Introduction: Magnesium sulfate is used for preventing seizures in patients with severe preeclampsia. Previous studies have demonstrated that magnesium plays a significant role in the endothelial function and might have clinically beneficial vasodilating properties. Objectives: This study is aimed at evaluating the effect of magnesium sulfate on the glomerular filtration rate (GFR) during the first 24 h after delivery and during the duration of recovery from hypertension in preeclampsia. Methods: Severe preeclamptic patients who had normal serum creatinine levels (0.4–0.8 mg/dL) were included in the study. Twenty-three women with severe preeclampsia were divided into groups of 9, 8, and 6, and given 1.0, 1.5, and 2.0 g/h of magnesium sulfate, respectively. Magnesium sulfate infusion was used as seizure prophylaxis for 24 h after delivery. The cystatin C-based GFR was monitored for 24 h, and the blood pressure was recorded for 12 weeks postpartum. Results: Despite the minimal improvement of GFR 24-h after treatment initiation, survival analysis demonstrated a statistically significant relationship (log rank, p = 0.04) between magnesium dosage and recovery period from hypertension. The group receiving 2.0 g/h of magnesium experienced the shortest recovery period from hypertension (6.5 ± 1.8 days). Meanwhile, the other groups required 66.0 ± 26.9 and 48.3 ± 15.6 days to recover after 1.0 and 1.5 g/h of magnesium infusion, respectively. Conclusion: Magnesium sulfate has no impact on GFR improvement during the first 24 h after delivery. However, magnesium maintenance infusion at 2.0 g/h is capable of preventing seizure by optimizing the therapeutic magnesium level (4.8–8.4 mg/dL) and shortening the hypertensive episode in preeclampsia.
Background: The trend in the use of fluoroscopic-guided transcatheter aortic valve implantation (TAVI) is increasing because the procedure is less invasive than surgical procedure. However, high radiation doses have been reported with the procedure. Moreover, the amount of radiation received by patients undergoing TAVI has never before been registered in Thailand. Objectives: This study aimed to investigate the radiation dose and the effects of sex and body mass index (BMI) on the radiation dose received by patients undergoing TAVI at Chulabhorn Hospital. Materials and methods: Data were collected on the radiation dose received by patients undergoing the TAVI procedure during the first 26 months after the operation at the Cardiology Center, Chulabhorn Hospital. We recorded patient demographic data including age, sex, and BMI and the following measures of radiation dose from the procedure: the number of exposure images, air kerma-area product (PKA), cumulative air kerma at the patient entrance reference point (Ka,r), and total fluoroscopy time. Results: In total, 68 patients (35 male and 33 female) underwent TAVI, with median exposure images, PKA, Ka,r, and total fluoroscopy time of 1,067 images, 166.14 Gy/cm2, 1,171.50 mGy, and 31.90 minutes, respectively. The patient’s sex did not affect total fluoroscopy time or the radiation dose received. Patients with BMI ≥30.0 kg/m2 had the highest median values of PKA, Ka,r, and total fluoroscopy time. Moreover, patients with BMI ≥18.5-24.9 kg/m2 received higher doses of radiation than patients with BMI ≥25.0-29.9 kg/m2; the result corresponded with longer total fluoroscopy time in the lower BMI category. Conclusion: The amount of radiation that patients received during TAVI was appropriate for diagnosis and treatment. However, to ensure patient safety, operators should consider reducing the duration of radiation during the procedure. Data from this study are a starting point for the recording of radiation doses received by patients undergoing TAVI and can be used as a future dose reference.
Background Several electrocardiographic (ECG) criteria are used to diagnose left ventricular hypertrophy (LVH); however, they have low sensitivity. Objective To assess the sensitivity of LVH diagnosis using Peguero–Lo Presti criteria modified by body surface area (BSA). Methods This study used retrospective data from 9,438 patients who attended the Central Chest Institute of Thailand from January 2017 to December 2017 with available echocardiography, and who were categorized into those with and without LVH to determine diagnostic accuracy. We randomly selected 317 patients after excluding others based on various conditions. The left ventricular mass of the 317 patients was estimated using echocardiography. Peguero–Lo Presti criteria were modified by dividing original criteria by BSA. The accuracy of the modified criteria was compared with that of the original Peguero–Lo Presti, Sokolow–Lyon, and Cornell voltage criteria. A McNemar test was used to determine the agreement of all ECG criteria examined with LV mass index. The area under a receiver operating characteristic curve (AUC) was used to assess the performance of the criteria. Results LVH was diagnosed in 164 of the 317 patients using echocardiography. The sensitivity of modified Peguero–Lo Presti criteria was 50.6% (95% confidence interval [CI] 42.7% to 58.5%), and specificity was 88.2% (95% CI 82.0% to 92.9%), with an AUC of 0.67 (95% CI 0.61–0.73). Conclusions Peguero–Lo Presti criteria modified by dividing them by BSA can improve sensitivity with acceptable specificity for the diagnosis of LVH compared with other ECG criteria examined, at least in selected Thai patients. The modified Peguero–Lo Presti criteria have accuracy similar to that for the original criteria.
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