Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study.

BACKGROUND: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. OBJECTIVE: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. METHODS: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (≥23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. RESULTS: Of the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. CONCLUSIONS: The MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals.

Determinants of Lung Function at Age 8.5 Years in a Birth Cohort of Thai Children.

BACKGROUND AND AIMS: Early life factors have reported the associations with impaired lung function in later life. In the present study, the birth cohort was followed up longitudinally to investigate the determinants of lung function in Thai children. METHODS: Cohort subjects were recruited from children born in Songkhla Province in southern Thailand. Data collections were obtained starting from antenatal, at birth, and at 1, 5 and 8.5 years of age. Spirometry was assessed at age 8.5 years. The variables investigated included birth weight, smoke exposure, respiratory diseases during the newborn period and during the first year of life, and asthma diagnosed at age 5 or 8.5 years. RESULTS: Of 1056 subjects, 892 (84.5%) subjects completed the spirometric measurements. The presence of asthma was the only factor that was significantly associated with a lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio, forced expiratory flow at 25-75% vital capacity (FEF25-75%VC) and peak expiratory flow rate (PEFR). The regression analysis found that asthma was significantly associated with a lower FEV1/FVC ratio, FEF25-75%VC, and PEFR value with estimated coefficients ± standard error of -1.27 ± 0.55%, p = 0.02; -131.8 ± 48.2 ml/s, p = 0.006; and -166.2 ± 65.0 ml/s, p = 0.01, respectively. Asthma diagnosed at age 5 or 8.5 years was more likely among children who had lower respiratory tract illness during the first year of life. The odds ratio for the association was 4.81 (95% confidence interval 2.14-10.83, p < 0.001). CONCLUSION: The main factor associated with lower lung function in Thai cohort subjects was the present of asthma by age 5 or 8.5 years and early respiratory illness was the risk factor for asthma in childhood period.

Recurrence of intracranial meningioma after surgery: analysis of influencing factors and outcome.

OBJECTIVE: To analyze the recurrent rate, timing, and influential factors of recurrence, including clinical outcome in patients with intracranial meningioma who underwent surgery. MATERIAL AND METHOD: The medical records of surgically treated intracranial meningioma patients with histological confirmation were reviewed. The diagnosis of recurrence was based on clinical condition and imaging study during follow-up. The recurrent rate, timing of recurrence, factors that influence the recurrence and clinical outcome were analyzed Clinical outcome was measured by the Glasgow outcome scale. RESULTS: One hundred eighty one patients were recruited. Mean tumor diameter was 4.9 cm (1.2-9 cm). Mean follow-up was 32.3 months. Median recurrent time was 21.6 months and overall recurrent rate was 21.5% with 5-year recurrence-free survival rate of 65%. Factors associated with tumor recurrence were headache at presentation (p = 0.002), Simpson grade III (p = 0.012), Simpson grade IV (p < 0.001), Simpson grade V (p = 0.004), WHO grade II (p = 0.004) and WHO grade III (p < 0.001). Mortality rate in recurrent group was 12.8% compared with 3.5% in non-recurrent group (p = 0.039). The favorable outcome was higher in non-recurrent group 91.5% compared with 76.9% in recurrent group(p = 0.02483). CONCLUSION: The risk factors of recurrence were headache at presentation, extent of resection, and histological grading. The extent of resection identified by Simpson grading effect the recurrent rate as stated previously in the literature. The higher histological grade was associated with higher recurrent rate. The wide range of timing of tumor recurrence needs both clinical evaluation and imaging study in short- and long-term follow-up especially in high-risk group. Recurrent meningioma increased rate of morbidity and mortality.

Association between Bell's Palsy and Cardiometabolic Risks: An Age- and Sex-Matched Case-Control Study.

BACKGROUND: Bell's palsy is possibly an ischemic cranial neuropathy, although reactivation of herpes virus infection has been proposed. METHODS: This was an age-and sex-matched and 1:2 case-control study enrolling Bell's palsy patients during 2011-2021 in a university hospital to investigate the significant associations of cardiometabolic risks (CMRs) with Bell's palsy. We analyzed the differences in waist circumference (WC), body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP), fasting blood sugar (FBS), and lipid levels at 12 weeks post-Bell's palsy with those of the controls by descriptive statistics (p < 0.05). The differences in means or medians of individual CMR values across the consecutive 10-year age intervals were analyzed by ANOVA F-tests and Kruskal-Wallis tests (p < 0.05). RESULTS: A total of 140 cases and 280 controls were enrolled. Bell's palsy patients had significantly higher WC, BMI, SBP, DBP, FBS, and triglyceride but lower high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Moreover, high WC, elevated FBS (≥100 mg/dL), SBP (≥130 mmHg), and total cholesterol were significantly associated with Bell's palsy cases by multivariable analysis. Only FBS in Bell's palsy patients significantly elevated across consecutive 10-year age intervals. CONCLUSION: Screening and monitoring for CMRs, especially hyperglycemia, in every patient presenting with Bell's palsy is essential despite initial normoglycemia, particularly in older-onset cases.

Effects of lawsone methyl ether mouthwash on oral Candida in HIV-infected subjects and subjects with denture stomatitis.

OBJECTIVES: To determine (i) effects of lawsone methyl ether (LME) mouthwash on antifungal drug resistance of oral Candida, (ii) effects of LME mouthwash on changes in genotype of oral Candida, and (iii) allergy and subjects' satisfaction on LME mouthwash in comparison with chlorhexidine (CHX). MATERIALS AND METHODS: A randomized clinical trial was conducted in HIV-infected subjects and denture wearers receiving either LME or CHX mouthwash. Candidal culture by oral rinse technique was performed as baseline and after using the mouthwash for 2 weeks. Antifungal drug resistance and changes in genotype of oral Candida were assessed by microdilution assay, inverted repeat polymerase chain reaction and restriction fragment length polymorphism assays, respectively. Allergy and subjects' satisfaction on the mouthwashes were recorded. Statistical analysis was performed using Chi-squared and Fisher's exact tests. RESULTS: Twenty-nine HIV-infected subjects (age range, 26-54 years; mean age, 41 years) and 38 denture wearers (age range, 27-76 years; mean age, 55 years) were enrolled. C. albicans was the most common specie found in both groups followed by C. tropicalis, C. parapsilosis, and C. glabrata. Neither antifungal drug resistance nor significant changes in genotyping of Candida were noted among those receiving LME mouthwash. Subjects' satisfaction on taste and smell of LME mouthwash was comparable to that of CHX. CONCLUSIONS: Use of LME mouthwash for 2 weeks neither led to antifungal drug resistance nor significant changes in genotype of oral Candida. Thus, LME may be an alternative mouthwash in prophylaxis of oral candidiasis among those at risk of developing the disease.

Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients.

(1) Background: Early thymectomy is suggested in all clinically indicated myasthenia gravis (MG) patients. However, short-term clinical response after thymectomy in MG patients has been limitedly described in the literature. This study aimed to compare the 5-year post-thymectomy outcomes between thymoma (Th) and non-thymoma (non-Th) MG patients. (2) Methods: MG patients aged ≥18 years who underwent transsternal thymectomy and had tissue histopathology reports in Songklanagarind Hospital between 2002 and 2020 were enrolled in a retrospective review. The differences in the baseline demographics and clinical characteristics between ThMG and non-Th MG patients were studied. We compared the time-weighted averages (TWAs) of daily required dosages of pyridostigmine, prednisolone or azathioprine to efficiently maintain daily living activities and earnings between the MG patient groups during 5 consecutive years following thymectomy. Post-thymectomy clinical status, exacerbations or crises were followed. Descriptive statistics were used for analysis with statistical significance set at p < 0.05. (3) Results: ThMG patients had significantly older ages of onset and shorter times from the MG diagnosis to thymectomy. Male gender was the only significant factor associated with ThMG. TWAs of the daily MG treatment drug dosages required showed no differences between the groups. Additionally, the rates of exacerbations and crises were not different, but decremental trends were shown in both groups after the thymectomies. (4) Conclusions: The daily dosage requirements of MG treatment drugs were not different. There was a trend of decreasing adverse event rates despite no statistically significant differences during the first 5 years after thymectomy in ThMG and non-ThMG patients.

Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge.

BACKGROUND: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. OBJECTIVE: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. METHODS: A secondary data analysis was performed using data collected from the "MED PSU×ThaiSook Healthier Challenge," a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). RESULTS: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was -3.85% (IQR -3.40% to -4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of -1.08% (IQR -2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). CONCLUSIONS: More than half of the "MED PSU×ThaiSook Healthier Challenge" participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction.

Perioperative Outcomes of Laparoscopic Liver Resection and Risk Factors for Adverse Events.

PURPOSE: The perioperative outcomes and risk factors associated with adverse events (AEs) after initial laparoscopic liver resection (LLR) are unclear. We studied the outcomes of LLR and identified the predictive factors for AEs. MATERIALS AND METHODS: Data from 100 adults who underwent LLR between April 2014 and February 2020 were reviewed. Baseline characteristics, surgery details, intraoperative data, and postoperative outcomes were tabulated. The AEs included conversion to open surgery, morbidity, and mortality. RESULTS: Major and minor LLRs accounted for 16% and 84% of cases, respectively. Of the indications for LLR, 88% were malignancies. Conversion to open surgery was necessary for 7% of the patients, the overall morbidity rate was 21%, the major morbidity rate was 7%, and the 90-day mortality rate was 1%. Although the incidence of AEs was higher after major LLR (37.5%) than after minor LLR (21.4%), the difference was not statistically significant (P=0.095); the rate of AEs in the resection of posterosuperior segments (43.7%) did not significantly differ from that of the anteroinferior segments (19.2%; P=0.095). Multivariable analysis revealed that the significant predictors of AEs included American Society of Anesthesiologists (ASA) class III (odds ratio, 5.76; 95% confidence interval, 1.74-19.1; P=0.003) and an operative time longer than 5 hours (odds ratio, 9.20; 95% confidence interval, 2.41-35.07; P<0.001). CONCLUSION: To improve outcomes in LLR, patients with ASA class III and those in whom surgery is expected to last longer than 5 hours should be taken into account for better patient selection.

Antifungal activity of lawsone methyl ether in comparison with chlorhexidine.

OBJECTIVE: The aim of this study was to determine the antifungal activity of lawsone methyl ether mouthwash (LME) in comparison with chlorhexidine mouthwash (CHX) in vitro and in vivo. MATERIALS AND METHODS: For in vitro study, each mouthwash preparation was added into the inoculum of Candida. The turbidity was recorded after incubation at 37°C for 48 h. Candidal culture was performed and the number of colony of Candida albicans was recorded. For in vivo study, a crossover clinical trial was conducted in 22 HIV-infected subjects and 32 denture wearers. Clinical examination was performed and oral rinse technique was carried out immediately before and 0, 1, 2 h after using each mouthwash. Allergy and subjective assessment of the mouthwashes were recorded. Statistical analysis was performed using one-way ANOVA and linear mixed effect modeling. RESULTS: In vitro, antifungal activity of 0.25% LME was significantly greater than that of 0.12% CHX (P < 0.05) and comparable with that of 0.2% CHX. In vivo, antifungal activity up to 2 hours of 0.025% LME mouthwash was evidenced in both groups of subjects, although significantly lower than that of 0.12% CHX. No allergic reaction was reported. LME mouthwash was graded to have less bitter taste than that of CHX. Subjects' satisfaction on taste and smell of LME mouthwash was significantly greater than that of CHX (P < 0.05). CONCLUSIONS: Lawsone methyl ether mouthwash possesses potent antifungal activity both in vitro and in vivo. However, concentration of the mouthwash needs to be adjusted in addition to further clinical trials on long-term use.

Gestational Bell's Palsy Is Associated with Higher Blood Pressure during Late Pregnancy and Lower Birth Weight: A Retrospective Case-Control Study.

The associations between gestational Bell's palsy (GBP) and late obstetric complications (LOCs), i.e., preeclampsia (PE), eclampsia (EC), gestational hypertension (GHT), and gestational diabetes mellitus (GDM) remain unclear. This study aimed to evaluate these associations and the neonatal health of the newborns born from pregnant women with and without GBP. A retrospective 1:5 case-control study matching exact maternal age and gravidity between pregnant women with and without GBP in Songklanagarind Hospital from 2006 to 2016 was conducted. The associations between GBP and PE, EC, GHT, and GDM, as well as comparison of the newborns' health indices were analyzed by bivariate analysis (p < 0.05). Eight GBP cases out of 8,756 pregnant women were recruited. Six GBP cases were first or second gravid. GBP occurred during the third trimester in five cases. Except for higher median systolic blood pressure (125 (114.2, 127.5) vs. (110 (107.0, 116.0), p = 0.045) and diastolic blood pressures (77 (73.0, 80.8) vs. 70 (65.0, 73.2), p = 0.021) in the GBP cases, associations between GBP and all LOCs could not be concluded due to the lack of power. However, a significantly lower mean birth weight in the newborns of GBP mothers was found (2672.2 (744.0) vs. 3154.8 (464.7), p = 0.016) with statistically significant power. Except for the higher blood pressures and lower birth weights of the newborns of GBP mothers, an association between GBP and LOCs remains inconclusive.

Accuracy of high-resolution rectal magnetic resonance imaging re-staging with histopathology in locally advanced rectal cancer after neoadjuvant chemoradiotherapy.

BACKGROUND/OBJECTIVE: Re-staging of locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT) is a crucial step in surgical decision-making. Currently, MRI is the imaging of choice for evaluation of LARCs, however, the diagnostic accuracy of this modality is inconsistent. In this study, we evaluated the diagnostic accuracy of MRI in LARC and analyzed the factors that influenced the accuracy. METHODS: The records of 133 patients diagnosed with LARC who were operated on during 2011-2018 were retrospectively reviewed. All patients received NCRT followed by re-staging based on high-resolution rectal MRI. The MRI results were analyzed for their yT and yN accuracy and anal sphincter involvement and compared with the related histopathological studies after definitive surgery. RESULTS: Re-staging MRIs gave overall accuracy in both the yT stage and yN evaluation of 85% (K 0.45 and 0.21, respectively). The MRI tended to overstaging for tumor invasion and understaging for lymph node involvement (sign test p-values = 0.017 and 0.022, respectively.) The highest accuracy of the yT stage was yT4b (93%, K 0.71). The study found that larger tumors (>3 cm) were associated with significantly higher accuracy in the yT readings while lack of lymphovascular invasion was associated with higher accuracy in the yN readings. The negative predictive value for anal sphincter involvement was 100%. CONCLUSION: MRI has limited accuracy in post-NCRT re-staging in LARC, tending to give overstaged yT readings and understaged yN readings. An MRI exclusion of sphincteric involvement is highly reliable.

Clinical Features, Endoscopic Findings, and Predictive Factors for Mortality in Tissue-Invasive Gastrointestinal Cytomegalovirus Disease between Immunocompetent and Immunocompromised Patients.

BACKGROUND AND AIMS: Tissue-invasive gastrointestinal cytomegalovirus (TI-GI CMV) disease is common in immunocompromised patients, but the increasing prevalence in immunocompetent patients has been reported. This study compared the clinical manifestations, endoscopic features, treatment outcomes, and predictors for inhospital mortality of TI-GI CMV between immunocompromised and immunocompetent patients. METHODS: Patients with HIV infection, malignancy, or receiving immunosuppressive agents (chemotherapy, high dose, or long-term corticosteroids) were defined as the immunocompromised group. Demographic and inhospital mortality data were obtained and retrospectively analyzed. RESULTS: A total of 213 patients (89 immunocompetent) with histologically confirmed TI-GI CMV were enrolled. Immunocompetent patients were older (70 vs. 52 years; p < 0.001), had more GI bleeding as a presenting symptom (47.2% vs. 29.0%; p = 0.010), and shorter symptom onset (2 vs. 14 days, p = 0.018). Concomitant extra-GI involvement was only seen in the immunocompromised group (6.5% vs. 0%; p = 0.02). Diffuse GI tract (14.5% vs. 4.5%; p = 0.032) and esophageal involvement (14.5% vs. 5.6%; p = 0.046) were more frequent in the immunocompromised, while small bowel involvement was more frequent in the immunocompetent group (19.1% vs. 8.1%; p = 0.029). An overall inhospital mortality was 27.7%. There was no significant difference in inhospital survival probability between the two groups (Peto-Peto test, p = 0.65). ICU admission (hazard ratio [HR] 7.21; 95% CI 2.55-20.36), sepsis or shock (HR 1.98; 95% CI 1.08-3.66), malnutrition (HR 2.62; 95% CI 1.05-7.01), and receiving chemotherapy (HR 5.2; 95% CI 1.89-14.29) were independent factors for inhospital mortality. Antiviral treatment for more than 14 days was the only protective factor to improve survival (Peto-Peto test, p < 0.001). CONCLUSIONS: Immunocompetent and immunocompromised patients with TI-GI CMV disease had distinct clinical and endoscopic characteristics. There was no significant difference in the inhospital mortality between the two groups. The factors for mortality were ICU admission, sepsis/shock, malnutrition, and receiving chemotherapy. Early diagnosis and initiation of antiviral treatment might improve the survival probability.

Effects of long-term use of HAART on oral health status of HIV-infected subjects.

BACKGROUND: The aim of this study was to determine the effects of long-term use of highly active antiretroviral therapy (HAART) on oral health status of HIV-infected subjects. METHODS: Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in HIV-infected subjects with and without HAART, and in non-HIV individuals. The following data were recorded; duration and risk of HIV infection, type and duration of HAART, CD4 cell count, viral load, presence of orofacial pain, oral dryness, oral burning sensation, oral lesions, cervical caries, and periodontal pocket. Multiple logistic regression analysis was performed to determine the effects of long-term use of HAART on oral health status of HIV-infected subjects. RESULTS: One hundred and fifty-seven HIV-infected subjects - 99 on HAART (age range 23-57 years, mean 39 years) and 58 not on HAART (age range 20-59 years, mean 34 years) - and 50 non-HIV controls (age range 19-59 years, mean 36 years) were enrolled. The most common HAART regimen was 2 NRTI + 2 NNRTI. HIV-infected subjects without HAART showed greater risks of having orofacial pain, oral dryness, oral lesions, and periodontal pockets than those with short-term HAART (P < 0.01). The subjects with long-term HAART were found to have a greater risk of having oral lesions than those with short-term HAART (P < 0.05). The unstimulated and stimulated salivary flow rates of the subjects with HAART were significantly lower than in those without HAART (P < 0.05). CONCLUSION: We conclude that long-term HAART has adverse effects on oral health status of HIV-infected subjects.

Denver Developmental Screening Test (DDST) survey and degree of malnutrition among children born to HIV infected mothers under the Prevention of Mother to-Child-Transmission (PMTCT) Program.

OBJECTIVE: To examine morbidity experience, pattern of nutrition status and development of the children born to HIV infected mothers under the Prevention of Mother to Child Transmission (PMTCT) Program compared to the national standard. MATERIAL AND METHOD: In 2008, births given by mothers under PMTCT in five selected hospitals of Health Region 4 of Thailand between 2002 and 2006 were identified from the registered data and the medical records, were reviewed. Their homes were visited to collect the data. RESULTS: Among 138 mothers and 143 children studied, nobody died. Forty-four were healthy 91 experienced mild episode of various infections and allergy within the past three months, one was admitted for pneumonia, two were HIV-positive, 53 were negative and the other 88 had no final blood tested In the Denver Developmental Screening Test (DDST), all parameters were minimal, less than 5%. Overall, the suspected delay development is around 15.4%. For nutritional status assessment by height for age (HFA), weight for age (WFA) and weight for height (WFH) reported a quarter (23.1%) was stunting whereas 12.6% were thin and 5.6% were wasting, respectively. CONCLUSION: Among the study PMTCT children, serious morbidity was rare. Nutritional deficiency was more common than delayed development.

Serum S100ß as a predictor of severity and outcomes for mixed subtype acute ischaemic stroke.

INTRODUCTION: Serum S100ß levels are mostly used for predicting outcomes of large-vessel stroke. Its application to mixed subtypes of acute ischaemic stroke (AIS) has been limited. METHODS: Patients with mixed subtypes of AIS who were aged over 18 years and presented within 24 hours of stroke onset were consecutively enrolled. Serum S100ß levels at presentation (S100ßb) and 72 hours (S100ß72hrs), and corresponding National Institutes of Health Stroke Scale (NIHSSb and NIHSS72hrs, respectively) scores were assessed. Stroke outcomes were evaluated using the modified Rankin Scale (mRs) at 30 days (mRs30) and 90 days (mRs90). Correlations between S100ßb and S100ß72hrs, as well as differences between the two (∆S100ß) and the corresponding NIHSS, mRs30 and mRs90 scores, were evaluated (p < 0.05). RESULTS: 35 patients were eligible for analysis. On univariate analysis, stroke outcomes had a significant association with S100ßb, S100ß72hrs, NIHSSb, NIHSS72hrs and ∆S100ß. Both S100ßb and S100ß72hrs correlated with corresponding NIHSS values (ρb = 0.51, p < 0.001; ρ72hrs = 0.74, p < 0.001), mRs30 (ρb = 0.58, p < 0.001; ρ72hrs = 0.72, p < 0.001) and mRs90 (ρb = 0.51, p = 0.002; ρ72hrs = 0.68, p < 0.001). Correlations existed between ∆S100ß and mRs30 (ρ = 0.74, p < 0.001) and mRs90 (ρ = 0.71, p < 0.001). Practical cut-off points for unfavourable outcomes (mRs 3-6) were S100ß72hrs > 0.288 µg/L (sensitivity 92.3%, specificity 86.4%) and ∆S100ß > 0.125 µg/L (sensitivity 100%, specificity 81.8%). CONCLUSION: High serum S100ß is associated with unfavourable outcomes for mixed subtype AIS. Cut-off values of S100ß72hrs and ∆S100ß were optimal for predicting unfavourable stroke outcomes.

Variations by sex and age in the association between alcohol use and depressed mood among Thai adolescents.

BACKGROUND: Alcohol is associated with depression among adolescents, but variations in the association by age and sex are relatively unexplored. This study aims to assess variations in the association between alcohol consumption and depressed mood among adolescents by age and sex. METHODS: We analyzed data from a school-based survey of 38,186 students in junior high school (Year 7 and 9) and senior high school (Year 11). The mean age of the participants was 15.2 (SD = 1.9) years. We used multivariate logistic regression to measure the association between self-reported alcohol drinking (past-year, past-month, and binge-drinking) and history of depressed mood for two weeks or more during the past year. We stratified the analyses by school level (as proxy for age group) and sex of the respondent. RESULTS: Approximately 1% of students in surveyed schools refused to answer the questionnaires and fewer than 5% of all questionnaires were invalid. Prevalence of depressed mood was 13.2%. Prevalence of past-year alcohol drinking was 41.0% among those with depressed mood vs. 24.6% among those with no depressed mood (Adj OR = 1.78, 95% CI = 1.60, 1.98). The association was strongest among girls in junior high school (Adj OR = 2.38, 95% CI = 2.03, 2.79) and weakest among boys in senior high school (Adj OR = 1.19, 95% CI = 0.99, 1.42). CONCLUSION: Associations between alcohol drinking and depressed mood were particularly strong among junior high school girls. Youth mental health and alcohol programs should consider prioritizing this sub-group accordingly.

Predictors of hospital discharge outcome from the presenting clinical characteristics and the first cerebrospinal fluid analysis among the patients with cryptococcal meningitis.

OBJECTIVE: Prognosticators of the outcome of patients with cryptococcal meningitis (CM) at variable follow-up time has been reported. We aimed to identify prognosticators of an outcome on hospital discharge of treated CM. PATIENTS AND METHODS: The presenting characteristics of CM patients admitted in Songklanagarind Hospital from 2002 to 2017 were retrospectively reviewed. The unfavorable outcome was defined as no improvement or death after starting treatment. The significant differences in clinical presentations between the patients with favorable and unfavorable outcomes were descriptively analyzed. The significant independent predictors from the clinical presentations and the first results of cerebrospinal fluid (CSF) analysis with cut-off values were further defined by multiple logistic regression analysis and shown in adjusted odds ratios (p < 0.05). RESULTS: Sixty-two CM patients were enrolled and 33 (53.2%) of them were females. Their median (IQR) age was 37 (30, 46) years old. HIV serology was positive in 71.0%. Concurrent immunosuppressant use and systemic malignancies were 6.5 and 4.8%, respectively. The median (IQR) days of hospital stay was 18.0 days (12.8, 23.0). Eleven patients had unfavorable outcomes at hospital discharge (8 died, 3 no neurological improvement). Cranial nerve palsy and high CSF protein were dependent predictors for the unfavorable outcome, while high CSF glucose was a protective factor. In addition, CSF protein >270 mg/dL was an independent predictor for the unfavorable outcome when adjusted for other CSF analysis results (adjusted odds ratio 27.1, 95% confidence interval 1.1-678.5, p = 0.034). CONCLUSION: Elevated CSF protein was a significant independent predictor for an unfavorable outcome.

Audit of paediatric residents' medical records.

BACKGROUND: The quality of the information contained in a medical record is dependent on the knowledge and skills of the doctor. The auditing of medical records is one of the items included in the competency evaluation of residents at the Department of Pediatrics, Prince of Songkla University (PSU), Thailand. OBJECTIVES: To determine the percentages of 'not met' and 'not acceptable' charts written by residents, which parts of the residents' writing required improvement and associated factors. METHODS: The charts of four newly admitted cases at each ward were selected non-randomly by attending staff for bi-weekly audit. The audit form comprised 15 components, with each component scored as 'met' or 'not met'. Medical records with more than two 'not met' items were categorised as 'not acceptable'. RESULTS: From September 2012 to October 2013, a total 506 in-patient medical records written by PSU paediatric residents were reviewed. The components identified as having the highest rates of 'not acceptable' completion were 'initial investigations' (5.3%), 'summary of investigations' (4.5%) and 'progression of clinical conditions' (4.3%). The reasons for a 'not acceptable' evaluation were 'incomplete documentation' (65.0%), 'lack of follow-up' (26.7%) and 'incorrect clinical reasoning' (8.3%). Using logistic regression analysis, the charts of patients from the chronic illness wards were found to be most significantly associated with the 'not acceptable' rating. Residents need skills and knowledge when completing patient records CONCLUSIONS: Residents need skills and knowledge when completing patient records, and attending staff should be aware that it is their responsibility to ensure that residents complete documentation fully and correctly.

Relationship between xerostomia and salivary flow rates in HIV-infected individuals.

AIM: The aim of the present study was to determine the relationship between self-reported xerostomia and salivary flow rates among HIV-infected individuals. METHODS: A cross-sectional study was performed on 173 individuals (81 HIV-infected individuals, mean age: 32 years, and 92 non-HIV controls, mean age: 30 years). Subjective complaints of dry mouth, based on a self-report of xerostomia questions, and dry mouth, based on a visual analogue scale (VAS), were recorded along with measurements of salivary flow rate of both unstimulated and wax-stimulated whole saliva. The relationship between subjective responses to the xerostomia questions, the VAS of dry mouth, and objective measurements of salivary flow rates were analyzed. RESULTS: Responses to the questions--Do you carry water or a saliva substitute? and Have you had taste disturbance?--were significantly different between HIV-infected and non-HIV individuals (P < 0.05). Individuals' responses to questions concerning dry mouth were significantly correlated with a low unstimulated salivary flow rate. A significant correlation between the VAS of dry mouth and salivary flow rates was observed (P = 0.023). CONCLUSIONS: Responses to self-reported xerostomia questions reflects low unstimulated salivary flow rates. Thus, questions concerning dry mouth might be useful tools to identify HIV-infected individuals with hyposalivation, especially at a resting stage.