Trang Hospital

INTRODUCTION:Acquired methemoglobinemia results from exposure to various oxidizing agents; however, data remain limited in Asia, including Thailand, where certain drugs and agricultural chemicals are widely used. Local epidemiologic data are essential for early recognition and clinical management. METHODS:A 10-year retrospective cohort study of poison center - identified cases of acquired methemoglobinemia (2013-2022). Patients were included if they had a methemoglobinemia (concentration >3%) or a characteristic oxygen saturation gap with subsequent clinical recovery. Demographic, exposure, clinical, treatment, and outcome data were collected, and factors associated with mortality were analyzed using a multivariate binary regression model. RESULTS:Among 169 patients (median age 43 years; 59.17% male), the leading causes were dapsone (30.18%) and propanil (27.22%), followed by herbal and food-related agents. In some patients (19.53%), the specific oxidizing agents could not be identified. Neurological, cardiovascular, and hematologic manifestations occurred in 24.26%, 33.73%, and 40.24% of cases, respectively. The median and highest methemoglobin concentrations were 11.50% and 48.85%. Most patients (88.76%) were hospitalized, with 40.24% requiring admission to the intensive care unit. Treatments included administering oxygen (95.86%), intravenous fluids (81.07%), and methylthioninium chloride (31.36%; median dose: 1 mg/kg), as well as blood transfusion (43.20%) and intubation (33.73%). Complications occurred in 29.59% of cases, most commonly sepsis and pneumonia. The mortality rate was 11.24%. DISCUSSION:Mortality was driven not only by the severity of methemoglobinemia but also by systemic complications that occurred during hospitalization. Shock at presentation was the sole prognostic factor and likely reflected severe concurrent complications rather than a direct effect of methemoglobinemia, emphasizing the prognostic importance of early systemic illness. Early recognition, prompt resuscitation, and timely management of complications are essential for improving survival rates. CONCLUSIONS:Acquired methemoglobinemia is most often caused by dapsone and propanil. Shock at presentation may prognosticate a fatal outcome. Early diagnosis, timely therapy, and aggressive management of systemic complications are required to improve the patients' clinical outcomes.

This paper presents the development of a knee rehabilitation device designed in strict compliance with ISO 13485, the international standard for Quality Management Systems (QMS) specific to medical devices. The aim is to create a safe, effective, and user-friendly rehabilitation solution that supports patients recovering from knee injuries or surgeries, with a particular focus on elderly patients who often experience reduced mobility and longer recovery periods. The development process integrates interdisciplinary engineering approaches, including biomechanical analysis, embedded systems, and ergonomic design. Key features of the device include adjustable motion control, data logging for physiotherapist evaluation, and user interface optimization to enhance patient engagement and safety. Risk management, traceability, and documentation were rigorously implemented throughout the design phases in accordance with ISO 14971 and ISO 13485 requirements. Testing was conducted to verify device performance, safety, and compliance with regulatory standards. The resulting system demonstrates both functional reliability and the ability to improve rehabilitation outcomes. This work highlights the importance of aligning product development with international medical device standards to ensure market readiness and patient safety.

BACKGROUND:Patient-reported outcome measures (PROMs) are widely recognized as valuable predictors of clinical outcomes in peritoneal dialysis (PD). Our study aimed to explore the connections between patient-reported constipation and clinical outcomes.METHODS:We assessed constipation in patients across 22 facilities participating in the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Constipation diagnosis utilized objective assessment tools such as the Bristol stool form scale (BSFS) and a self-reported questionnaire known as the constipation severity score (CSS). The BSFS is a 7-level scale that visually inspects feces based on texture and morphology, while the CSS measures constipation duration and severity using a 5-point Likert scale for various factors. We employed Cox proportional hazards model regression to determine the associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis.RESULTS:Among 975 randomly selected PD patients from 22 facilities, 845 provided written informed consent, and 729 completed CSS questionnaire. Constipation was prevalent in the PD population (13%), particularly among older patients, those who were caregiver dependent, had diabetes and poorer nutritional status (indicated by lower time-averaged serum albumin, potassium, creatinine and phosphate concentrations). Twenty-seven percent of which experiencing symptoms of constipation for over a year. Notably, self-reported constipation at baseline was significantly associated with a shorter time to first peritonitis and higher rates of peritonitis and death. However, no significant association was found between constipation and HD transfer after adjusting for various factors, including age, gender, PD vintage, comorbidities, shared frailty by study sites and serum albumin.CONCLUSION:Patient-reported constipation independently correlated with increased risks of peritonitis and all-cause mortality, though no such correlation was observed with HD transfer. These findings underscore the need for further investigation to identify effective interventions for constipation in PD patients.

Background: Nowadays, the development of training programs for speed, agility and reaction time responses in football players is increasing widely. Motor imagery is a new method that uses collateral with physical training. However, there is still a scarcity of evidence concerning the addition of motor imagery protocol to routine training programs. Objective: The main objective was to compare speed, agility and reaction time after motor imagery training in university athletes and amateur athletes who received and did not receive motor imagery training for 2 weeks. Methods: Participants were divided into 4 subgroups as follows: university athlete group with motor imagery training and control group, amateur athlete group with motor imagery training and control group. This study collected the training effects of speed, agility and reaction time. The Wilcoxon signed-rank test and the Mann–Whitney U test were selected to analyse the differences within and between groups, respectively. Results: The result presented positive changes in all variables after training sessions for 2 weeks in all groups. Speed at 20[Formula: see text]m, agility, and reaction time were found to be significantly different after motor imagery training in both university athletes and amateur athletes. Conclusion: This finding demonstrated that the addition of the motor imagery training along with routine physical training promotes physical performance in athletes at all experience levels. In further studies, the retention effect after practice should be considered.