Publications by authors named "Thakkinstian A"
Background: Inhaled corticosteroids (ICS) are recommended treatment for mild asthma. We aimed to update the evidence on the efficacy and safety of ICS-containing regimens, leukotriene receptor antagonists (LTRA), and tiotropium relative to as-needed (AN) short-acting β2-agonists (SABA) in children (aged 6-11 years) and adolescents/adults.
Methods: A systematic review of randomized controlled trials (RCTs) of regular and AN treatment for mild asthma was conducted (CRD42022352384).
Article Synopsis
- SGLT2 inhibitors (SGLT2i) show promise in slowing chronic kidney disease (CKD) progression but lack extensive real-world data in diverse populations.
- This study analyzed data from nearly 7,000 CKD patients (stages 2-4) treated with either SGLT2i or RAAS blockers to evaluate effectiveness and safety.
- Results indicated that SGLT2i therapy was linked to a significantly lower risk of severe kidney-related events and CKD progression, with similar adverse event rates and fewer urinary tract infections compared to RAAS treatment.
Background: Stroke is a major cause of death and disability worldwide. Identifying individuals who would benefit most from preventative interventions, such as antiplatelet therapy, is critical for personalized stroke prevention. However, traditional methods for estimating treatment effects often focus on the average effect across a population and do not account for individual variations in risk and treatment response.
View Article and Find Full Text PDFBackground: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.
Methods: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand.
No cost-effectiveness information of preventive strategies for mother-to-child transmission (MTCT) of hepatitis B virus (HBV) has existed for policy decision making. This study aimed to compare the cost-effectiveness of alternative strategies to prevent MTCT of HBV in Vietnam. Cost-utility analysis using a hybrid decision-tree and Markov model were performed from healthcare system and societal perspectives.
View Article and Find Full Text PDFIntroduction: The purpose of this study was to compare the growth factor concentrations in undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) eye drops.
Methods: This was a single-center, prospective trial conducted in a tertiary university hospital in Bangkok, Thailand. Ninety-six patients with moderate-to-severe dry eye disease, who were randomly assigned to receive either 100% APRP or 100% AS, were enrolled in the study.
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- Bariatric surgery is a treatment option for obese patients who cannot lose weight through non-surgical methods, but it is expensive; this study evaluates its cost-effectiveness against nonbariatric surgery for patients with a BMI ≥32.5 kg/m2 and type 2 diabetes in Thailand.
- A Markov model was used to analyze lifetime costs and quality-adjusted life years (QALYs) from both payer and societal perspectives, showing that bariatric surgery has higher costs but also more QALYs gained compared to nonbariatric surgery.
- The study concluded that bariatric surgery is cost-effective with an incremental cost-effectiveness ratio (ICER) below the cost-effectiveness threshold of 160,000 baht/Q
Can SGLT-2 inhibitors improve cardiovascular outcomes and ensure safety for patients with type 2 diabetes and heart failure in Thailand? A real-world multicentre retrospective cohort study.
BMJ Open
December 2024
Objectives: To assess the real-world effectiveness and safety of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2D) and heart failure (HF) and to evaluate the associated risks of adverse events.
Design: A retrospective cohort study using propensity score analysis to control confounding variables.
Setting: Data were collected from the electronic health records of two large tertiary care hospitals in Thailand over a 12-year period (2010-2022).
Background: Systematic reviews (SRs) are considered the highest level of evidence, but their rigorous literature screening process can be time-consuming and resource-intensive. This is particularly challenging given the rapid pace of medical advancements, which can quickly make SRs outdated. Few-shot learning (FSL), a machine learning approach that learns effectively from limited data, offers a potential solution to streamline this process.
View Article and Find Full Text PDFBackground: Percutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center.
Aims: This study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure.
Methods: Retrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved.
Article Synopsis
- This study assessed the impact of glucagon-like peptide-1 receptor agonists (GLP-1RA) on reducing body mass index (BMI) and blood glucose levels in adults with type 2 diabetes mellitus (T2DM) using a specific analysis method (difference-in-differences).
- It analyzed data from 1000 patients between 2010 and 2023, comparing those on GLP-1RA to those on other antidiabetic medications and found that GLP-1RA significantly lowered BMI, fasting plasma glucose (FPG), and hemoglobin A1C (HbA1c) levels.
- The results suggest that GLP-1RA may be a more effective treatment option for overweight T
Article Synopsis
- * Data from over 6,500 patients was analyzed, comparing those treated with SGLT2i to those who weren't, showing that SGLT2i users were more likely to maintain CKD stage 3 status over a 10-year period.
- * Results indicated that patients taking SGLT2i had significantly lower transition probabilities to more severe CKD stages and death, suggesting SGLT2i may help delay kidney function decline in T2D patients.
Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level.
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- The study aimed to validate and improve the SENIC model for predicting surgical site infections (SSIs) using logistic regression and machine learning techniques, focusing on patients who had gastrointestinal, colorectal, and hernia surgeries.
- After analyzing data from over 12,000 surgeries, the original SENIC model showed a modest predictive capacity (C-statistic of 0.668), while an updated version using six predictors improved its accuracy (C-statistic of 0.768).
- Machine learning models using more predictors performed worse than the updated logistic regression model and showed signs of overfitting, suggesting that the updated SENIC model is more reliable for assessing SSI risk after abdominal surgery.
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- The study assessed various blood pressure screening methods, focusing on home blood pressure measurement (HBPM), serial screenings, and clinic blood pressure measurement (CBPM) to determine their cost-effectiveness in Thailand for individuals aged 35 who haven't been diagnosed with hypertension.
- Serial1 (screening those with high BP) showed cost savings compared to CBPM, while HBPM was found to be more expensive and less effective, making it less favorable.
- The findings suggest implementing Serial1 as a preferred screening strategy due to its cost-effectiveness and potential benefits for policymakers in designing health interventions in Thailand.
The contemporary management and coronary angioplasty outcomes in young patients with ST-Elevation myocardial infarction (STEMI) age < 40 years old: the insight from nationwide Thai PCI registry.
BMC Cardiovasc Disord
October 2024
Article Synopsis
- Cardiovascular disease, particularly ST elevation myocardial infarction (STEMI), remains a leading cause of death globally, with different outcomes observed in young adults compared to older patients.
- A study analyzed data from 5,479 STEMI patients to identify factors and short-term outcomes, revealing young patients (under 40) were predominantly male, had higher smoking rates, and greater instances of obesity and family history of coronary artery disease (CAD).
- Despite experiencing higher rates of procedural failure and complications, the in-hospital death rate for young patients was lower compared to older counterparts, indicating different mortality trends among age groups.
Objective: The 0bjective is to compare treatment effects between undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) in patients with moderate-to-severe dry eye disease (DED).
Methods And Analysis: A single-centre, randomised, double-masked, non-inferiority clinical trial was conducted. 96 adult DED patients with an Ocular Surface Disease Index (OSDI) Score of ≥23 and/or Oxford staining grade of ≥2 were randomised to receive either 100% APRP (n=48) or 100% AS (n=48) for 4 weeks.
Background: Migraine is a debilitating neurological disorder that presents significant management challenges, resulting in underdiagnosis and inappropriate treatments, leaving patients at risk of medication overuse (MO). MO contributes to disease progression and the development of medication overuse headache (MOH). Predicting which migraine patients are at risk of MO/MOH is crucial for effective management.
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- End-stage kidney disease (ESKD) requires kidney replacement therapies (KRTs) like kidney transplantation (KT), hemodialysis (HD), and peritoneal dialysis (PD) for survival, but access to these treatments is often limited due to high costs.
- A systematic review analyzed economic evaluations and comparisons of KRTs across thirteen studies, revealing that KT was generally the most cost-effective option, while HD was the least effective and most expensive compared to PD.
- The review emphasizes that enhancing access to both KT and PD could significantly improve treatment options for ESKD patients, especially in high-income countries.
Background: Heart failure (HF) in type 2 diabetes (T2D) patients poses a significant clinical and financial burden. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown cardiovascular benefits in trials, they are not included in Thailand's National List of Essential Medicines (NLEM), and their value-for-money remains unassessed.
Objective: This study aims to evaluate the cost-utility of adding SGLT2i to the standard treatment for T2D-HF patients in Thailand.
Article Synopsis
- Postoperative cognitive dysfunction (POCD) is linked to cognitive decline after major surgery, affecting outcomes like physical function, length of hospital stay, dementia, and mortality.
- A review of 20 studies found that patients with POCD following cardiac surgery had more than double the risk of death, while those with POCD after noncardiac surgery also faced increased mortality risks.
- Patients with POCD experienced longer hospital stays compared to those without, emphasizing the need for early identification and intervention in at-risk surgical patients, though the role of postoperative delirium (POD) complicates these findings.
Individual treatment effects of sodium-glucose co-transporter-2 inhibitors on the risk of chronic kidney disease in patients with type 2 diabetes: A counterfactual prediction model based on real-world data.
Diabetes Obes Metab
October 2024
Article Synopsis
- The study aims to estimate the individual treatment effects (ITEs) of sodium-glucose co-transporter-2 inhibitors (SGLT2is) on reducing the risk of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D).
- Researchers followed a cohort from Ramathibodi Hospital in Thailand from 2015 to 2022, using a counterfactual model to assess CKD risks among patients who did or did not receive SGLT2is.
- Results showed that approximately 50% of patients experienced a 4.49% or greater reduction in CKD risk with SGLT2is, with the most benefit seen in older males with longer diabetes history and other
Aim: Liver transplantation (LT) is essential due to its curative efficacy, but liver-graft shortages have limited its widespread application. Bridging locoregional therapy (LRT) before LT has been performed to prevent tumor progression, and a recent literature review revealed that it is associated with a nonsignificant trend toward better survival outcomes. However, much more information on bridging therapy has become available since then.
View Article and Find Full Text PDFSeveral hepatitis A outbreaks have recently been reported in Kerala state, India. To inform coverage decision of hepatitis A vaccine in Kerala, this study aimed to examine the cost-effectiveness of 1) hepatitis A vaccination among children aged 1 year and individuals aged 15 years, and 2) serological screening of individuals aged 15 years and vaccination of susceptible as compared to no vaccination or vaccination without serological screening. Both live attenuated hepatitis A vaccine and inactivated hepatitis A vaccine were considered in the analysis.
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