1
|
Chayapinun V, Koratala A, Assavapokee T. Seeing beneath the surface: Harnessing point-of-care ultrasound for internal jugular vein evaluation. World J Cardiol 2024; 16:73-79. [PMID: 38456073 PMCID: PMC10915892 DOI: 10.4330/wjc.v16.i2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Point-of-care ultrasound (POCUS) of the internal jugular vein (IJV) offers a non-invasive means of estimating right atrial pressure (RAP), especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery. While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein, this method lacks sensitivity. The utilization of POCUS significantly enhances the visualization of the vein, leading to a more accurate identification. It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation. This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein, drawing upon existing data.
Collapse
Affiliation(s)
- Vichayut Chayapinun
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States.
| | - Taweevat Assavapokee
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
2
|
Rattarasarn I, Yingchoncharoen T, Assavapokee T. Prediction of rehospitalization in patients with acute heart failure using point-of-care lung ultrasound. BMC Cardiovasc Disord 2022; 22:330. [PMID: 35871645 PMCID: PMC9310393 DOI: 10.1186/s12872-022-02781-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background More than 50% of patients admitted for acute heart failure are discharged with residual pulmonary congestion. Residual pulmonary congestion at discharge is associated with rehospitalization and death within 6 months after discharge. B-lines detected by lung ultrasound are the sonographic manifestation of pulmonary congestion, a major predictor of morbidity and mortality in patients with heart failure. The present study was performed to evaluate the prognostic value of B-lines at discharge for prediction of rehospitalization and death at 6 months in patients with acute heart failure. Methods This study involved a prospective cohort of 126 patients admitted to Ramathibodi Hospital for acute heart failure (mean age, 69 ± 15 years). B-lines and the size of the inferior vena cava were assessed within 24 h before discharge. The patients were followed up for 6 months after discharge. Results The mean number of B-lines at discharge was 9 ± 9, and the rate of rehospitalization within 6 months was significantly higher in patients with a significant number of B-lines (≥ 12) than in patients with a non-significant number of B-lines (< 12) (log rank χ2 = 7.74, P = 0.004). In the univariable analysis, the presence of ≥ 12 B-lines before discharge (hazard ratio = 2.15, 95% confidence interval = 1.27–3.63) was an independent predictor of events at 6 months. Conclusions Residual pulmonary congestion before discharge as detected by point-of-care lung ultrasound predicts rehospitalization for heart failure at 6 months. The presence of non-significant B-lines identifies a subgroup at low risk of rehospitalization for heart failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02781-9.
Collapse
|
3
|
Termglinchan V, Daswani S, Duangtaweesub P, Assavapokee T, Milstein A, Schulman K. Identifying solutions to meet unmet needs of family caregivers using human-centered design. BMC Geriatr 2022; 22:94. [PMID: 35109822 PMCID: PMC8812059 DOI: 10.1186/s12877-022-02790-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Given the rapidly aging society, shrinking workforce, and reducing dependency ratio, there is an increasing challenge for family members to provide care for older adults. While a broad understanding of caregiver burden and its consequences have been studied across various contexts, there is a need to better understand this challenge among family caregivers in Asian societies. Methods This study is a cross-sectional observational study. A total of 20 dyads of community-based older adults, who required assistance with at least one activities of daily living, and family caregivers in Thailand participated in the study. We used the first three stages out of five stages of human-centered design: empathize, define, and ideate. Results On average caregivers were 59.2 years old, with 43% still employed. Of the older adult participants, 10 were interviewed, the others had moderate-to-severe cognitive impairment. Based on the analysis, six caregiver personas (i.e. semi-fictional characters) are identified. Caregiver personas of “The 2-Jober” and “My Life Purpose” has the highest caregiver burden score whereas “The Spouse” has the lowest. Based on the specific needs of the caregiver persona “My Life Purpose”, the team brainstormed more than 80 potential solutions which were classified into three categories of solutions that satisfied the metrics of desirability, feasibility and viability: distributed medical care system, technology-charged care network, and community gathering for rest and recuperation. Conclusions These solutions are culturally sensitive given that they are built around established behavioral patterns. This is an illustration of a method of innovation that can be applied to bring a culturally specific understanding, and to develop products and services to enable further independent aging. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02790-5.
Collapse
Affiliation(s)
- Vittavat Termglinchan
- Clinical Excellence Research Center, Department of Medicine, Stanford School of Medicine, Room 326, 366 Galvez St, Stanford, CA, 94305, USA
| | - Samira Daswani
- Hasso Plattner Institute of Design (d.school), Stanford, CA, USA
| | | | - Taweevat Assavapokee
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arnold Milstein
- Clinical Excellence Research Center, Department of Medicine, Stanford School of Medicine, Room 326, 366 Galvez St, Stanford, CA, 94305, USA
| | - Kevin Schulman
- Clinical Excellence Research Center, Department of Medicine, Stanford School of Medicine, Room 326, 366 Galvez St, Stanford, CA, 94305, USA.
| |
Collapse
|
4
|
Thanapluetiwong S, Chansirikarnjana S, Sriwannopas O, Assavapokee T, Ittasakul P. Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors. Patient Prefer Adherence 2021; 15:2389-2403. [PMID: 34754180 PMCID: PMC8568699 DOI: 10.2147/ppa.s334757] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Older people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors. METHODS We conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged ≥60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021. RESULTS In total, we interviewed 282 participants aged 60-93 years (mean age 73.0±7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system's ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day. CONCLUSION The prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand's senior citizens.
Collapse
Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirintorn Chansirikarnjana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orapitchaya Sriwannopas
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taweevat Assavapokee
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Thanapluetiwong S, Ruangritchankul S, Sriwannopas O, Chansirikarnjana S, Ittasakul P, Ngamkala T, Sukumalin L, Charernwat P, Saranburut K, Assavapokee T. Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial. BMC Geriatr 2021; 21:215. [PMID: 33789580 PMCID: PMC8010962 DOI: 10.1186/s12877-021-02160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days. Results A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n = 57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0 and 8.8% (OR = 1.698, 95% CI 0.520–5.545, P = 0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4–8) days versus 5 (4–8) days (P = 0.133), respectively; delirium duration, 4 (2.3–6.5) versus 3 (1.5–4.0) days (P = 0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P = 1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P = 0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P = 0.591). There were no significant differences in other outcomes. None of the participants reported adverse events. Conclusions Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prevent delirium in this population group should not be recommended. Trial registration This trial was retrospectively registered with the Thai clinical trials registry (TCTR) at clinicaltrials.in.th (TCTR20190927001) on September 26, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02160-7.
Collapse
Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sirasa Ruangritchankul
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Orapitchaya Sriwannopas
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sirintorn Chansirikarnjana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tipanetr Ngamkala
- Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Sukumalin
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piangporn Charernwat
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Krittika Saranburut
- Cardiovascular and Metabolic Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taweevat Assavapokee
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| |
Collapse
|
6
|
Affiliation(s)
- Taweevat Assavapokee
- From the Departments of Medicine (T.A., K.T.) and Clinical Epidemiology and Biostatistics (K.T.), Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- From the Departments of Medicine (T.A., K.T.) and Clinical Epidemiology and Biostatistics (K.T.), Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Poungvarin N, Lee JK, Yechoor VK, Li MV, Assavapokee T, Suksaranjit P, Thepsongwajja JJ, Saha PK, Oka K, Chan L. Carbohydrate response element-binding protein (ChREBP) plays a pivotal role in beta cell glucotoxicity. Diabetologia 2012; 55:1783-96. [PMID: 22382520 PMCID: PMC4010252 DOI: 10.1007/s00125-012-2506-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/10/2012] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS This study was aimed at the elucidation of the pathogenesis of glucotoxicity, i.e. the mechanism whereby hyperglycaemia damages pancreatic beta cells. The identification of pathways in the process may help identify targets for beta cell-protective therapy. Carbohydrate response element-binding protein (ChREBP), a transcription factor that regulates the expression of multiple hyperglycaemia-induced genes, is produced in abundance in pancreatic beta cells. We hypothesise that ChREBP plays a pivotal role in mediating beta cell glucotoxicity. METHODS We assessed the role of ChREBP in glucotoxicity in 832/13 beta cells, isolated mouse islets and human pancreas tissue sections using multiple complementary approaches under control and high-glucose-challenge conditions as well as in adeno-associated virus-induced beta cell-specific overexpression of Chrebp (also known as Mlxipl) in mice. RESULTS Under both in vitro and in vivo conditions, ChREBP activates downstream target genes, including fatty acid synthase and thioredoxin-interacting protein, leading to lipid accumulation, increased oxidative stress, reduced insulin gene transcription/secretion and enhanced caspase activity and apoptosis, processes that collectively define glucotoxicity. Immunoreactive ChREBP is enriched in the nucleuses of beta cells in pancreatic tissue sections from diabetic individuals compared with non-diabetic individuals. Finally, we demonstrate that induced beta cell-specific Chrebp overexpression is sufficient to phenocopy the glucotoxicity manifestations of hyperglycaemia in mice in vivo. CONCLUSIONS/INTERPRETATION These data indicate that ChREBP is a key transcription factor that mediates many of the hyperglycaemia-induced activations in a gene expression programme that underlies beta cell glucotoxicity at the molecular, cellular and whole animal levels.
Collapse
Affiliation(s)
- N Poungvarin
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, R614, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Hong IH, Assavapokee T, Ammons J, Boelkins C, Gilliam K, Oudit D, Realff M, Vannicola J, Wongthatsanekorn W. Planning the e-Scrap Reverse Production System Under Uncertainty in the State of Georgia: A Case Study. ACTA ACUST UNITED AC 2006. [DOI: 10.1109/tepm.2006.881769] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|