Prevalence of depression among epileptic patients at Phramongkutklao Hospital.

OBJECTIVES: To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression. MATERIAL AND METHOD: One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated. RESULTS: During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [equal or less than 5 and more than 5 per year (p = 0.43)], type of seizures [generalized tonic-clonic seizures and partial seizures (p = 0.69)], and number of antiepileptic drugs [monotherapy and polytherapy (p = 0.44)]. CONCLUSION: Prevalence of depression among epileptic patients was 38.3%, divided between mild (65.2%) and moderate (34.8%). There were no significant risk factors correlated with depression. Epileptic patients should be made aware of this and seek prompt treatment for depression.

Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study.

OBJECTIVE: To compare the prevalence of Post Dural Puncture Headache (PDPH) between 6 hour- supine recumbence and early ambulation in Thai patients. MATERIAL AND METHOD: The present study was a prospective controlled study and enrolled the patients who underwent Lumbar Puncture (LP) from Phramongkutklao Hospital, Thailand. The background characteristics were recorded Standard LP method was done. The patients were randomized to 6 hour-supine recumbence and < or = 1 hour- (early ambulation) groups. Prevalence and characteristics of PDPH were compared. RESULTS: Of 65 patients, there were 33 patients (50.8%) in the 6 hour-recumbent group and 32 patients (49.2%) in the early ambulation group. The background characteristics and CerebroSpinal Fluid (CSF) findings were not different between the groups. Prevalence of PDPH was 16.9% (overall), 18.2% (6 hours) and 15.6% (early ambulation). There was no statistically significant difference in prevalence, pattern and severity of PDPH between the groups. CONCLUSION: The prevalence and characteristics of PDPH were not different between the 6 hour- recumbence and early ambulation groups.

Dural sinus thrombosis in melioidosis: the first case report.

Melioidosis which is infection with Burkholderia pseudomallei, is an important cause of sepsis in India, southeast Asia and northern Australia. Mortality is high and treatment is problematic. Neurological melioidosis is unusual but meningoencephalitis, encephalomyelitis and brain microabscess can occur Dural sinus thrombosis is not an uncommon cerebrovascular disorder with various etiologies. Hypercoagulable state, pregnancy, dehydration, certain blood dyscrasia and contraceptive pills are common causes however meningitis and local head & neck infections may lead to this condition. Dural sinus thrombosis complicating septicemic melioidosis has never been reported. The authors report a 42-year-old Thai man suffering from septicemic melioidosis with dural sinus thrombosis. He had high fever, headache, left hemiparesis, focal seizure and increased intracranial pressure. Diabetes and mild alcoholic cirrhosis were diagnosed in this admission. CT scan, MRI brain and MRV revealed superior saggital sinus thrombosis with complicating venous infarction over right posterior parietal lobe. Hemoculture demonstrated Burkholderia pseudomallei and CSF was acellular Investigations for causes of dural sinus thrombosis were all negative. This patient gradually improved after treatment with ceftazidime, antiepileptic drug and heparin without clinical recurrence. Neuromelioidosis is a rare syndrome that may present as brain abscess, encephalitis or meningoencephalitis. The authors report dural sinus thrombosis associated with septicemic melioidosis. The authors' hypothesis of venous thrombosis in the presented case is sepsis induced hypercoagulable state. Physicians should be aware of cerebral venous thrombosis in case of suspicious melioidosis with neurological involvement. Prompt treatment with intravenous heparin and antibiotic is potentially effective.

Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study.

OBJECTIVES: To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin alone in acute intervention treatment after acute ischemic stoke among Thai patients. MATERIAL AND METHOD: This pilot study enrolled ischemic stroke patients within 48 hours and randomized to aspirin 300 mg/d or combination (aspirin 300 mg/d+ standard release dipyridamole 75 mg thrice a day) and followed up for 6 months. Endpoints were recurrent ischemic stroke, transient ischemic attack and vascular death. Side effects were recorded. National Institutes of Health Stroke Scale was assessed at entry and at 6 months period for determining neurological functions. RESULTS: Of 38 patients, mean age was 64.3 years. Male and female were 52.6% and 47.4% respectively. There were 18 patients in the aspirin group and 20 patients in the combination group. No patient developed end point events or no significant adverse event in both groups. The combination group showed more improvement in neurological function than the aspirin group (p-value 0.009). CONCLUSION: This pilot study showed equal efficacy and tolerability of the combination group and aspirin alone in acute intervention treatment for prevention of recurrent stroke or vascular death within 6 months.

Factors influencing MMSE-T score among Thai subjects.

OBJECTIVES: To explore association of variables influencing MMSE-Thai version (MMSE-T) score among Thai subjects. MATERIAL AND METHOD: 365 general non dementia Thai subjects of age 45-87 years were randomly recruited in Bangkok. All subjects were screened with MMSE-T and interviewed. Demographic factors that might affect the score of MMSE-T were collected. Relationship between demographic variables and MMSE-T score were evaluated. RESULTS: Of 365 subjects, mean MMSE-T score was 27.2 and ranged 17-30. There were 27 cases (7.44%) with MMSE-T score < or = 23. Subjects who had a score < or = 23, were 18 cases (27.69%) and 9 cases (3.01%) in education level less than bachelor degree and at least bachelor degree respectively (p value <0.001). By linear regression analysis, the factors significantly affected the lower score were age higher than 60 years (p=0.017) and education below bachelor degree (p<0.001). CONCLUSION: Factors including elderly and low education were negatively influenced on MMSE-T performance among Thai subjects.

Dementia and depression in end stage renal disease: comparison between hemodialysis and continuous ambulatory peritoneal dialysis.

OBJECTIVES: To determine the prevalence, risk factors of dementia and depression in end stage renal disease (ESRD) who were treated with hemodialysis (HD) compared with those who had continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND METHOD: A cross-sectional study was conducted on 90 ESRD patients (60 HD and 30 CAPD groups). The authors reviewed the demographic data, investigation results. Thai Mental State Examination, DSM IV criteria and Thai Depression Inventory were interviewed to determine dementia and depression respectively. RESULTS: Both prevalence of dementia and depression in ESRD on continuous dialysis were 6.7%. In the HD group had 8.3% prevalence of dementia and 6.7% of depression, whereas there was 3.3% of dementia and 6.7% of depression in the CAPD group. The severity of depression in the present study was mild to moderate (6.7%) and no major depression was seen. The significant risk factors for dementia were age > or = 60 years (p=0.003), Education < 10 years (p=0.037) and female sex (p=0.036). The significant risk factor for depression was female sex (p=0.036). There was no significance different on prevalence of dementia and depression comparison between the HD and CAPD group. CONCLUSION: Prevalence of dementia and depression in the overall dialysis in ESRD was 6.7% (with 8.3%, 6.7% among the HD group and 3.3%, 6.7% among CAPD group). There was no significant difference on prevalence of dementia and depression comparison between the HD and CAPD group.

Nasopharyngeal tuberculosis: a case report presenting with diplopia.

Tuberculosis (TB) is a common infectious disease worldwide. It can affect many organs, the most common is lungs infection. Upper respiratory tract involvement is uncommon and the least common regional involvement is nasopharyngeal region. The authors report a case of nasopharyngeal tuberculosis who came with diplopia which is a very rare presentation. Nasopharyngeal tuberculosis is a rare condition that is found in only reported cases in the literature. In Thailand, the present case is the second case of this condition with diplopia. Nasopharyngeal examination reveal mass or ulceration. The diagnostic tool is lesional biopsy. Histology is necessary to diagnose tuberculosis and to exclude other conditions especially nasopharyngeal cancer Nasopharyngeal tuberculosis has a good prognosis after treatment.

Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis.

Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a higher level and obstructive hydrocephalus. Finally, she died from status epilepticus and septic shock.

Invasive streptococcal group A infection and toxic shock syndrome in Songklanagarind hospital.

BACKGROUND AND OBJECTIVES: Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is streptococcal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital). METHOD: The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prognostic factors were analyzed by logistic regression model. RESULT: 176 cases of STSS and streptococcal group A infection, 89.9 per cent were community acquired infections. About 70 per cent of the infected patients had previous underlying conditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1%). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p<0.025), history of steroid use (odds ratio 11.17, p<0.017), STSS (odds ratio 22.16, p<0.005) and received cancer chemotherapy (odds ratio 115.19, p<0.003). Predictive factors for STSS couldn't be identified, while age >65 years and steroid use were suggested protective factors for this condition [odds ratio 0.02, p<0.0001 and odd ratio 0.07, p<0.027 respectively].