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Background and objective : Dental caries was a problem in thalassemia patients that should receive prevention. The objective of this study was to investigate risk factors for dental caries in thalassemia patients at Srinagarind Hospital, Khon Kaen University.Methods : This cross-sectional analytical study was conducted in 104 thalassemia patients and their parents who volunteered to participate in this study between December, 2005 and September, 2006. Data on patients were collected from medical records, questionnaires and oral examination records. Bivariable analysis and multivariate logistic regression was performed to identify the factors associated with dental caries.Results : Results showed that risk factors for dental caries in these samples were income, dental plaque, beverage and crowding tooth. Patients who their parents had low income had dental caries higher than patients who their parents had high income by adjusted odds ratio = 6.4 (95%CI = 1.1-35.0). Patient who had moderate to high dental plaque had dental caries higher than patient with low dental plaque by adjusted odds ratio = 4.9 (95%CI=1.1-23.3). Patients who drank beverage had dental caries higher than patients who did not drink beverage by adjusted odds ratio = 5.9 (95%CI=1.3-25.7). Patients with crowding tooth had dental caries higher than patients without crowding tooth by adjusted odds ratio = 4.9 (95%CI =1.04-23.3).Conclusion: This study showed that risk factors for dental caries in these samples were income, dental plaque, beverage and crowding tooth.Key words : risk factor, dental caries , thalassemia
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OBJECTIVE : 1To study knowledge and attitude towards thalassemia in reproductive women who have the disease or are carriers. 2. To assess factors affecting knowledge. 3. To study knowledge and attitude towards prenatal diagnosis in these women.STUDY DESIGN : A descriptive study.SETTING : University Hospital.SUBJECTS : 150 reproductive women with thalassemic disease or who are carriers. They were either mothers of thalassemic children or were found to have thalassemic disease found to be carrier in the antenatal clinic.MAIN OUTCOME MEASURES : knowledge was evaluated by a pretested questionnaire co7ntaining 16 questions. Women were classified as having adequate knowledge in thalassemia if they answered at least 10 questions correctly. Attitude was assessed also by a pretested questionnaire containing 14 questions. Factors associated with knowledge were assessed by univariate analysis using Chi-square statistics. Multiple logistic regression analysis was used as a control for potential confounding effects.RESULTS : Sixty women (40.0%) were defined as having adequate knowledge. Concerning attitude, the 150 women had a good attitude towards thalassemia. Factors affecting knowledge significantly (p
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Two hundred and thirty-six febrile episodes of one hundred and twenty leukemic patients seen at Department of Pediatrics, Srinagarind Hospital , KhonKaen University during June 1984-May 1989 were studied. The age ranged from 7 months-14 years (mean 6.6 years).Male to female ratio was 1.5 :1 .The majority of them was acute lymphoblastic leukemia (66%). One hundred and twenty-one episodes were associated with neutropenia (Absolute neutrophil count
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Background : Congenital factor VII deficiency is an uncommon inherited bleeding disorder which can result in mild to severe hemorrhage in affected patients. The screening tests for factor VII deficiency are thrombin time (PT) and partial thromboplastin time (PTT). Among the inherited bleeding disorders, factor VII deficiency is the only disease which found to have prolonged PT and normal PTT. Factor VII assay is needed for definite diagnosis.Objective : Herein is a old male newborn was referred to Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, because of gum bleeding at the site of a natal tooth since 12 days of life. The PT was 25.3 seconds (normal 10.3-13.5 seconds) and PTT was 41.8 seconds (normal 28.3-44.5 seconds). In addition, substitution tests were performed and revealed factor VII deficiency. The patient was treated with factor VII replacement therapy with fresh frozen plasma (FFP). The patient was found to have a subdural hemorrhage which resolved in 6 days. During admission the bleeding was controlled by infusion with FFP (20 ml/kg) every 12 hours. He has been receiving prophylactic FFP transfusions every other day. Currently, he is 6 years and has been doing well with normal intelligence and development. His elder sister was also found to have bleeding from the umbilical stump and frenulum when she was 6 days old. The coagulogram study revealed prolonged PT but normal PTT. She died at home at on month of age secondary to seizure and palor. The screening coagulogram of the parents was normal.Conclusions : A case of congenital factor VII deficiency was reported. The routine coagulogram revealed prolonged PT but normal PTT. Substitution tests may be used initially to confirm the diagnosis. The treatment and prophylaxis of the hemorrhage is the factor replacement. The disease may be cured by bone marrow transplant. Genetic counseling is of particular importance. The disease may be diagnosed prenatally.
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Background and objective: Dental caries is a problem in young thalassemia patients and it can lead to rampant decay, infection, pain, chewing problems and malnutrition. The objective of this study was to determine the prevalence of dental caries in thalassemia patients at Srinagarind Hospital, Khon Kaen University.Methods : This cross-sectional study was conducted from December, 2005 to September, 2006 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. One hundred and four thalassemia patients volunteered to participate in this study. Data on the patients were collected from medical records, questionnaires and dental examination records. The dental caries status were recorded using the DMFT index. Dental caries was diagnosed by visual examination using dental mirror, explorer and periodontal probe as per the criteria recommended by the World Health Organization. A questionnaire contained demographics and oral hygiene care. We collected type of thalassemia from medical record. Descriptive statistics used frequency, percent, mean and standard deviation.Results : The number of thalassemia patients were 104. Age averaged was 11+4.8 years old (min-max = 2 – 24 years old). The β thalassemia and α thalassemia were 71.5% and 28.5% respectively . The prevalence of dental caries was 88.5%. Decayed, missing and filling of deciduous teeth (DMFT) were averaged at 2.28+3.65 teeth/person. Decay, missing and filling of permanent teeth (DMFT) averaged 3.12+3.72 teeth/person. We found that #85 #65 #74 #54 in deciduous teeth and #46 #36 #16 #26 in permanent teeth had dental caries more than the other type of tooth.Conclusion : The prevalence of dental caries in this study was 88.5% which need the restorative dental care.Keywords : dental caries, thalassemia
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Background: Ocular involvement in leukemic patients is rare but can be associated with CNS leukemia or relapses the disease. We report a case of acute promyelocytic leukemia (APL) with ocular involvement at diagnosis. Objective: To report a case of APL with retinal detachment.Results: A 9-year-old boy presented with fever and bleeding of the gums, which had persisted for five days. He was diagnosed with APL. A peripheral blood smear and bone marrow aspirate revealed numerous abnormal promyelocytes with coarse granules. The cytochemistry was positive for peroxidase, PAS and NAE but negative for NBE. He developed left eye pain and blurred vision on the 2nd day of hospitalization. The platelet count was 500/mm3 and the coagulogram was normal. Although platelet concentrates were administered daily, the ocular symptoms worsened until the 4th day though he had no increased intracranial pressure or abnormal neurological signs. An ocular examination revealed dilatation of the left pupil and bullous retinal detachment with retinal and vitreous hemorrhage. His visual acuity was impaired so that he could only perceive movement. Ultrasonography and CT confirmed the retinal detachment, which was then treated medically. A second eye examination, done on the 8th day, revealed the involved eye was totally blind. The APL was treated with chemotherapy comprising vincristine, cytarabine, adriamycin and prednisolone. He received 12 courses of chemotherapy and cranial radiation. His condition was stable after at the 12-month follow-up.Conclusion: Retinal detachment was caused by leukemic cells infiltrating the subretina. We confirmed the diagnosis using ultrasound and CT scan of the orbit.
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Background: Iron-deficiency anemia is the most common medical problem. The common causes of iron-deficiency anemia in children are inadequate iron intake or the result of a parasitic infestation. We report a case of hemangioma, which caused prolonged gastrointestinal bleeding and a subsequent iron-deficiency anemia.Objective: To report the treatment of iron-deficiency anemia caused by a hemangioma at the jejunoileal junction.Results: A seven-month-old male was admitted with anemia. A physical examination revealed marked paleness but no hepatosplenomegaly. Laboratory evaluations indicated an iron-deficiency anemia and positive stool blood occult. The infant was treated for a cow’s milk allergy by changing to isomil, for iron deficiency anemia by iron supplyment. The iron-deficiency anemia remained unresolved after 4 months. Then a Pertechnetate scintigraphy showed an abnormal increased uptake at left lower abdomen suggesting the lesion had a gastric mucosa component. Surgery revealed a worm-like vascular structure with contact bleeding at the serosal surface of the jejunoileal junction. A segmental small bowel resection, with end-to-end anastomosis, and appendectomy were performed. A pathological examination confirmed hemangioma, so the child was given iron supplements. His condition was stable at the six-month follow-up. Conclusion: Hemangioma at the jejunoieal junction caused prolonged gastrointestinal bleeding and an iron-deficiency anemia.
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Objective: To investigate the survival of children with neuroblastomaMethods: Survey the records for survival of children under 15 who were diagnosed as having neuroblastoma treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between 1990 and 1995 and clinically followed up to the end of 2000. Postcards were sent to patients who missed appointments. The survival rates were analyzed using the Kaplan-Meier method.Result: There were 27 cases. The male to female ratio was 1.1 : 1. Most of the patients (77%) were less than 5 years old with a median age of 3 years and 4 months. All cases presented with advanced disease with staages 3 and 4 (4% and 96%). There were 4 patients alive after5-year follow up. One had the stage 3 disease at diagnosis. The longest survivor has been doing fine for 8 years and 11 months. The median survival time was 9 months. The overall survival rates at 1,2 and 3 years were 33.3% 18.5% and 14.8% respectively. Two of the 27 patients had the relapsed disease and died within 1 and 4 months.Conclusion: In comparison with the West, our survivals of neuroblastoma were lower but comparable to those of some neighboring countries. There are limitations of this study to evaluate other prognostic factors that may influence the survival. A further prospective multicenter trial is suggested.
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Background: In Thailand thalassemia has an incidence of 1 % and 30 – 40 % of its population are the carriers of this disease. Thalassemia is caused by an abnormality in genes which brings about fragility and being destroyed easily of red blood cells. The patients will become chronic anemic and icteric. Their livers and spleens will be enlarged. The patients’ general appearance will be abnormal, delayed developed, short and small. Their faces may be of thalassemic facies. Tese abnormalities affect their body images, socio-emotional developments and performances in school. Even we can cure thalassemia with bone marrow transplantation, the dtreatment is very expensive. In general, treatment is supportive dthroughout life. So the patients and their guardians should be educated how to prevent more thalassemic offspring and how to give an appropriate care to their thalassemic children in order to facilitate the patients’ quality of life.Objectives: To compare the depth of the knowledge of thalassemia before and after giving education about this disease among the guardians of the thalassemic children.Study design: Quasi – experimental research.Place: Pediatric OPD, Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversitySubjects: The guardians of the thalassemic chidren who attended the pediatric OPD dudring June 1, 2001 to May 31, 2002Method: Al first we used a true-false questionnaire to measure the depth of the knowledge of thalassemia.Then we started a semi-structure dialogue with the guardians in order to educate them about several aspects of thalassemia. Imediately after completion of the giving education their knowledge were measured again.Statistics: Percent and paired t test using SPSS/FW programResults: Most of the guardians were the thalassemic patients’ mothers. They addged between 31 – 40 years. Most of them were cicil servants and graduated bachelor level. Before erceining our education program the guardians had knowledge about thalassemia fairly well. The questionnaire had 29 points as a total, 8 of which was about how to care the patient. After completing our education program their khowledge about thalassemia was increased with statistical significance [t = 9.95, p \< 0.001, 95% confidence interval of the increment = 3.77 – 5.67]. The knowledge of how to care the patients were also increased significantly [t = 8.41, p \< 0.001, 95% confidence interval of the increment = 1.26 – 2.02]. However, even the knowledge about the genetic transmission of the illness were also increased but the number of the guardians who scored better knowledge in this aspect increased only slightly.Conclusion: By giving education at the pediatric OPD, the guardians of the thalassemic children could gain much statistically significant more knowledge about general aspects of thalassemia (p \< 0.001) and about how to care their thalassemic kids (p \< 0.001). However the increase in knowledge about the transmission of the illness did not reach statistical significance.Keywords: Thalassemia, educating the guardians.