Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study.

OBJECTIVE: Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies. METHODS: This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing. RESULTS: Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins. CONCLUSION: The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.

The impact of rotavirus vaccination on acute diarrhea in Thai children under 5 years of age in the first year of universal implementation of rotavirus vaccines in the National Immunization Program (NIP) in Thailand: a 6-year analysis.

BACKGROUND: Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015-2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). METHODS: Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015-2020, which were recorded as International Classification of Diseases and Related Health Problem 10th (ICD-10), were analyzed. RESULTS: The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P < 0.001), or a 17.8% reduction (incidence rate ratio (IRR) = 0.82; 95% confidence interval (CI): 0.81 to 0.82). The admission rate significantly declined from 31.4 to 30.5 cases per 1,000 person-years, (P < 0.001), or a 2.9% reduction (IRR = 0.97; 95% CI: 0.96 to 0.98). The diarrheal-related mortality rate also subsided from 10.2 to 8.1 cases per 100,000 person-years (P 0.3), or a 20.0% reduction (IRR = 0.88; 95% CI: 0.50 to 1.22). The major population in both admissions and deaths was infants under 1 year of age (P < 0.001). Seasonality was seen as a constant bimodal pattern, with a significant decrease in monthly admissions after 6 months of rotavirus vaccine introduction to NIP (P < 0.001). RotaC was 37.4% in the first year of NIP. CONCLUSIONS: The rotavirus vaccine had a potential benefit for reducing the diarrheal disease burden, especially in infants under one year of age. Seasonality outbreaks of acute diarrhea subsided after the rotavirus vaccine was introduced. The RotaC was fairly low in the first year of the NIP. The quality of the rotavirus vaccine should be warranted. TRIAL REGISTRATION: Number TCTR20220120003 , date of registration: 20/01/2022, site: Thai Clinical Trials Registry.

Mortality and Comorbidities in Extremely Low Birth Weight Thai Infants: A Nationwide Data Analysis.

This is the first nationwide study aimed to evaluate in-hospital mortality and comorbidities of extremely low birth weight (ELBW) infants in Thailand between 2015-2020. Data of ELBW infants were collected from the National Health Coverage Scheme. The incidence of ELBW Thai infants was 1.75 per 1000 live births. Sixty-five percent of ELBW infants were delivered in tertiary-care facilities, with 63% surviving until discharge. In-hospital mortality was 36.9%. Non-invasive respiratory supports were documented in just 17.6% of the study population, whereas total parenteral nutrition was used in 52.3% of neonates. There were several comorbidities, with the three most frequent including respiratory distress syndrome (70.7%), neonatal jaundice (66.7%), and sepsis (60.4%). The median hospitalization cost for one ELBW infant who survived was 296,438.40 baht ($8719). Conclusion: Thailand had an acceptable ELBW infant survival rate (63%), but comorbidities remained particularly severe and cost one hundred times the median hospital cost for one ELBW infant that survived in comparison to a normal newborn infant. Better health outcomes require strategies to raise awareness of the issues and the appropriate implementation of evidence-based solutions, particularly improving neonatal care facilities, as well as early referral of high-risk pregnant women and neonates, which will aid in the future reduction of neonatal morbidities and mortalities.

Burden of Respiratory Syncytial Virus Related Acute Lower Respiratory Tract Infection in Hospitalized Thai Children: A 6-Year National Data Analysis.

Objectives: This study sought to determine the epidemiology, seasonal variations, morbidity, and mortality of respiratory syncytial virus (RSV) infection among hospitalized children with lower respiratory tract infection in Thailand. In addition, we assessed the risk factors associated with severe RSV lower respiratory tract infection (LRTI)-related morbidity and mortality. Methods: The data were reviewed retrospectively from the National Health Security Office for hospitalized children younger than 18 years old diagnosed with RSV-related LRTI in Thailand, between the fiscal years of 2015 to 2020. The RSV-related LRTIs were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification. ICD-10-TM codes J12.1, J20.5, and J21.0, which represent respiratory syncytial virus pneumonia, acute bronchitis due to respiratory syncytial virus, and acute bronchiolitis due to respiratory syncytial virus, respectively, were studied. Results: During the study period, RSV-related LRTI accounted for 19,340 of the 1,610,160 hospital admissions due to LRTI. RSV pneumonia was the leading cause of hospitalization (13,684/19,340; 70.76%), followed by bronchiolitis (2849/19,340; 14.73%) and bronchitis (2807/19,340; 14.51%), respectively. The highest peak incidence of 73.55 percent occurred during Thailand's rainy season, from August to October. The mortality rate of RSV-related LRTI in infants younger than 1 year of age was 1.75 per 100,000 person years, which was significantly higher than that of children 1 to younger than 5 years old and children 5 to younger than 18 years old (0.21 per 100,000 person years and 0.01 per 100,000 person years, respectively, p-value < 0.001). Factors associated with mortality were congenital heart disease, hematologic malignancy, malnutrition, and neurological disease. Conclusions: In children with RSV LRTI, pneumonia was the leading cause of hospitalization. The admission rate was highest during the rainy season. Mortality from RSV-related LRTI was higher in children under 1 year old and in children with underlying illnesses; future preventive interventions should target these groups of patients.

Epidemiology and prognostic factors for successful expectant management of early-onset severe features preeclampsia: A retrospective multicenter cohort study.

BACKGROUND: To determine the incidence of early-onset severe features preeclampsia among pregnant women and compare maternal complications and perinatal outcome characteristics of expectance and immediate delivery management with identified prognosis factors for successful expectant management. MATERIALS AND METHODS: A retrospective descriptive multicenter cohort study of pregnant women diagnosed with severe features preeclampsia before 34 weeks of gestation according to the American College of Obstetricians and Gynecologists guidelines was conducted at Khon Kaen University, Srinagarind Hospital and Khon Kaen Hospital between January 1, 2015 and December 31, 2019. Medical records were reviewed for incidence of early-onset severe features preeclampsia, with maternal complications and perinatal outcome characteristics compared for expectant and immediate delivery management. RESULTS: In total, 42,948 deliveries were recorded during the study period. Of these, 971 were diagnosed with severe features preeclampsia (22 per 1,000 deliveries). Two hundred and sixty-five women (6.3 per 1,000 deliveries) were diagnosed with early-onset severe features preeclampsia before 34 weeks of gestation. No differences were recorded in characteristics between the expectant and delivery management groups. Perinatal outcomes were significantly different between the expectant and delivery management groups; birth weight below 1,500 g (23.5 % versus 58.9 %, p < 0.001), neonatal intensive care unit (65.9 % versus 87.2 %, p < 0.001); neonatal resuscitation (22.3 % versus 57.1 %, p < 0.001). Birth asphyxia, stillbirth and intrapartum death only occurred in women with early-onset severe features preeclampsia in the delivery management group. CONCLUSIONS: Incidence of early-onset severe features preeclampsia was 6.3 per 1,000 deliveries. For women with complications such as early-onset severe features preeclampsia, expectant management significantly benefitted neonatal outcomes, with no differences in maternal outcomes compared to the immediate delivery management group. The gestational age at diagnosis of more than 30 weeks and uric acid level of less than 5.5 mg/dL (327.14 µmol/L) were significant factors for the successful expectant management.

Effect of the COVID-19 Pandemic on Lower Respiratory Tract Infection Determinants in Thai Hospitalized Children: National Data Analysis 2015-2020.

Background: The COVID-19 outbreak emerged in January 2020 and remains present in 2022. During this period, nonpharmaceutical interventions (NPIs) have been used to reduce the spread of COVID-19 infection. Nationwide data analysis should be pushed as the new standard to demonstrate the impact of COVID-19 infection on other respiratory illnesses and the reliability of NPIs during treatment. Objective: This study aims to identify and compare the incidence of lower respiratory tract infections (LRTIs) among children in Thailand before and after the emergence of COVID-19. Methods: A retrospective study was carried out in hospitalized children under the age of 18 in Thailand from October 2015 to September 2020. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification, was used to identify patient diagnoses (ICD-10-TM). The data were extracted from the Universal Coverage Health Security Scheme Database. Results: A total of 1,610,160 admissions were attributed to LRTIs. The most common diagnosis was pneumonia (61.9%). Compared to the 2019 fiscal year, the number of hospitalizations due to LRTIs decreased by 33.9% in the 2020 fiscal year (COVID-19 period) (282,590 vs. 186,651). The incidence of all three diagnostic groupings was substantially lower in the pre- and post-COVID-19 eras, with a decrease of 28% in the pneumonia group (incidence rate ratio (IRR) = 0.72; 95% confidence interval (CI): 0.71 to 0.72), 44% in the bronchiolitis group (IRR = 0.56; 95% CI: 0.55 to 0.57), and 34% in the bronchitis group (IRR = 0.66; 95% CI: 0.65 to 0.67). Between fiscal years 2019 and 2020, the overall monthly cost of all hospitalizations for LRTIs decreased considerably (p value < 0.001). Conclusions: NPIs may decrease the number of pediatric hospitalizations related to LRTIs. All policies designed to prevent the spread of COVID-19 must be continually utilized to maintain the prevention of LRTIs.

Burden and pattern of acute diarrhea in Thai children under 5 years of age: a 5-year descriptive analysis based on Thailand National Health Coverage (NHC) data.

BACKGROUND: The incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019. METHODS: Data regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed. RESULTS: The incidence trend of yearly acute diarrhea in children 0-5 years of age slightly increased from 33.36 cases per 1,000 population in 2010 to an average of 33.79 cases per 1,000 population/ year from 2015 to 2019 or approximately 0.43 cases per 1,000 population over the last decade while diarrhea-related mortality had a low, constant rate of 0.71 to 1.16 per 100,000 population per year. Two thirds of the mortality rate was observed in children under 1 year of age or 4.1 cases per 100,000 person-years in 5-year period (P < 0.01). The high cost of performing the medical treatment of approximately four hundred million baht per year. Seasonal variations demonstrated consistency with similar patterns during the cold and rainy seasons throughout the 5-year period. Regional distribution of the causative agent was also observed in Cholera, Typhoid, and Amoebiasis cases. A08: viral and other specified intestinal infections and A09: other gastroenteritis and colitis of infectious and unspecified origin were the two most common causes of diarrheal diseases. CONCLUSIONS: The incidence rate of acute diarrhea in Thai children under five years of age was higher while the mortality rate of acute diarrhea was lower than those in the past decade. A similar seasonal outbreak of acute diarrhea was seen during each examined year. The causative agent was not significant and was mainly unspecific. TRIAL REGISTRATION: Number TCTR20220117002, date of registration: 17/01/2022, site: Thai Clinical Trials Registry, URL http://www.thaiclinicaltrials.org/show/TCTR20220117002.

Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019.

OBJECTIVES: Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database. METHODS: Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63). RESULTS: Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM. CONCLUSIONS: Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes.

Epidemiology of acute lower respiratory tract infection hospitalizations in Thai children: A 5-year national data analysis.

BACKGROUND: Lower respiratory tract infections (LRTIs) are the most common cause for hospitalization in pediatric patients. Pediatric patients with LRTIs are at an increased risk of morbidity and mortality. The national data analysis of epidemiologic variations facilitates awareness and develops solutions to prevent these conditions in the future. OBJECTIVE: This study aims to evaluate the epidemiology, causative pathogens, morbidity, and mortality of LRTIs in pediatric patients of Thailand from 2015 to 2019. METHODS: This was a retrospective study among pediatric patients aged between 0 and 18 years old admitted in hospitals due to LRTIs in Thailand from January 2015 to December 2019. The data were extracted from National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification; ICD-10-TM of J09 to J22. RESULTS: A total of 1,423,509 children hospitalized due to LRTIs were identified. Most of the patients were of age 1-5 years. Pneumonia was the most common LRTI (876,557 children, 61.58%) in hospitalized children. Respiratory syncytial virus (RSV) is the main etiologic pathogen of bronchiolitis, which presents in approximately 10.86% of all episodes. Influenza viruses were found predominantly in children with pneumonia (15.52%). The mortality rate since 2015-2019 was highest in pneumonia under 1 year old (P < 0.001). Pneumonia in children under 5 years old had the highest mortality rate, which accounted for 11.85 per 100,000 children in 2019. CONCLUSIONS: LRTIs had a high incidence rate of hospitalization and mortality, especially in children under 5 years old. Influenza virus was the most common pathogen of pneumonia.

Comparison of Low Dose versus High Dose of Oxytocin for Initiating Uterine Contraction During Cesarean Delivery: A Randomized, Controlled, Non-Inferiority Trial.

BACKGROUND: Oxytocin is used for initiating uterine contraction and preventing postpartum hemorrhage during caesarean delivery. Using a lower dosage of oxytocin may lower the risk of adverse effects while still being effective in stimulating initial uterine contraction. We aimed to compare the effectiveness and side effects of the standard 10 IU bolus of oxytocin with those of a 5 IU bolus during caesarean delivery. PATIENTS AND METHODS: We enrolled women in a randomized, double-blind, study comparing intravenous injections of high-dose (10 IU) and low-dose (5 IU) oxytocin administered after clamping of the umbilical cord. The primary outcome was adequate uterine contraction within the first 3 mins after administration. Secondary outcomes included uterine tone, use of additional uterotonic agents, additional obstetrics procedures, and oxytocin-related adverse events. RESULTS: A total of 155 women underwent randomization, with 78 in the low-dose group and 77 in the high-dose group. The proportion of women with adequate uterine contraction during the first 3 mins was 84.6% in the low-dose group and 77.9% in the high-dose group (relative risk, 1.09; 95% CI, 0.93 to 1.26). Methylergonovine maleate was used in 14.1% of cases in the low-dose group and 36.4% in the high-dose group (relative risk, 0.40; 95% CI, 0.22 to 0.73). The necessity for additional obstetric procedures, estimated blood loss >500 mL, neonatal outcomes, and oxytocin-related adverse effects did not differ significantly between the two groups. CONCLUSION: The 5 IU bolus of oxytocin was noninferior to the standard 10 IU bolus of oxytocin for initiating adequate uterine contraction, required fewer additional uterotonic agents, and led to fewer oxytocin-related adverse events.

The Transverse versus the Sagittal Approach in First-Trimester Uterine Artery Doppler Measurement.

OBJECTIVE: The uterine artery pulsatility index (UtA-PI) is an important marker for predicting and assessing the risk of various complications such as pre-eclampsia and fetal growth restriction. The measurement of UtA-PI in the first trimester is usually conducted via the sagittal approach. The aim of this study was to evaluate UtA Doppler measurement using the transverse approach in the first trimester. METHODS: This was a prospective observational study of 50 women with singleton pregnancy at between 11-13+6 weeks of gestation. Uterine artery (UtA) Doppler variables were measured using both the transverse and sagittal approach. The two approaches were compared in terms of time required to complete the measurements and early diastolic notch. The sample t-test and Wilcoxon rank sign test were used to analyze the outcomes when appropriate. Bland-Altman plots were used to determine the agreement between the two approaches. A P-value <0.05 was considered statistically significant. Intra-class correlation (ICC) was used to evaluate the reliability of measurements. RESULTS: There were a total of 50 pregnant women who participated in the study and completed the study protocol. The mean age of all subjects was 29.6 years, and 24 (48%) were nulliparous. We observed no difference in terms of mean UtA-PI between the two approaches (sagittal: 2.04, transverse: 2.03; mean difference 0.01, CI -0.01, 0.04; p>0.309), nor in the means of any other UtA variables. However, there were differences between the two approaches in terms of early diastolic notch (sagittal: 11, transverse: 13; p>0.999) and the mean time required to complete the measurements (transverse: 21.7 s, sagittal: 24.3 s; p=0.001). The intra-class correlation coefficients (ICCs) were 0.985, 0.963, and 0.988 for the right, left, and mean UtA-PIs respectively. CONCLUSION: The transverse approach at a bladder depth of less than 5 cm performed better than the sagittal approach in the measurement of first-trimester uterine arteries. It may, thus, may be useful as a complementary approach in cases in which there is difficulty obtaining measurements using the sagittal approach.

Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome.

OBJECTIVE: To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. MATERIALS AND METHODS: A retrospective descriptive study was conducted at Khon Kaen University's Srinagarind Hospital, a tertiary care facility in northeast Thailand. The pregnant women who had been diagnosed with preeclampsia according to American College of Obstetricians and Gynecologists guidelines from January 1, 2012 to December 31, 2016 were identified and their medical records were reviewed. Various characteristics were examined to compare maternal complications and perinatal outcomes. RESULTS: There was a total of 11,199 deliveries during the study period, out of which 213 preeclamptic women were identified. One hundred and seven women (9.6 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (1.4 per 1,000 deliveries) had HELLP syndrome. Twenty-one women (9.9%) experienced postpartum hemorrhage; 11 (10.3%) in the nonsevere features preeclampsia group and 10 (9.4%) in the preeclampsia with severe features and HELLP syndrome group. Placental abruption (3 women; 1.4%) and heart failure (1 women; 0.4%) only occurred among women in the preeclampsia with severe features group. Neonatal complications were significantly higher in the preeclampsia with severe features and HELLP syndrome group (low birth weight =35.1% versus 74.3%, p<0.001; birth asphyxia =4.4% versus 18.2%, p=0.001; neonatal intensive care unit admission =7.0% versus 30.9%, p<0.001; neonatal resuscitation =15.8% versus 42.7%, p<0.001). Stillbirths only occurred in cases of preeclampsia with severe features and HELLP syndrome (3 cases, 1.4%). Intrapartum death was higher in cases of preeclampsia with severe features and HELLP syndrome, but without statistical significance (2.6% versus 6.4%, p=0.190). CONCLUSION: The incidence of preeclampsia with severe features and HELLP syndrome was 9.5 per 1,000 deliveries. Severe maternal and perinatal outcomes were more commonly observed.

Factors predicting the outcomes of elderly hospitalized myasthenia gravis patients: a national database study.

BACKGROUND: Myasthenia gravis (MG) in elderly populations is increasing. This study aimed to evaluate predictors for treatment outcomes in elderly hospitalized MG patients using the national database. METHODS: We collected data of elderly hospitalized MG patients from the National Health Security Office from October 2009 to September 2010. Predictors for treatment outcomes were examined. RESULTS: During the study period, 1,948 identified MG patients were admitted to hospitals throughout Thailand. Of those, 441 patients (22.64%) were aged ≥ 60 years. There were 66 patients (14.97%) who had poor outcomes. There were only three significant factors in the final model. Presence of pneumonia, use of mechanical ventilators, and septicemia had adjusted odds ratios (95% confidence interval) of 2.83 (1.03, 7.75), 5.33 (2.24, 12.72), and 4.47 (1.86, 10.75), respectively. CONCLUSION: Pneumonia, being on a mechanical ventilator, and septicemia were independent factors associated with poor treatment outcomes in elderly hospitalized MG patients according to national data.

Status epilepticus in the elderly patients: A national data study in Thailand.

There are limited data in terms of incidence, clinical features, and outcomes in elderly patients with status epilepticus (SE) in national level. We retrospectively explored national data in Thailand for reimbursement of all SE in elderly patients admitted in the fiscal year 2004-2012. SE in elderly patients (age>60years old) were diagnosed and searched based on ICD 10 (G41) from the national database of from the National Health and Security Office. There were 3326 SE in elderly patients. The national incidence of SE was highest at 8.78patients/100,000/year in 2012. The average age was 72.02years and most were males (1379 patients; 58.8%). At discharge, 66% of patients had improved and in-hospital mortality rate was 14.5%. Predictors of poor outcomes were older age≥80years, being female, hospital levels, chronic renal failure, central nervous system infection, respiratory failure, pneumonia, septicemia, shock, acute renal failure, and hyperkalemia. In conclusion, the number of cases of SE in elderly patients in Thailand has been increasing annually. Increasing age was associated with poor outcome in admitted elderly SE patients.

Mortality and treatment costs of hospitalized chronic kidney disease patients between the three major health insurance schemes in Thailand.

BACKGROUND: Thailand has reformed its healthcare to ensure fairness and universality. Previous reports comparing the fairness among the 3 main healthcare schemes, including the Universal Coverage Scheme (UCS), the Civil Servant Medical Benefit Scheme (CSMBS) and the Social Health Insurance (SHI) have been published. They focused mainly on provision of medication for cancers and human immunodeficiency virus infection. Since chronic kidney disease (CKD) patients have a high rate of hospitalization and high risk of death, they also require special care and need more than access to medicine. We, therefore, performed a 1-year, nationwide, evaluation on the clinical outcomes (i.e., mortality rates and complication rates) and treatment costs for hospitalized CKD patients across the 3 main health insurance schemes. METHODS: All adult in-patient CKD medical expense forms in fiscal 2010 were analyzed. The outcomes focused on were clinical outcomes, access to special care and equipment (especially dialysis), and expenses on CKD patients. Factors influencing mortality rates were evaluated by multiple logistic regression. RESULTS: There were 128,338 CKD patients, accounting for 236,439 admissions. The CSMBS group was older on average, had the most severe co-morbidities, and had the highest hospital charges, while the UCS group had the highest rate of complications. The mortality rates differed among the 3 insurance schemes; the crude odds ratio (OR) for mortality was highest in the CSMBS scheme. After adjustment for biological, economic, and geographic variables, the UCS group had the highest risk of in-hospital death (OR 1.13;95 % confidence interval (CI) 1.07-1.20; p < 0.001) while the SHI group had lowest mortality (OR 0.87; 95 % CI 0.76-0.99; p = 0.038). The circumscribed healthcare benefits and limited access to specialists and dialysis care in the UCS may account for less favorable comparison with the CSMBS and SHI groups. CONCLUSIONS: Significant differences are observed in mortality rates among CKD patients from among the 3 main healthcare schemes. Improvements in equity of care might minimize the differences.

An Evaluation of Blood Glucose Measurement Using TRUEresult Blood Glucose Monitoring System.

BACKGROUND: Point of care testing using glucose meters that measure capillary blood are the most popular and widely used method for the routine monitoring ofblood glucose level. TR UEresult is one ofsuch commonly used blood glucose measuring tools with high accuracy and precision profile according to the manufacturer's data. OBJECTIVE: To evaluate the performance of TRUEresult in real life practice by examining the agreement between capillary and venous glucose result using TR UEresult and a laboratory plasma glucose. MATERIAL AND METHOD: The present study is a cross sectional analytical study. All the data were collected from the patients whose blood samples were drawn for the measurement of plasma glucose at the outpatient department of Srinagarind Hospital, Khon Kaen University Thailand. TR UEresult blood glucose monitoring system was used to perform blood glucose measurement in whole blood samples from capillary and veins. This was compared with plasma glucose result from the automated analyzer in the central laboratory, which was considered as reference method at Srinagarind Hospital. RESULTS: The ISO 15197:2013 criteria was used to determine technical accuracy of the TRUEresult tool. Blood glucose levels in whole blood sample from capillary and veins, as measured using the TRUEresult, were 88.24% and 92.16% of the acceptable bias limits. This is below the minimal acceptable criteria. When Parkes error grid analysis was used to define the significance in clinical decision, all the errors of blood glucose levels measured using the TRUEresult were within zone A and zone B, meaning that the errors have no or little influence on clinical decision. CONCLUSION: The blood glucose levels in whole bloodfrom capillary and veins measured using TR UEresult blood glucose monitoring was within acceptable accuracy limit. The observed error had no or little influence on clinical decision.

The burden of cirrhosis and impact of universal coverage public health care system in Thailand: Nationwide study.

BACKGROUND AND RATIONALE: Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand. MATERIAL AND METHODS: We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS). RESULTS: 92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001). CONCLUSIONS: Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.

Incidences and outcomes of status epilepticus: A 9-year longitudinal national study.

INTRODUCTION: The national database of status epilepticus (SE) in Thailand is limited in terms of the characteristics of the demographics, outcome, and prognostic factors. MATERIALS AND METHODS: We retrospectively explored national data in Thailand for reimbursement of all adult patients with SE admitted in the fiscal year 2004-2012. Patients with SE were diagnosed and searched based on ICD 10 (G41) from the national database of the Universal Health Coverage Insurance office. RESULTS: There were 12,367 patients with SE. The average age was 48.14 years, and 8119 patients were males (65.7%). At discharge, 75.2% of patients were improved, while 16.4% were not improved, and in-hospital mortality rate was 8.4%. The first three most common comorbid conditions were hypertension (1790 patients, 14.5%), diabetes mellitus (1064 patients, 8.6%), and previous stroke (819 patients, 6.6%). The common complications were respiratory failure (3990 patients, 32.3%), pneumonia (1201 patients, 9.7%) and septicemia (876 patients, 7.1%). The mean (SD) hospital stay was 5.48 (11.44) days. Patients with SE with age over 60 years, female patients, and patients at primary care hospitals had higher proportions of poor outcomes at 36.1%, 39.6%, and 40.9%. Out of 11 comorbid conditions, six of them were significantly associated with poor outcomes. Additionally, 5 complications and two procedures were significant factors of poor outcomes. CONCLUSIONS: Factors associated with poor outcome in admitted patients with SE by the national data were age, gender, hospital level, comorbid conditions, complications of SE, and procedural intervention. This article is part of a Special Issue entitled "Status Epilepticus".

National data on stroke outcomes in Thailand.

Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand.