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TO HIV-INFECTED CHILDREN IN QUEEN SIRIKIT NATIONAL INSTITUTE OF
CHILD HEALTHMallika Ridtong
Human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) is one of the world’s major health problems. Current available treatment options are antiretroviral drugs which can increase survival and reduce morbidity of infected individuals. As these patients continue to live longer, psychosocial aspects of the illness become the important issue that need to be taken into consideration when caring for infected patients. The purpose of this qualitative study was to explore factors affecting disclosure of HIV diagnosis to HIV-infected children in Queen Sirikit National Institute of Child Health and child’s emotional and behavioral responses to disclosure.
Twenty eight children aged 8 – 18 year old and 28 primary caregivers were enrolled in this study during May 2006 – October 2008 at Queen Sirikit National Institute of Child Health. Each respondent interviewed separately using semi-structure interview guide with open–ended questions. Data were tape-recorded, transcribed, and analyzed with qualitative software ATLAS. ti version 5.
The study revealed that only one thirds of primary caregivers had disclosed to their child about HIV diagnosis at the time of this interview. The important factors affecting disclosure of HIV diagnosis included child’s factors (age, cognitive maturity, psychosocial problem), disclosure process and environmental factors. Most primary caregivers underscored the importance of taking gradual steps in disclosure and mentioned that both caretakers and physician were needed to take part in this process. After disclosure, majority of these children appeared to be able to cope with the new relatively well without major psychological and emotional adverse reactions.
NEONATAL RESPIRATORY DISTRESS SYNDROME BETWEEN 2003-2005 AND 1999-2002
Nopphasorn Promwong Background: Exogenous surfactant replacement therapy has been a part of the routine care of preterm neonates with respiratory distress syndrome (RDS) since 1990s. In Thailand, surfactant replacement therapy had been limited utilization due to high cost until the national health insurance policy beginning in 2003. Nowadays surfactant replacement therapy is frequently used in our institute, so we are interested to evaluate the effects of this substance in treatment of RDS.Objectives: To study outcome, risk factors and complication of surfactant replacement therapy in newborns who were diagnosed as moderate to severe RDS.Study design: historical Cohort study
Methods: The data of infants who were diagnosed as moderate to severe RDS and treated with surfactant in Queen Sirikit National Institute of Child Health between January 1st,2003 to December 31th,2005 were reviewed and compared the outcome of this study(the second group) to the previous study(1999-2002 as the first group). All data were kept in database format and analyzed the difference in 2 groups include factors affecting RDS, complications, neurodevelopmental outcome, association between time to start surfactant, duration of ventilation and mortality rate.Results: The data of ninety-one moderate to severe RDS patients who received surfactant replacement therapy were reviewed. The mean birth weight and gestational age in the second group were (1,250±435.57 gm and 29.38±2.2 week) less than in the first group(1,344±452.37 gm and 29.69±2.61week). This study showed statistical different in antepartum hemorrhage(4.4%) and pregnancy induce hypertension(PIH) (17.6%) while the previous study showed 33.3% of antepartum hemorrhage and 3% of PIH. In neonatal conditions, there were statistical significant difference in anemia (28.6% compare to 9%) and patent ductus arteriosus (67% compare to 39.4%) between groups. The surfactant can be used in the younger age (4.75 hours) in this study as compare to the previous study (7.21 hour). The overall durations of patients on mechanical ventilation in this study (6 days) were shorter than the previous study (16 days) especially in patients who received surfactant in first six hours of life. Fractional inspired oxygen can decrease to 0.4 within six hours after treatment were found more cases in this study, 50 cases(56.8%) compare to the previous study, 10 cases(32.2%). The immediate complication, pulmonary hemorrhage was found more cases in previous study (33.3%) than in this
study (12.1%) but bronchopulmonary dysplasia(BPD) was found more cases in this study (46.1%) than the previous study (21.2%). The length of admission were longer in this study group (61.23±41.08 days) compare to the previous study (38.5±23.48 days). The mortality rate in this study was 18.7% (17 cases) less than the previous study 33.3% (11 cases). Conclusions: The benefit of surfactant therapy in moderate to severe RDS can reduce the duration of ventilation and decrease the mortality rate. However the incidence of chronic lung disease is not decreased. Nevertheless the more earlier the surfactant is administered, the more higher the survival rate is.
Tayatorn SudsuanseeBackground: Although highly effective anti-retroviral agents (ARV) have been proved in improving survival of HIV-infected children, their side effects are increasingly concerned. One of the important side effects is dyslipidemia and abnormal fat redistribution.Objectives: To study
1) Prevalence of dyslipidemia in pediatric HIV/AIDS2) Association between various ARV regimens and abnormalities in lipid profiles
3) Deviation of anthropometric parameters including waist circumference, hip circumference and waist-to-hip ratio in pediatric HIV/AIDS4) Association between abnormalities in lipid profiles and abnormal anthropometric parameters.
Method: A cross-sectional study was conducted in pediatric HIV clinic, Queen Sirikit National Institute of Child Health, during 1 April 2006-31 October 2007. Fasting lipid profiles, waist circumference and hip circumference were obtained during out-patient visit. Patients receiving current ARV regimen less than 90 days were excluded from regimens comparison analysis.Results: All 220 HIV-infected children (99 boys and 121 girls) had mean age of 9.1±3.34 years old. Mean duration of using current ARV regimens was 12.35±11.06 months and 2 patients were not receiving ARV. Percentage of HIV-infected patients having abnormal total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides were 26.4, 22.7, 5, and 24.5 percent respectively. Percentage of patients having high lipid level (either total cholesterol or LDL-cholesterol) was 28.18 percent.
Patients receiving 1 boosted protease inhibitor (PI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI) plus nucleoside reverse transcriptase inhibitor (NRTI) regimen had the highest mean total cholesterol and LDL-cholesterol levels (225.5 and 153.1 mg/dl) and patients receiving 2 boosted PI and/or NRTI had the second highest levels (197.1 and 125.1 mg/dl), both of which were above normal range and also statistically significant higher than other regimens when paired comparisons between regimens were tested. Patients receiving 2 boosted PI and/or NRTI had the highest mean triglycerides level and also higher than those receiving NNRTI plus 2 NRTI regimen with statistical significance. While mean HDL-
cholesterol level had no statistically significant difference between different regimens.
Waist circumference for age (Wa/A) and hip circumference for age (Hi/A) in this group of patients did not deviate from norm significantly (99.97±10.5% and 93.38±9.6% of 50th percentile value of Thai children). Wa/A, Hi/A and mean waist-to-hip ratio (WHR) were not different between ARV regimens. There were statistically significant association between abnormal WHR and abnormal total cholesterol and low HDL-cholesterol (p=0.042, 0.013 respectively). Abnormal Wa/A also had statistically significant association with abnormal triglycerides (p=0.003). Only anthropometric parameter that could predict dyslipidemia was WHR for detection of low HDL-cholesterol. Cut-off value of WHR 0.895 had 82% sensitivity and 62% specificity to detect HDL-cholesterol level below 35 mg/dl. Conclusions: Prevalence of dyslipidemia in pediatric HIV/AIDS in this study was 28 percent. Regimens associated with hyperlipidemia were the regimens containing PI. Patients receiving 1 boosted PI plus NNRTI plus NRTI had the highest cholesterol level than those receiving 2 boosted PI. Abnormal anthropometric parameters showed no difference between patients receiving different ARV regimens. WHR may potentially be used as the screening parameter for low HDL-cholesterol in this group of patients.
FOREIGN BODY INGESTION IN CHILDREN:A RETROSPECTIVE STUDY IN QUEEN SIRIKIT
NATIONAL INSTITUTE OF CHILD HEALTH
Manop Wangkieangsang Background: Foreign body ingestion is a common problem in children especially toddlers. Thailand data is scarce, but the international data shows that the most common age is toddler period( aged 1-4 years ).Objective: To study demographic data including ages, sex, occupation of parents, types of foreign
body, causes of ingestion, admission rate, signs & symptoms and management.Method: Medical records from June 1st, 2005 to June 30th, 2006 were retrospectively analized. Result: One hundred forty-seven children are included in this study, 75 of them are male and 72 are female. Most of them have age range between 6 months to 3 years. Of the study group, 73.5% live in Bangkok. Most of the parents are merchant and employee. Cause of foreign body ingestion mostly by accidents (91.1%). Most common types of foreign body are drugs (23.8%) followed by coins and chemical ingestion. About 54.4% of the children are admitted to the hospital, because of coins and sharp objects ingestion. For the children who have toxic foreign body ingestion, drugs and chemical are the most likely cause. Nearly half (42.9%) of the children who suffered from foreign body ingestion have no symptom. Management of these children are supportive and symptomatic Treatment.Conclusion: Foreign body ingestion in children is still a common problem which has been found for a period of time. It has not yet been solved, despite the parent’s education. Therefore pediatrician should pay attention on accident prevention and education parents especially during 6 month - 3 year in well child clinic.
Behavioral problems of epileptic children at Queen Sirikit National Institute Of Child Health
Janwanpen Suwanpairat
Children and adolescents with epilepsy increase risk of several psychiatric problems. The purposes of this study are to study the prevalence of behavioral problems in school-age children with epilepsy and to examine the association of their behavioral problems with specific medical epilepsy-related factors, academic comprehension and attention deficit-hyperactivity related behavior.
To assess parent-reported behavioral problems, The Thai Youth Checklist (TYC), comprehension batteries of academic tests, Iowa tests for Attention-Deficit/ Hyperactivity Disorder (ADHD) and questionnaires about epileptic factors associated with behavioral problems are used in 100 epileptic children, age 6- 11 years old children at pediatric out-patient department of Queen Sirikit National Institute Of Child Health. The data were analyzed by SPSS program.
The results showed that the prevalence of behavioral problems in epileptic children are 57%, which 32% have severe behavioral problems. The patients with severe behavioral problem are significantly related to complex partial seizure. The prevalence of learning problem is 23 %. The IOWA test show the prevalence of Attention -Deficit/ Hyperactivity Disorder is 58% and TYC shows that 25% of epileptic children have attention problems. There are statistically significant associations between severe behavioral problems and attention problems.
The patients with mild to severe behavioral problems have higher scores on the delinquent behavior and social problems. There are statistically significant between behavioral problems and friendships, parent relationships and housework skill.
There were no statistically significant associations between the behavioral problems and age at onset of seizures, frequency, EEG at the time of evaluation, anticonvulsive polytherapy and learning ability.
สำาหรบ piperacillin/tazobactam มแนวโนมทจะสามารถน ำามาใช รกษาไดกบเชอ ESBL- producing E. coli แตไมเหมาะสำาหรบการรกษาเชอ ESBL- producing K. pneumoniae และสำาหรบยา netilmicin เชอมการตอบสนองตอยาไมด จงไมควรนำามาใชในการรกษา เชอ ESBL- producing K. pneumoniae และ E. coli นอกจากนน fosfomycin อาจเปนอกทางเลอกในการนำามาใชรกษาการตดเชอกลม ESBL- producing K. pneumoniae และ E. coli แทนยากลม carbapenems เพอชวยลด selective pressure ของการใช carbapenems มากเกนไป หรอกรณทเชอมการพฒนาจนดอยากลม carbapenems ในอนาคต
IN VITRO ACTIVITY OF ERTAPENEM, IMIPENEM, NETILMICIN, FOSFOMYCIN, MEROPENEM,
PIPERACILLIN/TAZOBACTAM AND COLISTIN AGAINST CLINICAL ISOLATES OF EXTENDED-SPECTRUM BETA–LACTAMASE PRODUCING
KLEBSIELLA PNEUMONIAE AND ESCHERICHIA COLI
Worraporn Tantichattanon Background: Infections caused by multidrug-resistant bacteria have been increasingly reported in
nosocomial settings. Among these resistant pathogens, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli are currently the major problem worldwide. The expanded use of broad-spectrum antibiotics, especially carbapenems antibiotics for the treatment of these pathogens can create selection pressure that allow these pathogens to eventually develop carbapenems resistance in the near future. Therefore, it is vital that other antimicrobial agents are to be evaluated for their in vitro effectiveness and their role as the alternative agents against these bacteria. Objective: This study aims to determine in vitro activity and the susceptibility patterns of ertapenem, imipenem, meropenem, netilmicin, piperacillin/tazobactam, fosfomycin and colistin against clinical isolates of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli. Method: The clinical isolates of K. pneumoniae and E. coli were obtained from patients receiving care at Queen Sirikit National Institute of Child Health, Bangkok, Thailand, from October 2006-August 2007. Only ESBL-producing K. pneumoniae and E. coli were included. Antibiotic susceptibility was determined by disc diffusion method and E-test for the minimal inhibitory concentrations (MIC). The antimicrobial agents used in the susceptibility testing included ertapenem, imipenem, netilmicin, meropenem, piperacillin/tazobactam, fosfomycin and colistin. Results: Total of fivety-five isolates of K. pneumoniae and E. coli each were tested in this study. The result showed the potent in vitro activity of ertapenem, meropenem and imipenem against ESBL- producing K. pneumoniae and E. coli with 100 percent susceptibility by the disc diffusion and the MIC method with the
MIC90 of ESBL- producing K. pneumoniae for ertapenem, meropenem, and imipenem were 0.23, 0.09 and 0.38 µg/ml, respectively and the MIC90 of ESBL- producing E. coli for ertapenem, meropenem, and imipenem were 0.177, 0.064 and 0.25 µg/ml, respectively.
Fosfomycin was active against ESBL- producing K. pneumoniae with 85.4 and 94.2 percent susceptibility by the disc diffusion and the MIC method, respectively with the MIC90 of 59.2 µg/ml. For ESBL- producing E. coli, there was 100 percent susceptibility by both disc diffusion and the MIC method with the MIC90 of 2.85 µg/ml.
Piperacillin/tazobactam susceptibility for ESBL- producing K. pneumoniae was 67.2 and 68.1 by the disc diffusion and the MIC method, respectively with the MIC90 of 256 µg/ml. For ESBL- producing E. coli, there was 67.2 and 95.83 percent susceptibility by disc diffusion and the MIC method, respectively with the MIC90 of 16.8 µg/ml.
Colistin was active against ESBL- producing K. pneumoniae with 98.1 and 94.2 percent susceptibility by the disc diffusion and the MIC method, respectively with MIC90 of 0.75 µg/ml. For ESBL- producing E. coli, there was 100 percent susceptibility by both disc diffusion and the MIC method with the MIC90 of 0.58 µg/ml.
Netilmicin exhibited only 12.7 percent susceptibility by disc diffusion method for both ESBL- producing K. pneumoniae and E. coli.Conclusions Carbapenems, fosfomycin and colistin exhibit excellent in vitro activity against both ESBL- producing K. pneumoniae and E. coli. Based on the MIC results of ESBL- producing K. pneumoniae, meropenem showed the most potent activity, followed
by imipenem, ertapenem, colistin, and fosfomycin, respectively. For ESBL- producing E. coli, meropenem, again, was the most potent antibiotic, followed by fosfomycin, imipenem, ertapenem, and colistin, respectively.
In term of alternative antimicrobial agents, piperacillin/tazobactam may be used against ESBL- producing E. coli effectively but should not be used in ESBL- producing K. pneumoniae infection because of its low in vitro activity against this pathogen. Netilmicin is not recommended for the empirical treatment of either ESBL- producing K. pneumoniae or E. coli given its low in vitro activity against these bacteria. In addition, fosfomycin appeared to have potential for being an alternative therapy for infection caused by ESBL- producing K. pneumoniae and E. coli to avoid selective pressure from the overuse of carbapenems as well as in case of carbapenems resistance in the future.
COMPARISON OF THE EFFICACY BETWEEN PEDIATRIC SYMPTOM CHECKLIST
AND THAI YOUTH BEHAVIOR CHECKLIST FOR THE DETECTION OF PSYCHOLOGICAL PROBLEM
Kanjana Amloy
Background : Early detection and treatment of psychosocial problems by pediatrician may lead to considerable health benefits, and a short questionnaire could support this aim.Objective : To assess whether the Pediatric Symptom Checklist (PSC) is valid and suitable for the early detection of psychosocial problems among childrenType of Research : Cross sectional study Material and Methods : One hundred sixty children (Twelve children were excluded due to incompleted questionnaire) aged 6-11 years old who were attended to child psychiatry clinic or admitted to Queen Sirikit National Institute of Child Health between November 2006 to December 2007 were included in this study. Parents were asked to completed the questionnaires both PSC and TYC. Sensitivity, specificity, positive predictive value and negative predictive value were performed. Results : The area under the ROC curve using the TYC as a criterion was 0.895. The optimal cut-off point is 20. At this cut-off point, sensitivity and specificity were 58.76% and 93.65% Positive predictive value was 93.44% and Negative predictive value was 59.59%Conclusion : From this study, the PSC is useful screening tool for early detection of psychosocial
problems, especially with an adjusted cut-off point at 20.
A RETROSPECTIVE STUDY ATQUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD
HEALTHPatipat Panwichai
BACKGROUND : Myasthenia gravis is a disorder of neuromuscular transmission that results from autoimmune attack on postsynaptic acetylcholine receptors. Its features include fluctuating weakness and fatigability of skeletal muscles such as ptosis and ophthalmoplegia. Due to few studies of myasthenia gravis in Thai children, the author is motivated to study this illness and the response to treatment in
Thai children at Queen Sirikit National Institute of child health (QSNICH)OBJECTIVE : To study the prevalence, demographic data, symptoms and response of treatment in the myasthenia gravis patients at QSNICHMETHOD : A retrospective descriptive study for prevalence, signs, symptoms and treatment response of treatment in the myasthenia gravis patients, that was performed during January 1997 to December 2007 at QSNICH. Using percentage, Chi-Square test and Fisher’s Exact testRESULTS : There were 113 patients included to this study. Male to female ratio was 1:1.6. Most of their age onset were about 1-6 years. The mean onset-age of clinical presentation was 3 years and 10 months. Ocular myasthenia gravis was the most common type of the patient (83.2%), followed by extremities weakness (8.8%), respiratory involvement (8.0%). Ocular muscles were almost always involved and frequently were involved first. The weakness aggravated by repetitive uses of muscles in exercise or by illness. The patients were treated with pyridostigmine bromide (97.4%) more than with prednisolone (73.5%) and thymectomy (12.4%). Most patients were responded to the treatment; pyridostigmine bromide, prednisolone and thymectomy as 90.9%, 91.6% and 92.9% respectively. Most of the patients were transient recovery. Non of residual weakness was the common response in the patients whom were treated with prednisolone or thymectomy. In another group, the patients whom received pyridostigmine bromide, most of them still had some degree of weakness. Twenty patients (17.7%) could be taken off the medicine with no weakness.CONCLUSION : Most of the myasthenia gravis patients were presented with ocular involvement and
had a good response to the treatment. Some of them had no symptom after being taken off the medicine. Gender, symptom and treatment were no statistically significant with the patient who could be taken off the medicine.
การศกษาความสมพนธระหวาง tachycardia กบ late onset neonatal sepsis
LATE ONSET NEONATAL SEPSISSomporn Lairungrungsakul
Background : Sepsis is the common problem and major cause of morbidity and mortality in neonates. Early diagnosis and proper management will decrease neonatal mortality rate. Many studies has identified that abnormal heart rate characteristic might precede the clinical diagnosis of neonatal sepsis. Therefore, heart rate monitoring could be potentially useful tool in the diagnosis of neonatal sepsis.Objective : To evaluate the association between tachycardia and neonatal sepsis and the diagnostic accuracy of tachycardia in neonatal sepsis.Study design : Observational studySubjects : Term newborn at the age of 7-28 days and preterm at the corrected age of
34-40 weeks of gestational age who were diagnosed as sepsis were included in this study. This sepsis occurred in sick newborns at neonatal wards of Queen Sirikit National Institue Of Child Health for one year (May1st ,2006 to April 30th ,2007) Methods : The clinical signs, symptoms and laboratory values in newborns who were suspected sepsis were recorded.The mean of heart rate were recorded and these infants were evaluated for tachycardia( heart rate at rest of > 160 beats/minutes ). When tachycardia was noted, the heart rate was recorded every 15 minutes for one hour and every hour until therapy for sepsis was started. The patients were divided into two groups, hemoculture positive group and hemoculture negative group. Results : Eighthy-one newborns were diagnosed as suspected sepsis during the study period. In proven sepsis, probable sepsis and localized infection were 19, 34 and 28 cases,respectively The three most common pathogens were Klebsiella pneumoniae(ESBL) (26.3%) , Acinetobacter calcioacetricus baumannii complex and Escherichia coli(ESBL) (10.5%) in proven sepsis. The common clinical manisfestrations were fever (38.3%) , lethargy (33.3%) and jaundice (28.4%). We found that nineteen cases were sepsis (hemoculture positive) and sixty-two cases were Sepsis-like illness (hemoculture negative). The clinical manisfestations were not significantly different between groups except for platelet count. The predictive values of tachycardia for neonatal sepsis including sensitivity, specificity, positive predictive value and negative predictive value were 26, 79, 27 and 77 percent respectively.
Conclusions : This study did not show accuracy of tachycardia for predicting neonatal sepsis because of limitation in sample size and time.Further studies with larger sample size are needed to determine the usefulness of tachycardia in predicting neonatal sepsis.
HEARING SCREENING (OAE & ABR) IN HIGH RISK NEWBORN
AT QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEALTH
DURING 2003 - 2005Atinuch Surawongsin
Background: Hearing impairment is a major problem found in language handicapped populations in developing countries. Early detection of hearing impairment especially in infancy period would be beneficial in terms of treatment and rehabilitation outcome. Queen Sirikit National Institute of Child Health (QSNICH) has more than 2,500 newborns at risk for hearing impairment each year, assessment of incidence and risk in this population would also benefit in term of prevention and sequelaes.Objectives: To evaluate incidence and severity of hearing impairment in newborns at risk, including outcome of treatment after 1-year follow-up and
identification of associated factors found in this group of children who have hearing impairment. Methods: This descriptive study was conducted in children born at QSNICH and met inclusion criteria of newborn at risk for hearing impairment. Medical records were reviewed to identified risks and hearing screen results. Follow-up outcomes of treatment were traced until 1 year of age. Results: The number of newborns at risk during the period of this study were 2,709. Hearing screening test was done in 98.9% of these patients. Percentage of newborns who had abnormal hearing screening test was 39.36%. Confirmatory test done at the age of 5-8 month showed hearing impairment in 3.69% of these patients. Incidence of hearing impairment in this populations is 37/1000 newborns at risk. Risk factor most commonly found in the hearing impaired children was ototoxic drugs used for more than 5 days. There were 52.7% of infants with unilateral hearing impairment, 23.9% had only mild severity while 1.5% had profound loss, 46.3% of infants had bilateral hearing impairment, 10.4% had moderate bilateral hearing impairment while 6% had profound bilateral loss. Only 58.2% of patients were followed-up at 1 year of age. Bilateral hearing impairment was found in 56.4% and 12.81% had unilateral hearing impairment, while hearing test in 17.9% of these patients had returned to normal. Conclusions: Incidence of hearing impairment in newborns at risk at QSNICH has decreased when compared with the incidence in the past. This could be due to the large number lost at follow up in our study. But in the group who were followed till 1 year, 88% of those with unilateral hearing impairment had fully recovered. In contrast, only 20% of patients with bilateral hearing impairment regained their hearing while 16.67% had got worse.
จมกจำานวน 49 คน พบวาคา R na ในกลมทมอาการมากกวากลมทไมมอาการ P = 0.03 (0.90±0.59 v.s. 0.68±0.35 Pa/ml/sec) และ คา Vna กลมทมอาการนอยกวากลมทไมมอาการ P = 0.04 (222.79±121.65 v.s. 293.90±195.58 ml/sec)
เมอเปรยบเทยบระดบความรนแรงของการบวมของเยอบจมกในทงสองกลม (ระดบรนแรงนอย,ปานกลาง, มาก) พบวาในกลมทไมมอาการ คา R na และ V na ไมมความแตกตางกนทางสถต สำาหรบกลมทมอาการ พบวาคา R na และ V na มความแตกตางกนทางสถต เฉพาะในกลมทมการบวมของเยอบจมกระดบปานกลางกบระดบรนแรงโดย คา Rna กลมทมการบวมปานกลางเทากบ 0.70 ± 0.36 Pa/ml/sec ก ล ม ท ม ก า ร บ ว ม ม า ก 1.16±0.18Pa/ml/sec (P=0.02) แ ล ะ ค า V na ก ล ม ท บ ว ม ป า น ก ล า ง เ ท า ก บ 249.42±94.79ml/sec ก ล ม ท บ ว ม ม า ก 177.64±95.05ml/sec(P=0.04)
A COMPARATIVE STUDY OF NASAL AIRFLOW AND NASAL AIRWAY RESISTANCE IN ALLERGIC
RHINITIS PATIENTSWITH AND WITHOUT NASAL CONGESTION
Charinthip Paengkhruang History:The prevalence of allergic rhinitis is increasing worldwide. To diagnose and evaluate allergic rhinitis patients bases on history and physical examination. Diagnostic tests that help to confirm the diagnosis, such as specific IgE, fiberoptic rhinoscopy, skin prick test, nasal cytology, are complicated and take high cost.
Rhinomanometry is the test to evaluate nasal obstruction by using nasal airflow and nasal
resistance. It has high sensitivity, specificity and is easy to use.Objective: To compare the nasal airflow (V na) and nasal airway resistance (R na) in allergic rhinitis patients, aged 5-16 years with nasal turbinate hypertrophy, between patients with and without nasal congestion Place of study: The Allergy clinic, Queen Sirikit National Institute of Child Health Method: A prospective clinical study in allergic rhinitis children, aged 5-16 yrs. with hypertrophy of nasal turbinate, with or without symptom of nasal congestion is conducted. Rhinomanometry is done with informed consent from parents and guardians.Result: There are 100 allergic rhinitis patients, 67 boys and 33 girls, mean aged 9.3 ± 2.63 years. Mean weight and height are 34.08 ± 12.84kgs. and 133.98±14.58cms. respectively. They are divided into 2 groups, group I without nasal congestion (n=51), and group II with nasal congestion (n=49). Rna in group I is higher significantly than group 2 (P=0.03) (0.90±0.59 V.S. 0.68±0.35Pa/ml/sec), while V na in group I is significantly lower than group II (P=0.04) (222.79±121.65 V.S. 293.90±195.58ml/sec).
Compared with nasal turbinate hypertrophy, there is no significant difference in R na and V na in group I. In group II, R na is significantly increased in patients with severe nasal turbinate hypertrophy compared with moderate degree (P=0.02)(0.70±0.36 V.S. 1.16±0.18 Pa/ml/sec). V na is significantly decreased in patients with severe nasal turbinate hypertrophy compared with moderate degree(P=0.04)(177.64±95.05 V.S. 249.42±94.79 ml/sec).
ผลการวจย : เดกทเขารวมโครงการ จำานวน 222 คน เพศชาย 103 คน(46.4%), เพศหญง 119 คน (53.6%) คาปรมาณลมทไหลผานชองจมก ( V na) เทากบ 336+176 ml/sec คาความตานทานอากาศภายในจมก (R na) เทากบ 0.61+ 0.42 Pa cm-3 S-1 พบวาคา V na เพมขนเมอความสงเพมขน ( P = 0.10) คา R na ลดลงเมอความสงเพมขน( P = 0.004) และคา V na และ R na ของจมกขางขวา-ซาย ไมมความแตกตางกน (P=0.4, 0.3) เมอแบงตามกลมอายพบวาคา V na ในกลมเดกอาย 4-9 ปและ 10-15 ป เทากบ 284+191 ml. S-1 และ 353+ 168 ml. S-1 ตามลำาดบ คา R na ในกลมเดกอาย 4-9 ป และ 10-15 ป เทากบ 0.83+ 0.6 Pa cm-3 S-1 และ 0.54+ 0.32 Pa cm-3 S-1 ตามลำาดบ
สรป : คา V na จะเพมขนตามความสงและอาย และคา R na จะลดลงเมอความสงและอายเพมขนคา V na และ R na ในเดกปกตมประโยชนสำาหรบใชเปนเกณฑมาตรฐานในการตรวจผปวยทมการอดตนของจมก เพอชวยใหพบความผดปกตไดเรวขน หรอเฝาระวงในรายทมแนวโนมผดปกต และสามารถใชเปนคาอางองสำาหรบใชในการวจยในอนาคต เพอประโยชนสงสดของผปวย
A STUDY OF NASAL AIRFLOW AND NASAL AIRWAY RESISTANCE IN NORMAL THAI
Background: Nasal obstruction is a common problem found in children but this symptom is subjective. Nasal airflow and nasal resistance measured by rhinomanometry may be used as the objective parameters in children with this symptom. Objective: This study aimed to find normal nasal airflow and nasal resistance in Thai children, aged 4-15 years, who have no any nose symptoms as a baseline values.Method: This cross-sectional study is conducted in a primary and a secondary schools in Bangkok, Samsen Wittayalai school and Phayathai school. They were enrolled with informed consent from parents /guardians and divided into 2 groups, group 1 aged 4-9 years and group 2, aged 10-15 years. Data gathering included weight and height. Rhinoscopy and rhinomanometry were performed in all children.Results: There are 222 children, 103 boys (46.4%) and 119 girls (53.6%). The normal nasal airflow (V
na) and nasal resistance (R na) in Thai children are 336+176 ml/sec. and 0.61+ 0.42 Pa cm-3 S-1
respectively. The normal nasal airflow (V na) and nasal resistance (R na) in Thai children, aged 4-9 years, are 284+191 ml. S-1 and 0.83+ 0.6 Pa cm-3 S-1 . The normal nasal airflow (V na) and nasal resistance (R na) in Thai children, aged 10-15 years, are 353+ 168 ml. S-1 and 0.54+ 0.32 Pa cm-3 S.-1 V na has direct proportion to height but has no statistical significant difference ( P=0.10), while R na has inverse proportion to height with statistical significant difference ( P=0.004). There was no difference between left and right nostrils’ V na and R na (P=0.4, 0.3). Conclusions: Nasal airflow is increased proportionally to age and height, while nasal airway resistance is inversely decreased with age and height. Both may benefit in early detection of any diseases that results in nasal obstruction, but normal cut-off point for age should be proposed before application of these parameters.
Illness perception and future plan in Human Immunodeficiency Virus-infected
children and caretaker at Queen Sirikit National Institute of Child Health
Panitsa YuktananNowadays, HIV/AIDS is the important infectious
disease in Thailand. There are no curative treatments for this disease. Current available treatment options are antiretroviral drugs to prolong life and reduce morbidity. Given that there is no curative treatment and the increased survival of these children, quality of life becomes the important issue that need to be taken into consideration when caring for these infected children.
The purpose of this qualitative study was to explore the perception of HIV-infected children and their caregivers in terms of their understanding about the illness, current major concerns, and planning for the future of these children.
Twenty eight children aged 8 – 18 year old and 28 primary caregivers were enrolled in this study during May 2006 – October 2008 at Queen Sirikit institute of child health. Each respondent was participated in the individual in-depth interview separately using semi-structure interview guide with open–ended questions. Data were tape-recorded,
transcribed, and analyzed with qualitative software ATLAS.ti version 5th.
In terms of illness perception, most of the primary caregivers and the children who are aware of their HIV status, acknowledged this as a chronic and incurable illness. The children who were not aware of their diagnosis expressed that they had some kinds of chronic illness requiring long-term treatment. Most of the primary caregivers were concerned about the potential worsening of the illness and the psychosocial implications of the illness on their child’s future. There were very few caregivers who had made any concrete plans for their child’s future care or provisional arrangement in case of unexpected illness of primary caregivers. These factors may hinder future access to both treatment and social support. Therefore, it requires the involvement of social workers and appropriate referral to related organization.
THE STUDY OF CHEST RADIOGRAPHY OF COMMUNITY-ACQUIRED PNEUMONIA IN INPATIENT OF QUEEN SIRIKIT NATIONAL
INSTITUTE OF CHILD HEALTH IN 2005Jaruchat Viboonkulphunt
Background : Community acquired pneumonia is one of the main health care problem in Thailand. Laboratory investigations are difficult and invasive for children . Thus, many studies use clinical manifestration, basic laboratory and chest radiography to predict the cause of community acquired pneumonia. Objective : To use chest radiography in community acquired pneumonia and BPS (bacterial pneumonia score) predict the cause of disease (bacteria or virus)Study design : Retrospective descriptive studyMethod : The data of children who were diagnosed as community acquired pneumonia and admitted in Queen Sirikit National Institute of Child Health between January 1st ,2005 to December 31th,2005 and matched with inclusion. History of illness, clinical manifestration, physical examination, result of laboratory investigation, result of chest radiography(review by two radiologists), treatment and outcome were recorded. The data were calculated for BPS(bacterial pneumonia score). BPS
> 4 was predicted as bacterial pneumonia and BPS<4 was predicted as viral pneumonia.Result : Of the Total 517community-acquired pneumonia inpatient, 375 cases were enrolled as inclusion criteria. The result of chest radiography show normal 27 cases (7.2%), mixed pattern 181 cases (48.3 %), only infiltration 160 cases (42.7%), only hyperaeration 5 cases (1.3%) and only atelectasis 2 cases (0.5%). The 341 cases with infiltration, the pattern was divided in to well-defined, lobular, segmental, subsemental (round) pattern 5 cases (1.5%); poorly defined, patchy pattern 16 cases (4.7%); interstitial, peribronchial pattern 302 (cases 88.5%); mixed pattern (poorly defined, patchy + interstitial, peribronchial) 18 cases (5.3%). The BPS (bacterial pneumonia score) show that BPS >4 in 59 cases(17%), in which was received antibiotic drug in 57 cases, BPS < 4 in 289 cases (83%), in which was not received antibiotic drug in 50 cases Conclusion : Most common cause of community acquired pneumonia in children is viral that show in chest radiography and BPS. The overuse of antibiotic is still found in community acquired pneumonia.ศกษาความชก, อาการ, อาการแสดง, ผลการตรวจทางหองปฏบตการและ
THE STUDY OF PREVALENCE, CLINICAL MANIFESTATION, LAB INVESTIGATION AND MANAGEMENT OF COMMUNITY-ACQUIRED
PNEUMONIA IN INPATIENT OF QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEAITH IN
2005Pawinee Therakaroowongse
Background : In the developing countries, acute respiratory tract infections especially community-acquired pneumonia is one of the major cause of death in children younger than 5 years of age and identifying the etiology is difficult. WHO recommends making diagnosis based on clinical parameters. The study of history of illness, clinical manifestation, laboratory investigation and chest radiography is important in healthcare worker for early diagnosis and appropriate managementObjectives : To study the history of illness, clinical manifestation, laboratory investigation, chest radiography, treatment and outcome in inpatient with community-acquired pneumonia
Study design : Retrospective descriptive studyMethods : The data of children who were diagnosed as community-acquired pneumonia and admitted in Queen Sirikit National Institute of Child Health between January 1st ,2005 to December 31th,2005 and matched in inclusion criteria. History of illness, clinical manifestation, vital sign, physical examination, laboratory investigation, chest radiography, treatment and outcome were recorded.Results : The data of three hundred-seventy-four community-acquired pneumonia inpatients were reviewed. The male were 229(61%) and female were 145(39%), male : female ratio was 1.6 : 1. The mean age of population was 16.99 ±12.86 months. The prevalence of community-acquired pneumonia inpatient to total pneumonia inpatient ratio was presented in 18.2%. Most inpatient were admitted in October and July. The mean length of stay in hospital was 4.54 ±3.27 days.. The history of illness, fever was presented in 90.17%, the mean day of fever was 4.05±3.68 days, cough was presented in 97.06%, the mean day of cough was 5.45±10.41 days, tachypnea was presented in 71.93%, the mean day of tachypnea was 1.77±2.19 days. Abnormal auscultation was presented in 86.17%, crepitation was presented in 59.27%, rhonchi was presented in 51.73%, wheezing was presented in 13.07%, bronchial breath sound was presented in 0.53% and decrease breath sound was presented in 0.27%
Laboratory investigation, blood culture was done in 74.9% and result was positive for 1.8%, The result of chest radiography , infiltration was presented in 90.4%, hyperaeration was presented in 32%, atelectasis was presented in 28.8%, fluid in pleural
space was presented in 1.3%, pneumatocele or abscess or bullae was presented in 0.5%.
Supportive treatment, physiotherapy was done in 84.5%, bronchodilator was used in 82.4% oxygen therapy was given in 63.1%, and ventilatory support was done in 1.6%.
The specific treatment was antibiotic used, total used was 85.3%, penicillin group was used for 62%, cephalosporin group was used for 22.4% , macrolide group was used for 13.4% and combination antibiotic was 2%. The status of discharge, cure was 97.33%, chronic lung disease was 0.27% and no death Conclusion: Fever, cough and tachypnea were the main presentation of pneumonia. The abnormal auscultation of lung are crepitation, rhonchi and wheezing. Blood culture didn’t gain benefit because of the positive result was usually negative. Most inpatients were prescribed antibiotic. The outcome was good because of no inpatient was death.
OUTCOMES OF DIFFERENT INTERVENTIONS ON BREAST MILK JAUNDICE IN TERM
NEONATESPorncharut Arpornviriyawong
Background : Neonatal jaundice occurs in 60% of term newborn infants. Most of the cases are physiological but some cases can be pathological, caused by many conditions. Breast milk jaundice (BMJ) and breast feeding jaundice (BMJ) are 2 forms of jaundice associated with breast milk. Since there are many treatment regimens for BMJ, this study has been undertaken to compare 2 different regimens. Objective : To compare the treatment outcomes in term newborn infants with BMJ in whom breast milk
was discontinued for 24 hours versus continuation of breast milk during phototherapy.Methodology : A prospective randomized control trial study was conducted in the neonatal unit at Queen Sirikit National Institute of Child Health Between June 1st, 2006 to May 31st, 2007. Thirty five newborns infants diagnosed with breast milk jaundice were recruited for study. The infants were randomized to two treatment group, control group was assigned to discontinue breast milk for 24 hours substituted with formula and the study group, was assigned to continue breast milk. All infants were simultaneously treated with phototherapy. Data collection included demographic data, biochemical profiles, and duration of phototherapy, bilirubin level, and rate of drop of bilirubin and length of hospital stay. Data was analyzed by applying descriptive statistic such as mean, median, and comparative statistic (Mann-Whitney U test). Primary outcome was to compare the rate of drop of bilirubin between the groups. Secondary outcome was to see complications.Result : BMJ occurred in 7% of all infants admitted in the neonatal unit for jaundice during the study period. Thirty-five term newborns were initially recruited in the study, but 3 dropped out due to pneumonia, gut obstruction and hypothyroidism. All 32 newborns completed trial and were randomly assigned into the control (n=22) and study groups (n=10). There were a total of 21 males and 11 females. Demographic data was not significantly in both groups. Serum bilirubin level at admission in control group and study group were 20.4 mg/dl (19.2-21.3 mg/dl) and 19.4 mg/dl (18.4-22.4 mg/dl)
(p=0.95) respectively. After 4-6 hours of phototherapy initiated, newborn in the control group had median serum bilirubin 17.7 mg/dl (17.13-19.74 mg/dl) versus 17 mg/dl (16.32-20.89 mg/dl) in study group (p=0.67). After phototherapy was discontinued for 4-6 hours, bilirubin of the newborns in control group and study group were 11.1 mg/dl (7.9-11.37 mg/dl) and 10.65 mg/dl (9.9-13 mg/dl) (p=0.26). Primary outcome; Rate of bilirubin decrement in control group was 0.32 mg/dl/h (0.26-0.51 mg/dl/h) and in study group was 0.34 mg/dl/h (0.27-0.46 mg/dl/h) (p=0.85). Duration of phototherapy was 26 hours (18-42 hours) and 22.2 hours (18.1-35.5 hours) in control group and study group (p=0.79) respectively. Lengths of hospital stay in both groups were 3 days. There was no statistically significant difference in all the parameters including biochemical profiles between the two groups (p=0.85). Secondary outcome; none of the neonates in this study had rebound jaundice which required phototherapy again. Exchange transfusion for severe hyperbilirubinemia was not required in this study. All infants remained clinically well and no neurological complications were found in the study period.Conclusion : BMJ is not infrequently found in the neonates. This study did not find any statistically significant differences in treatment outcomes between the group where BM was discontinued VS continuation of BM during phototherapy, however due to the small number of neonates recruited, further studies will be needed to confirm these result.
THYROTROPIN SCREENING FOR CONGENITAL HYPOTHYROIDISM IN QUEEN SIRIKIT
NATIONAL INSTITUTE OF CHILD HEALTH Supawan Kengkhetkit
Background : Thailand National neonatal screening program started in 1996. This program launched in Queen Sirikit National Institute of Child Health since 1995. But the coverage of screening and rate of confirmatory test was low which need to improve. Objectives : To find the incidence of congenital hypothyroidism of Queen Sirikit National Institute of Child Health and review the program management to improve the screening program.Methodology : Data were abstracted from the records of neonates born at Rajvithi hospital between October 2004 and September 2006. Descriptive statistics were used to analyze the screening program and the incidence of congenital hypothyroidism was calculated.Results : There were 9,004, 8,237 and 4,910 neonates born at Rajvithi hospital each year during the study period. Eight thousand eight hundred and fifteen, 8,113 and 4,835 neonates were screened for congenital hypothyroidism. The coverage of thyroid screening was 97.9, 98.5 and 98.47 percentage respectively. The overall recall rate was 1.17 percent. The confirmatory test rate was 98.44 percent. Two hundred fifty two neonates were repeated blood test for T4, TSH to confirm the diagnosis. Abnormal test were found in 70 neonates. The incidence of congenital hypothyroidism was 1:311. Abnormal thyroid scan were found in 22 of 39 neonates (56.4%). The most common etiology was low uptake of thyroid gland (90.9%), ectopic thyroid and no thyroid was found only 1 case each. The median age of initiating treatment was 25 days old. Forty nine neonates (70%) with congenital hypothyroidism were started
with higher dosage of levothyroxine (>10 µg/kg/day) with the average dosage of 11.1 + 3.2 µg/kg/day.Conclusions : There were improvement of the coverage, confirmatory test rate and the initial treatment age of congenital hypothyroidism in this 3-year study period of Queen Sirikit National Institute of Child Health screening program. The incidence of congenital hypothyroidism was 1:311 live births.
Chawkaew Kongkanka Preamble: Obesity is becoming an important public health problem in Thailand. Therefore, many health risk factors and sickness are influenced by obese. Currently, increasing of children obesity is reported. Childhood obesity is trended to be obese in adulthood. However, obesity prevention is an important key performing to childhood and obese
treatment should be started in children. So, childhood obese treating is better than adulthood curing. Objective: To study lower-secondary students’ nutritional status group, weight alteration and comparison between nutritional status group, and trend of weight change and risk of obesity group. Method: The retrospective study, Mathayomsuksa 1–3 students growth data in individual record in a prolonged academic year of 2545 – 2547, was investigated. Student body mass index (BMI) were computed from students’ weight and height. Nutritional status assessment and weight changes comparison were made.Result: There were 409 Mathayomsuksa students, 232 male (56.7%) and 177 female (43.3 %) students. In a period of two year, average in weight and height of male student were increased to 10.3 5.3 kg. and 12.3 5.2 cm. respectively, and female student were increased to 5.3 4.3 kg. and 4.5 3.6 cm. Respectively. In the three year of study, most of students were a normal nutritional status, obese and overweight students group were 7.2 and 5.7 percent. In Mathayomsuksa 1, 2 and 3, it found that; overweight male student were 13.4, 13.4 and 15.5 percent, obese male student were 13.8, 9.9 and 9.5 percent, overweight female student were 9.6, 13.6 and 9.0 percent, obese female student were 8.5, 4.0 and 6.8 percent, respectively. In summarize, it found that male student were be more overweight and obese than female student. The new risk of obesity group, the raise of obese student male and female student were 5.5 and 5.1 percent, and there were statistical significantly weight increase more
9.1 kg. per year in male and 9.0 kg. per two year in female. Conclusion: The prevalence of obesity decreased in Mathayomsuksa 1-3 student. Statistical significant shown that obesity risk student group were more trend to be weight increased than other group.
Outcomes of Salvage Antiretroviral Therapyin Human Immunodeficiency Virus-infected
Children at Queen Sirikit National Institute of Child
HealthNapassawan Watcharajumroon
Introduction: Highly active antiretroviral therapy has proved to decrease morbidity and mortality in HIV-infected patients. However treatment failure may occur and some patients need to switch to salvage antiretroviral (ARV) regimen.
Objective: To study treatment outcome of various salvage regimens in ARV-experienced HIV-infected childrenMethods: A retrospective study was done in HIV-infected children at Queen Sirikit National Institute of Child Health from 1 October 2005 to 30 September 2007. We collected data of the patients who had treatment failure and were on salvage ARV regimens for at least 6 months.Results: There were 43 patients (19 male, 24 female) enrolled in this study. Most patients were more than 5 years of age (97.68%). Patients receiving various salvage ARV regimens were classified into 3 groups i.e. REGIMEN 1) One boosted protease inhibitor (PI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI) plus nucleoside reverse transcriptase inhibitor (NRTI) 9 patients, REGEMEN 2) One boosted PI plus NRTI 5 patients and REGIMEN 3) Two boosted PI and/or NRTI 29 patients. Clinical symptoms of the patients at baseline were mostly in CDC clinical category B for every group. Average baseline CD4 of patients in regimen 1 was 21.78% (662.56 cell/mm3), in regimen 2 was 13.6% (270.4 cell/mm3 and in regimen 3 was 11.28% (260.48 cell/mm3). Patients receiving regimen 1 had the lowest baseline viral load, average of 151,830.78 (4,105-492,857 copies/ml) or log 4.57 (3.61-5.69) and higher in the patients receiving regimen 3 and 2, that were 304,608 (3,204- >4,000,000 copies/ml) and 1,736,797 (116,000- >4,000,000 copies/ml) respectively.
After switching to salvage regimens, patients in all group had increase in CD4 percentage and count.
Improvement of immunological category occurred in 22.22% of patients receiving regimen 1, 40% of patients receiving regimen 2 and 55.17% of patients receiving regimen 3. Undetectable viral load (<400 copies/ml) of patient in regimen 1 was 100%, regimen 2 was 60% and regimen 3 was 82.76%. Among 7 patients with detectable viral load, 6 patients had markedly decrement in viral load to acceptable level. And 1 patient, who still had high viral load, took only 60% of pills prescribed.Conclusion: Salvage ARV regimens choices, compose of boosted PI with other groups of antiretroviral drug resulted in short-term good treatment outcome in HIV-infected children. Factors that may effect patients’ treatment outcome could be baseline viral load, resistance testing consideration and drug adherence.
การตดเชอ Streptococcus group B ในทารกแรกเกดอรารมย พนธมะผล
Systemic Streptococcus group B infection in neonates
Urarom Pantumapol
Objective : To study incidence, clinical manifestation, laboratory findings , bacterial sensitivity , outcome and complication in the neonates having systemic Streptococcus group B infection admitted to Queen Sirikit National
Institute of Child Health Hospital during January 1st,1995 to December 31 st ,2006. Methods : A retrospective study of 25 neonates ( Age ≤ 28 days ) who were diagnosed systemic Streptococcus group B infection ( clinical with hemoculture and/or cerebrospinal fluid culture positive ) at Queen Sirikit National Institute of Child Health during January 1st 1995 to December 31 st ,2006. Results : The incidence of systemic Streptococcus group B infection in neonates was 0.165 percent ( based on 15,101 admission cases of newborns ). Seventeen cases (68%) were male and eight cases (32%) were female and male : female ratio was 2.1:1. Seventy-six percent of cases were early onset infection. The maternal risk factors including premature rupture of membrane more than 18 hours, maternal intrapartum and maternal age less than 20 years old were 9 cases (36% ) , 7 cases( 28% ) and 4 cases (16%) respectively. The most frequent clinical manifestations were tachypnea 23 cases( 92%) , cyanosis and apnea each 16 cases (64%). The most common laboratory finding was metabolic acidosis in 11 cases ( 44%). Penicillin group were used for the treatment in 19 cases (76%). Complications: Including severe hydrocephalus
and ventriculitis were found in 5 cases (20%) and 4 cases of them were dead (16%). Conclusion: The authors found the systemic Streptococcus group B infections in neonates were 2.5 cases per year. The organisms were still
sensitive to penicillin. The mortality rate is 16 percent.
HYPOPLASTIC LEFT HEART SYNDROME AT QUEEN SIRIKIT NATIONAL INSTITUTE OF
CHILD HEALTHFROM 2000 TO 2006
Unyarat Tanrattananon
Background The prevalence of hypoplastic left heart syndrome(HLHS) varies between 0.21-0.28 per 1000 live births. There is no previous data of HLHS in Thailand. Objective To study the natural history of patients with HLHSduring the year 2000 and 2006 at Queen Sirikit National Institute of Child Health (QSNICH).Patients and methods All patients who had been diagnosed as HLHS from January 1st, 2000 to December 31st, 2006 were retrospectively studied by chart review.
Result The total number of patients was 39. Twenty one of the patients were male. One had been diagnosed prenatally at the gestational age of 30 weeks. Thirty five cases were full term infants and 4 cases were preterm infants. The birth weight was ranging from 1,750 to 4,470 grams with the median of 2,900 grams. Age at presentation ranged from newly born to 4 months.Most of the causes developed symptom within the first 24 hours of life. The common presentations including cyanosis (15 cases = 38.5%), congestive heart failure (14 cases = 36.0%), asymptomatic heart murmur (8 cases = 20.5%) and cardiogenic shock (2 cases = 5.1%). The abnormal physical findings were cyanosis ( 23 cases = 59.0%), heart murmur (29 cases = 74.4%), and hepatomegaly (22 cases = 56.4%). Chest X –ray findings were as follow: cardiomegaly in 17 cases(68%), increased pulmonary vasculature in 16 cases(64%), normal pulmonary vasculature in 5 cases(20%) and decreased pulmonary vasculature in 4 cases (16%). Extracardiac anomalies; such as cleft lip, cleft palate and imperforate anus; were found in 7 cases (18%). Conclusions The epidemiologic data of hypoplastic left heart syndrome at QSNICH are somewhat different from other studies.
PREVALENCE AND OUTCOMES OF MODIFIED BLALOCK-TAUSSIG SHUNT IN QUEEN SIRIKIT
NATIONAL INSTITUTE OF CHILD HEALTHPunjaporn Kiatkulkumjorn
Background : The modified Blalock-Taussig (MBT) shunt is a palliative shunt operation for patients with cyanotic heart disease and diminution of pulmonary blood flow. There was no previous data regarding the mortality and efficacy of the operation at Queen Sirikit National Institute of Child Health (QSNICH).Objectives : To review prevalence and outcomes of MBT shunt in patients with congenital heart disease at QSNICH from January 2000 to December 2004Methods :A retrospective study was performed by reviewing medical records of patients who underwent a MBT operation at QSNICH from January 2000 to December 2004 Results : Between January 2000 and December 2004, 161 patients (88 males and 73 females) underwent MBT shunts at QSNICH. The age ranged from 1 day to 16 years (median 24 months). Of these, 87 patients were infants and 54 patients were neonates. The diagnosis included Tetralogy of Fallot 65 cases ( 40.38% ), Pulmonary atresia with intact ventricular septum 33 cases (20.50%) , Pulmonary
atresia with ventricular septal defect 33 cases (20.50%), Pulmonary atresia with complex heart disease (include Right isomerism complex ) 15 cases (9.32%), Double outlet right ventricle with Pulmanary valve stenosis 6 cases (3.75%) and 8 cases with other diagnosis (5.55%). The operative mortality was 2.5%. The mortality was not correlated with age, diagnosis or the size of pulmonary artery. At one-year follow up, the overall patency rate was 76.5% Conclusion : The MBT shunt operation at QSNICH was an effective procedure with low mortality and morbidity comparable to that of other studies.
สรปผลการวจย : colistin เปนยาทมประสทธภาพทางหองปฏบตการสงทสดในการตานเชอ Acinetobacter spp. ทดอตอยาทกชนดในกลม third generation cephalosporins ในขณะทการพจารณาเลอกใชยาปฏชวนะตอเชอ Pseudomonas aeruginosa ทดอตอยาทกชนดในกลม third generation cephalosporins ควรใชคาความไวตอยาปฏชวนะทางหองปฏบตการรวมพจารณา โดยเฉพาะสำาหรบยา colistin ควรพจารณาจากคา MIC ดวยวธ E-test ซงเปนวธทมความนาเชอถอมากกวา
In vitro activity of imipenem, netilmicin, fosfomycin, meropenem,
piperacillin/tazobactam and colistin against clinical isolation of multidrug/pandrug-
resistant Acinetobacter spp. and Pseudomonas aeruginosa.
Siriporn Wongwatcharapaiboon
Background: Antibiotic resistance is an important problem in clinical practice. Acinetobacter spp. and Pseudomonas aeruginosa are part of the most important opportunistic pathogens in nosocomial infections, which are mainly concerned with high resistance especially resistant to all antibiotics
including carbapenems. This study was designed to examine in vitro activity of imipenem, netilmycin, fosfomycin, meropenem, piperacillin/tazobactam and colistin against clinical isolation of Acinetobacter spp. and Pseudomonas aeruginosa which resisted to third generation cephalosporins.Objectives: To evaluate in vitro activity of imipenem, netilmicin, fosfomycin, meropenem, piperacillin/tazobactam and colistin against clinical isolation of multidrug resistant Acinetobacter spp. and Pseudomonas aeruginosa. Antibiotic susceptibility profiles were derived from disk diffusion test and minimum inhibitory concentrations to piperacillin/tazobactam and colistin were obtained by E-test. Methods: This descriptive study was conducted in clinical isolation specimen at Queen Sirikit National Institute of Child Health (QSNICH) from October 2006 to August 2007. Bacterial identification were performed and third generation cephalosporins (cefoperazone/salbactam combination was not included) resistant Acinetobacter spp. and Pseudomonas aeruginosa were collected. Antimicrobial susceptibility test against imipenem, meropenem, fosfomycin, netilmicin, piperacillin/tazobactam and colistin were performed by disk diffusion method. Minimal inhibitory concentrations (MIC) of piperacillin/tazobactam and colistin were performed by E-test. Percentage of susceptibility, MIC50 and MIC90 were evaluated.Results: Twenty-four strains of clinical isolated Acinetobacter spp. which resisted to third generation cephalosporins were collected. For disk diffusion method, the percent susceptibility against imipenem
and meropenem were 9.09. In vitro activity of fosfomycin, netilmicin and piperacillin/tazobactam were 8.33, 12.50 and 16.67 percent susceptibility, respectively. Colistin demonstrated good activity with 100 percent susceptibility. The MIC50 and MIC90 for piperacillin/tazobactam were 256 mg/L with 17.65 percent susceptibility. The MIC50 and MIC90 for colistin were 0.5 and 1.4 mg/L, respectively with 95.24 percent susceptibility.
Six strains of clinical isolated Pseudomonas aeruginosa which resisted to third generation cephalosporins were collected. For disk diffusion method, all specimens resisted to meropenem. In vitro activity of fosfomycin, netilmicin, imipenem and piperacillin/tazobactam were 33.33, 33.33, 60.0 and 66.67 percent susceptibility, respectively. Colistin demonstrated good activity with 100 percent susceptibility. The MIC50 and MIC90 for piperacillin/tazobactam were 48 and 256 mg/L, respectively with 66.67 percent susceptibility. The MIC50 and MIC90 for colistin were 5 and 8 mg/L, respectively with 33.33 percent susceptibility.Conclusion: The results of our study showed the most potent in vitro activity of antibiotic against third generation cephalosporins resistant Acinetobacter spp. was colistin. However for third generation cephalosporins resistant Pseudomonas aeruginosa remained problematic, we recommended performing in vitro activity susceptibility test to determine appropriate antibiotic uses. E-test methods have been shown to be more accurate for testing colistin susceptibility.