Vajira Medical Journal : Journal of Urban Medicine

Unusual Pattern of Spread of High-Grade Serous Fallopian Tubal Carcinoma in a Woman with BRCA1 Gene Mutation

2024-08-07T11:45:31+07:00

A 40-year-old woman presented with chronic watery vaginal discharge for one-month and right pelvic pain radiating to the right flank for 2 weeks. Physical and pelvic examination revealed a right pelvic mass. Computerized tomography and magnetic resonance of whole abdomen revealed a 6-cm of heterogeneous mass at the right adnexa and a larger mass of 8-cm with internal cystic portions compressing on the inferior vena cava. Her serum cancer antigen (CA) 125 elevated to 540 U/ml. Surgical intervention revealed a right fallopian tube mass with an intact serosal surface, several enlarged pelvic and para-aortic nodes, and a bulky precaval node. No gross peritoneal nor other organ invasion was found. Complete surgical staging was performed by gynecologic oncologists and a surgeon, resulting in optimal surgery. Pathology revealed high-grade serous carcinoma of the right fallopian tube with metastasis to all resected nodes and a positive peritoneal cytology. Subsequent blood testing showed BReast CAncer (BRCA) 1 gene mutation. Adjuvant therapy with paclitaxel/carboplatin/bevacizumab was given for six cycles. Maintenance therapy with bevacizumab/olaparib, and periodic surveillance for other cancers, including breast magnetic resonance imaging were planned. This case presented an unusual pattern fallopian tubal cancer spread to a large precaval lymph node which was bulkier than the primary tumor. A thorough pre-operative evaluation and a surgical team specialized in cancer surgery are crucial for successful surgical management. Appropriate adjuvant treatment and follow-up for a woman with BRCA mutation were also to be emphasized.

Application of AI in Urban Medicine

2024-06-12T13:44:31+07:00

Globally, the application of artificial intelligence (AI) in urban medicine is changing the way healthcare is delivered in cities. AI is transforming how urban healthcare providers provide patient care, from early disease detection to personalised treatment plans. This review paper examines the various applications of AI in urban medicine, such as telemedicine, diagnostics, predictive analytics, patient monitoring, and drug development. The authors also discuss how AI influences healthcare efficiency, quality, and accessibility in cities.

The Urban Health Themes and Urban Factors Associated with Health: A Brief Review

2024-09-11T15:13:20+07:00

The current situation is of a population shift from rural to urban areas and is the acceleration of urban growth. In this perspective, comprehending how urbanization has affected human health is critical. Hence, the aim of a synthesized review is the current understanding of urban health themes and urban factors associated with health. The most common topics of concern that emerge from the urban health literature can be summarized in three principal themes: social environment, physical environment, and provision of health and social services. Additionally, the results from our review aim to serve as a springboard for a thorough investigation of urban factors associated with health and their causes to improve predictions of the global health burden, influence health system planning and policy, and direct urban design.

Correlation between Serum Vitamin D Levels and Allergic Rhinitis Severity at Vajira Hospital: A Cross-Sectional Study

2024-09-02T14:12:02+07:00

OBJECTIVE: Vitamin D affects the immune system and inflammatory process, and its deficiency is significantly associated with an increased prevalence of allergic rhinitis (AR). Therefore, the correlation between the serum 25-hydroxyvitamin D levels and the severity of AR symptoms must be investigated.
METHODS: This research utilized a cross-sectional approach, focusing on patients aged 18 years and above diagnosed with AR at the Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from August 15, 2023, to January 15, 2024. The relationship between AR severity and serum vitamin D levels was analyzed using Pearson correlation coefficient. AR severity on symptoms and quality of life was assessed using the Thai version of Sinonasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life questionnaire-36 (RCQ-36) questionnaires. Serum-specific immunoglobulin E (IgE) and total IgE levels were also measured to examine their relationship with the serum vitamin D level.
RESULTS: Among the 58 participants, 34 (58.60%) had vitamin D deficiency. These individuals with vitamin D deficiency exhibited significantly higher AR severity compared with those without vitamin D deficiency. The mean difference between these groups was 21.90 points for SNOT-22 scores (95%CI: 17.71–26.69, p-value < 0.001) and 19.17 points for RCQ-36 scores (95%CI: 12.08–27.34, p-value < 0.001). Further analysis revealed a significant inverse correlation between serum vitamin D level and AR severity, with Pearson correlation coefficients of −0.72 for RCQ-36 (95%CI: −0.82 to −0.56, p-value < 0.001) and 0.80 for SNOT-22 (95%CI: −0.88 to −0.68, p-value < 0.001). No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.
CONCLUSION: A significant inverse relationship existed between serum vitamin D levels and AR severity. No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.

Prevalence of 2-Year Breastfeeding among Thai Mothers and Associated Factors of Achievement

2024-08-08T09:57:33+07:00

OBJECTIVE: To assess 2-year breastfeeding (BF) rate and factors for the achievement of 2-year BF.
METHODS: This cross-sectional study was conducted between June 27 and December 11, 2023 by an electronic online questionnaire. Thai mothers with babies aged more than 2 years who registered on Facebook page of one author and could recall their infant’s 2-year feeding pattern were included in the study. Participating mothers completed a questionnaire covering personal data, history of BF pattern of previous and current child, and knowledge and attitude toward BF. The rate of 2-year BF and factors for the achievement were analyzed by univariate and multivariate analyses.
RESULTS: The included mothers had a mean age of 36.2 ± 4.7 years, and 94.1% reported BF for at least 2 years. Among favorable features, only four exhibited a significant association with 2-year BF according to the univariate analysis: age > 36 years (odds ratio (OR) 3.07, 95% confidence interval (CI) 1.90-4.95, p-value < 0.001), being self-employed or working from home (OR: 2.60, 95% CI 1.64-4.10, p-value < 0.001), used contraception within 2 years postpartum (OR: 2.07, 95% CI 1.08-3.97, p-value = 0.025), and good history of 2-year BF in their previous child (OR: 4.71, 95% CI 1.96-11.28, p-value < 0.001). Multivariate analysis revealed that only the mothers with a history of 2-year BF in their previous child was the only independent feature associated with their current 2-year BF (adjusted OR: 5.25, 95% CI 1.61-17.07, p-value = 0.006).
CONCLUSION: The results of this study revealed a high rate of 2-year BF among the studied mothers. The only independent factor for a 2-year BF was a mother’s history of 2-year BF with their previous child.

The Prevalence of Postpartum Contraception Use among Teenage Mothers at Vajira Hospital, Thailand

2024-08-02T15:47:05+07:00

OBJECTIVES: To determine the prevalence of postpartum contraception use among teenage mothers and to identify the factors influencing both postpartum contraception use and loss to postpartum follow-up at the Faculty of Medicine Vajira Hospital in Thailand.
METHODS: Four hundred and seventy-five participants were randomly selected from 1,060 Thai teenage pregnant that gave birth at the Faculty of Medicine Vajira Hospital between 1 January 2017 and 31 December 2020 and were scheduled postpartum visits. The clinical factors associated with postpartum contraception use and loss to postpartum follow-up were studied using multiple logistic regression analysis.
RESULTS: A total of 451 participants remained after excluding criteria. Of these, 212 participants did not follow-up on their postpartum visits, leaving the limitation to summarize the true prevalence of postpartum contraception use of the total population. However, of the 232 participants who visited postpartum follow-ups, the prevalence of contraceptive use was 95.8%. Married status was the only factor associated with higher postpartum contraceptive use (odds ratio (OR) 12.81 [3.38-48.64]). Age 18 years and older (OR_adj1.71 [1.16-2.53]), absence of previous contraceptive use (OR_adj1.91 [1.29-2.80]), and total antenatal care visits fewer than 8 (OR_adj 1.61 [1.07-2.42]) were significantly related with loss to postpartum follow-ups.
CONCLUSION: The prevalence of contraceptive use was high among teenage mothers who had follow-up postpartum visits. However, this population also had a high loss rate of postpartum visits. Interventions and close monitoring should be considered to evaluated further for effective adolescent reproductive services.

Reviewer Acknowledgement, 2024

2024-10-04T09:06:32+07:00

In order to maintain the high standards of the Vajira Medical Journal: Journal of Urban Medicine, our editorial team relies on the expertise of numerous professionals. They play a pivotal role in determining the topics to explore, deciding which manuscripts to publish, and making necessary adjustments to ensure the scientific integrity and reliability of the information provided. This fosters the growth and advancement of medical and health science research. I deeply appreciative of the dedication and proficiency exhibited by the individuals who reviewed manuscripts for the journal from September 1st, 2023, through August 31st, 2024.