Royal Thai Air Force Medical Gazette

Randomized controlled trial of Fluoxetine or placebo on quality of life after

2024-05-27T13:49:34+07:00

Introduction: Acute ischemic stroke is a leading cause of life-altering disability and death among the Thai population. Depression is a significant sequela of stroke which negatively impacts not only physical recovery, but also the quality of life of stroke survivors. Fluoxetine has been involved in numerous studies in improving functional recovery and preventing post-stroke depression, but with limited findings on the quality of life of stroke patients receiving fluoxetine. This current study strived to ascertain the effects of fluoxetine on the quality of life of patients with acute ischemic stroke following discharge.

Methods: A prospective, double blinded, randomized controlled trial was conducted at Bhumibol Adulyadej Hospital (Bangkok, Thailand) among 60 patients of consenting age admitted with acute ischemic stroke between April 2019 – March 2020. Patients with a diagnosed mental illness, complications following ischemic stroke, inability to communicate, or had high scores on depression screening tools were excluded. Enrolled patients were given either fluoxetine or a matching placebo upon discharge to take once daily for 90 days. They were also scheduled for assessments of quality of life, depression screening, and stroke evaluation at one month and three months following discharge. As of December 2019, 34 patients have been enrolled and followed up at the outpatient department. The primary outcome is the proportion of patients who have a clinically significant improvement (≥0.1) of quality of life at 3 months as measured by EQ-5D-5L. Quality of life as measured by the modified Rankin score (mRS) and incidence of depression as monitored by the 9Q questionnaire were studied as secondary outcomes. Proportional variables were compared using Chi-squared test and Fisher’s exact test and continuous variables were compared using T-test or Mann Whitney U test where appropriate. Statistical analyses were carried out using SPSS version 19.

Results: An interim analysis was planned after the complete follow up of 30 patients. A total of 34 patients were enrolled in which 3 patients were lost to follow up (1 from the fluoxetine group and 2 from the placebo group). Patient baseline characteristics including age, sex, body mass index, and alcohol and tobacco usage were not significantly different between the two groups. Baseline EQ-5D-5L, EQ-VAS, hospital anxiety and depression scale (Thai-HADS), and modified Rankin score (mRS) were similar between the two groups, while 9Q scores in the placebo group (mean=4) was significantly greater although not exceeding the cut-off point for a positive screening of depression (p=0.015). Improvements of EQ-5D-5L scores at the final follow up for patients receiving fluoxetine were higher than those receiving placebo (75% vs. 46.7%), but were not statistically significant (p=0.106). Proportions of patients with mRS ≤ 2 at 3 months were not significantly different between the placebo and the Fluoxetine group (p=1.0). A greater proportion of patients in the placebo group had a 9Q score of > 7 at the final visit as compared to the Fluoxetine group (33.5% vs. 18.75%). No major adverse effects accountable to fluoxetine were observed.

Conclusion: In this interim analysis, prescribing fluoxetine to patients after acute ischemic stroke revealed a potential for positive improvement of quality of life compared to placebo, although improvements of functional outcomes were equivocal. The incidence of higher depression screening scores was greater in patients who received placebo, suggesting fluoxetine as a potential agent for the prevention of post-stroke depression.

Risk Factors of Rapid Correction of Severe Hyponatremia in Bhumibol Adulyadej Hospital

2024-05-23T18:06:43+07:00

Background: Severe hyponatremia is a common electrolyte imbalance which can make patients develop neurological symptoms such as headache, nausea, vomiting, and coma. Treatment of severe hyponatremia need to be cautious because overcorrection may lead to serious neurological complications including osmotic demyelination syndrome (ODS). Nowadays, there are limited data on incidence and risk factors of overcorrection of severe hyponatremia.

Method: In a retrospective study of 400 patients aged 18 years and older who were hospitalized with serum sodium <120 mEq/L at Bhumibol Adulyadej Hospital from 2018 to 2021, we examined the incidence and risk factors of overcorrection. Overcorrection was defined as a serum sodium increase of ≥10 mEq/L at 24 hours and ≥18 mEq/L at 48 hours. Data on patient’s characteristics were collected and analyzed using descriptive and analytical statistics.

Result: Of all 400 patients with severe hyponatremia, 84 patients (21%) experienced overcorrection. Multivariate analysis revealed that the risk factors for overcorrection of severe hyponatremia include age younger than 65 years (odd ratio (OR) 1.99, 95% Confidence Interval (CI) 1.2-3.31, P-value 0.008), initial serum sodium lower than 115 mEq/L (OR 2.10, 95%CI 126-3.48, P-value 0.004) and hypovolemic volume status (OR 2.60, 95%CI 1.55-4.35, P-value <0.001). ODS following overcorrection was found in 4 patients accounted as 1% of population.

Conclusion: Among patients hospitalized with severe hyponatremia, overcorrection was occurred in 21%. The risk factors for overcorrection are age younger than 65 years, initial serum sodium lower than 115 mEq/L and hypovolemic volume status.

Editorial Notic

2024-08-15T10:51:33+07:00

The Impact of PM 2.5 on Pulmonary Immunophysiology and the Lung Microbiome

2023-12-30T15:54:25+07:00

Air pollution is a ubiquitous environmental challenge, with fine particulate matter (PM 2.5) being a prominent component, originating from diverse sources including combustion, dust, soil, biological particles, and sea salt aerosols. This review delves into the complex interplay between PM 2.5 and its various sources, elucidating their multifaceted impact on the pulmonary immune system and lung microbiome. PM 2.5, characterized by distinct compositions and biological constituents, can evoke inflammatory responses, oxidative stress, and immune dysregulation within the respiratory tract, precipitating a range of respiratory ailments. Concurrently, PM 2.5 can exert influences on the lung microbiome, potentially unsettling microbial equilibrium and compromising its protective functions. Dysbiosis induced by PM 2.5 exposure may not only compromise immune defenses but also extend its influence via the gut-lung axis, impacting systemic health. Addressing the pernicious effects of PM 2.5 necessitates a holistic approach, encompassing stringent air quality regulations, emission reductions, cleaner energy promotion, and public awareness. Moreover, further research endeavors are indispensable to unravel the intricate interactions and develop targeted interventions that mitigate PM 2.5-induced perturbations in lung immunophysiology and the microbiome. This comprehensive understanding is pivotal in fostering cleaner air, healthier lungs, and enhanced overall healthiness on a global scale