Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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In patient with non-valvular atrial fibrillation (AF), over 90% of thrombus accumulation originates in the left atrial appendage (LAA). Warfarin significantly reduces risk of stroke. However, long-term anticoagulant therapy is associated with a significant risk of major bleeding, particularly in elderly. Transcatheter occlusion of left atrial appendage with Watchman device has proved to be non-inferior to warfarin in preventing stroke in non-valvular AF patients. No previous report of transcatheter occlusion of LAA was found in Thailand ⋯ The result of the present study showed that percutaneous LAA occlusion with the Watchman device was feasible and safe. The successfulness of the procedures and periprocedural complications were similar to standard in literature.
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To determine long term effectiveness of trauma team activation criteria by measuring emergency department length of stay (EDLOS) and 28-day mortality. ⋯ Trauma team activation criteria significantly improved acute trauma care in the emergency department and decreased mortality.
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Randomized Controlled Trial
The Changes in Cortisol Levels during Cardiac Surgery: A Randomized Double-Blinded Study between Two Induction Agents Etomidate and Thiopentone.
To study the changes in cortisol levels during and after cardiac surgery after an inductive dose of either etomidate or thiopentone and their consequences. ⋯ ClinicalTrials.gov as NCT01495949.
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Many steps of myocardial preservation during open heart surgery are practical after the development of the heart-lung machine. A cardioplegia solution, infused after aortic cross clamping, is an important aspect. Two-thirds of cardioplegia solutions are an intracellular solution (such as HTK or Bretschneider solution) or extracellular solution (such as blood cardioplegia). Intracellular cardioplegia solution can provide protection for 3-4 hours after one-time infusion, which differs from extracellular cardioplegia solution requiring intermittent use every 20-30 minutes. ⋯ There was significantly more spontaneous ventricular fibrillation after release of cross clamping in HTK group. Clinical outcome of single doses of antegrade, cold Custodiol-HTK cardioplegia solution in CABG surgery protected the myocardium equally well as repetitive antegrade, cold blood cardioplegia.
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There is an absence of data describing pediatric patients who visit Emergency Department (ED) in Thailand. Therefore, this report creates a profile of pediatric emergency room visit at a university hospital in Thailand. ⋯ Pediatric patients attending the emergency service were mostly for medical conditions. Acute illnesses were the major group ofpediatric patients. A small proportion of visits in ED were true emergencies.