Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13882
Chest pain is a frequent complaint among patients in both the emergency department and outpatient clinics. Several urgent cardiac conditions, including acute coronary syndrome, aortic dissection, and pericarditis, must always be ruled out through meticulous clinical evaluations. Chest pain due to spontaneous sternal fractures is relatively common in patients diagnosed with multiple myeloma. Nevertheless, the clinical manifestation is usually subtle and progressive. In this particular case, the patient’s primary symptom during the treatment of multiple myeloma was acute chest pain, resulting from a spontaneous sternal fracture. The patient received pain management and chemotherapy for multiple myeloma, which effectively alleviated the pain. Keywords: Sternal fracture; Multiple myeloma; Spontaneous
{"title":"Spontaneous Sternal Fracture in Multiple Myeloma: A Case Report","authors":"","doi":"10.35755/jmedassocthai.2023.08.13882","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13882","url":null,"abstract":"Chest pain is a frequent complaint among patients in both the emergency department and outpatient clinics. Several urgent cardiac conditions, including acute coronary syndrome, aortic dissection, and pericarditis, must always be ruled out through meticulous clinical evaluations. Chest pain due to spontaneous sternal fractures is relatively common in patients diagnosed with multiple myeloma. Nevertheless, the clinical manifestation is usually subtle and progressive. In this particular case, the patient’s primary symptom during the treatment of multiple myeloma was acute chest pain, resulting from a spontaneous sternal fracture. The patient received pain management and chemotherapy for multiple myeloma, which effectively alleviated the pain.\u0000\u0000Keywords: Sternal fracture; Multiple myeloma; Spontaneous","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81310903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.35755/jmedassocthai.2023.08.13879
Background: Herniated nucleus pulposus (HNP) occurs when the annulus fibrosus is weakened and torn. Because research is limited, evidence is unclear as to whether percutaneous endoscopic lumbar discectomy (PELD) is superior to conventional surgery for patients with lumbar disc herniation in Thailand, particularly in terms of the costs for all treatment options. Objective: To evaluate from societal and hospital perspectives the clinical outcomes, cost, and cost-effectiveness of PELD, and conventional lumbar discectomy (CLD) in patients with herniated discs. Materials and Methods: The decision tree model was developed to capture the cost and effectiveness for patients with herniated discs under both procedures. Pre- and postoperative evaluations were performed with the Oswestry Disability Index (ODI), visual analog scale (VAS) for health state valuation and pain score. The following surgical variables were collected from medical records and analyzed, surgical time, blood loss, and presence of complications, length of hospital stay, and total days off. The cost of each surgery was collected from the hospital database and references. Results: Statistically significant differences were found in the length of hospital stay, surgical time, blood loss, size of the incision, the number of days off, and the ODI score. The cost of PELD was lower than CLD from the societal perspective but higher than CLD from the hospital perspective. The incremental cost-effectiveness ratio (ICER) was 29,742.92 Baht per ODI score from the societal perspective. Conclusion: PELD seemed to be more cost-effective than CLD in the present study. Keywords: Percutaneous endoscopic lumbar discectomy; Herniated nucleus pulposus; Cost-effectiveness analysis
{"title":"Cost-Effectiveness Analysis between Percutaneous Endoscopic Lumbar Discectomy (PELD) and Conventional Lumbar Discectomy for Herniated Nucleus Pulposus (HNP)","authors":"","doi":"10.35755/jmedassocthai.2023.08.13879","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.08.13879","url":null,"abstract":"Background: Herniated nucleus pulposus (HNP) occurs when the annulus fibrosus is weakened and torn. Because research is limited, evidence is unclear as to whether percutaneous endoscopic lumbar discectomy (PELD) is superior to conventional surgery for patients with lumbar disc herniation in Thailand, particularly in terms of the costs for all treatment options.\u0000\u0000Objective: To evaluate from societal and hospital perspectives the clinical outcomes, cost, and cost-effectiveness of PELD, and conventional lumbar discectomy (CLD) in patients with herniated discs.\u0000\u0000Materials and Methods: The decision tree model was developed to capture the cost and effectiveness for patients with herniated discs under both procedures. Pre- and postoperative evaluations were performed with the Oswestry Disability Index (ODI), visual analog scale (VAS) for health state valuation and pain score. The following surgical variables were collected from medical records and analyzed, surgical time, blood loss, and presence of complications, length of hospital stay, and total days off. The cost of each surgery was collected from the hospital database and references.\u0000\u0000Results: Statistically significant differences were found in the length of hospital stay, surgical time, blood loss, size of the incision, the number of days off, and the ODI score. The cost of PELD was lower than CLD from the societal perspective but higher than CLD from the hospital perspective. The incremental cost-effectiveness ratio (ICER) was 29,742.92 Baht per ODI score from the societal perspective.\u0000\u0000Conclusion: PELD seemed to be more cost-effective than CLD in the present study.\u0000\u0000Keywords: Percutaneous endoscopic lumbar discectomy; Herniated nucleus pulposus; Cost-effectiveness analysis","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77648280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13871
Background: In assessing male lower urinary tract symptoms (LUTS) by the International Prostate Symptom Score (IPSS), misunderstanding and misinterpretation were detected in low-educated and elderly patients. Thus, a modified IPSS Thai version had been created to solve these problems. Objective: To evaluate efficacy of the modified IPSS Thai version that had been developed and compare it to the original one. Materials and Methods: The present study was conducted in male participants having LUTS. Each participant was tested with the original and the modified IPSS Thai version. Data on age, educational level, and duration time to complete each questionnaire were collected. They were asked to select the preferred easier-to-understand version. The accuracy and validity of the modified version was assessed. Results: Overall, 101 participants, with a mean age of 64 years, were included. The interclass correlation of the modified and the original Thai IPSS was 0.932 with the Cronbach’s alpha score of 0.906 verifying no difference in total score of both versions. The mean (±SD) total score of the modified Thai IPSS was 13.82±7.88 while the original version was 14.19±8.58 demonstrated no significant difference (p=0.376). Five responders requested for assistance or explanation for the original version, but only 1 patient did for the modified one. Most participants (72.3%) voted for the modified Thai IPSS as the preferred easier-to-understand version. The mean (±SD) time to complete the modified version was 127.07±59.02 seconds, which was significantly less than the original one at 156.53±63.86 seconds (p<0.001). Conclusion: In assessing male LUTS, the modified Thai IPSS was more practical, easier to understand, and less time-consuming than the original version for all ages over 40 years and all education levels. The content validity of the modified version was comparable to the original one. Therefore, the modified Thai IPSS was useful in clinical practice. Keywords: International Prostate Symptom Score; IPSS; Thai version; Modification; Validity; Efficacy
{"title":"Validation and Efficacy of the Modified International Prostate Symptom Score (IPSS) Thai Version: A Simplified Version for Assessing Lower Urinary Tract Symptoms in Thai Men","authors":"","doi":"10.35755/jmedassocthai.2023.07.13871","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13871","url":null,"abstract":"Background: In assessing male lower urinary tract symptoms (LUTS) by the International Prostate Symptom Score (IPSS), misunderstanding and misinterpretation were detected in low-educated and elderly patients. Thus, a modified IPSS Thai version had been created to solve these problems.\u0000\u0000Objective: To evaluate efficacy of the modified IPSS Thai version that had been developed and compare it to the original one.\u0000\u0000Materials and Methods: The present study was conducted in male participants having LUTS. Each participant was tested with the original and the modified IPSS Thai version. Data on age, educational level, and duration time to complete each questionnaire were collected. They were asked to select the preferred easier-to-understand version. The accuracy and validity of the modified version was assessed.\u0000\u0000Results: Overall, 101 participants, with a mean age of 64 years, were included. The interclass correlation of the modified and the original Thai IPSS was 0.932 with the Cronbach’s alpha score of 0.906 verifying no difference in total score of both versions. The mean (±SD) total score of the modified Thai IPSS was 13.82±7.88 while the original version was 14.19±8.58 demonstrated no significant difference (p=0.376). Five responders requested for assistance or explanation for the original version, but only 1 patient did for the modified one. Most participants (72.3%) voted for the modified Thai IPSS as the preferred easier-to-understand version. The mean (±SD) time to complete the modified version was 127.07±59.02 seconds, which was significantly less than the original one at 156.53±63.86 seconds (p<0.001).\u0000\u0000Conclusion: In assessing male LUTS, the modified Thai IPSS was more practical, easier to understand, and less time-consuming than the original version for all ages over 40 years and all education levels. The content validity of the modified version was comparable to the original one. Therefore, the modified Thai IPSS was useful in clinical practice.\u0000\u0000Keywords: International Prostate Symptom Score; IPSS; Thai version; Modification; Validity; Efficacy","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81953801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13867
Background: Heat-related illnesses (HRI) are a major health problem among conscripts. Risk assessment using statistical equations is one strategy to help prevent HRI at the individual level. Objective: To create and evaluate an appropriate statistical model to predict HRI in basic conscript training courses. Materials and Methods: The study employed a prognostic and prospective design, divided into two phases. The model was developed in the first phase while the second evaluated the model. In the model development phase, the sample comprised first and second turn conscripts. The model evaluation phase involved a sample of first and second turn conscripts not in the year of the model development phase. Data on personal and environmental factors were collected in the model development phase to adjust the score level to align with the risk level. In the evaluation phase, data were collected using variables obtained during model development by categorizing the risk groups into two levels, low and high, and sorting them according to their symbolic color. Data were analyzed in the development phase using binary logistic regression and clinical predictive rule. Scores in the model evaluation phase were analyzed using the Net Reclassification Index (NRI). Results: In the model development phase, 2,217 subjects took part in the study, with a 100% response rate. The incidence of HRI was 1.6 per 1,000 persons/day. The predictive factors included alcohol consumption within seven days of military service, fever, systolic blood pressure, body mass index, and urine color. In the model evaluation phase, 2,217 subjects participated in the study, with a 100% response rate. When compared with symbolic color classification, a traditional risk assessment, the NRI was equal to 61.4% and considered to be appropriate. Conclusion: The use of score scales based on factors in the statistical model proved to be a suitable additional method for predicting heat-related illnesses at the individual level. Keywords: Statistical model; Heat-related illnesses; Conscripts
{"title":"The Statistical Model for Prediction of Heat-Related Illnesses in Conscript Training Course","authors":"","doi":"10.35755/jmedassocthai.2023.07.13867","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13867","url":null,"abstract":"Background: Heat-related illnesses (HRI) are a major health problem among conscripts. Risk assessment using statistical equations is one strategy to help prevent HRI at the individual level.\u0000\u0000Objective: To create and evaluate an appropriate statistical model to predict HRI in basic conscript training courses.\u0000\u0000Materials and Methods: The study employed a prognostic and prospective design, divided into two phases. The model was developed in the first phase while the second evaluated the model. In the model development phase, the sample comprised first and second turn conscripts. The model evaluation phase involved a sample of first and second turn conscripts not in the year of the model development phase. Data on personal and environmental factors were collected in the model development phase to adjust the score level to align with the risk level. In the evaluation phase, data were collected using variables obtained during model development by categorizing the risk groups into two levels, low and high, and sorting them according to their symbolic color. Data were analyzed in the development phase using binary logistic regression and clinical predictive rule. Scores in the model evaluation phase were analyzed using the Net Reclassification Index (NRI).\u0000\u0000Results: In the model development phase, 2,217 subjects took part in the study, with a 100% response rate. The incidence of HRI was 1.6 per 1,000 persons/day. The predictive factors included alcohol consumption within seven days of military service, fever, systolic blood pressure, body mass index, and urine color. In the model evaluation phase, 2,217 subjects participated in the study, with a 100% response rate. When compared with symbolic color classification, a traditional risk assessment, the NRI was equal to 61.4% and considered to be appropriate.\u0000\u0000Conclusion: The use of score scales based on factors in the statistical model proved to be a suitable additional method for predicting heat-related illnesses at the individual level.\u0000\u0000Keywords: Statistical model; Heat-related illnesses; Conscripts","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89241266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13819
Background: COVID-19 has become a global pandemic, leading to the development of various vaccines to protect against infection. Sinovac-CoronaVac COVID-19 vaccine, an inactivated virus vaccine developed by Sinovac Biotech, has been approved for use. However, limited information is available regarding the immunity level provided by Sinovac-CoronaVac. Objective: To determine the level of anti-SARS-CoV-2 spike protein antibodies 28 and 90 days after the administration of the second dose of CoronaVac. Materials and Methods: A descriptive study was conducted, involving 132 healthcare personnel. The antibody levels were measured using the Roche Elecsys anti-SARS-CoV-2 spike protein immunoassay, both at 28 and 90 days after the second dose of CoronaVac. Results: The majority of participants were female registered nurses. The geometric mean antibody levels on day 28 and 90 were 138.1±2.2 and 66.9±0.3, respectively. By day 90, the antibody levels had declined to 45.3% compared to day 28. Nearly all participants had immunity levels on day 90 lower than those resulting from natural infection. Conclusion: The present study findings indicated that the immunity level, as measured by anti-SARS-CoV-2 spike protein antibodies, declined below the level observed with natural infection by day 90. Additional vaccine doses are suggested for healthcare personnel to provide rapid protection of the infection. Keywords: Antibody level; COVID-19; Health care personnel; Immunity
{"title":"Level of Anti-SARS-CoV-2 Spike Protein amongst Frontline Health Personnel of a Supra-Tertiary Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.07.13819","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13819","url":null,"abstract":"Background: COVID-19 has become a global pandemic, leading to the development of various vaccines to protect against infection. Sinovac-CoronaVac COVID-19 vaccine, an inactivated virus vaccine developed by Sinovac Biotech, has been approved for use. However, limited information is available regarding the immunity level provided by Sinovac-CoronaVac.\u0000\u0000Objective: To determine the level of anti-SARS-CoV-2 spike protein antibodies 28 and 90 days after the administration of the second dose of CoronaVac.\u0000\u0000Materials and Methods: A descriptive study was conducted, involving 132 healthcare personnel. The antibody levels were measured using the Roche Elecsys anti-SARS-CoV-2 spike protein immunoassay, both at 28 and 90 days after the second dose of CoronaVac.\u0000\u0000Results: The majority of participants were female registered nurses. The geometric mean antibody levels on day 28 and 90 were 138.1±2.2 and 66.9±0.3, respectively. By day 90, the antibody levels had declined to 45.3% compared to day 28. Nearly all participants had immunity levels on day 90 lower than those resulting from natural infection.\u0000\u0000Conclusion: The present study findings indicated that the immunity level, as measured by anti-SARS-CoV-2 spike protein antibodies, declined below the level observed with natural infection by day 90. Additional vaccine doses are suggested for healthcare personnel to provide rapid protection of the infection.\u0000\u0000Keywords: Antibody level; COVID-19; Health care personnel; Immunity","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78313746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13767
Objective: To evaluate the recurrence rate and postoperative complications of fibrin glue fixation of conjunctival autografts following primary nasal pterygium excision. Materials and Methods: The present study was a retrospective study of all eyes with primary nasal pterygium that underwent pterygium excision with conjunctival autograft transplantation using fibrin glue for graft fixation at Mettapracharak (Wat Rai Khing) Hospital between July 2017 and December 2018. The author analyzed pterygium recurrence rates and postoperative complications such as graft loss, graft displacement or dehiscence, pyogenic granuloma, or any other complications. Results: Fifty-seven eyes of 57 patients were evaluated, of which 43 (75.4%) were female. The mean age was 57.09±1.38 years (range of 34 to 80 years). No serious complications occurred. One eye (1.8%) sustained recurrence in the six months follow-up. All grafts were intact. Graft displacement requiring suturing occurred in three cases (5%). Graft dehiscence was observed in 29.8%, and in all cases epithelialized without intervention. Other postoperative complications included pyogenic granuloma in 3.5%, graft edema, subgraft hemorrhage in 21.1%, and elevation of intraocular pressure over 21 mmHg in 5.3%. Conclusion: Fibrin glue for fixation for conjunctival autografts after primary nasal pterygium excision is safe and effective. The most common complication in the present study was graft dehiscence, which did not require surgical intervention. Keywords: Conjunctival autograft; Fibrin glue; Pterygium recurrence rate; Graft dehiscence
目的:探讨原发性鼻翼状胬肉切除术后自体结膜纤维蛋白胶固定的复发率及术后并发症。材料与方法:本研究是对2017年7月至2018年12月在metapracharak (Wat Rai Khing)医院行翼状胬肉切除联合自体结膜移植使用纤维蛋白胶固定的所有原发性鼻翼状胬肉患者的回顾性研究。作者分析了翼状胬肉的复发率和术后并发症，如移植物丢失、移植物移位或裂开、化脓性肉芽肿或任何其他并发症。结果:检查57例患者57只眼，其中女性43只(75.4%)。平均年龄57.09±1.38岁(34 ~ 80岁)。无严重并发症发生。随访6个月，1眼(1.8%)持续复发。所有移植物均完好。3例(5%)发生移植物移位需要缝合。29.8%的患者出现移植物开裂，所有病例均在未干预的情况下上皮化。其他术后并发症包括化脓性肉芽肿(3.5%)、移植物水肿、移植物下出血(21.1%)、眼压升高超过21 mmHg(5.3%)。结论:纤维蛋白胶用于原发性鼻翼状胬肉切除术后自体结膜移植固定是安全有效的。本研究中最常见的并发症是移植物开裂，不需要手术干预。关键词:自体结膜移植;纤维蛋白胶;翼状胬肉复发率;贪污裂开
{"title":"Outcomes of Fibrin Glue for Graft Fixation in Primary Pterygium Surgery with Conjunctival Autograft","authors":"","doi":"10.35755/jmedassocthai.2023.07.13767","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13767","url":null,"abstract":"Objective: To evaluate the recurrence rate and postoperative complications of fibrin glue fixation of conjunctival autografts following primary nasal pterygium excision.\u0000\u0000Materials and Methods: The present study was a retrospective study of all eyes with primary nasal pterygium that underwent pterygium excision with conjunctival autograft transplantation using fibrin glue for graft fixation at Mettapracharak (Wat Rai Khing) Hospital between July 2017 and December 2018. The author analyzed pterygium recurrence rates and postoperative complications such as graft loss, graft displacement or dehiscence, pyogenic granuloma, or any other complications.\u0000\u0000Results: Fifty-seven eyes of 57 patients were evaluated, of which 43 (75.4%) were female. The mean age was 57.09±1.38 years (range of 34 to 80 years). No serious complications occurred. One eye (1.8%) sustained recurrence in the six months follow-up. All grafts were intact. Graft displacement requiring suturing occurred in three cases (5%). Graft dehiscence was observed in 29.8%, and in all cases epithelialized without intervention. Other postoperative complications included pyogenic granuloma in 3.5%, graft edema, subgraft hemorrhage in 21.1%, and elevation of intraocular pressure over 21 mmHg in 5.3%.\u0000\u0000Conclusion: Fibrin glue for fixation for conjunctival autografts after primary nasal pterygium excision is safe and effective. The most common complication in the present study was graft dehiscence, which did not require surgical intervention.\u0000\u0000Keywords: Conjunctival autograft; Fibrin glue; Pterygium recurrence rate; Graft dehiscence","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89807932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13769
Background: Long-term immunotherapy use in patients with neuromyelitis optica spectrum disorder (NMOSD) raised concerns about the increased risk and severity of infection during the coronavirus disease 2019 (COVID-19) pandemic. Real-world data exploring the risks and outcomes of COVID-19 in NMOSD patients are warranted. Materials and Methods: A retrospective medical chart review of NMOSD patients at a tertiary care center in Thailand during the COVID-19 pandemic was performed. Patients with and without COVID-19 were compared using descriptive statistics. Among infected patients, those with asymptomatic-to-mild infection and severe-to-critical infection were compared. Univariate and multivariate logistic regression analyses for risk factors of infection were performed. Results: Of the 175 NMOSD, 24 (13.7%) patients had COVID-19. The risk factors for COVID-19 were type 2 diabetes mellitus (T2DM) (OR 14.72, 95% CI 3.17 to 68.43), rituximab use (OR 3.45, 95% CI 1.29 to 9.19), and younger age during the pandemic (OR 0.95, 95% CI 0.91 to 0.99). Four patients (16.7%) had a severe-to-critical disease, leading to one death. The more severe patients more commonly had comorbid T2DM, hypertension, and lymphopenia. Conclusion: NMOSD patients in Thailand had a higher infection rate than the general Thai population. In addition to the general risk factors of COVID-19, such as T2DM, NMOSD patients had an increased risk of infection from rituximab use. Keywords: Neuromyelitis optica; NMOSD; COVID-19; Risk factor; Outcome
背景:在2019冠状病毒病(COVID-19)大流行期间，视神经脊髓炎谱系障碍(NMOSD)患者长期使用免疫治疗引起了人们对感染风险和严重程度增加的担忧。研究NMOSD患者COVID-19风险和结果的真实数据是有必要的。材料和方法:对2019冠状病毒病大流行期间泰国一家三级保健中心收治的NMOSD患者的病历进行回顾性分析。采用描述性统计方法对患有和未患有COVID-19的患者进行比较。在感染患者中，比较无症状至轻度感染和重度至危重感染。对感染危险因素进行单因素和多因素logistic回归分析。结果:175例NMOSD患者中有24例(13.7%)合并COVID-19。COVID-19的危险因素是2型糖尿病(T2DM) (OR 14.72, 95% CI 3.17至68.43)、使用利妥昔单抗(OR 3.45, 95% CI 1.29至9.19)和大流行期间年龄更小(OR 0.95, 95% CI 0.91至0.99)。4例患者(16.7%)出现重症至危重症，1例死亡。越严重的患者越常合并T2DM、高血压和淋巴细胞减少症。结论:泰国NMOSD患者的感染率高于泰国一般人群。除了COVID-19的一般危险因素，如T2DM, NMOSD患者因使用利妥昔单抗而感染的风险增加。关键词:视神经脊髓炎;NMOSD;COVID-19;风险因素;结果
{"title":"Risk Factors and Outcomes of COVID-19 in Thai Patients with Neuromyelitis Optica Spectrum Disorder: A Single Center Study","authors":"","doi":"10.35755/jmedassocthai.2023.07.13769","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13769","url":null,"abstract":"Background: Long-term immunotherapy use in patients with neuromyelitis optica spectrum disorder (NMOSD) raised concerns about the increased risk and severity of infection during the coronavirus disease 2019 (COVID-19) pandemic. Real-world data exploring the risks and outcomes of COVID-19 in NMOSD patients are warranted.\u0000\u0000Materials and Methods: A retrospective medical chart review of NMOSD patients at a tertiary care center in Thailand during the COVID-19 pandemic was performed. Patients with and without COVID-19 were compared using descriptive statistics. Among infected patients, those with asymptomatic-to-mild infection and severe-to-critical infection were compared. Univariate and multivariate logistic regression analyses for risk factors of infection were performed.\u0000\u0000Results: Of the 175 NMOSD, 24 (13.7%) patients had COVID-19. The risk factors for COVID-19 were type 2 diabetes mellitus (T2DM) (OR 14.72, 95% CI 3.17 to 68.43), rituximab use (OR 3.45, 95% CI 1.29 to 9.19), and younger age during the pandemic (OR 0.95, 95% CI 0.91 to 0.99). Four patients (16.7%) had a severe-to-critical disease, leading to one death. The more severe patients more commonly had comorbid T2DM, hypertension, and lymphopenia.\u0000\u0000Conclusion: NMOSD patients in Thailand had a higher infection rate than the general Thai population. In addition to the general risk factors of COVID-19, such as T2DM, NMOSD patients had an increased risk of infection from rituximab use.\u0000\u0000Keywords: Neuromyelitis optica; NMOSD; COVID-19; Risk factor; Outcome","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74600373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13872
Background: Although outpatient surgery volume has rapidly grown in the western counties. However, the rate of growth for outpatient surgery has been slow in Thailand. There are limited studies comparing outcomes and cost analysis in outpatient arthroscopic knee surgery in Thailand. Objective: To compare the 24-hour postoperative pain score, side-effects and the total cost associated between inpatient and outpatient care following arthroscopic knee surgery. Materials and Methods: A retrospective cohort study of 42 patients undergoing elective arthroscopic knee surgery under general anesthesia and receiving ultrasound guided adductor canal block for post-operative analgesia. The two cohorts were matched with a 1:1 ratio for age, sex, body mass index, type of surgery and operation time. The primary outcome was the 24-hour postoperative pain score. Secondary outcomes included: the incidence of inadequate analgesia, adverse events, cost associated with outpatient versus inpatient care, and patient satisfaction score. Results: The 24-hour postoperative pain score was median 2 (IQR 0, 3) versus 2 (IQR 1, 3) in the outpatient and inpatient groups, respectively. No major complications, reoperation, or readmission after surgery was seen in either group. The total hospital cost between outpatient versus inpatient showed not significant difference (1,871.09±555.53 USD versus 1,966.49±549.70 USD, p=0.58). The costs related to perioperative service, inpatient surgery ward service, and room and food service were significantly different. Satisfaction score was comparable between groups. Conclusion: In Thailand, outpatient arthroscopic knee surgery provided the same 24-hour postoperative pain control scores and clinical outcomes when compared to inpatient setting. There was no significant difference in total hospital cost between outpatient and inpatient care. However, costs related to perioperative period (e.g., inpatient room and food service) were significantly different. Keywords: Ambulatory surgery; Arthroscopic knee surgery; Adductor canal block; Safety and satisfaction; Medical cost
{"title":"Safety and Satisfaction of Outpatient Versus Inpatient Care for Arthroscopic Knee Surgery in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.07.13872","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13872","url":null,"abstract":"Background: Although outpatient surgery volume has rapidly grown in the western counties. However, the rate of growth for outpatient surgery has been slow in Thailand. There are limited studies comparing outcomes and cost analysis in outpatient arthroscopic knee surgery in Thailand.\u0000\u0000Objective: To compare the 24-hour postoperative pain score, side-effects and the total cost associated between inpatient and outpatient care following arthroscopic knee surgery.\u0000\u0000Materials and Methods: A retrospective cohort study of 42 patients undergoing elective arthroscopic knee surgery under general anesthesia and receiving ultrasound guided adductor canal block for post-operative analgesia. The two cohorts were matched with a 1:1 ratio for age, sex, body mass index, type of surgery and operation time. The primary outcome was the 24-hour postoperative pain score. Secondary outcomes included: the incidence of inadequate analgesia, adverse events, cost associated with outpatient versus inpatient care, and patient satisfaction score.\u0000\u0000Results: The 24-hour postoperative pain score was median 2 (IQR 0, 3) versus 2 (IQR 1, 3) in the outpatient and inpatient groups, respectively. No major complications, reoperation, or readmission after surgery was seen in either group. The total hospital cost between outpatient versus inpatient showed not significant difference (1,871.09±555.53 USD versus 1,966.49±549.70 USD, p=0.58). The costs related to perioperative service, inpatient surgery ward service, and room and food service were significantly different. Satisfaction score was comparable between groups.\u0000\u0000Conclusion: In Thailand, outpatient arthroscopic knee surgery provided the same 24-hour postoperative pain control scores and clinical outcomes when compared to inpatient setting. There was no significant difference in total hospital cost between outpatient and inpatient care. However, costs related to perioperative period (e.g., inpatient room and food service) were significantly different.\u0000\u0000Keywords: Ambulatory surgery; Arthroscopic knee surgery; Adductor canal block; Safety and satisfaction; Medical cost","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74729473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13827
Background: Ezetimibe has been recommended to add on statin therapy when maximally tolerated statin cannot achieve low-density lipoprotein cholesterol (LDL-C) target. However, the safety and efficacy of generic formulation of ezetimibe has rarely been reported. Objective: To examine efficacy of branded generic ezetimibe in patients with high cardiovascular risk receiving high-potency statin. Materials and Methods: The present study was a prospective cohort study in adult patients with high cardiovascular risk receiving atorvastatin 40 mg/day, but the LDL-C level was still higher than 70 mg/dL. Branded generic ezetimibe 10 mg once daily (MiBEAZ™) was added on the highpotency statin therapy as a combination treatment. Lipid parameters were evaluated three months after ezetimibe treatment. Results: Of the 61 patients, mean age was 62.4±11.5 years, and 33 (54.1%), were male. Coronary artery disease was reported in 58 patients or 95.1%. The median baseline of LDL-C was 95.0 mg/dL (IQR 79.5, 108.5). At 3-month follow-up, total cholesterol and LDL-C levels were significantly decreased by branded generic ezetimibe add-on therapy. The relative change of LDL-C reduction was 26.3% (IQR –38.8, –11.1, p<0.001). The LDL-C target under 70 mg/dL was attained in 60% of the patients. Triglyceride and high-density lipoprotein cholesterol levels remained unchanged. After ezetimibe medication, there were no differences in renal or hepatic function. Conclusion: The authors demonstrated that branded generic ezetimibe significantly reduced levels of LDL-C in high cardiovascular risk patients with uncontrolled LDL-C level despite the high-potency statin treatment. There was no concern regarding safety issues with the branded generic ezetimibe add-on therapy. Keywords: Low-density lipoprotein cholesterol; Generic ezetimibe; Lipid-lowering; Dyslipidemia
{"title":"Efficacy of Generic Formation of Ezetimibe in Patients with High Cardiovascular Risk Receiving High-Potency Statin","authors":"","doi":"10.35755/jmedassocthai.2023.07.13827","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13827","url":null,"abstract":"Background: Ezetimibe has been recommended to add on statin therapy when maximally tolerated statin cannot achieve low-density lipoprotein cholesterol (LDL-C) target. However, the safety and efficacy of generic formulation of ezetimibe has rarely been reported.\u0000\u0000Objective: To examine efficacy of branded generic ezetimibe in patients with high cardiovascular risk receiving high-potency statin.\u0000\u0000Materials and Methods: The present study was a prospective cohort study in adult patients with high cardiovascular risk receiving atorvastatin 40 mg/day, but the LDL-C level was still higher than 70 mg/dL. Branded generic ezetimibe 10 mg once daily (MiBEAZ™) was added on the highpotency statin therapy as a combination treatment. Lipid parameters were evaluated three months after ezetimibe treatment.\u0000\u0000Results: Of the 61 patients, mean age was 62.4±11.5 years, and 33 (54.1%), were male. Coronary artery disease was reported in 58 patients or 95.1%. The median baseline of LDL-C was 95.0 mg/dL (IQR 79.5, 108.5). At 3-month follow-up, total cholesterol and LDL-C levels were significantly decreased by branded generic ezetimibe add-on therapy. The relative change of LDL-C reduction was 26.3% (IQR –38.8, –11.1, p<0.001). The LDL-C target under 70 mg/dL was attained in 60% of the patients. Triglyceride and high-density lipoprotein cholesterol levels remained unchanged. After ezetimibe medication, there were no differences in renal or hepatic function.\u0000\u0000Conclusion: The authors demonstrated that branded generic ezetimibe significantly reduced levels of LDL-C in high cardiovascular risk patients with uncontrolled LDL-C level despite the high-potency statin treatment. There was no concern regarding safety issues with the branded generic ezetimibe add-on therapy.\u0000\u0000Keywords: Low-density lipoprotein cholesterol; Generic ezetimibe; Lipid-lowering; Dyslipidemia","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79886316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.35755/jmedassocthai.2023.07.13870
Background: Spinal anesthesia is a popular anesthetic of choice for cesarean section but inadequate analgesia may result in delayed ambulation and healing after surgery. Multimodal analgesia is currently applied to decrease the adverse effect of each medication, enhance analgesic efficacy and promote Enhanced Recovery After Surgery (ERAS). Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are recommended for enhanced recovery after cesarean section (ERAC). Objective: To compare the analgesic efficacy of a combination of acetaminophen or selective COX-II inhibitors with intrathecal morphine and intrathecal morphine alone after cesarean section. Materials and Methods: Eighty-eight parturients undergoing cesarean section were divided into three groups. Acetaminophen group: intrathecal morphine 0.1 mg and intravenous acetaminophen 1 gram every 6 hours. Parecoxib group: intrathecal morphine 0.1 mg and intravenous parecoxib every 12 hours. Control group: intrathecal morphine 0.2 mg only. The primary outcome was total morphine consumption in the first 24 hours postoperatively. The secondary outcomes were pain intensity, vomiting episodes, and time to first dose of opioid. Results: The parecoxib group showed total morphine reduction in the first 24 hours of 10.655 mg (95% CI –15.04 to –6.27, p<0.001) compared with the control group. The pain intensity at rest and movement decreased in the parecoxib group compared to the control group at 4, 8, and 12 hours postoperatively (at rest: p=0.020, 0.001, and 0.002, at movement: p=0.002, 0.002, and 0.002). The acetaminophen group showed reduction of the pain intensity at 4 hours postoperative compared with the control group (p=0.011). Vomiting episodes and total ondansetron consumption were lower in the parecoxib group and the acetaminophen group. The parecoxib group also showed prolonged time to first dose of opioid usage. Conclusion: Parecoxib decreased total opioid consumption, decreased postoperative vomiting episodes and increased time for first dose opioid requirement. Acetaminophen also reduced the pain intensity and vomiting at 4 hours postoperative. The alternative and multimodal concepts in intraoperative and postoperative pain medications are the easiest ERAC components to improve outcome for the anesthesiologist. Keywords: Acetaminophen; Cesarean section; COX-II inhibitor; Intrathecal morphine
{"title":"The Comparison of Efficacy between Intrathecal Morphine Combined with Either Intravenous Selective COX-II Inhibitor or Acetaminophen and Intrathecal Morphine Alone for Analgesia after Cesarean Section: A Double-Blinded Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.07.13870","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.07.13870","url":null,"abstract":"Background: Spinal anesthesia is a popular anesthetic of choice for cesarean section but inadequate analgesia may result in delayed ambulation and healing after surgery. Multimodal analgesia is currently applied to decrease the adverse effect of each medication, enhance analgesic efficacy and promote Enhanced Recovery After Surgery (ERAS). Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are recommended for enhanced recovery after cesarean section (ERAC).\u0000\u0000Objective: To compare the analgesic efficacy of a combination of acetaminophen or selective COX-II inhibitors with intrathecal morphine and intrathecal morphine alone after cesarean section.\u0000\u0000Materials and Methods: Eighty-eight parturients undergoing cesarean section were divided into three groups. Acetaminophen group: intrathecal morphine 0.1 mg and intravenous acetaminophen 1 gram every 6 hours. Parecoxib group: intrathecal morphine 0.1 mg and intravenous parecoxib every 12 hours. Control group: intrathecal morphine 0.2 mg only. The primary outcome was total morphine consumption in the first 24 hours postoperatively. The secondary outcomes were pain intensity, vomiting episodes, and time to first dose of opioid.\u0000\u0000Results: The parecoxib group showed total morphine reduction in the first 24 hours of 10.655 mg (95% CI –15.04 to –6.27, p<0.001) compared with the control group. The pain intensity at rest and movement decreased in the parecoxib group compared to the control group at 4, 8, and 12 hours postoperatively (at rest: p=0.020, 0.001, and 0.002, at movement: p=0.002, 0.002, and 0.002). The acetaminophen group showed reduction of the pain intensity at 4 hours postoperative compared with the control group (p=0.011). Vomiting episodes and total ondansetron consumption were lower in the parecoxib group and the acetaminophen group. The parecoxib group also showed prolonged time to first dose of opioid usage.\u0000\u0000Conclusion: Parecoxib decreased total opioid consumption, decreased postoperative vomiting episodes and increased time for first dose opioid requirement. Acetaminophen also reduced the pain intensity and vomiting at 4 hours postoperative. The alternative and multimodal concepts in intraoperative and postoperative pain medications are the easiest ERAC components to improve outcome for the anesthesiologist.\u0000\u0000Keywords: Acetaminophen; Cesarean section; COX-II inhibitor; Intrathecal morphine","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84931383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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