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Open access

Engcanit Cholkraisuwat, Yuthapong Buddharaksa and Jarun Sayasathid

Abstract

Background: Congenital heart diseases (CHD) comprise about one-third of all major birth defects. Children with delayed diagnosis and improper treatment are at a high risk of morbidity and mortality.

Objective: To determine the prevalence of unrecognized congenital heart disease among elementary school students and study the types and frequency of congenital heart disease in Phitsanulok, Pichit, and Kampangpetch provinces of Thailand using trained nurses and other health care personnel.

Methods: Between September 2008 and September 2010, 138,529 students from 1,243 elementary schools were screened for abnormal heart conditions by trained nurses or health care workers. The students who were suspected to have CHD were referred to a pediatric cardiologist for complete evaluation and identification of the lesions.

Results: Five hundred forty eight students were suspected to have heart diseases and 102 students were diagnosed as CHD. The average prevalence of unrecognized CHD in Phitsanulok, Pichit, and Kampangpetch was 0.74 per 1,000. Simple acyanotic lesions (ventricular septal defect, atrial septal defect, and pulmonary stenosis) were common in this study (32.35%, 16.67%, and 11.76%, respectively).

Conclusion: Qualified nurses or health care workers can be useful for identifying patients with CHD. The role of these personnel in the national heart screening program should be further clarified.

Open access

Jarun Sayasathid, Naraporn Somboonna, Siraphop Thapmaogkol, Yuthapong Buddharadsa and Kanchapan Sukonpan

Abstract

Background: While teratomas account for the leading cause of germ cell tumors, the mediastinal teratomas represent one of the infrequent types of congenital germ cell tumors. Neonates with large mediastinal teratomas generally show severe respiratory distress, and the immediate surgical treatment is needed to alleviate their problems.

Objectives: Report clinical symptoms, diagnostic procedures, treatment option, and outcomes after the treatment for a neonate with a large mediastinal teratoma.

Methods: A 2-day-old female infant presented with acute respiratory failure diagnosed as mediastinal teratoma. It was followed with surgical treatment. The removed tissues were examined pathologically.

Results: The girl suffered an acute respiratory failure two days after birth. The chest radiography, echocardiography, and chest computerized tomography results showed the considerable size of the mediastinal teratoma. A median sternotomy was performed on the third day of infant life to remove the tumor without rupturing the capsule. Pathological diagnosis was germ cell tumor. Clinical follow-ups reported no complication.

Conclusion: The successful management of a neonate with large mediastinal teratomas was presented. Immediate detection and proper treatment of the large mediastinal teratoma in a neonate was most important to decrease the morbidity and mortality of the infant.

Open access

Jarun Sayasathid, Pentip Supachokchaipattana, Kraminee Pipatvech, Kanchapan Sukonpan, Naraporn Somboonna and Supasit Pannarunothai

Abstract

Background: Congenital heart disease (CHD) is one of the major congenital anomalies among newborns. Although many infants with CHD are symptomatic and identified soon after birth, others remain undiagnosed until the disease becomes severe. Objectives: Unravel the number of CHD cases among 7-12 years old students who reported neither clinical complication nor history about cardiac diseases, stressing the importance for regular cardiac examination in children, even if they appeared healthy. Methods: The study selected students without clinical history of heart disease from 1,041 elementary schools in northern Thailand (Tak, Nakhon Sawan and Uttaradit). Certified nurses and health officers examined the students for abnormal heart conditions. Pediatric cardiologists scrutinized the students with suspected CHD for confirmation and characterization of cardiac lesion types. Results: Out of 144,293 students included in the study, 851 students showed atypical heart symptoms, and 87 were verified to have the CHD. This conferred the prevalence rate of unrecognized CHD among the elementary school children to be 0.60 per 1,000. The frequently-detected heart defects were ventricular septal defect (41.4%) and pulmonary stenosis (16.1%). Fifty-one children (58.6%) required surgery for cardiovascular correction. The prevalence of the CHD in elementary school students ranged from 0.41 to 1.05 cases per 1000 study subjects. The greatest number of incidences was found in Tak province where medical resources are inadequate. Conclusion: This study highlights the significance of routine cardiac examination among school-aged students, particularly in the regions with limited medical facilities, providing information essential for appropriate health care planning and managements.

Open access

Siraphop Thapmongkol, Patarabutr Masaratana, Thaworn Subtaweesin, Jarun Sayasathid, Kanthachat Thatsakorn and Jule Namchaisiri

Abstract

Background

Cardiopulmonary bypass (CPB) can contribute to the development of an inflammatory response and postsurgical morbidity. Conventional ultrafiltration and modified ultrafiltration (MUF) can mitigate the adverse effects of CPB by removing free water and inflammatory mediators, at least in part.

Objectives

To evaluate evidence for the effects of MUF on clinical outcomes of cardiac surgery in pediatric and adult patients.

Methods

A literature review of MEDLINE-indexed articles published between 1990 and June 2014 was conducted on PubMed. A search on the CTS.net website and the Cochrane Central Register of Controlled Trials was also performed with relevant keywords. The search was limited to English language articles and human studies.

Results

Our primary search identified 84 potential articles, of which 55 articles were relevant to conventional ultrafiltration, modified ultrafiltration, ultrafiltration, cardiopulmonary bypass, extracorporeal circulation, pediatric and adult cardiac surgery. There were 3 meta-analyses, 7 review literatures, 21 randomized controlled trials. The remainder consisted of 18 controlled and 6 observational studies. MUF has been beneficial effects on postoperative bleeding, chest drainage, transfusion requirement, and improvement cardiac function, but effects in adult cardiac surgery inconclusive because data was relatively limited.

Conclusions

MUF may improve post-CPB hemodynamic activity and cardiac function in pediatric cardiac surgery. By contrast, the clinical trials in adults are limited mostly by small sample sizes that preclude an adequately powered assessment of clinically relevant outcomes. The available data are conflicting and several studies show no differential outcomes. Further studies are required to identify patients who will most likely benefit from ultrafiltration and to establish standard protocols.

Open access

Naraporn Somboonna, Ilada Choopara, Kanchapan Sukhonpan and Jarun Sayasathid

Abstract

Background

Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) infections among women and girls may be symptomatic or asymptomatic.

Objectives

To survey and identify C. trachomatis, N. gonorrhoeae, and HPV infections in symptomatic and asymptomatic women and girls in Bangkok and surrounding neighborhoods using molecular techniques, evaluate the use of doxycycline treatment for clinically symptomatic patients infected with C. trachomatis, and identify possible genetic mutations associated with persistence and/or drug resistance.

Method

We enrolled 150 women and girls with inflamed urogenital tracts and 134 asymptomatic controls, both without a history of HIV infection or cervical cancer in this prospective study. Genomic DNAs were extracted, and C. trachomatis, N. gonorrhoeae, and HPV infections were detected using established PCR primers and protocols. PCR controls included no confirmatory template controls or human β-globin. Patients infected with C. trachomatis were treated with doxycycline and re-examined after treatment. C. trachomatis major outer membrane (ompA) and tryptophan synthesis A (trpA) genes were sequenced to identify possible genetic mutations associated with persistence and/or drug resistance.

Results

C. trachomatis, N. gonorrhoeae, and HPV were detected in 22%, 6%, and 48% of symptomatic, and in 3%, 16%, and 10% of asymptomatic women and girls, respectively. Coinfection with C. trachomatis and HPV were frequent in the 15-34 year age group, and associated with upper urogenital tract symptoms. Doxycycline was not considered effective for C. trachomatis infection. Several nonconserved amino acid changes were detected in C. trachomatis ompA and trpA.

Conclusion

We found different distributions of these pathogens among symptomatic and asymptomatic patients. We also found doxycycline treatment failures, and mutated trpA supported persistent C. trachomatis infections.