Browsing by Author "Chaophraya Yommarat Hospital"

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    Effectiveness and safety of polymyxin B for the treatment of infections caused by extensively drug-resistant gram-negative bacteria in Thailand
    (2018-01-01) Thundon Ngamprasertchai; Adhiratha Boonyasiri; Lantharita Charoenpong; Sireethorn Nimitvilai; Narisorn Lorchirachoonkul; Luksame Wattanamongkonsil; Visanu Thamlikitkul; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University; Ratchaburi Regional Hospital; Nakhornpathom Hospital; Chaophraya Yommarat Hospital
    © 2018 Ngamprasertchai et al. Background: Colistimethate sodium (colistin) has been used in the treatment of infections caused by extensively drug-resistant (XDR) Gram-negative bacteria in Thailand over the past decade, with a mortality rate of 50% and a nephrotoxicity rate of 40%. Polymyxin B has not been available in Thailand. We conducted a Phase II clinical study to determine the effectiveness and safety of polymyxin B, compared with colistin, for the treatment of XDR Gram-negative bacterial infections in Thai patients. Methods: A total of 73 adult patients hospitalized at four participating tertiary care hospitals from January 2015 to December 2015 who had infections caused by XDR Gram-negative bacteria and had to receive colistin were enrolled in the study. Polymyxin B (100 mg/day) was administered intravenously every 12 hours for 7–14 days. Results: Most of the patients were older males with comorbidities who had received antibiotics, particularly carbapenems, prior to receiving polymyxin B. More than half of the patients had pneumonia, and 51.5% of the infections were caused by XDR Acinetobacter baumannii, which was susceptible to colistin. Good clinical responses at the end of treatment were observed in 78.1% of cases, the overall 28-day mortality rate from all causes was 28.7%, the microbiological clearance of the targeted bacteria after therapy was 56.2% and nephrotoxicity occurred in 24.7% of cases. Neurotoxicity relating to reversible numbness was observed in two cases. Conclusion: Polymyxin B seems to be effective and safe for the treatment of XDR Gram-negative bacterial infections. Polymyxin B should be considered as an alternative to colistin for treatment of infections caused by XDR Gram-negative bacteria in Thai adult patients, especially those at risk of nephrotoxicity.
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    Femoral neck stress fracture in marathon runners: A case report
    (2019-01-01) K. Yusuwan; K. Chareancholvanich; Faculty of Medicine, Siriraj Hospital, Mahidol University; Chaophraya Yommarat Hospital
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Background: Femoral neck stress fracture (FNSF) accounts for 3% of all sports-related stress fractures. The most common cause is marathon running. The main types of FNSF are compression-sided, tension-sided, and displaced fracture. The most common symptom is groin pain. Plain radiograph is the first-line investigation, and the magnetic resonance imaging (MRI) is the second-line investigation. The location and displacement of the fracture guide the management. Early detection and diagnosis decrease the rate of fracture displacement and osteonecrosis of the femoral head. Objective: To report two cases of FNSF that developed in two Thai marathon runners, and to review what is currently known about FNSF in this specific sports-related setting. Materials and Methods: Two cases of FNSF are described, and a review of the literature relative to FNSFs in long-distance runners describes the role of imaging, management, and return to running. Results: FNSFs are a rare injury, and marathon runners presenting with exercise-related groin pain should be evaluated. Management is based on fracture location and whether or not the fracture is displaced. The first case profiles a patient with delayed FNSF diagnosis. Fracture displacement was found two weeks after symptom onset, and total hip arthroplasty was performed. The second case describes a patient with early FNSF diagnosis that was treated conservatively with good outcome. Conclusion: Although FNSF is a rare injury, it should be considered in marathon runners who present with exercise-related groin pain. Delayed diagnosis can adversely affect quality of life. Early detection and management of FNSF shows excellent results in terms of return-to-sport rates.