University Hospital In Bangkok Research Articles

Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study.

This study aimed to identify the characteristics, causes, perioperative anesthetic, and obstetric outcomes of patients experiencing postpartum hemorrhage (PPH) after cesarean delivery. We retrospectively analyzed patients who underwent cesarean delivery at the largest university hospital in Bangkok, Thailand, during a 5-year period (January 1, 2016-December 31, 2020). PPH was defined as an estimated blood loss (EBL) of ≥ 1000 ml within 24 hours postpartum. Of 17 187 cesarean deliveries during the study period, 649 patients were included for analysis. The mean EBL was 1774.3 ± 1564.4 ml (range: 1000-26 000 ml). Among the patients, 166 (25.6%) experienced massive PPH (blood loss > 2000 ml). Intraoperative blood transfusions were necessary for 264 patients (40.7%), while 504 individuals (77.7%) needed intraoperative vasopressors. The analysis revealed uterine atony as the leading cause of PPH in 62.7% (n = 407) of the patients, with abnormal placentation following at 29.3% (n = 190). Abnormal placentation was associated with a significantly higher mean EBL of 2345.0 ± 2303.9 ml compared to uterine atony, which had a mean EBL of 1504.0 ± 820.7 ml (P < 0.001). Abnormal placentation also significantly increased the likelihood of blood transfusions and hysterectomies (P < 0.001 for both) and led to more intensive care unit admissions (P = 0.032). The risk of EBL exceeding 2000 ml was markedly higher in patients with abnormal placentation (odds ratio [OR] 5.12, 95% confidence interval [CI] 3.45-7.57, P < 0.001) and in cases involving trauma to the internal organs (OR 2.33, 95% CI 1.16-4.71, P = 0.018) than in patients with uterine atony. The study documented three instances of perioperative cardiac arrest, one of which was fatal. These findings highlight the importance of comprehensive perioperative management strategies, including the ready availability of adequate blood and blood products, particularly in scenarios predisposed to significant hemorrhage. Clinical trial registration: Clinicaltrial.gov registration number NCT04833556 (April 6, 2021).

Lactation duration and development of type 2 diabetes and metabolic syndrome in postpartum women with recent gestational diabetes mellitus

BackgroundThe World Health Organization and United Nations Children’s Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant’s life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months.MethodsThis prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the “recall since birth” method.ResultsOf the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively.ConclusionsMaintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women’s health after GDM.Trial registrationThai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020.

Frailty as a Key Predictor of Malnutrition among Older Adults with Swallowing Problems

Geriatric syndrome—frailty—has a more significant influence on the health of older, pre-frail and frail older adults who tend to have a poor nutritional status or develop severe malnutrition. Investigation of frailty and its association with malnutrition and swallowing problems is limited in older Thais. This cross-sectional study examined the association among frailty and other associated factors with malnutrition in older adults with swallowing problems. A purposive sampling method was employed to recruit 120 participants who met the specified inclusion criteria. Data were obtained from older adults who visited and received medical services at the rehabilitation department of a university hospital in Bangkok, Thailand, from July 2022 to February 2023. The instruments included the Demographic and Health Information Record Form, Mini Nutritional Assessment Short-Form - MNA® Elderly, Reported Edmonton Frail Scale-Thai Version, and Modified Barthel Activities of Daily Living Index. Data were analyzed using descriptive statistics and multiple logistic regression.The findings indicated that 82.5% of participants were frail, and approximately 30% and 80.0% presented with dependence and at-risk or malnutrition, respectively. Frailty, age, comorbidities, a history of aspiration, and activities of daily living could predict malnutrition, accounting for 71.7%. Significantly, frailty demonstrated a 4.47-fold increased risk of malnutrition, while dependence on activities of daily living had a 6.41-fold increased risk of malnutrition among this population. The findings of this study provide valuable insights for healthcare professionals, especially gerontological nurse practitioners, to raise awareness of the early detection of frailty, swallowing problems, and potential risks of malnutrition, together with promoting daily activity in older adults across settings. Implementing comprehensive management to improve swallowing and physical function in older adults at risk of frailty and malnutrition may enable gerontological nurse practitioners to strengthen professional care. By doing so, maintaining nutritional health among these populations can be achieved.

The effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results: A time-series quasi-experimental study.

Due to the cervical cancer screening campaign, there is a gradual increase in the number of women diagnosed with abnormal cervical cytology results. Most women experience high anxiety upon learning about these results, leading to adverse psychological effects. Therefore, nurses play a vital role in counseling these women to alleviate their concerns. This study aimed to examine the effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results. The study employed a time-series quasi-experimental design with a comparison group. It was conducted at the colposcopy clinic of a university hospital in Bangkok, Thailand, from August 2022 to April 2023. A total of 68 women with abnormal cervical cytology results were purposively recruited based on inclusion criteria. The comparison group (n = 34) received only usual care, while the experimental group (n = 34) received colposcopy counseling and usual care. Colposcopy counseling was provided after collecting baseline data. Anxiety was assessed at baseline, immediate post-test, and 12th week post-test. Data were analyzed using descriptive statistics, Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA). There was no statistically significant difference in anxiety across the three-time points between the two groups (F1, 66 = 0.062, p = 0.804). However, anxiety in the experimental group significantly decreased over time (p <0.05). In contrast, anxiety in the comparison group at baseline was not significantly different from that at the immediate post-test (p = 0.480). Colposcopy counseling was effective in reducing anxiety in Thai women with abnormal cervical cytology results, especially during the initial period after receiving the results. Nonetheless, anxiety could gradually decrease regardless of the intervention. Therefore, colposcopy counseling by nurses and healthcare providers is helpful for women in relieving anxiety during their first colposcopy attendance.

The relationship between creamatocrit and cumulative percentage of total milk volume: a cross-sectional study in mothers of very preterm infants in Bangkok, Thailand

BackgroundHuman hindmilk contains higher concentrations of fat than foremilk and is more desirable for growth in preterm infants who can tolerate limited volumes of breastmilk. There is currently no clear demarcation between foremilk and hindmilk. This study characterized the change in breastmilk’s fat content from the start to end of milk flow and defined this demarcation.MethodsMothers of infants born at ≤ 32 weeks gestational age and ≥ 14 days after childbirth in a University hospital in Bangkok, Thailand between July, 2011, and April, 2012 were included in this cross-sectional study. Breastmilk samples were sequentially collected from the start to end of milk flow in 5-mL aliquots using breast pumps. The fat content of each aliquot from each breast was determined through creamatocrit. The average creamatocrit of foremilk and hindmilk were compared in predefined foremilk to hindmilk ratios of 20:80, 25:75, 33:67, and 50:50. Creamatocrit of the first and last aliquots were compared for mothers who expressed low- (≤ 25-mL per breast) and high-volumes (> 25-mL per breast) of breastmilk.ResultsOf the 25 mothers enrolled, one was excluded due to unsuccessful creamatocrit measurement. The last aliquot of breastmilk had a significantly higher creamatocrit than the first from the same breast (median [interquartile range] of 12.7% [8.9%, 15.3%] vs. 5.6% [4.3%, 7.7%]; test statistic 1128, p < 0.001). Mean creamatocrit in hindmilk portions (9.23%, 9.35%, 9.81%, and 10.62%, respectively) was significantly higher than foremilk portions (6.28%, 6.33%, 6.72%, and 7.17%, respectively) at all predefined ratios. Creamatocrit increased by 1% for every 10% incremental increase in expressed breastmilk volume until the breast was emptied. Low-volume mothers had a significantly higher creamatocrit in the first aliquot compared with high-volume mothers (U = 437, p = 0.002). No significant difference in breastmilk volume was observed between mothers with and without breastfeeding experience.ConclusionsFat content in breastmilk increased on an incremental basis. More fluid definitions of foremilk and hindmilk should be adopted. Mothers should prepare their breastmilk into aliquots based on the required feeding volume of their infant. Hindmilk aliquots can be prioritized over foremilk aliquots to ensure infants obtain optimal caloric intake.

Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial.

Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital. This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG. In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher's exact, and Mann-Whitney U tests. The intervention group had significantly lower mean scores-indicating favorable wound healing-for SVG donor site wound healing level than the control group on days 14-21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores-indicating good wound healing-than the control group. The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge. Thai Clinical Trials Registry (TCTR20211112002).

Prescribers’ Compliance to Human Serum Albumin Usage Criteria and Its Implication on Cost Saving

Human serum albumin (HSA) is a commonly used product with high impact on healthcare expenditure. Little is known regarding the appropriateness of HSA use in healthcare system. This study aimed to assess prescriber’s compliance to the approved HSA criteria. Potential cost saving was also estimated. A cross-sectional study was performed in a tertiary care, university hospital in Bangkok in 2019. Prescriptions for HSA for all adult patients along with corresponding medical records were reviewed and assessed against the approved HSA criteria. Deviation from the criteria was used to estimate the potential cost saving. A total of 688 prescriptions were reviewed, 200 prescriptions met the inclusion criteria and were included in the analysis. Among six indications in the approved criteria for HSA, the rates of criteria compliance ranged from 48 to 90%. Hypoalbuminemia was found to be the main reason for inappropriate use. The estimated cost saving from inappropriate HSA use was €3,543 (€59 per prescription). Significant deviation from the approved criteria of HSA use was seen in a Thai hospital and significant cost saving can be made by increasing the compliance to the criteria. A practice improvement initiative to promote rational use of HSA is warranted.

Factors associated with bleeding events from enoxaparin used for patients with acute coronary syndrome

BackgroundLow molecular weight heparins (LMWHs) are the mainstay of treatment for acute coronary syndrome (ACS). However, bleeding, the main side effect, is associated with prolonged hospitalization and mortality. Therefore, assessment of the incidence of bleeding and associated risk factors is crucial in developing an appropriate treatment plan to prevent bleeding.MethodsA retrospective cohort study was conducted in patients with ACS admitted to a university hospital in Bangkok, Thailand between 2011 and 2015 and received enoxaparin. To estimate the incidence of bleeding events, patients were followed up for 30 days from the first enoxaparin dose. Multiple logistic regression was used to determine factors associated with bleeding events.ResultsFrom a total of 602 patients, the incidence of bleeding was 15.8%, of which 5.7% involved major bleeding. The risk factors for any form of bleeding were aged at least 65 years (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.18 to 3.36), history of bleeding (OR, 3.79; 95% CI, 1.24 to 11.55), and history of oral anticoagulant exposure (OR, 4.73; 95% CI, 1.74 to 12.86).ConclusionACS patients treated with enoxaparin had an increased risk of bleeding if they were aged 65 years or older, had a history of bleeding events, and had a history of taking oral anticoagulants.

SARS-CoV-2 Variants by Whole-Genome Sequencing in a University Hospital in Bangkok: First to Third COVID-19 Waves.

Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants emerged globally during the recent coronavirus disease (COVID-19) pandemic. From April 2020 to April 2021, Thailand experienced three COVID-19 waves, and each wave was driven by different variants. Therefore, we aimed to analyze the genetic diversity of circulating SARS-CoV-2 using whole-genome sequencing analysis. A total of 33 SARS-CoV-2 positive samples from three consecutive COVID-19 waves were collected and sequenced by whole-genome sequencing, of which, 8, 10, and 15 samples were derived from the first, second, and third waves, respectively. The genetic diversity of variants in each wave and the correlation between mutations and disease severity were explored. During the first wave, A.6, B, B.1, and B.1.375 were found to be predominant. The occurrence of mutations in these lineages was associated with low asymptomatic and mild symptoms, providing no transmission advantage and resulting in extinction after a few months of circulation. B.1.36.16, the predominant lineage of the second wave, caused more symptomatic COVID-19 cases and contained a small number of key mutations. This variant was replaced by the VOC alpha variant, which later became dominant in the third wave. We found that B.1.1.7 lineage-specific mutations were crucial for increasing transmissibility and infectivity, but not likely associated with disease severity. There were six additional mutations found only in severe COVID-19 patients, which might have altered the virus phenotype with an inclination toward more highly pathogenic SARS-CoV-2. The findings of this study highlighted the importance of whole-genome analysis in tracking newly emerging variants, exploring the genetic determinants essential for transmissibility, infectivity, and pathogenicity, and helping better understand the evolutionary process in the adaptation of viruses in humans.

Workplace Violence Against Frontline Nurses in a University Hospital in Bangkok, Thailand: A Cross-sectional Study

Background: Workplace violence against nurses has increased attention worldwide. This study aimed to investigate the prevalence of workplace violence (WPV) and related factors against frontline nurses in a university hospital in Bangkok, Thailand.

Molecular characterization and antibiotic resistance of Staphylococcus aureus isolated from clinical specimens in an urban university hospital in Bangkok, Thailand.

Little is known about the properties of the current strains of Staphylococcus aureus associated with human infections in Thailand. This study examined the rate of resistance to various antimicrobial agents, prevalence of virulence genes, and biofilm formation ability of 60 clinical S. aureus isolates from a single Thai hospital. Moreover, the Staphylococcus protein A gene (spa) type was determined among methicillin-resistant S. aureus (MRSA) isolates. Most methicillin-susceptible S. aureus isolates were susceptible to antimicrobials, whereas all MRSA isolates were resistant to erythromycin and clindamycin. The major virulence genes among the isolates were hla (100%), sec (26.7%), and hlb (20%). Meanwhile, 46.7% and 1.7% of the strains exhibited low-grade and high-grade biofilm formation, respectively. Our findings revealed the presence of spa types among MRSA isolates were: t032 (37.5%, 6/16), t088 (25%, 4/16), t001 (12.5%, 2/16), t008 (6.25%, 1/16), t034 (6.25%, 1/16), t439 (6.25%, 1/16), and t1928 (6.25%, 1/16). These findings will be useful for future research on anti-virulence therapies and the epidemiology of the strains circulating in our hospital.

High-protein delivery in mechanically ventilated patients: A study protocol for a randomized trial

Background: Critically ill patients are at risk of malnutrition; thus, optimal nutrition delivery is a key treatment for better outcomes. Inadequate energy and protein intake increase rate of hospital-acquired infection, duration of mechanical ventilation and mortality. However, there is no clear consensus regarding optimal protein dose in mechanically ventilated patients. In this study, we aim to compare between the effect of high and usual protein delivery on clinical outcomes in this patient group. Methods: This is a single-centered, open-labelled, parallel-group, randomized controlled study conducting in medical, surgical and trauma intensive care units (ICU) at a tertiary university hospital in Bangkok, Thailand. We plan to enroll 240 adult mechanically ventilated patients who are expected to require ventilator support for at least 3 days. The intervention group will be prescribed high protein dose (at least 1.5 g/kg/day) throughout ICU stay since day 4 until a maximum of 28 days, whereas the control group will be prescribed usual protein dose (1-1.3 g/kg/day). Nutrition is provided by enteral or parenteral route or both. The primary outcome is ventilator-free days at 28 days. The main secondary outcomes include the temporal change in muscle mass and SOFA score, rate of nosocomial infection and 28-day mortality. Conclusion: The robust evidence whether delivering high protein in critically ill patients improves outcome is lacking. This randomized trial will examine the consequence of high protein delivery in ICU population.

Urinary neutrophil gelatinase‐associated lipocalin: A novel biomarker for predicting chronic kidney disease in patients with nonalcoholic fatty liver disease

AbstractAimsNonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are common diseases worldwide. Reports of a high prevalence of CKD in NAFLD patients have been documented. Urinary neutrophil gelatinase‐associated lipocalin (NGAL) is a reliable biomarker for renal dysfunction, and it is recommended for early detection of acute kidney injury (AKI) in cirrhotic patients. Currently, there is no evidence for using urine NGAL to predict CKD in NAFLD patients. We aim to determine the proportion of CKD and identify the predictive value of NGAL and other factors associated with CKD in these patients.MethodsA single‐center, cross‐sectional study was conducted between July 2018 and December 2019 in consecutive NAFLD patients diagnosed by transient elastography (TE) or liver biopsy at a tertiary care university hospital in Bangkok, Thailand. Advanced liver fibrosis is defined as fibrosis stages 3–4. The definition of CKD is estimated glomerular filtration rate (eGFR) &lt;60 ml⋅min−1⋅1.73 m−2 based on the Kidney Disease Improving Global Outcomes (KDIGO) guideline 2012. Urine NGAL level was measured by enzyme linked immunosorbent assay technique.ResultsA total of 101 NAFLD patients were included with a mean age of 54 ± 16 years. Among these patients, 14 (13.9%), 13 (12.9%), and 32 (31.7%) had fibrosis stages 2, 3, and 4, respectively. Nine percent (9 of 101) of patients with NAFLD with a mean eGFR of 42.66 ± 17.42 ml⋅min−1⋅1.73 m−2. The statistically significant factors associated with CKD were a higher level of urine NGAL (55.1 [25.15–150.60] vs. 15.1 [9.67–25.15] ng/ml; p = 0.006), a higher level of TE (17.3 [6.85–46.20] vs. 7.7 [5.6–11.7] kPa; p = 0.038), and a presence of advanced fibrosis (77.8% vs. 40.7%; p = 0.041), compared to those without CKD. Urine NGAL was the only significant factor associated with CKD in NAFLD patients. The cutoff level of urine NGAL at 36.75 ng/ml showed odds ratio of 21.27 (95% CI: 3.97–113.82; p &lt; 0.001) and 1.02 (95% CI: 1.00–1.04; p = 0.024) by univariate and multivariate analyses, respectively. The selected urine NGAL cutoff demonstrated a sensitivity and specificity of 77.8% and 85.9% for predicting CKD, respectively.ConclusionsThe proportion of CKD in NAFLD patients was 9% and the presence of advanced fibrosis was a significant risk factor associated with CKD. Additionally, urine NGAL was significantly associated with CKD in NAFLD patients using a cutoff level of 36.75 ng/ml for predicting CKD with acceptable sensitivity and specificity. A larger prospective cohort study is needed to validate our findings.

Genotyping, antifungal susceptibility testing, and biofilm formation of Trichosporon spp. isolated from urine samples in a University Hospital in Bangkok, Thailand.

The basidiomycetes yeast Trichosporon is widespread in the natural environment, but can cause disease, mainly in immunocompromised patients. However, there have been only few studies about this infection in Thailand. In this study, we characterized 53 Trichosporon spp. isolated from urine samples from patients admitted to a single hospital in Bangkok, Thailand over a one-year period from 2019 to 2020. The strains were identified using colony morphology, microscopy, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and nucleotide sequence analysis of intergenic spacer 1 (IGS1). Fifty-one isolates were Trichosporon asahii, and the remaining isolates were Trichosporon inkin and other Trichosporon species. Three genotypes of IGS1-1, 3, and 7 were observed among T.asahii. The sensitivity of the yeasts to the antifungal drugs amphotericin B, fluconazole, and voriconazole ranged from 0.25 to >16 μg ml-1, 0.5-8 μg ml-1, and 0.01-0.25 μg ml-1, respectively. We investigated biofilm formation by the isolates, and no biofilm production was found in one isolate, low biofilm production in forty-four isolates, and medium biofilm production in six isolates. T. inkin produced biofilms at low levels, and Trichosporon spp. produced biofilms at medium levels. This research increases our understanding of the molecular epidemiology of Trichosporon spp. isolated from one university hospital in Bangkok, Thailand, and reveals their genetic diversity, antifungal susceptibility profiles, and capacity for in vitro biofilm production.

Factors Predicting Frailty Among Postoperative Brain Tumor Patients.

BACKGROUND: Surgical frailty is a condition in which patients are weak with varied recovery of various organ functions after surgery resulting in unpleasant outcomes. Frailty studies have been conducted in several populations with a limited knowledge on postoperative brain tumor patients. This study aimed to examine factors predicting frailty in brain tumor patients after craniotomy. METHODS: This study was a cross-sectional predictive study. The sample included 85 patients who were 18 years or older and underwent craniotomy with tumor removal from 1 university hospital in Bangkok, Thailand, between February and October 2021. Data were analyzed using descriptive statistic, Pearson correlation, and multiple linear regression, which determined significance level at .05. RESULTS: The prevalence of frailty among participants was 50.6%. Postoperative symptom and mood state were positively associated with frailty ( r = 0.410 and r = 0.448, respectively; P < .01). Postoperative symptom, mood state, age, tumor type, and income could explain the variance of frailty in brain tumor patients after craniotomy by 40.3% ( R2 = 0.403, P < .01). CONCLUSION: Healthcare providers should plan for discharge planning including assessment and develop the intervention for managing postoperative symptoms and psychological symptoms to promote recovery from frailty that generally occurs after brain tumor surgery.

Association between Mode of Transport and Patient Outcomes in the Emergency Department following Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Study

Background Out-of-hospital cardiac arrest (OHCA) remains a health problem worldwide, carrying a high mortality rate. Comparison of emergency department (ED) return of spontaneous circulation (ROSC) after OHCA in relation to emergency medical services (EMS) and non-EMS modes of transportation to the hospital was conducted to assess the impact points of the EMS system in Thailand. Methods This retrospective observational study enrolled all OHCA patients who visited the ED of Ramathibodi Hospital, a tertiary university hospital in Bangkok, between January 1, 2008, and May 31, 2020. Patients were differentiated into EMS and non-EMS groups according to mode of transportation to the ED. Patients’ characteristics and comorbidities, witnessed arrests, bystander chest compression, initial rhythm, and resuscitation treatment were documented. ED-sustained ROSC, ED survival, 30-day survival, and 30-day survival with good cerebral performance category (CPC) scores were monitored and recorded. Multivariate logistic analyses were performed to assess factors influencing clinical outcomes. Results A total of 339 patients were enrolled, 117 (34.51%) of whom were in the EMS transport group. There were no differences between the EMS and non-EMS groups in ED-sustained ROSC (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.58–1.70; P = 0.98), or ED survival (aOR, 0.99; 95% CI, 0.57–1.71; P = 0.97). There were also no differences in 30-day survival or 30-day survival with good CPC score between the two groups. Conclusions In our cohort data of OHCA, ED-sustained ROSC and ED survival outcomes were not superior in the EMS transportation group. Evidence to show that EMS transportation affected 30-day survival and 30-day good CPC score was also lacking. Thus, public promotion of Thailand’s EMS system is advocated with a simultaneous improvement of EMS response to enhance OHCA outcomes.

Stroke Incidence, Rate of Thrombolytic Therapy, Mortality in Thailand from 2009 to 2021

BACKGROUND: Thrombolytic treatment is the main treatment of acute ischemic stroke. Thailand started thrombolytic treatment in 2008 only at university hospitals in Bangkok and gradually increased services in large provincial hospitals until widespread in 2014. However, no studies regard the services in stroke management in Thailand.&#x0D; AIM: This study aims to present data: incidence, rate of thrombolytic treatment, mortality rate of acute stroke in Thailand for 13 years&#x0D; METHODS: A study from the National Health Security Office's database between 2009 and 2021 was reported using percentage statistics, and the number of patients per 100,000 population.&#x0D; RESULTS: The overall incidence of acute stroke patients aged 15 years and over was 172.33- 328.00 per 100,000 population. The incidence of acute ischemic stroke patients aged 15 years and over was 90.37-222.73 per 100,000 population. The incidence of non-traumatic intracerebral hemorrhage patients aged 15 years and over was 55.77-87.63 per 100,000 population. Rate of acute ischemic stroke patients who treated with thrombolytic treatment was 0.18-8.04%. Mortality rate of acute stroke patients was 10.24-14.77%. Mortality rate of acute ischemic stroke patients who treated with thrombolytic treatment was 3.97-10.53%.&#x0D; CONCLUSIONS: Stroke incidence tends to increase over 13 years. Acute ischemic stroke patients receiving thrombolytic treatment tends to increase in number. The mortality rate in patients with acute stroke tends to decline. Especially in patients with acute ischemic stroke, the mortality rate was greatly reduced.

Outcome of Parathyroidectomy for Renal Hyperparathyroidism: A Single Center Experience

Background: Renal hyperparathyroidism (HPTH) is a common complication of chronic kidney disease and is known to cause significant morbidity in these patients. There has been substantial debate on the best possible treatment of this condition. Surgical treatment is now considered to be of vital importance as its efficacy is well documented. The present study reported the outcome of parathyroidectomy in King Chulalongkorn Memorial Hospital, a university hospital in Bangkok, Thailand. Objective: To determine surgical outcomes, including success rate and perioperative complications of parathyroidectomy in patients with renal HPTH. Materials and Methods: The data was collected by retrospective review of patients’ records between June 2014 and May 2019. One hundred ten patients were enrolled. Their demographic data, laboratory results, and outcomes were collected and categorized. Results: Among 110 patients, men accounted for 48.6%. The mean age was 49.5 years (SD 13.3). The most frequent operation was total parathyroidectomy with autotransplantation (TPTX+AT). All four glands were identified and excised in 84.5% of all patients. The mean preoperative serum intact parathyroid hormone (iPTH) level was 1,938 pg per dL with a range of 171 to 5,000 pg per dL. Postoperative hypocalcemia requiring intravenous calcium supplement was present in 70%. Postoperative cardiovascular complication occurrences were 16.4%, with one mortality due to myocardial infarction. In addition, one patient suffered unilateral recurrent laryngeal nerve injury, while two had stroke. The overall success rate of treatment was 81.1%, with 7.3% and 8.2% of patients that had persistently high PTH and recurrence of HPTH, respectively. Conclusion: Parathyroidectomy is an essential choice of treatment in patients with renal HPTH. Further validation of correlations with other factors is now being processed, and more data are needed. Keywords: Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Chronic kidney disease mineral bone disease; Parathyroidectomy

Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital.

Introduction:Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists’ interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units.Methods:A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.’s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes.Results:A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists’ interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients.Conclusion:The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.

Etiology and outcome of acute recurrent pancreatitis and chronic pancreatitis.

Owing to the lack of data, we aimed to determine the etiology and outcome of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) in children in Southeast Asia. This retrospective study was conducted at a university hospital in Bangkok, Thailand. We included patients aged <18 years who were diagnosed with pancreatitis from 2000 to 2021. Among 155 patients with pancreatitis, 21 (13.5%) were diagnosed with either ARP (n = 7) or CP (n = 14). Clinical manifestations of CP included chronic abdominal pain (n = 10, 71.4%), steatorrhea (n = 8, 57.1%), and diabetes mellitus (n = 1, 7.1%). Positive radiological findings compatible with CP were detected from an abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography in 70%, 90.9%, and 92.9% of patients, respectively. Genetic, metabolic, and pancreaticobiliary causes were the major causes of ARP/CP (23.8% each) and the etiologies were unidentified in one-fifth of the patients. Patients with metabolic diseases who had AP were at-risk of developing ARP (hazards ratio [HR], 4.7, 95% confidence interval [CI]: 1.5-13.9). Children with ARP or CP were younger than those with AP (P = 0.04). Approximately two-thirds of patients with CP had growth faltering and they had more episodes of hospitalization due to acute attacks when compared to patients with ARP ( 4 [interquartile range [IQR], 3-6] vs. 3 [IQR, 2-3]; P = 0.02). Genetic, metabolic, and pancreaticobiliary diseases were the common etiologies of ARP and CP among children living in a developing country in Southeast Asia. The burden of CP included malnutrition and frequent hospitalization. The findings emphasize the importance of an early etiological diagnosis and monitoring for pancreatic insufficiency in ARP/CP.