Pre-operative factors correlated with arthroscopic reparability of large-to-massive rotator cuff tears.

BACKGROUND: The purpose of this study is to determine the pre-operative factors that are associated with reparability of the large-sized and massive rotator cuff tears. METHODS: Sixty-six patients were included in this prognostic study. Demographic data, radiographic and MRI parameters were collected. Arthroscopic rotator cuff repair was performed for all included patient. Complete rotator cuff repair was achieved when the tendon covered up at least 50% of the anatomical footprint. The receiver operating characteristic (ROC) curve was analysed to define the cut-off level of each significant factor. RESULTS: Eleven large-sized rotator cuff tears and fifty-five massive rotator cuff tears were defined from MRI. Fifty-four patients were in the complete repair group, and twelve patients were in the partial repair group. The mean duration between MRI and surgery of 5.5 weeks. Reparability was correlated with age, mediolateral (ML) and anteroposterior (AP) tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration and atrophy of the supraspinatus muscle, and fatty infiltration of infraspinatus muscle (p < 0.05). The ROC curve defined a cut-off level of each predicting factor which included age of ≥65 years, mediolateral tear size of ≥36 mm, anteroposterior tear size of ≥22 mm, Hamada's rotator cuff arthropathy of ≥class2, acromiohumeral interval of ≥6 mm, ≥stage3 supraspinatus fatty infiltration, the presence of supraspinatus muscle atrophy, and ≥ stage1 infraspinatus fatty infiltration. In multivariated regression analysis, age, acromiohumeral interval, and anteroposterior tear size were statistically associated with the reparability. The intra- and inter-observer reliabilities were moderate to excellent. CONCLUSION: Age, ML tear size, AP tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration of supraspinatus and infraspinatus muscles and supraspinatus muscle atrophy all correlate with reparability of large to massive rotator cuff tear.

Medical and economic burden of chronic hepatitis B patients at Queen Savang Vadhana Memorial Hospital.

OBJECTIVE: To study and to compare the medical and economic burden among chronic hepatitis B (CHB) patients. MATERIAL AND METHOD: A prospective observational study was conducted among 129 adult CHB patients. The medical burden was assessed by using the EuroQol-5D (EQ-5D) and the Chronic Liver Disease Questionnaire (CLDQ) at initial day, the six and 12-month follow-up. The economic burden was assessed in term of total cost per case per year RESULTS: At one-year follow-up, the mean age of 129 patients was 41.6 (SD = 11.8) years. For medical burden at over time, CHB with antiviral drugs (ARV) for hepatitis B infection had a significant decreased in percentage of anxiety, and increased the mean (SD) CLDQ score. The mean total costs per case per year of CHB without ARV (52 cases), CHB with antiviral drugs (50 cases), and CHB with cirrhosis/hepatocellular carcinoma (HCC) with ARV (27 cases) were significantly different (p < 0.001) with USD 615.9 (SD = 688.0), 1,777.4 (SD = 1,220.4), and 2,651.3 (SD = 3,885.0), respectively. CONCLUSION: CHB causes a great economic burden in Thailand Early antiviral drugs treatment prevents complication in CHB patients.

Comparison of maternal factors and neonatal outcomes between elective cesarean section and spontaneous vaginal delivery.

BACKGROUND: The rising rate of cesarean section has been of concern worldwide. Maternalfactors and neonatal outcomes of cesarean section and vaginal delivery remain unclear OBJECTIVE: To compare the diferences of maternal factors and neonatal outcomes between mothers who underwent Elective Cesarean Section (ECS) and spontaneous vaginal delivery (SVD) MATERIAL AND METHOD: A cross-sectional descriptive research studied all delivery data of Queen Savang Vadhana Memorial Hospital between June 1, 2010 and May 31, 2011. Two thousand eight hundred seventy six deliveries were included. From these, 648 mothers delivered by ECS while 2,228 mothers delivered by SVD. The data quality was tested via the agreement between the 115 sampling delivery records and the same delivery of the extracted data. The percent agreement was 99% (minimum 97-maximum 100). Pearson's Chi-square test and an independent t-test were used to compare the distribution or mean of two groups as appropriate. The statistically significant diference was defined as p-value less than 0.05. RESULTS: The statistically significant diferences of maternal factors, and neonatal outcomes between mothers who underwent ECS and SVD were found as follows. The ECS mother showed the mean age (28.7 (3.5) vs. 27.1 (3.8) years, p< O. 001), the mean (SD) of number of antenatal care (9.9 (2.8) vs. 7.0 (3.3) times, p< 0.001) and the mean (SD) of hematocrit (36.8 (3.3)% vs. 35.8 (3.5)%, p = 0.001) greater than SVD mother The neonates of ECS mother had weight greater than SVD (3,194.5 vs. 3,078.3 grams, p = 0.001), and showed the percentage of presence of respiratory distress syndrome (RDS) higher than the neonate of SVD mother (5.5% vs. 0.4%, p = 0.010). The neonates of SVD mother had mean Apgar scores at first minute (8.0 vs. 7.9 scores, p = 0.015) and at fifth minute (9.8 vs. 9.5 scores, p = 0.001) greater than the neonates of ECS mother They demonstrated the percentages of presence of meconium stain in amniotic fluid (MSAF) and presence of cord accident higher than neonate of CS mother (5.3% vs. 2.5%, p = 0.002, and 16.9% vs. 2.5%, p = 0.001, respectively). CONCLUSION: The neonates of ECS mother had a greater weight and a higher risk for pulmonary problems. The neonates of SVD mother have a higher risk for MSAF cord accident, and meconium aspiration. It reflected the need for prolong process of labor and delivery prevention.

Outcomes of antituberculosis treatments at 18 months follow-up in TB-HIV co-infected patients on ART: a retrospective review of 166 cases.

OBJECTIVES: To study the outcomes of antituberculosis treatment in HIV/AIDS patients on antiretroviral therapy (ART). MATERIAL AND METHOD: This retrospective cohort study was performed by reviewing medical records of 166 patients co-infected with tuberculosis (TB) and HIV in a hospital in Thailand seen between January 2005 and February 2008. These patients were treated with both antituberculosis (antiTB) and antiretroviral drugs (ART) and were followed for 18 months after the beginning of antiTB. RESULTS: Total 166 HIV patients with TB on ART and anti tuberculosis drugs were analyzed. The median age of patients was 36 years (20-72). Sixty-nine (41.6%) patients had pulmonary TB and 97 (58.4%) disseminated TB. Among them, 127 (76.5%) were cured and 15 (9.0%) had unsuccessful treatment. Median time for successful treatment was 10.8 months (6-32) during 18 months follow-up. There was no statistically significant difference in outcome of tuberculosis between the NVP and EFV base regimens in combination with rifampicin (5.4% vs. 10.8%, p = 0.751). CONCLUSION: Majority of HIV patients on ARTwith tuberculosis were successfully treated with antiTB drugs with median time of 10.8 months and no significant difference ofadverse events reported between NVP and EFV