Publications by authors named "Kittisak Sawanyawisuth"

235 Publications

What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

Trauma Surg Acute Care Open 2021 4;6(1):e000717. Epub 2021 Aug 4.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Background: Although there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.

Methods: This was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.

Results: There were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.

Discussion: Open skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.

Level Of Evidence: III.
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http://dx.doi.org/10.1136/tsaco-2021-000717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340271PMC
August 2021

Prevalence and Risk Factors of Obstructive Sleep Apnea in Hypertensive Emergency.

J Emerg Trauma Shock 2021 Apr-Jun;14(2):104-107. Epub 2021 Apr 27.

Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand.

Introduction: Obstructive sleep apnea (OSA) is a common factor associated with hypertensive crises. There is limited evidence of prevalence and risk factors of OSA in hypertensive emergency.

Methods: This study recruited adult patients who diagnosed as hypertensive emergency and tested for OSA. The study period was between July 2019 and January 2020. The patients were categorized as OSA and non-OSA groups by the evidence from polysomnography. Prevalence and risk factors for OSA were executed.

Results: During the study, there were 52 eligible patients. Of those, 30 patients (57.69%) were diagnosed with OSA. The stepwise logistic regression analysis for predicting OSA had two remaining factors: body mass index and diastolic blood pressure. Only body mass index was independently associated with OSA with an adjusted odds ratio of 1.166 (95% confidence interval of 1.033, 1.316). The body mass index of 25.02 kg/m gave sensitivity and specificity of 80.00% and 59.09%, respectively. The area under the receiver operating characteristic curve was 70.98%.

Conclusion: OSA had high incidence rate in patients with hypertensive emergency. High body mass index was a predictor for OSA associated with hypertensive emergency.
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http://dx.doi.org/10.4103/JETS.JETS_47_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312912PMC
April 2021

Oxygen saturation associated with recurrent primary spontaneous pneumothorax treated with an intercostal chest drainage.

Asian J Surg 2021 Jul 23. Epub 2021 Jul 23.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address:

Background: Primary spontaneous pneumothorax (PSP) is a condition that may lead to acute chest pain or dyspnea on exertion. Treatment with an intercostal chest drainage (ICD) is warranted. There is limited data on risk factors of recurrent PSP in patients treated with the ICD alone. This study aimed to evaluate risk factors of recurrent PSP in patients with PSP and treated with the ICD.

Methods: This was a retrospective study and enrolled patients diagnosed as PSP and treated with an ICD. Eligible patients were divided into two groups by evidence of recurrent PSP. Baseline characteristics, physical signs, laboratory results, and duration of ICD treatment were studied and recorded from medical charts. Factors associated with recurrent PSP were computed by using multivariate logistic regression analysis.

Results: There were 80 patients met the study criteria. Of those, 21 patients (26.3%) had recurrent PSP. Of those, 21 patients (26.3%) had recurrent PSP. There were eight factors in the final model for recurrent PSP. Only oxygen saturation at the time of diagnosis was independently associated with recurrent PSP. The adjusted odds ratio (95% confident interval) was 0.57 (0.34, 0.96). A cut point of 96% of oxygen saturation gave sensitivity of recurrent PSP of 80.95%.

Conclusion: The prevalence of recurrent PSP was 26.3% in patients with PSP and treated with the ICD. Initial oxygen saturation may be an indicator for recurrent PSP.
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http://dx.doi.org/10.1016/j.asjsur.2021.07.021DOI Listing
July 2021

Hypertensive crisis in patients with obstructive sleep apnea-induced hypertension.

BMC Cardiovasc Disord 2021 06 23;21(1):310. Epub 2021 Jun 23.

Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, 40002, Thailand.

Background: Hypertensive crisis is an urgent/emergency condition. Although obstructive sleep apnea (OSA) in resistant hypertension has been thoroughly examined, information regarding the risk factors and prevalence of hypertensive crisis in co-existing OSA and hypertension is limited. This study thus aimed to determine prevalence of and risk factors for hypertensive crisis in patients with hypertension caused by OSA.

Methods: The inclusion criteria were age of 18 years or over and diagnosis of co-existing OSA and hypertension. Those patients with other causes of secondary hypertension were excluded. Patients were categorized by occurrence of hypertensive crisis. Factors associated with hypertensive crisis were calculated using multivariate logistic regression analysis.

Results: There were 121 patients met the study criteria. Of those, 19 patients (15.70%) had history of hypertensive crisis. Those patients in hypertensive crisis group had significant higher systolic and diastolic blood pressure at regular follow-ups than those without hypertensive crisis patients (177 vs. 141 mmHg and 108 vs. 85 mmHg; p value < 0.001 for both factors). After adjusted for age, sex, and Mallampati classification, only systolic blood pressure was independently associated with hypertensive crisis with adjusted odds ratio (95% CI) of 1.046 (1.012, 1.080).

Conclusions: The prevalence of hypertensive crisis in co-existing OSA and hypertension was 15.70% and high systolic blood pressure or uncontrolled blood pressure associated with hypertensive crisis in patients with OSA-associated hypertension.
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http://dx.doi.org/10.1186/s12872-021-02119-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220687PMC
June 2021

Any Effective Intervention to Improve CPAP Adherence in Children with Obstructive Sleep Apnea: A Systematic Review.

Glob Pediatr Health 2021 28;8:2333794X211019884. Epub 2021 May 28.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Obstructive sleep apnea (OSA) in children is leading to several consequences as reported in adults. A continuous positive airway pressure (CPAP) machine is one of the effective treatments in pediatric OSA. However, the CPAP adherence rate is approximately 50%. This study aimed to evaluate if any interventions that improve CPAP adherence in pediatric patients with OSA using a systematic review. We included intervention studies on CPAP adherence in pediatric patients with OSA regardless of machine types. Five databases were used for article searching. Search terms included OSA, adherence, compliance, and CPAP. The outcomes of this study were adherence rate and usage hours/minutes. The outcomes were compared between the intervention and comparator groups with descriptive statistics. There were 2931 articles from 5-database searching. There were 41 articles related with children. There were 7 articles conducted with any intervention on CPAP compliance. Of those, 4 studies included in the analysis. There were 3 significant differences between both groups in 2 studies. Those with caregiver support had significantly longer CPAP use/night by 86.60 minutes (95% CI 10.90, 162.30) and percentage of CPAP usage more than 4 hours/night by 18.10% (95% CI 3.87, 32.33) than those without caregiver support. Those who received BPAP therapy had higher chance of good PAP adherence than those who received CPAP by 18.17 times (95% CI 5.19, 63.70). Caregiver support and BPAP therapy significantly improved CPAP adherence in children with OSA. Further studies are required to add additional comparisons and also other interventions.
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http://dx.doi.org/10.1177/2333794X211019884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165832PMC
May 2021

Impact of Hospital Level on Stroke Outcomes in the Thrombolytic Therapy Era in Northeast Thailand: A Retrospective Study.

Neurol Ther 2021 May 18. Epub 2021 May 18.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.

Introduction: Stroke is a common neurological disease. Thrombolytic therapy has been shown to be beneficial in acute ischemic stroke. This treatment can be given in various hospital levels. This study aimed to evaluate the quality of acute ischemic stroke care among various hospital levels.

Methods: Data were randomly selected from the medical records that were sent to the National Health Security Office (NHSO) for reimbursement purposes between October 2015 and August 2016. Patient demographics, risk factors, stroke subtypes, stroke severity, quality of care indicators, and complications were recorded. Paired comparisons between two groups were carried out using the Bonferroni correction.

Results: A total of 947 patients, including 169 patients from community hospitals (CHs), 629 from regional hospitals (RHs), and 149 from tertiary hospitals (THs), were included in the final analysis. The CH group had a higher median age but lower median initial National Institutes of Health Stroke Scale (NIHSS) score than the RH and TH groups (median age = 70, 66, and 67 years, respectively, and initial NIHSS = 6, 8, and 9, respectively). The CH group had shorter onset-to-needle times for intravenous recombinant tissue plasminogen activator (rt-PA) treatment than the other two groups (147 vs. 178.5 and 180 min). After adjustment for baseline characteristics, stroke type, and stroke severity, the CH group was significantly associated with lower mortality and presence of complications. The adjusted odds ratios (95% confidence intervals) for the two factors were 0.13 (0.03, 0.67) and 0.59 (0.35, 0.99). None of the patients received endovascular therapy or non-thrombolytic interventional therapy.

Conclusion: CHs may have the potential for acute ischemic stroke care in the same way as RHs or THs, with faster rt-PA treatment, in northeast Thailand. However, further studies should be performed to evaluate appropriate patient characteristics for CHs.
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http://dx.doi.org/10.1007/s40120-021-00254-3DOI Listing
May 2021

The epidemiology of Guillain-Barré syndrome in Thailand over 13 years (2005-2017): A nationwide population-based retrospective cohort study.

J Peripher Nerv Syst 2021 Jun 27;26(2):202-208. Epub 2021 May 27.

Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

There have been no published studies examining the epidemiology of Guillain-Barré syndrome (GBS) in large populations in Thailand. This study aimed to explore the incidence, patient characteristics, seasonality, treatments, and outcomes of GBS in Thailand. The National Health Security Office (NHSO) provided data on in-patient admission between fiscal year 2005 and 2017. We selected all patients with a primary diagnosis of GBS. We retrieved data regarding the total population from the Department of Provincial Administration. A total of 4521 patients with GBS were included. The median age was 42 years (IQR 22-56), and 61.5% were male. The incidence rate increased from 0.48 to 0.93 per 100 000 population over the 13 years. The incidence was increased with age and a male-to-female ratio of 1.6:1. There was seasonal variation in the rate of admission for GBS, with significantly more patients admitted in rainy vs summer (IRR 1.94, 95%CI 1.80-2.10, P < .001) and winter vs summer (IRR 1.48, 95%CI 1.36-1.60, P < .001). Treatment with IVIg increased from 4.4% to 29.6% (P < .001), whereas plasmapheresis decreased significantly from 4% to 1.32% (P = .017). The mortality rate was 3.5%. Elderly and young adults had a significantly higher mortality rate when compared to children and teenagers (P < .001 and P = .003). The incidence of GBS in Thailand was steady over 13 years and was greater in rainy and winter season. Treatment with IVIg increased while plasmapheresis decreased. Mortality was higher in elderly patients.
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http://dx.doi.org/10.1111/jns.12453DOI Listing
June 2021

Importance of computed tomography pulmonary angiography for predict 30-day mortality in acute pulmonary embolism patients.

Eur J Radiol Open 2021 25;8:100340. Epub 2021 Mar 25.

Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Objective: The purpose of the present study was to assess the implications of different parameters of computed tomography pulmonary angiography (CTPA) to predict 30-day mortality in acute pulmonary embolism (APE) patients.

Material And Method: Patients who had clinical suspicion of APE and underwent CTPA were recruited in a retrospective cohort study. The findings of the CTPA included the parameters of right ventricular dysfunction (RVD), the severity of obstruction to the pulmonary artery by CT obstruction index, and the ratio of pulmonary trunk diameter and aorta. The endpoint of the study was established as the 30-day mortality associated with APE.

Results: A total of 238 patients with a confirmed APE diagnosis with CTPA were included in the study; 26 (10.9 %) of those patients died within 30 days. In patients with cancer and the Pulmonary Embolism Severity Index (PESI) class 5, the mortality rate was significantly higher. Compared with survivors, the mean CT obstruction index in the non-survivor group was significantly higher ( < 0.001). Higher mortality was associated with all RVD parameters identified by CTPA, such as the RV/LV ratio ( < 0.001), interventricular septum deviation grade 3 ( < 0.001), increased RV diameter ( < 0.001), and IVC contrast reflux ( < 0.001). The highest adjusted odds ratio was RV diameter at 1.094, followed by PESI and the CT obstruction index at 1.040.

Conclusion: CTPA-detected RVD parameters and CT obstruction index can predict a 30-day mortality rate in APE patients and be used for risk stratification. In APE patients, the RV diameter of 53 mm or greater and the CT obstruction index >70% is associated with increased 30-day mortality.
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http://dx.doi.org/10.1016/j.ejro.2021.100340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027691PMC
March 2021

Can a multidisciplinary approach slow renal progression in CKD patients?

Int J Med Sci 2021 3;18(9):1975-1979. Epub 2021 Mar 3.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 Thailand.

: Several randomized controlled trials have examined the benefits of multidisciplinary CKD care on estimated glomerular filtration rate (eGFR). But, the results are inconclusive. This study aimed to evaluate whether or not multidisciplinary CKD care was beneficial in terms of CKD progression. : This is a randomized controlled trial and conducted at community hospital, Thailand. The inclusion criteria were patients with age of 18 years or older and diagnosed with up to stage 3b CKD based on the KDIGO guidelines. Eligible patients divided into two groups: intervention and control group. The intervention group received a type of multidisciplinary treatment, while patients in the control group received the standard treatment administered at the outpatient clinic. The primary outcome was eGFR outcomes at three months after enrollment. : During the study period, there were 334 patients who met the study criteria. Eligible patients were divided into two groups: intervention (166 patients; 49.70%) and control (168 patients; 50.30%). There were three outcomes that differed significantly between the two groups at 3 months: mean difference of eGFR from baseline, proportion of patients with eGFR decline greater than 4 mL/min/1.73 m, and difference in CKD stage from baseline. A significantly higher percentage of patients in the intervention group experienced CKD improvement by one stage (24.10% vs 5.95%), and a significantly lower percentage experienced decline by one stage (8.43% vs 35.12%) than in the control group. : Slower renal progression in patients with up to stage 3b CKD was shown in patients who were treated by a multidisciplinary approach.
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http://dx.doi.org/10.7150/ijms.53189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040396PMC
March 2021

Clinical factors predictive of mortality in acute leukemia patients with febrile neutropenia.

Am J Blood Res 2021 15;11(1):59-65. Epub 2021 Feb 15.

Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand.

Background: Acute leukemia is mainly treated with chemotherapy leading to febrile neutropenia (FN). There is limited data on clinical factors predictive of mortality in adults with acute leukemia and FN.

Methods: This was a retrospective cohort study and enrolled adult patients, diagnosed as acute leukemia, and developed FN. The eligible patients were admitted and followed up with mortality as the primary outcome. A stepwise, multivariate logistic regression analysis was used to find predictors for mortality.

Results: There were 203 patients met the study criteria. Of those, 14 patients died (6.89%). AML was the most common type of acute leukemia with FN (64.04%). There were five remaining factors in the final model: AML, FN at admission, prolong broad spectrum antibiotics, lower respiratory tract infection, and Aspergillosis. Only lower respiratory tract infection was significant with adjusted odds ratio of 7.794 (95% CI of 1.549, 39.212). The Hosmer-Lemeshow Chi square was 2.74 ( value 0.907). The lower respiratory tract infection group had higher proportions of Gram negative and fungus than the non-lower respiratory tract infection group; specifically (p 0.003), and (P < 0.001).

Conclusions: There were two independent predictors of mortality in acute leukemia patients with FN: septic shock and lower respiratory tract infection regardless of leukemia type or pathogen. and were more common in those with lower respiratory tract infection than those without. No specific pathogens were found in cases of septic shock.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010598PMC
February 2021

Association of Combined TCF7L2 and KCNQ1 Gene Polymorphisms with Diabetic Micro- and Macrovascular Complications in Type 2 Diabetes Mellitus.

Diabetes Metab J 2021 Jul 22;45(4):578-593. Epub 2021 Mar 22.

Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand.

Background: Vascular complications are the major morbid consequences of type 2 diabetes mellitus (T2DM). The transcription factor 7-like 2 (TCF7L2), potassium voltage-gated channel subfamily Q member 1 (KCNQ1), and inwardly-rectifying potassium channel, subfamily J, member 11 gene (KCNJ11) are common T2DM susceptibility genes in various populations. However, the associations between polymorphisms in these genes and diabetic complications are controversial. This study aimed to investigate the effects of combined gene-polymorphisms within TCF7L2, KCNQ1, and KCNJ11 on vascular complications in Thai subjects with T2DM.

Methods: We conducted a case-control study comprising 960 T2DM patients and 740 non-diabetes controls. Single nucleotide polymorphisms in TCF7L2, KCNQ1, and KCNJ11 were genotyped and evaluated for their association with diabetic vascular complications.

Results: The gene variants TCF7L2 rs290487-T, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-C were associated with increased risk of T2DM. TCF7L2 rs7903146-C, TCF7L2 rs290487-C, KCNQ1 rs2237892-T, and KCNQ1 rs2237897-T revealed an association with hypertension. The specific combination of risk-alleles that have effects on T2DM and hypertension, TCF7L2 rs7903146-C, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-T, as genetic risk score (GRS), pronounced significant association with coronary artery disease (CAD), cumulative nephropathy and CAD, and cumulative microvascular and macrovascular complications (respective odds ratios [ORs] with 95% confidence interval [95% CI], comparing between GRS 2-3 and GRS 5-6, were 7.31 [2.03 to 26.35], 3.92 [1.75 to 8.76], and 2.33 [1.13 to 4.79]).

Conclusion: This study demonstrated, for the first time, the effect conferred by specific combined genetic variants in TCF7L2 and KCNQ1 on diabetic vascular complications, predominantly with nephropathy and CAD. Such a specific pattern of gene variant combination may implicate in the progression of T2DM and life-threatening vascular complications.
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http://dx.doi.org/10.4093/dmj.2020.0101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369220PMC
July 2021

A Point-of-Care Serum Lactate Level and Mortality in Adult Sepsis Patients: A Community Hospital Setting.

J Prim Care Community Health 2021 Jan-Dec;12:21501327211000233

Khon Kaen University, Khon Kaen, Thailand.

Introduction: Sepsis is a serious and emergency condition that may lead to acute circulatory failure associated with infection. Serum lactate level of over 4 mmol/L is associated with sepsis mortality. However, there is limited data on using a point of care (POC) for fingertip lactate level on sepsis mortality in community hospital setting. This study aimed to evaluate roles of POC for serum lactate with combination of clinical factors on mortality prediction in sepsis patients.

Methods: This was a retrospective cohort study conducted at 7 community hospitals. The inclusion criteria were adult patients with diagnosis of sepsis who were tested for POC lactate level. Electronic chart reviews of eligible patients were performed. Predictors for mortality were computed using clinical factors and POC lactate level.

Results: There were 1641 patients met the study criteria. The mortality rate was 8.96% (147 patients). There were 3 independent factors associated with mortality: age, co-morbid diseases, and POC lactate level. The adjusted odds ratio (95% CI) of POC lactate level was 1.025 (1.002, 1.048). The cut point of serum lactate was 1.6 mmol/L gave sensitivity of 79.59% and specificity of 32.10%.

Conclusion: POC serum lactate level may be associated with mortality in sepsis patients at community hospitals. Lactate level of 1.6 mmol/L may be an indicator for mortality with good sensitivity. Physicians may consider more aggressive and prompt management in individuals with sepsis and POC serum lactate of 1.6 mmol/L or over.
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http://dx.doi.org/10.1177/21501327211000233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983462PMC
June 2021

Clinical factors associated with bloodstream infection at the emergency department.

BMC Emerg Med 2021 03 12;21(1):30. Epub 2021 Mar 12.

Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123/2000 Mitraparp Rd, Muang, Khon Kaen, 40002, Thailand.

Background: Bloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection.

Methods: This study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis.

Results: A total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture.

Conclusions: Clinical factors at ED arrival can be used as predictors of bloodstream infection.
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http://dx.doi.org/10.1186/s12873-021-00426-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953601PMC
March 2021

Efficacy of Generic Atorvastatin in a Real-World Setting.

Clin Pharmacol 2021 5;13:45-51. Epub 2021 Mar 5.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Background: The ability of statins to reduce LDL-c plays an important role in both primary and secondary prevention of atherosclerotic cardiovascular diseases. Such treatment can often be costly, but using generic atorvastatin may reduce cost by up to US$2635. In addition, a previous 8-week study found that it exhibited comparable efficacy to the brand-name medication. This study aimed to evaluate the efficacy of generic atorvastatin over a longer period of six months in a real-world setting.

Methods: This was a retrospective cohort study in adult patients who had received brand-name atorvastatin for at least three months and then had switched to generic atorvastatin for at least six months. Lipid and safety profiles were evaluated at six months after switching. Adjusted analyses for age, sex, co-morbid disease, dosage, and indications for statin therapy were also performed.

Results: During the study period, there were 488 patients who met the study criteria. The mean (SD) age of the patients was 60.97 (12.26) years, and 48.36% were male (236 patients). At six months, average total cholesterol, HDL-c, and LDL-c were all lower, from 174.43 to 166.15 mg/dL, from 51.64 to 49.51 mg/dL, and from 110.08 to 100.78 mg/dL (p < 0.001), respectively. There were no significant differences in terms of any other laboratory test results. LDL-c exhibited the highest significant reduction at 9.30 mg/dL. Stratified analyses by age, sex, co-morbid disease, dose, and indications for statin therapy revealed similar decreases in HDL-c and LDL-c as in the study population as a whole.

Conclusion: Generic atorvastatin resulted in significantly lower LDL-c than name-brand atorvastatin but less of an increase in HDL-c.
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http://dx.doi.org/10.2147/CPAA.S285750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943322PMC
March 2021

Characteristics of Pediatric Emergency and Risk Factors for Life-saving Interventions.

Glob Pediatr Health 2021 24;8:2333794X21990340. Epub 2021 Jan 24.

Khon Kaen University, Khon Kaen, Thailand.

Pediatric emergency patients are vulnerable population and require special care or interventions. Nevertheless, there is limited data on the prevalence and risk factors for life-saving interventions. This study is a retrospective analytical study. The inclusion criteria were children aged 15 years or under who were triaged as level 1 or 2 and treated at the resuscitation room. Factors associated with LSI were executed by logistic regression analysis. During the study period, there were 22 759 ER visits by 14 066 pediatric patients. Of those, 346 patients (2.46%) met the study criteria. Triage level 1 accounted for 16.18% (56 patients) with 29 patients (8.38%) with LSI. Trauma was an independent factor for LSI with adjusted odds ratio (95% CI) of 4.37 (1.49, 12.76). In conclusion, approximately 8.38% of these patients required LSI. Trauma cause was an independent predictor for LSI.
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http://dx.doi.org/10.1177/2333794X21990340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841656PMC
January 2021

Which diagnostic criteria of metabolic syndrome are predictors of cardiovascular diseases in elderly populations?

J Clin Transl Endocrinol 2021 Mar 31;23:100248. Epub 2020 Dec 31.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Introduction: Metabolic syndrome (MetS) is one contributing factor to cardiovascular diseases (CVD). Although there have been several reports showing MetS to be a risk factor for CVD, there are limited data available on which of the diagnostic criteria for MetS carries the greatest risk for CVD in the elderly population. This study thus aimed to evaluate these criteria in terms of risk of CVD in this population.

Methods: This was a retrospective cohort study conducted at three referral hospitals in Thailand. The study period was between January 1, 2007 and December 31, 2016. Eligible patients were identified whether presence of MetS or not at the beginning of study and followed until the end of study. The primary outcome of study was presence of CVD. Predictors for CVD were analyzed by Cox proportional-hazards regression.

Results: During the study period, there were 1080 patients who met the study criteria, 253 (23.42%) of whom had CVD. There were five factors significantly associated with CVD occurrence including age, smoking, SBP, FPG, and HDL-c. The two factors with the highest adjusted hazard ratio were FPG and SBP at 2.92 and 2.34, respectively.

Conclusions: The three MetS criteria including SBP, FPG, and HDL-c may be predictors for cardiovascular diseases in elderly populations. Physician may need to focus on these particular factors of MetS in terms of CVD prevention in elderly patients.
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http://dx.doi.org/10.1016/j.jcte.2020.100248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811162PMC
March 2021

Any heart failure treatments associated with worsening renal function in patients admitted due to acute heart failure?

Ren Fail 2021 Dec;43(1):123-127

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Background: Worsening renal function (WRF) occurs in approximately 25% of acute heart failure patients, and both baseline characteristics and heart failure treatment may increase the risk of WRF. This study aimed to evaluate additional risk factors for WRF in acute heart failure, particularly those related to heart failure treatment.

Methods: This was a retrospective, observational, analytical study. The inclusion criteria were age 18 years or over, hospital admission due to acute heart failure, and having undergone at least two serum creatinine tests during admission. The eligible patients were classified into two groups: WRF and non-WRF. Predictors for WRF (including treatment parameters) were determined using logistic regression analysis.

Results: During the study period, there were 301 eligible patients who met the study criteria. Of those, 82 (27.24%) had WRF. There were two independent factors associated with WRF occurrence: baseline diastolic blood pressure and beta blocker treatment, with adjusted odds ratios (95% confidence interval) of 1.060 (1.008, 1.114) and 0.064 (0.006, 0.634), respectively. The Hosmer-Lemeshow Chi square for the final model was 6.11 ( = .634).

Conclusions: After examining several heart failure treatments and baseline factors, we found that beta blocker treatment results improvement in kidney function.
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http://dx.doi.org/10.1080/0886022X.2020.1858100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801054PMC
December 2021

ADC cut points for chronic kidney disease in pathologically-proven cholangiocarcinoma.

Eur J Radiol Open 2021 10;8:100304. Epub 2020 Dec 10.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Purpose: Apparent diffusion coefficient (ADC) has been shown to indicate renal function in various conditions. As cholangiocarcinoma may have renal involvement due to immune complex-mediated glomerulonephritis, this study aimed to determine whether or not there is any association between ADC values and renal function in these patients.

Methods: This was a retrospective, analytical study. The inclusion criteria were age over 18 years, pathologically proven cholangiocarcinoma diagnosis and having undergone either 1.5 T or 3.0 T diffusion-weighted MRI. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min/1.73m. Patients' ADC levels in the CKD and non-CKD groups were compared, and subgroup analysis was performed by MRI field strength and type of cholangiocarcinoma.

Results: One hundred fifty-eight patients participated in the study. Most were male (66.46 %), and the average age (SD) was 61.59 years (7.91). Average ADC levels in the CDK and non-CDK group differed significantly, regardless of MRI field strength or type of cholangiocarcinoma (2.11 mm/s in the ADC group vs 1.91 mm/s in the non-ADC group; < 0.001). An ADC cut-point of 1.75 mm/s yielded sensitivities ranging from 66.67-90.00 in almost all study populations. The distal cholangiocarcinoma group had a perfect cut-point at 1.78 mm/s with 100 % sensitivity and area under the ROC curve.

Conclusions: Radiologists can use ADC to detect CKD in cholangiocarcinoma patients regardless of MRI field strength or type of cholangiocarcinoma.
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http://dx.doi.org/10.1016/j.ejro.2020.100304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734226PMC
December 2020

Clinical features and course of eosinophilic meningitis in patients receiving supportive therapy.

Food Waterborne Parasitol 2020 Dec 16;21:e00095. Epub 2020 Sep 16.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Acute severe headache is the main presentation of eosinophilic meningitis (EOM) caused by . Oral corticosteroid treatment is effective in reduction of duration of headache but may be contraindicated in particular patients. This study investigated clinical features and clinical course of eosinophilic meningitis caused by . if left untreated. Additionally, factors associated with duration of headache were evaluated. We conducted a retrospective study between 1997 and 2019 at a university hospital in Thailand. The inclusion criteria were adult patients who were diagnosed with EOM, had a positive serological test for . , received only supportive treatment, and had the complete clinical course documented. Factors associated with duration of headache were executed by multivariate linear regression analysis. A total of 54 patients were used in the final analysis. Of those, 39 patients (79.2%) were male and the mean ± SD age of all patients was 33.7 ± 12.2. The mean ± SD duration of headache was 16.0 ± 12.4 days with the longest duration of 49 days. The only factor associated with duration of headache was gender ( = 0.036). The male gender had a coefficient of -8.4 (95% CI: -16.2, -0.6). The median duration of headache in male and female patients was 11 and 20 days, respectively. In conclusion, . eosinophilic meningitis can cause long lasting headache, and gender may be associated with duration of headache.
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http://dx.doi.org/10.1016/j.fawpar.2020.e00095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689049PMC
December 2020

Clinical comparisons between previously diagnosed SLE and newly diagnosed SLE by kidney biopsy.

Auto Immun Highlights 2020 Dec 2;11(1):18. Epub 2020 Dec 2.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.

Background: Lupus nephritis is a type of major organ involvement in systemic lupus erythematosus (SLE) patients that leads to higher rates of morbidity and mortality and may present initially in 28% of SLE patients. However, there are limited data available on clinical differences or predictors for biopsy-proven lupus nephritis in established versus newly diagnosed SLE cases.

Methods: Adult patients undergoing kidney biopsy for the first time with a diagnosis of lupus nephritis were eligible for inclusion. Patients were categorized into two groups: those with previously diagnosed SLE and those with newly diagnosed SLE by kidney biopsy. Factors associated with newly diagnosed SLE were determined using logistic regression analysis.

Results: There were 68 patients diagnosed with lupus nephritis by kidney biopsy. Of those, 31 cases (45.58%) were newly diagnosed. The newly diagnosed SLE group was significantly older (36.87 vs 30.95 years) and had a lower proportion of females (74.19% vs 91.89%) than the previously diagnosed group. A new-onset hypertension was the only factor independently associated with newly diagnosed SLE by kidney biopsy. The adjusted odds ratio (95% CI) was 5.152 (1.046, 25.363).

Conclusions: Nearly half of the biopsy-proven lupus nephritis cases in this study were patients with newly diagnosed SLE. Patients with previously diagnosed SLE and newly diagnosed SLE by kidney biopsy had clinical differences.
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http://dx.doi.org/10.1186/s13317-020-00140-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709425PMC
December 2020

IQ-CPR Meter for Chest Compression Monitoring During Simulated Cardiopulmonary Resuscitation; a Comparative Study.

Arch Acad Emerg Med 2020 19;8(1):e76. Epub 2020 Sep 19.

Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand.

Introduction: Adequate chest compression is crucial for cardiopulmonary resuscitation (CPR). There are several chest compression monitoring devices with different costs. This study aimed to evaluate the agreement rate of Improved Quality of Cardiopulmonary Resuscitation meter (IQ-CPR meter) and automated external defibrillator (AED) in chest compression quality monitoring.

Methods: In this comparative study, participants were instructed to perform chest compression on the CPR manikins with the set rate of 110 times/minute for two minutes. The CPR manikins had two monitors: AED (R series, Zoll company) and IQ-CPR meter. AED showed the depth and speed of chest compression on the screen, while IQ-CPR meter showed the depth of each chest compression by color light for quality of chest compression depth. Video-based analysis was used to compare the chest compression quality monitoring between the 2 devices.

Results: There were 27 participants in the study with a mean age and body mass index (standard deviation; SD) of 26.00 (5.65) years, and 22.93 (3.62) kg/m (70.37% male). The median (1 to 3 quartile range) of chest compression experience was 3 (1.00-6.50) years. The mean (SD) of chest compression rate was 107 (5.29) times/minute. Based on Cohen's Kappa correlation, agreement between the IQ-CPR meter and the AED was 66.54%.

Conclusion: The IQ-CPR meter had fair agreement with the computerized chest compression monitoring device with lower cost and simple, real time audiovisual feedback.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587996PMC
September 2020

Seasonality of stroke: Winter admissions and mortality excess: A Thailand National Stroke population database study.

Clin Neurol Neurosurg 2020 12 2;199:106261. Epub 2020 Oct 2.

Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB252ZD, UK. Electronic address:

Objectives: We examined the existence and potential burden of seasonality of stroke admissions and mortality within a tropical climate using cohort data collected between 1 st November 2003 and 31 st October 2012.

Patients And Methods: In a prospective cohort of hospitalised stroke patients from the catchment of ∼75 % of the Thai population (n = 569,307; mean SD age = 64(14.5)), incident stroke admissions, in-hospital mortality, prolonged hospitalisations, and stroke related complications by season were determined. Rates of incident stroke admissions by month and season were plotted. Winter excess indexes for study outcomes expressed as a percentage were calculated. Using logistic regression we examined the association between winter admission and in-hospital mortality (non-winter admission as reference) adjusting for age, sex, stroke type, year of admission, and presence of pre-existing comorbidities.

Results: We observed a winter excess in mortality during hospitalisation (+10.3 %) and prolonged length of stay (+7.3 %). Respective winter excess indexes for dyslipidaemias, arrhythmias, anaemia, and alcohol related disorders in patients that died during hospitalisation were +1.4 %, +6.2 %, +0.2 %, +1.5 %. In these patients, respective winter excess indexes for post-stroke complications of pneumonia and sepsis were +6.7 % and +3.2 %. In fully adjusted analyses, winter admission (compared to non-winter admission) was associated with increased odds of in-hospital mortality (OR (95 % CI) = 1.023 (1.006-1.040)).

Conclusions: We provide robust evidence for the existence of an excess in winter stroke admissions and subsequent in-hospital deaths within a tropical region.
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http://dx.doi.org/10.1016/j.clineuro.2020.106261DOI Listing
December 2020

Are symptoms of obstructive sleep apnoea related to good continuous positive airway pressure compliance?

ERJ Open Res 2020 Jul 28;6(3). Epub 2020 Sep 28.

Dept of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand.

Obstructive sleep apnoea (OSA) is a common disease that can be treated with continuous positive airway pressure (CPAP). CPAP tolerance may be associated with its compliance. Even though there are several predictors for good CPAP compliance, there are limited data available on the correlation between CPAP compliance and OSA symptoms. This study aimed to evaluate this correlation. We conducted a cross-sectional study and enrolled adult patients diagnosed with OSA through polysomnography who had experience using a CPAP machine. A self-report questionnaire was used to evaluate CPAP compliance and study variables. Predictors of CPAP compliance were analysed using stepwise multivariate logistic regression analysis. There were 68 patients with OSA who completed the questionnaire during the study period. Of those, 14 (20.59%) exhibited good CPAP compliance. Only fatigue as a symptom was an independent factor associated with good CPAP compliance, with an adjusted odds ratio of 5.380 (95% CI 1.274-22.719). In conclusion, fatigue was the only symptom associated with good CPAP compliance in patients with OSA.
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http://dx.doi.org/10.1183/23120541.00169-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520172PMC
July 2020

Role of Inhaled Corticosteroids for Asthma Exacerbation in Children: An Updated Meta-Analysis.

J Emerg Trauma Shock 2020 Apr-Jun;13(2):161-166. Epub 2020 Jun 10.

Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand.

Background: Several studies showed that inhaled corticosteroids (ICS) may be a potential treatment in acute asthma exacerbation in children. This study was an update meta-analysis on the roles of ICS in the management of acute asthma exacerbation in children presenting to the hospital.

Materials And Methods: Published articles with key words of ICS for asthma exacerbation, asthma attacks, and acute asthma in children aged under 18 years in the hospital setting with outcome of hospital admission between 2009 and 2018 were enrolled. The databases used in this study were Medline, Scopus, and Web of Science. Odds ratio of comparison between ICS and other treatments on hospital admissions was calculated.

Results: There were 311 eligible studies met the searching criteria; seven eligible studies for the analysis; comprised of three meta-analysis and four added studies. The ICS had a significant reduction in hospital admission compared with placebo in overall with odds ratio of 0.63 (95% confidence interval [CI]: 0.41-0.96) and in moderate-to-severe group with odds ratio of 0.17 (95% CI: 0.05-0.51). Comparing with systemic corticosteroid (SC), ICS had significantly lower hospital admissions overall and in mild-to-moderate group with odds ratios of 0.63 and 0.26, respectively. The combination of ICS and SC had odds ratio of 0.75 (95% CI: 0.57-0.99) over SC in moderate-to-severe asthma exacerbation.

Conclusions: ICS significantly reduced hospital admission in asthma exacerbation in children. It may be used alone for mild-to-moderate asthma exacerbation and combination with SC for moderate-to-severe asthma exacerbation.
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http://dx.doi.org/10.4103/JETS.JETS_116_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472813PMC
June 2020

Obstructive sleep apnea in patients with diabetes less than 40 years of age.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):1859-1863. Epub 2020 Sep 10.

Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand. Electronic address:

Background And Aim: Obstructive sleep apnea (OSA) is known to be associated with diabetes mellitus (DM). Age is factor associated with different clinical features of OSA. There is limited data on clinical differences of young DM patients with OSA versus older DM patients with OSA. This study aimed to find clinical differences of DM coexisting with OSA between young age group and older.

Methods: This is a retrospective, analytical study conducted at Srinagarind Hospital, Thailand. The inclusion criteria were adult patients diagnosed as DM with OSA. The study period was between January 2008 and December 2019. The diagnosis of OSA was made by presence of apnea hypopnea index (AHI) of ≥5 times/hour by polysomnography. Clinical predictors of OSA in young DM patients with age under 40 years were executed.

Results: There were 56 patients in the young diabetes mellitus group, while there were 137 patients in the older diabetes mellitus group. The mean (SD) age of diagnosis for diabetes mellitus of both groups were 31.61 (6.53) and 54.68 (7.62) years, respectively. There were three independent predictors for DM in the young: atrial fibrillation (AF), body mass index (BMI) and glomerular filtration rate (GFR). Presence of AF perfectly predicted DM with OSA in age over 40 years. The adjusted odds ratio for BMI and GFR were 1.29 (95% CI 1.05, 1.58) and 1.06 (1.01, 1.13). The BMI over 32 kg/m and GFR over 77 ml/min/m gave sensitivity of 80.00%.

Conclusions: Young DM patients with OSA had more severe OSA, were more obese, had better renal function, and had fewer AF than the older ones.
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http://dx.doi.org/10.1016/j.dsx.2020.09.008DOI Listing
September 2020

A 2-point difference of NIHSS as a predictor of acute ischemic stroke outcome at 3 months after thrombolytic therapy.

Clin Neurol Neurosurg 2020 11 8;198:106206. Epub 2020 Sep 8.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Objective: A good functional response at 24 h from an intravenous recombinant tissue plasminogen activator (rtPA) treatment is associated with 3-month ischemic stroke outcome. The criterion for 24 -h neurological improvement is varied from 4 to 8 point the National Institutes of Health Stroke Scale (NIHSS) score reduction. This study aimed to evaluate the smaller difference of the NIHSS at 2 points on long term functional status.

Patients And Methods: The inclusion criteria were adult patients diagnosed as acute ischemic stroke and received the rtPA treatment. There were two stroke outcomes comprised of immediate 24 -hs and 3 month long term outcomes. Favorable 24 -h outcome defined by improvement of the NIHSS at 24 h after the rtPA treatment at least 2 points or equal to 0. At 3 months, the outcome was evaluated by using the modified Rankin scale (mRS). The mRS of 0-1 and 2-6 defined as favorable and poor outcome, respectively. Factors associated with poor outcomes at 24 h and 3 months after the rtPA treatment were calculated by logistic regression analysis.

Results: There were 618 patients met the study criteria. Of those, 403 patients (65.2 %) received the rtPA treatment at the tertiary care hospital. At 24 h after the rtPA treatment, 163 patients (26.38 %) had poor outcome. After adjusted, age and atrial fibrillation had adjusted odds ratios (95 % confidence interval) for poor outcome at 24 h after the rtPA treatment of 1.026 (1.009, 1.043) and 1.725 (1.119, 2.658). At 3 months after the rtPA treatment, the poor outcome at 24 h after rtPA treatment had the highest adjusted odds ratio at 42.876 (95 % confidence interval of 21.500, 85.501).

Conclusions: The NIHSS differences of 2 points at 24 -h after the rtPA treatment from baseline may be an additional tool to predict the 3-month functional outcome of acute ischemic stroke patients.
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http://dx.doi.org/10.1016/j.clineuro.2020.106206DOI Listing
November 2020

Development and validation of CAVE score in predicting presence of pressure ulcer in intensive care patients.

Heliyon 2020 Aug 19;6(8):e04612. Epub 2020 Aug 19.

Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.

Background: Pressure ulcers (PUs) are one of the quality care indicators in nursing care. They are considered to primarily be preventable. Early identification of the patients most at risk particular for critically ill patients is crucial for providing prompt care. Several tools have been developed to support healthcare providers, but their validities are limited in Thailand. Development of tools with better performance is essential.

Aims: To develop and validate a PU risk assessment tool with good diagnostic properties in intensive care units (ICUs).

Methods: A prospective study was conducted in ICUs of a tertiary care hospital, Thailand from January 2019 to April 2020. Baseline data were collected at admission to the ICUs. Skin assessment was evaluated every 24 h. Data were divided into two sets: model development and model validation. Creating a risk score which was derived from multivariate methods were performed. Youden index were used to determine the optimal cut-off point. Then, the other dataset was used to validate the risk score. Receiver Operating Characteristic (ROC) curves was used to demonstrate the performance of the test.

Results: The study included 288 and 270 patients for development and validation models. The risk score consisted 4 clinical factors; presence of Cardiovascular disease, low serum Albumin, having Ventilated, and Edema (CAVE score). The area under the ROC curve (AUC) was 0.8 and a score at 2.5 was the best cut-off point. The AUC in the validation group was 0.6, age<60 years was 0.78, and age≥60 years was 0.57.

Conclusion: The predictive validity of the CAVE score is limited but comparable to the existing tools in Thailand. However, it has a good diagnostic property in young patients. The CAVE score could be considered as an alternate screening tool in critical care setting particularly for young patients.
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http://dx.doi.org/10.1016/j.heliyon.2020.e04612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452482PMC
August 2020

Effectiveness and safety of sodium-glucose co-transporter-2 inhibitors in Thai adults with type 2 diabetes mellitus: a real-world study.

Curr Med Res Opin 2020 10 26;36(10):1601-1610. Epub 2020 Aug 26.

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand.

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2is) are widely used to improve both glycemic control and cardio-renal outcomes. We aim to evaluate the real-life clinical effectiveness, safety and outcomes of SGLT2is in Thai adults with type 2 diabetes mellitus (T2DM).

Methods: This was a retrospective study involving adults with T2DM who were treated with SGLT2is for ≥3 months.

Results: Among 1159 participants (women 52.6%; age: 61.1 ± 10.9 years; body mass index: 28.7 ± 5.2 kg/m), 65.1%, 34.3% and 0.6% received dapagliflozin, empagliflozin and canagliflozin, respectively. Median SGLT2i treatment duration was 15 (IQR, 8-23) months. Of the patients, 16.5%, 6.4%, 4.9% and 1.6% had pre-existing coronary artery disease, stroke, heart failure and peripheral arterial disease, respectively. Mean HbA1c decreased by 0.7% (95% CI, -1.0 to -0.4) from a baseline of 8.3 ± 1.5%. At 24 months, body weight, and systolic and diastolic blood pressure decreased significantly from the baseline average of 2.5 kg, 3.5 mmHg and 2.4 mmHg, respectively. The median decline in eGFR was -1.3 ml/min/1.73 m/year. The incidences of pollakiuria, genital tract infection, urinary tract infection and hypoglycemia were 7.2%, 2.8%, 2.2% and 0.9%, respectively. No participants developed diabetic ketoacidosis during the observation period.

Conclusions: SGLT2is improved cardiometabolic parameters in Thai adults, clinically confirming findings in controlled trials.
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http://dx.doi.org/10.1080/03007995.2020.1808454DOI Listing
October 2020

Diagnostic properties of a portable near-infrared spectroscopy to detect intracranial hematoma in traumatic brain injury patients.

Eur J Radiol Open 2020 29;7:100246. Epub 2020 Jul 29.

Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand.

Traumatic brain injury (TBI) is a major public health issue worldwide. A portable near-infrared spectroscopy (NIRS) is a non-invasive device to detect intracranial hematoma. The advantages of the NIRS include real time results and non-radiation exposure. However, sensitivity and specificity of the NIRS for intracranial hematoma are varied. This study aimed to evaluate the diagnostic properties of the NIRS in TBI patients to detect intracranial hematoma. This study was a diagnostic and prospective study conducted at the Emergency Department. The inclusion criteria were adult patients (age of 18 years or over) with moderate to high risk of all degrees of traumatic brain injury within 24 h after the injury. The primary endpoint of the study was a description of diagnostic properties of the NIRS compared with the CT brain. There were 47 patients enrolled in the study. Most of patients had Glasgow Coma Scale of 15 (44 patients; 93.62 %). Of those, 11 patients (23.40 %) had intracranial hematoma: subdural hematoma (n = 9), epidural hematoma (n = 1), intracerebral hematoma (n = 1), and subarachnoid hemorrhage (n = 3). One patient had subdural hematoma, epidural hematoma, intracerebral hematoma and subarachnoid hemorrhage. There were 31 patients had abnormal findings by the NIRS but only 11 patients had bleeding detected by the CT brain. There were 16 patients had negative results on both the NIRS and the CT brain. The sensitivity and specificity of the NIRS compared with the CT brain was 100 % and 44.4 %, respectively. The area under the ROC curve of the NIRS was 0.722. The median time to complete the NIRS examination was 3 min. In conclusion, the NIRS has high sensitivity and negative predictive value for intracranial hematoma detection in mild TBI patients with extra-axial hematomas.
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http://dx.doi.org/10.1016/j.ejro.2020.100246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394853PMC
July 2020
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