Objectives. To develop a simple scoring system to predict dengue infection severity based on patient characteristics and routine clinical profiles. Methods. Retrospective data of children with dengue infection from 3 general hospitals in Thailand were reviewed. Dengue infection was categorized into 3 severity levels: dengue infection (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Coefficients of significant predictors of disease severity under ordinal regression analysis were transformed into item scores. Total scores were used to classify patients into 3 severity levels. Results. Significant clinical predictors of dengue infection severity were age >6 years, hepatomegaly, hematocrit ≥40%, systolic pressure 5000 /μL, and platelet ≤50000 /μL. The derived total scores, which ranged from 0 to 18, classified patients into 3 severity levels: DF (scores 11.5, n=50, 6.4%). The derived score correctly classified patients into their original severity levels in 60.7%. An under-estimation of 25.7% and an over-estimation of 13.5% were clinically acceptable. Conclusions. The derived dengue infection severity score classified patients into DF, DHF, or DSS, correctly into their original severity levels. Validation of the score should be reconfirmed before application of routine practice.

Background: Symptomatic dengue infection can be classified into 3 patterns based on their severity; dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In clinical practice, the diagnosis and management are based on clinical findings and abnormal initial laboratory tests. We conducted the present study to explore a set of parameters, preferable routine, or at least easy to investigate, that could be used as indicators for dengue infection severity. Methods: A retrospective cohort study was conducted in three university-affiliated hospitals, one general hospital and two referral hospitals, in the northern part of Thailand. Patients were grouped into the three severity categories (DF, DHF, and DSS), using modified WHO criteria. Pre-defined prognostic indicators were compared. The prognostic indicators for dengue severity were analyzed by a multivariable polytomous logistic regression and presented with odds ratios. Results: From 777 patients overall, 391 were classified as DF, 296 with DHF, and 90 with DSS. The characteristics that increased the risk of DHF were; age > 6 year (OR = 1.85), hepatomegaly (OR = 3.49), any bleeding episodes (OR = 1.43), white cell count > 5,000/µL (OR = 1.80), and platelet ≤ 100,000/µL (OR = 3.72). The characteristics that increase the risk of DSS were; hepatomegaly (OR = 43.44), any bleeding episodes (OR = 5.58), pulse pressure ≤ 20 mmHg (OR = 19.09), SBP < 90 mmHg (OR = 2.45), hematocrit > 40% (OR = 1.88), white cell count > 5,000/µL (OR = 2.36), and platelet ≤ 100,000/µL (OR = 10.60). Conclusions: The severity of dengue infection is significantly associated with some routine clinical parameters. These parameters may be used to develop a future scoring system to predict and manage dengue infection severity early in the course of the illness. doi: http://dx.doi.org/10.4021/ijcp73w

Background: Major depressive disorder (MDD) is the leading cause of suicidal behaviors. Risk related to suicide attempts among individuals with MDD remains uninvestigated in upper northern Thailand, where the completed suicide rate is the highest in the nation. Objective: To examine risk related to suicide attempts among individuals with MDD. Methods: Individuals diagnosed with MDD using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), codes F32.x and F33.x, seeking care at Suanprung Psychiatric Hospital between October 2006 and May 2009 were eligible. All individuals with MDD admitted due to suicide attempts were defined as cases (n = 186), and four controls per case were selected from those who did not attempt suicide on the same day or within a week of case selection (n = 914). Their medical charts were reviewed for sociodemographic and clinical factors influencing suicide attempts using multivariable logistic regression analysis. Results: Factors related to suicide attempts were stressful life events (adjusted odds ratio [OR], 2.32; 95% confidence interval [CI]: 1.27–4.24), alcohol use (adjusted OR, 2.08; 95% CI: 1.29–3.34), intermittent or poor psychiatric medications adherence (adjusted OR, 2.25; 95% CI: 1.44–3.51), up to two previous suicide attempts (adjusted OR, 3.64; 95% CI: 2.32–5.71), more than two previous suicide attempts (adjusted OR, 11.47; 95% CI: 5.73–22.95), and prescribed antipsychotics (adjusted OR, 3.84; 95% CI: 2.48–5.95). Risk factors that were inversely related to suicide attempts were increasing years of MDD treatment; one to five years (adjusted OR, 0.22; 95% CI: 0.11–0.44), over five years (adjusted OR, 0.44; 95% CI: 0.23–0.86), and antidepressant prescribed (norepinephrine [NE] and/or serotonin reuptake inhibitors [SRIs], adjusted OR, 0.28; 95% CI: 0.10–0.78). The final model explained 85.8% probability of suicide attempts. Conclusion: Seven key factors suggested from this study may facilitate clinicians to identify individuals with MDD at risk of suicide attempt and provide them close monitoring, timely assessment, and intensive treatments.

Predicting Difficult Intubation in Emergency Department by Intubation Assessment Score

Objective. To investigate the length of follow-up needed to detect recurrence of antrochoanal polyps.Methods. A retrospective investigation was performed on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from 2006 to 2012.Results and Discussion. Of the 38 cases of choanal polyps, 27 were adults (71%). The median age was 23.5, ranging from 7 to 64 years old. Eighteen patients were male (47.4%). The origin of choanal polyps was the maxillary antrum in 32 patients. The most common symptom was nasal obstruction (97.4%). The surgical procedures were polypectomy in one child and combined endoscopic and transcanine fossa approach in two adults. The remainder of the patients underwent endoscopic removal of the polyps. The follow-up time ranged from 1 day to 8 years. There were 5 cases of recurrence of which four were in children. The time for recurrence was 1.2±0.6 years (95% CI 0.51, 1.97).Conclusion. Antrochoanal polyps are more common in younger patients. Recurrence was significantly higher in children. Follow-up of patients should be for at least 2 years postoperatively in order to detect 95% of recurrence.