Journal of The Department of Medical Services

นวัตกรรมบริการสุขภาพ: การดูแลผู้ป่วยยาเสพติดในที่บ้าน (Home ward)

นันทา ชัยพิชิตพันธ์ — 2024-12-16

ยาและสารเสพติดก่อให้เกิดความเสียหายร้ายแรงต่อบุคคล ครอบครัว เศรษฐกิจ สังคมและประเทศชาติ จากการรายงานปัญหายาเสพติดโลก พบว่าในปี ค.ศ. 2023 มีประชากร 292 ล้านคนทั่วโลกที่เข้าไปเกี่ยวข้องกับยาเสพติดที่ผิดกฎหมาย และมีจำนวนเพิ่มขึ้นร้อยละ 20 ใน 10 ปีที่ผ่านมา ยาและสารเสพติดที่นิยมใช้กันทั่วโลกใน 3 อันดับแรก ได้แก่ กัญชา (cannabis) ฝิ่น/อนุพันธ์ของฝิ่น (opioids/ opiated) และแอมเฟตามีน (amphetamine) โดยมีการประมาณการณ์ผู้ที่ใช้กัญชาทั่วโลกมีจำนวน 228 ล้านคน ผู้ที่ใช้ฝิ่น/อนุพันธ์ของฝิ่นมีจำนวน 60 ล้านคน และผู้ที่ใช้แอมเฟตามีน มีจำนวน 30 ล้านคน ทั้งนี้ผู้ใช้ยาและสารเสพติด และได้รับการวินิจฉัยว่าเป็นผู้เสพติด (drug use disorder) มีจำนวน 64 ล้านคน ซึ่งเพิ่มขึ้นคิดเป็นร้อยละ 3 ในห้าปีที่ผ่านมา โดยบุคคลในกลุ่มนี้มีโอกาสเข้ารับการบำบัดรักษาเพียง 1 คนใน 11 คนเท่านั้น¹ สำหรับประเทศไทยจากรายงานผลการสำรวจครัวเรือนเพื่อคาดประมาณจำนวนประชากรผู้ใช้สารเสพติดของประเทศไทยปี พ.ศ.2562 รายงานว่า ผู้ที่มีประสบการณ์ “เคยใช้ยาเสพติดชนิดใดชนิดหนึ่ง” ซึ่งเป็นผู้ใช้สารเสพติดสะสมมีจำนวนประมาณ 3,749,618 คน หรือคิดเป็น อัตราส่วน 74.56 ต่อ 1,000 ของประชากรอายุ 12 – 65 ปี ทั้งนี้จากรายงานยังพบว่า ผู้ที่มีประสบการณ์ในการใช้ยาและสารเสพติด “30 วันก่อนสัมภาษณ์” มีจำนวนมากถึง 1,318,016 คน หรือคิดเป็นอัตราส่วน 26.21 ต่อ 1,000 ประชากร โดยพบผู้ที่ใช้สารเสพติดประเภทยาบ้ามากที่สุด พบอัตราส่วน 31.91 ต่อ 1,000 ประชากร² จากสถิติผู้เข้ารับการบำบัดรักษาในกลุ่มธัญญารักษ์ 6+1 (สถาบันบำบัดรักษาและฟื้นฟูผู้ติดยาเสพติดแห่งชาติบรมราชชนนี (สบยช.) โรงพยาบาลธัญญารักษ์เชียงใหม่ โรงพยาบาลธัญญารักษ์แม่ฮ่องสอน โรงพยาบาลธัญญารักษ์ขอนแก่น โรงพยาบาลธัญญารักษ์อุดรธานี โรงพยาบาลธัญญารักษ์สงขลา และรงพยาบาลธัญญารักษ์ปัตตานี) ในปีงบประมาณ 2565 – 2567 มีจำนวนเพิ่มมากขึ้นดังนี้ 8,369, 10,798 และ 14,728 ราย ตามลำดับ โดยในปี 2567 มีจำนวนผู้ป่วยยาเสพติดที่เข้ารับการบำบัดรักษาแบบผู้ป่วยนอกคิดเป็นร้อยละ 41.96 และบำบัดรักษาแบบผู้ป่วยในร้อยละ 58.04 จากการทบทวนสถิติย้อนหลัง 3 ปี (2565 – 2567)^3-4 พบว่า ผู้ป่วยเสพติดส่วนใหญ่เมื่อผ่านการบำบัดในระยะบำบัดด้วยยามักไม่ย้ายเข้ารับการฟื้นฟูสมรรถภาพ โดยมีผู้ป่วยยาเสพติดเพียงร้อยละ 30-38 เท่านั้นที่ยอมเข้ารับการฟื้นฟูสมรรถภาพภายในโรงพยาบาล ซึ่งผู้ป่วยเสพติดกลุ่มนี้มักให้เหตุผลว่า ตนเองเป็นเสาหลักของครอบครัวต้องกลับไปทำงานหาเลี้ยงครอบครัว มีปัญหาเรื่องค่าใช้จ่าย ยังไม่พร้อมที่จะเข้ารับการบำบัดฟื้นฟูฯ เป็นระยะเวลานาน ๆ หรือให้เหตุผลว่า ตนเองไม่มีอาการถอนพิษยาเสพติด แข็งแรงดีแล้วขอกลับไปรักษาตัวที่บ้าน เป็นต้น สบยช. ในฐานะสถาบันหลักที่มีหน้าที่ในการบำบัดรักษาและฟื้นฟูสมรรถภาพผู้ใช้ยาและสารเสพติดรวมถึงมีบทบาทเชิงวิชาการด้านการศึกษา วิเคราะห์ วิจัย สร้างนวัตกรรม ถ่ายทอดความรู้และเทคโนโลยีด้านการบำบัดรักษาและฟื้นฟูฯ จึงมีแนวคิดในการพัฒนานวัตกรรมบริการสุขภาพ: การดูแลผู้ป่วยยาเสพติดในที่บ้าน (Home ward) ขึ้น โดยมีวัตถุประสงค์เพื่อ เพิ่มโอกาสให้ผู้ใช้ยาเสพติดเข้าถึงบริการบำบัดรักษาฯ ได้อย่างเสมอภาค ได้รับการดูแลอย่างต่อเนื่อง ลดจำนวนวันนอนในโรงพยาบาล ลดภาระค่าใช้จ่าย ส่งผลให้ผู้ป่วยมีคุณภาพชีวิตที่ดีขึ้น และสามารถอยู่ในสังคมได้โดยไม่พึงพายาเสพติด

Development of a Real-time PCR Assay of HLA-B*15:02 Allele for Prevention of Carbamazepine Induced Steven Johnson Syndrome/ Toxic Epidermal Necrolysis in Neurological Institute of Thailand

Patthamaphong Jaiklom — 2024-12-16

Background: Steven Johnson Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are severe adverse drug reactions (ADR) that increase the morbidity and mortality. Most are hospitalized for a long period of time. This causes high treatment costs and possibly requires continuous treatment after being discharged from the hospital. Therefore, HLA-B*15:02 detection before drug dispensing can help physicians in selecting therapeutic drugs to prevent ADR or drug allergies in patients. Objectives: The researcher aimed at developing a real-time PCR assay for detection of HLA-B*15:02. Methods: EDTA whole blood samples were collected from 76 patients during 2022-2023, extract for DNA and screened for HLA-B*15:02 gene using the real-time PCR with in-house designed primers and probes specific for HLA-B*15:02 gene according to the HLA databases. Then, we compared the result of our developed real-time PCR assay with Sanger gene sequencing for HLA-B*15:02 gene genotyping. Results: In this study we found 29 positive HLA-B*15:02 (38.15%) and 47 negative HLA-B*15:02 were samples (61.85%) The sensitivity and specificity of this developing method were 100% and 100%, respectively. All samples were compared with Sanger sequencing and all results showed similar to sanger sequencing. Conclusion: This study was successful developed assay for detecting HLA-B*15:02 allele to prevent CBZ-induced SJS/TEN.

Behavior and Attitude about Self-use of Marijuana Use Among HIV Patients at Rajavithi Hospital

Chuleekorn Preechaviboon — 2024-12-16

Background: Thailand has announced the use of the Narcotic Act, Version 7, which restricts access to medical marijuana to specific medical conditions. These conditions include nausea and vomiting from chemotherapy, difficult-to-treat epilepsy in children, treatment-resistant seizures, muscle stiffness in multiple sclerosis, nerve pain not responding to other treatments, loss of appetite in AIDS patients with weight loss, to enhancement quality of life for individuals receiving palliative care. Currently, there is no available information regarding the use of marijuana in HIV/AIDS patients in Thailand. Objective: To study self-use of marijuana to relieve symptoms in patients with HIV infection. Methods: A cross-sectional survey research design was employed to study patients diagnosed with HIV infection at Rajavithi Hospital's Tropical Disease Department from April to August 2023. A total of 851 participants were randomly sampled, and written consent was obtained before inclusion. Data collection utilized a self-reported questionnaire, with subsequent analysis involving descriptive statistics and binary logistic regression. Results: The majority of patients were male, middle age, and held a bachelor's degree as their highest level of education. Most were employed in private companies with a monthly income below 30,000 baht. The study found that 10% of HIV patients used marijuana products, with 35% predominantly using marijuana-infused beverages. Marijuana was primarily sourced through cultivation (37%) and acquired information through the internet (75%). The reasons for marijuana use include alleviate insomnia (78.18%), and stimulate appetite (37.27%) .Usage was mainly occasional. Attitudes towards marijuana were largely positive, with an average attitude score of 3.75±0.49. Education level, occupation, and attitude significantly influenced the medical marijuana use among HIV patients. Conclusion: Approximately 10% of HIV patients in the study used medical marijuana, It’s used for insomia, muscle pain. Attitudes toward its use were generally favorable, influenced by education level, occupation, and attitude.

The Incidence of Mechanical Complication in Patients Treated with Single Tooth Implant: A Retrospective Cohort Study

Kantapon Kuanun — 2024-12-16

Background: Nowadays, replacing lost teeth with dental implants has become more popular while the mechanical complications of the implant are still being reported. In Thailand, a few studies are relevant to the number of implants due to the increasing use rate. Objectives: The research aimed to study the incidence of mechanical complications and related factors of single tooth implant in patients from 2017 to 2018.Methods: From the study of dental records and intra-oral examination, 40 patients were treated with 70 single tooth implants by the Institute of Dentistry in 2017–2018. The test consisted of a clinical assessment and radiographs to assess mechanical complications and record them in dental records. Then the data was analyzed and displayed as a percentage and correlated the mechanical complications with other related factors. Results: The incidence of mechanical implant complications was 18.5%. The most common complication was loose contact, accounting for 12.8%, followed by screw loosening at 4.3%. Porcelain veneer fractures were found to be 1.4%. In this research, no other mechanical complications of the implant were found. A study of the relationship between the factors studied and the implant mechanics complications revealed that gender and improper occlusion of the crown were significantly associated with implant mechanical complications (p < .05). Conclusion: The incidence of mechanical complications and related factors of single tooth implant in patients of the Institute of Dentistry during the year 2017-2018 revealed the most common complication is proximal contact loss, screw loosening, and fractures of porcelain veneer respectively. Gender and improper occlusion of the crown were significantly associated with the occurrence of implant mechanical complications.

Effectiveness of Disabled Patient Semi-sit to Stand Electric Transfer Lift “Easy Safety Transfer Model 3” to Caregiver’s Ergonomic (Phase 2)

Punyapha Surasitsin — 2024-12-16

Background: This innovation was reviewed for risk incidence in 2018 according to the 2P Safety principles that occurred at the Sirindhorn National Medical Rehabilitation Institute and then introduced into the design thinking process, which focuses on human user-centered. Objective: To study the effectiveness of a disabled patient's semi-sit-to-stand electric transfer lift on the ergonomics of caregivers and further develop a prototype device that is easy to use and safe. Method: This was an experimental study using a disabled patient's semi-sit-to-stand electric transfer lift. Tested in a group of 30 pairs of disabled patients and caregivers (n = 30). Data was analyzed using descriptive statistics and a Wilcoxon signed-rank test, setting the statistical significance level at < .05. Results: When comparing the ergonomic risks of the two methods, it was found that the risk score in the disabled patient transfer step using a transfer device was different from transferring disabled patients using a caregiver (p-value < .001), significance level α = 0.05 and most of the disabled patient group felt comfortable to very comfortable (86.67%) and felt safe to very safe (93.33%). The group of caregivers were very satisfied with the use of the equipment in terms of the dimensions of the equipment, the ease of adjusting the parts of the equipment, the safety and security of the equipment, the durability, and the effectiveness of the equipment in meeting needs for a total of 5 items. Conclusion: The prototype innovation can greatly reduce the ergonomic risks of caregivers and meet the needs of users. This research does not yet have enough evidence to conclude that it can be commercially produced.

Retrospective Analysis of Denosumab-related Osteonecrosis of the Jaw in Osteoporosis Patients at Lerdsin Hospital: A 5-Year study

Puttakrong Raksantikul — 2024-12-16

Background: Denosumab are widely used to treat osteoporosis. A serious adverse effect of these drugs is denosumab-related osteonecrosis of the jaw (DRONJ). However, data on its prevalence in Thailand is currently limited. Objective: This study aimed to analyze the incidence of DRONJ in patients with osteoporosis receiving denosumab at Lerdsin Hospital from 2018 to 2022. Method: A retrospective analysis was conducted using electronic medical records of osteoporosis patients receiving denosumab between January 2018 and December 2022. Descriptive statistics (mean, median, percentage, and disease incidence) were employed for data analysis. Result: The study included 579 patients, predominantly female (ratio: 17.6:1). Mean age was 77.54±9.64 years. Hypertension (39.0%) was the most prevalent comorbidity, followed by dyslipidemia (23.3%) and diabetes mellitus (15.4%). Denosumab monotherapy was used in 81.9% of patients, while 8.6% switched from oral bisphosphonates to denosumab. The mean frequency of denosumab administration was 3.95±2.73 times. Only 4.5% of patients received dental care prior to denosumab initiation. Two cases of DRONJ were identified, resulting in an incidence of 0.345%. Dental extraction and denture irritation were identified as potential predisposing factors. Conclusion: This study demonstrates the uncommon occurrence of DRONJ among patients with osteoporosis receiving denosumab. Limited sample size restricts definitive conclusions regarding risk factors. However, the findings suggest a potential association between DRONJ development and irritated dentures or tooth extractions. Implementing dental health education for patients and healthcare professionals is crucial for DRONJ prevention. Further research with larger datasets is warranted to analyze disease trends and elucidate risk factors conclusively.

Effectiveness of Giving Information, Motivation, and Behavior Skills Model (IMB Model) on Blood Sugar Level, Diabetes Control Behavior, and Practical Knowledge in Patients Undergoing Retinal Surgery

Saowaluck Kuntawee — 2024-12-16

Background: Diabetic retinopathy was an eye condition that could cause vision loss and blindness by 2%. It was caused by an inability to control blood sugar levels for a long period, resulting in vitreous hemorrhage, epiretinal membrane, retinal detachment, and blindness. Objectives: To study the effectiveness of giving information, motivation, and behavior skills model (IMB model) on blood sugar level, diabetes control behavior, and practical knowledge in patients undergoing retinal surgery. Methods: A quasi-experimental research with two-group, pre- and post-experimental study. Data were collected from May to July 2023. The researchers selected patients who had a fasting plasma glucose 140-250 mg/dl and were equally divided into experimental and control groups, each group of 30 cases. Sampling was used for inclusion in the sample due to their common criteria of a fasting plasma glucose level and types of diabetes medications. The experimental group received the information, motivation, and behavior skills model for 4 weeks and the control group received routine nursing care. Data were analyzed by descriptive statistics and t-tests. Results: The mean score of a fasting plasma glucose level in the experimental group was lower than before receiving the information, motivation, and behavior skills model, and also in the control group, with a statistical significance of p < .01. Furthermore, the mean score of diabetes control behavior and practical knowledge in the experimental group was higher than before receiving the information, motivation, and behavior skills model, and also in the control group, with a statistical significance of p < .01. Conclusions: Giving information, motivation, and behavior skills model to patients undergoing retinal surgery had a positive effect on diabetes control behavior, lowered blood sugar level, and increased practical pre- and post-surgery knowledge level.

Incidence and Related Factors of Peri-implant Diseases in Patients Treated with Single Crown on Implant

Pichapad Supunnasri — 2024-12-16

Background: Dental implants are a treatment with a high survival rate. However, long-term complications after implant function can be occurred. Peri-implant diseases is a biological complication leading to dental implant failure. There are several factors that related to peri-implant diseases progression. Controlling risk factors are necessary to prevent the peri-implant diseases that is the critical cause of implant loss. Objective: To investigate the incidence and related factors of peri-implant diseases. Method: The observational cross-sectional study was conducted from 41 patients with 70 implants. All implants were supported with a single crown that loaded for at least 4 years. The data of implant treatment were obtained from review dental records. Clinical examination was performed to accumulate data such as oral hygiene status, gingival inflammation, probing pocket depth and contact of restoration. The periapical radiograph was examined to evaluate the level of bone loss around implant. All collected data were analyzed to examine the incidence and associated factors of peri-implant diseases by chi-square test. Result: 41 patients with 70 implants participated in this study. The incidence of peri-implant diseases was 81.4% (95% CI: 70.3%, 89.7%) categorized as peri-implant mucositis at 77.1% (95% CI: 65.6%, 86.3%) peri-implantitis at 4.3% (95% CI: 0.9%, 12.0%) and peri-implant health at 18.5% (95% CI: 10.3%, 29.7%). The risk factors such as poor oral hygiene, lack of regular maintenance and improper prosthesis were statistically significantly associated with the diseases. While, inadequate keratinized and history of periodontitis were no statistically significant of the diseases. Conclusion: Peri-implant diseases patients in this study were related with poor oral hygiene, lack of regular maintenance and improper prosthesis. So, controlling these risk factors maybe reduce the severity of peri-implant diseases and other complication after implant function.

The Incidence and Factors Related to the Musculoskeletal Adverse Events after COVID-19 Vaccination in Adults at Nopparat Rajathanee Hospital Service Unit

Piyachart Suttinark — 2024-12-16

Background: The musculoskeletal system is most frequently affected by the COVID-19 vaccine adverse events. However few studies focus on the risk factors related to these adverse effects. Objective: To study the incidence and risk factors for musculoskeletal adverse events after the COVID-19 vaccination in adults. Method: Ethiognosis research using case-control design among 302,700 people who received the COVID-19 vaccination and were more than 18 years of age at the Nopparat Rajathanee Hospital service unit from 22 March 2021 to 31 December 2022. Information was derived from the database of the Ministry of Public Health. Among those who experienced musculoskeletal adverse events (22,539 cases) and those who did not experience adverse events (280,161 cases), risk was analyzed with logistic regression, presented as a multivariable odds ratio. Result: The incidence of musculoskeletal adverse events after the COVID-19 vaccination in adults was 7.45%. The statistically significant risk factors include: 1) Female gender (OR 1.65; 95%CI: 1.60, 1.70) 2) Age less than 50 years (OR 2.06; 95%CI: 1.98, 2.13) 3) Comorbidity: respiratory disease (OR 1.58; 95%CI: 1.45, 1.73) cardiovascular disease (OR 1.45; 95%CI:1.26, 1.67) cancer (OR 1.58; 95%CI: 1.31, 1.90) diabetes mellitus (OR 1.26; 95%CI:1.14, 1.39) and obesity (OR 1.53; 95%CI: 1.37, 1.72) 4) Vaccine types: Moderna^® (OR 6.63; 95%CI:4.01, 10.94), Astrazeneca^® (OR 1.60; 95%CI: 1.52, 1.68), Pfizer^® (OR 1.30; 95%CI: 1.22, 1.39) 5) Five or more vaccinations (OR 9.33; 95%CI: 6.54, 13.32) Conclusion: Adults who received the COVID-19 vaccination that may have the potential to musculoskeletal adverse events include those who are a-female less than 50 years of age and those who have exhibited chronic respiratory disease, cardiovascular disease, cancer, diabetes mellitus, obesity and those who have received five or more doses of the vaccine.

Cost Analysis of Alopecia Areata Treatment Using Telemedicine and Standard Care at a Tertiary Care Unit

Pitchayasak Pichai — 2024-12-16

Background: Alopecia areata is a disease caused by an abnormality in the immune system, which attacks hair follicles and leads to hair loss. This condition significantly impacts the patient's mental state, emotions, and quality of life, necessitating continuous treatment. The Institute of Dermatology, a tertiary care unit, provides telemedicine services to patients who have previously been treated at the Institute of Dermatology to enhance continuous access to care. Objective: To study the costs of telemedicine and hospital treatment for patients with alopecia areata from the perspective of service providers, focusing on the Hair and Nail Division at the Institute of Dermatology. Methods: This retrospective study utilized medical records, financial data, inventory data, and pharmaceutical information. The cost analysis of telemedicine and standard treatment methods for alopecia patients was conducted for the year 2021. Results: The total cost of the telemedicine method amounted to 84,209.09 THB, with direct costs, labor costs, capital costs, and material costs accounting for 27.21%, 47.22%, and 25.57%, respectively. The cost per unit was 1,026.94 THB per visit. In contrast, the total cost of the standard treatment method was 143,947.55 THB, with direct costs, labor costs, capital costs, and material costs accounting for 44.55%, 27.65%, and 27.80%, respectively. The cost per unit was 778.09 THB per visit. The higher average cost per patient in telemedicine was due to the lower usage volume and higher capital costs. Increasing patient volume or reducing treatment duration could potentially lower the average cost of telemedicine services. Conclusion: From the service provider's perspective, the cost per patient of telemedicine services for alopecia areata is higher compared to the standard treatment method.

1 Year Outcome of Clinical Efficacy and Safety of Drug Coated Balloon Usage in Coronary Artery Disease in Thailand

Purich Surunchupakorn — 2024-12-16

Background: Drug coated balloon is indicated as the treatment of in stent restenosis (ISR) and de novo lesion in coronary artery disease. The evidence of drug coated ballon (DCB) used for Thai patient in term of safety and efficacy is limited. Objectives: Our real-world cohort study was aimed to evaluate the paclitaxel coated balloon (Sequent please) for 1-year clinical efficacy and safety in Thai population. Methods: From June 2020 to January 2022, a total of 97 symptomatic patients with 100 procedures including de novo, bifurcation and in stent restenosis (ISR) were treated with DCB at Central Chest Institute of Thailand. The composite end point was major adverse cardiac events (MACE) which was a composite of cardiovascular death, target vessel related myocardial infarction (MI) and target lesion revascularization (TLR) at 12 months follow-up. Results: The majority of patients were presented with chronic stable angina (51%). The most common indication for the use of DEB was ISR (82%) followed by de novo lesion (17%), bifurcation lesions (1%). The mean DEB diameter of 2.88 ± 0.58 mm and average total length of 24.95 ± 8.80 mm. At 12 months follow-up, 4% of patients developed MACE in ISR subgroup only. MACE was mainly driven by TLR (4%) followed by target vessel related myocardial infarction (1%) .No cardiovascular death was occurred in study. Conclusion: In our cohort of Thai patients demonstrated that DCB was a safe and effective treatment modality with a low incidence of MACE observed at 12 months follow-up.

Registered Nurses’ Anxiety at the National Cancer Institute, Department of Medical Services, During the Pandemic of Coronavirus Disease 2019

Sathaporn Khankaew — 2024-12-16

Background: The coronavirus disease 2019 pandemic has had an impact on people’s mental health all around the world. Objective: To analyze the anxiety level and personal characteristics associated with anxiety among registered nurses at the National Cancer Institute, Department of Medical Services, during the 2019 coronavirus disease outbreak, delta wave. Method: In November 2022, 179 registered nurses completed a self-administered questionnaire asking retrospectively about anxiety during the delta epidemic in August 2021. At .05 significance, descriptive statistics and the chi-square test were used to evaluate the data. Result: High levels of overall anxiety are reported by 54.70% of registered nurses. Marital status and department were statistically significantly associated with anxiety (p < .01). Gender, age, education, monthly income, and period of employment had no significant association with anxiety. Conclusion: Registered nurses' anxiety levels were greater among those who work in the outpatient department and are married. Propose to the institution's administration rules for offering anxiety care services for nurses in an emergency outbreak to avoid further long-term health consequences.

The Critical Response Time Threshold to Increase 24-hour Mortality in Emergency Medical Service Operations: A Study at Saraburi Hospital

Patcharee Duongthong — 2024-12-16

Background: Response time (RT) refers to the duration in minutes from the moment an incident is reported to the emergency dispatch center until the operational team arrives at the scene. Objective: This study aimed to investigate the relationship and determine the optimal response time (RT) that most significantly impacts 24-hour mortality among patients with critical and severe emergency conditions, focusing on emergency medical service operations within the jurisdictional area of Saraburi Hospital, Thailand. Methods: This explanatory retrospective cohort study focused on emergency patients who reported incidents via the 1669 hotline or other channels and were dispatched to advanced life support (ALS) teams using the red code protocol from May 2017 to July 2019, with 2,500 cases. Data was analyzed and presented with flexible parametric survival analysis to find RT values that affect the hazard ratio each minute that passes for patients who die within 24 hours. Results: After excluding 179 cases that did not meet the inclusion criteria, the remaining 2,321 cases were analyzed. Among these, 118 cases resulted in death within 24 hours. The crude HR of RT was 0.97 (95%CI: 0.94, 1.00, p = .06), while the adjusted HR was 1.05 (95%CI: 0.97, 1.14, p= .20). Upon examining RT on a minute-by-minute basis, the adjusted HR was found to be significantly higher within the first 2 minutes (adjHR) 3.85, 95%CI: 1.00, 14.79, p = .05) and between 12-16 minutes (adjHR) 0.40, 95%CI: 0.18, 0.88, p = .02) - (adjHR) 2.62, 95%CI: 1.14, 6.03, p = .02)]. The time interval associated with the lowest hazard risk corresponded to an RT of 7-12 minutes, although this finding was not statistically significant. Conclusions: Prolonged RT values were associated with an increased risk of 24-hour mortality, and RTs exceeding 12-16 minutes were significantly correlated with a higher likelihood of death.

The Knowledge of the Use of Household Remedies Commonly Used by Undergraduate Students not Majoring in the Health Sciences, Rangsit University

Waroonrat Sukarnjanaset — 2024-12-16

Background: Household remedies are available in convenient stores and online shopping. However, previous studies found that some people still had misunderstandings. Objective: To survey the knowledge of the household remedies commonly used. Methods: The study was a cross-sectional survey in undergraduate not majoring in the health sciences, Rangsit University. Online questionnaires consisted of 2 parts: baseline characteristics and knowledge test about indications and uses. Convenient sampling was used to collect data between January 31^st and February 10^th, 2023. Results: Majority of 297 participants were the first-year female students who studying in humanities and social sciences, median age 19 (IQR 19-20). The results found that the mean of knowledge scores was 12±3.4 out of 21. The common misunderstandings on indication were that electrolyte drinks can be used instead of oral rehydration salts (ORS) followed by 70% ethyl alcohol can be used with fresh wound. The common misconceptions on use were that povidone-iodine can be applied on open wound and paracetamol dose adjustment based on weight. The major sources of drug information were learning from family and studying in secondary school. The significant factors related to getting scores below the mean were the student levels, high school education areas, and the study fields. Conclusion: As a result, labeling and advertising of electrolyte drinks could be clear and precise. The learning topic about household remedies and wound dressing should be incorporated into all academic curriculums and more available on social media: television, radio, and public website.

Relationship of Nutritional Status and Sepsis Mortality

Roongthip Tangsaghasaksri — 2024-12-16

Background: Sepsis is the leading cause of death among hospitalized patients. Nutritional status was found to have an impact on survival and death rate of critically ill patients. Malnutrition is associated with treatment failure in critically ill patients. It is associated with organ failure, an increased risk of complications and death. Objective: This research aimed to study the relationship between nutritional status and sepsis mortality and to find factors associated with sepsis mortality. Method: This was a retrospective descriptive study of sepsis patients screened for nutritional status during 2019 in Rajavithi Hospital. Result: Of the 808 patients diagnosed with sepsis, of whom 400 died (49.5%). Nutritional status was not found to be associated with sepsis mortality, and malnutrition was not a risk factor for sepsis mortality. Factors associated with sepsis mortality included: patients over 60 years old were more than twice as likely to die as those aged 40 or younger. Patients with septic shock were four times more likely to die than patients without septic shock. Patients who received parenteral nutrition (PN) and patients who received both PN and enteral nutrition (EN) were almost four times more likely to die than patients who did not receive any nutrition support. Patients with kidney disease were twice more likely to die than patients without kidney disease. Patients with cancer were almost twice more likely to die than patients without cancer. Patients who received vancomycin and colistin were 1.67 and 1.9 times more likely to die, respectively, than those who did not receive the drugs. Conversely, mortality rates dropped by 40% and 51% in patients treated with quinolone and metronidazole, respectively. Conclusion: Nutritional status is not associated with mortality in sepsis. Factors associated with sepsis mortality are receiving PN, age>60, septic shock, cancer, CKD, and treatment with vancomycin, colistin, fluoroquinolone, and metronidazole.

Cardiac Investigation in Ischemic Stroke Patients That Should be Known in Clinical Practice

Anunya Ujjin — 2024-12-16

According to the report of the World Stroke Organization (WSO) in 2022, stroke remains the second-leading cause of death in the world. Cardiac sources of cerebral emboli are responsible for around 15-30% of ischemic strokes. These strokes have a poor prognosis and a high likelihood of catastrophic recurrence. To develop an effective preventive approach, it is essential to determine the underlying etiology of the cerebral embolism. Following a comprehensive diagnostic evaluation, around 30% of strokes remain of unknown origin, with the majority being assigned to an embolic mechanism that indicates a potential cardiac source. By examining clinical symptoms and conducting brain imaging, as well as studying the cerebral vasculature using ultrasonography or magnetic resonance imaging (MRI)/ computed tomography (CT)-based angiography, it is feasible to uncover other reasons or consider the potential involvement of a cardioembolic origin. Atrial fibrillation (AF) is the primary etiology of cardioembolic stroke. Detecting hidden AF is crucial. Baseline electrocardiogram (ECG), serial ECGs, continuous cardiac monitoring within the initial 48 hours, and Holter monitoring exhibit individual detection rates ranging from 4% to 8%. Extended cardiac monitoring utilizing event recorders has demonstrated increased rates of paroxysmal AF detection. Moreover, echocardiography is essential for identifying the anatomical origins of cardiac emboli. However, transthoracic echocardiogram is moderately accurate in diagnosing heart illness, while transesophageal echocardiography is more accurate and is required when no cardiac source has been found in individuals with cryptogenic stroke.

Painless Aortic Dissection Presented with Ischemic Stroke and Developed Congestive Heart Failure: A Case Report

Nunnapas Paparkun — 2024-12-16

Aortic dissection (AD) is a life-threatening condition that presents with diverse and atypical symptoms. Although transient or permanent neurological symptoms at onset of aortic dissection are not frequent (17-40% of the patients), a diagnosis with predominant neurological symptoms can be difficult and delayed especially in pain-free dissection (which occur in 5-15%). Additionally, only 6% of aortic dissections present with acute congestive cardiac failure, recognized as a potential complication of aortic dissection. We reported the case of 53-year-old female who presented with left-side weakness and numbness without chest pain. After 5 days of admission, she developed atrial fibrillation, congestive heart failure and respiratory failure. Transthoracic echocardiography (TTE) revealed dilated ascending aorta, dissection flap at the ascending aorta extended to descending aorta with hemopericardium. She received a delayed diagnosis of type A aortic dissection. Aortic dissection should always be included in the differential diagnosis of ischemic stroke and unexplained acute congestive heart failure, regardless of the presence of chest pain.

Subepithelial Connective Tissue Graft for the Treatment of Gingival Recessions in Miller Class III in Patient with Anterior Crossbite: A Case Report

Chutiporn Kerdtip — 2024-12-16

This case report showed the treatment of gingival recessions on 41, 42 and 32 in Thai female 34 years old with anterior crossbite. The recessions with the loss of bone and soft tissue in the interdental area were classified in Miller class III gingival recession, result in aesthetic problem and hypersensitivity, especially on 41 which presented the recession depth at 6 mm. and 1 mm. of keratinized gingiva. Root coverage procedure by subepithelial connective tissue graft technique was indicated. The results demonstrated partial root coverage on 41; root coverage on 1 month: 83.3%, 5 months: 66.7%, 1 year: 58.4%, 3 years to 5 years: 50%. The width of keratinized gingiva was 1 mm. before treatment, 1 month after: 7 mm., 5 months: 6 mm., 1 year: 5 mm., 3 years to 5 years: 4 mm. The percentage of root coverage and the width of keratinized gingiva on 41 seemed to decrease exponentially with a longer follow-up time, although seemed to slightly reduced in 3 years after treatment and then stable. Long-term stability was not predictable, longer follow-ups were needed . In the patients with anterior crossbite, orthodontic treatment with surgery may reduced the occurrence of gingival recession, thus, it should be considered.