Biomedical subjects
Publications and source records attributed to P Pruekprasert.
This is an unique case report of concomitant dengue hemorrhagic fever and Kawasaki disease, not reported previously. The unusual clinical course of persistent fever, coronary artery involvement evidenced from 2-D echocardiogram, and hydrops of the gallbladder is discussed.
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A neonate who had a nonfatal echovirus 11 infection with severe hepatitis, hepatic necrosis, disseminated intravascular coagulation, and thrombocytopenia was seen at the University of Tennessee Medical Center (UTMC) in Knoxville. Clinical data from this neonate were examined and compared with clinical data from histories of 8 other cases of neonatal enteroviral infections seen at UTMC, Knoxville, during a 3-year period. The purpose of our study was to increase awareness of the clinical presentations of neonatal enteroviral infections, especially in summer months. The patients in our study presented with various clinical manifestations of disease, including overwhelming systemic infection characterized by severe hepatic dysfunction and coagulopathy with possible disseminated intravascular coagulation and central nervous system infection. Myocarditis was sometimes manifested as well. In agreement with findings from other studies, our study concluded that most enteroviral infections in neonates resulted from perinatal transmission during delivery where the mothers had experienced recent, febrile, viral-like illness prior to or during delivery. One uncommon finding in our study was that the cases were strikingly seasonal, with 8 of the 9 infants hospitalized during late summer or early fall (July through September).
One hundred and fourty episodes of septicemic children seen at Songklanagarind Hospital during a period of two years were reviewed to determine factors related to mortality. One hundred episodes (70.4%) of septicemia were hospital-acquired in which 98 (69%) were caused by gram negative bacilli, with Pseudomonas being the most common agent. Thirty episodes were from gram-positive cocci and eight were from polymicrobial infections. The remainder were caused by Candida species. The overall case-fatality rate was 28.6%. Using a logistic regression model, appropriateness of antibiotic use and host status (being newborn or a compromised host compared to a normal host), but not neutropenia and acquisition of infection were the only statistically significant risk factors. The exact odds ratio of inappropriate use of antibiotic adjusted for host status was 13.6 (95% confidence limits = 5.7-32.3). Percentages of inappropriate usage among the premature and full term newborn, compromised host and normal were 50, 11, 28 and 24, respectively. Inappropriate antibiotic use was the major cause of case-fatality in the study population. It was more common among the premature newborn and compromised hosts.
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Clinical data from 175 patients with squamous cell carcinoma of the oesophagus or cardia admitted to Songklanagarind Hospital between 1982 and 1988 were analysed to evaluate the effects on survival of various tumour and treatment variables. Most tumours (greater than = 86%) were in stage III or IV. Forty-seven percent of stage-IV tumours and 99 per cent of those in stages I, II or III were resectable. One-year and 3-year survival rates of resected stage-III patients (57.3% and 27.5%) were significantly higher than those of resected stage-IV patients (33.3% and 0%). Resection conferred no benefit over radiotherapy chemotherapy or no treatment on the survival of stage-IV cases beyond one year. Combined chemotherapy/radiotherapy/resection of stage-III and stage-IV patients gave no statistically significant improvement in survival. Among resected patients, only lymph node involvement was associated with significantly lower survival (relative risk compared to no involvement = 2.3, 95% CL: 1.2, 4.6), while the fungating type of tumour was possibly associated with improved survival (relative risk compared with all other types = 0.24, 95% CL: 0.05, 1.1).