Search

Background: Inhaled corticosteroid (ICS)-containing regimens are the mainstay for treating asthma despite usually being ineffective in noneosinophilic asthma (NEA). Data on the prevalence of NEA versus eosinophilic asthma (EA) in mild-to-moderate asthma are limited., Objective: We performed a systematic review of the prevalence of mild-to-moderate asthma in adolescents and adults using sputum inflammatory cell analysis and their responses to ICS., Methods: We searched electronic databases (PubMed, Scopus, EMBASE, Cochrane) for studies in adolescents and adults with mild-to-moderate asthma. The primary outcome was the prevalence of asthma subtypes based on sputum inflammatory cell analysis, categorized into EA and NEA. The secondary outcome involved comparing asthma outcomes between different subtypes after ICS therapy. Certainty of evidence was reported for each pooled analysis., Results: Eighteen studies involving 3,533 adolescents and adults with mild-to-moderate asthma were reviewed. The pooled prevalence (95% confidence interval) of NEA was estimated at 40.39% (27.54, 53.93) in patients with ICS naive with very low certainty of evidence. On reevaluating sputum cytology, the disease of approximately 20% to 30% of patients initially diagnosed as NEA transitioned to the EA subtype. EA patients showed significant improvements in asthma symptoms after ICS therapy: forced expiratory volume in 1 second (standardized mean difference, 0.79; 95% confidence interval, 0.30, 1.27), and airway hyperresponsiveness (standardized mean difference, 1.34; 95% confidence interval, 0.29, 2.40). NEA patients exhibited limited response., Conclusion: A high proportion of adolescents and adults with mild-to-moderate asthma were identified with NEA subtype disease, which exhibited a poor response to ICS. A thorough diagnostic evaluation before initiating treatment should be integrated into clinical practice.Registered in PROSPERO (CRD42023484334)., Competing Interests: Disclosure of potential conflict of interest: C. Wongsa has received honoraria for scientific lectures from A. Menarini, Astra-Zeneca, GSK, Novartis, Sanofi, Takeda, and Abbott; and research support from Abbott and Sanofi. J. A. Bernstein has received funding from Novartis, Genentech, Amgen, Sanofi Regeneron, GSK, and Astra Zeneca. T. Thongngarm has received honoraria for scientific lectures from A. Menarini, Astra-Zeneca, GSK, 10.13039/100004336Novartis, P&G, 10.13039/100004339Sanofi, Takeda, and Viatris; has received research support from Abbott, Sanofi, and Viatris; and has served on the advisory board for Sanofi and Viatris. The rest of the authors declare that they have no relevant conflicts of interest. Declaration of generative AI– and AI-assisted technologies: The graphical abstract was created by Canva Pro/Chamard Wongsa. After the creation process, the authors carefully reviewed and edited all content, and they take full responsibility for the accuracy and integrity of this publication., (© 2024 The Author(s).)

Objectives: Fatigue is a prominent feature of long COVID (LC) and may be related to several pathophysiologic mechanisms, including immune hyperstimulation. Aerobic endurance exercise training may be a useful therapy, with appropriate attention to preventing post-exertional malaise. Methods: Fourteen participants completed a pilot study of aerobic exercise training (twenty 1.5 h sessions of over 10 weeks). Cardiorespiratory fitness, 6 min walk distance, quality of life, symptoms, 7-day physical activity, immunophenotype, and inflammatory biomarkers were measured before and after exercise training. Results: The participant characteristics at baseline were as follows: 53.5 ± 11.6 yrs, 53% f, BMI 32.5 ± 8.4, 42% ex-smokers, 15.1 ± 8.8 months since initial COVID-19 infection, low normal pulmonary function testing, V.O 2peak 19.3 ± 5.1 mL/kg/min, 87 ± 17% predicted. After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V.O 2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030). Patients reported improvements in fatigue severity (-11%), depression (-42%), anxiety (-29%), and dyspnea level (-46%). There were no changes in 6MW distance or physical activity. The circulating number of CD3+, CD4+, CD19+, CD14++CD16, and CD16++CD14+ monocytes and CD56+ cells (assessed with flow cytometry) increased with acute exercise (rest to peak) and was not diminished or augmented by exercise training. Plasma concentrations of TNF-α, IL-6, IL-8, IL-10, INF-γ, and INF-λ were normal at study entry and not affected by training. Conclusions: Aerobic endurance exercise training in individuals with LC delivered beneficial effects on cardiorespiratory fitness, quality of life, anxiety, depression, and fatigue without detrimental effects on immunologic function.

Objectives: Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI., Methods: A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans., Results: A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement., Conclusion: Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results., (© 2023. The Author(s).)

This study marked the first investigation into the presence of plastic particles in the stomachs of three mud crab species (Scylla olivacea, S. paramamosain and S. tranquebarica) collected across the Andaman Sea and the Gulf of Thailand. The highest number of plastic particles in the stomach of crab samples was polyethylene (PE) that contributed 88.5 %; while green was the predominant colour (60.3 %). Ingested particles recovered from the stomachs of crabs differed significantly between species and sites (p < 0.001). The average number of plastic particles per individual was 2.3 ± 8.6 in Scylla olivacea, 7.2 ± 16.9 in S. paramamosain, and 13.5 ± 48.9 in S. tranquebarica. Satun, revealed the highest number of plastic particles recovered from mud crabs, while the lowest number of plastic particles were from Pattani. To conclude, species of crab and site of collection plays a crucial factor in the propensity of plastic particles ingested by the genus Scylla mud crabs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study investigated the reproductive traits of the hermaphroditic four-finger threadfin, Eleutheronema tetradactylum, along the coasts of Thailand during January to December 2021. Fish samples were collected from Pattani Bay, Thailand to assess the sex ratio, gonadosomatic index (GSI), maturity stage and fecundity. Additional fish samples were also collected from other areas to evaluate the length and weight at first sex change (Ls 50 and Ws 50 ) and length at first maturity (Lm 50 ). The overall sex ratio for male and female was 1:0.69 with male being predominant throughout the year. Threadfin fish spawn the whole year round with peaks during moderate rainy and heavy rainy seasons. Histological examination confirmed its protandrous hermaphrodite posing multiple spawning habits. The average fecundity was 1.85 × 10 5  ± 1.05 × 10 5 eggs and positively related with standard length, body weight, gonad weight, and egg diameter (p < 0.05). The Ls 50 and Ws 50 were 27.58 cm and 419.39 g, and 29.71 cm and 457.28 g, for fish from Pattani Bay and Samut Prakan province, respectively. The Lm 50 of male from Pattani Bay and Samut Prakan province were 25.78 cm and 25.56 cm, respectively, which were larger than those from Satun and Nakhon Sri Thammarat provinces. The Lm 50 of females from Pattani Bay was smaller than that from Samut Prakan province. This study provided fundamental information on the reproductive characteristics of E. tetradactylum, which can be implemented to support management of natural fish stock and aquaculture development., (© 2023. BioMed Central Ltd., part of Springer Nature.)

No evidence shows that one intranasal corticosteroid (INCS) is better than another for treating moderate-to-severe allergic rhinitis (AR). This network meta-analysis assessed the comparative efficacy and acceptability of licensed dose aqueous INCSs. PubMed/MEDLINE, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until 31 March 2022. Eligible studies included randomized controlled trials comparing INCSs with placebo or other types of INCSs in patients with moderate-to-severe allergic rhinitis. Two reviewers independently screened and extracted data following the Preferred Reporting Items in Systematic Reviews and Meta-analysis guideline. A random-effects model was used for data pooling. Continuous outcomes were expressed as standardized mean difference (SMD). The primary outcomes were the efficacy in improving total nasal symptom score (TNSS) and treatment acceptability (the study dropout). We included 26 studies, 13 with 5,134 seasonal AR patients and 13 with 4,393 perennial AR patients. Most placebo-controlled studies had a moderate quality of evidence. In seasonal AR, mometasone furoate (MF) was ranked the highest efficacy, followed by fluticasone furoate (FF), ciclesonide (CIC), fluticasone propionate and triamcinolone acetonide (TAA) (SMD -0.47, 95% CI: -0.63 to -0.31; -0.46, 95% CI: -0.59 to -0.33; -0.44, 95% CI: -0.75 to -0.13; -0.42, 95% CI: -0.67 to -0.17 and -0.41, 95% CI: -0.81 to -0.00), In perennial AR, budesonide was ranked the highest efficacy, followed by FF, TAA, CIC, and MF (SMD -0.43, 95% CI: -0.75 to -0.11; -0.36, 95% CI: -0.53 to -0.19; -0.32, 95% CI: -0.54 to -0.10; -0.29, 95% CI: -0.48 to -0.11; and -0.28, 95% CI: -0.55 to -0.01). The acceptability of all included INCSs was not inferior to the placebo. According to our indirect comparison, some INCSs have superior efficacy to others with moderate quality of evidence in most placebo-controlled studies for treating moderate-to-severe AR., Competing Interests: KS, TK, CP, SN, and PP: None. TT: received honoraria for scientific lectures from A. Menarini, Astra-Zeneca, GSK, Novartis, P&G, Sanofi, Takeda, and Viatris; research supports from Abbott, Sanofi, and Viatris; served on the advisory board for Sanofi and Viatris., (Copyright © 2023 Soe, Krikeerati, Pheerapanyawaranun, Niyomnaitham, Phinyo and Thongngarm.)

This study assessed the feeding habits and ingestion of anthropogenic debris in 34 marine fish species from the southern Gulf of Thailand. A total of 5478 fish samples of 12 families were categorised into seven groups: planktivore, Lucifer feeder, fish feeder, Acetes feeder, shrimp feeder, piscivore, and zoobenthivore fish. A total of 2477 anthropogenic debris items were extracted from 12 fish species by visual inspection. Their ingestion of anthropogenic debris was influenced by season ( p < 0.0001), with the highest ingestion during the northeast monsoon season. Furthermore, planktivorous fish displayed more ingested anthropogenic debris than the other investigated species ( p = 0.022). Blue-coloured anthropogenic debris was commonly detected in the stomachs of fish and significantly differed between species ( p > 0.001). Water depth and season significantly influenced the availability of food types (AF) for fish ( p < 0.001). These findings provide evidence of the ingestion of anthropogenic debris by fish inhabiting a natural bay and signal the future anthropogenic pollution of marine fish.

Understanding trophic relationships of fish in estuarine ecosystem is an important element for sustainable resource management. This study examined the feeding habits of 29 dominant fish species, characterized the trophic guilds, assessed the impact of season and clarified the role of diets in structuring the fish community in the mouth region of Pattani Bay, Thailand. Samples of 5792 fishes collected monthly by gillnets from March 2019 to February 2020 were used for stomach content analyses. It was found that the number of food types and fullness index differed between fish taxa (P < 0.001). Most fishes were specialist feeders feeding on specific food components and were categorized into five trophic guilds: piscivore, shrimp-fish feeder, polychaete feeder, zooplanktivore and planktivore. Six species were piscivorous, considered as apex predators, that fed almost entirely on fishes. High diet overlaps among some species (>0.6) were recorded. Not much variation in seasonal guilds was observed: four guilds in the dry season, three in the moderate rainy season and four in the rainy season. Some species remained in the same guild the whole year round, but some fishes changed seasonally. Two fish communities from different regions of the bay were segregated based on feeding habits. The inner bay community comprised mainly copepod and plankton feeders, but there were more piscivores in the deeper bay mouth area. Results from this study help us to understand the feeding habits and trophic guilds of dominant fish species at the mouth of this tropical estuarine bay., (© 2021 Fisheries Society of the British Isles.)

Background: Classic electrocardiographic manifestations of hyperkalemia starting with peaked symmetrical T-waves are widely recognized in daily clinical practice but little evidence is documented how quickly it can evolve in real-time., Case Summary: An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis. He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis. Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest., Conclusion: In hyperkalemia, telemetry rhythm can change instantaneously in a significant way. Rapidly rising potassium could be life threatening and may require more than medical treatment., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To discuss the diagnosis and management of paraprotein interference in the setting of multiple myeloma (MM)., Methods: We discuss the evaluation of hypophosphatemia in a patient with MM and present a review of the relevant literature., Results: Our patient, who had a history of MM, was found to have persistently undetectable serum phosphate which did not respond to aggressive phosphate replacement. His clinical condition was not consistent with severe phosphate depletion and hence paraprotein interference secondary to MM was suspected. Re-analyzation of samples on a different machine showed normal serum inorganic phosphate levels., Conclusion: Paraprotein interference from MM causing pseudohypophosphatemia can be overlooked and lead to unnecessary treatment. Recognition of this phenomenon is important to all clinicians, especially in light of potential complications of unnecessary treatment., Competing Interests: DISCLOSURE The authors have no multiplicity of interest to disclose., (Copyright © 2020 AACE.)

Objectives: To obtain basic data on dental caries and gingival status of students in Myanmar, and to identify related risk indicators, including socioeconomic conditions and oral health behaviours and habits., Study Design: This cross-sectional study enrolled 537 fifth-grade students in Myanmar. Oral health behaviours and dietary patterns of students were assessed using questionnaires. Oral examinations were conducted to identify dental caries and gingivitis, and the oral samples were obtained to determine the bacteria levels in dental plaque., Results: The dental caries prevalence was 68.5%, with a mean number of decayed teeth of 2.07 ± 2.15. The prevalence of gingivitis was 98.9%, and the mean number of inflamed gingival areas in the anterior region was 16.2 ± 5.4. No significant differences were found between the sexes in terms of dental caries and gingivitis. Oral hygiene was significantly poorer, and levels of bacteria in dental plaque were significantly higher in boys than in girls. Multiple linear regression tests were used to analyse the association between risk indicators and dental caries and gingivitis. Tooth brushing frequency, a daily habit of mouth rinsing, dental visit experience, consumption of sugary snacks and oral hygiene status were significantly associated with dental caries. Mother's occupation, tooth brushing frequency, consumption of sweet drinks, oral hygiene status and bacterial levels in dental plaque were significant predictors of gingivitis., Conclusions: Myanmar students had a high prevalence of dental caries and gingivitis. Socioeconomic condition, oral hygiene status and oral health behaviours were all determined to be significant risk indicators., (© 2019 FDI World Dental Federation.)

BACKGROUND Trazodone is widely used in the treatment of depression, anxiety, and insomnia. It is thought to have a safe cardiac profile due to the relative lack of anticholinergic effects. Publications about cardiac toxicities of trazodone are scant. CASE REPORT A 55-year-old woman presented with acute disorder of consciousness secondary to an intentional trazodone overdose. She was found to have seizure activity without cerebral edema. The initial electrocardiogram was unremarkable, with a normal QTc interval. She eventually developed QTc prolongation that evolved into ventricular tachycardia, and then into a transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal blocks at 12-24 h after ingestion. She then developed generalized tonic-clonic seizures, cardiogenic shock, and respiratory arrest. She was intubated and treated with antiepileptics, norepinephrine, and dopamine infusion. QTc interval prolongation gradually resolved and the various forms of heart block did not recur after at 24-36 h. She did not require transcutaneous pacing, and was successfully extubated with intact neurological function. CONCLUSIONS Fatal arrhythmias can occur in trazodone overdose. Close monitoring and supportive care are crucial for patient survival.

Background: Mangrove forests are ecologically important but globally threatened intertidal plant communities. Effective mangrove conservation requires the determination of species identity, management units, and genetic structure. Here, we investigate the genetic distinctiveness and genetic structure of an iconic but yet taxonomically confusing species complex Rhizophora mucronata and R. stylosa across their distributional range, by employing a suite of 20 informative nuclear SSR markers., Results: Our results demonstrated the general genetic distinctiveness of R. mucronata and R. stylosa, and potential hybridization or introgression between them. We investigated the population genetics of each species without the putative hybrids, and found strong genetic structure between oceanic regions in both R. mucronata and R. stylosa. In R. mucronata, a strong divergence was detected between populations from the Indian Ocean region (Indian Ocean and Andaman Sea) and the Pacific Ocean region (Malacca Strait, South China Sea and Northwest Pacific Ocean). In R. stylosa, the genetic break was located more eastward, between populations from South and East China Sea and populations from the Southwest Pacific Ocean. The location of these genetic breaks coincided with the boundaries of oceanic currents, thus suggesting that oceanic circulation patterns might have acted as a cryptic barrier to gene flow., Conclusions: Our findings have important implications on the conservation of mangroves, especially relating to replanting efforts and the definition of evolutionary significant units in Rhizophora species. We outlined the genetic structure and identified geographical areas that require further investigations for both R. mucronata and R. stylosa. These results serve as the foundation for the conservation genetics of R. mucronata and R. stylosa and highlighted the need to recognize the genetic distinctiveness of closely-related species, determine their respective genetic structure, and avoid artificially promoting hybridization in mangrove restoration programmes.

Objective: To assess two Oral Health Related Quality of Life (OHQoL) measures and the levels of oral impacts among 14-year-old students in Yangon Division, Myanmar., Design: Cross-sectional validation study. Setting High schools in Yangon Division., Participants: A multi-stage stratified random cluster sample of 543 students., Outcome Measures: Prevalence, extent (number of impacts) and total score as recorded using the Oral Impacts on Daily Performance (OIDP) and the short form of the Oral Heath Impact Profile (OHIP-14). Psychometric measures of validity and reliability., Results: 15.8% and 53.0% of participants had an impact using OIDP and OHIP-14 respectively. The extents and total scores were low among those with impacts. Both measures had good reliability (Cronbach's alpha 0.72 for OIDP and 0.86 for OHIP-14). The presence of dental caries was associated with summary measures of OHIP-14 but not with OIDP. The most frequent cause of impact was dental caries., Conclusions: Both OIDP and OHIP-14 had reasonable reliability but OHIP-14 had superior construct validity. OHIP-14 appears to be more useful as an instrument to discriminate between groups with and without impacts in population surveys.