Postoperative analgesic efficacy of nefopam after anorectal surgery: a retrospective observational study

Objective: To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries. Methods: We retrospectively reviewed the electronic medical records of patients who underwent anorectal surgeries from January 2019 to March 2022 at two medical centers. The data were divided into nefopam and conventional groups. The primary outcome was the number of patients who requested additional opioids in the 24-h postoperative period. The secondary outcomes were numeric rating pain scores (NRPS) within a 24-h postoperative period and analgesic drugs-related side effects. Results: Eighty-seven patients in the conventional group and 60 in the nefopam group were recruited. The nefopam group reported less additional opioid consumption than the conventional group in all dimensions of analysis, including overall, adjusted to anesthetic techniques and types of surgery. However, these did not reach statistical significance (P = 0.093). Only patients in the nefopam group who underwent hemorrhoidectomy under TIVA or spinal anesthesia significantly required fewer additional opioids (P = 0.016, 60% mean difference). Similarly, the 24-h postoperative morphine consumption was lower in the nefopam group (mean difference = -3.4, 95%CI: 0.72,6.08). Furthermore, significantly lower NRPS were reported in the nefopam group during the 12-18 h postoperative period (P = 0.009). On the other hand, analgesic drugs related side effects were similar in both groups. Conclusions: The administration of nefopam after major anorectal surgery is beneficially evident in reducing postoperative opioid requirements. (AU)

Discrepancy in diagnoses of diabetes and prediabetes using fasting plasma glucose and glycosylated hemoglobin and the underdiagnosis by ICD-10 coding: data from a tertiary hospital in Thailand.

Background: Early detection of prediabetes and diabetes better prevents long-term health complications. FPG and HbA1c levels are some common laboratory tests utilized as tools to diagnose diabetes and prediabetes, but the agreement rate between these two diagnostic tests varies, which could lead to underdiagnosis and thus undertreatment. This study aimed to analyze the agreement rate between FPG and HbA1c, as well as the physicians' accuracy of using these results to make a prediabetes or diabetes diagnosis through ICD-10 coding at a tertiary care hospital in Bangkok, Thailand. Methods: A cross-sectional descriptive study was conducted using secondary data collected in a tertiary hospital's check-up clinic from August 16, 2019 to June 30, 2022 to study the prevalence and diagnosis of diabetes and prediabetes, determined through FPG and HbA1c laboratory results. We analyzed the two laboratory tests' diagnosis agreement rate and the physicians' accuracy of diagnosing diabetes and prediabetes in ICD-10 coding using the FPG and HbA1c results. Results: Among 8,024 asymptomatic participants, the period prevalence diagnosed through laboratory results was 5.8% for diabetes and 19.8% for prediabetes. Diabetes and prediabetes prevalence based on laboratory data differs from that of ICD-10 coding data. Specifically, 79.6% of diabetes patients and 32.3% of prediabetes patients were coded using the ICD-10 coding system. 4,094 individuals had both FPG and HbA1c data. The agreement rate for diagnosing diabetes and prediabetes between the two laboratory results is 89.5%, with Kappa statistics of 0.58. Using only one of the two laboratory results would have missed a substantial number of patients. Conclusion: Our findings highlight screening test discrepancies and underdiagnosis issues that impede diagnostic accuracy enhancement and refined patient management strategies. Early diagnoses of prediabetes and diabetes, especially before symptoms arise, could increase health consciousness in individuals, thereby enabling the implementation of lifestyle modifications and prevention of serious health complications. We emphasize the importance of diagnosing these conditions using both FPG and HbA1c, along with subsequent accurate ICD-10 coding. Even though some hospitals lack certified HbA1c testing, we suggest enhancing the availability of HbA1c testing, which could benefit many people in Thailand.Clinical trial registration:https://www.thaiclinicaltrials.org, identifier [TCTR20230824003].

Effect of behavioral activation on time and frequency domain heart rate variability in older adults with subthreshold depression: a cluster randomized controlled trial in Thailand.

BACKGROUND: Increased prevalence of depression highlights the need for effective interventions. Behavioral activation (BA), which can easily be adapted for non-clinical populations, has been the recommended treatment for depression. It is based on a model of psychopathology explaining that losses or chronically low levels of positive reinforcement yield behavioral and emotional changes in depression and that encouraging individuals to increase their engagement in reinforcing activities can improve their mood and enhance their valuable life experiences. Heart rate variability (HRV) provides indices of autonomic function related to depression, but only a few studies have investigated the effect of BA on HRV, particularly among older adults with subthreshold depression. Accordingly, we aimed to investigate the effect of BA on HRV in older adults with subthreshold depression. METHODS: We conducted a 9-month cluster randomized controlled trial in two Health Promoting Hospitals (HPHs). Eighty-two participants were randomized into either intervention (BA with usual care) or control (usual care only) groups, with 41 participants per group. Daily step count was collected weekly during the 12-week BA intervention period, while HRV parameters, including the Standard Deviation of the Normal-to-Normal interval (SDNN), High Frequency (lnHF), Low Frequency (LF), and Low Frequency/High Frequency ratio (LF/HF), were examined at 0, 3, 6 and 9 months. Generalized Estimating Equations (GEEs) were used in the data analysis. RESULTS: Over nine months, the intervention and control groups differed significantly in the unadjusted mean change of HRV, SDNN [7.59 ms (95% CI: 1.67, 13.50)], lnHF [0.44 ms2 (95% CI: 0.04, 0.85)], and LF [0.53 ms2 (95% CI: 0.09, 0.98)], whereas the groups did not differ significantly in LF/HF ratio [0.01 ms2 (95% CI: -0.04, 0.06)]. CONCLUSION: Our results suggest that BA may have a therapeutic effect on depression symptoms of older adults with subthreshold depression via improved HRV. TRIAL REGISTRATION: TCTR20211019003 , thaiclinicaltrials.org, retrospectively registered on 19 October 2021.

Predictive validity of the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program fall risk screening algorithms among community-dwelling Thai elderly.

BACKGROUND: Fall risk screening using multiple methods was strongly advised as the initial step for preventing fall. Currently, there is only one such tool which was proposed by the U.S. Centers for Disease Control and Prevention (CDC) for use in its Stopping Elderly Accidents, Death & Injuries (STEADI) program. Its predictive validity outside the US context, however, has never been investigated. The purpose of this study was to determine the predictive validity (area under the receiver operating characteristic curve: AUC), sensitivity, and specificity of the two-step sequential fall-risk screening algorithm of the STEADI program for Thai elderly in the community. METHODS: A 1-year prospective cohort study was conducted during October 2018-December 2019. Study population consisted of 480 individuals aged 65 years or older living in Nakhon Ratchasima Province, Thailand. The fall risk screening algorithm composed of two serial steps. Step 1 is a screening by the clinician's 3 key questions or the Thai Stay Independent brochure (Thai-SIB) 12 questions. Step 2 is a screening by 3 physical fitness testing tools including Time Up and Go test (TUG), 30-s Chair Stand, and 4-stage balance test. Participants were then followed for their fall incidents. Statistical analyses were conducted by using Cox proportional hazard model. The AUC, sensitivity, specificity, and other relevant predictive validity indices were then estimated. RESULTS: The average age of the participants was 73.3 ± 6.51 years (range 65-95 years), and 52.5% of them were female. The screening based on the clinician's 3 key questions in Step 1 had a high AUC (0.845), with the sensitivity and specificity of 93.9% (95% CI 88.8, 92.7) and 75.0% (95% CI 70.0, 79.6), respectively. Appropriate risk categorization however differed slightly from the original STEADI program. CONCLUSIONS: With some modification, the fall risk screening algorithm based on the STEADI program was applicable in Thai context.

Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults' limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell's C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

Efficacy of chlorhexidine patches on central line-associated bloodstream infections in children.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections. Chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) are reported to decrease CLABSIs in adults. This study aims to determine the efficacy of CHG patches in reducing CLABSIs in children. METHODS: An open-label randomized controlled trial was conducted in children aged 2 months to 18 years, requiring a short-term catheter. Patients were randomized into two groups, allocated to receive CHG patches or standard transparent dressings. Care of the catheter was in accordance with Asia Pacific Society of Infection Control (APSIC) recommendations. Central-line-associated bloodstream infections were defined using National Healthcare Safety Network surveillance criteria. RESULTS: From April 2017 to April 2018, 192 children were enrolled. There were 108 CHG patch catheters and 101 standard dressing catheters, contributing to 3,113 catheter days. The median duration of catheter dwelling was 13 days, with an interquartile range (IQR) of 8-20 days. Half were placed at the jugular vein and 22% at the femoral vein. There were 23 CLABSI events. Incidence rates for CHG patches and standard dressings were 7.98 (95% confidence interval (CI), 4.25-13.65) and 6.74 (95% CI, 3.23-12.39) per 1,000 catheter days, respectively (incidence rate ratio 1.18; 95% CI, 0.52-2.70). The CLABSI pathogens were 15 Gram-negative bacteria, six Gram-positive bacteria, and two Candida organisms. Catheter colonization of CHG patches and standard dressings were 2.02 (95% CI, 0.42-5.91) and 3.07 (95% CI, 1.00-7.16) per 1,000 catheter days, respectively. Only local adverse effects occurred in 6.8% of the participants. CONCLUSIONS: In our setting, there was no difference in CLABSI rates when the chlorhexidine patch dressings were compared with the standard transparent dressings. Strengthening of CLABSI prevention bundles is mandatory.

Antimicrobial prescription patterns in a tertiary-care pediatric unit in Thailand.

BACKGROUND: Antimicrobial resistance is one of the greatest public health threats worldwide. The improper prescription of antibiotics is one factor that promotes antibiotic resistance. Access to antimicrobial surveillance data is essential when assessing the pattern and appropriateness of antimicrobial prescriptions in hospitals and for the establishment of an antimicrobial stewardship program. This study aimed to describe the rate of antimicrobial use and the pattern of prescriptions in a tertiary care pediatric unit in Thailand. METHODS: A point prevalence survey on antimicrobial use was conducted monthly between January and June 2016, using standardized tools. The survey included all inpatient pediatric beds and identified all children receiving antimicrobial treatment on the day of the survey. RESULTS: The study included 644 children, 43.3% of whom received antimicrobial treatment during hospitalization. In general wards, the rate of antimicrobial prescriptions was 37.2%; in oncology wards it was 47.0%; in intensive care units it was 38.7%, and in surgical wards it was 67.7%. Meropenem was the most prescribed antimicrobial in the general wards (24.5%) and intensive care units (28.6%), whereas antipseudomonas was the most commonly prescribed antimicrobial in the oncology ward (26.6%). For the surgical ward, the most prescribed antimicrobial was third-generation cephalosporin for both prophylaxis and treatment (39.0%). The most common reason for antimicrobial use was the treatment of infections. CONCLUSIONS: Nearly half of hospitalized children received at least one antimicrobial. This was comparable with other pediatric tertiary care centers, although the high use of meropenem was different. This study provides important baseline information on antimicrobial use in a large tertiary-care pediatric unit and could lead to a nationwide survey in the future.

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program in Pediatric Units in Tertiary Care Teaching Hospital in Thailand.

BACKGROUND: Antimicrobial stewardship programs (ASPs) have been proven to be beneficial in reducing the use of antimicrobial agents, antibiotic resistance, and health care costs. The data supporting the utility of ASPs has come largely from adult hospital units, but few pediatric hospital units have implemented ASPs. Our objective for this study was to assess the impact of ASPs in pediatric units in tertiary care teaching hospitals. METHODS: We conducted a retrospective chart review to compare antimicrobial use pre- and post-ASP over a 6-month period in a tertiary care hospital in which an ASP had been in use since July 2017. Meropenem, vancomycin, and colistin were selected to be monitored. ASP rounds were conducted twice a week to assess and provide feedback on antimicrobial prescriptions. Antimicrobial use was measured as days of therapy (DOTs) per 1000 patient-days and was compared pre- and post-ASP by using independent t tests. RESULTS: Charts of children hospitalized who were in antimicrobial treatment pre-ASP (44.3%) and post-ASP (41.7%) were reviewed. The percentages of children who received selected antimicrobial agents did not differ between pre- and post-ASP. During the post-ASP period, a significant reduction in DOT with vancomycin and colistin was observed. Vancomycin use decreased from 58.5 to 40.2 DOTs per 1000 patient-days (P = .038), and colistin decreased from 36.3 to 13.8 DOTs per 1000 patient-days (P = .026). Meropenem use decreased from 126.8 to 111.2 DOTs per 1000 patient-days (P = .467). Between the 2 periods, there was no effect on length of stay and mortality. CONCLUSIONS: ASPs can lead to a significant reduction in selected antimicrobial use in children who are hospitalized, with no effect on length of stay or mortality rate.

Shift Work and Leukocyte Count Changes among Workers in Bangkok.

OBJECTIVES: Previous epidemiological evidence for the association of shift work exposure and increased leukocyte count is cross-sectional in nature, thus limiting cause-effect inference. We therefore used a longitudinal design to: (i) compare leukocyte counts at baseline between shift and day workers and (ii) examine the time trend of leukocyte counts over the follow-up period for these workers. METHODS: A retrospective cohort study was conducted among 6737 workers aged <60 years at two large organizations (a humanitarian organization and a university) in Bangkok, Thailand who had participated in at least two annual health check-ups during the period 2005-2016. Shift work exposure history was assessed by a self-administered questionnaire and categorized into day, former, and current shift workers. Data on leukocyte count were collected annually as part of worksite health screening during the observation period. Association of shift work exposure and increased leukocyte count was then examined cross-sectionally and longitudinally by using multiple linear regression and multilevel analysis of repeated measures data, respectively. In addition, trends for leukocyte count over the follow-up period and work years were examined using LOWESS smooth curves. RESULTS: Compared to day work, the current shift work was associated with increased leukocyte counts. The magnitude of percentage increase was the highest for basophil counts, followed by eosinophil and lymphocyte counts. Both cross-sectional and longitudinal evidence revealed this association, although it was less pronounced longitudinally. For total leukocyte count, the magnitude of difference was constant across the 11-year follow-up period. However, for lymphocyte and basophil counts, these discrepancies tapered over the work years until they no longer differed (for lymphocyte count) or even differed in the opposite direction (for basophil count) in later work years. CONCLUSION: This study confirmed previous cross-sectional evidence that shift work exposure-increased leukocyte counts and that this was reversible. Whether this increase in immune cell count also results in an increased immune cell activity and serves as the intermediary in the association between shift work exposure and subsequent chronic disease development needs further investigation.

Lung function change in hyperbaric chamber inside attendants.

BACKGROUND: Hyperbaric oxygen therapy is one of new trends of additional treatment, especially for non-di- ving-related diseases in Thailand. Hyperbaric inside attendants have to work under hyperbaric environment to provide medical care for patients in the hyperbaric chamber. This study aims to investigate longitudinal change in lung function in hyperbaric inside attendants (HIAs) and the relationship with hyperbaric exposure. MATERIALS AND METHODS: This is a retrospective longitudinal study exploring the adverse long-term effects to the lungs in HIAs. All inside attendants (HIAs) who worked in the public hospitals or medical centres with multiplace hyperbaric chamber in Thailand were included. To be considered for inclusion in the study, inside attendants were required to have at least two follow-up lung function tests and minimum 1-year interval at baseline from annually periodic examination. Lung function of HIAs were compared against reference values of the Thai population. RESULTS: There were 51 subjects with 9.26-year mean period of follow-up. The HIAs showed a significantly decrease in measured lung function in average forced expiratory volume in 1 second (FEV1), forced expi- ratory flow at 25-75% of functional vital capacity (FEF25-75%) and FEV1/FVC ratio over time. The annual reductions in FEV1, FEF25-75% and FEV1/FVC ratio were 22.52 mL per year, 44.92 mL/s per year and 0.48% per year, respectively. The study showed significant differences in annual changes in FVC, FEF25-75% and FEV1/FVC ratio between HIAs and the lung function predicted values for the Thais. However, the results revealed no differences of annual change in FEV1 from predicted values. The average working depths, average session duration and total working hours as HIAs were related with the changes of lung function. CONCLUSIONS: Working in a hyperbaric environment does affect the lung function of HIAs. In addition to fitness to work implementation, periodic lung function evaluation should be encouraged to monitor further possible harm to the attendants.

Immediate risk of myocardial infarction following physical exertion, tea, and coffee: A case-crossover study in Thailand.

BACKGROUND: Physical exertion and caffeine consumption are associated with acute myocardial infarction (MI). However, physical exertion and caffeine consumption have not been examined as immediate triggers of MI in low and middle-income countries. OBJECTIVE: Using a self-matched case-crossover design, we examined the acute risk of MI in the hour following episodes of physical exertion, caffeinated coffee, and tea consumption among MI survivors in Thailand. METHODS: A total of 506 Thai participants (women = 191, men = 315) were interviewed between 2014 and 2017 after sustaining an acute MI. We compared each subject's exposure to physical exertion and consumption of caffeine- containing beverages in the hour preceding the onset of MI with the subject's expected usual frequency in the prior year to calculate relative risks (RRs) and 95% confidence intervals (95%CIs). RESULTS: Of the 506 participants, 47 (9.3%) engaged in moderate or heavy physical exertion, 6 (1.2%) consumed tea, and 21 (4.2%) consumed coffee within the hour before MI. The relative risk of MI after moderate or heavy physical exertion was 3.0 (95% CI 2.2-4.2) compared to periods of no exertion, with a higher risk among more sedentary participants compared to active participants. Compared to times with no caffeinated beverage consumption, there was a higher risk of MI in the hour following consumption of caffeinated tea (RR = 3.7; 95%CI: 1.5-9.3) and coffee (RR = 2.3; 95%CI: 1.4-3.6). CONCLUSION: Physical exertion, coffee and tea consumption were associated with a higher risk of MI in the subsequent hour compared to times when the participants were sedentary or did not consume caffeinated beverages. Our study identifies high-risk populations for targeted screening and intervention to prevent acute MI.

Increased Risk Of Type 2 Diabetes And Abnormal FPG Due To Shift Work Differs According To Gender: A Retrospective Cohort Study Among Thai Workers In Bangkok, Thailand.

PURPOSE: The gender differential evidence of the association between shift work and type 2 diabetes risk remains scarce. This longitudinal study determines whether the association between shift-work exposure and type 2 diabetes risk and abnormal fasting plasma glucose (FPG) differs according to gender; the study aims to find the association between shift work and changes in physiological, behavioral, and psychosocial stress. PATIENTS AND METHODS: This retrospective cohort study was conducted among 5947 workers (4647 female and 1300 male) aged ≤60 years old in Bangkok, Thailand. Participants required a normal FPG level (<100 mg/dL) at baseline and at least two health check-up results from 2009 to 2016. Shift-work exposure history was assessed using a self-administered questionnaire; FPG levels were measured annually. Cox proportional hazard models were used to assess the aforementioned association. RESULTS: During the follow-up period, 1470 new abnormal FPG and 154 new type 2 diabetes cases developed. Stratified analysis of male workers' data revealed an association was significant in the unadjusted model, which tended to be stronger after adjustment for demographic data and the baseline values of anthropometric and biochemical parameters. This was the case both for type 2 diabetes [Hazard Ratio (HR) (95% Confidence Interval (CI))=2.98 (1.58-5.62)] and abnormal FPG [HR (95% CI)=1.86 (1.43-2.41)]; this association was less obvious among women. CONCLUSION: Shift work is a risk factor for type 2 diabetes and abnormal FPG; this risk is gender differential, being more pronounced in men. Preventive measures aiming at ameliorating shift work induced type 2 diabetes risk should pay more attention to men.

Incidence of infusion hypersensitivity reaction after withholding dexamethasone premedication in early breast cancer patients not experiencing two previous cycles of infusion hypersensitivity reaction for weekly paclitaxel chemotherapy.

BACKGROUND: Premedication with dexamethasone is an essential part of the prevention of hypersensitivity reaction (HSR) associated with taxane administration. However, the possibility of stopping dexamethasone premedication has been investigated in previous studies to reduce the steroid's adverse events; however, either the result or the particular protocol was limited. Thus, our study aimed to evaluate the incidence of HSR after dexamethasone premedication discontinuation after lack of HSR in two previous weekly paclitaxel infusions. METHOD: Early breast cancer patients who received adjuvant weekly paclitaxel in a retrospective cohort from January 2012 through February 2016 at the King Chulalongkorn Memorial Hospital were reviewed. All patients received a standard premedication protocol prior to the first and second paclitaxel infusion. Dexamethasone was omitted in later cycles in all patients who did not undergo infusion HSR. Patients who developed HSR during the first or second cycles of paclitaxel infusion were excluded. The incidence of HSR during the later cycle of paclitaxel administration and factors associated with this adverse reaction were collected. RESULTS: Eighty-one of 85 patients who did not undergo infusion HSR after 2 cycles of weekly paclitaxel administration were retrospectively reviewed. The median age was 51 years (range 27-74 years). Only 16% of the patients had a BMI greater than 30 kg/m2, 57.8% were premenopausal, 67.9% had no comorbidity, none had a history of allergy or asthma, 65.4% received weekly paclitaxel as a single agent, and 34.6% received weekly paclitaxel in combination with trastuzumab. Five of 81 patients reported grade I-II HSR (6.25%), which occurred mostly during the first 6 cycles (60%). Temporary discontinuation of paclitaxel infusion was observed in all HSR patients. No differences regarding age, BMI, menopausal status, and underlying disease between the HSR and no HSR groups were identified. Concerning the safety profile, peripheral neuropathy (gr I 60%, gr II 13.5%, and gr III 2.4%), myalgia (43.4%), and edema (10.5%) were commonly reported, whereas dyspepsia (5.3%) and insomnia (14.5%) were rarely described in withholding patients. CONCLUSION: Withholding dexamethasone premedication in non-experiencing HSR patients after two previous cycles of weekly paclitaxel administration was safe and did not impact the higher incidence of HSR. A discontinuing dexamethasone protocol should be recommended generally in these patients, especially those with a high risk for steroid-induced side effects.

Relationship between Poor Sleep Quality and Psychological Problems among Undergraduate Students in the Southern Thailand.

We conducted this study to fill the noted gap in the available literature by evaluating the prevalence of poor sleep quality in this understudied population and to explore the relationship between sleep quality and psychological problems among undergraduates in Thailand. This study used a cross-sectional survey. Self-administrated questionnaires included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Depression, Anxiety and Stress Scale and the Thai General Health Questionnaire. The study group included 1,055 undergraduates, aged 18-25 years. The prevalence of poor sleep quality was 42.4%. Students classified as poor quality sleepers reported significantly more psychological problems, indicating a linear trend of progressively worse global sleep quality associated with greater mood and anxiety symptomatology. Prospective studies that include objective measures of sleep duration and quality are needed to more fully develop focused health promotion strategies for Southeast Asian undergraduates.

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand.

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life-threatening adverse drug reaction. Several criteria have been established to aid the diagnosis. However, patients with DRESS remained underdiagnosis and undertreatment. METHODS: Medical records of hospitalized patients at the King Chulalongkorn Memorial Hospital from January 2004-December 2014 due to DRESS were enrolled retrospectively using RegiSCAR diagnostic criteria. RESULTS: A total of 52 patients were included. Thirty-seven patients (71.2%) were female. The four most common causative agents were phenytoin (23.1%), nevirapine (17.3%), allopurinol (15.4%), and cotrimoxazole (13.5%). The overall prevalence was 9.63 cases per 100,000 inpatients. Median onset time (IQR) was 16 (9-27) days. Allopurinol was associated with longer onset time than others (p = 0.014). CLINICAL PRESENTATION: skin rash 100%, fever 78.8%, and lymphadenopathy 50%. The majority (84.6%) had single internal organ involvement. The most common internal organ involvement was liver (94.2%). Allopurinol was associated with higher incidence of renal involvement (p = 0.01). Up to 60% of patients had eosinophilia. Allopurinol was associated with higher eosinophilia (p = 0.003). A half of patients received systemic corticosteroids. Two mortality cases were reported (omeprazole-fulminant hepatitis and phenytoin-nosocomial infection). CONCLUSIONS: DRESS is associated with severe morbidity and mortality. Phenytoin, nevirapine, allopurinol, and cotrimoxazole were the major causes. Allopurinol-induced DRESS had the longest onset time, and was associated with higher eosinophilia and incidence of renal involvement. Raising awareness among both health care providers and public for early detection and withdrawal of the causative agent is critical to save life and reduce morbidity.

FACTORS ASSOCIATED WITH DELAY IN TUBERCULOSIS TREATMENT AT 10 TERTIARY LEVEL CARE HOSPITALS IN THAILAND.

Tuberculosis (TB) is common in Thailand. Delay in initiating tuberculosis treatment is a major public health problem. Delay in treatment can result in more severe diseases, risk for death, and greater risk of tuberculosis transmission in the community. We attempted to determine the duration from onset of TB symptoms to the date of first consultation (patient delay) and the factors associated with that delay at 10 tertiary level care hospitals in Thailand. All participants aged 18 years who were willing to participate were included in the study, which was conducted from January to December 2012. A structured questionnaire and medical records were used to collect data. One hundred ninety-nine TB patients were included in the study. The mean age of subjects was 48 years (SD = 15.9); 69.8% were male. The median duration from onset of symptoms to first medical consultation was 30 days. On multivariate analysis, living in an urban area (adjusted odds ratio = 2.81; 95% CI: 1.29-6.14) was an independent risk factor for the delay. Delay in seeking help is a common problem among TB patients in Thailand. At risk populations need to be educated on the importance of presenting for early medical consultation if they have symptoms of TB.

Circadian rhythm characteristics, poor sleep quality, daytime sleepiness and common psychiatric disorders among Thai college students.

INTRODUCTION: To investigate the relationship between common psychiatric disorders (CPDs) and sleep characteristics (evening chronotype, poor sleep quality and daytime sleepiness) among Thai college students. METHODS: A cross-sectional study was conducted among 2,970 undergraduate students in Thailand. Students were asked to complete a self-administered questionnaire that collected information about lifestyle and demographic characteristics. The Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate circadian preference, sleep quality and daytime sleepiness, respectively. The General Health Questionnaire-12 (GHQ-12) was used to evaluate presence of CPDs. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of CPDs in relation to the covariates of interest. RESULTS: A total of 337 students were classified as having CPDs (11.2%; 95% CI 10.1-12.3%). Evening chronotype (OR = 3.35; 95% CI 2.09-5.37), poor sleep quality (OR = 4.89; 95% CI 3.66-6.54) and excessive daytime sleepiness (OR = 1.95; 95% CI 1.54-2.47) were statistically significantly associated with CPDs. DISCUSSION: Our study demonstrated that CPDs are common among Thai college students. Further, evening chronotype, poor sleep quality and excessive daytime sleepiness were strongly associated with increased risk of CPDs. These findings highlight the importance of educating students and school administrators about the importance of sleep and their impact on mental health.

Daytime Sleepiness, Circadian Preference, Caffeine Consumption and Use of Other Stimulants among Thai College Students.

We conducted this study to evaluate the prevalence of daytime sleepiness and evening chronotype, and to assess the extent to which both are associated with the use of caffeinated stimulants among 3,000 Thai college students. Demographic and behavioral characteristics were collected using a self-administered questionnaire. The Epworth Sleepiness Scale and the Horne and Ostberg Morningness-Eveningness Questionnaire were used to evaluate prevalence of daytime sleepiness and circadian preference. Multivariable logistic regression models were used to evaluate the association between sleep disorders and consumption of caffeinated beverages. Overall, the prevalence of daytime sleepiness was 27.9 % (95% CI: 26.2-29.5%) while the prevalence of evening chronotype was 13% (95% CI: 11.8-14.2%). Students who use energy drinks were more likely to be evening types. For instance, the use of M100/M150 energy drinks was associated with a more than 3-fold increased odds of evening chronotype (OR 3.50; 95% CI 1.90-6.44), while Red Bull users were more than twice as likely to have evening chronotype (OR 2.39; 95% CI 1.02-5.58). Additionally, those who consumed any energy drinks were more likely to be daytime sleepers. For example, Red Bull (OR 1.72; 95% CI 1.08-2.75) or M100/M150 (OR 1.52; 95% CI 1.10-2.11) consumption was associated with increased odds of daytime sleepiness. Our findings emphasize the importance of implementing educational and prevention programs targeted toward improving sleep hygiene and reducing the consumption of energy drinks among young adults.

Sleep quality and sleep patterns in relation to consumption of energy drinks, caffeinated beverages, and other stimulants among Thai college students.

PURPOSE: Poor sleep and heavy use of caffeinated beverages have been implicated as risk factors for a number of adverse health outcomes. Caffeine consumption and use of other stimulants are common among college students globally. However, to our knowledge, no studies have examined the influence of caffeinated beverages on the sleep quality of college students in Southeast Asian populations. We conducted this study to evaluate the patterns of sleep quality and to examine the extent to which poor sleep quality is associated with consumption of energy drinks, caffeinated beverages, and other stimulants among 2,854 Thai college students. METHODS: A questionnaire was administered to ascertain demographic and behavioral characteristics. The Pittsburgh Sleep Quality Index was used to assess sleep habits and quality. Chi-square tests and multivariate logistic regression models were used to identify statistically significant associations. RESULTS: Overall, the prevalence of poor sleep quality was found to be 48.1 %. A significant percent of students used stimulant beverages (58.0 %). Stimulant use (odds ratios (OR) 1.50; 95 % confidence intervals (95 % CI) 1.28-1.77) was found to be statistically significant and positively associated with poor sleep quality. Alcohol consumption (OR 3.10; 95 % CI 1.72-5.59) and cigarette smoking (OR 1.43; 95 % CI 1.02-1.98) also had a statistically significant association with increased daytime dysfunction due to sleepiness. In conclusion, stimulant use is common among Thai college students and is associated with several indices of poor sleep quality. CONCLUSION: Our findings underscore the need to educate students on the importance of sleep and the influences of dietary and lifestyle choices on their sleep quality and overall health.