Healthcare Resource Utilization and Healthcare Costs of COVID-19 Patients in A Tertiary Care Public Hospital: A Retrospective Cohort Study in Thailand

Objective: Health care costs (HCCs) are a significant concern in developing countries. The authors investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 based on disease severity and infection site. Materials and Methods: The authors reviewed data from the electronic medical records of COVID-19 patients admitted to the present study hospital between January 2020 and April 2020. The authors used comorbidities and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log-link and gamma distribution. Results: Two hundred two patients had confirmed SARS-CoV-2 infection. Total costs per patient were 6,626 USD (756 to 45,586). Personal protection equipment costs were the most significant cost for COVID-19 patients with a mean of 3,778 USD. The mean treatment cost per patient was 326 USD. Patients with severe symptoms and lower respiratory tract infection (LRI) had a higher cost and resource utilization value before and after adjusting for covariates. Conclusion: COVID-19 patients with severe symptoms and LRI had higher HCRU. Length of stay, severity of symptoms, and LRI were associated with higher cost of treatment. Keywords: SARS-CoV-2; COVID-19; Healthcare resource utilization; Healthcare costs; Thailand

Static and Dynamic Plantar Pressure and Normalized Plantar Pressure Characteristics among Children, Adults, and the Elderly

Background: A better understanding of plantar pressure while standing and walking would help in improving balance and gait performance across different age ranges. Objective: To clarify the differences of plantar pressure while standing and walking among children, adults, and the elderly. Materials and Methods: Fifty-three participants including eleven aged 3 to 8 years, thirty aged 20 to 40 years, and twelve aged 60 to 90 years were included in the present study. Plantar pressure and related parameters while quiet standing and walking with self-selected speed were assessed. Results: In static plantar pressure, no significant differences were observed of mean different pressure and mean different contact area between dominant and non-dominant limbs among the three groups, while center of pressure (COP) displacement was shown as significantly greater between children and adults (p<0.05). For dynamic plantar pressure, no significant differences in COP velocity were found among the three groups. The elderly showed significant lower normalized maximum plantar pressure in areas of the second and third metatarsal, and internal heel compared with the young adults (p<0.05). Additionally, normalized maximum plantar pressures among children seemed to differ from adults. Conclusion: Plantar pressure characteristics could indicate that children develop gait ability in braking and propulsion phases with greater heel and toe function, while the ability of braking and propulsion declined with aging. These could reflect balance ability while standing or walking. Keywords: Foot pressure; Children; Elderly; Normalization

Impact of Molecular Imaging on the Diagnosis of Dementia Subtypes

Objective: To evaluate the impact of positron emission tomography with ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 on the diagnosis of Alzheimer’s disease, primary tauopathies, and other dementia subtypes. Materials and Methods: The authors recruited 30 patients with varying degrees of cognitive impairment that included 14 males and 16 females, aged 50 to 77 years and with a mean age ±SD: 66.6±6.9 years). All patients underwent ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 PET/CT scans. Quantitative and visual analyses of the PET images were performed and reported back to the neurologists responsible for the initial diagnoses. Outcome measures were changed between pre- and post-PET clinical diagnoses and treatment. Results: The primary diagnoses changed after the disclosure of ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 PET scan results in 18 of 30 patients (60%) and was able to resolve 20 of 21 (95.2%) pre-PET diagnostic dilemmas. No new diagnostic dilemmas were created. All changes in clinical diagnoses were accompanied by changes in treatment plan. PET imaging results confirmed the initial diagnoses of six patients. Conclusion: Combined ¹¹C-PiB, ¹⁸F-THK 5351, and ¹⁸F-FDG-PET are of additional diagnostic value over standard diagnostic work-up, especially in diagnostic dilemmas or difficult-to-diagnose dementia patients. Keywords: ¹⁸F-FDG; ¹¹C-PiB; ¹⁸F-THK 5351; Positron emission tomography; Tauopathy

Balance Assessment Using Multi-Directional Reach Test in Community-Dwelling Elderly People with Different Body Mass Index

Objective: To assess ability of balance in community-dwelling elderly people with different body mass index (BMI) using multi-directional reach test (MDRT) test. Materials and Methods: The cross-sectional study design was used to evaluate the effects of body mass index (BMI) on ability of balance using MDRT in community-dwelling elderly people. Results: Obese community-dwelling elderly people had the lowest scores in all directions of MDRT when compared with those of normal weight and overweight groups. Furthermore, in overweight group, the scores in all directions of MDRT were significantly reduced compared to those of normal weight group (p<0.05). Moreover, the scores of MDRT were negatively correlated with BMI (p<0.05). Conclusion: Obese and overweight community-dwelling elderly people had decreased ability of balance. Additionally, BMI was negatively correlated with the scores of MDRT in community-dwelling elderly people. Keywords: Body mass index; Multi-directional reach test; Falls; Elderly; Balance

Risk Factors for The First Episode of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients in Pranangklao Hospital

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease patients. Peritonitis is a common complication in CAPD patients leading cause of technical failure and patient mortality. Investigating the risk for the first episode of peritonitis could help to prevent and improve CAPD outcomes. Objective: To investigate the risk factors for the first episode of peritonitis in CAPD patients in Pranangklao Hospital. Materials and Methods: A single-center, retrospective descriptive study was conducted to evaluate patients undergoing peritoneal dialysis (PD). All incident CAPD patients between October 1, 2011 and March 1, 2021 were recruited. Baseline demographic, and clinical and laboratory data were collected from medical records. Results: In a cumulative 10,916.9 patient-months follow-up of the 411 CAPD patients, 227 were male and 184 were female. One hundred eightyeight (45.7%) patients presented the first episode of peritonitis. The mean age of peritonitis free group and first peritonitis group was 58.2 years and 56.7 years, respectively. The mean duration from starting CAPD to the first episode of peritonitis was 19.4 months. The average peritonitis rate was 0.26 episodes per year, or one episode per 46.84 patient-months. There were no significant differences in clinical characteristics and laboratory data between these two groups, except there were more diabetes mellitus in the infectious peritonitis group at 72.6% versus 62.8% (p=0.03). Coagulase-negative Staphylococcus was the most common organism causing peritonitis. The multivariate logistic regression showed that diabetes mellitus (OR 1.59, 95% CI 1.03 to 2.46, p=0.04) was the risk factors associated with peritonitis. Conclusion: Diabetes mellitus was the risk factor associated with the first episode of peritonitis. Therefore, special supervision should be provided to this group of patients by optimally controlling the diabetic conditions. Keywords: Continuous ambulatory peritoneal dialysis; First peritonitis episode; Risk factors

Clinical Characteristics of Febrile Urinary Tract Infection and Application of Thai Guideline Imaging Recommendations Compared between Children Aged 2 Months to 2 Years and Children Aged 2 to 5 Years

Background: In 2014, the Thai Pediatric Nephrology Association (TPNA) launched a guideline for febrile urinary tract infection (UTI) in children aged two months to five years. Renal and bladder ultrasound (RBUS) is recommended for first febrile UTI, and voiding cystourethrography (VCUG) is recommended in patients with at least one of eight proposed risk factors. Objective: To compare characteristics of febrile urinary tract infection (UTI), compliance with the imaging study recommendation regarding to the TPNA guide, and kidney, ureter, and bladder (KUB) abnormality detections between children aged two months to two years and older than two years to five years. Materials and Methods: The present study was a retrospective study, reviewed children aged two months to five years presenting with first or recurrent episode of febrile UTI between 2014 and 2019 at Siriraj Hospital. Clinical parameters during febrile UTI, indications to perform VCUG, and kidney, ureter, and bladder (KUB) abnormality detections were compared between the younger group and the older group. RBUS and VCUG undergone according to the recommendation were accounted for the compliance. Results: The mean age of 259 younger and of 51 older age children was 8.2±5.6 and 40.0±10.9 months, respectively. Female gender (p=0.01), complaint of constipation (p=0.03), abnormal bladder emptying (p<0.01), and renal impairment (p=0.03) were more frequent in the older than the younger. Overall imaging study compliance was 73.9% and the KUB abnormality detection was 16.5%. High-grade vesicoureteral reflux (VUR) was more common than low-grade VUR. The rates of compliance (p=0.45) and KUB abnormality detections (p=0.54) between the younger and older children were not different. Conclusion: Female gender, and bladder and bowel dysfunction were associated to febrile UTI in older children. The TPNA febrile UTI guideline imaging recommendation was shown to be applicable in both younger and older children. Keywords: Clinical characteristics; Febrile urinary tract infection; Thai guideline imaging recommendations; Renal and bladder ultrasound; Voiding cystourethrography

A Solitary Rosai-Dorfman Disease of The Talus: The First Case Report of Bisphosphonate Therapy with Imaging Follow-up

Rosai-Dorfman disease (RDD) manifesting as a solitary osseous lesion especially of talus bone is rare. The authors reported a 31-year-old Thai man who had chronic left ankle pain and the biopsy of his talar lesion demonstrated emperipolesis, the typical histological feature of RDD. He was treated with curettage and adjuvant bisphosphonate and appeared to show improvement in clinical symptoms and radiological evidence. To the authors’ knowledge, this is the first report of an intraosseous RDD lesion treated with bisphosphonate with imaging follow-up. Keywords: Rosai-Dorfman disease; Talus; Solitary; Radiology; Bisphosphonate

Effectiveness of Nicotine Withdrawal Symptoms Management Program Using LINE Application to Increase Self-Efficacy for Industrial Workers

Background: Smoking is a risk factor for chronic diseases. A combination of tobacco use with occupational hazards among industrial workers could increase the risk of occupational disease and injury. Nicotine is known to be highly addictive. It is difficult not only to maintain the decrease in smoking but also to continue quitting tobacco use. Moreover, nicotine withdrawal can be challenging and lead to failure in the smoking cessation process. Self-efficacy theory has been used recently for the development of effective smoking cessation programs. Objective: To develop an online nicotine withdrawal symptoms management program based on self-efficacy theory and examine its effectiveness. Materials and Methods: A quasi-experimental design with a control group pretest-posttest design was used. The sample consisted of male employees working in a consumer product manufacturing industry in Bangkok. An intervention group (n=28) received an online nicotine withdrawal symptoms management program via LINE application based on self-efficacy theory for one month. In comparison, participants in the control group (n=29) received a conventional smoking cessation program. The effectiveness of the intervention on nicotine withdrawal symptoms, cigarette craving, self-efficacy perception of nicotine withdrawal management, cigarette rolls per day, nicotine dependence level, exhaled carbon monoxide level, and smoking cessation behavior the first and fourth week were examined using a repeated-measures analysis of variance. Results: At one-month follow-up, there were significant differences between the two groups on nicotine withdrawal symptoms score, cigarette craving level, self-efficacy perception of nicotine withdrawal management, cigarette rolls per day, nicotine addiction level, exhaled carbon monoxide level, and smoking cessation behaviors (p<0.001). In addition, there was a significant difference in the self-reported nicotine withdrawal symptoms score in terms of irritability, anger, anxiety, concentration deficit, depression, and insomnia (p<0.001) between groups, between times, and between times and groups (p<0.001). Conclusion: Nicotine withdrawal symptoms management program using LINE application is effective in encouraging smoking cessation. Keywords: Smoking cessation; Nicotine withdrawal symptoms; LINE application; Industrial workers

Physical Activity (PA) of Pre-Clinical and Clinical Medical Students: Is Clinical Medical Student Less Physically Active than Pre-Clinical Medical Student?

Background: An increase of sedentary behavior was observed in each year especially in clinical year. This accounts for a decrease in physical activities (PAs) of medical students, which could lead to reduced overall health and physical performance. Objective: To compare the levels of PA between pre-clinical and clinical medical students of Mae Fah Luang University (MFU) and to explored association between the levels of PA and school year. Materials and Methods: A cross-sectional study was conducted between May and August 2019. Online questionnaire, including personal profiles and global PA questionnaire, were distributed to all MFU medical students currently studying in the academic year of 2019. Results: One hundred fifty-six medical students participated in the present study. From the questionnaires, 67.74% of pre-clinical medical students (n=63) and 52.99% of clinical medical students (n=36) had moderate to high levels of PA. Pre-Clinical students had significantly higher levels of PA by median metabolic equivalent value (MET) at 1,908.73 versus 1,339.05 MET-minutes/week (p=0.03). The sixth-year medical students increased risk of lower PA than the first year about 8.34 times (p<0.01). Conclusion: One-third of the medical students reported as having low levels of PA. Clinical medical students had reduced levels of PA compared to pre-clinical medical students. Therefore, PA should be promoted to help increase the overall health of medical students. Keywords: Physical activity; Metabolic; Equivalent; Medical Student; Clinic; Pre-clinic

Case Report of SLE Patients with Cryptococcosis in Nongkhai Hospital

Background: Cryptococcal infection, especially cryptococcal meningitis, is the most common cause of central nervous system (CNS) infection with a high mortality rate in patients with systemic lupus erythematosus (SLE). The clinical features of cryptococcal meningitis may be non-specific, which may lead to miss or delay diagnosis and treatment. Objective: To collect the case series of SLE patients with cryptococcosis treated in Nongkhai Hospital between 2013 and 2021 and compared it with other studies. Materials and Methods: The medical records of SLE patients (ICD-10 M320-M329) with cryptococcal infection (ICD-10 B450-B459) treated in Nongkhai Hospital between 2013 and 2021 were reviewed and collected onto a medical record form. The following information were obtained, gender, occupation, age at SLE diagnosis, age of onset, duration of disease, comorbid or risks, previous infection, SLE disease activity, glucocorticoids, and immunosuppressors administered before or at infection diagnosis, cryptococcosis clinical manifestations, laboratory data, Cerebrospinal fluid (CSF) findings, antifungal agents used, and outcomes. Results: Six hundred thirty-six patients with SLE were identified and six patients developed cryptococcosis. Five patients had cryptococcal meningitis and one patient had cryptococcocemia. Fever and headache were the symptoms of all patients. CSF cryptococcal antigen was positive in five patients. Antifungal therapy was initiated as soon as the diagnosis was confirmed in all patients. Five patients (83.3%) recovered completely, and one patient was against the advice. Conclusion: The present study suggested that SLE patients presenting with fever and headache along with a history of moderate to high dose steroids and immunosuppressants administration should always be suspected of cryptococcal infection and cryptococcal meningitis. Meanwhile, CSF cryptococcal antigens are the effective screening tools to establish an early diagnosis. Accordingly, early appropriate treatment is crucial for a favorable outcome. Keywords: Cryptococcal infection; Cryptococcosis; Cryptococcal meningitis; SLE; Lupus