Time Duration of Oxygen Adaptation Immediately after Birth; Monitoring by Pulse Oximeter in Perinatal Period of the Infants at Charoenkrung Pracharak Hospital.

BACKGROUND: Oxygen Saturation is one of the important data to determine patient status and worldwide applied in several situations. Evaluation about status of immediate perinatal period of the infant usually uses clinical assessment, Apgar scoring, which had been used for a long time without other scientific measurement. Pulse oximeter the non-invasive measurement of oxygen saturation, may play role for oxygen saturation evaluation in newborn that immediately change from intra to extra uterine environment. OBJECTIVE: Monitoring the time duration that immediately born infants by normal labor or Cesarean section modes, used to archived target oxygen saturation (SpO) and looking for the other factors that influence oxygen saturation adaptation. MATERIAL AND METHOD: The data of the 553 infants born in Charoenkrung Pracharak Hospital, Bangkok, Thailand between October 2012 and April 2013 were collected. The 204 healthy newborns that met all criteria were studied. All infants were recorded pulse oximeter from the second to the tenth minute after birth. They were grouped by several factors such as maternal gravidity, gestational age, mode of delivery, Apgar score, birth weight, and sex. Time interval to achieve target oxygen saturation (SpO2 ≥ 90%) was collected for analysis. RESULTS: The oxygen saturation of infants immediately after birth showed an increase. Median time interval was 6.5 (2-10) minutes for 90% saturation and 7 (2-10) minutes for 95% saturation, respectively. Only mode of delivery showed statistical significant time difference (p < 0.001). A Cox proportional hazards analysis of the Kaplan-Meier curves demonstrated that infants born by cesarean delivery took significantly longer time to reach a stable SpO2 ≥ 90% than infants born by vaginal delivery (95% CI = 1.28 to 2.74; p < 0.01). CONCLUSION: A newly born infant has to take 6.5 minutes (2-10) after birth to adjust their oxygen saturation to reach normal higher level of extra uterine life, median SpO2 of 90%. Furthermore, mode of delivery makes a significant difference of oxygen saturation status; the cesarean route takes significantly longer time than the vaginal route to achieve SpO2 ≥ 90%.

Knowledge, attitudes and practices (kap) regarding influenza A (H1N1) among a population living along Thai-Myanmar border, Ratchaburi Province, Thailand.

The 2009 influenza A (H1N1) outbreaks in Thailand was successfully controlled, partly through the use of electronic media to educate the public. People living along the Thai-Myanmar border may have less access to this electronic media or might have health beliefs that differ from the general Thai population with potential to impact an influenza outbreak. We conducted a survey to assess the knowledge, attitudes and practices regarding influenza among people living along the Thai-Myanmar boder in Ratchaburi Province, Thailand. Of 110 house- holds surveyed, 96% were Karen ethnicity. Greater than 50% were uneducated and most had a low family income. Knowledge about influenza was low. Attitudes regarding infection were mostly negative among the elderly in this area. Practices regarding influenza were moderately good. Education level was associated with knowledge and practice. Income level and wealth indicators were associated with knowledge and having a radio or TV was associated with good practices. Preventive behavior was associated with good knowledge but not with attitudes about influenza. Health education campaigns are needed in these communities to help people adopt desired changes in behavior to improve personal hygiene.

Clinical significance of atypical glandular cells in cervical Papanicolaou smears.

OBJECTIVE: To determine the prevalence and the rate of clinically significant lesions in women with atypical glandular cells in cervical Papanicolaou smears. MATERIAL AND METHOD: A retrospective study was performed from the cytologic database of Charoenkrung Pracharak Hospital. All cervical cytologic examinations with a diagnosis of atypical glandular cells (AGC) between January 2002 and December 2009 were identified. Medical records were reviewed to determine the clinical data. Cytologic and histologic follow-up was obtained to establish the presence of clinically significant lesions. RESULTS: One hundred eleven AGC Pap smears were identified from 47,347 Pap smears. The prevalence of AGC was 0.23% over the eight years of the period studied. Clinically significant lesions were diagnosed in 32.4% of the women, including invasive cancer in 18.3%. Women with AGC favor neoplasia were more likely to have clinically significant lesions (53.8%) than women with AGC not otherwise specified (20%, p = 0.003). The rate of clinically significant lesions in women aged 35 years or older (35.7%) was not statistically significant different from women younger than 35 years of age (20%, p = 0.356). All cases of invasive cancer were found in women aged 35 years or older Cervical adenocarcinoma was the most common invasive cancer found in the present study. CONCLUSION: Women with atypical glandular cells on Papanicolaou smears were correlated with significant risk for clinically significant lesions, including invasive cancer Initial evaluation should include colposcopy, directed biopsy, and endocervical curettage. Women with risk factors for endometrial cancer should have an endometrial sampling.

Directly observed therapy with primaquine to reduce the recurrence rate of plasmodium vivax infection along the Thai-Myanmar border.

This study was carried out from April 2005 to June 2006 to evaluate the recurrence of P. vivax malaria infection in relation to drug compliance along the Thai-Myanmar border in Ratchaburi, Thailand. Ninety-two patients with vivax malaria were sequentially assigned to 2 groups. Both groups received a standard dose of chloroquine (total dose = 2.5 g) for 3 days and primaquine (total dose = 210 mg) for 14 days. The experimental group received a full course of treatment using daily directly observed therapy (DOT) while subjects in the control group were given the medication with necessary instructions to take as self-administered therapy (SAT). Patients were followed up for 3 months on Days 14, 21, 28, 60 and 90. Five of 46 patients from the SAT group had recurrence of malaria on Days 21, 44, 60, 72 and 87. Recurrence was not observed among patients in the DOT group. Survival analysis also showed significant differences between the SAT and DOT groups (p <0.05). The study suggests patient compliance with the 14-day primaquine treatment with DOT improve the outcome of .vivax malaria treatment.

Postoperative color Doppler sonography of the ureteral jets to detect ureteral patency in laparoscopic hysterectomy.

OBJECTIVE: To assess the accuracy of color Doppler sonography of the ureteral jets in detecting ureteral injury for gynecologic patient who had undergone laparoscopic hysterectomy. MATERIAL AND METHOD: A prospective study was performed on 170 patients scheduled for laparoscopic hysterectomy. The operations were performed for benign gynecologic disease. All patients had pre-and post-operative color Doppler sonography of the ureteral jets to determine ureteral patency. Transabdominal color Doppler sonography was used to evaluate the presence or absence of the ureteral jets from both ureteric orifices. The time for detection of the first jet and the number of jets in five minutes were recorded separately for each side. Preoperative assessment was used as control. Statistical analysis was performed by using Wilcoxon signed ranks test, considering p < 0. 05 as significant. If there was absence of the ureteral jet on one or both sides, the patient was sent to repeat color Doppler sonography on the next day Intravenous pyelography was performed to confirm ureteral injuries when the repeat examination was still found abnormal. RESULTS: Bilateral ureteral jets were demonstrated by color Doppler sonography in 168 of the 170 patients. In two patients, postoperative examination demonstrated the absence of the ureteral jet on the left side. Intravenous pyelography was performed and confirmed left ureteral obstruction. They underwent left ureteroneocystostomy. In 168 patients, bilateral ureteral jets were demonstrated in either preoperative or postoperative examination. The time for detection of the first jet was not significantly different between preoperative and postoperative examination of either the right side (p = 0.189) or the left side (p = 0.694). The number of jets in five minutes was not significantly different between preoperative and postoperative examination of either the right side (p = 0.854) or the left side (p = 0.675). CONCLUSION: Color Doppler sonography is a simple and reliable technique that may be used to evaluate ureteral jets into the bladder in patients who underwent laparoscopic hysterectomy. The time for detection of the first jet and the number of jets in five minutes are not affected by the postoperative status. The presented test may be a good screening test to detect ureteral injuries following laparoscopic hysterectomy.

Lower uterine segment compression for management of early postpartum hemorrhage after vaginal delivery at Charoenkrung Pracharak Hospital.

OBJECTIVE: 1. To evaluate the efficacy of lower uterine compression method in treatment of postpartum hemorrhage (PPH). 2. To compare the amount of blood loss in PPH between the lower uterine compression method and the conventional treatment. STUDY DESIGN: Randomized control trial. MATERIAL AND METHOD: This Randomized control trial was done at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, between January and August 2008. During the study period, 66 cases of PPH were identified. Two patients were excluded from the present study due to cervical tear and extensive birth canal tear. Sixty-four patients met all inclusion criteria and were included in the present study. Thirty-two patients were randomly assigned to the conventional protocol and the other 32 were managed by the conventional protocol with the addition of lower uterine compression. The lower uterine compression treatment was started promptly together with other modalities of PPH treatment. This technique can be performed by using one hand to compress tightly at the lower segment of uterus for 10 minutes. MAIN OUTCOME MEASUREMENT: The amount of blood loss in both control and experiment groups were collected after treatment of PPH for 2 hours postpartum. RESULTS: In all 64 cases, the blood loss after treatment in the conventional group is statistically significantly higher than the blood loss in the group that received lower uterine compression (225 +/- 401 ml vs. 120 +/- 211 ml; p = 0.026). The addition of lower uterine compression resulted in 105 ml or 47% reduction of blood loss. CONCLUSION: The lower uterine compression method is a very effective procedure for treating PPH. It is simple to use, safe and no cost. This technique is an innovative scheme in the obstetrics field. The more efficient treatment of PPH would have a positive impact on the outcome of many patients who have postpartum hemorrhage, leading to the reduction in morbidity or even save the lives of patients.

Longitudinal study of Plasmodium falciparum and Plasmodium vivax in a Karen population in Thailand.

BACKGROUND: Clinical case treatment of malaria infections where Plasmodium falciparum and Plasmodium vivax are sympatric has achieved effective reductions in P. falciparum prevalence and incidence rates, but has been less successful for P. vivax. The high transmissibility of P. vivax and its capacity to relapse have been suggested to make it a harder parasite species to control. METHODS: A clinical malaria case treatment programme was carried out over a decade in a Karen community composed of seven hamlets on the Thai-Myanmar border. RESULTS: From 1994 to 2004, prevalence rates of both P. falciparum and P. vivax decreased by 70-90% in six of the seven study hamlets, but were unchanged in one hamlet. Overall, incidence rates decreased by 72% and 76% for P. falciparum and P. vivax respectively over the period 1999-2004. The age-incidence and prevalence curves suggested that P. vivax was more transmissible than P. falciparum despite a greater overall burden of infection with P. falciparum. Male gender was associated with increased risk of clinical presentation with either parasite species. Children (< 15 years old) had an increased risk of presenting with P. vivax but not P. falciparum. CONCLUSION: There was a considerable reduction in incidence rates of both P. vivax and P. falciparum over a decade following implementation of a case treatment programme. The concern that intervention methods would inadvertently favour one species over another, or even lead to an increase in one parasite species, does not appear to be fulfilled in this case.

Mixture of carbol fuchsin and alcian blue staining of gastric tissue for the identification of Helicobacter pylori and goblet cell intestinal metaplasia.

The purpose of this study was to evaluate the role of the mixture of carbol fuchsin and alcian blue stain in the diagnosis of Helicobacter pylori (HP) and goblet cell intestinal metaplasia (IM) in comparison to the more commonly used Giemsa and hematoxylin and eosin (H&E) stains. Pathological blocks of gastric tissues obtained from January 2006 to December 2007 were recut and processed for Giemsa and a mixture of carbol fuchsin and alcian blue stains. Clinical data regarding the patients were collected and previous slides stain with H&E from gastric tissues were reviewed. The Giemsa and the mixture of carbol fuchsin and alcian blue stains were studied by a pathologist who was blinded to the pathological and clinical data. Direct comparisons were made between the stains for diagnosis of HP. Of 423 cases studied the concordance rate was 97.8% (kappa value=0.947, p< 0.05). Using the mixture of carbol fuchsin and alcian blue stain, 4.3 % of goblet cell IM which were not detected by H&E stain were additionally identified. The prevalences of HP infection diagnosed by Giemsa, the mixture of carbol fuchsin and alcian blue, and H&E stains were 72.1%, 72.3%, and 71%, respectively. In conclusion, the mixture of carbol fuchsin and alcian blue stain can be used in place of Giemsa stain for the identification of HP, and is probably preferable because of its low cost and is less time-consuming. Carbol fuchsin and alcian blue which are commonly available dyes are more beneficial than Giemsa stain and aid in identifing goblet cell IM undiagnosed by conventional H&E stain.

Prognostic significance of microvessel density and mast cell density for the survival of Thai patients with primary colorectal cancer.

BACKGROUND: Angiogenesis has been found to be a reliable prognostic indicator for several types of malignancies. In colorectal cancer, however there has been controversy as to whether there is a correlation between this feature and the tumors' behavior. OBJECTIVE: Determine the correlation between microvessel density (MVD) and mast cell density (MCD) in order to evaluate these factors in terms of their prognostic relevance for primary colorectal carcinoma in Thai patients. MATERIAL AND METHOD: One hundred and thirty colorectal carcinoma patients diagnosed between January 2002 and December 2004 were identified. Eleven patients were excluded from the present study due to recurrence of colorectal carcinoma in eight cases whereas pathologic blocks were not found in three cases. One hundred and nineteen patients met all inclusion criteria and were included in the present study. Representative paraffin sections obtained by the tissue micro-array technique (9 x 5 arrays per slide) from areas of highest vascular density (hot spots) were prepared. Sections were immuno-stained by monoclonal anti CD 31 for microvessel and antibody mast cell tryptase for mast cell detections, respectively. Three readings at different periods of time under a microscopic examination of high power magnification were examined by a pathologist who was blinded to clinical data. The highest microvessel and mast cell counts were recorded as MVD and MCD. Patients were then divided into groups of high and low MVD and high and low MCD by median values (20.5 and 14.5, respectively). Overall survival of the patients in each group was estimated by the Kaplan-Meier Method while a multivariate Cox regression backward stepwise analysis was employed to find out independent prognostic factors. RESULTS: Significant positive correlation was found to exist between MVD and MCD in the hot spots (R = 0.697, p < 0.0001). Regarding their prognostic role, patients with tumors of low MVD (hypovascular) and low MCD (low mast cell counts) had significantly longer survival rates than those with hypervascular and high mast cell counts (p < 0.0001). The Multivariate Cox hazard showed that MVD and distance metastasis of cancer were independent poor prognostic factors to survival (p = 0.036 and p = 0.024, respectively). The patients with high MVD (hypervascular) tumors and with presence of distant metastasis had 1.9 and 2.5 times higher death rates than the corresponding hypovascular and non-metastatic groups, respectively during the period from January 2002 to September 2007. CONCLUSION: Assessment of microvessel density in the invasive front of primary colorectal carcinoma could serve as useful prognosis tool of primary colorectal carcinoma in Thai patients.

Very high carriage of gametocytes in asymptomatic low-density Plasmodium falciparum and P. vivax infections in western Thailand.

BACKGROUND: Low-density asymptomatic infections of Plasmodium spp. are common in low endemicity areas worldwide, but outside Africa, their contribution to malaria transmission is poorly understood. Community-based studies with highly sensitive molecular diagnostics are needed to quantify the asymptomatic reservoir of Plasmodium falciparum and P. vivax infections in Thai communities. METHODS: A cross-sectional survey of 4309 participants was conducted in three endemic areas in Kanchanaburi and Ratchaburi provinces of Thailand in 2012. The presence of P. falciparum and P. vivax parasites was determined using 18S rRNA qPCR. Gametocytes were also detected by pfs25 / pvs25 qRT-PCRs. RESULTS: A total of 133 individuals were found infected with P. vivax (3.09%), 37 with P. falciparum (0.86%), and 11 with mixed P. vivax/ P. falciparum (0.26%). The clear majority of both P. vivax (91.7%) and P. falciparum (89.8%) infections were not accompanied by any febrile symptoms. Infections with either species were most common in adolescent and adult males. Recent travel to Myanmar was highly associated with P. falciparum (OR = 9.0, P = 0.001) but not P. vivax infections (P = 0.13). A large number of P. vivax (71.5%) and P. falciparum (72.0%) infections were gametocyte positive by pvs25/pfs25 qRT-PCR. Detection of gametocyte-specific pvs25 and pfs25 transcripts was strongly dependent on parasite density. pvs25 transcript numbers, a measure of gametocyte density, were also highly correlated with parasite density (r 2 = 0.82, P < 0.001). CONCLUSIONS: Asymptomatic infections with Plasmodium spp. were common in western Thai communities in 2012. The high prevalence of gametocytes indicates that these infections may contribute substantially to the maintenance of local malaria transmission.