This study aimed to evaluate the practicality and advantage of Global Antimicrobial Resistance Surveillance System (GLASS) for surveillance of urine culture samples collected from patients with bacteriuria. GLASS has been implemented at a tertiary care university hospital in Thailand by using the web application program to collect clinical data and urine culture data from patients with positive urine culture. There were 5085 urine samples from 3545 patients that were sent to our microbiology laboratory during June-December 2017. Bacteriuria was found in 1944 patients. Of those, 952 had urinary tract infection (UTI), and 1161 had colonization. Among UTI patients, hospital-acquired infection (HAI) was observed in 74.2 %, and community-acquired infection (CAI) was found in 28.7 %. E. coli and S. agalactiae were more frequently observed in CAI, but P. aeruginosa, P. mirabilis, E. faecium, and A. baumannii were more prevalent in HAI. UTI isolates demonstrated less resistance to antibiotics than colonized isolates. Non-duplicate isolates of bacteria demonstrated less resistance than duplicate isolates. E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, E. faecalis, and E. faecium causing HAI were more resistant to antibiotics than those causing CAI. GLASS is feasible to implement and more beneficial than laboratory-based surveillance. This study collects additional information beyond GLASS including causative bacteria and colonizing bacteria; types of UTI; and more specific criteria to distinguish HAI from CAI so that such data can be used for developing more valid local guidelines for selecting antibiotic therapy in UTI patients in addition to AMR surveillance in urine samples.

Chronic obstructive pulmonary disease (COPD) is a risk factor for death in patients admitted to intensive care units (ICUs) for respiratory support. Previous reports suggested higher mortality in COPD patients with COVID-19. It is yet unknown whether patients with COPD were treated differently compared to non-COPD patients. We compared the ventilation management and outcomes of invasive ventilation for COVID-19 in COPD patients versus non-COPD patients. This was a post hoc analysis of a nation-wide, observational study in the Netherlands. COPD patients were compared to non-COPD patients with respect to key ventilation parameters. The secondary endpoints included adjunctive treatments for refractory hypoxemia, and 28-day mortality. Of a total of 1090 patients, 88 (8.1%) were classified as having COPD. The ventilation parameters were not different between COPD patients and non-COPD patients, except for FiO₂, which was higher in COPD patients. Prone positioning was applied more often in COPD patients. COPD patients had higher 28-day mortality than non-COPD patients. COPD had an independent association with 28-day mortality. In this cohort of patients who received invasive ventilation for COVID-19, only FiO₂ settings and the use of prone positioning were different between COPD patients and non-COPD patients. COPD patients had higher mortality than non-COPD patients.

Objective: To evaluate the incidence, characteristics, and risk factors of complications related to anesthesia complication in ASA Class III patients undergoing combined esophagogastroduodenoscopy (EGD) and colonoscopy under total intravenous anesthesia (TIVA). Materials and Methods: This prospective cohort study was conducted from April 1, 2024, to February 11, 2025. Data collected included baseline characteristics (age, sex, comorbidities, functional capacity, nutritional status, smoking, fasting and medications) and intraoperative/postoperative parameters (anesthetic technique, sedative dosing, IV fluids, complications, and 24-hour status). Descriptive statistics, univariate analysis, and binary logistic regression were applied. Results: Of 403 ASA Class III patients enrolled, 393 were analyzed after excluding 10 for inadequate bowel prep or early termination due to malignancy. A total of 207 patients (52.7%) experienced at least one complication. Common complications included transient hypotension (40.2%), desaturation (15.8%), and airway obstruction (15.5%). Less frequent events were bradycardia (4.1%), hypoxia (1.8%), hypertension (1.8%), tachycardia (0.3%) and respiratory depression (0.5%). Five independent risk factors were significantly associated with complications: preexisting cardiovascular disease - odds ratio (OR=1.678), respiratory disease (OR=1.877), functional capacity < 4 metabolic equivalents (METs), (OR=1.851), nutritional screening score ≥ 1 (OR =1.518), and single - dose bowel prep regimen (OR=1.614). Complications were more common in women, patients aged 65 years or older, and inpatients, although the difference in hospitalization and outpatient was not statistically significant. Patients with complications received lower total doses of propofol and fentanyl per weight per hour. Dexmedetomidine use was significantly associated with complications among inpatients (p = 0.015). The duration of the procedure was longer in patients with complications (p = 0.002). Conclusion: Anesthesia-related complications were frequent among ASA Class III patients who underwent combined EGD and colonoscopy under TIVA, particularly cardiovascular and respiratory events. Identification of five preprocedural risk factors supports the need for improved risk stratification and individualized sedation planning to optimize safety in this high-risk group. Plain Language Summary: What is already known on this topic? High-risk patients, particularly those classified as ASA Class III, are more vulnerable to anesthesia-related complications during endoscopic procedures. While total intravenous anesthesia (TIVA) with propofol is commonly used for esophagogastroduodenoscopy (EGD) and colonoscopy, its cardiopulmonary effects—such as hypotension and respiratory depression—are more pronounced in patients with pre-existing comorbidities. However, there is limited evidence detailing specific preprocedural predictors of complications in this population, especially during combined EGD and colonoscopy. What this study adds: This study identifies five independent, clinically accessible preprocedural predictors of sedation-related complications in ASA Class III patients undergoing combined EGD and colonoscopy under TIVA: cardiovascular disease, respiratory disease, functional capacity < 4 METs, a nutritional risk score ≥ 1, and single-dose bowel preparation. These findings provide a practical framework for preprocedural risk stratification and personalized sedation planning. Additionally, the study highlights the importance of adjunct medication use and procedural duration in influencing complication rates, while demonstrating that patient satisfaction remains high despite the presence of transient adverse events.

This article presents a novel statistical distribution, known as the DUS exponential distribution, and conducts a comprehensive examination of its essential characteristics and applications. In this study, the fundamental properties of the distribution such as reliability, survival and hazard function, stress-strength reliability, moments, order statistics, entropy function, moment generating function, as well as Bonferroni and Lorenz curves are studied. The estimation of parameters by the maximum likelihood estimation method is discussed. The article also explores the reliability of the upgraded system using three different approaches: reduction, hot duplication, and cold duplication methods. To validate the efficacy of maximum likelihood estimators, a comprehensive simulation study is conducted. Finally, the authors of this article have analyzed real-life data sets from banking sector and medical science, and it has been found that the proposed DUS exponential distribution provides a better fit compared to other distributions.

Data on stigmatizing attitudes toward people living with psoriasis (PLWP) in the general population are scarce. This study aimed to determine the prevalence and predictors of stigmatizing attitudes toward PLWP among three Thai groups: medical students (MS), nonmedical students (NMS), and laypeople. A standardized online questionnaire was completed by 1200 Thais. The Thai lay sample was recruited using power calculations and demographic quotas based on national census data to ensure representativeness of the general population. The incorrect belief that psoriasis is contagious was most common among NMS (37.3%), followed by laypeople (25.3%) and MS (11.3%). The MS had the highest proportion (66.8%) of participants who believed that PLWP were disadvantaged, stigmatized, or discriminated against. Among the 1200 Thai participants, 577 (48.1%) considered psoriasis to be a societal burden. Shaking or touching lesional areas and sharing a swimming pool caused the greatest discomfort. Greater psoriasis knowledge and awareness of “World Psoriasis Day” were significantly associated with fewer stigmatizing attitudes and reduced stigma. These findings underscore the urgent need for public health interventions and educational campaigns to improve societal attitudes toward PLWP, particularly within Thai society.