วันพุธที่ 18 มกราคม พ.ศ. 2549

Diffusion weighted image (DWI) and magnetic resonance spectroscopy (MRS) of mass like lesions in the brain as correlated to histopathology.

Pichest metarugcheep
From the Department of neuroradiology. Prasat neurological institute, bangkok, Thailand.

Background and purpose : DWI and MRS have been used for the differentiation and grading of brain tumors for more than 10 years. We attempted to study the diagnostic efficacy of these two techniques inn MR imaging as correlated to the histopathology.

Methods : Seventy patients with mass like lesions diagnosed by conventional MRI and pathologically or clinically proved (11 low grade astrocytomas and 10 high grade astrocytomas. 7 metastases, 3 lymphomas, 2 germinomas, 1 medulloblastoma and 1 neuroblastoma, as well as 17 meningiomas, 5 schwannomas and 13 non tumors) and 20 normal controls were prospectively evaluated with conventional MRI (Press TR1500 and TE135) and DWI (b=0.500 and 1000 s/ mm2)

Results: Seventy patients were screwed to the inclusion criteria comprising of 40 men and 30 woman, age ranging from 15 to 75 yrs (mean age 45 years). Fifty seven patients (81%) were tumors and thirteen patients (19%) non-tumors. Base on the histopathologic classification, 24/57 (42%) were malignant ( 10 high grade astrocytomas, 7 metastases, 3 lymphomas, 1 medulloblastoma, 1 neuroblastoma and 2 germinomas) and 33/57 (58%) were benign (11 low grade astrocytomas, 17 menigiomas, 5 schwannomas). The 13 non-tumors were cerebral infarct 6, cysticercosis 3, abscess 2 and multiple sclerosis 2. The MRS showed benefit in differentiating tumor from non-tumor, malignant from benign and extraaxial from intraaxial tumor. The most significant parameter were the Cho/Cr value with cut point at 1.3 and the presence of lactate or lipid. Cho/Cr more than 1.3 favored tumor and less than 1.3 favored non-tumor. Malignant tumor showed more-frequent lactate and lipid. The character of Choline mono peak was found only in extraaxial tumor with helped to differentiate from intraaxial tumor. The Alanin was present only in meningioma. The ADC values were not useful in the differ entiating tumor from non-tumors, malignant from benign, or in grading of the tumor, However restricted diffusion with low ADC value was noted in both of the brain abscesses.

Conclusion : MRS showed diagnosis efficacy in differentiating tumor from non-tumor (p<0.5), benign from malignant tumors (P<0.5) and intraaxial tumors. Cho/Cr more than 1.3 was the key value for the differentiation of tumors from non-tumor. The increased frequency in lactate or lipid might be used for differentiation of malignant from benign tumor. The Choline mono peak was the characteristic of extraaxial tumor. The presence of the alanin was the feature of menunioma , ADC values were not effective for grading tumor or differentiating malignant from benign tumor, and tumor from non-tumor, but restricted diffusion (low ADC value) was noticed in brain abscess.

จาก บทคัดย่อผลงานทางวิชาการ
การประชุมวิชาการกระทรวงสาธารณสุขครั้งที่ 13 ประจำปี 2548

The Geographic Information System Application to Developing a Model of Distribution of Public Health Service Places : A Case Study in Changwat Kalasin

AUTHOR Mr.Asa Asachai

ADVISORS Asst. Prof. Dr. Somjit Arch-Int and Surasak Tiabrith

DEGREE M.P.H. MAJOR Health Informatic Management

UNIVERSITY Mahasarakham University DATE 2006


The medical and public health service system in Changwat Kalasin area has not yet systemized the health care service that can cover all the people in the area. The public health resource allotment planning in the past held the criteria based on the population. The public health information did not demonstrate clear spatial relationships. As a result, the resources allotments were inefficient. Thus this study implemented different factors in developing a model of distributing health care service centers by applying the geographic information system to analyzing convenience indices of accessing towns. Then the relationships with the numbers of health care service centers were calculated. The model of distributing health care service centers was developed by analyzing population density, public health resource distribution ratios, health assurance rates, and rates of passing the minimum health requirements. Data involving all the 135 Tambons were transformed into standard Z-scores and standard T-scores respectively. The obtained values were analyzed by means of a stepwise regression equation analysis. The obtained analysis results were then calculated for appropriateness of the numbers of health care service centers in Kalasin area.

The findings reveled that each. Each of the convenience indices of town access was in accordance with one another. If any index was high, all the other indices would be also high. The convenince indices of town access and the numbers of health care service centers showed low relationships (p>0.05). A predictive equation of the trend of distributing health care service centers was as below.

The number of health care service centers = 45.873 + 0.213 (rate of health assurance)

The rate of health assurance was an appropriate independent variable which would provide a predictig value of the variable Y close to an actual value. Also, from prediction, it was found that there were 97 Tambons in Changwat Kalasin in which additional health care service centers should be established. In planning for allotting public health resources, the geographic information system together with data in other aspects should be considered implementing in spatial resource allotment to originate more efficiency.

In conclusion, for development of the model of distributing health care service centers in Changwat Kalasin, the data concerned in each period of time should be examined in order to use such data for adjusting the policy and direction of developing the health care service centers to cover all the area and to respond to the peoples actual needs.

A Study of Environmental Factors and Hemorrhagic Fever Occurrcnce in Changwat Kalasin by Applying Geographic Information System

ชื่อผู้นิพนธ์ นายอดุลย์ กล้าขยัน


Hemorrhagic fever is regarded as an important public health problem of Thailand. The number of hemorrhagic fever patients increases year. Changwat Kalasin in 2001 had a rate of 115.03 patients per population of 100,000 people and in 2002 had a rate of 222.80 patients per population of 100,000. Although the medical personnel and public health agencies have helped one another prevent and control hemorrhagic fever, it has not been so successful as it should be because at present there are various factors leading to the widespread of hemorrhagic fever.

The purposes of this study were to examine the influences of environmental factors and hemorrhagic fever occurrences, and to construct an area model at risk of hemorrhagic fever occurrences of Changwat Kalasin. This study applied the geographic information system using secondary data comprising patient data. The data involved ages, seasons of sickness, and kinds of disease; collected from a total of 34, 36 patients during 2001-2005. There patients were divided into 1,903 dengue fever patients, 2,603 dengue hemorrhagic fever patients, and 130 dengue shock syndrome patients. The study also used data concerning 9 risk factors of hemorrhagic fever occurrence. A questionnaire was used for collecting data. The descriptive statistics used were percentage, mean, and standard deviation. The analytical statistic used for analysis of the data was multinomial logistic regression analysis.

The results of the study revealed the following. The environmental factors related to hemorrrhagic fever occurrences at the level of significance (p<> occurrences at 1.7-2.0 times ; the rainfalls 232.0-300.5 millimeters had results of in disease occurrences at 1.6 times ; the number of water sources of less than 89 sources could result in disease occurrences at 1.6 times ; and the age group of less than 12 years had 0.7 times of disease occurrences respectively . The power of hemorrhagic fever occurrence prediction was at 60.7 percent. And when the environmental factors were used to construct the area model at risk of disease occurrences by applying the geographic information system from all the 135 tambon, it was found that one tambon at a high level of risk of disease occurrence was Tambon Lao Oi, 112 tambon were at a medium level of risk of disease occurrence, and 22 tambon were at a low level of risk of disease occurrence.

In conclusion, most of the people living in Changwat Kalasin had opportunities at risk of becoming sick from hemorrhagic fever because the area model of risk of disease occurrences by applying the geographic information system provided each tambon of Changwat Kalasin mostly in the area at risk of hemorrhagic fever occurrences at a medium level. Therefore, it is extremely necessary for the people to protect themselves in every way from mosquito-bites. They would have no opportunity to get virus which causes hemorrhagic fever in the future.

Keywords : Geographic information system, Hemorrhagic fever

An Application of the Geographical Information System to Analyzing of Risk of Hemorrhagic Fever Occurrence in Changwat Nong Bua Lam Phu

AUTHOR Mrs. Julaporn Chaiyarat

ADVISORS Assoc.Prof.Wirat Pongsiri and Asst.Prof. Jirattha Phubunop

DEGREE M.P.H. MAJOR Management of Public Health Information

UNIVERSITY Mahasarakham University DATE 2005


The purposes of this study were to investigate factors at risk of hemorrhagic fever occurrence in changwat Nong Bua Lam Phu, and to construct an area model for analyzing levels of risk of hemorrhagic fever occurrence in Changwat Nong Bua Lam Phu by applying the geographical information system which used thesecondary source data consistiong of information involving a total of 1, 145 hemorrhagic fever patients in Chngwat Nong Bua Lam Phu. These patients were divided into 476 dengue fever patients, 549 hemorrhagic fever patients, and 120 shock hemorrhagic fever patients who were all sick during 1999-2003. Also, data involving factors of risk of hemorrhagic fever occurrence were included. The instrument used collecting data was a questionnaire already evaluated by experts. The data were analyzed by the uses of percentage, mean, standard deviation the multiple logistic regression analysis. Then area information was presented by using the package program by mens of overlapping information.

The study results were as follows :

There were totally 7 factors of risk of hemorrhagic fever occurrence in Changwat Nong Bua Lam Phu in this study. The factors of risk of hemorrhagic fever occurrence were ; density of population (p-value = 0.014), density of households (p-value = 0.001), andpatients’age group (p-value = 0.000). All these 3 factors had predicting powers of hemorrhagic fever occurrence at 7.1 percent (Nagelkerke R2 = 0.071). Then the factors of risk of hemorrhagic fever occurreence in Changwat Nong Bua Lam Phu were constructed into an area model for analyzing levels of risk of hemorrhagic fever occurrence by applying geographical information from a total of 59 tambon in Changwat Nong Bua Lam Phu. It was found that 30 tambon were at risk of hemorrhagic fever occurrence at a high level, and 29 tambon at risk of hemorrhagic fever occureenece at a mdium level.

In conclusion Changwat Nong Bua Lam phu People who lived in the areas with medium density of population, low to medium density of households, And age group of 6-12 years had a chance to be at risk of having hemorrhagic fever. Therefore, everyone had a chance to be at risk of having hemorrhagic fever because in the area model for analyzing the levels of risk of hemorrhagic fever occurrence by applying the geographical information system, and each tambon in Changwat Nong Bua Lam Phu was regarded as located in the area at risk of hemorrhagic fever occurrence at medium to high levels. It was greatly necessary for these people to prevent themslves in every way from not allowing mosquitoes to bite them. This would not provide a chance to receive a virus which could cause them to become sick of hemorrhagic fever in the future.

วันอังคารที่ 10 มกราคม พ.ศ. 2549


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"เรา รู้ว่าปัญหาคืออะไร ทุก ๆ ปีมีเด็ก 15 ล้านคน ในประเทศโลกที่สามเสียชีวิตจากโรคติดต่อ ซึ่งสามารถป้องกันได้ และเราก็รู้ว่าจะแก้ปัญหาได้อย่างไร วิธีแก้คือต้องฉีดวัคซีนที่สู้โรคได้"
แม้ว่าจะมีความคืบหน้าในการฉีดวัคซีนเด็ก แต่สำหรับในประเทศยากจนแล้วมีน้อยมาก เพราะวัคซีนส่วนใหญ่ต้องรับจากการฉีดซึ่งมีราคาแพง ทำให้มีทารกประมาณ 20% ในโลกที่มีโอกาสติดเชื้อโรคร้าย นอกจากนี้วัคซีนยังต้องแช่เย็นไปจนถึงจุดที่จะใช้ ปัญหาอีกข้อคือการฉีดวัคซีนต้องมีทักษะ เพราะต้องใช้เข็มฉีดยาซึ่งค่อนข้างอันตราย เข็มที่สกปรกอาจจะทำให้เชื้อโรคแพร่ไปมากกว่าที่จะจำกัดการขยายตัว

อาร์นทเซ็น คิดว่าพืชบางอย่างสามารถปรับปรุงดานพันธุกรรมเพื่อผลิตโปรตีนที่สามารถ สร้างระบบภูมิคุ้มกันแบบก้าวกระโดด เขาเริ่มจากการทดลองด้วยยาสูบ จากนั้นก็มันฝรั่งและมะเขือเทศจนกระทั่งมั่นใจในสมมุติฐาน แต่ก็คงไม่มีใครอยากทานมันฝรั่งดิบทั้งกระสอบเพื่อที่จะได้มีภูมิคุ้มกัน อาร์นทเซ็น เห็นว่ากล้วยเป็นผลไม้ที่เหมาะที่สุด เพราะรับประทานกันทั่วไปในประเทศยากจนอยู่แล้ว เขามองไปไกลถึงวันที่เด็ก ๆ จะได้ทานคุกกี้โอรีโอ ฉบับยา ที่จะมีไส้ตรงกลางเป็นกล้วยแทนครีมสีขาว

แต่ กว่าจะไปถึงขั้นนั้นได้ก็ยังต้องมีการพัฒนาอีกมาก อาร์นทเซ็นบอกว่าวัคซีนต้องได้รับการอนุมัติจากสหรัฐฯเสียก่อน เพื่อหลีกเลี่ยงข้อกล่าวหาที่ว่าจะใช้เด็กในประเทศยากจนเป็นหนูทดลอง นอกจากนี้ยังต้องทำให้แน่ใจว่าพืชจะให้วัคซีนในปริมาณที่เหมาะสม คงที่ และถูกต้อง นั่นหมายความว่าพืชที่จะใช้ผลิตวัคซีนต้องถูกแยกออกจากพืชอื่น ๆ และออกจากห่วงโซ่อาหาร ซึ่งก็อาจทำได้โดยการทำให้มันขยายพันธุ์ไม่ได้ ซึ่งก็อาจทำให้มันรสชาติไม่อร่อยเท่าพืชปรกติ