Purpose: Visual problems are a common reason for ophthalmic evaluation in children and encompass a wide spectrum of functional visual disturbances and visual impairment. Understanding the patterns of pediatric visual disorders across different clinical care settings is important for service planning and resource allocation, particularly in tertiary referral hospitals. Patients and Methods: This retrospective descriptive study included pediatric patients aged < 18 years who presented to a tertiary hospital with clinically assessed visual problems from January 1, 2015, to December 31, 2024. Patients were identified from outpatient (OPD) and inpatient (IPD) services using International Classification of Diseases, Tenth Revision (ICD-10) codes for visual disturbances (H53) and visual impairment or blindness (H54). Demographic data, laterality, clinical diagnoses, refractive status, and management indicators were collected. The distribution of visual disorders was compared between OPD and IPD settings. An exploratory multivariable logistic regression analysis was performed to identify clinical factors associated with inpatient admission. Results: A total of 321 pediatric patients were included, comprising 196 OPD and 125 IPD cases. Amblyopia and refractive-related conditions were the most common diagnoses in OPD, whereas cataract predominated in IPD. Surgical intervention was required significantly more frequently among IPD patients than OPD patients. Refractive error was common in both settings, but occurred more frequently in IPD. ICD-10-based analysis showed that visual disturbance codes (H53) were more prevalent in OPD, while visual impairment codes (H54) were more common in IPD. In multivariable analysis, cataract and bilateral involvement were independently associated with inpatient admission. Conclusion: Pediatric visual disorders presenting to a tertiary hospital demonstrate distinct patterns between outpatient and inpatient settings. Outpatient encounters are dominated by amblyopia and refractive-related conditions, whereas inpatient admissions are largely driven by cataract and conditions requiring surgical management. These findings highlight the importance of differentiated service strategies to optimize the delivery of pediatric eye care and resource utilization.
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.
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.
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. We evaluated monocyte subsets and activation markers in participants from the SEARCH007 cohort before ART initiation and at 6 and 12 months following treatment. 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 a composite neuropsychological performance Z-score (NPZglobal). 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. 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.
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.
