Region 11 Medical Journal

A comparison of labor induction outcomes using a single dose of misoprostol followed by Oxytocin versus two doses of misoprostol in women undergoing labor induction at Surat thani Hospital

Angsumalin Srisophon — 2026-07-21

Background: Induction of labor is a crucial obstetric procedure that plays a vital role in the care of pregnant women with medical indications, ensuring an appropriate and safe delivery. With the increasing rate of cesarean sections, induction of labor is essential to improving the chances of vaginal delivery. Choosing an effective and safe method is therefore necessary.

Objective: To compare vaginal delivery rates, induction time to vaginal delivery, maternal and neonatal outcomes between single-dose misoprostol combined with Oxytocin and two doses of misoprostol.

Methods: A quasi-experimental study was conducted among 104 pregnant women undergoing labor induction between April 2025 and January 2026 at Surat Thani Hospital. Participants were allocated into two groups: single-dose misoprostol with Oxytocin and two doses of misoprostol. Maternal and neonatal outcomes were compared between the groups.

Results: The combination group demonstrated a significantly higher vaginal delivery rate compared to the two doses of misoprostol group (50% vs 17.3%, P<0.001). The mean duration of labor was significantly shorter in the combination group (9.72 ± 1.92 vs 12.47 ± 3.59 hours, P<0.05). There was no statistically significant difference in postpartum hemorrhage (1.9% vs 3.8%, P=0.558), fetal heart rate abnormalities (17.3% vs 11.5%, P=0.402) and uterine rupture. (0% vs 0%).

Conclusion: Single-dose misoprostol combined with Oxytocin is more effective in increasing vaginal delivery rates and reducing labor duration compared with two doses of misoprostol, without increasing maternal or neonatal complications.

Outcomes of Fetal Down Syndrome Screening Using Quadruple Test at Surat Thani Hospital

Yuphadee Tokhao — 2026-07-21

Background: Surat Thani Hospital has been providing Down syndrome screening for pregnant women using the quadruple test since January 2024. However, there have been no studies on its performance to date. For these reasons, the researchers conducted this study.

Objective: To evaluate the effectiveness of Down syndrome screening using the quadruple test at Surat Thani Hospital.

Method: A retrospective cross-sectional study design for diagnostic test was utilized through the review of patient medical records. Data were collected from 3,746 eligible pregnant women who underwent Down syndrome screening using the Quadruple test at Surat Thani Hospital between January 1, 2021, and December 31, 2024. The data were analyzed using descriptive statistics, and the accuracy of the Quadruple test was presented in terms of sensitivity, specificity, and false positive rate.

Results: A total of 215 women (5.74%) were classified as high-risk for Down syndrome and underwent confirmatory amniocentesis. The results revealed abnormal fetal chromosomes in 6 pregnancies, including 5 cases (2.3%) of Down Syndrome and 1 case of Edwards Syndrome. The remaining 209 pregnancies had normal fetal chromosomes. The screening test demonstrated sensitivity of 100%, a specificity of 94.34%, and a false positive rate of 5.66%

Conclusion: The implementation of the Quadruple test for Down syndrome screening at Surat Thani Hospital demonstrated high clinical efficacy.

The comparison of pain reduction, quality of life and knee joint synovial thickness between Triamcinolone acetonide 20 mg and Triamcinolone acetonide 40 mg in patients with knee osteoarthritis.

Pichate Sripadet — 2026-08-04

Background: Intra-articular steroid injections are used to treat osteoarthritis of the knee. The dosages used vary, but the most popular currently is 40 mg.
Objective: To compare the pain reduction, quality of life and synovial membrane thickness improvement between triamcinolone acetonide 20 mg (TA20) and 40 mg (TA40).
Methods: A quasi-experimental study was conducted on 70 patients with osteoarthritis of the knee, divided into two groups of 35 patients each. Evaluations were performed at three stages: baseline/pre-treatment, 4 weeks, and 12 weeks. The primary outcomes were visual analog scale (VAS), modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and knee joint synovial thickness.
Results: Baseline characteristics of both groups were similar. All patients showed improved pain levels and quality of life at 4 weeks, but at 12 weeks, the TA40 group showed a significant reduction in pain (p=0.017) and generally had a better quality of life. Knee joint synovial thickness decreased in both groups at 4 weeks, but at 12 weeks, the TA40 group showed a significantly greater reduction in knee joint synovial thickness (p=0.034).
Conclusion: TA40 was associated with better pain reduction, quality of life, and reduction of knee synovial thickness than TA20 when followed up at 12 weeks.

Association Between Cycle Threshold Values in Self-Collected High-Risk HPV samples and High-Grade Cervical Lesions in Trang Hospital

Siboonluk Lukkhan — 2026-08-18

Background: Cervical cancer is strongly associated with high-risk human papillomavirus (HPV) infection. Cycle threshold (Ct) values obtained from HPV testing may reflect viral load and correlate with the risk of high-grade cervical lesions. This study aimed to evaluate the association between Ct values from self-collected HPV samples and high-grade cervical lesions at Trang Hospital.

Methods: A retrospective cohort study was conducted among Thai women aged 30–60 years who underwent high-risk HPV testing using self-collected samples and subsequent colposcopy between January 1 and December 31, 2025. Logistic regression analysis was used to assess the association between Ct values and histopathologic outcomes. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal Ct cut-off value.

Results: A total of 178 patients were included. Lower Ct values were significantly associated with high-grade cervical lesions (OR 0.925, 95% CI 0.877–0.976, p=0.005). Longer waiting time before colposcopy was also associated with increased risk of high-grade lesions (OR 1.006, 95% CI 1.000–1.012, p=0.034). The Ct value demonstrated limited discriminatory ability with an area under the ROC curve of 0.658. The optimal cut-off value was ≤30.21, yielding a sensitivity of 68% and specificity of 62%.

Conclusion: Ct values from self-collected HPV testing were associated with high-grade cervical lesions; however, their discriminatory performance was limited. Ct values should therefore be used in combination with other clinical factors for risk stratification.

Factors Associated with Remission in Children Presenting with Isolated Thrombocytopenia: A Retrospective Study at Vachira Phuket Hospital

Anuchit Choowet — 2026-08-23

Background: Most children with isolated thrombocytopenia achieve remission within 12 months. However, approximately 20–25% have persistent thrombocytopenia and progress to chronic immune thrombocytopenia (ITP). Data on factors associated with remission among Thai pediatric patients remain limited.

Objective: To identify factors associated with remission in children younger than 15 years who were initially diagnosed with isolated thrombocytopenia at Vachira Phuket Hospital.

Methods: This retrospective cohort study reviewed the medical records of 90 children younger than 15 years who were initially diagnosed with isolated thrombocytopenia at Vachira Phuket Hospital between 2020 and 2025. Demographic, clinical, and laboratory data were collected. Descriptive statistics were used to summarize the data. Factors associated with remission were analyzed using univariable and multivariable logistic regression analyses. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results: A total of 90 patients were included. Fifty-four patients (60.0%) achieved remission within 3 months after diagnosis, and an additional 9 patients (10.0%) achieved remission between 3 and 12 months after diagnosis. Twenty-seven patients (30.0%) had persistent thrombocytopenia beyond 12 months. However, two patients with chronic ITP subsequently achieved remission after 12 months. Overall, 65 patients (72.2%) achieved remission, while 25 patients (27.8%) did not achieve remission. Multivariable logistic regression analysis showed that male sex was independently associated with remission (adjusted OR 3.76, 95% CI 1.23–11.46; p=0.020)

Conclusion: Male sex was independently associated with remission in children initially presenting with isolated thrombocytopenia.

Development of an Integrated and Continuous Care Model for Pregnant Women Using Methamphetamine Through the Participation of the Health Service Network in Mahasarakham Province

Sukjai Booranabunyat — 2026-08-25

Background: Methamphetamine use among pregnant women are serious and growing public health problem in Thailand, causing adverse obstetric complications. Health services lack integration among maternal care, substance use treatment, and social support, creating critical gaps in continuous care.

Objective: To develop an integrated and continuous care model for pregnant women using methamphetamine through the participation of the health service network in Mahasarakham Province.

Method: This was participatory action research. A purposive sampling method was used to select the sample, comprising 20 multidisciplinary team members and 62 pregnant women with methamphetamine-positive urine tests. The study was conducted from 1 December 2024 to 30 May 2026. Research instruments included a substance use behavior assessment form, a depression screening form, a stress assessment form, an aggressive behavior assessment form, a care follow-up record form, interviews, and focus group discussions. We analyzed quantitative data using descriptive statistics and McNemar's test, and qualitative data using content analysis.

Results: The existing service system revealed three significant problems, namely inadequate screening coverage, the absence of a continuous referral and data documentation system, and social stigma. The model developed to address these problems comprised six core components: (1) a proactive integrated screening system, (2) antenatal care, (3) referral to mental health and substance use clinics, (4) multidisciplinary team care, (5) a continuous intrapartum and postpartum care system, and (6) discharge planning and community follow-up through the COCr9 program. Following implementation, evaluation showed that the risk of depression decreased from 56.5% to 16.1% (χ² = 18.58, p < 0.001), stress decreased from 54.8% to 29.0% (χ² = 11.27, p < 0.001), and semi-urgent aggressive behavior decreased to zero cases. Birth outcomes showed a term delivery rate of 69.36% and a normal birth weight rate of 70.96%. All participants (100%) were registered in the COCr9 system and referred to mental health clinics.

Conclusion: The developed model effectively reduced risks among pregnant women using methamphetamine.

The Association Between Pre-pregnancy Body Mass Index and Obstetric and Neonatal Outcomes Among Pregnant Women Attending Antenatal Care at Somdej Phra Yupparat Wiang Sa Hospital

Primrata Chumsri — 2026-08-31

Background: Pre-pregnancy body mass index (BMI) is associated with pregnancy outcomes, and metabolic risk may occur at lower BMI levels in Asian populations than under global BMI criteria. Evidence from Thailand comparing normal-weight, overweight, and obesity categories according to WHO Western Pacific Region criteria remains limited.

Objective: To examine the association of normal weight, overweight, and obesity before pregnancy with obstetric and neonatal outcomes among Thai pregnant women.

Methods: This retrospective cohort study included singleton pregnancies receiving antenatal care and delivering at Somdej Phra Yupparat Wiang Sa Hospital between October 1, 2022, and September 30, 2025. Among 1,365 women with BMI data, 176 underweight women were excluded, leaving a final cohort of 1,189 women: 497 with normal weight, 212 with overweight, and 480 with obesity. Delivery and neonatal outcomes were evaluated in 1,132 women with complete outcome data. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: Compared with normal weight, obesity was associated with gestational diabetes mellitus (aOR 1.98; 95% CI 1.12–3.48) and hypertensive disorders of pregnancy (aOR 2.53; 95% CI 1.37–4.66), whereas overweight was not significantly associated with either outcome. The odds of a large-for-gestational-age infant were significantly higher in both the overweight (aOR 2.75; 95% CI 1.47–5.14) and obesity groups (aOR 3.71; 95% CI 2.19–6.27).

Conclusion: Higher pre-pregnancy body mass index was associated with adverse pregnancy outcomes, with different patterns across body mass index categories. Obesity was associated with gestational diabetes mellitus, hypertensive disorders of pregnancy, and large for gestational age infants, whereas overweight was associated with large for gestational age infants. These findings support early risk assessment before pregnancy and during early antenatal care.

Effectiveness of Anticoagulation Control with Vitamin K Antagonist (Warfarin) Using Time in Therapeutic Range (TTR) at Community Hospital

Sujitkun Khantayana — 2026-08-31

Background: Warfarin remains the primary oral anticoagulant used in hospitals in Thailand. However, maintaining optimal anticoagulation control is challenging. Time in Therapeutic Range (TTR), with a threshold of TTR ≥65%, is a key indicator for assessing the quality of warfarin therapy. Data from community hospital settings remain limited.

Objectives: To evaluate the quality of anticoagulation control using TTR and to identify factors associated with achieving TTR ≥65%, and to determine the incidence of warfarin-related complications, including bleeding and thromboembolic events.

Methods: A single-center retrospective descriptive study was conducted among patients receiving warfarin at Tharongchang Hospital. Data were collected from medical records between January 1, 2023, and March 1, 2025. TTR was calculated using the Rosendaal method. Descriptive statistics were applied. Continuous variables were compared using Welch’s two-sample t-test, while categorical variables were compared using Pearson’s chi-square test or Fisher’s exact test, as appropriate. Statistical significance was set at p < 0.05. Significant factors were further analyzed using multivariable logistic regression.

Results: Of the 183 patients screened, 162 with complete INR data were included for analysis, with a mean age of 65.2 ± 15.6 years; 54.3% were female. The most common indication for warfarin use was atrial fibrillation (67.9%). The mean TTR was 57.7 ± 20.8%, and 31.5% of patients achieved TTR ≥65%. Patients with antiphospholipid syndrome (APS) or venous thromboembolism (VTE) had the highest mean TTR (64.5%), while the atrial fibrillation group had the lowest (54.5%). Patients with a history of ischemic stroke were more likely to achieve TTR ≥65% (p = 0.032), whereas polypharmacy was associated with a lower likelihood of achieving TTR ≥65% (p = 0.016), both remaining significant after adjustment (adjusted OR 2.62 and 0.38, respectively). Minor bleeding, major bleeding, and acute cardioembolic stroke occurred in 8.0%, 1.9%, and 0.6% of patients, respectively.

Conclusion: Warfarin-treated patients at Tharongchang Hospital achieved a mean TTR of 57.7%. Polypharmacy was significantly associated with suboptimal anticoagulation control. Strategies to improve warfarin management are needed to optimize clinical outcomes.

Chronic Progressive Visual Loss due to Petrocavernous Meningioma: A Case Report

Sittiphong Thongsuwan — 2026-07-21

Introduction: Chronic progressive visual loss in elderly patients is most commonly attributed to cataract; however, alternative etiologies such as compressive optic neuropathy should be considered when clinical findings are atypical.

Case Report: A 69-year-old Thai female presented with progressive left visual loss initially diagnosed as cataract. Examination revealed a relative afferent pupillary defect and optic disc pallor. Magnetic resonance imaging of brain and orbit demonstrated a petrocavernous meningioma compressing the left optic nerve. The patient underwent surgical decompression followed by radiotherapy, resulting in stable visual acuity and improved visual field.

Conclusion: This case highlights the importance of thorough evaluation to prevent misdiagnosis and irreversible visual loss.

Tooth replantation of Avulsed Permanent Anterior Teeth in Children: Two Case Reports with Long-Term Follow-Up

Sirinart Saewong — 2026-07-21

Introduction: Avulsion of a permanent tooth is a dental injury that requires emergency management in children according to the guidelines of the International Association of Dental Traumatology (IADT) in order to minimize potential complications.

Case Report: This report presents two pediatric patients who underwent tooth replantation following traumatic avulsion. Case 1 was a 9-year-old girl with avulsion of the permanent maxillary incisor (Tooth 21), and Case 2 was an 8-year-old boy with avulsion of the permanent maxillary incisor (Tooth 11). In both cases, the parents stored the avulsed tooth in milk and brought the patient to the dentist within 20 and 30 minutes, respectively. After examination, the dentist cleaned the tooth with sterile saline and replanted it into the original socket. The tooth was then stabilized using a flexible splint for 2 weeks, antibiotics were prescribed, and root canal treatment was initiated within 1 week. Follow-up showed favorable outcomes at 3 years in Case 1 and 1.5 years in Case 2. The teeth were stable and the gingival tissues appeared normal. Case 1 exhibited slight discoloration of the crown. Radiographic examination in both cases demonstrated a continuous periodontal ligament space with no signs of root resorption or ankylosis.

Conclusion: Management according to the IADT guidelines can effectively preserve avulsed permanent teeth even when the extra-oral time reaches up to 30 minutes. Therefore, educating parents and teachers about the first aid management of tooth avulsion is extremely important.