Arth Nana
Mahidol University, Medicine, Faculty Member
In a preliminary prospective study, eleven outpatients undergoing fibreoptic bronchoscopy using a titrated dose of topical lignocaine anaesthesia were studied. Patient comfort, lignocaine dosage and resultant plasma concentrations were... more
In a preliminary prospective study, eleven outpatients undergoing fibreoptic bronchoscopy using a titrated dose of topical lignocaine anaesthesia were studied. Patient comfort, lignocaine dosage and resultant plasma concentrations were measured at four stages during the procedure. Large total doses, mean 512 (SD 55) mg lignocaine, were frequent and systemic absorption was unpredictable with two patients having plasma concentrations in the toxic range (>5μg/ml). Peak plasma concentrations, mean 2.3 (SD 1.4) μg/ml, occurred 30 to 40 minutes after commencement of topical application and coincided with completion of the procedure. No correlation was found between the individual dose of lignocaine administered and either the resultant plasma concentration or patient comfort scores. In an effort to minimise potential lignocaine toxicity, a fixed total dose technique (lignocaine 370 mg) was studied in a further twenty-one patients. No change in patient comfort scores and no toxic plasma...
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To determine the efficacy of doxycycline in producing pleuroedesis in patients with malignant pleural effusion (MPE), 31 documented cases of MPE, aged 19-82 years were prospectively studied. Pleural sclerosis was done with 500 mg of... more
To determine the efficacy of doxycycline in producing pleuroedesis in patients with malignant pleural effusion (MPE), 31 documented cases of MPE, aged 19-82 years were prospectively studied. Pleural sclerosis was done with 500 mg of doxycycline. Response regarding respiratory symptoms and pleural fluid accumulation were evaluated monthly. At one month, 27 patients were evaluable (4 dropped out). All responded and required no therapeutic thoracentesis. At 3 months, 13 patients dropped out, only 14 patients were evaluable. It revealed that 13 out of 14 patients (92%) responded. Only one patient failed and required therapeutic thoracentesis. Five and two patients came for assessment at 6 and 12 months, respectively. They still benefited from doxycycline pleurodesis. Side effects including low grade fever in 30% of patients, moderate to severe pain in 60% and troublesome cough with hemoptysis in one patient (3%) were noted. Doxycycline is an effective agent in controlling MPE. It was successful in every patient at 1 month and in 92% at 3 months. At 6 and 12 months quite a few patients survived for evaluation. However, they still benefited from doxycycline pleurodesis. Side effects were tolerable.
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We examined the relationships between certain clinical and physiological data from 56 patients with chronic obstructive pulmonary disease, and have formulated 15 relevant equations from which various respiratory indices can be estimated.... more
We examined the relationships between certain clinical and physiological data from 56 patients with chronic obstructive pulmonary disease, and have formulated 15 relevant equations from which various respiratory indices can be estimated. Multiple linear regressions thus obtained evidently suggest that airway resistance and ventilatory drive are the main factors in the control of breathing among Thai COPD subjects; the exercise tolerance test showed some correlation with airflow obstruction and with respiratory muscle strength. Clinical implementation of certain findings has been outlined.
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The safety and efficacy of enprofylline were studied in 55 moderately severe asthmatic patients [forced expiratory volume in 1 s (FEV1) and peak expiratory flow rate (PEFR) no more than 50% of predicted values] presenting with an acute... more
The safety and efficacy of enprofylline were studied in 55 moderately severe asthmatic patients [forced expiratory volume in 1 s (FEV1) and peak expiratory flow rate (PEFR) no more than 50% of predicted values] presenting with an acute attack. A bolus injection of 1.5 mg/kg enprofylline was given over 20 min and then maintenance infusion of 0.4 mg/kg.h enprofylline for up to 24 h. On admission, 200 mg hydrocortisone was administered intravenously and additional oxygen and/or inhaled beta 2-agonist therapy was permitted after 1 h; this additional therapy was given to 39 patients. The bolus injection increased the PEFR from 121 +/- 44 l/min to 164 +/- 49 l/min at 20 min, with a further improvement during the maintenance infusion to 200 +/- 79 l/min at 24 h. Heart rate and blood pressure decreased towards normal in parallel with the improvement in lung function. The mean steady-state enprofylline plasma concentration was slightly higher than predicted. The mean renal clearance and reco...
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The normal spirometric reference values for Thai people are still not yet available. The aim of this study was to establish standard spirometric equations for Thai people. Subjects 10 years of age and over were selected and their... more
The normal spirometric reference values for Thai people are still not yet available. The aim of this study was to establish standard spirometric equations for Thai people. Subjects 10 years of age and over were selected and their demographic distributions represented that of the population of the whole country. Inclusion criteria were strictly lifetime nonsmokers, no history of chronic cardiopulmonary disease (using a modified ATS--DLD 78 respiratory adult questionnaire), normal standard chest radiograph and unremarkable physical examination. They had to be without respiratory symptoms at the time of the study. Spirometric values were obtained by 5 turbine system 'Pony graphic' (Cosmed, Italy) spirometers which met ATS recommendations. A normal group of 2299 women and 1655 men were selected. Regression analyses using sex, height and age as independent variables were used to provide equations for predicted values. The results were: [table: see text] FVC and FEV1 from this study are close to the Chinese but are 8-20 per cent lower than the Caucasians. These predicted equations are recommended to be used for future reference values in the Thai population.
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To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. The authors reviewed the data from OSA patients in Siriraj... more
To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. The authors reviewed the data from OSA patients in Siriraj Sleep Clinic from April 2005 to September 2006. Objective measurement for sleepiness (Epworth Sleepiness Scale, ESS), anthropometric measurements [body mass index (BMI), neck circumference, thyromental distance, Mallampati S score, and occlusion pattern] and polysomnographic recordings [apnea/hypopnea index (AHI) during REM and NREM periods, respiratory arousal index, periodic leg movement index, minimal oxygen saturation, total sleep time with oxygen saturation <90%, and desaturation index] were collected. The patients were stratified into the non-obese group and obese group if their BMI was <27 or > or =27 kg/m2 respectively. Of the total 158 patients, 71 were non-obese and 87 were obese, no difference in mean age and sex was observed, but ...
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Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic... more
Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of ...
Research Interests: Thailand, Medicine, Probability, Humans, Female, and 13 moreMale, ROC Curve, Aged, Spirometry, Analysis of Variance, Cost Benefit Analysis, Chronic obstructive pulmonary disease, Urban Population, Geriatric Assessment, Cross Sectional Studies, Logistic Models, Case Control Studies, and mass Screening
Percutaneous dilatational tracheostomy (PDT) was increasingly performed after the commercial kit was available in 1985. Several studies showed that PDT was equivalent to surgical tracheostomy considering perioperative and long-term... more
Percutaneous dilatational tracheostomy (PDT) was increasingly performed after the commercial kit was available in 1985. Several studies showed that PDT was equivalent to surgical tracheostomy considering perioperative and long-term complications and PDT was more cost-effective and provide greater feasibility in terms of bedside capacity and nonsurgical operation. The data of patients who were performed PDT at Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital were retrospectively reviewed since March 2007 to December 2011. All procedures were done at bedside in intensive care unit or general ward of internal medicine under intravenous anesthesia. PDT was performed by using Griggs' technique. This technique is based on Seldinger guidewire technique and uses the guidewire dilator forceps (GWDFs) to enlarge the hole in the trachea under flexible bronchoscopic visualization. Ninety-one patients were enrolled with a mean age...
Research Interests: Thailand, Adolescent, Medicine, Hospitals, Humans, and 7 moreFemale, Male, Young Adult, Aged, Middle Aged, Adult, and Tracheostomy
BACKGROUND Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical... more
BACKGROUND Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical thoracoscopy based upon 10 years experience. MATERIAL AND METHOD Medical thoracoscopy was first performed in our unit in 1998. The early indication was undiagnosed pleural effusion. Other indications which were empyema, pneumothorax and talc pleudrage were carried on for the last 3 years. The patients' demographic data, indication for medical thoracoscopy, procedures, complication and outcome were recorded and analyzed separately. RESULTS During 1998 to 2007, there were 142 procedures of medical pleuroscopy performed. There were 86 procedures for the indication of undiagnosed pleural effusion. The diagnostic yield was 95.2%. The malignancy was recovered by thoracoscopy in 45.35% of procedure. For indication of talc pleurodesis, there were 22 patients wi...
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Background : Several reports have suggested that about one-fifth of car accidents are sleep-related and obstructive sleep apnea (OSA) is one of the major causes of increased daytime sleepiness. Various reports from western countries have... more
Background : Several reports have suggested that about one-fifth of car accidents are sleep-related and obstructive sleep apnea (OSA) is one of the major causes of increased daytime sleepiness. Various reports from western countries have shown that different groups of drivers, especially truck drivers have a high prevalence of OSA, which may play a part in the occurrence of car accidents. Objectives : To determine the frequency of OSA and other sleep related problems in a group of professional drivers. Study design : Descriptive study. Methods : All 21 male professional drivers at one government hospital, aged between 27-57 years old, were recruited to the study. Data were collected by clinical examination, questionnaire and overnight polysomnography. OSA was defined as a Respiratory Disturbance Index (RDI) or an apnea / hypopnea index of over 5 events per hour. Results : The prevalence of OSA was 4%. Only 1 subject had severe OSA with an RDI of 102. None of them reported having car...
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OBJECTIVE Silicosis is the most common occupational lung disease in Thailand. Determinants of pulmonary function impairment in Thai silicotic patients have not been mentioned before. MATERIAL AND METHOD The present study was conducted in... more
OBJECTIVE Silicosis is the most common occupational lung disease in Thailand. Determinants of pulmonary function impairment in Thai silicotic patients have not been mentioned before. MATERIAL AND METHOD The present study was conducted in silicotic patients who attended the Siriraj Occupational Lung Clinic in the year 2006. Patients were classified according to the forced expiratory volume in one second (FEV1) into the severe impairment group (< 50% predicted) and the non-severe group (FEV1 > 50% predicted) which includes normal FEV1. Comparison between the two groups in terms of demographic characteristics, smoking history, history of pulmonary tuberculosis, and radiographic features were assessed. RESULTS Thirty-four patients of which 24 were female (70.6%) had an overall mean age of 53.7 years. Seven patients (20.6%) had severe impairment, four were female, three were smokers, and two had a history of pulmonary tuberculosis. All of the severe impairment patients had nodule p...
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Patients with obstructive sleep apneoa (OSA) are at increased risk for coronary artery disease and cerebrovascular disease. Higher platelet activation and improvement after treatment with continuous positive airway pressure (CPAP) have... more
Patients with obstructive sleep apneoa (OSA) are at increased risk for coronary artery disease and cerebrovascular disease. Higher platelet activation and improvement after treatment with continuous positive airway pressure (CPAP) have been demonstrated. Platelet function as determined by plasma level of β-thromboglobulin β-TG), was studied in 37 patients with polysomnographic verified OSA (mean apnoea/hyponoea index, AHI, 58.1 ± 26.8 n/h) before and after treatment with CPAP for seven days. Increased platelet activation in OSA patients was demonstrated by higher baseline plasma level of β-TG than normal (47.3 ± 4.2 IU/L). There was no significant change after 7-day treatment period (43.3 ± 3.4 IU/L, p = 0.42). Considering between subgroups of responder (21 patients) and non-responder (16 patients), only the difference of arousal index correlated with the response to CPAP treatment. Although platelet dysfunction was demonstrated in patients with obstructive sleep apneoa, response to...
This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the... more
This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the gold standard of diagnosis based on the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated and completed all the tests. The results showed that the cut-off miniPEF percentage of predicted value of highest average accuracy was 62 per cent. The sensitivity was 72.7 per cent (95% CI 67.0-78.6) and the specificity was 81.1 per cent (95% CI 79.7-82.5) The cost of screening 19 elderly to detect one case of COPD is 923 baht, with a false negative rate of 1.9 per cent (95% CI 1.3-2.5%) and a false positive rate of 17.5 per cent (95% CI 15.4-19.6%). It is suggested that measuring a miniPEF is regarded as one of the cost-effective screening tests for COPD in the elderly.
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. A lower serum folate level is common in older populations and is associated with increased serum homocysteine concentration. In turn, an elevated homocysteine level is associated with increased risk of cardiovascular disease and... more
. A lower serum folate level is common in older populations and is associated with increased serum homocysteine concentration. In turn, an elevated homocysteine level is associated with increased risk of cardiovascular disease and age-related diseases. Contemporary studies of folate and dietary risk factors for cardiovascular disease among the elderly population in Thailand are lacking. This cross-sectional study aimed to investigate the relationships among serum folate, homocysteine level, and nutritional status in the elderly Thai. Three hundred individuals, aged 60 years and over, underwent anthropometric and physiological measurements, and biochemical parameters, and eating habits were also determined. Folate insufficiency was found in approximately 35% of subjects. Folate and homocysteine showed a significant inverse correlation. Serum homocysteine levels rose with increasing age. Folate deficiency and high waist-to-hip ratio were associated with 7-fold and 2.5-fold increased risk for hyperhomocysteinemia, respectively. There were positive correlations between homocysteine and waist-to-hip ratio and systolic blood pressure, but a negative correlation between homocysteine and high-density lipoprotein ( r = −0.239, p
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Objective: To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. Material and method: The authors reviewed the data... more
Objective: To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. Material and method: The authors reviewed the data from OSA patients in Siriraj Sleep Clinic from April 2005 to September 2006. Objective measurement for sleepiness (Epworth Sleepiness Scale, ESS), anthropometric measurements [body mass index (BMI), neck circumference, thyromental distance, Mallampati S score, and occlusion pattern] and polysomnographic recordings [apnea/hypopnea index (AHI) during REM and NREM periods, respiratory arousal index, periodic leg movement index, minimal oxygen saturation, total sleep time with oxygen saturation <90%, and desaturation index] were collected. The patients were stratified into the non-obese group and obese group if their BMI was <27 or > or =27 kg/m2 respectively. Results: Of the total 158 patients, 71 were non-obese and 87 were obese, no difference in mean age and sex was observed, but more patients with hypertension and coronary artery disease were noted in the obese group. Mean ESS was not different between the 2 groups. In anthropometric measurements, the obese group had statistically significant large neck circumference (41.6 +/- 3.5 cm vs. 37.0 +/- 2.9 cm, p<0.001), but the nonobese group had a shorter thyromental distance (56.4 +/- 11.7 mm vs. 61.4 +/- 11.2 mm, p=0.006), with no significant difference in Mallampatis score and occlusion pattern. In polysomnographic data, the obese group had statistical significantly more severity of various indices except for AHI during the REM period and the periodic limb movement index. Conclusion: Non-obese obstructive sleep apnea patients have more bony structural change than the obese ones as demonstrated by shorter thyromental distance. But degree of abnormalities during sleep was less severe in nearly all aspects.
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ABSTRACT
Peripheral pulmonary lesions are technically challenging with conventional bronchoscopy in obtaining tissue diagnosis. The recently developed small-caliber ultrasonographic probe can be introduced via the working channel of a flexible... more
Peripheral pulmonary lesions are technically challenging with conventional bronchoscopy in obtaining tissue diagnosis. The recently developed small-caliber ultrasonographic probe can be introduced via the working channel of a flexible bronchoscope to localize peripheral pulmonary lesions (PPLs) prior to transbronchial lung biopsy (TBLB). The endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) is a new diagnostic method for the diagnosis of pulmonary lesions in our center. To evaluate the diagnostic yield of EBUS-TBLB in pulmonary lesions. A prospective cross-sectional study. We enrolled 152 patients with pulmonary lesions that were beyond the segmental bronchus and had no evidence of endobronchial lesion, who underwent bronchoscopy in our center. With EBUS assisted, transbronchial lung biopsy was performed after localizing and measuring distance from the tip of bronchoscope to the lesion. The diagnostic yield was calculated. The pulmonary lesions were visible on E...
The associations between Chlamydophila (Chlamydia) pneumonia infection and chronic asthma or bronchial hyper-responsiveness (BHR) have been inconclusive. We aimed to determine the association between C. pneumonia infection and asthma as... more
The associations between Chlamydophila (Chlamydia) pneumonia infection and chronic asthma or bronchial hyper-responsiveness (BHR) have been inconclusive. We aimed to determine the association between C. pneumonia infection and asthma as well as BHR in the adult Thai population. This nested case-control study retrieved the data from a nation-wide Respiratory Health Survey (2001-02) in the adult population (age 20-44 year) in Thailand. Each subject underwent questionnaire interview, spirometry, bronchoprovocative test, skin prick test for common aeroallergens and venous blood collection. Subjects with BHR (n = 79) including those with asthma (n = 52), were randomly selected as cases. Subjects without BHR or asthma were also randomly selected as the control (n = 137). We used the stored serums for the C. pneumonia serologic assay including IgA, IgG and IgM by microimmunofluorescence (MIF) technique. There is no significant relationship between chronic Chlamydia infection (IgG > or =...
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Silicosis is the most common occupational lung disease in Thailand. Determinants of pulmonary function impairment in Thai silicotic patients have not been mentioned before. The present study was conducted in silicotic patients who... more
Silicosis is the most common occupational lung disease in Thailand. Determinants of pulmonary function impairment in Thai silicotic patients have not been mentioned before. The present study was conducted in silicotic patients who attended the Siriraj Occupational Lung Clinic in the year 2006. Patients were classified according to the forced expiratory volume in one second (FEV1) into the severe impairment group (< 50% predicted) and the non-severe group (FEV1 > 50% predicted) which includes normal FEV1. Comparison between the two groups in terms of demographic characteristics, smoking history, history of pulmonary tuberculosis, and radiographic features were assessed. Thirty-four patients of which 24 were female (70.6%) had an overall mean age of 53.7 years. Seven patients (20.6%) had severe impairment, four were female, three were smokers, and two had a history of pulmonary tuberculosis. All of the severe impairment patients had nodule profusion in category 2 and had large o...
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To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. The authors reviewed the data from OSA patients in Siriraj... more
To compare the clinical features, anthropometric indices, and polysomnographic data between different body mass index (BMI) subgroups of obstructive sleep apnea (OSA) patients. The authors reviewed the data from OSA patients in Siriraj Sleep Clinic from April 2005 to September 2006. Objective measurement for sleepiness (Epworth Sleepiness Scale, ESS), anthropometric measurements [body mass index (BMI), neck circumference, thyromental distance, Mallampati S score, and occlusion pattern] and polysomnographic recordings [apnea/hypopnea index (AHI) during REM and NREM periods, respiratory arousal index, periodic leg movement index, minimal oxygen saturation, total sleep time with oxygen saturation <90%, and desaturation index] were collected. The patients were stratified into the non-obese group and obese group if their BMI was <27 or > or =27 kg/m2 respectively. Of the total 158 patients, 71 were non-obese and 87 were obese, no difference in mean age and sex was observed, but ...
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To evaluate the effect of long-term treatment with continuous positive airway pressure (CPAP) on the heart rate variability (HRV) of obstructive sleep apnea (OSA) patients. Patients with moderate to severe OSA who had never used CPAP... more
To evaluate the effect of long-term treatment with continuous positive airway pressure (CPAP) on the heart rate variability (HRV) of obstructive sleep apnea (OSA) patients. Patients with moderate to severe OSA who had never used CPAP treatment were enrolled. Short recording HRV analysis was performed at baseline then at one, three, and six months after CPAP treatment. The measurement included low frequency HRV (LF), high frequency HRV (HF), low frequency to high frequency ratio (LHR), and standard deviation of R-R intervals (SDNN). All domains were measured both during spontaneous and deep breathing. There were 10 patients in the present study, all were men with the mean age of 45 years, mean body mass index 29.3 kg/m2, mean apnea-hypopnea index 60.9 events/hour, and mean average CPAP usage 4.8 hours/night. The HRV showed no significant change after one and three months of CPAP treatment. At 6 months, the only significant change was the SDNN measured after deep breathing (28.80 +/- ...
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Our previous studies demonstrated the high prevalence and incidence of Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly, as well as the cost-effectiveness of a questionnaire, chest radiography, and mini peak... more
Our previous studies demonstrated the high prevalence and incidence of Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly, as well as the cost-effectiveness of a questionnaire, chest radiography, and mini peak expiratory flow rate (miniPEF) as screening tools. This final study aimed to identify the most cost-effective screening method among individual, serial and parallel combinations of the above tools, based on the guidelines for diagnosing COPD of the Thoracic Society of Thailand. There were 3,094 elderly aged 60 years and over in 124 urban communities around Siriraj Hospital who participated and completed all the tests. The results showed that the most cost-effective screening method was the miniPEF at cut-off percentage of 62 per cent of predicted value. This needed to screen 19 elderly people at a cost of 923 baht to detect one case of COPD, with a false negative rate of 1.9 per cent (95%CI 1.3-2.5), a false positive rate of 17.5 per cent (95%CI 15.4-19.6)....
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This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the... more
This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the gold standard of diagnosis based on the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated and completed all the tests. The results showed that the cut-off miniPEF percentage of predicted value of highest average accuracy was 62 per cent. The sensitivity was 72.7 per cent (95% CI 67.0-78.6) and the specificity was 81.1 per cent (95% CI 79.7-82.5) The cost of screening 19 elderly to detect one case of COPD is 923 baht, with a false negative rate of 1.9 per cent (95% CI 1.3-2.5%) and a false positive rate of 17.5 per cent (95% CI 15.4-19.6%). It is suggested that measuring a miniPEF is regarded as one of the cost-effective screening tests for COPD in the elderly.
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Clonidine was used to reduce withdrawal symptoms of nicotine and increase the success rate of smoking cessation in the smoking cessation clinic of Siriraj Hospital. One hundred and fourteen subjects enrolled in a double-blind, randomised,... more
Clonidine was used to reduce withdrawal symptoms of nicotine and increase the success rate of smoking cessation in the smoking cessation clinic of Siriraj Hospital. One hundred and fourteen subjects enrolled in a double-blind, randomised, placebo-controlled trial. Subjects were divided as clonidine group (n = 58) with the mean age of 38 years and placebo group (n = 56) with the mean age of 33 years. Both groups received information about harmful effects of smoking as well as behavioral modification protocol. The dose of clonidine used in this study was 300 micrograms and the duration of the trial was 5 weeks. Both subject groups attended the clinic weekly and received identical counselling. Clonidine did not reduce withdrawal symptoms of nicotine when compared to the placebo and the success rate of smoking cessation at the end of the 5 weeks&amp;amp;amp;amp;amp;amp;#39; period was identical between the two groups (clonidine 50%; placebo 48%, p &amp;amp;amp;amp;amp;amp;gt; 0.05). No significant side effects of clonidine were found. There was no correlation between background educational level, income, amount of cigarettes smoked per day and the success rate in both groups. In conclusion, clonidine did not show any beneficial effect on smoking cessation.
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Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powder inhaler (Turbuhaler) with pressurized metered-dose inhaler (pMDI), were included in... more
Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powder inhaler (Turbuhaler) with pressurized metered-dose inhaler (pMDI), were included in this 1-week follow-up study with the aim of assessing whether inhaled budesonide via Turbuhaler may be an alternative to prednisolone tablets after an acute asthma attack. Eighty-one patients with a mean age of 38 years and forced expiratory volume in 1 sec (FEV1) of 64% predicted normal value after treatment with salbutamol were randomized in this double-blind, double-dummy, parallel-group study. The doses given were budesonide 1600 microg b.i.d. or prednisolone in daily doses from 40 mg (day 1) decreased to 5 mg (day 7). FEV1 was recorded before and after the 7-day treatments and peak expiratory flow (PEF) morning and evening, clinical symptoms (visual analogue scale 0-100), and doses of rescue medication (terbutaline Turbuhaler 0.25 mg/dose) were recorded daily. The mean increase in FEV1 from baseline to day 7 was 17.3% in the budesonide Turbuhaler group and 17.6% in the prednisolone group. Mean values of morning PEF increased from day 1 to day 7 by 67 L/min in the budesonide Turbuhaler group and by 57 L/min in the prednisolone group (not significant). There were no statistically significant differences between the groups in clinical symptoms and in the number of doses of rescue medication. Because of disease deterioration, five patients in the Turbuhaler group and three in the prednisolone group needed additional symptomatic as well as corticosteroid treatment. Inhaled budesonide in high doses may be a substitute for oral therapy as follow-up treatment after an acute asthma attack.
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IMPLEMENTATION OF A SLEEP APNEA SCREENING PROTO-COL IN AN INPATIENT POPULATION Debra Repasky RRT, RPSGT* Darius Rhodes Zoroufy MD Ralph Pascualy MD Paul Doyle Brooke Brown Swedish Sleep Medicine Insti-tute, Seattle, WA PURPOSE: A ...
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... E-mail: pierre.ernst{at}clinepi.mcgill.ca. Next Section. Abstract. ... Wallace and colleagues (10) found no statistically significant excess of BHR among 66 seropositive subjects when compared with a volunteer control group (19.3 and... more
... E-mail: pierre.ernst{at}clinepi.mcgill.ca. Next Section. Abstract. ... Wallace and colleagues (10) found no statistically significant excess of BHR among 66 seropositive subjects when compared with a volunteer control group (19.3 and 12.9%, respectively). ...
Research Interests: Asthma, Urban Health, Quebec, HIV, Multivariate Analysis, and 15 moreHumans, Smoking, Male, American, Immunoglobulin E, Risk factors, Prevalence, Questionnaires, Adult, Hiv seropositivity, Risk Factors, Cross Sectional Studies, Predictive value of tests, Case Control Studies, and Medical and Health Sciences
This study aimed to explore the cost-effectiveness of using a questionnaire as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around Siriraj Hospital. The gold standard used for... more
This study aimed to explore the cost-effectiveness of using a questionnaire as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around Siriraj Hospital. The gold standard used for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. The questionnaire consisted of 10 questions on smoking status, respiratory symptoms and previous history of pulmonary tuberculosis. There were 3,094 elderly who participated, completed the questionnaire, and underwent spirometry as well as chest radiography in the community. The results showed that elderly individuals who are smokers (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.5 pack-year) or have ever experienced sudden cough with chest oppression or dyspnea when the weather changes or who have expectorated more than two tablespoons of sputum would be suspected of having COPD with a sensitiviy of 81.4 per cent (95% CI 79.4-83.4), specificity of 62.2 per cent (95% CI 60.4-64.0) false negative rate 1.2 per cent (95% CI 0.7-1.7) and false positive rate 38 per cent (95% CI 35.3-40.7) and subsequently required spirometry and chest X-ray for definitive diagnosis. The test needed to screen 17 elderly individuals to detect one COPD case at a cost of 1,538 baht. This questionnaire is also a self-assessment tool for COPD screening among the elderly in order to encourage them to seek for early medical attention and it is recommended that this should be publicized via the mass media.
Research Interests: Health Education, Thailand, Probability, Humans, Female, and 14 moreMale, Confidence intervals, Aged, Middle Aged, Questionnaires, Spirometry, Cost Benefit Analysis, Chronic obstructive pulmonary disease, Urban Population, Chi Square Distribution, Geriatric Assessment, Sensitivity and Specificity, Cross Sectional Studies, and mass Screening
BACKGROUND: Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical... more
BACKGROUND: Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical thoracoscopy based upon 10 years experience.MATERIAL AND METHOD: Medical thoracoscopy was first performed in our unit in 1998. The early indication was undiagnosed pleural effusion. Other indications which were empyema, pneumothorax and talc pleudrage were carried on for the last 3 years. The patients' demographic data, indication for medical thoracoscopy, procedures, complication and outcome were recorded and analyzed separately.RESULTS: During 1998 to 2007, there were 142 procedures of medical pleuroscopy performed. There were 86 procedures for the indication of undiagnosed pleural effusion. The diagnostic yield was 95.2%. The malignancy was recovered by thoracoscopy in 45.35% of procedure. For indication of talc pleurodesis, there were 22 patients with 3 who had early failure of pleurodesis because of trapped lung. After mean follow up of 124 days, 17 patients did not have recurrence of pleural effusion. 15 patients who had loculated pleural effusion were done medical thoracoscopy. Operations were successful in only 6 patients. For indication of pneumothorax 5 out of 6 procedures were successful after mean follow up of 167 days. In 12 empyema patients, mean hospital admission was 9.1 days after thoracoscopy. There was no serious complication from the procedure.DISCUSSION: There are many indications for medical thoracoscopy and the experience of the performer is the important factor determining success of the procedure. In undiagnosed pleural effusion, our result was comparable to other studies in the past in which the rate of malignancy was around 40-60%. The result of talc pleudrage was also comparable with the need to improve the diagnosis of trapped lung to prevent the unnecessary medical thoracoscopy. The result was excellent in patients who came for pleurodesis indicated in pneumothorax also in empyema but number of patient was still low. The problem was in loculated pleural effusion from malignancy which showed high failure rate. The early pleurodesis in malignant pleural effusion before it became loculated should be considered.CONCLUSION: Outcome of medical thoracoscopy varies from various indications. The success rate was high and decreasing in undiagnosed pleural effusion, pneumothorax, empyema and talc pleurodesis in malignant effusion. Great skill was needed to perform medical thoracoscopy in loculated malignant pleural effusion
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COPD substantially affects the national healthcare resource and healthcare cost especially among the older persons. Identifying the accurate prevalence and incidence reflects the scale of problem posed by COPD. This epidemiological study... more
COPD substantially affects the national healthcare resource and healthcare cost especially among the older persons. Identifying the accurate prevalence and incidence reflects the scale of problem posed by COPD. This epidemiological study using the criteria for diagnosing COPD based on ratio of FEV1.0/FVC less than 70 per cent and the reversibility of less than 15 per cent increase of post bronchodilator FEV1.0 in the absence of parenchymal lesions and cardiomegaly in CXR (PA and lateral view) revealed the prevalence (1998) of COPD among the 3094 older persons aged 60 years and over in the communities of Bangkok Metropolis 10 km around Siriraj Hospital was 7.11 per cent (95% CI: 6.21-8.01), whereas the incidence (1999) of COPD was 3.63 per cent (95% CI: 2.83-4.43). Both the prevalence and the incidence were increased with increasing age. The disease occurred predominantly among male smokers. The distribution of mild : moderate : severe COPD in the prevalence study was 5.6:2.2:1. The current findings also suggest that tobacco smoking is the prime important cause of COPD and the indoor pollution especially cooking smoke is not significant. In particular, the unexpectedly high incidence compared with prevalence in this population probably represents the warning message to the national policy maker for prompt and effective health promotion and disease prevention to prevent further social and economic loss.
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Research Interests:
We evaluated the immunogenicity of a reduced-dose intradermal trivalent, inactivated, split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease (COPD)... more
We evaluated the immunogenicity of a reduced-dose intradermal trivalent, inactivated, split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease (COPD) patients. One hundred and fifty-six COPD patients randomly received either 0.2 ml (6 microg hemagglutinin (HA) per strain) split into two-site intradermal (ID) injections or a single 0.5 ml (15 microg HA per strain) intramuscular (IM) injection. Geometric mean titers, seroconversion factors, seroconversion rates and seroprotection rates at 4 weeks post-vaccination in the ID group were less than those in the IM group. Only the seroconversion factor to influenza B in the ID group was statistically less than in the IM group (18.8 in the ID group, n=81 versus 37.3 in the IM group, n=75, p=0.045). Nevertheless, each strain of the ID vaccination met all the Committee for Proprietary Medicinal Products (CPMP) criteria. Seroprotection rates were above 60% throughout the year in influenza A (H3N2), for at least 6 months in influenza A (H1N1) and at least 4 weeks in influenza B in both ID and IM groups. The reduced-dose intradermal vaccination may be considered for use in COPD patients in a vaccine shortage situation.
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Research Interests:
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The Asian Pacific Society of Respirology held its 13th Congress in Bangkok, Thailand, between 19 and 22 November 2008. It was attended by over 1500 delegates from around the world, particularly well represented by delegates from the Asia... more
The Asian Pacific Society of Respirology held its 13th Congress in Bangkok, Thailand, between 19 and 22 November 2008. It was attended by over 1500 delegates from around the world, particularly well represented by delegates from the Asia Pacific Rim. The congress was highlighted by an excellent scientific program, preceded by an educational course on pulmonary laboratory practices and several postgraduate courses. Office bearers representing the American Thoracic Society, European Respiratory Society and American College of Chest Physicians, among others, made significant contributions, further enhancing the high-quality faculty.