Songkhla Hospital

Dengue virus (DENV) infection imposes a major global health burden, with around 100 million symptomatic cases and about 40 000 deaths each year. Despite decades of effort, no direct-acting antivirals are licensed and current vaccines show serotype-dependent and baseline serostatus-dependent efficacy, raising concerns about antibody-dependent enhancement. Early phase therapeutic trials therefore rely mainly on quantitative viraemia as a virological endpoint. However, DENV RNA in blood becomes undetectable soon after presentation, and may be an imperfect surrogate for infectious virus owing to defective interfering particles and continued replication in tissues. The secreted non-structural protein 1 (NS1) correlates with viral replication and disease severity in many studies and remains detectable after virological clearance, making it an attractive complementary biomarker. Here, we review mechanistic and clinical evidence linking NS1 to viral burden, vascular leakage and thrombocytopenia, and summarize data from human challenge studies, natural infection cohorts and pharmacometric modelling. We highlight the extended analytical window and growing availability of quantitative NS1 assays and propose practical analysis frameworks for incorporating NS1 into early phase dengue trials alongside viral RNA. We also discuss limitations, including serotype, immune status and assay-dependent effects and outline priorities for standardization of NS1-based endpoints. This article is part of the Theo Murphy meeting issue 'Evaluating anti-infective drugs'.

Fungal peritonitis is a severe complication of peritoneal dialysis (PD), increasingly involving rare yeasts that challenge routine diagnostics. We report PD-associated peritonitis caused by Blastobotrys adeninivorans, initially misidentified as Candida ciferrii by automated platforms (VITEK 2 and MALDI-TOF MS). Persistent neutrophilic inflammation and elevated effluent β-D-glucan prompted multilocus sequencing, which confirmed B. adeninivorans. Susceptibility testing showed markedly elevated MICs to amphotericin B, azoles, and echinocandins, interpreted cautiously because validated breakpoints are unavailable. This case illustrates how persistent culture-positive PD peritonitis with discordant or unusual yeast identification should prompt molecular confirmation. Clinical resolution followed PD catheter removal and transition to haemodialysis, underscoring the importance of early source control in refractory PD-associated fungal peritonitis.

Objectives: To compare rehabilitation outcomes up to 24 weeks post-stroke, therapy exposure, and complication rates between home-based and outpatient-based IMC stroke rehabilitation programs, before and after propensity score matching in a hospital. Study design: Retrospective observational cohort design with Propensity Score Matching Setting: Department of Rehabilitation Medicine, Songkhla Hospital, a tertiary care hospital in southern Thailand Participants: Intermediate care stroke patients who received rehabilitation services through either the home-based or outpatient-based model between October 2022 and September 2025. Methods: This retrospective study analyzed stroke patients enrolled in the IMC program. Baseline characteristics, Barthel Index (BI) scores, dependency levels, complications, and therapy session counts were collected at baseline, 2 weeks, 12 weeks, and 24 weeks. Propensity score matching was conducted using initial BI, National Institutes of Health Stroke Scale (NIHSS), age, sex, and other key covariates to ensure baseline clinical balance. Results: Before matching, the home-based group was older and predominantly female, while the outpatient-based group tended to present with more-severe strokes and lower initial BI scores. The outpatient-based group also received substantially more therapy (median PT: 10 vs. 3; OT: 8 vs. 1; both p < 0.001). After matching, therapy exposure remained higher in the outpatient-based group (PT: 1.6 [SD = 1.9] vs. 8.5 [SD = 6.6], SMD = –1.63; OT: 8.5 [SD = 6.2] vs. 9.2 [SD = 6.2], SMD = –1.43). Short- and intermediate-term BI gains were similar between the groups, with identical median gains during several intervals. Long-term BI gain (baseline–24 weeks) was greater in the outpatient-based group. The home-based group met non-inferiority criteria for BI gain at 24 weeks (p = 0.035), but not at 12 weeks. Trends toward higher pneumonia and pressure ulcer rates were observed in the home-based group, whereas recurrent stroke tended to be more common in the outpatient-based group, though neither reached statistical significance. At 6 months, 62.7% of the home-based and 63.7% of the outpatient-based group had achieved a level of mild or no disability. Conclusions: Home-based and outpatient-based IMC rehabilitation yielded broadly comparable outcomes despite a substantially lower therapy dosage in the home-based group. Increasing therapy intensity and integrating advanced rehabilitation technologies could potentially further improve functional recovery within the IMC framework. The home-based group demonstrated statistically non-significant trends toward higher rates of preventable complications such as pneumonia and pressure ulcers.

Migraine is a common and disabling neurological disorder, yet diagnostic accuracy remains suboptimal, especially in non-specialist settings. Misdiagnosis may lead to delayed treatment, medication overuse, and reduced quality of life. The objective of this study was to estimate the proportion of patients with migraine attending the headache clinic who were misdiagnosed or not diagnosed as having migraine before attending the headache clinic, and to identify factors associated with inaccurate migraine diagnosis among patients before attending a tertiary hospital in Southern Thailand. A prospective, cross-sectional study was conducted at Songkhla Hospital between July 2024 and April 2025. Adult patients (≥ 18 years) with a final migraine diagnosis confirmed by two blinded independent neurologists were enrolled. Participants were divided into two groups: (1) an appropriate diagnosis group, defined as patients who received a correct diagnosis of migraine at their initial consultation with any physicians prior to attending the headache clinic; and (2) an inappropriate diagnosis group, defined as patients who were previously misdiagnosed with another headache disorder or had not been diagnosed with migraine before their headache clinic visit. Data on demographics, clinical features, and the specialty of the first attending physician were analyzed using univariable and multivariable logistic regression. 90 patients were included (87.8