Rangsit University

Cataract surgery requires ophthalmic viscosurgical devices (OVDs) to stabilise the anterior chamber and protect the corneal endothelium during phacoemulsification. VISIOL, a viscoadaptive OVD containing sodium hyaluronate and mannitol, is designed to support safer surgical manoeuvres and minimise endothelial trauma. Contemporary real-world data on VISIOL remain limited. This post-market clinical follow-up prospectively evaluated VISIOL's performance and safety in routine cataract surgery in accordance with ISO 15798. Adult patients undergoing phacoemulsification at Thai tertiary hospitals received VISIOL as a surgical aid at any stage. Intraocular pressure (IOP) and surgeons' evaluations were recorded during surgery. Corneal integrity, anterior chamber inflammation, IOP, and best-corrected visual acuity (BCVA) were determined preoperatively and at 1, 7, 30, and 90days postoperatively. The study included 100 patients (mean age 67.4 ± 8.4years) with severe cataracts (mean LOCS III nuclear opacity score 3.9 ± 1.4); 26% had glaucoma. Mean BCVA improved from logMAR 0.68 ± 0.69 before surgery to 0.088 ± 0.27 and 0.084 ± 0.24 after 1 and 3months, respectively (p < 0.0001). Mean endothelial cell density change was -6.3% at 3months (p < 0.0001). Anterior chamber inflammation progressively decreased to grade 0-1 in all cases at 1month. IOP changes were nonsignificant (+0.4 ± 4.7mmHg on day 1, p = 0.3378), with the occurrence of four transient IOP peaks ≥ 30mmHg; all resolved within ≤ 1.5h with or without treatment. Surgeons rated VISIOL as very effective for maintenance of anterior chamber depth during capsulorhexis (79%) and phacoemulsification (99%), and for the ease of capsulorhexis (98%) and removal (99%). In patients with severe cataracts, including those with glaucoma, VISIOL demonstrated excellent safety, minimal complications, and favourable surgical outcomes. The study was registered at ClinicalTrials.gov (registration number NCT04866706).

The Diversity and Equity Committee (DEC) of the Asian Pacific Society of Nephrology (APSN) conducted a regional review to characterise disparities in kidney disease burden, healthcare access and nephrology service delivery across the Asia-Pacific (AP) region. A descriptive summary was compiled using national reports, registries, and expert inputs from DEC representatives. Data included kidney disease prevalence, dialysis and transplant modalities, healthcare system characteristics and disparity-related indicators. Comparative insights were drawn across countries using structured tables and narrative synthesis. The AP region exhibits a disproportionate burden of chronic kidney disease (CKD) and kidney failure with marked heterogeneity in disease aetiology, healthcare financing, and infrastructure. High-income countries such as Japan, Korea, Taiwan and Australia demonstrate mature universal insurance systems, comprehensive dialysis networks and national CKD prevention programs. Middle- and lower-income countries-including Indonesia, Myanmar, Mongolia and parts of South and Southeast Asia-face critical challenges such as workforce shortages, limited dialysis and transplant capacity and geographic inequities. Despite these challenges, several countries have introduced exemplary models to enhance equity and sustainability in kidney care: PD-first policies (Hong Kong, Thailand), pay-for-performance CKD programs (Taiwan), Kidney Health Plan 2033 (Korea), HALT-CKD (Singapore), and ACT-KID (Malaysia), indigenous kidney health efforts in Australia and the inclusion of additional insurance points for patient education in Japan. Persistent gaps remain in early detection, transplantation access, rural care and minority equity. Kidney disease care in the Asia-Pacific region reflects both diversity and disparity. Although universal health coverage and national kidney health initiatives have improved access in many countries, substantial inequities persist across geography, income and cultural groups. The collective experiences highlight both common challenges and innovative solutions. Strengthening regional collaboration, policy-driven efforts and sustainable workforce development are essential to achieving equitable kidney health for all.

Background: Fluid overload is common in maintenance hemodialysis (MHD) patients and is associated with adverse cardiovascular events and mortality. Conventional clinical methods for fluid assessment have limited accuracy. This study evaluated the effectiveness of bioelectrical impedance analysis (BIA) for the fluid evaluation in MHD patients.Methods: A prospective interventional study was conducted in 34 clinically stable MHD patients at Ranong Hospital from June to August 2025. Fluid status was assessed monthly using BIA, combined with standard of care, and dry body weight was adjusted accordingly. The outcomes were the change in fluid status, expressed as target average fluid overload (TAFO), dialysis-related complications, and blood pressure control before and after BIA-guided management.Results: At baseline, 67.6% of patients were fluid overloaded, 20.6% were normovolemic, and 11.8% were dehydrated. In the overloaded group, mean TAFO significantly decreased from 3.4 ± 2.8 L to 2.1 ± 2.8 L at 3 months (p = 0.001). Dehydrated patients shifted toward normovolemia, while normovolemic patients remained stable. Dialysis-related complications, including intradialytic hypotension and hypertension, symptoms of cramps and fatigue, improved significantly in the overload group. The mean number of antihypertensive drug classes was also substantially reduced.Conclusions: BIA-guided fluid management improved fluid control in MHD patients, resulting in reduced dialysis-related complications and fewer anti-hypertensive drug classes. These findings support integrating BIA into standard clinical practice for individualized volume management, particularly in patients with fluid overload.

Saliva substitutes are the standard treatment for dry mouth. This study aimed to evaluate the clinical effectiveness of a novel artificial saliva gel (RSU gel) compared with a commercial product (GC Dry Mouth Gel®). A randomized, double-blind, two-phase crossover clinical trial was conducted with 37 participants with xerostomia. In the short-term phase, oral wetness, xerostomia scores, and clinical score of oral dryness (CSOD) were assessed up to 60 min after a single gel application. In the short-term repeated-use phase, each gel was applied 4 times daily for 14 days, separated by a 14-day washout period. The same parameters, including patient satisfaction and adverse events, were re-evaluated. Data were analyzed using generalized linear mixed models and generalized estimating equations. Both the RSU and GC Dry Mouth Gel® significantly improved oral wetness immediately after a single application. No significant difference was observed for the RSU gel relative to the GC Dry Mouth Gel® for oral wetness (OR = 1.01, 95% CI 0.98, 1.04, p = 0.248), xerostomia score (OR = 1.10, 95% CI 0.42, 2.88, p = 0.661), or CSOD (OR = 0.95, 95% CI 0.58, 1.55, p = 0.765) at 60 min. After 14 days of use, oral wetness increased significantly in both groups (2.94%, 95% CI 0.30%, 5.76%, p = 0.030) and did not differ significantly between the two products (p = 0.110). The xerostomia scores and CSOD also significantly improved, independent of product type (OR = 7.21, 95% CI 2.56, 20.34, p < 0.001, and OR = 2.82, 95% CI 1.50, 5.32, p = 0.001, respectively). The participants reported high satisfaction and acceptable taste, and no adverse effects were detected in those using the RSU gel throughout the study. Its lower cost and local availability make it a practical option for xerostomia management, particularly in populations with limited access to commercial saliva substitutes.

Chronic kidney disease (CKD) is a global health issue with widespread implications for public health. Primarily stemming from non-communicable diseases such as hypertension, heart disease, stroke, and diabetes, Studies have shown that in the eastern economic corridor there is a high risk of chronic non-communicable diseases has seen a substantial increase in mortality. Researchers have developed the 'Ticare' mobile health application (mHealth) for CKD patients. The primary objective of this research is to create a model mHealth app focusing on improving public access to healthcare. Data collection for app development was carried out through surveys, interviews, and insights from healthcare experts. The 'Ticare' app is compatible with all operating systems and offers key functionalities, including a disease news information system, hospital search and navigation, online service reservation, telemedicine, in-app medication ordering, and data visualisation. The satisfaction survey involving 400 participants revealed a high level of user satisfaction.