Journal of The Department of Medical Services

The Pace of The National Cancer Control Programme: Past, Present and Future

2025-02-17T09:53:05+07:00

โรคมะเร็งเป็นปัญหาสำคัญทางสาธารณสุขของทุกประเทศทั่วโลกทำให้เกิดการสูญเสียชีวิตของประชาชนก่อนวัยอันควร และเสียค่าใช้จ่ายในการรักษาเป็นจำนวนมาก องค์การอนามัยโลก (World Health Organization; WHO) จึงได้แนะนำให้ทุกประเทศดำเนินการวางแผนเชิงกลยุทธ์ที่ครอบคลุมตั้งแต่การป้องกันโรคมะเร็งจนถึงการดูแลผู้ป่วยระยะสุดท้าย¹ ภายใต้ความสอดคล้องกับโครงสร้างพื้นฐานและทรัพยากรที่มีอยู่ของแต่ละประเทศ โดยให้ความสำคัญกับโรคมะเร็งชนิดที่พบได้บ่อยและเป็นปัญหาสุขภาพหลักของประเทศสำหรับประเทศไทยมีการจัดทำแผนการป้องกันและควบคุมโรคมะเร็งแห่งชาติ (National Cancer Control Programme; NCCP) ขึ้นเป็นครั้งแรกเมื่อปี พ.ศ. 2540 ตามมติของคณะรัฐมนตรีในขณะนั้น โดยสถาบันมะเร็งแห่งชาติ กรมการแพทย์ กระทรวงสาธารณสุข ภายใต้ความร่วมมือกับหน่วยงานที่เกี่ยวข้องทั้งองค์กรภาครัฐ เอกชน องค์กรอิสระ ตลอดจนภาคีเครือข่ายต่าง ๆ มีวัตถุประสงค์สำคัญเพื่อจัดทำข้อเสนอแนะด้านนโยบายและแนวทางการป้องกันและควบคุมโรคมะเร็งครอบคลุมในทุกมิติโดยให้มีความเหมาะสมและสอดคล้องกับปัญหาของประเทศสามารถนำไปสู่การปฏิบัติได้จริงตามวิถีชีวิตของประชาชน ประกอบด้วยยุทธศาสตร์ด้านการป้องกันการเกิดโรค การตรวจหาโรคมะเร็งระยะเริ่มแรก การรักษาผู้ป่วยโรคมะเร็ง การดูแลผู้ป่วยแบบประคับประคอง สารสนเทศโรคมะเร็ง และการวิจัยเพื่อป้องกันและควบคุมโรคมะเร็ง

The Study of Tooth Loss and Associated Factors during Maintenance Phase in Patients Treated with a Comprehensive Program, Institute of Dentistry: A Retrospective Study

2023-02-10T14:46:35+07:00

Background: Maintenance of oral health status after dental treatment is essential to raise the patient's quality of life by being treated in a comprehensive program because multitasking work solves all the patient's dental problems. However, there is a possibility the treated tooth could be lost due to various factors, either patient related or tooth related factors. Knowing the risk factors is the best path to devise the most appropriate treatment plan. Objectives: To investigate the rate of tooth loss and determine the factors associated with tooth loss after comprehensive treatment. Method: Six hundred and seventy-six teeth from 38 patients treated in a comprehensive dental clinic and continuously monitored for at least 5 years were the representative sample to be studied about the rate of tooth loss and associated factors. Result: Eighty-five teeth (12.52%) were lost, and the rate of annual tooth loss was 0.32. When all the data were analyzed, there were consistent factors associated with tooth loss significantly (p < .05) including level of program compliance: erratic and non-compliance (irregular compliance) (OR 15.78, 95%CI: 3.76, 66.19), C/R ratio: C/R ratio 1-1.5 (OR 4.97, 95%CI: 2.96, 8.33), C/R ratio > 1.5 (OR 4.25, 95%CI: 1.52, 11.90) and type of retainer: direct retainer (OR 2.59, 95%CI: 1.45, 4.62), indirect retainer (OR 3.78, 95%CI:1.97, 7.27) Conclusion: The rate of tooth loss during the maintenance phase of in patients treated with a comprehensive program was 12.52%, rate of annual tooth loss: 0.32. The significant risk factors were irregular program compliance, crown/root ratio ≥ 1, and selected teeth as abutment (retainer)

Risk Factor of Acute Renal Failure after Open Heart Surgery

2024-02-20T13:43:07+07:00

Background: Acute renal failure (ARF) is one of the most serious complications of cardiac surgery. Its incidence varies between 1 and 30%. ARF requiring renal replacement therapy (ARF-RT) develops in 1% to 5% of patients and is associated with a very high mortality. Objective: This study evaluated the risk factors of ARF in a surgical population with or without preoperative renal dysfunction. Method: This was a cross-sectional study reviewing the medical records of 1,000 patients undergoing cardiac surgery. Data were collected from October 1, 2020 to September 30, 2021, using the data collection on the incidence of acute renal failure in patients undergoing cardiac surgery. The relationship between factors was analyzed using the chi-square test and stepwise binary logistic regression analysis. Result: From the sample of 1,000 cardiac surgical patients, it was found that the risk factors associated with acute renal failure after cardiac surgery, by the analysis of multivariate forward stepwise binary logistic regression, were age group (adjusted OR 7.40, 95%CI: 2.99, 18.29, p <. 001), male gender (adjusted OR 1.656, 95%CI: 1.18, 2.332, p = .004), left ventricular dysfunction (adjusted OR 1.446, 95%CI: 1.1,1.89, p =. 007), history of chronic kidney disease (adjusted OR 1.446, 95%CI: 1.1,1.89, p = .007), pre-operative IABP (adjusted OR 3.768, 95%CI: 2.43, 5.85, p < .001), higher pre-operative creatinine level (mg%) (adjusted OR 2.173, 95%CI: 1.39, 3.4, p = .001) with accuracy rate of 80.2 and area of ROC of 0.701±0.021 (95%CI: 0.661, 0.742, p-value < .001). Conclusion: The male patients with left ventricular dysfunction and underling chronic kidney disease who underwent open heart surgery should have prophylactic guideline in order to prevent acute renal failure after cardiac surgery in patients who had preoperative IABP had significant risk for developing acute renal failure that required treatment guidelines for reducing morbidity and mortality.

The Effectiveness of Ascending and Descending Stairs Assistive Devices for Independent Wheelchairs from the Perspective of Patients with Spinal Cord Injuries

2024-03-06T23:24:08+07:00

Background: A prototype ascending and descending stairs assistive device for independent wheelchairs is created based on the problem of wheelchair users who can help themselves independently, but limitations are found when used in different environments. It is possible that users could be in danger from ascending and descending. However, users can push their wheelchairs to safely ascend and descend the stairs, leading to a better quality of life. Objective: To study the effectiveness of ascending and descending assistive devices for independent wheelchair users and develop a prototype assistive device to meet user needs and safety concerns. Method: This was a quasi-experimental study, in which 15 healthy spinal cord injured patients tested a prototype device for ascending and descending the stairs. Results were measured using the WST Version 5.2 Form Manual Wheelchairs, Comfort rating and Perceived Safety Scale, and QUEST (Version 2.0). Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test, with the statistical significance level set at .05. Results: When comparing wheelchair skills and perception of comfort and safety before and after using the prototype of ascending and descending stairs assistive devices for independent wheelchairs, it was found that skill in ascending stairs and perception of safety were significantly different (p-value < .001), but skills in descending stairs and perception of comfort were not different at the significance level α = 0.05, (p-value = .149 and p-value = .120, respectively). The sample group was very satisfied with the use of the equipment in terms of weight, safety, convenience, efficiency, and response to needs. Conclusion: This prototype assistive device can help the sample group safely ascend and descend the stairs independently, meeting the needs of the users.

Development of a System to Prevent Repeated Drug Allergies Outpatient Services at Lerdsin Hospital

2024-03-14T10:47:56+07:00

Background: Adverse reactions from repeat drug allergies can lead to more severe and dangerous symptoms. The main causes often stem from inadequate communication between healthcare providers and patients, as well as insufficiently detailed patient allergy history checks. Additionally, inconsistencies in drug allergy documentation within hospital information systems contribute to incomplete data transfers. Implementing an efficient patient identification system and standardized methods for recording and communicating can help prevent repeated drug allergies. Objectives: To develop a system for preventing repeat drug allergies and to evaluate the outcomes of the system. Methods: The study was a research and development project consisting of three steps: 1) improvement of workflow efficiency; 2) enhancement of patient identification forms; and 3) development of guidelines for entering drug allergy data into the hospital information system (HIS). Data collection at Lerdsin Hospital, Outpatient Services, Pharmacy Department, from January 1, 2023 to December 31, 2023. Results: The number of patients whose history was taken by a pharmacist and recorded in the hospital information system before the patient was seen by a pharmacist in 2020, 2021, 2022, and 2023 was 2.46, 5.1, 5.02, and 7.27 per thousand prescriptions, respectively. The number of times the patient has a history of allergic drug prescribing outside the hospital is found. In 2020, 2021, 2022, and 2023, they were 0.27, 0.21, 0.27, and 0.09 per thousand prescriptions, respectively. Prescriptions for allergic drugs in the same group in 2022 and 2023 were 0.6 and 0.15 times per thousand prescriptions, respectively. Cross-prescribing of allergic drugs in 2022 and 2023 was 1.51 and 0.37 per thousand prescriptions, respectively. Conclusion: The improvement and development of the system for preventing repeat drug allergies have not only led to a reduction in the risk of patients receiving the same allergic drugs again but can also prevent the prescription of allergies within the same group and cross-reactivity medications.

Prevalence and Risk Factors of Malnutrition Among Adult Cancer Patients in Outpatient Clinic at Cancer Center: A Cross-sectional Study

2024-06-12T19:41:49+07:00

Background: Cachexia is a common issue among cancer patients. Nutritional assessments and awareness of the risk factors for malnutrition should be prioritized. Objectives: This study aimed to investigate the prevalence of malnutrition among adult cancer patients in the cancer center using the validated Nutrition Alert Form (NAF). The secondary objective was to evaluate the risk factors of malnutrition among adult cancer patients. Moreover, the aim is to find correlations among NAF, laboratory findings, and anthropometric parameters. Methods: We conducted a cross-sectional study involving 272 outpatients with cancer at the Cancer Center, Khon Kaen Hospital, from October 2022 to August 2023. Nutritional status was assessed using the NAF, and risk factors including baseline characteristics, anthropometric indices, laboratory results, and cancer-related factors were evaluated. Results: Among the 272 patients, the median age was 59 years (IQR 51-67) and the median BMI was 21.7 kg/m² (IQR 19.2-24.8). The prevalence of moderate and severe malnutrition, according to NAF-B and NAF-C, was 43.8% and 11.8%, respectively. Patients with severe malnutrition experienced significant weight loss compared to those without malnutrition (% of weight change -12.77% vs. -2.13%, p < .001). Factors significantly associated with malnutrition included age ≥ 60 years old and BMI < 20 kg/m² (Adjusted odds ratio (adjOR) 2.17, (95%CI: 1.15, 4.12); and adjOR 3.97 (95%CI: 1.93, 8.17)) respectively. There was a highly significant correlation among NAF. Conclusion: The prevalence of malnutrition among outpatients with cancer is high. NAF can effectively evaluate nutritional status. Significant risk factors include low BMI and being elderly.

Recurrence of Periodontitis and Tooth Loss in Patients with Supportive Periodontal Therapy: A 9-Year Retrospective Study in Rajavithi Hospital

2024-08-16T14:42:29+07:00

Background: Periodontitis is a chronic infectious disease that causes periodontal tissues destruction leading to tooth loss, affecting chewing efficiency, esthetics, and quality of life. Supportive periodontal therapy (SPT) aims to maintain periodontal tissues in a functional state and prevent the recurrence of periodontal disease. Objective: To study the prevalence and factors related with recurrence of periodontitis and tooth loss in patients receiving SPT at Rajavithi Hospital between January 1 2015 to July 31 2023. Method: A retrospective study was conducted using the medical records of 80 patients who received SPT at Dental Department, Rajavithi Hospital from January 1 2015 to July 31 2023. Data collected included general characteristics, history of diabetes (DM) and smoking, severity of periodontal disease, active periodontal therapy (APT) methods, periodontal condition after APT, duration of SPT, compliance, recurrence of periodontitis, number of remaining teeth, and the number of tooth loss due to periodontitis. Data were analyzed using SPSS version 22.0. Result: Out of the 80 patients, 80.0% were female with an average age of 58.58±11.33 years. 11.3% had DM, 56.3% were in stage III periodontal severity. The average duration of SPT was 61.99±34.01 months. Most patients (81.3%) received SPT by only scaling and root planning (s/rp). The prevalence of recurrence of periodontitis was 42.5%. DM (adjOR 7.27, 95%CI: 1.33, 39.67, p < .05) was related with recurrence of periodontitis. During SPT, 18 (0.9%) out of 2,069 teeth were extracted due to periodontitis with tooth loss rate 0.05 teeth/person/year. Age (adjOR 1.07, 95%CI: 1.01, 1.15, p < .05) was related with tooth loss. Conclusion: The prevalence of recurrence of periodontitis was 42.5%. DM was related with higher risk of the recurrence of periodontitis. Prevalence of tooth loss due to periodontitis is 0.9% and tooth loss rate was 0.05 teeth/person/year. Age was related with tooth loss, with older being at higher risk.

Resistance Training in Spinal Cord Injury Rehabilitation: Principles and Benefits

2024-07-09T14:27:05+07:00

Spinal cord injury results in limitations in daily functional activities and quality of life. Therefore, physical rehabilitation is crucial for restoring functional independence. Resistance training (RT) is one of the most effective methods of rehabilitation. This article aims to review the literature about RT in rehabilitation of patients with spinal cord injury (SCI), including principles, benefits, and potential adverse events. Electronic searches were conducted in PubMed, the Physiotherapy Evidence Database (PEDro), and Thai Journal Online (ThaiJO) for clinical trials published between 2013 and 2023, focusing on RT in SCI. Two independent reviewers selected studies based on title, abstract, and full text. Subsequently, reviewers extracted data, including study methods, intervention protocols, results, and reported adverse events. Fourteen studies were included for review. The review found that RT not only increases muscle strength but also positively affects functional ability and cardiovascular fitness. The types of exercises commonly used include progressive resistance training, circuit training, and manual resistance training. A non-serious adverse event of muscle soreness was occasionally reported. RT demonstrates potential for enhancing physical health and functional activity in SCI. Consideration of precautions according to health condition should be a concern to prevent adverse effects. Due to the limited number of studies, further research involving larger sample sizes and long-term follow-up assessments is recommended.

The Relationship between Osteoporosis and Periodontal Status

2024-08-30T15:33:14+07:00

Background: Osteoporosis and periodontitis have been taken into account in relation to relevance. Because both are common conditions in middle-aged and elderly people, which is identical in terms of bone mass destruction. Therefore, understanding the relationship of both conditions may lead to new knowledge in proper care for both groups of patients. Objective: To study the relationship between periodontal status and the severity of osteoporosis in patients in care program to prevent refracture of the orthopedic department of Lerdsin Hospital. Methods: This research was a descriptive prospective research. 64 patients were measured bone mineral density (BMD) by the x-ray bone densitometer, in a femoral neck, vertebral spine and total body for assess osteoporosis severity and assess periodontal status by measured by the Community Periodontal Index (CPI) (WHO, 1997). Then, all data are analyzed with Spearman's rank correlation coefficient. Results: According to studies, it had been found that There were 64 patients aged between 51-103 years (average 76.3±9.4 years). Community periodontal index (CPI) showed that CPI = 1 (bleeding gums) accounted for 15.6%, CPI = 2 (with calculus deposit) accounted for 48.4%. CPI = 3 (with periodontal pocket depth = 4-5 mm.), Representing 21.9% and CPI = 4 (periodontal pocket depth ≥6 mm.), Representing 14.1%. All patients will receive Bone Mineral Density (BMD) measurements. It was found that the periodontal condition was significantly related to BMD measured only from the femoral neck (p < .05). Conclusions: There is a correlation between bone mineral density (BMD) only in the femoral neck with different levels of community periodontal index (CPI). According to the data, the researcher has suggestions for the care of hip fracture patients as a symbol of multidisciplinary. Because there is a possibility of correlation between osteoporosis and periodontitis.

Adherence and Safety in Patients to Non-vitamin K Antagonist Oral Anticoagulants for the Treatment of Atrial Fibrillation at Neurological Institute of Thailand

2024-06-20T00:01:39+07:00

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are effectively used in atrial fibrillation (AF). However, some studies have found that low adherence is associated with adverse outcomes and stroke events. Objective: To investigate problems related to adherence and safety among patients using NOACs. Method: This was a cross-sectional descriptive study involving 180 patients with AF taking NOACs at Neurological Institute of Thailand. Data were collected from October 1, 2022 to October 31, 2023. Adherence and safety were assessed using the Pharmaceutical Care Network Europe (PCNE) version 8.02 criteria. Result: Adverse drug reactions (ADRs) were the most common cause (20%) of drug-related problems (DRPs). Rivaroxaban and dabigatran were the most associated ADRs, accounting for 28.6% and 27.3%, respectively. Common ADRs included ecchymosis (13.9%), bleeding per gum (1.7%), hematuria (1.1%), and hematochezia (0.6%). Adherence was also identified as one of the problems (5.0%). Of these, it was mostly caused by either patients or caregivers who took less medication than prescribed or not taking it at all (47.4%). Bleeding events in non-adherence were found to be 1.1%. Using the PCNE system, the intervention for 34.6 of DRPs was the side effect reported to authorities. All identified problems were accepted and resolved at a rate of 88.9%. Conclusion: The study emphasizes the importance of addressing adherence and safety concerns in patients receiving NOACs. Using PCNE Classification to identify and manage DRPs could improve patient adherence, reduce ADRs. In addition, interventions by pharmacists to resolve DRPs are accepted and thereby enhancing treatment outcomes.

The Study of Salivary Microbiome from Thai Elderly Patients with Alzheimer's Disease, Mild Cognitive Impairment, and Healthy Control

2024-07-30T15:20:42+07:00

Background: Alzheimer's Disease (AD) is a neurodegenerative disease that mainly affects the elderly population. The variation of microbiome in mouth may have an impact on the brain. However, the relationship between the oral microbiome and neurodegenerative diseases such as AD, remain unclear. Objectives: This study interested to compare the differences in microbiome from saliva of elderly people diagnosed with AD, mild cognitive impairment (MCI) and healthy controls. Methods: Saliva samples and clinical data from 10 AD patients, 46 MCI patients, and 44 healthy elderly subjects, were collected and analyzed using long-read next generation sequencing (NGS). In addition, bioinformatic analysis including, QIIME version qiime2, Linear discriminant analysis (LDA) and LDA effect size were performed in this study. Results: AD patients had Clinical Dementia Rating, Montreal Cognitive Assessment and Mini-mental Status Examination were lower than the MCI group. In addition, the AD patient group had a higher microbial diversity than the MCI and control groups. Moreover, AD patients had number of microorganisms including, Fusobacteriaceae and Fusobacterium, that increased significantly (p < .05) compared to samples from the control group (4.53±3.2 and 2.60±1.8 for AD and control, respectively). Interestingly, it was found that samples from AD patients had significantly lower number of Prevotella histicola than samples from the control group (p < .05) (1.10±1.4 and 5.36±5.4 for AD and control, respectively). Conclusions: The long-read NGS analysis to study oral microbial biomarkers in the elderly may be useful in indicating risk of Alzheimer's disease.

Incidence of Withdrawal Symptoms in Pediatric Intensive Care Units after Using the Guidelines for Prevention and Treatment of Withdrawal from Opioid Analgesics and Benzodiazepine Sedatives of the Queen Sirikit National Institute of Child Health (QSNICH)

2024-08-13T14:47:04+07:00

Background: Opioid drugs in combination with benzodiazepines are widely used in pediatric intensive care units (PICUs). These medications are prescribed to reduce pain from illness and medical procedures and to assist patients in breathing with a ventilator. Most patients receive these drugs through continuous intravenous infusion for an extended period. Abrupt discontinuation or rapid dose reduction may lead to withdrawal symptoms. Queen Sirikit National Institute of Child Health has developed guidelines for the prevention and treatment of withdrawal from opioid analgesics and benzodiazepine sedatives to be used in the PICU. It also uses the Withdrawal Assessment Tool Version 1 (WAT-1) to assess opioid and benzodiazepine withdrawal symptoms. Objectives: To determine the incidence of opioid and benzodiazepine withdrawal symptoms, as well as the cumulative dose and average duration of fentanyl or morphine administration in combination with midazolam among patients experiencing drug withdrawal. Methods: This descriptive study was conducted by collecting data from pediatric patients in the PICU at Queen Sirikit National Institute of Child Health. From January 1, 2023 to July 10, 2024, 64 patients, aged between 2 months and 18 years, participated in the study. All patients were managed using the withdrawal prevention and treatment guidelines. Results: Among 64 participants, aged 2 months to 16 years, 19 patients (29.7%) experienced withdrawal symptoms. Of these, 17 patients (89.5%) received midazolam combined with fentanyl, and 2 patients (10.5%) received midazolam combined with morphine. The average cumulative doses of midazolam, fentanyl, and morphine were 28.99, 0.44, and 5.59 mg/kg, respectively. The average duration from opioid and benzodiazepine administration to the onset of withdrawal symptoms was 7.74 days. Conclusions: The incidence of opioid or benzodiazepine withdrawal from continuous intravenous infusion, as assessed by the WAT-1 tool, was 29.7%.

Optimization of Preoperative Routine Cross-matching for Elective Surgery in Udonthani Cancer Hospital: An Appropriate Use of Resources

2024-08-04T15:48:34+07:00

Background: Blood transfusion is important and appropriate for patients who need surgery but are requiring blood to be prepared for specific medical operations. This could result in the lost cost of blood preparation In addition, the lost opportunity to donate blood to other patients increases the workload at the blood bank. Objective: To study the optimization of preoperative routine cross-matching for elective surgery in Udonthani Cancer Hospital. Method: Data from patients who had had elective surgery was obtained for this retrospective descriptive analysis during a one-year period. Blood preparation for surgery was ordered using routine cross-matching techniques. Furthermore, perioperative and postoperative blood transfusions were ordered within 24 hours. The most appropriate blood order was determined by cross-match to transfusion ratio (C/T ratio), transfusion probability (%T), and transfusion index (Ti). Result: There were 89 patients on elective surgeries who had a total of 172 units prepared, but only 32 patients (35.9%) with 63 units (36.6%) of blood were transfused. The C/T ratio, %T, and Ti were 2.7, 35.9, and 0.7, respectively. The cost of blood preparation for surgery was 49,830 baht, but the actual cost was 33,480 baht. The data were analyzed using the type and screen blood preparation, which was found to save up to 16,350 baht. Conclusion: Elective surgery requires more blood preparation than actual demand, and the information obtained could be used to develop appropriate blood preparation guidelines for surgery to make efficient use of resources.

Congenital Associated Malformations in Patients with Cleft Lip and Palate at Rajavithi Hospital

2024-08-10T20:27:36+07:00

Background: Orofacial clefts are often associated with other congenital malformations. Previous studies have reported varying incidences and types of anomalies. In Thailand, there has been no reported data on these associations in infants with cleft lip and/or cleft palate. Objective: To report the prevalence of congenital malformations occurring in conjunction with orofacial clefts from birth and to detail the number of cleft lip and/or cleft palate infants treated at Rajavithi Hospital. Methods: This was a descriptive study. It involved surveying the entire population of newborns with cleft lip and/or palate from the medical records of Rajavithi Hospital, covering births from April 2014 to February 2023. The diagnosis was based on the International Classification of Diseases (ICD-10-TM). Results: Out of 118 infants with orofacial clefts, the male-to-female ratio was 1:1. Among these, 35 infants (29.7%) had additional congenital malformations. Infants with isolated cleft palate had the highest rate of associated malformations, with 9 (36%) cases. The most common additional malformation was congenital anomalies of the digestive system, observed in 14 (11.9%) cases, all of which included ankyloglossia (tongue-tie). Conclusion: A comprehensive understanding of the congenital malformations associated with orofacial clefts is crucial for further diagnostic testing, genetic counseling, and holistic care of cleft lip and/or cleft palate patients.

Effect of Silver Diamine Fluoride as Cariostatic Agent in Irradiated Permanent Teeth

2024-09-01T22:58:42+07:00

Background: Oral and pharyngeal cancers have a high incidence among the elderly population. Most patients receive radiotherapy as a treatment. Radiation-induced dental caries is a common long-term complication that may lead to infection of jawbone and result in risk of osteoradionecrosis. Silver diamine fluoride (SDF) at 38% concentration is effective in inhibiting formation of new caries and arrested root caries in older adults. However, there is a lack of studies examining the effects of SDF on remineralization in permanent teeth that have undergone radiotherapy and developed caries. Objective: This study aims to investigate the effects of SDF on promoting remineralization in irradiated teeth with artificial caries lesions. Method: A total of forty permanent tooth specimens were prepared. All specimens were irradiated by fractional radiation to achieve a total dose of 70 Gy and created artificial caries lesions. 20 samples in each study group were applied with silver diamine fluoride (SDF) and 1,500 ppm fluoride toothpaste. Hydroxyapatite density was quantified by X-ray microcomputed tomography (µCT35) before and after application. Mean hydroxyapatite density and the percentage of remineralization in enamel and dentin were calculated and statistically analyzed by paired t test and unpaired t test. Result: The results demonstrate that SDF and fluoride toothpaste increased mineral density in enamel and dentin after application in all experimental groups. The mineral recovery percentage in enamel was statistically different between SDF and fluoride toothpaste applications. Furthermore, the percentage of mineral recovery in dentin after SDF application was higher than that of fluoride toothpaste. Conclusion: Treatment with SDF can increase mineral density in carious lesions and promote remineralization in irradiated teeth.

Effects of Using Nursing Competency Program for Caring Trauma Fast Track Patients of Emergency Nurse in Emergency Department

2024-09-16T11:55:29+07:00

Background: Trauma Fast Track (TFT) patients is a group that needs to receive treatment and care quickly and correctly. Emergency nurses (EN) must be competency in caring for TFT to ensure patient safety and reduce potential complications. Objective: To study the results of using the nursing competency program for caring TFT in emergency department. Method: It was a quasi experimental research design (one group pre posttest designs). The samples consisted of 31 ENs and 33 TFTs from January April 2024. The questionnaire for nurses comprised 3 parts: 1) demographic information 2) knowledge questionnaire for caring TFT was performed with Cranbreh's alpha value of .81, and 3) nurses practice questionnaire for caring TFT was performed with Cranbreh's alpha value of .78. Result: The results were found that most nurses were female, 28 cases (90.3%), age between 22-25 years old with average age of 31.7 years. The most common causes of TFT were traffic accidents 16 cases (48.1%) Body assault, 11 cases (33.4%), and 6 cases were falls (18.5%). Knowledge scores before and after implementing were shown mean 21.48, 28.58 respectively and practice scores before and after implementing were shown mean 32.87, 45.00 respectively. The comparison of knowledge score results revealed t = 12.607 (df) = 30 and p-value < .001 and practice results revealed t = 7.592 (df) = 30 and p-value < .001. Therefore, it could be concluded that the level of knowledge scores and practice scores after program implementation were higher than the knowledge scores and practice scores before using the program were statistically significant higher p = .01. Conclusion: This nursing competency program could increase the ENs'knowledge and practice.

A Case Report of Worsening Pancytopenia in a Patient with Evans Syndrome During a COVID-19 Infection

2024-06-03T15:51:05+07:00

In 2019, a coronavirus called SARS-CoV-2 was first discovered as a cause of adeadly pneumonia in China, before spreading worldwide leading to global COVID-19 pandemic. Major manifestations of the disease arefever and respiratory symptoms, with possible consequences of acute respiratory distress syndrome, thromboembolism, and multi-organ failure in severe cases. In addition to respiratory manifestations, hema- tologic complications have also been affecting patients with COVID-19 infections. This includes cytopenias, hemolysis and abnormal coagulation. Cases of newly diagnosed Evans syndrome have also been reported to occur both after and concomitantly with COVID-19 infections. In this case report, we present a case of Evans syndrome developing intopancytopenia during aCOVID-19 infection. A 48 year-old man with Evans syndrome was admitted due to acute fever and dark urine. He was positive for COVID-19 infection and his laboratory investigations showed pancytopenia withacute hemolysis. Remdesivir was given along with systemic glucocorticoid. This resulted in an overall improvement of cytopenias and his clinical status.

Fabrication of 3D Printed Complete Denture Using Existing Denture: Case Report

2024-11-24T19:36:52+07:00

Aging population that loses all their teeth affects their speech, chewing, and swallowing, which changes their daily lives. Therefore, wearing quality dentures is significantly related to their quality of life regarding oral health. Thailand has an increasing proportion of the aging population; complete dentures are included in all benefit packages. Therefore, Thai dentists have the opportunity to find older people who need new complete dentures and may have a higher average age as well. Traditional complete denture fabrication in older people is challenging for dentists because they usually have health problems that limit their physical ability and cooperation. Making new complete dentures from a patient's existing dentures reproduces the shape and contour of old dentures that they are familiar with and maintains their neuromuscular control. Thus, it improves patients' adaptability regarding the function of new dentures. In addition, the traditional technique involves many steps and requires 5 - 6 visits for treatment. Using CAD/CAM technology to make complete dentures can reduce working time and errors in clinics and laboratories and have good accuracy and physical properties. This case report presents a method for fabricating new complete dentures from existing dentures using the CAD/CAM system and smile design program in patients whose existing dentures have lost their retention and esthetics. This method reduces the steps and number of visits to the dentist to only 2 times. It also produces dentures that are similar in appearance to existing ones, are aesthetically pleasing to the patient's needs, and still have the same quality and functionality as making complete dentures with the traditional method.