Vajira Medical Journal : Journal of Urban Medicine

Ultrasound Percutaneous Tenotomy: An Intervention for Managing Lateral Epicondylitis: A Narrative Review

Tue, 13 Feb 2024 00:00:00 +0700

A growing emphasis is being focused on percutaneous ultrasonic tenotomy for expedited recovery from lateral epicondylitis (LE) and enhanced functionality. The TX1 tissue removal system, also known as the Tenex device from Tenex device (Tenex Health Inc., Lake Forest, CA, USA), notably excels in the management of chronic LE. Utilizing ultrasonic energy, this device offers three tips, namely, TX1, TX2, and TXBone-introducing novel avenues, for determining the previously inaccessible tendon pathology. The procedure disrupts degenerated segments, which creates fenestrations that induce local hemorrhage and the release of vasoactive substances. The overarching goal of Tenex is to boost vascularity through the initiation of tendon repair via the deposition of new collagen and elimination of necrotic tissues. This review assesses Tenex’s effectiveness though gathering information, aiming to understand how it helps doctors and other healthcare professionals in their work.

Outcomes Comparison in the Management of Displaced Femoral Neck Fractures among Elderly Patients: Total Hip Arthroplasty versus Bipolar Hemiarthroplasty

Somchai Taosuwan, Varah Yuenyongviwat — Tue, 13 Feb 2024 00:00:00 +0700

Treating femoral neck fractures in the elderly demands careful strategies for optimal results. This review explores into the roles of total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in addressing these fractures, considering their distinct advantages. THA, catering to active elderly patients, delivers excellent pain relief, enhanced mobility, and sustained functionality. In contrast, BHA presents a more conservative option suitable for less mobile patients. Factors like surgery time and dislocation risks play a crucial role in selecting between the two options, while postoperative complications, including infections and joint issues, significantly impact recovery. Adequate post-surgical care and advancements in techniques are pivotal for overcoming these challenges. Continuous research and enhancements in diagnostic methods and post-surgical care are critical for refining strategies, ultimately improving the recovery and quality of life for elderly patients.

The Effects of Two Interventions between Elastic Therapeutic Taping with Exercise and Sham Taping with Exercise on Pain Intensity, Knee Disability Reduction, Leg Strength, and Functional Ability Improvement for Gonarthrosis Patients at the Moderate Level

Thitiman Ngamchareonrujee — Mon, 12 Feb 2024 00:00:00 +0700

OBJECTIVE: To investigate the effects of elastic therapeutic taping with exercise on the pain, disability, muscle strength, and functionality of knee in patients with moderate knee osteoarthritis (OA) compared with the sham taping technique with exercise.
METHODS: Eighty patients with moderate knee OA (Kellgren-Lawrence grade II-III) were randomized and separated into 2 groups, including an elastic therapeutic taping group and a sham taping group. Both groups received the same homework exercise. The assessments were performed at baseline, and 2 weeks and 12 weeks after the elastic therapeutic taping application. Pain level, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale, muscle strength, Time Up and Go and Sit-to-Stand were used for the evaluation.
RESULTS: Patients that received elastic therapeutic taping and the sham taping technique with exercise demonstrated improvement in pain level, the WOMAC scale, muscle strength, Time Up and Go and Sit-to-Stand after 12 weeks of the applications, but the results showed a statistically significant difference in the outcome measurement of pain level, the WOMAC scale, and Time Up and Go between the 2 groups (p < 0.01, p = 0.03 and p = 0.03 respectively).
CONCLUSION: Elastic therapeutic taping with exercise can be an effective intervention for pain relief, reduced knee disability, and Time Up and Go in patients with moderate knee OA when compared with the sham taping technique with the exercise group.

Appropriate Use of Anticoagulants among Nonvalvular Atrial Fibrillation Patients at a University Hospital in Thailand

Phanthaphan Sureeyathanaphat, Padoemwut Teerawongsakul, Teetouch Ananwattanasuk — Fri, 01 Mar 2024 00:00:00 +0700

OBJECTIVE: Warfarin is primarily used for stroke prevention in atrial fibrillation (AF) patients in Thailand. Novel oral anticoagulants (NOACs) are used less commonly due to their high cost. This study aimed to evaluate the appropriate use of anticoagulants and clinical outcomes among nonvalvular AF (NVAF) patients.
METHODS: This retrospective study collected data from the electronic medical records of patients who were diagnosed with NVAF between January 2014 and December 2019 at the Faculty of Medicine, Vajira Hospital. Baseline characteristics, prescribed indication, types and doses of anticoagulant, and ischemic and hemorrhagic outcomes were recorded and analyzed.
RESULTS: We analyzed 783 patients with NVAF in this study. Of these, 539 (68.90%) were treated with oral anticoagulants (OAC), including 344 patients (43.90%) with warfarin therapy and 195 (24.90%) with NOACs. Meanwhile, 492 (73.10%) patients with CHA2DS2VASC score ≥ 2 received OAC therapy that was suitable for their indication. Of the 344 patients who received warfarin, 112 patients (32.60%) had an optimal time in therapeutic range (TTR) level of ≥ 65%. Of the 195 NOAC patients, only 98 (50.30%) received appropriate doses of NOACs. There was no statistically significant difference in the overall incidence rates of ischemic stroke/systemic embolism, bleeding, cardiovascular death, and all-cause death between the warfarin and NOACS groups. Appropriate TTR levels in the warfarin group was associated with significantly lower incidence rates of cardiovascular death (hazard ratio: 0.14; 95% CI: 0.02–0.79; p = 0.02) and all-cause death (hazard ratio: 0.36; 95% CI: 0.12–0.87; p = 0.01), than inappropriate TTR levels.
CONCLUSION: Most NVAF patients received oral anticoagulants with the appropriate indication. Warfarin is the most prescribed oral anticoagulant for patients with NVAF. About half of the patients received inappropriate doses of oral anticoagulants that potentially adversely affected the study outcomes of cardiovascular and all-cause deaths.

Non-neoplastic Kidney Diseases in Adult Tumor Nephrectomy and Nephroureterectomy Specimens in a Southeast Asian Tertiary Medical Center

Nontawat Benjakul, Kammi J Henriksen, Anthony Chang — Fri, 01 Mar 2024 00:00:00 +0700

OBJECTIVE: Non-neoplastic kidney diseases are concurrently present in up to 15% of patients with renal and ureteral tumors, which have been most studied in the United States. This study was conducted to determine the prevalence and spectrum of renal parenchymal diseases in similar patients from a Southeast Asian academic institution.
METHODS: We searched the database of the Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University (2012–2022) and found 194 adult nephrectomy and nephroureterectomy specimens with renal, renal pelvis, and ureteral tumors. Additional stains included periodic acid-Schiff, methenamine silver, and Masson trichrome. Direct immunofluorescence microscopy was performed on the paraffin tissue sections for immunoglobulin (Ig) G, IgA, IgM, and kappa and lambda light chains. Clinical information, including age, gender, and co-morbidities, was obtained from the electronic medical records.
RESULTS: Analysis of the 194 cases demonstrated the average age was 61 years (range: 17-89 years), with 126 males (65%) and 68 females (35%). After re-examination of the non-neoplastic renal parenchyma, 14 cases (7%) had diffused and/or nodular mesangial sclerosis. Diabetic nephropathy (12 cases) and idiopathic nodular glomerulosclerosis (2 cases) were diagnosed and associated with either stage 1 or 2 genitourinary cancers. Another case was diagnosed with atheroembolic renal disease. In all cases, the concurrent renal diseases were not identified during the initial evaluation.
CONCLUSION: Examination of the non-neoplastic renal parenchyma is important to identify non-neoplastic kidney diseases, such as diabetic nephropathy, so early treatment may result in improved clinical outcomes for kidney and urothelial cancer patients.

The Effect of a High Monosodium Glutamate Diet in Inducing Changes in Microbiota Diversity and Kidney Pathology in Hamsters Infected with Opisthorchis viverrini

Mon, 25 Mar 2024 00:00:00 +0700

OBJECTIVE: To investigate the effect of a combination of a high dose of monosodium glutamate (MSG) and chronic Opisthorchis viverrini (O. viverrini) infection on kidney pathology and microbiota changes compared to either factor alone.
METHODS: Forty male golden hamsters were divided into four groups (10 hamsters per group): non-infected hamsters fed with standard diet (NC), O. viverrini infected hamsters fed with standard diet (OV), non-infected hamsters fed with high doses of MSG in drinking water (MS), and O. viverrini infected hamsters fed with high doses of MSG in drinking water (OM). After 8 months, fecal samples were collected, DNA extracted and subjected to 16S-rRNA sequencing analysis to determine microbial diversity. Kidneys were also collected for histopathological study.
RESULTS: Kidney histopathology showed tubular damages and tubular fibrosis were significantly prominent in the OM group, which showed higher pathology changes than in the OV group or MS groups. Next generation sequencing indicated that the levels of Firmicutes to Bacteroides ratio decreased in the OV group (0.28), MS group (0.43) and OM group (0.43) respectively when compared to control group (0.52). In genus levels, Methanobrevibacter, Ruminococcus_1, Escherichia Shigella, Bacteroides, Akkermansia and Oligella were abundance in the OM group.
CONCLUSION: The changing of gut microbiota distribution and kidney pathology changes were more severe in the cases of O. viverrini infection together with MSG consumption. This study provides a first step towards focusing on diet and parasitic infections.