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Perioperative and Anesthetic Adverse events in Thailand (PAAd Thai) incident reporting study: anesthetic profiles and outcomes

Abstract

Background

The Royal College of Anesthesiologists of Thailand initiated registry and reporting of anesthesia service incidents and outcomes in 2005.

Objectives

The Perianesthetic Anesthetic Adverse Events in Thailand (PAAd Thai) study aimed to investigate patient, surgical, and anesthetic profiles, and suggest strategies for prevention of adverse events.

Methods

A prospective descriptive study was conducted in 22 hospitals across Thailand. Each hospital was invited to report, on an anonymous basis, any perianesthetic adverse incident during 12 months (between January 1 and December 31, 2015). A standardized incident report form was completed to determine the type of incident, and where, when, how, and why it occurred using closed and open-ended questionnaires. Data regarding main anesthetic techniques were also reported monthly. Descriptive statistics were used.

Results

For 333,219 cases, 2,206 incident reports with 3,028 critical incidents were reported. The incidents commonly occurred in male patients (52.0%), aged <10 y (13.0%) and >70 y (18.2%). The incidence of adverse events included cardiac arrest within 24 h (15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal intubation (8.5:10,000), difficult intubation (8.0:10,000), and malignant hyperthermia (1:200,000). General, cardiothoracic, neurological, and otorhinolaryngological surgical specialties posed a high risk of incidents. Operating and recovery rooms were common locations for incidents.

Conclusion

In the past decade, there were dramatic reductions of perioperative cardiac arrests and difficult intubations. Common factors related to critical incidents were inexperience, emergency, inadequate preanesthetic evaluation, inappropriate decisions, lack of vigilance, and inexperienced assistants. Suggested corrective strategies are compliance with guidelines, additional training, and improvement of supervision and quality assurance.

Open access
Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study: hospital characteristics and methods

Abstract

Background

Safety in anesthesia can be improved through monitoring and analysis of anesthetic complications. We conducted the present Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study to determine the current frequency distribution of incidents related to the anesthetic complications, factors contributing to the incidents, and corrective strategies.

Objective

To describe the characteristics of the hospitals participating in this study and methods used.

Methods

A multicenter prospective observational study was conducted in hospitals across Thailand in 2015. The participating hospitals were asked to anonymously report incidents of anesthesia-related adverse events and management. Three peer reviewers reviewed the completed record forms describing the incidents including possible mechanisms, contributing factors, appropriate management, and preventive strategies to achieve agreement by consensus.

Results

Twenty-two hospitals across Thailand participated in this study. Fourteen (64%) were nonuniversity (service directed) hospitals, while 8 (36%) were university (academic teaching) hospitals. Most hospitals were involved in residency training and teaching medical students (77%), while just more than half (57%) were involved in training nurse anesthetists. The ratio of anesthesiologists to an operating room was 0.67:1 and the ratio of nurse anesthetists to an operating room was 2.03:1.

Conclusions

A critical incident analysis of each reported adverse event is helpful for proposing a corrective or preventive strategy to ameliorate perioperative care and improve patient safety in the Thai health care system.

Open access
Polycythemia vera concomitant with renal angiomyolipoma: case report and clinical outcome

Abstract

Background

Polycythemia vera has been found in a wide range of hematopoietic tissue disorders, but rarely concomitant with renal abnormality. To our knowledge there is only one available report of a patient with polycythemia vera concomitant with renal angiomyolipoma, and the report does not cover the clinical course of this rare finding.

Objectives

To report the presentation and clinical course of a patient with polycythemia vera concomitant with right renal angiomyolipoma.

Methods

We retrospectively reviewed the medical records of a patient with polycythemia vera who presented with renal angiomyolipoma.

Results

Our patient presented with a right renal mass and polycythemia vera diagnosed by a point mutation in the gene for Janus kinase 2. The mass was diagnosed as renal angiomyolipoma on histopathology. After partial nephrectomy, she was prescribed a low dosage of hydroxyurea without the return of erythrocytosis for a year.

Conclusions

Polycythemia vera responded well to low dosage hydroxyurea, which controlled erythrocytosis after removing the renal mass.

Open access
Thai national guidelines for the prevention of mother-to-child transmission of human immunodeficiency virus 2017

Abstract

Background

Thailand has made progress in reducing perinatal HIV transmission rates to levels that meet the World Health Organization targets for so-called “elimination” (<2%) of mother-to-child transmission (MTCT).

Objectives

To highlight the Thailand National Guidelines on HIV/AIDS Treatment Prevention Working Group issued a new version of its National Prevention of MTCT guidelines in March 2017 aimed to reduce MTCT rate to <1% by 2020.

Discussion of guidelines

The guidelines include recommending initiation of antepartum antiretroviral therapy (ART) containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC)/emtricitabine (FTC) plus efavirenz regardless of CD4 cell count as soon as HIV is diagnosed for ART naïve HIV-infected pregnant women. An alternative regimen is TDF or zidovudine (AZT) plus 3TC/FTC plus lopinavir/ritonavir (LPV/r) for HIV-infected pregnant women suspected resistant to non-nucleoside reverse transcriptase inhibitors. Treatment should be started immediately irrespective of gestational age and continued after delivery for life. Raltegravir is recommended in addition to the ART regimen for HIV-infected pregnant women who present late (gestational age (GA) ≥32 weeks) or those who have a viral load (VL) >1000 copies/mL at GA ≥32 weeks. HIV-infected pregnant women who conceive while receiving ART should continue their treatment regimen during pregnancy. HIV-infected pregnant women who present in labor and are not receiving ART should receive single-dose nevirapine immediately along with oral AZT, and continue ART for life. Infants born to HIV-infected mothers are categorized as high or standard risk for MTCT. High MTCT risk is defined as an infant whose mother has a viral load (VL) > 50 copies/mL at GA > 36 weeks or has received ART <12 weeks before delivery, or has poor ART adherence. These infants should be started on AZT plus 3TC plus NVP for 6 weeks after delivery. Infants with standard MTCT risk should receive AZT for 4 weeks. Formula feeding exclusively is recommended for all HIV-exposed infants.

Open access
Utility of body mass index and neck circumference to screen for metabolic syndrome in Thai people

Abstract

Background

Anthropometric indices have been studied as tools with which to detect metabolic syndrome (MetS). Few data are available from Southeast Asian populations where ethnic differences are an issue.

Objectives

To compare the performance of body mass index (BMI) and neck circumference (NC) in predicting MetS, determine the correlation between waist circumference (WC), BMI and NC, and identify optimal cut-off points in older Thai people.

Methods

We prospectively recruited participants aged ≥50 years to the Healthy Ageing Khon Kaen University Campus Project from March 2012 to April 2015 and collected their baseline characteristics, anthropometric measures, and metabolic profiles. MetS was recognized using International Diabetes Foundation criteria.

Results

We enrolled 586 participants as part of a wider study (Limpawattana P, Manjavong M, Sopapong R. Endocr Prac 2016; 22:8-15). BMI and NC had positive correlations with WC in both sexes (P < 0.001). For women, the area under the receiver operating characteristic curve (AUC) for BMI was 0.88 (95%CI 0.84, 0.91) and for NC was 0.79 (95%CI 0.75, 0.84). For men, the AUC for BMI was 0.91 (95%CI 0.87, 0.95) and for NC was 0.84 (95%CI 0.79, 0.90). BMI ≥24.5kg/m2 in either sex, and NC ≥33 cm in women or ≥39 cm in men indicated MetS.

Conclusions

BMI and NC are good anthropometric indices for predicting MetS. BMI was better than NC. A BMI of 24.5kg/m2 in either sex and NCs of 33 cm in women and 39 cm in men are recommended as the optimal cutoff points to indicate MetS.

Open access
Wall vacuum-assisted closure technique for a complex enteroatmospheric fistula: report of a case

Abstract

Background

An enteroatmospheric fistula (EAF) is a devastating complication of abdominal surgery. EAF wound care is uniformly problematic and burdensome because the fistula effluent is difficult to contain, causing several abdominal skin problems.

Objectives

To report the case of a complex EAF in a patient in whom conventional wound care techniques failed to contain the fistula.

Methods

We reviewed the patient’s medical records and the novel wound care technique used to contain the fistula.

Results

We report the use of a modified vacuum-assisted closure (VAC) technique, the “Wall VAC”, for the wound care of a patient with a complex EAF having large and multiple fistula openings following multiple abdominal operations. The Wall VAC technique consists of (1) leveling the skin surrounding the EAF wound, (2) creating the Wall VAC using a rectangular-shaped VAC sponge with 2 suction systems, and (3) sealing the system with a plastic bag and incise drape. By using this technique, the fistula effluent was effectively contained and the abdominal skin was well protected. The system changed every 3 to 4 days.

Conclusions

Our modified VAC technique, the “Wall VAC”, is simple and effective in containing a large volume (3,000 to 4,000 mL) of fistula effluent and protecting the abdominal skin in a patient with a complex EAF. We recommend this particular technique as an alternative method for managing a complex EAF.

Open access
Young Thai sisters with growth hormone insensitivity or Laron syndrome

Abstract

Background

Growth hormone insensitivity (GHI) or Laron syndrome can result from GH receptor (GHR) or postreceptor defects, such as in GH binding or transduction, or insulin-like growth factor 1 (IGF-1) synthesis. Multiple defects in GHI have been reported in cohorts from the Middle East, Ecuador, and the Mediterranean, but rarely reported from Southeast Asia.

Methods

Genomic DNA was isolated from peripheral blood leukocytes of young Thai sisters with severe short stature. Coding exons, including the intronic boundaries of the GHR were amplified from genomic DNA by PCR, and products were purified and sequenced. Serum GH, IGF-1, and IGF binding protein-3 were assayed immunometrically.

Results

We found an extreme GHI phenotype and a homozygous mutation in exon 7 of GHR.

Conclusions

This mutation can cause a new donor splice site and interfere with mRNA splicing. To our knowledge, these are first cases of Laron syndrome in Thais confirmed by genotyping.

Open access
Accuracy of noninvasive scoring systems to assess advanced liver fibrosis in Thai patients with nonalcoholic fatty liver disease

Abstract

Background

Liver biopsy is the criterion standard to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), which is important for prognosis, whereas noninvasive scoring systems showing promise for predicting fibrotic status include aspartate/alanine aminotransferase (AST/ALT) ratio, BARD score, fibrosis–4-score (FIB-4), and the NAFLD Fibrosis Score (NFS).

Objectives

To determine the accuracy of noninvasive scoring systems to predict advanced fibrosis in Thai patients with NAFLD.

Methods

A prospective cross-sectional study of Thai patients with liver biopsy-proven NAFLD during January 2009-October 2012 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Baseline NFS, BARD, and FIB-4 calculations were used to distinguish patients with NAFLD with and without advanced liver fibrosis, using cutoffs for NFS ≥ -1.455, BARD ≥ 2, and FIB-4 >1.3 (http://gihep.com/calculators/hepatology/).

Results

We included 139 patients mean age 40.95 (SD 13.3) years (47% male). Impaired fasting glucose or diabetes mellitus was found in 75, 9 showed advanced fibrosis (≥F3) by liver histology. NFS with cutoff ≥ -1.455 was determined as the best system with the highest sensitivity for identifying patients with advanced fibrosis, followed by BARD ≥2, FIB-4 >1.45, and AST/ALT ratio >0.8. Liver biopsy could potentially be avoided in >38% of patients with BARD, 46% with NFS, 64% with AST/ALT ratio, and 81% with FIB-4.

Conclusions

Advanced fibrosis was prevalent in 6% of our Thai patients with NAFLD. NFS had the highest negative predictive value for excluding patients with advanced fibrosis. At least 38% of patients with NAFLD could avoid liver biopsy by using the BARD system.

Open access
Acute diarrhea, a significant burden to Thailand’s universal health care system: a nationwide database

Abstract

Background

The burden of acute diarrheal diseases is a major problem in Thailand. The mortality rate is 0.5% of admissions in the 2010 Nationwide Hospital Admission Data. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study in 2010 showed that the mortality rate of diarrheal disease was 2.65% of all deaths globally.

Objectives

To examine the burden of adult acute diarrhea in Thailand using nationwide data in 2010.

Methods

There were 820,735 admissions of patients aged ≥19 years with a diagnosis of digestive diseases (ICD10-K00-K93) and acute diarrhea (ICD10-A09). About one-third of admissions (214,722 admissions; 26%) were for acute diarrhea with a mean patient age 51.5 (SD 15.3) years.

Results

Approximately two-thirds of the 214,722 admissions were for acute diarrhea (59%) in patients 19–60 years old, and the remaining 41% were elderly patients >60 years old. Approximately 0.5% of admitted patients (1,048 patients) died. The complications during hospitalization were septicemia (2.2%), mechanical ventilation (0.6%), and renal failure requiring hemodialysis (0.14%). The predictors of mortality were patients >60 years old at admission, male sex, and the presence of complications. The total cost for management of acute diarrhea in Thailand in 2010 was 905,784,298 baht or 30,035,807 USD for 214,722 admissions.

Conclusions

Acute diarrheal diseases accounted for 26% of the digestive diseases in the 2010 Thai nationwide data with high expenditure.

Open access