Journal of the Medical Association of Thailand = Chotmaihet thangphaet
-
Observational Study
Incidence of major adverse cardiac event in low risk chest pain patients in emergency department of Rajavithi Hospital.
Acute myocardial infarction is a major problem of public healthcare in Thailand. In the emergency room, patients who present chest pain are at low risk for myocardial infarction and short term risk of adverse cardiac events. In the present study, the incidence of major adverse cardiac events among low risk chest pain patients who presented at the emergency room of Rajavithi Hospital was investigated to improve treatment in the future. ⋯ Incidence of a major adverse cardiac event within 30 days among low risk chest pain patients was low. No significant difference was observed between each group of TIMI score 0-2 for major adverse cardiac event and no significant risk factor was found for major adverse cardiac events in low risk chest pain patients.
-
Clinical Trial
Predictors for low disease activity and remission in rheumatoid arthritis patients treated with biological DMARDs.
Optimal outcome of treatment in rheumatoid arthritis (RA) is early clinical remission to delay joint damage. Therefore, severe RA patients with inadequate response to conventional disease modifying anti-rheumatic drugs (cDMARDs) need highpotency drug as biological DM4RDs (bDMARDs). In general, one-third of RA patient could not get into disease remission with cDMARDs, and half ofthem are still suffering from severe arthritis. However, high cost of this agent is the major barrier for patient engagement, and it is affordable to only 5-10% of patients. We need a good strategy to distribute bDMARDs to patients, especially in limited resource situation. ⋯ Chance to control rheumatoid arthritis in the level of remission or low disease activity is predicted by time of bDAMRDs exposure. This result is mainly influenced by dose ofmethotrexate and number of cDMARDs.
-
Pheochromocytoma (PCC) and paraganglioma (PGL) are uncommon tumors. Clinical manifestations are mass effect or hormone secretion. The initial manifestation with pericardial effusion is rare. ⋯ Pericardial effusion may be the first manifestation of paraganglioma especially if the patient had hypertension or could not find the etiology. Thus, pericardial effusion should be investigated for paraganglioma. Due to long term follow-up, this indolent growing tumor may respond to NSAIDs or regress spontaneously.