Bhumibol Adulyadej Hospital

Lumbar fusion has evolved from open transforaminal lumbar interbody fusion (TLIF) to minimally invasive TLIF (MIS-TLIF), the current minimally invasive benchmark. Endoscopic techniques, proven in discectomy and decompression, have been extended to fusion (uniportal endoscopic TLIF and biportal endoscopic TLIF), offering an alternative to MIS-TLIF. This structured debate-style review critically compares both techniques across 7 domains to clarify their respective roles in lumbar degenerative disease. It combined independent advocacy drafts with an international survey of 106 respondents across 35 countries, capturing procedural preferences and case-based reasoning. Using a prespecified 70% agreement threshold, domains were classified as domains with ≥70% panel agreement, whereas domains falling below this threshold were categorized as domains below the prespecified agreement threshold. This represents structured international survey agreement, not a formal Delphi process. Endoscopic fusion offers advantages in decreased blood loss, soft-tissue preservation, early postoperative back pain, and early recovery, with comparable mid-term clinical outcomes (long-term insufficiently established) to MIS-TLIF, which remains more reproducible and familiar. Complication rates are similar but technique-sensitive for endoscopic fusion. Panel responses favored endoscopic approaches for morbidity-related domains (soft-tissue preservation 89.6%, visualization 81.1%, recovery 74.5%), while fusion stability, short- to mid-term clinical outcomes, complications, and revision remained context-dependent without clear agreement. Endoscopic fusion is a credible option for selected single-level lumbar degenerative disease, offering perioperative advantages with comparable mid-term outcomes to MIS-TLIF; core endpoints, including fusion rate and revision rate, did not reach 70% panel agreement, even among endoscopy-favorable panelists. MIS-TLIF retains reproducibility advantages. The debate has shifted from feasibility to implementation, training standardization, cost-effectiveness, and long-term durability.

Background: Angiographic haziness after coronary stent implantation is nonspecific and may represent thrombus, edge dissection, tissue protrusion, intramural hematoma, or stent underexpansion. Case summary: A 61-year-old man with anterior ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention (PCI) of a subtotal mid-left anterior descending artery lesion. One minute after implantation of a 3.0 × 26-mm zotaro-limus-eluting stent, new haziness appeared. It was interpreted as an edge dissection and treated with two additional proximal stents, after which the artery abruptly occluded and cardiogenic shock developed. Aspiration retrieved red thrombus, confirming intraprocedural stent thrombosis. Activated clotting time (ACT), fi rst measured 2 min after the onset of shock, was 150 s. Supplemental heparin and eptifi batide restored TIMI grade 2 fl ow. At staged intravascular ultrasound-guided reintervention on day 4, the vessel was larger than initially estimated and a fluoroscopic balloon waist suggested underexpansion; quantitative imaging data were lost. Conclusion: Thrombotic, anticoagulants, and mechanical abnormalities were documented at different time points, but their relative contribution cannot be established. Haziness that persists after a first mechanical correction should prompt verification of anticoagulation and intracoronary imaging before further stenting.

Background:Despite widespread favipiravir (FPV) use for coronavirus disease 2019 (COVID-19) in Thailand, pediatric clinical evidence remains limited. Objectives:This study evaluated FPV's effectiveness and safety for treating COVID-19 in children and adolescents. Methods:This multicenter, retrospective, observational cohort study included patients ≤18 years old testing COVID-19 positive between July 2021 and December 2022 across 11 hospitals in Thailand. Patients were divided into those with and without chest X-ray-confirmed pneumonia. Patients who received FPV were treated with 35 mg/kg twice daily on day 1 and 15 mg/kg twice daily on days 2-5. Pharmacokinetic (PK) modeling estimated plasma exposure in children using scaled Thai adult data. Results:Of 2,999 patients, 68.2% had no pneumonia. FPV recipients (n = 1,886) were mostly <5 years old, had a fever, infected during the Omicron wave, had lower mean cycle threshold (Ct) values of SARS-CoV-2 gene at diagnosis, and hospitalized compared to non-recipients. FPV treatment significantly shortened fever duration and hospitalization in both pneumonia and non-pneumonia patients. For non-pneumonia patients, being <5 years old, and receiving FPV were associated with complete recovery at discharge. For pneumonia patients, a history of preterm birth, pulmonary disease, and ICU admission reduced the likelihood of complete recovery at discharge. No serious adverse events were reported. PK models predicted that FPV plasma trough concentrations in children ≥10 kg were above efficacy targets. Conclusions:Early FPV treatment shortened fever duration and hospital stays in children and adolescents with COVID-19, promoting clinical recovery in both pneumonia and non-pneumonia cases.

The Thai Transplantation Society developed these clinical practice guidelines to establish a comprehensive standard for immunosuppressive therapy in adult kidney transplantation. While rooted in evidence-based medicine, the objective of this document extends beyond local application, serving as a practical model for low-to-middle-income countries, particularly within the Asia-Pacific and Southeast Asian regions, where specific genetic profiles and resource limitations require tailored management strategies. This publication addresses a critical need in the field, as there has been no updated comprehensive international consensus on immunosuppression since the KDIGO Clinical Practice Guideline in 2009, over 17 years ago. These guidelines bridge this gap by synthesizing modern clinical data with practical applicability. The scope of the guidelines is extensive, covering all aspects of immunosuppression usage including induction, maintenance, therapeutic drug monitoring, and the treatment of rejection. Uniquely, this document addresses specific challenges relevant to resource-limited settings, offering protocols for cost reduction through the use of generic drugs and the co-administration of cytochrome P450 3A4 and 3A5 inhibitors to minimize dosage requirements. Furthermore, it provides distinct guidance for immunosuppression in special clinical settings, including management during periods of fasting, pregnancy, and malignancy. This guideline ultimately benefits clinicians by offering a pragmatic, updated reference that balances therapeutic efficacy with economic sustainability.