Phramongkutklao 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 provide recommendations for the most appropriate endovascular intervention of femoropopliteal (FP) arterial disease based on plaque characterization. A panel of 22 physicians from multiple disciplines participated in a modified Delphi consensus, leveraging the RAND/UCLA Appropriateness Method. Panelists engaged in 2 rounds of voting, following a literature review, with an in-person discussion prior to the second round of voting. A rigorous statistical approach was used to analyze the points of agreement and disagreement. Consensus-based recommendations on the most appropriate endovascular approaches for treating patients with FP lesions, stratified by lesion morphology, were generated. Overall, 490 individual items were included in the voting, 458 (93%) of which achieved consensus and 32 (7%) were nonconsensus items, based on a priori criteria under the following categories: (a) recommendations on method for determining plaque morphology, (b) preferred endovascular devices for vessel preparation and definitive treatment stratified by (i) plaque morphology and (ii) Tosaka classification of in-stent restenosis, and (c) vessel preparation device safety-related considerations. This international, multidisciplinary consensus provides evidence- and expert-informed recommendations for vessel preparation and definitive treatment of FP arterial disease, tailored to plaque morphology. These consensus recommendations aim to support clinical decision making and promote best interventional practices by serving as an expert opinion supplement to existing guideline-based care pathways.

Non-variceal upper gastrointestinal bleeding (NVGIB) represents an urgent medical condition with high mortality. Standard endoscopic therapies (ST) still carry a high rebleeding rate. Novel modalities such as the over-the-scope clip (OTSC) and hemostatic powder (HP) could be promising alternatives, but their efficacy and cost-effectiveness remain to be explored. A network meta-analysis and cost-effectiveness analyses were conducted to compare OTSC vs HP vs ST. Primary endpoints include 30-day rebleeding and 30-day further bleeding. Markov models with a 12-month time horizon were created across 3 different health care settings: the United States, Thailand with Boston Scientific products (TH-BOS), and Thailand with China-manufactured alternatives (TH-CHN). Incremental cost-effectiveness ratio (ICER) was evaluated at a willingness-to-pay of $100,000 per quality-adjusted life year for the US model and THB 150,000 per quality-adjusted life year for the TH-BOS and TH-CHN models. Ten randomized controlled trials with 1,120 patients with NVGIB were included in the network meta-analysis. Lowest 30-day rebleeding was seen in OTSC ( P -score: 0.996), followed by ST (0.296) and HP (0.208). Similarly, OTSC also achieved lowest 30-day further bleeding (0.906), followed by HP (0.570) and ST (0.024). In cost-effective analysis, the US model reported OTSC as a dominant approach compared with HP (ICER: -$314) and ST (-$3,112). In the TH model, OTSC still dominated ST (ICER: -THB 28,423 for TH-BOS and -22,858 for TH-CHN) and was more cost-effective than HP (THB 1,833 for TH-BOS and THB 2,026 for TH-CHN). OTSC was superior to HP and ST in efficacy and cost-effectiveness, favoring its use as a first-line endoscopic hemostasis intervention for NVGIB.

Children with thalassemia carry a risk of malnutrition and cognitive impairment due to their underlying chronic disease. Our study aimed to investigate the effect of nutritional status on academic performance among children with thalassemia at Phramongkutklao Hospital. This cross-sectional study was performed on patients ages 7-18 years who were diagnosed with thalassemia. Growth parameters, basic laboratory data, academic performance, and daily nutritional intakes were obtained. Nutritional status was evaluated using World Health Organization classification. Forty-seven thalassemia patients were enrolled in this study. The prevalence of malnutrition was 55.3% (57.1% in transfusion-dependent thalassemia and 50% in non-transfusion-dependent thalassemia). Percent height-for-age (%H/A) in the malnutrition group (92.0+5.37) was significantly lower than %H/A in the normal group (98.9+3.3) with p value of <0.001. Grade point average (GPA) in the malnutrition group (2.9±0.6) was significantly lower than that in the normal group (3.5±0.51) with p value 0.002. In multivariate analysis, GPA was significantly associated with malnutrition. In addition, parents' income was significantly lower in the malnutrition group (p valve 0.039). Malnutrition is common in children with thalassemia and has significant impact on their academic achievement. Exploration of financial situation and providing appropriate supports for patients and their families might decrease the burden of malnutrition. Additionally, regular assessment of nutritional status among these patients is warranted.

Background and Objectives: While non-vitamin K antagonist oral anticoagulants (NOACs) show better renal preservation than warfarin in nonvalvular atrial fibrillation (NVAF) patients, real-world evidence within Asian populations remains limited. This study compared the renal outcomes between NOACs and warfarin in Thai patients with NVAF. Materials and Methods: A retrospective cohort study was conducted among NVAF patients who received either NOACs or warfarin from two university hospitals in Thailand from January 2015 to December 2019. The primary outcome was a ≥30% decline in the estimated glomerular filtration rate (eGFR) with a doubling of the serum creatinine (SCr), while acute kidney injury (AKI) and incidence rate of stroke and systemic embolism event (SEE) were secondary outcomes. All outcomes of each NOAC versus the warfarin group were analyzed using Cox proportional hazards regression. Results: A total of 1456 patients were enrolled. During a follow-up period of 24 months, NOACs were associated with a lower risk of a ≥30% decline in the eGFR than warfarin after inverse probability of treatment weighting (IPTW) and multivariable adjustment (adjusted hazard ratio (aHR) of 0.67, 95% confidence interval [CI] 0.45-1.00, p = 0.050). No significant differences were observed between NOACs and warfarin regarding the doubling of SCr (aHR 0.64, 95% CI 0.24-1.72, p = 0.373) or AKI (aHR 0.69, 95% CI 0.41-1.17, p = 0.169), although a trend toward a lower risk was noted in the NOAC group. Similarly, a trend toward a lower risk of the incidence rate of ischemic stroke and SEE were observed in the NOAC group (aHR 0.49, 95% CI 0.22-1.10, p = 0.084). Conclusions: In real-world data, NOACs may be associated with a lower eGFR decline and lower doubling of SCr and AKI than warfarin. Additionally, NOACs may reduce the risk of ischemic stroke and SEE, supporting their potential benefit over warfarin in both renal and thromboembolic outcomes.

Precontoured clavicular locking compression plates (LCP) aim to minimize implant-related complications by providing a close fit to the clavicle's complex morphology. Nevertheless, the inherent anatomical variation observed across patients can lead to discrepancies between implant and bone, potentially contributing to suboptimal fit and an increased risk of complications requiring reoperation. This study analyzed the anatomical compatibility of precontoured clavicular LCPs, detailing their fit characteristics and exploring the correlation between these findings and clinical outcomes. Fifty-six 3D, patient-specific clavicular models were reproduced from patients undergoing clavicular fixation (2018-2024). These models were created using 3D printing based on individual 3D-CT reconstructions. Two commercially available clavicular LCP designs were virtually assessed for anatomical compatibility using Computer-Aided Design (CAD) technology. Additionally, a retrospective evaluation of patient outcomes following fracture fixation with the LCPs was conducted. Correlation analysis was used to investigate the relationship between plate compatibility and implant-related complications, as well as reoperation rates. Our findings revealed a significant inverse relationship between plate length and compatibility, with longer plates demonstrating reduced overlap, increased overhang, and lower bicortical screw purchase rates. Clinically, 19.64% of patients required hardware removal due to symptomatic hardware, while 33.93% experienced implant prominence. Importantly, our analysis revealed a significant negative correlation between plate compatibility and both implant-related complications and the need for reoperation. The currently available precontoured clavicular LCPs exhibit suboptimal fit, particularly in the lateral region of the clavicle. These findings highlight the importance of selecting the appropriate plate and improving plate designs to enhance anatomical conformity and potentially reduce the incidence of implant-related complications. Level III (Translational Study).

Orbital floor fractures are frequently associated with head trauma, and the complex three-dimensional (3D) structure of the orbital cavity poses a significant challenge for accurate repair of orbital wall defects. Accordingly, this study aimed to compare preoperative titanium mesh bending using 3D-printed models with conventional intraoperative bending techniques, focusing on the accuracy of orbital geometry reconstruction and intraoperative efficiency, with the goal of determining potential advantages in optimizing surgical outcomes. This study presents a comparative analysis between a prospective preoperative bending (3D pre-bent) of titanium mesh and retrospective data from conventional intraoperative bending. Clinical and radiographic evaluations of orbital geometry, along with intraoperative efficiency metrics, were assessed at both preoperative and postoperative stages. Sixty-four patients were included, with 32 in the 3D pre-bend titanium mesh group and 32 in the conventional bending group. Mean operative time was shorter in the 3D pre-bend group (81.07± 13.04 minutes) than in the conventional group (96.07± 4.46 minutes). The 3D pre-bend group achieved more accurate reconstruction, with orbital volume and height correction rates of 96.78% ± 4.91% and 100.62%± 3.77%, respectively, versus 94.88% ± 4.33% and 96.08% ± 5.44% in the conventional group. Patient and surgeon satisfaction was higher in the 3D pre-bend group. Pre-bending titanium mesh using a 3D-printed model significantly reduces intraoperative time and improves orbital height correction. Additionally, this technique enhances both patient and surgeon satisfaction. However, long-term clinical outcomes remain comparable between groups.

Rheumatoid arthritis (RA) frequently affects the joints of the hands, with joint space narrowing (JSN) representing an important early marker of structural damage. The semi-quantitative Sharp/van der Heijde (SvdH) scoring system is widely used in clinical practice but is inherently subjective and susceptible to observer variability. Moreover, the complex anatomy of the wrist and substantial overlap of carpal bones pose challenges for automated quantitative assessment of wrist JSN on routine radiographs. This study aimed to introduce a novel quantitative assessment perspective and to clinically validate an automated, compactness-related quantification framework for evaluating wrist JSN in RA. This study initially enrolled 51 patients with RA. After excluding one case with severe carpal fusion that precluded anatomical differentiation, 50 patients (44 females and 6 males) were included in the final analysis. The cohort had a mean age of 61 years (range: 21-82), a median symptom duration of 9 years (IQR: 1-32), and a median follow-up interval for bilateral hand radiographs of 1.06 years (IQR: 0.82-1.30). To quantify global wrist JSN, 10 compactness-related metrics were computed based on the spatial distribution of bone centroids extracted from carpal segmentation masks. These metrics were validated against the wrist JSN subscore of the SvdH score (SvdH-JSN_wrist) and the total Sharp score (TSS) as gold standards. Several distance-based metrics among the compactness-related metrics showed significant negative correlations with the wrist joint space narrowing subscore of the Sharp/van der Heijde score (SvdH-JSN_wrist). Specifically, mean-pairwise-distance (MPD), root-mean-square-radius (RMSR), and median-radius (R50) showed moderate to strong correlations (r = -0.52 to -0.63, all p≤0.0001) that were consistent at BL and FU. Correlations with TSS were weaker overall, with only R50 and its normalized form showing stable negative correlations (r = -0.40 to -0.43, p < 0.01). Longitudinal analyses showed limited correlations between metric changes and clinical score changes. The proposed automated compactness quantification framework enables objective and reliable assessment of wrist JSN on standard radiographs and complements conventional scoring systems by supporting automated and standardized evaluation of RA-related wrist structural changes.