Objective: For acute migraine patients unresponsive to sumatriptan, the choice is between another triptan, eletriptan, and the novel CGRP antagonist, rimegepant. As of now, no cost-effectiveness analysis comparing rimegepant and eletriptan has been conducted in Thailand. This study aims to evaluate the cost-effectiveness of rimegepant and eletriptan for the treatment of acute episodic migraine in Thailand using data from the Thai healthcare system. Materials and Methods: This study was a health economic evaluation using a lifetime decision tree–Markov model with 30-day cycles, from a societal perspective. Total costs and quality-adjusted life years (QALYs) were projected using effectiveness data from a systematic review, cost data from Thai healthcare databases, and utility values from published literature. The incremental cost-effectiveness ratio (ICER) was evaluated, and uncertainty was assessed through sensitivity analyses. Results: The results revealed that, using a 3% discount rate and 2025 costs, the total cost of treatment with rimegepant for acute episodic migraine in Thailand was 2,442,622.42 THB, yielding 25.21 QALYs. In comparison, treatment with eletriptan incurred a total cost of 2,450,782.33 THB and yielded 17.59 QALYs. The ICER of rimegepant compared with eletriptan was −1,071.79 THB per QALY gained. Therefore, rimegepant was considered a dominant strategy, as it generated more QALYs while incurring lower overall costs than eletriptan. Conclusion: Rimegepant has demonstrated cost-effectiveness in treating acute episodic migraine in Thailand, as it is a dominant strategy, generating higher QALYs while incurring lower overall costs. This economic evidence would help policymakers make informed decisions.
This corrigendum relates to the following article: Wannapaschaiyong P, Penphattarakul A, Rojmahamongkol P, Sutchritpongsa S. Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD. Siriraj Med J. 2024;76(3):116–124. DOI: https://doi.org/10.33192/smj.v76i3.267462 URL: https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/267462 The author would like to correct the error in the publication of the original article(1) and has informed the editor to correct as follows: Content of Correction: Incorrect: The COA number in the article: COA no. Si 719/2023 (IRB3) Correct: COA no. Si 719/2023
Objective: This study aimed to systematically review the existing evidence of the impact of air pollutants on acne vulgaris. Materials and Methods: The studies assessed the relationship between air pollution and acne, in terms of the number of acne lesions, severity of acne, number of patients who visited the hospital with acne complaints, and impact on quality of life, which were the eligibility criteria for the outcome of this study. The studies that were not in the English language, case reports, conference abstracts, and studies with duplicate publication data were excluded. Risk of Bias in Non-randomized Studies (ROBINS-E) was used to assess the risk of bias. Descriptive analysis was conducted because of different outcomes reported among the studies. Results: 226 articles were identified through the literature search. Four studies were included. El Haddad, et al, reported that NO₂ exposure aggravated acne vulgaris. Xiang Li, et al, presented that exposure to Particulate matter10 (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) in Xi’an, China, as well as PM2.5 in Chongqing, China showed inconclusive results regarding increases in outpatient visits of acne vulgaris. Wei Liu, et al. demonstrated that exposure to SO₂ decreases the outpatient visits of acne vulgaris. Conclusion: PM2.5, PM10 and SO2 presented controversial outcomes. Since current studies had a risk of bias and methodological limitations, a prospective cohort or panel studies using personal or high-resolution exposure estimates, standardized measures of acne incidence and severity, prespecified lag periods, and adjustment of confounders were suggested for a better understanding of the correlation.
Objective: This study aimed to develop and evaluate a low-cost medical gas monitoring system to enhance safety in hospital gas storage rooms. Continuous monitoring of oxygen and carbon dioxide levels may help identify oxygendeficient or oxygen-enriched conditions and elevated carbon dioxide concentrations that may pose occupational safety risks to healthcare personnel. Materials and Methods: An Internet of Things (IoT)-based device was developed to monitor medical gases and environmental conditions, including oxygen, carbon dioxide, temperature, and relative humidity. The system enables real-time monitoring and online data visualization. Sensor performance was validated against standard reference equipment. Results: The developed system demonstrated normalized root mean square differences (nRMSD) of 15.47%, 0.085%, 4.80%, and 5.39% for carbon dioxide, oxygen, temperature, and relative humidity, respectively, under ambient environmental conditions. The corresponding normalized mean bias differences (nMBD) were -9.70%, 0.283%, 2.54%, and -3.00%, respectively. However, validation was conducted over a narrow ambient concentration range and did not include controlled gas concentrations near the predefined alarm thresholds. Therefore, these results represent preliminary measurement agreement under ambient conditions and do not establish alarm performance or safety-monitoring performance across the intended decision range. Conclusion: The proposed low-cost monitoring system (approximately USD 255) enables continuous real-time monitoring of oxygen, carbon dioxide, temperature, and relative humidity under ambient environmental conditions. The system may support environmental monitoring and improve occupational safety in hospital medical gas storage areas.
Objective: To assess the diagnostic accuracy of umbilical artery (UA), middle cerebral artery (MCA), and cerebroplacental ratio (CPR) Doppler indices for composite fetal compromise in preeclampsia and derive exploratory cut-offs. Materials and Methods: This prospective study included 77 women with preeclampsia at one Vietnamese centre (June 2021–June 2023). UA and MCA Doppler were performed within 48 hours before delivery; CPR was MCA pulsatility index divided by UA pulsatility index. The prespecified reference standard was at least one of category III cardiotocography (CTG), thick meconium-stained amniotic fluid, or umbilical arterial pH <7.10. CTG classification was blinded, ascertainment was complete, and delivery decisions did not use Doppler thresholds. Analyses were prespecified for <37 and ≥37 weeks. Cut-offs maximised the Youden index; optimism was assessed using 2,000 bootstrap replicates, and gestational-age interaction was tested. Results: Fetal compromise occurred in 35/77 women (45.5%): 18/40 before 37 weeks and 17/37 thereafter. All components were strictly nested; thus, the composite identified the same 35 women as category III CTG. Cord acidaemia occurred in five women, all before 37 weeks. CPR provided the best discrimination (AUC 0.78; 95% CI 0.65–0.87). CPR <1.10 yielded 74.3% sensitivity and 78.6% specificity, decreasing to 71.3% and 76.5% after optimism correction. Gestational-age interactions were non-significant (p=0.22 and p=0.46), but stratum-specific thresholds differed (<1.08 versus <1.22); gestational-age independence was not established. Conclusion: CPR outperformed single-vessel indices, but estimates were imprecise and internally derived. These thresholds are hypothesis-generating and require external validation before clinical use.
Objective: To evaluate the effect of combined sit-to-stand and heel-raise (STS-HR) exercises on dynamic balance function in sedentary male adolescents. Materials and Methods: A randomized controlled trial with a pretest–posttest design was conducted involving 30 sedentary male adolescents, randomly allocated into a control group (n = 15) and an intervention group (n = 15). The intervention group performed STS-HR exercises three times per week for 8 weeks. Dynamic balance was assessed using the Y-Balance Test (YBT), with composite reach length (CRL) of both limbs as the primary outcome. Results: No significant changes were observed in the control group across all YBT directions (p > 0.05). In contrast, the intervention group demonstrated significant improvements in anterior, posterolateral, and posteromedial reach directions, as well as CRL values for both limbs (p < 0.001). After adjustment for baseline bilateral composite score and caloric intake, the bilateral mean composite Y-Balance Test score at week 8 was 12.4 percentage points higher in the STS-HR group than in the control group (95% CI 8.6–16.1; p < 0.001; partial η² = 0.642). Conclusion: Among sedentary male adolescents, the 8-week STS-HR program improved week-8 Y-Balance Test performance compared with the control condition. The clinical importance and longer-term functional implications of this improvement remain uncertain.
This corrigendum relates to the following article: Wannapaschaiyong P, Penphattarakul A, Rojmahamongkol P, Sutchritpongsa S. The Relationship Between Primary Caregivers’ Psychosocial Factors and Self-Esteem in Children and Adolescents with ADHD: An Exploratory Cross-sectional Study. Siriraj Med J. 2023;75(8):584–591.DOI: https://doi.org/10.33192/smj.v75i8.263447 URL: https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/263447 The author would like to correct the error in the publication of the original article(1) and has informed the editor to correct as follows: Content of Correction: Incorrect: The COA number in the article: COA no. Si 661/2022 (IRB1) Correct: COA no. Si 661/2022
Background: Thyroid hormone is essential for preterm infant development, particularly neurological. Understanding thyroid disorder prevalence and function test characteristics enables proper interpretation and risk identification. Objectives: To determine the prevalence, etiologies, risk factors, and thyroid function test characteristics of thyroid disorders in preterm infants. Materials and Methods: This retrospective review included infants with gestational age (GA) < 37 weeks born at Siriraj Hospital in 2022. Infants with genetic syndromes, multiple congenital anomalies, chromosomal abnormalities, or maternal thyroid disease were excluded. Thyroid-stimulating hormone (TSH) from neonatal dried blood spots and thyroid function tests from blood were obtained at 1 week, 2 weeks, and from 4 weeks until term-corrected age. Multiple logistic regression identified risk factors. Results: Among 603 infants, thyroid disorder prevalence was 2.99% (18/603). Disorders included hyperthyrotropinemia 8/18, hypothyroxinemia 4/18, congenital hypothyroidism 2/18, transiently elevated free thyroxine 2/18, central hypothyroidism 1/18, and transiently low TSH 1/18. Maternal preeclampsia was statistically significantly associated with hyperthyrotropinemia (P = 0.039; adjusted odds ratio 5.064; 95% CI 1.084–23.661). TSH increased from the first to second week in infants with GA 28–33 weeks, particularly GA 31–33 weeks, but decreased in GA 34–36 weeks. Free thyroxine increased with GA in infants < 34 weeks but decreased in GA 34–36 weeks. Conclusions: Thyroid disorder prevalence was approximately 3%, with hyperthyrotropinemia most common. Maternal preeclampsia was a hyperthyrotropinemia risk factor. TSH and free thyroxine levels trended upward in infants with GA < 34 weeks but downward in GA > 34 weeks.
Objective: To determine the screening prevalence of bladder and bowel dysfunction (BBD) using the Thai version of the Dysfunctional Voiding Symptom Score (DVSS) and explore associated psychosocial and environmental factors. Materials and Methods: A school-based cross-sectional survey was conducted among children aged 3-18 years with hearing impairment. Baseline data and DVSS were collected using questionnaires supported by standardized visual and sign-language materials. DVSS-positive BBD was defined as a total DVSS score ≥ 5. Prevalence, symptom domains, and factors associated with DVSS-positive BBD were analyzed using group comparisons and multivariable logistic regression. Results: Among 181 participants (mean age 10.4±2.7 years; 65.7% female), 93 (51.4%; 95% CI: 44.1-58.6) screened positive for BBD. DVSS-positive prevalence was 42.9% in children aged <=10 years and 58.8% in those aged >10 years. The most frequent domains were bowel dysfunction/constipation (65.7%), urgency/holding maneuvers (53.6%), and infrequent voiding (47.5%). Independent associated factors were female sex (adjusted OR 2.37, 95% CI 1.08-5.17), anxiety about urination (adjusted OR 6.97, 95% CI 2.48-19.64), behavioral/emotional problems (adjusted OR 2.36, 95% CI 1.04-5.34), aggressive/noncompliant behavior (adjusted OR 2.76, 95% CI 1.13-6.77), and a pressuring toileting environment (adjusted OR 18.56, 95% CI 2.20-156.96). Conclusions: More than half of students with hearing impairment were DVSS-positive for BBD. Psychosocial and environmental factors were independently associated with screening-positive findings. These results support targeted school-based screening and supportive, non-coercive toileting interventions, while emphasizing that DVSS-positive cases are not clinically confirmed diagnoses.
This Corrigendum relates to the following article: Chanprapaph P, Thippayacharoentam C, Iam-am A, Lumlerdkij N, Akarasereenont P, Laohapand T, Bangkha S, Kumleemak N, Piyophirapong S, Nimmannit A, Thippayacharoentam T. Effectiveness of Ayurved Siriraj Prasa-Nam-Nom Recipe on Breast Milk Volume in Early Postpartum Women: A Randomized, Double-Blind, Placebo- Controlled Trial. Siriraj Med J. 2022;74(1):11–18. DOI: https://doi.org/10.33192/Smj.2022.2 URL: https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/255495 The author would like to correct the error in the publication of the original article1 and has informed the editor to correct as follows: Content of Correction: Incorrect Study design in the article: between November 2010 and December 2012 Correct Study design: between August 2012 and February 2014
Objective: This study aimed to examine predictors of depressive symptoms among patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: A cross-sectional study was conducted among 202 patients diagnosed with COPD, with dyspnea severity ranging from stage 0 to 3 according to the modified Medical Research Council Dyspnea Scale. Participants were recruited from the pulmonary clinic and internal medicine outpatient department of a tertiary care hospital in Thailand. The majority of participants were male (81.7%), with ages ranging from 28 to 87 years. Data were collected using demographic and standardized questionnaires assessing depressive symptoms, perceived stress to COVID-19, functional ability in activities of daily living, social support, coping strategies, duration of illness, and severe acute exacerbation. Descriptive statistics and multiple linear regression were used for data analysis. Results: Overall, 24.8% of participants reported having depressive symptoms. The regression model explained 54.3% of the variance in depressive symptoms (R² = 0.543; F(8,193) = 28.7, p < 0.001). Three variables were identified as significant predictors: perceived stress related to COVID-19 (β = 0.41, p < 0.001), number of acute exacerbations in the previous year (β = 0.34, p < 0.001), and ability to perform activities of daily living (β = −0.15, p < 0.05). Conclusions: Depressive symptoms among patients with COPD are influenced by a combination of disease-related clinical burdens, psychosocial stress, and functional limitations. Integrating routine screening for depressive symptoms along with interventions aimed at preventing exacerbations, reducing stress, and maintaining functional independence may improve mental health and overall well-being in this population.
Objective: This study aimed to determine the effects of a nurse-led telehealth-based Diabetes Self-management Education and Support (DSMES) program on health literacy (HL), self-management (SM), and glycemic control (GC) in individuals with poorly controlled type 2 diabetes mellitus (T2DM). Materials and Methods: A 24-week quasi-experimental study with a non-equivalent control group design was conducted. Sixty adults (HbA1c ≥ 7.0%) were sequentially allocated to experimental (n = 30) or control (n = 30) groups. Both groups received standard DSMES at baseline. The experimental group additionally received structured, nurse-led telehealth sessions at Weeks 4, 6, 8, 16, and 20 via digital platforms. HL and SM were measured using validated Thai scales. Fasting blood glucose (FBG) and HbA1c were retrieved from medical records at baseline, 12, and 24 weeks. Data were analyzed using repeated measures ANOVA. Results: Significant between-subject effects favored the experimental group for HL (F(1,58) = 9.70, p = .003) and SM (F(1,58) = 6.21, p = .016). A significant Time × Group interaction was found for FBG (p = .037), showing a more pronounced reduction trajectory in the experimental group. Although both groups achieved significant HbA1c reduction over time (p < .001), the experimental group demonstrated a clinically superior mean reduction of 1.97% (from 9.29% to 7.32%), compared to 1.22% in the control group. Conclusion: Integrating nurse-led telehealth services with routine DSMES is effective for improving HL, SM, and FBG control in T2DM patients with poor GC. This intervention supports telehealth as a potent nursing strategy for enhancing patient empowerment and achieving superior behavioral and clinical results.
Objective: Photobiomodulation (PBM) has emerged as a potential noninvasive intervention for autism spectrum disorder (ASD), but pediatric evidence remains limited and fragmented. This scoping review aimed to map the current literature on PBM for children and adolescents with ASD, focusing on core symptom outcomes and safety. Materials and Methods: PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library were searched from inception to February 1, 2026. The searches identified 53 records, comprising 51 database records and 2 records from supplementary searching. After deduplication and screening, 8 reports representing 6 independent cohorts were included. Results: The included studies involved children and adolescents aged 2 to 17 years, with sample sizes ranging from 21 to 46 participants. PBM modalities included transcranial photobiomodulation, low-level laser therapy, and laser acupuncture, with wavelengths ranging from 635 to 850 nm. Treatment schedules ranged from 8 sessions over 4 weeks to home-based treatment for up to 6 months. The reports described improvement in selected autism-related outcomes. Controlled studies reported greater improvements in autism severity, language, communication, and social interaction outcomes, including a between-group Childhood Autism Rating Scale difference of 7.23 points in one trial. No serious treatment-related adverse events were reported; however, safety monitoring and adverse-event ascertainment were incomplete and inconsistent. Conclusion: PBM appears promising but remains investigational for children and adolescents with ASD. Further rigorous sham-controlled trials with standardized outcome measures and clearer safety reporting are needed.
Objective: To evaluate and compare the accuracy of pH paper and urine pH test strips for ocular surface pH assessment in chemical eye injury settings. Materials and Methods: Nine standard pH solutions (pH 2.00, 4.01, 5.00, 7.00, 8.00, 9.21, 10.00, 11.00, and 12.45) were measured by two observers. Each reference solution was measured 10 times using pH paper and 10 times via urine pH test strips, with each observer conducting five tests per method, resulting in a total of 180 measurements. Accuracy was defined as the percentage of measurements that matched the standard pH value. Results: All the measurements exhibited good to excellent interobserver and intraobserver reliability. pH paper demonstrated slightly higher accuracy than urine pH test strips (pH paper: 44.4% [95% CI 34.6%–54.7%]; urine pH test strips: 37.8% [95% CI 28.5%–48.1%]). Bland–Altman analysis further indicated superior precision with pH paper measurements than those of the urine pH test strips (95% limits of agreement of -1.6 to +1.8 and -3.0 to +2.8, respectively), particularly at pH extremes outside the range of 5-10. Conclusion: This study suggests that pH paper provides more accurate and reliable measurements than urine pH test strips across a wider pH range, particularly when analyzing minute fluid volumes like tear samples in cases of ocular chemical injury. Additionally, pH paper's soft texture is not just a matter of convenience but a safety advantage during acute trauma. Therefore, pH paper should be the preferred diagnostic tool for evaluating ocular chemical injury. However, clinical studies are needed to confirm these findings in real-world settings.
Objective: Disability in activities of daily living (ADL) is one of the most common sequelae of ischemic stroke. The factors that govern the course of functional recovery in this group of patients need to be identified to inform clinical management. The objective of this study was to explore the prognostic factors of ADL for the functional outcome of patients with acute ischemic stroke at 3-month follow-up. Materials and Methods: A prospective cohort study in patients with acute ischemic stroke was performed. Prognostic factors were obtained from patient records. The Barthel index (BI) was used to evaluate functional status both before discharge and at a 3-month follow-up. Correlates of worsening or unchanged ADL were calculated using multivariable ordinal logistic regression. Results: A total of 305 patients were enrolled (mean age, 65 years; male, 55.4%). At 3 months, ADL improved in 64.9% of patients, remained unchanged in 28.2%, and worsened in 6.9%. Several independent prognostic factors for worse or unchanged ADL at 3 months were identified and included: higher NIHSS (aOR = 2.70, 95% CI: 1.43–5.12), lower GCS (aOR = 3.03, 95% CI: 1.26–7.35), absence of thrombolytic therapy with rt-PA (aOR =17.52, 95% CI:2.84-346.30), and absence of a caregiver (aOR =4.95, 95% CI, 1.13–21.64). Conclusions: Stroke severity (NIHSS, GCS) and acute intervention (rt-PA), as well as social support (caregivers), are important determinants of functional evolution in ischemic stroke patients. These results support the need for early risk stratification and optimized post-discharge support to enhance long-term rehabilitation outcomes.
Objective: Evaluate the prevalence of malnutrition and explore the issue of eating disturbances in cognitively impaired patients at the memory clinic. Materials and Methods: Sixty-two cognitively impaired patients from the memory clinic were assessed. The cognitive stage was categorized using the Clinical Dementia Rating scale-Sum of Boxes. Participants underwent a comprehensive assessment including: Mini-Nutritional Assessment-Short Form (MNA-SF) questionnaire, Body Mass Index (BMI) and Waist-Hip Ratio (WHR) measurements, biochemical markers such as total protein, albumin, and hemoglobin levels, and a comprehensive questionnaire to evaluate eating disturbances. Logistic regression and chisquare analyzed the relationship between cognitive impairment severity, nutritional status, and eating disturbances. Results: Participants were classified into three groups: mild cognitive impairment (MCI) (n=30), mild dementia (n=22), and moderate dementia (n=10). No significant differences were observed between the groups in terms of BMI, WHR, total protein, albumin, and hemoglobin levels. Based on the MNA-SF score, the odds of malnutrition increased with the severity of cognitive impairment. Moderate dementia patients exhibited a significantly higher risk of malnutrition compared to MCI patients (adjusted OR = 8.87; 95%CI = 1.59-49.46; p = 0.013). The prevalence of eating disturbances increased with the severity of cognitive impairment. Patients with moderate dementia had higher odds of experiencing changes in eating habits compared to those with MCI (aOR=9.37; 95%CI = 0.98–89.64; p=0.052). Conclusions: Cognitive impairment was associated with increased malnutrition risk and progressive eating disturbances, including changes in appetite and eating habit.
Objective: Septic shock resuscitation targets hemodynamic stabilization (mean arterial pressure 65 mmHg) and tissue perfusion, defined by lactate < 2 mmol/L or lactate clearance > 10%. Because urine output is widely used as an organ perfusion goal, we examined its behavior during resuscitation and its association with lactate kinetics and outcomes. Materials and Methods: We conducted a prospective cohort study of patients with intact urine flow during resuscitation. Serum lactate was measured at resuscitation start and at hemodynamic stabilization, and hourly urine flow was recorded. The primary outcome was survival without organ support at 28 days after septic shock diagnosis. We assessed correlations between urine flow and lactate clearance at stabilization. Results: From January to July 2024, 95 patients were screened; 20 were excluded. The remaining 75 achieved hemodynamic stabilization within 12 hours, and all but 2 met tissue oxygenation goals regardless of urine flow rate. The proportion with urine output < 0.5 mL/kg/hour did not differ between survivors and the death/organ support group. In multivariable analysis, urine output at stabilization < 0.4 mL/hour was not associated with unfavorable outcomes, whereas lactate at stabilization > 3 mmol/L was associated with in-hospital mortality and organ support. Conclusions: During septic shock resuscitation, intact urine flow at hemodynamic restoration may serve as a surrogate of adequate tissue perfusion when infection is controlled. However, lactate remains a key milestone for confirming perfusion restoration.
Objective: This study aimed to investigate the prevalence, clinical outcomes, and predictive factors of AKI among intensive care unit (ICU) patients at Siriraj Hospital. Materials and Methods: We conducted a single-center retrospective study of ICU patients admitted between January 2014 and December 2021. The primary outcome was hospital mortality following ICU admission. Results: Of the 1,950 patients included, 1,453 (74.5%) developed AKI, with 14.3% classified as stage 1, 12.9% as stage 2, and 47.3% as stages 3. The hospital mortality rate was significantly higher in the AKI group compared to the non-AKI group (49.6% vs. 17.9%, p < 0.01). The highest mortality rate was observed in patients with stage 3 AKI (60.6%, p < 0.001). Additionally, patients with AKI had longer ICU stays (32 vs. 22 days; p < 0.001) and a higher prevalence of nosocomial infections (39.8% vs. 26.6%; p < 0.001). Multivariable analysis identified a Non-renal Sequential Organ Failure Assessment (SOFA) score > 6, urine output <1 ml/kg/h, vasopressor use, and hypertension as factors associated with AKI. Conclusion: AKI was relatively common among critically ill patients in this cohort, and its presence and severity were associated with worse clinical outcomes. High SOFA scores, low urine output, vasopressor use, and hypertension were identified as factors associated with AKI.
Objective: To identify the cutoff value for the optimal number of days to surgery, and to investigate the independent association between the diagnosis-to-surgery interval time (DIT) and survival outcome in Thai patients with nonmetastatic/stage I-III colorectal cancer. Materials and Methods: A chart review of patients diagnosed with and operated upon for stage non-metastatic/stage I-III colorectal cancer at Siriraj Hospital (Bangkok, Thailand) during January 2010-December 2020 was conducted. The primary outcome was the survival rate compared between two different DITs. Multivariate regression was used to identify independent predictors of decreased survival. Results: A total of 979 patients (median age: 65 years) were included. Of those, 18.4% had stage I, 38.6% had stage II, and 43.0% had stage III disease. The calculated median DIT of 30 days (IQR: 19-47) was used as the cutoff value to categorize patients into the ≤30-days or >30-days group. The 5-year overall survival rate was 97.6% and 97.1% (p=0.536), and the median survival time was 59.4 and 58.9 months - both respectively. The 3-year disease-free survival (DFS) rate was 86.9% and 85.7%, respectively (p=0.523). The independent predictors of decreased 3-year DFS among all patients were lymph node metastasis (p=0.037), adjuvant chemotherapy (p=0.005), and lymphovascular invasion (p=0.051). Further multivariate analysis in the DIT >30-days group found low preoperative albumin level (p=0.035), perineural invasion (p=0.011), and adjuvant chemotherapy (p<0.001) to independently predict significantly poorer 3-year DFS. Conclusions: A DIT >30 days was not found to independently predict significantly poorer survival outcomes in Thai patients with non-metastatic/stage I-III colorectal cancer.
Objective: To compare the efficacy of a novel constipation prevention and management protocol with that of routine physician-directed management of constipation in critically ill cardiac patients. Materials and Methods: This randomized controlled trial was conducted in the cardiac care unit and intermediate cardiac care unit of a tertiary hospital in Bangkok, Thailand. A total of 170 patients were randomized and analyzed according to the intention-to-treat principle. Missing outcome data were handled using multiple imputation. The protocol group was further subdivided using the ROME criteria into Group 1 and Group 2 (abnormal patterns; received immediate laxatives) and Group 3 (normal pattern; received laxatives only if no defecation occurred within 48 hours). The primary outcome was enema use. Secondary outcomes included the incidence of constipation and diarrhea, and patient satisfaction. Data were analyzed using appropriate statistical methods. Results: The incidence of enema use was 17.41% in the protocol group and 16.45% in the usual care group. Constipation occurred in 25.41% and 36.94% of patients, respectively, while diarrhea occurred in 1.0% and 1.2%. Patient satisfaction was comparable between groups (p = 0.221). Conclusion: The individualized bowel management protocol did not significantly reduce enema use, constipation, or diarrhea compared with usual care. Exploratory findings suggest that early laxative administration based on defecation patterns may facilitate earlier bowel movement.
