Vajira Hospital Research Articles

Impact of COVID-19 on Maxillofacial Trauma Incidence at Vajira Hospital: A Retrospective Study (2018-2021)

Background: Maxillofacial injuries vary globally depending on social, cultural, and environmental factors. The coronavirus disease 2019 (COVID-19) pandemic has further contributed to global variations in maxillofacial injury incidence owing to precautionary restrictions. Objective: To investigate the impact of COVID-19 on maxillofacial fractures. Materials and Methods: The present study was a retrospective cohort study that analyzed the medical records of patients with maxillofacial fractures admitted to the Emergency Department, Vajira Hospital, Bangkok. The incidence, causes, and anatomical sites of fractures were compared between the pre-COVID-19, 2018 to 2019, and COVID-19 periods, in 2020 to 2021. Results: The present study included 749 patients with maxillofacial fractures. The analysis revealed a 15% decrease in the number of patients with maxillofacial fractures during the COVID-19 pandemic. Males were more affected than females in both periods. Traffic accidents remained the primary cause of injuries, while assault-related injuries decreased significantly. Nasal bone fractures were the most frequent, with a significant reduction in orbital fractures caused by assault (p=0.033) during the COVID-19 period. The incidence of isolated zygomatic arch and panfacial fractures caused by assault increased during the COVID-19 period (p=0.026 and 0.041, respectively). The incidence of mandibular fractures due to other causes was significantly higher (p=0.009). Conclusion: The COVID-19 pandemic had led to significant changes in daily life in Thailand. Understanding the characteristics of patients with maxillofacial trauma provides valuable insights into prevention and management strategies, particularly during prolonged infectious disease outbreaks such as COVID-19 and potential future incidents.

Readmission Rate and Percentage of Drug used as Guideline-Directed Medical Therapy Before and After Checklist (QR Code) Implement in Heart Failure Treatment

Background: Congestive heart failure (CHF) is a common cardiac syndrome that produces high morbidity, mortality, and rehospitalization. Nowadays, heart failure reduced ejection fraction (HFrEF) treatment as guideline directed medical therapy (GDMT) following by Thai Heart Failure Guideline 2019 has proven benefits. The authors recognized that many patients were readmitted because of improper medications. Implementing checklist before discharge might improve drug adherence and decrease hospitalization rate. Objective: Compared rehospitalization rate of CHF among patients using checklist and non-using checklist, as the primary outcome. Drug use as GDMT were also evaluated among both groups, as the secondary outcome. Materials and Methods: The present study used a retrospective cohort and compared HFrEF patients who used checklist, as intervention group, with non-using checklist, as control group. Intervention group patients were admitted between December 2020 and December 2021, whereas control group patients were admitted between December 2019 and November 2020 in Vajira Hospital. The medical records of the intervention and control groups were retrospectively reviewed at the first admission. The rehospitalization rate at one and three months were compared. The prescribed medications including angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptorneprilysin inhibitor (ARNI), beta-blockers, spironolactone, and diuretics, as GDMT, before discharge were compared between groups. Results: One hundred forty-six patients were included, 56 patients in the checklist group and 90 patients in the control group. Prescription of beta-blockers was significantly higher in the checklist group compared to control group at 96.4% versus 83.3% (p=0.016). However, ACEI/ARB/ARNI prescribed was significantly lower in checklist group at 62.5% versus 84.4% (p=0.003). Spironolactone and diuretics used was not different between the groups. The 3-month readmission rate due to CHF was significantly lower in checklist group at 17.3 persons-3-months versus 37.9 persons-3-months (p=0.035). Conclusion: The checklist, or using QR code, implementation before discharge in HFrEF patients decreased the rate of rehospitalization at three months for CHF. Checklist using increased adherence to beta-blockers but decreased prescription of ACEI/ARB/ARNI drugs.

DEEP LEARNING DEVELOPMENTAL MODEL FOR EMBRYO GRADING IN THAI POPULATION

In light of the growing challenges associated with infertility, an increasing number of researchers are resorting to assisted reproductive technologies such as In Vitro Fertilization (IVF). Embryo grading is a crucial step in the IVF process that requires embryologists’ expertise. However, their limited availability has led to the exploration of technological alternatives. This study aims to use deep learning for human embryo grading, with models specifically designed for the dataset in Thailand at Vajira Hospital. The process of IVF at Vajira Hospital presents its own set of challenges since its embryo classification extends beyond the Istanbul consensus. Furthermore, classes that occur infrequently are removed and classes with similarities are merged. We apply transfer learning to pretrained deep learning models like VGG19, VGG16, ResNet152, Resnet101, Xception, InceptionV3, and EfficientNet, to create a system capable of accurately classifying embryo quality scores. Experimental results from the embryo dataset collected from Vajira Hospital in Thailand demonstrate the proposed classifier’s accuracy, precision, recall, f1-score, and AUC superiority. This research contributes to the field of IVF in Thailand by potentially reducing human errors and addressing the demand for skilled embryologists.

Correlation between Serum Vitamin D Levels and Allergic Rhinitis Severity at Vajira Hospital: A Cross-Sectional Study

OBJECTIVE: Vitamin D affects the immune system and inflammatory process, and its deficiency is significantly associated with an increased prevalence of allergic rhinitis (AR). Therefore, the correlation between the serum 25-hydroxyvitamin D levels and the severity of AR symptoms must be investigated.METHODS: This research utilized a cross-sectional approach, focusing on patients aged 18 years and above diagnosed with AR at the Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from August 15, 2023, to January 15, 2024. The relationship between AR severity and serum vitamin D levels was analyzed using Pearson correlation coefficient. AR severity on symptoms and quality of life was assessed using the Thai version of Sinonasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life questionnaire-36 (RCQ-36) questionnaires. Serum-specific immunoglobulin E (IgE) and total IgE levels were also measured to examine their relationship with the serum vitamin D level.RESULTS: Among the 58 participants, 34 (58.60%) had vitamin D deficiency. These individuals with vitamin D deficiency exhibited significantly higher AR severity compared with those without vitamin D deficiency. The mean difference between these groups was 21.90 points for SNOT-22 scores (95%CI: 17.71–26.69, p-value < 0.001) and 19.17 points for RCQ-36 scores (95%CI: 12.08–27.34, p-value < 0.001). Further analysis revealed a significant inverse correlation between serum vitamin D level and AR severity, with Pearson correlation coefficients of −0.72 for RCQ-36 (95%CI: −0.82 to −0.56, p-value < 0.001) and 0.80 for SNOT-22 (95%CI: −0.88 to −0.68, p-value < 0.001). No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.CONCLUSION: A significant inverse relationship existed between serum vitamin D levels and AR severity. No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.

The Prevalence of Postpartum Contraception Use among Teenage Mothers at Vajira Hospital, Thailand

OBJECTIVES: To determine the prevalence of postpartum contraception use among teenage mothers and to identify the factors influencing both postpartum contraception use and loss to postpartum follow-up at the Faculty of Medicine Vajira Hospital in Thailand.METHODS: Four hundred and seventy-five participants were randomly selected from 1,060 Thai teenage pregnant that gave birth at the Faculty of Medicine Vajira Hospital between 1 January 2017 and 31 December 2020 and were scheduled postpartum visits. The clinical factors associated with postpartum contraception use and loss to postpartum follow-up were studied using multiple logistic regression analysis.RESULTS: A total of 451 participants remained after excluding criteria. Of these, 212 participants did not follow-up on their postpartum visits, leaving the limitation to summarize the true prevalence of postpartum contraception use of the total population. However, of the 232 participants who visited postpartum follow-ups, the prevalence of contraceptive use was 95.8%. Married status was the only factor associated with higher postpartum contraceptive use (odds ratio (OR) 12.81 [3.38-48.64]). Age 18 years and older (ORadj1.71 [1.16-2.53]), absence of previous contraceptive use (ORadj1.91 [1.29-2.80]), and total antenatal care visits fewer than 8 (ORadj 1.61 [1.07-2.42]) were significantly related with loss to postpartum follow-ups.CONCLUSION: The prevalence of contraceptive use was high among teenage mothers who had follow-up postpartum visits. However, this population also had a high loss rate of postpartum visits. Interventions and close monitoring should be considered to evaluated further for effective adolescent reproductive services.

Prevalence and Factors Associated with Participation in Health Checkups among Thai Adults Aged 19-60 Years: Cross-Sectional Study at Vajira Hospital, Bangkok, Thailand

Prevalence and Factors Associated with Participation in Health Checkups among Thai Adults Aged 19-60 Years: Cross-Sectional Study at Vajira Hospital, Bangkok, Thailand

Thai postmenopausal woman's view in genitourinary syndrome of menopause.

To determine the prevalence of genitourinary syndrome of menopause (GSM) and their awareness, attitudes, and perception of this issue. Using a specifically designed questionnaire, interviews were performed on 500 Thai postmenopausal women who attended at Vajira Hospital, Bangkok, Thailand, from August 2021 to April 2022. The mean age of the 500 participants was 60.39 ± 8.12years. The prevalence of GSM was 47.2%. The common symptoms affected by GSM were vaginal dryness (38.5%), urinary urgency (24.6%), dyspareunia (13.6%), vaginal irritation (10.2%), vaginal burning (7.2%), and dysuria (5.9%). One-half of the women were uncomfortable talking about GSM. Three-quarters who did not reveal GSM symptoms believed that the problem was a part of aging. Only 20.3% of women who suffer from symptoms consulted a health care provider (HCP). Of the women who had been prescribed treatment, 84.6% of these women reported better quality of life. GSM is a meaningful decrement in quality of life. Most Thai postmenopausal women who had symptoms believed that the problem was the aging process. Awareness of GSM and available treatment would be a further benefit.

Diagnostic and prognostic performances of GALAD score in staging and 1-year mortality of hepatocellular carcinoma: A prospective study

BACKGROUND The GALAD score has improved early hepatocellular carcinoma (HCC) detection rate. The role of the GALAD score in staging and predicting tumor characteristics or clinical outcome of HCC remains of particular interest. AIM To determine the diagnostic/prognostic performances of the GALAD score at various phases of initial diagnosis, tumor features, and 1-year mortality of HCC and compare the performance of the GALAD score with those of other serum biomarkers. METHODS This prospective, diagnostic/prognostic study was conducted among patients with newly diagnosed HCC at the liver center of Vajira Hospital. Eligible patients had HCC staging allocation using the Barcelona Clinic Liver Cancer (BCLC) categorization. Demographics, HCC etiology, and HCC features were recorded. Biomarkers and the GALAD score were obtained at baseline. The performance of the GALAD score and biomarkers were prospectively assessed. RESULTS Exactly 115 individuals were diagnosed with HCC. The GALAD score increased with disease severity. Between BCLC-0/A and BCLC-B/C/D, the GALAD score predicted HCC staging with an area under the curve (AUC) of 0.868 (95%CI: 0.80–0.93). For identifying the curative HCC, the AUC of GALAD score was significantly higher than that of Alpha-fetoprotein (AFP) (0.753) and Lens culinaris agglutinin-reactive fraction of AFP-L3 (0.706), and as good as that of Protein induced by vitamin K absence-II (PIVKA-II) (0.897). For detecting aggressive features, the GALAD score gave an AUC of 0.839 (95%CI: 0.75–0.92) and significantly outperformed compared to that of AFP (0.761) and AFP-L3 (0.697), with a trend of superiority to that of PIVKA-II (0.772). The performance to predict 1-year mortality of GALAD score (AUC: 0.711, 95%CI: 0.60–0.82) was better than that of AFP (0.541) and as good as that of PIVKA-II (0.736). The optimal cutoff value of GALAD score was ≥ 6.83, with a specificity of 72.63% for exhibiting substantial reduction in the 1-year mortality. CONCLUSION The GALAD model can diagnose HCC at the curative stage, including the characteristic of advanced disease, more than that by AFP and AFP-L3, but not PIVKA-II. The GALAD score can be used to predict the 1-year mortality of HCC.

Accuracy of physical examination versus Doppler ultrasonography for determining maturity in postoperative arteriovenous fistula formation

Differentiating between arteriovenous fistula (AVF) maturation and failure can help determine which AVF will undergo successful canulation and which ones will require immediate rescue. A prospective observational study was conducted at Vajira Hospital in Bangkok, Thailand, between October 2020-November 2022. A single vascular surgeon performed a physical examination on patients with chronic kidney disease undergoing AVF placement, and a radiologist conducted Doppler ultrasonography during the second and sixth postoperative weeks. Dialysis nurses determined AVF maturity by performing cannulation. The study compared the accuracy of physical examination and Doppler ultrasonography. A model was developed to predict the success of AVF use. Out Of the 125 recruited patients, 81% demonstrate unassisted maturation of their AVF. The male sex and brachiocephalic type are associated with AVF maturation. The physical examination findings of palpable thrill and the absence of a strong pulse at the 6th week show an area under the receiver operating curve (AUC) value of 0.79. Similarly, arterial end-diastolic velocity on ultrasonography at the 6th week also demonstrates a comparable predictive value with an AUC of 0.82 (p=0.697). Meanwhile, the model that combined end-diastolic velocity and venous volume flow yields the best results for predicting AVF maturation, with an AUC of 0.92. These models provide more accurate predictions compared to physical examination alone (AUC: 0.92 vs. 0.79; p<0.01). Although a prudent physician predicts AVF maturation through a thorough physical examination, Doppler ultrasonography is preferred in anticipating the success of postoperative AVF placement.

Unveiling the emerging of fluconazole-resistant Candida albicans in preterm with acute kidney injury: a growing challenge at Vajira hospital

This case presents a challenging scenario in a preterm female newborn born at 25 weeks gestation,who developed respiratory distress syndrome, followed by pneumonia, sepsis, subsequent renal complications, and candida albicans infection. Despite initial susceptibility to fluconazole, the emergence of fluconazole-resistant candida albicans led to a shift in antifungal treatment to amphotericin B in an acute kidney injury neonate. This case underscores the growing concern of drug-resistant candida albicans in neonates, highlighting the importance of judicious selection of empirical antifungal therapy and comprehensive management strategies, especially in the context of acute kidney injury.

Non-neoplastic Kidney Diseases in Adult Tumor Nephrectomy and Nephroureterectomy Specimens in a Southeast Asian Tertiary Medical Center

OBJECTIVE: Non-neoplastic kidney diseases are concurrently present in up to 15% of patients with renal and ureteral tumors, which have been most studied in the United States. This study was conducted to determine the prevalence and spectrum of renal parenchymal diseases in similar patients from a Southeast Asian academic institution.METHODS: We searched the database of the Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University (2012–2022) and found 194 adult nephrectomy and nephroureterectomy specimens with renal, renal pelvis, and ureteral tumors. Additional stains included periodic acid-Schiff, methenamine silver, and Masson trichrome. Direct immunofluorescence microscopy was performed on the paraffin tissue sections for immunoglobulin (Ig) G, IgA, IgM, and kappa and lambda light chains. Clinical information, including age, gender, and co-morbidities, was obtained from the electronic medical records.RESULTS: Analysis of the 194 cases demonstrated the average age was 61 years (range: 17-89 years), with 126 males (65%) and 68 females (35%). After re-examination of the non-neoplastic renal parenchyma, 14 cases (7%) had diffused and/or nodular mesangial sclerosis. Diabetic nephropathy (12 cases) and idiopathic nodular glomerulosclerosis (2 cases) were diagnosed and associated with either stage 1 or 2 genitourinary cancers. Another case was diagnosed with atheroembolic renal disease. In all cases, the concurrent renal diseases were not identified during the initial evaluation.CONCLUSION: Examination of the non-neoplastic renal parenchyma is important to identify non-neoplastic kidney diseases, such as diabetic nephropathy, so early treatment may result in improved clinical outcomes for kidney and urothelial cancer patients.

Association between alteration of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, cancer antigen-125 and surgical outcomes in advanced stage ovarian cancer patient who received neoadjuvant chemotherapy

IntroductionOptimal resection significantly influences the prognosis of advanced-stage epithelial ovarian cancer (EOC) patients undergoing debulking surgery. In patients who received neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), the determination of the ideal timing for surgery remains a challenge. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and CA-125 levels, have been recognized as potential predictive markers. ObjectiveThis study aims to evaluate the predictive value of changes in NLR, PLR, and CA-125 levels following NACT, specifically assessing their impact on surgical outcomes during IDS for advanced-stage EOC. MethodsA retrospective cohort study enrolled advanced-stage EOC patients who underwent NACT followed by IDS at Vajira Hospital in Thailand from January 2009 to June 2023. Data on clinical, surgical, and inflammatory markers were collected, and the predictive value of these markers for suboptimal resection outcomes was assessed. ResultsAmong the 65 patients, 98.5 % exhibited radiologic responses post-NACT, while 29.2 % experienced suboptimal resections. Univariate analysis did not reveal significant associations between suboptimal resection and NLR changes after the first NACT cycle or alterations in NLR, PLR, and CA-125 levels at the end of NACT. Subsequent analysis suggested that an NLR decrease exceeding 70 % after the first cycle and NACT completion might predict suboptimal resection, yet statistical analyses showed limited prognostic efficacy (AuROC = 0.608 and 0.597). ConclusionOur study does not support that changes in NLR, PLR, platelet count, and CA-125 levels after NACT reliably predict IDS outcomes. Additional prospective investigations using larger cohorts or a combination of evaluation methods, rather than relying solely on NLR, are recommended.

Appropriate Use of Anticoagulants among Nonvalvular Atrial Fibrillation Patients at a University Hospital in Thailand

OBJECTIVE: Warfarin is primarily used for stroke prevention in atrial fibrillation (AF) patients in Thailand. Novel oral anticoagulants (NOACs) are used less commonly due to their high cost. This study aimed to evaluate the appropriate use of anticoagulants and clinical outcomes among nonvalvular AF (NVAF) patients. METHODS: This retrospective study collected data from the electronic medical records of patients who were diagnosed with NVAF between January 2014 and December 2019 at the Faculty of Medicine, Vajira Hospital. Baseline characteristics, prescribed indication, types and doses of anticoagulant, and ischemic and hemorrhagic outcomes were recorded and analyzed. RESULTS: We analyzed 783 patients with NVAF in this study. Of these, 539 (68.90%) were treated with oral anticoagulants (OAC), including 344 patients (43.90%) with warfarin therapy and 195 (24.90%) with NOACs. Meanwhile, 492 (73.10%) patients with CHA2DS2VASC score ≥ 2 received OAC therapy that was suitable for their indication. Of the 344 patients who received warfarin, 112 patients (32.60%) had an optimal time in therapeutic range (TTR) level of ≥ 65%. Of the 195 NOAC patients, only 98 (50.30%) received appropriate doses of NOACs. There was no statistically significant difference in the overall incidence rates of ischemic stroke/systemic embolism, bleeding, cardiovascular death, and all-cause death between the warfarin and NOACS groups. Appropriate TTR levels in the warfarin group was associated with significantly lower incidence rates of cardiovascular death (hazard ratio: 0.14; 95% CI: 0.02–0.79; p = 0.02) and all-cause death (hazard ratio: 0.36; 95% CI: 0.12–0.87; p = 0.01), than inappropriate TTR levels. CONCLUSION: Most NVAF patients received oral anticoagulants with the appropriate indication. Warfarin is the most prescribed oral anticoagulant for patients with NVAF. About half of the patients received inappropriate doses of oral anticoagulants that potentially adversely affected the study outcomes of cardiovascular and all-cause deaths.

Non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer patients

IntroductionVideo-assisted thoracoscopic surgery (VATS) lobectomy has been shown to be a standard treatment for lung cancer patient due to less pain, post-operative complication and faster recovery. In recent years, Non-intubated video-assisted thoracoscopic surgery (NIVATS) is become an alternative approach for various types of thoracic surgery with a benefit on fewer complication from mechanical ventilation. Out study is aimed to study outcome compare between NIVATS lobectomy and to general anesthetic video assisted thoracoscopic surgery (GAVATS) lobectomy. MethodsThis is a retrospective cohort study conduct in Vajira hospital, Navamindradhiraj University, Bangkok, Thailand between January 2019 to September 2022.152 lung cancer patients underwent lobectomy. However, lung cancer patients whom needed to convert to GAVATS, open thoracotomy or emergency surgery were excluded from this study. In this study, we compare lung patients whom underwent NIVATS lobectomy and those whom underwent GAVATS lobectomy. These two groups are compared in term of pre-, intra- and post-operative outcomes. The inverse-probability weighting propensity score is used to identify the treatment effects of NIVATS. ResultsIn total, there are 132 cases patients including in this analysis. There are 54 and 78 patients in the NIVATS and GAVATS respectively. Intra-operative outcome, induction and operative time are lower in the NIVATS lobectomy group (25 vs 30 min, p < 0.001 and 90 vs 120 min, p = 0.003). There is no difference regarding number of node resection, station of lymph node dissection, arrhythmia, postoperative complications, and pain visual analogue score (VAS) in both groups. Postoperative outcome, length of hospital stay is shorter in NIVATS lobectomy group (4 vs 5 days, p < 0.001). There is no patient which needed to convert from NIVATS to GAVATS. The treatment-effect analyzed by using inverse-probability weighting propensity score has shown benefits of NIVATS in terms of shorter hospital stays (coefficient −2.31, 95%CI -3.65 to −0.97, p = 0.001), and shorter chest tube duration (coefficient −1.59, 95%CI -2.93 to −0.26, p = 0.019). ConclusionNIVATS lobectomy could be an alternative approach for lung cancer patients with benefits of lesser in hospital stays and duration of chest tube.

Early detection of diabetic peripheral neuropathy using EMLA-induced skin wrinkling

Background &amp; Objective: Screening for early diabetic peripheral neuropathy (DN) is essential for foot ulcer prevention. The Semmes–Weinstein monofilament (SWMF) is commonly used to detect DN in Thailand. However, SWMF interpretation requires patient participation, which is susceptible to risk of error in patients with impaired cognitive function or uncooperative patients. In contrast, stimulated skin wrinkling (SSW) can be interpreted by trained investigators, which is more appropriate. This study aimed to investigate the utility of SSW using a eutectic mixture of local anesthetic (SSW-EMLA) for early DN diagnosis. Methods: This cross-sectional study, recruited 102 patients with diabetes (DM group), 33 with diabetes with foot ulcer (DN control group), and 30 without diabetes (non-DN control group) from the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Thailand, from February 3, 2021 to November 30, 2021. SSW was conducted by applying EMLA on the tips of the 2nd, 3rd, and 4th fingers of both hands. SWMF, sensory perception of pain (SPP), vibration perception threshold (VPT), joint position sense (JPS), and deep tendon reflexes (DTR) were also evaluated on the same day. Results: The Interrater agreement of two investigators for SSW-EMLA was high with intraclass correlation coefficients of 0.87 (0.824–0.904) for the right hand and 0.874 (0.830–0.907) for the left hand. The kappa coefficients of agreement of SSW-EMLA for SPP, SWMF, VPT, JPS, and DTR testing were 0.411, 0.478, 0.714, 0.444, and 0.681, respectively. The sensitivity and specificity of SSW-EMLA testing for DN detection were 83.3%, was 85.7%, respectively. Conclusion: The SSW-EMLA test can be considered as an alternative method for DN detection, due to its noninvasiveness, inexpensiveness (50THB), being a simple procedure, high sensitivity and specificity, and acceptable rater variation.

Stigma Experienced by Patients Who Recovered from COVID-19 in Post-Vaccination Period in Thailand; Prevalence and Associated Factors.

Social stigma related to coronavirus disease-2019 (COVID-19) has been a public concern since its emergence, especially in the patients who are reintegrating into their society. However, the insights into COVID-19 stigmatization after vaccine availability are limited. This study aimed to estimate the prevalence, severity and associated factors of stigma experienced by patients who recovered from COVID-19 and reintegrated into their communities. The insights gained from this study are not only beneficial to COVID-19 but can also be used as a background information in future epidemics. This study consisted of two phases. The first phase involved the translation and validation of the COVID-19-related stigma questionnaire. The second phase was a questionnaire-based cross-sectional survey conducted between January and February 2022, at the Vajira Hospital, Bangkok, Thailand. A series of questionnaires regarding stigma, negative emotions (Depression Anxiety Stress Scale-21), and personal information were administered to COVID-19 patients who were already discharged and returned to their communities from June 2021 to February 28, 2022 (N = 354). The prevalence of stigma among the patients who recovered from COVID-19 was 57.9%. These were classified as mild (28.2%), moderate (21.5%), and severe (8.2%). Pearson's correlation analysis revealed that longer admissions (r = - 0.151, p = 0.001) and longer duration from discharge (r = - 0.222, p = 0.001) were related to lower stigma. Higher stigma was associated with higher levels of depression (r = 0.528, p <0.001), anxiety (r = 0.506, p <0.001) and stress (r = 0.583, p <0.001). Social stigma related to COVID-19 in Thailand declined during the post-vaccination period. However, this issue did not disappear, and still took a toll on mental health. Our findings suggested that providing appropriate assessment and help to the patients who recovered from COVID-19 is essential, even in the post-vaccination period.

Prevalence of Snoring in Pregnancy and Its Maternal-Fetal Outcomes at Vajira Hospital

Background: Snoring is an important symptom that is associated with obstructive sleep apnea and increases the risk of adverse pregnancy outcomes. In Thailand, the prevalence of snoring during pregnancy is uncertain. Determining the prevalence and characteristics may reduce the prevalence of snoring and improve pregnancy outcomes. Objective: The primary outcome was to determine the prevalence of snoring in Thai pregnant women in the third trimester, including pregnancy and chronic onset. The secondary outcome was to investigate the associations between pregnancy outcome and habitual snorer or those identified as high risk by the Thai Berlin Questionnaire. Materials and Methods: Three hundred eighty-two singleton pregnant women aged at least 18 years and at least 33 weeks of gestational age were recruited from the antenatal care clinic at Vajira Hospital, Navamindradhiraj University, between November 2021 and September 2022 and filled out the Thai Berlin Questionnaire. The 382 pregnant women were identified the presence of snoring or high risk of OSA in the previous month. Medical records, including demographic information and pregnancy outcomes, were collected, and analyzed. Results: The prevalence of snoring was 31.4% in the third trimester of pregnancy of which 27% were pregnancy onset snoring and 4.4% were chronic onset snoring. Habitual snoring was significantly different from non-snoring in regard to the requirement for positive-pressure ventilation in newborns (aOR 6.67, 95% CI 1.2 to 35.54). The high risk group had significantly more pregnancy induced hypertension than the low risk group (aOR 5.96, 95% CI 2.15 to 16.5), gestational hypertension (aOR 13.6, 95% CI 2.1 to 86.8), preeclampsia (aOR 4.07, 95% CI 1.09 to 15.2), severe preeclampsia (aOR 4.9, 95% CI 1.15 to 20.93), preterm birth (aOR 6.21, 95% CI 1.58 to 24.42), and low birth weight of newborn (aOR 6.09, 95% CI 2.5 to 14.87). Conclusion: The prevalence of snoring among Thai pregnant women was comparable to previous Western studies. Screening pregnant women at risk of the symptom may provide an early chance to lower the prevalence of snoring and adverse pregnancy outcomes. Keywords: Snoring; Snoring in pregnancy; Pregnancy outcomes

Comparison of outcomes of the Epley and self-Epley maneuvers in PC-BPPV: A randomized controlled trial

ObjectivesThis study aimed to compare the efficacy of the self-Epley and Epley maneuvers in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) in patients at the outpatient clinic at the Department of Otolaryngology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. MethodsIn this prospective, randomized, comparative study, patients with PC-BPPV were randomized to receive the self-Epley or Epley maneuver. The self-Epley maneuver group received illustrated instructions and a video of how to perform the self-Epley maneuver. They then performed the first self-Epley maneuver under supervision in the clinic. The efficacy of the treatment was evaluated with the Dix–Hallpike test at the 1-week follow-up visit. ResultsSixty-four patients with PC-BPPV were enrolled, 32 patients were the self-Epley maneuver group and the other 32 patients were the Epley maneuver group. After 1 week, 29 of the 32 patients (90.62 %) in the self-Epley maneuver group were cured, while 28 of the 32 patients (87.5 %) in the Epley maneuver group were cured. The Kaplan–Meier survival estimates with a log-rank test for cumulative therapeutic effects at 1 week showed no statistically significant difference between the groups (P = 0.755). ConclusionsThe twice-a-day self-Epley maneuver had a high success rate and could be used for patients who cannot reach a hospital or needs quarantine due to covid-19. For the self-Epley maneuver, adequate instruction is important to obtain a good result. Level of evidenceII

The use of respiratory rate-oxygenation index to predict failure of high-flow nasal cannula in patients with coronavirus disease 2019-associated acute respiratory distress syndrome: A retrospective study.

Patients with mild-to-moderate coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) can be treated with a high-flow nasal cannula (HFNC). The use of the respiratory rate-oxygenation (ROX) index, calculated as the ratio of oxygen saturation (SpO2)/fractional oxygen (FiO2) to respiratory rate, in the first few hours after HFNC initiation can help identify patients who fail HFNC therapy later. However, few studies have documented the use of the ROX index during the period of HFNC therapy. Therefore, we aimed to demonstrate the diagnostic performance of the ROX index when calculated throughout the HFNC therapy period and to determine the best cut-off point for predicting HFNC failure. We conducted a retrospective study of patients with COVID-19-associated ARDS who commenced HFNC at the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand, between April 1 and August 30, 2021. We calculated the ROX index every 4 h throughout the HFNC therapy period and defined HFNC failure as a subsequent endotracheal tube intubation. The performance of the ROX index was analyzed using the area under the receiver operating characteristic curve (AUC). We applied the ROX index ≤ 4.88 to predict HFNC failure and obtained a new ROX cut-off point using Youden's method. In total, 212 patients with COVID-19 treated with HFNC were included in the study. Of these, 81 patients (38.2%) experienced HFNC failure. The ROX index ≤ 4.88 demonstrated a reasonable performance in predicting HFNC failure (AUC, 0.77; 95% confidence interval [CI], 0.72-0.83; p<0.001). However, compared with the original cut-off point of ≤ 4.88, the new ROX index cut-off point of ≤ 5.84 delivered optimal performance (AUC, 0.84; 95% CI, 0.79-0.88; p<0.001), with a significantly better discriminative ability (p = 0.007). In conclusion, a ROX index ≤ 5.84 was found to be optimal for predicting HFNC failure in patients with COVID-19-associated ARDS.

Efficacy of the Enhanced Recovery After Surgery program for thoracic surgery in a developing country

PurposeEnhanced Recovery After Surgery (ERAS) is a strategy used to improve perioperative outcomes and reduce complications. However, data on the efficacy of ERAS in thoracic surgery in developing countries are limited. The current study aimed to validate the benefits of ERAS among patients at a single institution.MethodsThis was a retrospective study of patients who underwent pulmonary resection at Vajira Hospital, Bangkok, Thailand, between 2016 and 2020. To compare outcomes, patients were divided into the pre-ERAS group (2016–2018) and the post-ERAS group (2019–2020) using propensity score matching (1:2) with the year 2019 as the cutoff for introducing ERAS protocols at our institution.ResultsIn total, 321 patients were included in the analysis (pre-ERAS group, n = 74; post-ERAS group, n = 247). After propensity score matching, 56 and 112 patients were classified under the pre- and post-ERAS groups, respectively. The post-ERAS group had significantly lower pain scores than the pre-ERAS group on postoperative days 1, 2, and 3, and a lower volume of intraoperative blood loss. In the multivariable analysis, the post-ERAS group had a shorter chest tube duration (mean difference = −1.62 days, 95% confidence interval = −2.65 to −0.31) and length of hospital stay (mean difference = −2.40 days, 95% confidence interval = −4.45 to −0.65) than the pre-ERAS group.ConclusionThe use of ERAS guidelines in pulmonary resection is beneficial. Although no significant differences were observed in postoperative complication rate, intensive care unit stay, and additional cost burden between the two groups, patients in the post-ERAS group had a shorter postoperative chest tube duration, shorter hospital stays, shorter operative time, lower postoperative pain score, and lower volume of intraoperative blood loss.