Siriraj Medical Journal

The Correlation between Chest X-ray and Cardiac Magnetic Resonance Imaging in the Assessment of Left Atrial Enlargement

Satchana Pumprueg, Methat Meechuen, Thananya Boonyasirinant — Thu, 01 Jan 2026 00:00:00 +0700

Objective: Left atrial enlargement (LAE) is common in cardiovascular disease and is associated with heart failure, atrial fibrillation, and stroke. Chest X-ray (CXR) is widely available; however, its diagnostic value for LAE has not been validated against cardiac magnetic resonance imaging (CMR). We evaluated the correlation and diagnostic performance of conventional CXR signs for detecting LAE using CMR as the reference standard.

Materials and Methods: We retrospectively analyzed 110 patients who underwent CMR and had a posteroanterior CXR within 6 months. Left atrial volume was calculated by the biplane area–length method and indexed to body surface area. CXR signs assessed were the subcarinal angle, double density sign, and left atrial appendage prominence (“third contour”). Sensitivity, specificity, and diagnostic accuracy were calculated against CMR-defined LAE.

Results: CMR identified LAE in 85 patients (77.3%). The third contour had the highest sensitivity (78.8%) but poor specificity (8.0%), whereas a subcarinal angle > 90° had the highest specificity (92.0%) with low sensitivity (8.2%). Overall diagnostic accuracy for individual or combined CXR signs was 27.3%–62.7%, with no correlation between CXR findings and CMR-derived left atrial volume index (all P > 0.05).

Conclusions: To our knowledge, this is the first study validating CXR parameters against CMR for detecting LAE, revealing that conventional radiographic signs have limited diagnostic performance. Despite its accessibility and routine use, CXR demonstrated low sensitivity and specificity for LAE compared with CMR.

Prevalence and Factors Associated with Urologic Abnormalities in Hypospadias Patients

Donlaporn Rungwilaicharoen, Ravit Ruangtrakool — Thu, 01 Jan 2026 00:00:00 +0700

Objective: To estimate the prevalence of urinary tract abnormalities in boys with hypospadias and identify clinical factors that warrant screening.

Materials and Methods: A retrospective review was conducted of patients with hypospadias treated at Siriraj Hospital between January 2014 and December 2023. No standardized radiographic screening protocol was applied.

Results: Urinary tract abnormalities were identified in 6.2% (21/340) of patients with hypospadias. The most prevalent findings were vesicoureteral reflux (VUR) and hydronephrosis, primarily non-obstructive, non-reflux hydronephrosis. Ultrasound KUB was a valuable screening tool (n = 95), detecting 19 urinary tract abnormalities and 13 additional abnormalities. Analysis of KUB-related anomalies in hypospadias showed no direct relationship between urethral opening and the frequency of urinary tract abnormalities, except in coronal hypospadias, which demonstrated a higher rate of anomalies. On multivariable binary logistic regression, anorectal malformation (adjusted OR 13.95, 95% CI 2.47 - 78.63; p = 0.003) and undescended testis (adjusted OR 6.55, 95% CI 1.42 - 30.21; p = 0.016) predicted KUB abnormalities in patients with hypospadias. In the univariable model, cardiovascular abnormalities and coronal hypospadias were also significantly associated with urinary tract abnormalities (p = 0.015 and p = 0.006, respectively), with medium to high effect sizes.

Conclusion: Of patients with hypospadias, 6.2% had anomalies of the urinary tract. It is advised that patients with hypospadias who additionally have anorectal anomalies or undescended testes undergo ultrasound KUB. Additionally, screening can be advantageous for patients with cardiovascular abnormalities or coronal hypospadias.

Incidence and Factors Associated with Perioperative Respiratory Adverse Events in Pediatric Patients with Upper Respiratory Tract Infection Undergoing Surgery Under General Anesthesia: A Retrospective Cohort Study

Thu, 01 Jan 2026 00:00:00 +0700

Objective: The primary objective is to determine the incidence of perioperative respiratory adverse events (PRAEs) in pediatric patients with upper respiratory tract infections (URIs) undergoing general anesthesia (GA); the secondary objective is to identify associated risk factors, including the COLDS score.

Materials and Methods: This retrospective cohort study included pediatric patients aged 0–18 years with URIs who underwent surgery under GA at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, between January 1, 2018, and December 31, 2022.

Results: A total of 229 pediatric patients were analyzed, with a PRAE incidence of 3.9%. In univariable logistic regression analysis, the American Society of Anesthesiologists (ASA) classification III, severe URI, underlying respiratory disease, endotracheal tube use, emergency surgery, and minor airway surgery (compared with other surgery types) were identified as factors associated with PRAEs. In multivariable analysis, only ASA classification III compared with ASA classification II (adjusted odds ratio [OR] 83.33; 95% CI, 7.10 to 1363.56; p < 0.001) and minor airway surgery compared with other surgery types (adjusted OR 18.54; 95% CI, 1.97 to 237.98; p = 0.009) remained significantly associated with PRAEs.

Conclusion: The incidence of PRAEs in pediatric patients with URIs undergoing GA was 3.9%. ASA classification III and minor airway surgery were associated with PRAEs. Careful preoperative assessment and targeted prevention strategies are recommended for pediatric patients with URIs to reduce PRAEs.

Minimum Ischiopubic Ramus Width as a Single Metric for Sex Estimation: A Pilot Study

Robert W. Mann, Sittiporn Ruengdit, Patara Rattanachet, Napakorn Sangchay — Tue, 02 Dec 2025 00:00:00 +0700

Objective: The present study assesses the effectiveness of the minimum width of the ischiopubic ramus as a single measurement for sex estimation.

Materials and Methods: Visual and metrical examination of 135 known-identity male and female os coxae was investigated by measuring the minimum mediolateral width of the ischiopubic ramus, a novel and simple measurement of the narrowest part of the ischiopubic ramus.

Results: The results revealed females typically have a narrow (“pinched”) ischiopubic ramus in comparison to males, with a statistically significant difference in the minimum mediolateral width of the ischiopubic ramus between sexes. Logistic regression, which delivered the best sex estimation model among traditional statistical analysis and machine learning approaches, provided an accuracy of 77.8%, a sensitivity of 83.33% and a specificity of 73.33% with a demarking point of 11.977 mm.

Conclusion: Although the method yields moderate accuracy, the minimum width of the ischiopubic ramus provides a straightforward and practical approach that may assist in sex estimation when only a fragment of the ischiopubic ramus is available. Further validation using larger and more diverse samples is recommended to confirm its applicability.

Comparison of Bridging and Contactless Technique for Umbilical Catheter Securement in Preterm Infants: A Pilot Randomized Controlled Trial

Thu, 01 Jan 2026 00:00:00 +0700

Objective: To compare the rate of catheter dislodgement between the bridging technique and contactless technique (CLT) for umbilical catheter securement in preterm infants.

Materials and Methods: This pilot randomized controlled trial enrolled 30 preterm infants who were randomized in a 1:1 ratio into either the bridging or CLT group. The primary outcome was catheter dislodgement. Secondary outcomes included skin injury, procedural duration, and complications such as omphalitis, catheter-related bloodstream infection (CRBSI), and hypothermia.

Results: A total of 15 patients were included in each group. In the CLT group, 25 catheters were placed (12 umbilical arterial catheters (UAC) and 13 umbilical venous catheters (UVC)), while 24 catheters were placed in the bridging group (10 UACs and 14 UVCs). There was no significant difference in catheter dislodgement rates (1 in 25 catheters in the CLT group vs 0 in 24 catheters in the bridging group, p = 1.00). There was no CRBSI in either group. Skin injuries were minimal, with one case in the bridging group and none in the CLT group (p = 1.00). Repositioning challenges were observed with the CLT after the umbilical stump had dried.

Conclusion: The CLT method demonstrated comparable catheter stability to the bridging technique and may reduce skin injury. It is cost-effective and simple to apply. However, its effectiveness in extremely preterm infants requires further investigation.