Nuanchan Prapphal - Academia.edu (original) (raw)

Papers by Nuanchan Prapphal

PubMed, Dec 1, 1994

We studied the factors influencing the colonization of Streptococcus in school age children aged ... more We studied the factors influencing the colonization of Streptococcus in school age children aged 6-11 years from 2 low socioeconomic schools of the Bangkok Metropolitan area. 4,055 throat swab cultures were performed. Beta hemolytic Streptococcus (BHS) and beta hemolytic Streptococcus group A (BHSA) were isolated in 1,747 (43%) and 744 (18%) respectively. 1,547 questionnaires were returned from the children. Of these, 750 and 570 were found to have BHS and BHSA in the throat, respectively. Among the risk factors, considered, teeth brushing of one time or none per day was significant for BHS positive in the throat as compared with the BHS negative group, while personal hygiene such as sharing glass with other, playing in dirty water, poor housing sanitation and low family income was significantly associated with the BHSA positive group. With the combination of certain clinical manifestations, these factors may increase the accuracy of predicting streptococcal infection.

Asian Biomedicine, Oct 1, 2014

PubMed, Mar 1, 1989

Controversies exist regarding the clinical presentation and characteristics of cystic fibrosis (C... more Controversies exist regarding the clinical presentation and characteristics of cystic fibrosis (CF) in American blacks. Between 1971 and 1986, 188 patients with CF (165 whites, 20 blacks, and 3 others) seen at Children's Hospital National Medical Center, Washington, DC, were evaluated for age at diagnosis, duration of symptoms prior to diagnosis, clinical presentations, initial sputum culture results, and weight and height at diagnosis. Comparisons between black and white patients revealed no statistically significant differences in average age at diagnosis, average duration of symptoms prior to diagnosis, average sweat electrolyte concentrations, or sputum culture results. A breakdown of presenting symptoms by race showed some points of disparity. About twice as many black patients as white patients (40% v 22%) presented with only pulmonary symptoms, whereas slightly more whites presented with only gastrointestinal symptoms (46% v 35%). Those patients presenting with a combination of symptomatology were equally distributed by race (25% black, 21% white). At diagnosis, age-adjusted weight percentiles were significantly lower for black patients than for white patients (chi 2 = 9.60, P less than or equal to 0.05). Although the authors agree that CF is relatively rare among blacks, a high index of suspicion is essential for early diagnosis.

PubMed, Oct 1, 2000

Objectives: To determine the correlation between clinical score (based on respiratory rate, chest... more Objectives: To determine the correlation between clinical score (based on respiratory rate, chest wall retractions, air entry, wheezing, consciousness and audible wheezing) and arterial oxygen saturation (SaO2: measured by pulse oximetry) as well as the most appropriate total score for predicting hypoxemia (SaO2 < or = 95%) in children diagnosed to have wheezing associated respiratory illness (WARI). Subjects: 70 children (1 month-5 years old) hospitalized in the Department of Pediatrics, Chulalongkorn Hospital with the diagnosis of WARI from January 1, 1996 to December 31, 1996 were studied. Half of them were diagnosed to have acute lower respiratory tract infection (LRI) with wheezing while the remainder had reactive airway disease (RAD). Design: Cross sectional, analytical study. Methods: In each group of patients, the clinical score and SaO2 were assessed by the same pediatrician throughout the study. The correlation between the clinical signs and SaO2 as well as the cut off point of total score for predicting hypoxemia were analyzed. The sensitivity, specificity and accuracy of that total score in predicting hypoxemia were also calculated. Result: In both groups of patients (acute LRI with wheezing and RAD group), the clinical signs correlated with SaO2 were wheezing (rs = -0.67 and -0.47 respectively) and chest wall retractions (rs = -0.57 and -0.59 respectively). Total score was also correlated with SaO2 (rs = -0.68 and -0.5 respectively). The cut off point of total score in predicting hypoxemia was 4 providing 80 per cent sensitivity in both groups with accuracy 74.3 per cent and 80 per cent respectively. Conclusion: This clinical score may be used to assess the severity of hypoxemia in WARI patients. Wheezing, chest wall retractions and total score correlated well with SaO2. The total score > 4 was most appropriate in predicting hypoxemia in both children with RAD and wheezing associated with LRI.

PubMed, Apr 1, 2007

Objectives: To assess the knowledge of asthma among the caregivers of asthmatic children and to e... more Objectives: To assess the knowledge of asthma among the caregivers of asthmatic children and to evaluate the outcomes of preliminary education. Material and method: The caregivers of asthmatic patients aged 2-15 years who attended the pediatric chest clinic of King Chulalongkorn Memorial Hospital from January to December 2003 were randomly recruited to answer the questionnaire about asthma prior to the educational discussion with the investigators or nurses. The questionnaire was done again 6 months later. The significant factors associated with adequate knowledge and change of knowledge of the caregivers were identified. Results: Among the 79 study caregivers, forty-two (53.2%) had sufficient knowledge of asthma (score > or = 34 out of 44). The average pre-test score was 33 +/- 3.6 (24-42). The duration of caring for their asthmatic child was the only significant factor associated with adequate knowledge (p < 0. 05). After the educational session, the post-test score was significantly improved (36.0 +/- 2.6; p < 0.001). Conclusion: Half of the caregivers of the asthmatic children had insufficient knowledge of asthma. Education about asthma is still needed to improve their knowledge.

PubMed, Jul 1, 1994

The responsiveness to bronchodilator is variable in infants with wheezing associated respiratory ... more The responsiveness to bronchodilator is variable in infants with wheezing associated respiratory illness (WARI). Factors for prediction of the response will lead to more rational use of the bronchodilator in these infants. We examined the possible predictive factors in 44 children under 2 years of age who had their first episode of WARI. All of them were treated with 0.15 mg/kg of nebulized salbutamol. Thirty patients (68%) with decreasing clinical score > or = 3 after treatment were considered as the responders while the remainder (14 infants) were non responders. By using Chi-square test, Fisher exact test and Mann-Whitney U test to compare the data of the 2 groups, the significant factors for the responders were older than 6 months and history of previous LRI (p < 0.01). The significant factors for the non-responders included concurrent diarrhea, patchy pulmonary infiltration and positive RSV in the nasopharyngeal secretion (p < 0.01). These results suggested effective bronchodilator therapy in infants older than 6 months or having a history of previous LRI. Those who had acute RSV infection or patchy infiltration in chest X-ray and associated diarrhea were less likely to respond.

PubMed, Jun 1, 2004

We report a case of pneumonia caused by Mycoplasma pneumoniae in an 8-year-old Thai girl. She had... more We report a case of pneumonia caused by Mycoplasma pneumoniae in an 8-year-old Thai girl. She had a dual infection with dengue hemorrhagic fever with unusual manifestations; liver failure. The diagnoses were based on relevant clinical findings and laboratory confirmations of both infections.

PubMed, Jun 1, 1995

Recent Chlamydia pneumoniae infections were investigated in children with respiratory tract infec... more Recent Chlamydia pneumoniae infections were investigated in children with respiratory tract infections and in normal children. Four groups of sera were tested for C. pneumoniae antibody IgG and IgM serum fraction by the method of MIF test. A total of 7 cases of recent infection were detected, 3 of 116 with pneumonia, 3 of 123 with other respiratory tract infections, 1 of 263 normal school children and none in sera from cord blood. The cases with recent C. pneumoniae infection were as young as 24 days and 2 months old.

PubMed, Jul 1, 2007

Background: The prevalence of community-acquired pneumonia (CAP) caused by atypical pathogens in ... more Background: The prevalence of community-acquired pneumonia (CAP) caused by atypical pathogens in Thai children is unknown. Objective: To examine the prevalence of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections in paediatric patients (aged 2-15 years) with CAP in three academic hospitals using standardised laboratory techniques. The characteristics of atypical pneumonia were also compared with other causes of CAP. Methods: Diagnosis of current infection was based on a four-fold or more rise in antibody serum samples or persistently high antibody titres together with the presence of mycoplasmal or chlamydial DNA in secretions. Results: Of 245 patients with CAP, 17.5% of cases were caused by atypical pathogens (M. pneumoniae 14.3%, C. pneumoniae 2.8% and co-infection 0.4%). We also found atypical pathogens in young children aged 2-5 years. The clinical and laboratory findings did not distinguish atypical pneumonia from other CAPs. Segmental or lobar consolidation on chest X-rays was more common in atypical pneumonia, while dyspnoea was more prominent in other CAPs. Conclusion: Our data show a high prevalence of M. pneumoniae and C. pneumoniae in Thai children with CAP, including in children aged 2-5 years.

PubMed, Feb 1, 2016

Background: Lack of asthma knowledge among the pediatric patients and their caregivers contribute... more Background: Lack of asthma knowledge among the pediatric patients and their caregivers contribute to poor asthma control in children. There is no data from Thailand on the health outcomes of school-based educational interventions for asthmatic children. Objective: To assess the effectiveness of school-based asthma educational interventions on health outcomes, asthma control, and management in asthmatic children. Material and method: Forty-seven asthmatic students (6-15 years old), 14 caregivers, and five teachers from the Homkred School participated in the study. Asthma knowledge, workshops on pMDI (pressurized metered dose inhaler) techniques, use of asthma diaries, and self-management plans were provided Pre- and post-tests were administered to assess the asthma knowledge of the asthmatic students, their caregivers, and teachers. Pulmonary function tests (PFT) were used to assess the health outcomes. The controls of asthma and self-management behaviors were assessed at three and six months post-intervention. Results: There were significant improvements of asthma knowledge in all groups (p < 0.01) immediately post-intervention and six months later. At pre-intervention phase, there were 18 children who had FEV₁ less than 80% of the predicted value. Their PFT significantly improved for all parameters at post-intervention, but in children who had normal FEV₁ at baseline, there were no significant changes. Control of asthma was significantly better three and six months post-intervention. The rate of regular use of ICS (inhaled corticosteroid) significantly increased to 40% at three months and 30% at six months (p < 0.001) post-intervention. In addition, the self-management behaviors in the asthmatic children improved. The teachers' management of asthmatic attacks during the classes also improved. As a result of this, there were fewer emergency room (ER) visits. Conclusion: School-based educational interventions can significantly improve asthma outcomes in children with asthma. Therefore, the authors highly recommend the use of this intervention.

PubMed, Oct 21, 2009

Ninety-three asthmatic children and their caregivers were studied on their techniques of inhaler ... more Ninety-three asthmatic children and their caregivers were studied on their techniques of inhaler administration. Factors associated with the correct use of the device were also evaluated. Only 55.9% of the studied children demonstrated the correct technique in using their inhalation devices. In children using MDI (n = 42), the most common incorrect performance was the step of breathing in slowly at the same time with actuation (n = 17, 40.5%). Among those who used MDI-spacer (n = 51), all medication was given by their caregivers. The most common error was the step of waiting for 30 seconds prior to the next MDI actuation (n = 13, 25.5%). Factors related to the correct performance included duration of use for more than 1 year (p = 0.02), instruction of inhalation technique by trained technicians (p = 0.04) and the education level of the caregivers (p = 0.01). Our study demonstrates that incorrect technique during inhalation is common among Thai children with asthma and emphasizes an essential role of health professionals in regular evaluation of their patients and caregivers to ensure their correct application.

PubMed, Dec 1, 2005

Soluble intercellular adhesion molecule-1 (sICAM-1), an important adhesion molecule that mediates... more Soluble intercellular adhesion molecule-1 (sICAM-1), an important adhesion molecule that mediates leukocyte-endothelial interaction, has been identified as a marker for the outcome of acute respiratory tract infection. We postulate that plasma ICAM-1 may be a valuable marker for both biological and clinical severity of acute respiratory distress syndrome (ARDS). Sixteen pediatric patients (> 1 month and < 15 years of age) diagnosed with ARDS were recruited from the Pediatric Intensive Care Unit at King Chulalongkorn Memorial University Hospital, Bangkok. The patients were randomized to receive either high frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation. Plasma sICAM-1 was measured by enzyme linked immunosorbent assay (ELISA) on days 1, 3, 5 and 7 of ARDS. Plasma sICAM-1 levels in survivors and non-survivors of the HFOV and conventional treatment groups were compared. Nine and 7 patients constituted the control group receiving conventional treatment and HFOV group, respectively. Overall nine patients survived. The patients in the HFOV group had a better chance of survival compared to the controls (71% versus 31.5%), but it was not statistically significant (p = 0.2). The overall mortality was 45.7%. The mean plasma sICAM-1 levels (n = 13/16) were significantly elevated among non-survival patients as compared to survival patients at all time points, which indicates that an unfavorable outcome in ARDS is related to the degree of epithelial and endothelial alveolar cell injury. The elevation of plasma slCAM-1 on day 3 provided the best predictor of mortality (likelihood ratio 11.9, p < 0.001). It was concluded that HFOV facilitated a potentially better outcome compared to conventional treatment and it was associated with less lung injuries evidenced by lower plasma sICAM-1.

Indian Journal of Critical Care Medicine, 2018

Pediatric Pulmonology, 2005

The objectives of this study were to identify possible risk factors of bronchial hyperesponsivene... more The objectives of this study were to identify possible risk factors of bronchial hyperesponsiveness (BHR) in children up to 5 years of age with wheezing‐associated respiratory infection (WARI), and to study the prevalence of BHR. Children up to 5 years of age with WARI were enrolled in the study. The parents or caregivers of children were asked about their demographic data and clinical histories. Physical examination and clinical score assessment were performed. Pulmonary function tests, i.e., tidal breathing flow volume (TBFV), were performed to measure tidal breathing parameters before and after salbutamol nebulization. If volume at peak tidal expiratory flow/expiratory tidal volume and time to peak expiratory flow/total expiratory time increased ≥20%, or tidal expiratory flow at 25% of tidal volume/peak tidal expiratory flow increased ≥20% after nebulization therapy, BHR was diagnosed. The number in the positive BHR group was used to calculate the prevalence of BHR, and clinical features were compared with those of the negative BHR group. Categorical data were analyzed for statistical significance (P < 0.05) by chi‐square test or Fisher's exact test, or Student's t‐test, as appropriate. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for those with statistical significance. One hundred and six wheezing children underwent pulmonary function tests before and after salbutamol nebulization. With the aforementioned criteria, 41 cases (38.7%) were diagnosed with BHR. History of reactive airway disease, (OR, 6.31; 95% CI, 1.68–25), maternal history of asthma (OR, 3.45; 95% CI, 1.34–9), breastfeeding less than 3 months (OR, 3.18; 95% CI, 1.26–8.12), and passive smoking (OR, 3; 95% CI, 1.15–7.62) were significant risk factors of BHR. The eosinophil count was significantly higher in the BHR (+) group particularly, in children 1–5 years of age (P ≤ 0.01). Patchy infiltrates were more commonly found in patients with negative BHR but not statistically significant. In conclusion, a history of reactive airway disease, maternal history, breastfeeding less than 3 months, and passive smoking were significant risk factors for BHR. Pediatr Pulmonol. © 2005 Wiley‐Liss, Inc.

Pediatric Critical Care Medicine, 2009

To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in childre... more To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in children requiring mechanical ventilation for longer than 48 hrs. Prospective analytic study. Ten-bed-pediatric intensive care unit of a tertiary care University Hospital. A total of 110 patients requiring mechanical ventilation for longer than 48 hrs from January 1, 2005 to December 31, 2005. UGI bleeding was defined by evidence of blood in nasogastric aspirates, hematemesis, or melena within 5 days of pediatric intensive care unit admission. We prospectively collected data on patient demographics, admission diagnosis, operative status, and pediatric risk of mortality score. UGI bleeding and the potential risk factors including organ failure, coagulopathy, maximum ventilator setting, enteral feeding, stress ulcer prophylaxis as well as sedation were daily monitored. Of the 110 patients who required mechanical ventilation for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;48 hrs, the incidence of UGI bleeding was 51.8%, in which 3.6% of the cases presented with clinically significant bleeding (shock, requiring blood transfusion and/or surgery). Significant risk factors were thrombocytopenia, prolonged partial thromboplastin time, organ failure, high pressure ventilator setting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=25 cm H2O, and pediatric risk of mortality score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/= 10 using univariate analysis. However, the independent factors of UGI bleeding in the multivariate analysis were organ failure (relative risk = 2.85, 95% confidence interval 1.18-6.92) and high pressure ventilator setting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=25 cm H2O (relative risk = 3.73, 95% confidence interval 1.59-8.72). The incidence of UGI bleeding is high in children requiring mechanical ventilation. Organ failure and high pressure ventilator setting are significant risk factors for UGI bleeding.

Journal of the Medical Association of Thailand Chotmaihet thangphaet, Dec 1, 2006

The present study was performed to determine the relationship between environmental tobacco smoke... more The present study was performed to determine the relationship between environmental tobacco smoke (ETS) exposure and acute lower respiratory tract infection (LRI) caused by respiratory syncytial virus (RSV) in children. The authors did the study in 71 children (median age 12 months; 60% male) who were admitted to King Chulalongkorn Memorial Hospital with acute LRI between June and September 2004. 27% had RSV infection. RSV-LRI required longer duration of oxygen therapy than non RSV-LRI (4.5 +/- 1.7 vs 2.8 +/- 1.3 days; p &lt; 0.001). Desaturation in room air was more common in the former group compared to the latter group (37 vs 11%; p = 0.01). There was no difference in urinary cotinine level between the two groups (median 0.5 vs 0.6 mcg/mg Cr; ns). Among RSV-LRI, those with desaturation had higher urinary cotinine level than those without desaturation (median 0.8 vs 0.0 mcg/mg Cr; p = 0.04). ETS exposure was not associated with RSV-LRI but increased the risk of desaturation in the...

Authorea (Authorea), Jul 31, 2023

Pediatric Critical Care Medicine, Jun 1, 2018

Pediatric Research, Nov 1, 2011