Surin Hospital

BACKGROUND AND AIM:The efficacy of high-dose oral omeprazole in peptic ulcer bleeding after successful therapeutic hemostatic endoscopy has not been well established. This study aimed to compare the efficacy of high-dose oral omeprazole versus continuous intravenous (IV) pantoprazole in rebleeding and percent time of gastric pH above 6. METHODS:Eligible patients were randomized with 1:1 concealed allocation to 40-mg oral omeprazole twice daily or IV pantoprazole 8 mg/h for 72 h after index gastroscopy. Gastric pH was measured for 24 h during 48-72 h after starting the assigned medication. Rebleeding at 72 h and 30 days, as well as 24-h gastric pH, were assessed. RESULTS:A total of 124 patients were analyzed. Seventy-two-hour rebleeding occurred in 1.6% (1/61) of the oral omeprazole group and 4.8% (3/63) of the IV pantoprazole group requiring endoscopic hemostasis (risk difference [RD] -3.1%, 95% CI -11.6% to 4.6%). Rebleeding within 30 days also showed no difference between groups (3.3% vs. 4.8%, RD -1.5%, 95% CI -10.1% to 7.0%). Gastric pH monitoring was completed in 48% (29/61) of the oral group and 41% (26/63) of the IV group. The median percentage of gastric pH > 6 was 56.3% (IQR 28.0%-92.0%) in the oral group and 27.3% (IQR 4.4%-77.7%) in the IV group (p = 0.064). CONCLUSIONS:High-dose oral omeprazole may represent a feasible alternative to continuous IV pantoprazole in terms of preventing rebleeding at 72 h and 30 days and maintaining gastric pH > 6 among patients with peptic ulcer bleeding who underwent successful therapeutic hemostatic endoscopy. TRIAL REGISTRATION:Registration number: NCT04394663.

Objective: This cross-sectional study aimed to determine the factors related to sleep quality among older adults aged 60 years and above in a northeastern province of Thailand. Material and Methods: A total of 355 participants were randomly selected by multistage sampling between October and December 2024. Data collection tools included general characteristics, physical environment, family relationships, stress assessment, the Thai Geriatric Depression Scale (TGDS-15), and the Pittsburgh Sleep Quality Index (PSQI). The instrument’s content validity was ≥0.67 for each item, and the reliability was 0.77. Descriptive statistics and multiple logistic regression analysis were performed using a statistical software package. A p-value set at <0.05.Results: Average age of participants was 68.59±8.741 years old; 45.7% had no underlying medical conditions and 23.1% lived in a rural area. Factors associated with sleep quality were being female (aOR, 0.58; 95%CI, 0.352 to 0.954), living in a rural area (aOR, 1.97; 95%CI, 1.104 to 3.493), having severe problems related to their physical environment (aOR, 3.60; 95%CI, 1.362 to 9.510), having moderate stress (aOR, 2.11; 95%CI, 1.219 to 3.635), and having signs of depression (aOR, 2.12; 95%CI, 1.270 to 3.553). Conclusion: People in both urban and rural areas should be supported by intervention programs in order to increase good sleep quality. Furthermore, encouraging family bonding can promote a supportive home environment, strengthen relationships, and enhance overall family well-being. Activities that promote mental health, such as exercise, recreational activities, and meditation, are suggested to help reduce stress and depression in this population.

Background: A large proportion of the world population lives in the Asia-Pacific region where uncontrolled hypertension impacts global trends. This study aimed to summarise age-adjusted prevalence estimates of hypertension in the region to project the future burden of the disease to 2030.Methods: A comprehensive literature search was conducted using PubMed®, Web of Science®, SCOPUS®, and Embase®, alongside manual reference reviews, to identify studies from 2001 to 2023 in the Asia-Pacific region. Inclusion criteria required standardised blood pressure measurement, population-based data, and definitions of hypertension as systolic and diastolic ≥140/90 mmHg, or antihypertensive use. The hypertension prevalence was determined based on the identified studies. Within countries, the linear regression of age-standardised prevalence estimates predicted trends in hypertension prevalence to 2030.Results: 285 population-based studies were included. Age-specific and crude hypertension prevalence estimates from 19 countries were used to estimate predicted values. The estimated age-standardised prevalence of hypertension in 2030 ranged from 11.0% to 46.2% and was projected to increase in most countries. The exceptions were Iran, Nepal, and Mongolia, which were estimated to achieve 30% reduction in hypertension relative to 2010. Six countries were estimated to have reductions in prevalence by 2030, but without achieving the WHO goal of 30% reduction relative to 2010.Conclusion: The hypertension prevalence has been increasing in most countries. Only three countries are projected to achieve their target goal by 2030. Initiatives to strengthen primary prevention and treatment, along with consistent measurement of population blood pressure in this region, should remain important agenda items for policy makers.

Introduction:PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome is a rare autoinflammatory disorder. Systemic inflammation, cytopenia, and skin lesions are classic features, accompanied by hypercalprotectinemia and hyperzincemia. Gastrointestinal manifestations such as colitis are infrequent. We present the first case in Thailand of PAMI syndrome presenting as refractory colitis. Case Presentation:A 23-year-old male presenting with adult-onset refractory colitis and a history of a teenage perianal abscess. Despite the relatively late onset of intestinal symptoms, the patient exhibited a complex clinical picture across multiple domains of inborn errors of immunity, including autoimmune hemolytic anemia, chronic neutropenia, hepatosplenomegaly, and severe cystic acne. Genetic testing revealed a PSTPIP1 mutation (E250K variant), and laboratory results showed pathognomonic hyperzincemia, confirming PAMI syndrome. Treatment with adalimumab led to significant clinical and endoscopic remission. Conclusion:PAMI syndrome should be considered a differential diagnosis in patients with atypical or refractory colitis, particularly when accompanied by systemic clues such as cytopenia, severe acne, or organomegaly. Serum zinc levels serve as a simple, cost-effective screening tool to facilitate prompt diagnosis and can function as a practical biomarker for monitoring the response to therapy.

Background:Vascular trauma of the lower extremity remains a major cause of preventable deaths in combat environments. Among these, injury to the profunda femoris artery is rare due to its deep location in the thigh. Blast injuries in military settings can cause extensive soft tissue and vascular disruption, making both diagnosis and hemorrhage control challenging. In such circumstances, early bleeding control and revascularization are crucial to optimize outcomes. Initial hemorrhage control can begin on the battlefield through appropriate tourniquet application. Definitive management may involve either open surgical or endovascular techniques, with embolization serving a vital role when suitable equipment and hospital resources are available. Case report:A 37-year-old soldier sustained a blast injury to the right thigh during the Thailand-Cambodia border conflict and self-applied a tourniquet in the field. On arrival, he was hypotensive with diminished distal pulses. Emergency surgical exploration with intraoperative angiography revealed active bleeding from a profunda femoris artery branch. Coil embolization was performed, supplemented with Gelfoam to reinforce thrombosis and ensure complete vessel occlusion. Fasciotomy was performed for compartment decompression. A vacuum-assisted closure dressing was applied for 2 weeks, followed by split-thickness skin graft coverage. At two months, the wound was fully healed, and the patient was able to ambulate independently. Conclusion:This case highlights the importance of prehospital tourniquet application and a pragmatic, resource-based approach to vascular trauma management in wartime conditions, utilizing available resources to achieve the best possible outcome.