Krit Pongpirul

Chulalongkorn University, Preventive and Social Medicine, Faculty Member

Harvard School of Public Health, Health Policy and Management, Alumnus

Johns Hopkins Bloomberg School of Public Health, International Health, Faculty Member

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Supervisors: Courtland Robinson and Damian G. Walker
Phone: +66-866-055-088
Address: 159-161 Charansanitwong 8, Tapra, Bangkokyai, Bangkok, Thailand 10600

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Papers by Krit Pongpirul

Accuracy of Screw Placement and Fusion Rate after Transforaminal Lumbar Interbody Fusion with O-arm Navigation: A Review of 475 Patients

Research Square (Research Square), Mar 26, 2021

Purpose To evaluate the accuracy of screw placement and fusion rate after the minimally invasive ... more Purpose To evaluate the accuracy of screw placement and fusion rate after the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique under O-arm navigation. Methods In 475 consecutive patients at a single-center, the accuracy of screw placement was evaluated on intraoperative O-arm imaging. Misplaced screws were investigated to identify the direction of deviation and associated clinical outcomes. The fusion rate was evaluated on postoperative computed tomography scan at 1 and 2 year(s). The assessment of screw placement and fusion level was analyzed for inter-rater reliability and reported as a kappa value. Accuracy of screw placement (Gertzbein-Robbins Classification), extent of fusion (Bridwell Interbody Fusion Grading System), and complications were considered as outcome measures. Results A retrospective data analysis from 2,098 pedicle screws in 475 patients. The mean age of participants was 56.61 ± 12.30 years, and 45.26% were female. Their ethnicities w...

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ความคาดหวังของผู้อำนวยการโรงพยาบาลชุมชนในเขตสุขภาพที่ 2 ต่อหลักสูตรแพทยศาสตรบัณฑิตของคณะแพทยศาสตร์ มหาวิทยาลัยนเรศวร

An early experience of Check List to Improve Patient Self-care and Product Defect Report in Continuous Ambulatory Peritoneal Dialysis (CLIP-SP) study

International Journal of Artificial Organs, Sep 27, 2019

An increase in number of peritoneal dialysis patients and demand for peritoneal dialysis products... more An increase in number of peritoneal dialysis patients and demand for peritoneal dialysis products following implementation of “PD First” policy in Thailand has led to logistics supply chain challenges and inherent product quality problems. Available evidences suggested that defective peritoneal dialysis products may predispose the patients to peritonitis. Thailand Clinical Practice Guideline for Peritoneal Dialysis 2017 recommends the patients to check peritoneal dialysis products themselves before use. In this report, we present our early experience from the Check List to Improve Patient Self-care and Product Defect Report in Continuous Ambulatory Peritoneal Dialysis study, a cluster randomized trial conducted in 22 peritoneal dialysis centers in Thailand. Patients from 11 randomly selected sites were asked to use the check list to report any product quality defects. The peritoneal dialysis product check list required patients to check the expiration date, glucose concentration, clarity, color, and integrity of bags of peritoneal dialysis fluid as well as the peritoneal dialysis connectors prior to each use. Among 338 patients who had received the check list from 5 centers, 28 returned the reports, detecting 8 defects out of 3960 products in total (0.2%). Although the obtained check list reports were not perfectly completed, they were comprehensible and provided important information on product defects which meant that the check list was simple enough for the patients and/or caregivers to follow. In conclusion, despite low response rate and incomplete report in this early phase analysis, the check list provides important information on product defects while an impact of these defects on peritoneal dialysis outcomes requires a further investigation.

Relative selenium insufficiency is a risk factor for developing severe Graves’ orbitopathy: a case–control study

BMJ open ophthalmology, May 1, 2021

Background/aims Selenium (Se), an antioxidant agent, is effective in preventing mild Graves' orbi... more Background/aims Selenium (Se), an antioxidant agent, is effective in preventing mild Graves' orbitopathy (GO) deterioration. However, the significant risk of low serum Se concentration for GO progression has not been identified. Here, we aimed to investigate the risk of relative Se insufficiency and to identify its optimal cut-off value in the development of disease severity in patients with GO. Methods Serum Se levels were prospectively measured in 100 consecutive patients with GO. The patients were classified into groups with mild and severe GO (logistic regression analysis outcome). A receiver operating characteristic (ROC) curve and the minimum p value corresponding to χ 2 statistics were analysed to select the optimal cut-off Se level for the diagnosis of severe orbitopathy. Results Thirty-two patients (32%) had mild GO and 68 (68%) had severe GO. The ROC revealed a cut-off Se level of 93 µg/L. Se levels ≤93 µg/L were observed in 48.5% and 12.5% of the patients in the severe and mild (p<0.001) groups, respectively. The risk estimate (OR) for an Se level ≤93 µg/L was 8.14 (95% CI 2.39 to 27.75). It remained a significant risk factor after adjusting for age, sex, thyroid status, smoking status, thyroidectomy and radioactive iodine. Relative Se insufficiency (≤93 µg/L) is a potential risk factor for severe GO development. An evaluation of Se status is recommended in patients with GO for predicting disease progression and guiding supplementation therapy. How might these results change the focus of research or clinical practice? ► An evaluation of Se status is recommended in patients with GO for predicting disease progression and guiding supplementation therapy. ► Correcting Se insufficiency with supplementation may restore the pathological changes in the orbit caused by oxidative stress.

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A randomized controlled trial comparing the efficacies of ketorolac and parecoxib for early pain management after total knee arthroplasty

Knee, Dec 1, 2020

BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to reduce pain after ort... more BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to reduce pain after orthopedic surgery. Currently, selective COX-2 inhibitors can provide effective pain reduction with less platelet inhibition compared with conventional NSAIDs. We aimed to compare the analgesic effect and perioperative blood loss (PBL) after total knee arthroplasty (TKA) between ketorolac and parecoxib administration. METHODS We conducted a prospective randomized controlled study of 100 unilateral TKAs. The ketorolac group of 50 patients received an intraoperative periarticular injection (PAI) with 100 mg of bupivacaine and 30 mg of ketorolac. Afterwards, 30 mg of ketorolac was intravenously injected every 12 h until 48 h. In the parecoxib group of 50 patients, 20 mg of parecoxib was added to PAI, and the first intravenous dose was 20 mg followed by 40 mg every 12 h. The primary outcomes were visual analog scales (VASs) of postoperative pain, amount of morphine consumption, PBL, and blood transfusion rate. RESULTS The ketorolac group had a significantly lower VAS pain score than the parecoxib group at 6 h after TKA (2.38 ± 2.52 vs. 4.12 ± 2.86, P < 0.01). Thereafter, the VAS of both groups and total morphine consumption at 24 and 48 h were comparable. The PBLs of the ketorolac and parecoxib groups were 529.72 ± 263.02 and 402.40 ± 191.47 ml, respectively (P = 0.01). However, the blood transfusion rates between groups were not different. CONCLUSION Parecoxib provides comparable analgesic effects to ketorolac. Additionally, perioperative use of parecoxib is safe and is associated with significantly less blood loss after TKA.

การประเมินโครงการอบรมเชิงปฏิบัติการนักวิจัยเขตสุขภาพรุ่นที่ 1 ระยะที่ 1 และ 2

Mechanical Needling With Sterile Water Versus Lidocaine Injection for Lumbar Spinal Stenosis

Global Spine Journal, May 4, 2022

Study Design: This was a retrospective observational study that assessed the clinical outcome of ... more Study Design: This was a retrospective observational study that assessed the clinical outcome of ageing patients who received ultrasound-guided (USG) mechanical needling with sterile water injection. In addition, the clinical outcome of age-and gender matched patients randomly selected from patients who received needling with sterile water was compared to the patients injected with lidocaine in a 1:1 ratio. Objective: This present study aimed to explore the clinical effects of USG mechanical needling with sterile water injection for lumbar spinal stenosis (LSS). Methods: The data was extracted from the medical records of ageing patients with LSS who received USG injection at the lumbosacral spine by the first author. Low back pain or axial pain, and leg pain or radicular pain were assessed by the visual analogue scale, and gait ability with walking distance were obtained at six different time points. Results: A total of 4328 medical records were examined. Four thousand two hundred and twenty-eight ageing patients received mechanical needling with sterile water injection and found the efficacy lasted up to 6 months. One hundred patients were compared with 100 patients who received lidocaine injection. Those who received lidocaine had pain returned at 3 months and 6 months post-injection. Conclusions: USG mechanical needling with sterile water injection could help relieve axial and radicular pain for at least 6 months. Removal of calcification and fibrosis as well as reduction of sensitization are all possible mechanisms.

Development and psychometric properties of the Thai Graves’ ophthalmopathy quality of life (GO-QOL) questionnaire

Journal of Patient-Reported Outcomes, Dec 31, 2019

Purpose: To develop and assess the psychometric properties of the Thai version of the Graves' Oph... more Purpose: To develop and assess the psychometric properties of the Thai version of the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. Background: Graves' ophthalmopathy (GO) is a chronic condition that causes negative self-image and impaired visual function. These conditions impact quality of life (QOL) but are rarely documented. Graves' Ophthalmopathy Quality of Life Questionnaire (GO-QOL) has good validity, reliability and responsiveness. In this study we developed a Thai GO-QOL questionnaire by translating the questionnaire from English to the Thai language and evaluated its reliability and validity. Patients and methods: Forward and backward translations were performed independently by four translators with extensive experience in both English and Thai. Seventy patients at the thyroid clinic responded to the Thai translated version upon their first visit and again 2-3 weeks afterwards. Validity was assessed by the content validity index (CVI) and correlation with relevant clinical parameters. Reliability was evaluated by Cronbach's alpha, the intraclass correlation coefficient, and the Bland-Altman plot. The Thai GO-QOL version showed high CVI (0.97) and a moderate negative correlation of the functional QOL score with disease severity (r = -0.49), the clinical activity score (r = -0.31), and exposure parameter (r = -0.32). It showed good reliability with a high intraclass correlation coefficient (0.92) and high Cronbach' s coefficient (0.86). The Thai GO-QOL has good validity and reliability. It can be used to evaluate the quality of life of Graves' ophthalmopathy patients as a consequence of their disease in thyroid treatment programs.

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Full-Endoscopic Interlaminar Lumbar Discectomy: Retrospective Review of Clinical Results and Complications in 545 International Patients

World Neurosurgery, Dec 1, 2019

BACKGROUND Minimally invasive techniques have been developed to provide access to the disc with b... more BACKGROUND Minimally invasive techniques have been developed to provide access to the disc with better visualization while causing less muscle trauma and its consequences. This study was aimed to evaluate the clinical outcomes and complications of the fully endoscopic lumbar discectomy interlaminar approach in a large number of patients. METHODS Patients diagnosed with lumbar herniated nucleus pulposus who underwent fully endoscopic interlaminar lumbar discectomy from 2011 to 2016 were reviewed. Perioperative data, preoperative and postoperative Oswestry Disability Index (ODI) scores, visual analogue scale (VAS) back pain, VAS leg pain, and complications were evaluated and recorded at 1 week and 3 and 6 months postoperatively and each year thereafter. RESULTS 545 patients (average age 46.43 years; 34.31% female) were included. The affected levels were L2-3 1.47%, L3-4 6.96%, L4-5 49.45%, and L5-S1 44.69%. Mean preoperative ODI, VAS back, and VAS leg were 43.00%, 5.00, and 5.69, respectively. Postoperative ODI at 1 month was reduced to 15.59% and remained within a range of 14.83-18.32% throughout the follow-up. Postoperative VAS back and leg results at 1 week were reduced to 1.66 and 1.79, respectively, and remained at 1.89-3.14 and 1.59-2.66, respectively, throughout the follow-up. Sixty-six (12.11%) recurrences were diagnosed. Intraoperative complications were nerve root-related (n=3) and dural tear (n=1). Postoperative complications included numbness (n=18), weakness (n=5), and residual disc (n=1). No infections or hematomas were reported. CONCLUSION Fully endoscopic interlaminar lumbar discectomy is a safe, effective option for treating lumbar disc herniation, with a long recurrence-free recovery. IRB approval and trial registration number: 245-15-17 Dh Exp.

P16-031-23 Glycemic Index and Glycemic Load of Brief Sugary Sweets and Effect on Gut Microbiome: Randomized Controlled Trials of 8 Thai Desserts

Current developments in nutrition, Jul 1, 2023

Multisystem inflammatory syndrome in an adult with severe hypoxaemia and thyroiditis responsive to corticosteroid and interleukin 6 inhibitor treatment

Case Reports, May 1, 2022

Multisystem inflammatory syndrome in adults (MIS-A) has been reported as a rare but severe conseq... more Multisystem inflammatory syndrome in adults (MIS-A) has been reported as a rare but severe consequence of COVID-19 infection. Adult patients were more likely to present with hypotension and cardiac illness when compared with multisystem inflammatory syndrome in children. Although the exact prevalence of MIS-A is unknown, more cases have been observed in men and younger adults. The pathophysiology of MIS-A is also unclear, but is thought to be caused by a delayed, dysregulated immune response. Given no established guideline for treatment of MIS-A, treatment has been based on case reports. We present a case of MIS-A in a woman in her 60s who had severe hypotension, progressive dyspnoea, massive pleural effusion, hypoxaemia, thyroiditis and multiple organ failure, which dramatically improved after treatment with corticosteroid and interleukin 6 inhibitor.

An epidemiology-based model for the operational allocation of COVID-19 vaccines: A case study of Thailand

Computers & Industrial Engineering, May 1, 2022

This paper addresses a framework for the operational allocation and administration of COVID-19 va... more This paper addresses a framework for the operational allocation and administration of COVID-19 vaccines in Thailand, based on both COVID-19 transmission dynamics and other vital operational restrictions that might affect the effectiveness of vaccination strategies in the early stage of vaccine rollout. In this framework, the SIQRV model is first developed and later combined with the COVID-19 Vaccine Allocation Problem (CVAP) to determine the optimal allocation/administration strategies that minimize total weighted strain on the whole healthcare system. According to Thailand’s second pandemic wave data (January 17 th , 2021, to February 15 th , 2021), we find that the epicenter-based strategy is surprisingly the worst allocation strategy, due largely to the negligence of provincial demographics, vaccine efficacy, and overall transmission dynamics that lead to higher number of infectious individuals. We also find that early vaccination seems to significantly contribute to the reduction in the number of infectious individuals, whose effects tend to increase with more vaccine supply. With these insights, healthcare policy-makers should therefore focus not only on the procurement of COVID-19 vaccines at strategic levels but also on the allocation and administration of such vaccines at operational levels for the best of their limited vaccine supply.

<p>Five-year clinical outcomes of Crohn’s disease: a report of 287 multiethnic cases from an International Hospital in Thailand</p>

Clinical and Experimental Gastroenterology, May 1, 2019

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will app... more Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: Background: Crohn's disease (CD) has been relatively rare in Asian region whereas its clinical outcomes have been dominated by evidence from Caucasians in developed countries. This study reported clinical characteristics and outcomes of the multiethnic patients who visited our institution. Materials and methods: Medical records of all patients who visited our institution during 2005-2010 were reviewed. Colonoscopy and sigmoidoscopy were performed in compliance with the ASGE guidelines. Results: A total of 287 CD patients were followed up for 5.65 years on average: 41.80% Middle Eastern (ME), 29.62% Caucasian, 28.57% Asian. ME and Caucasian had higher CD prevalence than Asian (286.71, 278.66, and 43.10 per 100,000 population, respectively). Significant variation in male proportion was observed (p=0.001): 39.02% Asian, 65.83% ME, 68.24% Caucasian. The mean age was 39.46 years (ME 32.88, Asian 43.35, Caucasian 45.00; p<0.001). ME had alonger duration of symptoms (26.55 months) than Caucasian (11.98 months) and Asian (12.35 months) (p=0.0008). The proportions of perianal lesions were statistically different across ethnic origins (p=0.014): 9.76% Asian, 24.17% ME and 12.94% Caucasian. Caucasian was severely active, compared with ME (10.83%) and Asian (6.10%). Disease progression existed in 88 of 254 patients who initially had non-severe pathology: 19.63% ME, 40% Caucasian, 50.65% Asian (p<0.0001). Clinical improvement was observed in 82% of the patients. Seventy-five patients required either surgery or hospitalization with a significant ethnic variation: 37.65% Caucasian, 28.33% ME, 10.98% Asian (p<0.0001). Conclusions: Crohn's disease prevalence, gender, age, duration of symptoms, perianal lesion, pathological severity and disease progression varied across ethnic origins.

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1992. Automated Classification of Pulmonary Tuberculosis-Associated Radiograph in the US Hospital-Scale Chest X-ray Database by Using Deep Convolutional Neural Network

Open Forum Infectious Diseases, Nov 1, 2018

Background. Rapid diagnosis of causative agents of bloodstream infections improves patient outcom... more Background. Rapid diagnosis of causative agents of bloodstream infections improves patient outcomes and antibiotic stewardship. BioFire Diagnostics, LLC, is developing the BioFire® Blood Culture Identification 2 (BCID2) Panel, increasing the coverage of the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for key pathogens and antimicrobial resistance (AMR) markers in aerobic and anaerobic positive blood culture (PBC). This revision expands the menu from 27 to 42 targets, with 26 bacterial (14 revised, six new) and seven fungal analytes (two revised, three new), as well as nine AMR markers (one revised, six new). Notable additions include the anaerobe Bacteroides fragilis, the emerging fungus Candida auris, and the mobile colistin resistance gene, mcr-1. This study details the reactivity and specificity of an RUO BioFire BCID2 panel. Methods. The prototype was tested with fungal and bacterial isolates, some carrying AMR markers, at two sites by multiple operators. Reactivity was assessed at 10 6 CFU/mL for 301 analytes, and specificity at 10 8 CFU/mL for 43 on-panel and 93 offpanel strains. Evaluation included multiple strains for species level and AMR marker assays, as well as multiple species for family/genus level assays. Concordance with standard of care (SoC) results was examined for 126 archived PBC. Results. Testing against 136 on-panel organisms, phylogenetic-neighbors, and normal cutaneous flora, showed 100% specificity for 41/42 targets. Reactivity was confirmed for 346/351 target analytes, and comprehensive detection was observed for the revised family-level Enteric assay (90/90) and genus-level Staphylococcus spp. (51/51), Streptococcus spp. (17/17), and Candida spp. (67/71) assays. The prototype showed excellent sensitivity (97.1%) and specificity (99.7%) compared with SoC with archived PBC. Conclusion. Performance of this RUO BioFire BCID2 Panel indicates that many key pathogens implicated in bloodstream infections can be identified with high sensitivity and specificity, and highlights the utility of the expanded menu to provide actionable information. Future panel versions will address observed deficiencies. RUO products used in this study have not been evaluated by the FDA or other regulatory agencies for In Vitro Diagnostic use.

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Deep learning for automated classification of tuberculosis-related chest X-Ray: dataset distribution shift limits diagnostic performance generalizability

Heliyon, Aug 1, 2020

Background Machine learning has been an emerging tool for various aspects of infectious diseases ... more Background Machine learning has been an emerging tool for various aspects of infectious diseases including tuberculosis surveillance and detection. However, the World Health Organization (WHO) provided no recommendations on using computer-aided tuberculosis detection software because of a small number of studies, methodological limitations, and limited generalizability of the findings. Methods To quantify the generalizability of the machine-learning model, we developed a Deep Convolutional Neural Network (DCNN) model using a Tuberculosis (TB)-specific chest x-ray (CXR) dataset of one population (National Library of Medicine Shenzhen No.3 Hospital) and tested it with non-TB-specific CXR dataset of another population (National Institute of Health Clinical Centers). Results In the training and intramural test sets using the Shenzhen hospital database, the DCCN model exhibited an AUC of 0.9845 and 0.8502 for detecting TB, respectively. However, the AUC of the supervised DCNN model in the ChestX-ray8 dataset was dramatically dropped to 0.7054. Using the cut points at 0.90, which suggested 72% sensitivity and 82% specificity in the Shenzhen dataset, the final DCNN model estimated that 36.51% of abnormal radiographs in the ChestX-ray8 dataset were related to TB. Conclusion A supervised deep learning model developed by using the training dataset from one population may not have the same diagnostic performance in another population. Conclusion: Technical specification of CXR images, disease severity distribution, dataset distribution shift, and overdiagnosis should be examined before implementation in other settings.

Total Hip Arthroplasty in Obese Patients: An Updated Literature Review

Orthopaedic Proceedings, Feb 21, 2018

PurposeTo update recent findings about the relationship between obesity and post-operative outcom... more PurposeTo update recent findings about the relationship between obesity and post-operative outcome including acetabular cup positioning, complications, readmissions and revision rates, and also inpatient rehabilitation outcome following total hip arthroplasty.MethodsA literature review was done using standard keyword search. Articles were scrutinized by the investigators to ensure relevancy to the purpose of this review.Summary of the reviewAs the number of all obese(body mass index(BMI) >30) are rising, the development of hip osteoarthritis and the need for total hip arthroplasty(THA) increased. Recent studies found that high BMI was the most significant risk factor contributed to acetabular cup malpositioning following THA. Obesity was found to be a predicting factor for 30-day readmission due to complications include wound infections and thromboembolism after THA. A meta-analysis had shown increased rates of aseptic loosening, dislocation and infection in obese patients thus resulted in higher revision...

Surgical Techniques and Tools for Osteoarthritis of the Knee: An Updated Literature Review

Orthopaedic Proceedings, Feb 21, 2018

PurposeTo update current surgical management of knee osteoarthritis.MethodsA literature review wa... more PurposeTo update current surgical management of knee osteoarthritis.MethodsA literature review was done using standard keyword search. Articles were scrutinized by the investigators to ensure relevancy to the purpose of this review.Summary of the reviewArthroscopy, osteotomy and arthroplasty are three major techniques for knee osteoarthritis. Arthroscopy is more and more common as it is diagnostically and therapeutically useful, especially for patients with painful osteoarthritis with mechanical symptoms. Recently, arthroscopic techniques to treat subchondral bone marrow lesions associated with knee osteoarthritis have been developed. Osteotomy is a technique that preserves the natural biomechanics of the joint and reestablishes joint alignment. Its accuracy has been improved with the advancement of computer-assisted surgery. Arthroplasty includes Unicompartmental knee arthroplasty (UKA) and Total knee arthroplasty (TKA). In UKA, patient selection is a key factor for good outcomes, which can be enhanced w...

Factors affecting decision making of new graduate physicians in choosing potential areas of practice: A national survey

Background In equitable distribution of physicians is a challenge especially in rural areas of de... more Background In equitable distribution of physicians is a challenge especially in rural areas of developing countries including Thailand. The resignations of newly graduated physicians imply a failure of in comprehensive policy interventions that are not based on real and holistic understanding of the issue. Objective This study was aimed to empirically explore factors influencing decision making of newly graduated physicians in choosing future practice areas. Design Descriptive statistics and exploratory factor analysis (EFA) were used for analyzing the responses. Setting Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University Methods A national survey of 751 physicians who graduated from all 12 medical schools in Thailand was conducted in April, 2012. The questionnaire was carefully developed based on literature review and qualitative study that contained three sections: basic information of responding physicians, potential workplace and duration they intended to work, as well as opinions on issues that influence their decision making, using 5-point Likert’s scale. นพินธต์น้ฉบบั

Variation of tuberculosis prevalence across diagnostic approaches and geographical areas of Indonesia

PLOS ONE, Oct 15, 2021

Tuberculosis (TB) has contributed to a significant disease burden and economic loss worldwide. Gi... more Tuberculosis (TB) has contributed to a significant disease burden and economic loss worldwide. Given no gold standard for diagnosis, early identification of TB infection has been challenging. This study aimed to comparatively investigate the prevalence of TB across diagnostic approaches (sputum AFB, sputum culture, sputum genetic test, and chest x-ray) and geographical areas of Indonesia. Participant demographic variables and TB screening test results were obtained from the Tuberculosis Unit, Health Research and Development Agency, Ministry of Health (HRDA-MoH). The prevalence of pulmonary TB in populations aged 15 years and over was calculated using TB cases as a numerator and populations aged 15 years and over as a denominator. Variations across geographical areas and diagnostic approaches were expressed as prevalence and 95% confidence interval (CI).

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Short Practical Regimen of Acupuncture for Melasma: A Prospective Cohort Study in a Tertiary Hospital in Thailand

medRxiv (Cold Spring Harbor Laboratory), Feb 9, 2021

Background: Melasma is a common skin pigmentation disorder. Acupuncture shows benefits for patien... more Background: Melasma is a common skin pigmentation disorder. Acupuncture shows benefits for patients with melasma, although no standardized method or optimal number of sessions have been determined. To comparatively assess clinical outcomes of melasma between five vs ten standard acupuncture sessions. We performed a prospective observational cohort study in all melasma patients at the Acupuncture Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. All patients were treated with standard acupuncture procedure twice a week and were evaluated after the fifth and the tenth sessions of acupuncture, with a follow-up one week after the last session. Participants were divided into two treatment groups: Groups A and B received five and ten acupuncture sessions respectively. Melasma outcomes were assessed by using the Melanin Index (MI), Melasma Area and Severity Index (MASI), patient-reported improvement scores and acupuncture-related adverse events. Results: Of 113 participants, 67 received five sessions of acupuncture treatment while 39 received ten sessions. 7 participants did not finish treatment. After five sessions of acupuncture in Group A, the mean MI decreased by 28.7 (95%CI -38.5 to -18.8), whereas the median MASI decreased by 3.4 (-6.9, -1.2) points. After ten sessions of acupuncture in Group B, the mean MI decreased by ), whereas the median MASI decreased by 5.4 (-9.9, -3.0) points. The first five sessions of acupuncture had a higher effect on the change in magnitude than the last five sessions, although there was no statistically significant difference. However, ten-session of acupuncture, had not reached the peak benefit on melasma yet. Further studies should be done with a higher number of sessions to determine the optimal rounds of treatment. Twenty-nine participants reported minor side effects, mostly consisting of persistent pain and small hematoma. Group B had RR of having adverse events 1.8 times (95% CI 1.0-3.4) compared to group A. Conclusion: Acupuncture has a potential dose-response effect on clinical and patient-reported melasma outcomes with minor side effects.

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