Asian Medical Journal and Alternative Medicine

Nutritional Support Leading to the Accomplishment of Treatment Goal: A Case Report of Recurrent Locally Advanced Breast Cancer

Panuch Eiamprapaporn, Kanokkarn Chupisanyarote — Tue, 31 Dec 2024 00:00:00 +0700

A 56-year-old woman with recurrent locally advanced breast cancer (rcT1a N3a M0, Luminal B) underwent curative intent treatment. Oral nutritional support (ONS), which was an immune-nutrition formula, was implemented to optimize her nutritional status and support treatment tolerance. This case highlights the importance of nutritional support in improving treatment outcomes for patients with recurrent breast cancer.

Clinical Characteristics and Treatment Outcomes of Primary Aldosteronism in a Tertiary Hospital in Thailand

Peeradon Vibhatavata, Nuttapong Namfa, Kanokporn Sanpawithayakul — Tue, 31 Dec 2024 00:00:00 +0700

Background: Primary aldosteronism (PA) is the most common cause of endocrine hypertension, increasing cardiovascular and renal risks. This study aimed to provide comprehensive information on PA patients in Thailand, where data are limited. Materials and A retrospective study of 127 PA patients during 2012 to 2023 from Thammasat University

Methods: Hospital was conducted. Data on clinical and biochemical parameters, screening, confirmatory testing, subtype classification, and treatment outcomes were evaluated.

Results: Fifty patients (39%) had unilateral PA, 50 (39%) bilateral PA, and 27 (21%) were classified as inconclusive subtype. Mean age was 54 years, and 54% were female. All participants had hypertension, with 10% having resistant hypertension. Eighty-three percent had hypokalemia. Median plasma aldosterone concentration (PAC), direct renin concentration (DRC), and PAC/DRC ratio (ADRR) were 21.7 ng/dL, 3.7 μIU/mL, and 5.3 ng/dL: μIU/mL, respectively. The recumbent saline infusion test (RSIT) was the most common confirmatory test, with a 66% positive rate. Adrenal CT scan was performed in all cases. Ninety-two percent of patients underwent adrenal venous sampling, with a 78% success rate. Among adrenal ectomy patients, 53% achieved complete clinical success and 94% achieved biochemical success. Unilateral PA showed higher PAC, ADRR, PAC-potassium ratio, and lower DRC.

Conclusions: Comprehensive PA data supports accurate diagnosis and tailored treatment. Hypokalemia is common in Thai PA patients. Unilateral PA shows a severe phenotype with distinctive hormonal profiles. For confirmatory testing, RSIT is reliable and SSIT promising. AVS, superior to CT for subtyping, is crucial for accurate subtype classification, as nearly all unilateral PA patients achieve complete biochemical remission post-adrenalectomy.

Effect of Benzalkonium Chloride and Chlorhexidine on the Antibiotic Susceptibility of Pseudomonas aeruginosa

Thitinan Phutthilertmethawee, Potjanee Srimanote, Pholawat Tingpej — Tue, 31 Dec 2024 00:00:00 +0700

Introduction: The transmission of Pseudomonas aeruginosa can be controlled using biocides such as benzalkonium chloride (BKC) and chlorhexidine (CHX). However, debates continue over whether biocide exposure contributes to the development of antibiotic resistance.

Objectives: To investigate the impact of BKC and CHX exposure on the development of antibiotic resistance in P. aeruginosa.

Methods: The minimal inhibitory concentrations (MICs) of P. aeruginosa PAO1 (ATCC27853) and 15 clinical isolates against BKC and CHX were determined. The bacteria were grown in media containing subinhibitory concentrations (SICs) of these biocides for five consecutive passages. MICs for ciprofloxacin, ceftazidime, and gentamicin, as well as their susceptibility status, were compared before and after exposure.

Results: The MIC of BKC ranged from 0.002% to 0.047%, while the MIC of CHX was 0.001%, both well below their recommended concentrations. After exposure to BKC and CHX, most strains showed minimal or no changes in MIC values for ciprofloxacin, ceftazidime, and gentamicin, with no significant changes in antibiotic susceptibility. A few strains, such as SP275, P330, SP119, SP546, and SP48, exhibited more than twofold MIC increases, but these changes were not statistically significant. After CHX exposure, strain P10 showed significant MIC changes without altering its susceptibility status to ciprofloxacin or ceftazidime.

Conclusion: Exposure to SICs of BKC and CHX increased antibiotic MICs in a minority of P. aeruginosa strains without affecting their antibiotic susceptibility status. This research provides valuable data supporting the use of biocides in infection control in both healthcare settings and the general environment.

Incidence and Risk Factors of Iatrogenic Pneumothorax after Thoracentesis in Medical Wards: A 1-year Prospective Single-center Study

Phattaraphol Limsakul, Nathaorn Phuangsombut, Pattarin Pirompanich — Tue, 31 Dec 2024 00:00:00 +0700

Introduction: Iatrogenic pneumothorax (IP) after thoracentesis can lead to life-threatening conditions and increased treatment costs. Understanding the associated risk factors is crucial for prevention.

Objectives: This study aims to investigate the incidence of IP and its contributing risk factors.

Methods: This one-year prospective consecutive study was conducted in a tertiary teaching hospital, documenting all thoracentesis procedures performed in the medical wards from July 2021 to June 2022.

Results: Data were collected from a total of 47 procedures involving 39 patients, with a mean age (SD) of 69.4 (13.9) years. Among the patients, 21 (53.9%) were male. The incidence of IP was 10.6% (5 events). Most incidents (80.0%) took place in the general ward, while the remaining 20.0% occurred in the intensive care units (p = 0.136). Notably, periprocedural events, particularly coughing, were reported in 80.0% of IP cases (IRR 8.40, 95% CI [3.00, 23.53], p < 0.001). No significant associations were found between IP and factors such as body mass index, use of mechanical ventilator, drainage volume, needle type, number of attempts, or the quarter of the training year in which the procedures were performed.

Conclusions: Over the course of the year, the incidence of IP following thoracentesis was found to be low. Although specific risk factors could not be identified, peri-procedural events warrant careful consideration, as they may indicate an increased likelihood of this complication.

Prevalence of Coronary Artery Calcification in Non-ECG Gated Staging Chest CT Scans of Patients with Primary Lung Cancer

Warit Tarathipmon, Wattanai Amnuaysin — Tue, 31 Dec 2024 00:00:00 +0700

Introduction: Patients with primary lung cancer have an elevated risk of cardiovascular disease, which requires further assessment. In which, a non-ECG-gated chest CT scan performed for lung cancer staging may be used to reveal coronary artery calcification.

Objective: The objective of this study was to determine the prevalence of coronary artery calcification using a non-ECG gated staging chest CT scan in patients with primary lung cancer.

Methods: A retrospective review of fifty-one patients with primary lung cancer and at least one staging chest CT was carried out from May 1, 2020, to August 31, 2021, in Thammasat University Hospital. The prevalence of coronary artery calcification identified on the non-ECG gated staging chest CT was documented. Coronary artery calcium scores were analyzed using automated computerized software, employing the Agatston method. The association between coronary artery calcium scores and established cardiovascular disease risk factors, including age, sex, smoking behavior, systolic blood pressure, diabetes mellitus, and serum low-density
lipoprotein level was examined.

Results: The observed prevalence of coronary artery calcification on non-ECG gated staging chest CT scans was 74.5%. The median coronary artery calcium score was 46.03, with an inter quartile range (IQR) of 0-259.81. Thirteen patients did not have coronary artery calcification, twenty-five patients had coronary artery calcium scores equal to or less than 300, and thir teen patients had scores greater than 300. No significant association was identified between coronary artery calcium scores and cardiovascular disease risk factors.

Conclusions: Patients with primary lung cancer have a high prevalence of coronary artery calcification, and coronary artery calcium scores can be calculated from non-ECG gated staging CT chest scans.

Prevalence of Hematoma Expansion and Signs in Non-contrast Computed Tomography for Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage at Siriraj Hospital

Tue, 31 Dec 2024 00:00:00 +0700

Introduction: Hematoma expansion (HE) in intracerebral hemorrhage (ICH), defined by over 33% or > 6 ml volume increase, often leads to poor outcomes and mortality. This study aims to examine non-contrast computed tomography (NCCT) indicators for HE prediction and their associations with patient clinical data and HE occurrence.

Methods: We retrospectively analyzed data and measured HE by using image analysis software in NCCT images including initial and follow-up scan at <7 days from 169 patients during Jan 2013 - Aug 2019 in Siriraj Hospital.

Results: HE was found in 44 of the 169 patients with spontaneous ICH (26%), occurring in two periods: at 10–25 h (peak 7 h) and at 50–75 h (peak 50 h). Atrial Fibrillation (AF) and anticoagulant use were more prevalent in the HE group (15.9% and 20.5%) compared to the non-HE group (4.8% and 7.2%, p = 0.042 and p = 0.022). HE was linked to increased 60-day and 90-day mortality (29% and 32.3%, p = 0.016 and p = 0.010) and decreased time to follow-up scan (median = 21 h and 48 h). Satellite sign, heterogeneous density, intra-hematoma hypodensity, and fluid level prevalence were 46.2%, 35.5%, 21.9%, and 4.1%, but only heterogeneous density and intra-hematoma hypodensity were significantly associated with HE (p =0.003 and p =0.011), with heterogeneous density being an independent predictor (OR, 2.4; 95% CI, 1.2-5.1, p = 0.019) according to logistic regression analysis.

Conclusions: Heterogeneous density in NCCT is found as an independent predictor of HE among other significant HE-associated findings, which included heterogeneous density, intra-hematoma hypodensity, and various clinical data. Two peaks in expansion activity related to HE development were noted, a novel finding in this study, emphasizes the importance of delayed follow-up NCCT.

Self-assessment of Ophthalmology Competency among Thai Medical Interns

Pakornkit Phrueksaudomchai, Passawut Tokeaw — Tue, 31 Dec 2024 00:00:00 +0700

Introduction: Ocular issues encountered in general practice significantly impact patients’ health and quality of life. However, Thai medical undergraduate programs dedicate only 1-2 weeks to ophthalmology rotation, potentially impacting students’ knowledge, skills, and confidence in managing patients with eye problems. Despite this potential concern, limited empirical evidence on students’ competency exists. This study investigates the knowledge, skills, and confidence of medical interns in ophthalmology to inform curriculum development within Thailand’s medical schools.

Objectives: To evaluate ophthalmology competency of Thai medical interns through self-assessment questionnaires.

Methods: A cross-sectional descriptive design was used to survey 160 medical interns who graduated from Thai medical schools nationwide. A self-assessment questionnaire assessed their knowledge and confidence in ophthalmic diseases and procedures. The questionnaire also investigated their perceptions of the training duration’s adequacy.

Results: The study reveals that 51.9% of interns spent 2 weeks and 25.5% spent 4 weeks in ophthal mology rotation. The majority of interns (49.4%) think that time spent on ophthalmology rotation is adequate but needs some curricular improvement while 43.1% think that it is not adequate. The top three topics that interns want more clinical exposure are “ocular emergency” (68.1%), “ophthalmic procedure” (62.5%) and “ophthalmic examination” (53.1%). Regarding self-assessed knowledge level, Thai medical interns chose glaucoma, hyphema and corneal abrasion as areas where they have the least knowledge level, respectively. Glaucoma and hyphema are areas that they had the least confidence level. Time spent on ophthalmology rotation did not correlate with interns’ confidence and knowledge levels.

Conclusion: This study illustrates areas for improvement in ophthalmology education within Thai medical schools. While most interns felt comfortable with common eye diseases, knowledge gaps existed for some specific diseases. By using targeted educational strategies to address knowledge gaps and enhance practical procedural skills, the curriculum could be improved without increasing more time spent on ophthalmology rotation. These findings can guide improvements in ophthalmology education, ultimately leading to better care for eye patients.

The Cerebral to Middle Cerebellar Peduncle Width Ratio: An Imaging Biomarker for Differentiating Multiple System Atrophy from Degenerative Parkinsonism

Shinnaphat Wattanasin, Praween Lolekha — Tue, 31 Dec 2024 00:00:00 +0700

Introduction: The differentiation between Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS) is clinically challenging. Magnetic resonance imaging (MRI) measurement of the cerebral peduncle (CP) and middle cerebellar peduncle (MCP) axial widths have not been investigated. The objective was to evaluate the utility of the CP and MCP axial widths in the differentiation of degenerative parkinsonian syndromes and their clinical correlations.

Methods: The CP and MCP were retrospectively measured based on the axial T1-weighted MRI in 100 patients with probable PD, multiple system atrophy (MSA), progressive supranuclear palsy, Lewy body dementia, or Alzheimer’s disease from the movement disorders clinic at Thammasat University Hospital between January 2018 and December 2021 and in ten controls. Diagnostic accuracy was determined based on the final diagnosis. The Schwab & England activity of daily living (ADL), the Hoehn & Yahr (H&Y), and the levodopa equivalence dose (LED) were evaluated.

Results: Patients with parkinsonian syndromes had smaller mean CP and MCP axial widths than controls. Patients with probable MSA had the largest axial CP widths and the smallest MCP axial widths. A CP to MCP width ratio ≥ 0.88 suggested the diagnosis of probable MSA (sensitivity 90.0%, specificity 91.2%, AUC 0.93). There was no difference in the CP width between probable PD and APS. The small CP width correlated with advanced age and poor ADL, while the small MCP width was associated with poor ADL, advanced H&Y, and low LED.

Conclusion: This study shows the benefit of using CP and MCP axial widths as an imaging biomarker for patients with degenerative parkinsonian syndromes and could help differentiate MSA patients from others with parkinsonism.

Pseudomonas aeruginosa and Its Resistance

Thana Khawcharoenporn — Tue, 31 Dec 2024 00:00:00 +0700