Utcharee Intusoma

Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend preoperative carbohydrate loading; however, local hospitals often use syrup concentrate sweet drinks rather than specialized carbohydrate formulations. We compared gastric emptying, glycemic response, and fasting discomfort of a novel carbohydrate drink versus syrup concentrate sweet drinks. Methods: In this pilot randomized, crossover trial at Prince of Songkla University Hospital, Thailand, 16 healthy volunteers received three interventions with a 1-week washout period: novel carbohydrate drink 400 mL (C400), novel carbohydrate drink 250 mL (C250), and syrup sweet drink 250 mL (SYR). The primary outcome was gastric antral cross-sectional area (CSA) measured using ultrasonography at baseline, 10, 60, 120, and 180 min post-ingestion. Secondary outcomes included glycemic response and visual analog scales for thirst and hunger. Results: All drinks showed comparable gastric CSA, peaking at 10 min (5.5–6.5 cm², p < 0.01) and returning to baseline by 120 min. Novel carbohydrate drinks produced higher glucose peaks at 60 min (C400: 147.4 mg/dL [28.0]; C250: 148.7 mg/dL [21.7]) than SYR (123.1 mg/dL [22.4], p = 0.006) with sustained elevation through 120 min. All drinks similarly reduced thirst and mouth dryness scores at 60 min (p < 0.05), though hunger increased progressively after 120 min across all groups. Conclusions: Both 400 mL and 250 mL volumes of novel carbohydrate drinks demonstrated safe gastric emptying profiles comparable to syrup concentrate sweet drinks while providing more sustained glycemic responses.

Background: Postoperative venous thromboembolism (VTE) prophylaxis for hepatectomy is debated in low‐VTE incidence regions like Thailand due to bleeding risks. This study evaluated single‐dose preoperative enoxaparin safety for VTE prophylaxis, focusing on post‐hepatectomy hemorrhage (PHH).Methods: This retrospective review compared VTE and PHH incidence before (no prophylaxis) and after implementation of a single preoperative dose of enoxaparin 40 mg for all patients undergoing elective hepatectomy in a center in Thailand. PHH and post‐hepatectomy liver failure (PHLF) were defined per International Study Group of Liver Surgery criteria. Factors associated with PHH were analyzed using logistic regression.Results: One hundred eighty‐six patients underwent elective hepatectomy (mean age 58 years). Fifty‐two percent underwent major hepatectomy. PHLF occurred in 11% of patients. VTE occurred in 0% (0/96) of the pre‐protocol and 1.1% (1/90) of the post‐protocol group. PHH rate was 3.8%, with no difference between pre‐protocol (3/96) and post‐protocol groups (4/90). Factors associated with PHH were intraoperative transfusion > 2 units (OR 33.3; 95% CI 1.9–587.7) and PHLF (OR 17.2; 95% CI 2.1–140.8), but not enoxaparin (OR 1.9; 95% CI 0.3–12.8).Conclusions: Single preoperative enoxaparin did not increase PHH risk in this low VTE incidence cohort and may be considered for VTE prophylaxis in similar populations.

Objective To elucidate the clinical characteristics and standard of care (SoC) of spinal muscular atrophy (SMA) patients in Thailand, focusing on primary endpoints: age at death and a composite of death or tracheostomy need. Design Retrospective observational study. Setting Seven tertiary centres across Thailand. Patients Records of 110 patients with genetically confirmed SMA, spanning 2012–2021. Interventions Historical data review; no active interventions. Main outcome measures Age at death and a composite measure of death or tracheostomy necessity. Results The cohort included 1 SMA0, 50 SMA1, 40 SMA2 and 19 SMA3 cases. Median ages at the onset and diagnosis of SMA1 were 3 and 6.2 months. Of SMA1 patients, 63% required ventilators, and eight received dimethyltryptamines (DMTs) at a median of 15 months (range 6.4–24.5 months). The median time from onset to DMT was 11 months (range 4.2–20.5 months). Among SMA1 patients, 73% died by the study’s end. SMA2 and SMA3 patients' median onset ages were 11 and 24 months, respectively, with diagnosis at 24.8 and 68.7 months. Half of all types received physical therapy. Conclusions Significant delays in diagnosis and SoC access, including DMTs, were observed, underscoring urgent needs for improved diagnostic and care strategies to enhance SMA patient outcomes in Thailand.

Background: Patients receiving parenteral nutrition (PN) may develop refeeding syndrome (RFS). This study determined RFS prevalence in hospitalized adults on PN and evaluated whether higher energy delivered by PN on day 1 of PN initiation was associated with RFS development.Methods: We reviewed the medical records of adult patients receiving PN at a Thai quaternary hospital from June 2019 to May 2022. RFS was defined based on the Nutrition Management Clinical Practice Recommendation by the Society of Parenteral and Enteral Nutrition of Thailand. The association between PN energy delivery and RFS development was determined using a generalized estimating equation for multiple logistic regression analysis adjusted for NICE guideline risk factors.Results: A total of 547 patients was included (mean age 59.8 ± 17.2 years, mean body mass index 20.7 ± 4.8 ). The prevalence of RFS was 45%. Factors associated with RFS included energy from PN on the first day of PN initiation (adjusted odds ratio [aOR] 1.17; 95% CI 1.04–1.33; for every 5 kcal/kg/day increase), starvation >5 days prior to PN (aOR 1.54; 95% CI 1.04–2.26), concomitant diuretic use (aOR 1.81; 95% CI 1.25–2.64), low baseline potassium level (aOR 1.79; 95% CI 1.19–2.70), and individual compounding PN (aOR 1.61; 95% CI 1.04–2.51).Conclusion: RFS was common among hospitalized patients receiving PN. The amount of energy delivered on the first day of PN was independently associated with RFS, raising a concern regarding initiation of PN with higher energy.

Nearly all asthma predictive tools estimate the future risk of asthma development. However, there is no tool to predict the probability of successful ICS cessation at an early age. Therefore, we aimed to determine the predictors of successful ICS cessation in preschool wheezers, and developed a simple predictive tool for clinical practice. This was a retrospective cohort study involving preschool wheezers who had undergone an ICS therapeutic trial during 2015–2020 at the University Hospital, Southern, Thailand. A predictive scoring system was developed using a nomogram to estimate the probability of successful ICS cessation. We calculated area under ROC curve and used a calibration plot for assessing the tool’s performance. A total of 131 medical records were eligible for analysis. Most of the participants were male (68.9%). More than half of the preschool wheezers had successful ICS cessation after an initial therapeutic trial regimen. The predictors of less successful ICS cessation were perinatal oxygen use [OR 0.10 (0.01, 0.70), P = 0.02], allergic rhinitis [OR 0.20 (0.08, 0.56), P = 0.002], blood eosinophil count > 500 cell/mm³ [OR 0.20 (0.06, 0.67), P = 0.008], and previous ICS use > 6 months [OR 0.30 (0.09, 0.72), P = 0.009]. Conclusions: Predictors of less successful ICS cessation were the following: perinatal oxygen use, allergic rhinitis, blood eosinophil count > 500 cell/mm³, and previous ICS use > 6 months. A simple predictive score developed in this study may help general practitioners to be more confident in making a decision regarding the discontinuation of ICS after initial therapeutic trials. What is Known: • Early allergic sensitization is associated with reduced chances of inhaled corticosteroid cessation at school age. • Prolonged ICS is associated with the emergence of adverse effect and discontinuing too early can result in recurrence symptoms. What is New: • Requirement of oxygen support within 7 days after birth in term neonate is a postnatal factor associated with less successful ICS cessation. • We propose a simple predictive tool with easily available clinical parameters (perinatal oxygen use, allergic rhinitis, blood eosinophil count, parental asthma history, and duration of previous ICS use) to determine the timing of inhalational corticosteroid cessation in preschool wheezers.

Objectives: To conduct the first pre‐Haemophilus influenzae (Hi) type b (Hib) immunisation programme‐based epidemiological study using national health data.Methods: We analysed National Health Security Office data, which cover 72% of the Thai population. The study population included children aged <18 years admitted for Hi disease from 2015 to 2019. Hi disease diagnosis and death were based on the International Statistical Classification of Diseases and Related Health Problems (10th revision) hospital discharge summary codes. We estimated the hospital cost per admission using diagnosis‐related grouping with a global budget.Results: A total of 1125 children aged <18 years were admitted for Hi disease. During the 5‐year‐study, the annual incidence of Hi disease varied from 1.5 to 1.9 per 100,000 children, with an overall case fatality rate (CFR) of 2%. Pneumonia was the most common clinical form, followed by meningitis and sepsis. The incidence, clinical forms and severity of Hi disease were age specific. Infant CFR was higher than that of other age groups. The incidence of Hi disease in children aged 5 years. The hospital cost ranged from 25,000 to 30,000 THB per admission.Conclusions: This analysis provided epidemiological data of Hi in Thai children before the Hib routine immunisation programme. The incidence of Hi disease was lower than that previously speculated. Our results could facilitate an assessment of the impact of Hib immunisation programme in Thailand.

Hyperornithinemia–hyperammonemia–homocitrullinuria (HHH) syndrome, an inborn error of metabolism, is an inherited syndrome caused by loss-of-function mutations in the SLC25A15, resulting in ornithine translocase1 (ORNT1) deficiency. Disrupted ornithine transportation in an affected individual usually manifests with the accumulation of intermediate metabolites, leading to neurological impairment, hepatitis, and/or protein intolerance at various ages of onset. In this paper, we report a compound heterozygous mutation in SLC25A15 from a 2-year-old girl who presented with neurological alterations and hepatic failure. Before developing neurological sequelae, she had signs of globally delayed development. The accumulation of toxic metabolites may explain these neurological consequences. After biochemical confirmation of HHH, whole-exome sequencing (WES) was performed, which identified mutations at codons 21 and 179 of SLC25A15 that are predicted to result in the loss of function of ORNT1. Each of the mutations was found to be inherited from one of her parents. After therapy, her toxic metabolites decreased significantly. In conclusion, HHH syndrome frequently manifests with nonspecific symptoms and unapparent biochemical profiles, which may lead to delayed diagnosis. Correction of the accumulating metabolites is necessary to prevent irreversible neurological impairment. Furthermore, performing a WES provides a shortcut for accurate diagnosis.

Background Prognosis of low-grade glioma are currently determined by genetic markers that are limited in some countries. This study aimed to use clinical parameters to develop a nomogram to predict survival of patients with diffuse astrocytoma (DA) which is the most common type of low-grade glioma. Materials and Methods Retrospective data of adult patients with DA from three university hospitals in Thailand were analyzed. Collected data included clinical characteristics, neuroimaging findings, treatment, and outcomes. Cox’s regression analyses were performed to determine associated factors. Significant associated factors from the Cox regression model were subsequently used to develop a nomogram for survival prediction. Performance of the nomogram was then tested for its accuracy. Results There were 64 patients with DA with a median age of 39.5 (interquartile range [IQR] = 20.2) years. Mean follow-up time of patients was 42 months (standard deviation [SD] = 34.3). After adjusted for three significant factors associated with survival were age ≥60 years (hazard ratio [HR] = 5.8; 95% confidence interval [CI]: 2.09–15.91), motor response score of Glasgow coma scale < 6 (HR = 75.5; 95% CI: 4.15–1,369.4), and biopsy (HR = 0.45; 95% CI: 0.21–0.92). To predict 1-year mortality, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve our nomogram was 1.0, 0.50, 0.45, 1.0, 0.64, and 0.75, respectively. Conclusions This study provided a nomogram predicting prognosis of DA. The nomogram showed an acceptable performance for predicting 1-year mortality.

Background: Lamotrigine (LTG) is commonly used for treatment of epilepsy and bipolar disorder. It is one of the common cause of cutaneous adverse drug reactions (CADR). Clinical symptoms of LTG-induced CADR range from maculopapular exanthema (MPE) to severe cutaneous adverse reactions (SCAR). This study aimed to determine the association of the LTG-induced CADR with human leukocyte antigen (HLA) alleles in Thai patients. Methods: Fifteen patients with LTG-induced CADR [10 MPE; 4 Stevens–Johnson syndrome; and 1 drug reaction with eosinophilia and systemic symptoms] and 50 LTG-tolerant controls were included in the study. HLA-A and HLA-B genotyping was performed using polymerase chain reaction-sequence-specific oligonucleotides probes. Results: The proportion of HLA-A^∗02:07 and HLA-B^∗15:02 allele carriers were significantly higher in the LTG-induced CADR group than in the tolerant controls [odds ratio (OR): 7.83; 95% confidence interval (CI): 1.60–38.25; P = 0.013, and OR: 4.89; 95% CI: 1.28–18.67; P = 0.014]. In addition, subjects with HLA-A^∗33:03, HLA-B^∗15:02, and HLA-B^∗44:03 were significantly higher in the LTG-induced MPE group than in the tolerant controls (OR: 8.27; 95% CI: 1.83–37.41; P = 0.005, OR: 7.33; 95% CI: 1.63–33.02; P = 0.005; and OR: 10.29; 95% CI: 1.45–72.81; P = 0.029). In contrast to the LTG-induced MPE group, there were no significant differences between HLA alleles and LTG-induced SCAR group. Conclusion: HLA-A^∗02:07 and HLA-B^∗15:02 were associated with LTG-induced CADR in Thai patients. We also identified an association between HLA-A^∗33:03, HLA-B^∗15:02, and HLA-B^∗44:03 and LTG-induced MPE in this population. These results suggest that these alleles could be useful screening markers for preventing CADR before LTG treatment in Thai patients, but further replication studies with larger sample sizes are needed.