Vajira Hospital

Severe dengue, marked by plasma leakage, is often linked to secondary heterotypic dengue virus (DENV) infection. While mast cells and basophils contribute to dengue pathogenesis, the role of anti-DENV IgE remains unclear. Here, we investigated whether anti-DENV IgE promotes FcεRI-dependent basophil activation, potentially contributing to disease severity. Plasma from dengue fever (DF, n = 42) and dengue hemorrhagic fever (DHF, n = 56) patients, collected at febrile, defervescence, and convalescent phases, were analyzed using an in-house IgE-capture ELISA developed to detect antibodies against all four DENV serotypes. Functional assays employed RS-ATL8, a human FcεRI-expressing basophil reporter cell line, to assess IgE-mediated activation following DENV antigen cross-linking. The anti-IgE monoclonal antibody Omalizumab was used to evaluate FcεRI dependence. Anti-DENV IgE was detected in both DF and DHF, peaking at defervescence and significantly higher in DHF. Total IgE was elevated but did not differ between groups. About one-third of anti-DENV-IgE-positive plasma samples induced RS-ATL8 activation upon DENV challenge, an effect abolished by omalizumab. These findings indicate a potential pathogenic role of anti-DENV IgE and provide a rationale for further investigation of IgE-targeted interventions.

OBJECTIVE This study aimed to cross-culturally translate and evaluate the psychometric properties of the Thai version of the Barthel Index Self-Report (BI-SR-TH) for Thai people with spinal cord injury (SCI). METHODS A descriptive cross-sectional validation and reliability study was conducted at the Maharaj Nakorn Chiang Mai Hospital, involving 109 Thai people aged 18 or older with either traumatic or non-traumatic SCI. The English postal version of the Barthel Index was translated into Thai following standard cross-cultural procedures, including forward and backward translation. Participants completed both the BI-SR-TH and the Thai EuroQoL (EQ-5D-5L) questionnaires via self-report and clinician assessment using the Barthel Index. The BI-SR-TH was re-administered to the participants one week later. Psychometric evaluation included assessments of internal consistency (Cronbach’s alpha), concurrent validity (Spearman’s correlation with clinician-rated BI), construct validity (convergent and discriminant validity assessed by correlations with relevant and distinct EQ-5D-5L domains), and test-retest reliability (intraclass correlation coefficient, ICC). The agreement between the BI-SR-TH and BI scores was assessed using ICC and the Bland-Altmand Altman analysis. Item-level agreement was assessed using the Kappa statistic. RESULTS The BI-SR-TH demonstrated good internal consistency (Cronbach’s alpha = 0.836) and excellent concurrent validity with a clinician-rated BI (r = 0.884). In terms of construct validity, the BI-SR-TH showed strong negative correlations with relevant EQ-5D-5L domains, e.g., mobility, self-care, and usual activities (r = –0.67 to –0.81, p < 0.01), demonstrating convergent validity. In contrast, correlations with unrelated domains such as anxiety and pain were weak or nonsignificant, indicating discriminant validity. The total score agreement between BI-SR-TH and the clinician BI was high (ICC = 0.916), and Bland-Altman analysis indicated a small mean difference. Most BI-SR-TH items showed good agreement with clinician ratings (Kappa 0.61–0.72) with the exception of the bowels and bladder items which showed only fair agreement (Kappa = 0.34 and 0.35, respectively). Test-retest reliability was also high (ICC = 0.924). CONCLUSIONS The BI-SR-TH is a valid and reliable tool for assessing functional independence in Thai people with SCI. However, the bowels and bladder items require further refinement for this population KEYWORDS Barthel Index, self report, functional status, spinal cord injury, reliability and validity

HER2-directed treatments for HER2-overexpressing (HER2-OE; immunohistochemistry [IHC] 3+/2+) NSCLC are needed. DESTINY-Lung03 is an open-label, multi-arm, phase 1b study. Part 1 evaluated trastuzumab deruxtecan (T-DXd, 4.4 or 5.4 mg/kg) plus durvalumab (1120 mg) and cisplatin (60 or 75 mg/m2; Arm 1A)/carboplatin (area under the plasma concentration-time curve [AUC] 4 or 5; Arm 1B) or T-DXd 5.4 mg/kg monotherapy (Arm 1D) in pretreated metastatic HER2-OE NSCLC. Primary end points: dose-limiting toxicities (DLTs) and adverse events (AEs: Arms 1A and 1B). Secondary end points: safety (Arm 1D) and efficacy (all arms). At data cutoff (April 1, 2024), 11, 24, and 36 patients received treatment in Arms 1A, 1B, and 1D, respectively. DLTs reported in Arm 1A: febrile neutropenia (n = 1; grade [G] 5; 4.4 mg/kg/1120 mg/60 mg/m2 doses); decreased platelet count (n = 2; G4 and G5; 5.4 mg/kg/1120 mg/75 mg/m2 doses). DLTs reported in Arm 1B: febrile neutropenia (n = 1; G3; 4.4 mg/kg/1120 mg/AUC 5 doses; n = 1; G4; 4.4 mg/kg/1120 mg/AUC 4 doses); decreased platelet count (n = 1; G4; 5.4 mg/kg/1120 mg/AUC 5 doses). Drug-related serious AEs occurred in 63.6%, 37.5%, and 16.7% of Arms 1A, 1B, and 1D, respectively. Confirmed objective response rate (95% confidence interval) per investigator: 37.5% (18.8-59.4; Arm 1B) and 44.4% (27.9-61.9; Arm 1D). Data confirm the activity of T-DXd monotherapy in pretreated HER2-OE NSCLC but do not support T-DXd plus durvalumab and platinum chemotherapy use in this population. NCT04686305.

Introduction According to the existing studies, there are relatively few studies about the effectiveness of the health literacy promotion program on health behaviours and health outcomes among pre-aging individuals with overweight and obesity. According to the aforementioned problems and reviewed data, this study aimed to address the need for accessible health knowledge. Particularly, older adults with obesity should aim to lose weight and prevent chronic diseases caused by obesity, thereby preparing them to handle age-related health conditions. Methods This study employed a pretest-posttest Randomized Controlled Trial (RCT) conducted between February and June 2024 among pre-aging individuals with overweight and obesity in Thailand. The total sample size was 136 (the control arm had 68 samples, the experimental arm had 68 samples). Results The study assessed the health behaviors and outcomes of an older adult group with overweight and obesity, following their participation in a health literacy development program. Post-intervention, the experimental arm exhibited significantly higher health literacy scores ( p < 0.001) and health behavior scores related to overweight and obesity ( p < 0.001) compared to the control arm. Furthermore, the overall health outcomes of the experimental arm were also significantly better than those of the control arm (p-values ranging from 0.001 to 0.004). Discussion This study shows that a health literacy promotion program can significantly improve health behaviors and outcomes in pre-aging individuals with overweight and obesity. Compared to the control arm, participants in the experimental arm received better clinical scores and effectively improved their own health conditions, indicating that the program is conducive to promoting a healthy lifestyle and preparing for aging. Conclusions These findings provide evidence to support the health literacy concepts as guidelines for developing a health-promoting program for the pre-aging group with overweight and obesity.

This study aimed to evaluate the efficacy of platelet-rich plasma (PRP), a biologic agent that facilitates tissue regeneration and wound healing, in improving postoperative outcomes of frontal sinus ostium (FSO) and need for postoperative intervention. A prospective, randomised controlled trial included chronic rhinosinusitis (CRS) patients undergoing bilateral endoscopic frontal sinus surgery. PRP-soaked absorbable hemostat was applied to the frontal sinus ostium on the randomised side, while a plain absorbable hemostat was used on the control side. Endoscopic evaluations were conducted intraoperatively (baseline), and at 30 and 90 days postoperatively to assess the FSO area, FSO patency, inflammatory visual analog scale (VAS) score, presence of polypoid edema, adhesion/scarring grade, and the need for postoperative interventions. Thirty participants were enrolled and PRP was applied to 30 frontal sinus ostia on randomised side. On 30-day post-ESS PRP significantly improved inflammatory VAS score (p = 0.041), reduced polypoid edema (odds ratio (OR) 0.49; 95% CI: 0.24, 0.98) and adhesion scarring (OR 0.33; 95% CI: 0.15, 0.74), and improved the need of postoperative intervention compared to the control (risk ratio (RR) 0.25; 95% CI: 0.11, 0.58). On 90-day post-ESS, PRP significantly reduced polypoid edema (OR 0.35; 95% CI: 0.17, 0.67), and adhesion scarring (OR 0.20; 95% CI 0.07, 0.52) compared to the control. The FSO area changes and patency grade were not significantly different between groups. The PRP application following frontal sinusotomy improved the inflammatory VAS score, polypoid edema and adhesion scarring grades, and reduces the need for oral steroid intervention.

Abstract Background/Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly increasing and a global problem. It is associated with significant liver disease and hepatocellular carcinoma. Patients with fatty liver with metabolic risks, particularly those with advanced liver fibrosis, exhibit a higher prevalence of subclinical cardiovascular disease (CVD) and are associated with increased all-cause mortality. The fibrosis-4 (FIB-4) index is a standard noninvasive biomarker for fibrosis prediction and has been widely utilized for fibrosis screening in MASLD. Nonetheless, its role in classifying cardiovascular risk remains uncertain. Purpose This study evaluates individuals with MASLD identified with vibration-controlled transient elastography (FibroScan@) and investigates the clinical value of the FIB-4 index in forecasting long-term cardiovascular outcomes. Methods This retrospective cohort study evaluates patients with MASLD diagnosed with a controlled attenuation parameter (CAP) of > 260 dB/m. and followed for 10 years period. Participants with excessive alcohol consumption were excluded. The FIB-4 index is categorized into two groups: low (<1.3) and immediate to high risk (≥ 1.3) for fibrosis. The primary endpoint was a composite outcome of major adverse cardiovascular events (MACEs), including myocardial infarction, heart failure hospitalization, new-onset atrial fibrillation (AF), stroke, and all-cause mortality. Cox proportional hazard models and multivariate analysis were used to assess the composite outcomes of MACEs. Results The study included 1,169 participants with a mean age of 55.3 ± 10.4 years and a median FIB-4 index of 1.25 (interquartile range [0.83–1.97]). The median follow-up duration is 4.93 years (interquartile range [2.63–6.47]). Diabetes was present in 256 participants (21.9%). The average body weight index (BMI) is 27.16 ± 3.69 kg/m2. The primary outcome was a composite of MACEs, occurring in 50 participants (4.28%). This comprised 12 participants (1.03%) with myocardial infarction, 5 (0.43%) with heart failure hospitalizations, 18 (1.54%) with new-onset AF, 8 (0.68%) with strokes, and 7 (0.60%) with all-cause deaths. The FIB-4 index was a significant predictor of MACEs (adjusted hazard ratio [aHR] 2.16, 95% confidence interval [CI] 1.09–5.36, p = 0.030). Conclusion(s) The FIB-4 score is a simple, non-invasive biomarker that effectively classifies the extent of liver fibrosis and forecasts long-term cardiovascular consequences. A moderate to high FIB4 score is significantly associated with an increased risk of adverse cardiovascular events over ten years.FIB4 index group and MACEs

Because neurodegenerative diseases such as Parkinson’s and Alzheimer’s Diseases [AD and PD] as well as the progressive forms of multiple sclerosis [MS] are invariably associated with clinically significant cortical symptoms such as language difficulties, motor skill deficits and cognitive impairments, especially memory, a tacit assumption evolved that visual disorders related to cortical dysfunction must localize only to the temporal, parietal and occipital lobes. Based upon our current understanding, retinal changes in MS are most likely secondary to optic neuropathy, whereas in AD and PD, they appear to represent primary retinal changes. The paradigm was reinforced by the lack of retinal findings using ophthalmoscopy. Spectral domain optical coherence tomography [OCT], optical coherence angiography [OCT-A], and fundus autofluorescence [FAF] have challenged this creed by uncovering structural changes within the retina over and above what can occur as a consequence of optic neuropathy in the case of MS. Still, definitive diagnostic and prognostic data have yet to emerge. Fluorescence lifetime imaging ophthalmoscopy [FLIO], a non-invasive, non-contact, painless imaging technology, measures nanosecond lifetimes of endogenous retinal fluorophores, some of which are linked to mitochondrial activity. Therefore, FLIO is a metabolic, not a structural imaging modality. Because mitochondrial dysfunction occurs in many neurodegenerative diseases, FLIO offers a unique strategy for investigating retinal metabolism in AD, PD, and MS. This article reviews the basic biomedical engineering of FLIO and reports preliminary data from these diseases, correlated with disease duration. These functional in vivo data are consistent with retinal metabolic changes in AD, PD, and progressive MS that were “hiding in plain sight” from structural examinations.

BackgroundTracheostomy-related pressure injuries (TRPIs) compromise recovery and prolong hospital stay.MethodsWe conducted a prospective randomized controlled trial at a tertiary hospital to compare the efficacy of petroleum jelly application versus normal saline irrigation in preventing peristomal pressure injuries and promoting tracheostomy wound healing. This study enrolled 28 participants, aged 18–80 years, who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University. They were randomly assigned using a permuted-block randomization methods (block size = 4) to either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group. The outcomes were evaluated by one physician and one nurse at first, second, and fourth weeks postoperatively using the Pressure Ulcer Scale for Healing (PUSH) Tool and Skin Integrity Score.ResultsThe petroleum jelly application group demonstrated significantly lower mean scores on the PUSH Tool at first, second, and fourth weeks than the sodium chloride irrigation group. Moreover, the petroleum jelly application group exhibited significantly higher median scores for skin integrity at first, second, and fourth weeks than the sodium chloride irrigation group. The interrater reliability between the two observers was good to excellent. The petroleum-jelly arm showed faster improvement on both scoring tools across all follow-up points.ConclusionsThe participants who received petroleum jelly application following tracheostomy demonstrated better results in preventing pressure injuries and maintaining skin integrity compared with those who received sodium chloride irrigation.Trial registrationTCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. (https://www.thaiclinicaltrials.org/show/TCTR20240806002).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03224-w.

Objective: Intraoperative nefopam infusion was documented as safe and viable for supplemental pain management, alongside opioids following surgery. Postoperative pain control with nefopam after video-assisted thoracoscopic surgery (VATS) is not well understood. This study assessed the effects of nefopam towards postoperative morphine requirements and pain intensity 24 hours after VATS lobectomies. Materials and Methods: This multicenter, double-blind, randomized, controlled trial enrolled 18-70-year-old elective VATS lobectomy patients. Patients were randomized 1:1, receiving nefopam or normal saline solution (NSS) administered during the maintenance of anesthesia and 24-hour postoperative period. All received multimodal analgesia, including paracetamol, ibuprofen, and intercostal nerve blocks. Postoperative morphine was administered via patient-controlled analgesia (PCA) devices and recorded at 10 and 30 minutes, and 1, 2, 6, 12, 18 and 24 hours.Postoperative pain was graded at rest and during deep breathing using numeric rating scale (NRS) scores 1, 2, 12, and 24 hours. Results: Of 72 enrolled patients, 70.8% were female, with a mean (± standard deviation) age of 56.5 ± 10.4 years. No significant postoperative difference was observed between groups for: total median (P25, P75) morphine amounts administered over 24 hours (nefopam, 14 [8, 24] mg; control, 8 [4.5, 19] mg; p = 0.17); NRS pain scores during rest (p = 0.98) or deep breathing (p = 0.82) 1, 2, 12, and 24 hours Conclusion: Intraoperative and postoperative nefopam infusion, including multimodal analgesia, did not reduce morphine consumption or NRS pain scores in VATS lobectomy, but may have prolonged the duration of pain relief.

ObjectivesNewborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing recommends screening near hospital discharge but does not specify an optimal timing. To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates.Study DesignNeonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24, 24 to 36, 36 to 48, and more than 48 hours, with follow-up at 1 month for persistent failures. Statistical analyses included Fisher's exact test to compare pass rates across time intervals and multivariate Cox's proportional hazards regression and Laplace regression to assess factors associated with screening outcomes.ResultsAmong 408 neonates, the median passing age was 23.8 hours (interquartile range: 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24 to 36 hours, 92.6% at 36 to 48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (odds ratio: 5.26;p = 0.0153). Cesarean delivery was associated with delayed passing compared with vaginal delivery (p = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (p < 0.01), whereas small for gestational age neonates passed earlier by 8.2 hours (p = 0.021).ConclusionScreening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention.Key PointsThe ideal timing for newborn hearing screening remains unclear, affecting accuracy and follow-up rates.Early TEOAE screening may lead to high false positives due to residual ear fluid, increasing unnecessary follow-ups.Optimizing timing of the hearing screening window can enhance accuracy, reduce false positives, and improve clinical efficiency.