Vajira Medical Journal: Journal of Urban Medicine

e266163

Authors: Phanthaphan Sureeyathanaphat, Padoemwut Teerawongsakul, Teetouch Ananwattanasuk

OBJECTIVE: Warfarin is primarily used for stroke prevention in atrial fibrillation (AF) patients in Thailand. Novel oral anticoagulants (NOACs) are used less commonly due to their high cost. This study aimed to evaluate the appropriate use of anticoagulants and clinical outcomes among nonvalvular AF (NVAF) patients. METHODS: This retrospective study collected data from the electronic medical records of patients who were diagnosed with NVAF between January 2014 and December 2019 at the Faculty of Medicine, Vajira Hospital. Baseline characteristics, prescribed indication, types and doses of anticoagulant, and ischemic and hemorrhagic outcomes were recorded and analyzed. RESULTS: We analyzed 783 patients with NVAF in this study. Of these, 539 (68.90%) were treated with oral anticoagulants (OAC), including 344 patients (43.90%) with warfarin therapy and 195 (24.90%) with NOACs. Meanwhile, 492 (73.10%) patients with CHA2DS2VASC score ≥ 2 received OAC therapy that was suitable for their indication. Of the 344 patients who received warfarin, 112 patients (32.60%) had an optimal time in therapeutic range (TTR) level of ≥ 65%. Of the 195 NOAC patients, only 98 (50.30%) received appropriate doses of NOACs. There was no statistically significant difference in the overall incidence rates of ischemic stroke/systemic embolism, bleeding, cardiovascular death, and all-cause death between the warfarin and NOACS groups. Appropriate TTR levels in the warfarin group was associated with significantly lower incidence rates of cardiovascular death (hazard ratio: 0.14; 95% CI: 0.02–0.79; p = 0.02) and all-cause death (hazard ratio: 0.36; 95% CI: 0.12–0.87; p = 0.01), than inappropriate TTR levels. CONCLUSION: Most NVAF patients received oral anticoagulants with the appropriate indication. Warfarin is the most prescribed oral anticoagulant for patients with NVAF. About half of the patients received inappropriate doses of oral anticoagulants that potentially adversely affected the study outcomes of cardiovascular and all-cause deaths.

e266185

Authors: Ingkarat Sarutipaiboon, Rungtiwa Dangtakot, Sudaluck Thunyaharn, Somchai Pinlaor, Ornuma Haonon

OBJECTIVE: To investigate the effect of a combination of a high dose of monosodium glutamate (MSG) and chronic Opisthorchis viverrini (O. viverrini) infection on kidney pathology and microbiota changes compared to either factor alone. METHODS: Forty male golden hamsters were divided into four groups (10 hamsters per group): non-infected hamsters fed with standard diet (NC), O. viverrini infected hamsters fed with standard diet (OV), non-infected hamsters fed with high doses of MSG in drinking water (MS), and O. viverrini infected hamsters fed with high doses of MSG in drinking water (OM). After 8 months, fecal samples were collected, DNA extracted and subjected to 16S-rRNA sequencing analysis to determine microbial diversity. Kidneys were also collected for histopathological study. RESULTS: Kidney histopathology showed tubular damages and tubular fibrosis were significantly prominent in the OM group, which showed higher pathology changes than in the OV group or MS groups. Next generation sequencing indicated that the levels of Firmicutes to Bacteroides ratio decreased in the OV group (0.28), MS group (0.43) and OM group (0.43) respectively when compared to control group (0.52). In genus levels, Methanobrevibacter, Ruminococcus_1, Escherichia-Shigella, Bacteroides, Akkermansia and Oligella were abundance in the OM group. CONCLUSION: The changing of gut microbiota distribution and kidney pathology changes were more severe in the cases of O. viverrini infection together with MSG consumption. This study provides a first step towards focusing on diet and parasitic infections.

e266094

Authors: Somchai Taosuwan, Varah Yuenyongviwat

Treating femoral neck fractures in the elderly demands careful strategies for optimal results. This review explores into the roles of total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in addressing these fractures, considering their distinct advantages. THA, catering to active elderly patients, delivers excellent pain relief, enhanced mobility, and sustained functionality. In contrast, BHA presents a more conservative option suitable for less mobile patients. Factors like surgery time and dislocation risks play a crucial role in selecting between the two options, while postoperative complications, including infections and joint issues, significantly impact recovery. Adequate post-surgical care and advancements in techniques are pivotal for overcoming these challenges. Continuous research and enhancements in diagnostic methods and post-surgical care are critical for refining strategies, ultimately improving the recovery and quality of life for elderly patients.