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.

Background: Prenatal attachment—the bond a pregnant woman forms with her unborn child—has been associated with postpartum bonding and infant development, yet its predictors among first-time pregnant adolescents remain unclear. Methods: This cross-sectional predictive correlational study examined prenatal attachment and its predictors among 136 first-time pregnant adolescents aged 13–19 years in Songkhla, Thailand. Hierarchical regression (gestational age entered first) used 134 participants. Results: Prenatal attachment was very high (M = 123.23, SD = 12.65; mean item score = 4.25/5). No participant screened positive for intimate partner violence, so this variable was excluded from regression. Gestational age alone explained 20.1% of the variance (β = 0.448, p < 0.001); adding the psychosocial block raised this to 36.7% (ΔR2 = 0.166, p < 0.001), with gestational age (β = 0.454), social support (β = 0.269), and self-esteem (β = 0.160) being significant and marital relationship, stress, and depression not. These results remained unchanged when we analyzed all 136 participants and after adjusting for maternal age, pregnancy planning, and hospital site. Conclusions: Prenatal attachment was very high, and social support and self-esteem predicted it independently of gestational age. Nursing interventions that strengthen social support and self-esteem early in pregnancy may help promote prenatal attachment in this group.

Abstract Background Preventable maternal mortality remains a major public health concern and often driven by delays in reaching and receiving appropriate obstetric care. This study implemented a hybrid care integrating digital tools enabled 24-hour One Labor Room Network Model to strengthen coordination between a tertiary hospital and local hospitals network. Methods A quasi-experimental prospective study was conducted from Oct 2023–September 2025 across the tertiary Hospital (hub) and local hospitals network. The intervention integrated 24/7 specialist consultation via digital platforms, fast-track referral pathways, daily multidisciplinary case reviews, and high-risk pregnancy surveillance. Quantitative data were extracted from medical records and digital platforms. Qualitative data were collected through in-depth interviews with health professionals. Results All six local hospitals in the network participated. All pregnant women were systematically risk-screened with specialist consultation. The study detected 393 pregnancies with high risk of medical or obstetric complications, and all cases received appropriated co-management or referrals. Compared with the pre-intervention period, preterm rate decreased by 3.72%, while the successful natural births in local hospitals increased by approximately 30% and successful seamless referrals increased by 5.06 %. Postpartum home follow-up for high-risk women reached 100% coverage. The mean ‘work satisfaction’ scores among health professionals increased from 3.72 to 4.26 after joining this hybrid care model, with the highest gains in inter-hospital coordination (4.40) and referral efficiency (4.35). Conclusions The hybrid 24-hour One Labor Room Network Model reduced preventable maternal risks, strengthened referral systems, enhanced workforce capacity, and improved maternal health outcomes. The network-based, digitally hybrid care model shows promising feasibility and efficacy in preventing high-risk pregnancy and is scalable. Key messages • A hybrid 24-hour One Labor Room Network Model reduces preventable maternal deaths and improved maternal health by strengthening real-time referral and specialist support across the hospitals network. • Networked obstetric care increased local hospitals capacity, reduced delays in care, and improved workforce confidence and coordination in maternal health services.