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

PREVALENCE AND ASSOCIATED FACTORS OF MALNUTRITION AMONG ELDERLY PATIENTS AT AN OUTPATIENT CLINIC, COMMUNITY HOSPITAL IN THAILAND: A CROSS-SECTIONAL STUDY

Yanisa Praneetvatakul — 2023-06-12

Background: The number of Thais aged 60 and older has increased dramatically, and this trend will continue, making Thailand an increasingly aging society in the coming decades. The nutritional state of the elderly should be a major priority because it harms mortality and quality of life.

Methods: From August to September 2022, the prevalence and associated determinants of malnutrition were determined based on a survey and hospital records using the Mini Nutritional Assessment (MNA®) as a screening tool for malnutrition among the elderly attending the outpatient department at Bangkhla Hospital. Multinomial regression analysis accounted for any confounding factors yielding an adjusted odds ratio (aOR) and 95% confidence intervals (95%CI).

Results: This study enrolled a total of 91 individuals. Of these, 4.40% (95%CI= 0.01-0.11) of the participants were malnourished, while 18.70% (95%CI=0.11-0.28) were at risk of malnutrition. After controlling for potential confounding factors, a history of Covid-19 was associated with malnutrition (aOR=55.00, 95%CI= 2.70 to 1110.30), cancer (aOR= 25.80, 95%CI= 1.60-409.40) and gouty arthritis (aOR= 8.80, 95%CI= 1.20-59.60) was similarly associated with at risk of malnutrition. However, the protective effect of exercise was associated with malnutrition and risk of malnutrition, respectively (aOR= 0.04, 0.13, 95%CI= 0.00-0.80, 0.00-0.50).

Conclusion: Overall, the study emphasized the significance of addressing malnutrition which was on the rise among the elderly in community hospitals in Thailand, especially in light of the aging population. Health professionals and policymakers should be aware of the various factors associated with malnutrition and strive to implement appropriate interventions to improve the nutritional status and quality of life of the elderly.

COMPARISON OF EFFICACY IN RENOPROTECTION BETWEEN AZILSARTAN AND ENALAPRIL: A RANDOMIZED CONTROLLED TRIAL

Ployrawee Thanaprirax — 2023-06-19

Background: Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) are reported to improve renal outcomes among patients with hypertension and chronic kidney disease (CKD), but there might be substantial differences in their renoprotective effects. Azilsartan medoxomil is a relatively new available ARB, highly specific angiotensin type 1 receptor and superior in terms of blood pressure reduction, with respect to other ARBs.

Methods: The study employed a randomized controlled trial; hypertensive subjects with albuminuria >30 mg/g creatinine at the outpatient clinic, Phramongkutklao Hospital, Bangkok, Thailand were randomly assigned to azilsartan 40-80 mg/day (n=27) or enalapril 10-40 mg/day (n=23) for 24 weeks. The primary outcome was the change in urine albumin creatinine ratio (UACR). UACR, estimated glomerular filtration rate (GFR), blood pressure and serum electrolytes were evaluated at baseline, 12 and 24 weeks.

Results: A total of 50 patients with hypertension and albuminuria were recruited. At the end of treatment, systolic blood pressure level was significantly reduced in the azilsartan group compared with the enalapril group (-12.2 mmHg [95%CI -18.9 to -5.5] vs. -1.1 mmHg [95% -7.8 to 5.7], p=0.021). In addition, at 24 weeks, significantly reduced median UACR was observed in the azilsartan group compared with that of the enalapril group (-59.9 mg/g Cr [95% CI -284.6 to -31.0] vs. -40.4 mg/gCr [95% CI -129.4 to 88.3], p=0.026)). No statistically significant difference was found between the two groups in hyperkalemia, estimated GFR, acute kidney injury and serious adverse events.

Conclusion: This study demonstrated that azilsartan had superior antihypertensive and albuminuric efficacy compared with the standard dose of enalapril without increasing adverse events.

TRIMETHOPRIM-SULFAMETHOXAZOLE FOR PNEUMOCYSTIS JIROVECII PNEUMONIA PROPHYLAXIS AMONG HIV-POSITIVE PATIENTS IN THE ERA OF EARLY ANTIRETROVIRAL THERAPY INITIATION

Wutthiseth Dhitinanmuang — 2023-07-02

Background: Trimethoprim-Sulfamethoxazole (TMP-SMX) is currently recommended for the primary prevention of Pneumocystis jirovecii pneumonia (PCP) among HIV-positive patients whose CD4 count is less than 200 cells/mm3. However, adverse drug reactions (ADR) have been reported among some patients. In the era of early antiretroviral therapy (ART) initiation, the prevalence of PCP has gradually decreased. Therefore, to avoid unnecessary ADR, TMP-SMX might be less beneficial when the patient receives early ART initiation.

Objectives: The study aimed to evaluate the incidence of PCP, all-cause mortality, CD4 count at 6 months after ART, other opportunistic infections (OIs), and ADRs among HIV-positive patients receiving early ART initiation with and without TMP-SMX for PCP prophylaxis.

Methods: This retrospective cohort study was conducted in Ratchaburi Hospital between January 2014 and February 2022. HIV-positive patients with an initial CD4 count <200 cells/mm3 or <14% and receiving early ART initiation within 2 weeks after HIV diagnosis were investigated. Patients with and without TMP-SMX prophylaxis were analyzed in terms of baseline characteristics, the incidence of PCP, all-cause mortality, other OIs and ADRs from TMP-SMX. The ratio of TMP-SMX vs. no TMP-SMX groups was 2:1.

Results: In total, 230 HIV-positive patients presenting an initial CD4 count <200 cells/mm³ or <14% were included in this study. All patients received early ART initiation within 2 weeks after HIV diagnosis and showed good adherence. The incidence of PCP in the TMP-SMX prophylaxis group was 2 of 153 cases (1.31%) and in the no prophylaxis group was 3 of 77 cases (3.89%), OR 0.329; 95% CI, (0.053 – 1.998); p=0.226. CD4 count at 6 months after ART initiation significantly increased in the no prophylaxis group (277.4 vs. 179.5 cells/mm³; mean difference 97.92; 95% CI of difference, (65.15-130.69); p <0.001). All-cause mortality and other bacterial and OIs did not differ between the two groups. All adverse events from TMP-SMX were minor rashes, 13 of 153 cases (8.5%).

Conclusion: Among HIV-positive patients receiving early ART initiation, the incidence of PCP revealed no difference between with and without TMP-SMX prophylaxis. All-cause mortality and rate of OI were also comparable between the 2 groups.

COST-UTILITY OF VARIOUS BIOLOGIC VERSUS ENDOPROSTHETIC RECONSTRUCTION FOR PRIMARY BONE SARCOMA OF THE HUMERUS

Sittichoke Watcharamasbonkkot — 2023-07-15

Background: The development of bone sarcoma treatment has resulted in a higher survival rate of patients including the developed surgical treatment called limb salvage surgery. Reconstructive surgery plays a vital role among patients and their quality of life after treatment. However, cost-effectiveness is another crucial factor in choosing a treatment method.

Methods: Eighteen patients with osteosarcoma were recruited in this study. All were treated using limb salvage surgery. The data were collected using the utility coefficient from the EQ-5D-5L Health Questionnaire. The patient’s medical cost was obtained from Phramongkutklao Hospital, and all data were calculated for cost-effectiveness using the cost-utility analysis.

Results: Endoprosthesis reconstruction exhibited the highest utility value of 0.85 QALY and the lowest treatment complications. Nevertheless, the most increased cost was an average of 238,432.34 THB. In terms of cost, the recycled autograft showed the lowest treatment cost at an average of 60,774.61 THB. However, the complication of this method was quite severe, with a 50% recurrence rate. Allograft reconstruction was the most cost-effective method with a lower cost than endoprosthesis reconstruction (61,341.40 THB), despite having a lower utility of 0.49 QALY.

Conclusion: This study reported that endoprosthesis reconstruction resulted in more optimistic patient well-being but still indicated high cost. Using one-way sensitivity analysis, the QALY gain was only 16.9% of Thai per capita. When the cost of endoprosthesis reconstruction was reduced by only 15%, it could replace allograft reconstruction. In addition, an increase of the QALY, gaining only 20% of the average Thai per capita, would be cost-effective when the expense of endoprosthesis reconstruction was reduced by 4%.

INCIDENCE AND RISK FACTORS FOR RAPID DECLINE OF PRESERVED ESTIMATED GLOMERULAR FILTRATION RATE AMONG PATIENTS WITH HYPERTENSION IN A COMMUNITY HOSPITAL

Rada Thiannitiworakun — 2023-07-21

Background: Hypertension is the second most common leading cause of chronic kidney disease. Related studies explored the causes of the rapid decline of kidney function in advanced kidney disease. However, the causes of the rapid decline of kidney function in the early stage or preserved function of hypertensionrelated kidney disease are less evident.

Objectives: The study aimed to identify the incidence and associated risk factors for the decline of the glomerular filtration rate (GFR) among patients with hypertension with preserved kidney function, estimated GFR (eGFR) above 60/mL/min/1.73m², at a community hospital.

Methods: A retrospective cohort study was conducted among patients with hypertension with 2 eGFR measures at least 1 year apart and were identified from all cases attending at the Outpatient Department, Sanam Chai Khet Hospital, Chachoengsao Province. The incidence of the estimated rate of eGFR decline greater than 5 mL/min/1.73m² yearly (ERGFR5/yr) was determined. In addition, potential risk and protective factors were identified using Poisson Regression.

Results: Of 1,328 patients with hypertension, 53.05% were females. The mean age was 59.68 ± 11.58 years. The mean GFR measure at the 1st visit was 88.71± 14.73 mL/min/1.73m². The incidence of ERGFR5/yr was 11.1 (95% CI: 10.1-12.3)) per 100-person year. Risk factors were being 60 years or older with an incidence rate ratio (IRR) of 1.4 (95% CI: 1.11-1.77), having diabetes mellitus with an IRR of 1.67 (95% CI: 1.37-2.04) and uncontrolled hypertension with an IRR of 1.15 (95% CI: 1.10-1.20).

Conclusion: The incidence of ERGFR5/yr among renal preserved patients with hypertension was relatively low compared with other studies. Aggressive intervention among patients with comorbidity could reduce the incidence of rapid decline in eGFR.

TRENDS IN THE PREVALENCE OF TYPE 2 DIABETES AMONG ROYAL THAI ARMY PERSONNEL AND ASSOCIATED FACTORS FROM 2017 TO 2021

Boonsub Sakboonyarat — 2023-08-11

Background: Diabetes is one of the essential noncommunicable diseases associated with an increased risk of atherosclerosis and cardiovascular diseases. However, limited information is available regarding type 2 diabetes (T2D) among Royal Thai Army (RTA) personnel.

Objectives: The present study aimed to determine the prevalence of T2D among RTA personnel and its associated factors.

Methods: We carried out a serial cross-sectional study from 2017 to 2021. A total of 235,491 active-duty RTA personnel aged 35–60 years were included in the study. We defined T2D as fasting plasma glucose ≥126 mg/dL or having a history of T2D diagnosed by medical personnel, or having a history of taking antihyperglycemic medication. We used a multivariable logistic regression model to estimate adjusted prevalence ratios (APR) and 95% confidence intervals (CIs) for behavioral factors associated with T2D.

Results: Age- and sex-adjusted T2D prevalence among RTA personnel was 17.9% (95% CI 17.5%- 18.2% in 2017 and then decreased to 16.5% (95% CI 16.1%–16.8%) in 2021 (p for trend < 0.001). The age-adjusted prevalence of T2D among males and females was 17.6 (95% CI 17.4%–17.8%) and 11.3 (95% CI 11.0%–11.7%), respectively. The independent behavioral factors associated with T2D included current cigarette smoking (APR 1.12; 95%CI 1.10-1.14), current alcohol use (APR 1.03; 95%CI 1.01-1.05), regular exercise (APR 0.89; 95%CI 0.87-0.90), body mass index ≥30 kg/m2 (APR 2.21; 95%CI 2.15-2.27) and hypertension comorbidity (APR 3.97; 95%CI 3.88-4.05).

Conclusion: Our study indicated that T2D is a common health issue, especially among males, higher-aged participants and RTA personnel residing in Bangkok and the northeast. Cigarette smoking, alcohol use, and sedentary behavior played an essential role in the prevalence of T2D in this population. Furthermore, obesity and HT comorbidity were related to T2D.

RELIABILITY, VALIDITY AND AGREEMENT OF THE THAI SELF-REPORTED FIBROMYALGIA SURVEY QUESTIONNAIRE AMONG PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN

Nutta Wongthanavimok — 2023-08-22

Background: Fibromyalgia (FM) diagnosis is typically based on the American College of Rheumatology (ACR) criteria, relying on patient-reported symptoms. The Thai self-reported Fibromyalgia Survey Questionnaire (FSQ) was developed based on the 2016 version of the ACR criteria set.

Objectives: This study aimed to evaluate the internal consistency, convergent validity and agreement of the self-reported FSQ compared with the telephone interview of a physician among patients with chronic musculoskeletal pain.

Methods: The Thai FSQ consisting of 25 questions: 19 for widespread pain index (WPI) and 6 for symptom severity scale (SSS), was developed by three Thai physiatrists. The fibromyalgia severity (FS) scale (the sum of WPI and SSS: 0-31) of 13 or more was used to diagnose fibromyalgia. All participants completed a self-reported paper research questionnaire in a private room. Then 24-48 hours later, participants underwent a telephone interview with the Thai FSQ. The internal consistency and convergent validity of the Thai self-reported FSQ were assessed using Cronbach’s alpha and Pearson’s correlation, respectively. The agreement between the Thai self-reported FSQ (FS scale ≥13) and the telephone interview using the 2016 ACR criteria for diagnosing fibromyalgia was evaluated using Cohen’s kappa.

Results: Of 89 participants, the majority were females (66.3%) with a mean age of 53.5±15.9 years and had an educational level of bachelor’s degree or higher (79.7%). Cronbach’s alpha was 0.82, while the correlation between the FS scale and EQ-5D-5L utility was -0.48 (p <0.001). Cohen’s kappa for diagnosis agreement was 0.55 (p < 0.001).

Conclusion: The Thai self-reported FSQ exhibited good internal consistency and moderate construct validity. The diagnostic agreement of the Thai self-reported FSQ with the telephone interview was moderate. Although this questionnaire could be used as a screening tool, physicians would need to confirm the diagnosis of fibromyalgia.

EFFICACY OF LACTOSE-FREE FORMULA AS A 24-HOUR MANAGEMENT APPROACH FOR ACUTE DIARRHEA AMONG CHILDREN

Praewwanit Nitayakul — 2023-08-22

Background: Diarrhea continues to be a prominent contributor to morbidity and mortality among young children under five years, especially in developing nations. Secondary lactose intolerance is a significant complication that can arise from acute diarrhea. However, it can be effectively managed with lactose-free formula.

Objective: This study aimed to compare the rate of diarrhea resolution within a 24-hour period among children receiving lactose-free formula and those receiving lactose-containing formula.

Methods: This retrospective cohort study took place at Naresuan University Hospital and included 153 children aged between one month and five years admitted with acute diarrhea. Participants with bloody mucous diarrhea suspected to be bacterial in nature, positive stool culture, breastfeeding and chronic diarrhea (including cow’s milk protein allergy and inflammatory bowel disease) were excluded. We compared the effectiveness of lactose-free formula (n=48) and lactose-containing formula in improving clinical diarrhea within a 24-hour (n=105).

Results: The study findings indicated the lactose-free formula group demonstrated a statistically significant increase in efficacy, with a 3.90 fold improvement in diarrhea within 24 hours compared with that of the group receiving lactose-containing formula. These results were obtained after the confounding factors were adjusted using multivariable regression analysis. The adjusted relative risk (RR) for a 24-hour improvement in diarrhea was 3.90 (95% CI: 1.91-7.95). However, this study encountered limitations regarding the sample size and accurate measurement of stool output.

Conclusion: Lactose-free formula showed the potential for greater effectiveness in improving acute diarrhea within a 24-hour timeframe compared with lactose-containing formula.

UNUSUAL PRESENTATION OF MALIGNANT THYMOMA ASSOCIATED NEPHROTIC SYNDROME WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS: A CASE REPORT

Kamolphop Koomtanapat — 2023-07-18

Paraneoplastic syndromes (PS) are the consequences of hormones or immune cross-reactivity produced by a tumor. Nephrotic syndrome (NS) is an extremely rare PS resulting from a thymoma. Here, the case of a 55-year-old woman presenting progressive generalized edema and foamy urine is reported. The patient’s chest CT scan showed anterior mediastinum with intramural punctate calcification size 8.6x7.0x10.2 cm. The case was reviewed at the multi-dispensary team conference, and the clinical diagnosis was an unusual presentation of malignant thymoma known as NS. After that, a thymectomy and kidney biopsy was performed. Histopathologic examination showed Thymoma type B and focal segmental glomerulosclerosis, respectively. Therefore, we considered it paraneoplastic nephrotic syndrome (PNS), without glucocorticoids, immunosuppressants or other drugs to treat NS. After the thymectomy, her clinical spontaneous resolved at the first follow-up, proposing a causative relationship between the two conditions.

PERIPROSTHETIC JOINT INFECTION AFTER WIDE RESECTION BONE TUMOR AND ENDOPROSTHETIC RECONSTRUCTION IN A PATIENT WITH OSTEOSARCOMA: A CASE REPORT

Puwadon Veerapan — 2023-08-30

Bone and connective tissue cancer treatment has been improved to achieve a significant survival rate. Limb salvage surgery, an efficient surgical technique, has been established to preserve limbs. Endoprosthesis reconstruction constitutes an essential part of the treatment method, and the attending medical team requires knowledge to reduce the side effects of this operation. The consequential infection is a common complication, often leading to worse use of the limbs when finishing the treatment. This report describes a patient presenting an infection in a prosthesis after endoprosthesis reconstruction using a limb salvage surgery technique. Due to the comprehensive resection surgery, the typical structure has been significantly damaged, which could lead to a high risk of neurovascular structure damage during adequate debridement and lead to the need for amputation. Thus, the decision to treat an infection resulted in patients undergoing multiple surgeries and reducing their functional outcomes until crucial. These patients should be carefully monitored to prevent infection and obtain a good quality of life in the long term.