Continuous positive airway pressure therapy converted atrial fibrillation in a patient with obstructive sleep apnea

AbstractBackgroundObstructive sleep apnea (OSA) is one of the possible causes of atrial fibrillation (AF). Continuous positive airway pressure (CPAP) therapy may lower the recurrence rate of AF after cardioversion to normal sinus rhythm. We report a case of AF caused by OSA and successfully converted by CPAP therapy.CaseA 65-year-old man presented with AF of unidentified causes. After severe OSA was diagnosed, he was treated with CPAP for 2 months and his cardiac rhythm returned to sinus rhythm without any antiarrhythmic drugs or cardioversion.ConclusionAF caused by OSA may be converted to sinus rhythm by CPAP treatment

A web-based surveillance model of eosinophilic meningitis: future prediction and distribution patterns

Background: web-based surveillance is a useful tool for predicting future cases of various emerging infectious diseases. There are limited data available on web-based surveillance and patterns of distribution of eosinophilic meningitis (EOM), which is an emerging infectious disease in various countries around the world.  Methods: this study applied web-based surveillance to the prediction of EOM incidence and the analysis of its distribution pattern by using a national database, which may be used for future prevention and control. The number cases of EOM in each month over a period of 12 years (between 2006 to 2017) from Loei province were retrieved from the National Disease Surveillance (Report 506) website, operated by Thailand's Public Health Center.  Results: we developed autoregressive integrated moving average (ARIMA) models and seasonal ARIMA (SARIMA) models. The best model was used for predicting numbers of future cases. The forecast values from the SARIMA (1, 1, 2)(0,1,1)6 model were close to actual values and were the most valid, as they had the lowest RMSE and AIC. The predictive model for future cases of EOM was related to previous numbers of EOM cases over the past eight months. The disease exhibited a seasonal pattern during the study period.  Conclusions: web-based surveillance can be used for future prediction of EOM, that the predictive model applied here was valid, and that EOM exhibits a seasonal pattern

Additional risk factors associated with symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients

Background. Hydrochlorothiazide is a cheap and effective antihypertensive agent but may cause hyponatremia. Even though several risk factors for hydrochlorothiazide-induced hyponatremia have been reported, this study aimed to evaluate additional risk factors for hydrochlorothiazide-induced hyponatremia in hypertensive patients. Material and methods. The inclusion criteria were: adult patients, diagnosed with hypertension and receiving hydrochlorothiazide treatment. Eligible patients were divided into two groups: with and without hyponatremia. Those with hyponatremia were identified by using the ICD-10 code E871, while those without hyponatremia were patients who did not have any reported hyponatremia until the last visit. The ratio between hyponatremia and non-hyponatremia group was 1:2. Predictors for hyponatremia were analyzed by using logistic regression analysis. Results. During the study period, there were 68 patients admitted due to symptomatic hyponatremia from hydrochlorothiazide. There were four independent factors in the model predictive of occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients: sex, body mass index, plasma glucose, and serum albumin. Male sex, body mass index, and serum albumin were negatively associated with occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients with adjusted OR of 0.099, 0.683, and 0.122, respectively. The plasma glucose had adjusted OR of 1.030 [95% CI of (1.009, 1.051)]. Conclusions. Factors associated with hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients were sex, body mass index, plasma glucose level, and serum albumin level. The latter two risk factors have never been reported as risk factors for hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients

Frailty as a Predictor of Hospitalization and Low Quality of Life in Geriatric Patients at an Internal Medicine Outpatient Clinic: A Cross-Sectional Study

Frailty is an aging-associated state that increases patients’ vulnerability to disease, and can lead to various adverse outcomes. It is classified as either physical frailty alone or physical frailty in combination with cognitive impairment (cognitive frailty). There are currently limited data available regarding the prevalence and adverse outcomes of frailty in Thailand. This was a cross-sectional study aimed at determining the prevalence of physical and cognitive frailty and their effects on hospitalization and quality of life. Participants were older patients who attended an internal medicine outpatient clinic. Frailty was diagnosed using the Thai Frailty Index. The Thai version of the MoCA was used to evaluate cognitive status. Univariate and multivariate analyses were performed to compare adverse outcomes in terms of poor quality of life and history of admission to hospital between patients with frailty and non-frail patients, and among patients with physical frailty, cognitive frailty, cognitive impairment, and robust (non-frail and non-cognitively impaired) patients. We enrolled 198 participants. The prevalence of physical and cognitive frailty was 28.78% and 20.70%, respectively. When compared with non-frail patients, frailty was associated with hospitalization (adjusted OR 3.01, p = 0.002) but was not significantly related to quality of life (adjusted OR = 1.98, p = 0.09). However, physical and cognitive frailty were associated with fair quality of life when compared with normal patients (adjusted OR = 4.34, p = 0.04 and adjusted OR = 4.28, p = 0.03, respectively). The prevalence of frailty—particularly cognitive frailty—was high. Frailty was associated with adverse outcomes in terms of hospitalization and quality of life

The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid Cognitive Screening Tools with Comparable Performance in Detecting Mild NCD in Older Patients

Background: Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. Methods: This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools’ accuracy. Results: A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). Conclusions: All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice

Can RUDAS Be an Alternate Test for Detecting Mild Cognitive Impairment in Older Adults, Thailand?

The Montreal Cognitive Assessment (MoCA) is the commonly used cognitive test for detecting mild cognitive impairment (MCI) in Thailand. Nevertheless, cultural biases and educational levels influence its performance. The Rowland Universal Dementia Assessment Scale (RUDAS) seems to lower the limitation of the MoCA. This study aimed to compare the performance of the RUDAS and the MoCA for the diagnosis of MCI and demonstrate the correlation between them. A cross-sectional study of 150 older participants from the outpatient setting of the Internal Medicine Department, Srinagarind Hospital, Thailand was recruited during January 2020 and March 2021. The diagnostic properties in detecting MCI of the RUDAS and the MoCA were compared. MCI was diagnosed in 42 cases (28%). The AUC for both RUDAS (0.82, 95% CI 0.75–0.89) and MoCA (0.80, 95% CI 0.72–0.88) were similar. A score of 25/30 provided the best cut-off point for the RUDAS (sensitivity 76.2%, specificity 75%) and a score of 19/30 for the MoCA had sensitivity and specificity of 76.2% and 71.3%. The Spearman’s correlation coefficient between both tests was 0.6. In conclusion, the RUDAS-Thai could be an option for MCI screening. It was correlated moderately to the MoCA

The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section

Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m 2 who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m 2 . The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively

The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section

Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m2 who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m2. The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively

Frailty as a Predictor of Hospitalization and Low Quality of Life in Geriatric Patients at an Internal Medicine Outpatient Clinic: A Cross-Sectional Study

Frailty is an aging-associated state that increases patients’ vulnerability to disease, and can lead to various adverse outcomes. It is classified as either physical frailty alone or physical frailty in combination with cognitive impairment (cognitive frailty). There are currently limited data available regarding the prevalence and adverse outcomes of frailty in Thailand. This was a cross-sectional study aimed at determining the prevalence of physical and cognitive frailty and their effects on hospitalization and quality of life. Participants were older patients who attended an internal medicine outpatient clinic. Frailty was diagnosed using the Thai Frailty Index. The Thai version of the MoCA was used to evaluate cognitive status. Univariate and multivariate analyses were performed to compare adverse outcomes in terms of poor quality of life and history of admission to hospital between patients with frailty and non-frail patients, and among patients with physical frailty, cognitive frailty, cognitive impairment, and robust (non-frail and non-cognitively impaired) patients. We enrolled 198 participants. The prevalence of physical and cognitive frailty was 28.78% and 20.70%, respectively. When compared with non-frail patients, frailty was associated with hospitalization (adjusted OR 3.01, p = 0.002) but was not significantly related to quality of life (adjusted OR = 1.98, p = 0.09). However, physical and cognitive frailty were associated with fair quality of life when compared with normal patients (adjusted OR = 4.34, p = 0.04 and adjusted OR = 4.28, p = 0.03, respectively). The prevalence of frailty—particularly cognitive frailty—was high. Frailty was associated with adverse outcomes in terms of hospitalization and quality of life

Prevalence of Geriatric Syndromes in Elderly Cancer Patients Receiving Chemotherapy

The number of elderly patients with cancer is growing. Our study goals were to determine the prevalence of geriatric syndromes in elderly cancer patients receiving chemotherapy and its related factors using a basic geriatric screening tool. A cross-sectional study using the basic geriatric screening tool was conducted to survey geriatric problems in a population of elderly cancer patients receiving chemotherapy. There were 85 participants who were ≥60 years old. Descriptive statistics and regression analyses were used. The prevalence of having at least one geriatric syndrome was 58.8% (50 out of 85 cases). Depression was the most common component both in male and female patients. Age ≥65 years old was significantly associated with the geriatric syndrome (AOR 4.23, p=0.018), and a factor associated with depression was underweight (BMI<18.5 kg/m2) (AOR 13.2, p=0.003). In summary, geriatric syndromes are common in elderly cancer patients. Screening for geriatric syndrome adds substantial data on the assessment of elderly cancer patients, even those with a good performance status