BACKGROUND:Primary spontaneous pneumothorax (PSP) is a condition that may lead to acute chest pain or dyspnea on exertion. Treatment with an intercostal chest drainage (ICD) is warranted. There is limited data on risk factors of recurrent PSP in patients treated with the ICD alone. This study aimed to evaluate risk factors of recurrent PSP in patients with PSP and treated with the ICD. METHODS:This was a retrospective study and enrolled patients diagnosed as PSP and treated with an ICD. Eligible patients were divided into two groups by evidence of recurrent PSP. Baseline characteristics, physical signs, laboratory results, and duration of ICD treatment were studied and recorded from medical charts. Factors associated with recurrent PSP were computed by using multivariate logistic regression analysis. RESULTS:There were 80 patients met the study criteria. Of those, 21 patients (26.3%) had recurrent PSP. Of those, 21 patients (26.3%) had recurrent PSP. There were eight factors in the final model for recurrent PSP. Only oxygen saturation at the time of diagnosis was independently associated with recurrent PSP. The adjusted odds ratio (95% confident interval) was 0.57 (0.34, 0.96). A cut point of 96% of oxygen saturation gave sensitivity of recurrent PSP of 80.95%. CONCLUSION:The prevalence of recurrent PSP was 26.3% in patients with PSP and treated with the ICD. Initial oxygen saturation may be an indicator for recurrent PSP.

PURPOSE:Primary spontaneous pneumothorax (PSP) is an urgent/emergency condition. Treatment with intercostal chest drainage (ICD) is necessary, particularly in symptomatic patients or those with tension. A previous study found that systematic breathing exercise significantly reduced ICD duration when compared with controls. This study aimed to evaluate if pulmonary rehabilitation can reduce the duration of ICD treatment in patients with PSP.PATIENTS AND METHODS:This was a retrospective study of patients diagnosed with PSP treated with ICD. Duration of ICD treatment was recorded from patients' medical charts. Factors associated with ICD duration were calculated using linear regression analysis.RESULTS:There were 66 patients who met the study criteria, with average (SD) age and body mass index of 31.68 (13.53) years and 20.94 (2.72) kg/m2. The majority of the patients were male (72.73%), and average (SD) duration of ICD treatment was 9.90 (7.83) days. Three factors remained in the final model: body mass index, systolic blood pressure, and recurrent PSP. Two factors were independently associated with longer ICD duration: systolic blood pressure and recurrent PSP, with adjusted coefficients of 0.21 (p value 0.041) and 7.69 (p value 0.039), respectively. Pulmonary rehabilitation was not included in the final model.CONCLUSION:Patients with a history of recurrent PSP or high systolic blood pressure at presentation may require longer ICD duration. Pulmonary rehabilitation was not associated with the duration of ICD treatment.

Objective : To study clinical presentations and complications of OSA in Thai patients. Materials and Methods : This study was a retrospective, descriptive study conducted at OSA clinic, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand. The inclusion criteria were adult patients diagnosed as OSA. The diagnosis of OSA was made by evidence of apnea-hypopnea index of 5 times/hour or more by either in-laboratory or portable home sleep test. Clinical presentations and complications of OSA were studied by chart review. Results : There were 130 patients met the study criteria. The median age and body mass index of all patients were 50 years and 29.5 kg/m 2 . The male: female ratio was 1.1: 1.0. Snoring was the most common symptom (63.8%) followed by excessive daytime sleepiness (41.5%). The median AHI and lowest oxygen saturation were 19 times/hour and 83.5%. The top three complications were hypertension (80.8%), left ventricular hypertrophy (38.3%), and gastroesophageal reflux disease or GERD (36.9%). Conclusions : Clinical presentations of OSA in Thai patients may not be obvious as previously reported. Hypertension, left ventricular hypertrophy, and GERD may be suggestive complications of OSA.

Background. Hydrochlorothiazide is a cheap and effective antihypertensive agent but may cause hyponatremia. Even though several risk factors for hydrochlorothiazide-induced hyponatremia have been reported, this study aimed to evaluate additional risk factors for hydrochlorothiazide-induced hyponatremia in hypertensive patients. Material and methods. The inclusion criteria were: adult patients, diagnosed with hypertension and receiving hydrochlorothiazide treatment. Eligible patients were divided into two groups: with and without hyponatremia. Those with hyponatremia were identified by using the ICD-10 code E871, while those without hyponatremia were patients who did not have any reported hyponatremia until the last visit. The ratio between hyponatremia and non-hyponatremia group was 1:2. Predictors for hyponatremia were analyzed by using logistic regression analysis. Results. During the study period, there were 68 patients admitted due to symptomatic hyponatremia from hydrochlorothiazide. There were four independent factors in the model predictive of occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients: sex, body mass index, plasma glucose, and serum albumin. Male sex, body mass index, and serum albumin were negatively associated with occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients with adjusted OR of 0.099, 0.683, and 0.122, respectively. The plasma glucose had adjusted OR of 1.030 [95% CI of (1.009, 1.051)]. Conclusions. Factors associated with hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients were sex, body mass index, plasma glucose level, and serum albumin level. The latter two risk factors have never been reported as risk factors for hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients.

Obstructive sleep apnea [OSA] is very prevalent worldwide and causes several major cardiovascular diseases. There are limited studies on a correlation of OSA and musculoskeletal system. This study aimed to evaluate the effects of continuous positive airway pressure [CPAP] on musculoskeletal system focused on cervical alignment and pressure pain threshold of neck and shoulders in OSA patients. This study was an experimental study and conducted at Sleep Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. The study period was between September and December 2017. The inclusion criteria were adult patients (aged between 20 and 60 years), newly diagnosed as OSA, and able to use CPAP therapy. Both cervical range of motion and pressure pain threshold of neck and shoulder muscles were measured at baseline and one month after CPAP therapy. There were 15 OSA patients with CPAP therapy eligible for the study. The means [SD] age and body mass index of all patients were 39.13 (11.81) years and 32.20 (8.57) kg/m2. The average (SD) AHI was 23.06 (15.06) events/hour with average CPAP use of 6.5 hours. Regarding the cervical range of motion, there was no statistical difference between pre- and post-CPAP therapy in all six directions of the cervical range of motion. For pressure pain threshold in ten muscles of neck and shoulders were significantly lower after CPAP therapy. In conclusion, CPAP therapy significantly reduced pressure pain threshold in neck and shoulder muscles in a shortterm period. Keywords: Obstructive sleep apnea, Range of motion, Pressure pain threshold

Background: Obstructive sleep apnea (OSA) is one of the possible causes of atrial fibrillation (AF). Continuous positive airway pressure (CPAP) therapy may lower Lhe recurrence rate of AF after cardioversion to normal sinus rhythm. We report a case of AF caused by OSA and successfully converted by CPAP therapy.Case: A 65-year-old man presented with AF of unidentified causes. After severe OSA was diagnosed, he was treated with CPAP for 2 months and his cardiac rhythm returned to sinus rhythm without any antiarrhythmic drugs or carclioversion.Conclusion: AF caused by OSA may be converted Lo sinus rhythm by CPAP treatment. (C) 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.