Medical Specialties Commons^™

Cardiometabolical Risk Factors Associated With Renal Function In Apparently Healthy Young Students: A Cross-Sectional Study, Lucia M. Perez-Navarro, Rafael Valdez-Ortiz, Araceli Alegria-Diaz, Miguel Murgia-Romero, Rafael Jimenez-Flores, Rafael Villalobos-Molina, Srinivas Mummidi, Ravindranath Duggirala, Juan C. Lopez-Alvarenga

School of Medicine Publications

Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood.

Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old).

Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities.

Results: …

Spironolactone In Pulmonary Arterial Hypertension: Results Of A Cross-Over Study, Anita Deswal, E O'Brian Smith, Mark Entman

Faculty, Staff and Students Publications

The renin–angiotensin–aldosterone system is implicated in the pathophysiology of pulmonary arterial hypertension. We undertook this study to determine the effects of spironolactone, a mineralocorticoid receptor blocker, on collagen metabolism in pulmonary arterial hypertension patients. After obtaining institutional review board approval and informed consent, 42 pulmonary arterial hypertension patients were prospectively enrolled and 35 patients completed the 16-week randomized double-blinded crossover clinical trial. Subjects received 50 mg spironolactone or placebo and at the end of week 8, treatment arm was switched. Circulating levels of collagen biomarkers, brain natriuretic peptide, and aldosterone levels were measured, and six-minute walk distance, liver function tests, …

Large Sinus Of Valsalva Aneurysm Complicated By Thrombus Formation, Ernesto Jimenez, Umair Khalid

Faculty, Staff and Students Publications

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic …

Hypogonadism, Type-2 Diabetes Mellitus, And Bone Health: A Narrative Review

Faculty, Staff and Students Publications

One of the complications from chronic hyperglycemia and insulin resistance due to type 2 diabetes mellitus (T2DM) on the hypothalamic-pituitary-gonadal axis in men is the high prevalence of hypogonadotropic hypogonadism (HH). Both T2DM and hypogonadism are associated with impaired bone health and increased fracture risk but whether the combination results in even worse bone disease than either one alone is not well-studied. It is possible that having both conditions predisposes men to an even greater risk for fracture than either one alone. Given the common occurrence of HH or hypogonadism in general in T2DM, a significant number of men could …

Pregnancy And Lactation In A 67-Year-Old Elderly Gravida Following Donor Oocyte, Sonal Zambare, Kjersti M Aagaard

Faculty, Staff and Students Publications

There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum …

Broken And Forgotten: A Case Of Unintentionally Retained Foreign Object, Pralay Kumar Sarkar

Faculty, Staff and Students Publications

Central venous catheter have become ubiquitous with greater than 15 million catheter days/year in the intensive care setting alone. However, the procedure carries with it several immediate and other delayed complications that can result in significant morbidity, mortality, and increased healthcare cost. We report a rare case of significantly delayed complications associated with intravascular loss of guide wire during central venous catheter placement and its impact on patient's long term management. The case highlights not only the importance of proper technique and safety precaution in performing an increasingly common procedure, but also the need for timely identification and rectification of …

Metaproteomic Analysis Of Human Gut Microbiome In Digestive And Metabolic Diseases

Faculty, Staff and Students Publications

Metaproteomics, as a subfield of proteomics, has quickly emerged as a pivotal tool for global characterization of a microbiome system at a functional level. It has been increasingly applied in studying human digestive and metabolic diseases, and provides information-rich data to identify the dysbiosis of human gut microbiome related to healthy or disease states to elucidate the molecular events underlying host-microbiota interplays. While significant technical challenges still exist, this emerging technology has been demonstrated to provide essential information in interrogating functional changes in the human gut microbiome, complementary to metagenomics and metatranscriptomics. This chapter overviews the overall metaproteomic work flow …

A Topical Eye Drop Versus Intra-Meibomian Gland Injection Of Bevacizumab For Meibomian Gland Dysfunction Patients., Chitchanok Tantipat

Chulalongkorn University Theses and Dissertations (Chula ETD)

Purpose: To compare the efficacy and safety of topical bevacizumab eye drop versus intra-meibomian gland injection of bevacizumab when used with the standard lid hygiene in meibomian gland dysfunction (MGD) patients. Methods: 60 eyes of 30 MGD patients with lid margin telangiectasia were randomized to receive 0.05% bevacizumab eye drop or single 2.5% intra-meibomian gland bevacizumab injection plus standard lid hygiene. The primary outcomes were telangiectasia grading and the computerized lid margin neovascularized area (LMNA). The secondary outcomes were the ocular surface disease index (OSDI) score, corneal staining, meibomian gland quality, meiboscore, conjunctival redness, fluorescein break up time (FBUT), noninvasive …

Telomere Shortening And Cellular Senescence Induced By Oxalate And Nephrolithiasis Urine In Hk-2 Cells, Kamonchanok Chuenwisad

Chulalongkorn University Theses and Dissertations (Chula ETD)

Kidney stone disease is a common urologic problem worldwide, especially in the tropics such as Thailand. It is known as a multifactorial condition, and aging increases the risk of stone development. The major type of stones is calcium oxalate (CaOx), and its formation is driven by increased urinary oxalate excretion and calcium oxalate monohydrate (COM) crystallization. Both oxalate and COM are known to induce reactive oxygen species (ROS) production and cause oxidative stress. Furthermore, patients with CaOx stone have increased extent of oxidative stress. In this study, we investigated the induction of cellular senescence and telomere shortening through oxidative stress …

The Study Of Local Diagnostic Reference Levels At Unit Of Vascular And Interventional Radiology, King Chulalongkorn Memorial Hospital, Kornkamol Prajamchuea

Chulalongkorn University Theses and Dissertations (Chula ETD)

Interventional Radiology (IR) procedures are minimally invasive surgery using angiographic equipment which the patients and staffs may receive high radiation dose. DRLs, based on 75th percentile of the median dose for a sample of standard sized of patients, are an effective tool for optimization of protection in the medical exposure of patients for diagnostic and interventional procedures (ICRP Publication 135, 2017). The objective of this study is to establish the local DRLs distribution of patient radiation dose and related parameters in interventional radiology procedures in standard-sized of Thai patients. Local DRLs of radiation dose and related parameters of patients (45-75kg …

Agreement Of Total Corneal Power Measured By Casia 2, Pentacam Axl, And Iolmaster 700 In Normal And Keratoconic Patients, Rusaporn Yodying

Chulalongkorn University Theses and Dissertations (Chula ETD)

Purpose: To evaluate agreement of total corneal power (TCP), ocular biometry and IOL power calculation measured by CASIA 2, Pentacam AXL, and IOLMaster 700 in normal and keratoconic patients Setting: King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand Design: Prospective observational study Methods: One-hundred normal eyes and 34 keratoconic eyes were enrolled. Biometric values were measured by each device for three times by two operators to evaluate repeatability and reproducibility of TCP and other parameters. The agreement of TCP and other parameters including total corneal astigmatism, anterior keratometry, anterior corneal astigmatism, posterior keratometry, posterior corneal astigmatism, anterior chamber depth, white-to-white …

Surface And Build-Up Region Dose Measurement In Head And Neck Region Using Radio - Photoluminescent Glass Dosimeter, Sonam Choki

Chulalongkorn University Theses and Dissertations (Chula ETD)

The use of commercially available radio-photoluminescent glass dosimeter (RPLGD) for radiation measurement has increased in recent years. It has been shown to have superior dosimetric characteristics as compared to other dosimeters. The purpose of this research is to evaluate the suitability of the GD-302M glass dosimeter for surface and build-up region dose measurement in head and neck region. The glass dosimeter was analyzed for its dosimetric properties in photon beam. Then, the study was performed for surface and build-up region dose comparison between EBT3 film and RPLGD in solid water phantom at 0, 2, 3, 5, 10 and 15mm depths …

Determination Of Field Output Correction Factors Of Radiophoto Luminescent Glass Dosimeter In 6 Mv Small Photon Beams, Sumalee Yabsantia

Chulalongkorn University Theses and Dissertations (Chula ETD)

The objective of this study was to determine the field output correction factors of radiophotoluminescent glass dosimeter (RPLGD) for 6 MV photon beams by using Monte Carlo (MC) simulation. The ratios of absorbed dose of water and RPLGD were calculated using egs_chamber code for 6 MV, 90-cm SSD, 10-cm depth, and field size range from 0.5 × 0.5 to 10 × 10 cm2. Then the field output correction factors of RPLGD in perpendicular and parallel orientations were determined. Also, the volume averaging correction factors were discovered for supporting our results. Moreover, the comparison of measurement field output factors of RPLGD …

Developing A Novel Bioink From Hyaluronic Acid-Alginate-Silk Fibroin (Ha- Alg-Sf) For Cartilage 3d Printing, Truc Thanh Nguyen

Chulalongkorn University Theses and Dissertations (Chula ETD)

In the development of a bioink for cartilage 3D printing, Hyaluronic acid (HA), Alginate (Alg) were modified into amine-hyaluronic acid (HA-NH2) and aldehyde alginate (Alg-CHO). Magnetic Nuclear Resonance (NMR) and Fourier Transform Infrared Spectroscopy (FTIR) confirmed the successful modification of HA-NH2 and Alg-CHO. The hydrogel HA-Alg was crosslinked as a result of Schiff's base reaction, between primary amines and aldehydes to form imine bonds. By varying volume ratios, the optimal hydrogel HA-Alg (5:5) exhibited its printability, biocompatibility, and functionality as a bioink for cartilage tissue. HA-Alg (5:5) was printable with a custom-made extrusion 3D printer, had slow degradation, shear-thinning behavior, …

Patient-Specific Organ Dose Calculated By Dose Tracking Software Based On Monte Carlo Simulation In Pediatric Abdominal Ct, Yuparak Innan

Chulalongkorn University Theses and Dissertations (Chula ETD)

This study aimed to determine the patient-specific organ doses using Radimetrics dose tracking software in pediatric abdominal CT at Praram9 Hospital. The organ doses were measured using the anthropomorphic Rando phantom inserted with radiophotoluminescent glass dosimeters (RPLGDs) to verify the organ doses calculated by Radimetrics program. The retrospective data were collected from pediatric abdominal CT 164 studies (78 patients), age range 0-15 years-old), who underwent single phase abdominal CT at Praram9 Hospital. The tube voltages ranged between 80 and 135 kVp were adjusted according to the size and age of patients, and rotation time 0.35-0.5 sec. All patients were acquired …

Evaluating The Effects Of A Total Joint Education Class On Patient Outcomes, Kevin Marshall

Walden Dissertations and Doctoral Studies

As the population ages and as people live longer, there is a growing demand for total hip and total knee procedures. Possible outcomes for these procedures is a postoperative joint infection (PJI) that can cause long postoperative lengths of stay (LOS) in the hospital. The PJIs can also negatively impact the quality of life for the patient. Using the roadmap of the continuous quality improvement theory, the purpose of this quantitative study was to examine the relationship between the independent variables (joint education class participation, body mass index [BMI], A1c, and smoking) and dependent variables (PJI and LOS). To evaluate …

Development And Dosimetric Verification Of 3d Customized Bolus In Radiotherapy, Nichakan Chatchumnan

Chulalongkorn University Theses and Dissertations (Chula ETD)

Bolus is a tissue equivalent material that is commonly used to reduce the skin-sparing effect in radiotherapy. The commercial flat bolus cannot form perfect contact with the irregular surface of the patient's skin, resulting in an air gap, especially in irregular surface shape. The purpose of this study was to evaluate the feasibility of two types of silicone rubber bolus, RA-00AB, and RA-05AB that were made as to the fabricated flat and 3D customized bolus using 3D printing technology. The 1 cm thick boluses were made from two types of silicone rubber solutions. The point dose and planar dose differences …

Identification Of Genetic And Antigenic Variation And Evolution Pattern Among Influenza A And B Viruses In Thailand, Nungruthai Suntronwong

Chulalongkorn University Theses and Dissertations (Chula ETD)

Seasonal influenza viruses commonly cause respiratory disease and have a considerable impact on public health threats which annually estimates 3 to 5 million cases of severe illness worldwide. The triggering of the seasonal influenza epidemic results from a complex interplay between viral, host and external factors such as climate. Although vaccination is an effective tool for influenza prevention and its complications, the composition of vaccine strain has been changed every year due to influenza constantly evolving. Here, we aim to examine the association between influenza activity and local climate factors, host immunity, genetic and antigenic variation and evolution pattern among …

The Labeling Of 99mtc-Psma-Hbed-Cc For Prostate Cancer Imaging, Benchamat Phromphao

Chulalongkorn University Theses and Dissertations (Chula ETD)

Prostate cancer (PCa) is the second most common cancer and the fifth leading cause of death worldwide in 2018 (1). Initially, PCa diagnosis is based on Prostate Specific Antigen (PSA) blood test, which is low sensitivity and low specificity, and sonography guided needle biopsy, which is invasive. Therefore, molecular imaging recently enrolls as an important technique in PCa diagnosis using some small molecules which are well developed to bind to overexpressed Prostate Specific Membrane Antigen (PSMA). The small molecules, for example PSMA-HBED-CC, PSMA I&T, can be chelated with Ga-68 for diagnostic purpose using positron emission tomography (PET) scan. Even though …

The Effects Of Limited Infusion Rate Of Fluid In The Early Resuscitation Of Sepsis On Syndecan-1 Shedding: A Randomized Controlled Trial (Life3s Trial), Jutamas Saoraya

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Aggressive fluid administration is recommended in the resuscitation of septic patients. However, the delivery of a rapid fluid bolus might cause harm by inducing degradation of the endothelial glycocalyx. This research aimed to examine the effects of the limited infusion rate of fluid on glycocalyx shedding as measured by syndecan-1 in patients with sepsis-induced hypoperfusion. Methods: A prospective, randomized, controlled, open-label trial was conducted between November 2018 and February 2020 in an urban academic emergency department. Patients with sepsis-induced hypoperfusion, defined as hypotension or hyperlactatemia, were randomized to receive either the standard rate (30 ml/kg/hr) or limited rate (10 …

Evaluation Of Patient Doses From 177lu-Psma In Metastases Prostate Cancer Treatment At King Chulalongkorn Memorial Hospital, Kotchakorn Chatachot

Chulalongkorn University Theses and Dissertations (Chula ETD)

177Lu-PSMA I&T has increasingly used for targeted radionuclide therapy of metastatic castration-resistant prostate cancer (mCRPC). Dosimetric calculation, therefore, is critical to achieve the optimal therapeutic activity while sparing side effects to the normal tissues. The purpose of this study was to determine the radiation dosimetry for metastases prostate cancer patients treated by 177Lu-PSMA I&T at King Chulalongkorn Memorial Hospital (KCMH). Whole-body planar images were acquired in eight patients (12 treatment cycles) at immediately, 4 and 24 h after 177Lu-PSMA I&T injection (range 4.36 to 8.58 GBq). Region of interests (ROIs) were manually contoured on the whole-body, liver, spleen, urinary bladder, …

Generation Of Induced Pluripotent Stem Cells From Blood Cell Of Glucose-6-Phosphate Dehydrogenase (G6pd) Deficiency, Malinee Tongbaen

Chulalongkorn University Theses and Dissertations (Chula ETD)

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common genetic enzyme disorder that affects more than 400 million people worldwide. Insufficient of G6PD enzyme or defect in enzyme activity can cause acute hemolysis after exposure to oxidative stress. The disease model used for pathogenesis study underlying oxidative damage or drug screening in G6PD deficient patients is still needed. In vitro generation of human-induced pluripotent stem cells (iPSCs) afford the potential source of the disease model in medical research. This study aimed to generate the iPSCs derived from G6PD deficient-subjects for used as a specific-disease model. The G6PD-derived iPSCs were generated from …