Browsing by Author "S. Horsirimanont"

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    Application of APACHE-II and SOFA score as a predictive outcome in Ramathibodi surgical intensive care unit
    (2019-02-01) C. Pornwaragron; C. Wilasrusmee; S. Morakul; N. Poprom; S. Horsirimanont; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Background: Acute Physiology and Chronic Heatlh Evaluation II score (APACHE-II) and Initial Sequential Organ Failure Assessment score (SOFA) score are known as accepted severity scoring. From many studies, they both had good efficacy in predicting mortality for the critically ill patient in the intensive care unit. But in real practice, there are many factors that can affect the accuracy of this scoring system, such as the differences between each intensive care units or the pattern of patients. The aim of this study is to validate the performance of APACHE-II score and Initial SOFA score for predicting ICU mortality of Ramathibodi Surgical Intensive Care Unit. Materials and Methods: A retrospective reviewed for surgical patients who had been admitted to SICU between 1st May 2011 and 31st December 2011 at Ramathibodi Hospital, All surgical patients were included in this study. Patients, who were younger than 15 years, had ICU admission less than 48 hr for observation after elective surgery was excluded. Results: One hundred and eighty-five patients were enrolled in this study, twelve (6.5%) deaths were recorded in this SICU, the missing data were found to be 10%, Mean of APACHE-II score was 10.5 whereas mean of initial SOFA was 2.8. The factors that were related to ICU death were non-scheduled admission, sepsis, acute renal failure, APACHE-II score >10 and initial SOFA score >3. In univariate analysis, initial SOFA score had the strong correlation with mortality, especially if initial SOFA >3 (odd ratio = 14). The area under the receiver operating characteristic curve of APACHE-II was 0.85 and initial SOFA was 0.84. Conclusion: Both SOFA and APACHE-II had good discrimination for predicted ICU mortality for the surgical patients in Ramathibodi surgical intensive care unit. In the present study, we found that SOFA score is comparable to APACHE-II score.
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    Effect of normobaric oxygen therapy on wound healing in patients with minor tissue loss from critical limb ischemia: A randomized clinical trial
    (2019-02-01) P. Prasartritha; S. Horsirimanont; S. Jirasiritham; W. Tirapanich; P. Pootracool; P. Lertsittichai; S. Arj-Ong Vallibhakara; C. Pornwaragorn; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Objective: The present study is to evaluate the effect of normobaric oxygen therapy on wound healing in patients who presented with minor tissue loss from critical limb ischemia. Materials and Methods: This randomized controlled trial was conducted at Ramathibodi Hospital. From May 2017 to January 2018, critical limb ischemia patients with minor tissue loss were randomly assigned to be treated with or without normobaric oxygen therapy for four weeks. The primary outcome is to evaluate the wound healing by measuring the wound surface area. The secondary outcome is to evaluate the change in the transcutaneous oxygen tension at pre-and post-treatment and also complications from the treatment. Results: We assigned 28 patients with minor tissue loss into two groups (after excluding one patient from each group due to infection): 14 patients each group. The wound surface area at four-week times was smaller in intervention group (-0.06+1.25 cm2) but was larger in control group (0.825+1.10 cm2) without statistical significance (p = 0.057). Likewise, the transcutaneous oxygen tension in the intervention group showed superior result compared to the control group (3.22+9.54 vs.-3.02+7.25 mmHg) though there was no statistical significance (p = 0.059). Conclusion: Normobaric oxygen therapy may be beneficial for increasing wound healing in the critical limb ischemia patients who presented with minor tissue loss.
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    Mean platelet volume (Mpv) as a predictor of venous thromboembolism (Vte) in colorectal cancer
    (2019-02-01) C. Wilasrusmee; J. Wongsereepatana; N. Poprom; S. Horsirimanont; C. Supsamutchai; J. Jirasiritham; B. Siribumrungwong; S. Phuwapraisirisan; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Thammasat University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Background: Platelet activity is a major devilish atherothrombotic events and cancer. Mean platelet volume (MPV), which is widely available as a routine parameter of the complete blood count, is a potentially useful biomarker of platelet activity in the setting of venous thrombosis. Recent studies showed that high-MPV levels are associated with an increase VTE risk in cancer patients. Objective: To investigate the role of MPV in VTE and colorectal-cancer. Materials and Methods: A retrospective study was performed to analyze differences of MPV between patients with VTE, VTE and colorectal-cancer, and control. We identified comparative studies that compared the effect of MPV in VTE from PubMed and Scopus databases up to December 2017. Two reviewers independently extracted data for meta-analysis. Differences in MPV were expressed as unstandardized mean difference. Results: Among 170 patients, 58-control, 54-VTE, and 58-VTE with colorectal-cancer, MPV was significantly higher in VTE groups. From 403 articles, 10 studies (5 cohorts and 5 case-controls) comprising 2,265 patients. MPV was significantly higher in those with VTE (mean difference 0.61 fL, 95% CI 0.34 to 0.88, p<0.001). Elevated MPV increased the relative risk of VTE (RR 1.319, 1.061 to 1.641, I2 = 82.5%). Conclusion: Our evidence suggests that elevated MPV is associated with VTE and VTE with colorectal-cancer. A mechanistic study and RCT are required in order to use antiplatelet therapy.
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    Outcomes of ultrasound-guided catheter-directed foam sclerotherapy with or without perivenous tumescent enhancement in the treatment of great saphenous vein reflux
    (2019-02-01) P. Prayoonhong; S. Horsirimanont; W. Tirapanich; S. Jirasiritum; S. Leela-Udomlipi; P. Pootracool; N. Kittitirapong; C. Pornwaragorn; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Background: Great saphenous reflux is widely managed by endovenous methods as first line treatment. Sclerotherapy is a recommendation when other endovenous treatments are not. Ultrasound-guided catheter-directed foam sclerotherapy appears to be attractive and suitable. Tumescent anesthesia is used in other endovenous thermal treatments to help with vein compression around the catheter for better contact and prevent heat damage. In developing countries like Thailand, the costs of the standardized instruments such as radiofrequency ablation or endovenous laser are costly. Not many patients can afford such treatments alternative of a minimally invasive treatment in truncal vein reflux. But it is inferior in terms of closure rate. Objective: In general, foam sclerotherapy has an closure rate of only about 70% in 3 years. The compressive effect of tumescent anesthesia can be applied to help increase the effectiveness of sclerotherapy as it can compress the vein and empty the blood. Therefore, better contact of the sclerosant to the vein wall and the concentration of the sclerosant is not dissipated by the blood. Perivenous tumescent injection together with ultrasound-guided catheter-directed foam sclerotherapy was proposed. Reviewed literature showed lower costs and acceptable satisfaction. Materials and Methods: Randomization of 31 patients with 38 treated legs in total. 16 patients with 20 treated legs were enrolled in the tumescent group and 15 patients with 18 treated legs in the non-tumescent group. 1% aethoxysklerol was used as sclerosant. Tumescent solution was comprised of 1% xylocaine, ketorolac, 0.9% NSS, and dexamethasone. Patients were treated as ambulatory cases with light sedation in the operating room. Patients were followed-up at 2-week, 1-month, 3-month and 6-month intervals with duplex ultrasonography performed by vascular fellows. Primary outcome was closure rates between the two groups. Secondary outcomes were VCSS, incidence of DVT or symptomatic PE, any other adverse events and satisfaction score. Results: Both groups were not statistically significant in terms of occlusion rate by the Kaplan-Meier curve (p = 0.891). Occlusion rates at 90 days were 93.75% in the tumescent group and 100% in the non-tumescent group, at 150 days were 81.2% in the tumescent group and 78.1% in the non-tumescent group. DVT or PE 0%. Adverse events were ecchymosis in two patients and cord like tenderness in one. Mean satisfaction score at last follow-up was 4 out of 5. Reduction in the VCSS at the end of follow-up period compared to pre-operatively was not statistically different between the two groups. Conclusion: Perivenous tumescent enhanced ultrasound-guided foam sclerotherapy solution did not demonstrate improvement in occlusion rate. But it could be performed as an outpatient setting with no major adverse events.