Incidence of abnormal electrocardiograms which affected the changes of exercise programs at outpatient cardiac rehabilitation clinic.

Objective: the primary purpose of the study was to determine the incidence of abnormal electrocardiograms (ECGs) which affected the changes of exercise programs. The secondary purpose was to study types of ECG abnormality and the time of detecting the abnormality. Methods: The study was retrospective design. The studied population was selected from the followed up patients at our outpatient cardiac rehabilitation clinic from October 1, 2008 to May 31, 2009. The inclusion criteria were patients who had to follow up at our outpatient cardiac rehabilitation clinic and were monitored for ECG telemetry. The medical and ECG telemetry records of the patients were reviewed. The incidence of abnormal ECGs was reported as the percentage of patients with abnormal ECGs. The patients with abnormal ECGs were classified as the ECG changing group and those without abnormal ECGs were classified as the non-ECG changing group. The comparison of both groups was performed by Chi-square test for categorical data and the independent samples t-test for the quantitative data. The median survival time was carefully estimated by Kaplan-Meier method of Survival Analysis. The factors associated with time of detecting abnormal ECGs were analyzed by using Cox proportional hazards model. The data analysis was performed with statistical significant difference of the p-value < 0.05. Results: Five hundred and forty patients, 378 males and 162 females, were enrolled. There were 151 from 540 patients (28%) in the ECG changing group and 389 patients (72%) in the non-ECG changing group. The comparison between two groups indicated that there were no significant differences regarding gender, age, body mass index, diseases and co-morbidities (such as coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, dyslipidemia and chronic obstructive lung disease), left ventricular ejection fraction and status of cardiac surgery. The two most common types of ECG abnormality in the ECG changing group were tachyarrhythmia and bradyarrhythmia, respectively. The Cox proportional hazards model revealed that there was no factor associated with time of detecting abnormal ECGs. From the Kaplan-Meier method of Survival Analysis, the median survival time of detecting abnormal ECGs was 61 months (95%CI: 47.6, 74.9). Conclusion: The incidence of abnormal ECGs which affected the changes of exercise programs in our outpatient cardiac rehabilitation clinic was 28%. The most common type of abnormality was tachyarrhythmia. The median survival time for detecting abnormal ECGs was 61 months after cardiac hospital discharge. There was no associated factor with the time of detecting abnormal ECGs.

Pre-operative pulmonary training program in coronary artery bypass graft surgery patients at Siriraj Hospital.

Objective: To compare the incidence of pulmonary complications in coronary artery bypass graft surgery patients who underwent a pre-operative pulmonary training program to those who did not. Methods: The patients with coronary artery disease who underwent elective coronary artery bypass graft (CABG) surgery at Siriraj Hospital from January to December 2007 were included in this study and were divided into two groups depending on whether they received a pre-operative pulmonary training program. The primary clinical variable was the presence or absence of pulmonary complications. The comparison of the pre-operative pulmonary training and non- pre-operative pulmonary training group was performed by the Chi-square test for the qualitative data and the Independent sample t-test for the quantitative data. Results: A total of 627 patients were divided into two groups, the pre-operative pulmonary training group (G1) and non-pre-operative pulmonary training group (G2). Comparison between the two groups showed, pulmonary complications were significantly more frequent in G2 than in G1 (7.4% and 3.1%). The difference in incidence of pneumonia was also statistically significant (6.6% and 0.8% in G2 and G1), respectively. The odds ratio for total pneumonia of G2 was 9.3, 95% CI [2.1, 57.3] and for total pulmonary complication of G2 was 2.6, 95% CI [1.1, 6.3]. G2 also had a longer length of stay than G1 (11.0 ± 10.3 and 15.3 ± 12.2 days), respectively. Conclusion: A pre-operative pulmonary training program can prevent post-operative pulmonary complications and reduce the length of hospital stay in patients who underwent coronary artery bypass surgery.

Pancoast tumor as a cause of profound brachial plexopathy.

Pancoast tumor is also called superior sulcus tumor. The classic presentation is an aching pain about the shoulder region with some radiation to the scapula and weakness in the intrinsic hand muscles unilaterally (C8-T1 distribution). This case report demonstrates a rare case of Pancoast tumor which involved the fifth cervical through the first thoracic nerve roots with pain and severe muscle weakness throughout the arm.

Prosthetic usage among the Thai lower limb amputees.

Objective: To study the percentage of prosthetic usage and factors associated with prosthetic usage among lower limb amputees in Thailand. Methods: The postal survey with a questionnaire was sent to 1,300 amputees who received lower limb prostheses between 2001 and 2005. The participants were divided into two groups, namely, the prosthetic usage and prosthetic non-usage groups. A Chi-Square and an Independent Sample T test were used to compare the differences between the two groups. The multiple variables analysis by stepwise logistic regression was used to determine the associated factors. Results: Three hundred and nineteen questionnaires were completed among three hundred and twenty one returned questionnaires. The percentage of amputees who used a prosthesis over 5 hours per day was 82.1%. Demographically, the prosthetic usage group had less diabetes mellitus (p =0.010), were younger at the time of amputation (p <0.001), and had a currently employed status (p <0.001) than the non-prosthetic usage group. (You have not stated what you are comparing this group to!) In Amputation related factors the transtibial amputees were more likely to use prostheses (p <0.001). The factors associated with prosthetic usage were experiencing satisfactory to good wearing comfort (OR 12.83), a transtibial level of amputation (OR 9.65), having a currently employed status (OR 5.12), undergoing particular etiologies of amputation such as congenital problem or blast injury (OR 2.78) and being young at time of amputation (OR 0.95), respectively. Conclusion: The percentage of prosthetic usage among the Thai lower limb amputees was 82.1%. The factors associated with the prosthetic usage were wearing comfort, level of amputation, having a currently employed status and being of younger age at the time of amputation.