Journal of The Department of Medical Services

Health Impacts, Regulatory Frameworks, and Clinical Coding Guidelines for PM2.5 Exposure in Thailand

Supakorn Tultrairatana — 2026-06-15

Background: Fine particulate matter with an aerodynamic diameter of less than 2.5 micrometers (PM2.5) represents a critical environmental health risk factor. The World Health Organization (WHO) estimated that exposure to PM2.5 contributes to approximately 4-9 million premature deaths worldwide and 25,432 deaths annually in Thailand. Despite these severe impacts, statistical surveillance and the enforcement of regulatory frameworks in Thailand remain limited. Objective: To review scientific evidence regarding the health impacts of PM2.5 exposure within the context of occupational and environmental medicine; to analyze legal frameworks and ambient air quality standards in Thailand; and to identify clinical diagnosis and coding methods to enhance the statistical accuracy of tracking affected populations. Methods: A narrative literature review was conducted using PubMed and Scopus Databases, alongside relevant government policy documents published up to 2026. Results: PM2.5 exposure is significantly associated with various disease groups, while Thailand's annual average PM2.5 levels consistently exceed standard guidelines. In clinical practice, challenges persist in both differential diagnosis and the under-coding of co-morbidities. This article identifies guidelines for utilizing code Z58.1 (Exposure to air pollution) alongside code Y97 (Environmental-pollution-related condition) as secondary codes in health database systems. Conclusion: All physicians, alongside occupational and environmental medicine specialists, play a pivotal role in diagnosing PM2.5-related illnesses and supporting policy advocacy. Utilizing precise diagnostic data to generate robust health statistics is essential for driving sustainable public health policies and protecting the population from the hazards of PM2.5.

Highlights from 2024 Thai Guidelines on the Treatment of Hypertension by the Thai Hypertension Society and Intensive Blood Pressure Control to Reduce the Risk of Cardiovascular Disease in the Future

Kritsada Thanawutthikul — 2026-06-15

Hypertension is a common condition in the Thai population, affecting up to 14 million people. Increases in blood pressure levels increase the risk of death from cardiovascular disease and stroke. Therefore, hypertension is a condition that is significant to the Thai public health system. As a result, the Thai Hypertension Society has consistently created guidelines for managing hypertension in clinical settings, with the most recent version being 2024, aimed at the early detection of high blood pressure. Diagnosed when blood pressure levels are >140/90 mmHg in general, including blood pressure in the risk group >130/80 mmHg, along with the identification of hypertension-mediated organ damage, Patients ought to be diagnosed with hypertension when it is determined that the blood pressure recorded at the hospital aligns with the standards for diagnosing hypertension from being examined more than once. To manage hypertension, it is advised to implement lifestyle modification and utilize the required medication. Taking two different types of drugs from each of the five main drug groups at the same time is generally recommended and use two types of drugs in one pill if possible. And establish suitable treatment objectives based on age and risk. In general, in the population of 18-64 years, blood pressure levels <130/80 mm Hg, etc., and there is new research data, there is a tendency to intensive blood pressure control, blood pressure levels <120/80 (120-129/70-79) mm Hg in groups with high risk of cardiovascular disease. This article introduces the 2024 Thai Guidelines for Hypertension Management that have been created by the Thai Hypertension Society. These guidelines gather the evidence pertaining to the impacts of hypertension treatment.

The Effect of Mindfulness-based Cognitive Therapy Program on Depression among Breast Cancer Patients Receiving Chemotherapy

Ketkeaw Supattranon — 2026-06-15

Background: Breast cancer patients undergoing chemotherapy are at high risk of developing depression. Mindfulness-based Cognitive Therapy (MBCT) is an approach that may help alleviate depression in this patient population. Objective: This study aimed to study the effects of a Mindfulness-based Cognitive Therapy program on depression in breast cancer patients receiving chemotherapy. Method: This study was a quasi-experimental research with two group pre-post tests and follow-up design. The sample consisted of 22 breast cancer patients receiving chemotherapy, divided equally into experimental and control groups (11 patients each). The experimental group participated in a four-session MBCT program, with sessions held once weekly for 60-90 minutes, while the control group received standard nursing care. Data were collected using the Beck Depression Inventory. Statistical analyses included descriptive statistics, Mann-Whitney U test, Friedman test, and Wilcoxon signed-rank test with Bonferroni correction. Result: The experimental group showed significantly different mean depression scores compared to the control group at the statistical level of .05, both immediately after the intervention and at the one-month follow-up. Furthermore, the experimental group demonstrated statistically significant differences (p < .001) in mean depression scores across three time points including pre-intervention (mean = 12.73, SD = 2.53), immediately post-intervention (mean = 6.73, SD = 1.79), and at one-month follow-up (mean = 5.36, SD = 1.69). Conclusion: The Mindfulness-based Cognitive Therapy program effectively and sustainably reduced depression in breast cancer patients receiving chemotherapy. Healthcare professionals should consider implementing this program as an alternative approach for caring for and treating cancer patients with depression.

Effectiveness of Photodynamic Therapy and Antifungal Medication in Treating Denture Stomatitis: A Systematic Review and Meta-analysis

Panadda Tongwichian — 2026-06-15

Background: Denture stomatitis is a common condition among denture wearers, characterized by erythematous inﬂammation of the oral mucosa in areas in contact with the denture. Treatment is based on the underlying cause and often includes antifungal agents. However, this approach has limitations such as prolonged treatment duration, high recurrence rates, and potential allergic reactions. These challenges have led to the development of alternative therapies, with photodynamic therapy being proposed as a potential treatment option in several studies. Objective: To gather scientific evidence studying the effectiveness of photodynamic therapy in reducing Candida fungal counts in the treatment of denture stomatitis compared to antifungal medications. Methods: Research studies were searched from PubMed, Cochrane, and Google Scholar databases along with manual searching. Only articles in English or Thai published from January 2009 to January 2024 were included. Studies were conducted following PICO guidelines. Results: A total of six studies were included and analyzed in two aspects. First, photodynamic therapy showed lower effectiveness in reducing fungal counts compared to antifungal medications; however, the difference was not statistically significant (SMD = 0.015, 95%CI: –0.352, 0.383, p = .935). Second, the combined treatment demonstrated significantly greater effectiveness in reducing fungal counts than antifungal medication alone (SMD = –1.173, 95%CI: –1.990, -0.356, p = .005). Conclusion: This meta-analysis concludes that photodynamic therapy may serve as an alternative treatment for denture stomatitis. While it is less effective than antifungal medications when used alone, the difference is not statistically significant. Notably, when combined with antifungal medications, photodynamic therapy demonstrates significantly enhanced efficacy in reducing Candida fungal counts.

The Correlation of Glucose between Using Breathing Gas Monitoring and Venous Plasma in Diabetes and Non-diabetes People in Lerdsin Hospital

Tanapon Diewtragoonchai — 2026-06-15

Background: The standard glucose measurement is venous or capillary blood, which may cause pain or bruising at the puncture site. Our research aims to study the accuracy of breath glucose levels compared to blood glucose levels in order to develop a new approach to measuring glucose which convenient, painless, and effective. Objective: To study the relationship between breath glucose levels, compared to blood glucose levels in both diabetic and non-diabetic populations. Method: The analytical cross-sectional correlational study that compared the venous blood glucose level with the breath glucose levels, using the VAYU Breathology G-300. The analysis of correlation and consistency of the instruments use Intraclass correlation (ICC) statistics and Bland-Altman plot, statistically significant at p-value < .05. Result: The total 71 participants of diabetic and non-diabetic patients in Lerdsin Hospital. The results revealed the average breath glucose level was lower than blood glucose level by 1.23 mg/dL, which was not statistically significant (p = .185) and no difference in either diabetic and non-diabetic group (1.31 mg/dL and 1.12 mg/dL, p =.366 and p = .264, respectively), except for diabetic patient who aged 60-69 years or high HbA1c (> 8.0%). However, the interclass correlation coefficient (ICC) analysis of the relationship between the results was very high in all groups (ICC > 0.9, p < .001), indicating a very good consistency and the Bland-Altman plot analysis also showed that the differences were within the acceptable range. Conclusion: The breath glucose levels had a high correlation with blood glucose levels and no statistically significant difference. The breath glucose measurement has potential and may be served as an alternative to glucose testing. However, further studies are needed to confirm its accuracy and efficiency of clinical implementation.

The Practical Score for Predicting Colonic Polyps or Colorectal Cancer

Chollada Suwannachod — 2026-06-15

Background: Early detection of colorectal neoplasia (adenomatous polyps and colorectal cancer; CRC) through the fecal immunochemical test (FIT) screening leads to increased colonoscopy referrals, causing delays in procedure because of limited colonoscopic capacity. Objective: This study aimed to develop a practical score for predicting of colorectal neoplasia in patients undergoing colonoscopy. Methods: This retrospective cohort study analyzed data from 345 patients who underwent colonoscopy by a single surgeon at Pak Kret Hospital, Thailand, between August 2017 and December 2024. Patients were divided into a normal group and a tumor group. Several clinical factors and laboratory results, including abdominal pain, change in bowel habit, bleeding per rectum, weight loss, anemia, family history of CRC, positive FIT result, and elevated CEA level, were collected and analyzed. A practical score was built using diagnostic weights, and its cut-off point was assessed at a ≥3. Results: Several symptoms and laboratory results showed statistically significant differences between the normal and tumor groups. The practical score at a cut-off of ≥3 points showed a sensitivity 78%, specificity 56%, PPV 40%, and NPV 87% for adenomatous polyps. For CRC, the sensitivity was 100%, specificity 56%, PPV 42%, and NPV 100%. Conclusion: This practical score, using available clinical and laboratory data, demonstrates good performance in identifying patients at higher risk of colorectal neoplasia, particularly CRC. A cut-off of 3 points effectively excluded CRC. This tool has the advantage to help in prioritizing patients for colonoscopy in resource-limited settings, colonoscopy scheduling and reducing diagnostic delays for high-risk patients.

Effect of STEMI from Home System Usage

Osit Bambat — 2026-06-15

Background: To date, evidence of pre-hospital electrocardiography (ECG) in STEMI patient in Thailand are lacking. Objectives: To study the clinical outcomes in STEMI from home system compared with old STEMI system. Methods: This prospective quasi-experimental study included in STEMI patients living in Mueang Chaing Rai who used the emergency medical system during October 2021 to September 2024. Primary outcome was a first medical contact (FMC) to balloon time. Secondary outcomes were other STEMI-related times and in-hospital mortality. The statistical analysis was used mean, standard deviation, chi-square test, student t-test and binary logistic regression. The risk results were showed as odds ratio, 95% confidence interval (CI) and statistically significant level p < .05. Results: A total of 36 patients were included in this study. There were 9 patients in STEMI from home system and 27 patients in old STEMI system. Most patients were male. An average age was 63.4 years old. Baseline characteristics were similar between 2 groups. The FMC to balloon time was 79.8 minutes in STEMI from home group and 124.2 minutes in old STEMI group (absolute difference 44.4 minutes; 95%CI: 12.5, 76.4; p < .01). The FMC to ECG time was 3.9 minutes in STEMI from home group and 37.8 minutes in old STEMI group (absolute difference 33.4 minutes; 95%CI: 19.8, 47.0; p < .01). The FMC to consult time was 13.0 minutes in STEMI from home group and 50.9 minutes in old STEMI group (absolute difference 37.9 minutes; 95%CI: 20.8, 55.0; p < .01). The in-hospital mortality was similar between 2 groups (0% and 14.8%; p = .30). Conclusions: Using STEMI from home system made STEMI patients faster done 12-lead ECG, faster diagnosed, and consulted cardiologist which the STEMI primary PCI protocol can activate at patient’s home or during referral, faster revascularization by primary PCI and trend to decrease in-hospital mortality.

Enhancing Self-care Skills and Health Literacy in Elderly Breast Cancer Patients Undergoing Radiation Therapy through a Health Literacy Program

Kasorn Thong-ngao — 2026-06-15

Background: Health literacy is a key factor in promoting effective self-care among elderly breast cancer patients undergoing radiation therapy. Objective: This study aimed to develop and evaluate a health literacy enhancement program to improve health literacy levels and self-care skills in this population. Methods: A quasi-experimental design was employed with 50 elderly breast cancer patients selected through simple random sampling from the Outpatient Radiation Therapy Department at Chonburi Cancer Hospital. There are 25 participants in the experimental group and 25 in a control group. The experimental group received an eight-week health literacy enhancement program. Data were collected using a personal information interview form, a health literacy questionnaire, and a self-care skills assessment. Descriptive statistics and repeated measures ANOVA were used for data analysis. Results: 1) The experimental group showed significantly higher mean scores in both health literacy and self-care skills immediately after the intervention and one month later compared to pre-intervention scores (p < .001). 2) The experimental group also demonstrated significantly higher post-intervention mean scores in health literacy and self-care skills than the control group at both time points (p < .001). Conclusion: The program effectively improved health literacy and self-care skills in elderly breast cancer patients receiving radiation therapy. This program may be a practical tool for healthcare professionals to support patient self-care and enhance their quality of life.

The Study of Specificity and Sensitivity of Teledentistry for Oral Lesion Diagnosis in Comparison to Clinical Examination: A Systematic Review and Meta-analysis

Thanyathorn Chanthorn — 2026-06-15

Background: Teledentistry, a branch of telemedicine utilizing information technology for dental diagnosis, treatment, and education, has gained popularity and development, particularly due to the COVID-19 pandemic. In resource-limited environments and rural areas lacking specialized expertise, the process of oral disease diagnosis is prolonged, potentially leading to the exacerbation of oral lesions or their progression to oral cancer. The implementation of teledentistry in oral medicine helps reduce barriers such as time, travel costs, and diagnostic waiting periods, facilitating earlier detection of oral cancer lesions and improving prognosis. Objective: To conduct a systematic review and meta-analysis to compile academic evidence and analyze the accuracy and efficiency of teledentistry systems in diagnosing oral lesions compared to clinical examinations. Methods: A systematic search was conducted in the PubMed database and Google Scholar. English or Thai articles published between 1990 and 2023 were included and subjected to meta-analysis. The data collected comprised sensitivity and specificity values of oral lesion examinations via teledentistry compared to clinical examinations. Results: Twelve studies met the inclusion criteria. The meta-analysis of sensitivity and specificity of teledentistry compared to clinical diagnosis of oral lesions from all 12 studies yielded a sensitivity of 94% (p < .001) and a specificity of 95% (p < .001). Subgroup analysis of five studies focusing on precancerous lesion diagnosis revealed a sensitivity of 96% (p < .001) and a specificity of 97% (p < .001). Subgroup analysis of eight studies providing final diagnoses showed a sensitivity of 93% (p < .001) and a specificity of 93% (p < .001). Conclusion: Teledentistry demonstrates high sensitivity and specificity in oral lesion examination compared to clinical examinations. However, definitive conclusions may be premature due to high heterogeneity in the data and insufficient studies.

Radiation Therapy Positioning Errors Evaluation from Cone Beam Computed Tomography Compared to the 3D Reference Images from Simulation in Cancer Patients Treated at the Thoracic Region with Volumetric Modulated Arc Therapy

Panratchanee Ruangtong — 2026-06-15

Background: Radiotherapy is an effective method for cancer treatment by delivering high-energy radiation to the tumor site. Therefore Image-Guided Radiation Therapy (IGRT) is essential in the treatment process to verify the tumor location prior to irradiation. The interfraction set up variation may affect the precision of radiation delivery. Objective: To evaluate the set up errors in radiotherapy positioning by comparing Cone Beam Computed Tomography (CBCT) images with reference images (a planning image used to guide and verify patient positioning) for verification before treatment with the Volumetric Modulated Arc Therapy (VMAT) technique. Method: During 1st June 2023 to 31th May 2024 The CBCT data was collected from 281 patients undergoing radiotherapy in the thoracic region with VMAT from three LINACs: Accuray-Radixact, Elekta-Infinity, and Elekta-Harmony Pro at Maha Vajiralongkorn Thanyaburi Hospital. The CBCT images were registered to the reference images and set up error on lateral, longitudinal, and vertical direction were recorded and analyzed using Microsoft Excel. Result: From a total of 3,409 CBCT images, the systematic errors in lateral, longitudinal, and vertical directions were 1.497 mm, 2.845 mm and 2.444 mm, respectively, and the random errors in lateral, longitudinal, and vertical directions were 2.833 mm, 3.108 mm, and 3.204 mm, respectively. Calculated Clinical Target Volume (CTV) to Planning Target Volume (PTV) margin by using the Van Herk formular in lateral, longitudinal, and vertical directions were 5.726 mm, 9.288 mm, and 8.353 mm, respectively. Conclusion: The CTV to PTV margin for thoracic radiotherapy patients were less than 10 mm, which remains within the recommended range of the Radiation Therapy Oncology Group (RTOG) protocols. These deviations may result from patient setup and internal organ motion. Therefore, improvements in patient immobilization devices should be considered to enhance comfort and stability. Additionally, IGRT should be performed before every treatment, and the use of 4D-CBCT and respiratory motion management techniques should be evaluated to improve treatment accuracy and reduce potential side effects.

Acceptability and Preference for Self-sampling HPV DNA Test among Thai Women Attending Songkhla Hospital

Piyarat Jeeravongpanich — 2026-06-15

Background: Cervical cancer is the fifth most common cancer among Thai women, with 5,422 new cases in 2023. Screening effectively reduces incidence; however, participation remains suboptimal. The method of specimen collection for HPV testing may be a barrier. Self-sampling has recently been introduced, but its satisfaction and acceptance among Thai women must be evaluated. Objectives: To assess satisfaction, compare self-sampling with physician-collected sampling, and evaluate acceptance of self-sampling method. Methods: A cross-sectional study was conducted at Songkhla Hospital between January and October 2023. Eligible women underwent HPV testing via self-sampling and completed questionnaires on demographics, satisfaction, and acceptance using a Likert scale. Results: A total of 1,170 women participated. Overall satisfaction was very high, particularly for ease and convenience (94.4%), safety (92.1%), and reliability (87.3%). Acceptance of self-sampling for future screening was reported by 81.3%. Among 772 women with prior physician-collected sampling, the most common disadvantages were embarrassment (78.3%), pain (75.2%), and fear (67.9%), all higher than self-sampling. However, physician-collected sampling was perceived as more reliable (46.7% vs. 22.2%). Importantly, 69.1% of those who initially trusted physician-collected sampling ultimately chose self-sampling for future screening. Conclusion: Self-sampling for HPV cervical cancer screening was associated with high satisfaction and broad acceptance, emerging as a preferred method for future screening. Women consistently cited embarrassment, pain, and fear as major disadvantages of physician collection, whereas self-sampling offered greater comfort and acceptability despite lower perceived reliability

A Comparison of Accuracy and Medication Preparation time between Automated Medication Dispensing and Dispensing by Pharmaceutical Personnel at Udonthani Cancer Hospital

Somsamorn Boonlert — 2026-06-15

Background: Inpatient medication dispensing is a complex process due to the wide variety of medications prescribed, which contributes to increased workload and a higher risk of dispensing errors. To address these challenges, an automated medication dispensing machine was implemented to improve efficiency and reduce errors. Objective: This study aimed to compare the rate of medication dispensing errors and the dispensing time between an automated medication dispensing machine and pharmaceutical personnel. Methods: A prospective experimental study was conducted between October and December 2024 to evaluate and compare the medication dispensing error rates and dispensing times between the automated system and pharmaceutical personnel. Results: A total of 545 prescriptions, comprising 1,498 individual medication items, were analyzed. The automated dispensing machine significantly reduced the average dispensing time to 6.77 seconds (SD ± 3.13), compared to 19.04 seconds (SD ± 6.79) by pharmaceutical personnel (p < .001). The machine recorded 5 dispensing errors (0.92%), all of which were technical. In contrast, pharmaceutical personnel recorded 13 errors (2.39%), primarily due to incorrect drug selection and quantity. Although the automated system exhibited a lower error rate, the difference was not statistically significant. Conclusion: The automated medication dispensing machine was able to prepare medications in less time than pharmaceutical personnel. In terms of accuracy, the automated medication dispensing machine achieved higher accuracy than the pharmaceutical personnel; however, the difference was not statistically significant.

A Study on the Incidence of Adverse Reactions and the Severity of Hypersensitivity in Cancer Patients Receiving Taxane-based Chemotherapy at Vajira Hospital

Kampon Introntakun — 2026-06-15

Background: Hypersensitivity reactions (HSRs) are acute adverse reactions that may occur following chemotherapy administration, particularly with Taxane agents such as Paclitaxel and Docetaxel, which have been reported to cause symptoms ranging from mild to severe. Objective: To investigate the incidence and severity of hypersensitivity reactions in cancer patients receiving Taxane-based chemotherapy. Methods: This study was a retrospective descriptive research based on medical records and nursing documentation. The sample included 120 cancer patients who experienced hypersensitivity reactions after receiving Paclitaxel or Docetaxel between January 1st and December 31st, 2024. The Common Terminology Criteria for Adverse Events (CTCAE) was applied for assessment, and data were analyzed using descriptive statistics. Results: Most patients were female (90.8%) and aged ≥41 years (82.5%). Common symptoms included chest tightness (77.5%), facial ﬂushing (67.5%), and dyspnea (46.7%). Symptoms typically occurred within the first 16-30 minutes of infusion (66.7%), with a volume of 11-20 mL (95.8%) and drug concentration between 250-299 mg (39.2%). Severity levels varied: among Docetaxel recipients (n=18), Grade I reactions occurred in 61.1% and Grade II in 38.9%, with no Grade III observed; in contrast, Paclitaxel recipients (n=102) experienced Grade I in 45.1%, Grade II in 53.9%, and Grade III in 1.0%. Conclusion: Paclitaxel was associated with a higher incidence of Grade II-III hypersensitivity reactions, while Docetaxel showed a higher proportion of Grade I cases. These reactions typically occurred during the 2nd-3rd infusion cycles and within the first 30 minutes of administration. Therefore, this period should be defined as a critical monitoring window, and a pre-infusion screening system should be developed for high-risk patients to enhance chemotherapy safety.

Effects of a Health Literacy and Self-management Promotion Program on Health Literacy, Self-management Behavior, and Blood Sugar in Patients with Type 2 Diabetes

Linda Ongnok — 2026-06-15

Background: Diabetes is a non-communicable disease and a major public health problem worldwide. If patients are unable to control their blood sugar levels, it may lead to serious complications such as diabetic retinopathy and diabetic kidney disease. Objective: To study the effects of the health literacy and self-management promotion program on health literacy, self-management behavior and blood sugar level in patients with type 2 diabetes. Method: A quasi-experimental research with two groups, pre- and post-test design was conducted. The study samples were selected according to the specified criteria; blood sugar level greater than or equal to 154 mg/dl. They were equally divided into an experimental group and a control group with 30 patients in each group. The groups were matched for characteristics such as fasting blood sugar level, diabetes medication treatment, and duration of diabetes within 5 years. During 6 weeks of intervention, the experimental group received the health literacy and self-management promotion program, the control group received conventional care. Result: After the experiment, the experimental group demonstrated significantly higher mean scores in health literacy and self-management behavior compared to both their pre-experiment scores and those of the control group (p < .01). In addition, the mean blood sugar level in the experimental group after the intervention was significantly lower than before receiving program and lower than that of the control group (p < .01). Conclusion: Health literacy and self-management programs lead to positive behavioral changes in patients. Implementing such programs is recommended to promote better blood sugar control in individuals with diabetes.

Comparison of Hematocrit and Serum Microbilirubin at 48 Hours of Age between Delayed Cord Clamping for 60 Seconds Versus Delayed Cord Clamp for 60 Seconds with Milking the Cut Cord in Term Neonates Delivered by Cesarean Section

Wichan Kaewkhiew — 2026-06-15

Background: Management of neonatal anemia often involves delayed umbilical cord clamping (DCC) or umbilical cord milking (UCM). Evidence regarding the combined effect of DCC and UCM in cesarean-delivered neonates remains scarce. Objective: To compare hematocrit (Hct) and microbilirubin levels at 48 hours of age in full-term infants delivered by cesarean section between those receiving DCC for 60 seconds and those undergoing DCC for 60 seconds plus UCM. Methods: A retrospective cohort study was performed using data from the HosOS39 program between May 1st, 2023, and January 31st, 2024. Infants in the control group received DCC for 60 seconds, while the intervention group received DCC for 60 seconds followed by UCM of a 25 cm cord segment. Hct and microbilirubin values at 48 hours were compared using student’s t-test and Fisher’s exact test. Results: A total of 160 neonates were included: 83 in the control group and 77 in the intervention group. Maternal and neonatal baseline characteristics were similar between groups. The intervention group showed significantly higher mean Hct levels than the control group (53.9 ± 5.6% vs. 52.0 ± 5.1%, p = .024). Microbilirubin levels did not differ significantly (9.4 ± 2.3 mg/dL vs. 9.1 ± 2.0 mg/dL, p = .314). Conclusion: DCC for 60 seconds combined with cut UCM significantly increased neonatal hematocrit without elevating microbilirubin levels or causing complications. However, as baseline cord blood Hct was not obtained, the causal relationship cannot be fully established. Prospective studies measuring Hct both before and after the intervention are warranted.

Effects of Trigger Tools for Detecting Extrapyramidal Side Effects from Antipsychotic Drugs in Thanyarak Songkhla Hospital

Jariya Sangsrikam — 2026-06-15

Background: Extrapyramidal side effects (EPS) are common adverse drug reactions from antipsychotic drugs use. Trigger tools are a better method for detecting adverse events than spontaneous reporting. The researchers therefore proposed using trigger tools to identify patients who had developed EPS from antipsychotic drugs in hospital setting. Objective: To study the outcomes of each trigger tool in detecting EPS and to study the incidence of EPS from antipsychotic drugs. Methods: This retrospective study reviewed inpatient medical records after discharge. Four types of trigger tools were examined: 1) Prescription of Benztropine injection, 2) Prescription of Diazepam injection, 3) Initiation or dose increase of Trihexyphenidyl oral, and 4) Initiation or dose increase of Propranolol oral. Medical records where trigger tools were identified were then evaluated for adverse drug reactions using Naranjo’s algorithm. Cases scoring 5 or higher (indicating “probable” or “definite”) were classified as EPS. Data were analyzed using descriptive statistics and Fisher’s exact test, with statistical significance set at p < 0.05. Results: Reviews of 430 medical records found that 26 patients were identified with EPS using trigger tools, which were higher than the spontaneous reporting method of only 2 cases. The initiation or dose increase of Trihexyphenidyl oral was the most frequent trigger leading to EPS detection (23 occurrences). The prescription of Benztropine injection had the highest EPS detection rate (100%). The incidence of EPS was 2.03 per 100 hospitalizations. The most common type of EPS observed was Acute dystonia (24 cases). Conclusion: The use of all four trigger tools increased the detection of EPS from antipsychotic drugs.

Effectiveness of Virgin Coconut Oil in Preventing Radiation-induced Dermatitis in Breast Cancer Patients Receiving Radiotherapy at Lopburi Cancer Hospital

Natthaphat Sangplan — 2026-06-15

Background: Breast cancer is the most common malignancy among patients receiving radiotherapy at Lopburi Cancer Hospital. Radiotherapy is an effective treatment for breast cancer; however, radiation-induced skin reactions are frequent adverse effects. Recognizing the importance of this issue, this study was conducted to compare the effects of virgin coconut oil with standard nursing care in breast cancer patients undergoing radiotherapy. Objectives: To compare the effects of virgin coconut oil and standard nursing care on radiation-induced skin reactions in breast cancer patients receiving radiotherapy. Methods: This experimental study was conducted in breast cancer patients undergoing radiotherapy at Lopburi Cancer Hospital. The control group (n = 34) received standard nursing care, while the intervention group (n = 34) received virgin coconut oil in addition to standard care. Research instruments included a structured questionnaire and a skin assessment form. Data were analyzed using the Chi-square test. Results: The control and intervention groups were comparable in baseline characteristics, including age, sex, education, occupation, radiation dose, and radiation technique. During weeks 1–2, no significant difference in the incidence of radiation-induced skin reactions was observed between the two groups (p = 0.493). From weeks 3–6, patients in the control group developed grade 1–2 skin reactions, while no skin reactions were observed in the intervention group. Conclusions: Virgin coconut oil was effective in delaying the onset of radiation-induced skin reactions in breast cancer patients receiving radiotherapy. It also alleviated discomfort such as dryness, itching, tightness, cracking, and secondary skin infections.

Catamenial Pneumothorax: A Case Series

Warach Taksinachanekij — 2026-06-15

Background: Catamenial pneumothorax is a rare form of spontaneous pneumothorax characterized by recurrent episodes occurring within 72 hours of the onset of menstruation. It is most frequently observed in women between 30 and 40 years old. Although the exact cause remains unproven, prevailing hypotheses propose that congenital diaphragmatic fenestrations may permit translocation of air from the peritoneal cavity into the pleural cavity. This condition predominantly involves the right hemithorax. Hormonal therapy, particularly with gonadotropin-releasing hormone agonists, is a recommended therapeutic approach. Objective: To present a series of catamenial pneumothorax cases. Methods: This retrospective review included cases diagnosed with catamenial pneumothorax between 2021 and 2024. A total of six women were included, with a mean age of 38.5 years (range: 25-46 years; SD = 7.79). All patients presented with dyspnea associated with their menstrual cycle and progressive symptoms of recurrent right-sided pneumothorax. Each underwent a video-assisted thoracoscopic surgery (VATS) procedure for wedge resection to obtain tissue for histopathological diagnosis, along with surgical pleurectomy for definitive management. Results: In all cases, diaphragmatic nodules and diaphragmatic fenestrations were identified intraoperatively. Following wedge resection for histopathological diagnosis, the diaphragmatic defects were repaired using mesh grafts, and surgical pleurectomy was performed via VATS. Histopathologic findings confirmed the presence of endometrial stroma in four cases, while the remaining two showed benign fibromuscular tissue. Postoperatively, all patients received hormonal therapy under gynecologic supervision: gonadotropin-releasing hormone (GnRH) analogues (n = 2), medroxyprogesterone acetate (n = 2), leuprorelin acetate (n = 1), and dienogest (n = 1). Over a mean follow-up duration of 24.83 months (SD = 6.43), no cases of recurrent pneumothorax were reported. Conclusions: VATS surgery is considered the treatment of choice for catamenial pneumothorax. A multidisciplinary approach provides significant benefits to patients. Postoperative hormonal therapy is essential for optimal clinical outcomes and long-term disease control.