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- PublicationBeing overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose(2018-01-01) Summon Chomchai; Chulathida Chomchai; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol UniversityCopyright © 2017 John Wiley & Sons, Ltd. Purpose: Increased incidences of hepatotoxicity have been observed in obese patients with acute acetaminophen overdose. We evaluate whether the status of being overweight or obese is associated with increase in the development of hepatotoxicity and acute liver injury (ALI) in patients with acute acetaminophen overdose. Methods: This was a retrospective cohort study comparing the risk of hepatotoxicity and ALI between overweight or obese patients (body mass index [BMI] ≥ 25) and normal BMI patients (BMI ≤ 24.9) presenting with acute acetaminophen overdose at Siriraj Hospital during January 2004 to June 2012. All patients were treated with intravenous N-acetylcysteine. Psi parameters were calculated. High psi was defined as psi of ≥5.0 mM-hour. Data were analyzed using multinomial logistic regressions, odds ratio (OR), stratified OR, and 95% confidence interval (CI). Results: There were 197 patients who fulfilled the criteria for analysis, 35 (17.8%) were obese, 24 (12.2%) were overweight, and 138 (70%) were normal BMI cases. Hepatotoxicity and ALI developed in 25 (12.7%) and 40 (20.3%) cases, respectively. Multinomial logistic regression revealed that the overweight-obesity status and log10(psi value) were significant risk factors of ALI, with OR (95% CI) of 2.68 (1.21-5.95) and 1.74 (1.27-2.38), respectively, while only log10(psi) was a significant risk factor of hepatotoxicity with OR (95% CI) 378.51 (39.49-3627.99). From stratification, overweight-obesity had significant odds ratios for ALI in strata with low acetaminophen concentration, early initiation of N-acetylcysteine and low psi. Conclusion: We conclude that being overweight or obese is an independent risk factor of ALI in acute acetaminophen overdoses.
- PublicationOpen-source discovery of chemical leads for next-generation chemoprotective antimalarials(2018-12-07) Yevgeniya Antonova-Koch; Stephan Meister; Matthew Abraham; Madeline R. Luth; Sabine Ottilie; Amanda K. Lukens; Tomoyo Sakata-Kato; Manu Vanaerschot; Edward Owen; Juan Carlos Jado Rodriguez; Steven P. Maher; Jaeson Calla; David Plouffe; Yang Zhong; Kaisheng Chen; Victor Chaumeau; Amy J. Conway; Case W. McNamara; Maureen Ibanez; Kerstin Gagaring; Fernando Neria Serrano; Korina Eribez; Cullin Mc Lean Taggard; Andrea L. Cheung; Christie Lincoln; Biniam Ambachew; Melanie Rouillier; Dionicio Siegel; François Nosten; Dennis E. Kyle; Francisco Javier Gamo; Yingyao Zhou; Manuel Llinás; David A. Fidock; Dyann F. Wirth; Jeremy Burrows; Brice Campo; Elizabeth A. Winzeler; GlaxoSmithKline plc, Spain; Harvard School of Public Health; University of California, San Diego; The University of Georgia; Columbia University Medical Center; University of California, San Diego, School of Medicine; Mahidol University; The Genomics Institute of the Novartis Research Foundation; Nuffield Department of Clinical Medicine; University of South Florida, Tampa; Pennsylvania State University; Broad Institute; BioSero; California Institute for Biomedical Research; Medicines for Malaria Venture© 2017 The Authors, some rights reserved To discover leads for next-generation chemoprotective antimalarial drugs, we tested more than 500,000 compounds for their ability to inhibit liver-stage development of luciferase-expressing Plasmodium spp. parasites (681 compounds showed a half-maximal inhibitory concentration of less than 1 micromolar). Cluster analysis identified potent and previously unreported scaffold families as well as other series previously associated with chemoprophylaxis. Further testing through multiple phenotypic assays that predict stage-specific and multispecies antimalarial activity distinguished compound classes that are likely to provide symptomatic relief by reducing asexual blood-stage parasitemia from those which are likely to only prevent malaria. Target identification by using functional assays, in vitro evolution, or metabolic profiling revealed 58 mitochondrial inhibitors but also many chemotypes possibly with previously unidentified mechanisms of action.
- PublicationUtility of SOFA score, management and outcomes of sepsis in Southeast Asia: A multinational multicenter prospective observational study(2018-02-14) Khie Chen Lie; Chuen Yen Lau; Nguyen Van Vinh Chau; T. Eoin West; Direk Limmathurotsakul; Pratiwi Sudarmono; Abu Tholib Aman; Mansyur Arif; Armaji Kamaludi Syarif; Herman Kosasih; Muhammad Karyana; Tawee Chotpitayasunondh; Warunee Punpanich Vandepitte; Adiratha Boonyasiri; Keswadee Lapphra; Kulkanya Chokephaibulkit; Pinyo Rattanaumpawan; Visanu Thamlikitkul; Achara Laongnualpanich; Prapit Teparrakkul; Pramot Srisamang; Phan Huu Phuc; Le Thanh Hai; Nguyen Van Kinh; Bui Duc Phu; Nguyen Thanh Hung; Tang Chi Thuong; Ha Manh Tuan; Lam Minh Yen; Nguyen Van Vinh Chau; Janjira Thaipadungpanit; Stuart Blacksell; Nicholas Day; Claire Ling; Guy Thwaites; Heiman Wertheim; Le Van Tan; Motiur Rahman; H. Rogier van Doorn; Sappasitthiprasong Hospital; Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia; University of Indonesia, RSUPN Dr. Cipto Mangunkusumo; UCL; National Institute of Allergy and Infectious Diseases; University of Washington, Seattle; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University; Queen Sirikit National Institute of Child Health; Nuffield Department of Clinical Medicine; Oxford University Clinical Research Unit; Hue Central Hospital; National Hospital of Peadiatrics; Wahidin Soedirohusodo Hospital; Shoklo Malaria Research Unit; Children's Hospital 2; Children's Hospital 1; Sardjito Hospital; National Hospital of Tropical Diseases; Chiangrai Prachanukroh Hospital; Oxford University Clinical Research Unit© 2018 The Author(s). Background: Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods: We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n=3), Thailand (n=3), and Vietnam (n=3). In patients with organ dysfunction (total SOFA score ≥2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥3 for an individual organ system. Results: From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥1500 mL fluid in 50% of patients with hypotension or lactate ≥4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p<0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p<0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62-0.74). Conclusions: Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.
- PublicationThe different faces of renal angiomyolipomas on radiologic imaging: A pictorial review(2018-01-01) Shanigarn Thiravit; Wanwarang Teerasamit; Phakphoom Thiravit; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018 British Institute of Radiology. All rights reserved. Renal angiomyolipoma (AML) is an uncommon renal tumour, generally composed of mature adipose tissue, dysmorphic blood vessels and smooth muscle. Identification of intratumoral fat on unenhanced CT images is the most reliable finding for establishing the diagnosis of renal AML. However, AMLs sometimes exhibit atypical findings, including cystic as well as solid forms; some of these variants overlap with the appearance of other renal tumours. A rare type of AML, the epithelioid type, possesses malignant potential. The aim of this pictorial review is to gather the different imaging features of AMLs including the classic and fat-poor types, AMLs with epithelial cysts, epithelioid AML, AML associated with tuberous sclerosis, haemorrhagic AML and large AMLs mimicking retroperitoneal liposarcomas. The diagnostic clues that help to distinguish AMLs from other renal tumours are also described in the review.
- PublicationDesigning evaluation studies to optimally inform policy: What factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes?(2018-02-23) Shishi Wu; Helena Legido-Quigley; Julia Spencer; Richard James Coker; Mishal Sameer Khan; London School of Hygiene & Tropical Medicine; National University of Singapore; Mahidol University© 2018 The Author(s). Background: In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. Methods: Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. Results: Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. Conclusions: Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.
- PublicationAcute gastrointestinal bleeding in anticoagulated patients: Prevalence and predictors of significant endoscopic lesions and change of the management(2018-04-01) Napaporn Nawarawong; Supot Pongprasobchai; Tawesak Tanwandee; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018, Medical Association of Thailand. All rights reserved. Objective: Acute gastrointestinal [GI] bleeding is common in anticoagulant users. Optimal management regarding the role of endoscopy is lacking. This study aimed to elucidate the prevalence of significant endoscopic lesions and predictors of significant lesions and management change with endoscopy. Materials and Methods: A retrospective cohort study of anticoagulated patients with GI bleeding who underwent endoscopy between January 2005 and December 2014 were reviewed and analyzed. Results: There were 94 patients. Male and female were equal in number with a mean age of 71.6±10.8 years. Most (81.8%) received warfarin. Upper GI bleeding was the most common site (60.9%) followed by lower GI bleeding (28.2%), mid GI bleeding (5.5%) and undetermined (2.7%). Significant GI lesions were found in 62.7%. Peptic ulcer and colonic diverticulosis were the 2 most common causes (41.8% and 28.2%, respectively). Bleeding from coagulopathy occurred in 26.4%. Significant GI lesions led to the change of management in 53.6%, mostly with endoscopic therapy. Hematochezia (odds ratio [OR] 4.90, 95% confidence interval [CI] 1.22 to 19.50, p = 0.024) and INR <4 (OR 4.07, 95% CI 1.17 to 14.27, p = 0.028) were associated with significant GI lesions, while concomitant antiplatelets was negatively associated with significant lesions (OR 0.32, 95% CI 0.12 to 0.88, p = 0.027). Hematochezia at presentation (OR 3.64, 95% CI 1.27 to 10.53, p = 0.016) and no use of antiplatelets (OR 0.28, 95% CI 0.09 to 0.89, p = 0.031) were associated with the change of management. Conclusion: Significant GI lesions were present in two-third of anticoagulated patients who had acute GI bleeding and led to the change of management in one-third. Hematochezia, INR <4 and no concomitant antiplatelets predicted significant GI lesions. Hematochezia and no concomitant antiplatelets predicted the change of management, mostly with endoscopic therapy.
- PublicationModified Semilateral Decubitus Position for Shoulder Arthroscopy and Its Application for Open Surgery of the Shoulder (One Setting for All Shoulder Procedures)(2018-04-01) Ekavit Keyurapan; Chaiwat Chuaychoosakoon; Mahidol University; Prince of Songkla University© 2017 Arthroscopy Association of North America Two standard patient positions for shoulder arthroscopy are the beach-chair and lateral decubitus positions. Both positions have advantages and disadvantages in many aspects. Surgeons choose the position based on their preferences, mainly the orientation of the anatomy. If an operation needs to be converted to an open procedure, a patient who is placed in the lateral decubitus position might need to undergo repositioning and re-draping, which result in extending the operative time and increasing the risk of infection. For this circumstance, the modified semilateral decubitus position offers the same advantages as the lateral decubitus position and can be adjusted to achieve a more upright position similar to the beach-chair position.
- PublicationUltrasound of focal lesions of the hand and wrist: Accuracy, validity, and factors determining treatment decision(2018-03-01) Thumanoon Ruangchaijatuporn; Nattaree Chunlertrith; Suphaneewan Jaovisidha; Patarawan Woratanarat; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018, Medical Association of Thailand. All rights reserved. Objective: To estimate the accuracy and validity of ultrasound in evaluating focal lesions of the hand and wrist and determine the factors affecting the treatment. Materials and Methods: Eighty focal lesions were enrolled and divided into two groups (surgical and non-surgical group). The lesions in each group were subclassified as cystic, solid, vascular, and inflammation or infectious lesion, using either pathological, or ultrasound diagnosis as the reference. Results: The accuracy of ultrasound was low at 57%, 54%, 29%, and 25% for cystic, solid, vascular lesion, and inflammatory or infectious lesion, respectively. There was no significant difference between the ultrasound and clinical diagnosis for hand and wrist lesions (p-value 0.8793). Based on pathological findings, all lesions in the study were benign. The factors that were found to influence treatment (surgical versus non-surgical) in the present study relied on the ultrasound findings and size of the lesion. The ultrasound report of cyst or inflammatory or infectious tended to be followed by conservative treatment (73% and 90%, respectively). On the other hand, surgical treatment was performed if the ultrasound reports resulted as solid or vascular lesion (60% and 67%, respectively) or regarding to the larger size as well (2.5±1.8 cm in surgical versus 1.5±1.1 cm in non-surgical group). Conclusion: The accuracy of ultrasound evaluation of focal lesions in the hand and wrist is low (25% to 57%). However, the lesions with larger size or the solid and vascular lesions had more tendency to undergo surgery. Therefore, ultrasound may help suggesting the therapeutic decision.
- PublicationThe association between mammographic and ultrasound features and histologic grade in invasive ductal carcinoma of the breast(2018-03-01) Voraparee Suvannarerg; Woranuj Tangcharoensathien; Shanigarn Thiravit; Wasu Tanasoontrarat; Kobkun Muangsomboon; Pornpim Korparaphong; Vajira Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: To evaluate the relationships between mammographic and ultrasound features and histological grades of invasive ductal carcinoma using the terminology of the fifth edition of Breast Imaging Reporting and Data System (BI-RADS). Methods: Mammographic and ultrasound features of invasive breast carcinomas diagnosed in 104 consecutive women between January 2011 and August 2014 were retrospectively reviewed, described according to the BI-RADS lexicon, and correlated with histological tumor grade according to the Nottingham histologic scoring system. Results: 104 invasive ductal carcinomas were graded histologically as follows: grade 1, 12.5%; grade 2, 50%; and grade 3, 37.5%. In multivariate analyses, mammographically identified oval or round shape of masses and indistinct margin were significantly associated with grade 3 tumors (p < 0.05). In addition, ultrasound-identified microlobulated margin was significantly associated (p = 0.013) with grade 3 tumors. In contrast, mammographically identified spiculated margin and ultrasound-identified posterior shadowing occurred significantly more frequently in grade 1 tumors (p < 0.05). Conclusion: Mammographic and ultrasound features are effective predictors of histologic tumor grade of breast cancer.
- PublicationUnusual pediatric abdominal cysts: A pictorial review of imaging findings(2018-05-01) Pira Neungton; Preeyacha Pacharn; Kriengkrai Iemsawatdikul; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018, Faculty of Medicine Siriraj Hospital, Mahidol University. This article presents images and imaging features of unusual abdominal cysts in pediatric population. Recognition of imaging features and their location are helpful in diagnosis and therapeutic decision. Meconium pseudocyst usually has calciied wall and may contain debri or air. Lymphangioma can be located in mesentery or omentum and presents as uni or multilocular cyst. Pseudocyst is the most common complication of acute pancreatitis. Ovarian cyst is sometimes present as an abdominal mass in the newborn and young child. Cystic mass containing fat and calciications is the pathognomonic inding of mature cystic teratoma. Duplication cyst has gut signature or double wall sign on ultrasound. Communication with bile duct is the helpful clue in diagnosis of choledochal cyst. When adrenal hemorrhage liqueies, it becomes cystic and gradually decreases in size.