Journal of Southeast Asian Medical Research Journal of Southeast Asian Medical Research Phramongkutklao Hospital Foundation en-US Journal of Southeast Asian Medical Research 2586-8241 <p><span style="color: #000000; font-family: Arial, sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Copyright to all published articles will be held by Journal of Southeast Asian Medical Research. Copyright forms are handled by the production department of the publisher once a manuscript is accepted and scheduled for publication.</span></p> FREQUENCIES OF PREDICTED MIA ANTIGEN AMONG SOUTHERN THAI BLOOD DONORS <p><strong>Background:</strong> The Mi<sup>a</sup> antigen (MNS7) of the MNS blood group system is clinically important in Asian populations. Anti-Mi<sup>a</sup> has been implicated in hemolytic transfusion reactions and hemolytic disease of the fetus and newborn in Thai populations. However, data of this antigen frequency among southern Thais remains unknown.</p> <p><strong>Objective:</strong> This study aimed to determine and predict Mi<sup>a</sup> antigen frequencies among southern Thai blood donors and to estimate the risk of alloimmunization among Thais.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted. Altogether, 400 southern and 500 central Thai blood samples were genotyped for <em>GYP(B-A-B)</em> and <em>GYP(A-B-A)</em> MNS hybrids using polymerase chain reaction with sequence-specific primer (PCR-SSP).</p> <p><strong>Results:</strong> Among them, 19 of 400 (4.45%), and 28 of 500 (9.33%) were positive with the set of GP. Hut, GP.HF, GP.Mur, GP.Hop, and GP.Bun. No GP.Vw phenotype was found among southern and central Thais. The predicted Mi(a+)frequency among southern Thais was significantly lower than among central and northern Thais (<em>p</em>&lt;0.05). Its frequency was similar to Vietnamese, Taiwanese, and Southern Han Chinese populations (<em>p</em>&gt;0.05) but significantly differed from Indonesian, Filipino, and Chinese (Guangzhou) populations (<em>p</em>&lt;0.05). The risk of Mi<sup>a</sup> alloimmunization among southern Thais was significantly lower than among both Thai groups (<em>p</em>&lt;0.05).</p> <p><strong>Conclusion:</strong> This constitutes the first study to report Mi(a+) frequencies among southern Thais, supporting the estimation risk of alloimmunization and providing transfusion safety among Thai populations.</p> Warunrat Khosidworachet Supratta Mitundee Kamphon Intharanut Sasitorn Bejrachandra Oytip Nathalang Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-02-17 2022-02-17 6 e0107 e0107 10.55374/jseamed.v6i0.107 ZERO-PROFILE DEVICE IMPLANTATION IN ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SINGLE INSTITUTE EXPERIENCE <p><strong>Background:</strong> A surgical procedure, anterior cervical discectomy and fusion (ACDF), is used for neural decompression in degenerative cervical disk disease and cervical spondylosis. A new type of cervical interbody cage, the Zero-profile device (ZPD), has been developed which could reduce postoperative complications among patients.</p> <p><strong>Objectives:</strong> The study aimed to examine the effect of ZPD on clinical outcomes and cervical spine alignment of enrolled patients at 1-year follow-up in the management of ADCF.</p> <p><strong>Methods:</strong> This study retrospectively evaluated the clinical and radiographic outcomes using the Zero-profile device (ZPD) in the anterior cervical discectomy and fusion (ACDF). All patients who underwent ACDF at Vajira Hospital between May 2017 and June 2021 were included in this study. Radiographic images obtained from picture archiving and communication systems (PACS) were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), and intervertebral disk height. The Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) were obtained from the patients’ medical records. The preoperative DLCA, SCA, GCA, SVA, and intervertebral disk height measurements were compared with the postoperative measurements at 1 year.</p> <p><strong>Results:</strong> A total of 31 patients (45 disks) who underwent ACDF with the ZPD were included in this study. A significant improvement was found in JOA, VAS, DLCA, SCA, GCA, SVA, and intervertebral disk height after ACDF with ZPD (<em>p</em>&lt;0.001). Immediate postoperative dysphagia occurred in two patients (6.5%), which resolved after 3 months. No subsidence was reported at 1-year follow-up. Age, BMI as well as the preoperative cervical alignment did not affect outcomes in this study.</p> <p><strong>Conclusion:</strong> The use of the ZPD in ACDF improved clinical and radiographic outcomes in the correction of cervical spine alignment, and minimized postoperative complications of dysphagia. No device-related failure occurred, and favorable outcomes persisted at 1-year follow-up.</p> Nattawut Niljianskul Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-02-18 2022-02-18 6 e0104 e0104 10.55374/jseamed.v6i0.104 CUT OFF VALUE OF GOOD PRONOSTIC FACTOR OUTCOMES IN LARGE TERRITORY ISCHEMIC STROKE UNDERGOING EARLY DECOMPRESSIVE CRANIECTOMY <p><strong>Background:</strong> Decompressive craniectomy (DC) significantly reduces mortality in large territory ischemic strokes that develop intractable cerebral edema. However, evidence for functional benefit remains sparse and contradictory.</p> <p><strong>Objective:</strong> This study aimed to assess cut-off value for predictor outcomes of early DC.</p> <p><strong>Methods:</strong> We conducted a prospective, observational cohort study from December 2016 to June 2021. Patients were screened for ischemic stroke involving the middle cerebral, internal carotid artery or both using the National Institutes of Health Stroke Scale score. All patients underwent DC. Multivariate analysis was performed for an array of clinical variables in relation to functional outcomes according to the modified Rankin Scale (mRS) and Pearson’s correlation coefficient analysis. Clinical outcome was assessed after 3- and 6-month follow-up.</p> <p><strong>Results:</strong> In total, 243 patients were included in this study. Age ≤71 years (AUC=0.955, <em>p</em> &lt;0.001 accuracy 89.7%), onset to DC ≤9 hours (AUC=0.824, <em>p</em> &lt;0.001 accuracy 78.8%), volume of infarction ≤155 cm3 (AUC=0.939, <em>p</em> &lt;0.001 accuracy 93.6%) and the Alberta Stroke Program Early CT Score or ASPECT score ≥6 (AUC = 1, <em>p</em> &lt;0.001 accuracy 100%) were significantly associated with good clinical outcomes in early DC (mRS 0 to 3).</p> <p><strong>Conclusion:</strong> Among patients with large territory ischemic strokes undergoing early DC, age ≤71 years, onset to DC ≤9 hours, volume of infarction ≤155 cm3 and ASPECT score ≥6 was significantly associated with good clinical outcomes. All prognostic factors in early DC correlated well with functional outcomes at 6 months which could be used to predict outcome, and consider clinical indications and informed postoperative complications among patients with large territory ischemic stroke.</p> Panu Boontoterm Siraruj Sakoolnamarka Pusit Feungfoo Chesda Udommongkol Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-17 2022-03-17 6 e0102 e0102 10.55374/jseamed.v6i0.102 PREVALENCE AND RISK FACTORS OF VITAMIN D INADEQUACY AMONG THAI ELDERLY PATIENTS WITH OSTEOPOROTIC HIP FRACTURE <p><strong>Background: </strong>Vitamin D deficiency directly impacts bone biology, eventually resulting in elevated risk of fragility fracture. Despite its global abundance, data concerning its prevalence and risk factors among Thai patients with osteoporotic hip fractures remains lacking.</p> <p><strong>Objectives</strong>: This study aimed to evaluate the average level of serum vitamin D, prevalence of hypovitaminosis D and its risk factor among Thai elderly patients with fragility hip fractures.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among Thai patients with fragility hip fractures aged 60 years or older in a single center from April 2016-April 2020. The patients were divided according to serum 25-hydroxy vitamin D (25-(OH)D) levels. Demographic data were compared to identify risk factors of vitamin D inadequacy.</p> <p><strong>Results: </strong>Of 258 patients, 74.81% were females with mean age of 78.76 years. The average serum 25(OH)D level was 19.64 ng/mL. Prevalences of vitamin D inadequacy, vitamin D insufficiency and vitamin D deficiency were 86.05, 28.69 and 57.36%, respectively. When compared with the vitamin D sufficiency group, the vitamin D inadequacy group had a history of frequent falls, higher body mass index (BMI) as well as high parathyroid hormone (PTH) levels.</p> <p>&nbsp;Risk factors associated with vitamin D inadequacy were BMI <u>&gt;</u>23 kg/m<sup>2</sup> (AOR= 4.67, 95%CI=1.24-17.73), and two or more falls within a year (AOR= 3.96, 95%CI=1.38-11.33). Moreover, risk factors associated with vitamin D deficiency were being female (AOR= 2.87, 95%CI=1.06-7.78), BMI <u>&gt;</u>23 kg/m (AOR=7.20, 95%CI =1.67-31.02), two or more falls within one year (AOR=7.32, 95%CI =2.17-24.69) and elevated PTH level (AOR= 3.38, 95%CI=1.17-0.74).</p> <p><strong>Conclusion: </strong>Most elderly patients with fragility hip fractures had hypovitaminosis D. Risk factors included high BMI, frequent falls for vitamin D inadequacy, being female and high PTH levels for vitamin D deficiency. Serum 25(OH)D assessment and appropriate supplement are recommended, especially for patients with fragility hip fractures and aforementioned risk factors.</p> Tanawat Amphansap Pipat Wongthanakitcharoen Nitirat Stitkitti Worawut Chaiyosburana Atiporn Therdyothin Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-17 2022-03-17 6 e0110 e0110 10.55374/jseamed.v6i0.110 USE OF TENSION BAND WIRING TECHNIQUE IN PROXIMAL ULNAR FRACTURES: A FINITE ELEMENT BIOMECHANICAL ANALYSIS <p><strong>Background:</strong> Tension band wiring is considered the standard treatment for olecranon fracture. A recentstudy proved that it can be used for the fracture as distal to the coronoid process.</p> <p><strong>Objective:</strong> The study aimed to investigate whether tension band wiring can be used in proximal ulnarfracture fixation up to and distal to the coronoid process.</p> <p><strong>Methods:</strong> Models of simple proximal ulnar fracture including 4 intraarticular and 2 extraarticularfractures were created. Fixation was completed using tension band wiring technique, and biomechanicalresponses were evaluated using finite element analysis. After a physiologic load was applied, thefracture displacement, von Mises stress, and stiffness were recorded.</p> <p><strong>Results:</strong> All fracture models were able to withstand the load of daily activities with a maximumdisplacement of 50% of the articular surface. In addition, the von Mises stress was the highest in themiddle articular fracture. The mean transcortical K-wire tension band wiring stiffness of the intraarticular and extra-articular fractures was 1144.89 N/mm and 1231.45 N/mm, respectively.</p> <p><strong>Conclusion:</strong> Tension band wiring is another option to treat proximal ulnar fractures with the ability towithstand immediate postoperative load.</p> Woraphon Jaroenporn Vajarin Phiphobmongkol Jaruwat Vechasilp Thanupat Kulsinsap Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-17 2022-03-17 6 e0099 e0099 10.55374/jseamed.v6i0.99 THE PSYCHOLOGICAL IMPACT AND COPING AMONG MEDICAL STUDENTS IN PHRAMONGKUTKLAO COLLEGE OF MEDICINE DURING THE COVID-19 PANDEMIC <p><strong>Background:</strong> The COVID-19 pandemic has impacted on medical education and other areas of life causing psychological distress.</p> <p><strong>Objectives:</strong> The study aimed to assess psychological impact and coping and to identify factors associated psychological impact among medical students.</p> <p><strong>Methods:</strong> An online cross-sectional study was conducted at Phramongkutklao College of Medicine (PCM) in April 2021. All medical students were invited to complete a standardized online questionnaire for demographics data, impact of COVID-19, coping, fear of illness and virus evaluation (FIVE). The Depression Anxiety Stress Scales (DASS-21) Thai version was used to assess the psychological impact. The factors associated with depression, anxiety and stress were analyzed using logistic regression analysis.</p> <p><strong>Results:</strong> In total, 256 medical students completed the questionnaire. Of these, 54.7% reported having psychological impact, 43.4% depression, 36.7% anxiety and 29.7% stress. Depression was associated with preclinical students (adjusted OR(AOR) =3.03, 95% confidence interval (95% CI) =1.54-5.97), sleep problem (AOR =2.20, 95% CI=1.16-4.16) and extreme deterioration of family income (AOR =7.27, 95% CI=1.81-29.29). Anxiety was associated with preclinical students (AOR =3.20, 95% CI=1.52-6.72), COVID-19 like symptoms (AOR =2.93, 95% CI=1.26-6.83), slight problems adjusting to new learning methods (AOR =6.11, 95% CI=1.54-24.24) and extreme deterioration of family income (AOR =8.29, 95% CI=1.44-47.59). Stress was associated with preclinical students (AOR =3.84, 95% CI=1.75-8.40), COVID-19-like symptoms (AOR =3.54, 95% CI=1.53-8.19), and no confidence in COVID-19 policy of PCM (AOR =2.3, 95% CI=1.06-4.98). A positive correlation between Fear of Illness and Virus Evaluation (FIVE) and psychological impact was observed (r=0.449; <em>p</em>&lt;0.001). Common coping activities were the use of social media, video chats and exercise.</p> <p><strong>Conclusion:</strong> A high prevalence of psychological impact was observed among medical students during the COVID-19 pandemic. To establish psychological support and resilience, training is needed to improve mental wellbeing and prepare medical students to cope with unprecedented situations.</p> Poomwit Puttakiaw Thiraporn Tangjittiporn Boonsub Sakboonyarat Nawaporn Hirunviwatgul Wantipa Wittayasai Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-23 2022-03-23 6 e0106 e0106 10.55374/jseamed.v6i0.106 CORRELATION BETWEEN CLINICAL AND PATHOLOGIC FEATURES OF DIABETIC NEPHROPATHY <p><strong>Background:</strong> Diabetic nephropathy is the most common cause of end stage renal disease in Thailand. Renal biopsy remains the gold standard investigation to diagnose and classify diabetic nephropathy.</p> <p><strong>Objectives:</strong> In this study, we aimed to evaluate the correlation between clinical parameters and renal pathology classification among patients with type 2 diabetic and nephropathy.</p> <p><strong>Methods:</strong> We conducted an observational study and enrolled 63 patients undergoing renal biopsy between 1 January 2014 and 31 December 2018. Pathologic classification established by the Renal Pathology Society was used to assess the severity of histologic lesions in diabetic nephropathy. Clinical parameters including age, sex, duration, presence of diabetic retinopathy, blood urea nitrogen, creatinine, urine protein creatinine ratio, fasting plasma glucose and hemoglobin A1C were collected.</p> <p><strong>Results:</strong> At the time of biopsy, mean age was 50.25±11.46 years. Median duration of diabetes mellitus was 10 years with interquartile range (IQR) 3.75-12.00 years, mean serum creatinine was 2.44 ± 1.31 mg/dL and estimated glomerular filtration rate was 22.41±12.16 mL/min/1.73 m2. Based on the glomerular classification, 1 patient (1.6%) was in class I, 16 (25.3%) in class II, 25 (39.7%) in class III and 21 (33.3%) in class IV. Using multivariate analysis, class IV was associated with rising serum creatinine compared with class II [adjusted odds ratio (AOR)= 2.58; 95% CI= 1.13-5.89]. Patients with interstitial fibrosis and tubular atrophy (IFTA) &lt;25%, 25-50% and &gt;50% were observed in 10, 27 and 22 patients, respectively. Patients with IFTA &gt;50% were significantly associated with duration of diabetes (OR=1.27; 95%CI=1.21-1.57), serum creatinine (OR=3.92; 95%CI=1.34-11.48) and urine protein (OR= 1.25; 95%CI=1.01-1.55) compared with patients with IFA&lt;25%. Using multivariate analysis, only serum creatinine (AOR=3.48; 95%CI=1.23-12.65) was confirmed as independently correlated to IFTA &gt;50% compared with IFTA &lt;25%. A univariate analysis revealed no significant correlation between vascular indexes and renal function.</p> <p><strong>Conclusion:</strong> The results revealed that advanced glomerular lesions and high IFTA &gt;50% correlated with impaired renal function in type 2 diabetic nephropathy</p> Paramat Thimachai Nichamon Suttitossatam Naowanit Nata Ouppatham Supasyndh Bancha Satirapoj Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-28 2022-03-28 6 e0113 e0113 10.55374/jseamed.v6i0.113 The EFFECT OF PULMONARY HYPERTENSION ON INTRADIALYTIC HYPOTENSION AMONG PATIENTS WITH END STAGE RENAL DISEASE <p><strong>Background:</strong> Intradialytic hypotension (IDH) is an important problem in end stage renal disease (ESRD). Therefore, this study aimed to assess the effect of pulmonary hypertension (PHT) on IDH among patients with ESRD using transthoracic echocardiography.</p> <p><strong>Methods:</strong> In this prospective etiognostic study, transthoracic echocardiography was performed among patients with ESRD in Burapha University Hospital, Thailand. The hemodialytic flow chart data of patients in the hemodialysis unit was collected to ascertain whether these patients presented IDH. The baseline clinical hemodialysis profiles and echocardiographic findings were analyzed using univariate predictors of IDH. Multivariate risk regression was used to identify independent predictors of IDH.</p> <p><strong>Results:</strong> A total of 35 patients with ESRD were enrolled between June 2020 and March 2021. Of these, 16 had PHT (45.7%). The incidence of IDH was 48.5%. All patients exhibited a normal left ventricular ejection fraction. No significant difference was observed of RVSP between frequent-IDH group and occasional-IDH group (45.33 ± 11.62 mmHg and 41.06 ± 13.78 mmHg, respectively, <em>p</em>=0.401). Using univariate analysis, being female, left ventricular mass index, left ventricular ejection fraction and PHT were significantly associated with IDH. No factors were indicated related to IDH occurrence using multivariate analysis. Nevertheless, female patients with ESRD presenting PHT illustrated a tendency to have IDH. This was evidenced by the risk ratio of being female and patients with PHT being 3.13 (95% CI: 0.74-13.30) and 2.18 (95% CI: 0.34-7.06), respectively.</p> <p><strong>Conclusion:</strong> Patients with ESRD presenting PHT showed a higher tendency of developing IDH during hemodialysis than patients with ESRD without PHT. The difference however was statistically insignificant.</p> Sukrisd Koowattanatianchai Akaphol Kaladee Patchara Kochaiyapatana Thammaporn Kajornsin Raweewan Witoon Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-03-31 2022-03-31 6 e0098 e0098 10.55374/jseamed.v6i0.98 APPLICATION OF ARTIFICIAL INTELLIGENCE TO ASSIST HIP FRACTURE DIAGNOSIS USING PLAIN RADIOGRAPHS <p><strong>Background:</strong> Most hip fractures occur among elderly people. They are usually treated in the emergency room where orthopedic surgeons may not be readily available. The problem of delayed diagnosis and treatment results increase risks of further complications and mortality rate. Thus, applying artificial intelligence (AI) can assist physicians having limited experience to rapidly and confidently diagnose hip fractures using radiographs.</p> <p><strong>Objective:</strong> This study aimed to validate AI programs to assist diagnosing of hip fractures on plain radiographs.</p> <p><strong>Methods:</strong> This study employed a retrospective diagnostic study design. From 1 January 2015 to 31 December 2019, compiled ortho pelvis, anterior-posterior (AP) films from the diagnosis of hip fractures at Ananthamahidol Hospital were performed. The performance of the AI program was compared with one orthopedic surgeon who reviewed the same images. The accuracy, sensitivity and specificity of the diagnosis of hip fractures between the orthopedic surgeon and AI program were analyzed.</p> <p><strong> Results:</strong> In total, 217 patients were enrolled in this study. Of these, 56 (28.5%) were male and 161 (74.2%) female. Areas of hip fractures were as follow: intertrochanteric (108, 49.8%), femoral neck (102, 47.0%), subtrochanteric (6, 2.7%) and femoral head (1, 0.5%). The orthopedic surgeon and AI program revealed an accuracy of 93.59% (95%CI 90.8-95.73) vs. 81.24% (95% CI 77.17-84.85), sensitivity of 90.30% (95% CI 85.60-93.90) vs. 89.40% (95%CI 84.50-93.20) and specificity of 97.10% (95%CI 93.60-98.90) vs. 72.5% (95%CI 65.90-78.50), respectively.</p> <p><strong>Conclusion:</strong> Our results showed that the AI model (VGG16) showed a sensitivity of 89.40% vs. 90.30% obtained from the orthopedic surgeon. Thus, improvement in the sensitivity and specificity of AI software is further required. In the future, AI models have the potential as useful tools for emergent screening and evaluation of patients with hip fractures using plain radiographs, especially in the Emergency Department where orthopedic surgeons may not be readily available.</p> Phichai Udombuathong Ruthasiri Srisawasdi Waravut Kesornsukhon San Ratanasanya Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-04-08 2022-04-08 6 e0111 e0111 10.55374/jseamed.v6i0.111 OUTCOME OF USING PLATELET, PLASMA AND GROWTH FACTORS AS AN ORTHOBIOLOGIC DERIVATIVE TO AVOID INVASIVE SURGICAL PROCEDURES FOR TREATING KNEE OSTEOARTHRITIS AMONG ELDERLY PATIENTS <p><strong>Background:</strong> The application of platelet, plasma and growth factors (PP&amp;GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&amp;GF has yet to be well established.</p> <p><strong>Objectives:</strong> This study aimed to report the survival analysis of 24-month follow-up treatment using PP&amp;GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score.</p> <p><strong>Methods:</strong> A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&amp;GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&amp;GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed.</p> <p><strong>Results:</strong> A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&amp;GF products contained 6-10 times higher platelet concentration than those in the peripheral blood.</p> <p><strong>Conclusion:</strong> Intra-articular injection of PP&amp;GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&amp;GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.</p> Thana Turjane Pamok Saengsirinavin Chaivat Sriratanavudhi Vorasilp Cheeva-akrapan Wanpen Larpaiwong Jongjate Aojanepong Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-04-12 2022-04-12 6 e0105 e0105 10.55374/jseamed.v6i0.105 RADIOLOGIC CHARACTERISTICS OF COMPUTERIZED TOMOGRAPHY ATTENUATION IN RENAL CELL CARCINOMA <p><strong>Background:</strong> Renal cell carcinoma (RCC) is the most common kidney cancer in adults. Computed Tomography (CT) with contrast study is used to diagnose RCC. The enhancement in the nephrogenic phase more than 15 Hounsfield units (HU) is suspected of RCCs. However, this threshold HU shows 15-20% false positive results for RCCs.</p> <p><strong>Objectives:</strong> This study aimed to determine RCC enhancement in CT that was below the standard threshold and to analyze the attenuation range of RCCs in noncontrast CT. Methods: Patients with pathological RCC and undergoing CT with contrast study were retrospectively reviewed. An average of attenuation values of three regions of interest (ROI) were measured in noncontrast and nephrogenic phases, by avoiding foci of calcification and peritumoral region. ROI values were calculated for enhancement and range of attenuation values in the noncontrast CT.</p> <p><strong>Results:</strong> A total of 152 pathologically RCCs were included in the study. Mean ± SD attenuation values were 32.54 ± 8.02 HU (range 13.3-57.23 HU) and 71.26 ± 33.1 HU (range 16.87-202.8 HU) for noncontrast and contrast CT, respectively. Thirty-one (20.4%) of RCCs did not reach 15 HU enhancement. Using multivariate analysis, significant differences among subtypes (p&lt;0.001) and renal mass less than 7 cm (p&lt;0.001) were observed. In noncontrast CT, using a range of 20-60 HU, 129 (84.9%) RCCs were entirely within this range. To improve the accuracy of RCC diagnosis, the combined use of both non-contrast attenuation group (&lt;20 HU and &gt;20 HU) and enhancement &gt;15 HU could increase the accuracy to 96.7%.</p> <p><strong>Conclusion:</strong> One-fifth of RCCs did not reach the standard enhancement threshold that were mostly found in nonclear cell subtype. Especially, when the mass was larger than 7 cm or involved nonclear cell RCCs, the enhancement threshold &gt;15 HU must be carefully used for diagnosis. Using a noncontrast phase regardless HU combined with enhancement &gt;15 HU could improve the accuracy of RCC diagnosis.</p> Satit Siriboonrid Waraporn Pongmorakot Chatwadee Limpaiboon Nattapong Binsri Sarayut Kanjanatarayon Weerayut Wiriyabanditkul Vittaya Jiraanankul Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-06-28 2022-06-28 6 e0117 e0117 10.55374/jseamed.v6i0.117 CORRELATION BETWEEN RETICULOCYTE HEMOGLOBIN EQUIVALENT AND IRON STATUS IN PEDIATRIC CHRONIC KIDNEY DISEASE <p><strong>Background:</strong> Anemia is a major complication of pediatric chronic kidney disease (CKD). Iron deficiency is one of the most common causes of anemia. Conventional markers of iron deficiency anemia, transferrin saturation (TSAT) and serum ferritin could be interfered with various factors. in CKD. Reticulocyte hemoglobin equivalent (Ret-He) is useful for assessing iron status among these patients.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study enrolling children with CKD stage 3 and above was conducted between April and November 2021. Demographic information was also collected. Correlation of Ret-He, anemia indices and markers of iron status were analyzed.</p> <p><strong>Results:</strong> Among 50 participants, we found moderate positive correlations between Hb and Ret-He (r=0.518; <em>p</em> &lt;0.001), Hct and Ret-He (r=0.403; p=0.004), and MCHC and Ret-He (r=0.667; <em>p</em>&lt;0.001); a modest negative correlation between RDW and Ret-He (r=-0.616; <em>p</em>&lt;0.001) and strong correlations between MCV and Ret-He (r=0.747; <em>p</em>&lt;0.001) including MCH and Ret-He (r=0.865; <em>p</em>&lt;0.001). No correlations between TSAT and Ret-He, serum ferritin and Ret-He, TSAT and Hb, or TSAT and Hct were observed. In addition, weak negative correlations between serum ferritin and Hb (r=-0.307; p=0.032) and between serum ferritin and Hct (r=-0.305; <em>p</em>=0.033) were detected. The median RetHe was 28.42 ± 3.37 pg. Twenty-seven participants (54%) met the criteria for iron deficiency anemia (cut-off value &lt;29 pg) of which 2 (4%) had absolute iron deficiency and 9 (18%) had functional iron deficiency defined by conventional markers.</p> <p><strong>Conclusion:</strong> Ret-He is a relevant marker of iron status among pediatric patients with CKD and correlates well with anemia indices which could help identify more patients with iron deficiency.</p> Pacharin Mungklarat Chantida Subun Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-08-31 2022-08-31 6 e0118 e0118 10.55374/jseamed.v6i0.118 PULMONARY TUBERCULOSIS MORTALITY AND ITS RISK FACTORS AMONG PATIENTS WITH TYPE 2 DIABETES AND PULMONARY TUBERCULOSIS IN FOUR COMMUNITY HOSPITALS, CENTRAL THAILAND <p><strong>Background:</strong> Tuberculosis (TB), a communicable disease, is currently a significant health problem in Thailand. Type 2 diabetes (T2D) is an indicator of poor TB outcomes; however, data according to specific antihyperglycemic use and tuberculosis outcomes in community hospital settings in Thailand remain limited. We aimed to determine TB mortality as well as explore the demographic and clinical risk factors among patients with pulmonary TB and underlying T2D.</p> <p><strong>Methods:</strong> A retrospective cohort study was conducted between January 1, 2013, and December 31, 2020, to determine tuberculosis mortality and its risk factors among patients with T2D and pulmonary TB visiting three community hospitals, in central Thailand. T2D and pulmonary TB were determined according to the International Classification of Diseases, Tenth Revision codes presented in medical records. TB mortality data were reviewed and retrieved from the tuberculosis treatment cards. Patients were classified as “dead” when they died before completing treatment regardless of the causes. Multivariable cox proportional regression analysis was performed to obtain the adjusted hazard ratios (AHR) and 95% confidence interval (CI) of factors related to TB mortality.</p> <p><strong>Results:</strong> A total of 133 patients with T2D and pulmonary TB were enrolled in the present study; 74 (55.6%) participants were males. At baseline, the average age of participants was 57.29+12.51 years. During the study period, the TB mortality rate was 15.74 (95% CI 8.13-27.50) deaths per 100 person-years. The independent risk factors for TB mortality included age ≥70 years (AHR 5.45, 95% CI; 1.36-21.84), use of insulin (AHR 4.62, 95% CI; 1.11-19.21), and positive sputum test result at 1st follow-up (AHR 16.10, 95% CI; 2.10-123.40).</p> <p><strong>Conclusion:</strong> TB mortality among patients with T2D should be emphasized. Insulin use may be a proxy indicator for poor glycemic control associated with mortality. Additionally, elderly patients should be closely observed for successful treatment as well as monitoring for any adverse events.</p> Sethapong Lertsakulbunlue Passawith Kunsuwan Ram Rangsin Boonsub Sakboonyarat Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-09-03 2022-09-03 6 e0120 e0120 10.55374/jseamed.v6i0.120 DIAGNOSIS OF IRON DEFICIENCY ANEMIA IN THAI FEMALE ADOLESCENTS USING RETICULOCYTE HEMOGLOBIN EQUIVALENT <p><strong>Background:</strong> Female adolescents aged 10 to 19 years are at remarkable risk of iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is an initial indicator of iron incorporation in red blood cells (RBCs) hemoglobin and reflects the iron functional availability in the RBCs.</p> <p><strong>Objective:</strong> This study aimed to assess the diagnostic performance of Ret-He to identify IDA and determine a specific cut-off value for Thai female adolescents.</p> <p><strong>Methods:</strong> Blood samples of 191 Thai female adolescents, ages ranging from 12 to 18 years, were included. Patients underwent complete blood count, reticulocyte count, Ret-He, serum iron (SI), total iron-binding capacity (TIBC), and transferrin saturation (TSAT). The correlation of Ret-He with other parameters and the diagnostic performance to identify IDA were evaluated.</p> <p><strong>Results:</strong> Among 191 patients, 89 and 102 were defined as IDA and non-IDA groups. Ret-He value in the IDA group was significantly lower than that in the non-IDA group (p&lt;0.001). Strong positive correlations were observed between Ret-He and RBC indices and SI and TSAT (p&lt;0.001). A Ret-He value of ≤27.0 pg could distinguish IDA from non-IDA with a sensitivity of 91.2% and a specificity of 100.0% (area under the curve, AUC of 0.99, 95% CI: 0.98-0.99; p&lt;0.001).</p> <p><strong>Conclusion:</strong> This study confirmed that Ret-He is a cost-effective parameter representing an advantage over other traditional iron markers. A specific Ret-He cut-off value of ≤27.0 pg is suitable for distinguishing IDA from non-IDA with excellent diagnostic performance among Thai female adolescents.</p> Natthawadi Thimthong Apichat Photi-a Chanchai Traivaree Dollapak Apipongrat Oytip Nathalang Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-09-18 2022-09-18 6 e0126 e0126 10.55374/jseamed.v6i0.126 DIFFERENTIATION BETWEEN ALLERGIC AND NON-ALLERGIC RHINITIS IN CHILDREN WITH CHRONIC RHINITIS, ALLERGY CLINIC, PHRAMONGKUTKLAO HOSPITAL <p><strong>Background:</strong> Chronic rhinitis in children is a common problem. Investigation to diagnose allergic rhinitis (AR) using a skin prick test for aeroallergens requires a specialist doctor, which is not simply performed in primary health care facilities. Therefore, diagnosing patients with AR and non-allergic rhinitis (NAR) is based on clinical symptoms essential for treatment planning. This study compared clinical symptoms between AR and NAR, comorbidities, disease severity, and common aeroallergen sensitization.</p> <p><strong>Methods:</strong> A retrospective descriptive study was conducted among participants aged between 2-18 years with chronic rhinitis who were treated at the Department of Allergy and Immunology, Division of Pediatrics, Phramongkutklao Hospital, between 2014 and 2018. The medical records were reviewed on clinical symptoms, allergic test results, environmental data, and the severity according to Allergic Rhinitis and its Impact on Asthma (ARIA) classification. If the patient tested positive for aeroallergen, the allergist diagnosed AR. NAR is characterized by the same symptoms but with a negative skin prick test.</p> <p><strong>Results:</strong> Three hundred and seven participants were included. Among these patients, 226 (73.6 %) were categorized as AR, and 81 (26.4%) were NAR. The AR group had a higher percentage of males than the NAR group. Nasal pruritus and ocular symptoms were more commonly found in AR than in NAR. Regarding comorbidities, both groups had similar snoring, sinusitis, asthma, and atopic dermatitis. The most common aeroallergens among AR patients were Dermatophagoides pteronyssinus (82.7%), Dermatophagoides farinae (81.4%), followed by American cockroaches (38.1%), and German cockroaches (37.6%). Cat owners were associated with cat sensitization in AR patients (OR =2.77; 95% CI = 1.27-5.88).</p> <p><strong>Conclusions:</strong> In this study, the proportion of AR was higher than NAR. Nasal pruritus, ocular symptoms, or both strongly supported AR. The most common aeroallergen sensitization was house dust mites, followed by cockroaches. Initial treatment with antihistamine and other drugs can improve the severity of the disease.</p> Tanuntorn Songchitsomboon Anupong Sirisungreung Yiwa Suksawat Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-09-21 2022-09-21 6 e0125 e0125 10.55374/jseamed.v6i0.125 EFFECT OF AGOMELATINE AND SERTRALINE ON PATIENTS WITH MAJOR DEPRESSIVE DISORDERS AND CHRONIC KIDNEY DISEASE: A RANDOMIZED CONTROLLED TRIAL <p><strong>Background:</strong> Depression is highly prevalent and is well known to affect patients with chronic kidney disease (CKD). Agomelatine exerts psychotropic effects upon mood and anxious states. There is limited data on agomelatine treatment among patients with CKD.</p> <p><strong>Methods:</strong> Patients with CKD stage 3-5 with DSM-5-defined major depressive disorder (MDD) were randomly assigned to receive 25 mg/day of agomelatine or sertraline 50 mg/day for eight weeks at Phramongkutklao Hospital. Hamilton Depression Rating Scale (HDRS) score and concerning adverse events were measured at baseline and the end of the study. Efficacy assessment compared the improvements in clinical response and remission between the agomelatine and placebo groups.</p> <p><strong>Results:</strong> Of 53 enrolled patients, 27 were assigned to the agomelatine group and 26 to the sertraline group. The mean age was 64.8±13.4 years. Baseline characteristics were comparable across treatment groups. After eight weeks, agomelatine-treated showed reductions in HDRS score from baseline (-15.6 with 95% CI -18.6 to -12.5). A significant difference was observed in the reduced HDRS scores between agomelatine and sertraline groups (-12.4; 95% CI -18.4 to -6.5). Over the 6-week treatment period, clinical response (55.0 vs. 9.0%, p &lt;0.001) and remission (45.0 vs. 17.4%, p =0.049) improved significantly more with agomelatine than with sertraline. Both agomelatine and sertraline were well-tolerated during the treatment period.</p> <p><strong>Conclusion:</strong> Agomelatine showed superior antidepressant efficacy over sertraline in treating CKD patients with depression after eight weeks, with a good tolerability profile.</p> Fadhil A-Hamad Saleh-Arong Nattaphon Chokemaitree Naowanit Nata Pamila Tasanavipas Narittaya Varothai Bancha Satirapoj Copyright (c) 2022 Journal of Southeast Asian Medical Research 2022-10-05 2022-10-05 6 e0127 e0127 10.55374/jseamed.v6i0.127