BACKGROUNDPreclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr.(Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident.OBJECTIVEWe sought to assess the efficacy and safety of Phlai for treating AR.METHODSA phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events.RESULTSTwo hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD) -0.62; 95%CI -1.22, -0.03; p = 0.039], rhinorrhea (aMD -0.19; 95%CI -0.37, 0.002; p = 0.048), itchy nose (aMD -0.24; 95%CI -0.43, -0.05; p = 0.011), and itchy eyes (aMD -0.19; 95%CI -0.36, -0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups.CONCLUSIONSPhlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.
Pediculosis capitis remains a persistent public health issue, especially in developing countries where resistance to standard neurotoxic pediculicides like permethrin is increasingly prevalent. This study aimed to compare the effectiveness of alternative treatment options against the standard care in a resource-limited setting. We conducted a single-blind randomized controlled trial involving three primary schools in Chachoengsao Province, Thailand (ClinicalTrials.gov: NCT06332872). Eighty-five female participants ages 6-13 years with active infestations were enrolled. Schools were randomly assigned to three treatment arms: 1) oral ivermectin (200 µg/kg) on Days 0 and 7; 2) 1% permethrin shampoo on Days 0 and 7, or 3) 4% dimethicone liquid gel as a single dose on Day 0. The primary outcome was the cure rate, defined as the absence of live lice and viable nits upon clinical assessment on Day 9. Of the 66 participants included in the final per-protocol analysis, oral ivermectin achieved a cure rate of 95.5% (21/22), which was significantly higher than that of the 1% permethrin standard of care (37.0%; 10/27) and the 4% dimethicone physical suffocant (29.4%; 5/17) (P <0.001). Although dimethicone achieved high initial parasitic clearance on Day 0 (88.2%), a rapid reinfestation rate of 58.8% was observed by Day 9, indicating that a single-dose protocol may be clinically insufficient. Adverse events were mild and temporary across all groups. Oral ivermectin appears significantly more effective than both 1% permethrin and single-dose 4% dimethicone in this population. These findings suggest that permethrin resistance is clinically prevalent and relevant in this area.
Abstract Blast-induced neurotrauma (BINT) remains a major cause of morbidity and mortality in modern military conflict. During the 2025 Thai–Cambodian border conflict, a forward-deployed Role 2+ Mobile Surgical Field Hospital with neurosurgical and intensive care capability was established within 35 km of active combat. This study evaluates its clinical performance and operational effectiveness. This retrospective study reviewed de-identified operational medical records from July 24 to August 4, 2025. Collected data included demographics, mechanism of injury, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), time to operating room (OR), surgical interventions, transfusion requirements, ICU length of stay (LOS), and in-hospital outcomes. Ethical approval was obtained from the Royal Thai Army Medical Department Institutional Review Board. A total of 144 combat-related casualties were managed. Mean age was 27.8 ± 6.4 years. Blast-related mechanisms accounted for 62% of injuries. Mean ISS was 18.6 ± 7.9. Operative intervention was required in 31% of patients. Median injury-to-OR time was 92 minutes (IQR 70–118). A total of 23 patients (16%) required ICU admission, with a median ICU LOS of 3 days (IQR 2–5). Massive transfusion protocol was activated in 8% of cases. No in-hospital mortality occurred among patients arriving alive at the Role 2+ facility. Forward deployment of neurosurgical and intensive care capability is associated with favorable clinical outcomes among patients who arrive alive at the Role 2+ facility. Interpretation is limited by survivor bias and absence of prehospital mortality data.
This study evaluated the cost-effectiveness of routine screening for acetylcholine receptor antibody (AChR-Ab) and thyroid function tests (TFT) in patients with acquired comitant esotropia (ACE) without overt signs of myasthenia gravis (MG) or thyroid eye disease (TED). A retrospective cost-utility analysis was conducted in 110 patients at a Thai tertiary hospital between 2014 and 2024. A decision tree combined with a 10-year Markov model compared two strategies: no routine screening (symptom-triggered testing) and universal baseline screening with AChR-Ab and TFT. Costs were expressed in 2024 Thai Baht (THB) from a healthcare sector perspective, and outcomes were measured in quality-adjusted life years (QALYs). Model uncertainty was assessed using one-way sensitivity analyses and probabilistic sensitivity analysis with 10,000 simulations, incorporating downstream costs of follow-up, confirmatory evaluation, and treatment. In the base-case analysis incorporating real-world diagnostic accuracy, universal screening yielded higher QALYs (109.56 vs. 105.45) but also higher costs (฿2,826,680 vs. ฿1,653,500), resulting in an incremental cost-effectiveness ratio (ICER) of ฿285,360 per QALY gained. This exceeded Thailand's willingness-to-pay threshold of ฿160,000-200,000 per QALY, indicating that universal screening was not cost-effective. Probabilistic sensitivity analysis showed that most simulations were located in the northeast quadrant of the cost-effectiveness plane, reflecting greater effectiveness with higher cost, with many exceeding the willingness-to-pay threshold. Key drivers included MG prevalence, utility loss from undiagnosed MG, and AChR-Ab test cost. TFT screening contributed minimal benefit due to the very low prevalence of thyroid dysfunction. Universal AChR-Ab screening may improve early detection of MG in ACE, but it was not cost-effective under current assumptions. Exploratory targeted screening appeared relatively more efficient, and symptom-triggered thyroid testing may be a more appropriate approach. These findings are preliminary and require validation in larger studies.
RATIONALE:Persistent monocyte activation contributes to HIV-associated neurocognitive disorders (HAND), yet biomarkers that predict neurocognitive impairment before and after antiretroviral therapy (ART) remain incompletely defined. OBJECTIVES:We evaluated monocyte subsets and activation markers in participants from the SEARCH007 cohort prior to ART initiation and at 6 and 12 months following treatment. METHODS AND RESULTS:Increased frequencies of CD14+CD16+ monocytes and elevated CD163 expression were associated with worsening neurocognitive performance and HAND severity. Plasma soluble CD163 levels increased with neurocognitive impairment and correlated with plasma HIV RNA levels, while CCR2 expression was associated with NPZ Global scores. Notably, CD169 expression was elevated across all monocyte subsets and demonstrated a stepwise increase with worsening neurocognitive impairment. Although ART reduced overall monocyte activation, elevated CD169 expression persisted in some individuals despite virologic suppression. Bayesian kernel machine regression and random forest analyses identified CD169 expression as one of the strongest predictors of cognitive impairment, surpassing plasma viral load, CD4+ T-cell count, and several established monocyte activation markers. CONCLUSIONS:These findings identify monocyte CD169 expression as a biomarker of neurocognitive dysfunction before and during the first year of ART and support further investigation of its role in HAND pathogenesis.
