Real-World Clinical Burden of Newly Diagnosed Heart failure in Thai Patients.

INTRODUCTION: There are limited data on the burden of newly diagnosed patients with heart failure (HF) in Thailand. Thus, this study aimed to fully understand the hospitalization, rehospitalization, mortality rates, demographics and characteristics, and quality of care in these patients. METHOD: A retrospective review of all eligible adult patients' medical records from 2018 and 2019 was conducted at five hospitals. The patients were newly diagnosed with HF, as indicated by the International Classification of Diseases (ICD)-10 code "I50." Descriptive statistics was used to investigate patients' hospital burden and clinical outcome data. RESULTS: There were 1134 patients newly diagnosed with HF, classified as HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF) (44.0, 40.0, and 16.0%, respectively). The male-to-female ratios in HFmrEF and HFpEF were similar. In contrast, the proportion of men with HFrEF was greater. The mean age of all patients was 66.0 years. The hospitalization rate was 1.3. Rehospitalization rates for HF-related issues were 0.1, 0.2, 0.4, and 0.5 at 30 days, 60 days, 180 days, and 1 year, respectively. The percentage of deaths from all causes among these patients was 9.8%, while the percentage of deaths from cardiovascular-related causes was 8.5%. Only a small proportion of patients received a target dose of guideline-directed medical therapy (GDMT). CONCLUSIONS: The study revealed that the characteristics, hospitalization rate for HF, and in-hospital mortality rate among newly diagnosed patients with HF were higher compared to similar studies conducted in Thailand and other countries. Moreover, a high quality of care is needed to improve the morbidity and mortality associated with HF in Thailand.

Real-World Heart Failure Burden in Thai Patients.

INTRODUCTION: Heart failure (HF) is one of the leading causes of hospitalization worldwide. In Thailand, data on HF burden remains limited. This study aimed to describe comprehensive evidence detailing the HF prevalence, hospital admission rates, in-hospital mortality, and overall mortality rates at the hospital level. METHOD: All eligible adult patients' medical records from 2018 and 2019 were analyzed retrospectively at five hospitals in different regions. The patients were diagnosed with HF, as indicated by the International Classification of Diseases (ICD)-10 code I50. Descriptive statistics were used to examine the hospital burden as well as patients' clinical and outcome data. RESULTS: A total of 7384 patients with HF were identified from five tertiary hospitals. Around half of the patients were male. The mean age was 67 years, and the main health insurance scheme was the Universal Coverage Scheme. The prevalence of HF was 0.1% in 2018 and 0.2% in 2019. Heart failure with preserved ejection fraction (HFpEF) was the most common type of HF in both visits, followed by heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF). The proportion of HF hospitalizations was 1.2% in 2018 and 1.5% in 2019. The proportion of HF rehospitalizations versus hospitalizations in patients with HF was 22.7% in 2018 and 23.9% in 2019. The risk of rehospitalization was highest at 180 days after hospital discharge (87.8%). Among the patients with HF, the proportion of all-cause mortality was 9.1% in 2018 and 8.0% in 2019. Most of the deaths occurred within 30 days after hospitalization. CONCLUSION: Our study demonstrated that the burden of HF in terms of hospitalization and in-hospital mortality was notably high when compared to similar studies conducted in Thailand and other countries.

Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction.

Background: This study aimed to assess the prescribing patterns of evidence-based pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) in Thailand. Methods: A retrospective cohort study of patients with HFrEF was conducted. Treatment with a ß-blocker and renin-angiotensin system inhibitors (RASIs) with or without mineralocorticoid receptor antagonists (MRAs) at discharge was regarded as guideline-directed medical therapy (GDMT). All others were considered non-GDMT. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Inverse-probability-treatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects. Results: In total, 653 patients with HFrEF (mean age 64.1 ± 14.3 years; 55.9% male) were included. GDMT with ß-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%. During a median of 1-year follow-up, 167 patients (27.5%) had a composite event, 81 patients (13.3%) had all-cause mortality, and 109 patients (18.0%) had HF rehospitalization. Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint (adjusted hazard ratio [HR] 0.63; 95% CI 0.44-0.89; p = 0.009) compared with patients who did not receive GDMT. The use of GDMT was also associated with a significantly lower risk of all-cause mortality (adjusted HR 0.59; 95% CI 0.36-0.98; p = 0.045) and HF rehospitalization (adjusted HR 0.65; 95% CI 0.43-0.96; p = 0.031). Conclusions: For HFrEF treatment, GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization. Nevertheless, prescribing GDMT remains underused, and it could be encouraged to improve HF outcomes in real-world settings.

Gaps in the Care of Subjects with Familial Hypercholesterolemia: Insights from the Thai Familial Hypercholesterolemia Registry.

AIMS: Familial hypercholesterolemia (FH) is currently underdiagnosed and undertreated. The establishment of a FH registry could facilitate a deeper understanding of this disease. We described the clinical characteristics of subjects with FH from the Thai FH Registry, compared our data with the regional and global data, and identified gaps in the care of these subjects. METHODS: A multicenter, nationwide prospective FH registry was established in Thailand. Our data were compared with those of the European Atherosclerosis Society-FH Studies Collaboration. Multiple logistic regression analyses were performed for variables associated with lipid-lowering medication (LLM) use and the attainment of low-density lipoprotein-cholesterol (LDL-C) goal. RESULTS: The study includes 472 subjects with FH (mean age at FH diagnosis: 46±12 years, 61.4% women). A history of premature coronary artery disease was found in 12%. The percentage of LLM use in subjects with a Dutch Lipid Clinic Network score of ≥ 6 (probable or definite FH) in our registry (64%) was slightly lower than the regional data but higher than the global data. Among those who received statins, 25.2% and 6.4% achieved LDL-C levels of ＜100 mg/dL and ＜70 mg/dL, respectively. Women with FH were less likely to achieve LDL-C ＜70 mg/dL (adjusted odds ratio: 0.22, 95% confidence interval: 0.06-0.71, p=0.012). CONCLUSIONS: FH in Thailand was diagnosed late, and treatment was inadequate for the majority of subjects. Women with FH were less likely to achieve LDL-C goals. Our insights could potentially help raise awareness and narrow the gap in patient care.

Prevalence and risk factors for persistent atrial fibrillation in obstructive sleep apnea.

Objectives: Obstructive sleep apnea (OSA) is a common cause of atrial fibrillation (AF). The prevalence rate of OSA in AF is highest at 80%. There is limited data if who will develop AF in OSA patients. This study aimed to evaluate the prevalence of AF in patients with OSA and find clinical factors predictive of AF in patients with OSA. Material and Methods: This was a cross-sectional study. We enrolled consecutive patients diagnosed with obstructive sleep apnea diagnosed by polysomnography. The primary outcome was persistent AF identified by electrocardiogram. Prevalence and predictors of AF in patients with OSA were analyzed. Results: During the study period, there were 199 patients with OSA enrolled in the study. Of those, 31 patients (15.57%) had AF. There were five factors in the final model predictive for AF in OSA patients. Among those factors, three factors were independently associated with AF in OSA including age, tiredness, and glomerular filtration rate. The latter two factors were protective factors, while age was a predictor for AF with an adjusted odds ratio (95% confidence interval) of 1.052 (1.004, 1.103). Conclusion: The prevalence of AF in patients with OSA was 15.57%. Elderly patients with renal deterioration are at risk of AF but AF risk was decreasing in patients with tiredness.

Monosodium glutamate consumption reduces the renal excretion of trimethylamine N-oxide and the abundance of Akkermansia muciniphila in the gut.

We previously demonstrated that monosodium glutamate (MSG) consumption increases trimethylamine (TMA) level in the renal tissue as well as dimethylamine and methylamine levels in urine of rats, suggesting the effects of MSG on humans. To better define the findings, we investigated whether MSG consumption alters serum trimethylamine N-oxide (TMAO) level, and as a consequence, induces kidney injury in the rat model. Adult male Wistar rats (n = 40) were randomized to be fed with a standard diet (control group) or a standard diet with 0.5, 1.5 or 3.0 g% MSG corresponding to 7, 21, or 42 g/day in 60 kg man, respectively in drinking water (MSG-treated groups), or a standard diet with 3.0 g% MSG in drinking water which was withdrawn after 4 weeks (MSG-withdrawal group). Blood and urine samples were collected to analyze the TMAO levels using 1H NMR and markers of kidney injury. Fecal samples were also collected for gut microbiota analysis. We found serum TMAO levels increased and urinary TMAO excretion decreased during MSG consumption, in parallel with the increase of the neutrophil gelatinase-associated lipocalin (NGAL) excretion which subsided with the withdrawal of MSG. The fecal 16 S rRNA analysis during MSG consumption showed gut microbiota changes with a consistent suppression of Akkermansia muciniphila, a mucin producing bacteria, but not of TMA-producing bacteria. In conclusions, our findings suggested that prolonged high dose MSG consumption may cause TMAO accumulation in the blood via reduction of renal excretion associated with acute kidney injury. The mechanisms by which MSG reduced TMAO excretion require further investigation.

Differential Association Between Significant Coronary Stenosis and Cardiac Troponin T Serial Algorithms in Chronic Kidney Disease Patients Diagnosed with Non-ST-Segment Elevation Acute Coronary Syndromes.

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. METHODS: This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. RESULTS: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. CONCLUSION: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.

Efficacy and Safety of Low-Dose Prasugrel Versus Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis.

PURPOSE: To assess the efficacy and safety of low-dose prasugrel compared to clopidogrel based on the occurrence of major adverse cardiac events (MACEs) and major bleeding in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were systematically searched up to May 2020 to identify relevant randomized controlled trials (RCTs) and observational studies. A meta-analysis was conducted using a random effects model to estimate relative risks (RRs) with 95% confidence intervals (CIs). The primary efficacy and safety endpoints were MACE and major bleeding, respectively. RESULTS: Three RCTs (n = 2884) and five observational studies (n = 30,117) were included. A meta-analysis of RCTs revealed no significant differences in terms of MACE (RR 0.92, 95% CI 0.74 to 1.16) or major bleeding (RR 0.97, 95% CI 0.57 to 1.65) between low-dose prasugrel and clopidogrel. A meta-analysis of observational studies revealed no significant difference in terms of MACE (RR 1.13, 95% CI 0.82 to 1.55) between the two groups, but low-dose prasugrel was associated with a significantly increased risk of major bleeding (RR 1.33, 95% CI 1.02 to 1.72). CONCLUSIONS: We found that low-dose prasugrel was not associated with changes in MACE or major bleeding compared with clopidogrel in RCTs. However, analysis of data from observational studies revealed that low-dose prasugrel was associated with an increased risk of major bleeding compared with clopidogrel.

Hyponatremia induced Brugada syndrome mimicking ST segment elevation myocardial infarction.

Seventy-three year-old male with history of diabetes, hypertension, and chronic kidney disease stage 3 presented with epigastric pain and hyponatremia. ECG showed new ST segment elevation at precordial leads consistent with Cove-type Brugada ECG pattern. Cardiac catheterization revealed non-significant coronary artery stenosis. He experienced pre-syncope and palpitations a year prior to admission with family history sudden cardiac death. Brugada syndrome was diagnosed. Cove-type Brugada ECG pattern and palpitations resolved with corrected sodium to 135.

Predictive models for Angiostrongylus cantonensis and Gnathostoma spinigerum infection in pathologically or serologically proved eosinophilic meningitis.

OBJECTIVE: The two most common causes of eosinophilic meningitis (EOM) are the parasites: Angiostrongylus cantonensis and Gnathostoma spinigerum. This study aimed to evaluate whether clinical factors can predict either neuroangiostrongyliasis or gnathostomiasis in EOM patients. MATERIALS AND METHODS: We included reports of patients with eosinophils in the CSF and either serological or pathological diagnosis of neuroangiostrongyliasis or gnathostomiasis published in 2014 or earlier and available on PubMed. Predictive clinical models were generated for neuroangiostrongyliasis and gnathostomiasis. RESULTS: In total, 155 patients were included in the study, 24 in the gnathostomiasis group and 131 in the neuroangiostrongyliasis group. According to the separate models, factors associated with neuroangiostrongyliais were gender of male, Pila/Pomacea snail exposure, and headache, and independent factors for gnathostomiasis were weakness (adjusted odds ratio 50.8) and radicular pain (adjusted odds ratio 35.3). The combined model identified two independent factors for neuroangiostrongyliasis: weakness and radicular pain. The laboratory models revealed that xanthochromic CSF perfectly predicted both neuroangiostrongyliasis and gnathostomiasis. Two other predictive factors were blood eosinophilia and CSF eosinophils, which positively predicted gnathostomiasis (adjusted odds ratios of 1.13 and 1.08, respectively). CONCLUSION: Clinical factors may be predictive of neuroangiostrongyliasis and gnathostomiasis in EOM.

Prevalence and factors correlated with hypertension secondary from obstructive sleep apnea.

BACKGROUND: In 2003, the JNC 7 reported obstructive sleep apnea (OSA) as a cause of secondary hypertension. The prevalence of OSA in hypertension ranges from 30-80%. There are limited data on the prevalence and risk factors of OSA in hypertensive patients. This study thus aimed to evaluate prevalence and clinical predictors of obstructive sleep apnea (OSA) in these patients. METHODS: This was a cross-sectional study and conducted at the hypertension clinic at Khon Kaen University's Srinagarind Hospital, Thailand. We enrolled patients with hypertension treated at the clinic. OSA was defined as apnea-hypopnea index of 5 events/hour or over according to cardiopulmonary monitoring. Patients whose hypertension was due to any other causes were excluded. The prevalence of OSA was calculated and risk factors for OSA were analyzed using multivariate logistic regression. RESULTS: There were 726 hypertensive patients treated at the clinic. Out of those, 253 (34.8%) were randomly studied and categorized as either non-OSA (147 patients, 58.1%) or OSA (106 patients, 41.9%). There were four independent factors associated with OSA-induced hypertension: age, sex, history of snoring, and history of headache. Headache had an adjusted odds ratio (95% confidence interval) of 3.564 (95% confidence interval of 1.510, 8.411). CONCLUSION: Age, male sex, history of snoring, and headache were independent predictors of hypertension caused by OSA.

Prevalence and Risk Factors of Obstructive Sleep Apnea in Hypertensive Emergency.

INTRODUCTION: Obstructive sleep apnea (OSA) is a common factor associated with hypertensive crises. There is limited evidence of prevalence and risk factors of OSA in hypertensive emergency. METHODS: This study recruited adult patients who diagnosed as hypertensive emergency and tested for OSA. The study period was between July 2019 and January 2020. The patients were categorized as OSA and non-OSA groups by the evidence from polysomnography. Prevalence and risk factors for OSA were executed. RESULTS: During the study, there were 52 eligible patients. Of those, 30 patients (57.69%) were diagnosed with OSA. The stepwise logistic regression analysis for predicting OSA had two remaining factors: body mass index and diastolic blood pressure. Only body mass index was independently associated with OSA with an adjusted odds ratio of 1.166 (95% confidence interval of 1.033, 1.316). The body mass index of 25.02 kg/m2 gave sensitivity and specificity of 80.00% and 59.09%, respectively. The area under the receiver operating characteristic curve was 70.98%. CONCLUSION: OSA had high incidence rate in patients with hypertensive emergency. High body mass index was a predictor for OSA associated with hypertensive emergency.

Gut microbiota-generated metabolite, trimethylamine-N-oxide, and subclinical myocardial damage: a multicenter study from Thailand.

Plasma Trimethylamine-N-oxide (TMAO), a gut microbiota metabolite from dietary phosphatidylcholine, is mechanistically linked to cardiovascular disease (CVD) and adverse cardiovascular events. We aimed to examine the relationship between plasma TMAO levels and subclinical myocardial damage using high-sensitivity cardiac troponin-T (hs-cTnT). We studied 134 patients for whom TMAO data were available from the Cohort Of patients at a high Risk of Cardiovascular Events-Thailand (CORE-Thailand) registry, including 123 (92%) patients with established atherosclerotic disease and 11 (8%) with multiple risk factors. Plasma TMAO was measured by NMR spectroscopy. In our study cohort (mean age 64 ± 8.9 years; 61% men), median TMAO was 3.81 µM (interquartile range [IQR] 2.89-5.50 µM), and median hs-cTnT was 15.65 ng/L (IQR 10.17-26.67). Older patients and those with diabetic or hypertension were more likely to have higher TMAO levels. Plasma TMAO levels correlated with those of hs-cTnT (r = 0.54; p < 0.0001) and were significantly higher in patients with subclinical myocardial damage (hs-cTnT ≥ 14 ng/L; 4.48 µM vs 2.98 µM p < 0.0001). After adjusting for traditional risk factors, elevated TMAO levels remained independently associated with subclinical myocardial damage (adjusted odds ratio [OR]: 1.58; 95% CI 1.24-2.08; p = 0.0007). This study demonstrated that plasma TMAO was an independent predictor for subclinical myocardial damage in this study population.

Hypertensive crisis in patients with obstructive sleep apnea-induced hypertension.

BACKGROUND: Hypertensive crisis is an urgent/emergency condition. Although obstructive sleep apnea (OSA) in resistant hypertension has been thoroughly examined, information regarding the risk factors and prevalence of hypertensive crisis in co-existing OSA and hypertension is limited. This study thus aimed to determine prevalence of and risk factors for hypertensive crisis in patients with hypertension caused by OSA. METHODS: The inclusion criteria were age of 18 years or over and diagnosis of co-existing OSA and hypertension. Those patients with other causes of secondary hypertension were excluded. Patients were categorized by occurrence of hypertensive crisis. Factors associated with hypertensive crisis were calculated using multivariate logistic regression analysis. RESULTS: There were 121 patients met the study criteria. Of those, 19 patients (15.70%) had history of hypertensive crisis. Those patients in hypertensive crisis group had significant higher systolic and diastolic blood pressure at regular follow-ups than those without hypertensive crisis patients (177 vs. 141 mmHg and 108 vs. 85 mmHg; p value < 0.001 for both factors). After adjusted for age, sex, and Mallampati classification, only systolic blood pressure was independently associated with hypertensive crisis with adjusted odds ratio (95% CI) of 1.046 (1.012, 1.080). CONCLUSIONS: The prevalence of hypertensive crisis in co-existing OSA and hypertension was 15.70% and high systolic blood pressure or uncontrolled blood pressure associated with hypertensive crisis in patients with OSA-associated hypertension.

Association of Combined TCF7L2 and KCNQ1 Gene Polymorphisms with Diabetic Micro- and Macrovascular Complications in Type 2 Diabetes Mellitus.

BACKGROUND: Vascular complications are the major morbid consequences of type 2 diabetes mellitus (T2DM). The transcription factor 7-like 2 (TCF7L2), potassium voltage-gated channel subfamily Q member 1 (KCNQ1), and inwardly-rectifying potassium channel, subfamily J, member 11 gene (KCNJ11) are common T2DM susceptibility genes in various populations. However, the associations between polymorphisms in these genes and diabetic complications are controversial. This study aimed to investigate the effects of combined gene-polymorphisms within TCF7L2, KCNQ1, and KCNJ11 on vascular complications in Thai subjects with T2DM. METHODS: We conducted a case-control study comprising 960 T2DM patients and 740 non-diabetes controls. Single nucleotide polymorphisms in TCF7L2, KCNQ1, and KCNJ11 were genotyped and evaluated for their association with diabetic vascular complications. RESULTS: The gene variants TCF7L2 rs290487-T, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-C were associated with increased risk of T2DM. TCF7L2 rs7903146-C, TCF7L2 rs290487-C, KCNQ1 rs2237892-T, and KCNQ1 rs2237897-T revealed an association with hypertension. The specific combination of risk-alleles that have effects on T2DM and hypertension, TCF7L2 rs7903146-C, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-T, as genetic risk score (GRS), pronounced significant association with coronary artery disease (CAD), cumulative nephropathy and CAD, and cumulative microvascular and macrovascular complications (respective odds ratios [ORs] with 95% confidence interval [95% CI], comparing between GRS 2-3 and GRS 5-6, were 7.31 [2.03 to 26.35], 3.92 [1.75 to 8.76], and 2.33 [1.13 to 4.79]). CONCLUSION: This study demonstrated, for the first time, the effect conferred by specific combined genetic variants in TCF7L2 and KCNQ1 on diabetic vascular complications, predominantly with nephropathy and CAD. Such a specific pattern of gene variant combination may implicate in the progression of T2DM and life-threatening vascular complications.

Clinical features and course of Angiostrongylus cantonensis eosinophilic meningitis in patients receiving supportive therapy.

Acute severe headache is the main presentation of eosinophilic meningitis (EOM) caused by Angiostrongylus cantonensis. Oral corticosteroid treatment is effective in reduction of duration of headache but may be contraindicated in particular patients. This study investigated clinical features and clinical course of eosinophilic meningitis caused by A. cantonensis if left untreated. Additionally, factors associated with duration of headache were evaluated. We conducted a retrospective study between 1997 and 2019 at a university hospital in Thailand. The inclusion criteria were adult patients who were diagnosed with EOM, had a positive serological test for A. cantonensis, received only supportive treatment, and had the complete clinical course documented. Factors associated with duration of headache were executed by multivariate linear regression analysis. A total of 54 patients were used in the final analysis. Of those, 39 patients (79.2%) were male and the mean ±â€¯SD age of all patients was 33.7 ±â€¯12.2. The mean ±â€¯SD duration of headache was 16.0 ±â€¯12.4 days with the longest duration of 49 days. The only factor associated with duration of headache was gender (p = 0.036). The male gender had a coefficient of -8.4 (95% CI: -16.2, -0.6). The median duration of headache in male and female patients was 11 and 20 days, respectively. In conclusion, A. cantonensis eosinophilic meningitis can cause long lasting headache, and gender may be associated with duration of headache.

Role of Inhaled Corticosteroids for Asthma Exacerbation in Children: An Updated Meta-Analysis.

BACKGROUND: Several studies showed that inhaled corticosteroids (ICS) may be a potential treatment in acute asthma exacerbation in children. This study was an update meta-analysis on the roles of ICS in the management of acute asthma exacerbation in children presenting to the hospital. MATERIALS AND METHODS: Published articles with key words of ICS for asthma exacerbation, asthma attacks, and acute asthma in children aged under 18 years in the hospital setting with outcome of hospital admission between 2009 and 2018 were enrolled. The databases used in this study were Medline, Scopus, and Web of Science. Odds ratio of comparison between ICS and other treatments on hospital admissions was calculated. RESULTS: There were 311 eligible studies met the searching criteria; seven eligible studies for the analysis; comprised of three meta-analysis and four added studies. The ICS had a significant reduction in hospital admission compared with placebo in overall with odds ratio of 0.63 (95% confidence interval [CI]: 0.41-0.96) and in moderate-to-severe group with odds ratio of 0.17 (95% CI: 0.05-0.51). Comparing with systemic corticosteroid (SC), ICS had significantly lower hospital admissions overall and in mild-to-moderate group with odds ratios of 0.63 and 0.26, respectively. The combination of ICS and SC had odds ratio of 0.75 (95% CI: 0.57-0.99) over SC in moderate-to-severe asthma exacerbation. CONCLUSIONS: ICS significantly reduced hospital admission in asthma exacerbation in children. It may be used alone for mild-to-moderate asthma exacerbation and combination with SC for moderate-to-severe asthma exacerbation.

Obstructive sleep apnea in patients with diabetes less than 40 years of age.

BACKGROUND AND AIM: Obstructive sleep apnea (OSA) is known to be associated with diabetes mellitus (DM). Age is factor associated with different clinical features of OSA. There is limited data on clinical differences of young DM patients with OSA versus older DM patients with OSA. This study aimed to find clinical differences of DM coexisting with OSA between young age group and older. METHODS: This is a retrospective, analytical study conducted at Srinagarind Hospital, Thailand. The inclusion criteria were adult patients diagnosed as DM with OSA. The study period was between January 2008 and December 2019. The diagnosis of OSA was made by presence of apnea hypopnea index (AHI) of ≥5 times/hour by polysomnography. Clinical predictors of OSA in young DM patients with age under 40 years were executed. RESULTS: There were 56 patients in the young diabetes mellitus group, while there were 137 patients in the older diabetes mellitus group. The mean (SD) age of diagnosis for diabetes mellitus of both groups were 31.61 (6.53) and 54.68 (7.62) years, respectively. There were three independent predictors for DM in the young: atrial fibrillation (AF), body mass index (BMI) and glomerular filtration rate (GFR). Presence of AF perfectly predicted DM with OSA in age over 40 years. The adjusted odds ratio for BMI and GFR were 1.29 (95% CI 1.05, 1.58) and 1.06 (1.01, 1.13). The BMI over 32 kg/m2 and GFR over 77 ml/min/m2 gave sensitivity of 80.00%. CONCLUSIONS: Young DM patients with OSA had more severe OSA, were more obese, had better renal function, and had fewer AF than the older ones.

Are full-face helmets the most effective in preventing head and neck injury in motorcycle accidents? A meta-analysis.

Motorcycles are the most common type of vehicle involved in traffic deaths in developing countries. Although helmets can provide protection against injury, there is limited evidence available regarding which type of helmet best protects against head and neck injuries in this setting. This review was conducted based on articles in the PubMed, Scopus, and Web of Science databases. We compared full-face helmets with other types of helmet with regard to head and neck injury prevention in road accidents involving motorcyclists. Of 702 studies, six were eligible with a total of 6,529 participants. When compared with partial and open helmets, the odds ratio of full-face helmets was 0.356 (95% CI of 0.280, 0.453) and 0.636 (95% CI of 0.453, 0.894), respectively, for reduction of head and neck injuries. In conclusion, full-face helmets reduced head and neck injuries in motorcycle accidents to a greater extent than other types of helmet. Policy makers should recommend that motorcyclists use full-face helmets.