this study was to determine the clinical effect of inhaled corticosteroid treatment for persistent cough, post upper respiratory tract infection (URTI) in previously healthy individuals, and on bronchial hyperresponsiveness (BHR). METHODOLOGY: This was a prospective, randomized, double-blinded, placebo-controlled study conducted at a university hospital. A total of 30 non-asthmatic, non-smoking patients who were >15 years old and who had persistent post-URTI cough for >3 weeks were assessed by a physical examination, CXR and spirometry, and were allocated to receive inhaled budesonide (400 microg/puff, twice daily) or placebo for 4 weeks. If a patient suffered from sinusitis, it was a requirement that it had been well treated. A symptom score (frequency of cough, frequency of coughing bouts, symptoms associated with cough, night-time cough, frequency of taking medications to relieve cough, and number of medications) was recorded at entry, and after 2 and 4 weeks of treatment. A methacholine challenge test was performed at entry and after 4 weeks of treatment. RESULTS: The mean symptom scores for the treatment group (9.4) and the placebo group (9.8) at baseline were not significantly different (P=0.79), and no differences were found between the groups after week 2 and week 4 of treatment (3.93 and 4.27 vs 2.26 and 2.66, P=0.29). The mean change in symptom scores from baseline to week 2 and to week 4 of treatment were also not different between groups (5.93 and 5.6 vs 7.00 and 7.58, P=0.23). No difference between groups was found in the mean changes in FEV(1), FVC, and FEF(25--75%) after 4 weeks of treatment. A positive bronchial provocation test occurred in three patients (10%) but these were borderline. CONCLUSION: Inhaled corticosteroid is ineffective in treating persistent post-URTI cough in previously healthy individuals. 相似文献
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ABSTRACT: BACKGROUND: Numerous emerging data from research on osteoporosis among Asians found differences from Caucasians. Therefore, the aim of this study was to determine the prevalence of vitamin D insufficiency and osteoporosis in elderly participants from two nursing homes in Thailand, a country located near the equator. METHODS: The subjects of this cross-sectional study comprised 93 elderly Thai women who were living in institutional long-term nursing homes for the aged. Demographic data, daily food and calcium intake, physical activity, and sunlight exposure were measured. Lumbar spine and femoral neck bone mineral density (BMD) and biochemical levels including serum 25 hydroxyvitamin D [25(OH)D] and bone turnover markers were assessed. Vitamin D insufficiency was defined as 25(OH)D level < 70 nmol/l. RESULTS: The mean age of subjects was 75.2 +/- 6.0 (SD) years. Dietary calcium intake was low (322 +/- 158 mg/day) The mean 25(OH)D level was 64.3 +/- 14.9 nmol/L and the prevalence of vitamin D insufficiency was 38.7 % (95 % CI: 28.8 %, 49.4 %). There was no correlation between serum 25(OH)D concentrations and age (r = -.11, p = 0.3). The mean BMD of lumbar spine and femoral neck were 0.92 +/- 0.19 and 0.65 +/- 0.10 g/cm2, respectively. Nearly a half of the subjects had osteopenia (44.1 %, 95 % CI: 33.8 %, 54.8 %) and osteoporosis (47.3 %, 95 % CI: 36.9 %, 57.9 %). Circulating C-terminal telopeptide of type I collagen (CTx) level correlated significantly with both lumbar spine (r = -0.26, p = 0.01) and femoral neck BMD (r = -0.25, p = 0.02). CONCLUSIONS: More than one-third of Thai elderly women residing in nursing homes had vitamin D insufficiency. Almost all nursing home residents had osteoporosis and/or osteopenia. 相似文献
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Philip Etabee Bassey Pawin Numthavaj Sasivimol Rattanasiri Piyamitr Sritara Mark McEvoy Boonsong Ongphiphadhanakul Ammarin Thakkinstian 《The Journal of international medical research》2022,50(4)
ObjectiveBody mass index (BMI), uric acid, diabetes mellitus, and hypertension are risk factors for reduced kidney function and are associated with fetuin-A levels, but their causal pathways remain unclear. The objective of this study was to investigate this knowledge gap.MethodsA repeated cross-sectional design was used to assess causal pathway effects of fetuin-A on the estimated glomerular filtration rate (eGFR), which is mediated through BMI, uric acid, diabetes mellitus, and hypertension.ResultsAmong 2305 participants, the mean eGFR at baseline decreased from 98.7 ± 23.6 mL/minute/1.73 m2 in 2009 to 92.4 ± 22.9 mL/minute/1.73 m2 in 2014. Fetuin-A was significantly associated with eGFR , suggesting that increasing fetuin-A levels predict a decrease in eGFR. Additionally, the indirect effect of fetuin-A on eGFR, as assessed through BMI, was also significant. The effects of fetuin-A on eGFR through other mediation pathways showed variable results.ConclusionsOur study revealed a possible role of fetuin-A in the etiology of declining renal function through mediating body mass index, uric acid, diabetes mellitus, and hypertension via complex causal pathways. Further studies to clarify these mediated effects are recommended. 相似文献
6.
Chumpon Wilasrusmee Boonying Siribumrungwong Samart Phuwapraisirisan Napaphat Poprom Patarawan Woratanarat Panuwat Lertsithichai John Attia Ammarin Thakkinstian 《World journal of emergency surgery : WJES》2017,12(1):49
Background
Diagnosis of appendicitis is still clinically challenging where resources are limited. The purpose of this study was to develop and externally validate Ramathibodi Appendicitis Score (RAMA-AS) in aiding diagnosis of appendicitis.Methods
A two-phase cross-sectional study (i.e., derivation and validation) was conducted at Ramathibodi Hospital (for derivation) and at Thammasat University Hospital and Chaiyaphum Hospital (for validation). Patients with abdominal pain and suspected of having appendicitis were enrolled. Multiple logistic regression was applied to develop a parsimonious model. Calibration and discrimination performances were assessed. In addition, our RAMA-AS was compared with Alvarado’s score performances using ROC curve analysis.Results
The RAMA-AS consisted of three domains with seven predictors including symptoms (i.e., progression of pain, aggravation of pain, and migration of pain), signs (i.e., fever and rebound tenderness), and laboratory tests (i.e., white blood cell count (WBC) and neutrophil). The model fitted well with data, and it performed better discrimination than the Alvarado score with C-statistics of 0.842 (95% CI 0.804, 0.881) versus 0.760 (0.710, 0.810). Internal validation by bootstrap yielded Sommer’s D of 0.686 (0.608, 0.763) and C-statistics of 0.848 (0.846, 0.849). The C-statistics of two external validations were 0.853 (0.791, 0.915) and 0.813 (0.736, 0.892) with fair calibrations.Conclusion
RAMA-AS should be a useful tool for aiding diagnosis of appendicitis with good calibration and discrimination performances.7.
Different impacts of hepatitis B virus and hepatitis C virus on the outcome of kidney transplantation 总被引:12,自引:0,他引:12
Ingsathit A Thakkinstian A Kantachuvesiri S Sumethkul V 《Transplantation proceedings》2007,39(5):1424-1428
Previous studies had shown that HBV and HCV infections lead to increased morbidity and mortality after kidney transplantation when compared with the nonhepatitis group. However, few studies have compared the impact among a population with a high prevalence of HBV and HCV infections. We studied the outcomes of 346 recipients including 23 HBsAg (+) patients (6.6%; group 1), 22 patients with anti-HCV+ (6.3%, group 2), and 301 nonhepatitis patients (group 3) in a single center during a 6-year period. No patient had evidence of precirrhosis or cirrhosis before transplant. The primary end point was graft and patient survival rates. Secondary end point was the rate of progression of chronic allograft, nephropathy. The median follow-up time was 3.7 (0.5-6.8) years. Five-year actuarial graft survival was 80% for group 1, 61% for group 2, and 88 % for group 3 (P = .005). Cox regression showed HCV (hazards ratio 2.96; 95% CI = 1.03-8.51) and acute rejection episode (HR 3.01; 95%CI = 1.86-4.87) to be significant predictors of graft survival. Actuarial 5-year patient survival of group 1 was significantly lower than group 2 or group 3 (79 % vs 89% and 96%; P = .003). Cox regression revealed that the hazards ratio of HBV for death was 7.63 (95%CI = 1.88-30.86; P = .004). In contrast, HCV infection had no significant effect on patient survival (HR 1.59; 95%CI = 0.28-9.02). The rate of chronic allograft nephropathy progression was significantly faster in group 1 (-6.74 mL/min per year) and group 2 (-6.14 mL/min per year) than the controls. We concluded that HBV infection decreased patient survival earlier than HCV and that HCV decreased graft survival more significantly than HBV. Both HBV and HCV were associated with rapid progression of chronic allograft nephropathy. HBV was the strongest risk factor for mortality compared with HCV, with acute rejection episode, with diabetes mellitus, or other hazardous factors. 相似文献
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Atichartakarn V Angchaisuksiri P Aryurachai K Onpun S Chuncharunee S Thakkinstian A Atamasirikul K 《British journal of haematology》2002,118(3):893-898
Small pulmonary arterial thromboses can occur following splenectomy of patients with haemoglobin E/beta-thalassaemia (Hb E/beta-thal). We compared plasma markers of coagulation activation in vivo and red blood cell (RBC) markers of procoagulant activity in 15 Hb E/beta-thal patients who were not splenectomized (NS), 15 who had been splenectomized (S), and 15 normal controls (NC). Levels of plasma thrombin-antithrombin III complex (TAT) were significantly higher in the S group than in either the NS or the NC groups, and levels of prothrombin fragment 1.2 (F 1.2) were significantly higher in the S than in the NC group. Diluted Russell's viper venom clotting times were significantly shorter when RBCs from group S patients were added to the assay compared with RBCs from the NC group. Phosphatidylserine (PS) expression (% of annexin V-positive RBCs) on the outer leaflet of RBC membrane of both 'larger'- and 'smaller'-sized RBCs was significantly higher for the S than the NC group. The RBC PS expression of the S and the NS groups, respectively, accounted for 25 x 3% (P = 0 x 174) and 6.3% (P = 0 x 675) of the variation in plasma TAT levels. Our findings indicated that, when compared with NC, splenectomized patients with Hb E/beta-thal were in a chronic low-grade hypercoagulable state associated with increased numbers of circulating PS exposed RBCs. This condition may have a role in the risk of these patients for pulmonary arterial thromboses. 相似文献
10.
Staton JM Sayer MS Hankey GJ Attia J Thakkinstian A Yi Q Cole VJ Baker R Eikelboom JW 《Journal of neurology, neurosurgery, and psychiatry》2006,77(9):1067-1069