Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Ornithine transcabamylase (OTC) deficiency is the most common and severe form of abnormal urea synthesis. It can result in hyperammonemia, severe neurologic manifestation, brain edema, and early death. Rapid removal of ammonia by hemodialysis can decrease mortality and morbidity in the patients with severe increase of ammonia levels. ⋯ Continuous venovenous hemofiltration (CVVH) is increasingly used as an alternative for HD, but performing CVVH in a neonate can be problematic due to small body size and difficult vascular access. The authors reported a successful CVVH using umbilical vein as a vascular access site for ammonia removal in a neonate with OTC deficiency with progressive elevation of plasma ammonia. Technical problems, pitfalls in performing the CVVH, and how the authors overcame the problems are discussed.
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To evaluate the effectiveness of the uterine compression suture (B-Lynch and modified B-Lynch suture) in avoiding hysterectomy in cases ofpostpartum hemorrhage and in eliminating the need for surgical intervention to arrest bleeding. ⋯ The present study showed that the B-Lynch suture is an effective and safe surgical option for treatment of intractable postpartum hemorrhage with no apparent adverse outcomes. The procedure should be taught to any physician who deals with parturition and should be applied as standard protocol for the management of PPH in the operating room.
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Randomized Controlled Trial
Efficacy of benzydamine hydrochloride dripping at endotracheal tube cuff for prevention of postoperative sore throat.
Postoperative sore throat (POST) is a frequent consequence following ETT intubation, which may negatively affect the postoperative course and patient satisfaction. Benzydamine hydrochloride is a topically-applied non-steroidal anti-inflammatory drug (NSAID). The authors evaluated the analgesic effect of benzydamine hydrochloride dripping on the ETT cuff on POST. ⋯ We found that dripping benzydamine hydrochloride on the ETT cuff neither reduced the incidence of POST nor increased the incidence of adverse effects in comparison with no intervention.
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Randomized Controlled Trial
Pharmacodynamics of meropenem in critically ill patients with ventilator-associated pneumonia.
Pharmacokinetic changes have been found in critically ill patients, including ventilator-associated pneumonia (VAP) when compared with healthy volunteers leading to fluctuation of plasma concentrations. ⋯ A 3-hour infusion of 2 g of meropenem regimen was predicted to have the highest PTA rates. Only the prolonged infusion regimens achieved a high CFR against E. coli, Klebsiella spp., P. aeruginosa, and Acinetobacter spp.
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Multi-drug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) becomes an increasing problem in management. Linezolid has been off-label used in treatment of MDR/XDR-TB with major adverse effects. ⋯ Linezolid has good efficacy in treatment of MDR/XDR-TB with major adverse effect and should be used with caution. If capreomycin is susceptible or likely active, long-term injection should be considered when likely active drugs are not enough to strengthen the regimen.