Vajira Medical Journal: Journal of Urban Medicine

591-600

Authors: Pornthep Sirimahachaiyakul, Usasun Kortawat, Panisa Uttamang, Witan Tanyawiboon, Radchapoom Ketkeaw, Russawadee Bussayajaru, Charasporn Wilaisai, Sukrit Viriyasakultong, Pimprapa Verasmith, Chartchai Chaichana

OBJECTIVE: Hydrogel dressings are commonly used as wound dressings and provide a moist environment in the wound area. Silver nanoparticles (AgNPs) are widely considered as useful therapeutic agents for the prevention and eradication of wound colonization by microorganisms. Recently, there has been a hydrogel dressing that consists of carboxymethyl cellulose hydrogel with blue AgNPs. It provides a moist and optimal healing environment for pain relief and protection from infection. This study aimed to evaluate the use of blue AgNPs hydrogel in acute and chronic wound care. METHODS: From September 2017 to September 2018, 62 wound sites from 39 patients were randomized to receive daily application of either the blue AgNPs hydrogel (31 wound sites from 20 patients) or a commercially available reference hydrogel (31 wound sites from 19 patients). The primary outcome was wound area reduction, expressed as the wound healing rate; secondary outcomes included pain intensity and infection prevention. RESULTS: The blue AgNPs and reference hydrogels were comparable in terms of wound area reduction and pain scores during the changing of wound dressings, with no significant differences (p > 0.05). Patients in the blue AgNPs hydrogel group showed low rates of bacterial infection for both gram-negative and gram-positive strains; in particular, there was almost complete prevention of infection by gram-positive strains at day 21 after treatment initiation. CONCLUSION: The blue AgNPs hydrogel may be effective in preventing bacterial infections of both gram-negative and gram-positive strains at 14–21 days. Thus, the blue AgNPs hydrogel is a promising material for therapeutic applications in wound care.

611-620

Authors: Preawkalaya Suksai, Pathaporn Prempraphan

OBJECTIVE: To determine the prevalence and clinical features associated with early onset neonatal bacterial meningitis (EONBM) in term infants with early onset neonatal sepsis (EOS). METHODS: This was a retrospective descriptive study of term neonates with EONBM (defined as diagnosis of proven meningitis within 72 hours of age) at Vajira Hospital during 2013–2019. Data from medical records including demographic data, cerebrospinal fluid (CSF) analysis, microbiological results, and neonatal outcomes were reviewed. RESULTS: There were 1,203 term neonates with EOS. Of these, 18 neonates were diagnosed with EONBM, which corresponded to a prevalence of 15.0 cases per 1000 term neonates with EOS. A total of 409 (34.0%) neonates with EOS underwent lumbar puncture (LP) within 72 hours of age, of which 4.4% had EONBM. Of the 18 neonates with EONBM, 1 (5.6%), 2 (11.1%), and 15 (83.3%) neonates had positive CSF Gram stain, latex agglutination test, and CSF white blood cell > 20 cells/millimeter3 (mm3), respectively. All neonates with EONBM had negative blood and CSF culture. Median gestational age and birthweight were 39.0 (interquatile range [IQR] 37.0–39.0) weeks and 3.3 (IQR 2.9–3.4) kg, respectively. Apnea (adjusted odds ratio [aOR] 57.2; 95% confidence interval [CI] 7.1–460.9), history of maternal chorioamnionitis (aOR 13.66; 95% CI 2.08–89.59), and absolute neutrophil count ≥ 18,000 cells/mm3 (aOR 7.05; 95% CI 2.13–23.30) showed a significant association with EONBM. CONCLUSION: The prevalence of EONBM in this cohort of term neonates with EOS was relatively low. The current literature does not provide the definite elucidation of risk factors associated with EONBM. A promptly p

631-640

Authors: Supaphong Eiamakarawit, Wichada Hunsakunachai

OBJECTIVE: This study aimed to determine whether the heart failure (HF) clinic setting can improve guideline-directed medical therapy (GDMT) use and reduce HF readmission and mortality rates in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: This was a retrospective cohort study including patients with HFrEF admitted to Vajira Hospital between May 2016 and December 2021. Data were collected from electronic medical records to compare the usage of GDMT, including beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs)/ angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs), and sodium glucose transporter 2 inhibitors (SGLT2s), after discharge from the inpatient department at 1-, 3-, 6-, and 12-month follow-up between the HF clinic and general cardiology clinic groups. Moreover, readmission, mortality rates and composite endpoint of mortality and HF admission rate at the 1-year follow-up were recorded. RESULTS: In total, 234 patients with HFrEF were included in this study (88 in the HF clinic group and 146 in the general cardiology clinic group). After 1-year follow-up, the incidence rates of mortality in the HF clinic and general cardiology clinic groups were 3.45 and 11.66 per 100 person-years, respectively (p = 0.040), and the incidence rates of readmission were 23.77 and 79.01 per 100 person-years, respectively (p < 0.001). The HF clinic group showed reduced risk for the composite outcome of readmission and mortality (0.37, 95% confidence interval (CI): 0.23–0.60) (p < 0.001), mortality (0.30, 95% CI: 0.09–1.02) (p = 0.054), and readmission (0.33, 95% CI: 0.21–0.53) (p < 0.001) than the general cardiology clinic group. At the 12-month follow-up, the HF clinic could up-titrate GDMT to target doses higher than the general cardiology clinic (beta-blockers 68.20% vs. 32.90% (p < 0.001), ACEIs/ARBs/ARNIs 12.50% vs. 3.40% (p = 0.003), MRAs 9.10% vs. 4.10% (p = 0.001), and SGLT2s 4.50% vs. 7.50% (p = 0.648)). CONCLUSION: Patients in the HF clinic showed a significant improvement in survival and HF readmission rates and had a higher use of GDMT with a shorter duration to achieve the target doses.