The current epidemiology of upper gastrointestinal bleeding (UGIB) in Thailand is poorly understood and the reported prevalence of Helicobacter pylori infection is outdated.
To investigate the etiologies of UGIB and prevalence of H. pylori infection in Thailand, including its association with UGIB.
We retrieved information regarding patients attending the endoscopic unit of King Chulalongkorn Memorial Hospital from June 2007 to January 2013. A database search using keywords “upper gastrointestinal bleeding” and “iron deficiency” was used. From 4,454 diagnoses, after exclusion criteria, 3,488 patients (2,042 male (58.5%) and 1,446 female (41.5%); mean age 63.3 ± 15.94 years, range 13–103 years) were included.
The three most common causes of UGIB were peptic ulcer (38.2%), nonulcer-mucosal lesions (23.4%), and esophageal-related causes (20.4%). The 5 year-incidence of H. pylori was 25%–30%. The overall prevalence was 27%. The prevalence of H. pylori infection was found to decrease with age from 43.8% at <40 years to 21.7% at >79 years old. H. pylori infection was significantly associated with duodenal and gastroduodenal ulcers. Cirrhosis and nonulcer-mucosal lesions were significantly unrelated to H. pylori infection. Patients with concurrent cirrhosis with peptic ulcer were found to be negative for H. pylori infection.
Peptic ulcer is the leading cause of UGIB in Thailand. However, its incidence is declining. Patients who presented to hospital with UGIB were older, compared with those a decade ago. H. pylori infection plays an important role in UGIB and its incidence was stable during the past 5 years.
Salmonella typhimurium is a cause of gastroenteritis including diarrhea. Lactobacillus plantarum is a probiotic widely used to prevent and treat diarrhea.
To determine the protective effects of L. plantarum B7 on diarrhea in mice induced by S. typhimurium.
Inhibition of S. typhimurium growth by L. plantarum B7 was determined using an agar spot method. Mice were divided into 3 groups (n = 8 each): a control group, an S group administered 3 × 109 CFU/mL S. typhimurium, and an S + LP group administered 1 × 109 CFU/mL L. plantarum B7 and 3 × 109 CFU/mL S. typhimurium daily for 3 days. Counts of S. typhimurium and percentage of fecal moisture content (%FMC) were determined from stool samples. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and CXCL1 were determined.
L. plantarum B7 produced a clear zone on S. typhimurium. There were significantly less S. typhimurium in the feces from mice in the S+LP group than in the S group. Serum levels of TNF-α, IL-6, and CXCL1 in mice from the S group were significantly higher than levels in the S+LP and control groups. Feces from mice in the S group were soft and loose, whereas in the S+LP group they were hard and rod shaped. The %FMC in the S+LP group was significantly less than in the S group.
L. plantarum B7 can inhibit growth of S. typhimurium, decrease levels of proinflammatory cytokines, and attenuate symptoms of diarrhea induced in mice by S. typhimurium.
The Royal College of Anesthesiologists of Thailand initiated registry and reporting of anesthesia service incidents and outcomes in 2005.
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.
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.
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.
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.