Suthipol Udompunturak

Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Objective: To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre- and post-trial. Setting: University hospital from January 2009 to May 2010. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P < 0.001) except for functional reach in the frequent fall group. Most subjects (72%–79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ≥3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

Neodymium:YAG laser damage threshold of foldable intraocular lenses

Purpose: To determine the energy level of the neodymium:YAG (Nd:YAG) laser that induced a 50% incidence of intraocular lens (IOL) damage in 5 foldable IOL materials. Setting: Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand. Methods: To simulate the condition within the capsular bag, an IOL was sandwiched between 2 rubber membranes. The front membrane had a central opening mimicking the anterior capsulotomy; the back membrane acted as the posterior capsule. The model was submerged in a water‐filled chamber. The Nd:YAG laser with an automatic focus 150 &mgr;m beyond the focus of the aiming beam was used to perform a posterior capsulotomy. Three IOLs of each of 5 foldable IOL materials were tested. One type of poly(methyl methacrylate) (PMMA) was studied as a reference. The incidence of IOL damage at various energy levels was recorded. Linear regression analysis was used to determine the 50% incidence damage threshold. Results: The 6 materials tested included 1 silicone lens (SI‐40NB, AMO), 1 hydrophobic acrylic lens (MA60BM, Alcon), 3 hydrophilic acrylic lenses (Haptibag Ang, IOLtech; ACR6D, Corneal; H60M, Bausch & Lomb), and 1 PMMA lens (LX10BD, Alcon). The 50% incidence damage threshold values were 0.37 mJ, 0.54 mJ, 0.58 mJ, 0.52 mJ, 0.66 mJ, and 0.68 mJ, respectively. Conclusions: The 50% incidence damage threshold in all the IOLs was below the energy level normally used to perform a posterior capsulotomy in clinical practice. However, setting the laser at the lowest possible energy, focusing the laser beam beyond the posterior capsule, and performing the capsulotomy early should minimize the risk of IOL damage.

Applicability of American and British Criteria for Screening of the Retinopathy of Prematurity in Thailand

PurposeThe aim of this study was to verify the applicability of standard guidelines for the screening of retinopathy of prematurity (ROP) and to determine the appropriate criteria for Thai neonates.MethodsRecords of ROP screening of infants born in our hospital between 1995 and 2000 with a birth weight below 2000 g or a gestational age of less than 36 weeks were studied. Criteria to screen infants with a birth weight below 1500 g or a gestational age of less than 28 weeks in the American guidelines and similar birth weight but a gestational age of less than 31 weeks in the British recommended guidelines were applied and evaluated in terms of sensitivity and specificity. Criteria reaching 100% sensitivity with the maximum specificity were deemed appropriate.ResultsOf the 514 screened infants, 33 had developed stage 2+ ROP and beyond. The mean ± SD birth weight and gestational age were 1046 ± 257 (710–1680 g) and 29.2 ± 2.5 weeks (24–35 weeks), respectively. The age at intervention was 6–16 weeks. Sensitivity for both American and British guidelines was 93.9%. By screening infants with birth weights below 1500 g or gestational age less than 33 weeks, we could achieve 100% sensitivity with 18.3% specificity. We decided that the initial examination should be performed 4–6 weeks after birth. By applying these criteria to 62 referred cases we also were able to include in the screening all cases of concern in this group.ConclusionsRegional criteria for ROP screening is required and should be evaluated periodically and modified accordingly. Jpn J Ophthalmol 2004;48:50–53

Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery

BackgroundThe objective was to compare the value of late gadolinium enhancement (LGE) and end-diastolic wall thickness (EDWT) assessed by cardiovascular magnetic resonance (CMR) in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG).MethodsWe enrolled patients with coronary artery disease and left ventricular ejection fraction < 45% who were scheduled for CABG. Regional contractility was assessed by cine CMR at baseline and 4 months after CABG. EDWT and LGE were assessed at baseline. Predictors for improvement of regional contractility were analyzed.ResultsWe studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 ± 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6%) and 1,196 segments (59.2%) respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2%) that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC) curves demonstrated that the LGE area was the most important predictor (p < 0.001). Adding information from LGE to the EDWT can decrease the number of false predictions by EDWT alone from 483 to 127 segments.ConclusionLGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.

Prevalence and prognosis of myocardial scar in patients with known or suspected coronary artery disease and normal wall motion

BackgroundSome patients may have normal wall motion after myocardial infarction. The aim of this study was to determine the prevalence and prognosis of patients with myocardial scar in the absence of abnormal wall motion. We studied patients with suspected or known coronary artery disease (CAD) who were referred for cardiovascular magnetic resonance (CMR) for the assessment of global and regional cardiac function and late gadolinium enhancement (LGE) and had normal left ventricular wall motion. Prognostic value was determined by the occurrence of hard endpoints (cardiac death and nonfatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization due to unstable angina or heart failure or life threatening ventricular arrhythmia.ResultsA total 1148 patients (70.3%) were studied. LGE was detected in 104 patients (9.1%). Prevalence of LGE increased in patients with increased left ventricular mass. Average follow-up time was 955 ± 542 days. LGE was the strongest predictor for hard endpoints and MACE.ConclusionLGE was detected in 9.1% of patients with suspected or known CAD and normal wall motion. LGE was the strongest predictor of significant cardiac events.

Prognostic significance of left ventricular mass by magnetic resonance imaging study in patients with known or suspected coronary artery disease.

Objectives To study the prognostic value of left ventricular mass (LVM) assessed by cardiac magnetic resonance in patients with known or suspected coronary artery disease. Methods We studied patients who were referred for cardiac magnetic resonance for the assessment of cardiac function, LVM, and late gadolinium enhancement (LGE). Prognostic value was determined by the occurrence of hard cardiac endpoint, including death or nonfatal myocardial infarction and major adverse cardiac event, which also included hospitalization due to heart failure or unstable angina and life-threatening ventricular arrhythmia. We analyzed prognostic value of LVM index stratified by quintiles and specific percentile ranges. Results A total of 2194 patients with the average age of 65 ± 11 years were enrolled. Average left ventricular ejection fraction and LVM index were 59.2 ± 19.4% and 56.6 ± 21.3 g/m2, respectively. LGE was present in 785 patients (35.8%). Average follow-up duration was 926 ± 582 days. Hard events and major adverse cardiac events occurred in 92 (4.2%) and 210 patients (9.6%). Cox regression analysis showed that left ventricular ejection fraction, LGE, and LVM index were independent predictors for clinical events. The highest quartile of LVM index had the greatest risk for clinical events independent of other factors, including left ventricular ejection fraction and LGE. Conclusion LVM index by cardiac magnetic resonance is an independent predictor for cardiovascular event in patients with known or suspected coronary artery disease.

Cut‐off points of quadriceps strength, declines and relationships of sarcopenia‐related variables among Thai community‐dwelling older adults

To define quadriceps strength cut‐off points for both sexes to be used in the working diagnosis of sarcopenia in older Asian people, and to investigate the age‐related declines of sarcopenia‐related variables and correlations between those variables among community‐dwelling older adults.

Comparative outcomes of different endovenous thermal ablation systems on great and small saphenous vein insufficiency: Long-term results.

This study examined the outcomes of over a decade of endovenous thermal ablation (EVTA) treatments for great and small saphenous vein (GSV and SSV) insufficiency, utilizing three different endovenous thermal ablation systems.

Comparison of Diagnostic and Prognostic Value of Different Electrocardiographic Criteria to Delayed-Enhancement Magnetic Resonance Imaging for Healed Myocardial Infarction

The accuracy of various electrocardiographic (ECG) criteria for the diagnosis of healed myocardial infarction (MI) has never been validated. The objective of this study was to determine the accuracy and prognostic value of standard ECG criteria for the diagnosis of healed MI compared with cardiac magnetic resonance (CMR). Consecutive patients with known or suspected coronary artery disease who were referred for CMR were studied. Twelve-lead electrocardiography and CMR were performed the same day. A standard CMR protocol including a delayed-enhancement (DE) technique was performed. The prognostic value of using various ECG criteria and DE-CMR was assessed for the occurrence of cardiac death, nonfatal MI, or major adverse cardiac events. We studied 1,366 patients. Average follow-up was 31.4 +/- 15.8 months. Myocardial scar was detected in 507 patients (37.1%) using DE-CMR. Healed MI using various ECG criteria had sensitivity, specificity, and accuracy of 44% to 59%, 91% to 95%, and 75% to 79% compared with DE-CMR, respectively. Multivariable Cox regression analysis showed that myocardial scar using DE-CMR was the most powerful predictor for cardiac events, followed by left ventricular ejection fraction. In the absence of DE-CMR data, MI using European Society of Cardiology/American College of Cardiology (ESC/ACC) 2000 criteria was the most powerful predictor. In conclusion, various ECG criteria had limited sensitivity, but high specificity, for the diagnosis of healed MI compared with myocardial scar using DE-CMR. Myocardial scar, left ventricular ejection fraction, and MI using ESC/ACC 2000 criteria were important predictors for cardiac events.

NT-proBNP levels in the evaluation of right ventricular dysfunction in patients with coronary artery disease and abnormal left ventricular wall motion: a magnetic resonance imaging study.

BackgroundData available on the correlation of N-terminal probrain natriuretic peptide (NT-proBNP) levels and right ventricular (RV) function in patients with coronary artery disease (CAD) are limited. ObjectiveTo determine the relation between plasma NT-proBNP and RV function in patients with CAD and abnormal left ventricular (LV) wall motion. MethodsThis is a cross-sectional study. We studied 176 patients with CAD and abnormal LV wall motion. All patients underwent cardiac magnetic resonance imaging for the assessment of LV and RV function and plasma NT-proBNP analysis on the same day. Multivariable analysis was performed to evaluate the independent factors associated with RV dysfunction. Receiver-operating characteristic analysis was used to assess the use of NT-proBNP levels for the diagnosis of LV and RV dysfunction. ResultsAverage LV ejection fraction (LVEF) and RV ejection fraction were 37.6 and 52.0%, respectively. Median levels of NT-proBNP were 978 pg/ml. Log NT-proBNP levels had a positive correlation with age, LV and RV volume, LV and RV mass, and had a negative correlation with body size, creatinine clearance, LVEF, and RV ejection fraction. From a multivariable analysis, log NT-proBNP levels and LVEF were independently associated with RV dysfunction. From receiver-operating characteristic analysis, NT-proBNP at the levels of 1706 and 378 pg/ml was shown to detect RV dysfunction and LV dysfunction at an accuracy of 80.7 and 77.8% and area under the curve of 0.837 and 0.765, respectively. ConclusionNT-proBNP levels can be used to diagnose RV dysfunction in patients with CAD and abnormal LV wall motion.