Importance of delayed perfusion with primary angioplasty on short-term mortality in acute myocardial infarction patients.

BACKGROUND: Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain. OBJECTIVE: The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI. MATERIAL AND METHOD: The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI. RESULTS: Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction < 40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809). CONCLUSION: The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.

The Thai version of the quality-of-life in epilepsy inventory (QOLIE-31-Thai version): translation, validity and reliability.

OBJECTIVE: To assess the validity and reliability of the QOLIE-31-Thai Version. MATERIAL AND METHOD: The original questionnaire of the QOLIE-31 was first translated into Thai and, then, item comprehension was assessed. Back translation into English and cross-cultural modification were conducted. Its reliability was assessed using a sample of consenting epileptics aged 18-65 years visiting community hospitals in Nakhon Ratchasima Province, Thailand. RESULTS: One hundred and sixty one epileptics completed the questionnaire. The internal consistency of each scale of the QOLIE-31 was above the accepted standard of 0.7, except for Cognitive Functioning, Medication Effect and Social Functioning. CONCLUSION: The QOLIE-31-Thai Version is reliable for use in Thai rural epileptics even for low educated epileptics but interviews might have to be used instead.

Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.

The Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).

Factors affecting the experiences of drug use by adolescents in a Bangkok slum.

The purpose of this research was to study the demography, financial status, social status, knowledge of amphetamines, perceived harmfulness of amphetamines, and life skills in the prevention of drug abuse in adolescents. The factors leading to drug use among young people were also studied. The study group was composed of 354 subjects aged 12 to 22 years, living in 2 slums in Bangkok. The research showed that about 7% of the sample group had used drugs before. Four percent had never used drugs, but someone had tried to talk them into using them. Almost 20% had friends who had used drugs, and 11% had friends who were still using drugs. About 13% of the adolescents in the study group had family members who used drugs and another 9% had family members who were still using drugs. In our study, we found that the most common drug group was amphetamines. On average, the participants had a low level of understanding about drug abuse, especially of the symptoms, side effects, and legal penalties. Most of the adolescents realized how harmful amphetamines and other drugs were and had a high degree life skills. Factors influencing adolescent drug use were (1) personal factors, such as monthly income/allowance and life skills; (2) family environment, such as drug abuse history in the family; and (3) social environment, such as a drug abuse history among friends. When studying the life skill factors of the adolescents, which is an independent factor capable of influencing the experience with drugs, the researchers found that the time spent with other members of the family and the family members' drug experiences were the only factors leading to life skills in the prevention of drug abuse in adolescents. In addition to letting children learn on their own, training them to acquire life skills is beneficial when faced with problematic situations. Creating relationships between adolescents and other members of the family, friends, and society can increase their life skills, diminishing the risk of drug abuse.

Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.

Upper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand. Based on recorded diagnoses and symptoms, 91% of the patients probably had viral URIs; 60% of viral and 89% of bacterial URI patients were prescribed an antibiotic. Compliance with the national treatment guideline was 36.4% for treatment of viral URIs and only 1.7% for treatment of bacterial URIs. Amoxicillin was the most frequently prescribed antibiotic regardless of diagnosis. Among viral URI patients, those who were young, male, and self-paying were more likely to receive antibiotics; part-time physicians were more likely to prescribe antibiotics for these patients. Among patients with bacterial URIs, those who paid for drugs by themselves were more likely to receive antibiotics compared to patients covered by the national health insurance plan. We used these formative results as input to the design of health center and community interventions to encourage more appropriate prescribing for URI among adults.

Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of single hydrogen peroxide vaginal douching and a single oral dose of metronidazole for the treatment of bacterial vaginosis. METHOD: A randomized trial was performed at the outpatient clinic in King Chulalongkorn Memorial Hospital. 142 patients diagnosed as having bacterial vaginosis were randomly allocated into two groups. The subjects in the first group were douched with 20 milliliters of 3 per cent hydrogen peroxide and received an oral placebo. The subjects in the second group received oral metronidazole 2 grams orally and were douched with a placebo. The cure rate in each group was assessed using Amsel's criteria 2 weeks after treatment. RESULT: The cure rate in the subjects treated with hydrogen peroxide douching was lower than the cases who received oral metronidazole (62.5% versus 78.6%, p-value = 0.036). Rate of gastrointestinal side effects in metronidazole group was higher than in the hydrogen peroxide group (48.6% versus 13.9%, p-value < 0.001). CONCLUSION: Single hydrogen peroxide vaginal douching was less effective than a single oral dose of metronidazole in the treatment of bacterial vaginosis.

Sexual behaviors and opinions on sexuality of adolescents in a slum community in Bangkok.

This study was a survey research aiming to investigate sexual behaviors and opinions on sexuality of adolescents in a slum community. The study group comprised of 377 adolescents aged 12-22 years in a slum community in Bangkok randomly selected, and data were collected using self-administered questionnaires. Results indicated that 18.8% of the adolescents were sexually experienced with the average age of 15 years old at first intercourse. 63.1% of the adolescents had unprotected sexual intercourse with lovers or friends. Almost one-third of the population believed that premarital sexual activity was acceptable. One-sixth of the adolescents agreed that having sexual intercourse with a lover is safe, assuming that they had trustworthy partners and that having sexual intercourse was the best way to prevent their lover from having sexual activities with other partners. In addition, gender and age range were found to be the factors that significantly related to the adolescents' opinions that premarital sexual activity was acceptable and having sexual intercourse with a lover was safe (p < 0.05), whereas the relationship between the opinions and education level was statistically insignificant. It is recommended that familial, academic, community and public health support are necessary in educating the adolescents on reproductive health and family planning in order to reduce high risk behaviors associated with acquiring HIV and other STDs.

Compliance with treatment of adult epileptics in a rural district of Thailand.

BACKGROUND: Epilepsy, a disease when seizures can occur from antiepileptic drug withdrawal, requires regular drug taking. Non-compliance, therefore, is a major factor contributing to sub-optimal control of the seizures. PURPOSE: To determine the factors associated with noncompliance in epileptics in rural Thailand. METHOD: All epileptics, registered in the Pak Thong Chai District and their caregivers were invited to be interviewed and examined by a neurologist in their village. RESULTS: Of a total of 93 epileptics registered, 83 with their caregivers were interviewed and examined by the neurologist (T.A.) and of those 72 were adults. Of the 72 adult epileptics, 41 (56.9%) were 100 per cent compliant and factors found to be significantly associated with compliance were gender, household income and patient's health insurance (p-value < 0.05). The major reasons for non-compliance were misunderstanding (48.4%), forgetfulness (16.1%) and economic problem (12.9%). CONCLUSION: To improve patient-compliance, the real factors for non-compliance, which are unique to patients in a specific area, need to be identified.

Prevalence of epilepsy in rural Thailand: a population-based study.

BACKGROUND: A study of the community-based burden of illness based upon prevalence is needed to plan intervention strategy. PURPOSE: To determine the prevalence of epilepsy in a rural population in Thailand. METHOD: From January to June, 2000, all of the people in Talardkav sub-district were invited to be interviewed and examined by a neurologist who visited their village. RESULTS: Of the 2,069 people in 553 households who gave information (72.2% of the total households), 43 had a history of seizure and of the 43, 15 were epileptics. The prevalence of epilepsy was estimated at 7.2 per 1,000 population. The highest two peaks were in the age groups of 5-9 and 25-34 years (17.0, 17.4/1,000, respectively). CONCLUSION: The prevalence of epilepsy in rural Thailand is low, although probably underestimated, but it is the best to date for rural Thailand.