Warangkana Keeratichananont

Although, sputum induction (SI) with hypertonic saline increases the diagnostic yield for suspected pulmonary tuberculosis (PTB) in patients with smear-negative microscopy, but, it carries adverse effects (AEs), particularly bronchospasm. This study assessed and compared the diagnostic yields and safety profiles of three consecutive SI procedures using nebulized salbutamol vs conventional 3% sodium chloride (NaCl) in patients with suspected PTB and initially negative sputum smears. A randomized, double-blind study was conducted at Songklanagarind Hospital, Thailand, between 2016 and 2019. Three hundred forty-five adults with suspected smear-negative or sputum-scarce PTB were randomized to undergo 3 consecutive days of SI with either nebulized salbutamol ( n = 172) or 3% NaCl ( n = 173). Diagnostic yields were assessed using acid-fast bacilli (AFB) smear and culture for Mycobacterium tuberculosis . Nebulized salbutamol produced a significantly higher overall diagnostic yield by AFB smear or culture than 3% NaCl (18.0% vs 9.2%, P = 0.043). For culture, both cumulative and incremental yields were consistently higher in the salbutamol group across all three samples (all P < 0.050). The 3% NaCl group experienced significantly more overall SI-related AEs than the salbutamol group (28.3% vs 9.8%, P = 0.034). Specifically, chest tightness (8.1% vs 2.3%, P = 0.031) and bronchospasm requiring rescue bronchodilators (13.3% vs 0.0%, P < 0.001) were more frequent in the 3% NaCl group. Three consecutive SI using nebulized salbutamol provide higher overall and cumulative diagnostic yields than conventional hypertonic saline, primarily driven by culture positivity, while offering a superior safety profile by eliminating bronchospasm risk. Nebulized salbutamol should, therefore, be considered the preferred induction agent for SI, particularly in high-risk patients such as those with airway diseases. IMPORTANCE: Delays in diagnosing pulmonary tuberculosis or initiating treatment without bacteriological confirmation increase mortality, often because of inadequate sputum samples or negative acid-fast bacilli smears from self-expectoration. Sputum induction with hypertonic saline can improve diagnostic yield in patients with scanty sputum or smear-negative disease, but it is associated with adverse effects—particularly bronchospasm—which may require stopping the procedure. We demonstrated that three consecutive sputum inductions using nebulized racemic salbutamol produced significantly higher overall diagnostic yields by acid-fast bacilli smear and Mycobacterium tuberculosis culture compared with 3% NaCl. For culture, both cumulative and incremental yields were consistently superior in the salbutamol group. Regarding safety, 3% NaCl caused more chest tightness and symptomatic bronchospasm. These findings highlight the diagnostic benefit and favorable safety profile of three consecutive salbutamol-induced sputum procedures, supporting its use as the preferred agent for sputum induction.

In the absence of a definitive gold standard for diagnosing latent tuberculosis infection (LTBI) in healthcare workers (HCWs), alternative specific biomarkers are needed. This longitudinal cohort study with baseline testing evaluated the diagnostic performance of stimulated plasma interferon-γ inducible protein 10 (IP-10) for LTBI detection among HCWs in a high tuberculosis (TB)–burden setting, using interferon-γ release assays (IGRAs) as the reference standard. The study was conducted at Songklanagarind Hospital, Thailand, between 2021 and 2024, and included 64 healthy HCWs. Serum and stimulated plasma samples were collected, and IP-10 and IFN-γ concentrations were measured by ELISA. Nine HCWs (14.0%) were LTBI-positive. Stimulated plasma IP-10, but not serum IP-10, showed significant correlations with IFN-γ levels in TB1 ( r = 0.719) and TB2 ( r = 0.768; p < 0.0001) tubes. At cut-off values of ≥ 2,980.0 pg/mL for TB1 and ≥ 3,108.0 pg/mL for TB2, sensitivity was 100%, specificity was 96.0% and 94.5%, and overall accuracy was 96.8% and 95.3%, respectively. Based on either IGRA or stimulated plasma IP-10 cut-off levels, five of nine LTBI cases declined treatment; among these, one individual (20.0%) progressed to active pulmonary TB 16 months later. Stimulated plasma IP-10 shows high diagnostic performance for LTBI detection among HCWs and may serve as an alternative for LTBI screening in high–TB-incidence with universal BCG vaccination.

Background: Osteoporosis is a silent chronic obstructive pulmonary disease (COPD) comorbidity that is often under-detected. We aimed to study the prevalence and potential predictors of osteoporosis in COPD. Dynamic changes in bone mass density (BMD) and treatment efficacy of bisphosphonate were also assessed.Methods: This prospective cohort study included COPD patients between January 2017 and January 2019. Demographics data, spirometric parameters, and C-reactive protein (CRP) were collected. Bone mineral density (BMD) at the lumbar spine (L2-4) and both femoral necks were measured after enrollment and the 12-month follow-up. Participants were categorized into three groups per the baseline BMD T-score: normal (≥ − 1.0), osteopenia (between −1.0 and − 2.5), and osteoporosis (≤ − 2.5). In the osteoporosis group, alendronate 70 mg/week with vitamin D and calcium was prescribed.Results: In total, 108 COPD patients were enrolled. The prevalence of osteoporosis and osteopenia were 31.5 and 32.4%, respectively. Advanced age, lower body mass index (BMI), history of exacerbation in the previous year, and high CRP levels were significant predictors of osteoporosis. After 12 months, 35.3% in the osteoporosis group reported new vertebral and femoral fractures, compared to none in the non-osteoporosis group (p < 0.001). In the normal BMD and osteopenia groups showed a further decline in BMD after 12-month. Conversely, the osteoporosis group showed a statistically significant improvement in BMD after anti-resorptive treatment (p < 0.001).Conclusion: The prevalence of osteoporosis was high in Thai COPD patients. Advanced age, lower BMI, history of exacerbation, and high CRP levels were potential predictors. A rapid decline in BMD was observed in COPD patients without treatment.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by multiple systemic comorbidities, not only airflow limitation. Metabolic syndrome (MetS) is a common comorbidity. Patients with COPD have a higher risk of MetS than do healthy individuals. Objectives: We aimed to investigate the prevalence of and explore the factors associated with MetS in Thai COPD patients and to assess the clinical consequences of MetS after a 5-year follow-up period. Methods: A prospective observational study was conducted in patients with stable COPD at Songklanagarind Hospital between June 2015 and November 2019. MetS was defined according to the International Diabetes Federation 2005 criteria. The patients were followed-up for 5 years. The prevalence, associated factors, and consequences of MetS were analyzed. Results: A total of 115 patients with COPD were enrolled, of whom 95.3% were male. The overall prevalence of MetS was 37.4% (43 patients). Chronic bronchitis and high C-reactive protein (CRP) levels were independently and significantly associated with MetS in patients with COPD ( p = 0.036 and 0.044, respectively). After following patients for 5 years, the incidence of cardiovascular disease and stroke, exacerbation rate, and mortality rate were significantly higher in the COPD with MetS group [relative risk (RR) = 15.36, 95% confidence interval (CI) = (2.13–110.67), RR = 45.43, 95% CI = (4.61–447.07), RR = 1.94, 95% CI = (1.40–2.70), and RR = 48.01, 95% CI = (1.12–2049.43), respectively]. Conclusion: The prevalence of MetS is high in patients with COPD. Chronic bronchitis and high CRP levels are associated with MetS in COPD. The incidence of clinical consequences was significantly higher in patients with COPD and MetS after a 5-year follow-up. Screening for MetS is strongly recommended for all patients with COPD.

Autologous blood is a novel, high-efficacy sclerosant for treatment of malignant pleural effusion (MPE), similar to tetracycline. There has been no comparative data between autologous blood and a worldwide sclerosant like talc. We aimed to compare the effectiveness of autologous blood versus talc pleurodesis. A prospective study was conducted at Songklanagarind Hospital, Songkhla, Thailand. A total of 123 symptomatic MPE cases were randomized to receive autologous blood pleurodesis (ABP) versus pleurodesis with talc slurry. In the ABP group, 100 ml of autologous venous blood was instilled through a chest drain, followed by 50 ml of sterile normal saline (NSS). In the talc group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled, followed by 4 g of sterile talc (Steritalc®, a non-small particle size talc) suspended in 100 ml of NSS. A 30-day pleurodesis efficacy (according to Paladine’s criteria), along with the adverse events, was evaluated. Fifty-six cases in the ABP, and 54 cases in the talc group completed the study. There was no difference between the two groups in the demographic data. The overall pleurodesis success rate at 30 days was 82.0% in the ABP group, comparable to the talc pleurodesis group (87.0%, p = 0.12). The percentage of fever (9.0% versus 28.0%, p = 0.04), amount of acetaminophen required by each participant (2.2 ± 0.7 versus 4.6 ± 0.9 tablets, p = 0.03), pain score and percentage of cases who needed opioids (9.0% versus 26.0%, p = 0.02) and hospital stay (10.2 ± 2.7 versus 12.8 ± 3.4, p = 0.04) were significantly lower in the ABP group; no infectious or serious events occurred. ABP had an equivalent efficacy compared to talc pleurodesis for MPE treatment. ABP offered less fever and pain and could shorten hospital stays, and neither produced means ABP did not produce clotted drainage, pulmonary or systemic adverse events.

Autologous blood pleurodesis (ABP) is used for the treatment of pneumothorax with a good efficacy. The aim of this study is to determine the efficacy and safety of ABP in the treatment of malignant pleural effusion (MPE). A prospective study was conducted at Songklanagarind Hospital, Thailand. Symptomatic MPE patients were randomized to receive pleurodesis with either autologous blood or tetracycline. In the ABP group, 100 ml of autologous venous blood was instilled via chest tube followed by 50 ml of sterile normal saline (NSS). In the tetracycline group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled followed by 1 g of tetracycline diluted in 100 ml of NSS. The chest tube was clamped for 2 hours, then reconnected to suction and removed. Pleurodesis effectiveness was evaluated according to Paladine’s criteria and adverse events were recorded. A total of 48 symptomatic MPE patients were recruited. Of these, 24 cases were randomized to receive ABP and 24 cases received tetracycline. There was no difference between the two groups in baseline characteristics. The overall success rate of pleurodesis was the same in both the autologous blood group and the tetracycline group (83.4% versus 87.5%, p = 0.36). In the ABP group, the pain score and fever were significantly lower (8.3% versus 29.1%, p = 0.003) and there was a small percentage of cases that needed analgesia (4.2% versus 75%, p < 0.001); no serious events occurred. ABP was as effective as tetracycline in the treatment of MPE. ABP produced less pain and fever, and could shorten the hospital stay.

Post-extubation stridor occurs after translaryngeal intubation results to re-intubation in a number of patients. To determine the cut-off value of the cuff leak volume test among Thai patients as a predictor for post-extubation stridor Demographic data and cuff leak volume were collected from patients who had been intubated with planned extubation. Clinical stridor was observed and identified after extubation. Among 115 patients, the cuff leak volume of less than 114 ml was used to predict post-extubation stridor with the sensitivity of 89%, specificity of 90%, positive predictive value of 65%, and negative predictive value of 98%, respectively. Among the stridor group, 12 of 19 cases (63.2%) needed re-intubation. The cuff leak volume of less than 114 ml can be used as a clinical predictor for identifying post-extubation stridor