Trabecular Bone Score Improves Fracture Risk Discrimination in Postmenopausal Rheumatoid Arthritis Patients Receiving Glucocorticoids

Ratthanin Ruangnopparut,1 Suranut Charoensri,2 Dueanchonnee Sribenjalak,2 Daris Theerakulpisut,3 Chatlert Pongchaiyakul2 1Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Suranut Charoensri, Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Email [email protected]: Bone mineral density (BMD) might not be a sensitive tool for predicting osteoporotic fracture risk among patients with rheumatoid arthritis (RA), especially when receiving glucocorticoids. Trabecular bone score (TBS), which has emerged as a new assessment technique representing bone microarchitecture and strength, may be considered an alternative approach.Materials and Methods: In this cross-sectional analytical study, postmenopausal RA patients receiving glucocorticoids were identified from the postmenopause BMD database. The database included clinical data of postmenopausal outpatients who had at least one BMD measurement between January 2014 and December 2017. TBS was calculated from lumbar spine BMD with the microarchitecture assessment software. The presence of osteoporotic fractures, either vertebral or non-vertebral, was identified at the time of BMD measurement.Results: A total of 64 postmenopausal RA patients receiving glucocorticoids were included. The TBS values were inversely associated with osteoporotic fractures, with a TBS cut-off of less than 1.24, showing the best accuracy with a sensitivity of 79% and a specificity of 84% in discriminating fractures. This newly proposed TBS threshold combined with a BMD T-score of − 2.5 or less demonstrated a greater area under receiver operating characteristic curve in identifying patients with osteoporotic fractures than the BMD threshold alone (p value = 0.003).Conclusion: The reduction in TBS was associated with an osteoporotic fracture in postmenopausal RA patients receiving glucocorticoids. Combining TBS and BMD in these patients incrementally improves fracture risk discrimination and may serve as a supplementary tool in identifying patients at greatest risk of osteoporotic fracture.Keywords: bone mineral density, trabecular bone score, osteoporotic fractures, rheumatoid arthritis, glucocorticoid

The prevalence and clinical features associated of hypothyroidism among Thai systemic sclerosis patients

Thyroid disease, particularly hypothyroidism, has been reported in systemic sclerosis (SSc). Some clinical features of SSc can also present in hypothyroidism. Our aims were to determine the prevalence of, and describe clinical features associated with, hypothyroidism in SSc patients. We conducted a historical cohort study of adult SSc patients who underwent screening thyroid function tests at the Scleroderma Clinic, Khon Kaen University, Thailand, between 2009 and 2018. The patients who had any thyroid disorders before the onset of SSc and were diagnosed as an overlap syndrome were excluded. A total of 200 SSc were included according to sample size calculation, among whom the female to male ratio was 2:1. The majority of cases (137; 69.5%) were diffuse cutaneous SSc subset. The mean age was 55.8 ± 10.7 years and the median duration of disease 4.9 (IQR 1.6–9.9) years. Of the total, 9 had primary hypothyroidism (prevalence 4.5%; 95%CI 2.1–8.4) and 22 had subclinical hypothyroidism (prevalence 11%; 95%CI 7.0–16.2). Of the latter 22, 71% had dcSSc. Logistic regression analysis indicated that unexplained anemia was significantly associated with either subclinical hypothyroid or hypothyroidism (OR 2.74; 95% CI 1.17–6.47), whereas Raynaud’s phenomenon had a negative association (OR 0.28; 95% CI 0.11–0.66). Neither severity of skin tightness nor internal organ involvement were associated with hypothyroidism among SSc patients. Clinical-subclinical hypothyroidism is uncommon among SSc patients, it is frequently associated with anemia, and less so Raynaud’s phenomenon. Clinical-subclinical hypothyroidism should thus be considered in cases of unexplained anemia in SSc patients

Genetic diversity and population structure of the upriver orange mangrove Bruguiera sexangula along the coastlines of Thailand

Upriver orange mangrove Bruguiera sexangula is a member of the Rhizophoraceae family and is usually distributed in the intertidal zones of the tropical and subtropical coastal areas. The analyses of genetic diversity and population structure of B. sexangula are essential for their conservation and management. In the present study, the genetic diversity and structure of 101 B. sexangula individuals from mangrove forests in Thailand were evaluated using single nucleotide polymorphisms (SNPs) through restriction site-associated DNA sequencing (RAD-seq). A total of 3482 high-quality SNPs were obtained after filtration for genetic study. All 3 genetic structure analyses (Bayesian analysis, principal components analysis, and maximum likelihood tree) revealed that these individuals can be clustered into 2 groups corresponding to geographical regions, namely the Andaman Sea and Gulf of Thailand. The level of genetic differentiation between the clusters was moderate (FST = 0.122, p < 0.001), and the analysis of molecular variance (AMOVA) indicated that the individual differences within groups were greater than the differences between the 2 groups. A moderate level of genetic diversity (Shannon's information index, I = 0.458; observed heterozygosity, Ho = 0.416; expected heterozygosity, He = 0.295) of B. sexangula was observed. These results give us a better understanding of the genetic variations and will provide a framework for the conservation of B. sexangula

Creation of an International Interprofessional Simulation-enhanced Mechanical Ventilation Course

BACKGROUND: Evidence shows poor adherence to strategies for reducing morbidity and mortality in intensive care unit (ICU) patients receiving mechanical ventilation globally. Best practice management relies on training all members of the interprofessional ICU team, each with complementary roles in patient management. OBJECTIVES: To develop and evaluate a novel two-phase, train-the-trainer, interprofessional and multicultural "Best Practice Management of the Ventilated ICU Patient" multimodality, simulation-enhanced curriculum for Thai education leaders in critical care. METHODS: In phase 1 (Oregon Health and Science University cohort), two groups of nine ICU nurses and one critical care physician representing experts in critical care and education from a large hospital system in Thailand participated in a weeklong, immersive course consisting of didactic, simulation, and in situ immersive sessions focused on best practice management of mechanically ventilated ICU patients, as well as training in our educational techniques. Outcomes were assessed with pre- and postcourse knowledge assessments and overall course evaluation. In phase 2 (Thai cohort), participants from phase 1 returned to Thailand and implemented a lower fidelity curriculum in two hospitals, using the same pre- and posttest knowledge assessment in 41 participants, before the onset of the coronavirus disease (COVID-19) 6 pandemic. RESULTS: In the Oregon Health and Science University cohort, the mean pretest knowledge score was 58.4 +/- 13.2%, with a mean improvement to 82.5 +/- 11.6% after completion of the course (P &lt; 0.05). The greatest improvements were seen in respiratory physiology and advanced/disease-specific concepts, which demonstrated absolute improvements of 30.4% and 30.6%, respectively (P &lt; 0.05). Participants had a high degree of satisfaction, with 90% rating the course as "excellent" and .90% reporting that the course "greatly improved" their understanding of best practices and comfort in managing mechanical ventilation. The Thai cohort had a mean baseline score of 45.4 +/- 15.0% and a mean improvement to 70.3 +/- 19.1% after training (P &lt; 0.05). This cohort also saw the greatest improvement in respiratory physiology and advanced/disease-specific concepts, with 26.2% and 26.3% absolute improvements, respectively (P &lt; 0.05). CONCLUSION: A novel, two-phase, interprofessional, multicultural, simulation-enhanced train-the-trainer curriculum was feasible and effective in improving education in best practice management of mechanically ventilated patients and may be a useful model for improving the care of ICU patients across the world

Formation of Virus-Like Particles of the Dengue Virus Serotype 2 Expressed in Silkworm Larvae

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