Region 11 Medical Journal

Diagnostic Accuracy of Computed Tomography Features for Acute Appendicitis: A Three-Year Retrospective Cross-Sectional Study at Surat Thani and Wiangsa Crown Prince Hospitals

Pariratana Phopluechai — 2025-12-24

Background: Acute appendicitis is among the most common causes of emergency abdominal surgery. Timely and accurate diagnosis of surgical management is crucial to avoid serious medical complication and reduce the rate of negative appendectomies.

Objective: This study aimed to evaluate the predictive value of four computed tomography (CT) features appendiceal diameter ≥6 mm, wall thickening, periappendiceal fat stranding, and appendicolith in diagnosing acute appendicitis using histopathology as the reference standard. Because the study included only surgically treated patients, diagnostic analysis was restricted to specificity and positive predictive value (PPV). These parameters were calculated to assess the confirmatory role of CT features in clinical practice.

Methods: A retrospective cross-sectional study was conducted at Surat Thani Hospital and Wiangsa Crown Prince Hospital between January 2022 and December 2024. Patients who underwent appendectomy with histopathological confirmation were included. CT scans were reviewed for the four predefined features. Specificity and PPV were calculated for each feature to assess their confirmatory diagnostic value.

Results: A total of 269 patients were analyzed. Appendicolith demonstrated the highest specificity (95.45%) and PPV (97.22%), indicating its strong role as a rule-in feature. Wall thickening (specificity 63.64%, PPV 94.37%) and periappendiceal fat stranding (specificity 45.45%, PPV 93.81%) also showed high PPV despite moderate specificity. Appendiceal diameter ≥6 mm had the lowest specificity (27.27%) but still demonstrated high PPV (93.73%).

Conclusion: CT features provide robust confirmatory value in diagnosing acute appendicitis in surgical patients. Appendicolith, in particular, is highly specific and predictive, while other features offer supportive diagnostic value. Integrating these parameters into diagnostic protocols can improve decision-making, reduce unnecessary appendectomies, lower healthcare costs, and enhance patient outcomes. Future prospective studies including non-operated patients are warranted to enable full evaluation of sensitivity and negative predictive value.

Prevalence and factors associated with medication adherence among child and adolescent psychiatric patients at Suratthani Hospital

Tanatta Anantaseriwidhya — 2025-12-16

Background: The department of child and adolescent psychiatry, Suratthani hospital provides treatment to approximately 250 patients per month. Most patients have received treatment with behavior modification and medications. Consistent adherence to medication has been improved clinical symptoms. However, most patients still have poor medication adherence due to multiple factors, which contribute to ineffective treatment outcomes.

Objectives: To determine the prevalence of child and adolescent mental disorders in Suratthani hospital and identify factors associated with medication adherence.

Method: A cross-sectional analytical study was conducted on 230 patients aged 5–18 years who received outpatient treatment at Child and Adolescent Psychiatry Department, Suratthani Hospital, from May to July 2025.

Results: A total of 235 participants were included in this study; however, some did not complete the questionnaires as required, resulting in valid 230 participants. Among them, 157 were males (68.26%), 73 were females (31.74%), average age 10.35 ± 3.1 years. The majority of the sample group had academic results between 2.01-2.50 (34.78%), studied at the primary school level (69.57%), had no history of using alcohol, cigarettes, or drugs (92.61%). 67.83% of cases were diagnosed with Attention-Deficit/Hyperactivity disorder. 40% of participants were found to adhere regularly to their medication regimen. After adjusting by multiple logistic regression, young children who do not yet have academic performance results had 21 times on medication adherence (AOR 21.069, 95%CI 1.566–283.364) compared to children with academic performance results of 3.51-4.00. Patients with secondary school level had 1021 times on medication adherence (AOR 1021.379, 95%CI 17.534–59496.0) compared to the group without education. Having psychiatric comorbidities had 3 times on medication adherence (AOR 3.983, 95%CI 1.164–13.629) compared to the group without psychiatric comorbidities. The frequency of medication more than 3 times per day had 0.027 times on medication adherence (AOR 0.027, 95%CI 0.000 - 0.850) compared to frequency of medication 1 time per day.

Conclusion: Factors predicting medication adherence were academic performance, grade level, presence of psychiatric comorbidities, and medication frequency.

Incidence and factors associated with postoperative intensive care unit admission in Thungsong Hospital, Nakhon Si Thammarat Province

Pattiya Suttidate — 2025-10-16

Background: High-risk surgical patients were recommended to admitted to the intensive care unit (ICU) in order to reduce postoperative complications and mortality. However, ICU resources are limited. Identifying factors thus is crucial to operate the ICU admissions efficiently.

Objectives: To identify the incidence and factors associated with the postoperative ICU admissions.

Methods: A retrospective, case-control study was conducted in patients who underwent the surgeries in Thungsong hospital between October 1^st, 2018 to September 30^th, 2023. The associations between the surgical patients with the potential factors were analyzed using univariate and multiple logistic regressions.

Results: 695 out of 30,671 patients (2.3%) underwent the postoperative ICU admissions. The results showed that ASA class III, coronary artery disease, heart failure, general anesthesia, operative time ≥ 180 minute, blood loss 750-1,500 ml, blood loss > 1,500 ml, hypotension, hypoxemia, bronchospasm, difficult intubation and MEWS after surgery ≥ 4 significantly contributed to the postoperative ICU admissions. Also, the inotrope or vasopressor infusion, MEWS at ICU 6-7 and MEWS at ICU ≥ 8 were significant factors associated with the ICU mortality.

Conclusion: The findings highlighted the important factors related to the postoperative ICU admissions. The patients with these factors require the attentive care from health professions to reduce the risk of morbidity and mortality.

The Effectiveness and Safety of Aspirin Desensitization in Patients Undergoing Percutaneous Coronary Intervention with Stent Implantation at Surat Thani Hospital.

Taweechai Leeyutthanont — 2025-12-25

Background: Patients with a history of Aspirin or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) allergies who require Aspirin use during percutaneous coronary intervention (PCI) with stent implantation may benefit from the process of Aspirin desensitization. This process is designed to reduce immune reactions and enable patients to safely resume Aspirin use, following the acute coronary syndrome treatment protocol.

Objective: To study the effectiveness and safety of aspirin desensitization in patients undergoing percutaneous coronary intervention with stent implantation at Surat Thani Hospital.

Methods: This descriptive study involved a retrospective analysis of patients with a history of Aspirin or NSAIDs allergies who underwent balloon angioplasty and stent implantation at Surat Thani Hospital between November 16^th, 2022, and May 31^st, 2024. Descriptive statistics, including frequency and percentage, were used for data analysis.

Results: The 10 patients with a history of allergy to Aspirin or NSAIDs drugs underwent an Aspirin desensitization process. Nine of them (90%) were successful, while one (10%) was not. In the unsuccessful case, the patient developed mild angioedema.

Conclusion: The Aspirin desensitization process demonstrated effectiveness in patients with a history of Aspirin or NSAIDs allergies and were safe, with no adverse drug reactions occurring after the procedure.

The predictive factors of precancerous lesions and colorectal cancer in Wiengsa Crown Prince Hospital, Surat Thani

Thep Jusuwan — 2025-10-16

Background Colorectal cancer (CRC) is one of the leading causes of global cancer-related mortality. Most CRC cases arise from precancerous lesions, such as adenomatous and sessile serrated polyps, which can be detected and removed through colonoscopy. However, the epidemiological profile and risk factors for CRC and precancerous lesions in Thailand, especially in secondary care settings, remain underexplored.

Objective This study identified the demographic and clinical predictors of colorectal neoplasia, including precancerous lesions and CRC, among patients undergoing colonoscopy at Wiengsa Crown Prince Hospital in Surat Thani, Thailand.

Materials and methods A retrospective analysis was conducted on 481 individuals who underwent colonoscopy from June 2023 to December 2024. Data collected included demographic characteristics, comorbidities, smoking history, and colonoscopy findings. Multivariable logistic regression was used to identify independent predictors of neoplastic polyps and CRC.

Results Among the 481 individuals who underwent colonoscopy, 453 patients were included in the final analysis, with 28 patients excluded due to incomplete data. Among these, 25.6% had precancerous colorectal lesions, and 3.31% were diagnosed with colorectal cancer (CRC). Multivariable logistic regression identified male gender (adjusted odds ratio [aOR] 2.08, 95% CI: 1.25–3.45, P=0.005), smoking (aOR = 3.66, 95% CI: 1.76–7.59, P<0.001), hyperlipidemia (aOR = 1.73, 95% CI: 1.01–2.97, P=0.047), and increasing age (aOR per year = 1.03, 95% CI: 1.01–1.06, P=0.004) as independent predictors of precancerous lesions. For CRC, independent predictors included smoking (aOR = 11.2, 95% CI: 2.49–50.27, P=0.002), hematochezia or change in bowel habits (aOR = 17.66, 95% CI: 4.76–65.53, P<0.001), and American Society of Anesthesiologists (ASA) Physical Status Classification Class 3 (aOR = 7.71, 95% CI: 1.52–39.14, P=0.014).

Conclusions Precancerous colorectal lesions and colorectal cancer were significantly associated with modifiable and demographic risk factors. Male gender, smoking, hyperlipidemia, and advancing age were identified as independent predictors of precancerous lesions, while smoking, lower bowel symptoms, and higher ASA classification were strongly associated with colorectal cancer. These findings support the implementation of risk-based screening strategies, particularly in resource-limited settings, and underscore the clinical value of symptom-driven colonoscopy in early CRC detection.

Overall survival and association factors of malignant superior vena cava syndrome in Suratthani Hospital

Piyaporn Srikaew — 2025-12-08

Background: Superior vena cava (SVC) syndrome is an oncologic emergency associated with high mortality. Treatment outcomes depend on multiple clinical and therapeutic factors.

Objective: To study survival rates and associated prognostic factors in cancer patients with malignant SVC syndrome.

Methods: This retrospective study included cancer patients diagnosed with malignant SVC syndrome confirmed by histopathology at Surat Thani Hospital between 2017 and 2024. Survival analysis was performed using the Kaplan–Meier method. Differences between groups were assessed with the log-rank test, and multivariable prognostic factors were analyzed using the Cox proportional hazards regression model.

Result: A total of 215 patients were included, with a mean age of 52 years (SD 16.3); 76.7% were male. Lung cancer was the most common cause (65%), followed by lymphoma (16.3%). Chemotherapy and radiotherapy were administered in 62.7% and 44.2% of cases, respectively. The overall survival rates at 1, 2, and 5 years were 33.75% (95%CI 27.2–40.41), 22.21% (95%CI 16.4–28.6), and 14.48% (95%CI 8.85–21.45), respectively. The median overall survival was 6.4 months (IQR 3.8–7.36). Multivariable analysis identified Eastern Cooperative Oncology Group (ECOG) performance status 4 as an adverse prognostic factor (adjusted hazard ratio [aHR] 3.63; 95% CI 1.73–7.64; p=0.001), while receipt of chemotherapy was associated with improved survival (aHR 0.45; 95% CI 0.30–0.67; p<0.001).

Conclusion: Association factors for survival in malignant SVC syndrome were ECOG performance status 4, which was associated with poorer outcomes, and receipt of chemotherapy, which was associated with better survival.

Factors Associated with Late Antenatal Care after gestational age 12 Weeks at Thalang Hospital, Phuket Province.

Parinya Saringkanan — 2025-12-08

Background: Antenatal care (ANC) is a crucial component of maternal healthcare services, enabling pregnant women to receive regular health check-ups to prevent, detect, and treat complications that may arise during pregnancy. It was found that pregnant women who came for antenatal care at Thalang Hospital received antenatal care late after 12 weeks, which was higher than the standard and affected the health of the mother and the baby.

Objectives: To study the factors associated with delayed antenatal care after gestational age 12 weeks of pregnancy among pregnant women who first attended antenatal care at Thalang Hospital, Phuket Province.

Method: The study employed a descriptive research design. The sample consisted of 182 pregnant women who came for their first antenatal visit after 12 weeks of pregnancy at Thalang Hospital. The research instruments consisted of a questionnaire on personal characteristics and health perception, with a Cronbach’s alpha reliability of 0.87. Data were analyzed using descriptive statistics and correlation analysis using the Chi-square Test.

Results: The results showed that factors related to delayed antenatal care included personal characteristics, such as marital status, education level, occupation, income, number of pregnancies, number of children, and use of contraception. Health perception related to delayed antenatal care included perception of pregnancy risks and perception of the benefits of antenatal care, perceived barriers to antenatal care, pregnancy intention, acceptance of pregnancy by spouses, and acceptance of pregnancy by the community.

Conclusion: To achieve the goal of antenatal care, there should be two parts of action: in the hospital and in the community, to raise awareness among pregnant women of the importance of early antenatal care.

Development of Anaphylaxis Surveillance System for Iodinated Contrast Media at Suratthani Hospital

Sahusa Ruangsri — 2025-12-08

This article focuses on a significant public health issue—the occurrence of allergic reactions to contrast media used in radiological examinations, which has shown an increasing trend alongside rapid advancements in medical technology. The objective is to develop an appropriate initial management system for patients experiencing severe allergic reactions to contrast media and to reduce subsequent complications. A multidisciplinary working group was established, consisting of physicians, pharmacists, nurses, and other related personnel, to monitor allergic reactions in two stages: before and after contrast administration. The results showed improved patient safety, with reductions in the incidence of renal failure and extravasation of contrast media. In conclusion, the use of nonionic iodinated contrast media (nonionic ICM) has significantly decreased the mortality rate from allergic reactions to only 0.1 per 100,000 patients. Therefore, the Radiology Department of Surat Thani Hospital has developed a comprehensive monitoring system for severe contrast media allergy to enhance efficiency and patient safety in clinical practice.