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1.
J Med Assoc Thai ; 99 Suppl 2: S153-60, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27266230

RESUMO

BACKGROUND: Behavioral and social changes in the modern era have triggered an increase in the incidence of early sexual contact and teenage pregnancy. Since there is no routine Gonococcal & Chlamydial (GC & CT) screening in teens in antenatal clinics in Thailand, the present study was performed to find the prevalence of STI, especially Chlamydial infection, in teenage pregnancy. OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs), especially Chlamydial infection (CT), in teenage pregnancy and its related factors. MATERIAL AND METHOD: One hundred and twenty-one teenage pregnancies were recruited at the ANC in Rajavithi Hospital from October 2006 to May 2007. After signing informed consent forms, they were asked to answer questionnaires about baseline data, sexual information and risk factors, after which urine specimens were collected for screening for GC and CT using the PCR technique (AMPLICOR by Roche). Later, pelvic examination was per formed by the gynecologist at the STD (sexually transmitted disease) clinic. All the data and LAB results were recorded and analyzed by the SPSS program. Numbers, percentages, means with SD, Chi-squared test, Fisher's exact test and odds ratio were used. Potential risk factors were analyzed using binary logistic regression. RESULTS: The prevalence of STI in pregnant teenagers was 28.1% (CT = 19.8%, GC = 1.7%, hepatitis B = 3.3%, trichomoniasis 1.7%, Herpes simplex = 0.8% and condyloma acuminata = 0.8%). No Syphilis, chancroid or HIV were found in the present study Other non-STI like candidiasis and bacterial vaginosis were found in 45.5% of participants (candidiasis and bacterial vaginosis at 19.0% and 24.8%, respectively). The risk of CT infection was significantly related (6.9 times higher) to having previous sexual contact before the current partner (95% CI, 1.8-27.0). CONCLUSION: STI, especially Chlamydial infection, was found in a significant number of teenage pregnancies. Measures should be taken to prevent this resulting in complicated outcomes in the future.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Gravidez na Adolescência , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Tailândia
2.
J Med Assoc Thai ; 97 Suppl 6: S89-94, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25391178

RESUMO

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is the most serious condition that causes high mortality in term and post term infants. The authors have an experience of using high frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) for treatment of this condition with a good result. However, due to high cost of iNo, other pulmonary vasodilators have been use. Sildenafil had some side effects of systemic hypotension. Thus, inhaled iloprost was introduced for treatment of PPHN at our institute. OBJECTIVE: To evaluate the outcome of inhaled iloprost for the treatment of PPHN. MATERIAL AND METHOD: This was a retrospective study. The data from medical records of newborns, diagnosed as persistent pulmonary hypertension of the newborn and had received inhaled iloprost from October 1st, 2008-October 31st, 2012, were reviewed. RESULTS: Nineteen cases of PPHN treated with inhaled iloprost were reviewed. Male to female ratio was 1.3 7:1 (11:8). Mean birth weight and gestational age of these patients were 2,997 ± 531.63 grams and 37.9 ± 2.51 weeks, respectively. Meconium aspiration syndrome was the leading underlying cause of this condition. The mortality rate in this study was 21% (4 from 19 cases). After the addition of inhaled iloprost, the oxygen index (OI) in the survivor group decreased significantly at one hour after treatment (from 32.89 to 22.06, 18.76, 13. 76 at 1, 6, 12 hours, respectively). Oxygen saturation (SpO2) continued increasing after treatment in the survivor group (from 82.40% to 92.20%, 95.00%, 95.80% at 1, 6, 12 hours, respectively) with significant difference at one hour. There was a significant difference of OI and SpO2 between the survivor and non-survivor groups after treatment. Low Apgar score at 5 minutes and early diagnosis of PPHN were found statistically significant different in the non-survivor compared to the survivor groups. CONCLUSION: Inhaled iloprost could be used as an alternative treatment of PPHN without side effects of systemic hypotension.


Assuntos
Administração por Inalação , Iloprosta/administração & dosagem , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Esquema de Medicação , Feminino , Ventilação de Alta Frequência , Humanos , Recém-Nascido , Pulmão/efeitos dos fármacos , Masculino , Óxido Nítrico/administração & dosagem , Oxigênio/administração & dosagem , Piperazinas/administração & dosagem , Purinas/administração & dosagem , Estudos Retrospectivos , Citrato de Sildenafila , Sulfonamidas/administração & dosagem , Tailândia , Fatores de Tempo , Vasodilatadores/administração & dosagem
3.
J Med Assoc Thai ; 97 Suppl 6: S182-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25391192

RESUMO

BACKGROUND: Deaths attributed to birth defects are a major cause of infant and under-five mortality as well as lifetime disabilities among those who survive. In Thailand, birth defects contribute to 21% of neonatal deaths. There is currently no systematic registry for congenital anomalies in Thailand. Queen Sirikit National Institute of Child Health has initiated a Thailand Birth Defects Registry to capture birth defects among newborn infants. OBJECTIVE: To establish the national birth defects registry in order to determine the burden of birth defects in Thailand. MATERIAL AND METHOD: The birth defects data come from four main sources: National Birth Registry Database; National Health Security Office's reimbursement database; Online Birth Defect Registry Database designed to capture new cases that were detected later; and birth defects data from 20 participated hospitals. All data are linked by unique 13-digit national identification number and International Classification of Diseases (ICD)-10 codes. This registry includes 19 common structural birth defects conditions and pilots in 20 hospitals. The registry is hospital-based, hybrid reporting system, including only live births whose information was collected up to 1 year of age. RESULTS: 3,696 infants out of 67,813 live births (8.28% of total live births in Thailand) were diagnosed with congenital anomalies. The prevalence rate of major anomalies was 26.12 per 1,000 live births. The five most common birth defects were congenital heart defects, limb anomalies, cleft lip/cleft palate, Down syndrome, and congenital hydrocephalus respectively. CONCLUSION: The present study established the Birth Defects Registry by collecting data from four databases in Thailand. Information obtained from this registry and surveillance is essential in the planning for effective intervention programs for birth defects. The authors suggest that this program should be integrated in the existing public health system to ensure sustainability.


Assuntos
Anormalidades Congênitas/epidemiologia , Sistema de Registros , Fissura Palatina/epidemiologia , Coleta de Dados , Bases de Dados Factuais , Síndrome de Down/epidemiologia , Feminino , Geografia , Cardiopatias Congênitas/epidemiologia , Hospitais , Humanos , Incidência , Recém-Nascido , Classificação Internacional de Doenças , Masculino , Defeitos do Tubo Neural/epidemiologia , Morte Perinatal , Prevalência , Tailândia
4.
J Med Assoc Thai ; 94 Suppl 3: S35-40, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22043752

RESUMO

BACKGROUND: The utilization of surfactant replacement therapy had been limited in treatment of respiratory distress syndrome (RDS) due to the high cost especially in developing countries. Nowadays, the National Health Insurance Policy has covered the cost of surfactant for the patients. Therefore, bronchopulmonary dysplasia (BPD) may be found increasing due to increased survival in patients with severe RDS. OBJECTIVE: To compare immediate treatment outcome of severity of BPD and outcome after hospital discharge in neonates with RDS who were treated with or without surfactant. STUDY DESIGN: Retrospective cohort study. MATERIAL AND METHOD: The data of 54 infants who developed BPD after RDS at Queen Sirikit National Institute of Child Health between January 1st, 2003 and December 31th, 2005 were kept in database format. The database was analyzed for difference between groups and the outcome of immediate treatment, severity of BPD and outcome after hospital discharge were compared. The study group was BPD cases from RDS treated with surfactant compared to control (BPD cases from RDS treated without surfactant) groups. RESULTS: Forty-three (80%) from fifty-four cases had completed data and were included into the present study. There was no statistically significant difference in maternal conditions and neonatal conditions between groups. Antenatal steroid was prescribed more often in RDS without surfactant group than surfactant group. The mean birth weight and gestational age in surfactant and without surfactant groups were 1,179.1 +/- 274.3 gm vs. 1,114.4 +/- 338.3 gm and 29 +/- 1.6 weeks vs. 29.2 +/- 2.7 weeks respectively, but no significant differences were observed between groups. To compare the severity of RDS, only 17.6% of moderate to severe RDS in the control group was found, whereas 100% was found in the study group. Moderate to severe BPD cases were found more often in the control group (70.6%) than in the study group (61.6%), but no statistically significant difference was shown. The immediate complications, e.g. pneumothorax (5.9%) and pneumomediastinum (5.9%) were found in the control group, but pulmonary hemorrhage occurred more often in the study group than the control group (11.5% vs. 5.9%). For long-term follow-up, the development outcome was not different between groups. CONCLUSION: The present study revealed no statistically significant difference in severity of BPD in neonates with RDS treated with and without surfactant groups. In addition, surfactant was useful in moderate to severe RDS because no early complication such as air leak syndrome was found in this group.


Assuntos
Displasia Broncopulmonar/epidemiologia , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Adulto , Displasia Broncopulmonar/etiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Alta do Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
J Med Assoc Thai ; 91 Suppl 3: S109-14, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19253505

RESUMO

BACKGROUND: Exogenous surfactant replacement therapy has been a part of the routine care of preterm neonates with respiratory distress syndrome (RDS) since 1990s. In Thailand, the utilization of surfactant replacement therapy had been limited due to the high cost until the National Health Insurance Policy began in 2003 which covered the cost of surfactant. Nowadays surfactant replacement therapy is more frequently used at Queen Sirikit National Institute of Child Health, so the authors were interested in evaluating its use in RDS. OBJECTIVES: To compare the outcome and complications of surfactant replacement therapy in newborns who were diagnosed with moderate to severe RDS during two times period. STUDY DESIGN: Retrospective study. MATERIAL AND METHOD: The data of infants who were diagnosed as moderate to severe RDS and treated with surfactant at Queen Sirikit National Institute of Child Health between January 1st, 2003 and December 31th, 2005 were reviewed. The outcome of this study (Group II) was compared to the previous study conducted in 1999-2002 (Group I). The complications, mortality rate, association time of start surfactant and duration of ventilation were reviewed. RESULTS: The data of ninety-one moderate to severe RDS patients who received surfactant replacement therapy were reviewed. The mean birth weight and gestational age in this group were 1250 +/- 435.57 gm and 29.38 +/- 2.2 week less than in the first group 1,344 +/- 452.37gm and 29.69 +/- 2.61 week. The second group showed statistical differences in antepartum hemorrhage (4.4%) and pregnancy induced hypertension (PIH) (17.6%) while the first group had 33.3% ofantepartum hemorrhage and 3% of PIH. In neonatal conditions, there were statistical significant differences in anemia 28.6% in group II compared to 9% in group I and patent ductus arteriosus 67% in group II compared to 39.4% in group I. Surfactant was given earlier in life (4.75 +/- 2.76 hours) in the second group compared to the first group (7.21 +/- 4.92 hour) and the overall duration ofpatients on mechanical ventilation in Group II (6 days) was shorter than in Group I (16 days). This was especially more evident in patients who received surfactant within the first six hours of life. The immediate complication, pulmonary hemorrhage was found in more cases in Group I (33.3%) than in Group II (12.1%) but bronchopulmonary dysplasia (BPD) was found to be a late complication in more cases in Group II (46.1%) than in Group I (21.2%). The mean length of admission was longer in Group II (61.23 +/- 41.08 days) compared to Group I (38.5 +/- 23.48 days) and the mortality rate in Group II was 18.7% (17 cases) lower than Group I 33.3% (11 cases). CONCLUSION: Surfactant therapy in moderate to severe RDS can shorten the duration of ventilation and decrease the mortality rate, but has no effect in decreasing the incidence of chronic lung disease. Nevertheless the earlier the surfactant therapy is started, the higher the survival rate.


Assuntos
Doença da Membrana Hialina/tratamento farmacológico , Surfactantes Pulmonares/uso terapêutico , Feminino , Humanos , Doença da Membrana Hialina/epidemiologia , Doença da Membrana Hialina/mortalidade , Incidência , Recém-Nascido , Masculino , Estudos Retrospectivos , Sobreviventes , Tailândia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
6.
J Med Assoc Thai ; 90(1): 167-70, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17621749

RESUMO

The authors report one case of persistent pulmonary hypertension that had hypoxia although receiving treatment with high frequency oscillation, inotropic drugs, blood transfusion, and oral sildenafil for pulmonary vasodilatation. The patient developed hypotension after two doses of oral sildenafil and no response to high dose of inotropic drugs. So aerosolized iloprost was given via endotracheal tube and oxygen saturation improved within 10 minutes. Oxygen was weaned at 36 hours after treatment with this drug and no any side effect was found.


Assuntos
Iloprosta/administração & dosagem , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Vasodilatadores/administração & dosagem , Feminino , Ventilação de Alta Frequência , Humanos , Hipotensão/induzido quimicamente , Recém-Nascido , Intubação Intratraqueal , Síndrome da Persistência do Padrão de Circulação Fetal/terapia , Piperazinas/efeitos adversos , Purinas/efeitos adversos , Citrato de Sildenafila , Sulfonas/efeitos adversos , Falha de Tratamento , Vasodilatadores/efeitos adversos
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