Siriraj Medical Journal

Factors Associated with Pain Scores in Late Preterm and Term Infants Undergoing Routine Procedures

Supranee Rugsapol — 2025-07-01

Objective: To identify factors associated with Premature Infant Pain Profile-Revised (PIPP-R) scores in late preterm and term infants undergoing routine skin-puncture procedures.

Materials and Methods: A secondary analysis of a prospective cohort study was conducted in hemodynamically stable late preterm and term infants (gestational age [GA] 34–41 weeks) undergoing routine procedures. PIPP-R scores were evaluated through video recordings by a blinded assessor.

Results: Among 59 infants, 31 (52.5%) underwent venipuncture, 15 (25.4%) received intramuscular (IM) injections, and 13 (22%) underwent heelsticks. The median PIPP-R score was 11.0 [7.0, 14.0]. IM injections and heelsticks resulted in significantly higher pain scores compared to venipunctures (regression coefficient: 4.6, 95% CI: 2.3–6.8, and 2.8, 95% CI: 0.6–5.0, respectively). No correlation was observed between procedure duration and pain scores (r = -0.06, p = 0.68), but GA showed a weak positive correlation (r = 0.32, p = 0.01). After adjustment, low birthweight (<2500 g) was independently associated with lower PIPP-R scores (-2.9, 95% CI: -4.8, -1.1), while postnatal age <48 hours was linked to higher scores (5.8, 95% CI: 3.3–8.4). Oral sucrose solution significantly reduced pain scores (-6.4, 95% CI: -9.4, -3.3).

Conclusion: IM injections were associated with the highest pain scores, while procedure duration did not affect pain intensity. LBW infants and those >48 hours old exhibited lower pain scores, suggesting developmental factors. The demonstrated efficacy of oral sucrose underscores its importance in neonatal pain management, emphasizing the need for routine implementation of analgesic strategies.

Integrating Artificial Intelligence into Chronic Kidney Disease Care: Enhancing Hemodialysis Scheduling, Comorbidity Management, and Diagnostic Capabilities

Raniah I. Alnaser — 2025-07-01

Chronic kidney disease (CKD) is one of the most common and serious illnesses affecting individuals worldwide, potentially leading to kidney failure. Various strategies exist to manage CKD, with hemodialysis being the most effective. However, this treatment comes with numerous limitations that can significantly affect patients’ quality of life. Therefore, it is crucial to explore new approaches to address these challenges. Recently, artificial intelligence (AI) has emerged as a promising tool in nephrology. This review aims to reduce the need for frequent dialysis and to explore the future potential of AI in the field of nephrology. The frequency of hemodialysis refers to the regular, scheduled dialysis sessions mainly prescribed for patients with CKD, in addition to the unplanned or premature initiation of hemodialysis through predictive and preventive interventions. This narrative review systematically searched Google Scholar and PubMed using keywords related to CKD, hemodialysis, and AI. AI is used in kidney disease to predict CKD progression, evaluate drug prescriptions, detect medical errors, adjust dialysis schedules, and identify unknown comorbidities and phenotypes. Integrating AI in nephrology holds promise for reducing kidney dialysis frequency through its applications in the management plans of patients with CKD.

A Systematic Review and Meta-Analysis of Interventions to Manage Stress and Burnout in Physicians

Nopparat Rakkan — 2025-07-01

Objective: To assess interventions aimed at reducing stress and burnout among physicians.

Materials and Methods: A systematic review and meta-analysis was performed in line with PRISMA guidelines. Randomized controlled trials published in English up to December 2022 were identified through searches in medical databases, including PubMed, EMBASE, and CINAHL. The primary outcomes were stress and burnout levels.

Results: A total of 13 studies investigated interventions to reduce stress and burnout, including mindfulness and non-mindfulness-based approaches. Non-mindfulness interventions included professional coaching, group-coaching programs, and training in humanism and professionalism. Outcomes were assessed at two time points: immediately post-intervention and at the final follow-up. Stress-reduction interventions significantly decreased stress levels (Hedges’ g = -0.20, 95% CI: -0.37 to -0.02, p = 0.03; I² = 6.66%). In contrast, burnout-reduction interventions showed a non-significant trend toward improvement (Hedges’ g = -0.08, 95% CI: -0.32 to 0.17, p = 0.53; I² = 43.89%).

Conclusion: Stress-reduction interventions are effective in lowering stress among physicians. However, improvements in burnout remain limited, possibly due to variations in intervention effectiveness across studies. Further research should focus on long-term follow-ups to address the well-being and resilience of healthcare professionals.

Osteitis in Chronic Rhinosinusitis: A State-of-the-Art Review

Wiyono Hadi — 2025-07-01

Chronic rhinosinusitis (CRS) is characterized by inflammation of the nasal mucosa and paranasal sinuses. Mucosal inflammation can induce bone remodeling leading to osteitis. Paranasal sinus osteitis is a relatively new clinical finding, describing changes in the bone due to inflammation that will damage the lamellar bone structure and new bone formation. As many as 36-53% of CRS patients have osteitis, which makes CRS difficult to cure despite adequate management and is related to a substantial number of revision surgeries. Understanding all the evidence regarding osteitis in CRS is critical in discovering effective treatments for this incurable disease. Hence, we summarize the essential yet well-established features of osteitis in CRS, including the updated definition, the role of biofilm formation along with cytokines and runt-related transcription factor 2 axis as its possible underlying pathogenesis, the transforming growth factor beta signaling pathway of the disease, histopathological bone changes, radiographic staging and scoring systems, disease impacts on the CRS severity and quality of life, as well as the most up-to-date treatment strategies for osteitis in CRS. These include functional or radical endoscopic sinus surgery, interleukin-13 inhibitors, anti-biofilm agents, high-dose intranasal corticosteroids, and other potential therapies.

Efficacy of Topical Andrographis Paniculata Extract for Pruritus in Chronic Liver Disease: A Randomized, Placebo-Controlled Trial

Chotipong Siripipattanamongkol — 2025-07-01

Objective: Assessing the effectiveness of topical extract from Andrographis paniculata, which has anti-inflammatory properties, in reducing pruritus in individuals with chronic liver disease.

Materials and Methods: At Chiang Rai Prachanukroh Hospital, a randomized, placebo-controlled trial was carried out from 2021 to 2024. Forty-five individuals with chronic liver disease and persistent pruritus who were at least eighteen years old were randomly assigned (1:1) to receive 4% extract cream from Andrographis paniculata or a placebo, which was applied twice a day for four weeks. The dynamic pruritus score (DPS), which was used to measure pruritus severity at baseline, week 1, and week 4, was the main outcome. The dermatology life quality index (DLQI) was used to measure the quality of life as the secondary outcome.

Results: The Andrographis paniculata extract significantly improved the pruritus severity compared to placebo, with DPS scores of 6.31±0.41 at week 1 and 6.82±0.40 at week 4 versus 5.01±0.24 and 5.59±0.35, respectively (p<0.001). However, there was no significant difference in DLQI scores between treatments. There were no adverse effects reported, and one participant in the treatment arm withdrew due to logistical issues.

Conclusion: Andrographis paniculata topical extract is a reliable and efficient remedy for alleviating pruritus in individuals with chronic liver disease. However, larger sample numbers and longer follow-up times are required for future research to validate these findings and evaluate the impact on quality of life.