Dobutamine stress echocardiography for the evaluation of coronary artery disease in Thai population: Siriraj experience.

OBJECTIVE: No previous report of dobutamine stress echocardiography in the Thai population has been available. The present study seeks to document the protocol, indications, results and safety of dobutamine stress echocardiography performed at Siriraj Hospital. MATERIAL AND METHOD: The authors studied 421 [mean age 67.7 +/- 11.0 years, 179 (43%) men] consecutive Thai patients undergoing dobutamine stress echocardiography at Siriraj Hospital. The protocol, indications and echocardiographic analysis were described. Clinical characteristics, hemodymanics, results and adverse effects were recorded at the time of dobutamine stress echocardiography. RESULTS: Dobutamine stress echocardiography was performed for preoperative assessment before non-cardiac surgery in 212 patients (50%), for the diagnosis of suspected Coronary Artery Disease (CAD) in 179 patients (43%), for risk stratification of CAD in 24 patients (6%), and for other reasons in six patients (1%). The results were normal and positive for inducible ischemia in 276 (66%) and 80 (19%) patients, respectively. Limiting side effects were observed in 3%. No death, myocardial infarction or life-threatening arrhythmias occurred. Transient stress-associated tachyarrhythmias, such as atrialfibrillation, nonsustained ventricular tachycardia or supraventricular tachycardia, occurred in 3.5% of patients. CONCLUSION: Dobutamine stress echocardiography was considered a safe and tolerable technique for the evaluation of CAD in Thai population.

Amikacin: Area under curve for once daily dose and its correlation with plasma concentration at six hours post infusion.

Aminoglycosides are commonly used for gram-negative septicemia. Formerly, peak and trough plasma levels were the monitoring parameters for conventional dose which was every eight hours. At present the recommended dose is once daily and the recommended monitoring parameters are the area under concentration time curve and the six-hour (range 146-180) for the area under curve and 6.79 milligrams per liter (range 5.6-7.9) for the six-hour plasma concentration post-infusion. The correlation of the area under curve and the six-hour plasma concentration post-infusion was reported in a linear equation with significance.

Health status of Siriraj Hospital's nurses: Uncover the underlying health problems.

Health care providers' exposure to the hospital environment including infectious diseases and lack of self-awareness of illnesses may lead to critical health problems. The present cross sectional study was conducted to survey the magnitude of health problems in nurses at Siriraj Hospital. The study population included 1,435 nurses, 1,366 female and 69 male, with an average age of 44 ฑ 6 (range 30-60) years. Results of the study showed that 5.7 % of subjects had high fasting plasma glucose (FPG), 59.4 % had hypercholesterolemia (cholesterol > 200 mg/dl) and 6.0 % had hypertriglyceridemia (triglyceride > 200 mg/dl). Isolated hypercholesterolemia and isolated hypertriglyceridemia were found in 54.4 % and 1.0 % respectively. Combined hypercholesterolemia with hypertriglyceridemia was found in 5.0 %. Hyperuricemia was found in 8.2 % of subjects. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of more than 2 times the upper normal limit were found in 0.4 % and 1.5 % respectively. Serum alkaline phosphatase of more than the upper normal limit was found in 4.2 %. Anemia was found in 24.9% of cases. Abnormal chest x-ray findings including nodules, calcification, infiltration, fibrosis and effusion were found in 4.5 %. This study uncovered underlying health problems in the majority of the population of health care providers at Siriraj Hospital, who were presumed to be healthy. The most frequent finding was dyslipidemia, which was found in more than half of the study population. This abnormality may lead to more serious illnesses especially cardiovascular diseases. More intensive study is required to determine the associated factors and to find the appropriate strategy in managing this problem on the basis.