Care Hospital In Thailand Research Articles

A cost-utility analysis of fracture liaison service in osteoporotic hip fracture patients at tertiary care hospital in Thailand

A cost-utility analysis of fracture liaison service in osteoporotic hip fracture patients at tertiary care hospital in Thailand

852. Epidemiology, clinical characteristics and outcomes of invasive pulmonary aspergillosis among critically ill patients in medical intensive care unit: A retrospective study from the tertiary care hospital in Thailand

Abstract Background Invasive pulmonary aspergillosis (IPA) is a serious infection which leads to poor outcomes particularly in immunocompromised patients. Recently, IPA in critically ill patients in intensive care unit (ICU) has been increasingly recognized owing to its substantial morbidity and mortality. However, clinical data of IPA in ICU is scarce especially in Thailand. Methods A single-center, retrospective, observational study was conducted in King Chulalongkorn Memorial Hospital. We collected data on demographic, clinical characteristics, and outcomes of the patients who developed IPA during admission in the medical intensive care unit (MICU) between Jan 2016 to Dec 2021. IPA was identified by using ICD-10 and medication code for voriconazole, amphotericin B or liposomal amphotericin B. Patients met proven, probable IPA according to EORTC/MSG definition or putative IPA were included. The primary outcome was the incidence of IA in the MICU. Clinical characteristics, 12-week all-cause mortality and associated risk factor were the secondary outcomes. Results During the study period, a total of 5,019 patients were admitted in MICU. Fifty-seven met definitions of IPA which represented incidence of 1.14%. Seven patients (12.3%) had proven IPA, while 37 (61.4%) and 13 (22.8%) patients had probable and putative IPA, respectively. Cardiovascular disease (33.3%), chronic liver disease (26.7%), and diabetes (20.0%) were common comorbidities in patients with putative IPA. Diagnosis was made at median of 5 (3-10) days after ICU admission. Organisms were identified in 36 patients (63%) which Aspergillus fumigatus was the most common species (36.8%). All-cause mortality at week 12 was 89.5%. SOFA score (OR 1.494, 95%CI 1.058-2.110) and vasopressor used on admission (OR 16.00, 95%CI 2.209-115.92) had trend toward increase mortality. Median survival in putative and probable IPA group were 4 and 8 days after diagnosis (p= 0.023). Patients who received treatment with voriconazole had median survival 13 days compared to 5 days in other antifungal agents (p= 0.006). Conclusion IPA carried a high mortality among critically ill patients in MICU. High SOFA score and vasopressors used at the MICU admission were associated with mortality. Voriconazole therapy appeared to correlate with longer survival time. Disclosures All Authors: No reported disclosures

2729. Clinical characteristics, treatment and outcomes of infections among adult-onset immunodeficiency with anti-interferon (IFN)-γ autoantibodies patients: A single-center 10-year review from tertiary care hospital in Thailand

Abstract Background Adult-onset immunodeficiency (AOI) with anti-interferon (IFN)-γ autoantibodies is an acquired immunodeficiency syndrome increasingly recognized in East and Southeast Asia. Antibody against IFN- γ or its receptor is the main pathophysiology leading to opportunistic infections especially mycobacterial, dimorphic fungal or Salmonella infection. However, clinical information of infectious complications in this patient population remains scarce. Methods A retrospective study was conducted in Buddhachinaraj hospital, Phitsanuloke, Thailand. We collected data on demographic, infectious complications, treatment and outcomes in patients with AOI with anti-IFN-γ autoantibodies who presented to our center between March 2013 and February 2023. All patients were diagnosed by elevation of anti-IFN- γ antibody level in serum more than 1.0. Results A total of 35 patients. 54.3% were men with a median age of 58 years (IQR 14-63). Lymphadenopathy was the most common initial presentation (57%), followed by prolonged fever (40%), cough (11%) and skin lesions (11%). Lymph node involvement was found in 80% while 31% and 11% had intra-abdominal abscess and osteomyelitis. Organisms were identified in 21 patients (60%). Mycobacterial infections were found in 19 patients (90%) which the main etiologic agent was Mycobacterium abscessus (43%). Six patients (28%) had evidence of mycobacterial infection but were unable to specified. Histoplasma capsulatum was found in 2 patients (9%). Another 14 patients (40%) were presumptive treated as non-tuberculous mycobacterium (NTM) infection without retrieving specific organism. All patients were treated with antimicrobial agents according to identified causative organism. Fourteen patients with presumptive NTM infection were empirically treated with combination antibiotics. Median time of treatment was 24 months (IQR 12-35). Seven patients (20%) experienced relapse after antimicrobial discontinuation requiring retreatment. Three patients (6%) had died at median duration of 4 months from diagnosis. Conclusion AOI with (IFN)-γ autoantibodies should be considered in patient whom suspected mycobacterium or fungal infection among non-HIV patients. Diagnosis and treatment are challenge and recurrent infection is common. Disclosures All Authors: No reported disclosures

Maternal and Neonatal Outcomes of Pregnant Women with Abnormal 50 g Glucose Challenge Tests in Nakhon Si Thammarat, Thailand: A Retrospective Study.

(1) Background: An abnormal 50 g glucose challenge test (50 g GCT) during pregnancy, even without a diagnosis of gestational diabetes mellitus (GDM), may result in undesirable obstetric and neonatal outcomes. This study sought to evaluate the outcomes in pregnant women with abnormal 50 g GCT in secondary care hospitals in Thailand. (2) Methods: A total of 1129 cases of pregnant women with abnormal 50 g GCT results who delivered between January 2018 and December 2020 at Thasala, Sichon, and Thungsong hospitals were retrospectively reviewed and divided into three groups: abnormal 50 g GCT and normal 100 g oral OGTT (Group 1; n = 397 cases), abnormal 50 g GCT and one abnormal 100 g OGTT value (Group 2; n = 452 cases), and GDM (Group 3; n = 307 cases). (3) Results: Cesarean section rates in group 3 (61.9%) were statistically higher than those in groups 1 (43.6%) and 2 (49.4%) (p < 0.001). In addition, the highest rate of birth asphyxia was found in group 2 (5.9%), which was significantly higher than that in Groups 1 (1.8%) and 3 (3.3%) (p = 0.007). (4) Conclusions: Pregnant women with abnormal 50 g GCTs without a diagnosis of GDM had undesirable maternal and neonatal outcomes, as well as those who had GDM, suggesting that healthcare providers should closely monitor them throughout pregnancy and the postpartum period.

Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand.

Background: Early detection of elderly patients with COVID-19 who are at high risk of mortality is vital for appropriate clinical decisions. We aimed to evaluate the risk factors associated with all-cause in-hospital mortality among elderly patients with COVID-19. Methods: In this retrospective study, the medical records of elderly patients aged over 60 who were hospitalized with COVID-19 at Thammasat University Hospital from 1 July to 30 September 2021 were reviewed. Multivariate logistic regression was used to identify independent predictors of mortality. The sum of weighted integers was used as a total risk score for each patient. Results: In total, 138 medical records of patients were reviewed. Four identified variables based on the odds ratio (age, respiratory rate, glomerular filtration rate and history of stroke) were assigned a weighted integer and were developed to predict mortality risk in hospitalized elderly patients. The AUROC of the scoring system were 0.9415 (95% confidence interval, 0.9033-0.9716). The optimized scoring system was developed and a risk score over 213 was considered a cut-off point for high mortality risk. Conclusions: A simple predictive risk score provides an initial assessment of mortality risk at the time of admission with a high degree of accuracy among hospitalized elderly patients with COVID-19.

Using a discrete choice experiment to elicit patients’ preferences and willingness-to-pay for knee osteoarthritis treatments in Thailand

Osteoarthritis is the most common type of joint disease among elderly patients around the world. In response to the need for patient-centered care, patients’ and physicians’ preferences for knee osteoarthritis treatments have been studied in multiple countries, but not in Thailand. The objective of this study was to investigate Thai patients’ preferences and their willingness to pay (WTP) for knee osteoarthritis treatments by using a discrete choice experiment (DCE). Six knee osteoarthritis treatment attributes, including pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and cost, were used to develop a paper-based, DCE questionnaire survey. Patients with knee osteoarthritis, who were at least 18 years old and who provided written informed consent, were recruited from the orthopedic department in a tertiary care hospital in Thailand via convenience sampling. The conditional logit model was used to determine patients’ preferences and WTP. The Institutional Review Board at Chulalongkorn University approved this study before it started. A total of 232 patients were collected and analyzed in this study. Patients preferred treatments with a higher efficacy (pain relief and delayed disease progression), a lower probability of side effects (gastrointestinal, kidney, and cardiovascular side effects), and a lower cost. Regarding efficacy and side effects, the patients weighted the importance of a 1% change in cardiovascular side effects (− 0.08) more heavily than 1% changes in kidney (− 0.07) and gastrointestinal (− 0.02) side effects, delayed disease progression (0.02), and pain relief (0.01). Patients were willing to pay 29.56 Thai Baht (THB) and 41.84 THB per month for every 1% increase in pain relief and delayed disease progression, respectively. Conversely, patients were willing to pay 52.04 THB, 145.18 THB and 164.23 THB per month for every 1% decrease in gastrointestinal, kidney, and cardiovascular side effects, respectively. In conclusion, pain relief, delayed disease progression, gastrointestinal side effects, kidney side effects, cardiovascular side effects, and the cost of treatment were significant factors among patients undergoing knee osteoarthritis treatment. Additionally, patients had a higher WTP for delayed disease progression than pain relief and a higher WTP for a reduced probability of cardiovascular side effects than gastrointestinal and kidney side effects. These findings could be used to support treatment decisions for knee osteoarthritis patients in Thailand.

Health Risk Assessment and Covid-19 Infection Rate by Using Bacterial Aerosol in Healthcare Workers in a Tertiary Care Hospital in Thailand During SARS-CoV-2 Pandemic

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a worldwide transmission and healthcare worker is the risk group. Therefore, the infection rate and health risk assessment from exposure to airborne transmission for healthcare workers were performed. Methods: This cross-sectional study was carried out on 106 healthcare workers at four selected service areas in Songklanagarind Hospital, Thailand, from February to September 2021. The N6 impactor was used with simultaneous measurement of temperature, relative humidity, and wind speed. The general characteristics of subjects and hospitals were collected by questionnaire and presented by descriptive statistics. Results: Most of the participants were female and they worked more than 8 hours per day. The bacteria concentration was highest in the Pediatric Outpatient Department (1837.46±177.52 cfu/m3). The lowest chronic daily intake and hazard quotient with no threshold (4.86±3.81, 95%CI: 3.59, 6.13) were at Covid-19 Intensive Care Unit - due to negative pressure ventilation in this room was effective in reducing the airborne concentration of the pathogens. Overall, the hospital’s hazard index with no threshold (30.87±35.25, 95%CI: 23.91, 37.83) was higher than 1.0, indicating that bacterial bioaerosol may affect healthcare workers’ health. The highest confirmed Covid-19 case was at Acute Respiratory Infection Clinic (19.29±10.67 cases/week). The probability of infection by SARS-CoV-2 in healthcare workers was high at Acute Respiratory Infection Clinic (1.0) and Covid-19 Intensive Care Unit (0.998±0.002, 95%CI: 0.998, 0.999). Conclusion: Therefore, inhalation reference concentration for hospitals should be as low as possible and appropriate ventilation systems should be implemented with adherence to standards to protect healthcare workers.

Readmission Rate of Outpatient Distal Radius Fixation Surgery with Brachial Plexus Block and Midline Pronator Quadratus Approach in the COVID-19 Era: A Retrospective Case Series Report in a Secondary Care Hospital in Thailand

Objective: To demonstrate the readmission rate after distal radius fixation surgery performed with a brachial plexus block and the midline pronator quadratus approach in an ambulatory manner in a secondary care hospital. Materials and Methods: This retrospective study analyzed data on distal radius fracture patients treated with ambulatory surgery. The patients were enrolled from 1 January 2020 to 28 February 2022, which was during the COVID-19 pandemic. The primary outcome was the readmission rate within 30 days after the surgery. The secondary outcomes were complications, postoperative pain, radiographic outcome, and functional score. All patients were followed up for at least 1 year after the surgery. Results: Thirty-one patients were enrolled in this study. Their mean age was 58.5 years, and the fractures were mainly caused by low-energy trauma. No postoperative complications were reported, and no readmission after surgery was observed. Overall radiographic parameters were in the acceptable range (radial inclination = 21.9, radial height = 10.26, volar tilt = 2.65, and ulna variance = 1.33). All patients returned to their preinjury statuses within 5 months. Conclusion: Distal radius fixation surgery can be managed in an ambulatory manner with a low readmission rate, even in secondary care hospitals. This repair technique provides adequate soft tissue coverage of the volar radius plate while decreasing the risk of iatrogenic radial artery injuries.

Factors Predictive of In-Hospital Mortality in Patients with Systemic Lupus Erythematosus: A Single-Centre Retrospective Analysis.

We aimed to investigate the causes and factors predictive of in-hospital death among patients with systemic lupus erythematosus (SLE) admitted to a tertiary care hospital in Thailand. We retrospectively reviewed the records of patients with SLE admitted between 2017 and 2021. We collected data related to age, sex, body mass index, comorbidities, disease duration, medication usage, clinical symptoms, vital signs, laboratory results, evidence of infection, presence of systemic inflammatory response syndrome, quick sepsis-related organ assessment scores, and SLE disease activity on the date of admission. The length of hospitalization, treatment administered, and subsequent clinical outcomes (including in-hospital complications and death) were also recorded. Among 267 enrolled patients, the overall in-hospital mortality rate was 25.5%, and infection was the most common cause of death (75.0%). Multivariate analysis revealed that prior hospitalization within 3 months (odds ratio [OR]: 2.311; 95% confidence interval [CI]: 1.002-5.369; P=0.049), initial infection on admission (OR: 2.764; 95% CI: 1.006-7.594; P=0.048), use of vasopressor drugs (OR: 2.940; 95% CI: 1.071-8.069; P=0.036), and mechanical ventilation (OR: 5.658; 95% CI: 2.046-15.647; P=0.001) were independent risk factors for in-hospital mortality. Infection was the major cause of mortality in patients with SLE. Prior hospitalization within 3 months, initial infection on admission, vasopressor use, and mechanical ventilation during admission are independent risk factors for in-hospital mortality in patients with SLE.

Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand

BackgroundInadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort.ObjectiveTo determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes.Materials and methodsA retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia.ResultsA total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8–90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08–2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia.ConclusionThis study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk.RegistrationClinical Trials.gov (NCT04307095) (13/03/2020).

Spinal Extramedullary Arteriovenous Fistulas: A 15-Year Endovascular Treatment Experience in a Tertiary Care Hospital in Thailand.

Spinal arteriovenous shunts are rare diseases. Different classifications have been proposed, but the most widely used are those classified by locations. Different locations (i.e., intramedullary and extramedullary) have different treatment outcomes and different posttreatment angiographical results. Our study presents the 15-year endovascular treatment outcomes of patients who had spinal extramedullary arteriovenous fistulas (AVFs) at Ramathibodi Hospital, which is a tertiary care hospital in Thailand. A retrospective medical record and imaging review of all patients with spinal extramedullary AVFs, which were confirmed by a diagnostic spinal angiogram in our institute from January 2006 to December 2020, were performed. The angiographic complete obliteration rate in the first session of endovascular treatment, clinical outcomes of the patients, and complications of the procedures for all eligible patients were analyzed. Sixty-eight eligible patients were included in the study. The most common diagnosis was spinal dural AVF (45.6%). The most common presenting symptoms were weakness, numbness, and bowel-bladder involvement (70.6%, 67.6%, and 57.4%, respectively). Ninety-four percent had spinal cord edema in preoperative magnetic resonance imaging. All patients had pial venous reflux. Sixty-four patients (94.1%) received endovascular treatment as the first option. The complete obliteration rate in the first session of endovascular treatment was 75% and was high in all subgroups except for the perimedullary AVF group. The overall intraoperative complication of endovascular treatment was 9.4%. Follow-up imaging showed no residual AVF in 50 patients (87.7%). Most of the patients (57.4%) had improvement of neurological functions at 3- to 6-month follow-up. Treatment results of spinal extramedullary AVFs were good in terms of angiographic aspects and clinical outcomes. This may have resulted from the locations of the AVFs, which mostly did not involve the spinal cord arterial supply, with the exception of perimedullary AVFs. Although perimedullary AVF is difficult to treat, it can be cured by careful catherization and embolization.

Pre-epiglottic Space and Epiglottis to Vocal Cord Ratio in Order to Predict Difficult Intubation in Adults: A Multivariate Analysis

Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic parameters (pre-epiglottic space (Pre-E), distance between epiglottis to middle part of vocal cord (E-VC) and Pre-E/E-VC) adjusting for traditional airway assessments. Material and Methods: This prospective cohort study was conducted at a super-tertiary care hospital in Thailand. Participants aged 18-65 years with ASA classification I-III and who required general anesthesia with endotracheal intubation were included. Preoperative traditional and ultrasonographic airway assessments were performed by two investigators. The outcome was difficult intubations as diagnosed by laryngoscopic view grade 3 or 4. Multivariate logistic regression was used to identify predictors for difficult intubation presented by adjusted odds ratio (OR) and 95% confidence interval (CI). Results: A total of 94 patients were recruited. The incidence of difficult intubation was 15%. The median Pre-E/E-VC ratio among this group was 0.8 compared with 1.0 in the control group (p-value 0.124). The cut-off point of &lt;1.0 of Pre- E/E-VC was not associated with difficult intubation after adjusting for sex and other traditional parameters (p-value 0.11). Predictors of difficult intubation were female sex (OR [95% CI]: 13.8 [2.8, 68.3]), sternomental distance ≤175 mm (OR [95% CI]: 11.6 [1.9, 71.4]) and interincisor gap &lt;4 cm (OR [95% CI]: 19.8 [1.1, 373.8]) with the area under the receiver operating characteristic curve at 0.88 and a specificity of 90.0%. Conclusion: There was no association between the Pre-E/E-VC in predicting difficult intubation in low-risk patients. The ultrasonographic measurements of Pre-E/E-VC were not helpful in predicting difficult intubations in our setting. Trial registration: thaiclinicaltrials.org: TCTR20180115002, Registered 9 January 2018 - Prospectively registered, https:// www.thaiclinicaltrials.org/#

Prevalence and Related Factors of Lower Urinary Tract Infection in Frail Older Adults Undergoing Major Noncardiac Surgery.

Urinary tract infections are the most common complication after surgery in older adults, resulting in poor operative outcomes and reduced quality of life after discharge. However, there is limited research investigating the relationships between urinary tract infection and associated factors in frail older surgical patients, particularly in Thailand. This retrospective study included 220 frail older patients aged ≥ 60 years who had undergone major noncardiac surgery at a tertiary care hospital in Thailand from January 2015 to December 2019. The sample was recruited using the criteria indicated in the modified Frailty Index-11 and having the blood glucose level determined within 2 h before surgery. The prevalence of lower urinary tract infections was 15% post-surgery. Firth's logistic regression analysis revealed that the equation could predict the accuracy of lower urinary tract infections by 88.5%. Frailty, blood glucose levels, complication during admission, and personal factors together predicted the variability of lower urinary tract infections. Adjusting for other variables, being an older adult with severe frailty and complications during hospital admission significantly increased the risk of developing lower urinary tract infections (odds ratio = 3.46, p < 0.05; odds ratio = 9.53, p < 0.001, respectively).

Isolation and Antibiotic Susceptibility Profile of Salmonella spp. from Patients in a Tertiary Care Hospital in Thailand

Objective: The impact of COVID-19 on the number and antibiogram profile of Salmonella was studied between January 2018 and December 2021. The present time period included years before the COVID-19 pandemic, which are 2018 and 2019, and during the pandemic, which are 2020 and 2021. Materials and Methods: Salmonella infections were classified into eight distinct serogroups using slide agglutination with specific antisera (A, B, C, D, E, F, G, and I). The susceptibility to antimicrobial agents were evaluated by the standard disk diffusion method. Results: Four hundred fifty-one isolates were detected (139 in 2018, 119 in 2019, 102 in 2021, and 91 in 2021). Salmonella infection decreased by 25.2% from 258 isolates in 2018 and 2019 to 193 in 2020 and 2021. When comparing Salmonella infections in different age groups (0 to 10, 11 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and older than 70 years), before and during COVID-19, statistical significance was noted only in patients aged 11 to 20 (p=0.016). For clinical specimens (stool, blood, urine, pus, etc.), statistical significance was found only in blood specimens (p=0.036). The four most predominant Salmonella serogroups were B (31.1%), C (30.6%), E (15.7%), and D (11.4%). S. Typhi was present in 2.1% (4/193) of Salmonella isolates during COVID-19. The findings of a susceptibility test using the disk diffusion method for four commonly used drugs in treatment of severe salmonellosis as ampicillin, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, before and during COVID-19 demonstrated statistical significance only in Salmonella serogroup D (p=0.028). Overall, drug susceptibility of Salmonella serogroup B, C, D, and E was ampicillin (range 15.1% to 55.9%), cefotaxime (range 66.7% to 100%), ciprofloxacin (range 18.8% to 59.1%), and trimethoprim/sulfamethoxazole (range 70.0% to 93.8%). Conclusion: The present study results suggested the importance of monitoring the prevalence of Salmonella at a hospital in Bangkok. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment. Keywords: Salmonella; COVID-19 pandemic; Thailand

Brain and Spinal Cord MRI Findings in Thai Multiple Sclerosis Patients

Previous studies have demonstrated different MRI characteristics in Asian and Western patients with multiple sclerosis (MS). However, the number of studies performed on Thai patients is still limited. Furthermore, these studies were conducted before the revision of the McDonald criteria in 2017. A retrospective descriptive study was performed on Thai patients diagnosed with MS, according to the McDonald criteria (2017), in a tertiary care hospital in Thailand. Thirty-two patients were included (twenty-seven female and five male patients). The mean age was 37.8 years. Most (28 patients) had relapsing remitting MS. Brain MRIs were available for all 32 patients, all of which showed abnormalities. The most common locations were the periventricular regions (78.1%), juxtacortical regions (75%) and deep white matter (62.5%). Dawson's fingers were identified in 20 patients (62.5%). Tumefactive MS was noted in two patients. Gadolinium-enhancing brain lesions were noted in nine patients (28.1%). Optic nerve lesions were found in seven patients. Six of the seven patients showed short segmental lesions with predominant posterior-half involvement. Spinal MRIs were available for 26 patients, with abnormalities detected in 23. Most (11 patients) had lesions both in the cervical and in the thoracic spinal cord. In total, 22 patients (95.7%) showed lesions at the periphery, most commonly at the lateral column. Fifteen patients showed lesions shorter than three vertebral segments (65.2%). Enhancing spinal lesions were noted in 14 patients. Dissemination in space was fulfilled in 31 patients (96.9%). Some of the MRI findings in our study were similar to those of previous studies in Thailand and Asia, emphasizing the difference between Asian and Western MS.

Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand

SummaryFragility hip fracture (FHF) is a serious complication of osteoporosis. A fracture liaison service (FLS) is crucial in preventing FHF. Our retrospective data of 489 patients with FHF and 3-year follow-ups demonstrated that the FLS improved functional outcomes. Our study’s mortality rates were lower than in other published series.PurposeThis study assessed the 3-year outcomes after fragility hip fracture (FHF) treatment by a multidisciplinary team from the Siriraj Fracture Liaison Service (Si–FLS). The review investigated the administration rates of anti-osteoporosis medication, refracture, and mortality; activities of daily living; mobility; and health-related quality of life.MethodsA retrospective review was performed of the records of Si-FLS patients given FHF treatment between June 2016 and October 2018. The outcomes were evaluated at 3 time points: before discharge, and 1 and 3 years after treatment.ResultsThe study enrolled 489 patients (average age, 78). The mortality and refracture rates at 1 year after hip fracture were 13.9% and 1.6%, respectively. At the 3-year follow-up, both rates were higher (20.4% and 5.7%, respectively). The Barthel Index and EuroQoL Visual Analogue Scale had risen to a plateau at the 1-year follow-up and remained stable to the 3-year follow-up. One year after treatment, approximately 60% of the patients could ambulate outdoors, and the proportion remained steady until the 3-year follow-up. There was no difference in the 1- and 3-year follow-up anti-osteoporosis medication administration rates (approximately 40%).ConclusionsThis study confirms the benefits of having a multidisciplinary FLS care team to manage older people with FHF. An FLS improves the care of patients with FHF and the social support of caregivers and relatives. The FLS maintained the functional outcomes of the patients through 3 years of postfracture treatment.

Retinopathy prediction in type 2 diabetes: Time-varying Cox proportional hazards and machine learning models

BackgroundDiabetic retinopathy (DR) is one of the most common complications in type 2 diabetes (T2D) with an estimated prevalence of 22%. Predictive modelling has largely been dependent on Cox proportional hazards (CPH) with assumptions of linearity and constant hazards. Machine learning (ML) approaches may prove advantageous in more adequately capturing non-linear effects. ObjectiveTo construct and compare DR prediction models using CPH and ML models with time-varying covariates. DesignReal-world, retrospective cohort study. SettingA tertiary care hospital in Thailand. ParticipantsData on 48,622 T2D patients from electronic health records between 1st January 2010 and 31st December 2019. MethodsTime-to-event time-varying models that included 13 variables were trained in diabetic retinopathy prediction. The CPH and ML models were compared using left-truncated right censoring relative risk forest (LTRC-RRF) and left-truncated right censoring conditional inference forest (LTRC-CIF) algorithms. ResultsThe CPH model outperformed both ML approaches with a Harrell's C-index (c-index) of 0.70 compared to c-indices of 0.51–0.57 for the ML models in the test dataset. Both CPH and ML models showed insulin use and the presence of chronic kidney disease increased DR risk. Sodium glucose transporter 2 inhibitors and dyslipidemia were associated with reduced DR risk. ConclusionCPH provided better predictive power for DR risk than ML modelling using real world data. The presence of comorbidities and the use of antidiabetic medications were associated with the greatest drivers of DR risk.

Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage

BackgroundEarly unexpected hospital admission after emergency department (ED) discharge is an important topic regarding effective preventive measures. Reducing avoidable return visits can improve ED effectiveness and emergency care. This study evaluated the effects of an increase in the number of physicians and the 24-h coverage of emergency physicians on 48-h ED revisits with subsequent hospital admission. The characteristics and risk factors of the patients were also investigated.ResultsThis was a retrospective analysis performed 2 years before and 2 years after the implementation of an intervention in a tertiary care hospital in Thailand. The medical records of adult patients who revisited the ED within 48 h for related complaints were reviewed. The effect of the intervention was analyzed, and a prediction model was developed based on logistic regression.After implementing the intervention, the hospital admission rate at the second ED visit decreased from 44.5 to 41.1%; no significant difference was found (95% confidence interval (CI) − 5.05 to 11.78). Patients who required hospital admission had a significantly higher comorbidity score, more ED visits, and more hospitalizations within the past 12 months. A significantly higher hospital admission rate was also observed among patients older than 60 years, those who had an initial infectious diagnosis, and those who had a higher triage severity level (ESI II) at their first visit. The odds ratio (OR) showed lower odds of hospital admission at the second visit in the postintervention period; this difference was not significant (OR 0.87; 95% CI 0.61 to 1.23).ConclusionOur intervention did not significantly decrease the incidence of admission at an ED revisit. However, some factors identified in this study seem to have some benefits and might be helpful for preventing errors and constructing a standard discharge care plan for patients with these risk factors.

Time to Treatment Intensification to Reduce Diabetes-Related Complications: A Post Hoc Study.

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce—especially outside of developed countries. This study aimed to explore the association between time to treatment intensification and diabetes-related complications. A database from a tertiary care hospital in Thailand was retrieved in order to conduct a retrospective cohort study for the years 2011–2017. This study comprised outpatients with T2DM presenting an HbA1c of ≥7.0%. Eligible patients were divided into three groups based on the time of treatment intensification: no delayed treatment intensification, treatment intensification within 6 months, and treatment intensification after 6 months. A Cox proportional hazards model was used to investigate the association between time to treatment intensification and diabetes-related complications. A total of 686 patients were included in the final analysis. During 6.5 years of median follow-up, the group with treatment intensification within 6 months was more strongly associated with diabetic nephropathy compared to the group with no delayed treatment intensification (adjusted HR 2.35; 95%CI 1.35–4.09). Our findings reveal that delaying treatment intensification by even 6 months can increase the likelihood of diabetic nephropathy compared to no delayed treatment intensification. We suggest that patients with T2DM whose blood glucose levels are outside the target range promptly receive treatment intensification.

Evaluation of the effectiveness of platelet crossmatching by the solid-phase red cell adherence assayin adult patients of a tertiary care hospital in Thailand: A retrospective study.

Background and AimsPlatelet transfusion refractoriness is well aware to be associated with poor clinical outcomes. Patients with the alloantibody causing refractoriness required cross‐matched compatible products to improve the platelet number. This study aims to evaluate the effectiveness and availability of platelet crossmatching provided by the solid‐phase red cell adherence (SPRCA) technique in the context of a tertiary university hospital.MethodsA retrospective chart review was performed of the records of 214 patients with platelet refractoriness in Siriraj Hospital, a tertiary university hospital in Thailand, between January 1, 2017, and December 31, 2020.ResultsThe SPRCA technique successfully provided cross‐matched compatible platelets to 114 patients (69.7%). Platelet crossmatching significantly improved the platelet counts, as shown by the increased 1‐ and 24‐h corrected‐count increments (p< 0.0001). No acute transfusion reactions were observed in these patients. Of the 114 patients who received cross‐matched platelets, 82 patients (71.9%) survived at 30‐day posttransfusion; whereas, 16 patients (14.0%) died within 7‐day posttransfusion.ConclusionThe SPRCA method can provide a high availability rate of cross‐matched platelets, which is effective at stopping and preventing clinical bleeding conditions. This method is appropriate to apply for platelet crossmatching in the context of a hospital blood bank.