Background: Physician attrition from the public health sector has emerged as a pressing issue in Thailand, with significant implications for healthcare delivery and workforce sustainability. Objective: To explore the key factors contributing to physicians’ resignation from the Thai public health system and to examine physicians’ perceptions of factors that may support retention. Materials and Methods: A cross-sectional survey was conducted in 2025 among 50 physicians who previously worked in the public health sector and are currently employed in private hospitals or other organizations. Data were collected using a structured questionnaire assessing demographics, workload, stress, career stability, and opinions on systemic problems. Descriptive statistics and the Stuart-Maxwell test was used for analysis. Results: Most respondents were male (54%), aged 25-44 years (48%) and had >10 years of experience (66%). During public service, 40% reported working >60 hours/week, compared to 12% after resignation (p<0.001). The leading causes of resignation were inadequate income (62%), unsupportive management (46%), occupational stress (40%), and excessive working hours (38%). In contrast, job security (86%), welfare benefits (70%), and career advancement (64%) were key factors retaining physicians in the system. Physicians emphasized that improved welfare, adequate remuneration, supportive workplace environments, and transparent governance would prolong their service in the public sector. Conclusion: Heavy workload, insufficient income, and organizational stressors were the most significant drivers of physician resignation. Policy reforms ensuring fair compensation, workload regulation, and adequate staffing are urgently required to mitigate brain drain and sustain Thailand’s public healthcare workforce.
Background: The aging population in Thailand is rapidly increasing, leading to a rise in elderly trauma cases. Understanding the epidemiology, causes, complications, and outcomes of geriatric trauma is crucial for improving care and developing preventive strategies. Objective: To analyze the epidemiological patterns, causes, complications, and outcomes of elderly trauma patients, and to assess the relationship between the Geriatric Trauma Outcome Score (GT OS) and mortality. Materials and Methods: This retrospective study included 466 patients aged 60 years and older who were diagnosed with trauma between 2011 and 2021 at Chiang Mai University Hospital. Medical records were retrospectively reviewed, and data were extracted between September 2022 and July 2023. Statistical analyses included descriptive statistics, Fisher’s exact test, Student’s t-test, and univariable and multiple risk regression analyses. Results: The majority of patients were over 65 years old (77.68%) and male (51.93%). Falls (62.66%) and traffic accidents (24.68%) were the main causes of injury. The mortality rate was 3.43%. Pneumonia (RR 1.54, 95% CI 1.02 to 2.33, p=0.040) and failed or difficult intubation (RR 1.81, 95% CI 1.15 to 2.85, p=0.010) were significant predictors of mortality. GT OS showed good predictive ability for mortality (AUC 0.807, 95% CI 0.73 to 0.88). Factors associated with high GT OS included age >65 years, ISS >15, and blood transfusion. Conclusion: Falls are the primary cause of injury in elderly patients, with a significant impact on mortality. GT OS is an effective tool for predicting mortality in this population. Prevention strategies need to focus on fall prevention, and care protocols should address the specific needs of elderly trauma patients.
Background: Sarcopenia is common among community-dwelling older adults and is associated with increased risks of falls, disability, and mortality. Although several screening tools exist, many require specialized equipment or show limited diagnostic accuracy in community settings. Practical clinical prediction models using easily obtainable variables are therefore needed. Objective: To develop and internally validate a simple clinical prediction model and scoring system for screening sarcopenia in community-dwelling older adults. Materials and Methods: A cross-sectional study was conducted among 1,474 adults aged ≥60 years in Nan Municipality, Thailand (January to December 2024). Sarcopenia was defined using handgrip strength according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Clinical variables included sex, age, body mass index (BMI), Timed Up and Go (TUG) test, and SARC-F questionnaire score. Logistic regression analysis was used to identify independent predictors of sarcopenia. A sarcopenia score (SS) was derived from multivariate beta coefficients and internally validated using receiver operating characteristic (ROC) analysis. Results: Sarcopenia was identified in 731 participants (49.6%). Independent predictors included male sex (adjusted OR 3.43), age ≥70 years (adjusted OR 2.78), BMI <20 kg/m² (adjusted OR 1.82), TUG ≥12 seconds (adjusted OR 2.50), and SARC-F score ≥4 (adjusted OR 3.34) (all p<0.001). The SS ranged from 0 to 8.5 points and demonstrated good discrimination (AUC 0.756; 95% CI: 0.732–0.781). An optimal cut-off score of 2.25 yielded a sensitivity of 60.1% and specificity of 78.1%. The SS showed higher overall accuracy (69.1%) than TUG or SARC-F alone. Conclusion: The SS is a simple, low-cost, and practical screening tool that may support early identification of sarcopenia among community-dwelling older adults in primary care settings.
Background: Intravitreal injection is the most commonly performed procedure in outpatient retina clinics. However, the optimal injection site for intravitreal injection has not been determined. Objective: To identify the least painful intravitreal injection site. Materials and Methods: Prospective, randomized, six-armed clinical trial. One hundred ninety-two patients who were treated with intravitreal injection were randomized into 6 groups according to the injection site: superonasal (SN), superior (S), superotemporal (ST ), inferotemporal (IT), inferior (I), and inferonasal (IN). The pain score (visual analog scale), anxiety score (visual analog scale), visual experience during injection, and baseline demographic data were recorded. Results: The overall median (interquartile range, IQR) pain score across all groups was 2 (2). By injection site, the median pain scores were SN 3 (3), S 2 (2), ST 2 (2), IT 2 (2), I 2 (2), and IN 1 (2). The lowest pain scores were observed in the IN group, whereas the highest were in the SN group. Statistically significant differences were observed between the IN and S sites (p=0.021) and between the IN and SN sites (p<0.001), at a significance level of 0.05. Further analysis comparing the upper and lower halves of the eye showed significantly higher pain scores in the upper half (p<0.001). Pain scores were positively correlated with anxiety scores, with a low correlation observed (Spearman’s rank correlation coefficient of 0.399, p<0.01). The three most common visual experiences during injection were water flow (47.6%), bright light (32.5%), and shadow of the needle object (12.6%). Conclusion: The site of injection that gave the minimum pain score and anxiety score was IN. The pain and anxiety scores seem to be less when the injection was performed in the inferior half of the eye.
Objective: To evaluate the clinical outcomes of selective nerve root block (SNRB) in patients with degenerative lumbar spinal stenosis with radiculopathy and lumbar disc herniation with radiculopathy, focusing on pain relief and functional improvement over a 6-month follow-up period. Materials and Methods: For this single-arm prospective longitudinal study, 64 patients with clinically and radiologically confirmed degenerative lumbar spinal stenosis with radiculopathy and/or lumbar disc herniation with radiculopathy, who had undergone SNRB at Somdej Phra Sangkharat 17th Hospital between August 2023 and May 2024, were enrolled. Pain severity was assessed using the visual analogue scale (VAS), and the patients’ functional disability was evaluated with the Oswestry Disability Index (ODI). Outcomes were measured at the baseline, as well as 24 hours, 2 weeks, 3 months, and 6 months post-injection. Repeated measures ANOVA was used to compare outcomes across follow-up time points. Results: Among the 64 patients (65.6% female, mean age 57.97±12.17 years), the most common lesion level was L4 to L5 (95.3%). Mean VAS scores had decreased significantly from the baseline (7.95±0.86) to 24 hours (1.11±0.85), 2 weeks (1.64±0.75), 3 months (2.96±1.03), and 6 months (4.16±1.23) post-SNRB (p<0.001). Mean ODI had also decreased from 47.72±10.99 at baseline to 11.84±7.07 at 2 weeks and 26.41±13.51 at 6 months (p<0.001). However, 78.1% of patients had reported a recurrence of symptoms at 6 months. Conclusion: SNRB was associated with significant short- to mid-term improvements in pain and functional outcomes among patients with degenerative lumbar spinal stenosis with radiculopathy and lumbar disc herniation with radiculopathy. However, symptom recurrence was common at 6 months, suggesting that SNRB may provide temporary symptom control rather than definitive long-term treatment.
Background: Foreign body airway obstruction (FBAO) is a life-threatening emergency in which early bystander intervention is critical. However, gaps in practical skills and confidence among lay responders remain a major challenge. Simulation-based training combined with dispatcher guidance may improve first-aid performance in community settings. Objective: To evaluate the effectiveness of dispatcher-guided simulation training in improving lay responder performance for managing FBAO. Materials and Methods: A quasi-experimental, single-arm simulation study was conducted among 30 adult community volunteers with no prior Heimlich maneuver training. Participants managed a simulated choking scenario using an Act+Fast Anti-Choking Trainer while receiving real-time telephone guidance based on the National Institute for Emergency Medicine (NIEMS) protocols. Performance was assessed using predefined critical procedural steps. Results: Participants who correctly followed key procedural steps—particularly appropriate hand positioning and forceful upward thrusts—demonstrated significantly higher success rates in relieving airway obstruction (p<0.05). The training approach also enhanced participant confidence, although challenges related to communication clarity and procedural understanding were observed. Conclusion: Dispatcher-guided simulation training improved lay responder performance in managing FBAO in a controlled setting. This approach may serve as a scalable educational strategy to enhance community preparedness for choking emergencies. Further studies with controlled designs and real-world settings are needed to confirm these findings.
This article reviews the roles of nurse anesthetist (NA) in the perioperative management of patients undergoing endovascular therapy (EVT) for unruptured cerebral aneurysms (UCAs). The EVT has emerged as a minimally invasive and effective treatment for UCAs, necessitating comprehensive perioperative care to optimize patient outcomes. In the pre-procedural phase, responsibilities include neurological and hemodynamic assessments, risk identification, and patient education to reduce anxiety and improve readiness. Intra-procedural care emphasizes maintaining hemodynamic stability, monitoring vital signs, and managing complications such as vasospasm, thromboembolism, and contrast reactions in collaboration with the interprofessional team. In the post-procedural phase, the NA provides vigilant monitoring for neurological deterioration, preventing vascular complications, and supporting recovery through patient education and discharge planning. By integrating evidence-based care plans to address risks such as hypertension, hemorrhage, impaired respiratory function, and hematoma, NAs play a critical role in enhancing safety and reducing complications. Their specialized expertise significantly advances perioperative nursing practice in complex neurointerventional procedures. This review also proposes structured nursing care plans that integrate risk-prevention strategies to support safe perioperative management in EVT procedures.
Background: Work-related asthma (WRA), including occupational asthma and work-exacerbated asthma, accounts for a substantial proportion of adult asthma cases. Although workplace surveillance aims to promote early detection, most cases are identified in clinical settings after symptom onset. Early recognition of occupational asthmagens/irritants in clinical practice is therefore essential. However, existing screening tools may inadequately capture specific occupational exposures, and workers often have difficulty identifying asthmagens/irritants. Objective: 1) To develop a Thai questionnaire for occupational asthmagens/irritants identification in clinical settings. 2) To examine the content and face validity of the developed questionnaire. Materials and Methods: This descriptive study included a literature review and review of existing resources, including the Occupational Asthma Web Application or OAKKU database of known asthmagens/irritants, to identify allergenic and irritant agents. A Thai version questionnaire was developed using occupation- and task-based exposure descriptions rather than chemical names alone. Content and face validity were assessed by six experts using item-level content validity index (I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave). Pretesting was conducted among 30 adult patients with new-onset or worsening asthma and a history of occupational exposure from two tertiary hospitals in Thailand. Participants completed both the newly developed questionnaire and the existing Medical Surveillance of Occupational Asthma Questionnaire (MSOAQ) routinely used in the occupational medicine clinic at Srinagarind Hospital, and the identified exposures from the two instruments were compared. Results: The final developed questionnaire comprised three sections: confirmation of asthma diagnosis, identification of asthmagen/irritant exposure, and screening for the likelihood of WRA. After two rounds of expert review, all items met predefined content validity criteria (I-CVI ≥0.83 and S-CVI/Ave ≥0.90). Face validity supported clarity and clinical applicability. During pretesting, task-based descriptions and practical examples facilitated greater recognition of asthmagen/irritant exposures compared with name-based items in the MSOAQ. Conclusion: The developed questionnaire demonstrated good validity and improved identification of occupational asthmagens/irritants, supporting its use as a screening tool in clinical settings.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a major cause of healthcare-associated infections with substantial morbidity and mortality. Optimizing treatment and infection-control strategies is crucial to minimizing its spread in healthcare settings. Objective: To characterize MRSA isolates from two tertiary hospitals in Thailand, including Thammasat University Hospital (TU) and Songklanagarind Hospital (PSU) at the molecular level, and to identify clinical and microbiological factors associated with treatment failure. Materials and Methods: Whole genome sequencing (WGS) was performed using the Illumina MiSeq. SCCmecFinder, PubMLST, and spaTyper were used to determine SCCmec, MLST, and spa types, respectively. Phylogenetic trees were constructed with RaxML (54 samples). Vancomycin MICs were determined by the broth microdilution (BMD) method, and susceptibility data for other antibiotics (by disk diffusion method) were obtained from hospital medical records. Clinical and microbiological data were analyzed using STATA, version 17. The isolates and medical records were provided from both hospitals with official permission. Results: The predominant genotypes were SCCmec type IV, ST239, and t037, with CC8 being the most common clonal complex in both hospitals. Most isolates were vancomycin-susceptible S. aureus (VSSA). However, a few heteroresistant vancomycin-intermediate S. aureus (hVISA) strains were detected. Isolates were highly susceptible to fusidic acid and linezolid but resistant to β-lactams, macrolides, and clindamycin. Pneumonia and acute kidney injury were independently associated with treatment failure. Conclusion: The findings revealed multiple genetic lineages and identified clinical and microbiological characteristics of MRSA-infected patients associated with treatment outcomes. These results highlight the need for prompt and appropriate therapy, continuous susceptibility surveillance, and rigorous infection-control measures to prevent the spread of MRSA. In addition, the phylogenetic tree provided valuable insights into the evolutionary relationships among the isolates, facilitating the identification of clonal lineages and transmission patterns, which are essential for infection control and epidemiological surveillance.
Objective: Steroidogenesis is associated with low-density lipoprotein (LDL) metabolism. The objective was to compare basal cortisol levels in statin-treated diabetic patients who had LDL-cholesterol (LDL-C) levels of less than 1.8 mmol/L (70 mg/dL) or 1.8 mmol/L or more. Materials and Methods: Seventy-six statin-treated diabetic patients were divided into two groups of 38 patients each: low LDL-C (less than 1.8 mmol/L) and high LDL-C (1.8 mmol/L or more). Basal cortisol levels were measured, and adrenocorticotropic hormone (ACTH) stimulation tests were performed. Results: The low LDL-C group had insignificantly higher basal cortisol levels. There were no significant differences in cortisol levels between the two groups at 20, 30, and 40 minutes during the 1-μg ACTH stimulation tests, nor among differing levels of statin intensity. There were also no significant differences in the proportion of patients with abnormal ACTH stimulation test results between low and high LDL-C groups. Conclusion: The present data indicate that low LDL-C does not compromise steroidogenesis in diabetic patients receiving statin treatment. Aggressive LDL-C lowering in diabetic patients should be encouraged as indicated.
Objective: To evaluate the effectiveness of nutritional education combined with nutrition and iron supplementation reminders compared with standard iron supplementation over a 3-month period in preventing iron deficiency anemia among infants aged 6 to 12 months. Materials and Methods: A randomized controlled trial was conducted with 49 infants aged 6 to 12 months at Naresuan University Hospital. Participants were randomized into three groups: nutritional reminder for iron-rich food, iron supplements reminder, and standard therapy. All groups received a weekly ferrous sulfate 12.5 mg. Data collected included general information, caregiver, family background, nutritional habits prior to the study, adherence to iron-rich food, and iron supplementation. Complete blood count (CBC) results were compared before and after the study. Results: The nutritional reminder group for iron-rich foods had a mean daily elemental iron intake from food of 1.88±0.99 mg/day, which was higher than the other groups but not statistically significant. Comparing blood test results among subgroups revealed that children consuming iron-rich food daily and adhering to prescribed iron supplementation showed increased post-study hemoglobin and hematocrit levels. Specifically, the nutritional reminder for iron-rich food groups showed a statistically significant increase in hemoglobin levels by 0.47±0.78 g/dL. Conclusion: The outcome of the nutritional reminder for iron-rich food and the iron supplements reminder on iron deficiency anemia for prevention in infants is not superior compared to standard treatment in children aged 6 to 12 months. The nutritional reminder for iron-rich food groups showed a statistically significant increase in hemoglobin level. Therefore, nutritional education with prophylactic iron supplementation remains essential in preventing iron deficiency anemia.
Objective: To develop and comprehensively evaluate a one-day surgery system for elderly patients in community hospitals, examining feasibility, clinical safety outcomes, success factors, patient-reported outcomes, and cost-effectiveness. Materials and Methods: The present study was a mixed-methods study conducted at Laplae Hospital, Uttaradit, Thailand, between November 2024 and October 2025. Forty-one elderly patients, aged 60 years and older, who underwent one-day surgery procedures were included. The system development involved three main components: screening and preparation, surgery and post-operative care, and post-discharge follow-up. Quantitative data included clinical outcomes and quality of life (EQ-5D-5L) assessed at baseline, 7 days, and 30 days post-surgery using paired t-test analyses. Qualitative methods explored success factors through in-depth interviews with patients/caregivers (15 participants) and focus groups with healthcare providers (14 participants). Cost-effectiveness analysis compared one-day surgery with conventional hospitalization using propensity score-matched historical controls (41 pairs). Results: The one-day surgery system achieved a 95.1% success rate, with only two patients requiring overnight hospitalization. Most patients (87.8%) experienced no complications, with minor complications (12.2%). Pain scores showed a biphasic pattern, increasing significantly at seven days post-surgery compared to baseline (5.2±2.3 versus 3.8±1.9, p<0.001), then decreasing by 30 days (2.1±1.5 versus 3.8±1.9, p<0.001). Quality of life demonstrated parallel trajectories, with temporary deterioration at seven days (0.68±0.16 versus 0.72±0.14, p=0.047) followed by significant improvement at 30 days post-surgery compared to baseline (0.81±0.12 versus 0.72±0.14, p<0.001), exceeding the minimal clinically important difference. Key success factors included appropriate patient selection, caregiver readiness, multidisciplinary teamwork, and effective post-discharge monitoring. Cost-effectiveness analysis showed one-day surgery was 26.04% (6,026.14 THB per patient) less expensive than conventional surgery while providing better health outcomes (QALY gained 0.0257 versus 0.0238). Probabilistic sensitivity analysis confirmed dominance in 92.5% of simulations. Conclusion: One-day surgery for elderly patients in community hospitals is feasible, safe, and cost-effective when implemented with appropriate patient selection and comprehensive support systems. The biphasic recovery pattern with peak pain at seven days highlights the need for enhanced early postoperative pain management protocols. This approach offers a promising solution for addressing the surgical needs of the growing elderly population in resource-limited settings.
Background: There is a hypothesis that additional radioiodine activity for each clinical risk factor would increase the success rate of radioiodine therapy (RIT) for Graves’ disease (GD). Objective: To compare the success rates of RIT using standard and new dosage calculation protocols. Materials and Methods: The present study was a retrospective cohort study that enrolled 341 GD patients who received RIT between January 2014 and July 2023 at Burapha University Hospital, Thailand. Participants were divided into two groups: those who received protocol 1, a standard radioiodine dosage calculation method, and those who received protocol 2, a risk-modified dosage calculation method. The primary outcome was the success rate of RIT with the two protocols at the 6-month follow-up. Results: The group receiving protocol 2 displayed a significantly higher RIT success rate than those who received protocol 1 (69.2% versus 49.7%, p<0.001). Based on the measured effects of protocols 1 and 2, the risk of treatment failure was higher in protocol 1 (RR 1.39, 95% CI 1.16 to 1.68, p<0.001) than in protocol 2. After matching analysis with sex and thyroid size, the risk of treatment failure was more conspicuous (RR 1.64, 95% CI 1.20 to 2.25, p=0.001). Conclusion: The new precision protocol, which incorporates clinical risk factors into radioiodine dosage calculation, significantly improves treatment outcomes in patients undergoing RIT for Graves’ disease.
Objective: To compare the characteristics and associated factors of depressive disorders in children and adolescents treated at Siriraj Hospital in 2014 and 2022. Materials and Methods: A retrospective review of medical records was conducted, including 93 patients from 2014 and 172 patients from 2022. Data collected included demographics, diagnoses, comorbidities, and treatment outcomes. Statistical analyses included two-sample t-tests, Pearson’s chi-square tests, and Fisher’s exact test to compare characteristics of depressive disorders between the two years, and modified Poisson regression to explore factors associated with remission. Results: The proportion of female patients increased from 49.5% in 2014 to 73.7% in 2022 (p<0.001). Reports of domestic violence rose from 7.5% to 20.3% (p=0.006), suicidal ideation increased from 16.1% to 51.2% (p<0.001), and self-harming behaviors increased from 22.7% to 57.6% (p<0.001). Referrals to psychologists increased from 22.6% to 43.9% (p<0.001), and hospitalization rates within the first year rose from 6.5% to 15.2% (p=0.037). No significant differences were observed in age, family structure, parenting style, psychotic symptoms, comorbidities, medication use, or remission rates. Regression analysis indicated that authoritative parenting was associated with a 1.98-fold higher likelihood of remission (p=0.042). Conclusion: The prevalence and severity of depressive disorders among female children and adolescents are rising, marked by an increase in suicidal ideation, self-harm, and hospitalization. However, remission rates remain unchanged. Authoritative parenting may improve remission rates. These findings highlight the need for enhanced screening, updated treatment guidelines, and targeted parental counseling.
Objective: The effectiveness of different configurations of upper arm arteriovenous grafts (AVGs) in hemodialysis remains controversial. This study aimed to compare outcomes between upper arm straight AVGs (AS-AVG) and loop AVGs (AL-AVG). Materials and Methods: A retrospective study included all upper arm AVGs performed for hemodialysis between January 2018 and December 2022. An AS-AVG was selected if the cubital brachial artery diameter was greater than 4 mm; otherwise, an AL-AVG was chosen. Postoperative and long-term complications, as well as primary patency, were compared between the two groups. Multivariable regression analyses were used to account for potential confounding factors due to imbalanced baseline characteristics. Results: Two hundred eleven patients were included, with 127 (60%) receiving AS-AVGs and 84 (40%) receiving AL-AVGs. Baseline characteristics were not significantly different between the groups, except for a high proportion of males in AS-AVG (37% versus 57%, p=0.003). The rates of postoperative and long-term complications (i.e., infection, stenosis, thrombosis, and hemodialysis access-induced distal ischemia) were not significantly different between the groups. The primary patency rates were also comparable. The 1-year primary patency is 67% (95% CI 53 to 77) for AL-AVG and 73% (95% CI 62 to 81) for AS-AVG. However, the operation time for AL-AVG was significantly longer, taking approximately 15 minutes (95% CI 8 to 22, p<0.001) more than AS-AVG. Conclusion: The outcomes between AS-AVG and AL-AVG are not significantly different in terms of effectiveness and safety. Further study is needed to confirm the results. This conclusion specifically applies to patients with a cubital brachial artery diameter greater than 4 mm, indicating that both graft types may be viable options.
Background: Transposition of the great vessels (TGA) is the second most common congenital cyanotic cardiac defect in infants. Fortunately, correction via arterial switch operations (ASO) is possible. Objective: To review the early experiences of a university hospital in Southern Thailand performing ASO. Factors associated with 90-day survival were analyzed and compared with three anatomical subtypes of dextro-transposition for TGA, TGA with intact ventricular septum (TGA/IVS), ventricular septal defects (TGA/VSD), and Taussig-Bing anomaly (DORV/TGA). Materials and Methods: Patient electronic medical records with TGA having undergone ASO at Songklanagarind Hospital, Thailand, between 2010 and 2024 were retrospectively reviewed. The primary outcome measurement was 90-day survival. Survival outcomes, re-operation, and complications were also analyzed. Data were compared between those with good and poor outcomes, and among types of TGA. Results: Over the 15-year period, 78 consecutive cases were identified: TGA/IVS 48 (61.5%), TGA/VSD 20 (25.6%), and DORV/TGA 10 (12.8%). Median age at operation was 15 days (interquartile range 9.25 to 26.25), with the DORV/TGA group being the highest (45 days). Overall, the 90-day survival rate was 65.4%: trending towards improved survival over time. Surgical complications, especially valvular complications and pulmonary hypertension, were significantly associated with the 90-day mortality odds ratio. Pre-ASO balloon atrial septostomy was performed in 42.3% of cases, with the TGA/IVS group having a significantly higher frequency. The Kaplan-Meier survival curves indicated poorer survival in the DORV/TGA group, although the difference in survival probability among the three groups was not statistically significant. Patients receiving pre-ASO interventions had significantly higher survival rates. Conclusion: Patient survival for TGA having undergone ASO improved with the learning curve. Perioperative care, especially pre-ASO intervention and early operation, may be the key to improving outcomes.
Background: Right atrial pressure (RAP) is crucial for pulmonary pressure estimation by echocardiography, particularly in the assessment of pulmonary hypertension. Objective: To evaluate the correlation between RAP measured by right heart catheterization and parameters derived from three-dimensional (3D) echocardiographic imaging of the inferior vena cava (IVC), and to develop an equation to predict RAP from these IVC parameters. Materials and Methods: Patients scheduled for right heart catheterization or electrophysiologic study in the cardiac catheterization laboratory of the Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, between October 2019 and February 2020 were prospectively enrolled. RAP was measured invasively via right heart catheterization. Two- and three-dimensional echocardiography were performed to acquire IVC images. The IVC parameters of interest included the maximal and minimal diameters of the longitudinal IVC, cross-sectional dimensions obtained from multiplanar 3D image analysis, and the collapsibility index. Results: Seventy-four patients, with a mean age of 50 years, were included in the study. Preexisting cardiac conditions included valvular heart disease in 45.9%, congenital heart disease in 36.5%, arrhythmia in 60.8%, and coronary heart disease in 6.8%. All IVC parameters were significantly correlated with RAP (r-value range of 0.31 to 0.67). The minimal cross-sectional area of the 3D IVC (IVC3DminCSA) showed the strongest correlation with RAP (r=0.67, p<0.001). The validated equation for estimating RAP was RAP = 5.57 + (2.10 × IVC3DminCSA). Conclusion: Predicting RAP using the IVC3DminCSA is a novel parameter that can mitigate the translational effects of respiration and facilitate more accurate, earlier detection of pulmonary hypertension.
Objective: To compare fetal thymus size between fetuses of diabetic and non-diabetic pregnant women and to explore the relationship between thymus size, maternal diabetes type, glycemic control, and pregnancy outcomes. Materials and Methods: This prospective study at Bhumibol Adulyadej Hospital included singleton pregnancies between 28 and 34 weeks, with participants divided into control (118 participants) and diabetic (121) groups. Fetal thymic diameter (TD) and thymic thoracic ratio (TTR) were measured via ultrasound. The diabetic group was further classified into pregestational diabetes mellitus (PGDM), GDMA1, and GDMA2. Maternal blood sugar control and HbA1c levels were recorded. Pairwise comparisons with Bonferroni correction identified differences between diabetes types, and receiver operating characteristic (ROC) curve analysis determined the cutoff for fetal thymus size. Results: Among 239 participants, fetuses in the diabetic group had significantly smaller thymus sizes compared to the control group (TD: 32.7 vs. 33.9 mm, TTR: 0.34 vs. 0.40, p<0.05). The TTR was significantly lower in PGDM and GDMA2 subgroups than in non-diabetic pregnancies. Poor glycemic control and HbA1c ≥7% was associated with a significantly lower TTR but not TD. ROC analysis identified a TTR cutoff of ≤0.34 (AUC 71%) as a better predictor of fetal thymic size reduction than TD (AUC 58%). Neonatal complications, including higher birth weight, NICU admission, and early neonatal jaundice, were more prevalent in the diabetic group. Conclusion: Fetal thymus size in pregnant women was significantly smaller than that of non-diabetic pregnant women. TTR was an effective measurement to detect the decrease in fetal thymus size.
Background: Percutaneous balloon aortic valvuloplasty (PBAV) has been introduced as a first-line treatment for congenital aortic valvular stenosis. However, complications such as residual valvular stenosis and valvular regurgitation can occur following PBAV, requiring re-intervention or surgery. Materials and Methods: The present study was a retrospective descriptive study that enrolled 34 patients under the age of 18 with a diagnosis of aortic valvular stenosis who underwent PBAV between 2003 and 2023. Medical records, including patients’ demographic data, clinical presentations, echocardiographic reports, and cardiac catheterization reports, were reviewed, collected, and analyzed. Results: Median pre-procedural peak-to-peak systolic pressure gradient (PSG) between left ventricle and aorta was 57 mmHg (IQR 39 to 88) and decreased to the median PSG of 15 mmHg (IQR 10 to 28) after the procedure. Median decremental rate of PSG after procedure in overall patients was 74.3%. A significant association was found between the high reduction rate of PSG and the severity of aortic regurgitation (AR) (p=0.03). Median follow-up time was 35.6 months (range 7.4 to 66.9). At the last follow-up, half of the patients had more than moderate AR. Freedom from moderate and severe AR was 85.5% at one year and 64.3% at five years post-procedure. Overall re-intervention-free rate was 94.1% at one year and 75% at five years. Conclusion: PBAV is an effective and safe treatment for congenital aortic stenosis, resulting in a high survival rate. However, it carries long-term risks of aortic valvular dysfunction, restenosis, and significant regurgitation, often leading to re-intervention. Balancing the minimization of residual stenosis and the avoidance of significant regurgitation is crucial for achieving a favorable long-term outcome.
Objective: To assess the effect of lavender aromatherapy on preprocedural anxiety, pain, and vital signs in patients undergoing intravitreal anti-VEGF injections. Materials and Methods: This randomized, prospective, placebo-controlled trial enrolled 114 patients undergoing their first intravitreal injection at Thammasat University Hospital between May 2024 and March 2025. The intervention group received lavender essential oil via inhalation, while the control group received normal saline. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) scale, along with vital signs and pain scores, both before and after the injection. Results: Fifty-eight patients received aromatherapy, and fifty-six patients received a placebo. Baseline characteristics were comparable. Both groups demonstrated a significant reduction in STAI scores following treatment (treatment group: –2.69±5.17, p<0.001, and control group: –1.39±7.54, p=0.016). Although the reduction was greater in the treatment group, the between-group difference was not statistically significant (p=0.233). Systolic and diastolic blood pressure increased slightly in both groups , with no significant differences between groups. Mean pain scores were lower in the treatment group (2.77±2.07) compared to the control group (2.93±2.09), but without statistical significance. Conclusion: Lavender aromatherapy was associated with lower anxiety and pain scores in patients undergoing intravitreal injection compared with placebo, but differences were not statistically significant.
