Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Cardiovascular disease (CVD) has been reported to be a major cause of both morbidity and premature mortality in systemic lupus erythematosus (SLE) patients. ⋯ Lupus damage, waist circumference more than 90 centimeters in male or more than 80 centimeters in female were the independent risk factors for CVD in SLE patients.
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Severe sepsis, septic shock and bacteremia are critical illnesses, and patients with these conditions require close monitoring and immediate medical treatment. Any delay in diagnosis may lead to an increase in mortality in such critically ill patients. Serum procalcitonin (PCT) has emerged as a highly accurate biomarker for differentiating sepsis from other non-infectious triggers. ⋯ PCT can be usefully employed as a promising chemical biomarker to differentiate the severity of infections in critically ill patients. Used together with clinical data, the PCT value of ≥ 2 ng/dL is efficient in categorizing such patients as having severe sepsis, septic shock or bacteremia.
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Acute pulmonary embolism (PE) is associated with a variety of non-specific clinical manifestations. Using diagnostic algorithms that are based on internationally recognized guidelines, pulmonary computed tomography angiography (CTA) serves as the gold standard diagnostic imaging tool in PE. However; inappropriate use of pulmonary CTA may lead to unnecessary radiation exposure, contrast exposure, and cost. Based on our review of the literature, there is no existing data regarding prevalence and appropriate use of pulmonary CTA in suspected acute PE in Thailand. ⋯ This was the first study to investigate prevalence of positive pulmonary CTA for acute PE in a large university-based tertiary referral hospital in Thailand Prevalence of positive test for PE by pulmonary CTA in patients with suspected acute PE was approximately 33%. Sign of DVT S1Q3T3 pattern, and enlarged right pulmonary artery were significant clinical predictors of positive pulmonary CTA. Positive pulmonary CTA result was much less likely in patients with low probability, especially in the absence of thromboembolic risk factors and positive D-dimer This study emphasized the importance and value of accurate and effective triage in reducing both patient care costs and patient radiation exposure.
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Randomized Controlled Trial
Target Controlled Infusion versus Sevoflurane/Desflurane Anesthesia for Laparoscopic Cholecystectomy: Comparison Postoperative Nausea/Vomiting and Extubation Time.
Target-controlled infusion (TCI) systems have been developed from manually controlled infusion systems and have rapidly increased in popularity, especially in laparoscopic surgery. Propofol is claimed to decrease nausea and vomiting. ⋯ Laparoscopic cholecystectomy under propofol with TCI is one option of anesthetic technique with a significantly lower incidence of PONV compared with both sevoflurane and desflurane otherwise there is no statistical difference in the extubation time. Propofol-TCI technique is suggested for laparoscopic and ambulatory surgery.
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Randomized Controlled Trial
Efficacy and Safety of Single Botulinum Toxin Type A (Botox®) Injection for Relief of Upper Trapezius Myofascial Trigger Point: A Randomized, Double-Blind, Placebo-Controlled Study.
Botulinum toxin injection has been applied for pain relief in various chronic pain syndromes. Recently, systematic review studies reported inconclusive effects of Botulinum toxin in myofascial pain management. The present study aimed to demonstrate the efficacy and safety of Botulinum toxin type A (BTxA) (Botox®) injection for pain reduction in myofascial trigger point (MTrP) of the upper trapezius muscle. ⋯ The efficacy in VAS reduction of a single 20 IU of Botulinum toxin type A (Botox®) injection was not different from 0.9% NaCl for myofascial trigger point at the upper trapezius muscle. However Botulinum toxin type A (Botox®) showed statistically significant more increased in pressure pain threshold at 6-week after injection without severe adverse effects.