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Background@#Persistent cough following an upper respiratory tract infection (URTI) is common in clinical practice. We investigated the effects of procaterol on cough-specific quality of life (QoL) and peripheral-airway function among adults suffering from postinfectious cough (PIC). @*Methods@#This was a prospective, randomized, double-blinded placebo-controlled trial (NCT 02349919) conducted at a university hospital. Seventy-four non-asthmatic adults who had persistent post-URTI cough for ≥3 weeks were assessed by a physical examination, chest/paranasal sinus radiographs, spirometry, and impulse oscillometry (IOS) and were allocated to receive procaterol or placebo for 4 weeks. The Thai version of the Leicester Cough Questionnaire (LCQ-T), spirometry and IOS were assessed at baseline, 2 weeks, and 4 weeks. @*Results@#Mean LCQ-T total scores for the procaterol group (10.8) and placebo group (10.9) at baseline were not significantly different (P=0.821). After adjustment for baseline Borg Cough Scale score and post-nasal drip, the mean between-group difference was not significant for LCQ-T total score (-1.26; 95% confidence interval [CI], -2.69 to 0.17), physical domain score (-0.35; 95% CI, -0.76 to 0.06), psychological domain score (-0.53; 95% CI, -1.06 to 0.01), or social domain score (-0.38; 95% CI, -0.92 to 0.16). Large improvements in LCQ-T total score were reported in both groups after 2 weeks (procaterol, 4.21±2.73; placebo, 5.34±3.2), and 4 weeks (procaterol, 5.94±3.68; placebo, 7.07±3.44). No differences between groups were found in the mean changes of spirometry or IOS parameters after 4 weeks. @*Conclusion@#Our study shows that procaterol is not effective in the treatment of PIC, in terms of improvement of cough-specific QoL or peripheral-airway function.
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Background@#Persistent cough following an upper respiratory tract infection (URTI) is common in clinical practice. We investigated the effects of procaterol on cough-specific quality of life (QoL) and peripheral-airway function among adults suffering from postinfectious cough (PIC). @*Methods@#This was a prospective, randomized, double-blinded placebo-controlled trial (NCT 02349919) conducted at a university hospital. Seventy-four non-asthmatic adults who had persistent post-URTI cough for ≥3 weeks were assessed by a physical examination, chest/paranasal sinus radiographs, spirometry, and impulse oscillometry (IOS) and were allocated to receive procaterol or placebo for 4 weeks. The Thai version of the Leicester Cough Questionnaire (LCQ-T), spirometry and IOS were assessed at baseline, 2 weeks, and 4 weeks. @*Results@#Mean LCQ-T total scores for the procaterol group (10.8) and placebo group (10.9) at baseline were not significantly different (P=0.821). After adjustment for baseline Borg Cough Scale score and post-nasal drip, the mean between-group difference was not significant for LCQ-T total score (-1.26; 95% confidence interval [CI], -2.69 to 0.17), physical domain score (-0.35; 95% CI, -0.76 to 0.06), psychological domain score (-0.53; 95% CI, -1.06 to 0.01), or social domain score (-0.38; 95% CI, -0.92 to 0.16). Large improvements in LCQ-T total score were reported in both groups after 2 weeks (procaterol, 4.21±2.73; placebo, 5.34±3.2), and 4 weeks (procaterol, 5.94±3.68; placebo, 7.07±3.44). No differences between groups were found in the mean changes of spirometry or IOS parameters after 4 weeks. @*Conclusion@#Our study shows that procaterol is not effective in the treatment of PIC, in terms of improvement of cough-specific QoL or peripheral-airway function.
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Objectives: To study the outcome of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in medical ICU, Ramathibodi Hospital and identify factors that contribute independently to mortality. Study design: Retrospective study. Methods: All patients admitted in medical ICU between January 1998 and December 2002, that met the criteria of the American-European Consensus Conference for ALI and ARDS were reviewed. The data collection included patient baseline characteristics, risk factors for ARDS, initial PaO₂/FiO₂, PaO₂/PAO₂, static lung compliance, best PEEP level, APACHE II score, associated early and late nonpulmonary organ dysfunction, mode of ventilator, ventilator days, outcomes and complications. The probability of death and median survival time were assessed by Kaplan-Meier method. Prognostic factors associated with mortality were determined by Cox Proportional Hazard method. Results: A total of 48 patients met the criteria of ALI and ARDS. The mean age of these patients was 46.8 \±18 yrs. Direct lung injuries were the most common causes of ARDS in this series (35/48), of which pneumonia attributed to the majority of cases (80%). The mean APACHE II score of the group was 20.9\±7.4, with 70.8% hospital mortality. Main cause of death was multiple organ dysfunction, while refractory hypoxemia was less common. Factors independently associated with mortality were initial APACHE II score of more than 20 (hazard ratio, 2.09; 95%CI 1.02 to 4.32) and the presence of circulatory dysfunction 24 h after the onset of ARDS (hazard ratio, 5.78; 95%CI 2.11 to 15.86). Conclusion: Mortality rate of ARDS in medical patients had been unchanged. The extreme high mortality (70.8%) in this group could be due to the high proportion of patients with pneumonia and sepsis. Only initial APACHE II score of more than 20 and the presence of circulatory dysfunction were found to be the independent predictors of mortality. These further confirmed and emphasized the concept of \“lung as a part of systemic inflammatory process\” in ARDS.
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Abstract Comparison of Amphotericin B Induced Nephrotoxicity between 6 Hours vwesus 24 Hours Continuous Infusion: A Randomized Controlled Trial On-umar Banpamai MD* Kumthorn Malathum MD*** Somnuek Domrongkitchaiporn MD*** Weerawat Manosuthi MD**** Sasivimol Rattanasiri MSc (Biostatistics)***** *Division of Infectious Diseases, Department of Medicine, BMA Medical College and Vajira Hospital **Division of Infectious Diseases, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity ***Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity **** Department of Medicine, Bamrasnaradura Institute *****Clinical Epidemiology Unit, Ramathibodi Hospital, Mahidol Unrversity Objective: To compare nephrotoxicity and infusion-related reactions between 6 hours versus 24 hours infusion of amphotericin B. Study design: Prospective, randomized controlled study. Subjects: Seventy-two patients who required amphotericin B therapy for various indications, between August 2004 and March 2005 at Department of Medicine, Ramathibodi Hospital and Bamrasnaradura Institute were randomly allocated to receive either 6 hours or 24 hours infusion of amphotericin B. Methods: Thirty-five patients received continuous infusion of amphotericin B for a period of 6 hours as a control group and 37 patients for a period of 24 hours as a study group. Creatinine clearance, serum potassium (k+), serum magnesium ( Mg+ ), fractional excretion of potassium and magnesium were determined in all patients once a week. Infusion-related side effects of both regimens were also recorded throughout the study. Main outcome measures: Creatinine clearance at 7 and 14 days after receiving amphotericin B, infusion-related side effects, fractional excretion of potassium and magnesium. Results: Creatinine clearance at day 7 and day 14 in study group were 83.922.9 and 81.822.5 ml/min. In control group, creatinine clearance at day 7 and day 14 were 62.7 25.3 and 51.718.9 ml/min. These levels in study group were higher than control group significantly (p-value 0.05). The incidence of renal impairment, defined as doubling of baseline serum creatinine, in study and control group were 2.7% and 45.7% that was different significantly (p-value 0.001). The incidences of infusion-related reactions other than thrombophlebitis were significantly lower in study group. Fractional excretion of statistically different between the two groups. Conclusion: The creatinine clearance, the incidence of renal impairment and infusion-related reactions in continuous 24-hour infusion of amphotericin B were lower than 6-hour infusion. Key word: amphotericin B, creatinine clearance, fractional excretion Vajira Med J 2006 ; 50 : 153 - 164