Rajavithi Hospital Research Articles

Efficacy of High Dose Pulse Methylprednsiolone (Somidex) vs Oral Prednisolone for Treatment of Newly Diagnosed Idiopathic Thrombocytopenic Purpura in Rajavithi Hospital: Open Labelled Randomized Controlled Trial

Efficacy of High Dose Pulse Methylprednsiolone (Somidex) vs Oral Prednisolone for Treatment of Newly Diagnosed Idiopathic Thrombocytopenic Purpura in Rajavithi Hospital: Open Labelled Randomized Controlled Trial

The Association of Preoperative Prognostic Nutritional Index With Survival Outcome in Ovarian Clear Cell Cancer.

The preoperative prognostic nutritional index (PPNI) has been investigated as a prognostic indicator in various cancers including epithelial ovarian cancer (EOC). However, its prognostic relevance in epithelial ovarian clear cell cancer (EOC-CC) remains uncertain. The objective of the study was to clarify the prognostic values of PPNI in EOC-CC patients. We retrospectively reviewed 290 EOC-CC patients who underwent staging surgery at Rajavithi Hospital between January 2008 and December 2019. The PPNI was calculated using serum albumin × 10 (g/L) + 0.005 × peripheral blood lymphocyte count (per mm3). The association between PPNI and survival outcome was analyzed using the Kaplan-Meier method and the Cox proportional hazard model. The optimal cut-off value of PPNI, set at a mean of PPNI as 50, divided the EOC-CC patients into two groups: the low (n = 115) and the high (n = 175) PPNI group. With a median follow-up time of 63 months, patients with high PPNI exhibited significantly superior 5-year overall survival (OS) rates (76.4% vs. 56.8%, P = 0.004) and 5-year progression-free survival (PFS) rates (71.0% vs. 58.7%, P = 0.017) compared to patients with low PPNI. Univariate analysis revealed high PPNI correlated with increased OS (hazard ratio (HR): 0.51; 95% confidence interval (CI): 0.35 - 0.75) and PFS (HR: 0.63; 95% CI: 0.43 - 0.92). Nevertheless, in a multivariate analysis, high PPNI did not retain its status as an independent prognostic factor for a favorable prognosis in EOC-CC patients. The present study did not confirm the prognostic significance of PPNI on survival outcomes in EOC-CC patients. Therefore, conducting prospective clinical research with large samples is necessary to illustrate the predictive values of PPNI in this rare disease.

Development and Validation of a Clinical Prediction Model for Paclitaxel Hypersensitivity Reaction on the Basis of Real-World Data: Pac-HSR Score.

Paclitaxel is effective chemotherapy against various cancers but can cause hypersensitivity reaction (HSR). This study aimed to identify predictors associated with paclitaxel HSR and develop a clinical prediction model to guide clinical decisions. Data were collected from the medical records database of Rajavithi Hospital. Patients with cancer treated with paclitaxel from 2015 to 2022 were included, and a multivariable logistic regression analysis identified predictors associated with paclitaxel HSR. The scoring system was transformed and calibrated on the basis of diagnostic parameters. Discrimination and calibration performances were assessed. Internal validation was conducted using bootstrap resampling with 1,000 replications. This study involved 3,708 patients with cancer, with an incidence of paclitaxel HSR of 10.11%. An 11-predictor-based Pac-HSR scoring system was developed, involving the following factors: younger age; poor Eastern Cooperative Oncology Group performance status; previous history of paclitaxel HSR; medication allergy history; chronic obstructive airway disease; lung and cervical cancers; high actual dose of paclitaxel; no diphenhydramine premedication; low hemoglobin level; high WBC count; and high absolute lymphocyte count. The C-statistics was 0.73 (95% CI, 0.70 to 0.76), indicating acceptable discrimination. The P value of the Hosmer-Lemeshow goodness-of-fit test was 0.751. The ratio of observed and expected values was 1.00, indicating good calibration. At a cutoff point of 8, specificity was 75.28% and sensitivity was 57.07%. Internal validation indicated good performance with minimal bias, and decision curve analysis demonstrated improved prediction with the use of this scoring system in clinical decision making. This study developed the 11-predictor-based Pac-HSR scoring system for predicting paclitaxel HSR in patients with cancer. High-risk patients identified by this score should be prioritized for close monitoring and early treatment prophylaxis.

Appropriateness of direct oral anticoagulant dosing in patients with atrial fibrillation at a tertiary care hospital in Thailand

BackgroundAppropriate dosing of direct oral anticoagulants (DOACs) has been associated with clinical efficacy and safety. Several studies have shown that DOAC dosing are often inconsistent with guideline recommendations. Little is known about this issue in Thailand. This study aimed to evaluate the appropriateness of DOAC dosing in Thai hospitalized patients with atrial fibrillation (AF). MethodThis was a retrospective descriptive study conducted on hospitalized patients at Rajavithi Hospital, a tertiary care hospital in Thailand. Inpatients diagnosed with AF and treated with DOACs between February 2021 and February 2023 were enrolled in the study. The appropriate dosing of DOACs was assessed according to the recommendation of the 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation (EHRA). Descriptive statistics were used to analyze the data; median (interquartile range) for continuous variables, and numbers and percentages for categorical variables. ResultsA total of 120 patients with AF were evaluated for dosing. The patients received rivaroxaban in 47 cases (39.2 %), apixaban in 32 cases (26.7 %), edoxaban in 31 cases (25.8 %), and dabigatran in 10 cases (8.3 %). Most of the patients were elderly, with a median age of 77.5 (68–84) years. Females were predominant (57.5 %). Our findings indicate that the prevalence of appropriate dosing of DOACs was 63.3 %. However, approximately one-third of patients received inappropriate dosing, with 24 (20.0 %) being overdosed, and 20 (16.7 %) being underdosed. The highest overdosing and underdosing rates were seen in dabigatran (90.0 %) and apixaban (21.9 %), respectively. ConclusionInappropriate dosing of DOACs according to the 2021 EHRA recommendations was high in 36.7 %, with overdosing mostly occurring in 20.0 %. The high number of inappropriate dosing highlights the need for implementation of optimal strategies to select the appropriate dose of DOACs in Thai hospitalized patients with AF.

Incidence of Urinary Incontinence During the Postpartum Period in Rajavithi Hospital: A Prospective Cohort Study.

The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women. A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45years, and gestational age ≥ 37weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2days, 6weeks, 3 months, and 6months. Multivariate logistic regression was used to analyze risk factors for UI. The incidence of self-reported UI at 2days, 6weeks, 3 months, and 6months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL. In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6weeks and all resolved at 6months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.

A novel score predictor for atrial fibrillation in cardiac implantable electronic device patients

Abstract Background Atrial fibrillation (AF) in individuals with cardiac implantable electronic devices is associated with heightened risks of adverse outcomes. Despite this, risk stratification for AF development in this patient cohort remains unexplored. Consequently, we present the development and validation of a simplified multi-parameter risk-based scoring system for predicting AF in patients with cardiac implantable electronic devices. Methods and Results A cohort of 226 consecutive patients with cardiac implantable electronic devices at Rajavithi Hospital underwent comprehensive follow-up to observe AF development, defined by 12-lead EKG evidence of AF. Analysis encompassed risk factors and AF incidence. The resulting V-DASH score integrated a History of vascular disease, including coronary artery disease (CAD) and peripheral arterial disease (PAD) (1.5 points), Diabetes (1 point), Apical lead position (1 point), Sex (female gender (1.5 points)), and Hypertension (1 point). Predictive value assessment revealed that Diabetes, Female gender, and a history of vascular disease were significantly associated with AF incidence. Apical lead position and Hypertension emerged as robust risk factors for AF development. Over a median follow-up duration of 13 months, 8 (3.53%) patients developed AF. The incidence of AF exhibited a noteworthy escalation in correlation with the V-DASH score (4.68 times higher risk per point increase). Among patients with a V-DASH score ≥4, the probability of AF occurrence was 97.34%. The V-DASH score demonstrated exceptional predictive capability (area under the curve, 0.90; 95% CI, 0.79–1.00), calibration ability (Hosmer-Lemeshow goodness-of-fit P=0.552), and accuracy (sensitivity 87.50% and specificity 83.94%), surpassing other clinical scores such as the C2HEST score. Conclusions The V-DASH score emerged as a robust predictor of AF incidence in patients with cardiac implantable electronic devices, with the highest risk observed in those with a V-DASH score ≥4. The potential clinical utility of the V-DASH score in this patient population warrants further investigation.ROC curve for predicting AFPerformance calibration plot

Prevalence and Factors Related to Sarcopenia in Older Adults in a Tertiary Care Hospital: A Cross-Sectional Study

Background: Sarcopenia frequently manifests in an aging population. Its prevalence is notable among adults aged 60 to 70 years, affecting 5% to 13% of this age group. The prevalence increases over the age of 80, encompassing a range of 11% to 50%. This significantly heightens the risk of various health conditions, including falls and infections. To alleviate the challenges posed by sarcopenia, it is imperative that factors associated with the condition are thoroughly investigated and well-established. Objective: To examine the prevalence of sarcopenia among older adults and explore the factors associated with this condition in depth. Materials and Methods: The present study was a retrospective cross-section study. The data were obtained through a meticulous review of medical records and diet diaries of elderly patients in the Geriatric Clinic of Rajavithi Hospital between November 2022 and May 2023. Three hundred forty-one adults aged 60 years and above were included as participants in the study. To analyze the data comprehensively, both univariate and multivariate logistic regression analyses were employed as the primary statistical methods. Results: The prevalence of sarcopenia was 36.66%. Several factors exhibited a significant association with sarcopenia, including age over 74 years (adjusted odds ratio [OR] 4.89, 95% CI 2.51 to 9.50, p&lt;0.001), absence of obesity (adjusted OR 0.16, 95% CI 0.06 to 0.40, p&lt;0.001), daily protein intake of 60 grams or less (adjusted OR 6.50, 95% CI 2.80 to 15.09, p&lt;0.001) and daily energy intake 1,410 kilocalories or less (adjusted OR 2.49, 95% CI 1.06 to 5.82, p=0.036). Conclusion: The prevalence of sarcopenia among the elderly patients in the geriatric clinic was significantly elevated. Sarcopenia exhibited statistically significant association with age, obesity, protein intake, and energy intake per day. Therefore, ensuring sufficient daily protein intake should be a priority in preventing sarcopenia among older adults.

Sustained virological response in chronic hepatitis C patients by direct-acting antiviral treatment significantly reduces liver stiffness over 24 weeks posttreatment.

To investigate whether direct-acting antiviral (DAA) treatment affected liver fibrosis testing, including transient elastography (TE), aspartate aminotransferase-to-platelet ratio index (APRI), and Fibrosis-4 (FIB-4) index, after establishing a sustained virological response for 24 weeks. This prospective cohort study was conducted between October 1, 2019, and September 30, 2020, at Rajavithi Hospital, Bangkok, Thailand. All the patients had significant liver fibrosis (TE ≥ 7.0 kPa) at baseline and completed 12 weeks of DAA therapy. After achieving SVR, liver stiffness measurements were repeated for at least 24 weeks. The primary outcome was a > 30% improvement in TE score at the end of the study compared to baseline. A multivariate logistic regression model was used to identify the parameters associated with the primary outcome. Temporal changes in APRI and FIB-4 indices from baseline to 24 weeks posttreatment were also examined. A total of 110 chronic HCV patients were included in our cohort, of which 57 (52.3%) achieved the primary outcome. The median TE decreased from 15.05 (8.76-23.68) kPa at pretreatment to 9.60 (6.50-14.40) kPa at 24 weeks posttreatment (P < .001). Those who had a baseline TE ≥ 9.5 kPa had higher odds of meeting the primary outcome, and this remained significant after adjusting for age, sex, baseline body mass index, underlying diabetes mellitus, HCV genotype 3, baseline laboratory levels, and treatment regimens (OR 3.04; 95% CI 1.22-7.60, P = .017). Similar to TE, the median APRI and FIB-4 index displayed a considerable reduction from baseline to 24 weeks after successful therapy. Modern DAA treatment has been associated with considerable improvement in liver stiffness measured by TE in chronic HCV patients who achieve SVR, with roughly 52% of patients experiencing a reduction of > 30% in TE over 24 weeks posttreatment compared to baseline. This probably indicates early fibrosis regression, although the effect of resolution of inflammation after treatment completion cannot be ruled out.

Comparison of Conventional Radiography and Multidetector Computed Tomography Scan in Knee Trauma in Rajavithi Hospital

Objective: This study aimed to compare the diagnostic results and agreement among XR, MDCT, and combined examination between XR and MDCT in diagnosing knee bone fractures.&#x0D; Methods: A retrospective was conducted of 243 patients who experienced knee trauma and underwent both XR and MDCT scans between January 1, 2016, and January 1, 2021, at Rajavithi Hospital in Bangkok, Thailand.&#x0D; Results: Out of the 243 patients, 147 were male (60.5%), and 96 were female (39.5%), with 226 (93%) displaying fractures. MDCT identified a total of 319 fractures in various anatomic regions. Computed tomography scans compared with the two combined methods showed no difference in results. However, the radiography results were significantly different compared to the two methods combined (p&lt;0.05). MDCT+XR proved more effective in diagnosing fractures than XR alone. The agreement between MDCT versus MDCT+XR exceeded 0.98, whereas the agreement between XR versus MDCT+XR was less than 0.9, except for femoral fractures (0.935). Overall, utilizing both MDCT and XR together significantly enhanced the diagnostic effectiveness compared to using XR alone.&#x0D; Conclusion: MDCT imaging provides more accurate results, while XR imaging is still valuable for certain fractures. The combined methods were more accurate, especially in cases where the fracture type and characteristics cannot be determined with XR alone. The high level of agreement between XR and MDCT supports the combined use of both methods in clinical practice for diagnosing knee injuries.

Gender Differences in Thyroid Notch on Computed Tomography in Thailand

Background: The prominence of the Adam’s apple can cause dissatisfaction with physical appearance among transgender people. However, there seems to be no difference of the particular organ between Thai males and females. Objective: To analyze variations between the genders in the interlaminar angle (IA) and the convex distance (CD) of the thyroid cartilage. Additionally, measurements from the thyroid cartilage’s most prominent point to the thyroepiglottic ligament’s attachment point as the Notchto-Epiglottis (NTE) were compared. Materials and Methods: The present study was a retrospective cross-sectional study. Data were collected from patients that attended Rajavithi Hospital for neck computed tomography (CT) in the two-year period between 2019 and 2020. These patients were divided into two groups, one consisted of 100 males and the other of 100 females, all of whom were aged 18 to 60 years. The IA, CD, and the NTE of the two genders were analyzed. Results: The IA was measured at 65.3±9.4° for males and 88.9°±11.3° for females. The CD was measured at 9.9±2.1 mm and 7.8±1.5 mm for males and females, respectively, while the NTE was measured at 7.4±1.2 mm and 6.1±1.1 mm, respectively. All of these differences between the genders were statistically significant (p&lt;0.001). Previous neck radiation and thyroid disease did not affect differences in the IA, CD, or NTE. Conclusion: Based on the population samples, it was observed that, in comparison to females, males exhibited a more acute IA, a notably larger CD, and a greater NTE measurement. Developing a comprehensive understanding of the thyroid notch can help to reduce the occurrence of complications in chondrolaryngoplasty. Keywords: Protuberant thyroid notch; Thyroid cartilage

Surgical Experience and Results of Retzius Sparing Robotic Assisted Laparoscopic Radical Prostatectomy: First Report in Thailand

Objective: To evaluate the outcomes and safety of the surgical technique Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALRP), with prostatic cancer; the first report in Thailand. Material and Methods: The authors conducted a retrospective analysis from the medical records of 100 patients who underwent RS-RALRP by a single surgeon; from 1st January 2021 until 31st May 2023, at Rajavithi Hospital. The authors analyzed demographic data, clinical staging, Gleason grade group, operative time, pathologic staging, positive surgical margin rate; postoperative continence recovery and postoperative complications. Results: The median age was 71.34±6.84 years: mean total PSA was 17.16±17.55 ng/ml; with the majority in clinical T1 and T2. The mean operative time was 221.7±51.93 minutes, and the mean estimated blood loss was 312.30±264.55 ml. Of all patients, 88% did not require blood transfusion. The complication rate was 8%. The pathologic stages pT2 and pT3 or greater were 62% and 38%, respectively. Positive surgical margins (PSM) pT2 and pT3 were 14.5% and 63.2%. The postoperative continence recovery after RS-RALRP were 83%, 95%, 97%,100% and 100%: at 1, 3, 6, 9 and 12 months postoperatively, respectively. Conclusion: RS-RALRP has a potential to become the new standard for prostate cancer treatment, with improved early continence and equivalent oncologic efficacy. The limitations of this study are the small number of population, which require prospective multicenter studies.

Comparison of mutation landscapes of pretreatment versus recurrent squamous cell carcinoma of the oral cavity: The possible mechanism of resistance to standard treatment.

A high recurrent rate of oral squamous cell carcinoma (OSCC) is a major concern in head and neck cancer treatment. The study of the genetic mutation landscape in recurrent OSCC may provide information on certain mutations associated with the pathobiology and treatment response of the OSCC. We investigated the mutation landscape of matched pretreatment and recurrent tumors to understand the influence of genetic mutations on the pathobiology and clinical outcomes in OSCC. We sequenced 33 formalin-fixed paraffin-embedded (FFPE) recurrent tumors, primary tumors, and primary tumors before recurrence that matched the recurrent tumors collected from Rajavithi Hospital during 2019-2021. We identified recurrent mutations from these samples by the Oncomine Ion Torrent-based next-generation sequencing on the 517 cancer-associated gene panel. From the results, we found that the most commonly mutated gene in the cohort is a histone methyltransferase KMT2D (54.55%), implicating that aberrance in epigenetic regulation may play a role in oral cancer tumorigenesis. Functional protein association network analysis of the gene frequently mutated in the recurrent tumors showed enrichment of genes that regulate the cancer cell cycle, that is, MRE11A, CDKN2A, and CYLD. This finding was confirmed in the primary-recurring matched pair. We found that recurrent tumors possess a small but recurring group of genes, with presumably the subclonal mutations driving the recurrence of the tumor, suggesting that the recurrent disease originated from a small fraction of the cancer cell that survives standard treatment. These genes were absent in the primary tumor with a good response to the standard treatment. On the other hand, we found an enrichment of DNA repair genes, namely ATR, BRCA1, BRCA2, RAD50, and MUTYH, in nonrecurrent tumors suggesting that the mutations in the DNA repair pathway may at least partially explain the different response to the standard treatment. Our pilot study identified pathways of carcinogenesis in oral cancer and specific gene sets that indicate treatment responses and prognoses in this group of patients.

Predicting factors of survival rates among alpha- and beta-thalassemia patients: a retrospective 10-year data analysis

BackgroundThalassemia is a genetic hemoglobinopathy in which a defective globin chain can cause transfusion-dependent anemia and other complications. As genotype interactions lead to variations in the clinical course among patients with thalassemia, clinical factors may help predict survival in the types of thalassemia complicated by gene interactions.AimThis study aimed to determine the clinical factors associated with survival in patients with thalassemia. We retrospectively reviewed the medical records of patients with thalassemia older than 15 years between 2002 and 2020 that were available at the Rajavithi Hospital. Data on the clinical parameters, laboratory tests, treatments, and survival status were collected and analyzed.ResultsOf the 478 thalassemia patients included, 68.8% were women, and the mean age was 41 ± 17 years. The most common type of thalassemia was β-thalassemia (53.3%). Male sex, low body mass index, the thalassemia type, comorbidities, low hemoglobin level, high ferritin level, and regular blood transfusion were significantly associated with short-term survival. However, only the thalassemia type (β-thalassemia, p = 0.048) and the co-inheritance of the α- and β-thalassemia genotypes (p = 0.03) were independently associated with death. The overall survival rates among patients with α-thalassemia, β-thalassemia, and co-inheritance of the α- and β-thalassemia genotypes were 98.1%, 90.6%, and 75.0%, respectively. The death rate was 6.3%, and the most common cause of death was infection.ConclusionThe thalassemia genotype was a predictive factor of survival, and co-inheritance of the α- and β-thalassemia genotypes results in a shorter-term survival compared with other types, especially transfusion-dependent thalassemia. These results can be applied in clinical settings to predict and possibly extend the life expectancy of patients with thalassemia.

Insights into Visual Outcomes and Determinants in Pituitary Adenoma Surgery: A 5-Year Retrospective Cohort Study.

To investigate the long-term visual outcome and their determinants after an operation in Thai pituitary adenoma (PA). A retrospective cohort study was conducted on PA patients who underwent surgery at Rajavithi Hospital. Baseline characteristics and visual parameters, including visual acuity (VA) and visual field (VF), were analyzed in relation to the visual prognosis outcome. The outcome was defined as VA improvement at 1-year postoperatively. Visual parameters were measured at each follow-up visit and compared. Factors for improved visual prognosis were evaluated using logistic regression analysis. A total cohort of 87 patients (64.37% female), 62.07% showed improvement in visual outcome. Most improvement occurred immediately after surgery, evident at the 1-month visit. The mean follow-up time was 47.45 months (±28.49 SD), mean difference in VA improvement at 1-year was -0.56 logMAR (95% CI -0.73, -0.47). In multivariable logistic regression model, prolonged onset duration was associated with a reduced odds of improved visual outcome, with an odds ratio (OR) of 0.946 (95% CI 0.899-0.996, p = 0.034). Baseline characteristics, tumor volume, Hardy and Knops classification, and surgical approaches were not identified as significant predictors. Both TSS and transcranial approaches are effective for pituitary adenoma. A prompt operation is recommended for patients with prolonged onset duration, with thorough discussion on poor postoperative visual outcomes.

Association between the levels of postoperative pyuria and urinary tract infection in patients undergoing Transurethral Anatomical Enucleation of Prostate (TUAEP) in Rajavithi Hospital

Objective: Pyuria is a common condition that can occur after TUAEP. One possible cause is postoperative inflammation. To limit this many physicians prescribe antibiotic prophylaxis to prevent postoperative urinary tract infections, however this can lead to the overuse of antibiotics and increase the growing problem of antibiotic resistance. Therefore the object of this study is to evaluate the association between the level of postoperative pyuria and urinary tract infections in patients undergoing TUAEP and to identify other risk factors associated with postoperative urinary tract infection facilitating appropriate antibiotic management. Materials and Methods: Data from 94 patients who underwent TUAEP in Rajavithi Hospital from 1st December 2016 to 31st March 2021 were retrospectively analyzed. The data collected from medical records included demographic data, details from operative record sheets and laboratory results. Results: A significant association was found between a level of postoperative pyuria &gt;100 WBCs/HPF and postoperative bacteriuria (46.15% vs 19.35%, p = 0.024). Diabetes mellitus and preoperative bacteriuria were also significant risk factors for postoperative bacteriuria. The bacterium which was the most frequently cultured from samples taken both preoperatively and postoperatively was Escherichia coli. Conclusion: The risk factors for postoperative bacteriuria in patients undergoing TUAEP are a level of postoperative pyuria &gt; 100/HPF, diabetes mellitus and preoperative bacteriuria. It may be concluded from the results that the most frequent cause of postoperative pyuria was more likely to be due to a tissue reaction after surgery than from a urinary tract infection. Selective antibiotic treatment in patients who have these risk factors can reduce problems of antibiotic overuse and anti- biotic resistance.

Intravesical recurrence in upper tract urothelial carcinoma patients after radical nephroureterectomy in Rajavithi Hospital

Objective: Upper tract urothelial carcinoma (UTUC) is a malignant disease which is challenging to manage. The modalities for diagnosis and accurate clinical staging are limited, radical nephroureterectomy (RNU) with bladder cuff excision being the gold standard for treatment of UTUC. Subsequent intravesical recurrence (IVR) following RNU is a common problem. This study investigated the risk factors that affect IVR in Rajavithi Hospital. The objective of this study is to investigate whether the risk factors affect intravesical recurrence in UTUC patients after RNU. Materials and Methods: This retrospective study evaluated 94 patients who had undergone RNU in Rajavithi Hospital for UTUC between November 2006 and February 2021; 69 patients were included in the analysis. Data was analyzed to investigate risk factors that impact IVR and IVR-free survival using Kaplan-Meier and Cox proportional regression methods. Results: Out of 69 patients, at a mean follow up of 24 months, IVR occurred in 27 patients (39.1%). The overall postoperative 5-year IVR-free survival was 51.3%. Multivariate analysis indicated significant risk factors were high- grade tumor (adjusted HR = 3.47, 95%CI: 1.12-10.76, p = 0.031), ureterorenoscopy (URS) (adjusted HR = 3.45, 95%CI: 1.35-8.81, p = 0.01) and tumor multifocality (adjusted HR = 2.75, 95%CI: 1.02-7.38, p = 0.045). Postoperative 5-year IVR-free survival was significantly different for high-grade tumor compared with low-grade tumor (36.6% vs 82%, p = 0.006) and multiple tumors compared with a solitary tumor (18.4% vs 68.8%, p = 0.003) but there was no significant difference in URS compared with no URS (46.3% VS 51.6, p = 0.158). Conclusion: The risk factors that affect intravesical recurrence in UTUC patients after Radical nephroureterectomy are high-grade tumor, tumor multifocality, and URS.

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Objective: To evaluate the outcomes and safety of the surgical technique holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) for whom surgeryis indicated. Materials and Methods: The demographic characteristics, duration of surgery, blood transfusion rate, weight of tissue removed, catheterization time and complica- tions were recorded in 25 patients who underwent HoLEP surgery between January 2021 and May 2022 in Rajavithi Hospital. The International Prostate Symptom Score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR), hematocrit (Hct) and prostate-specific antigen (PSA) levels were comparedbefore and after surgery. Results: The mean age of the patients was 71.28±7.54 years. There were statistically significant differences between mean preoperative and postoperative Hct (%) (40.5± 5.9 and 38.4±5.1), p = 0.001. Only 1 in 25 patients had 1 unit of blood transfusion. One month postoperatively the mean PSA had decreased from 4.55 to 1.2 ng/ml (p &lt; 0.001); mean IPSS had improved from 21.0 to 7.0 (p &lt; 0.001); mean QoL score had improved from 4.47 to 1.10 (p &lt; 0.001); mean PVR had decreased from 98.0 to 39.7 ml (p = 0.002) and the mean Q-max had increased from 8.0 to 17.8 ml/sec (p = 0.015). The mean catheterization time was 2.40±0.57 days. There were no serious complications or incidence of TUR syndrome in this study. Conclusion: HoLEP is a safe alternative to the current gold standard transurethral resection of the prostate for BPH patients as there are fewer complications with similar functional outcomes

The Long-Term Patency of the Internal Jugular Vein and the Common Facial Vein as Entrance Sites for Venous Access in Ventriculoatrial Shunts: A Comparative Analysis from a Single-Center Study

The ventriculoatrial (VA) shunt is a surgical intervention used to manage hydrocephalus, although it is less often utilized compared to the ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy. Placement of the distal catheter typically involves the utilization of either the common facial vein (CFV) or the internal jugular vein (IJV), 2 frequently employed options for venous access. This study aims to determine whether there is a statistically significant difference between the long-term patency (2years) of the distal end of the VA shunt of these 2 options. A retrospective cohort analysis was conducted of patients who received VA shunt surgeries with the employment of the CFV or IJV as access veins at Rajavithi Hospital in Thailand between January 2015 and December 2020. The analysis focused on long-term patency and potential complications. The study comprised a total of 42 participants. Twenty-six (61.9%) individuals underwent ventriculoatrial (VA) shunt surgery via the CFV, while the other 16 (38.1%) underwent the same procedure using the IJV. Neither of the 2 groups required shunt revision due to distal catheter malfunction. Most cases exhibited no significant complications apart from a single instance of shunt system infection. In VA shunt surgery, both the CFV and IJV can be used as venous access sites for the right atrium because there is no discernible difference between their complications or long-term patency. Anatomical considerations, patient-specific characteristics, and the surgeon's preference should all be considered when choosing the venous access location for the placement of a VA shunt.

Diagnostic Accuracy of Immunohistochemistry for HER2-Positive Breast Cancer.

Currently, human epidermal growth factor receptor 2 (HER2)-positive breast cancer cells are diagnosed under the American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) 2018 guidelines. The guideline combined the results of in situ hybridization (DISH) and immunohistochemistry (IHC) techniques. The IHC technique is easy, cheap, and suitable for developing country. Therefore, in this study, we validated the use of IHC alone compared to the results of HER2 amplification under ASCO/CAP 2018 guidelines in diagnosed HER2 positive breast cancer cells. A total of 510 breast cancer tissue samples from Rajavithi Hospital in Bangkok, Thailand, from January 1st, 2022, to May 31st, 2023, were analyzed by IHC, followed by dual ISH (DISH). We selected 58 samples of IHC equivocal (score 2+) and 98 samples of IHC positive (score 3+) to analyze the diagnostic values by comparing them to the results of HER2 amplification. The HER2 IHC score was found to agree with HER2 amplification with a sensitivity of 87.96%, a specificity of 93.75%, a positive predictive value of 96.94%, a negative predictive value of 77.59%, a positive likelihood ratio of 14.07, a negative likelihood ratio of 0.13, and an accuracy of 89.74%. The promising outcomes suggest that a positive IHC test result (score 3+) could potentially stand alone for patients with breast cancer undergoing anti-HER2 treatment, even without DISH confirmation.

Factors predictive of poor visual outcome in indirect traumatic optic neuropathy: A retrospective cohort study

IntroductionThe gold standard treatment for indirect traumatic optic neuropathy (ITON) has not yet been conclusively established, and it is essential to gain an understanding of visual prognosis and to counsel patients regarding the predictive risk factors of poor visual outcomes. Currently, there is limited information regarding ITON in Thai populations; therefore, this study aimed to determine the risk factors of poor visual outcome in patients with this condition. MethodsA retrospective review was conducted of all ITON cases diagnosed at Rajavithi Hospital and Sawanpracharak Hospital between January 2016 and December 2022 in order to determine clinical characteristics and evaluate associated risk factors of poor visual prognosis using binary logistic regression analysis. ResultsThe mean age of this cohort of 101 patients was 36.17 years, with a male predominance of 73.3 %. Motor vehicle accidents were the most common cause of ITON, with a statistically significant 79.2 % of cases. The patients were categorized into an “improved group” of 29 patients and an “unimproved group” of 72. The unimproved group had a significantly older mean age and poorer initial visual acuity of 20/200 (p-values 0.001 and p < 0.001 respectively). There was no significant difference between Computed Tomography (CT) findings in the two groups. The improved group had significantly better visual acuity (VA) at 1-month and final follow-up visit than the unimproved group (both p < 0.001). Differences between gender, Glasgow coma score, associated underlying diseases, and duration from trauma to intravenous glucocorticoids therapy in the two groups were not statistically significant. Multivariable logistic regression analysis identified patient age of 40 years or more (Odds ratio (OR) 3.447, 95 % CI, 1.085–10.955, p = 0.036) and poor baseline VA (OR 6.628, 95 % Confidence Interval (CI), 2.308–19.036, p < 0.001) as significant risk factors for poor visual outcome in ITON patients. ConclusionsNo clear benefit was found of intravenous glucocorticoids in treatment of ITON. Patients aged 40 years or more and/or with poor baseline visual status should be advised that they are at increased risk of poor final visual outcomes.