Boonphiphop Boonpheng

OBJECTIVE: This study aims to investigate the prevalence of health checkup attendance among Thai adults aged 19-60 years and the factors associated with participation in health checkups.METHODS: A cross-sectional study was conducted from October to December 2023 among 292 Thai individuals aged 19–60 years who received medical services at Vajira Hospital without prior appointments for chronic disease follow-up. Data were collected using a questionnaire comprising the following four sections: personal information, health-related and health checkups data, possible factors facilitating checkup attendance, and the reasons why non-checkup participants choose not to undergo health checkups. The factors associated with participation in health checkups were identified by multivariable logistic regression analysis with a significance level of 0.05.RESULTS: A total of 156 volunteers (53.4%) participated in checkups in the past 3 years. The factors associated with participation in checkups included earning more than 20,000 Baht per month (OR 3.06, 95% CI 1.12–8.41), checkups arranged by their workplace (OR 5.64, 95% CI 2.42–13.15), and encouragement by family or friends (OR 2.18, 95% CI 1.06–4.51). Underweight (OR 0.28, 95% CI 0.10–0.81) and overweight individuals (OR 0.23, 95% CI 0.08–0.64) were less likely to participate in health checkups than people with a normal body mass index. Lastly, individuals who could participate in checkups on weekends or holidays were less likely to do so than those unable to participate (OR 0.41, 95% CI 0.18–0.96).CONCLUSION: A portion of Thai adults aged 19-60 years still fails to attend health checkups. Health checkup utilization must be increased using various strategies, such as encouraging workplace-organized checkups and fostering peer encouragement, especially among low-income and underweight/overweight individuals.

Background: The optimal treatment for chronic active antibody‐mediated rejection (ca‐AMR) remains unclear. Tocilizumab (TCZ), a monoclonal antibody against IL‐6, has been proposed as a therapeutic option. We reported our experience treating ca‐AMR with TCZ either as the first line option or as a rescue therapy.Methods: We studied 11 adult kidney transplant recipients with biopsy‐proven ca‐AMR and preserved kidney function (eGFR 57 ± 18) who were treated with TCZ (8 mg/kg IV monthly). All biopsies were prompted by abnormal surveillance biomarker testing with DSA and/or dd‐cfDNA. Clinical monitoring included dd‐cfDNA and DSA testing every 3 months during the treatment with TCZ.Results: In this cohort, ca‐AMR was diagnosed at a median of 90 months (range 14–224) post‐transplant, and 4 of 11 patients had DSA negative ca‐AMR. Patients received a minimum of 3 months of TCZ, with 6 patients receiving at least 12 months of TCZ. Dd‐cfDNA was elevated in all patients, with a median 2.24% at the start of TCZ treatment. After 6 months of TCZ treatment, 8/11 patients had dd‐ cfDNA p = .05) and 47% by 12 months (p = .04). DSA also stabilized and, by 12 months, was reduced by 29% (p = .047). Graft function remained stable with no graft loss during treatment. There was a nonsignificant trend towards proteinuria reduction. During the course of treatment with tocilizumab, two patients experienced moderate to severe infections.Conclusions: In our early short‐term experience, TCZ appears to reduce graft injury as measured by dd‐cfDNA and modulate the immune response as evident by a modest reduction in immunodominant DSA MFI. Allograft function and proteinuria also stabilized.

Background Post-transplant erythrocytosis (PTE) can occur in up to 10-16% after kidney transplant (KT). However, the post-transplant outcomes of recipients with PTE in the literature were conflicting. We performed systematic review and meta-analysis of published studies to evaluate risk factors of PTE as well as outcomes of recipients who developed PTE compared to controls. Methods A literature search was conducted evaluating all literature from existence through February 2, 2021, using MEDLINE and EMBASE. Data from each study were combined using the random-effects model. (PROSPERO: CRD42021230377) Results Thirty-nine studies from July 1982 to January 2021 were included (7,099 KT recipients). The following factors were associated with PTE development: male gender (pooled RR=1.62 [1.38, 1.91], I²=39%), deceased-donor KT (pooled RR=1.18 [1.03, 1.35], I²=32%), history of smoking (pooled RR=1.36 [1.11, 1.67], I²=13%), underlying polycystic kidney disease (PKD) (pooled RR=1.56 [1.21, 2.01], I²=44%), and pretransplant dialysis (pooled RR=1.6 [1.02, 2.51], I²=46%). However, PTE was not associated with outcomes of interest, including overall mortality, death-censored graft failure, and thromboembolism. Conclusion Our meta-analysis demonstrates that male gender, deceased-donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on prognosis of KT patients.

Background: This study aimed to assess outcomes of delivery hospitalizations, including acute kidney injury (AKI), obstetric and foetal events and resource utilization among pregnant women with kidney transplants compared with pregnant women with no known kidney disease and those with chronic kidney disease (CKD) Stages 3–5.Method: Hospitalizations for delivery in the US were identified using the enhanced delivery identification method in the National Inpatient Sample dataset from the years 2009 to 2014. Diagnoses of CKD Stages 3–5, kidney transplantation, along with obstetric events, delivery methods and foetal events were identified using ICD‐9‐CM diagnosis and procedure codes. Patients with no known kidney disease group were identified by excluding any diagnoses of CKD, end stage kidney disease, and kidney transplant. Multivariable logistic regression accounting for the survey weights and matched regression was conducted to investigate the risk of maternal and foetal complications in women with kidney transplants, compared with women with no kidney transplants and no known kidney disease, and to women with CKD Stages 3–5.Result: A total of 5, 408, 215 hospitalizations resulting in deliveries were identified from 2009 to 2014, including 405 women with CKD Stages 3–5, 295 women with functioning kidney transplants, and 5, 405, 499 women with no known kidney disease. Compared with pregnant women with no known kidney disease, pregnant kidney transplant recipients were at higher odds of hypertensive disorders of pregnancy (OR = 3.11, 95% CI [2.26, 4.28]), preeclampsia/eclampsia/HELLP syndrome (OR = 3.42, 95% CI [2.54, 4.60]), preterm delivery (OR = 2.46, 95% CI [1.75, 3.45]), foetal growth restriction (OR = 1.74, 95% CI [1.01, 3.00]) and AKI (OR = 10.46, 95% CI [5.33, 20.56]). There were no significant differences in rates of gestational diabetes or caesarean section. Pregnant women with kidney transplants had 1.30‐times longer lengths of stay and 1.28‐times higher costs of hospitalization. However, pregnant women with CKD Stages 3–5 were at higher odds of AKI (OR = 5.29, 95% CI [2.41, 11.59]), preeclampsia/eclampsia/HELLP syndrome (OR = 1.72, 95% CI [1.07, 2.76]) and foetal deaths (OR = 3.20, 95% CI [1.06, 10.24]), and had 1.28‐times longer hospital stays and 1.37‐times higher costs of hospitalization compared with pregnant women with kidney transplant.Conclusion: Pregnant women with kidney transplant were more likely to experience adverse events during delivery and had longer lengths of stay and higher total charges when compared with women with no known kidney disease. However, pregnant women with moderate to severe CKD were more likely to experience serious complications than kidney transplant recipients.

We describe the case of a 62-year-old female who presented with gradually progressing abdominal distension and dyspnea. Computed tomography (CT) chest and abdomen revealed large bilateral pleural effusions with large ascites, a mid-abdominal mass, and peritoneal carcinomatosis. Pleural and peritoneal tap revealed chylous fluid, and the biopsy findings from abdominal mass were consistent with follicular lymphoma. We then discuss a review of the literature and diagnoses for bilateral chylothorax and chylous ascites.

Background: This study aimed to 1) determine the incidence of acute kidney injury (AKI), 2) identify risk factors for AKI, and 3) evaluate the impact of AKI on in-hospital outcomes in hospitalized patients for methanol intoxication. Methods: We searched the National Inpatient Sample Database for hospitalized patients from 2003 to 2014 with a primary diagnosis of methanol intoxication. We excluded patients with end-stage kidney disease. We identified the AKI using a discharge diagnosis code. We compared clinical characteristics, in-hospital treatment, outcomes, and resource use between AKI and non-AKI patients. Results: A total of 603 hospital admissions for methanol intoxication were analyzed. AKI developed in 135 (22.4%) admissions. Anemia (OR 3.43 p < 0.001), hypertension (OR 1.86; p = 0.02), volume depletion (OR 3.46; p = 0.001), sepsis (OR 6.91; p < 0.001), rhabdomyolysis (OR 6.25; p = 0.003), and acute pancreatitis (OR 5.30; p = 0.004) were independent risk factors for AKI development. AKI was significantly associated with increased risk of in-hospital mortality and organ failure. AKI patients needed more mechanical ventilation, and extracorporeal therapy, had longer length of hospital stay, and higher hospitalization costs. Conclusion: Over one-fifth of methanol intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilization.

Goodpasture’s syndrome is a rare and life-threatening autoimmune disease. While Goodpasture’s syndrome is well described in Caucasian and Asian populations, its prevalence and outcomes among Africa...

Chronic liver disease (CLD) causes more than 1 million deaths every year and remains a pandemic in the last decade affecting more than 600,000 patients in the United States. Previous studies found patients with CLD had increased risk of osteoporosis, so fractures were inferred to be complications of this condition. The aim of this meta-analysis is to summarize the best evidence that correlates CLD patients and the risk to develop osteoporotic fractures versus control patients without CLD. A review of the literature using MEDLINE and EMBASE database was performed during December 2017. We included cross-sectional and cohort studies that reported relative risks (RR), odds ratios (OR) and hazard ratios (HR) comparing the risk of developing osteoporotic fractures among patients with CLD versus patients without CLD. Pooled OR and 95% confidence interval (CI) were calculated using generic inverse- variance method. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. After the review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. Significant association was found between CLD and osteoporotic fractures with a pooled OR of 2.13 (95% CI, 1.79 - 2.52). High heterogeneity among the studies was found (I2=88.5). No publication bias was found using Egger regression test (p=0.44). We found a significant association between CLD and the risk of developing osteoporotic fractures. The calculated risk was 2.13 times higher for patients with CLD when compared with controls. The results showed high heterogeneity but no publication bias. More prospective studies are needed to fully understand the mechanisms involved in loss of bone density and osteoporotic fractures in order to improve the morbidity associated with this disease.

The objective of this study was to evaluate the predictors and associated outcomes of rhabdomyolysis in admitted patients for heat stroke in the United States. The National Inpatient Sample was uti...

Several studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. The aim of this meta-analysis study is to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. A systematic literature review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease. We included randomized controlled trial, cross sectional and cohort studies that reported the odds ratio, relative risk, hazard ratio, and standardized incidence ratio comparing the risk of developing atrial fibrillation among patients with celiac disease, versus patients without celiac disease as control. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Celiac disease is an autoimmune condition. This inflammatory state predisposes patients to develop AF. After a review of the literature, four observational studies with a total of 64,397 participants were enrolled. The association between celiac disease and increased risk of atrial fibrillation was significant, with a pooled OR of 1.38 (95% CI: 1.01-1.88). No publication bias as assessed by the funnel plots and Egger's regression asymmetry test with p = 0.54. However, the heterogeneity of the included studies was high (I2 = 96). A significant association between celiac disease and risk of atrial fibrillation was reported in this study. There is a 38% increased risk of atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and celiac disease. Some of the limitations of this study are that all were observational studies, some were medical registry-based and there was high heterogeneity between studies.