Maharaj Nakorn Chiang Mai Hospital (Thai: โรงพยาบาลมหาราชนครเชียงใหม่) is a university teaching hospital, affiliated to the Faculty of Medicine of Chiang Mai University, located in Mueang Chiang Mai District, Chiang Mai Province. It is a hospital capable of super tertiary care and is the first university hospital in Northern Thailand, and the first to be located outside Bangkok. The hospital is known as 'Suandok Hospital' locally, due to its close proximity to Suan Dok Gate.
OBJECTIVES:Laboratory detection of myositis-specific autoantibodies (MSAs) utilizes ELISA and multianalyte line blot assays (LBA). We sought to evaluate the concordance and reliability of these two commercial assays. METHODS:Serum samples from patients with idiopathic inflammatory myopathies (IIMs) were obtained from seven countries across the Asia-Pacific region. Anti-Jo-1, anti-EJ, anti-PL-7, anti-PL-12, anti-MDA5, anti-Mi-2 and anti-TIF1-γ antibodies were centrally measured with commercial ELISA and LBA kits. The positive percentage agreement (PPA), negative percentage agreement (NPA) and Cohen's kappa were calculated by comparing the two assays. Sera with discordant results were subjected to 'gold-standard' immunoprecipitation (IP) assays. RESULTS:Serum samples obtained from 485 patients with IIMs, including 180 with DM, 44 with amyopathic DM, seven with JDM, 197 with PM or immune-mediated necrotizing myopathy and 57 with IBM, were subjected to ELISA and LBA. The PPA was the highest for anti-Jo-1 at 0.98, followed by 0.94 for anti-PL-7, 0.93 for anti-EJ, 0.93 for anti-MDA5, 0.89 for anti-TIF1-γ, 0.78 for anti-PL-12 and 0.67 for anti-Mi-2, whereas the NPA was high (ranging from 0.97 to 1 for all MSAs). Kappa values exceeded 0.80 for anti-Jo-1, anti-EJ, anti-MDA5 and anti-TIF1-γ, whereas anti-PL-7, anti-PL-12 and anti-Mi-2 exhibited low values. IP assays using sera with discordant results revealed a high rate of false positives for anti-PL-7 and anti-Mi-2 in LBA. CONCLUSION:Discrepancies in the measurement results were observed between commercially available ELISA and LBA, especially for anti-PL7 and anti-Mi-2. ELISA is more accurate than LBA.
ABSTRACT: Objective: This study aimed to characterize the mobile genetic context of an ∼ 82 kb chromosomal region showing co-localization of heavy-metal and an antibiotic resistance island in an extensively drug-resistant (XDR) Enterobacter cloacae NH77. Methods: Genomic DNA was sequenced using the Pacific Biosciences RS II platform. Long reads were de novo assembled with Canu v1.4 and annotated using Prokka v1.12b. The complete genome was analyzed to identify sequence type, antimicrobial resistance genes, integrons, insertion sequences, and plasmid type using MLST 2.0, ResFinder 4.7.2, Comprehensive Antibiotic Resistance Database (CARD) 4.0.1, INTEGRALL, and PlasmidFinder 2.1. Comparative analyses were performed using BLAST against Enterobacteriaceae genomes available in the NCBI GenBank database. Results: E. cloacae NH77 belonged to ST995 and was classified as XDR. The genome consisted of a 5 040 532 bp chromosome and a 41 179 bp IncN2 plasmid carrying bla NDM-1 . A 49 286 bp chromosomal resistance gene island (RGI) contained two class 1 integrons (In 191 and In 705 ) associated with 15 antimicrobial resistance genes. BLAST analysis showed the high similarity of the ∼49 kb RGI to sequences found in the chromosomes of Enterobacter hormaechei and Enterobacter asburiae and Escherichia coli plasmid. The ∼49 kb RGI was located immediately downstream of a Tn 7 - sil – pco cluster, forming an ∼82 kb composite mobile resistance island. All sequences contained pcoSE located at the end of the ∼49 kb RGI. Conclusions: This study describes an XDR- E. cloacae ST995 clinical isolate containing an ∼82 kb chromosomal resistance island comprising Tn 7 – sil – pco and a ∼49 kb RGI. The mobile genetic context suggests that pcoSE may function as a recombination target site for the ∼49 kb RGI.
Background and Objectives:Migraine is a significant disabling neurologic headache disorder globally. Evaluating patient-related outcomes (PROs) is necessary to assess the impact of therapeutic interventions in preventive therapy. An exploratory analysis of data from the EMPOwER study examined the effect of erenumab on PROs in patients with episodic migraine (EM) in regions underrepresented in the pivotal Phase 3 trials of erenumab, specifically Asia, the Middle East, and Latin America. Methods:Patients (N = 900) were randomized (2:3:3) to receive monthly subcutaneous injections of erenumab 140 mg, erenumab 70 mg, or placebo. Adjusted mean changes from baseline in the Headache Impact Test (HIT-6), Migraine Physical Function Impact Diary (MPFID), modified Migraine Disability Assessment (mMIDAS), and EuroQoL 5-dimension 5-level scale (EQ-5D-5L) scores were assessed during the double-blind treatment phase of 3 months. Results:A statistically significant reduction from baseline in the HIT-6 total score was observed for erenumab 140 mg (-9.34, p < 0.001) and 70 mg (-8.39, p = 0.004) vs placebo (-6.62) at Month 3. Improvement in MPFID scores was also greater in the erenumab groups vs the placebo group (Everyday Activity: 140 mg, -5.61 [p = 0.002]; 70 mg, -4.94 [p = 0.011]; placebo, -3.19; Physical Impairment: 140 mg, -4.27 [p = 0.014]; 70 mg, -3.95 [p = 0.021]; placebo, -2.31) at Month 3. Similar findings were observed for mMIDAS scores (140 mg -8.99 [p < 0.001], 70 mg -8.11 [p = 0.011] vs placebo [-6.59]) and the EQ-5D-5L quality-of-life visual analog scale scores (140 mg 8.13 [p = 0.017], 70 mg 7.08 [p = 0.088] vs placebo [5.22]), although no meaningful between-group difference was noted for index values. Discussion:Erenumab showed favorable effects on PROs when compared with placebo in patients with EM. These results enhance the evidence for erenumab as an effective preventive therapy for patients with EM. Trial Registration Information:Clinicaltrials.gov/study/NCT03333109.
Background Rapid identification of potentially reversible causes is essential during cardiac arrest resuscitation. The American Heart Association 5Hs and 5Ts framework is widely used as a structured cognitive aid during resuscitation. Emergency department cardiac arrest (EDCA) occurs in a distinct clinical environment and may involve different patterns of clinically identified reversible causes than out-of-hospital cardiac arrest (OHCA). We aimed to compare the distribution of clinically identified reversible causes between EDCA and OHCA. Methods We conducted a retrospective cohort study of adult cardiac arrest patients who received cardiopulmonary resuscitation in a tertiary emergency department between 2018 and 2024. Patients were classified as EDCA or OHCA. Reversible causes were classified using predefined operational definitions based on contemporaneous clinical documentation and available diagnostic information during resuscitation, representing clinically identified or suspected reversible causes rather than definitive etiologic diagnoses. The primary analysis compared the distribution of clinically identified reversible causes between EDCA and OHCA. Secondary exploratory analyses used Firth’s penalized logistic regression with prespecified confounding adjustment. Results Among 910 patients, 275 (30.2%) had EDCA and 635 (69.8%) had OHCA. Hypoxia was the most frequently identified cause but occurred less often in EDCA (46.6% vs. 57.2%; adjusted odds ratio [aOR], 0.61; 95% CI, 0.45–0.83). Hypovolemia was identified more frequently in EDCA (33.1% vs. 23.2%; aOR 1.80, 95% CI 1.22–2.65). Cardiac tamponade was also identified more frequently in EDCA (2.9% vs. 0.6%; aOR 5.14, 95% CI 1.52–17.40). No statistically significant adjusted differences were observed for the remaining reversible causes. Conclusion Among patients receiving cardiopulmonary resuscitation in the emergency department, the distribution of clinically identified reversible causes differed between EDCA and OHCA. Hypovolemia and cardiac tamponade were identified more frequently in EDCA, whereas hypoxia was identified less frequently. These findings describe patterns of clinical recognition during resuscitation rather than definitive etiologic differences and should be confirmed in multicenter studies using standardized disease-based etiologic classifications.
