Prevalence of factors associated with poor outcomes of hospitalized myasthenia gravis patients in Thailand

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.

Conclusions:

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.Myasthenia gravis (MG) is a neurological disease involving neuromuscular junctions. Antibodies against acetylcholine receptors in the post-synaptic membrane lead to muscle weakness. The prevalence of MG is 2-7/10,000 in the UK,1 and 14.2/100,000 population in the United States.2 Myasthenia gravis patients may need hospitalization if they have myasthenic crisis resulting in respiratory failure. Intubation and mechanical ventilation may be needed. Other treatment options include treatment by plasmapheresis or intravenous immunoglobulin (IVIG).3 Hospitalization of MG patients is the major cause of morbidity, and may result in high economic burdens. Requiring ventilator support and management in the intensive care unit are the main requirements in hospitalized MG patients.4 In Thailand, there is a lack of studies on the prevalence and also the factors associated with treatment outcomes of hospitalized MG patients at a national level. These results may be of benefit in Asian countries concerning treatment protocols and financial plans for hospitalization of MG patients. We aimed 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.     

A comparison of multiphasic oral contraceptives containing norgestimate or desogestrel in acne treatment: a randomized trial

Objective

This study aimed to compare the effectiveness and safety of triphasic combined oral contraceptives (OCs) containing ethinyl estradiol (EE) and norgestimate (NGM) and biphasic combined OCs containing EE and desogestrel (DSG) in the treatment of mild to moderate acne.

Study design

This was an investigator-blinded, randomized, parallel group trial conducted at 3 centers in Thailand. Female subjects 18–45 years old were assigned to one or the other OCs and evaluated for efficacy and safety parameters at the baseline visit and after 1, 3 and 6 months of treatment.

Results

Among 201 randomized subjects, data from 93 subjects in the EE/NGM group and 95 subjects in the EE/DSG group were analyzed. After 6 months of treatment with EE/NGM and EE/DSG, no differences between formulations were found for the decrease in total acne lesion counts (74.4% vs. 65.1%, respectively, p=.070) or facial improvement score. More women using EE/NGM showed a decrease in severity of facial seborrhea than those using EE/DSG (p=.005). No changes in weight were noted in either group as compared to baseline.

Conclusion

Multiphasic OCs containing EE/NGM and EE/DSG provided comparable efficacy and tolerability in the treatment of acne. However, EE/NGM had a more beneficial effect on facial seborrhea reduction than EE/DSG.

Implications

EE/NGM and EE/DSG are multiphasic OCs, which were shown to be clinically equally effective for mild to moderate facial acne, and the multiphasic combined OC with NGM was more effective for women with facial seborrhea. Clinicians may apply the results of this study when considering treatment options for facial acne and seborrhea.     

Necrotising fasciitis causing compartment syndrome of the forearm and septic shock due to Vibrio vulnificus: a case report.

Compartment syndrome caused by necrotising fasciitis has rarely been described. We report a case of systemic Vibrio vulnificus necrotising fasciitis presented with compartmental syndrome of the forearm and septic shock. The patient was treated with systemic antibiotic treatment and urgent surgical decompression followed by multiple necrotic tissue debridements. The patient recovered with some limited motion of the hand function. Prompt recognition and immediate treatment with antibiotics and surgical intervention are essential.     

An HIV-Infected Woman with Choriocarcinoma Presenting with a Nasal Mass

Gestational choriocarcinoma metastasized to the nasal mucosa is extremely rare. An HIV-infected woman with choriocarcinoma presenting with a nasal mass is reported. The clinical findings are compared with a previous reported case. She responded to multiagent chemotherapy and has obtained complete remission. The role of HIV infection is also discussed.     

Perceived Burden of Thai Caregivers for Older Adults After Stroke

Perception of caregiver burden among stroke survivors varies based on socioeconomic and cultural backgrounds. The objectives of this study were to identify the burdens among Thai caregivers of older stroke survivors, characteristics of caregivers and severity of caregiver burden. Caregivers of older stroke survivors were randomly interviewed (March–June, 2012). Information on baseline characteristics and caregiver burden using Zarit Burden Inventory (ZBI) was collected. One hundred one participants were assessed. The mean ZBI was 21.6 ± 14.5 [95% CI, 18.7–24.8]. More than half of caregivers reported no burden (54.5%). High burdens were associated with low self-reported income, high numbers of basic activities of daily living needed and coexisting musculoskeletal conditions. The observed low degree of burden might be the result of the sociocultural view of the study participants.     

Synthesis of Benzoazepine Derivatives via Azide Rearrangement and Evaluation of Their Antianxiety Activities

A new synthetic method for the construction of benzoazepine analogues has been developed employing ortho-arylmethylbenzyl azide derivatives as precursors using an azide rearrangement reaction. In this work, 14 benzoazepine compounds were successfully synthesized in moderate to excellent yields. All synthetic benzoazepines were evaluated for their cytotoxicity against normal human kidney cell line (HEK cell). The results showed that compound 18c had the lowest cytotoxicity (IC₅₀ = 65.68 μM) among tested compounds, which was comparable with the antianxiety drug diazepam (IC₅₀ = 87.90 μM). Based on the cytotoxicity results, five benzoazepine analogues (compounds 18c, 18h, 18j, 18n, and 18p) were selected to determine the antianxiety effect on stressed rats using elevated plus maze (EPM) and open field test (OFT) methods. Interestingly, compound 18c showed better anxiolytic activity than diazepam without a sedative effect by showing superior hyperlocomotor activity. Therefore, this discovery could pave the way for drug development to treat patients with anxiety disorder.