Siriraj Hospital Research Articles

Abstract 1068: Plasma metabolite biomarkers for EGFR-mutated non-small cell lung cancer (NSCLC)

Abstract Background: Lung cancer is the leading cause of cancer death. More than half of the patients are diagnosed in the advanced stage for which the 5-year survival is below 10%. Lung cancer screening using low-dose CT scan reduced lung cancer mortality among heavy smokers. However, no standard screening method exists for non-smokers. Up to 35% and 90% of male and female lung cancer patients in Southeast Asia, respectively, do not smoke. Half of NSCLC patients in this region harbor EGFR mutations, which is common in women and non-smokers. Thus, we sought to explore novel biomarkers that help to identify lung cancer patients and those who have EGFR mutation. Metabolic reprogramming is one of the hallmarks of cancer. It leads to changes in metabolite levels in the blood. Hence, we conducted plasma metabolomic analysis to identify potential metabolite biomarkers in lung cancer patients. Methods: Plasma samples were collected from 69 lung cancer patients at Siriraj hospital and 10 healthy individuals during 2018-2022. Plasma metabolites from 29 treatment-naïve EGFR-mutated NSCLC patients, 30 treatment-naïve EGFR-wild-type NSCLC patients, 10 treatment-resistant EGFR T790M-mutated NSCLC patients, and 10 healthy individuals were profiled using GC-MS and untargeted LC-MS with Metlin database matching. EGFR mutation was detected from plasma ctDNA using real-time PCR. Negative plasma EGFR mutation results were confirmed with corresponding tumor tissues. Metabolomics data were processed by the metabox R package. Results: Among 114 candidate metabolites that passed the variable importance in projection (VIP) cutoff of 1.5, the top ten metabolites that differentiate NSCLC patients with EGFR mutation from those without were shown in Table 1. Many of them can also separate between NSCLC patients and healthy individuals. Table 1. ROC curve analysis Discriminant metabolites (Mutated EGFR vs Wild-type EGFR NSCLC) AUC Accuracy Sensitivity Specificity PG(a-13:0/i-12:0) 0.8000 0.7833 0.8333 0.7333 Nervonic ceramide 0.7736 0.6772 0.7259 0.6333 Valine 0.7678 0.7298 0.7259 0.7333 L-Histidinol 0.7644 0.7281 0.7222 0.7333 Leucine 0.7563 0.7632 0.7259 0.8000 Tryptophan 0.7425 0.6289 0.5593 0.7000 8-methylcaffeine 0.6793 0.6096 0.6222 0.6000 Formic acid 0.6759 0.6447 0.5889 0.7000 PC(20:0/24:0) 0.6506 0.6614 0.8259 0.5000 Sucrose 0.6471 0.6596 0.7593 0.5667 Discriminant metabolites (NSCLC patients vs Healthy individuals) AUC Accuracy Sensitivity Specificity Tryptophan 0.9986 0.9867 1.0000 0.9848 PC(20:0/24:0) 0.8609 0.9505 0.6111 1.0000 L-Histidinol 0.8572 0.9625 0.7778 0.9861 Formic acid 0.6696 0.9262 0.6667 0.9704 Conclusions: Plasma L-Histidinol, tryptophan, PC(20:0/24:0), and formic acid are potential metabolite biomarkers for NSCLC patients harboring EGFR mutation. Citation Format: Lucksamon Thamlikitkul, Siriphan Manocheewa, Suphitcha Limjiasahapong, Kwanjeera Wanichthanarak, Atikorn Panya, Naravat Poungvarin, Yotsawat Pomyen, Sakda Khoomrung. Plasma metabolite biomarkers for EGFR-mutated non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1068.

Composite adverse events compared early versus conventional cessation of hydrocortisone in patients with septic shock: Randomized-controlled trial (The CESSHYDRO study)

Background: Intravenous hydrocortisone has benefits in the treatment of septic shock patients, but there are adverse events mentioned in the secondary outcomes of several studies, such as hyperglycemia, hypernatremia, secondary infection, and muscle weakness. In addition, there are no recommendations regarding the precise duration and steps to discontinue hydrocortisone administration. The CESSHYDRO trial evaluates the adverse outcomes of intravenous hydrocortisone between early cessation versus conventional cessation of hydrocortisone in septic shock patients. Methods: The CESSHYDRO trial is a single-center, double-blind, randomized controlled clinical trial conducted at Siriraj Hospital. One hundred and eighty septic shock patients receiving vasopressors and hydrocortisone at least 200 mg/day with hemodynamic stability will be included. The patients are randomized into 2 groups: intervention A (early cessation of hydrocortisone) and intervention B (conventional cessation). The primary outcomes were composite adverse events, including hyperglycemia, hypernatremia, muscle weakness, and new infections. Hypothesis: We hypothesize that early cessation of hydrocortisone in patients with septic shock would reduce composite adverse events including hyperglycemia, hypernatremia, muscle weakness, and the new onset of infection. Ethics and dissemination: The trial receives ethical approval from Siriraj Hospital, Mahidol University (COA No.SI012/2023). Trial registration: ClinicalTrials.govNCT05818826. Registered on April 19, 2023.

Factors influencing decision-making for the anesthetic technique in molar pregnancy patients for suction curettage: A retrospective study

Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p < 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p < 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.

The Outcomes of Peripherally Inserted Central Catheter (PICC) Insertion in Pediatric Patients at Siriraj Hospital

Objective: Peripherally Inserted Central Catheters (PICC) are widely used for intermediate to long term venous access. Venipunctures and catheterizations in pediatric patients can be challenging and traumatizing to children’s veins due to frequent and painful needle sticks. This study aims to demonstrate the outcomes of PICC insertion and management in pediatric patients by the Anesthesia Line Service Team (ALiST) at Siriraj Hospital. Materials and Methods: This is a retrospective, descriptive study collecting data from January 2018 to December 2021. The inclusion criteria were pediatric patients aged 15 years and under, body weight equal to or exceeding 5 kg with no history of previous complicated central venous accesses. The primary outcome is the success rate of insertion. Results: 124 PICCs were inserted in pediatric patients. The median age of patients was 5.0 years, with a median height of 107.8 cm, and a median weight of 10.0 kg. The successful insertion rate was 96.92%, and all insertions were inserted using ultrasound-guided technique, with or without fluoroscopy. No acute complications were noted during insertion. Most patients received either intravenous sedation (39.5%) or general anesthesia (26.6%) during the procedure. The mean duration of catheter indwelling was 66.48 days. Reasons for removal of PICC included completion of therapy and patient demise (70.97%), catheter malformation (8.06%), accidental removal (4.03%), infection (8.06%), and patient non-adherence (1.61%). Conclusion: Our research demonstrates a notably high rate of successful PICC placement among pediatric patients, with data indicating a minimal occurrence of complications and an extended duration of catheter usage.

Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD

Objective: This study aimed to investigate the relationship between sleep habits and behavioral problems in preschool-aged children with ADHD. Materials and Methods: A cross-sectional study was conducted in a child developmental clinic at Siriraj Hospital between October and December 2023. Parents of children aged 4-6 years with ADHD completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analysis, Pearson correlation, and multivariate linear regression analysis were used to examine the association between sleep habits and behavioral problems. Results: This study recruited 80 preschoolers with ADHD and 75% were boys. The mean total CSHQ score was 43.76 ± 7.38 and 40% of the participants had sleep problems. 31.3 % had clinically significant behavioral problems. The most common behavioral problems were hyperactivity (33.8%), emotional problems (16.3%), and conduct behavior (10%). More sleep disturbances were highly correlated with all behavioral problems in SDQ, with a Pearson correlation between 0.78 and 0.90. After multivariate regression analysis, the total CSHQ score remained the strongest predictor of all domains of behavioral problems in preschool-aged children with ADHD (p < 0.05). Conclusion: More than 1/3 of preschool children with ADHD were affected by sleep disturbances. Furthermore, sleep problems in these children can contribute to significant behavioral problems. Therefore, the treatment of ADHD in preschoolers should always include the management of sleep disturbances.

Impact of COVID-19 on Health Status and Management of Patients with CNS Demyelinating Diseases: A Single-Center Study

Objective: Study the effects of COVID-19 on health status and alterations in managing patients with CNS-IDDs. Materials and Methods: A questionnaire-based approach was commenced at the MS and Related Disorders Clinic at Siriraj Hospital in Thailand from March 2021 to December 2021. The data obtained from the questionnaire was subjected to statistical analysis. Results: The study comprised 92 patients with CNS-IDDs, with 72.8% female and a mean age of 44.6±14.0 years. Overall, 67.4% of patients were vaccinated following Thai National guidelines. Only two patients were confirmed to have contracted COVID-19 infection. The most common treatment administered in the 92 CNS-IDD patients was Azathioprine (39.1%), prednisolone (32.6%), then 14.1% each in MMF and Rituximab. Sixty-one patients (66.3%) reported no relapse in the past year and no statistically significant difference among the diseases. The mean self-rated quality of life (QoL) score was 8.0±1.9 before the COVID-19 pandemic then drastically decreasing to 5.4±2.4 during the pandemic period. Overall, 56.5% indicated at least some impact on physical well-being, and 69.6% reported challenges to psychological health. 16.3% postponed or canceled their appointments during the COVID-19 pandemic, and 8.3% transitioned from face-to-face meetings with doctors in the clinic to telemedicine or telephone follow-up. Conclusion: Our study revealed that patients with CNS-IDDs experienced no significant change in relapse and a low incidence of COVID-19 infection. During the pandemic, overall, patients' QoL decreased both physically and psychologically.

Spleen anatomic variations in the context of morphology

The immune and hematopoietic systems in the human body depend on the spleen. The understanding of anatomical and morphological variations of the spleen and its arterial vascular segments (AVS) is crucial for performing whole or partial splenectomy in the treatment of splenomegaly and splenic rupture. The aim of this study was to compare the anatomical differences in the spleen and its AVS in Thai cadavers of both sexes. This cadaveric study was performed on 77 cadaveric spleens (males = 38 and females = 39) from the Gross Anatomy Laboratory at the Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University. The average morphological measures of the observed spleens were 9.11±1.40 cm in length, 6.57±1.46 cm in width, 3.11±0.67 cm in thickness in male cadavers, and 8.77±1.87 cm in length, 5.91±1.35 cm in width, and 2.90±0.78 cm in thickness in female cadavers. The variations in spleen form were 7.79% oval, 16.88% tetrahedral, 28.57% triangular, and 46.75% wedge. The mean splenic hilum length was 5.14±1.10 cm in males and 5.12±1.22 cm in females. The mean lobar branch to hilum distance was 2.26±0.98 cm in males and 2.29±1.05 cm in females. Females were more likely than males to have two lobar arteries. Three lobar arteries, however, were more prevalent in males. The occurrence of accessory spleens was 2.63% for males and 7.50% for females. According to the data, there were significant differences in the number of lobar arteries and spleen size between male and female Thai cadavers.

A qualitative study of pregnant women’s perceptions and decision-making regarding COVID-19 vaccination in Thailand

To identify pregnant women’s attitudes towards, and acceptance and rejection of, COVID-19 vaccination. This prospective, descriptive, implementation study was conducted in the Antenatal clinic of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 pregnant women were interviewed. Phase II consisted of questionnaire development and data validation. In Phase III, the questionnaire was administered to 400 participants. Pregnant women’s attitudes towards and acceptance and rejection of COVID-19 vaccination. Most pregnant women were uncertain about the potential harm of vaccination to themselves or their unborn child, including risks such as miscarriage or premature birth (59–66/101 [58.4%–65.3%]; OR 2.53–8.33; 95% CI 1.23–3.60, 5.17–19.30; P < 0.001) compared to those who disagreed with vaccination. Their vaccination decisions were significantly influenced by social media information regarding vaccination complications in pregnant women (74/101 [73.3%]; OR 15.95; 95% CI 2.15–118.55; P = 0.001) compared to those who disagreed with vaccination. Most pregnant women opined that they should not receive a COVID-19 vaccination during pregnancy (adjusted odds ratio [AOR] 6.57; 95% CI 2.44–17.70; P = 0.001). Most also rejected vaccination despite being aware of its benefits (AOR 17.14; 95% CI 6.89–42.62; P < 0.001). Social media messages and obligatory vaccination certifications influence maternal vaccination decisions. Pregnant women believe vaccination helps prevent COVID-19 infection and reduces its severity. Nevertheless, the primary reason for their refusal was concern about potential harm to their unborn child or themselves during pregnancy.The Thai clinical trials registry: TCTR20211126006.

The effects of transcription factor 7-like 2 rs7903146 and paired box 4 rs2233580 variants associated with type 2 diabetes on the therapeutic efficacy of hypoglycemic agents

AimThis study aims to investigate the effects of the TCF7L2 rs7903146 and PAX4 rs2233580 (R192H) variants associated with T2D on the therapeutic efficacies of various HAs in patients with T2D after follow-up for 3 years. MethodsA total of 526 patients who were followed up at the Diabetic Clinic of Siriraj Hospital during 2016–2019 were enrolled. The variants TCF7L2 rs7903146 and PAX4 rs2233580 (R192H) were genotyped using the RNase H2 enzyme-based amplification (rhAmp) technique and the associations between genotypes and glycemic control after treatments with different combinations HA were evaluated using Generalized Estimating Equations (GEE) analysis. ResultsPatients who carried TCF7L2 rs7903146C/T + T/T genotypes when they were treated with biguanide alone had significantly lower fasting plasma glucose (FPG) than those of the patients who carried the C/C genotype (p = 0.01). Patients who carried the PAX4 rs2233580 G/G genotype when they were treated with sulfonylurea alone had significantly lower FPG than those of the patients who carried G/A + A/A genotypes (p = 0.04). ConclusionGenotypes of TCF7L2 rs7903146 and PAX4 rs2233580 (R192H) variants associated with T2D influence the therapeutic responses to biguanide and sulfonylurea. Different genotypes of these two variants might distinctively affect the therapeutic effects of HAs. This finding provides evidence of pharmacogenetics in the treatment of diabetes.

Clinical characteristics and outcomes of acute bacterial meningitis in adults at a tertiary university hospital in Thailand.

The epidemiology of acute bacterial meningitis varies among settings, areas, and times. This study aimed to determine the clinical characteristics, the causative organisms and their antibiotic susceptibility, and the outcomes of patients with acute bacterial meningitis in Thai adults. This retrospective study included hospitalized patients aged ≥18 years diagnosed with acute bacterial meningitis at Siriraj Hospital during January 2002-December 2016. Of 390 patients, the median age was 48 years, 51% were male, and 80% had at least 1 underlying illness. Over half (54%) of patients had community-acquired bacterial meningitis (CBM), and 46% had nosocomial bacterial meningitis (NBM). The triad of acute bacterial meningitis (fever, headache, and neck stiffness) was found in 46% of CBM and 15% of NBM (P < .001). The causative organisms were identified in about half (53%) of patients. Most study patients (73%) received antibiotic treatment before the CSF collection. Causative organisms were identified more frequently in CBM (P < .001). Gram-positive cocci were more prevalent in CBM (P < .001), whereas Gram-negative bacilli were more common in NBM (P < .001). Streptococcus agalactiae (29%), Streptococcus pneumoniae (12%), and Streptococcus suis (11%) were most common in CBM, and all of them were sensitive to third-generation cephalosporins. Acinetobacter baumannii (19%), Klebsiella pneumoniae (16%), and Staphylococcus aureus (11%) were the most common organisms in NBM, and antibiotic-resistant isolates were frequently found among these organisms. Ceftriaxone monotherapy and meropenem plus vancomycin were the most common empiric antibiotic in CBM and NBM, respectively. Mortality was 19% among CBM and 23% among NBM (P = .338). HIV infection, alcoholism, pneumonia, shock, and disseminated intravascular coagulation were independent predictors of mortality. Mortality remains high among adults with acute bacterial meningitis in Thailand. A clinical practice guideline for acute bacterial meningitis should be developed that is based on local epidemiology and microbiology data.

Incidence and Risk Factors Associated With Chronic Kidney Disease After Liver Transplantation: A Review of a 20-Year Experience at a Single Center

Chronic kidney disease (CKD) is one of the major complications after liver transplantation (LT), with a significant impact on patient outcomes. This study aims to investigate the incidence and risk factors of CKD in LT recipients at Siriraj Hospital over the past 20 years. There were 366 adult patients undergoing LT at Siriraj Hospital between January 2002 and December 2021. After excluding patients with pretransplant CKD stages 4 to 5, simultaneous liver-kidney transplantation, and patients who died after LT within 90 days, we retrospectively reviewed a total of 288 patients. Univariable and multivariable binary logistic regression analyses were used to identify the risk factors of post-transplant CKD. Of the 288 patients, 171 (59.4%) developed CKD after LT. The median time to develop CKD was 5.8 months (IQR, 3.8-15.3). Univariable and multivariable analyses revealed that age ≥55 years (odds ratio [OR] = 2.44; 95% CI, 1.34-4.42; P = .003), pretransplant kidney dysfunction defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 (OR = 2.23; 95% CI, 1.16-4.27; P = .016), and postoperative acute kidney injury (OR = 3.06; 95% CI, 1.73-5.42; P < .001) were significantly associated with post-transplant CKD. Patients with preexisting kidney dysfunction who received delayed calcineurin inhibitor introduction without antibody induction protocol had a significantly lower incidence of post-transplant CKD (OR = 0.28; 95% CI, 0.11-0.70; P = .007). Advanced age, pre-transplant kidney dysfunction, and postoperative acute kidney injury are risk factors for CKD after LT. Importantly, delayed calcineurin inhibitor introduction can protect patients with pretransplant kidney dysfunction from developing post-transplant CKD. These results may have important clinical implications in reducing the incidence of CKD after LT.

Organomegalies as a predictive indicator of leukemia cutis in patients with acute myeloid leukemia.

Leukemia cutis (LC) is an extramedullary acute myeloid leukemia (AML) infiltrate. No previous study has described the clinical characteristics and outcomes of Thai patients diagnosed with AML with LC. We conducted a 7-year retrospective case-control study on Thai AML patients at Siriraj Hospital from November 2013 to July 2020. Patients were divided into LC and non-LC groups. Initial clinical presentations and laboratory findings were examined to identify LC-associated factors. Overall survival (OS) and relapse-free survival (RFS) were assessed. Pathological tissues underwent re-evaluation to validate the LC diagnoses. The study included 159 patients in a 2:1 ratio (106 non-LC and 53 LC). The LC group had a mean ± SD age of 54.3 ± 15.5 years; females were predominant. Three-fifths of the LC patients had intermediate-risk cytogenetics; 20.4% had an adverse risk, and 10.2% had a favorable risk. Most were classified as AML-M4 and AML-M5. Leukemic nodules were the primary finding in 58.5% of the cases, mainly on the legs. In the multivariate analysis of predictive factors associated with LC, organomegalies, specifically hepatomegaly, and lymphadenopathy, remained significant factors associated with LC [OR 4.45 (95%CI 1.20, 16.50); p = 0.026 and OR 5.48 (95%CI 1.65, 18.20); p = 0.005], respectively. The LC group demonstrated a significantly reduced OS (log-rank test p = 0.002) (median OS of 8.6 months vs. 32.4 months). RFS was considerably lower in the LC group (log-rank test p = 0.001) (median duration of 10.3 months vs. 24.4 months in the non-LC). AML patients who developed LC tended to experience notably poorer prognoses. Therefore, it is imperative to consider aggressive treatment options for such individuals. The presence of organomegalies in AML patients serves as a strong predictor of the possible occurrence of LC when accompanied by skin lesions.

Vertebro-Vertebral Arteriovenous Fistulae: A Case Series of Endovascular Management at a Single Center.

Vertebro-vertebral arteriovenous fistulae (VVFs) are a rare disorder characterized by a direct shunt between the extracranial vertebral artery and the veins of the vertebral venous plexus. This study aims to comprehensively review the characteristics and outcomes of endovascular treatments for VVFs at our center. A retrospective review was conducted on 14 patients diagnosed with a VVF who underwent endovascular treatment at Siriraj Hospital from January 2000 to January 2023. The study assessed patient demographics, presentation, fistula location, treatment strategies, endovascular techniques employed, and treatment outcomes. Among the 14 patients, 11 (78.6%) were female, with an age range from 25 to 79 years (median: 50 years). Spontaneous VVFs were observed in 64.3% of the cases, including three associated with neurofibromatosis type 1 (NF-1). Iatrogenic injury accounted for two cases, and three patients had VVFs resulting from traffic accidents. A pulsatile neck mass and tinnitus, with or without neurological deficits, were common presenting symptoms. Active bleeding was observed in three cases with vascular injury, while unilateral proptosis, congestive heart failure, and incidental findings each presented in one patient. All the VVFs were successfully obliterated without major treatment complications. Parent vessel sacrifice was performed in 85.7% of the cases, while vertebral artery preservation was achieved in the remaining two patients. Embolic materials included detachable balloons, detachable coils, and n-butyl cyanoacrylate (NBCA) glue. All the presenting symptoms showed improvement, and no morbidity or mortality was observed. Endovascular embolization is a feasible and effective approach for achieving complete VVF obliteration with safety. Parent artery sacrifice should not be reluctantly performed, particularly when adequate collateral circulation is demonstrated.

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

In Thailand, resource limitations lead many multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients to use off-label immunosuppressants. This study assesses the efficacy and safety of rituximab (RTX) with a CD19-based reinfusion regimen among Thai MS and NMOSD patients. A retrospective review of patients at the Faculty of Medicine Siriraj Hospital from January 1994 to April 2023 was conducted. The primary outcome assessed was the change in annualized relapse rate (ARR) for patients using RTX for over a year. Secondary outcomes included changes in the Expanded Disability Status Scale (EDSS) scores, time to the first relapse after RTX initiation for patients using RTX for over a year, and an evaluation of the safety of RTX. The study encompassed 36 MS and 39 NMOSD patients. A majority of patients (91.7% of MS and 79.5% of NMOSD) experienced no relapses during a median follow-up of 30 months (Interquartile range [IQR] 20–46) and 31 months (IQR 23–41), respectively. The median ARR significantly decreased in both MS (from 0.77 [IQR 0.42–1.83] to 0 [IQR 0–0], p < 0.001) and NMOSD (from 0.92 [IQR 0.68–1.78] to 0 [IQR 0–0.17], p < 0.001) patients after switching to RTX, with no difference between those following a fixed 6-month time point regimen and a CD19-based reinfusion regimen. Median EDSS scores improved significantly at the last follow-up visit in both groups. The mean time to the first subsequent relapse was 8.3 ± 3.0 months in MS and 6.8 ± 1.7 months in NMOSD. Mild adverse drug reactions occurred in 44% of patients. RTX effectively prevents relapses in Thai MS and NMOSD patients, with no observed serious adverse drug reactions.

Association between advanced glycation end products and uveitis/scleritis activity in patients with active immune-mediated ocular inflammatory diseases

PurposeTo investigate for association between skin autofluorescence (SAF) advanced glycation end products (AGEs) and uveitis/scleritis activity in systemic inflammatory disease-related active non-infectious uveitis/scleritis patients.MethodsThis cross-sectional study was conducted at Siriraj Hospital during October 2019 to March 2020. AGEs were measured by SAF method in systemic immune-related disease patients with active uveitis/scleritis, and those results were compared with those of healthy age-matched controls.ResultsThirty-one active non-infectious uveitis/scleritis patients and 31 age-matched controls were enrolled. The mean age of patients was 40.0 ± 12.8 years, and most were female (55.0%). The most common associated systemic immune-related disease was Vogt–Koyanagi–Harada disease (n = 14). Mean SAF AGE level in the study group compared to the control group was 2.38 ± 0.66 arbitrary units (AU) versus 2.58 ± 0.56 AU, respectively (p = 0.20). Multivariate analysis showed decreased SAF AGE level to be significantly associated with active ocular inflammation, (odds ratio: 0.01, 95% confidence interval: 0.00004–0.81; p = 0.04).ConclusionsSAF AGE level was not so far found to be a reliable biomarker for indicating uveitis/scleritis activity in systemic immune-related disease patients with active ocular inflammation.Clinical trial registrationThai Clinical Trials Registry, https://www.thaiclinicaltrials.org/. (Reg. No. TCTR20200114004, registered date 01/01/2020, beginning date of the trial 10/01/2019).

Whole blood clotting time: Current practices among Thailand National External Quality Assessment Scheme for blood coagulation member laboratories.

The Thai National Guidelines for Hemostatic Laboratory Testing were established in 2018. The guidelines recommend that the 20-min whole blood clotting time (20WBCT) method be used to diagnose/monitor snake bites. The aim of this study was to survey members of the Thailand National External Quality Assessment Scheme (NEQAS) for Blood Coagulation to investigate the use of 20WBCT testing compared between the 2021 post-guideline and 2007 pre-guideline periods. In July 2021, questionnaires were sent from the Faculty of Medicine Siriraj Hospital, Mahidol University to 521 Thailand NEQAS for Blood Coagulation member laboratories to survey their WBCT practices. Current WBCT practices were compared with pre-guideline WBCT practices, and chi-square test (x2) was used to test for differences between groups. Ninety-seven (18.6%) of 521 surveys were returned. Seventy-one laboratories (73.2%) reported knowing about 20WBCT from the Thai national guidelines. The reported average frequency of overall WBCT testing in 2021 was 12.4 times/month. The proportion of laboratories that reported using the 20WBCT test increased from 2.0% in 2007 to 46.4% in 2021 (p < 0.001), and the indications for performing WBCT were virtually unchanged from 2007 to 2021. The proportion of laboratories that reported having problems with WBCT testing decreased from 32.7% in 2007 to 16.5% in 2021. Despite our findings that almost three-quarters of respondent laboratories reported knowing about 20WBCT testing from the WBCT guidelines, and that WBCT-specific problems decreased significantly from 2007 to 2021, more work and training is needed to improve WBCT guideline dissemination, understanding, and adherence in Thailand.

Comparison between Anal Dilatation Protocols Following an Endorectal Pull-through for Hirschsprung Disease

Objective: The purpose of this study was to compare the mechanical obstruction rate following a transanal endorectal pull-through (TERPT) in patients with Hirschsprung disease, between regular anal dilatation (AD) and selective anal dilatation (NAD) which meant that dilatation was only performed when an obstructive symptom occurred. Materials and Methods: A retrospective chart review of patients with Hirschsprung disease who underwent TERPT/abdominal assisted TERPT at Siriraj Hospital between January 2009 and December 2021 was carried out. It was the surgeon’s preference that the dilatation protocols between the 2 groups (AD or NAD) were assigned. Mechanical obstructions included evidence of stricture, a clinical symptom of constipation, presence of Hirschsprung-associated enterocolitis (HAEC), and/or requirement of re-operation. Results: In total, 132 patients were included in this study, including 55 cases in the AD group (41.7%) and 77 cases in the NAD group (58.3%). Postoperative mechanical obstructions occurred in 84 patients (63.6%). Among the mechanical obstructions, there were 35 strictures (26.5%), 26 constipation (19.7%), 40 HAECs (30.3%), and 6 reoperation (4.5%). The mechanical obstruction rates in the AD [33/55 (60.0%)] and NAD [51/77 (66.2%)] groups were not significantly different (p = 0.582). The AD group was of a significantly younger age (p = 0.022) and lower body weight (p = 0.048) than the NAD group; however, a younger age and lower body weight were not significantly related with any of the obstructive complications. AD had a rate of anastomosis/cuff stricture [13/55 (23.6%)] similar to NAD [22/77 (28.6%)] (p = 0.665).

Retrospective Analysis of Inpatient Dermatologic Consultations in a Residency Training Program

Objective: This study assessed the prevalence and clinical characteristics of inpatient dermatologic diseases, examined trends over 3 academic years in a tertiary care hospital in Thailand, and evaluated their relevance to the current dermatology residency curriculum. Materials and Methods: A retrospective review was performed at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Consultation records from July 2018 to June 2021 were assessed. Data extracted included patient age, sex, referring departments, and diagnoses. Results: Of the 1964 consultations, 2002 diagnoses were identified. Consistent with previous findings, the predominant diagnostic categories were drug eruptions (28.02%; 561), eczema (16.18%; 324), and viral infections (9.29%; 186). Internal medicine made the most requests, followed by surgery and orthopedics. While the prevalence of consulted diseases remained constant over the 3 academic years, the total number of consultations increased. Most of the consulted conditions were already covered in the “must-know” section of the dermatology residency curriculum, with a few exceptions. The consultation cases satisfied the inpatient evaluation requirements of EntrustableProfessional Activity. Conclusion: The prevalence of inpatient dermatologic diseases was highest for drug eruptions, followed by eczema and viral infections. The consistent trend in the prevalence of these consulted diseases underscores the significance of inpatient dermatology. Incorporating these insights into revisions of the dermatology residency curriculum may enhance the training of dermatologists.

P422 Prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaire in Inflammatory Bowel Disease patients and its association with disease activity and quality of life

Abstract Background An association between active inflammatory bowel disease (IBD) and poor sleep quality has been proposed, however studies evaluating both subjective and objective assessment of disease activity and sleep quality are limited. Our study aimed to investigate the prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaires in IBD patients and its association with disease activity and quality of life. Methods A prospective observational study was conducted in Siriraj Hospital, Mahidol University, Bangkok, Thailand from March 2021 to December 2022. Eligible IBD patients were categorized into remission, mild, and moderate-to-severe groups, based on standard clinical disease activity scores. Demographic data, inflammatory markers, inflammatory bowel disease questionnaire (IBDQ), sleep questionnaire (Pittsburgh Sleep Quality Index, PSQI), and seven-day sleep data from wrist actigraphy (Actiwatch®, CamNtech, Cambridge, United Kingdom) were obtained. The prevalence of sleep disorder and group comparison were analyzed. Results Eighty-four participants (40 Crohn’s disease, 44 UC), consisting of 60 remission, 16 mild, and 8 moderate-to-severe disease activity, were enrolled. Baseline demographic data were comparable between each group. Lower hemoglobin and albumin levels, and higher serum C-reactive protein, and fecal calprotectin levels were found in the more clinically active groups (table1). Fifty patients (60%) had poor sleep defined by PSQI &amp;gt; 5 with a trend to be higher in the group with active symptoms (57% in remission, 63% in mild, and 75% in moderate-to-severe group, p=0.31). Using actigraphy, the group with moderate-to-severe symptoms tended to have longer sleep latency, more frequently awake after sleep, and poorer sleep efficiency than the other groups (Figure 1). Patients with more severe disease activity had poorer quality of life with a mean IBDQ of 190 in remission, 159 in mild, and 134 in moderate-to-severe group (p&amp;lt;0.001). Conclusion Poor sleep quality is common among IBD patients, even those with clinical remission. Those with more severe symptoms had poorer sleep quality and worse quality of life. Sleep assessment and treatment should be integrated into IBD standard clinical care.

Beverage consumption in patients with metabolic syndrome and its association with non-alcoholic fatty liver disease: a cross-sectional study.

Previous research has examined the association between coffee and tea consumption and non-alcoholic fatty liver disease (NAFLD). Preclinical studies have indicated the potential hepatoprotective properties of cocoa/chocolate. However, clinical research on the consumption of cocoa/chocolate and soft drinks and their relation to NAFLD, particularly among individuals with metabolic syndrome, is limited. This study primarily aimed to assess the association between beverage consumption and NAFLD in these patients. This cross-sectional study enrolled adult patients with metabolic syndrome visited the Medicine Outpatient Department at Siriraj Hospital, Thailand, from November 2011 to January 2013. The exclusion criteria were secondary causes of hepatic steatosis, such as excessive alcohol use, viral hepatitis, or drug-induced hepatitis. Participants completed a 23-item self-administered questionnaire covering their beverage consumption habits, including type, frequency, volume, duration, and additives in drinks, namely, coffee, tea, cocoa/chocolate, and soft drinks. To ensure accurate responses, these questionnaires were supplemented by face-to-face interviews. Ultrasonography was employed early in the methodology to diagnose NAFLD. Univariable analyses were used to compare the beverage consumption behaviors of participants with and without NAFLD. Multivariable logistic regression was used to adjust for potential confounders, including total beverage energy intake, age, anthropometric data, laboratory results, and comorbidities. This study included 505 patients with metabolic syndrome. Of these, 341 (67.5%, 95%CI: 63.2-71.6%) were diagnosed with NAFLD. The consumption rates of coffee, cocoa/chocolate, and soft drinks were similar between the two groups. However, tea consumption was significantly more common in patients with NAFLD (68.3% vs. 51.8%, p < 0.001). The groups had no significant differences in caffeine intake or total energy intake from beverages. Notably, daily intake of three or more cups of coffee was correlated with a reduced prevalence of NAFLD, with an adjusted odds ratio of 0.35 (95%CI: 0.14-0.89). This study revealed that patients with metabolic syndrome, irrespective of NAFLD status, exhibited similar patterns of beverage consumption. While no definitive associations were identified between the intake of coffee, tea, cocoa/chocolate, or soft drinks and NAFLD, a notable exception was observed. A higher consumption of coffee (≥3 cups daily) was associated with a lower prevalence of NAFLD.