Journal of Southeast Asian Medical Research

COGNITIVE FUNCTIONS AMONG PATIENTS WHO RECOVERED FROM COVID-19

Sirinapa Saneemanomai — 2023-03-02

Introduction: The Coronavirus disease 2019 (COVID-19) spread, causing a worldwide pandemic and affecting multiple organs and systems. The possible long-term sequelae of COVID-19 have become an increasing concern. Currently, little information exists about prolonged COVID-19 affects related to cognitive functions.

Objective: The study aimed to investigate the cognitive functions of patients who recovered from COVID-19 at least three months after the diagnosis.

Methods: A cross-sectional study was conducted to investigate cognitive functions among 150 employees of Buddhasothorn Hospital, Chachoengsao, Thailand. Of these, 75 employees had a history of COVID-19 at least three months after the diagnosis. Demographic characteristics were recorded and screened for depression, anxiety and insomnia. They were tested for their cognitive functions using the Montreal Cognitive Assessment (MoCA) and compared with 75 employees without a history of COVID-19.

Results: All postCOVID-19 cases presented mild COVID-19 symptoms. The results showed that 96% of COVID-19 in both groups, cases and the healthy group, had normal cognitive functions using the MoCA that did not significantly differ. However, the depression score in the postCOVID-19 cases was significantly higher than that of the participants without a history of COVID-19 (1.09 ± 1.36 and 0.61 ± 1.09, respectively (p = 0.018). Regression analysis between the postCOVID-19 cases and depression using multivariate analysis showed that the postCOVID-19 cases were associated with depression scale (β coefficient=0.470; 95%CI: 0.073, 0.867, respectively), after adjusting for age, sex, educational level and underlying diseases.

Conclusion: The cognitive functions of employees having a history of COVID-19 and without infection did not differ.

COMPARISON OF ANALGESIC EFFICACY BETWEEN ULTRASOUND-GUIDED ILIOHYPOGASTRIC/ILIOINGUINAL NERVE BLOCK AND WOUND INFILTRATION AMONG PATIENTS UNDERGOING GYNECOLOGIC SURGERY: A RANDOMIZED CONTROLLED TRIAL

Teerawat Poojinya — 2023-03-22

Background: Postoperative pain control is essential after surgery to ensure early mobilization, decrease the length of hospital stay and provide patient comfort. Local anesthetic (LA) wound infiltration has been used to reduce postoperative pain. In addition, the bilateral iliohypogastric/ilioinguinal nerve block (IINB) has been used to control pain in abdominal surgery but not in gynecologic or pelvic surgery.

Objectives: This study aimed to evaluate the efficacy of ultrasound-guided iliohypogastric/ ilioinguinal nerve block compared with local anesthetic wound infiltration on postoperative pain control among patients undergoing gynecologic surgery through a Pfannenstiel incision.

Methods: In this prospective, double-blinded, randomized controlled trial, 50 patients were allocated to either an IINB group (N=25) or LA group (N=25). In both groups, postoperative IV patient-control analgesia (PCA) was planned 24 hours, postoperatively. The primary outcomes were differences in pain score using a numerical rating scale (NRS) and morphine consumption between both groups immediately following 2, 4, 8, 12 and 24 hours, postoperatively.

Results: The postoperative pain scores were significantly lower in the IINB group than in the LA group at all time points, with p <0.05. Total morphine consumption for 2-24 hours postoperative was significantly lower in the IINB group than in the LA group with p <0.001.

Conclusion: Compared with LA wound infiltration, this study demonstrated that IINB provided better pain control and reduced the consumption of morphine in the first 24 hours among patients undergoing gynecologic surgery through a Pfannenstiel incision.

PREVALENCE, ASSOCIATED FACTORS AND REINTERVENTION RATE OF ENDOLEAKS AFTER THORACIC ENDOVASCULAR AORTIC REPAIR AMONG PATIENTS WITH THORACIC AORTIC ANEURYSMS, PHRAMONGKUTKLAO HOSPITAL, BANGKOK, THAILAND

Dithapol Wongcharoendham — 2023-04-08

Background: Endoleaks are one of the complications seen after endovascular repair of thoracic aortic aneurysms (TAA). The study evaluated the prevalence, associated factors and reintervention rate, the classified type of endoleaks and the outcomes of secondary interventions among patients with endoleaks.

Methods: Between 2010 and 2020, medical and radiologic data of all patients receiving a diagnosis of TAA treated by thoracic endovascular aortic repair (TEVAR) and undergoing postoperative CT angiogram at Phramongkutklao Hospital were retrospectively reviewed and analyzed.

Results: Over a median follow-up of 569 days (IQR=93-1256), 6 of 26 (23.08%) patients developed endoleaks, of which 50% (3 of 6) were type I, 16% (1 of 6) were type II, IV and V each and none were type III. The median aneurysm diameter was 62 mm (IQR=52.5-75.5). Endoleaks were associated with younger age (p<0.05) and a higher percentage of graft oversizing over the aorta distal to the aneurysm (p=0.014). All patients with endoleaks underwent reintervention (100%) with good outcomes.

Conclusion: Endoleaks were detected in one of the four patients treated with TEVAR during follow-up, particularly when they were young or exhibited a too oversized graft over the aorta distal to the aneurysm. All patients with endoleaks underwent reintervention with good outcomes.

IMPACT OF THE COVID-19 PANDEMIC ON FRAGILITY HIP FRACTURE MANAGEMENT AND MORTALITY RATE

Tana Rattanakitkoson — 2023-05-12

Background: The COVID-19 pandemic has greatly affected patients without COVID, including osteoporotic hip fractures. Treatment protocols and time for surgery have been disrupted and delayed resulting in unsatisfactory outcomes. This study compared the mortality rate among patients with osteoporotic hip fractures during the COVID-19 pandemic and during the prepandemic periods.

Methods: The patients’ information recorded in the Fracture Liaison Service (FLS) registry was retrospectively reviewed. We defined the prepandemic group as the admissions between May 2019 and March 2020 and the pandemic group as admissions from April 2020 to February 2021. The demographic data were collected, including serum calcium and 25(OH)D levels. Time to surgery, postoperative complications, length of stay and death were obtained and compared between the two periods.

Results: We included 813 patients, with 444 and 369 patients in the prepandemic and the pandemic groups, respectively. Mean age, sex and comorbidities were comparable in both groups. The proportion of patients with insufficient and deficient vitamin D was significantly higher in the pandemic group (46.41 vs. 62.85%, p<0.01). Time to surgery and length of hospital stay was significantly longer in the pandemic period (p <0.05). The mortality was higher but did not significantly differ in the pandemic period with an adjusted hazard ratio of 1.08 (95% CI = 0.76-1.54).

Conclusion: Properly managing hip fractures during the pandemic is crucial to prevent and reduce morbidity and mortality. Inadequate serum vitamin D level has been noted in the pandemic group but was not associated with mortality rate.

DIAGNOSTIC VALUE OF MEDIAN NERVE CONDUCTION VELOCITY ACROSS WRIST AMONG PATIENTS WITH SUSPECTED CARPAL TUNNEL SYNDROME

Chanasak Hathaiareerug — 2023-05-13

Background: Carpal Tunnel Syndrome (CTS) is the most prevalent type of compressive neuropathy. At present, electrodiagnosis is considered the gold standard in diagnosing CTS. However, no clear cutoff point has been established regarding the diagnostic value of the median nerve conduction velocity, across the carpal tunnel area, among patients with CTS.

Objectives: This study aimed to determine the cutoff point for patients’ median nerve conduction velocity (NCV), to diagnose CTS among suspected patients, which is determined using electrical stimulations conducted across the carpal tunnel area. The present study also aimed to determine the diagnostic value of the median nerve conduction velocity across the carpal tunnel area, compared with the standard method.

Methods: This cross-sectional study was conducted among 56 participants (106 wrists) suspected of CTS. Motor and sensory NCV across the carpal tunnel was investigated to yield diagnostic value of CTS compared with the standard technique.

Results: The optimal cutoff point in diagnosing CTS using the wrist to midpalm conduction velocity, was 40 m/s (with a sensitivity of 87.04% and specificity of 87.18%) for the sensory nerve conduction study, and 35 m/s (with a sensitivity of 88.06% and specificity of 89.74%) for the motor nerve conduction study.

Conclusion: Our study determined that the optimal cutoff conduction velocities for CTS diagnosis, using the wrist-to-midpalm electrical stimulation method, was 40 m/s for the sensory nerve, and 35 m/s for the motor nerve.

COMPARISON OF THE EFFECTIVENESS OF REMDESIVIR VERSUS FAVIPIRAVIR ON CLINICAL IMPROVEMENT AND MORTALITY AMONG PATIENTS WITH COVID-19 PNEUMONIA: A RETROSPECTIVE SINGLE-CENTER STUDY

Sarawut Krongsut — 2023-05-13

Background: Antiviral drug administration in the early phase of COVID-19 during peak viremia can reduce the progression to severe disease. The optimal antiviral treatment against severe coronavirus disease 2019 (COVID‐19) has not been proven.

Objective: The study aimed to examine the effectiveness of remdesivir versus favipiravir to treat patients with COVID-19 pneumonia on clinical improvement and mortality.

Methods: This retrospective observational cohort study was conducted in the modular intensive care unit and cohort ward from 1 June 2021 to 31 December 2021. Patients were screened for COVID-19 pneumonia. A propensity score was used to handle selection bias and potential confounding factors. The propensity score estimation was obtained from the multivariable logistic regression model, including prognostic covariates. Then 1:1 matching was performed. Finally, the balance after matching was checked concerning the p-value.

Results: Overall, 362 patients were matched using propensity score analysis; they were enrolled and divided in 2 groups: remdesivir and favipiravir (181:181). Remdesivir was associated with an increased proportion of clinical improvement (70.72 vs. 56.91%, adjusted HR=1.52 [1.16-2.01]; p=0.002), reduced inhospital mortality (adjusted HR=0.68 [0.47-0.99]; p=0.047), an increased proportion of being free from the use of a high flow nasal cannula (HFNC) and a low flow oxygen cannula (LFNC) (74.34 vs. 56.10%, adjusted HR 1.79 [1.32-2.45]; p<0.001; 86.4% vs. 74.8, adjusted HR=1.34 [1.01-1.78]; p=0.037, respectively), increased median survival time (26 vs. 24 days, median survival time difference of 2 days [IQR, 2-6]; p=0.048). In addition, patients treated with remdesivir showed a significantly higher proportion of discharge from the hospital measured using the WHO ordinary scale (66.85 vs. 53.04%, adjusted HR =1.19 [1.01-1.41]; p=0.035).

Conclusion: Among hospitalized patients with COVID-19 pneumonia, receiving oxygen supplementation, remdesivir was associated with increased clinical improvement, reduced in-hospital mortality and reduced need for HFNC and LFNC.

EFFECT OF AGOMELATINE AND SERTRALINE ON SLEEP QUALITY AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE AND MAJOR DEPRESSIVE DISORDER: A DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL

Witchakorn Trisukon — 2023-05-16

Background: Depression is a common comorbid disease among patients with chronic kidney disease (CKD). Insomnia, a symptom related to these conditions, negatively impacts disease progression and quality of life. Unfortunately, no consensus has been reached concerning treatment guidelines and choices of antidepressants suitable for treating depression among patients with CKD.

Objectives: The study aimed to evaluate the efficacy to sleep quality, depressive symptoms, safety and tolerability of agomelatine and sertraline in treating major depressive disorder among patients with CKD.

Methods: A double-blinded randomized controlled trial was conducted in the Nephrology Unit, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand. Patients with CKD and a diagnosis of major depressive disorder were randomly assigned to receive once-daily, fixed-dose sertraline 50 mg/d and agomelatine 25 mg/d. The treatment outcome was evaluated at 4 and 8 weeks. The Pittsburgh Sleep Quality Index score (PSQI) was used to measure sleep quality, and the Hamilton rating scale of depression, the Thai version (Thai HRSD-17), was used to evaluate depressive symptoms. Other outcomes included overall quality of life, side effects and tolerability.

Results: Agomelatine significantly improved sleep quality based on PSQI score throughout the observed period (p=0.002). Also, agomelatine more efficiently reduced depressive symptoms than sertraline (p=<0.001). In addition, patients receiving agomelatine as a treatment could continue their medication, whereas 52% of patients receiving sertraline discontinued because of side effects.

Conclusion: Agomelatine significantly improved sleep quality and tolerated well compared to sertraline.

Trial registration: thaiclinicaltrials.org ID: TCTR20200319005