Objectives The coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19. Methods and study design A cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5–22.9 (normal weight), 23.0–24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia. Results Of the totals, patients having a BMI <18.5, 18.5–22.9, 23.0–24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50–14.94; p = 0.003) compared to having a BMI 18.5–22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness. Conclusions Obesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.

Background Cisplatin is one of the most potent chemotherapeutic drugs used in head and neck cancer treatment; however, nephrotoxicity is the major side-effect limiting usage. Magnesium supplementation has been reported to reduce risk in non-controlled studies. We investigated whether preloading with magnesium prevents nephrotoxicity with a low-dose weekly cisplatin regimen. Methods We carried out a prospective pilot, single-blinded, randomized controlled trial to compare cisplatin-associated acute kidney injury (cis-AKI) and acute kidney disease (cis-AKD) between two groups: intravenous 0.9% NaCl 500 ml + KCL 20 mEq over 4 h pre-cisplatin 40 mg/m 2 weekly for 7-8 weeks (control group) compared with additional 16 mEq magnesium added to the saline infusion (Mg group) in 30 head and neck cancer patients. Cis-AKI was defined as an increased serum creatinine (SCr) ≥ 0.3 mg/dl within 7 days and cis-AKD is an increased SCr ≥ 0.3 mg/dl between last SCr and baseline pre-chemotherapy SCr. Results The overall cisplatin tumor response rate and survival were comparable between groups. The baseline characteristics were comparable between groups, although SCr was lower in the controls (0.70 ± 0.17 versus 0.87 ± 0.17 mg/dl, P = 0.01). The incidence of cis-AKI was similar (4.6% versus 1.3%); however, the incidence of cis-AKD was higher for the control group (46.7% versus 6.7%, hazard ratio = 0.082, 95% confidence interval 0.008-0.79, P = 0.03). The time to develop cis-AKD was significantly shorter in the control group ( P = 0.007). Conclusions The magnesium-preloading regimen was safe and significantly showed a decreased incidence of cis-AKD. The encouraging results of our pilot study need to be confirmed in a large-scale randomized controlled trial.

Limited data are available on the utilization of sodium thiosulfate (STS) treatment for calciphylaxis in peritoneal dialysis (PD) patients, while it is well-studied in hemodialysis (HD) patients. A systematic literature search was conducted using Ovid MEDLINE, EBM Reviews—Cochrane Central Register of Controlled Trials, and EBM Reviews—Cochrane Database of Systematic Reviews to identify reported cases of PD patients with calciphylaxis who received STS. The search covered the inception of the databases through August 2022. Across 19 articles, this review identified 30 PD patients with calciphylaxis who received STS. These included 15 case reports, 2 case series, and 2 cohort studies. The administration routes and doses varied depending on the study. For intravenous (IV) administration (n = 18), STS doses ranged from 3.2 g twice daily to 25 g three times weekly for 5 weeks to 8 months. Outcomes included 44% of patients experiencing successful wound healing, 6% discontinuing STS due to adverse effects, 67% transitioning to HD, and 50% dying from calciphylaxis complications. For intraperitoneal (IP) administration (n = 5), STS doses ranged from 12.5 to 25 g three to four times weekly for 12 h to 3 months. Results showed 80% of patients achieving successful wound healing, 80% discontinuing STS due to adverse effects, 40% transitioning to HD, and 20% dying from IP STS-related chemical peritonitis. In cases where patients switched from IV to IP STS (n = 3), doses ranged from 12.5 to 25 g two to three times weekly for 2.5 to 5 months. Among them, 67% experienced successful wound healing, while 33% died from sepsis. Two cases utilized oral STS at a dose of 1500 mg twice daily for 6 and 11 months, resulting in successful wound healing without adverse effects or need for HD. However, one patient (50%) died due to small bowel obstruction. This systematic review provides an overview of STS treatment for PD patients with calciphylaxis. Although successful treatment cases exist, adverse effects were significant. Further research, including larger clinical studies and pharmacokinetic data, is necessary to establish the optimal route, dose, and efficacy of STS in PD patients.

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Background: Cardiovascular disease has become important cause of death among HIV-infected patients. The risk of acute myocardial infarction (AMI) in HIV-infected Thai patients has never been evaluated. This study aimed to evaluate the risk of AMI using RAMA-EGAT score among HIV-infected patients in Ramathibodi Hospital.Methods: A cross-sectional study was carried out in HIVinfected patients who visited Infectious Disease Clinic at

Background: Lanthanum carbonate is a phosphate binder in the form of a chewable tablet, which is commonly prescribed in chronic kidney disease patients. We reported an unusual radio-opaque foreign body which was accidentally found in a chest X-ray of an elderly female patient and later identified as an intact lanthanum carbonate tablet.Case Presentation: A 60-year-old woman with end stage renal disease, receiving lanthanum carbonate was found having a coin-shaped, homogeneous radiopaque foreign body in the position of esophagus of her chest X-ray. Due to awareness of mimicking other conditions (e.g. button battery or coin ingestion), urgent endoscopy was performed. An intact lanthanum carbonate tablet was found in the upper stomach and was removed successfully.Conclusion: Physicians should be aware of unchewed lanthanum carbonate tablets when a metallic-like object is detected on chest radiograph of a lanthanum carbonate user. Also, prescription of chewing medication should be cautioned particularly in an elderly female patient.

Background: Clinical heterogeneity was observed among COVID-19 patients with acute respiratory distress syndrome (CARDS). The heterogeneity of disease was contributed to different clinical progression, responses to treatment, and mortality. Objective: We aim to study the phenotype and associated mortality of COVID-19 respiratory failure in Thai patients. Methods: We conducted a single-center, retrospective observational study. The data were collected in CARDS who received an invasive mechanical ventilator in ICU. Patient-related data were collected at admission before the onset of respiratory failure. The main features include demographics data, SOFA score, laboratory, CXR severity score, treatment during hospitalization, and the following data at the onset of respiratory failure during invasive mechanical ventilator. We also collected patients’ status at 28-day, in-hospital complications, and ventilator-free days at 28-day after intubation. The latent profile analysis was performed to identify distinct phenotypes. After identifying phenotypes, characteristics and clinical outcomes were compared between phenotypes. The primary outcome was the phenotype and associated mortality of COVID-19 respiratory. Secondary outcomes include characteristics of phenotype, ventilator-free days, response to treatment, and complications in each phenotype. Discussion: This study aims to identify the phenotype of COVID-19SARS-CoV-2 Respiratory Failure in Thai Patients The different phenotypes may be associated with varying responses to treatment and outcomes that the result of this study may be useful for determining treatment and predicted prognosis of COVID-19 SARS-CoV-2 Respiratory Failure In Thai Patients. Ethics and dissemination: The study protocol was approved by the Institution Review Board of Ramathibodi Hospital, Mahidol University, Thailand (No. MURA2021/740). We plan to disseminate the results in peer-reviewed critical care medicine or pulmonology related journal, conferences nationally and internationally.

Background: End-stage kidney disease (ESKD) patients are significantly at risk of higher mortality than the general population. While cardiovascular disease and infection are the major causes of death in ESKD patients on hemodialysis (HD), the impact of vascular access type on long-term mortality in the Thai population remains unclear. Objective: To find an association between types of vascular access and long-term mortality in HD Thai patients. Methods: A multicenter, retrospective cohort of HD patients with a 55-month follow-up (November 2015 to December 2020) was conducted. Patients’ baseline characteristics, and HD profiles were reviewed. A logistic regression model and survival analysis were used to test the association and survival probability of each type of vascular access and mortality. Results: Of 196 HD patients over 55 months, the proportions of initial vascular access included 46.94% of arteriovenous fistula (AVF), 27.55% of arteriovenous graft (AVG), and 25.51% of tunneled dialysis catheter (TDC). The overall mean all-cause mortality in this cohort was 29.1%. Compared with AVF, TDC was associated with increased mortality (adjusted OR, 3.18; 95% CI, 1.37 - 7.37; P < .05) while the association between AVG and mortality was borderline significant (adjusted OR, 2.29; 95% CI, 0.96 - 5.46; P > .05). Conclusions: TDC as initial vascular access for incident HD Thai patients was associated with increased all-cause mortality at 55 months compared with functioning AVF.