Role of Duodenal Bulb Biopsy in Diagnosing Suspected Celiac Disease in Adult Patients: A Systematic Review and Meta-analysis.

Background And Aims: Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we aimed to find whether D1 biopsy can increase the diagnostic yield of adult celiac disease.

Methods: Literature databases were searched until January 2023 for studies reporting diagnosis of celiac disease in the adult population using D1 biopsy.

A red herring colonization of in cutaneous sporotrichosis lesions misleading the diagnosis.

A 42-year-old man presented with a sporotrichoid lymphocutaneous infection for 1 month. The histopathology of the lesions showed numerous intracellular mycobacteria within foamy histiocytes suggestive of nontuberculous mycobacteria and misled the empiric treatment. The final culture grew spp.

Antiplatelet therapy associated with lower prevalence of advanced liver fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis.

Despite the growing disease burden of non-alcoholic fatty liver disease (NAFLD), approved medical treatments to improve or prevent liver fibrosis are effective only in a small number of patients. Recent studies have found the new use of antiplatelet agents for antifibrotic benefits in NAFLD, but human studies are still limited. The goal of this meta-analysis was to combine the findings of existing relevant studies to investigate the effects of antiplatelet therapy in reducing or preventing advanced liver fibrosis in patients with NAFLD.

Upper gastrointestinal bleeding as the initial manifestation of gastroenteropancreatic neuroendocrine tumors.

A 78-year-old man presented with upper gastrointestinal bleeding, which was biopsy proven to be from a gastric neuroendocrine tumor. By the time of diagnosis, he developed liver metastasis and died 2 months later. Upper gastrointestinal bleeding is an uncommon feature in gastroenteropancreatic neuroendocrine tumor.

Intestinal angioedema caused by an acquired C1 esterase inhibitor deficiency associated with underlying splenic marginal zone lymphoma.

A 75-year-old woman presented with recurrent abdominal pain and vomiting for 1 year and was later found to have splenomegaly and pancytopenia. This case report depicts a clinical picture of intestinal angioedema, a challenging diagnosis, and an underlying rare syndrome of acquired C1 esterase inhibitor deficiency associated with splenic marginal zone lymphoma.

Atypical Presentation of Fatal Disease: Painless Aortic Dissection.

Aortic dissections (ADs) are uncommon but they are highly lethal. Due to atypical signs and symptoms, diagnosis of type B AD can be easily missed or delayed. Our patient presented to the emergency center with dizziness and fall for which he was evaluated and treated for hypertension.

Intervening alcohol marketing to reduce harmful alcohol use and lessons learned from the theory of changes: Case studies in Thailand.

Objectives: Globally, the burden of disease caused by alcohol use has been steadily increasing, including in Thailand. In this study, we aim to test the effectiveness of Anderson et al.'s suggested three approaches to change the collective social norms, which comprise of: (1) providing information and an understanding about alcohol use behaviour, its causes and distribution; (2) focusing strategies on groups rather than individuals; and (3) strengthening supportive laws, regulations and approaches.

Sinus of Valsalva aneurysm presenting with chest pain.

Sinus of Valsalva aneurysm is a rare aortic root defect that can be dangerous due to its serious complications. It is defined as dilatation of one or more of the aortic valve sinuses. It is usually asymptomatic, and patients rarely present with chest pain, arrhythmias, or heart failure.

Marijuana use-induced spontaneous pneumomediastinum.

The presence of air in the mediastinum is a rare finding called pneumomediastinum. Spontaneous pneumomediastinum is typically benign. Marijuana use has been rarely reported to cause pneumomediastinum.

Paradox of sustainability in tobacco control in Thailand: A comprehensive assessment of three-decade experiences.

Background: Over the past 3 decades of tobacco control, Thailand has gained international recognition as a middle-income country with sustained achievement of declining smoking prevalence. However, the number of key Framework Convention on Tobacco Control measures implementation is still far away from the highest-level implementation. As a result, we aim to explore explanatory factors for the paradoxical phenomenon of sustainability in tobacco control in Thailand, to understand what the paradox means, why it happens, and how to take further steps in minimizing the paradox.

Pica/Pagophagia-Associated Hyponatremia: Patient Presenting With Seizure.

Pica is an unusual condition in which patients crave and chew substances with no nutritional value. Ice pica (pagophagia) is commonly seen in patient with iron deficiency. People chew ice cubes or add ice to their drinks to cool or refresh themselves, and they may not consider this as an abnormal behavior.

Assessment of nationwide emergency systems in Thailand, a middle-income country setting with UHC.

Background: Evidence has been limited regarding broader emergency systems assessment in low- and middle-income countries. The aim of the present study was to provide the empirical evidence of Thai emergency department (ED) workforce vis-à-vis workload on a national scale, the availability of services for selected high-priority health burdens, and the governance obstacles in addressing the workforce management.

Method: One hundred thirty public Thai EDs that provide 24-hour emergency medical care were identified across Thailand as meeting the inclusion criteria.

Relevance of using length of stay as a key indicator to monitor emergency department performance: Case study from a rural hospital in Thailand.

Objective: The present study explores factors related to length of stay (LOS) in a rural public hospital in Thailand and assesses the feasibility of using LOS as an ED key performance indicator.

Methods: Using a mixed-methods approach, qualitative methods (in-depth interviews, patients' chart review and participatory observations) were used to guide and elaborate findings from quantitative analysis of 555 electronic ED records.

Results: Multivariate analysis revealed that age, Emergency Severity Index score and number of laboratory tests were significantly associated with LOS.

Closing the Equity Gap of Access to Emergency Departments of Private Hospitals in Thailand.

Background: Previous policy implementation in 2012 to incentivize private hospitals in Thailand, a country with universal health coverage, to provide free-of-charge emergency care using DRG-based payment resulted in an equity gap of access and copayment. To bridge the gap, strategic policies involving financial and legal interventions were implemented in 2017. This study aims to assess whether this new approach would be able to fill the gap.

Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach.

Introduction: Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems.