Greater Mekong Subregion Medical Journal

Treatment of HIV/AIDS with “Dolutegravir-Based Regimen” Antiretroviral Therapy

Worapong Nasomsong — 2024-05-10

Current guidelines recommend dolutegravir (DTG) as the first-line antiretroviral regimen in the treatment of HIV/AIDS. DTG is a second-generation integrase strand transfer inhibitor that has demonstrated high potency, high genetic barrier to resistance, tolerability, minimal drug-drug interactions, and convenience. DTG is also used in a 2-drug regimen among treatmentnaive individuals, as well as for switching regimens in virally suppressed HIV/AIDS patients with impaired renal function. However, DTG also has a few considerations. Firstly, DTG has revealed drug-drug interactions with antacids containing aluminum or magnesium, as well as with food or medications containing calcium, iron, or multivitamins, and metformin. Secondly, DTG can increase serum creatinine levels without impacting glomerular filtration rate by inhibiting tubular creatinine secretion. Finally, there was previously a recommendation against using DTG in pregnant women due to concerns about an increased risk of neural tube defects. However, it has been found that the incidence does not differ significantly from the general population. Therefore, almost all current guidelines permit the use of DTG in reproductive-age women and during pregnancy.

Prognosis Factors for In-hospital Mortality in Spontaneous Intracerebral Hemorrhage

Kriangsak Champawong — 2024-05-10

Background: Spontaneous intracerebral hemorrhage has the highest mortality of cerebrovascular disease. Previous studies have examined factors contributing to death using binary outcomes but have not analyzed time to death.

Objective: To study prognostic factors for in-hospital mortality in spontaneous intracerebral hemorrhage.

Method: This retrospective cohort design of prognostic research included patients with spontaneous intracerebral hemorrhage from January 2018 to January 2023. Study variable factor and follow time to death refer to the number of days from diagnosis until death within 90 days of hospitalization. Statistical analysis included proportional hazard (PH assumption), then univariable and multivariable Cox’s PH regression analysis; results were presented using the Hazard Ratio, 95% CI, p-value < 0.05, and Kaplan-Meier survival curve. Results: 799 patients were eligible during the period; 153 patients were excluded, and 646 patients were included in the analysis. The mortality rate was 20.7%. Most of the patients were male, with an average age of 60. Multivariable analyses demonstrated that the prognostic factors of mortality included the Glasgow Coma Scale ≤ 8. [mHR 6.33 (95% CI 3.86-10.37), p < 0.001], intraventricular hemorrhage [mHR 5.31 (95% CI 2.94-9.58), p < 0.001], infratentorial location [mHR 2.73 (95% CI 1.51-4.94), p = 0.001], midline shift ≥ 5mm [mHR 2.08 (95% CI 1.04-4.16 p = 0.038], stroke in the young (age ≤ 45 years) [mHR 2.21 (95% CI 1.40-3.47), p = 0.001] and male sex [mHR 1.86 (95% CI 1.25-2.77), p = 0.002]. The prognostic factor for decreased mortality included surgery [mHR 0.25 (95% CI 0.15-0.41), p < 0.001] and door to target SBP in 1 hour [mHR 0.62 (95% CI 0.41-0.93), p = 0.020]. 138 (21.4%) patients underwent a neurosurgical intervention; 106 (76.8%) patients among the survivors compared with 32 (23.2 %) patients who died. Independent predictors of mortality included intraventricular hemorrhage [mHR 6.31 (95% CI 1.49-26.83), p = 0.013] and midline shift > 10 mm [mHR 4.25 (95% CI 1.17-15.39 p = 0.027]

Conclusion: Glasgow Coma Scale ≤ 8, intraventricular hemorrhage, infratentorial location, midline shift ≥ 5 mm, stroke in the young (age ≤ 45 years), and male sex were significant predictors of in-hospital mortality in a spontaneous intracerebral hemorrhage, whereas surgical therapy and reducing blood pressure to target within 1 hour decreased the in-hospital mortality. Intraventricular hemorrhage and midline shift > 10 mm were predictors of in-hospital mortality in patients who underwent neurosurgical intervention. To reduce death, management for spontaneous intracerebral hemorrhage cases needed to focus on targeting these factors.

The Processing and Characterization of the New Semi-absorbable Bone Wax Made from Rice Starch Blended with Beeswax

Sittiporn Punyanitya — 2024-05-10

Background: In the 21st century, bone wax is one of the most prevalent biomaterials to help mechanically control bleeding from bone surfaces in almost every surgical procedure. It is bio-inert, albeit a foreign body with non-absorbability, and rarely causes complications such as granuloma and persistent serous discharge. Semi-absorbable bone wax is an encouraging alternative since it highly reduces the risk of harmful response reactions on the host, which is what we primarily aim for.

Objective: This research studied the amount of medical-grade rice added to beeswax with different amounts of addition. It is used as a semi-absorbable hemostatic agent to improve the biodegradable efficiency of beeswax.

Materials and Method: Material characteristics such as scanning electron microscopy (SEM), melting point, Fourier transform infrared spectroscopy (FTIR), and water diffusibility are used to study the effect of adding rice starch powders. Bone wax is prepared from the mixture of white beeswax with isopropyl palmitate and liquid paraffin and three different compositions of rice starch powders in aqueous suspension (30, 40, and 50 wt %).

Results: The addition of rice starch powder increases the absorbability mechanism, smoothness, and whiteness and can be easily smeared on the bone surface. We have concluded that an optimized composition of 40 wt % rice starch powder has adequate quality for utilizing it as a semi-absorbable bone wax.

Conclusion: Rice starch that is incorporated into bone wax is more bio-absorbable than the original bone wax itself and will furthermore undergo additional testing in animal laboratories.

“Surasi Smart Service” Innovations to Access to Medical History

Supanut Promrungruang — 2024-05-10

Background: Information plays the crucial role in real life. Access to medical history is essential for medical treatments for both patients and medical personnel. Missing an appointment and intermittent treatment leads to worse consequence.

Objective: To ensure that all personnel and service recipients have access to their own health information. To use the same set of health data history. Support the diagnosis and treatment of diseases. To remind patient to come back to see a doctor and reduce waiting time and density in hospital.

Method: Surasi smart service is an innovative invention using Line OA program. After confirming the information, you will be able to view the health check-up results, appointment history, and medication history that you have received. As a result of this innovation, people can view their history even in areas close to hospitals.

Results: The percentage of patients missing appointments decreased from 10.24 % to 2.3%. The percentage of personnel satisfaction with Surasi Smart Service was 93.7%.

Conclusion: The program “Surasi Smart Service” is a program that can increase access to medical services and reduce the rate of missing appointments with eventually increase customer satisfaction.

Primary Cutaneous Follicle Center Lymphoma Masquerading as Tumid Lupus Erythematosus

Krittin Sowphitakwattana — 2024-05-10

Cutaneous lymphomas, notably indolent cutaneous B-cell lymphoma, can exhibit clinicopathological characteristics resembling those of inflammatory skin conditions. Here, we present the case of an 82-year-old female with recurrent lesions resembling tumid lupus erythematosus on her face. Subsequent histopathological examination and immunohistochemical analysis definitively diagnosed primary cutaneous follicle center lymphoma. This report highlights a rare instance underscoring the importance of considering cutaneous lymphoma as part of the differential diagnosis in patients presenting with inflammatory skin lesions.

Cancer-Associated Venous Thromboembolism

Montakarn Ittiamornlert — 2024-05-10

Venous thromboembolism (VTE) presents a significant clinical challenge in the management of cancer patients, marked by a notably higher incidence compared to the general population. This article focuses on cancer-associated venous thromboembolism, exploring its multifaceted nature and the complexities encountered in both diagnosis and treatment. Additionally, the evolution of anticoagulant therapy, including the emergence of low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs), is examined for their efficacy in preventing recurrent cancer-associated VTE. Emphasizing the need for personalized treatment approaches. Through a comprehensive understanding of these challenges and advancements, clinicians can optimize therapeutic strategies to enhance outcomes for cancer patients at risk of VTE.