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Background: Lower respiratory tract infections (LRTIs) are the most common cause for hospitalization in pediatric patients. Pediatric patients with LRTIs are at an increased risk of morbidity and mortality. The national data analysis of epidemiologic variations facilitates awareness and develops solutions to prevent these conditions in the future. Objective: This study aims to evaluate the epidemiology, causative pathogens, morbidity, and mortality of LRTIs in pediatric patients of Thailand from 2015 to 2019. Methods: This was a retrospective study among pediatric patients aged between 0 and 18 years old admitted in hospitals due to LRTIs in Thailand from January 2015 to December 2019. The data were extracted from National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification; ICD‐10‐TM of J09 to J22. Results: A total of 1,423,509 children hospitalized due to LRTIs were identified. Most of the patients were of age 1–5 years. Pneumonia was the most common LRTI (876,557 children, 61.58%) in hospitalized children. Respiratory syncytial virus (RSV) is the main etiologic pathogen of bronchiolitis, which presents in approximately 10.86% of all episodes. Influenza viruses were found predominantly in children with pneumonia (15.52%). The mortality rate since 2015–2019 was highest in pneumonia under 1 year old (P < 0.001). Pneumonia in children under 5 years old had the highest mortality rate, which accounted for 11.85 per 100,000 children in 2019. Conclusions: LRTIs had a high incidence rate of hospitalization and mortality, especially in children under 5 years old. Influenza virus was the most common pathogen of pneumonia. [ABSTRACT FROM AUTHOR]

Objectives: Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database.Methods: Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63).Results: Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM.Conclusions: Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database.Materials and Methods: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004–2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied.Results: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p< 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16).Conclusions: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion , the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population. [ABSTRACT FROM AUTHOR]

Objective: To study the national incidence of admission for diabetic ketoacidosis (DKA) in Thai children and adolescents with type 1 diabetes (T1D) and characterize risk factors for DKA admission., Methods: Admission records of children and adolescents with T1D during the years 2015-2019 were retrieved from the Thai health coverage system of all schemes. Hospitalization was categorized according to patients' age groups (<1, 1-5, 6-12 and 13-17 years), sex and geographical regions (Bangkok, Central, Northeast, North and South). DKA admission incidence and rate were calculated and compared among subgroups., Results: The annual incidences of T1D and DKA admissions progressively increased over the study period (T1D: 12.0 to 15.0, p<0.001 and DKA: 4.8 to 7.3 per 100,000 child-years, p<0.001). About half of DKA admissions (52%) were recurrent episodes. DKA admission rate was 1.49 admissions/patient. The incidence of DKA admission was greatest in individuals aged 13-17 years (13-17 years: 10.3; 6-12 years: 6.3; 1-5 years: 1.7; and <1 year: 0.6 per 100,000 child-years, p<0.001). DKA admission incidence was greater in females than males (7.6 vs. 4.3 per 100,000 child-years, p<0.001). Among 5 geographical regions, greatest percentage of recurrent DKA (57%), rate of increased annual incidence of DKA admission (3.8 to 7.8 per 100,000 child-years), and DKA admission rate (1.64 admissions/patient) were found in the Northeast region., Conclusions: During the years 2015-2019, rising annual incidences of T1D and DKA admissions among Thai youth were observed. Individuals older than 6 years, being females, and resided in the Northeast region had higher risk for DKA hospitalization.

Background: Point of care testing using glucose meters that measure capillary blood are the most popular and widely used method for the routine monitoring ofblood glucose level. TR UEresult is one ofsuch commonly used blood glucose measuring tools with high accuracy and precision profile according to the manufacturer's data., Objective: To evaluate the performance of TRUEresult in real life practice by examining the agreement between capillary and venous glucose result using TR UEresult and a laboratory plasma glucose., Material and Method: The present study is a cross sectional analytical study. All the data were collected from the patients whose blood samples were drawn for the measurement of plasma glucose at the outpatient department of Srinagarind Hospital, Khon Kaen University Thailand. TR UEresult blood glucose monitoring system was used to perform blood glucose measurement in whole blood samples from capillary and veins. This was compared with plasma glucose result from the automated analyzer in the central laboratory, which was considered as reference method at Srinagarind Hospital., Results: The ISO 15197:2013 criteria was used to determine technical accuracy of the TRUEresult tool. Blood glucose levels in whole blood sample from capillary and veins, as measured using the TRUEresult, were 88.24% and 92.16% of the acceptable bias limits. This is below the minimal acceptable criteria. When Parkes error grid analysis was used to define the significance in clinical decision, all the errors of blood glucose levels measured using the TRUEresult were within zone A and zone B, meaning that the errors have no or little influence on clinical decision., Conclusion: The blood glucose levels in whole bloodfrom capillary and veins measured using TR UEresult blood glucose monitoring was within acceptable accuracy limit. The observed error had no or little influence on clinical decision.

Objective: To examine the prevalence of hospitalized myasthenia gravis (MG), and to determine the factors associated with poor outcomes of hospitalized MG patients at a national level., Methods: This study was based on a retrospective design. We collected data of hospitalized MG adults recorded by the National Health Security Office, Bangkok, Thailand between October 2009 and September 2010. Clinical data and treatment outcomes were examined., Results: The total number of hospitalized MG patients was 936 cases. The prevalence rate of hospitalized MG patients was 2.17/100,000 population. The average age (SD) was 44.93 (14.16) years. Regarding the discharge status of MG patients, 845 cases (90.3%) had improved. The total hospital charge of MG patients was 64,332,806 baht (USD 2,144,426.87) or an average of 68,731.63 baht/admission (USD 2,291.05), with an average length of stay of 10.45 days. There were 3 significant factors associated with poor outcomes in hospitalized MG patients; namely, hospital category, pneumonia, and respiratory failure., Conclusion: The prevalence of admission in MG patients was 2.17 persons/100,000 population. Hospital category, pneumonia, and respiratory failure were significant factors associated with poor outcomes.

Background: Febrile neutropenia (FN) is a serious complication following chemotherapy and is associated with significant mortality and financial expenditure. The aim of this study was to evaluate risk factors for longer length of stay (LOS) and mortality and cost of treatment among hospitalized adults with cancer who developed febrile neutropenia in Thailand., Materials and Methods: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data covered 96% of the population and were analyzed by age groups, hospital level, and insurance year schemes in patients with febrile neutropenia., Results: A total of 5,809 patients were identified in the study. The mortality rate was 14%. The median LOS was 8.67 days and 69% of patients stayed for longer than 5 days. On bivariate analysis, age, cancer type, and infectious complications (bacteremia/sepsis, hypotension, fungal infections, and pneumonia) were significantly associated with longer LOS and death. On multivariate analysis, acute leukemia and infectious complications were linked with longer LOS and death significantly. The median cost of hospitalized FN was THB 33,686 (USD 1,122) with the highest cost observed in acute leukemia patients., Conclusions: FN in adult patients results in significant mortality in hospitalized Thai patients. Factors associated with increased mortality include older age (>70), acute leukemia, comorbidity, and infectious complications.

Background: The incidence of diarrhea in Thai children under five years of age increased over the last decade while mortality dramatically decreased. To evaluate the effectiveness of MCH services under Universal Coverage Schemes, health outcomes should be performed., Objective: To assess the burden and pattern of childhood diarrheal diseases in Thai children under five., Materials and Method: The information on Intestinal Infectious Diseases ICD10: A00-A09 was divided into two groups: 1. Infectious diarrhea: A04, A05, A08, A09 and 2. Dysentery: A02, A03. The authors investigated the number of OPD visits, IPD, mortality, length of hospital stay and co-morbidity of severe cases., Results: The burden of diarrhea was: 3.7 million (1:1) episodes, 756,552 OPD visits (1:5), 124, 403 IPD admissions (1:30), 202 (1:18,460) persistent diarrhea and 48 (1:77, 685) deaths. Diarrheal incidence had two peaks: cool season and early rainy season. Admissions lasted a collective 309,398 days. Diarrhea was persistent in 202 episodes (1.6 per 1,000 admissions) and the associated factors included: age, sepsis, anemia, chronic diseases, malnutrition and HIV. The risks for diarrhea-related mortality included: infant, septicemia and dehydration., Conclusion: The incidence of diarrhea was higher than expected albeit mortality was low. The mortality rate was associated with age under one year persistent diarrhea, septicemia, chronic and underlying diseases.

Background: Unintended pregnancy during adolescence can have profound effects on adolescents, their parents and family, the child and the country's developing population., Objective: To analyze the adolescent pregnancy situation in Thailand in order to provide data and suggestions for refining the nation's medical curricula and enhancing health services for adolescents., Material and Method: National data from Thailand's 3 major health care systems, regarding; adolescent pregnancy complications, deliveries, outcomes and deaths in the 2010 fiscal year were analyzed and compared to women 20-34 years of age., Results: There were 80,523 adolescent pregnancies, comprising 25.9% of all pregnancies. The pregnancy rate for 15-19 year-olds was 33.4 per 1,000 and abortion was the outcome in 14.4%, (18.0% of all abortions). The adolescent birth rate was 28.7 in women 15-19 years of age-on average, there were 188.8 adolescent deliveries per day. Adolescents gave birth to 37.2% of all preterm infants: the preterm birth rate was significantly greater than in women in the optimum reproductive age. Most deliveries were spontaneous vertex deliveries with lower complications and mortality rates than for women in the optimum reproductive age., Conclusion: Unintended pregnancy can have profound effects on adolescent parents, their parents and families, the child and the country's developing population. It should, therefore, be considered a major public health problem that warrants immediate intervention at the national level.