Bhumibol Adulyadej Hospital

Sarcopenic obesity is an age-related condition characterized by a simultaneous decline in muscle mass and function and by increased adipose tissue. Its prevalence, particularly in Asian populations with type 2 diabetes mellitus (T2DM), remains unclear. This study aimed to determine the prevalence and risk factors associated with sarcopenic obesity in Thai people with T2DM. This cross-sectional, observational study included 329 Thai adults with established type 2 diabetes mellitus (T2DM), consecutively recruited from an outpatient clinic. Participants underwent standardized assessments, including bioelectrical impedance analysis, physical performance testing, and laboratory evaluations. Obesity was defined based on percentage body fat derived from bioelectrical impedance analysis, rather than body mass index. The study aimed to determine the prevalence of sarcopenic obesity and to identify associated risk factors. Univariate and multivariate logistic regression analyses were performed to identify independent predictors after adjustment for potential confounders. The prevalence of sarcopenic obesity in T2DM was 16.4%, with rates of 15.4% in males and 17.5% in females. Sarcopenia was present in 23.7% of participants, including 7.3% with sarcopenia alone (without obesity). Obesity without sarcopenia was reported in 61.1% (95% CI: 55.7, 66.2). Factors significantly associated with a higher risk of sarcopenic obesity included older age (adjusted OR 1.08, 95% CI 1.01-1.15, P<0.001) and smaller calf circumference (aOR 1.35, 95% CI 1.11-1.67, P<0.001). Protective factor included greater handgrip strength (aOR 0.93, 95% CI 0.87-0.99, P<0.001). The study found a high prevalence of sarcopenic obesity among Thai people with T2DM. Older age and smaller calf circumference were identified as key risk factors. Higher muscle strength was associated with a lower risk of developing sarcopenic obesity.

To evaluate real-world outcomes of dolutegravir (DTG)-based first-line antiretroviral therapy (ART) among people with HIV in Thailand, where baseline HIV-1 RNA and resistance testing is not routinely available. This retrospective cohort study enrolled ART-naive Thai people with HIV aged ≥15 years who initiated DTG-based ART between 2020 and 2023 under the national Universal Health Coverage programme. People with HIV with ≥1 post-baseline HIV viral load (VL) measurement were included. Virological non-suppression (VNS) was defined as VL ≥1000 copies/mL after ≥6 months of ART. The primary outcome was the proportion achieving virological suppression (VL <50 copies/mL). Competing-risk regression was used to identify factors associated with VNS, accounting for death and loss to follow-up (LTFU). Mortality data were confirmed via the national death registry. Of 10 475 people with HIV initiating DTG-based ART, 84.5% achieved virological suppression and 95.3% achieved VL < 200 copies/mL within 1 year. The cumulative VNS incidence was 10.1% (95% confidence interval [CI]: 9.6%-10.5%), and highest among those with late ART initiation (10.6% [95% CI: 7.4%-14.3%]). VNS was significantly associated with younger age, 15-24 years (aSHR 2.28, 95% CI:1.66-3.12), 25-34 years (aSHR1.43, 95% CI:1.07-1.90), baseline CD4 < 100 cells/mm3 (aSHR 2.11, 95% CI: 1.36-3.27) and residence in northern (aSHR 1.64, 95% CI: 1.12-2.40) or southern Thailand (aSHR 1.99, 95%: 1.30-3.04). Same-day/rapid ART initiation, sex and WHO HIV clinical staging were not associated with VNS. Nationwide rollout of DTG-based ART achieved excellent virological outcomes in Thailand. However, higher VNS risk among adolescents, individuals with advanced HIV disease and those in specific regions underscores the need for targeted interventions to improve treatment equity and long-term viral suppression.

To develop consensus-based guidance for bone health optimization in instrumented spine surgery, specifically addressing the limited guidance available in the Thai context. The study utilized a modified Delphi technique, engaging 10 orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted, followed by 2 online surveys and a face-to-face consensus meeting to develop and refine the statements. Twenty-five main statements and 45 substatements that focused on patient evaluation, assessment tools, and risk stratification were drafted for the panel's deliberation. There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50 to 59 years. The panelists supported using the fracture risk assessment tool score for clinical evaluation and recommended using several assessment tools, including dual-energy x-ray absorptiometry scans for specific age groups, Computed Tomography Hounsfield Unit, Trabecular Bone Score, and vertebral fracture assessment for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for patients at high risk and very high risk and specialized surgical techniques for patients at very high risk. Surgical delay of at least 3 months should also be considered for patients at very high risk/with severe osteoporosis who have been scheduled for instrumented spine surgery. This guidance includes patient screening, evaluation, and treatment for patients with poor bone health based on risk stratification, including normal/low risk, osteopenia/intermediate risk, osteoporosis/high risk, and severe osteoporosis/very high risk. Spine surgeons should be aware of poor bone health and consider bone health optimization to improve surgical outcomes and prevent osteoporosis-related complications. Bone health optimization is crucial for instrumented spine surgery. Spine surgeons should consider bone health optimization guidance, including patient screening for poor bone health, assessment tools for evaluating bone health, and treatment for patients with poor bone health, to improve surgical results and minimize poor bone health-related complications.

Background: While positive end expiratory pressure (PEEP) is beneficial for oxygenation, it may potentially increase intracranial pressure (ICP): especially in post-cranial surgical patients. The optic nerve sheath diameter (ONSD) is the non-invasive method of ICP measurement. Our study focuses on the association between PEEP and intracranial pressure (ICP) in post-cranial surgery patients using optic nerve sheath diameter (ONSD) as a surrogate marker. Method: A prospective non-randomized interventional study was conducted on post-cranial surgical patients who required mechanical ventilation with ages 16-80 years, initial PEEP at 5 mmH2O were included in this study. Patients with intracranial hypertension (defined as ICP ≥22 mmHg), a history of traumatic brain injury, or cardiopulmonary disease at enrollment were excluded from the study. ONSD measurement was performed at varying PEEP levels from 5 to 20 cmH2O. Result: In adult (18-60 years) patients who had post-cranial surgery within 72 hours and required a mechanical ventilator, ONSD corresponding to ICP significantly increased when PEEP exceeded 13 cmH2O. PEEP more than 15 cmH2O resulted in a significant increase in ONSD exceeding 5.5 mm (corresponding to ICP &gt; 22 mmHg); Mean arterial pressure (MAP) significantly decreased with an increase in PEEP value (p &lt; 0.001). PEEP 20 cmH2O reduced MAP to below 65 mmHg. Conclusion: PEEP less than 15 cmH2O can be safely applied to post-cranial surgical patients, whereas PEEP more than 20 cmH2O may be harmful due to both ICP elevation and MAP decrement for these patients.

The Thailand Renal Replacement Therapy (TRT) Registry is a vital database tracking patient demographics, treatment modalities, and outcomes across hemodialysis centers nationwide. This study analyzes TRT Registry data from 2000 to 2023 to identify trends and challenges in managing end-stage kidney disease (ESKD). Among 152 827 patients, 129 113 received hemodialysis, and 23 714 underwent peritoneal dialysis. Diabetic nephropathy and hypertension accounted for over 80% of cases, with IgA nephropathy as the most common biopsy-confirmed glomerulonephritis. Most patients had a primary school education or lower. The Universal Coverage Scheme (46.2%) was the primary funding source. Thrice-weekly dialysis was the most common regimen (65.0%), while 34.3% of patients received twice-weekly dialysis. Key challenges included anemia, malnutrition, vascular access issues, and disparities in dialysis adequacy. Cardiac disease (34.7%), infections (19.7%), and cerebrovascular disease (7.7%) were the leading causes of death. Thailand's growing ESKD burden demands improved renal replacement therapy (RRT) strategies. The TRT Registry offers essential insights to guide policy and healthcare improvements.

Despite universal health coverage, patients with chronic kidney disease (CKD) in middle-income nations still face financial hardship. Catastrophic health care expenditures (CHEs) serve as a valuable index of patient-derived financial hardship, but few studies have explored the connection of CHE with clinical correlates, especially in patients with CKD. This study aimed to assess the association between CHE and health-related quality of life (HRQoL) in a spectrum of patients with CKD in Thailand. A multicenter, nationwide cross-sectional study. Patients with CKD (stages 3-5 and dialysis) from 11 centers across Thailand. Catastrophic health expenditures. Health-related quality of life. Data on clinical, socioeconomic status, and out-of-pocket expenses were acquired via interviews. The CHE was defined ashealth care expenditures of at least 40% of the household's capacity to pay. The HRQoL wasassessed using the EuroQol-5 Dimensions (EQ5DL) questionnaire. Fractional and multivariable logistic regression models were used to determine the CHE's effect on EQ5DL composite utility scores and each HRQoL dimension. Of 1,224 patients with CKD, 20% experienced CHE. EuroQol-5 Dimensions utility scores were notably lower in those with CHE (CHE, 0.76 vs No CHE, 0.82, P<0.001) after adjustments for confounding factors. Differences between CHE and non-CHE appeared in mobility, self-care, and usual activity, with multivariable analysis showing more severe mobility and activity issues in CHE. (adjusted OR [95% CI] in CHE vs non-CHE: mobility: 1.89 [1.23-2.91], P=0.004; usual activity: 1.82 [1.10-3.02], P=0.020]. Cross-sectional design prevents causal inferences. Despite health coverage, patients with CKD with financial strain experience reduced quality of life, with pronounced effects on mobility and daily activity. Integrating the assessment of patient-derived financial burden is an essential step into CKD care plans in middle-income countries.

ObjectivesTo report on the process and results of clinical application of 3D printed patient-specific metal plates in orthopaedic trauma.Materials and MethodsA retrospective review was conducted on 11 pilot patients managed with 3D printed Patient-Specific Plates (PSPs) together with 3D printed guides, 3D printed bone models and 3D virtual planning for malunions or acute fractures. There were six clavicles, three forearm shafts, one ankle, and one tibial plateau. The surgeon and the engineering team collaborated on the designing of customized treatment solutions for each case.ResultsFrom obtaining the CT data to manufacture of all 3D printed parts, the required ranged from 3 to 43 days (mean 16 days) and the cost ranged from 1590 to 4100 USD (mean 1360 USD). All 11 patients were followed up from 6 to 24 months. All patients had bony union, good to excellent clinical outcomes documented from clinical scores and with no complications. Challenges with the workflow were collected qualitatively and listed out.ConclusionImplementation of 3D printing technology with customized patient specific implants appears to be beneficial with good outcomes in patients with complex anatomy and malunions. We have described the logistical and regulatory considerations. Further studies should be conducted to demonstrate its cost-effectiveness compared to conventional solutions.

Objective: This study aimed to evaluate and compare nuchal translucency (NT) measurement between sagittal and transverse planes for aneuploidy screening. Materials and Methods: This prospective study was conducted at the antenatal clinic, department of obstetrics and gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand between November 2023 and July 2024. Subjects were singleton pregnant women who underwent fetal chromosome anomaly screening by NT measurement of both sagittal and transverse planes by transabdominal ultrasonography between 11 and 14 weeks of gestational age (GA). Demographic and clinical data were collected and evaluated. Relationship between sagittal and transverse planes measurement was analyzed. Results: A total of 295 pregnant women were recruited. The mean age and GA of participants were 31.7 years old and 12.9 weeks, respectively. Prevalence of aneuploidy was 2.7 (8/295) percent. The mean NT measurement in the sagittal plane was significantly lower than in the transverse plane (1.5 and 1.7 mm). Transverse and sagittal plane measurement exhibited a linear correlation. The cut off point of NT by transverse and sagittal approach were 2.9 mm and 3.0 mm, respectively that giving comparable diagnostic value. Conclusion: NT measurement cut off by transverse approach at 2.9 mm had comparable to 3.0 mm of sagittal approach.