Long-term outcomes of anti-thyroid drug treatment in childhood-onset Graves' disease.

OBJECTIVE: Outcomes of childhood-onset Graves' disease (GD) and suggested duration of anti-thyroid drug (ATD) therapy have been controversial. This study aimed to determine long-term outcomes following ATD therapy, including remission and relapse rates. DESIGN, PATIENTS AND MEASUREMENTS: A retrospective study of 265 paediatric patients with GD who were initially treated with ATD was conducted. Long-term outcomes were analysed. RESULTS: Median (IQR) age at diagnosis was 11.5 (9.4, 13.7) years. Duration of ATD treatment was 4.3 (2.3, 6.7) years and time since diagnosis to the enrolment was 7.1 (3.8, 10.9) years. There were 77, 93 and 95 patients who underwent definitive treatment, had ATD discontinuation, and were still being treated with ATD, respectively. The remission rate was 21% (56 out of 265 patients) and relapse rate was 40% (37 out of 93 patients). Cumulative incidence of first remission increased with the duration of ATD treatment with maximum remission rate at 5.3 years following ATD therapy. Among patients who experienced relapse, approximately 50% had disease relapse which occurred within 1 year after ATD discontinuation. Patients with goitre size of less than 3.5 cm, thyroid-stimulating hormone receptor antibody of less than 10 IU/L, no ophthalmopathy at diagnosis and methimazole dose requirement of less than 0.25 mg/kg/day at 1 year after treatment were more likely to achieve remission. CONCLUSIONS: Remission rate of childhood-onset GD was relatively low following ATD treatment. Longer-term ATD therapy was associated with increased remission rate. Approximately 50% of patients with relapse had disease relapse within 1 year following ATD discontinuation.

Incidences of newly diagnosed childhood diabetes and onset severity: a multicenter regional study in Thailand over two decades and during the COVID-19 pandemic.

OBJECTIVES: While global  incidence rates (IR) of childhood diabetes are increasing, there is a notable lack  of current information on the incidence of childhood-onset diabetes in Thailand. This study aims to illustrate the age-standardized IR and types of childhood diabetes using multicenter regional data in Northern Thailand from 2005 to 2022 and to assess the impact of the COVID-19 pandemic. METHODS: Data on newly diagnosed childhood diabetes were retrospectively collected between 2005 and 2016 and prospectively recorded for all incident cases between 2016 and 2022. The capture-recapture method was applied to estimate the completeness of ascertainment. The age-standardized IR of diabetes was calculated. The IR of diabetes and the prevalence/severity of DKA at onset were compared between the pre-pandemic and pandemic periods. RESULTS: Among 210 patients, type 1 diabetes (T1D) accounted for 56.2 %, type 2 diabetes (T2D) for 39 %, and other types for 4.8 %. The T1D age-standardized IR significantly increased from 0.30 in 2005 to 3.11/100,000 person/year in 2022, mirroring the T2D trend, which increased from 0.33 to 3.15/100,000 person/year. The average T1D age-standardized IR, including the prevalence/severity of DKA at diagnosis, did not significantly differ between the pre-pandemic and pandemic periods (2.11 vs. 2.36/100,000 person/year, p-value=0.67). However, the average T2D age-standardized IR significantly increased from 0.83 to 2.15/100,000 person/year during the pandemic (p-value=0.0057). CONCLUSIONS: This study highlights an increased incidence of childhood T1D and T2D in Northern Thailand over a two-decade period. Notably, during the COVID-19 pandemic, the T1D incidence remained stable, while a significant rise in T2D incidence was observed.

Accuracy of various recent recommendations to estimate the optimal depth of orotracheal tube in Thai neonates.

BACKGROUND: Malposition of an endotracheal tube (ETT) may lead to many serious consequences. Recently, various methods have been proposed to estimate the proper position of orotracheal intubation (Pro-depth) for neonates. OBJECTIVES: To determine and compare the accuracy of various methods for estimating the Pro-depth and to define the most accurate method for the Asian population. METHOD: This cross-sectional study was conducted at the Chiang Mai University Hospital, Thailand in Asian neonates who required orotracheal intubation and their ETT's position were confirmed with anteroposterior chest radiographs. The estimated depths of orotracheal tubes (Est-depth) were calculated by using 4 methods: the rule of 7-8-9, NTL + 1 cm, corrected gestational age (GA)-based table, and body weight (BW)-based table. We defined the Pro-depth as the depth which provided the ETT's tip placed at mid trachea. The Pearson's correlation coefficient, the Bland-Altmann plot and mean differences with standard deviation (SD) between paired Est-depth by each method and Pro-depth were determined. New formulae were generated to estimate the Pro-depth based on a linear regression equation. The accuracy of each method to predict the optimal depth of orotracheal intubation (Opt-depth) was calculated. RESULTS: Fifty-eight Asian neonates were enrolled of which, 82.8% were Thai. The mean ± SD of GA and BW were 33 ± 5 weeks and 1562 ± 842 g, respectively. NTL + 1 cm and the Pro-depth showed the strongest correlation (r = 0.90, p-value < .01) and agreement with mean difference ± SD of 0.28 ± 0.53 cm. The accuracies of the rule of 7-8-9, NTL + 1cm, corrected GA-based and BW-based table to predict the Opt-depth were 56.9%, 63.8%, 62.1%, and 60.3%, respectively. We created two simple formulae for our population to increase the accuracy of NTL parameter: NTL + 1 cm for measured NTL ≤ 6.5 cm and NTL + 0.5 cm for measured NTL > 6.5 cm. This new method provided more accuracy (72.4%) with mean difference ± SD of -0.03 ± 0.53 cm. CONCLUSION: NTL was the most suitable parameter for estimating the Pro-depth. Our new modified NTL method should be used for Thai neonates with high accuracy and non-significantly underestimated trend. However, promptly clinical assessment and final confirmation by a chest radiography should be done in all intubated patients.