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1.
Blood Purif ; 53(1): 10-22, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37918373

RESUMO

INTRODUCTION: Severe COVID-19 pneumonia can activate a cytokine storm. Hemoperfusion can reduce pro-inflammatory cytokines in sepsis but is still debated in the COVID-19 setting. Thus, we sought to investigate the benefits of HA-330 cytokine adsorption through clinical and laboratory outcomes. METHODS: We conducted a single-center prospective observational study in adults with severe COVID-19 pneumonia admitted to the intensive care unit at Chiang Mai University Hospital (Chiang Mai, Thailand). Those with cytokine storms indicated by organ injury, including acute respiratory distress syndrome (ARDS), and high inflammatory markers were included. Patients treated with the HA-330 device were classified as a hemoperfusion group, while those without cytokine adsorption were classified as a control group. We compared the outcomes on day 7 after treatment and evaluated the factors associated with 60-day mortality. RESULTS: A total of 112 patients were enrolled. Thirty-eight patients received hemoperfusion, while 74 patients did not. Baseline cytokine storm parameters were comparable. In univariate analysis, there was an improvement in clinical and laboratory effects from hemoperfusion therapy. In multivariate analysis, APACHE II score, SOFA score, PaO2/FiO2, the number of hemoperfusion sessions, the amount of blood purified, high-sensitivity C-reactive protein, and IL-6 were associated with mortality. Using at least 3 sessions of hemoperfusion could mitigate, the 60-day mortality (adjusted odds ratio 0.25, 95% confidence interval: 0.03-0.33, p = 0.001). By categorizing the amount of blood treated into 3 groups of <1 L/kg, 1-2 L/kg, and ≥2 L/kg, there was a linear dose-response association with survival, which was better in the higher volume purified (mortality 60% vs. 33.3% vs. 0%, respectively, p = 0.015). CONCLUSIONS: The early initiation of HA-330 hemoperfusion could improve the severity score and laboratory outcomes of COVID-19 ARDS. The optimal dose of at least three sessions or the amount of blood purified greater than 1 L/kg was associated with a reduction in 60-day mortality.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Adulto , Humanos , Adsorção , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/terapia , COVID-19/complicações , COVID-19/terapia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Citocinas
2.
J Asthma ; 60(12): 2177-2188, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37405933

RESUMO

OBJECTIVE: Short-acting ß2-agonist (SABA) overuse is associated with poor asthma outcomes; however, the extent of SABA use in Thailand is largely unknown. As part of the SABA use IN Asthma (SABINA) III study, we describe asthma treatment patterns, including SABA prescriptions, in patients treated by specialists in Thailand. METHODS: In this observational, cross-sectional study, patients (aged ≥12 years) with an asthma diagnosis were recruited by specialists from three Thai tertiary care centers using purposive sampling. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma [GINA] recommendations). Data on sociodemographics, disease characteristics, and asthma treatment prescriptions were collected from existing medical records by healthcare providers and transcribed onto electronic case report forms. Analyses were descriptive. RESULTS: All 385 analyzed patients (mean age: 57.6 years; 69.6% female) were treated by specialists. Almost all (91.2%) patients were classified with moderate-to-severe asthma (GINA treatment steps 3-5), 69.1% were overweight/obese, and 99.7% reported partially/fully reimbursed healthcare. Asthma was partly controlled/uncontrolled in 24.2% of patients; 23.1% experienced ≥1 severe asthma exacerbation in the preceding 12 months. Overall, SABAs were over-prescribed (≥3 canisters/year) in 28.3% of patients. Inhaled corticosteroids (ICS), ICS/long-acting ß2-agonists, oral corticosteroid (OCS) burst treatment, and long-term OCS were prescribed to 7.0, 93.2, 19.2, and 6.2% of patients, respectively. Additionally, 4.2% of patients reported purchasing SABA over the counter. CONCLUSIONS: Despite receiving specialist treatment, 28.3% of patients were over-prescribed to SABA in the previous 12 months, highlighting a public health concern and the need to align clinical practices with current evidence-based recommendations.


Assuntos
Antiasmáticos , Asma , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Asma/tratamento farmacológico , Asma/diagnóstico , Tailândia/epidemiologia , Estudos Transversais , Corticosteroides/uso terapêutico , Prescrições , Administração por Inalação , Antiasmáticos/uso terapêutico
3.
Artigo em Inglês | MEDLINE | ID: mdl-36773278

RESUMO

BACKGROUND: The concept of heterologous vaccination against SARS-CoV-2 infection has been adopted in Thailand with limited data on the induction of humoral and cellular immunity, particularly the CoronaVac/ChAdOx-1 (CoVac/ChAd) regimen in the elderly. OBJECTIVE: In this study, the immune responses of the elderly induced by heterologous CoVac/ChAd and homologous ChAdOx-1 (ChAd/ChAd) vaccinations were demonstrated. METHODS: A prospective observational study involving healthy participants aged ≥ 60 years who received heterologous CoVac/ChAd or homologous ChAd/ChAd vaccination was conducted. Surrogate neutralizing antibody (NAb) and T-cell responses against the SARS-CoV-2 wild type (WT) and variants of concern were determined at pre and post vaccinations. RESULTS: At 4 and 12 weeks after heterologous or homologous vaccination, the NAb levels against WT, Alpha, Beta, and Delta variants between each group were not significantly different, except for significant lower NAb against the Beta variant in heterologous group at 12 weeks after vaccination. The NAb against the Omicron at 4 weeks post-vaccination were below the cutoff level for antibody detection in both groups. However, higher spike-specific CD4 T cell producing IFN-γ and TNF-α in the heterologous than the homologous vaccination were observed. Insignificant difference of cellular immune responses to spike-peptides of Alpha, Beta, and Delta variants and their WT homologues was demonstrated. CONCLUSIONS: In the elderly, heterologous CoVac/ChAd vaccination could induce NAb response against the WT and non-Omicron variants not different from the homologous ChAd/ChAd vaccination. Both regimens could not give adequate NAb of the Omicron strain. The heterologous vaccination, however, induced higher spike-specific Th1 cell response.

4.
Immun Ageing ; 19(1): 24, 2022 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-35610643

RESUMO

BACKGROUND: The existence of SARS-CoV-2 variants of concern (VOCs) in association with evidence of breakthrough infections despite vaccination resulted in the need for vaccine boosting. In elderly individuals, information on the immunogenicity of booster vaccinations is limited. In countries where the CoronaVac inactivated vaccine is the primary vaccine, the appropriate boosting regimen is not clear. Immunologic studies of the effects of booster vaccination against VOCs, particularly Delta and Omicron, following CoronaVac in elderly individuals are helpful for policy makers. In this study, we determined the immune responses against VOCs following ChAdOx-1 or BNT162b2 boosting in elderly individuals previously immunized with CoronaVac. RESULTS: Before boosting, the median % inhibition of neutralizing antibodies (NAbs) against the wild-type (WT), Alpha, Beta, Delta and Omicron variants in the ChAdOx-1 and BNT162b2 groups was 52.8% vs. 53.4, 36.6% vs. 39.9, 5.2% vs. 13.7, 34.3% vs. 44.9, and 20.8% vs. 18.8%, respectively. After boosting with ChAdOx-1 or BNT162b2, the % inhibition of NAbs were increased to 97.3% vs. 97.4, 94.3% vs. 97.3%, 79.9 vs. 93.7, 95.5% vs. 97.5, and 26.9% vs. 31.9% for WT, Alpha, Beta, Delta and Omicron variants, respectively. Boosting with BNT162b2 induced significantly higher NAb levels than boosting with ChAdOx-1 against the Alpha, Beta and Delta variants but not the WT and Omicron variants. NAb levels against Omicron variant were not significantly different before and after boosting with ChAdOx-1 or BNT162b2. To evaluate T-cell responses, S peptides of the WT, Alpha, Beta and Delta variants were used to stimulate T cells. Upon stimulation, the expression of IL-17A in CD8 T cells was higher in the BNT162b2 group than in the ChAdOx-1 boosting group. However, IFN-γ production in CD4 and CD8 T cells did not significantly differ under all vaccination regimens. The expression of FasL in CD4 T cells, but not CD8 T cells, was higher in the BNT162b2-boosted group. CONCLUSION: Boosting with either ChAdOx-1 or BNT162b2 in CoronaVac-primed healthy elderly individuals induced high NAb production against all examined VOCs except Omicron. BNT162b2 stimulated higher NAb and some T-cell responses than ChAdOx-1. Vaccine boosting is, therefore, recommended for elderly individuals previously immunized with CoronaVac.

5.
Allergol Immunopathol (Madr) ; 50(3): 125-131, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35527666

RESUMO

BACKGROUND: No studies are comparing the impact of the add-on leukotriene-receptor antagonist (LTRA) with a step-up dose of inhaled corticosteroids (ICS) in partly controlled asthma patients with asthma control test (ACT) score ˂ 23. OBJECTIVE: To study the effect of LTRA add-on therapy in comparison to a step-up to medium dose of ICS in partially controlled asthma. METHODS: An open-labeled randomized controlled trial was conducted in asthma subjects with partly controlled asthma who had been in regular receipt of low dose ICS. All subjects were assessed for asthma using ACT, daytime and nighttime symptoms, rate of relievers used, spirometry, and impulse oscillometry (IOS) at 3 and 6 months. Subjects were randomized to receive daily oral LTRA 10 mg or step-up medium dose of ICS. RESULTS: Between June 2020 and January 2021, 50 participants were enrolled, all patients completing the study. After treatment, mean ACT scores were increased to more than 23 indicating well-controlled asthma in both groups, control being sustained throughout the whole 6-month study period (P ˂ 0.001). Within each group, ACT scores were improved by a minimal clinical important difference (MCID) ≥ 3 points at 6 months, compared to baseline values. There were significant decreases in nighttime and daytime symptoms, and the numbers of rescue relievers used in 4 weeks in both groups compared to baseline (P ˂ 0.001). CONCLUSIONS: LTRA add-on therapy in partially controlled asthma patients is comparable with step-up to medium dose of ICS/LABA as regards asthma control.


Assuntos
Antiasmáticos , Asma , Administração por Inalação , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Quimioterapia Combinada , Humanos , Antagonistas de Leucotrienos/uso terapêutico , Leucotrienos/uso terapêutico
6.
Medicina (Kaunas) ; 58(7)2022 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-35888669

RESUMO

Background and Objective: Bradycardia has been observed among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is suspected to be associated with poorer outcomes. Heart rate (HR) fluctuation has been found to be correlated with a greater mortality rate in critically ill patients. The association of bradycardia and HR fluctuation with the outcome of severe coronavirus disease 2019 (COVID-19) patients has not been clarified. Therefore, we aimed to examine whether bradycardia and HR fluctuation correlated with poor outcomes in patients with severe COVID-19. Materials and Methods: We conducted a secondary analysis from a prospective data collection of patients admitted to the intensive care unit, between April and June 2021, at Chiang Mai University Hospital. Results: The results showed that 62 of 86 patients (72.1%) had bradycardia, defined by HR < 60 beats per minute (bpm). The number of patients with high HR fluctuation, defined as the difference in HR during admission ≥ 40 bpm, was greater among the bradycardia group than in the non-bradycardia group (70.9% vs. 14.7%, p = 0.015, respectively). The patients with bradycardia had greater levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In addition, a greater proportion of patients with bradycardia received interleukin-6 inhibitors and hemoperfusion as a rescue therapy than those with non-bradycardia. After adjusting for age, gender, body mass index, CRP, and mechanical ventilator; bradycardia and the high HR fluctuation were significantly associated with a longer length of stay in the intensive care unit (ICU-LOS), with adjusted risk ratios of 2.67, 95% CI; 1.02, 6.94, p = 0.045 and 2.88, 95% CI; 1.22, 6.78, p = 0.016, respectively. Conclusion: We found that bradycardia and a high heart rate fluctuation were associated with a poorer ICU outcome in terms of longer ICU-LOS among the patients with severe COVID-19.


Assuntos
COVID-19 , COVID-19/complicações , Estado Terminal/epidemiologia , Estado Terminal/terapia , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , SARS-CoV-2
7.
Medicina (Kaunas) ; 58(2)2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35208539

RESUMO

Background and Objectives: Scant data regarding early post-COVID-19 effects are available, especially in younger people. Therefore, the objective of this study was to explore the early clinical impacts of post-COVID-19 pneumonia, comparing severe and non-severe patients. Materials and Methods: A cross-sectional study was conducted in adult patients admitted with COVID-19 pneumonia from April to May 2021. Demographic data, symptoms and signs, quality of life, Hospital Anxiety and Depression Scale (HADS), chest radiograph (CXR), pulmonary function tests (spirometry, impulse oscillometry), fractional exhaled nitric oxide (FeNO), and exercise capacity were assessed one month after hospital discharge. Twenty-five healthy control subjects that were age- and gender-matched were recruited for comparisons. Results: One hundred and five patients, with a mean age of 35.6 ± 15.8 years and 54 (51.4%) males, participated and were categorized into the non-severe pneumonia (N = 68) and severe pneumonia groups (N = 37). At a one-month follow-up visit (the time from the onset of the disease symptoms = 45.4 ± 5.9 days), the severe group had more cough, fatigue, and skin rash with higher dyspnea scale, more residual CXR lesions, and lower quality of life scores. Forced vital capacity (FVC) was lower in the severe group (88.3% of predicted value) and non-severe group (94.6% of predicted value) than in the healthy controls (p = 0.001). The six-minute walk distance was significantly lower in the non-severe group, at 79.2 m, and in the severe group, at 103.8 m, than in the healthy control subjects (p < 0.001). Conclusions: Adult patients with COVID-19, especially those with clinically severe pneumonia, still had residual symptoms and chest radiographic abnormalities, together with poorer quality of life and lower exercise capacity, one month after hospital discharge.


Assuntos
COVID-19 , Pneumonia , Adulto , Estudos Transversais , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Pneumonia/epidemiologia , Qualidade de Vida , SARS-CoV-2 , Adulto Jovem
8.
Int J Environ Health Res ; 31(5): 538-547, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31569960

RESUMO

Open burnings, agricultural and forest fires, are the major sources of particulate matters (PM) in Chiang Mai during dry season. We aim to determine the association of an increased daily PM (PM10, PM2.5) and daily non-accidental mortality and causes of death in Chiang Mai. The association between PM and daily non-accidental mortality including causes of death were analyzed using a generalized linear model with Poisson distribution. The results showed that PM10 and PM2.5 were associated with daily non-accidental mortality on different lag days (adjusted RR range from 1.009-1.018 and 1.016 for each 10 µg/m3 increment of PM10 and PM2.5, respectively). The causes of death associated with PM10, PM2.5 found on different lag days were chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), and sepsis. We concluded that PM10 and PM2.5 are associated with daily non-accidental mortality and causes of death were COPD, CAD, and sepsis.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Exposição Ambiental/efeitos adversos , Material Particulado/toxicidade , Doença Pulmonar Obstrutiva Crônica/etiologia , Sepse/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos Transversais , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/mortalidade , Fatores de Risco , Estações do Ano , Sepse/mortalidade , Tailândia/epidemiologia , Adulto Jovem
9.
Indian J Crit Care Med ; 24(10): 946-954, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33281320

RESUMO

PURPOSE: To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand. MATERIALS AND METHODS: The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptation guidelines. After reliability and validity testing, we consecutively surveyed the satisfaction of family members of ICU patients over 1 year. Adult family members of patients admitted to medical or surgical ICUs for 48 hours or more who had visited the patients at least once during the ICU stay were included. RESULTS: In all, 315 (95%) of 332 surveys were returned from family members. Cronbach's α of the Thai FS-ICU 24 questionnaire was 0.95. Factor analysis demonstrated good construct validity. The mean (±SD) of total satisfaction score, overall ICU care subscale, and decision-making subscale were 81.5 ± 14.3, 81.0 ± 15.6, and 82.0 ± 14.0. Items with the lowest scores were the waiting room atmosphere and the frequency of doctors communicating with family members about the patient's condition. The mean total satisfaction score tended to be higher in family members of survivors than in family members of nonsurvivors (81.9 ± 13.8 vs 77.7 ± 16.2, p value = 0.059). The overall satisfaction scores between medial ICU and surgical ICU were not significantly different. CONCLUSION: The Thai version of FS-ICU questionnaire was found to have acceptable reliability and validity in a Thai population and can be used to drive improvements in ICU care. TRIAL REGISTRATION: www.clinicaltrials.in.th, TCR20160603002. HOW TO CITE THIS ARTICLE: Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, et al. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020;24(10):946-954.

10.
Medicina (Kaunas) ; 55(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234279

RESUMO

Background and objective: Changing to a different spirometry reference equation can result in misinterpretation of spirometric findings. Currently, there is limited data about any discordance between the interpretations of airway obstruction (AO) using the Global Lungs Initiative (GLI) 2012 and the currently employed Thai reference equations (Siriraj) in Thai adults. Therefore, this study aimed to determine differences in diagnosis around AO and classification of the severity of AO using the GLI2012 and Siriraj reference equations in Thai adults. Materials and Methods: We analyzed spirometric results from Thai adults aged 40-80 years old (n = 2084), which were collected at the Lung Health Center, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January 2005 and December 2015. The diagnoses concerning the AO were interpreted using the GLI2012 and Siriraj reference equations. The severity of AO in each case was classified into five grades, including mild, moderate, moderately severe, severe, or very severe. McNemar's test was used to analyze differences in diagnosis of AO and classification of the level of severity. The Kappa statistic was used to determine agreements of diagnosis of AO and classification of severity between the two reference equations. Results: There were significant differences in both diagnosis of AO and their classifying severity level between the two reference equations (p-value < 0.001). However, the levels of agreement between the two reference equations were moderate to very good in different age and sex groups (Kappa values ranged from 0.62 to 0.78 for the diagnosis of AO and 0.54 to 0.89 for the classification of severity). Conclusions: Changing from the Siriraj to the GLI2012 reference equations underestimates the proportion of airway obstruction in Thai adults.


Assuntos
Obstrução das Vias Respiratórias/classificação , Obstrução das Vias Respiratórias/diagnóstico , Espirometria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/fisiopatologia , Feminino , Saúde Global/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Espirometria/instrumentação , Tailândia
11.
Medicina (Kaunas) ; 55(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137581

RESUMO

Background and objective: Six-minute walk test (6-MWT) is a widely used test for assessing exercise performance in chronic obstructive pulmonary (COPD). However, the association between reduced walking distance and balance impairment in COPD has not been directly investigated. Therefore, the aim of this study was to identify exercise performance as a predictor for balance impairment in COPD. Materials and Methods: The cross-sectional study was conducted at a single visit involving stable COPD patients in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. The 6-MWT was measured for in all subjects. The prognostic confounding factors were also collected for all subjects. Balance test was measured using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. A cut-off score of BBS < 46 and/or the TUG ≥ 13.5 s was classified as balance impairment. Multivariable logistic regressions were performed to identify the six-minute walk distance (6-MWD) as a predictor for balance impairment in COPD. Results: Of the 176 COPD subjects assessed for eligibility, 118 COPD patients were enrolled including 86 males (72.9%) with a mean age of 73.5 ± 8.1 years. Thirty-three (28.0%) cases were classified with a balance impairment. The 6-MWD < 300 m was the predictor of balance impairment in COPD with an adjusted risk ratio of 10.10 (95%CI; 2.87, 35.61, p-value < 0.001). Conclusions: The 6-MWT is not only useful for evaluation of exercise performance, but also for prediction of balance impairment in patients with COPD. Our study suggests that the 6-MWD < 300 m is an important risk factor for balance impairment in COPD.


Assuntos
Exercício Físico/fisiologia , Equilíbrio Postural/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida/psicologia , Estatísticas não Paramétricas , Tailândia , Teste de Caminhada/métodos
12.
J Med Assoc Thai ; 100(2): 142-8, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29916233

RESUMO

Objective: The present study intended to determine the risk factors of severe exacerbation in chronic obstructive pulmonary disease patients even though managed by pulmonologists on a regular basis. Material and Method: A retrospective case-controlled study was conducted at the chest clinic, Maharaj Nakorn Chiang Mai Hospital from 1st August 2009 to 31st July 2010. The clinical relevant data for acute exacerbation (age, sex, co-morbidity, severity of COPD, COPD medication, annual influenza vaccination, compliance with inhaled drug use, chest radiographic abnormality, and long-term oxygen therapy) were compared between severe AECOPD and stable COPD patients by logistic regression analysis. Results: Out of 137 COPD patients, 17 (12.4%) had severe AECOPD with 29 episodes (21.2%). Six risk factors were identified, two modifiable and four non-modifiable. The two modifiable risk factors were annual influenza non-vaccination (odds ratio [OR] 27.79; 95% confidence interval [CI], 2.29-337.66, p-value = 0.01) and improper use of inhaled devices (OR 9.94, 95%CI 1.07-92.54, p-value = 0.04). The four non-modifiable risk factors were age <60 yrs (OR, 10.67; 95%CI, 1.92-59.31, p-value = 0.01), hypertension (OR, 4.03; 95%CI. 1.05-15.44, p-value = 0.04), enlarged pulmonary trunk as demonstrated by chest radiograph (OR, 8.61; 95%CI, 1.49-49.85, p-value = 0.02), and long-term oxygen therapy (OR, 7.09; 95%CI, 1.36-37.00, p-value = 0.02). Conclusion: Six risk factors of severe AECOPD among patients whom were provided regularly managed by pulmonologists were identified; two of them, annual influenza non-vaccination and improper use of inhaled devices, could be potentially modified.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Fatores Etários , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/complicações , Pulmão/diagnóstico por imagem , Masculino , Adesão à Medicação , Oxigenoterapia/efeitos adversos , Pneumologistas , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
13.
J Med Assoc Thai ; 99(9): 1005-13, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29927203

RESUMO

Objective: To identify the prevalence, clinical characteristics, disease severity, and correlations of major chronic respiratory diseases (CRDs) among the adult population living in Chiang Mai. Material and Method: A cross-sectional study was conducted with adults living in municipal areas of Chiang Mai. All clinical relevant data collected by face-to-face interview was confirmed by pulmonologists. The chest radiographic findings and post-bronchodilator spirometry were done in all subjects. The aeroallergen skin test and rhinoscopy were performed in all chronic rhinitis and asthma subjects. Results: Five hundred seventy four subjects with mean age 52.9±10.0 years, 59.6% female, and 37.5% smokers were recruited. The prevalence of overall CRDs was 59.2%. Chronic rhinitis was the most prevalent chronic respiratory disease (n = 239, 41.6%), followed by asthma (n = 58, 10.1%), and chronic obstructive pulmonary disease (COPD) (n = 21, 3.7%). The most common abnormal pulmonary function test was restrictive lung disorders (n = 53, 9.6%). Asthma subjects were determined to be more allergic than chronic rhinitis subjects (58.1% vs. 39.9%, p-value = 0.033). Regarding the disease severity, 14.9% of chronic rhinitis and 10.3% of asthma subjects were classified as moderate to severe degree, whereas 81% of chronic obstructive pulmonary disease subjects were classified as moderate to very severe degrees. In asthma patients, there were positive association with chronic rhinitis (OR 3.9, 95% CI 2.1-7.0, p-value <0.001). Conclusion: The prevalence of major CRDs in adults among Chiang Mai population was significantly high with overlapped respiratory symptoms and varying disease severity. Additionally, chronic rhinitis had correlation with asthma but not with COPD.


Assuntos
Transtornos Respiratórios/epidemiologia , Adulto , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Espirometria , Tailândia/epidemiologia
14.
J Med Assoc Thai ; 99(4): 386-93, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27396222

RESUMO

OBJECTIVE: Identify a correlation between body mass index (BMI) and fat-free mass index (FFMI) to clinical parameters in chronic obstructive pulmonary disease. MATERIAL AND METHOD: The cross-sectional study was conducted at a single visit involving stable chronic obstructive pulmonary disease (COPD) patients at the outpatient chest clinic of the Chiang Mai University Hospital, Thailand. Eligible patients were evaluated for BMI, FFMI, lung function, modified medical research council (mMRC) dyspnea score, COPD assessment test (CAT) score, and number of acute exacerbation (AE) in the past year. The correlations of FFMI and BMI with other parameters were determined using Pearson correlation coefficient analysis. Body composition was categorized into four groups, normal, semi-starvation, muscle atrophy/sarcopenia, and cachexia based on BMI and FFMI. Statistical significance was accepted at p-value < 0.05. RESULTS: One hundred twenty one stable COPD patients met study inclusion criteria. The FFMI showed a strong correlation with BMI (r = 0.792, p < 0.001). The FFMI, but not BMI, was significantly correlated with mMRC, precentage ofp redicted forced expiratory volume in first second (FEV1), and CAT score (r = -0.315, 0.214, and -0.278, respectively). Body composition was categorized into four groups: normal body composition (n = 62, 51.2%), semi-starvation (n = 4, 3.3%), sarcopenia/ muscular atrophy (n = 12, 9.9%), and cachexia (n = 43, 35.5%). CONCLUSION: FFMI, but not BMI, was significantly correlated with dyspnea severity, lung function, and quality of life. Body composition category assignment is a useful clinical tool.


Assuntos
Composição Corporal/fisiologia , Doença Pulmonar Obstrutiva Crônica , Estudos Transversais , Dispneia , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
15.
J Med Assoc Thai ; 99(7): 777-83, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29901382

RESUMO

Objective: To identify risk factors and clinical course of asthma with fixed airflow limitation. Material and Method: A retrospective case-control study of asthma patients was conducted over a 15-month period. Asthma with fixed airflow limitation patients were defined as chronic asthmatics who had both post-bronchodilator (BD) and on-treatment ratio of forced expiratory in first second (FEV1)/forced vital capacity (FVC) persistently less than 0.7, whereas usual chronic asthma patients had post-BD and/or on-treatment ratio of FEV1/FVC more than 0.7. Serial asthma control tests (ACT), medication used, exacerbations were assessed. The risk factors were analyzed using logistic regression. Clinical characteristics between groups were compared using Student's t-test and Fisher's exact test. Results: One hundred twenty from 142 eligible subjects were enrolled. They had asthma with fixed airflow limitation (n = 40) and usual chronic asthma (n = 80). Potential risk factors of asthma with fixed airflow limitation included early disease onset (age <15 years) [(adjusted odd ratio (OR) = 3.9, 95% confidence interval (CI) 1.9-8.3)] with longer disease duration (adjusted OR = 8.4, 95% CI 4.6-15.4 for >30 years). Asthma with fixed airflow limitation patients had lower ACT scores (p<0.001), lower level of asthma control (p<0.001), required more asthma medications (p = 0.002), and higher rates of hospitalization (p = 0.001) than usual chronic asthma. Conclusion: The potential risk factors of asthma with fixed airflow limitation were earlier disease onset and longer disease duration. They had poorer asthma control, more medications needed, and higher rates of exacerbation than usual chronic asthma.


Assuntos
Asma , Adulto , Asma/epidemiologia , Asma/fisiopatologia , Estudos de Casos e Controles , Doença Crônica , Humanos , Estudos Retrospectivos , Fatores de Risco
16.
J Infect Chemother ; 21(8): 570-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26026660

RESUMO

Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii remains a significant cause of morbidity and mortality. Increasing antimicrobial resistance influences the selection of antibiotic treatment especially pandrug-resistant A. baumannii. A retrospective cohort study was conducted in the Medical Intensive Care Unit to identify the risk factors of VAP caused by multidrug-resistant A. baumannii (MDR-AB), extensively drug-resistant A. baumannii (XDR-AB) and pandrug-resistant A. baumannii (PDR-AB). All 337 adult patients with confirmed A. baumannii VAP were included. The incidence of MDR-AB, XDR-AB and PDR-AB were 72 (21.4%), 220 (65.3%) and 12 (3.6%), respectively. The risk factor for MDR-AB was prior use of carbapenems (OR 5.20; 95% CI 1.41-19.17). Risk factors for XDR-AB were the prior use of carbapenems (OR, 6.30; 95% CI, 1.80-21.97) and a high Sequential Organ Failure Assessment (SOFA) score (OR 1.35; 95% CI 1.07-1.71). In PDR-AB, the risk factors were the prior use of colistin (OR, 155.95; 95% CI, 8.00-3041.98), carbapenems (OR, 12.84; 95% CI, 1.60-103.20) and a high Simplified Acute Physiology Score (SAPS II) (OR 1.10; 95% CI 1.01-1.22). In conclusion, previous exposure to antibiotics and severity of VAP were risk factors of drug-resistant A. baumannii. Judicious use of carbapenems and colistin is recommended to prevent the antimicrobial-resistant strains of this organism.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Hospitais Universitários , Pneumonia Associada à Ventilação Mecânica/microbiologia , Infecções por Acinetobacter/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carbapenêmicos/uso terapêutico , Colistina/uso terapêutico , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Escores de Disfunção Orgânica , Estudos Retrospectivos , Fatores de Risco , Tailândia
17.
J Thorac Dis ; 16(3): 2004-2010, 2024 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-38617771

RESUMO

Background: Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM10) and particulate matter with a diameter of less than 2.5 microns (PM2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM10 and PM2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM10, PM2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA). Methods: We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients' electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM10 and PM2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors. Results: There was no effect of an increase in PM10 and PM2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM10 and PM2.5, respectively]. Conclusions: There was no effect of particulate matter on CPAP adherence in OSA patients.

18.
J Clin Med ; 13(5)2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38592016

RESUMO

Background and Objectives: After recovering from COVID-19, patients may experience persistent symptoms, known as post-COVID-19 syndrome or long COVID, which include a range of continuing health problems. This research explores the prevalence, associated factors, and overall health outcomes of long COVID during a period of extensive vaccination and antiviral treatment availability in Thailand. Materials and Methods: This observational study involved 390 adult patients with COVID-19 between January and March 2022. Beginning three months after their diagnosis, these patients were interviewed via telephone every three months for a period of one year. The data collection process included gathering demographic information and administering a standardized questionnaire that addressed the patients' physical condition following COVID-19, their mental health, sleep disturbances, and overall quality of life. Results: The cohort consisted of 390 participants, with an average age of 31.8 ± 13.6. Among them, 96.7% (n = 377) were vaccinated, and 98.2% (n = 383) underwent antiviral treatment. Long-COVID prevalence was observed at 77.7%, with the most frequently reported symptoms being fatigue (64.1%) and cough (43.9%). Regarding mental health, depression was reported by 8.2% of the participants, anxiety by 4.1%, and poor sleep quality by 33.3%. Advanced statistical analysis using multivariable logistic regression showed significant links between long-COVID symptoms and patients aged below 60 (p = 0.042), as well as the initial symptom of cough (p = 0.045). In the subset of long-COVID sufferers, there was a notable correlation in females with symptoms such as headaches (p = 0.001), dizziness (p = 0.007), and brain fog (p = 0.013). Conclusions: Despite the extensive distribution of vaccines and antiviral therapies, the prevalence of long COVID remains high, being associated particularly with individuals under 60 and those exhibiting a cough as an early symptom. The study further reveals that mental health issues related to long COVID are profound, going beyond the scope of physical symptomatology.

19.
J Clin Med ; 13(1)2024 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-38202305

RESUMO

(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization.

20.
J Thorac Dis ; 15(6): 3488-3500, 2023 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-37426127

RESUMO

Background: Continuous positive airway pressure (CPAP) is the most effective treatment for symptomatic obstructive sleep apnea (OSA). The identification of actual predictors of CPAP adherence in real-world practice is essential since it enhances more individualized management for the patient. CPAP acceptance and adherence in elderly patients with OSA have the same challenges but the conclusion remains unclear. Therefore, our aim was to explore the factors influencing the adherence of CPAP in elderly OSA patients. Methods: The retrospective observational study was conducted from OSA patients' computerized medical records at Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University Hospital, Chiang Mai, Thailand between 2018 and 2020. Multivariable risk regression analyses were performed to evaluate the independent factors associated with CPAP non-acceptance and CPAP non-adherence. Results: Of the 1,070 patients who underwent overnight polysomnography (PSG), 336 (31.4%) were elderly. Of 759 patients who accepted CPAP treatment, 221 (29.1%) were elderly, including 27 (12.2%) non-adherences, 139 (62.9%) adherences and 55 (24.8%) loss follow-up. Elderly patients with adverse attitudes toward CPAP use affected adherence to treatment [adjusted risk ratio (RR) =4.59, 95% CI: 1.79, 11.78, P=0.002]. Female was also associated with low CPAP adherence with adjusted RR =3.10 (95% CI: 1.07, 9.01), P=0.037. Conclusions: In our largest cohort to date, elderly OSA patients treated with CPAP over long-term follow-ups demonstrated that adherence rates were associated with personal life issues and adverse attitudes towards treatment as well as health problems. Female was also associated with low CPAP adherence. Therefore, in the elderly with OSA, the indication and treatment of CPAP should be customized individually, and if prescribed, regular monitoring to address noncompliance and tolerance should be considered.

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