Chulalongkorn Medical Journal

Factors influencing outcomes in neonatal abdominal surgery: surgeons’ perspectives

Nimmita Srisan — 2026-05-01

Background: Neonatal abdominal surgery is often indicated by congenital conditions, which present considerable morbidity and mortality risks. However, comprehensive surgical data and identification of complication-related risk factors are still lacking.

Objective: The objectives of this study were to characterize neonatal patients undergoing abdominal surgery and to identify prognostic factors associated with complications and mortality.

Methods: A retrospective study was conducted on newborn patients aged 0–30 days who underwent index surgery at a university hospital from 2013 to 2021. Categorical data were compared between the with and without complications groups. Complications were defined as any events that required intervention, either surgical or medical.

Results: There were 154 neonates undergoing 173 index procedures, and 19 patients had more than one condition. The five most common conditions requiring abdominal surgery included abdominal wall defect (31.0%), colorectal disease (16.0%), intestinal atresia (14.0%), necrotizing enterocolitis (8.0%), and meconium peritonitis (7.0%). The incidence of patients with at least one complication was 44.8%, and the mortality rate was 7.8%. Using logistic regression, factors associated with complications included birth weight <1,000 g (P = 0.01), APGAR (CDH) (P = 0.04), and operative time >110 min (P = 0.03). Significant influences on mortality were birth weight <1000 g (P = 0.02), cardiovascular anomalies (P = 0.02), CDH (P = 0.001), and platelet count <100,000/µL (P = 0.03).

Conclusion: This study provides valuable insights into factors that influence outcomes in neonatal abdominal surgery. Birth weight <1000 g, CDH, and operative time >110 min were identified as significant contributors to complications. Furthermore, birth weight < 1000 g, cardiovascular anomalies, CDH, and platelet count <100,000/µL strongly influence mortality. These findings emphasize the complexity of neonatal abdominal surgery with various conditions. Understanding these prognostic factors can help predict the outcome of neonatal abdominal surgery, and improving these outcomes may be achievable in the future.

Clinical outcomes between transradial and transfemoral primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction in Chonburi Hospital

Artit Torpongpun — 2026-05-01

Background: Recent global data have shown that transradial primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) yields better procedural outcomes than transfemoral PCI.

Objective: This study compared clinical outcomes between the transradial approach (TRA) and the transfemoral approach (TFA) in primary PCI for patients with STEMI at Chonburi Hospital.

Methods: This retrospective study enrolled 913 patients with STEMI who underwent primary PCI at Chonburi Hospital between October 1, 2016, and September 30, 2023. Clinical data were extracted from medical records and the hospital’s STEMI registry.

Results: Of the 913 patients with STEMI, 532 underwent TRA and 381 underwent TFA. The TRA group was significantly younger (58.3 ± 12.2 vs. 64.0 ± 14.0 years) and predominantly male (81.2% vs. 68.5%). The TFA group had a higher rate of diabetes (35.7% vs. 27.6%), cardiac arrest (19.7% vs. 11.1%), and Killip class IV (24.2% vs. 9.7%). The mean left ventricular ejection fraction was higher in the TRA group (50.3% vs. 47.1%), while infarct locations (anterior/inferior) were similar. TRA was associated with significantly better outcomes than TFA, including lower all-cause mortality (2.1% vs. 12.9%), major bleeding (0.4% vs. 1.6%), hemorrhagic stroke (0.0% vs. 0.8%), and shorter mean length of stay (3.0 vs. 4.1 days). Multivariate regression analysis identified Killip class (odds ratio (OR) 3.15; 95% confidence interval (CI) 2.21–4.49), cardiac arrest (OR 2.65; 95% CI 1.18–5.95), and age (OR 1.05; 95% CI 1.02–1.09) as predictors of mortality, while the TRA was independently associated with reduced mortality (OR 0.37; 95% CI 0.12–0.93).

Conclusion: In this study, the TRA was associated with significantly reduced all-cause mortality, major bleeding events, and hospital length of stay compared to the TFA, thereby confirming its benefit in patients with STEMI undergoing primary PCI.

Association between sarcopenia and functional outcomes after bipolar hemiarthroplasty in elderly patients with displaced femoral neck fracture: Structural equation modeling

Sanzhar Artykbay — 2026-05-01

Background: Sarcopenia is an underrecognized condition that may impair recovery in older adults after hip fracture surgery.

Objectives: This study aimed to assess the effect of sarcopenia on the functional outcomes and hip muscle strength in elderly individuals with femoral neck fractures while accounting for other potential confounding factors using a structural equation model (SEM).

Methods: This prospective cohort study was conducted at a tertiary university hospital between January 2023 and October 2024, enrolling patients aged 60 years and older undergoing bipolar hemiarthroplasty for displaced femoral neck fractures. Functional recovery was evaluated at the 3-month follow-up using the Barthel Index (BI), Short Physical Performance Battery (SPPB), Harris Hip Score (HHS), and hip muscle strength. Sarcopenia was diagnosed per the 2019 Asian Working Group criteria, alongside assessments for osteoporosis and nutrition. SEM analyzed the effect of sarcopenia on recovery while adjusting for key factors.

Results: Sixty patients (mean age: 81.0 ± 8.4 years; 76.7% female) were included, of whom 15 (25.0%) were identified as sarcopenic. Sarcopenia and malnutrition had substantial negative effects on the BI, HHS, and SPPB scores. Longer hospital stays were independently associated with lower HHS. SEM revealed indirect pathways that linked age, body mass index, and baseline functional status to outcomes via sarcopenia and malnutrition. Sarcopenia was notably associated with reduced hip muscle strength, as measured by a latent variable.

Conclusion: Sarcopenia and malnutrition are major contributors to impaired short-term functional recovery after bipolar hemiarthroplasty in elderly patients with femoral neck fractures. Both factors affect the physical performance, hip-specific function, and independence in daily activities, independently and synergistically. The SEM highlighted the interrelationships between nutritional status, sarcopenia, and baseline function, emphasizing the importance of early detection and targeted interventions during postoperative care.

The use of electronic notifications to improve guideline adherence in amiodarone adverse reaction monitoring

Naruepat Sangpornsuk — 2026-05-01

Background:Amiodarone is an anti-arrhythmic drug that can cause side effects on the thyroid, liver, lungs, vision, and nervous system. Guidelines for monitoring and surveillance of these side effects have been in place since 2000, but adherence to them remains low in many countries,including Thailand. An electronic alert system has been implemented at Vajira Hospital,Navamindradhiraj University, Thailand, to remind physicians of the monitoring guideline since August 2023.

Objectives:This study aimed to compare adherence with the amiodarone guideline before and after implementing an electronic notification system and to evaluate the incidence of amiodarone-related adverse reactions.

Methods:This cohort study used electronic medical records of patients who visited the outpatient department at Vajira Hospital, Thailand, and received amiodarone for at least 1 month between February 2022 and February 2025. Adherence to the amiodarone guideline and incidence of adverse reactions were compared before and after implementing the electronic alert system in August 2023. The primary outcome was to compare adherence before and after the implementation of an electronic notification system. The secondary outcome was to assess the incidence of amiodarone-related side effects.

Results: We screened 201 patients who received amiodarone during that period, but only 110 patients received amiodarone continuously through the period of the electronic notification system(August 2023). The overall adherence to the amiodarone guideline increased from 11.8% to 46.4%(adjusted relative risk 3.92, 95% confidence interval [2.13–7.21]) following the implementation of the electronic alert system. Adherence to chest x-ray, liver function tests, and thyroid function tests also improved substantially after the intervention. The most common adverse reaction suspected from amiodarone usage was abnormal thyroid-stimulating hormone (TSH) levels. The incidence of abnormal TSH levels increased from 18.2% before the notification system to 23.6% after,although the difference was not significant.

Conclusion: The electronic alert system improved adherence to the guideline for monitoring amiodarone side effects in overall aspects. This intervention has the potential to enhance patient safety by facilitating the early detection of amiodarone-related adverse effects. We encourage the implementation of an electronic alert system in hospitals, particularly in the cardiology clinic, to monitor for potential amiodarone-related side effects.

Psychosocial predictors of depression and anxiety in Thai stroke caregivers

Chanatip Tongyonk — 2026-05-01

Background: Stroke is a leading cause of disability and places a considerable burden on caregivers worldwide. However, studies on the burden of stroke caregivers in Thailand remain limited.

Objective: This study aimed to identify characteristics of patients with ischemic stroke and their caregivers that may predict distress, depression, and anxiety symptoms in the caregivers.

Methods: The Hospital Anxiety and Depression Scale (HADS), Zarit Burden Interview (22-item F), and Perceived Stress Scale (PSS-10) were used to measure the caregivers’ burden, stress, depression, and anxiety symptoms. Furthermore, we used partial least squares structural equation modeling (PLS-SEM) to establish a multistep mediation model.

Results: Ninety-seven stroke patients and their caregivers were included in this study. The regression on ZBI-personal strain and stroke of other identified etiology explained 15.0% of the variation in the HADS depression score. We observed that the caregiver’s underlying condition and the patients’ National Institutes of Health Stroke Scale (NIHSS) explained 13.6% of the variation in the caregiver’s overall ZBI score. The total ZBI score, the presence of lacunar circulatory infarction in the patients, and the caregiver’s underlying condition explained 40.9% of the variation in the caregivers’ overall PSS score. Moreover, PLS analysis revealed that the NIHSS and the caregiver’s underlying medical condition had substantial indirect effects on the HADS score, mediated by the ZBI score.

Conclusions: The patient’s disability, reliance, cognition, and stroke phenotypes, as well as the caregiver’s health condition and burden, account for a considerable portion of variation in the stress and depression ratings in caregivers of patients with ischemic stroke. Therefore, screening ischemic stroke caregivers for the aforementioned risk factors is crucial.

Association of microRNAs as biomarkers for severe liver dysfunction in severe dengue infection

Napat Pas-arj — 2026-05-01

Background: The identification of early biomarkers to predict liver dysfunction in patients with severe dengue is essential. Currently, there is no available data on circulating microRNAs to predict this important complication.

Objectives: This study aimed to explore the role of circulating microRNAs in predicting severe liver dysfunction in dengue infection by identifying and validating predictive microRNAs via NanoString and quantitative reverse transcription-polymerase chain reaction (qRT-PCR).

Methods: On the initial day of admission, serum samples were gathered from patients with dengue infection. These patients were monitored for 14 days post-admission to ascertain their final diagnosis. Following the WHO 2009 criteria, participants were categorized into severe and non-severe liver dysfunction groups. To perform transcriptomic analysis of the circulating microRNAs, we used the NanoString nCounter 1 Human v3 microRNA Expression Assays. Subsequently, we validated the levels of the selected microRNAs using qRTPCR.

Results: In the discovery phase, 5 non-severe cases and 4 severe cases were tested, and elevated liver enzymes were found in the severe cases. In the validation phase, 11 severe cases demonstrated substantially longer durations of fever before admission; higher white blood cell counts, total bilirubin, direct bilirubin, and liver enzyme levels; and lower platelet counts and abdominal pain, compared with those of the 92 non-severe cases. Analysis revealed that only 2 of 798 microRNAs, microRNA-424-5p and microRNA-30d-5p, were upregulated in the non-severe group compared to the severe group, and only microRNA-424-5p was significantly higher. microRNA-424-5p had an area under the receiver operating characteristic curve of 0.67 (95% confidence interval: 0.52–0.86, P = 0.04) and exhibited sensitivity, specificity, positive predictive value, and negative predictive value of 63.6%, 76.1%, 16.3%, and 83.7%, respectively. Functional enrichment and gene-targeting analyses indicated that microRNA-424-5p may influence important signaling pathways, including mitogen-activated protein kinase, PI3K-Akt, and mTOR, which are involved in cellular development and metabolic regulation.

Conclusion: Notably, microRNA-424-5p exhibited modest diagnostic performance in distinguishing severe from non-severe liver dysfunction. Our research highlighted the potential of circulating microRNAs, particularly microRNA-424-5p, as biomarkers for predicting severe liver dysfunction in patients with dengue.

Imaging of the centromedian thalamic nucleus using 3D fast gray matter acquisition T1 inversion recovery sequence in 3T MRI in epilepsy

Tunchanok Paprad — 2026-05-01

Background: The centromedian thalamic nucleus (CM) is an emerging deep brain stimulation (DBS) target for neurological disorders, including drug-resistant epilepsy. Traditional DBS localization relies on predefined stereotactic coordinates, which may be imprecise. Innovative magnetic resonance imaging (MRI) sequences enhance gray–white matter contrast, potentially allowing direct CM visualization and improving accuracy in DBS planning and targeting.

Objective: This study evaluated the 3D fast gray matter acquisition T1 inversion recovery (FGATIR) MRI sequence for visualizing the CM in patients with epilepsy.

Methods: This prospective IRB-approved descriptive study included adult patients with epilepsy who underwent a 3D FGATIR MRI sequence at 3 Tesla. Two neuroradiologists independently assessed CM visualization using qualitative grading and quantitative measurements of signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) of the CM and three neighboring nuclei. These nuclei included the mediodorsal (MD), medial pulvinar (PuM), and ventrolateral (VL) nuclei in each thalamus. Interobserver agreement for quantitative assessment was evaluated with the intraclass correlation coefficient (ICC).

Results:A total of 16 patients with epilepsy (mean age 42.8 ± 21.3 years, 44.0% male) were included. Qualitative assessment revealed good CM visualization in 84.0% and poor CM visualization in 16.0% of cases. Mean signal intensities and SNRs differed significantly between the CM and other neighboring thalamic nuclei (P < 0.001). CNRs of the CM relative to the MD, PuM, and VL varied across the thalami. Interobserver agreement was excellent, with ICC > 0.96 for all measurements.

Conclusion: The 3D FGATIR MRI sequence is a practical tool to visualize the CM. Its adoption in clinical practice could potentially improve DBS planning.

Artificial photosynthesis to overcome oxygen deprivation during respiratory disease crisis: A mini review

Devadass Jessy Mercy — 2026-05-01

Patients with respiratory diseases are primarily treated for their symptoms, with oxygen therapy as support.During the Coronavirus Disease 2019 (COVID-19) pandemic, oxygen concentrators were in high demand, and even afterward, many patients died due to a shortage of oxygen cylinders. This crisis prompted many entrepreneurs to establish oxygen plants, which required a large-scale setup. The articles included in this review were searched using Google Scholar, Scopus, and Web of Science using appropriate keywords. Here,we summarize the need for oxygen and how this need can be met through artificial photosynthesis. Using solar energy in the presence of a catalyst, water can be split into hydrogen and various organic products,resulting in oxygen production. The produced oxygen can be stored in oxygen cylinders and supplied to hospitals for patients in need. The difference between oxygen concentrators and artificial photosynthesis is that in the former, atmospheric oxygen is concentrated, and no new oxygen is produced, whereas in the latter,oxygen is produced from water, which is more useful. This mini review discusses artificial photosynthesis, the process, and the role of nanotechnology in enabling it.