Browsing by Author "Prapaporn Pornsuriyasak"

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    A 76 -year-old man with anemia, bone pain, and progressive dyspnea
    (2014-01-01) Thitiporn Suwatanapongched; Prapaporn Pornsuriyasak; Wasana Kanoksil; Thotsaporn Morasert; Warapat Virayavanich; Mahidol University
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    Acute respiratory failure secondary to eosinophilic pneumonia following influenza vaccination in an elderly man with chronic obstructive pulmonary disease
    (2014-01-01) Prapaporn Pornsuriyasak; Thitiporn Suwatanapongched; Jettanong Klaewsongkram; Supranee Buranapraditkun; Porpon Rotjanapan; Mahidol University; Chulalongkorn University
    Acute respiratory failure with diffuse pulmonary opacities is an unusual manifestation following influenza vaccination. We report herein a patient with chronic obstructive pulmonary disease who developed fever with worsening of respiratory symptoms and severe hypoxemia requiring ventilatory support shortly after influenza vaccination. Bronchoalveolar lavage was compatible with acute eosinophilic pneumonia. Rapid clinical improvement was observed 2 weeks after systemic corticosteroid treatment, followed by radiographic improvement at 4 weeks. No disease recurrence was observed at the 6-month follow-up. © 2014 The Authors.
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    Assessment of proximal and peripheral airway dysfunction by computed tomography and respiratory impedance in asthma and COPD patients with fixed airflow obstruction
    (2018-10-01) Prapaporn Pornsuriyasak; Thitiporn Suwatanapongched; Wasana Thaipisuttikul; Chayanin Nitiwarangkul; Theerasuk Kawamatawong; Naparat Amornputtisathaporn; Kittipong Maneechotesuwan; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © 2018 Annals of Thoracic Medicine. OBJECTIVE: To ascertain: (i) if elderly patients with fixed airflow obstruction (FAO) due to asthma and chronic obstructive pulmonary disease (COPD) have distinct airway morphologic and physiologic changes; (ii) the correlation between the morphology of proximal/peripheral airways and respiratory impedance. METHODS: Twenty-five asthma cases with FAO and 22 COPD patients were enrolled. High-resolution computed tomography was used to measure the wall area (WA) and lumen area (LA) of the proximal airway at the apical segmental bronchus of the right upper lobe (RB1) adjusted by body surface area (BSA) and bronchial wall thickening (BWT r ) of the peripheral airways and extent of expiratory air trapping (AT exp ). Respiratory impedance included resistance at 5 Hz (R 5 ) and 20 Hz (R 20 ) and resonant frequency (Fres). Total lung capacity (TLC) and residual volume (RV) were measured. RESULTS: Asthma patients had smaller RB1-LA/BSA than COPD patients (10.5 ± 3.4 vs. 13.3 ± 5.0 mm 2 /m 2 , P = 0.037). R 5 (5.5 ± 2.0 vs. 3.4 ± 1.0 cmH 2 O/L/s, P = 0.02) and R 20 (4.2 ± 1.7 vs. 2.6 ± 0.7 cmH 2 O/L/s, P = 0.001) were higher in asthma cases. AT exp and BWT r were similar in both groups. Regression analysis in asthma showed that forced expiratory volume in one second (FEV 1 ) and Fres were associated with RB1-WA/BSA (R 2 = 0.34, P = 0.005) and BWT r (0.5, 0.012), whereas RV/TLC was associated with AT exp (0.38, 0.001). CONCLUSIONS: Asthma patients with FAO had a smaller LA and higher resistance of the proximal airways than COPD patients. FEV 1 and respiratory impedance correlated with airway morphology.
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    Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: A case report of intractable strongyloidiasis
    (2004-09-01) Prapaporn Pornsuriyasak; Kannika Niticharoenpong; Atipoom Sakapibunnan; Division of Pulmonary and Critical Care; Mahidol University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    We describe a patient with an overlapping syndrome disseminated strongyloidiasis and gram-negative sepsis. She was previously treated with albendazole 400 mg/day 14 days before admission without success. This admission, she was treated with a combination of oral ivermectin (injectable solution form), with a dosage of 200-400 μg/kg/day, and albendazole for 14 days. Strongyloides larvae disappeared from the stool by day 4 and from the sputum by day 10. No side effects were encountered during hospitalization or at the 1-month follow-up visit.
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    Effects of Oral Procaterol for Postinfectious Cough in Adults: Single- Centre, Randomized Double-Blind, Placebo-Controlled Trial
    (2021-01-01) Prapaporn Pornsuriyasak; Sasivimol Rattanasiri; Nattawut Unwanatham; Theerasuk Kawamatawong; Pennapa Jankum; Ammarin Thakkinstian; Ramathibodi Hospital
    Background: Persistent cough following an upper respiratory tract infection (URTI) is common in clinical practice. We investigated the effects of procaterol on cough-specific quality of life (QoL) and peripheral-airway function among adults suffering from postinfectious cough (PIC). Methods: This was a prospective, randomized, double-blinded placebo-controlled trial (NCT 02349919) conducted at a university hospital. Seventy-four non-asthmatic adults who had persistent post-URTI cough for ≥3 weeks were assessed by a physical examination, chest/paranasal sinus radiographs, spirometry, and impulse oscillometry (IOS) and were allocated to receive procaterol or placebo for 4 weeks. The Thai version of the Leicester Cough Questionnaire (LCQ-T), spirometry and IOS were assessed at baseline, 2 weeks, and 4 weeks. Results: Mean LCQ-T total scores for the procaterol group (10.8) and placebo group (10.9) at baseline were not significantly different (P=0.821). After adjustment for baseline Borg Cough Scale score and post-nasal drip, the mean between-group difference was not significant for LCQ-T total score (-1.26; 95% confidence interval [CI], -2.69 to 0.17), physical domain score (-0.35; 95% CI, -0.76 to 0.06), psychological domain score (-0.53; 95% CI, -1.06 to 0.01), or social domain score (-0.38; 95% CI, -0.92 to 0.16). Large improvements in LCQ-T total score were reported in both groups after 2 weeks (procaterol, 4.21±2.73; placebo, 5.34±3.2), and 4 weeks (procaterol, 5.94±3.68; placebo, 7.07±3.44). No differences between groups were found in the mean changes of spirometry or IOS parameters after 4 weeks. Conclusion: Our study shows that procaterol is not effective in the treatment of PIC, in terms of improvement of cough-specific QoL or peripheral-airway function.
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    Efficacy and safety of inhaled nebulized sodium nitrite in asthmatic patients
    (2021-02-01) Tidarat Sriboonyong; Theerasuk Kawamatawong; Thanaporn Sriwantana; Sirada Srihirun; Varin Titapiwatanakun; Pornpun Vivithanaporn; Prapaporn Pornsuriyasak; Nathawut Sibmooh; Harutai Kamalaporn; Chulalongkorn University; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Mahidol University
    Background: Nitrite is a physiologic nitric oxide (NO) derivative that can be bioactivated to NO. NO has been shown to attenuate airway inflammation and enhance the anti-inflammatory effect of corticosteroids in the animal model of asthma. Here, we aimed to investigate the efficacy and safety of inhaled sodium nitrite as add-on therapy with inhaled corticosteroid (ICS) in adult patients with persistent asthma. Methods: In protocol 1, 10 asthmatic patients were administered a single dose of nebulized 15-mg sodium nitrite to assess safety, effect on lung function, and pharmacokinetics of nitrite within 120 min. In protocol 2, 20 patients were randomly assigned to a nitrite (15 mg twice daily) group or a placebo group to assess the efficacy over 12 weeks. The primary outcome was the forced expiratory volume in 1 s (FEV1). The secondary outcomes were other lung function parameters, unplanned asthma-related visits at the emergency department (ED) or outpatient department (OPD), admission days, asthma control test (ACT), and safety. Results: Nebulized sodium nitrite had neither acute adverse effect nor effect on lung function test within 120 min. No blood pressure change was seen. At week 12, FEV1 increased in the nitrite group, whereas there was no change in the placebo group. There were 5 events of asthma exacerbation, 4 ED visits, and one unplanned OPD visit in the placebo group, but none of these was noted in the nitrite group. There was no change in ACT scores in both groups. No adverse event was reported during 12 weeks in the nitrite group. There was no change in methemoglobin levels and sputum inflammatory markers. Conclusion: From our pilot trial, nebulized sodium nitrite is safe in asthmatic patients, and shows the potential to reduce asthma exacerbation compared with placebo.
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    Efficiency of the home cardiac rehabilitation program for adults with complex congenital heart disease
    (2018-11-01) Adikan Bhasipol; Nopawan Sanjaroensuttikul; Prapaporn Pornsuriyasak; Sukit Yamwong; Tarinee Tangcharoen; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2018 Wiley Periodicals, Inc. Objective: We aimed to study the efficiency and safety of once-a-week outpatient rehabilitation followed by home program with tele-monitoring in patients with complex cyanotic congenital heart disease. Design: Prospective nonrandomized study. Method: Patients who have been diagnosed either Eisenmenger's syndrome or inoperable complex cyanotic heart disease and able to attend 12-week cardiac rehabilitation program were included. Training with treadmill walking and bicycling under supervision at cardiac rehabilitation unit once-a-week in the first 6 weeks followed by home-based exercise program (bicycle and walking) with a target at 40%-70% of maximum heart rate (HRmax) at pretraining peak exercise for another 6 weeks was performed in the intervention group. Video and telephone calls were scheduled for evaluation of compliance and complication. Data from cardiopulmonary exercise testing (CPET) on cycle ergometry including peak oxygen consumption (peakVO 2 ), oxygen pulse (O 2 pulse), ventilatory equivalent for carbon dioxide (VE/CO 2 at anaerobic threshold), constant work-rate endurance time (CWRET) at 75% of peak VO 2 , and 6-minute walk distance (6MWD) were compared between baseline and after training by paired t test. Result: Of the 400 patients in our adult congenital heart disease clinic, 60 patients met the inclusion criteria. Eleven patients who could follow program regularly were assigned home program. There was a statistically significant improvement of CWRET, O₂ pulse, and 6MWD after finishing the program (P =.003,.039, and.001, respectively). The mean difference of 6MWD change in the home-program group was significantly higher than in the control group (69.3 ± 47.9 meters vs. 4.1 ± 43.4 meters, P =.003). No serious adverse outcomes were reported during home training. Conclusion: Once-a-week outpatient hospital-based exercise program followed by supervised home-based exercise program showed a significant benefit in improvement of exercise capacity in adults with complex cyanotic congenital heart disease without serious adverse outcomes.
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    Executive summary thai pulmonary hypertension guidelines 2020
    (2021-04-01) Kritvikrom Durongpisitkul; Suree Sompradeekul; Ratanavadee Nanagara; Decho Jakrapanichakul; Suthep Wanitkun; Alisa Limsuwan; Nattapong Jaimchariyatam; Prasert Sawasdiwipachi; Smonporn Boonyaratavej; Pornthep Lertsapcharoen; Burabha Pussadhamma; Prapaporn Pornsuriyasak; Worawit Louthrenoo; Emvalee Arromdee; Paweena Chungsomprasong; Chodchanok Vijarnsorn; Srisakul Chirakarnjanakorn; Arintaya Phrommintikul; Apichart Kanitsap; Thiti Sricharoenchai; Supparerk Disayabutr; Tarinee Tangcharoen; Adisorn Wongsa; Piamlarp Sangsayune; Nuttapol Rittayamai; Piya Samankatiwat; Siriraj Hospital; Chulalongkorn University; Faculty of Medicine, Khon Kaen University; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Thammasat University; Phramongkutklao College of Medicine; Chiang Mai University; Central Chest Institute of Thailand
    In 2011, the Heart Association of Thailand (HAT) approved the first Thai guideline for the diagnosis and management of patients with pulmonary hypertension (PH). Since then, significant changes have occurred in the diagnosis and management of patients with PH, such as risk assessment and new strategies for combination therapies based on the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines. The most recently updated definition of PH was from the Sixth World Symposium on Pulmonary Hypertension in 2018. Hence, HAT has revised the Thai guidelines for the diagnosis and management of patients with PH, which was approved by the Royal College of Physicians of Thailand in 2019. These guidelines are intended for use by 1) general practitioners for preliminary diagnoses and referral to a PH referral center and 2) specialist physicians such as cardiologists and pulmonologists, to collaborate in the caring process and diagnosis and management, including the use of Pulmonary artery hypertension (PAH)-specific drugs. The guidelines were written in Thai language to be easily understood and approved by HAT and the Royal College of Physicians of Thailand in 2019. The current executive summary is aimed to highlight important details of the 2020 Thai Pulmonary Hypertension Guidelines for a broader distribution. This updated version of the executive summary of the guidelines is aimed to achieve three objectives, 1) early diagnosis by using the algorithm, including pathophysiology into one of five PH groups, 2) risk assessment for PAH patients into low, intermediate, or high risk, and 3) sequential combination therapy as indicated by the risk assessment for PAH-specific drugs to maintain PAH patients within the low-risk group as much as possible to improve their long-term survival.
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    Exercise-induced bronchoconstriction in rhinitis children without asthma
    (2011-09-26) Kasalong Rakkhong; Wasu Kamchaisatian; Soamarat Vilaiyuk; Cherapat Sasisakulporn; Wanlapa Teawsomboonkit; Prapaporn Pornsuriyasak; Suwat Benjaponpitak; Mahidol University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    Background: Exercise-induced bronchoconstriction (EIB) is a condition that leads to limited participation in sports. Prevalence of EIB ranges from 5-20% in general population to 40 - 90% in asthmatic patients. But the prevalence among rhinitis children with EIB remains debatable. We aimed to determine the prevalence of EIB in nonasthmatic children with rhinitis. Methods: A cross-sectional study was performed on 53 rhinitis patients without known asthma who attended the Pediatric Allergy Clinic between March 2009 and February 2010.They all underwent physical examination, skin prick test, pulmonary function tests and an exercise challenge test (ECT) on a treadmill. A positive ECT was defined as a decrease in FEV 1 > 10% after exercise. Results: The patients' mean age was 12.3±2.6 years. Most of them (60.4%) had moderate to severe persistent rhinitis. Eleven out of 53 patients (20.7%) had EIB. The peak time for occurrence of EIB was 10 minutes after exercise. Most of the EIB episodes observed were of mild degree. Patients who had persistent symptoms and a short duration of rhinitis treatment prior to the ECT day had more positive ECT results (72.7% vs. 28.6%, p 0.013, 0.2 years vs.1.9 years, p 0.012, respectively). The history (Hx) was not a reliable means of identifying children who had EIB (ECT+/Hx+ 54.6%, ECT-/Hx+ 54.8%). There was no significant relationship between baseline pulmonary function and the decline in FEV 1 after exercise. Conclusion: The prevalence of EIB in rhinitis children without asthma is 20.7%. History, physical examination and pulmonary function are insufficient to diagnose EIB.
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    Heterogeneous properties of intermediate- and low-density lipoprotein subpopulations
    (2013-10-01) Pornpen Srisawasdi; Somlak Vanavanan; Mana Rochanawutanon; Prapaporn Pornsuriyasak; Visasiri Tantrakul; Khanat Kruthkul; Kazuhiko Kotani; Mahidol University; Jichi Medical University
    Objective: Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) consist of heterogeneous particles whose subpopulations may have different atherogenic characteristics. This study investigated the associations between these subpopulations and other lipids, lipoproteins and atherosclerosis-related markers. Design and methods: A total of 416 subjects (124 males and 292 females, mean age: 50.8. years) were enrolled in this study. Using polyacrylamide gel electrophoresis, serum lipoproteins were separated according to their specific electrophoretic mobility based on particle size. The IDL particles were separated into three midbands (MID-A to C), and the LDL particles were separated into seven subfractions (LDL1 to 7). Results: MID-B, MID-C, LDL2 and LDL3 to 6 (as a small LDL fraction) were significantly and positively correlated with very LDL (VLDL), while MID-A and LDL1 were significantly and inversely correlated with VLDL. MID-A and LDL1 were significantly and positively correlated with high-density lipoprotein (HDL). The correlation patterns between MID-A or LDL1 and triglycerides, apolipoprotein A-I, glucose, the insulin resistance index, creatinine and the mean LDL particle size had similar trends to those between HDL and these parameters. Conclusions: The respective subpopulations of IDL and LDL particles can vary in their ability to predict cardiovascular disease risks. These variations may partially explain why quantitative assessments using LDL-cholesterol concentrations, as typically performed in conventional practice, are not perfect predictors of cardiovascular disease. Further studies are required to determine the clinical relevance of analyzing the IDL and LDL subpopulations. © 2013 The Canadian Society of Clinical Chemists.
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    Inhaled corticosteroid for persistent cough following upper respiratory tract infection
    (2005-09-01) Prapaporn Pornsuriyasak; Poonkasem Charoenpan; Kulanee Vongvivat; Ammarin Thakkinstian; Mahidol University
    Objective: The aim of this study was to determine the clinical effect of inhaled corticosteroid treatment for persistent cough, post upper respiratory tract infection (URTI) in previously healthy individuals, and on bronchial hyperresponsiveness (BHR). Methodology: This was a prospective, randomized, double-blinded, placebo-controlled study conducted at a university hospital. A total of 30 non-asthmatic, non-smoking patients who were >15 years old and who had persistent post-URTI cough for >3 weeks were assessed by a physical examination, CXR and spirometry, and were allocated to receive inhaled budesonide (400 μg/puff, twice daily) or placebo for 4 weeks. If a patient suffered from sinusitis, it was a requirement that it had been well treated. A symptom score (frequency of cough, frequency of coughing bouts, symptoms associated with cough, night-time cough, frequency of taking medications to relieve cough, and number of medications) was recorded at entry, and after 2 and 4 weeks of treatment. A methacholine challenge test was performed at entry and after 4 weeks of treatment. Results: The mean symptom scores for the treatment group (9.4) and the placebo group (9.8) at baseline were not significantly different (P = 0.79), and no differences were found between the groups after week 2 and week 4 of treatment (3.93 and 4.27 vs 2.26 and 2.66, P = 0.29). The mean change in symptom scores from baseline to week 2 and to week 4 of treatment were also not different between groups (5.93 and 5.6 vs 7.00 and 7.58, P = 0.23). No difference between groups was found in the mean changes in FEV 1, FVC, and FEF25-75% after 4 weeks of treatment. A positive bronchial provocation test occurred in three patients (10%) but these were borderline. Conclusion: Inhaled corticosteroid is ineffective in treating persistent post-URTI cough in previously healthy individuals.
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    Initial diagnosis and successful treatment of pulmonary tumor embolism manifesting as the first clinical sign of prostatic adenocarcinoma
    (2020-01-01) Tananchai Petnak; Thitiporn Suwatanapongched; Wipawi Klaisuban; Chayanin Nitiwarangkul; Prapaporn Pornsuriyasak; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2020 The Author(s) Although pulmonary tumor embolism (PTE) is a well-recognized end-stage form of pulmonary metastases at postmortem examination, the entity is rarely the first clinical sign of prostate cancer. Diagnosis of this condition in patients who have no previous history of malignancy is a challenge. Herein, we reported a 79-year-old man presented with progressive, unexplained dyspnea on exertion. Microscopic PTE coinciding with pulmonary lymphangitic carcinomatosis were readily recognized based on the presence of multifocal dilatation and beading of the peripheral pulmonary arteries with thickening of the bronchial walls and interlobular septa on the initial thin-section chest CT images. Pathologic examination of the transbronchial lung biopsy specimen revealed tumor emboli occluding both the small muscular pulmonary arteries and lymphatic vessels. These tumor cells were positive for prostatic specific antigen on immunohistochemical staining. The final diagnosis of prostatic adenocarcinoma was confirmed. Remarkable clinical and radiographic improvement was achieved following bilateral orchiectomies and anti-androgen treatment.
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    Interleukin-2 levels in exhaled breath condensates, asthma severity, and asthma control in nonallergic asthma
    (2013-09-01) Sawad Boonpiyathad; Prapaporn Pornsuriyasak; Supranee Buranapraditkun; Jettanong Klaewsongkram; Chulalongkorn University; Phramongkutklao College of Medicine; Mahidol University
    There was evidence that interleukin (IL)-2 and IL-10 in the airways play roles in regulating the asthmatic inflammatory response. The purpose of this study was to measure the levels of these cytokines in exhaled breath condensates (EBCs) from asthmatic airways and their correlation with a clinical assessment of asthma severity. The levels of IL-2 and IL-10 in EBC, Asthma Control Test (ACT) score, and the forced expiratory volume in 1 second (FEV1) were studied in 28 steroid-free asthmatic patients and 10 healthy volunteers. The results were analyzed according to their allergic status, asthma severity, and body weight. The correlations between IL-2 and IL-10 levels, percent predicted FEV1, ACT score, and body mass index were also determined. Both IL-2 and IL-10 levels in EBC significantly increased in asthmatic patients, especially in patients with moderate-to-severe persistent asthma, compared with those in normal controls. However, the signification correlations between IL-2 levels and ACT (r = -0.684; p = 0.007), as well as with percent predicted FEV1 (r = -0.671; p = 0.009), were established only in patients with nonallergic asthma. The elevation of IL-2 levels in EBC in obese subjects was observed but was probably related to asthma severity. The levels of IL-2 and IL-10 in EBC increase in asthmatic patients but only IL-2 levels significantly correlate with the ACT score and percent predicted FEV1 in nonallergic asthma. Additional studies should be explored to confirm the reliability of ACT score as a predictor of inflammatory response in asthmatic airways. Copyright © 2013, OceanSide Publications, Inc., U.S.A.
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    Long-term effectiveness of omalizumab treatment in Thai severe asthmatic patients: A real-life experience
    (2018-12-01) Theerasuk Kawamatawong; Orapan Poachanukoon; Chalermporn Boonsiri; Atik Saengasapaviriya; Chanchai Sittipunt; Kittipong Maneechotesuwan; Pintip Ngamchanyaporn; Kunchit Piyavechviratana; Praparn Yongjaiyut; Apichart Khanisap; Siwasak Juthong; Warangkana Rithirak; Prapaporn Pornsuriyasak; Chaicharn Pothirat; Watchara Boonsawat; Chulalongkorn University; Khon Kaen University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Thammasat University; Royal Thai Air Force; Faculty of Medicine, Siriraj Hospital, Mahidol University; Phramongkutklao College of Medicine; Prince of Songkla University; Chiang Mai University; Thai Asthma Council
    BACKGROUND: To evaluate long-term effectiveness of omalizumab in 'real-life' setting of Thai asthmatic patients. METHODS: We conducted multi-center, observational study in severe asthma patients who received omalizumab in Thailand. Outcomes were asthma exacerbation (hospitalization and ER visit), asthma control test (ACT), and daily ICS dose. Data were evaluated at baseline, 16 Week, and 52 Week. RESULTS: A total of 78 patients received omalizumab treatment (average duration 16.9 months with range 16 weeks-2 years). The mean annualized rate of exacerbations was reduced from baseline (3.79) at Week 16 (3.54) and Week 52 (1.16), (p<0.05), respectively. The mean hospitalization rate was reduced from 0.49 in previous year to 0.15 at Week 16 and 0.19 at Week 52. A reduction in ER visit rates was observed at Week 16 (0.15) and Week 52 (0.97) respectively from baseline (1.44) (p<0.05). The ACT score increased from 15.4 at baseline to 20.6 at Week 16 (p<0.001) and increased to 21.5 at Week 52 (p<0.001). The number of patients with controlled asthma (ACT≥20) increased from 16 of 51 at baseline to 32 of 45 at Week 16 and 25 of 32 at week 52, respectively. The median daily dose of ICS equivalent to fluticasone was reduced from baseline 680 mcg to 500 mcg at Week 52. In all, 22 patients discontinued omalizumab after 1 year. Six patients who discontinued omalizumab were restarted due to relapse of symptoms. CONCLUSIONS: These data confirms the effectiveness of one-year duration of omalizumab treatment in Thai severe asthmatic patients. Furthermore, 27% of patients who discontinued treatment required restarting due to relapse of symptoms.
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    Massive hemothorax in a beta-thalassemic patient due to spontaneous rupture of extramedullary hematopoietic masses: Diagnosis and successful treatment
    (2006-03-01) Prapaporn Pornsuriyasak; Thitiporn Suwatanapongched; Narathip Wangsuppasawad; Montian Ngodngamthaweesuk; Pantep Angchaisuksiri; Division of Pulmonary and Critical Care; Division of Diagnostic Radiology; Division of Cardiovascular and Thoracic Surgery; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Gynecology Harbor-University; Mahidol University
    Intrathoracic extramedullary hematopoiesis is an unusual but well-described entity. The condition is typically found in patients who have chronic hemolytic anemias, especially thalassemia. We report a case of a 38-year-old man with underlying beta thalassemia/hemoglobin E who developed intrathoracic extramedullary hematopoiesis. The hematopoietic masses spontaneously ruptured, resulting in massive hemothorax. The condition was confirmed by video-assisted thoracoscopy and successfully treated with surgery, hydroxyurea, and radiation. © 2006 Daedalus Enterprises.
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    Minimal Clinically Important Differences (MCIDs) of the Thai Version of the Leicester Cough Questionnaire for Subacute and Chronic Cough
    (2017-05-01) Prapaporn Pornsuriyasak; Poungrat Thungtitigul; Theerasuk Kawamatawong; Surinder S. Birring; Tipaporn Pongmesa; Mahidol University; King's College London; Silpakorn University
    © 2017 Objectives To investigate the minimal clinically important differences (MCIDs) of the Thai version of the Leicester Cough Questionnaire (LCQ-T) in patients with subacute and chronic cough. Methods Patients with cough for 3 or more weeks were recruited from outpatient clinics. They self-completed the LCQ-T at an initial evaluation and repeated the LCQ-T with a Global Rating of Change scale at follow-up. For the anchor-based method, the MCID was defined as a change in the LCQ scores that corresponded to the smallest improvement in Global Rating of Change score (+2 to +3). For distribution-based methods, the MCIDs were estimated from the standard error of measurement and a half and one-third of the SD of the LCQ score changes from baseline to follow-up. Results A total of 107 patients were included. The causes of cough were postinfectious cough/bronchitis (35.5%), asthma (20.6%), rhinosinusitis (16.8%), bronchiectasis (17.8%), and chronic obstructive pulmonary disease (9.3%). The anchor-based method yielded MCIDs of 1.1, 0.4, 0.4, and 0.4 for the total, physical, psychological, and social domains, respectively. The distribution-based method using standard error qof measurement yielded MCIDs of 0.8, 0.3, 0.3, and 0.3, whereas those using a half SD yielded MCIDs of 2.0, 0.6, 0.8, and 0.8 and those using one-third SD yielded MCIDs of 1.4, 0.4, 0.5, and 0.5 for the total, physical, psychological, and social domains, respectively. Conclusions The MCIDs of the LCQ-T for subacute and chronic cough are 1.1, 0.4, 0.4, and 0.4 for the total, physical, psychological, and social domains, respectively. These estimates should be useful in making meaningful interpretations of the changes in quality of life because of cough.
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    Oxygen Uptake and Lactate Kinetics in Patients with Chronic Obstructive Pulmonary Disease during Heavy Intensity Exercise: Role of Pedaling Cadence
    (2018-05-04) Prapaporn Pornsuriyasak; Mehdi Rambod; Richard M. Effros; Richard Casaburi; Janos Porszasz; University of Vermont College of Medicine; Harbor-UCLA Medical Center; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2018, © 2018 Taylor & Francis Group, LLC. Oxygen uptake slow component ((Formula presented.) sc) is associated with lactate accumulation, likely a contribution of poorly oxidative muscle fibers. We aimed to test the hypothesis that higher muscle tension during slow pedaling rates would yield more prominent (Formula presented.) sc in healthy subjects, but not in COPD patients. Eight severe COPD patients and 8 age-matched healthy individuals performed 4 rest-heavy exercise transitions at 40 and 80 RPM. Work rates at the two cadences were balanced. Venous blood was sampled for measurement of lactate concentration at rest and every 2 minutes until the end of exercise. (Formula presented.) kinetics were analyzed utilizing nonlinear regression. (Formula presented.) phase II amplitudes at the two cadences were similar in both groups. In healthy individuals, (Formula presented.) sc was steeper at 40 than 80 RPM (46.6 ± 12.0 vs. 29.5 ± 11.7 mL/min2, p = 0.002) but not in COPD patients (16.2 ± 14.7 vs. 13.3 ± 7.6 mL/min2). End-exercise lactate concentration did not differ between cadences in either group. In healthy individuals, greater slow-cadence (Formula presented.) sc seems likely related to oxidative muscle fiber recruitment at higher muscular tension. COPD patients, known to have fast-twitch fiber predominance, might be unable to recruit oxidative fibers at high muscle tension, blunting (Formula presented.) sc response.
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    Performance of real-time PCR and immunofluorescence assay for diagnosis of Pneumocystis pneumonia in real-world clinical practice
    (2021-12-01) Darunee Chotiprasitsakul; Pataraporn Pewloungsawat; Chavachol Setthaudom; Pitak Santanirand; Prapaporn Pornsuriyasak; Faculty of Medicine Ramathibodi Hospital, Mahidol University
    Background PCR is more sensitive than immunofluorescence assay (IFA) for detection of Pneumocystis jirovecii. However, PCR cannot always distinguish infection from colonization. This study aimed to compare the performance of real-time PCR and IFA for diagnosis of P. jirovecii pneumonia (PJP) in a real-world clinical setting. Methods A retrospective cohort study was conducted at a 1,300-bed hospital between April 2017 and December 2018. Patients whose respiratory sample (bronchoalveolar lavage or sputum) were tested by both Pneumocystis PCR and IFA were included. Diagnosis of PJP was classified based on multicomponent criteria. Sensitivity, specificity, 95% confidence intervals (CI), and Cohen’s kappa coefficient were calculated. Results There were 222 eligible patients. The sensitivity and specificity of PCR was 91.9% (95% CI, 84.0%–96.7%) and 89.7% (95% CI, 83.3%–94.3%), respectively. The sensitivity and specificity of IFA was 7.0% (95% CI, 2.6%–14.6%) and 99.2% (95% CI, 95.6%–100.0%), respectively. The percent agreement between PCR and IFA was 56.7% (Cohen’s kappa -0.02). Among discordant PCR-positive and IFA-negative samples, 78% were collected after PJP treatment. Clinical management would have changed in 14% of patients using diagnostic information, mainly based on PCR results. Conclusions PCR is highly sensitive compared with IFA for detection of PJP. Combining clinical, and radiological features with PCR is useful for diagnosis of PJP, particularly when respiratory specimens cannot be promptly collected before initiation of PJP treatment.
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    Prevalence of small airways dysfunction in asthma with-and without-fixed airflow obstruction and chronic obstructive pulmonary disease
    (2021-12-01) Prapaporn Pornsuriyasak; Supattra Khiawwan; Sasivimol Rattanasiri; Nattawut Unwanatham; Tananchai Petnak; Ramathibodi Hospital
    Background: Small airways dysfunction (SAD) is not uncommon in asthma without fixed airflow obstruction (FAO). Objectives: We aimed to determine if SAD in non-FAO asthma is different from FAO-asthma and COPD. Methods: Cases of obstructive airway diseases who underwent spirometry, plethysmography, and impulse oscillometry [resistance at 5 Hz (R5) and at 20 Hz (R20), peripheral resistance (R5-R20), and reactance area (AX)] were reviewed, and classified as; 1) COPD, 2) FAO-asthma, and 3) non-FAO asthma. FAO was defined as post-bronchodilator (post-BD) FEV1/FVC < 0.7. SAD was considered if 1) RV/TLC ≥ 40%, or 2) post-BD R5-R20 ≥ 0.075 kPa.L-1s. Results: A total of 73 patients (22 COPD, 24 FAO-asthma, and 27 non-FAO asthma) were analysed. RV/TLC ratio was higher in FAO-asthma and COPD (45 ± 5% and 42 ± 8%) than in non-FAO asthma (32 ± 8%), p < 0.001. Post-BD values of R5-R20 and AX (median; range) were higher in FAO-asthma (0.17; 0.08, 0.47, 13.24; 6.52, 82.11) than in non-FAO asthma (0.11; 0.03, 0.23, 8.63; 2.40, 22.02), p = 0.007 and p = 0.017, respectively. The prevalence of SAD among diagnosis group by RV/TLC criterion was different (95%, 59%, and 15% in FAO-asthma, COPD, and non-FAO asthma, p < 0.001), but those were not observed by R5-R20 criterion (95%, 68%, and 77%, p = 0.052). Conclusion: SAD in non-FAO asthma was less prevalent than FAO-asthma and COPD.
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    Pseudomembranous aspergillus tracheobronchitis superimposed on post-tuberculosis tracheal stenosis
    (2009-01-01) Prapaporn Pornsuriyasak; Septimiu Murgu; Henri Colt; University of California, Irvine; Mahidol University
    Pseudomembranous aspergillus tracheobronchitis superimposed on post-tuberculosis tracheal stenosis has not been previously reported. In the patient described in this case report, the airway obstruction was worsened by aspergillus infection which responded to antifungal therapy and debridement of pseudomembranous tissues by rigid bronchoscopic procedures. A silicone stent was successfully placed in the trachea to restore airway patency when there was no more evidence of tracheobronchial aspergillosis. This case raises the questions of whether, how and when to restore airway patency in patients with tracheal stenosis and concurrent aspergillus tracheobronchitis. © 2008 The Authors.