Hepatitis B screening rates and reactivation in solid organ malignancy patients undergoing chemotherapy in Southern Thailand

BACKGROUND/AIMS: Hepatitis B virus reactivation (HBVr) following chemotherapy (CMT) is well-known among hematologic malignancies, and screening recommendations are established. However, HBVr data in solid organ malignancy (SOM) patients are limited. This study aims to determine hepatitis B surface antigen (HBsAg) screening rates, HBV prevalence, and the rate of significant hepatitis caused by HBVr in SOM patients undergoing CMT.METHODS: Based on the Oncology unit’s registration database from 2009–2013, we retrospectively reviewed records of all SOM patients ≥18 years undergoing CMT at Songklanagarind Hospital who were followed until death or ≥6 months after CMT sessions. Exclusion criteria included patients without baseline liver function tests (LFTs) and who underwent CMT before the study period. We obtained and analyzed baseline clinical characteristics, HBsAg screening, and LFT data during follow-up.RESULTS: Of 3,231 cases in the database, 810 were eligible. The overall HBsAg screening rate in the 5-year period was 27.7%. Screening rates were low from 2009–2012 (7.8–21%) and increased in 2013 to 82.9%. The prevalence of HBV among screened patients was 7.1%. Of those, 75% underwent prophylactic antiviral therapy. During the 6-month follow-up period, there were three cases of significant hepatitis caused by HBVr (4.2% of all significant hepatitis cases); all were in the unscreened group.CONCLUSIONS: The prevalence of HBV in SOM patients undergoing CMT in our study was similar to the estimated prevalence in general Thai population, but the screening rate was quite low. Cases of HBVr causing significant hepatitis occurred in the unscreened group; therefore, HBV screening and treatment in SOM patients should be considered in HBV-endemic areas.

Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources

<p><b>INTRODUCTION</b>Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning.</p><p><b>METHODS</b>The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis.</p><p><b>RESULTS</b>A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days).</p><p><b>CONCLUSION</b>Bulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.</p>

A Pilot Study of a Comparison of Glycemic Control in Critically Ill Patients

 Objective: To compare glycemic control in the critically ill patients between a single dose of subcutaneous injection of insulin glargine and a continuous intravenous infusion of regular insulin.Study design: Prospective, experimental pilot study.Subjects: Twelve critically ill patients with hyperglycemia who required glycemic control according to the standard continuous intravenous infusion of regular insulin protocol with constant insulin infusion rate per hour for at least 24 hours.Materials and methods: These patients received a single dose subcutaneous injection of insulinglargine, which was equal to 80% of the total daily requirement of regular insulin in the previous 24hours. The blood sugar level was continuously checked every 2 hours for the next 24 hours after either insulin glargine administration or the blood sugar level was outside the desired range, in which case the standard regular insulin infusion was then resumed. The blood sugar levels before and after injection of insulin glargine was then compared by pair t-test and generalized linear mixed models (GLMM).Results: Of the 12 patients, only 8 patients achieved a good glycemic control with the single dosesubcutaneous injection of insulin glargine. However, the mean blood sugar after injection of insulin glargine was statistically significantly higher than the continuous intravenous infusion of regularinsulin period (175.62±58.82 mg/dl vs. 145.45±30.33 mg/dl, p

Noise Exposure Assessment in a Dental School

OBJECTIVES: This cross-sectional study was performed in the Dental School of Prince of Songkla University to ascertain noise exposure of dentists, dental assistants, and laboratory technicians. A noise spectral analysis was taken to illustrate the spectra of dental devices. METHODS: A noise evaluation was performed to measure the noise level at dental clinics and one dental laboratory from May to December 2010. Noise spectral data of dental devices were taken during dental practices at the dental services clinic and at the dental laboratory. A noise dosimeter was set following the Occupational Safety and Health Administration criteria and then attached to the subjects' collar to record personal noise dose exposure during working periods. RESULTS: The peaks of the noise spectrum of dental instruments were at 1,000, 4,000, and 8,000 Hz which depended on the type of instrument. The differences in working areas and job positions had an influence on the level of noise exposure (p < 0.01). Noise measurement in the personal hearing zone found that the laboratory technicians were exposed to the highest impulsive noise levels (137.1 dBC). The dentists and dental assistants who worked at a pedodontic clinic had the highest percent noise dose (4.60 +/- 3.59%). In the working areas, the 8-hour time-weighted average of noise levels ranged between 49.7-58.1 dBA while the noisiest working area was the dental laboratory. CONCLUSION: Dental personnel are exposed to noise intensities lower than occupational exposure limits. Therefore, these dental personnel may not experience a noise-induced hearing loss.