Phra Nakhon Si Ayutthaya Hospital

The clinical benefit of fresh frozen plasma (FFP) transfusion prior to endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) and mild coagulopathy remains uncertain. We evaluated the association between pre-endoscopic FFP transfusion and clinical outcomes in patients with AUGIB and an international normalized ratio (INR) of 1.5-2.5. We conducted a retrospective two-center cohort study including adult patients admitted with AUGIB and INR 1.5-2.5 at two tertiary referral hospitals in Thailand between 2016 and 2020. Patients were categorized according to receipt of pre-endoscopic FFP transfusion. Multivariable logistic regression analyses were performed using baseline covariates and bleeding severity scores. An exploratory composite in-hospital major adverse event endpoint was evaluated to improve model stability. Among 244 patients (158 received FFP; 86 did not), those receiving pre-endoscopic FFP had higher crude rates of 30-day all-cause mortality (23.4% vs. 11.6%), in-hospital mortality (24.1% vs. 7.0%), pulmonary edema (23.4% vs. 4.7%), and the composite in-hospital major adverse event endpoint (40.5% vs. 10.5%) (all p < 0.01). After multivariable adjustment, pre-endoscopic FFP transfusion remained associated with the composite endpoint (adjusted odds ratio [aOR] 5.28; 95% confidence interval [CI], 2.17-12.82), in-hospital mortality (aOR 5.36; 95% CI, 1.87-15.37), pulmonary edema (aOR 3.85; 95% CI, 1.21-12.26), and 30-day mortality (aOR 2.69; 95% CI, 1.09-6.66). In subgroup analyses, these associations were more consistent among patients with variceal bleeding. In patients with AUGIB and mildly elevated INR, pre-endoscopic FFP transfusion was associated with higher mortality and pulmonary complications, particularly in those with variceal bleeding. Given the retrospective design and potential for residual confounding, these findings should be interpreted with caution. Nevertheless, these findings support consideration of a more selective, context-based approach to plasma transfusion and highlight the need for prospective studies to inform evidence-based transfusion strategies.

BackgroundAsthma and allergic rhinitis (AR) can coexist and cause disabilities. This study aimed to assess the association between AR, asthma control, asthma-related quality of life, and other comorbidities.MethodsA cross-sectional study was conducted in adults with asthma in six hospitals in Thailand. The outcomes were association of asthma control assessed by the asthma control test (ACT), AR, and asthma comorbidities. Not-well-controlled asthma was defined as ACT scores ≤22. The severity of AR was determined by visual analog scale (VAS). Severe AR was defined as VAS ≥5. Asthma-related quality of life (AQLQ), comorbidities, and total IgE were recorded.ResultsA total of 682 asthmatic patients were included. Median (IQR) age was 58.0 (47.0–64.0) years. 69.9% were female. Not-well-controlled asthma was present in 44.7%. The prevalence of AR was 86.1%. Moderate/severe persistent AR was diagnosed in 21.7% and severe AR was diagnosed in 30.2% of the patients. Inhaled corticosteroid-containing regimens were prescribed in 97.7% of patients. Intranasal corticosteroid and antihistamine were prescribed in 65.7 and 31.7%, respectively. Patients with not-well-controlled asthma had higher body mass index, VAS scores, proportions of pollution exposure, aeroallergen sensitization, severe AR, nasal polyp, urticaria, food allergy, gastroesophageal reflux disease, depression and anxiety, peptic ulcer, and asthma exacerbations, but younger age, lower AQLQ scores, and lower FEV1. Correlation was found between AR severity and ACT (r = −0.461, p < 0.001), AQLQ (r = −0.512, p < 0.001), and total IgE (r = 0.246, p < 0.023). Multiple regression analysis revealed that ACT, AQLQ, and percentage of FEV1/FVC were significantly associated with severe AR.ConclusionAllergic rhinitis is prevalent in Thai asthmatic patients. AR severity is associated with asthma control, quality of life, and pulmonary function. Comprehensive care is essential for patients with uncontrolled asthma, particularly when coexisting with conditions.

OBJECTIVES To systematically review and pool the clinical outcomes of hybrid arch repair (HAR) and total arch replacement (TAR) with or without a frozen elephant trunk for treating aortic arch aneurysms, dissections, or other pathology in propensity score-matched studies. METHODS We conducted electronic database searches in PubMed, Embase, the Cochrane Library, and Google Scholar to identify studies reporting outcomes of HAR versus TAR. Risk of bias was assessed using non-randomized studies of interventions (ROBINS-I) tool. The primary outcome was in-hospital mortality analyzed using a random-effects model to compute the odds ratio (OR). Survival probability was expressed as hazard ratios (HR) calculated through the inverse variance method. The results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS This meta-analysis included 13 studies with 3,392 patients. There was no significant difference in in-hospital mortality between HAR and TAR groups (OR 1.08; 95% CI 0.78-1.49; p = 0.630). However, HAR group showed a higher incidence of permanent neurological dysfunction (PND) (OR 1.71; 95% CI 1.22-2.41; p < 0.001). In subgroup meta-analysis with isolated type A aortic dissection (ITAAD), HAR showed significantly lower in-hospital mortality (p = 0.040) but no difference in PND. Other post-operative complications were significantly lower in the HAR group for renal failure (OR 0.65; 95% CI 0.49-0.87; p < 0.001), sternal re-entry due to bleeding (OR 0.55; 95% CI 0.34-0.89; p = 0.010), and tracheostomy (OR 0.61; 95% CI 0.38-0.96; p = 0.030). There is no statistical difference in 3-year survival probability (HR 0.97; 95% CI 0.70-1.35; p = 0.870). CONCLUSIONS TAR has more favorable than HAR in MDAD patients, offering lower rates of neurological dysfunction and better 3-year freedom from re-intervention. For ITAAD patients, HAR potentially provides better in-hospital mortality and 3-year survival rates, with fewer complications such as renal failure, re-sternotomy, and tracheostomy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data that support the findings of this study can be obtained from the corresponding author upon reasonable request.

Background: Computer-assisted total hip arthroplasty using direct anatomic registration (DAR) with acetabular center axis software is an alternative method to the indirect anterior pelvic plane method. The software maps the center of hip rotation and orientation of the native acetabulum in 3 dimensions. This study aimed to evaluate the accuracy of acetabular cup alignment using DAR navigation combined with a mechanical guide device (MGD).Methods: This prospective nonrandomized controlled study included 106 patients who underwent primary cementless total hip arthroplasty through the posterolateral approach. Fifty-four patients in the study group underwent DAR combined with MGD, whereas 52 patients underwent MGD only for acetabular cup positioning. Plain radiographs of both hips and computerized tomographic scans were obtained 2 months postoperatively for the evaluation of acetabular cup inclination and anteversion, respectively.Results: The acetabular cup alignment in the study group was within the Lewinnek safe zone more than that in the control group (81.5% vs 59.6%, P < .05). The study group had a mean inclination angle of 43.88(degrees degrees) (standard deviation [SD] 5.38) and anteversion angle of 12.82(degrees)(SD 5.99), whereas the control group had 41.10(degrees)(SD 6.79) and 12.82(degrees) (SD 9.53), respectively. There were no significant differences in estimated blood loss, length of stay, and Harris hip scores at preoperative and 3 and 6 months postoperatively, except for the operative time, which was longer in the study group (P < .01). There was 1 posterior hip dislocation in each group.Conclusions: DAR navigation combined with MGD provides better accuracy for acetabular cup positioning within the Lewinnek safe zone compared with the conventional technique.(c) 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.