Vajira Medical Journal : Journal of Urban Medicine

A Review of the Beneficial Effects of Hesperidin on Urban Diseases

Chutamas Wunpathe — 2025-04-29

The urban environment is increasingly recognized as a key determinant of health, influencing lifestyles that can either promote or hinder well-being. This review aims to summarize recent studies (2020-2024) on the potential therapeutic effects of hesperidin, a flavonoid derived from citrus fruits, in addressing urban-related diseases worsened by pollution, sedentary habits, poor nutrition, and chronic stress. These health conditions include cardiovascular diseases respiratory issues, metabolic disorders, neurodegenerative diseases, mental health challenges, infectious diseases, and cancer. Hesperidin’s anti-inflammatory, antioxidant, and immunomodulatory properties have shown promise in improving cardiovascular health, reducing oxidative stress, enhancing insulin sensitivity, protecting against neurodegeneration, alleviating mental health symptoms, reducing respiratory inflammation, and inhibiting cancer cell growth. While preclinical studies show encouraging results, clinical evidence remains limited, underscoring the need for further research to validate its safety, efficacy, and optimal dosage for urban health interventions.

A Comparative Analysis of Interest in Advanced Care Planning and Organ Donation Following Exposure to Video or Pamphlet Media

Pavida Piyamahunt — 2025-01-28

OBJECTIVE: To compare the increase in interest in engaging in advance care planning between two groups: those receiving information via video media and those receiving information via pamphlets.
METHODS: A randomized controlled trial was conducted with 100 participants aged 18 to 60 years, who understood Thai and had no diagnosed psychiatric disorders or neurological conditions affecting consciousness, nor were they considered legally incompetent. The participants visited the Family Medicine Clinic at Vajira Hospital in 2024. The participants were screened using inclusion and exclusion criteria. The sample was divided using simple random sampling into two groups: 50 participants receiving information through a video and 50 participants receiving information through a pamphlet. Participants were asked to complete a questionnaire regarding their interest in engaging in advance care planning and organ donation. The level of interest was assessed using a five-point Likert scale, where a score of 5 indicates “very interested” and a score of 1 indicates “not interested”. The content validity of the questionnaire was evaluated by three medical experts, demonstrating an index of item objective congruence of 0.85. Afterward, they either watched the video or read the pamphlet and then immediately completed the same questionnaire.
RESULTS: There were no significant differences in the basic characteristics of both groups. The average score of interest in creating an advance directive and organ donation significantly increased in the experimental group (by 1.4 and 0.82 points, respectively) compared with the control group (by 0.38 and 0.16 points, respectively) (p < 0.001).
CONCLUSION: Providing information through video media was more effective in increasing interest in advance care planning and organ donation compared with providing information through pamphlets.

Chief Complaints, Clinical Characteristics, and Outcomes of Emergency Department Visit among Pediatric Cancer Patients: A Single-Center Experience

Oranooj Lertkovit — 2025-01-29

OBJECTIVE: The aim of this study was to examine the chief complaints and clinical characteristics, outcomes, and associated factors of pediatric cancer patients who present at the emergency department (ED).
METHODS: A retrospective, single-center study was conducted on children less than 18 years old with active cancer treatment at the Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from January 2017 to September 2023. The chief complaints, and clinical characteristics of ED encounter were captured. The outcomes of the patients were categorized into those from admitted patients and those from the discharged group, before the potential risk factors were analyzed.
RESULTS: A total of 91 ED encounters were documented among fifty cancer patients, representing 0.2% of total pediatric ED visits. Sixty-three (69.2%) ED visits met the inclusion criteria. The most common cancer was acute lymphoblastic leukemia. The common ED chief complaints were fever, gastrointestinal complaints, and respiratory complaints. Our results show that most pediatric cancer patients presenting at the ED were hospitalized (84.1%). There were no deaths at ED, and no patient died within 48 hours of ED visits. Seventy-seven percent of patients sought care within one day of developing emergency conditions. Fever as a chief complaint (p = 0.016), and levels 1 and 2 of emergency severity index (ESI) were the risk factors associated with cancer ED visits resulting in hospitalization (odds ratio = 5.64; 95% confidence intervals 1.09-29.14).
CONCLUSION: ED visits were common among children with cancer. The most frequent chief complaints were fever, gastrointestinal complaints, and respiratory complaints. Approximately 80% of ED visits resulted in hospitalization. Having fever as the chief compliant, especially in patients with high body temperature, and levels 1 and 2 of ESI, were associated with an increased likelihood of admission. This study provides valuable baseline information to enhanced the quality of emergency care for pediatric cancer patients.

Musculoskeletal Disorders among Medical School Staff in an Urban Tertiary Care Academic Hospital in Thailand

Titaporn Luangwilai Luangwilai — 2025-02-03

OBJECTIVE: This study aimed to assess the prevalence of musculoskeletal disorders (MSDs) and explore related factors among medical school workers.
METHODS: A cross-sectional study was conducted among workers at a medical school in Bangkok, Thailand (n = 152). Data were collected via online questionnaires, which gathered general information, sleep quality, working conditions, ergonomics, psychological factors, and the presence of MSDs. Sleep quality was measured using the Thai version of the Pittsburgh Sleep Quality Index. The prevalence of MSDs and psychological factors were measured using the standardized Nordic questionnaire for 12 body parts and the Depression Anxiety and Stress Scale, respectively. The Chi-square test was utilized to evaluate the association between related factors and MSDs. Additionally, binary logistic regression was performed to examine the relationship among sleep quality, ergonomics, psychological factors, and specific body pain.
RESULTS: Out of 152 workers, a significant majority (95.5% in females and 75.0% in males) reported experiencing MSDs in one or more body regions. The highest prevalence of MSDs was observed in the shoulder, with 74.3% reporting discomfort in the past seven days and 69.1% in the past 12 months. Nearly all participants reporting MSDs also experienced depression (97.0%) and anxiety (97.4%). Ergonomics (e.g., twisted postures and repetitive movements) and psychological factors (e.g., depression and anxiety) were significantly associated with the occurrence of MSDs. Repetitive movements (odds ratio (OR) = 2.50; 95% confidence interval (CI) = 1.19-5.25), depression (OR = 3.39; 95% CI = 1.48-7.79), anxiety (OR = 4.22; 95% CI = 1.88-9.50), and stress (OR = 5.40; 95% CI = 1.97-14.81) were significantly linked to shoulder pain.
CONCLUSION: There is a high prevalence of MSDs among medical school workers, with several individual, work-related, ergonomic, burnout-related, and psychological factors being key contributing factors. The findings suggest that both physical and psychological health should be addressed to prevent MSDs in this population.

Survival and Related Prognostic Factors for Patients with Superior Vena Cava Syndrome in Palliative Settings

Aniwat Berpan — 2025-01-31

OBJECTIVE: The safety of upfront systemic treatment without radiation is questionable in patients with superior vena cava (SVC) syndrome. Whether steroids or loop diuretics can improve patients’ outcomes is unclear. This study aimed to evaluate the prognostic factors affecting overall survival (OS).
METHODS: Data of patients with SVC syndrome caused by neoplasm and treated with palliative intent were retrospectively collected. Cox proportional hazard regression was used to analyze the associations between variables and time until death.
RESULTS: A total of 104 patients were identified. The median follow-up time was 81 days. The mean age was 56.4 years (standard deviation (SD) 16.5 years). Among the patients, 22.1% received systemic therapy as an upfront treatment. Steroids and loop diuretics were administered in 50% and 34.6% of patients, respectively, and 7.7% were intubated. Multivariable analysis revealed intubation as an only significant independent factor for OS (hazard ratio 3.47; 95% confidence interval 1.2–10.05). Intubated and nonintubated patients had 1-year OS rates of 12.5% and 17.6%, respectively, and their median OS values were 6 and 86 days, respectively (p-value 0.02). For patients treated with radiotherapy and systemic treatment, 1-year OS rates were 17.1% and 17.4% (median survival of 86 and 71 days) (p-value 0.8). Symptomatic improvement was reported in 8 and 27 patients after receiving systemic therapy and radiation with mean duration of 9.4 (SD 5.4), and 8.2 (SD 4.7) days.
CONCLUSION: Intubation is a poor prognostic factor. No difference in OS was observed between the patients who received systemic treatment and radiotherapy as upfront therapy. Neither steroids nor loop diuretics showed any benefit in terms of survival.

Exploring Factors Associated with Intolerance of Helmet Noninvasive Ventilation in High-Risk Postextubation Patients

Napat Jirawat — 2025-02-25

OBJECTIVE: Studies on the use of helmet noninvasive ventilation (NIV) to prevent postextubation respiratory failure in high-risk patients are limited compared with other types of NIV. Only one randomized controlled trial (RCT) has reported that patients may have high helmet NIV intolerance. This study aimed to determine the prevalence of helmet NIV intolerance among high-risk postextubation patients and identify factors associated with this intolerance.
METHODS: This retrospective cohort study included patients at high risk of postextubation failure between June 2022 and June 2023. This study was based on an RCT that included 114 patients at high risk of postextubation failure. A subgroup analysis was performed on patients who received helmet NIV. The primary outcome was the prevalence of helmet NIV intolerance. The secondary outcome was factors associated with helmet NIV intolerance.
RESULTS: Of the 114 patients, 57 received helmet NIV. Of the 57 patients, 43 (75.4%) exhibited intolerance. A higher prevalence of cancer was observed among patients with helmet NIV intolerance, along with lower initial heart rates and higher partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratios. No significant differences in the etiology of respiratory failure or severity scores, including Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, were observed between the two groups. Additionally, the 48-h extubation success rate was comparable. Multivariate analysis revealed that a lower heart rate was a significant factor associated with helmet NIV intolerance.
CONCLUSION: During the postextubation period in high-risk patients, helmet NIV use was significantly associated with a high rate of intolerance. However, no differences in extubation success were observed. Lower initial heart rate was a significant factor associated with helmet NIV intolerance.