Siriraj Medical Journal

The Refractive Legacy of Prematurity: A Systematic Review and Meta-Analysis of Refractive Errors and Ocular Biometry in Infants With and Without Retinopathy of Prematurity

Napat Booranapong — 2026-07-01

Objective: To compare the prevalence of refractive errors in children born prematurely with and without retinopathy of prematurity (ROP) and to identify potential factors contributing to heterogeneity.

Materials and Methods: Relevant literature was systematically searched in PubMed, EMBASE, and CINAHL for studies available through January 2025. Studies were eligible if they used cross-sectional, cohort, or case-control designs and reported refractive outcomes among preterm children stratified by ROP status. Effect estimates were synthesized using random-effects models and expressed as pooled odds ratios and mean differences. Between-study variability was evaluated using Cochran’s Q statistic and the I² metric. Additional analyses included subgroup comparisons, meta-regression, and assessment of potential publication bias.

Results: Twelve studies were included. ROP was significantly associated with myopia (OR, 1.76; 95% CI, 1.17–2.64; p = 0.01) and astigmatism (OR, 1.90; 95% CI, 1.49–2.43; p < 0.001), but not hyperopia (OR, 0.97; 95% CI, 0.64–1.47; p = 0.89). Strong associations were observed in upper-middle–income countries. Age significantly modified the ROP–myopia association (p = 0.002). Biometric analysis showed greater vitreous thickness in ROP children (mean difference, 0.16 mm; p = 0.04), while axial length, lens thickness, and anterior chamber depth were not significantly
different (all p > 0.4). No publication bias was detected.

Conclusions: ROP is associated with increased risks of myopia and astigmatism, with effects influenced by age and socioeconomic context. Vitreous thickness was the only biometric parameter significantly affected, suggesting a potential mechanism underlying refractive sequelae, although this requires further validation.

Clinicopathological Features of Primary Mediastinal Large B-cell Lymphoma: A 5-Year Retrospective Study

Mana Muang-iam — 2026-06-01

Objective: To describe the clinicopathological features and treatment outcomes of primary mediastinal large B-cell lymphoma (PMBCL) at Siriraj Hospital, Thailand.

Materials and Methods: This retrospective study included all patients diagnosed with PMBCL during 2020–2024. Clinical, pathological, treatment, and survival data were retrieved from medical records and pathology reports. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method.

Results: PMBCL accounted for 37 of 74 mediastinal lymphoma cases (50%). Median age was 29 years (IQR: 22–32), with female predominance (62.2%). Presentations included cough (79.4%), dyspnea (74.3%), and SVC syndrome (51.4%). Pleural or pericardial effusion was found in 75.0%. Bulky disease (>10 cm) and elevated LDH were 75.7% and 91.4%, respectively. Histologically, sclerotic pattern and HRS-like cells were observed in 41.7% and 31.4%, respectively. All cases were CD20-positive; CD23 and CD30 were expressed in 65.5% and 80.6%, respectively. A non-GCB phenotype was identified in 64.5% by the Hans algorithm. DA-EPOCH-R was the most common first-line regimen (63.9%). At a median follow-up of 25 months, the 24-month OS and PFS rates were 80.1% and 66.8%, respectively.

Conclusion: This study provides the first characterization of PMBCL in a Thai cohort, showing frequent SVC syndrome and pleural or pericardial effusion at diagnosis. Given the overlapping features and complexity of differential diagnosis, comprehensive immunohistochemical workup was essential for accuracy. DA-EPOCH-R was the dominant first-line therapy, with 2-year outcomes comparable to the rituximab era. Prompt recognition, diagnostic expertise, and multidisciplinary management are critical for optimizing PMBCL outcomes.

Myocardial Infarction in a Patient with Coexisting Protein C Deficiency: A Single Case Report and Systematic Review and Pooled Analysis of Published Case Reports

Chanakarn Kanitthamniyom — 2026-07-01

Objective: To report a case of MI in a patient with PC deficiency and to conduct a systematic review and pooled analysis of published cases to summarize clinical features, laboratory findings, recurrence patterns, and management strategies.

Materials and Methods: A systematic review and pooled analysis of reported cases with concurrent MI and PC deficiency was performed. Literature published through June 2024 was identified by searches of MEDLINE and Embase.

Results: Thirty-three patients, including the present case, were analyzed. Median age at presentation was 37 years (IQR 26.5–44). Traditional atherosclerotic risk factors were reported in 6 patients (18.2%). Recurrent arterial and/or venous thrombosis occurred in 19 patients (57.6%). Median PC activity and antigen levels were 42.8% (IQR 32.3–50.5%) and 44.0% (IQR 39.7–52.2%), respectively. Four distinct PROC mutations were described. Coronary angiography most often showed thrombotic occlusion without clear atherosclerotic disease. Combination anticoagulant and antiplatelet therapy was the most common treatment approach. Active smoking was associated with recurrent thrombosis (odds ratio 6.667, 95% CI 1.047–42.431; p=0.045).

Conclusions: PC deficiency may be associated with MI and a high rate of recurrent thrombosis. Targeted evaluation may be considered in selected MI patients, particularly when coronary angiography shows no significant atherosclerosis.

Low-Temperature Atmospheric Pressure Plasma in Acute Wound Healing: A Multi-Center Randomized Controlled Trial Using Split-Thickness Skin Graft Donor Sites as a Standardized Human Model

Pitawan Ratchata — 2026-06-01

Objective: To determine whether low-temperature atmospheric-pressure plasma (LTAPP) improves acute wound healing, using split-thickness skin graft (STSG) donor sites as a standardized clinical model.

Materials and Methods: A multi-center randomized controlled trial was conducted across five tertiary hospitals. A total of 111 patients undergoing STSG were randomized to receive standard of care (SOC) with LTAPP or SOC with sham treatment. Primary outcomes included wound healing rates and wound size/volume reduction. Secondary outcomes included exudate clearance, bacterial burden, and cost-effectiveness.

Results: Healing rates were comparable between LTAPP and SOC groups (71.2% vs. 75.0%, p=0.652). SOC achieved faster wound closure (median 1.6 vs. 2.3 weeks), while LTAPP demonstrated earlier wound volume reduction without translating into improved clinical healing. Both groups achieved complete bacterial clearance. LTAPP incurred significantly higher costs and was not cost-effective, with ICER analysis showing dominance by SOC. Better scar pigmentation quality was observed in a few patients.

Conclusion: Using STSG donor sites as a controlled acute wound model, LTAPP did not improve healing outcomes compared to SOC. These findings suggest that LTAPP may have limited utility in uncomplicated acute wounds but reinforce the value of donor site models for evaluating emerging wound technologies. Future research on LTAPP in wounds should focus on chronic, ischemic, or infected wounds where biological modulation may be more impactful.

Prevalence and Biopsychosocial Factors Associated with Relapse in Patients with First-Episode Schizophrenia in a Clinical Setting in Southern Thailand

Sakuna Kunchamnan — 2026-06-01

Objective: This study aimed to assess the prevalence of relapse among patients with first-episode schizophrenia and identify its associated biopsychosocial factors.

Materials and Methods: This was a cross-sectional study conducted at a major psychiatric hospital in southern Thailand. This study included patients aged 18–59 years diagnosed with schizophrenia within the preceding 3 years. Data were collected using a demographic questionnaire and five standardized instruments. Descriptive statistics and univariate and multivariate logistic regression analyses were performed to identify factors associated with relapse.

Results: A total of 220 patients were included in this study. The prevalence of relapse was 21.8%. The univariate analysis revealed that medication adherence, coping strategies, social support, substance use (p < .01), and cognitive insight (p < .05) were significantly associated with relapse. In the multivariate logistic regression analysis, medication adherence and coping strategies remained independently associated with relapse. Particularly, each one-unit increase in medication adherence was associated with a 71% decrease in the risk of relapse (odds ratio [OR] = 0.29, 95% confidence interval [CI] = 0.12–0.31, p < .01). Similarly, each one-unit increase in the coping strategy score was associated with a 20% decrease in the risk of relapse (OR = 0.80, 95% CI = 0.67–0.94, p < .01).

Conclusion: Higher levels of medication adherence and greater use of coping strategies were associated with a decreased risk of relapse. Healthcare professionals should promote medication adherence and strengthen coping skills among patients with first-episode schizophrenia to enhance long-term stability and successful community functioning.