Acute elevation of interleukin 6 and matrix metalloproteinase 9 during the onset of pituitary apoplexy in Cushing’s disease

Pituitary - Pituitary apoplexy is a rare endocrine emergency. The purpose of this study is to characterize physiological changes involved in pituitary apoplexy, especially during the acute phase. A...     

Predictors of Health-Related Quality of Life in Children with Cyanotic Heart Disease Who Underwent Palliative and Total Repair

Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce. Therefore, we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt (MBTS) and those who underwent total repair. Methods: In this historical cohort and concurrent follow-up study, data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained. Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation. Between January and December 2018, the “Pediatric Quality of Life Inventory 4.0 Generic Core Scales” with both child self-report and parent proxy-report scores were used to examine the HRQOL. Multivariate linear regression analysis was performed to identify independent predictors of HRQOL. Beta-coefficient (β) and 95% confidence intervals (95% CIs) were calculated and considered statistically significant at p < 0.05. Results: Among the 380 enrolled children, 148 died, 122 survived and waited for total repair, and 110 survived after total repair. In the multivariate analysis, chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents (β [95% CI]: −0.42 [−0.81, −0.03] and −0.49 [−0.89, −0.09], respectively). Total repair was a predictor of higher physical HRQOL according to both parents and children (β [95% CI]: 0.33 [0.09, 0.57] and 0.70 [0.36, 1.03], respectively). A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age (β [95% CI]: 0.012 [0.001, 0.022]). In the total repair subgroup, undergoing the Fontan procedure (vs. Glenn procedure) was a predictor for lower physical HRQOL reported by the parents (β [95% CI]: −0.82 [−1.52, −0.13]). Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL (β [95% CI]: 0.018 [0.001, 0.034] and 0.012 [0.0001, 0.04], respectively). Conclusions: Successful total repair was a predictor of higher physical HRQOL, and younger age during MBTS surgery was a predictor of higher psychological HRQOL in children with cyanotic heart disease. Higher socioeconomic status was a predictor of both physical and psychological HRQOL following total repair [Thai Clinical Trials Registry: TCTR20161221003].     

Serum and urine sodium levels in dengue patients

We evaluated serum and urine sodium levels in children with dengue infections. Children with acute febrile illness admitted to Bhumibol Adulyadej Hospital in Bangkok from January 1999 to January 2000 were enrolled. Serum and urine sodium levels were measured before initiating intravenous fluid therapy. Two milliliters of blood were obtained on admission and before discharge to test for anti-dengue virus antibody using the enzyme-linked immunosorbent assay technique. Hyponatremia was defined as a serum sodium level <130 mEq/l and depletion of circulatory volume was defined as a urine sodium level < 20 mEq/l. Out of 93 enrolled patients, 49 were categorized as dengue patients and 44 were as non-dengue patients. Six dengue patients developed shock whereas 43 patients did not. The mean serum sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). Hyponatremia was 9.7 times more common in dengue patients. Among dengue patients, the mean serum sodium level was significantly lower in shock patients compared to non-shock patients (p-value = 0.003). However, the prevalence of hyponatremia was not different between the two groups. The mean urine sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). A urine sodium level < or = 20 mEq/l was 8.1 times more common in dengue patients. Among dengue patients, the mean urine sodium level was not significantly different between shock and non-shock patients. In shock patients, a urine sodium level < or = 20 mEq/l was 7.6 times more common.     

Childhood shigellosis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand: a 5-year review (1996-2000)

The objective of this study was to evaluate the demographic data and clinical presentation of childhood shigellosis, and to study the microbiological data and antimicrobial susceptibilities of Shigella spp. Nine thousand nine hundred fourteen stool culture specimens from children aged 0-15 years who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2000 were retrospectively reviewed. Data were collected from microbiological records and medical charts of childhood shigellosis in terms of demographic data, symptoms, signs, and complications of the patients, and the species and antimicrobial susceptibilities of the organisms. The data were analyzed in terms of means, ranges, and percentages. Of 1,523 children whose stool cultures were positive for pathogenic bacteria, 80 (5.3%) were infected with Shigella spp; 34 females and 46 males. The age distribution ranged from 1 day to 13 years with a mean age of 3.6 years. Common clinical presentations included diarrhea (96.6%), fever (77.6%) and vomiting (44.8%); seizures were the most common complication found (27.6%). Watery and mucous were the most common characteristics of stools. The major Shigella spp found was S. sonnei (62.8%), which was susceptible to co-trimoxazole, ampicillin, cefazolin and ciprofloxacin in 2.3, 84.1, 100 and 100%, respectively. A short course of quinolones or oral cephalosporins should be recommended for the treatment of childhood shigellosis in areas with low susceptibility rates to co-trimoxazole and ampicillin.     

Numerical simulation of respiratory flow patterns within human lung

A computational fluid dynamics (CFD) modelling approach is used to study the unsteady respiratory airflow dynamics within a human lung. The three-dimensional asymmetric bifurcation model of the central airway based on the morphological data given by Horsfield et al. (J. Appl. Physiol. 67 (1971) 207) was used in the present study to simulate the oscillatory respiratory. The single bifurcation was found to be sufficient to give a number of results which both qualitatively and quantitatively agreed well with other published experimental and CFD results. Numerical simulation were made for two breathing conditions: (a) resting or normal breathing condition and (b) maximal exercise condition. The respiratory flow results for the both conditions are found strongly dependent on the convective effect and the viscous effect with some contribution of the unsteadiness effect. The secondary motions were stronger for the normal breathing condition as compared with the maximal exercise condition. The difference between the two cases is the flow separation regions found close to the carinal ridge for maximal exercise condition. For normal breathing condition no separation regions was observed in this region.     

A phase IV open label study to assess the safety, tolerability and immunogenicity of a Haemophilus influenzae type B (Hib) CRM197 conjugated vaccine administered to healthy infants at 2, 4, and 6 months of age

The objective of this prospective clinical study was to evaluate the safety, tolerability and immunogenicity of Chiron Hib vaccine (Vaxem Hib) in Thai infants. This trial was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand from June to November 1999. Three intramuscular injections of the vaccine were given to 119 infants at 2, 4 and 6 months of age. Reactions and adverse events after the vaccination were recorded. Blood samples for anti-PRP antibody were collected before the first immunization, and after the second and third immunizations. After the second dose, 91% and 58% of the subjects had anti-PRP antibody titers of > or =0.15 microg/ml and > or =1.0 microg/ml, respectively. After the third dose, 99% and 90% of the subjects had anti-PRP antibody titer > or =0.15 mcirog/ ml and > or =1.0 microg/ml, respectively. Local and systemic reactions were mild and transient. The study indicates that Vaxem Hib vaccine is safe and well tolerated. Three doses of the vaccine are necessary to achieve adequate protection in infants.