Obstructive sleep apnea is frequently observed in morbidly obese patients undergoing bariatric surgery and the severity tends to be severe. Snoring, STOP-Bang score ≥ 3, fatty liver, and BMI were significantly correlated with OSA. Dyslipidemia and BMI were demonstrated to be associated factors for severity of OSA in this population.
Background Asynchronous online lecture has become a common teaching method in medical education, especially during the COVID-19 pandemic. However, the effectiveness and students’ attitudes towards this method under this special circumstance have not been exclusively studied. Hence, we aimed to evaluate these aspects of cardiovascular physiology teaching in an undergraduate medical curriculum. Methods We analysed and compared the academic achievement and attitudes of 613 medical students on cardiovascular physiology between pre-COVID-19 and COVID-19 years in which different teaching methods were implemented. In addition, we also explored the importance of teaching methods and teachers by subgroup analysis to evaluate whether they influenced the academic achievement and attitudes of students. Results Overall students’ academic achievement was significantly higher when lectures were taught by the traditional method than by the asynchronous online method. Moreover, subgroup analysis revealed that teachers were also a factor influencing students’ academic achievement. Although most students had positive attitudes towards asynchronous online lectures, overall satisfaction was slightly higher when all lectures were taught by the traditional method than by the asynchronous online method. Conclusions Asynchronous online lectures might not be an effective teaching method especially during the abrupt change in education. Under the ‘new normal’ medical education, not only teaching methods but also teachers are the essential keys to the success in academic achievement and attitudes of undergraduate medical students.
The revision committee of the 2019 Thai Guidelines on the Treatment of Hypertension has reviewed new developments in the body of knowledge, together with the expertise in real-life clinical practice and evidence collected from clinical studies worldwide. The guidelines consist of newly highlighted key topics to ensure the guidelines remain up to date, user friendly, and suitable for the country’s context. The guidelines still maintain the current office blood pressure (BP) cut-off point of 140/90 mmHg for the diagnosis of hypertension. The use of out-of-office BP measurements, including home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM), is also advocated to confirm the diagnosis of hypertension. Target BP levels depend on the age of the patients, such as 120 to 130/70 to 79 mmHg for patients aged 18 to 65 years old, or 130 to 139/70 to 79 mmHg for patients over 65 years of age. There are five main groups of antihypertensive medication, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium-channel blockers, and thiazides or thiazide-like diuretics. Two types of medications should be started for most patients, except for frail elderly patients, patients with a relatively low initial BP of 140 to 149/90 to 99 mmHg, and low-risk patients, in which only one type of starting medication should be selected. Medication that involves a combination of two types in one pill should ideally be selected. Keywords: Hypertension; Guidelines; Thailand
Background During the COVID-19 pandemic, pre-clerkship medical education, including all physiology classes, was obliged to change to online teaching due to limitations of on-site (face-to-face) classes. However, the effectiveness of online teaching in non-lecture physiology topics during the COVID-19 pandemic has not been thoroughly investigated. Method We conducted a prospective study to evaluate the students’ academic achievement and opinions on online teaching during the COVID-19 academic year. Academic achievement of 312 students in the COVID-19 year was compared with that of 299 students in the pre-COVID-19 year. Student opinions regarding social interactions and the preferred learning method were also collected. Results We found that student academic achievement in the non-lecture physiology topics, assessed by summative scores, was 4.80±0.92 percent higher in the pre-COVID-19 year than in the COVID-19 year (P < 0.01, Cohen’s d = 0.42). Students rated that online classes tended to reduce their interactions with peers and teachers; however, students preferred online learning over traditional on-site learning. Conclusions This study pointed out that students’ academic performance related to the physiology topics taught by online non-lecture methods during the COVID-19 pandemic was lower than their performance when the topics were taught by the traditional (on-site) methods, although students reported that they preferred the online teaching. Hence, we suggest that medical teachers should deliberately plan and utilise a variety of tools and techniques when developing online non-lecture classes to preserve the interactivity of the classes, which might overcome this gap in students’ academic performance.
Russell's viper bite is an important public health problem of tropical countries including Thailand. Common manifestations after Russell's viper bite are local tissue swelling, coagulopathy, and nephrotoxicity. Cardiac manifestation and cerebral infarction rarely occur. Herein, we reported two cases of cardiac arrest with evidence of large vessel complication following Russell's viper bite. The first case was a 52-year-old man who presented with cardiac arrest due to acute myocardial infarction. His coronary angiography result showed 95% stenosis of the mid left anterior descending artery and a drug-eluting stent was successfully placed. The second case was a 46-year-old female who developed cardiac arrest followed by an acute ischemic stroke. Antivenom was given and her symptom improved. We hypothesized that our patients developed a prothrombotic state associated with consumptive coagulopathy, causing large vessel thrombosis. The exact mechanism to explain these complications, however, is still inconclusive. Nonetheless, early recognition of these events and prompt treatment may reduce morbidity and mortality.
Background Pre-clerkship medical curriculums consist of a series of organ system-based courses and lectures but often lack an integration between organ systems. Such integration could be beneficial for clerkship years and students’ future career. Hence, we aimed to share our process of organising an integrative teaching approach in a large class of pre-clerkship medical students and to reflect the students’ perspective toward the teaching process in this observational study. In addition, we tested effectiveness of this integrative approach compared with the traditional teaching (lecture). Methods We organised a two-dimensional (2D)-integrative teaching for 309 students in selected topics of cardiovascular physiology of the medical curriculum of the Faculty of Medicine, Chulalongkorn University, Thailand. The first dimension of integration is the incorporation of physiology of other organ systems into the cardiovascular physiology class. The second is the integration of multiple teaching methods and strategies, including small group discussion, student presentation, wrap-up, quiz, and question-and-answer sessions. Unless opting out, students evaluated this integrative teaching by filling in a questionnaire. The summative scores were also used to determine their comprehensive understandings of the content. Results The course evaluation showed that most students (81.9–91.2%) had positive attitudes toward all organised sessions, i.e. this teaching method helps promote their basic and applied physiology knowledge, critical thinking, information searching, presentation, and teamwork skills. In general, students at all performance levels attained higher scores in the summative exam for the 2D-integrative-class–relevant questions (74.4±16.1%) than for the lecture-pertinent questions (65.2±13.6%). Conclusions In a large class size of pre-clerkship students, 2D-integrative teaching strategies with careful planning and preparation can be successfully implemented, based on positive attitudes and relatively high summative scores of students in this study. Hence, this comprehensive teaching could be incorporated in current medical curriculums, particularly for the complex learning topics.
Background We sought to examine clinical characteristics and outcomes in patients hospitalized for acute heart failure (HF) and thyrotoxicosis. Methods Patients with thyrotoxic HF were compared with age and gender-matched patients hospitalized for acute HF (controls). Thyr-HF was defined by the Framingham criteria for HF and clinical hyperthyroidism. Thyrotoxic cardiomyopathy was defined as left ventricular ejection fraction (LVEF) < 55%. Results Of 11 109 consecutive patients hospitalized for acute HF between 1 January 2002 and 1 January 2017, 92 patients (0.8%) had thyrotoxic HF. Clinical and echocardiographic data were available in 87 patients (age 51 ± 16 years; 74% female), representing the study population. Compared with controls, patients with Thyr-HF had a smaller body surface area (BSA), a higher LVEF, a lower LV end-diastolic diameter, a higher tricuspid annular plane systolic excursion (TAPSE), higher blood pressure, higher heart rate, and were more likely to have right-sided HF at presentation (P < 0.01 for all). The survival rate among patients with thyrotoxic HF was higher than the control group (HR: 4.3; 95% CI: 2.1-9.5). Fifty-eight percent of patients with thyrotoxic HF had thyrotoxic cardiomyopathy. In multivariate analysis, TAPSE (OR = 46; 95% CI: 1.04-2008.20; P = 0.047) and leukocytosis (OR = 16; 95% CI 1.01-259.39; P = 0.049) correlated with thyrotoxic cardiomyopathy. LV recovery was observed in 69% of these patients. Conclusions Thyrotoxic HF was uncommon among patients hospitalized for acute HF. However, after definitive therapy, these patients had a more favourable prognosis than those hospitalized for acute HF without thyrotoxic HF. Clinical phenotypes of thyrotoxic HF include small BSA, middle-aged female, HF-pEF, and right-sided HF. Thyrotoxic cardiomyopathy affected over half of the patients with thyrotoxic HF with a two-third recovery rate.
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