Comparing Treatment Between Identification and Non-Identification of Micro-Organisms in Pyogenic Spondylodiscitis

Objective: The aim of this study was to determine an effective treatment by antibiotic for positive culture (culture+ve) pyogenic spondylodiscitis compared to a negative culture (culture-ve) by assessment of laboratory outcomes, Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP). The secondary objective is to determine incidence of pathogen micro-organisms of pyogenic spondylodiscitis.Material and Method: The study design was a single-center retrospective study performed by the ICD10 computer database of the Department of Orthopedic Surgery in the Prince of Songkla University for patient diagnosed pyogenic spondylodiscitis. After exclusion was done, patients were divided into 2 groups of study. The first group was tissue ulture+ve while the second group was tissue culture-ve. Patient culture+ve were analyzed for bacterial pathogen along with antibiotic sensitivity. In culture-ve patients were analyzed for the types of antibiotic and its usage. Both of two groups was compared with the effectiveness of treatment with ESR and CRP beforehand, and after four-weeks of treatment.Results: Compared with 56 culture+ve patients, the 69 culture-ve patients were no significant difference in median difference of ESR and CRP at the time before treatment and at four-weeks, after treatment.Conclusion: Antibiotic treatment of non-identified micro-organism pyogenic spondylodiscitis can be done by using the most common incidence of micro-organism. The effectiveness of antibiotic treatment was determine by ESR and CRP beforehand, and after four-weeks of antibiotic treatment.

Lower Gastrointestinal Bleeding in Klippel-Trenaunay Syndrome: A Case Report

Klippel-Trenaunay syndrome (KTS) is a rare, vascular malformation. The major clinical presentation is an overgrowth involving the extremities. The diagnosis of KTS was based on an imaging study, which revealed vascular malformations. The author’s report is of a 36-year Thai man with; hypertrophy of the right lower extremity, whilst having suffered from two-months of bloody defecation. The magnetic resonance imaging showed venous malformations with soft tissue hypertrophy of the affected limb, genitalia and rectum. The patient was diagnosed with: KTS accompanied by gastrointestinal complications.

Schizophrenias’ Quality of Life and Emotional Intelligence in Songklanagarind Hospital

Objective: To estimate the level of quality of life (QoL), emotional intelligence (EI) and the association between QoL and EI in schizophreniaMaterial and Method: A cross-sectional study was conducted at the outpatient department of Songklanagarind Hospital from; May to November, 2016. A total of 96 participants were interviewed. Demographic data and medical history were collected. QoL and EI were assessed using the WHO QOL BREF (Best available techniques REFerence document) Thai version and the Thai EI Screening Test for ages of 18-60. The results were analyzed by descriptive statistics and multiple logistic regression.Results: Our subjects were predominantly single males. Sixty-seven point seven percent of the participants were poor to moderate QoL while only two factors significantly related to their poor to moderate QoL; difficulties from psychiatric conditions and a lower level of life satisfaction. Fifty-seven point four to eighty-seven point two percent of the participants were generally within normal EI in every subscale. Moreover, there was statistical significance for positive relationships between EI with QoL in schizophrenia.Conclusion: The high prevalence of schizophrenia was a moderate QoL. A positive relationship of individual subscales of EI towards QoL was substantially found.

Prevalence of Aspirin Prescriptions among Type 2 Diabetic Patients in Songklanagarind Hospital

Objective: The American Diabetes Association (ADA) and the American Heart Association (AHA) recommend aspirin use for primary and secondary prevention of cardiovascular disease in patients with diabetes. There are, however, some doubts regarding the prescription of aspirin therapy to prevent cardiovascular events in diabetic patients, aspects of its safety, and contraindications of the drug administration. This study was conducted in order to evaluate the amount of prescribed aspirin for diabetic patients who received the treatment at Songklanagarind Hospital.Material and Method: A cross-sectional study was conducted to review the medical records of diabetic patients who received the treatment at outpatient departments from 1st-31st December 2013.Results: A total of 1,342 diabetic patients are included in this study: 80.3% from the primary prevention group and 19.7% from the secondary prevention group. Mean age was 64.3 years old. Of the patients, 44.7% were male. The study revealed that prescribed aspirin accounted for one-third of total prescriptions (31.7%). The primary prevention group was 19.0% (95% confidence interval (CI)=12.0-21.3) and the secondary prevention group was 83.7% (95% CI=78.6-87.9). The departments that frequently prescribed aspirin for the primary prevention group was endocrinology (21.2%) and for the secondary prevention group it was the Primary Care Unit (87.5%). Aspirin side effects were gastrointestinal 1.0% and tinnitus 0.1%. Aspirin contraindications were active peptic ulcer (0.1%), history of gastrointestinal bleeding (0.4%), bleeding disorders (0.2%), history of recent intracranial bleeding (0.2%) and severe liver disease (0.9%). There was a positive correlation between age, hemoglobin A1c (HbA1c) and the dose of prescribed aspirin (p-value<0.001, 0.003 respectively). These patients were more likely to have the dose of aspirin increased as age and HbA1c increased.Conclusion: Despite aspirin being a safe, inexpensive and readily available therapy that is effective in preventing cardiovascular disease in diabetic patients and likely to provide benefits rather than side effects and contraindications. The author found significant underuse of aspirin therapy, especially in the primary prevention of cardiovascular disease in diabetic patients.

Evaluation of a Novel Fluid Monitoring Device for Hysteroscopic Surgery

Objective: To evaluate the performance of a simplified fluid monitoring device for monitoring fluid deficit and uterine perforation during hysteroscopic surgery.Material and Method: A novel fluid deficit monitoring device was developed using a weighing system operated by a microcontroller. The deficit volume in milliliters (mL) is continuously monitored with an updated display every 30 seconds. The deficit LED is preset to begin flashing with an alarm sound if a fluid deficit reaches 750 mL, 1,000 mL, and 2,500 mL. A new algorithm for detection of small uterine perforations was also developed. The device can be loaded with a maximum of four bottles of 1 liter distention media and has two 2 liters collecting canisters. After having passed laboratory testing, the prototype was clinically used in hysteroscopic surgeries.Results: The laboratory testing showed a precision of ±7 mL at 500 mL, with an accuracy of ±8.9% for deficit volume measurement with 100% alarm at the preset levels. The perforation alarm could detect a small uterine perforation with 80.0% accuracy in an average (±standard deviation; S.D.) latency time of 3.2±0.2 minutes with an average (±S.D.) fluid leakage of 472±35 mL. The device performed well in a preliminary series of 42 hysteroscopic surgery cases from October 2014 to February 2016. Deficit-volume detection by the device correlated well with clinical evaluations by operating room personnel (r=0.840, p-value<0.001).Conclusion: The newly developed fluid monitoring device can provide acceptable precision and accuracy for monitoring fluid deficits and detection of small uterine perforations during hysteroscopic surgery.

Prevalence of Uncontrolled Blood Pressure in Hypertensive Patients Attending The Primary Care Unit of Songklanagarind Hospital

Objective: To evaluate the prevalence of uncontrolled hypertension based on the Thai Guideline on the Treatment of Hypertension 2012, the 7th report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) and its recently released version, 8th Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC8).Material and Method: We screened 1,311 hypertensive patients who visited the Primary Care Unit at Songklanagarind Hospital from October to December 2013. The outcome of this cross-sectional study was the prevalence of uncontrolled hypertension based on the Thai Guideline on the Treatment of Hypertension 2012, JNC7 and JNC8.Results: The study included a total of 1,181 patients. The prevalences of uncontrolled hypertension were 57.2%, 53.4% and 30.0%, based on the Thai guidelines, JNC7 and JNC8, respectively.Conclusion: The prevalence of uncontrolled hypertension in our setting remained unsatisfactory.

Radical Prostatectomy in High-Risk Prostate Cancer Patients: Results of a Single- Institution Study

Objective: To evaluate long-term outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for high-risk prostate cancer (PC).Material and Method: A retrospective review of high-risk PC patients who received RP, identified from medical records. We collected data from Songklanagarind Hospital, Prince of Songkla University from 2007 to 2015. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).Results: In 79 patients, the median follow-up was 27.2 months. The 3-year and 5-year biochemical free survival in men with high-risk PC were 67.7% and 62.9% respectively. Multivariate analysis shows that pathologic stage 3a (hazard ratio=4.87; 95% confidence interval=1.01-23.38) was independently associated with cancer control.Conclusion: Data support the belief that RP has a place in the treatment of high-risk PC. RP was a long-term cancer control in patients with high-risk PC. Only pathologic staging was independently associated with cancer control outcome.

Outpatient’s Preference and Attitudes Towards the Thai Physician’s Attire: A Cross-Sectional Study

Objective: To determine Thai, outpatients’ preference and attitudes towards various styles of a physicians’ attire, whilst they were on duty at Songklanagarind Hospital, within Songkhla province, Thailand.Material and Method: A cross-sectional study was conducted at Songklanagarind Hospital, Songkhla, Thailand; during the periods of January to March, 2015. Outpatients, who visited and were waiting to see their doctor, were approached by simply, convenience randomization. Demographic characteristics of participants along with their preference on attire were collected by using a self-rating questionnaire enclosed with 3 various styles of attire pictures.Results: Most patients preferred both male and female physicians, who wore white coats (70.0%), while they were on duty, either during weekdays or over the weekend. Similarly, the patients stated that they trusted physicians, who wore white coats (92.2%), more than those in a style of formal attire, (7.5%) or casual clothing (0.3%) during the weekday due to; a sense of professionalism and knowledge. Although, most patients also preferred physicians wearing white coats over the weekend and holiday periods (50.4%) they could accept a form of smart, casual dress, (45.0%) more so than a style of formal attire (4.7%).Conclusion: Most patients preferred and tended to trust physicians, who wore white coats during both official and non-official times.

Improvement of Cardio-Ankle Vascular Index by Arm-Swing Exercise in Older Adults

Objective: The purpose of this study was to determine the effect of the arm-swing exercise on cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), heart rate and blood pressure (BP) in older adults with abnormal CAVI values.Material and Method: Seventeen participants aged 50 or over were asked to do the arm-swing exercise at least 30 minutes a day, at least 3 times per week for 8 weeks. The vascular function parameters, CAVI and ABI, resting heart rate and blood pressure were measured before and after exercising. The comparison of these parameters was performed using statistical analysis.Results: It was shown that the arm-swing exercise could lower both left and right CAVI significantly (left CAVI, pre: 10.0±0.2 vs. post: 9.7±0.2, p-value=0.017 and right CAVI, pre: 10.0±0.2 vs. post: 9.7±0.2, p-value=0.034). Furthermore, the arm-swing exercise also reduced arterial blood pressure and pulse pressure significantly (systolic BP, pre: 141.9±4.3 mmHg vs. post: 130.5±4.8 mmHg, p-value=0.004, diastolic BP, pre: 82.1±1.6 mmHg vs. post: 76.5±1.7 mmHg, p-value=0.003, and pulse pressure, pre: 59.7±3.7 vs. post: 54.0±4.0 mmHg, p-value=0.031). However, the study demonstrated that ABI, resting heart rate and body mass index were not affected by the exercise.Conclusion: This study demonstrated that 8 weeks of the arm-swing exercise could lower systolic and diastolic blood pressure. This simple physical activity could also reduce CAVI values in older adults.