Greater Mekong Subregion Medical Journal

Impact of Type 2 Diabetes Mellitus on Severity and Outcomes of the Patients Admitted with COVID-19 Infection: A Case-Control Study

Kaset Chimplee, Peeradone Srichan, Wirawan Chimplee, Somprat Munjit — Mon, 08 Jan 2024 00:00:00 +0700

Background: COVID-19 pandemic caused global effects on health care, economics and society for a long period. Significant proportion of COVID-19 infected patients had diabetes mellitus. Meta-analysis showed increase on severity and mortality rate of COVID-19 in diabetes compared with non diabetes. In Thailand, a few clinical research to be conducted in case-control study to determine the effects of diabetes and in hospital glycemic control on outcomes of COVID-19.

Objective: This research aim was to compare the clinical presentations, laboratory findings, x-ray findings and treatment outcomes between patients admitted in the hospital by COVID-19 infection with diabetes and without diabetes and to determine factors contributing to the outcomes of COVID-19 in diabetic subgroup.

Method: A retrospective cohort study in case-control design was carried out. One hundred and eighty five cases of diabetes after 30 year of age was collected as a case. Age and sex matched for each selected case were served as control. Clinical, laboratory, radiological and treatment outcome information were analyzed in comparison between diabetes and non diabetes. Subgroup analysis in diabetic patients was performed to assess factors related to outcomes according to insulin treatment during admission. Chi-square and unpaired t-test were used in statistical analysis to determine the difference between groups.

Results: Clinical manifestations of COVID-19 infection were not different between diabetes and non diabetes. Diabetic group had more pulmonary infiltration, more white blood cell and neutrophil count at admission. On treatment and outcomes, diabetic group need more and longer antiviral treatment, more steroid treatment and oxygen treatment than non diabetic group. Severe pulmonary complication, ARDS, developed more significantly in diabetic group and need transfer for ventilatory support. Subgroup analysis of diabetic patients revealed that insulin treatment group had longer duration of antiviral treatment, higher percentage on steroid and high flow oxygen treatment and more ARDS which need transfer for mechanical ventilatory support than non insulin treatment group.

Conclusion: This study confirmed the impact of diabetes mellitus on clinical, laboratory findings, radiological findings and the severity, outcomes and complications of patients admitted with COVID-19 infection in comparison with non diabetes in Thai patients. The level of HbA1c at admission in diabetic patients did not affect the severity, outcomes and complications, but the need of insulin treatment during admission was the important predictor of poor clinical outcome.

Periorbital Dermatitis from EGFR Tyrosine Kinase Inhibitor

Apichai Leelasiri — Mon, 08 Jan 2024 00:00:00 +0700

A 56-year-old woman with EGFR mutation metastatic adenocarcinoma presented with bilateral eyelid inflammation, itching and persistent tearing for 2 months. She had been taking erlotinib 150 mg/day 10 months for lung cancer. She also had pruritic facial rash on both eyebrow area. She was initially diagnosed periorbital dermatitis induced by erlotinib and the drug was discontinued with supportive treatment. After one month, she had complete resolution of eye and skin problem. This was uncommon but quite newly recognized adverse events of erlotinib. The differential diagnosis includes allergic conjunctivitis and infection. Physicians in charge should ask for history of regular medicine and having thorough physical examination of other systems in order to make early diagnosis and management.

Transforming COPD Care in Tertiary Settings: The Role of Telerehabilitation

Simaporn Promsarn, Pairoj Suraprapapich, Rattanapond Pankratuk, Wilawan Ketpan — Mon, 08 Jan 2024 00:00:00 +0700

Telerehabilitation holds promise as an innovative and underrecognized approach for managing chronic obstructive pulmonary disease (COPD) patients within tertiary care settings. This paper aims to shed light on the potential of telerehabilitation as a management strategy for COPD patients who often face challenges accessing traditional rehabilitation methods. Through a comprehensive review of recent academic literature, this study explores the benefits, challenges, and future prospects of implementing telerehabilitation within tertiary care contexts. Telerehabilitation, characterized by remote exercise interventions, monitoring, education, and patient support, has demonstrated positive outcomes in terms of exercise capacity enhancement, symptom alleviation, and improved quality of life for COPD patients. Despite these potential advantages, the implementation of telerehabilitation faces challenges such as patient engagement, technological proficiency, and data security concerns. Real-world case studies highlight successful instances of telerehabilitation deployment in tertiary care, underscoring its practical viability. In light of the ongoing transformation of healthcare delivery, telerehabilitation emerges as an essential tool to address the underrecognized management needs of COPD patients in tertiary care settings. This paper advocates for further research, collaboration between healthcare providers and policy makers, and the integration of telerehabilitation into comprehensive COPD management strategies. By recognizing telerehabilitation’s potential and overcoming implementation barriers, the healthcare community can ensure equitable access to rehabilitation services, thereby improving patient outcomes in the tertiary care setting.

Cannabinoid Hyperemesis Syndrome

Kriengsak Jaikla, Kaset Chimplee — Mon, 08 Jan 2024 00:00:00 +0700

Cannabinoid Hyperemesis Syndrome (CHS) is a condition characterized by cyclic episodes of nausea and vomiting, abdominal pain, and relief of symptoms by taking of hot shower, this syndrome being associated with chronic cannabis use. CHS occurs in approximately one-third of individuals presenting with cannabis use disorder. The pathophysiology of CHS is not fully understood, but it is believed to involve the endocannabinoid system (ECS). This report describes an 18-year-old female, with a history of marijuana consumption spanning nearly two years, who presented with intense nausea and vomiting. The patient made a complete recovery following cannabis abstinence and supportive treatment. Two months follow-up revealed a full resolution of the symptoms.

Novel Rice Gel for Ultrasound Applications: Physical and Chemical Properties

Mon, 08 Jan 2024 00:00:00 +0700

Background: Ultrasound gel is a medical device that belongs to the category of consumables, which included in charge of radiological diagnosis and treatment such as X-ray, CT scan, ultrasonography, MRI, radionuclide scan and various radiotherapy, etc. This material is a pharmaceutical product, which produced in a gel state and obtained from synthesized for medical or veterinary. For example, physical examination acts a coupling agent between the body and the medical device. This gel is a product that must be imported from abroad at the level of billions of baht every year.

Objective: This research fabricated medical ultrasound gel within the country. The main raw material was being Thai rice to solve the problem of importing ultrasound gel from abroad.

Materials and Method: Novel rice gels containing different compositions of rice starch (RS) powder and additives. The formulations of gels were composed of RS powder, liquid glycerol, and additives by solution method. Five solutions with different concentration of RS powder (0.5 g, 1 g, 1.5 g, 2 g and 2.5 g) were prepared by solution method. These solutions were dried in electric oven at 65OC for 4 hours. The physical and chemical properties of rice gel characterized by turbidity, viscosity, smell, irritation, pH and moisture content of these gels have monitored.

Results: Results showed that 2 g of RS powder is optimized formulation which had turbidity, high viscosity, pleasant smell, non-irritating and easy to clean. The pH value of this gel was 6.92 ± 0.01, and the moisture content was 0.21 ± 0.07 %, which similar to commercial standard of ultrasound gel (UG).

Conclusion: These results concluded that the application of RS in gel ultrasound was safe and effective for replacement commercial gel ultrasound. This gel should be studied on image quality in ultrasound examination for next step.