Buddhachinaraj Hospital

BackgroundThis study aimed to determine the optimal time point at which the projected dose most accurately corresponds to the accumulated dose in head and neck cancer patients treated with helical tomotherapy. Dose metric differences between the International Commission on Radiation Units and Measurements Report 83 (ICRU83) (D50%) and Radiation Therapy Oncology Group (RTOG) (D95%) protocols were also evaluated for the planning target volume and critical organs, including the parotid glands, spinal cord, and brainstem.Materials and methodsThis methods-oriented study analyzed data from 61 head and neck cancer patients treated with helical tomotherapy. It compared projected and accumulated doses across the treatment course, assessing dose discrepancies at fractions 1, 5, 10, 15, 20, 25, and 30. A ±3% threshold was defined as the acceptable deviation for both target volumes and critical organs.ResultsAmong the 61 patients analyzed, 70.5% had T3–T4 tumors and 68.8% were planned using the ICRU83 protocol. No deviations exceeding ±3% were observed in planning target volume dose 70 Gy (PTV70) (D50%) under ICRU83 protocol, whereas 35.0% of RTOG protocol (D95%) cases showed dose underestimation during fractions 1, 5, and 10. Deviations exceeding ±3% occurred most frequently in the left parotid gland (up to 75.4% of cases), followed by the right parotid gland, spinal cord and brainstem, particularly during early fractions.ConclusionsProjected dose proved to be a reliable metric for evaluating dose consistency, with D50% under ICRU83 protocol stable from early treatment and D95% under RTOG protocol consistent after fraction 15. However, variations in projected doses for organs at risk emphasize the need for cautious interpretation and individualized adaptive planning.

This study aimed to develop and validate a simplified, size-specific model for estimating eye lens dose during head CT imaging, addressing the limitations of generalized size-based methods for anatomically peripheral structures. An equation using effective diameter (DEff) was derived from Monte Carlo simulations covering head sizes of 9.9-19.5cm and CTDIvol values of 7-160 mGy. DEff was selected for its direct measurability from axial CT images. Validation was performed using OSL dosimeters in phantoms across three scanner platforms, comparing model estimates with measurements and SSDE values calculated by AAPM Reports 204 and 293.The equation was derived for 120kV head CT protocols. The final exponential model demonstrated excellent agreement with reference values R2 = 0.996, MAE = 0.94 mGy, RMSE = 1.27 mGy). SSDE-based estimates showed larger discrepancies, particularly in smaller head sizes. The model's correction factor exhibited a more gradual decline with increasing DEff, accurately reflecting the dose-size relationship of anteriorly located structures. This study presents a practical size-specific approach for eye lens dose estimation in head CT, providing better alignment with reference values than generalized SSDE methods. The model can be readily implemented in clinical workflows, particularly benefiting emergency scenarios requiring rapid individualized dose estimation.

Background: Postpartum hemorrhage (PPH) is a serious and dangerous complication following a cesarean section that carries a significant risk of bleeding and can result in shock or death. Objective: To compare the cost-effectiveness of 100 mg of carbetocin with that of 10 units of oxytocin for the prevention of PPH in women at high risk for PPH undergoing cesarean section. Methods: A decision tree model was used to assess cost-effectiveness from societal and payer perspectives over a one-year time horizon, using a 3% discount rate and data from hospital records and published studies. Robustness was evaluated using with one-way and probabilistic sensitivity analyses. Results: From the societal perspective, carbetocin demonstrated a cost saving of ฿828.16 ($25.18) and yielded an incremental gain of 0.04 quality-adjusted life years (QALYs). In contrast, the payer’s perspective revealed an additional cost of ฿632.69, with an incremental cost-effectiveness ratio of ฿14 243.20 ($433.14) per QALY gained. Carbetocin was notably more effective in preventing severe PPH, with a prevention rate of 44.4% compared with 16.3% observed with oxytocin. Sensitivity analysis identified treatment response as the most influential factor in the economic model. Conclusions: Carbetocin is a cost saving and clinically effective option for managing PPH in women at high-risk for PPH undergoing cesarean section. Its performance remains within the acceptable willingness-to-pay threshold established by Thai context (฿160 000 per QALY), making it a viable candidate for broader policy inclusion.

This comprehensive narrative review examines FAMCARE as a measurement tool for evaluating the effectiveness of end-of-life care, exploring its development, psychometric properties, applications across various healthcare setting, and impact on quality improvement initiatives. Originally developed for assessing family satisfaction in advanced cancer care, FAMCARE has evolved into various validated versions (FAMCARE-2, FAMCARE-6, FAMCARE-P13) adapted for different healthcare settings and cultural contexts. The tool demonstrates robust psychometric properties, with high internal consistency (Cronbach’s alpha 0.93-0.96) across multiple studies and strong cross-cultural validity through successful adaptations in various languages and healthcare systems. Review of its implementation across diverse settings, including hospice, hospital-based palliative care units, home-based care, and oncology departments, reveals its effectiveness in measuring and improving care quality. The tool’s multidimensional structure, encompassing information provision, availability of care, physical patient care, and psychosocial support, provides comprehensive insights into family satisfaction with end-of-life care. However, potential limitations including ceiling effects and retrospective assessment challenges have been identified. This review also highlights FAMCARE’s significant contribution to quality improvement initiatives, particularly in enhancing communication skills training, symptom management, and psychosocial support services. Future directions for FAMCARE development include real-time assessment capabilities, personalization options, and integration with emerging healthcare technologies. These findings underscore FAMCARE’s value as both a research instrument and a practical tool for improving end-of-life care quality, while identifying areas for future refinement to ensure its continued relevance in evolving healthcare landscapes.

The aim of this study was to investigate whether psychiatrists around the world believe they might encounter cases of hikikomori (prolonged social isolation), and how they formulate and treat such cases. A hikikomori case vignette was sent to psychiatrists of 34 countries around the world. Participants rated for the vignette: frequency of similar cases in one's practicing country; and aspects of formulation, diagnosis, suicide risk, and treatment plan. In total, 344 complete responses from 34 countries were returned. Eight countries/areas had 10 or more respondents: Japan (61), South Korea (54), Nepal (48), Iran (40), Thailand (32), India (23), Hong Kong (12), and UK (10); the remainder were placed in the "others" group (64). Respondents from all countries except Thailand felt that similar cases were seen. Diverse patterns of response were obtained regarding formulation and treatment. Japan, South Korea, and "others" favored psychosocial aspects in the formulation, while Iran, Nepal, and India favored biological factors. Most respondents felt the case could be treated by an outpatient visit, while others preferred hospitalization. Psychotherapy was rated highly as an intervention; Iran, South Korea, and "others" also rated pharmacotherapy highly. Despite its limitations as an exploratory study, we found evidence that hikikomori-like cases might exist around the world. However, opinions on how such cases should be formulated and treated vary significantly among countries. We believe this reflects how the experience of hikikomori is dependent on the related sociocultural context. Further comparative work, preferably with standardized assessment tools, will help to clarify how society might influence the individual experiences of practitioner and hikikomori patients.

BackgroundEarly prognostic markers of severe dengue may improve case management and reduce dengue-related mortalities. This study aimed to identify circulating microRNAs (miRNAs) as biomarkers for predicting severe dengue.MethodologySerum samples from dengue-infected patients were collected on the first day of admission. Patients were followed up for 14 days after admission to determine the final diagnosis. Participants were divided into non-severe and severe dengue, as defined by WHO 2009 criteria. Circulating microtranscriptome analysis was performed using NanoString miRNA Expression Assay. The expression level of candidate miRNAs were then validated by quantitative reverse transcription-PCR method.Principal findingsThe discovery cohort (N = 19) lead to the identification of 37 differentially expressed miRNAs between the two groups. Six up-regulated candidate miRNAs were selected and further validated in the larger cohort (N = 135). MiR574-5p and miR1246 displayed the highest diagnostic performance in discriminating between severe from non-severe dengue (ROC-AUC = 0.83). Additionally, miR574-5p and miR1246 had high sensitivity and high negative predictive value for detecting severe dengue. Multivariate analysis suggested that serum miR574-5p was an independent predictor of severe dengue (odds ratio 3.30, 95% CI 1.81–6.04; p<0.001).ConclusionOur study indicated that circulating miRNAs, especially miR-574-5p and miR-1246, might be a promising diagnostic and prognostic biomarker for severe dengue upon hospital admission, especially when using these biomarkers on days 1 to 2 before the onset of severe dengue complications.

BackgroundAtrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare.ObjectivesTo explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan.DesignA nationwide, prospective, multicenter, cohort trial.SettingNational registry of 3402 patients with non-valvular AF in Thailand.ParticipantsAll patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed.Primary outcomesIncidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1–6), secondary (grade 7–12) and higher education (tertiary education).ResultsThe educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference −1.78; 95% CI, −3.25 to −0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference −1.04; 95% CI, −2.03 to −0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan.ConclusionEducational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand.Trial registration numberThai Clinical Trial Registration; Study ID: TCTR20160113002.

Abstract Obstructive colonic cancer is a common presentation of colonic cancer but extensive ischemic colitis proximal to an obstructive colonic cancer is an uncommon condition. It has been referred to by various terms in the literature such as obstructive colitis. A 59-year-old female presented with fever, abdominal pain and diarrhea. Abdominal CT revealed a short segment of circumferential bowel wall thickening at sigmoid colon with diffuse colonic wall thickening proximal to the lesion. Emergency surgery was performed, and intraoperative findings found a tumor located at sigmoid colon causing proximal colonic obstruction. The serosal surface of proximal colon appears normal but intraluminal appear black in color. The major vessels were patent. Total colectomy with side-to-end ileo-rectal anastomosis was performed. Obstructive colitis is a rare condition, and its etiology remains unclear. We report our case to share an experience and to review the literature to facilitate the recognition and proper management.