Tertiary Hospital In Thailand Research Articles

Risk factors and development of a predictive score model for tumor lysis syndrome in childhood leukemia: a 10-year experience from a single tertiary hospital in Thailand

Tumor lysis syndrome (TLS) in childhood leukemia was assessed retrospectively in 252 patients in a single tertiary center in Thailand during 2009–2019. Fifty-one (20.2%) developed TLS during their induction chemotherapy; 60.7% (31/51) were spontaneous TLS and 47% (24/51) developed clinical TLS. The predictive score model consisted of white blood cell (WBC) count more than 50,000 cells/mm3, glomerular filtration rate less than 90, and aspartate transaminase more than 44 units/L. The TLS development rates were 11.1%, 46.2%, and 78.5% in the low, intermediate, and high-risk groups, respectively. Death during the first induction phase in patients with TLS was significantly higher than in the patients without TLS. However, the 5-year overall survival rates for the children with and without TLS were not significantly different.

Effectiveness of Husbands' Support Exclusive Breastfeeding Facebook Programme During the COVID-19 Pandemic.

The exclusive breastfeeding rate for six months in the Northeast region of Thailand has recently significantly decreased, in contrast to all other regions in Thailand. Facebook is widely used worldwide to enhance knowledge, attitudes, and behaviours that support breastfeeding. This study aims to assess the effectiveness of a Facebook programme for husbands' support of exclusive breastfeeding during the COVID-19 pandemic. We employed a quasi-experimental study design conducted from September 2020 to November 2021. Data were collected from two tertiary hospitals in Thailand, involving a total of 72 participants-36 in the experimental group and 36 in the control group. These participants were husbands of postpartum women admitted to the postpartum wards. Four research instrument were the demographic questionnaire, the Husband's EBF Knowledge, Husband's EBF Attitude, and Husband's EBF Behavior Questionnaires. Demographic data were analysed using frequency distribution, percentages, and the Chi-square test. The mean difference in husbands' exclusive breastfeeding (EBF) knowledge scores was analysed using an independent samples t-test. At baseline, there was no significant difference in husbands' exclusive breastfeeding (EBF) knowledge scores between the experimental and control groups (p = 0.82). By the 1st month, there was a significant difference in the mean scores of husbands' EBF knowledge between the two groups (p < 0.01). However, the mean score of attitude at 6-month (mean=108.03, SD=19.89) was higher than the mean score of behaviour at baseline (mean=101.81, SD=17.99), but it was not significant (p=0.40). In addition, the different score of behaviour among baseline (mean=65.86, SD=7.02) and 6-month (mean=68.58, SD=10.42) was not significant (p=0.24). The findings suggest that the Facebook programme is an effective platform for conveying exclusive breastfeeding (EBF) knowledge to husbands in Northeast Thailand during the COVID-19 pandemic.

A Pilot Study of a Family Management Program for Parents of Children with Acute Lymphoblastic Leukemia

ObjectivesThe aim of this completed pilot study was to evaluate the feasibility of implementing a family management program (FMP) for parents of children with acute lymphoblastic leukemia (ALL). Data SourcesA convenience sample of 11 parents of preschool-aged children with ALL were recruited from an ambulatory chemotherapy-care clinic at a tertiary hospital in Thailand. Participants received three FMP sessions over 3 weeks. The FMP is based on two established family programs (ie, FMP-style framework and building on family strengths) and reviewed literature. The following measures were used to evaluate parents’ responses at baseline, postintervention, and follow-up: Family Management Measure, Beach-Center Family Quality-of-Life Scale, and Pediatric Quality of Life Inventory. Data were analyzed using one-way repeated-measures analysis of variance. ConclusionThe study results provide promising evidence that the FMP is feasible and improves family management and quality of life for parents of enrolled children with ALL. Implications for Nursing PracticeEducating pediatric oncology nurses and other healthcare professionals to replicate the FMP may help to provide better family management, and child quality of life support to future parents and other family members of young children diagnosed with ALL. This support should focus on educating parents about the potential effects of caring for a child with ALL on the family and fostering positive relationships within the family and offering guidance on effective family communications and decision-making processes.

Prognostic Risks for Tracheostomy in Pierre Robin Sequence: A Cohort From a Tertiary Hospital in Thailand.

Pierre Robin sequence (PRS), characterized by micrognathia, glossoptosis, cleft palate, and obstructed airways, is one of the craniofacial conditions challenging various approaches to managing compromised airways, ranging from conservative measures to invasive airway surgery. This study was conducted to identify predictive risk factors for tracheostomy in the PRS. A retrospective chart review was conducted at a tertiary referral hospital in Thailand. Children diagnosed with PRS from January 2010 to December 2021 were enrolled. Univariate and multivariate analysis methods were used to identify the risk factors. Sixty-five patients with PRS were identified in electronic medical records, but 6 were excluded. Thirteen of the remaining 59 patients underwent tracheostomy. There were no significant differences in sex, preterm gestational age, cleft palate, associated syndromes, chromosome abnormalities, or cardiac or neurological involvement between patients who received tracheostomy and those who did not. However, patients with oropharyngeal dysfunction who received tracheostomy tended to use a nasogastric tube or percutaneous gastrostomy 92.3% of the time ( P = 0.043). In addition, patients with abnormal airways from endoscopy were more likely to undergo tracheostomy (odds ratio, 2.17; 95% confidence interval [CI], 1.20-3.90). Interestingly, patients with a sum of Apgar scores at 1 and 5 minutes <15 were more likely to undergo tracheostomy (adjusted odds ratio, 9.91; 95% CI, 1.32-74.52). Furthermore, patients with at least 3 identified comorbidities were more likely to undergo tracheostomy (adjusted odds ratio, 11.34; 95% CI, 1.16-111.15). The need for tracheostomy depends on comorbidities, Apgar scores, and abnormal airway anatomy. Feeding methods can become more complex with tracheostomy. Prognostic risk factors can help guide treatment and counseling for health care workers and caregivers.

Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1

Gestational diabetes mellitus is glucose intolerance during pregnancy, increasing health risk in the mothers, feti, and subsequent children. Understanding the factors influencing glycemic control behaviors is necessary to control plasma glucose levels. This study developed and tested the Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1. The Theory of Planned Behavior was used as a conceptual framework to guide the study. The participants were 252 pregnant women with the condition from two tertiary hospitals in Thailand, and whose blood glucose could be controlled by exercise and diet. Data were collected using a demographic data form and five scales on attitude, subjective norm, belief in self-control behavior, intention, and glycemic control behavior. Statistical analysis was conducted using SPSS version 18.0 and the Mplus statistical package version 7.0. Results showed that the modified model fitted with the empirical data and accounted for 51.8% of the variance of glycemic control behavior. Intention and belief in self-control behavior directly affected glycemic control behavior. Attitude, subjective norm and belief in self-control behavior indirectly affected glycemic control behavior via intention. Among these factors, intention had the most substantial effect on glycemic control behavior. These findings suggest that nursing interventions should enhance intention by reinforcing positive attitudes, belief in self-control behavior, and support from subjective norms to promote glycemic control behavior. This model needs to be applied and tested for effectiveness in clinical practice.

Causal Model of Autonomous Motivation to Modify Dietary Behavior among People with Early-stage Chronic Kidney Disease

Dietary behavior is significant for delaying chronic kidney disease progression but is difficult to modify. Autonomous motivation is one of the key concepts that seem to be useful for behavior modification. Thus, this descriptive cross-sectional study was purposed to develop and test a causal model of autonomous motivation to modify dietary behavior among people with early-stage chronic kidney disease. Participants comprised 308 people with early-stage chronic kidney disease from ten tertiary hospitals in Thailand. Data collection employed a demographic and health information form, the Regulation of Eating Behaviour Scale: Autonomous Motivation Subscale, the General Causality Orientation Scale: Autonomy Orientation Subscale, the Health Care Climate Questionnaire Short-Form, the Importance Domain of the Aspiration Index: Intrinsic Life Aspiration Subscale, the Importance Domain of the Aspiration Index: Extrinsic Life Aspiration Subscale, and the Basic Need Satisfaction in General Scale. Data were analyzed through descriptive statistics and structural equation modeling using M-plus.The results showed the final model explained 57% of the variance in autonomous motivation to modify dietary behavior. Intrinsic life aspiration, autonomy support from healthcare providers, and autonomy orientation had a positive direct effect on autonomous motivation and an indirect effect through basic psychological need satisfaction. Basic psychological need satisfaction had a positive direct effect on autonomous motivation. On the other hand, extrinsic life aspiration had neither a direct nor an indirect effect on autonomous motivation. Nurses can use these findings to design and test nursing interventions by integrating autonomy orientation, autonomy support from healthcare providers, and intrinsic life aspirations for enhancing autonomous motivation to modify the dietary behavior of this population.

Comparing the Efficacy of Carboplatin plus 5-Fluorouracil, Cisplatin plus 5-Fluorouracil, and Best Supportive Care for Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score Analysis from a Tertiary Hospital in Southern Thailand.

Background: Although cisplatin plus 5-fluorouracil (5-FU) is the standard first-line treatment for advanced-stage esophageal squamous cell carcinoma (ESCC), carboplatin was substituted for cisplatin in cisplatin-ineligible patients. The efficacy of carboplatin plus 5-FU for advanced-stage ESCC remains unreported. Methods: This retrospective study analyzed first-line treatment-carboplatin plus 5-FU, cisplatin plus 5-FU, or best supportive care (BSC)-in advanced-stage ESCC patients at a tertiary hospital in Thailand (2012-2022). Survival was assessed using the Kaplan-Meier method, compared via the log-rank test, and adjusted through propensity score matching. Significance was set at p < 0.05. Results: Of 256 patients, 39.9% received carboplatin plus 5-FU, 27.7% cisplatin plus 5-FU, and 32.4% BSC. Carboplatin was significantly associated with older age, poorer performance status, more comorbidities, chronic kidney disease, and lower creatinine clearance. Median overall survival (OS) for carboplatin plus 5-FU, cisplatin plus 5-FU, and BSC was 8.05 (HR 0.31 [0.23, 0.43] vs. BSC, p < 0.001; HR 1.06 [0.78, 1.44] vs. cisplatin plus 5-FU, p = 0.7), 8.43, and 3.64 months, respectively. No significant OS difference was observed between carboplatin and cisplatin treatments after propensity score matching. Median progression-free survival (PFS) and objective response rates (ORR) showed no significant difference between carboplatin and cisplatin treatments. Conclusions: Despite less favorable baseline characteristics of patients receiving carboplatin plus 5-FU, this combination exhibited comparable OS, PFS, and ORR to cisplatin plus 5-FU in real-world scenarios. Furthermore, it significantly improved OS over BSC. Consequently, carboplatin plus 5-FU should be considered as an alternative regimen, particularly for advanced-stage ESCC patients who are ineligible for cisplatin.

The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study.

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand.

Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization(WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton,cephalic, term pregnancies. Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.

Factors Correlated to the Renoprotective Effect of Sitagliptin in Patients with Type 2 Diabetes Mellitus: Retrospective Observational Study.

Sitagliptin functions similarly to GLP-1RAs by incretin and insulin secretion and has a renoprotective effect. Diabetic kidney disease (DKD) is a kidney complication that increases the mortality rate in type 2 diabetes mellitus (T2DM) patients. The important parameters that predict appropriate sitagliptin treatment are known as factors. This study aimed to assess factors that correlated with the renoprotective effect of sitagliptin in patients with T2DM. This retrospective study collected data from a tertiary hospital in Thailand. All T2DM patients who were treated with sitagliptin and had complete data were recruited to analyze the outcome. The primary outcome was a correlation between demographics, laboratory data, and kidney outcome. The secondary outcome was the different laboratory results between pre- and posttreatment of patients treated with sitagliptin. The number of patients who were treated for T2DM with sitagliptin was 191. Only 102 patients had complete laboratory parameters. Results showed a positive correlation between baseline FBS, HbA1c, and Scr change (p value = 0.042 and 0.005) at 6 months and baseline age, TG, and Scr change (p value = 0.010 and 0.022) at 18 months; while a negative correlation was observed between baseline FBS, HbA1c, and eGFR change (p value = 0.017 and 0.007) at 6 months and baseline age and eGFR change (p value = 0.010) and between HDL-cholesterol and Scr change at 18 months (p value = 0.044). The eGFR stage 1 subgroup showed a positive correlation between baseline HbA1c and Scr change (p value <0.001) and baseline DM duration and eGFR change (p value = 0.004). Moreover, sitagliptin showed statistically significant FBS, HbA1c, LDL-cholesterol, and TC reduction. Furthermore, HDL-cholesterol showed statistically significant elevation. FBS, HbA1c, and age were factors that correlated with the renoprotective effect of sitagliptin. The eGFR ≥90.00 ml/min/1.73 m2 patients group showed a duration of DM in which factors correlated with renoprotective effect. Moreover, sitagliptin also can improve glucose levels and lipid profile.

Discrepancy in diagnoses of diabetes and prediabetes using fasting plasma glucose and glycosylated hemoglobin and the underdiagnosis by ICD-10 coding: data from a tertiary hospital in Thailand.

Early detection of prediabetes and diabetes better prevents long-term health complications. FPG and HbA1c levels are some common laboratory tests utilized as tools to diagnose diabetes and prediabetes, but the agreement rate between these two diagnostic tests varies, which could lead to underdiagnosis and thus undertreatment. This study aimed to analyze the agreement rate between FPG and HbA1c, as well as the physicians' accuracy of using these results to make a prediabetes or diabetes diagnosis through ICD-10 coding at a tertiary care hospital in Bangkok, Thailand. A cross-sectional descriptive study was conducted using secondary data collected in a tertiary hospital's check-up clinic from August 16, 2019 to June 30, 2022 to study the prevalence and diagnosis of diabetes and prediabetes, determined through FPG and HbA1c laboratory results. We analyzed the two laboratory tests' diagnosis agreement rate and the physicians' accuracy of diagnosing diabetes and prediabetes in ICD-10 coding using the FPG and HbA1c results. Among 8,024 asymptomatic participants, the period prevalence diagnosed through laboratory results was 5.8% for diabetes and 19.8% for prediabetes. Diabetes and prediabetes prevalence based on laboratory data differs from that of ICD-10 coding data. Specifically, 79.6% of diabetes patients and 32.3% of prediabetes patients were coded using the ICD-10 coding system. 4,094 individuals had both FPG and HbA1c data. The agreement rate for diagnosing diabetes and prediabetes between the two laboratory results is 89.5%, with Kappa statistics of 0.58. Using only one of the two laboratory results would have missed a substantial number of patients. Our findings highlight screening test discrepancies and underdiagnosis issues that impede diagnostic accuracy enhancement and refined patient management strategies. Early diagnoses of prediabetes and diabetes, especially before symptoms arise, could increase health consciousness in individuals, thereby enabling the implementation of lifestyle modifications and prevention of serious health complications. We emphasize the importance of diagnosing these conditions using both FPG and HbA1c, along with subsequent accurate ICD-10 coding. Even though some hospitals lack certified HbA1c testing, we suggest enhancing the availability of HbA1c testing, which could benefit many people in Thailand.Clinical trial registration:https://www.thaiclinicaltrials.org, identifier [TCTR20230824003].

Outcomes of hip fracture treatment with intravenous morphine and with other analgesics: postoperative analgesic medical expense, severity of pain and hospitalisation—a retrospective study

AimsThis study compares the postoperative medical costs and outcomes of hip fracture patients treated with intravenous (IV) versus other analgesics (weak opioids, NSAIDs or acetaminophen).MethodsWe performed a retrospective study at a tertiary hospital in Thailand, examining 1,531 patients who underwent hip fracture surgery between 2009 and 2020. We analyzed data on analgesic usage, costs, pain scores, and adverse effects.ResultsIn the study of 1531 patients, 63% of patients received as-needed analgesics, and 37% received preemptive prescriptions. In both groups, IV morphine was the predominant choice. The mean cost for the IV group was marginally higher than the other analgesics group ($2277 vs $2174). The other analgesics group had a significantly higher consumption of acetaminophen and selective NSAIDs (p = 0.004). Pain scores were similar across both groups, but the IV group had a significantly higher incidence of gastrointestinal side effects (24% vs 10.5%, p < 0.01).ConclusionThe choice of IV or other analgesics in treating hip fractures affects analgesic usage, side effects, medical costs, and patient outcomes. Further studies across different regions are recommended.

205. The increasing trend of penicillin resistance in Streptococcus suis clinical isolates during the past 5 years in a tertiary hospital in Thailand

Abstract Background Streptococcus suis, an emerging zoonotic pathogen, is able to cause a wide spectrum of infections including primary bacteremia, meningitis, endocarditis, and other localized infections. Due to the increasing and widespread use of antibiotics in pig industry in Thailand, will contribute to the emergence of antimicrobial resistance to infection caused by S. suis. We aimed to determine the in vitro susceptibility of S. suis clinical isolates, in accompanying with the treatment outcomes. Methods A retrospective study was carried out on all patients with S. suis bacteremia at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from 2017 to 2022. S. suis identification was analyzed by conventional biochemical tests, the API-20 STREP system (bioMérieux, Marcy-l'Étoile, France), or MALDI-TOF MS. In vitro susceptibility test of penicillin, cefotaxime, meropenem, and vancomycin was carried out by E-test according to CLSI recommendation. Results There were 32 patients with 17 (53.1%) male and median age of 57 (IQR: 50-65) years. Comorbidities were diabetes (10 patients, 31.3%) and cancer (4, 12.5%). 12 (37.5%) patients had a history of consumption of undercooked pork products. Regarding clinical syndrome, there were 15 (46.9%), 6 (18.8%), 6 (18.8%), and 3 (9.4%) patients with primary bacteremia, infective endocarditis, meningitis, and septic arthritis/spondylodiscitis, respectively. The median length of stay was 13 (IQR: 5-16) days. The most common empirically used antibiotic was ceftriaxone (26 patients, 81.3%), followed by meropenem (3, 9.4%), and ampicillin (2, 6.2%). De-escalation treatment to penicillin G sodium was performed in 11 (34.4%) patients. Of 29 patients with available outcomes, there were 19 (65.5%), 6 (20.7%), and 3 (10.3%) patients with complete recovery, hearing loss, and mortality, respectively. In vitro susceptibility results are shown in Tables 1 and 2.Table 1.The minimum inhibitory concentration (MIC) distribution for Streptococcus suis blood isolates.Table 2.MIC50, MIC90, MIC ranges, and susceptibility according to 2023 CLSI clinical breakpoints for Streptococcus suis blood isolates. Conclusion S. suis bacteremic patients still had favorable outcomes despite the emergence of penicillin resistance. All isolates were susceptible to meropenem and vancomycin, and most were susceptible to cefotaxime. However, only 28.1% was still susceptible to penicillin. Third-generation cephalosporin should be the first agent for empirical treatment in patients with suspected S. suis bacteremia. Disclosures All Authors: No reported disclosures

206. Prevalence of liver abscess in patients with Klebsiella pneumoniae bacteremia during a 5-year experience in a tertiary hospital in Thailand

Abstract Background The incidence of liver abscess in Thailand has increased in number nowadays. K. pneumoniae is the most common cause of pyogenic liver abscess in the recent large series. Liver abscess can be a complication of K. pneumoniae bacteremic patients. We aimed to study the prevalence of liver abscess in patients with K. pneumoniae bacteremia and the comparison in clinical and laboratory characteristics of patients with K. pneumoniae between a group with liver abscess and the other without liver abscess. Methods This is a retrospective study; data were collected in Bhumibol Adulyadej Hospital among patients who were diagnosed with K. pneumoniae bacteremia between January 2014 – December 2019 and compared the difference in clinical and laboratory characteristics of patients between a group with liver abscess and the other without liver abscess. Results Of All 758 patients with K. pneumoniae bacteremia, 335 (44.19%) patients were done abdominal imaging, and 37 (4.9%) patients were found with liver abscess. The mean age was 65 years old, and most were male. Comorbidities were present in almost half of the patients including diabetes (118 patients, 35.22%), previous hepatobiliary surgery (21, 6.26%), and history of cancer (70, 20.90%). The other demographic data are shown in Table 1. Patients with liver abscess had diabetes (54.1% vs 29.3%, p-value = 0.082) and fever (91.89% vs 76.84%, p-value = 0.056) more than patients without abscess, however only 29.7% of patients with liver abscess had abdominal pain. Elevated transaminases above 2 times the upper limit of normal range are more frequent among patients with liver abscess than patients without abscess, for AST; 54.1%vs 35.30% (p-value = 0.026) and ALT; 40.5% vs 25.20% (p-value = 0.048). Clinical and laboratory characteristics are shown in Table 2.Table 1:Demographic data of patients with K. pneumoniae bacteremiaTable 2:Clinical and laboratory characteristics of patients with K. pneumoniae bacteremia Conclusion The prevalence of liver abscess in patients with K. pneumoniae bacteremia is 37 from 758 (4.9%). Liver abscess should be suspected in K. pneumoniae bacteremic patients who have elevated transaminases above 2 times the upper limit of normal range regardless of abdominal pain. Disclosures All Authors: No reported disclosures

540. A Dose-Comparison Study of Methylprednisolone on Mortality in COVID-19 Patients Require Oxygen in A Tertiary Hospital in Thailand

Abstract Background Dexamethasone 6 mg IV for 10 days or an equivalent dose of another corticosteroid like methylprednisolone (MP) is recommended for severe COVID-19 patients. A higher dose has been reported as beneficial for severe patients. We aimed to compare the effect of &amp;lt; 3 and ≥ 3 mg/kg/day (MKD) of MP in patients who require conventional oxygen therapy or high-flow nasal cannula Methods A retrospective study was conducted between June and October 2022 in Bhumibol Adulyadej Hospital by reviewing the medical record of COVID-19 patients requiring conventional oxygen therapy or high-flow nasal cannula. The patients were divided into two groups by the dosing of MP to ≥ 3 MKD and &amp;lt; 3 MKD to compare baseline characteristics, treatment, and clinical course. Multivariate logistic regression was used to identify factors associated with mortality. Results There are 197 patients included in the study: 100 from ≥ 3 MKD group and 97 from &amp;lt; 3 MKD group. The mean daily dose of MP was 4.16 (± 0.93) and 2.25 (± 0.55) MKD. There were no statistical differences between the baseline characteristic of the two groups except enoxaparin prophylaxis were more used and LDH were higher in ≥ 3 MKD group. Mortality at 28 days was 26% in ≥ 3 MKD group vs 8.2% in &amp;lt; 3 MKD group (adjusted odd ratio, 3.52 [95% CI, 1.44-8.62]; P = 0.006). Age &amp;gt; 65 is also an independent factor associated with mortality (P = &amp;lt; 0.001). Bacteremia occurred in 10% VS 2% of ≥ 3 and &amp;lt; 3 MKD groups, respectively (odd ratio, 0.19 [95% CI, 0.04-0.89]; P = 0.02). Conclusion During the fourth wave of the COVID-19 pandemic with the Delta variant in Thailand, we found patients requiring conventional oxygen therapy or high-flow nasal cannula who received a higher dose of MP (≥ 3 MKD) were associated with significant 28-day mortality. Disclosures All Authors: No reported disclosures

Economic cost of patients with trisomy 13, 18, and 21 in a tertiary hospital in Thailand.

The purpose of this study was to determine direct and indirect costs of patients with trisomy (T) 13, 18, and 21 in Thailand. Direct medical costs were obtained from Siriraj Informatics and Data Innovation Center (SiData+), Faculty of Medicine, Siriraj Hospital, and indirect costs were estimated using a human capital approach. About 241 patients with T21 had outpatient care visits and 124 patients received inpatient care. For T13 and T18, five and seven patients were analyzed for outpatient and inpatient cares, respectively. For patients with T13, T18, and T21 receiving outpatient care, total annual mean direct medical costs ranged from 183.2 USD to 655.2 USD. For inpatient care, average yearly direct medical costs varied between 2,507 USD to 14,790 USD. The mean and median increased with age. In outpatient care, costs associated with drugs and medical devices were a major factor for both T13 and T21 patients, whereas laboratory costs were substantial for T18 patients. For inpatient care, costs of drug and medical devices were the greatest for T13 patients, while service fee and operation costs were the highest for T18 and T21 patients, respectively. For outpatient care, adult patients with congenital heart disease (CHD) had significantly higher mean annual direct medical costs than those without CHD. However, all adult and pediatric patients with CHD receiving inpatient care had significantly higher costs. Patients with T13, T18, and T21 had relative lifetime costs of 22,715 USD, 11,924 USD, and 1,022,830 USD, respectively.

Preoperative admission is non-essential in most patients receiving elective laparoscopic cholecystectomy: A cohort study.

We evaluated conventional overnight-stay laparoscopic cholecystectomy, focusing on the preoperative admission day, to assess the feasibility of implementing daycare laparoscopic cholecystectomy, which is currently underutilized in developing and some Asian countries. We retrospectively reviewed elective laparoscopic cholecystectomy data from March 2020 to February 2022 at a 700-bed tertiary hospital in Thailand. Variables included age, sex, body mass index, comorbidities, American Society of Anesthesiologists status, presence of preoperative anesthesiology visit, laparoscopic cholecystectomy indications, additional intraoperative cholangiography, and surgery cancellations. The primary focus was on preoperative treatment and monitoring needs; secondary outcomes included morbidity, mortality within 30 days, and prolonged hospital stay (>48 hours). Statistical analysis was conducted using the Fisher exact test, t-test, and logistic regression. The study included 405 patients. Of these, 65 (16.1%) received preoperative treatment, with 21 unnecessary (over) treatments and six under-treatments. Based on the results, approximately 12.1% (n = 49) of patients may have theoretically required preoperative admission and treatment. Multivariable analysis showed that the increasing of comorbidities was significantly associated with preoperative management (odds ratio [95% Confidence interval]: 7.0 [2.1, 23.1], 23.9 [6.6, 86.6], 105.5 [17.5, 636.6]) for one, two, and three comorbidities, respectively), but factors such as age, obesity, and American Society of Anesthesiologists status were not. The cohort had 4.2% morbidity (2.2% medical complications), with no mortality. Surgery cancellations occurred in 0.5%. In conclusion, on the basis of our data, a small proportion (12.1%) of patients undergoing elective laparoscopic cholecystectomy may require preoperative admissions to receive the necessary treatment, and most (87.9%) preoperative admissions may not provide treatment benefit. The traditional admission approach was safe but required re-evaluation for optimal resource management.

Quality of Life Outcomes Among Patients Being Screened for Cytomegalovirus Retinitis in Thailand

ABSTRACT Purpose Cytomegalovirus (CMV) retinitis can have debilitating impacts on quality of life (QOL), but few contemporary studies have characterized these ramifications. This study assessed the impact of CMV retinitis on vision-related QOL for those living with HIV/AIDS in Thailand. Methods QOL was assessed as part of a prospective interventional cohort study of patients referred to a tertiary hospital in Thailand for CMV retinitis screening. A validated vision-related QOL questionnaire was administered at the baseline screening visit and at the 6-month study visit. Multivariable linear regression models were performed to determine the effect of CMV retinitis diagnosis on QOL score. Results A total of 152 participants completed the QOL questionnaire at their initial clinic visit. At baseline, a diagnosis of CMV retinitis diagnosis was significantly associated with decreased QOL score: unilateral retinitis was associated with a 0.11 (95% CI: −0.26–0.03) decrement in QOL, and bilateral retinitis was associated with a 0.33 (95% CI: −0.51–0.16) decrement (joint P-value = 0.0009). For the 78 participants with a 6-month visit, changes in QOL from baseline were small and not significant. A diagnosis of CMV retinitis was still associated with decreased QOL score at 6 months (joint P-value = 0.03). Conclusions This study found that vision-related QOL was lower in those with CMV retinitis, especially with bilateral involvement, and did not improve after treatment among those with follow-up. These findings reinforce the debilitating clinical manifestations of this disease, and support efforts for earlier screening to detect CMV retinitis before impacts on QOL have occurred.

Survival Analysis of Lung Cancer: A 10-Year Real-Life Experience in a Non-University-Based Hospital in Thailand (2012-2021).

Over the past decades, several studies have mostly revealed that the overall survival among patients with lung cancer in university hospitals remained poor. However, the data on real-world treatments in non-university tertiary hospitals in Thailand still needs to be discovered. The primary objective was to assess the 10-year real-life overall survival among patients with lung cancer in a non-university hospital. A retrospective cohort study assessed patients diagnosed with lung cancer from a hospital-based lung cancer registry from January 2012 to December 2021 at Hatyai Hospital, Songkhla, Thailand. The demographic data and treatment outcomes were recorded. Kaplan-Meier methods were used for overall survival (OS), and a Log-rank test was used to compare the differences in survival based on different categories of prognostic factors. The prognostic factors for OS were assessed using a Cox-proportional hazard model. Of 1,528 patients, the median age was 63.2± 12.1years; 1,009 (66%) were male; 981 (64%) had a history of smoking; 1,433 (93.7)% were non-small-cell lung cancer (NSCLC); 1,327 (87%) presented with stage IV disease. The median OS was 7.8 months for all patients, eight months for those with NSCLC, and 6.4 months for those with small cell lung cancer (SCLC). The 1-year, 3-year, and 5-year cumulative survival rates with all patients were 38%, 11%, and 6%. With NSCLC, 39%, 12%, and 6%, whereas for those with SCLC, 29%, 5%, and 4%, respectively. Disease stage III/IV and male gender were significantly associated with an increased risk of death, whereas receiving 1-2 line systemic treatments and curative surgical resection was a significant factor for survival in lung cancer patients. In Thailand, the OS in patients with lung cancer has remained low over the decade. However, providing specific-lung cancer therapies and undergoing curative surgery remains a significant factor in improving their survival.

The prevalence and treatment outcomes of Helicobacter pylori infection in a tertiary hospital in Thailand, 2018-2021.

Helicobacter pylori (HP) infection remains a significant global public health problem. This study aimed to study the prevalence of HP infection and treatment outcomes in Thailand. We retrospectively reviewed the results of the urea breath test (UBT) performed at the King Chulalongkorn Memorial Hospital between 2018 and 2021. The prevalence of HP infection was evaluated in dyspeptic patients undergoing UBT screening. In patients with known HP infection, the treatment regimen and the success rate in each patient were recorded. One-thousand nine-hundred and two patients were included in this study. The prevalence of HP infection in dyspeptic patients was 20.77% (UBT was positive in 65 out of 313 patients). Of the 1589 patients who received the first treatment regimen, 1352 (85.08%) had a negative UBT result. Patients who failed in each treatment regimen were treated with subsequent regimens. The overall success rates for the second, third, and fourth regimens were 69.87% (109 of 156 patients), 53.85% (14 of 26 patients), and 50% (3 of 6 patients), respectively. Univariate logistic regression analysis found that using lansoprazole was associated with failure of treatment with OR = 2.11 (95% CI: 1.14-3.92, P = 0.018). Current primary HP treatment regimens have an eradication rate of >80%. Even though the previous regimens failed, without available antibiotic sensitivity results, the subsequent regimens were successful by at least 50%. In cases of multiple-treatment failure and where antibiotic sensitivity tests were unavailable, continuing to change regimens could provide satisfactory results.