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Open access

Nongnapat Jirawutthinan, Ouyporn Panamonta, Sumittra Jirawutthinan, Chatchai Suesirisawat and Manat Panamonta


Background: Onset of puberty has shifted toward a younger age in the 21st century. The useful pubertal assessment in the individual child must be based on recent and reliable reference data from the same population. However, currently representative pubertal data for Thai girls are lacking.

Objective: We determined the current prevalence and mean ages at onset of pubertal characteristics in healthy urban Thai girls in Khon Kaen Province, northeast Thailand.

Methods: A cross-sectional study was carried out between January and July 2011. Five hundred and three schoolgirls aged 7 to 16 years were enrolled. All were in good physical health. Stages of breast and pubic hair development were rated on girls by Tanner’s criteria. Assessment was performed by a trained pediatrician. Data on menstruation were collected by the status quo method.

Results: Median (range) ages of the onset of thelarche and pubarche were 9.3 (7.8 to 13.4) and 10.8 (8.9 to 14.5) years, with the mean±SD of 10.1±1.2 and 11.6±1.2 years, respectively. One hundred and eighteen girls had experienced menstruation. The median (range) age of menarche was 11.2 (10.0 to 14.0) years. Mean age was 11.6±0.8 years. The mean ages of pubarche and menarche decreased from the previous study significantly (p <0.001).

Conclusions: The secular trend in decline of the ages of pubarche and menarche were observed in urban Khon Kaen Thai girls. These data can be used as the reference of normal pubertal development in Thai girls in Khon Kaen to determine precocious or delayed puberty.

Open access

Noppol Kiatsopit, Ouyporn Panamonta, Chatchai Suesirisawat and Manat Panamonta



There is variation of the age of onset of puberty in a population. The secular trends in the timing of pubertal development have decreased in some parts of the world.


To determine the age of pubertal development in healthy Thai boys in Khon Kaen, Thailand and compare it with that in previous studies of Thai boys.


A descriptive, cross-sectional study was performed in 316 school boys aged 5–16 years between May and July 2011. Development of the genitals and pubic hair was determined by Tanner staging, and testicular volume was assessed using a Prader orchidometer. All boys were examined by a male pediatrician.


Genital stage of puberty in boys occurred at a median age of 11.3 years and a mean ± SD age of 11.3 ± 1.3 (mean ± SD, range 8.0–14.9) years, and pubarche occurred at a median age of 12.8 years and a mean ± SD of 12.5 ± 1.2 years (range 9.1–14.9) years.


No secular trend towards earlier age at pubertal onset for gonadarche in Khon Kaen boys, but pubarche seems to be later than found in previous studies in Thai boys.

Open access

Arnkisa Chaikitpinyo, Manat Panamonta, Yuttapong Wongswadiwat, Wiboon Weraarchakul, Ouyporn Panamonta, Aunejit Panthongviriyakul and Kaewjai Thepsuthammarat


Background: Rheumatic fever (RF), rheumatic heart disease (RHD), and congenital heart disease (CHD) are still major problems among Thai school children.

Objective: To examine trends in the prevalence of RF/RHD and CHD along with the socioeconomic status of school children in urban Khon Kaen, northeastern Thailand.

Methods: We conducted cross-sectional survey of 8,555 school children aged 5-15 years from 4 schools in urban Khon Kaen from January to March 2006. Pediatric cardiologists examined the school children and all cardiac diagnoses were confirmed by echocardiography. Socioeconomic data were also collected. Schools were divided into high and low socioeconomic status (SES) schools, based on the prevailing levels of parental education and household income. All positive cases of heart disease were followed and reviewed at a university hospital up to December 2013.

Results: Of 8,555 children examined, 2 had RF/RHD, and 10 had CHD. The prevalence of RF/RHD was 0.23 per 1,000 (95% CI 0.03-0.84), and the prevalence of CHD was 1.2 per 1,000 (95% CI 0.56-2.15). Prevalence of RF/RHD among urban school children in the center of northeastern Thailand had declined from 1.13 to 0.23 per 1,000 since 1986. The indices of socioeconomic development revealed marked improvement during this 20 year interim. The prevalence of RF/RHD was higher among low SES schools (4.6 per 1,000) compared with high SES schools (0 per 1,000).

Conclusion: There is a low prevalence of RHD in school children in this region compared with the period before 1986.

Open access

Kittiphop Somboonnithiphol, Ouyporn Panamonta, Pakaphan Kiatchoosakun, Junya Jirapradittha, Manat Panamonta, Pagakrong Lumbiganon and Pichet Somsapt


Background: Salt wasting 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is the most common cause of adrenal insufficiency during neonatal periods. Newborn screening for CAH will improve case early detection and decrease associated morbidity and mortality. The previous nationwide incidence of CAH in 1999 was 1:19,521. To date, CAH newborn screening has not been included in national newborn screening program.

Objective: We evaluated the incidence of CAH in newborns delivered at Srinagarind Hospital.

Methods: Between September 2005 and June 2008, the filter paper blood spot 17-hydroxyprogesterone (17-OHP) tests were determined in newborns delivered at Srinagarind Hospital. The tests were concurrently performed with TSH and phenylketonuria screening in national newborn screening program of the Ministry of Public Health of Thailand. Re-evaluation with completed physical examinations, repeated blood test for serum 17-OHP and serum electrolytes were performed in newborns who had 17-OHP levels higher than cut-off values. CAH was indicated in patients who had abnormal high serum 17-OHP concentration with or without hyperpigmentation and/or ambiguous genitalia in affected females and/or electrolyte imbalance.

Results: Five thousand seven hundred seventy one of 7,147 (80.74%) live births were screened for CAH. Fourteen infants (0.24%) were recalled for re-evaluation. Eight of fourteen (57.14% response rate) infants had the repeated blood tests. Abnormal elevated serum 17-OHP concentrations were found in two infants. Only one had clinical and laboratory findings indicative of CAH. The incidence of CAH was therefore 1:5,771.

Conclusion: The incidence of CAH from newborn screening in Srinagarind Hospital was obviously higher than national incidence of Thailand. The implement of CAH screening for all neonates should be reconsidered.

Open access

Chatchai Suesirisawad, Ouyporn Panamonta, Pakaphan Kiatchoosakun, Junya Jirapradittha, Pranom Buppasiri and Jadsada Thinkhamrop


Background: Thailand is an endemic area for iodine deficiency disorders (IDD) in Southeast Asia. More than 50% of pregnant women in northeast Thailand have low urine iodine levels. While rising thyroid- stimulating hormone (TSH) levels in neonates are particularly sensitive to IDD.

Objective: To establish the iodine status of postpartum mothers and neonates and its relationship with TSH in Khon Kaen Province.

Materials and Methods: A prospective study was conducted between June and October 2011. Three hundred postpartum mothers and their neonates were enrolled. Urine iodine was collected and measured using a simple microplate method. TSH assay was performed using an immunoradiometric assay. The optimum level of maternal urine iodine including children <2 years was >100 μg/L and neonatal whole blood TSH <5 mU/L (equivalent to serum TSH <11.2 mU/L).

Results: The median postpartum maternal urine iodine was 208.4 μg/L, 29.3% had values <100 μg/L and 42.3% <150 μg/L. The median neonatal urine iodine was 151.0 μg/L with 26.0% having urine iodine levels <100 μg/L and 49.7 % <150 μg/L. The median neonatal whole blood TSH was 4.3 mU/L, 3.0% had TSH >5 mU/L. There was no significant correlation between postpartum maternal urine iodine and neonatal TSH (p = 0.340, r = 0.055), but there was a significant positive correlation between maternal and neonatal urine iodine levels (p = 0.013, r = 0.143), neonatal urine iodine and TSH levels (p = <0.01, r = 0.203).

Conclusion: After a national campaign of iodized salt coverage and oral iodine supplement for all pregnant women, there was increasing median maternal and neonatal urine iodine and a weakly positive correlation between maternal and neonatal urine iodine levels, neonatal urine iodine and TSH levels, but no correlation between maternal urine iodine and TSH levels. The prevalence of IDD in pregnant women in northeast Thailand seems to have decreased, but intervention programs needs to be extended to reach populations that still have inadequate iodine intake.

Open access

Warawut Siwaprapakorn, Manat Panamonta, Arnkisa Chaikitpinyo, Pagakrong Lumbiganon, Ouyporn Panamonta, Orathai Pachirat, Sompop Prathanee, Yuttapong Wongswadiwat, Junya Jirapradittha and Kaewjai Thepsuthammarat


Background: Infective endocarditis (IE) is an important cause of child morbidity and mortality, but the current burden of the disease in Thai children is unknown.

Objectives: To determine the current burden of IE in Thai children.

Patients and Methods: The records of all children aged <15 years admitted to Khon Kaen University Hospital from 1992 to 2011 were reviewed.

Results: Of 69,822 admissions, 56 patients fulfilled the modified Duke criteria for definite IE giving a rate of 0.8 cases per 1,000 admissions. Age at diagnosis was 7.9 ± 3.8 years (range, 8 days to 14.8 years). There was congenital heart disease in 38 (68%) patients, rheumatic heart disease (RHD) in 10 (18%), and no previous heart disease in 8 (14%). RHD was a less frequent underlying disease during the latter half (2002-2011) of the period studied (1/34 vs. 9/22, P < 0.001). Blood cultures were positive for pathogens in 34 (61%) patients with 11 cases of Streptococcus viridians and 8 cases of Staphylococcus aureus infections. Vegetations on echocardiography were present in 46 (82%) patients. For 8 embolic events, patients with large vegetations had a higher rate (4/6) than patients with small and no vegetations (4/50) (P < 0.003). In-hospital mortality was 11%. Eight patients with S. aureus infection had a higher mortality (5/8) than 26 patients (1/26) infected with other pathogens (P < 0.001).

Conclusion: The changing epidemiology of pediatric IE was toward fewer children with RHD. Mortality among children with IE was higher in those with S. aureus infection.

Open access

Manat Panamonta, Arnkisa Chaikitpinyo, Pagakrong Lumbiganon, Ouyporn Panamonta, Narong Auvichayapat, Yuttapong Wongswadiwat, Kaewjai Thepsuthammarat, Aunejit Panthongviriyakul and Choowong Pongchaiyakul


Background: Although there have been many descriptive studies of diphtheria from resource limited countries, descriptions of the natural history of diphtheritic myocarditis in patients from these countries are scarce.

Objective: To present the natural history of diphtheritic myocarditis from a hospital in northeastern Thailand.

Methods: The clinical features of 38 patients with diphtheria admitted to the Khon Kaen University Hospital in northeastern Thailand between 1983 and 1996 were reviewed.

Results: Of the 38 cases of diphtheria, 10 progressed to diphtheritic myocarditis (26%). Electrocardiographic findings of the 10 patients with myocarditis were myocardial and conduction abnormalities. The presence of a clinically severe (toxic) type (P < 0.001) or a swollen neck (bull neck) (P = 0.001) was a predictor of the occurrence of myocarditis. Five (50%) of the 10 patients with myocarditis had conduction abnormalities (third-degree atrioventricular block 3, left bundle branch block 1, and right bundle branch block 1). Four patients with severe symptomatic bradyarrhythmia (third-degree atrioventricular block 3, and left bundle branch block 1) received ventricular pacing, and 3 patients died after this pacing. Echocardiographic abnormalities of left ventricular dilatation and myocardial hypertrophy were found in all 5 patients with conduction abnormalities. All 6 of 7 survivors of diphtheritic myocarditis had normal 12-lead electrocardiographic results at 1-month follow-up. A patient who was the survivor of third-degree AV block had an electrocardiographic finding of flat T waves, and with a complete echocardiographic normalization of left ventricular dilatation and myocardial hypertrophy.

Conclusion: The present study confirms that increasing diphtheria immunization coverage in the population remains the most important strategy for the control of diphtheria. In resource limited countries, clinical findings, electrocardiography, and sometimes where available, echocardiography are helpful in assessing the severity of diphtheritic myocarditis, decision making of acute management, and predicting fatal outcome.