- Clinical Characteristics, Treatment Outcomes and Risk Assessment of Patients with Acute Upper Gastrointestinal Bleeding in Rajavithi Hospital, Thailand. [Journal Article]
- JMJ Med Assoc Thai 2017; 100 Suppl 1:S104-15
- CONCLUSIONS: The overall outcomes of UGIB were good, with better outcomes in NVUGIB than in VUGIB. AIMS65 score and serum sodium may be useful in predicting rebleeding and complications in UGIB.
- Comparison of High Dose and Standard Dose Proton Pump Inhibitor before Endoscopy in Patients with Non-Portal Hypertension Bleeding. [Journal Article]
- JMJ Med Assoc Thai 2016; 99(9):988-95
- CONCLUSIONS: The high dose of PPIs administration before endoscopy reduced the chance of high-risk peptic ulcer bleeding compared to the standard dose. Both high dose and standard dose of PPIs did not affect the time of hospital stay, unit of blood transfusion, the complications after endoscopy, and mortality rate. Standard dose PPIs can be considered using in patients with Blatchford scores lower than 10. High dose PPIs would be beneficial in patients who have Blatchford scores between 10 and 12. For patients who have Blatchford scores greater than 12, high dose PPIs are recommended.
- Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study. [Journal Article]
- EREur Radiol 2018 Jun 20
- CONCLUSIONS: TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent.• Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage. • Superselective embolisation is essential to improve outcomes. • N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes.
- Phase Ia study of the indoleamine 2,3-dioxygenase 1 (IDO1) inhibitor navoximod (GDC-0919) in patients with recurrent advanced solid tumors. [Journal Article]
- JIJ Immunother Cancer 2018 Jun 20; 6(1):61
- CONCLUSIONS: Navoximod was well-tolerated at doses up to 800 mg BID decreasing plasma kynurenine levels consistent with its half-life. Stable disease responses were observed.
- Diphyllobothrium latum Mimicking Subacute Appendicitis. [Journal Article]
- GRGastroenterology Res 2018; 11(3):235-237
- Diphyllobothrium latum (D. latum) infection in humans is uncommon in the United States. Although there has been a drastic decline in the report of D. latum infection in this region, physicians should...
Diphyllobothrium latum (D. latum) infection in humans is uncommon in the United States. Although there has been a drastic decline in the report of D. latum infection in this region, physicians should be aware of an uncommon presentation and its clinical relevance. We report a case of 55-year-old female of Ecuadorian/Peruvian origin who presented with an unknown cause of chronic right lower quadrant abdominal pain for 2 months without other particular symptoms. Initial workup revealed evidence of iron deficiency anemia, and stool occult blood test was positive. She was scheduled for a colonoscopy to assess the source of occult gastrointestinal bleeding. During her bowel preparation, she passed a 25 cm long white tapeworm-like material confirmed microscopically. Despite passing a worm she continued to have abdominal pain. During the colonoscopy, another worm was found lodged in the appendiceal orifice. The colonoscopic images revealed a segmented tapeworm showing contractile motility, approximately 12 cm in length and 6 mm wide in the appendiceal orifice. The scope was unsuccessful in removing the worm. The parasitological and microbiological examination of the passed worm was positive for D. latum. D. latum a fish tapeworm that infects humans after the ingestion of raw or undercooked fish. The patient had a history of often eating lightly marinated raw fish ("ceviche") in Peru several months before presentation. It is uncommon for D. latum infection to present with iron deficiency anemia. As the worm absorbs approximately 80% of dietary vitamin B12, prolonged D. latum infection usually causes vitamin B12 deficiency and megaloblastic anemia, which is reported to affect about 40% of cases. Abdominal pain related to mechanical obstruction is reported, but this case is unique in that the worm preferentially attached to the appendiceal orifice causing subacute focal appendiceal pain. She was treated with a single dose of oral praziquantel. After the treatment, she developed minor cramping for the next 2 days which resolved by day 3, and recalled passing half-inch sized pieces of white tissue and subsequently improved. Although D. latum infection is an uncommon cause of chronic abdominal pain with iron deficiency anemia, it is crucial to consider because of the potentially treatable outcome.
- Effects of Stroke Unit Care in Acute Ischemic Stroke Patient Ineligible for Thrombolytic Treatment. [Journal Article]
- JMJ Med Assoc Thai 2017; 100(4):410-7
- CONCLUSIONS: The stroke unit increases the survival rate among stroke patient compared with the general medical ward and have less complication.
- Physiology and Pathophysiology in Ultra-Marathon Running. [Review]
- FPFront Physiol 2018; 9:634
- In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official f...
In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10-20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35-45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50-60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000-200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.
- Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-dose Aspirin. [Journal Article]
- CGClin Gastroenterol Hepatol 2018 Jun 13
- CONCLUSIONS: In a population-based study of low-dose aspirin users, the incidence of LGIB was higher than the incidence of UGIB. However, patients with LGIB had higher rates of hospitalization or death within 30 days than patients with UGIB. These estimates are valuable for benefit-risk assessments of low-dose aspirin for cardiovascular and colorectal cancer prevention.
- Timing of Gastrointestinal Bleeding After Implantation of Left Ventricular Assist Devices Associates With Anatomic Location, Presentation, and Management. [Journal Article]
- CGClin Gastroenterol Hepatol 2018 Jun 12
- CONCLUSIONS: In a retrospective study of patients who underwent implantation of continuous-flow LVADs, timing of GIB associates with the location and severity of bleeding. Although patients with LVADs have an overall increased risk of middle GIB, patients with GIB during their index LVAD hospitalization are recommended for initial evaluation with upper endoscopy and colonoscopy due to insufficient time for the development of small bowel angiodysplasias. Patients who later develop GIB should be consented for early small bowel evaluation.
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- Living Without a Pulse: The Vascular Implications of Continuous-Flow Left Ventricular Assist Devices. [Journal Article]
- CHCirc Heart Fail 2018; 11(6):e004670
- Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure comp...
Pulsatility seems to have a teleological role because evolutionary hierarchy favors higher ordered animals with more complex, multichamber circulatory systems that generate higher pulse pressure compared with lower ordered animals. Yet despite years of such natural selection, the modern generation of continuous-flow left ventricular assist devices (CF-LVADs) that have been increasingly used for the last decade have created a unique physiology characterized by a nonpulsatile, nonlaminar blood flow profile with the absence of the usual large elastic artery Windkessel effect during diastole. Although outcomes and durability have improved with CF-LVADs, patients supported with CF-LVADs have a high rate of complications that were not as frequently observed with older pulsatile devices, including gastrointestinal bleeding from arteriovenous malformations, pump thrombosis, and stroke. Given the apparent fundamental biological role of the pulse, the purpose of this review is to describe the normal physiology of ventricular-arterial coupling from pulsatile flow, the effects of heart failure on this physiology and the vasculature, and to examine the effects of nonpulsatile blood flow on the vascular system and potential role in complications seen with CF-LVAD therapy. Understanding these concomitant vascular changes with CF-LVADs may be a key step in improving patient outcomes as modulation of pulsatility and flow characteristics may serve as a novel, yet simple, therapy for reducing complications.