Clinical factors predictive of appropriate treatment in COPD: a community hospital setting

Prevalence and risk factors of depression in patients with chronic obstructive airway disease: a tertiary care hospital, outpatient setting

BACKGROUND

Chronic obstructive airway disease (COPD) has been found to be associated with depression. An overlap of COPD and depression may cause poor quality of life and an increase in mortality. A meta-analysis found that the prevalence and risk factors of depression in patients with COPD have high heterogeneity and are limited in tertiary care hospital outpatient settings. This study thus aimed to evaluate the prevalence and risk -factors of depression in patients with COPD using personal data in a tertiary care hospital outpatient setting.

METHODS

This cross-sectional study included adult patients who were diagnosed with COPD according to the GOLD guidelines, had stable functional status within the past 4 weeks with the same treatment regimen, and had no history of other serious medical or surgical illness. A diagnosis of depression was made according to a score of 11 or higher on the hospital anxiety and depression scale (HADS). The prevalence and predictors of depression were then computed.

RESULTS

The study enrolled and evaluated 150 patients with COPD, out of which 6 (4%) had depression. While the predictive model for depression comprised two factors, only severity of COPD was independently associated with depression. The adjusted odds ratio of severity of COPD was 5.20 (95% confidence interval of 1.75, 15.42;  p = 0.003).

CONCLUSION

The prevalence of depression in patients with COPD in a tertiary care outpatient setting was low, at 4%. According to the study's comprehensive assessment, severity of COPD was the only factor associated with depression in patients with COPD.

Impact of COVID-19 outbreak on stroke admission in Thailand: a quasi-experimental, ecological study on national database

This study aimed to evaluate the effect of COVID-19 outbreak on stroke admission by using a national database. A quasi-experimental, ecological study using the national database of Thailand was conducted. The study period was between January 2017 and August 2020 before and after COVID-19 outbreak starting from March 2020. Numbers of stroke admission were evaluated before and after the COVID-19 outbreak by an interrupted time series analysis for both pre- and post-COIVD-19 outbreak. There were 381,891 patients admitted throughout Thailand. Of those, 292,382 patients (76.56%) were admitted due to thrombotic stroke followed by hemorrhagic stroke (73,130 patients; 19.15%) and embolic stroke (16,379 patients; 4.29%). During pre-COVID-19 outbreak, all stroke subtypes had an increasing trend with a coefficient of 0.076 (p value < 0.001) for thrombotic stroke, 0.003 (p value < 0.001) for embolic stroke and 0.012 (p value = 0.025) for hemorrhagic stroke. The COVID-19 outbreak had significantly effect on reductions of incidence rates of thrombotic and hemorrhagic stroke with a coefficient of -2.412 (p value < 0.001) and -0.803 (p value = 0.023). The incidence rates of three stroke subtypes were increasing prior to the COVID-19 outbreak. The COVID-19 outbreak significantly impacts hospital admission rates of both thrombotic and hemorrhagic stroke subtypes.

Clinical Characteristics and Outcomes of Patients with Intracerebral Hemorrhage: Nonsurgical Versus Surgical Treatment

Introduction

Primary intracerebral hemorrhage (ICH) is a stroke subtype with high morbidity and mortality. Surgical treatments for ICH may be one of the beneficial modalities. There are inconsistent clinical outcomes of surgical treatments in several randomized controlled trials. This study aimed to evaluate if surgical treatment can reduce mortality in patients with ICH in a real-world setting.

Methods

This was a retrospective analytical study. The inclusion criteria were consecutive adult patients aged 18 years or over admitted to neurosurgery ward due to ICH, and indicated for surgical treatment according to the 2015 guideline for the management of spontaneous ICH. The outcomes of this study included mortality, length of stay, Barthel index, Glasgow Outcome Score (GOS), and Glasgow Coma Scale (GCS). Descriptive statistics were used to execute the differences between those who underwent and did not undergo surgical treatments. Factors associated with mortality were computed by multivariate logistic regression analysis.

Results

There were 110 patients with ICH who met the study criteria. Of those, 34 (30.91%) patients underwent surgical treatment: mainly craniotomy (16 patients; 47.06%). The surgical treatment group had significantly higher proportions of large ICH of 30 mL or over (62.96% vs. 27.54%; P = 0.002) and intraventricular hemorrhage (70.59% vs. 46.05%; P = 0.023) than the nonsurgical treatment group. However, both groups had comparable outcomes in terms of mortality, length of stay, Barthel index, GOS, and GCS. The mortality rate in the surgery group was 47.06%, whereas the nonsurgery group had a mortality rate of 39.47 (P = 0.532). There were three independent factors associated with mortality, including age, GCS, and intraventricular hemorrhage. The adjusted odds ratio (95% confidence interval) of these factors was 1.06 (1.02-1.12), 5.42 (1.48-19.81), and 5.30 (1.65-17.01). Intraventricular hemorrhage was more common in the elderly than in the nonelderly group (66.00% vs. 43.33%; P = 0.022).

Conclusions

Surgical treatment may not be beneficial in patients with severe ICH, particularly with intraventricular hemorrhage, large ICH volume, or low GCS. Elderly patients with ICH may also have high mortality if intraventricular hemorrhage is present.

PIVKA-II or AFP has better diagnostic properties for hepatocellular carcinoma diagnosis in high-risk patients

Background

Hepatocellular carcinoma (HCC) is a lethal cancer. Two biomarkers were used for HCC diagnosis including alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II or antagonist (PIVKA-II). However, data on biomarkers and HCC diagnosis are not consistent. This study aimed to evaluate if PIVKA-II, AFP, or a combination of both biomarkers had the best diagnostic properties for HCC.

Methods

This was a prospective study and enrolled patients 18 years or over with a high risk for HCC. AFP and PIVKA-II levels were calculated for HCC diagnosis. Diagnostic properties of both biomarkers were reported with sensitivity, specificity, and a receiver operating characteristic (ROC) curve.

Results

There were 260 patients with high risk for HCC in this cohort. Of those, 219 patients were diagnosed with HCC: confirmed by biopsy in 7 patients (2.69%) and by imaging in the others. Median values of AFP and PIVKA-II were 56 ng/mL and 348 mAU/mL, respectively. PIVKA-II level of 40 mAU/mL had sensitivity of 80.80%, while AFP of 10 ng/mL had sensitivity of 75.80%. A combination of PIVKA-II at 100 mAU/mL or over and AFP of 11 ng/mL gave sensitivity of 60.30%. The ROC curve of PIVKA-II plus AFP was significantly higher than the AFP alone (0.855 vs. 0.796; p = 0.027), but not significantly different from the PIVKA-II alone (0.855 vs. 0.832; p = 0.130).

Conclusion

PIVKA-II may have more diagnostic yield for HCC compared with AFP. It can be used alone without a combination with AFP.

A national surveillance of eosinophilic meningitis in Thailand

Introduction

Eosinophilic meningitis (EOM) is an emerging infectious disease worldwide. The most common cause of EOM is infection with Angiostrongylus cantonensis One possible method of monitoring and control of this infection is surveillance and prediction. There are limited data on national surveillance and predictive models on EOM. This study aimed to develop an online surveillance with a predictive model for EOM by using the national database.

Methods

We retrospectively retrieved reported cases of EOM from all provinces in Thailand and quantified them by month and year. Data were retrieved from Ministry of Public Health database. We developed a website application to explore the EOM cases in Thailand including regions and provinces using box plots. The website also provided the Autoregressive Integrated Moving Average (ARIMA) models and Seasonal ARIMA (SARIMA) models for predicting the disease cases from nation, region, and province levels. The suitable models were considered by minimum Akaike Information Criterion (AIC). The appropriate SARIMA model was used to predict the number of EOM cases.

Results

From 2003 to 2021, 3330 EOM cases were diagnosed and registered in the national database, with a peak in 2003 (median of 22 cases). We determined SARIMA(1,1,2)(2,0,0)[12] to be the most appropriate model, as it yielded the fitted values that were closest to the actual data. A predictive surveillance website was published on http://202.28.75.8/sample-apps/NationalEOM/.

Conclusions

We determined that web application can be used for monitoring and exploring the trend of EOM patients in Thailand. The predictive values matched the actual monthly numbers of EOM cases indicating a good fit of the predictive model.

Eosinophilic meningitis epidemiological data from a national database in Thailand's Department of Disease Control: a pragmatic, retrospective analytical study

Background

Eosinophilic meningitis (EOM) is a rare neurological disease that can be misdiagnosed or underdiagnosed. Based on reported cases in the literature, there have been 2,827 cases worldwide since 1945. There are limited data on the prevalence and trends of EOM in a real-world setting, even in Thailand, the country with the highest prevalence of EOM. Therefore, this study aimed to evaluate the prevalence of EOM and EOM epidemiological data in a real-world setting.

Methods

This was a pragmatic, retrospective analytical study using a national database. We retrieved EOM epidemiological data reported from government hospitals to Thailand’s Bureau of Epidemiology, within the Ministry of Public Health’s Department of Disease Control (DDC), between 2014 and 2019. The study was conducted by retrieving the data of all patients diagnosed with EOM and reported to the DDC. Diagnosis of EOM is made clinically by evidence of eosinophils of 10% or more of the total white blood cells in cerebrospinal fluid. Details of each patient were retrieved from the 506 Report Form, including age, month of reported case, zone of country, occupation, and mortality. Data regarding infection rate in each year and each zone were reported in rate/100,000 population, while data regarding age, month of reported case, and occupation were reported by year. Differences between means of age group, month of reported case, and occupation were tested by one-way analysis of variance (ANOVA). For those factors with significant differences among groups, Bonferroni method was used to compute pairwise differences.

Results

There were 1,083 EOM cases reported in Thailand during the six-year study period. The average annual incidence of EOM was 180.5 cases, or 0.27 cases/100,000 population. The northeast zone had the highest rate, with 0.89/100,000 population. The common age groups were 25–54 years, with the highest rate among the 35–44 age group, with a mean of 38.3 persons/year. These age groups were significantly different from other age groups (F value 39.23; p < 0.001). A relatively high cumulative monthly incidence (> 100 cases) was seen in four months, including January (117 cases), September (103 cases), October (112 cases), and November (103 cases), though these rates were not significantly different from the other months’ rates. Regarding occupation, the top two occupations with EOM diagnoses were farmers and laborers, which were significantly different from other occupations (F value 99.95; p < 0.001). There was no reported case of death during the study period.

Conclusion

EOM is common in Northeast Thailand among people of working age. The disease can be found throughout the year but is more common in the last quarter of the year. Farmers and laborers have the highest infection rate. To better understand the burden and outcomes of EOM, a national EOM reporting system with a better reporting form is required in endemic countries. Such a report form should include more details on risk exposure, symptoms, signs, treatment, and outcomes.

A real-world implementation of asthma clinic: Make it easy for asthma with Easy Asthma Clinic

Background and objective

Asthma is a common disease. Although several practice guidelines for asthma exist, good control is still problematic, particularly in developing countries. The Easy Asthma Clinic (EAC) was established in 2004 with the aim of providing simplified asthma guidelines, a multidisciplinary approach, and an online database. This study aimed to evaluate the outcomes of EAC in a real-world setting.

Method

Clinical data were collected from the EAC database between 2004 and 2017. Treatment data and asthma control data were evaluated during the study period.

Results

In all, 358 182 patients with asthma were treated at EAC in 1171 hospitals throughout Thailand during the 14-year period. For 3 264 117 visits, inhaled corticosteroid (ICS) was given at the highest percentage (average of 50.00%) with an average percentage of controllers at 75.08% and a trend of increasing treatment (coefficient 0.007; p < 0.001). The percentage of controlled asthma also increased from 20.48% to 27.76% with a coefficient of 0.015 (p for trend <0.001).

Conclusion

The EAC may facilitate controller use in patients with asthma thereby increasing asthma control according to a large sample size and long longitudinal study.

A surveillance for hepatitis C virus infection in northeastern, Thailand: a 10-year cohort

INTRODUCTION

Hepatitis C virus (HCV) infection is an infection that may lead to cirrhosis and hepatocellular carcinoma. Most patients with HCV infection are asymptomatic. The previous study conducted in age group of 30-64 years and in two provinces. Additionally, most surveillance studies conducted in a point period; not longitudinally. This study aimed to evaluate HCV infection rate in all age groups in the northeastern, Thailand in a longitudinal fashion.

METHODS

This was a surveillance study conducted in 20 provinces of northeastern, Thailand. The study period was between July 2010 and November 2019. During the surveillance, demographic data of participants were collected. HCV screening test was performed in each participant by using a rapid point-of-care assay. Rates of HCV infection in each province and in overall were calculated.

RESULTS

During the surveillance period, there were 31,855 subjects who participated the project. Of those, 1,285 subjects (4.037%) were tested positive for HCV infection (Tab. I). The HCV infection rate was highest in 2011 (8.98%): ranges 1.28 to 9.59%. The age group of over 50 years had 690 subjects with HCV infection (5.45%) out of 12,660 subjected tested in this age group. There was significant different among age groups (p < 0.001) and difference of age over 30 years and sex (p 0.043).

CONCLUSIONS

This longitudinal surveillance showed that HCV infection rates in northeastern, Thailand were varied across the provinces with the highest rate of 9.59%. The HCV infection should be aware in male with age over 30 years.

The association of ESBL Escherichia coli with mortality in patients with Escherichia coli bacteremia at the emergency department

BACKGROUND:

Escherichia coli is a common bloodstream infection pathogen in the emergency department (ED). Patients with extended-spectrum beta-lactamase (ESBL) E. coli have a higher risk of morbidity. However, there is still debate surrounding ESBL E. coli-associated mortality in community, intensive care unit, and tertiary care settings. In addition, there have been few studies regarding mortality in ESBL E. coli in ED settings, and results have been contradictory.

METHODS:

This was a retrospective cohort study conducted at the Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University in Thailand aimed at evaluating the possible association between ESBL E. coli bacteremia and mortality in the ED. The inclusion criteria were age 18 years or over, clinical presentation suspicious of infection, and positive blood culture for E. coli. Predictors for mortality were analyzed by logistic regression analysis.

RESULTS:

During the study period, 273 patients presented at the ED with hemoculture positive for E. coli. Of those, 27 (9.89%) died. Five factors remained in the final model, of which plasma glucose levels, serum lactate levels, and ESBL E. coli were significantly associated with 28-day mortality in the ED with adjusted odds ratios of 0.970, 1.258, and 12.885, respectively. Plasma glucose of less than 113 mg/dL yielded a sensitivity of 80.95% and specificity of 64.29%, while serum lactate over 2.4 mmol/L had a sensitivity of 81.48% and specificity of 45.50%.

CONCLUSION:

ESBL E. coli, plasma glucose, and serum lactate levels were associated with 28-day mortality in patients with E. coli bacteremia presenting at the ED.