Tetanus: a retrospective study of clinical presentations and outcomes in a medical teaching hospital.

BACKGROUND: Tetanus has been a serious infectious disease with high mortality and morbidity. Some clinical factors can predict its severity. OBJECTIVE: Survey the clinical profiles, their correlation with the severity of tetanus and the final outcomes after treatment. MATERIAL AND METHOD: A retrospective study of the medical records of patients with tetanus who attended Songklanagarind hospital between January 1982 and June 2008 was done. The correlation between clinical profiles and severity was analyzed by Fisher exact test to detect the significant correlation (p < 0.05). RESULTS: Forty-seven cases of tetanus, composed of 36 male and 11 female patients, were reviewed. The mean age of onset was 45.5 years (SD = 19.6 years). Generalized tetanus was the most common form found (91.4%). History of injury or wound was reported in 80.8%. Age over sixty, puncture wound, onset time of less than seven days, and generalized tetanus, significantly correlated with clinical severity. Only two cases died, but the rest of the cases had residual muscle rigidity after treatment. CONCLUSION: The overall clinical features of tetanus and their correlation with the disease severity were presented. Unlike in the past, patients with tetanus can now be reversible under appropriate intensive critical care.

Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study.

BACKGROUND: Dysphagia after stroke is associated with increased mortality, higher dependence, and longer hospitalization. Different therapeutic strategies have been introduced to improve swallowing impairment. There are no current studies that compare rehabilitation swallowing therapy (RST) and neuromuscular electrical stimulation therapy (NMES). OBJECTIVE: To compare treatment outcomes between RST and NMES intervention in stroke patients with pharyngeal dysphagia. STUDY DESIGN: A randomized controlled study. MATERIAL AND METHOD: Twenty-three stroke patients with persistent pharyngeal dysphagia (RST 11, NMES 12) were enrolled in the present study. The subjects received 60 minutes of either RST or NMES treatment for five consecutive days, had two days off and then five more consecutive days of treatment for a four-week period or until they reached functional oral intake scale (FOIS) level 7. The outcome measures assessed were change in FOIS, complications related to the treatment and number of therapy sessions. RESULTS: There were no significant differences in the stroke characteristics and the VFSS results between the two groups. At the end of treatment, the average numbers of therapy sessions per subject in the RST and NMES groups were 18.36 +/- 3.23 and 17.25 +/- 5.64, respectively, a non-significant difference. Average changes in FOIS scores were 2.46 +/- 1.04 for the RST group and 3.17 +/- 1.27 for the NMES group, statistically significant at p < 0.001. No complications were observed in either group. CONCLUSION: While both RST and NMES therapy showed a positive effect in the treatment of persistent dysphagia in stroke patients, NMES was significantly superior.

The validation of the disease-specific questionnaire for health-related quality of life in Thai patients with hemifacial spasm.

OBJECTIVE: To investigate the reliability and validity of the Thai version of disease-specific health-related quality of life instrument for patients with hemifacial spasm (HFS) as well as their response to botulinum toxin treatment. MATERIAL AND METHOD: A Thai version of HFS-30 has been developed with the permission of the author. Thirty patients with HFS were asked to complete this Thai HFS-30, the 6-point disability scale before treatment and between four and six weeks after botulinum toxin injections. Peak improvement (0-100%) was subjectively assessed by each patient between four and six weeks after injection. They were also asked to answer the existing Thai SF-36 questionnaire before treatment to test its correlation with Thai HFS-30. Another group of ten patients completed the questionnaire and then a second identical copy after a 2-week interval. The reliability, validity, and responsiveness were subsequently analyzed. RESULTS: The Thai HFS-30 showed a Cronbach's alpha coefficient of 0.78 and no significant difference of a test-retest reliability. The total content validity was 0.88 (range 0.5-1.0). There were good correlations between both the Physical and Mental Health parts of the Thai HFS-30 and Thai SF-36 (p < 0.05 and p < 0.01, respectively). The Thai HFS-30 also demonstrated a response to treatment similar to the 6-point disability scale and the peak improvement. CONCLUSION: The Thai version of HFS-30 is a valid, reliable, and sensitive to change instrument for disease specific health-related quality of life assessment.

Anxiety and depression in Thai epileptic patients.

OBJECTIVE: To study the prevalence of depression and anxiety in Thai epileptic patients at Songklanagarind Hospital, a tertiary care center in the South of Thailand. MATERIAL AND METHOD: One hundred and twenty six patients were included in the present study. A HADS questionnaire and demographics data were used for data collection in the present cross-sectional study. RESULTS: Thirty-nine percent of the respondents had anxiety and 20% had depression. Predictors of anxiety by univariate analysis were being female (p = 0.033) and seizure frequency (p = 0.001). Predictors of depression were seizure frequency (p = 0.001) and a history of trauma associated with seizure activity (p = 0.005). Age, type of seizure, amount of medication, duration of disease, socioeconomic status, occupation, education level, and marital status were not predictors of depression or anxiety. CONCLUSION: There is a high prevalence of depression and anxiety in Thai epileptics. Risk factors for depression are seizure frequency and history of trauma while for anxiety they are gender and frequency of seizure.