In addition to the Human Leukocyte Antigen B*58:01(HLA-B*58:01), several non-genetic factors have been associated with allopurinol hypersensitivity syndrome, particularly severe cutaneous adverse drug reactions (SCAR), which are clinically serious. However, the magnitude of the impact of these non-genetic factors on the development of SCAR remains unclear. This study aimed to develop a non-genetic risk prediction model for predicting allopurinol-induced SCAR. This retrospective observational study was performed during the same time period. SCAR cases were collected from tertiary care hospital centers, while the non-SCAR cases were collected from primary and tertiary care hospital centers. Non-genetic factors including sex, age, renal function, concomitant use of diuretics, starting dose of allopurinol, and serum urate (SU) were used for the development of the prediction models. Of the 23,294 cases, 209 were SCAR and 23,085 were non-SCAR cases. Three risk stratification models were developed. Models 1A and 1B were applied for patients who did not have and had SU level at the time of starting allopurinol, respectively. Model 2 was applied for patients who had all non-genetic risk factors, started allopurinol within 60 days, but had not yet developed SCAR. The area under the receiver operating characteristic curve for Models 1A, 1B, and 2 was 0.73 (95
Cancer remains a major global health challenge and is a leading cause of morbidity and mortality in Thailand. Industry-sponsored oncology trials (ISOTs) provide critical access to innovative therapies, including targeted agents, immunotherapies (IO), and antibody–drug conjugates (ADCs), particularly in resource-limited settings. We conducted a retrospective multicenter study to characterize temporal trends, geographic distribution, and clinical trial characteristics of ISOTs across institutions participating in the Thai Society of Clinical Oncology (TSCO) network between January 2012 and September 2024. Data on trial characteristics, geographic distribution, and patient enrollment were collected from institutions affiliated with the TSCO using a standardized data collection instrument. A total of 651 ISOTs were identified. Analyses were performed using available data for each variable, with complete-case analyses (n = 581) applied where complete trial-level information was required. Most trials were conducted in Bangkok (67
AIM:Anticholinergic (ACh) and central nervous system (CNS)-active drug burdens may be associated with adverse outcomes in older adults. This study assessed these burdens and examined their associations with adverse in-hospital outcomes. METHODS:A retrospective cross-sectional analysis was conducted among 13 607 hospitalizations in patients aged ≥60 years in 2024. ACh burden was assessed using the 2022 CRIDECO Anticholinergic Load Scale, and the 2023 Beers Criteria were used to assess CNS-active burden. For each exposure, hospitalizations were classified as having no, low, or high burden. The primary outcome was a composite of delirium, cognitive impairment, falls or fractures. Secondary outcomes included length of stay, in-hospital mortality and hospitalization costs. Separate multivariable regression models were used to estimate associations with ACh and CNS-active burdens. RESULTS:Low and high ACh burdens were identified in 30.24% and 63.65% of hospitalizations, respectively; the corresponding proportions for CNS-active burden were 49.17% and 21.99%. Compared with no ACh burden, high ACh burden was associated with the primary outcome (adjusted odds ratio [aOR] 8.40; 95% confidence interval [CI] 3.46-20.38), whereas low ACh burden was not. Compared with no CNS-active burden, both low (aOR 4.67; 95% CI 2.67-8.18) and high (aOR 32.64; 95% CI 19.06-55.89) CNS-active burdens were also associated with this outcome. High burden in either group was associated with longer hospital stay, higher mortality and greater costs. CONCLUSIONS:ACh and CNS-active burdens were associated with adverse in-hospital outcomes, supporting consideration of routine inpatient medication reviews to identify potentially harmful cumulative drug burden.
The vascular perfusion of a split tibialis anterior muscle (TAM) flap has not been specifically investigated. This cadaveric study was performed to evaluate the anatomical reliability of a split TAM flap using thermographic assessment and contrast injection. Five paired fresh-frozen cadaveric lower-extremity specimens were included. A split TAM flap was elevated using a design of longitudinal lateral split with a medial muscular hinge. Flap dimensions were recorded. Heated water was injected through the popliteal artery, followed by thermographic assessment using a thermal imaging camera. Subsequently, contrast medium was injected, and the number of intramuscular perforators supplying the split flap was evaluated. The mean flap dimension was 3 × 13.5 cm² (range, 2.5–4 × 12–15 cm²). Thermographic assessment demonstrated a mean temperature difference of 18.6 °C between pre- and post-injection measurements. Following contrast injection, a mean of 4 intramuscular perforators was identified within each split TAM flap (range, 3–5). The split tibialis anterior muscle flap demonstrates reliable vascular perfusion and represents a viable anatomical option for coverage of narrow anteromedial defects of the tibial shaft.
Stenotrophomonas maltophilia is a multidrug-resistant bacterium that causes high in-hospital mortality worldwide. However, published data on the utility of combination therapy for S. maltophilia infections remain limited. We enrolled adult patients with S. maltophilia infection in a randomized, double-blind, placebo-controlled, single-center clinical trial at Siriraj Hospital, Thailand. Patients were assigned 1:1 to receive minocycline capsules (100 mg twice daily) in combination with either levofloxacin or trimethoprim-sulfamethoxazole or monotherapy with either levofloxacin or trimethoprim-sulfamethoxazole. The study outcomes were 28-day mortality, clinical and microbiological responses, and adverse events. The favorable microbiological outcome was that the previously identified pathogen was not detected, and no new pathogen was detected. Between 2022 and 2024, 112 patients were randomly assigned to combination therapy (n = 55) or monotherapy (n = 57). Most patients were in the intensive care unit at the time of enrollment (71.4%). There was no difference in 28-day mortality between groups (43.6% combination therapy vs 38.6% monotherapy, p = 0.59). Patients on combination therapy had significantly more favorable microbiological outcomes than patients on monotherapy 72 hours after treatment (45.5% on combination therapy vs 14% on monotherapy, p < 0.001) and at the end of treatment (80% on combination therapy vs 56.1% on monotherapy, p = 0.023). However, we observed comparable favorable clinical response rates 72 hours after treatment and at the end of treatment (52.7% on combination therapy vs 42.1% on monotherapy, p = 0.30, and 54% on combination therapy vs 57% on monotherapy, p = 0.86, respectively). Acute kidney injury was independently associated with 28-day mortality per a multivariate analysis. Adverse events, including acute kidney injury (n = 65/112; 58%) and elevated liver enzymes (n = 8/112; 7%), occurred but were not related to the study drug. Combination therapy with minocycline had better microbiological efficacy than monotherapy in patients with S. maltophilia infection and was safe. However, a beneficial effect of combination therapy with minocycline on the clinical outcomes of S. maltophilia infections was not noted. All Authors: No reported disclosures
