Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Septic shock is a major healthcare problem effecting people worldwide with high mortality rate. Administering early and appropriate interventions can help improve the outcome. The 6-hour bundle, launched by the Surviving Sepsis Campaign committee was part of efforts to incorporate evidence-based guideline to clinical practice. There were many reports on outcome improvement of septic shock patients after implementation of the 6-hour bundle at the emergency department. ⋯ Septic shock mortality was decreased after implementation of the 6-hour sepsis protocol at the emergency department of Thammasat University Hospital.
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Autism spectrum disorder (ASD) is a common neurodevelopmental disorder in children. The clinical spectrum of ASD includes autism, childhood disintegrative disorder Asperger syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS). Although the DSM-IVcriteria are well acceptedforASD diagnosis, there are some known limitations for clinicians. The most important issue is lack'ofspecific age-appropriate items in each domain. Thus, the DSM-IVneeds some modifications in order to be appropriate for clinical use. ⋯ The newly developed structured interview for Thai children with ASD had a high level ofinterrater reliability between four clinicians. However, most children tested using this structured interview were 2-5years ofage, and the study did not include non-autistic groups. The application ofthis structured interview needs further study with a wider variety ofcases, such as ASD cases from different age groups, children with delayed development and normal children.
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Therapeutic hypothermia has been recently approved to show benefits for neurological outcomes in patients after cardiac arrest. Application of both ECMO and surface coolingfor treatment of therapeutic hypothermia has not yet been reported in the literature. We reported four cases that experienced in-hospital cardiac arrest during ECMO application treated with therapeutic hypothermia under surface cooling at Thammasat University Hospital. ⋯ Application of surface cooling together with extracorporeal membrane oxygenation (ECMO) is safe and feasible. Both devices facilitate treatment with therapeutic hypothermia in patients with post-cardiac arrest.
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Deltoid splitting is one of common and useful approaches in proximal humerus surgery. The disadvantage of this approach is high risk of axillary nerve injury. Nowadays, there is no consensus in the proper mean of the individual's axillary nerve location. ⋯ There is linear correlation between distance from the lateral acromial edge to axillary nerve and the upper arm length. The authors can predict the danger zone in the location of the anterior upper branch of the axillary nerve. However, further clinical study may helpful to prove the equations. Level ofevidence: Basic science anatomy study.
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According to controversial guideline for management in case of hemodynamically stable blunt abdominal injury with microscopic hematuria. Most ofthe patients could be omittedfor abdominal computed tomography (CT). Despite high sensitivity and specificity ofabdominal CT, in addition to high medical cost, there are risks from radiation exposure and adverse reaction from use of contrast media. ⋯ One-third ofthe patients have KUB injury but almost all ofthem could be conservatively managed. We proposed that the cutoffpoint of hematuria be equivalent to or greater than 20 cells/hpf to be one of the indicators for predicting KUB injury that needs radiological evaluation; but it should be carefully considered along with clinical information.