Region 11 Medical Journal

Surgery First approach: a case report

Pansak Sangsappan — 2024-12-25

This article is a case study revealed orthognathic surgery to reposition mandible and fix with miniplate and screws. Then patient was underwent to orthodontic treatment for proper occlusion. This treatment method can correct malocclusion and facial profile, diminish total treatment time and improve quality of life during treatment. A 24 years old, Thai male, came with with chief complaint that the lower teeth across the upper teeth. Orofacial examination reveals symmetry profile and malocclusion. Patient was treated with orthognathic surgery combined with orthodontic surgery. 6 months follow-up was found normal healing. Patient was satified with result.

Development of Community-based Traffic Accident Prevention System: An Integrated Area-based Approach Phuket Province

chuchart Nijwattana — 2024-12-29

Background: Road accidents pose a significant challenge in Phuket Province. To effectively address this systemic issue, active community engagement is crucial. The primary goal of this study is to establish a community-driven model that tackles the problem of road accident fatalities. This participatory approach incorporates the concepts of Safe Community and Safe System, guided by a comprehensive research and development cycle.

Objectives: Developing a Community-Based Traffic Accident Prevention System: An Integrated Area-Based Approach, Phuket Province

Method: Action research. The sample group comprised 46 community leaders working to address traffic accident issues in the target areas of three sub-districts. The tools used for study include surveys, questionnaires, and discussion form created by the researcher. Data was collected between February 2021 and February 2022. Model development activities included identifying community leaders to establish work teams in the area(6February,2021) creating a community information system (19March-May,2021) prioritizing problems, meeting with partners to set goals (June-July,2021), Solutions were developed by coordinating with relevant agencies to implement activities (August,2021) Budget integration was carried out and a team of academic mentors provided follow-up, evaluation, and support (August-December,2021). Data analysis was conducted using descriptive statistics.

Results: The primary common factor to accidents is driving behavior. The helmet usage rate was recorded at 28.9 percent, while 70.2 percent of passengers riding in the rear of pickup trucks. Additionally, 7.4 percent of drivers failed to use turn signals, and the same percentage exceeded the speed limit. An evaluation of the findings from three collaborative teams comprising interdisciplinary network partners within the community was conducted. Local government entities are actively addressing challenges related to improving traffic engineering and the promotion of safety helmet usage. As a part consequence of these efforts, there has been a notable reduction in the fatality rate by 20.8 percent.

Conclusion: The development of a community-based accident prevention system is a crucial initiative that requires the active participation of network partners. A dedicated team committed to effectively utilizing information, prioritizing problems, and providing feedback to administrators and the community is essential for its success. By leveraging the potential of the area and seeking guidance from a team of provincial mentors, the team can be empowered to effectively reduce the death rate from road accidents. Continuous monitoring of progress and regular feedback mechanisms will ensure the success of this model.

Effectiveness of Community-Based Psychiatric Treatment for SMI-V Patients: Buddy 4 Friends, the Patong Model

Chaiyasit Thepchatri — 2024-12-29

Background: Serious Mental Illness with a High Risk of Violence (SMI-V) is an urgent issue. The "Buddy 4 Friends Patong Model" was developed to provide integrated community mental health care, consisting of four types of "buddies": 1) Household buddy, 2) Public health doctor buddy, 3) Family doctor and Psychiatrist buddy, and 4) Community governance officer buddy.

Objective: To evaluate the effects of the model on the quality of life, medication adherence, aggressive behavior, and caregiver burden of SMI-V patients before and after discharge to the community at 1 and 3 months.

Methods: This retrospective cohort study reviewed medical records of SMI-V patients aged 18 and older discharged from Hat Yai Hospital to community care in Phatong Subdistrict, Songkhla, from February to April 2024. The outcomes included quality of life (WHOQOL-BREF-THAI), aggressive behavior (Overt Aggression Scale: OAS), medication adherence (Morisky Medication Adherence Scale 8-items: MMAS-8), and caregiver burden (Zarit Burden Interview: ZBI). Clinical results at 1 week, 1 month, and 3 months were compared using Repeated Measures ANOVA with a significance level of 0.05.

Results: The sample consisted of 71 participants, with a median age of 37 years (IQR: 30, 50), and 71.83% were male. Medication adherence increased significantly (p<.05), high level of medical adherence improving from 8.47 at week 1 to 26.42 and 32.08 at 1 and 3 months, respectively. Aggressive behavior improved significantly (p<.001), with no relapse observed. Quality of life showed no significant change (p>.05), while caregiver burden decreased significantly (p-value <.001).

Conclusions: The Buddy 4 Friends Patong Model improves medication adherence, reduces aggressive behavior, and alleviates caregiver burden. Policy support for the long-term expansion of the model should be prioritized.

Comparative Trabeculectomy Outcomes between Repeat Trabeculectomy and Initial Trabeculectomy with Mitomycin C and Prognostic Factors for Surgical Failure

Ekkarat Pothiruk — 2024-12-29

Background: Subconjunctival and episcleral fibrosis after glaucoma filtering surgery were the main causes of surgical failure. Therefore, repeated trabeculectomy was more likely to result in bleb failure.

Objective: To compare the efficacy between repeat and initial trabeculectomy, and study the prognostic factors for surgical failure.

Methods: A retrospective study of 123 glaucoma patients who underwent repeat or initial trabeculectomy with mitomycin-C between 1 July 2014 and 30 June 2022 and had a follow-up period of at least 12 months was reviewed. Main outcome measures included the rate of intraocular pressure reduction, number of glaucoma medications, surgical success, rate of bleb failure, and risk factors for failure. Statistical analysis included descriptive statistics, and multiple logistic regression analysis was used to identify risk factors for failure.

Result: Forty-five patients underwent repeat, and 78 patients underwent initial trabeculectomy. At 12 and 24 months postoperatively, the repeat group had higher intraocular pressure than the initial group (p = 0.0443 and 0.0369). At 12 months postoperatively, patients used medication, and the number of glaucoma medications in the repeat group was higher than in the initial group (p = 0.0450 and 0.0323). Complete success was higher in the initial group than in the repeat group, and bleb failure was more common in the repeat group, but the difference was not significant. Laser suture lysis and needling revision were risk factors for surgical failure, and the use of glaucoma eye drops after 3 months postoperatively was a protective factor for surgical failure.

Conclusions: Repeat trabeculectomy with mitomycin-C was effective in lowering intraocular pressure despite higher postoperative medication use, and the complication rate was not more than with the initial trabeculectomy.

Effects of Circuit Gait Training on Balance Performance in Patients with Chronic Stroke

Rungkarn Sittiritkawin — 2024-12-31

Background: Stroke survivors often experience impairments in walking, which limits their ability to perform daily activities and participate in society. Approximately 80% of stroke patients can recover their walking ability; however, 32-47% are unable to walk effectively in community settings and remain at risk of falling. Therefore, gait training is a crucial goal and a challenge for physical therapists in the rehabilitation process.

Objective: To investigate the effects of circuit gait training on balance performance and the risk of falling in patients with chronic stroke.

Methods: The study employed a quasi-experimental design. The sample included 26 chronic stroke patients (Duration of disease: 6 months or more) undergoing rehabilitation at Tha Sae Hospital in the fiscal year 2022-2023. Participants received circuit gait training across 10 continuous stations, with each station lasting 3-5 minutes. Rest periods of 1-2 minutes were allowed if participants felt tired. The total training time was 40-50 minutes per day, 3 times a week, for 6 weeks. Balance performance before and after training was assessed using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test to compare pre- and post-training BBS and TUG scores.

Results: The study found statistically significant differences in balance performance before and after circuit gait training (p < 0.05). The BBS scores improved from 34.61±11.04 before training to 46.34±9.34 after training. Similarly, TUG times improved from 28.91±16.40 seconds before training to 21.06±14.69 seconds after training.

Conclusions: Circuit gait training can improve balance performance and reduce the risk of falls in patients with chronic stroke.

Outcomes of Surgical Parathyroidectomy in Dialysis Patients with Renal Hyperparathyroidism at Suratthani Hospital

Apiradee Titawatanakul — 2024-12-29

Introduction: Chronic kidney disease results in abnormalities in mineral and hormonal balance. Hyperparathyroidism causes complications to the vascular system, bones and increase mortality. End stage kidney disease patients with renal hyperparathyroidism who do not respond to medication require parathyroidectomy if there are no contraindications. Suratthani Hospital has been performing parathyroid surgery on patients with this condition since 2010, but the data has never been analyzed before.

Objectives: To evaluate the outcomes of surgical parathyroidectomy in dialysis patients with renal hyperparathyroidism at Suratthani Hospital.

Method: This retrospective study includes patients with end-stage renal disease who were receiving dialysis, over 18 years old, had refractory renal hyperparathyroidism, and underwent parathyroidectomy at Suratthani Hospital between January 1, 2010, and December 31, 2023.

Results: A total of 216 patients underwent parathyroidectomy. 84 cases had subtotal parathyroidectomy, 73 had total parathyroidectomy with auto-transplantation, and 59 had total parathyroidectomy without auto-transplantation. Diffuse hyperplasia was found in 94.4%, while 6.9% had coexisting thyroid carcinoma. Postoperative hypocalcemia occurred in 37.7% of cases, and received intravenous calcium treatment. Preoperative alkaline phosphatase levels and corrected calcium levels were correlated with postoperative hypocalcemia. Follow-up of parathyroid hormone levels 6 months after parathyroidectomy in 195 patients revealed 48 cases of persistent hyperparathyroidism (24.6%) and 2 cases of recurrent hyperparathyroidism.

Conclusion: Surgical parathyroidectomy is an effective treatment for renal hyperparathyroidism in dialysis patients. Hypocalcemia is the main complication and requires careful evaluation and appropriate treatment.

Effectiveness of cumulative glycemic control in T2DM patients who walk for moderate intensity aerobics exercise by using smart watch at Po Wai Primary Care Unit, Surat Thani Province

Bunyapond Jeamtaweebun — 2024-12-27

Background : Current treatment guidelines for T2DM focus on educating patients and building self-care skills alongside medication. Researchers have chosen to incorporate smartwatch to increase physical activity, aiming to improve diabetes management outcomes.

Objective : This study investigated the outcomes and compared glycemic control in T2DM patients not using insulin, who engaged in moderate-intensity aerobic exercise with step counting using a smartwatch to achieve exercise goals, before and after a 12-week trial at the Po Wai Primary Care Unit, Surat Thani. The results can potentially be applied to community care.

Methods : This was a quasi-experimental study conducted from November 1, 2566, to March 30, 2567, involving 73 participants split into an experimental group of 24 and a control group of 49. Outcome measures included changes in HbA1c levels after completing the 12-week trial.

Result : There were no statistically significant differences (P > .05) between the experimental and control groups in terms of sex, age, BMI, waist circumference, and HbA1c levels. However, after completing the 12-week trial, within the experimental group, there were statistically significant decreases (P < .05) in mean HbA1c levels by 0.38 mg%, weight by 1.11 kg, and waist circumference by 1.05 cm. In contrast, the control group showed non-significant increases (P > .05) in these parameters. Comparing between groups, statistically significant differences (P < .01) were found in mean HbA1c levels, with the experimental group showing a lower average HbA1c level by 1.87 mg% (95% CI = -0.07 to 2.34, F = 55.79).

Conclusion : Moderate-intensity aerobic exercise using smartwatch to track steps significantly reduces HbA1c levels in T2DM patients not using insulin, compared to a control group instructed to maintain their usual lifestyle.