Achievement in Personality and Ethics Development 2nd year medical student, 1994 Academic year.

Objective1. To establish and develop personality in order  to promote good leadership and  remember the essential merit and that correlate to the social needs of students.2. To build up and create appropriate values in Thai society among the students themselves especially in terms of unity, affection and a sense of belonging to each other and to the Academic Institute.3. To develop the student in terms of Social, Emotional \& Moral behaviour so that they can adapt to the new society.4. Build up the sensitivity and responsibility of students to society and to the country after graduation5. To promote in Medical students and supervisors a better relationship which will lead to trust and consultationMethods: The students were asked to attend the camp and advisers encouraged to understand their role so that they had ability to extend group relations. After this the students attended a 2 day and 2 night camp with various activities. Each group had 1-2 supervisors for group relationship activities using games as a medium by which to present social situations and human behavioral analysis. There was a video show about development, community life, leadership and human relations. There were group planning conferences, project planning activities, self and family development group presentations and other activities. Assessment by collective observation and the use of questionnaires showed that the target objectives were achieved. As a result of the course students personalities were developed to produce good leaders as well as producing good team member of society. Good ethical beliefs were fostered as was the aim of  being a worthy member of society. The right values of affection, good person to person relations a pride in the institute, adaptation to the school environment and to colleagues were achieved. A feeling of responsibility to society and to the Nation together with the promotion of relationships both to students and supervisors was established. The recommendation from students and participating supervisors is that it should be extended from 2 days and 2 nights to be 3 says and 2 nights by using a weekday and weekend or only the former which means doing the course after the students finish their exam. The location should be nor too far away from University. It should have a wide-enough conference room that suits various activities, a yard or sports ground that is suitable for physical or moral exercise of the students and nearby accommodation with an adequate restroom. Food should be arranged for everyone. This could be used by 3 rd year medical students so that they could prepare themselves for the clinical year. The assessment should be carries out regularly so as to improve weak points and become Faculty’s policy in the following academic year by training the 1st or 3rs year medical student and applying the formula that has been practiced by the 2 nd year medical student for the 2 st year medical student. Furthermore, the formula arranged for clinical year students to be demonstrates in the 3 rd year to medical students before they start their 4 th year. Subsequently it should be distributes so as to be part of the University plan.

Achievement in Personality and Ethics Development 1st year medical student, 1994 Academic year.

Objective1. To establish and develop personality in order to promote good leadership and member the essential merit and ethics that correlate to the social needs of students.2. To build up and create appropriate values in Thai society among the students themselves especially in terms of unity, affection and a sense of belonging to each other and to the Academic Institute.3. To develop the students in terms of Social, Emotional \& Moral behaviour so that they can adapt to the new society.4. Build up the sensitivity and responsibility of students society and to the country after graduation.Methods – Assigning the students to attend the 2 night camp,s activities.  There was an Analysis lecture of the present situation, social problems and human behaviour.  There was a video show about the Developemtn trends or the ‘new life’ Community Development.  Example of development experiences, leadership and human relations were raised.  There was a planning group meeting, arranging a project, self and family development activities,  The proposal of group and other activities from evaluation by collective observations, interviews and questionaires.  It has been found that to accomplish the target object.  The students program needed to be supplemented \& develop in order to get better personality, leadership and member, good merit \& ethics in society.  Appropriate values had to be emphasized such as unity, affection, relationships with one another, a price in the institute, adaptation to colleaques and the environment.  These values also include the feeling of responsibility for society that effect the entire country in the future. The recommendation from students and lecturers who attended this program is that it should have there activities for the 2 nd year and the 3 rd year students and there should be a chane of locations for demonstration.  The suggested place should be within a walking distance to the campus and provide proper accommodation and a conference room.  Interesting \& effective media should be used.  There main meals should be arranged and the light meal or snack could be reduced.  Public relations procedure should be advertised throughroughly and lecturers should participate in the activities, The evaluation should be done regularly so as to adjust and improve the weak points and consequently become the faculty policy Further more.  The academic program should include the merit and ethical teaching and the supplementary activities should be continuously administered until graduation.

A Case Report : Congenital factor VII deficiency

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.

Survival Rate in Childhood Leukemia

no abstract

Update Treatment in Thalassemia and Hemoglobinopathy

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A Case of Acute Promyelocytic Leukemia Presented with Retinal Detachment

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.

Iron Deficiency Anemia caused from Hemangioma of the Intestine.

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.

Febrile Neutropenia

No abstract

Survival Rate of Children with Neuroblastoma in Srinagarind Hospital

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.

Predictive Statistical Model for the Risk of Cholangiocarcinoma in Northeast Thailand

Background and Objective: Cholangiocarcinoma (CHCA) is the most common cancer in Thai people especially in the Northeast of Thailand. Primary prevention is very important for CHCA control. This study attempted to find the exposures associate with CHCA in order to develop a predictive statistical model for CHCA in people in Northeast Thailand.Methods: This study was carried out in 2007 as a nested case-control study within the Khon Kaen cohort study at Cancer Unit, Khon Kaen University. The cohort recruitment was performed during 1990 to 2001. There were 108 CHCA cases occurred in the cohort and individual matched control was randomly selected for each case (1:1), matched by age, sex and date of recruitment to the cohort.Results: For the predictive model, was: logit (CHCA) = 0.69 X Opisthorchis Viverrini, OV (egg in stool finding) with the precision of 56.48% (95%CI:= 51.25-61.71), sensitivity 54.02% (95%CI: = 46.32 - 61.59), specificity 66.67% (95%CI: = 50.45 - 80.43), positive predictive value 87.04% (95%CI:=79.21-92.73) and negative predictive value 25.93% (95%CI:=17.97-5.25).Conclusion: The results of this study suggested that OV infestation has high association with CHCA. To reduce the incidence of CHCA, liver fluke control is priority work for health policy.Keywords: Cholangiocarcinoma, Risk factors for cholangiocarcinoma, Predictive model for cholangiocarcinoma