Journal of The Department of Medical Services

กุฏิชีวาภิบาล

สมเกียรติ เกษมธรรมคุณ — 2024-03-15

โรงพยาบาลสงฆ์ กรมการแพทย์ กระทรวงสาธารณสุข เป็นสถาบันสุขภาพสงฆ์แห่งชาติ และแห่งเดียวในโลกที่เปิดให้บริการรักษาพยาบาลพระสงฆ์และสามเณรอาพาธจากทั่วประเทศ ดำเนินการเข้าสู่ปีที่ 73 ซึ่งมีการพัฒนาในด้านต่าง ๆ ทั้งด้านโครงสร้าง อาคาร สถานที่ที่ทันสมัย รวมทั้งการพัฒนาสมรรถนะบุคลากรให้มีความรู้ความสามารถ และมีการถ่ายทอดองค์ความรู้ไว้ในบทบาทของศูนย์ความเป็นเลิศด้านการแพทย์ (Center of Excellence; COE) ที่สำคัญ คือ ศูนย์ความเป็นเลิศด้านการจัดบริการการดูแลพระสงฆ์สามเณรอาพาธแบบประคับประคอง (Palliative care)

Frozen Section Diagnostic Accuracy in Intraoperative Surgical Histopathology of Rajavithi Hospital

Nutpacha Chotikawichean — 2024-03-15

Background: An intraoperative diagnosis is a preliminary diagnosis that guide the management of the patient during the surgery. These may lead to a discrepancy between intraoperative diagnosis and subsequent permanent section. An accuracy validation will help to improve understandings between surgeon and pathologists, and also increase the treatment efficiency. Objective: To assess the accuracy, precision and specificity of intraoperative diagnosis, identifying the causes of misdiagnosis and analyzing for solution. Method: This was a retrospective study comparing between intraoperative diagnosis and subsequent permanent section in Rajavithi Hospital between January 1, 2018 and December 31, 2019. Results: There were 727 included cases. There was a concordance rate of 92.98% (676/727 patients) between the intraoperative diagnosis and permanent section diagnosis. The sensitivity rate was 81.86% while the specificity rate was 98.00%. Positive predictive value was 94.87% while negative predictive value was 92.29%. The accuracy rate was 92.98%. The period prevalence of cancer and/or positive margin was 31.09%. Conclusion: The frozen section accuracy in Rajavithi Hospital is in line with other institute in the literature. Surgeon should be aware of sources of false positive and negative that can occur.

Assessment of Skin Problems in Healthcare Personnel during COVID-19 Pandemic: A Cross-sectional Study from Central Vaccination Center

Jatakul Kietkhongnatee — 2024-03-15

Background: During the coronavirus disease 2019 (COVID-19) pandemic, Thai government opened the Central Vaccination Center (CVC) for people to be vaccinated, so healthcare personnel had to apply extra personal protective equipment (PPE) during extended hours. This occurrence may be related to some dermatologic conditions. Objective: To determine the skin problems of healthcare workers operate at CVC and contributing factors. Methods: A cross-sectional descriptive study was performed by a random survey of healthcare personnel working at CVC from October 2021 to September 2022. Demographic data, job, hobby, type and duration of PPE usage, working hours, frequency and type of substance for hand washing, moisturizer application and dermatologic problems were collected from the questionnaire. The diagnosis of skin condition was performed by the researcher. Results: From a total of 406 healthcare personnel, the mean age was 34.8±10.8 years. Skin problems were observed in 291 persons (71.6%), the most common conditions were xerosis (66.7%), skin damage from pressure injury (63.9%), and acne vulgaris (60.1%), respectively. Younger age was a protective factor against skin problems (prevalence risk ratio; PRR = 0.98, p = .021). The vaccine injector had skin problems more than other jobs (PRR = 1.11, p = .038). N95 facial mask was a risk factor (PRR = 1.11, p = .004), whereas fabric mask was a protective factor for acne (PRR 0.84, p = .001). Using latex gloves with powder enhanced the risk of hand eczema (PRR = 1.15, p < .001). Hand washing with soap increased the risk of skin pruritus (PRR = 1.71, p = .022). Conclusion: Dermatologic problems in health workers are common during COVID-19 pandemic. The protective factors are younger age and wearing fabric mask. On the other hand, the risk factors include working as a vaccine injector, wearing an N95 mask, using latex gloves with powder, and hand wash with soap.

The Mechanical Properties of Translucency Monolithic Zirconia vs Lithium Disilicate: A Systematic Review and Meta-analysis

Phornnalat Hamepaiboon — 2024-03-15

Background: Patients’ demand for esthetic dentistry is increasing. Translucency monolithic zirconia is developed to be the material of choice in term of esthetics besides from lithium disilicate. Objective: To synthesize research findings and a meta-analysis on the mechanical properties of translucent zirconia monolithic versus lithium disilicate materials. Methods: Systematic searching for relevant research on the PubMed, open-access and Google Scholar, as well as conducting manual searches were done. Only articles in English or Thai from 2011 to 2021 were taken. The meta-analysis of ﬂexural strength, fracture resistance, and fracture toughness was performed from 11 accepted publications. Results: Translucency monolithic zirconia had a statistically significant higher ﬂexural strength than lithium disilicate, but the result was inconclusive due to the lack of data homogeneity (I²=97.8%). Translucency monolithic zirconia also shown statistically significant higher fracture toughness and fracture resistance than lithium disilicate, but the result was inconclusive due to the lack of homogeneity in the data (I²=96.3%, I²=86.9%) and insufficient studies. Conclusion: Translucent monolithic zirconia is the material of choice for esthetics in high biting forces area or patients with parafunctional habits, however; further high-quality studies are required.

Listening Behavior, Prevalence of Ear Diseases and Hearing Loss in Primary Elementary School Children Who Studied Online (A Prospective Pilot Study)

Suwicha Kaewsiri Isaradisaikul — 2024-03-15

Background: During the COVID-19 pandemic, schools changed their teaching modalities to online modes. Increasing the duration of using and listening to personal listening devices (PLDs) was expected. The risk of noise-induced hearing loss should be increased. Objective: 1. To assess hearing health and listening behavior with earphones. 2. To evaluate the prevalence of hearing loss and ear diseases. Method: A prospective pilot study was performed at Chiang Mai Rajabhat University Demonstration School between June and August 2022. The data of primary elementary school children including hearing health and listening behaviors were collected with questionnaires answered by parents. Otoscopies and hearing tests with distortion product otoacoustic emissions (DPOAEs) were performed. Results: Data from 228 parents showed that duration of listening to PLD on day with online-studying was significantly longer than on day with no online-studying (p-value < .0001). Of 225 students who had ear examinations, 49.78% were boys and 50.22% were girls. The average age was 7.46±0.87 years. Otoscopic findings revealed occluded cerumen (27.55%) and partially occluded cerumen (13.33%). Other findings had only one student in each finding (2.20% in total; 95% CI: 0.7 - 5.1) and those were ear drum perforation, myringosclerosis, air bubbles behind the ear drum, dull or retracted ear drum, and foreign body in the ear canal. DPOAE results in 208 students with normal and seen ear drums showed normal in both ears at 97.60%, abnormal in either ear at 1.9%, and abnormal in both ears at 0.49%. Conclusion: The students increased their use of PLDs during the COVID-19 pandemic. Otoscopic findings revealed 40.88% of the students had impacted cerumen. DPOAE results showed an abnormality in only 2.4%. Though there was a low prevalence of ear diseases and hearing loss, safe listening programs should be implemented to prevent irreversible damage to the inner ear.

A Study of Health Status Screening Results of the Elderly Person in Ratchaphruek Clinic, Nopparat Rajathanee Hospital

Jannapa Petchmunee — 2024-03-15

Background: According to the shift towards an aging society in Thailand, an older population brings about health issues and raises the cost of elderly care. The screening for health status is very important to investigate the direct particular problems and set the policies for appropriate service undertaken the wholistic care. Objective: To study the health status of elderly patients at the Aging Clinic, Ratchaphruek, Nopparat Rajathanee Hospital. Method: All study samples were elderly people who visited Ratchaphruek Clinic, Nopparat Rajathanee Hospital and agreed to participate in the research project between December 1, 2022, to March 31, 2023, for a period of 4 months. The research tools were as follows: a personal data questionnaire and a screening form for health status of the elderly in 9 aspects. The form was developed from the guidelines for health promotion and disease prevention in the fiscal year 2023, created by the National Health Security Office, Region 13, Bangkok. Content validity, verified by 3 experts, level of validity (alpha conbrach coefficientcy) = 0.74, as well as descriptive statistical data were analyzed. Result: Amongst 80 elderly people, 49 were female (61.3%), the lowest age was 60 years old, the highest was 94, and the average age was 72 years old. It was found that the most prevalent healthcare problem was oral health problems (68.8%), following by visual problems (43.8%), and physical movement problems (33.8%), respectively. Other problems were as follows: thinking and memory, urinary incontinence, depression, hearing, and nutritional deficiencies. All elderly patients with health problems were referred to specialized clinical policies for appropriate treatment. Conclusion: The screening for abnormality problems among aging patients was crucial for disease prevention and finding various abnormalities of the body at an initial stage. Giving advice regarding behaviour change reduces the likelihood of complications that often occurs without prompt and proper treatment, which can maintain and promote the good health in elderly people.

Correlation between Glomerular Infiltration Rate and Left Ventricular Mass Index in Chronic Kidney Disease Patients

Kesinee Leedumrongwattanakul — 2024-03-15

Background: Chronic kidney disease induced increases in left ventricular mass index were found to correlate with glomerular filtration rate. The relationship and risk factors of cardiac structure and glomerular filtration rate have not been studied in Thai patients. Objectives: This study was to investigate the correlation between glomerular filtration rate (GFR) and left ventricular mass index in chronic kidney disease (CKD) Thai patients. Methods: This cross-sectional study was conducted at Pranangklao Hospital between January 2016 and December 2021. A total of 248 CKD patients were included in the study. The mean age of the patients was 64.18±14.57 years, and 37.1% of the patients were male. The mean glomerular infiltration rate (GFR) was 57.63±34.22 ml/min/1.73m2, and the mean LVMI was 113.31±41 g/m2. The majority of the patients had hypertension and dyslipidemia and were being treated with statins and beta blockers. Results: Left ventricular mass index (LVMI) was negatively correlated with hematocrit (r = -0.147, p = .02) and GFR (r = -0.283, p < .001) and positively correlated with hypertension (r = 0.228, p < .001), diabetes mellitus (r = 0.173, p = .006), dyslipidemia (r = 0.24, p < .001), coronary artery disease (r = 0.216, p = .001), LVMI (r = 0.947, p < .001), relative wall thickness (r = 0.205, p = .001), left atrial volume index (r = 0.557, p < .001), right atrial pressure (r = 0.161, p = .011), tricuspid regurgitation velocity (r = 0.214, p = .001), right ventricular systolic pressure (r = 0.306, p < .001), and mean pulmonary artery pressure (r = 0.344, p < .001). Conclusion: This study found a significant correlation between GFR and LVMI in Thai CKD patients (r = -0.283). The results suggest that as GFR declines, LVMI increases, which may lead to adverse cardiovascular outcomes.

The Health Impact Associated with Stress of Nurse Practitioners Working during COVID-19 Pandemic

Wiwat Sarapat — 2024-03-15

Background: Since 2019, nurse practitioners had been enduring and persevering during the COVID-19 pandemic. While the number of patients had been increasing, healthcare staff numbers remained the same. This brought stress to the staff and later caused health problems. Objective: To study the health impact associated with stress of nurse practitioners working during COVID-19 pandemic. Method: This was a survey study comprising of personal information and Stress Scale (PSS-10) evaluation. Result: The sample population was a total of 119 nurse practitioners responsible for COVID-19 screening for patients in Ubon Ratchathani Province. The samples had a mean age of 37.9±8.6 years and a mean year of working experience 15.6±8.7 years. Evaluation among 119 samples, the PSS-10 demonstrated 73 (61.3%) having a moderate level of stress and 46 (38.7%) with a mild level of stress. The health impact survey showed that 71 people (59.7%) having regular physical activity, 29 people (21.8%) having no regular physical activity, 109 people (91.6%) not drinking alcohol, all people not smoking, 90 people (59.7%) having no trouble in sleeping, 20 people (16.8%) waking up in the middle of the night. The relationship between the mentioned survey and level of stress was at 0.05 of the statistical significance only for the health perception, 97 people (81.5%) have the same health perception while 18 people (15.1%) feeling weaker. (R² = .36, = -3.40 , p < .05). Conclusion: The research showed that nurse practitioners’ health perception during COVID-19 pandemic related to stress. Therefore, a policy to promote physical and mental health wellness would help reduce healthcare staff’s level of stress.

Thai Population Survey of Knowledge about Risk Factors and Early Sign of Oral Cancer

Somjin Chindavijak — 2024-03-15

Background: Oral cancer is one of a common type of cancer in head neck region. Oral cancer mostly occurs in people who over the age 55 years and most often in men than women. Tobacco and alcohol are the most risk factors related to disease. Knowledge about risk factors and early signs of Oral cancer can improve awareness of prevention the disease. Objective: To survey knowledge about risk factors and early signs of Oral cancer in Thai population. Methods: This cross-sectional study was performed in Thai population who over 18 years old between September 2021 to July 2022. Data were collected by questionnaires via google form. The questionnaires composed of demographic data, knowledge about risk factors, and early signs of oral cancer. Data were displayed as number and percentage in categorical variables while continuous variables were presented as mean (SD). Results: Out of 1,536 participants completed the questionnaires including 74.2% of female and 25.8% of male, the mean age was 40.20±1.47 years, and education level were bachelor degree or higher 78.9%. Moreover, participants were civil servant 32.7%, employee 31.5%, and not working 14.5% respectively. Sixty-six (4.3%) of participants were screened oral cancer. Most of participants 59.9% were not receive information about oral cancer. The three risk factors which participants filled in the right answer were smoking 83.7%, followed by alcohol 69.9%, and chewing betel nut or tobacco 56.2% respectively, while a growth or lump inside mouth was the most of early sign of oral cancer that participants filled in the right answer 78.1%. Conclusion: Receiving information of knowledge about risk factors and early signs of oral cancer in Thai population were moderate. The organizations should have to communicated the knowledge to population for primary prevention severity and decreasing the mortality of disease.

Prevalence and Factors Associated with Insomnia in Elderly over 60 Years of Age at Family Medicine Outpatient Department Rajavithi Hospital

Apiwan Chareonwat — 2024-03-15

Background: Insomnia is a common problem among the elderly, causing many health problems resulting in the quality of life. In Thailand, it was found that the prevalence and associated factors of insomnia among the elderly differed from the study in each area. Therefore, this study was conducted to study the prevalence and related factors of insomnia patients in outpatient department of family medicine Rajavithi Hospital. Objective: This study examined the prevalence and factors associated with insomnia in elderly over 60 years at the Family Medicine Outpatient Department of Rajavithi Hospital. Method: This was a retrospective cross-sectional study. Data were collected by searching the medical records of 12,793 patients over 60 who visited between July 1, - September 30, 2022. Descriptive statistics, independent t-test, chi-square test, Fisher’s exact test, and multiple logistic regression were performed. Result: The prevalence of insomnia was 51.4% (95%CI 50.6, 52.3), but only 3.7% get diagnosed by physicians. 51.2% of the elderly had been prescribed sedative medications. Top fve medications prescribed were lorazepam, amitriptyline, diazepam, clorazepate, and alprazolam. The factors significantly associated with insomnia were female (adj.OR 1.64 [95%CI 1.52, 1.77] p < .001), age 70-79 years old (adj.OR 1.27 [95%CI 1.17, 1.37] p < .001), age over 80 years old (adj.OR 1.87 [95%CI 1.67, 2.09] p < .001), hypertension (adj.OR 1.17 [95%CI 1.05, 1.31] p = .005), peptic ulcer (adj.OR 2.16 [95%CI 1.91,2.45] p < .001), arthritis (adj.OR 1.22 [95%CI 1.07,1.39] p = .004), gastroesophageal reﬂux (adj.OR 1.82 [95%CI 1.42, 2.33] p < .001), cardiovascular disease (adj.OR 1.85 [95%CI 1.44, 2.37] p < .001), cancer (adj.OR 1.64 [95%CI 1.15, 2.34] p = .007), anxiety (adj.OR 12.93 [95%CI 7.97, 20.99] p < .001), depression (adj.OR 6.78 [95%CI 3.20, 14.33] p < .001). Conclusion: The prevalence of insomnia in elderly patients was 51.4%, but only 3.7% get diagnosed by physicians. 51.2% of the elderly had been prescribed sedative medications. The factors associated with insomnia were female, age 70-79 years old, age over 80 years old, hypertension, peptic ulcer, arthritis, gastroesophageal reﬂux, cardiovascular disease, cancer, anxiety, depression.

Predisposing Factors of Atrial High-rate Episodes in Patients with Permanent Pacemaker Implantation in Central Chest Institute of Thailand

Suriya Auitrakarn — 2024-03-15

Background: The atrial high-rate episodes (AHREs) are considered clinically correlated with atrial fibrillation (AF). Moreover, the stroke risk is increasing following the AHREs burden and/or CHA₂ DS₂ -VASc score. However, the predisposing factors of the AHREs were not clearly known. Objective: To investigate the predisposing factors of AHREs in patients with dual-chamber pacemakers. Method: This study was a retrospective observational study recruiting patients without history of AF prior to the dual-chamber pacemaker implantation. Patients with evidences of other atrial tachyarrhythmias prior to the dual-chamber pacemaker implantation were excluded. The baseline demographic data, past medical history, medications, echocardiographic parameters, electrocardiographic findings and pacemaker interrogation data were analyzed and compared between patients with and without AHREs. Predisposing factors predicting AHREs was analyzed by using univariate and multivariate logistic regression analysis. Result: A total of 239 patients undergoing dual-chamber pacemaker implantation in Central Chest Institute of Thailand among January 2017 to December 2021 were recruited. The data of 117 patients from 239 patients were analyzed. There were 89 patients had no AHREs and 28 patients had AHREs. Multivariate logistic regression analysis showed that the percentage of atrial pacing was significantly greater in patients with AHREs (odds ratio 1.02; 95% CI 1.003 to 1.041; p-value = .021). Conclusion: Increased atrial pacing was the only predisposing factor of AHREs in Thai patients with permanent pacemaker. However, larger prospective study should be studied in the future.

Value of Digital Breast Tomosynthesis-guided Vacuum-assisted Biopsy (DBT-VAB) in Diagnosis and Management of Suspicious Non-mass Microcalcifications of Breast: An Experience of Lop Buri Cancer Hospital

Duangporn Sereenonchai — 2024-03-15

Background: DBT-VAB is an alternative to surgical biopsy for early breast cancer detection when presented as calcifications without a mass. However, there is a possibility of pathologic underestimation. Objective: To evaluate malignancy rate and pathologic upgrade rate in suspicious calcifications via DBT-VAB. Method: A retrospective analysis of 98 patients (104 DBT-VAB procedures) was performed. Surgical pathology served as the gold standard for high-risk and malignant groups, with a 1-year follow-up for the benign group. The median follow-up was 51 months. Result: Malignancy rate: 29.8%, total upgrade rate: 21%. Breast MRI and MRI-guided biopsy detected one false negative. Final malignancy rates: BIRADS 4B: 27%, 4C: 56%, 5: 100%. Fine linear calcifications showed a malignancy rate of 70%, while linear and segmental distributions had rates of 100% and 60% respectively. Malignancy rates for calcifications related to BIRADS 3 follow-up, increasing calcifications, new calcifications, stable calcifications: 25%, 40%, 44%, 33% respectively. One-third of developing calcifications in benign background were malignant. Success rate: 98%, complications: small hematomas (15.3%), vasovagal reactions (2%), marker migration (24.4%). Conclusion: DBTVAB is a safe, minimally invasive, and accurate tool for diagnosing and planning the management of suspicious calcifications without masses, with a relatively low pathologic upgrade rate. High-risk and malignant lesions require surgery, while benign results enable reliable follow-up.

Antifungal Activities of Coconut Oil on C. albicans in Vitro

Piangsopin Huangyart — 2024-03-15

Background: The elderly have changing physical and oral conditions that affect various oral diseases, including oral candidiasis. Antifungal resistance and adverse effects have been described, resulting in reduced therapeutic efficacy. Objectives: The purpose of this study was to examine the antifungal effect of coconut oil on C. albicans in Vitro Methods: Coconut oil used for evaluating the antifungal effect on C. albicans was measured using an agar well diffusion method and specific dyes in the detection of antifungal compounds from coconut oil using a thin layer chromatography agar overlay technique. The broth microdilution method was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC), crystal violet assay was used to determine the inﬂuence of coconut oil on C. albicans biofilm development, and Time-kill measurements were done to assess the fungicidal kinetics by counting viable fungal after 0, 2, 4, and 6 hours, respectively. Results: Coconut oil had no antifungal effect in the study’s agar well diffusion method, bioautography agar overlay assay, as well as the broth microdilution method. Nystatin’s minimum inhibitory concentration (MIC) was discovered to be 0.12207 unit/ ml. The effect of coconut oil on C. albicans biofilm development found that coconut oil at concentrations of 0.3–3% v/v could reduce C. albicans biofilm formation by 20-40%, and the time kill study found that nystatin at a concentration of 80,000 units/mL could kill C. albicans by the second hour of the test, whereas coconut oil at 80 percent v/v, was not able to kill C. albicans. Moreover, the levels of C. albicans had risen. Conclusion: This study did not find that coconut oil can inhibit C. albicans. However, coconut oil was found that at a concentration of 0.3-3% v/v, it could reduce the biofilm formation of C. albicans by 20 to 40%.

The Development of Clinical Nursing Practice Guideline for Prevention and Reduction of Hypersensitivity Reaction Severity in Breast Cancer Patients undergoing Chemotherapy Taxane Regimen

Warunee Wangchai — 2024-03-15

Background: Hypersensitivity reaction is an important risk to monitor in cancer patients undergoing chemotherapy. Patients should receive proper and timely assessment and management of hypersensitivity reaction to ensure their safety. Objective: This study aimed to develop a clinical nursing practice guideline (CNPG) for the prevention and reduction of hypersensitivity severity in breast cancer patients receiving Taxane chemotherapy. Method: The study applied the clinical practice guideline development model of National Health and Medical Research Council of Australia 1999 and the Department of Nursing at Chulalongkorn Hospital Thai Red Cross Society in 2019. Collecting empirical evidence and assessing the level of credibility, comprising 29 research studies and 4 related guidelines, a total of 33 topics were extracted to develop evidence-based nursing practices. The CNPG was developed through a review process by 4 experts. The overall score on the AGREE II assessment form was 87.2 and was revised to ensure appropriateness. The CNPG was then trialed with 2 sample groups: 10 nurses’ chemotherapy and 31 breast cancer patients receiving taxane chemotherapy. Results: The synthesis of the results for creating CNPG included the following components: 1) Patient care before receiving chemotherapy by assessing readiness to receive chemotherapy and risk factors for hypersensitivity, 2) Patient care during chemotherapy, including drug administration methods, premedication, surveillance for signs and symptoms, and managing hypersensitivity reactions, and 3) Post-chemotherapy patient care, including assessing complications and providing advice and guidance. When trialed with a sample group was found that expressed satisfaction level was high in the nurse’s group (mean = 4.10, SD = 0.32). The highest level of satisfaction was clarity and the ability to practicality (mean = 4.60, SD = 0.52). While hypersensitivity severity was found in 1 patient (3.2%), mild (grade 2) severity, which could be resolved and continued chemotherapy. Conclusion: The CNPG should be implemented throughout the organization.

Clinical Spectrum and Outcome of Idiopathic Inﬂammatory Myopathy at Neurological Institute of Thailand (NIT)

Thanes Termglinchan — 2024-03-15

Background: Immune-mediated necrotizing myopathy (IMNM) is a severe inﬂammatory myopathy with a high relapse rate. Objective: We aimed to compare clinical characteristics, lab data, and treatment outcomes in Thai patients with immune-mediated necrotizing myopathy (IMNM) to other idiopathic inﬂammatory myopathies (IIMs). Methods: This retrospective study included IIMs patients aged 18 or older, treated at the Neurological Institute of Thailand (NIT) between 2015 and 2021. Patients had relevant clinical and lab data, including muscle enzymes, from a minimum of 3 follow-up visits within a year. Baseline clinical and lab data, including serum myositis-specific and associated autoantibodies (MSAs and MAAs), were documented. Results: Out of 25 IIMs patients, 18 had IMNM (15 anti-SRP, 2 anti-HMGCR, and 1 sero-negative). Five (20%) had dermatomyositis (2 anti-Mi2, 2 anti-NXP2, and 1 anti-1TIF1γ positive), and 2 (8%) had overlap myositis (OM) with anti-KU positive. The mean age of onset was 49±14.3 years, with 72% being female. Median symptom duration was 90 days (IQR, 45-150). The mean initial MRC sumscore for IMNM was 42.68±10.1, and for non-IMNM (DM and OM) it was 44.5±6.6 and 56±2.8, respectively. However, median CK level was significantly higher in IMNM patients compared to non-IMNM (DM and OM) (4952.5 vs. 1,816 U/L, p = .03). Eighty percent received 2 immunosuppressive drugs. Only 3 IMNM and 1 DM needed IVIg or rituximab as rescue therapy. Around 40-50% of patients had full motor strength at 1 year, but 38.9% of IMNM patients experienced relapses. Conclusions: Most patients with IIMs responded well to two immunosuppressive drugs. However, approximately 40% of IMNM experienced relapses and persistent mild hip ﬂexor weakness.

Clinical Practice Guidelines for Physicians and Healthcare Teams in Safety-care of Pregnant Women Infected with COVID-19 until Delivery, Obstetrics and Gynecology Department, Nopparat Rajathanee Hospital

Rungroj Sae-eng — 2024-03-15

Background: In 2021 - 2022, a large number of pregnant women were infected with COVID-19. Pregnant women are considered as a high-risk group with a chance of developing severe symptoms when infected with COVID-19. Objectives: 1) To study doctors’ diagnostic guidelines for treatment and prevention in pregnant women infected with COVID-19 to keep them safe. 2) To study the problems of doctors and medical personnel’s diagnostic guidelines for treatment and prevention, to take care of pregnant women infected with COVID-19 to keep them safe. 3) To study doctors and medical personnel’s management guidelines to take care of pregnant women infected with COVID-19 until the time of delivery. Methods: Study information of pregnant women from medical records from 1^st January - 31^st December 2021, at Nopparat Rajathanee Hospital, together with data from semi-structured interviews of healthcare experts, analyzing statistics, frequencies, percentages, and content, were collected in order to obtain the result. Results: The diagnostic guidelines consisted of key symptoms, history of exposure, COVID-19 testing, and chest x-rays. In terms of treatment guidelines, it was indicated to classify patient types, and to prescribe medicine according to standards, via online channels or telephone communication to prevent the spread of virus. However, there were still problems in communication. Some pregnant women were foreigners, which caused inaccurate communication, leading to a lack of awareness and understanding of self-protection. Conclusion: The 6 principles for managing safety in pregnant women by doctors and health care teams are as follows: safety culture, teamwork, communication, risk management, improving personnel efficiency, as well as improving awareness and response to event.

Factors Causing Allergies from Non-ionic Contrast Media Agents in Computed Tomography

Wayupa Wongwikom — 2024-03-15

Background: Injecting contrast media into the body for computed tomography increases the clarity of organs, helping to make the diagnosis more accurate. This may cause allergic reactions to contrast media agents. The researcher was therefore interested in studying the factors of allergic reactions to non-ionic contrast media. Objective: This prospective study aimed to analyse prevalence and risk factors in non-ionic contrast associated allergic reactions in patients. Method: The sample of 400 patients under computed tomography was collected from a record database between April 2023 - July 2023. Data were analysed using descriptive statistics, numbers, percentages. The research tool was computed tomography examination was collected from a record database (sex, age). Factors determining association between allergic and non-ionic contrast were collected, those include high creatinine or low eGFR, hypertension, asthma, seafood allergies, history of contrast media allergy. Results: It was found that there were more female patients than males in both age groups. Only in the age group of 46-70 years. Data on risk factors found that hypertension accounting for 15.0%, had an allergic reaction to contrast media agents accounting for 2.25%, high creatinine or low eGFR accounting for 1.0%, seafood allergy accounting for 0.5%, respectively. While males were found to have hypertension accounting for 7.0%, high creatinine or low eGFR accounting for 0.5%, allergic to seafood accounting for 0.25%, ever allergic to contrast media agents accounting for 0.00%, respectively. Conclusion: The results of the study found that among the 5 patients, accounting for 1.25%, they were allergic to the contrast media agents which no risk factors mentioned above were found. As for the patient who was allergic to contrast media agents, 1 patient, accounting for 0.25%, had hypertension risk factors out of 90 hypertensive patients, all 6 of whom were patients in the age group of 46 - 70 years.

Case Report and Literature Review: Intrathymic Bronchogenic Cyst

Chawalit Rungnaruethai — 2024-03-15

Thai female patient, she was 55 years old. Underlying disease was asthma. She was admitted at Samut Prakarn Hospital, chest X-ray was examined after has got Covid-19. This examination found an abnormal chest X-ray. Consequently, this had been sent for further computer X-ray, found cystic tumor size 7.6 centimeters in an anterior to middle mediastinum part. This was provided the surgical treatment plan with a median sternotomy to remove the tumor and wedge left upper lobe lung. After the operation can be extubation and she was being treated in hospital for 5 days. From the symptoms follow up appointment after operation, found the left diaphragm was lift up, had normal general symptoms. Pathologic reported no malignancy and detected consistent with bronchogenic cyst. Finally, intrathymic bronchogenic cyst will be found on the anterior mediastinal rarely. Used pathologic report for diagnosis.

Peritoneal Dialysis-related Peritonitis due to Psychrobacter Phenylpyruvicus: A Case Report

Sirayut Waramit — 2024-03-15

A member of the genus Psychrobacter, Psychrobacter phenylpyruvicus is a Gram-negative, catalase and oxidase-positive, nonmotile bacterium. Psychrobacter phenylpyruvicus can infect people and cause endocarditis, peritonitis, and fungating lesions of the foot, however these infections are uncommon. The patient in the current case-report was a 23-year-old female who underwent continuous ambulatory peritoneal dialysis before contracting peritonitis. She experienced stomach pain as well as hyperthermia. An abdominal dialysate analysis was done next to check for infection sources, and this revealed hyperleukocytosis. Psychrobacter phenylpyruvicus was detected during the solid and blood cultures’ incubation. After receiving the appropriate care, the patient eventually made a full recovery.