Maharaj Nakhon Si Thammarat Hospital

Background/Objectives: Early identification of ST-segment elevation myocardial infarction (STEMI) at first medical contact remains challenging, as high-sensitivity troponin T may be insufficiently sensitive during the initial phase of myocardial injury. Readily available complete blood count (CBC)-derived inflammatory indices may provide complementary early diagnostic signals. This study aimed to evaluate whether baseline CBC-derived inflammatory indices differ between STEMI and NSTEMI and whether they provide adjunctive discriminatory information at presentation (0 h) in patients with acute coronary syndrome (ACS). Methods: A 12-lead electrocardiogram (ECG), high-sensitivity troponin T, and CBC were obtained at presentation from 252 patients with ACS (195 STEMI and 57 NSTEMI). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis and 2 × 2 contingency tables to determine the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Results: High-sensitivity troponin T demonstrated the highest specificity (84.44%) and PPV (92.93%), supporting its role as a confirmatory biomarker; however, its low sensitivity (50.83%) and NPV (29.92%) may reduce its utility during early assessment. In contrast, WBC and neutrophil counts demonstrated relatively favorable discriminatory performance at presentation (AUC > 0.72; Youden’s index > 0.40). Among composite indices, NLPR demonstrated the highest sensitivity (88.66%) and NPV (53.19%), along with the lowest negative likelihood ratio (0.25), suggesting potential adjunctive value during early assessment. NLR, SII, SIRI, and adjusted NLR showed moderate performance, with aNLR providing a balanced sensitivity (67.01%) and specificity (74.55%). Conclusions: CBC-derived inflammatory indices, particularly neutrophil-based markers such as NLPR, may provide adjunctive discriminatory information during the early assessment of patients with ACS, particularly at first medical contact when baseline hs-Troponin T sensitivity may still be limited.

BACKGROUND: Regional teaching hospitals in Southern Thailand must train large student cohorts despite limited faculty and heavy clinical workloads. We explored whether a composite Self-directed learning, Self-video recording, Peer-to-peer review, and Direct feedback (SSPD) model can strengthen core clinical skills under these constraints. MATERIALS AND METHODS: A quasi-experimental one-group pretest–post-test study was conducted among n = 49 clinical-year medical students from Surat Thani and Maharaj Nakhon Si Thammarat Hospitals (March to September 2024). Students completed a four-station Objective Structured Clinical Examination (OSCE) covering history taking, physical examination, procedural skills, and patient counseling both before and after a four-component SSPD intervention. The primary outcome was the change in OSCE scores; secondary outcomes were learner satisfaction and frequency of video use. Mean differences were analyzed with paired-sample t-tests (α = 0.05), and effect sizes were expressed as Cohen’s d with 95% confidence intervals (CI). RESULTS: Significant gains were observed in history taking (Δ = 9.84 ± 15.39; 95% CI: 5.42–14.26; d = 0.64; P < 0.001), physical examination (Δ = 16.37 ± 19.08; 95% CI: 10.89–21.85; d = 0.86; P < 0.001), and patient counseling (Δ = 38.20 ± 18.71; 95% CI: 32.83–43.57; d = 2.04; P < 0.001). Procedural skills showed no meaningful change (Δ = 0.06 ± 17.51; 95% CI: −4.97–5.09; d ≈ 0.00; P = 0.981). Learners reported high satisfaction with self-directed learning and self-video recording components; 51% reviewed their videos. CONCLUSIONS: Despite the absence of a control group, medium-to-large effect sizes in three of four skill domains suggest the SSPD model is a feasible, scalable option for resource-limited clinical settings. Controlled trials should confirm these findings and determine long-term outcomes.

Background: Early assessment of myocardial injury severity at presentation remains challenging in acute myocardial infarction (AMI). Complete blood count (CBC)-derived inflammatory indices may provide accessible adjunctive biomarkers reflecting early systemic inflammatory activation associated with myocardial injury. This study evaluated the association and discriminative performance of CBC-derived inflammatory indices for presentation-time myocardial injury severity. Methods: This retrospective study included 252 patients with AMI. CBC-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-lymphocyte × platelet ratio (NLPR), were calculated from blood samples obtained at presentation (0 h). Correlation analysis, multivariable linear regression, logistic regression, incremental model analysis, and receiver operating characteristic (ROC) analysis were performed to assess associations with high-sensitivity Troponin T (hs-Troponin T) levels and high myocardial injury, defined as the highest hs-Troponin T tertile. Results: Both log NLR and log NLPR showed significant positive correlations with log hs-Troponin T (ρ = 0.422 and 0.396, respectively; p < 0.001). In multivariable linear regression adjusted for clinical variables and AMI subtype, log NLR (B = 0.88, p < 0.001) and log NLPR (B =0.77, p < 0.001) remained independently associated with log hs-Troponin T. Incremental model analysis demonstrated significant increases in explanatory performance after addition of log NLR (ΔR2 = 0.137) and log NLPR (ΔR2 = 0.121, p < 0.001). In logistic regression, log NLR (adjusted OR 2.77, 95% CI 1.65-4.66) and log NLPR (adjusted OR 2.46, 95% CI 1.53-3.95) were independently associated with high myocardial injury. ROC analysis demonstrated modest improvement in discrimination after incorporation of inflammatory indices, with AUC increasing from 0.709 for the baseline clinical model to 0.778 with log NLR and 0.770 with log NLPR. Supplementary reclassification analyses demonstrated improved classification performance. Conclusions: CBC-derived inflammatory indices, particularly NLR and NLPR, were independently associated with presentation-time myocardial injury severity in patients with AMI, even after adjustment for AMI subtype. Although improvements in ROC-based discrimination were modest, supplementary reclassification analyses suggested incremental value beyond conventional clinical variables and AMI subtype. These findings support the potential utility of CBC-derived inflammatory indices for early assessment of myocardial injury during AMI presentation.

Osimertinib is the preferred epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) for patients with EGFR-mutant non-small cell lung cancer (NSCLC) due to its superior efficacy and favorable safety profile. Nevertheless, dermatologic toxicities remain common and may disrupt treatment continuity, underscoring the importance of effective supportive care. Evidence regarding the clinical impact of proactive skin toxicity management during osimertinib therapy in real-world settings remains limited. To evaluate the association between proactive versus reactive skin toxicity management and toxicity severity, treatment modification, and clinical outcomes in patients with EGFR-mutant NSCLC treated with osimertinib. This retrospective cohort study included adult patients with advanced or recurrent EGFR-mutant NSCLC who received osimertinib at Surat Thani Hospital between January 2019 and January 2026. Patients were classified into a proactive skin toxicity management group, in which supportive skin care was initiated at the start of osimertinib therapy, or a reactive management group, in which skin toxicity management was initiated after the onset of dermatologic adverse events. Skin toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Multivariate logistic regression was used to evaluate the associations between skin toxicity management strategy (proactive vs reactive) and skin toxicity severity, osimertinib treatment modification, and objective response rate. Progression-free survival (PFS) was analyzed using Kaplan–Meier methods and Cox proportional hazards models. A total of 120 patients were included (60 per group), with comparable baseline characteristics. The overall incidence of skin toxicity did not differ between the proactive and reactive management groups (60.0

A 50-year-old man with severe presumed gallstone pancreatitis, multiorgan failure, and oliguric stage 3 acute kidney injury underwent bedside acute peritoneal dialysis (PD) for haemodynamically tolerated kidney support and intra peritoneal lavage. Catheter insertion drained a large volume of ascites that rapidly became vivid emerald green. Cultures remained sterile, whereas effluent amylase (11,041 U/L) and lipase (50,750 U/L) were markedly elevated, favouring inflammatory pancreatic leakage over infectious peritonitis or biliary perforation. During PD, effluent enzyme concentrations and cell counts declined, acidosis resolved, and kidney function improved. The patient subsequently died of septic shock. Emerald-green peritoneal effluent is rare and warrants urgent evaluation for serious intra-abdominal pathology.