The Bangkok Medical Journal

Use of Endobronchial Ultrasound Guided Mediastinal Cryobiopsy in Addition to Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and Rapid on Site Evaluation for Evaluation of Enlarged Mediastinal Nodes ( Case series )

2024-09-20T09:58:26+07:00

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS- TBNA) with rapid on site evaluation (ROSE) has been used worldwide in the diagnosis of enlarged mediastinal nodes, with minimally invasive techniques, for many years. With recent advances in the genetic study of cancer, in order to determine the appropriate chemotherapy for cancer, more tissue samples need to be studied, and the amount of tissue obtained via EBUS-TBNA may not be adequate in patients with cancer, lymphoma and sarcoidosis. Recently it has been found that the technique of EBUS-guided mediastinal cryobiopsy (EBUS-MCB) may provide an adequate tissue amount for study with minimal invasiveness and performed safely. We reported 3 cases of enlarged mediastinal nodes, using EBUS-TBNA, and ROSE, and EBUS-MCB in an additional 2 cases. EBUS-MCB provided additional information in 1 case, and confirmation in 1 case. EBUS-MCB is a useful tool to supplement EBUS-TBNA and ROSE in the investigation of enlarged mediastinal nodes.

Relationships between Post-Concussion Symptoms and Functional Performance among Persons with Mild Traumatic Brain Injury in Wenzhou, China

2024-03-08T06:57:02+07:00

OBJECTIVES: The study in Wenzhou, China aimed to describe post-concussion symptoms (PCS) and functional performance (FP) among mild traumatic brain injury (mTBI) persons during two weeks after trauma and determine the relationships between physical symptoms, cognitive symptoms, and behavioral symptoms with FP.

MATERIALS AND METHODS: This study used a correlational cross-sectional design among 108 randomly selected persons with first-ever mTBI during their follow-up visits at the neurosurgery clinic of a university hospital in China. Data was collected utilizing a demographic questionnaire, and two self-report questionnaires during August to December 2021. Data analysis used descriptive statistics and Pearson correlation.

RESULTS: Participants experienced a mild level of physical symptoms (0.47 ± 0.51), cognitive symptoms (0.55 ± 0.84), and behavioral symptoms (0.55±0.90). They also had a mild impaired FP (0.55 ± 0.70). The results revealed that the physical symptoms, cognitive symptoms, and behavioral symptoms had positive correlations with FP (r = 0.68, r = 0.58, r = 0.76, p < 0.001, respectively).

CONCLUSION: These findings provide scientific evidence for healthcare providers especially nurses to identify mTBI persons with high-risk symptoms and make targeted PCS management in the early stage to promote FP. In conclusion, it supports the roles of nurses in evaluating each dimension of PCS and developing individualized nursing interventions.

Understanding Knowledge and Health Behaviors Regarding Noise Prevention Practices Among Workers in a Small Automotive Parts Manufacturer in Chonburi Province

2024-04-29T14:53:28+07:00

OBJECTIVES: This study aimed to investigate the interplay between workplace knowledge, health belief factors, and noise prevention practices among workers in a small automotive parts manufacturer located in Chonburi province.

MATERIALS AND METHODS: The study targeted employees of the aluminum melting department within the manufacturer, totaling 52 participants. Data collection utilized an online questionnaire.

RESULTS: The result showed that the majority of this sample group was male (78.85%), with an age range of 20–39 years (84.62%), predominantly single (59.62%), and held educational qualifications ranging from junior high school to vocational certificates (67.31%). A significant portion reported exposure to noise during work for 6–10 hours per day (48.08%), with experience in the aluminum melting department spanning between 1 and 5 years (80.77%). Overall, a high level of knowledge regarding workplace noise prevention (78.85%), positive health beliefs (76.92%), and adherence to noise prevention practices (90.38%) was observed. Overall health belief with the correlation with noise prevention practice was statistically significant at 0.01 (p < 0.001, r = 0.550).

CONCLUSION: Based on these results, it was suggested that employees must be educated on noise prevention and the correct use of proper noise prevention methods on the job, such as noise protection devices. In addition, promoting awareness and practices for mitigating noise-related hazards is essential for addressing this pertinent issue in the future.

Pulmonary Tuberculosis in Healthcare Workers at a University Hospital: A Significant Burden of Subclinical Disease

2024-06-07T11:34:04+07:00

OBJECTIVES: This research intends to determine the incidence of subclinical and active pulmonary tuberculosis (TB) among healthcare workers at a university hospital in Bangkok, Thailand.

MATERIALS AND METHODS: A retrospective cohort study included data from full-time employees aged 18 and over from January 1st, 2018, to December 31st, 2022. Data from the hospital’s employee database and extracted cases of subclinical and active pulmonary TB were collected to calculate their annual incidences. The study also compared jobs with different levels of patient exposure risk and sputum culture positivity rates between both groups.

RESULTS: During the five-year period, 65 cases of pulmonary TB were diagnosed. Of these, 45 (69.2%) were subclinical, and 20 (30.8%) were active pulmonary TB. The annual incidence of subclinical pulmonary TB per 100,000 persons was 98.12, 47.85, 46.93, 53.70, and 23.24 between 2018 and 2022, respectively. Meanwhile, the incidence of active pulmonary TB for the same period was 18.40, 29.90, 35.20, 23.87, and 11.62 per 100,000 persons, respectively. Compared to Thailand’s overall TB incidence of 155 per 100,000 persons in 2022, our lower incidence was likely due to early detection and treatment of TB among healthcare workers, raising concerns about the transmissibility of subclinical pulmonary TB. Notably, a significant proportion of healthcare workers with pulmonary TB were nurses (41.5%), and 22.2% of subclinical pulmonary TB cases were culture-positive.

CONCLUSION: The study revealed that subclinical pulmonary TB constitutes a considerable proportion of pulmonary TB among healthcare workers. It also highlights the contagious potential of subclinical pulmonary TB, contributing to the TB burden in both healthcare workers and society. Given the asymptomatic nature of subclinical pulmonary TB, which complicates detection through passive case finding, implementing active case finding using routine chest radiographs is essential for preventing TB transmission.

Factors Related to Transfer Anxiety in Family Members of Critically Ill Patients

2024-06-17T11:13:40+07:00

OBJECTIVES: To describe transfer anxiety and its relationship with information support and illness uncertainty among family members of critically ill patients who are transferring out from Intensive care unit (ICU).

MATERIALS AND METHODS: The sample was family members of critically ill patients who were admitted to the ICU of hospitals under Bangkok Dusit Medical Company. A simple random sampling was used to recruit 136 family members into the study. Research instruments consisted of the demographic data questionnaire, the transfer anxiety questionnaire. Data were analyzed by using descriptive statistics and Pearson’s Product Moment Correlation Coefficient.

RESULTS: The mean score of transfer anxiety from ICU among family members was moderate anxiety about moving out of ICU (65.24 ± 18.02). Information support had a significantly negative correlation with transfer anxiety at a moderate level (r = -0.348, p < 0.01). While illness uncertainty had a significantly high positive association with transfer anxiety (r = 0.617, p < 0.01).

CONCLUSION: Results of the study can apply to prepare family readiness before transferring patients from the ICU. Consistently providing information related to treatments and patients’ conditions can reduce illness uncertainty and transfer anxiety among family members of critically ill patients. Moreover, nurses had recognized the importance of reducing transfer anxiety of patient’s family members.

Rates of Acute Wheezing in Children During the COVID-19 Pandemic in Rayong Province, Thailand

2024-04-29T13:11:55+07:00

OBJECTIVES: This study investigates the rates of acute wheezing and identifies the associated risk factors among children under five during the COVID-19 pandemic in Rayong Province, Thailand.

MATERIALS AND METHODS: A retrospective study was performed on pediatric patients aged from one day to five years who were diagnosed with respiratory diseases (ICD-10 codes J00-J99) at Sri Rayong Hospital between 2019 and 2022. The study included 6,733 patients with a total of 25,830 visits. Data were retrieved from the hospital’s information system.

RESULTS: From the study the majority of patients were male (51.77%). The highest acute wheezing rate appeared post-COVID-19 pandemic (25.16%) and the lowest acute wheezing rate appeared during COVID-19 pandemic (17.57%). The numbers of acute wheezing in all three phases were relevant to respiratory syncytial virus (RSV) infection. Tripledemic was not found, but only two viruses, COVID-19 and RSV were detected. In addition, no association of acute wheezing with infections of influenza A/B and COVID-19 was found, possibly because these infections rarely caused acute wheezing in children under five years old. Multiple logistic regression presented significant risk factors associated with acute wheezing, namely RSV infection (adjusted Odds ratio; 95% confidence interval (4.29; 2.34-7.86), human metapneumovirus (hMPV) infection (3.40; 1.32 - 8.74) and eosinophilia (2.51; 1.33-4.76).

CONCLUSION: Acute wheezing was highest in the post-COVID-19 pandemic (25.16%) and lowest in the period that had implemented COVID-19 preventive measures (17.57%). The infections of RSV and hMPV as well as eosinophilia were the risk factors associated with acute wheezing. The dramatic increase in RSV outbreaks after the easing of lockdown and restriction measures might be due to the immunity debt or immunity gap. COVID-19 prevention measures could only temporarily reduce RSV infection along with acute wheezing symptoms. RSV can be prevented by active immunity (monoclonal antibodies and vaccine). Infection and acute wheezing should be better prevented by RSV vaccine.

Validity and Reliability of Thai version of International Consultation on Incontinence Questionnaire Nocturia Module (ICIQ-N) and International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol)

2024-07-11T10:58:21+07:00

OBJECTIVES: To evaluate the validity and reliability of the Thai version of ICIQ-N and ICIQ-Nqol.

MATERIALS AND METHODS: Descriptive study, the English version of the ICIQ-N and ICIQ-Nqol were translated to Thai, Back-translations, evaluated by Urologist experts and calculated IOC for validity assessment. Then 284 subjects in Vajira hospital were randomly selected for test-retest method, twice, two weeks apart for reliability evaluation.

RESULTS: Completed data were obtained from 249 subjects. Their mean age was 37.7 ± 12 years old and 88 % of subjects were female. Most subjects were hospital personnel accounting for approximately 92.8% that complete questionnaires. The overall validity from index of item-objective congruence (IOC) ranged from 0.67-1.0. The internal consistency was strong in ICIQ-Nqol with Cronbach alpha = 0.937 and 0.938, respectively and moderate in ICIQ-N with Cronbach alpha = 0.677 and 0.653, respectively. The test-retest reliability of ICIQ-N and ICIQ-Nqol with Pearson product-moment correlation showed Coefficient of Stability close to 1 in both (r = 0.81, r = 0.92, respectively, p < 0.001) (statistically significant with p < 0.001 level and ≥ 0.5 values).

CONCLUSION: ICIQ-N and ICIQ-Nqol have good content validity and convergent validity. There is a strong internal consistency in ICIQ-Nqol but moderate in ICIQ-N. And they have excellent test-retest reliability. Therefore, these questionnaires can be used to evaluate nocturia problems in Thailand patients.

High Prevalence of Silicosis and Progressive Massive Fibrosis Amid Sandstone Engravers in Lopburi Province, Thailand

2024-08-07T11:05:52+07:00

OBJECTIVES: This study aimed to explore the prevalence of silicosis and chest radiographic features among sandstone engravers in Lopburi province, Thailand.

MATERIALS AND METHODS: This retrospective descriptive study was conducted in February 2021 through individuals’ medical records and chest radiographs. The diagnosis of silicosis was based on criteria by the Thailand Social Security Office, where chest radiographs with a profusion of at least 1/0 were suggestive of silicosis. All chest radiographs were read by the NIOSHcertified B reader according to the 2011 ILO International Classification of Radiographs of Pneumoconioses (ILO/ICRP).

RESULTS: Among thirty-one workers residing in the same village, the prevalence of silicosis was 41.9%. Regarding those with silicosis, 92.3% had a profusion category of 2 or 3, and 30.8% exhibited progressive massive fibrosis. The participants’ mean age and mean working year were 51.9 and 19.6 years, respectively. 48.4% of them were male, and 41.4% were ever-smokers. There was no statistically significant difference between silicotic and non-silicotic groups regarding sex, age, years of working, and ever-smoking status.

CONCLUSION: This study raises concerns regarding the ongoing burden of silicosis. The high prevalence of silicosis reflects the underreporting of at-risk workers and the prevalence of silicosis in Thailand. The Thailand Occupational and Environmental Diseases Control Act, B.E. 2562 (A.D. 2019) marks a significant milestone in strengthening silicosis surveillance systems. Hopefully, further vigorous support from all functional levels will put the silicosis preventive strategy in place in the near future.

Drug Clustering in a Private Hospital of Chiang Mai Province with K-Means Clustering Technique

2024-08-26T08:26:04+07:00

OBJECTIVES: The study was to establish a methodology for clustering medicines into distinct groups, hence facilitating effective management within each category.

MATERIALS AND METHODS: This study employed the k-means clustering technique to examine the drug inventory data of a hospital. This research gathered data from a private hospital located in Chiang Mai province, Thailand. The dataset consisted of 1,501 unique items that were monitored over a period of 24 months. Each item was described by parameters such as importance, annual drug expenditure (ADE), variance, and mobility. The clinical importance of the medicine was determined by Vital, Essential, Desire Analysis (VED analysis), which involved input from healthcare professionals such as physicians, pharmacists, and inventory personnel. Subsequently, the chosen medication category was subjected to k-means clustering using the RapidMiner software, which also contributed to data preparation, transformations, and the identification of appropriate parameters for the clustering procedure.

RESULTS: The VED analysis shows the result of clinical importance grouping which are vital (213 items), essential (588 items), and desirable (700 items). Only the essential group is focused on and processed by k-means clustering analysis, due to higher complexity and contribution to various patient outcomes. The clustering analysis yielded six discrete clusters of drugs, each exhibiting distinct characteristics, and management strategies have been recommended for each cluster. Some clusters can be handled using simple methods or existing inventory management policy, while others need the use of statistical forecasting tools and/or machine learning techniques to precisely predict demand.

CONCLUSION: This study provides a baseline and framework for future studies and the management of drug inventory by using mathematical methods and models. The use of VED analysis also contributes significant data clarification in terms of clinical importance to the hospital. Integrating k-means clustering is one of the current machine learning technologies for inventory management, which is needed to improve the efficiency of patient care and to ensure more effective management of drugs. As a result, by introducing a new clustering technique, hospital staff members in charge of managing the drug inventory gain new insight and guidelines into inventory policy, which they can then apply as circumstances change and implement further.

Comparison of The Effectiveness of Different Prototypes of Wrist Support in Prevention of Radial Hematoma and Bleeding After Transradial Coronary Angiography among Patients Undergoing Percutaneous Coronary Interventions: A Retrospective Study

2024-09-05T12:31:23+07:00

OBJECTIVES: To compare the proportion of hematoma and bleeding occurrences between P1, P2, and P3 holding wrist supports as well as to evaluate the user satisfaction of P3 wearers among patients who underwent transradial access site procedures.

MATERIALS AND METHODS: This study is retrospective drawing on analytical data from Bangkok Hospital Chiang Mai medical records whose patients underwent percutaneous coronary interventions (PCI); 136 cases were gathered between June 1, 2019 – December 31, 2021. The division of the samples into three groups was based on the duration of use for each device namely prototypes as follows: Wrist Supported Prototype 1 (P1) group, Wrist Supported Prototype 2 (P2) group, and Wrist Supported Prototype 3 (P3) group. The baseline characteristics were presented as frequency (%) and Chi-square test or Fisher’s exact test was used to evaluate the difference in variables between the 3 groups. Chi-square test was used to compare the proportion of hematoma and bleeding. A p < 0.05 was considered statistically significant.

RESULTS: Patients undergoing PCI, 133 cases, who satisfied the criteria for eligibility were divided into 3 groups; 8 cases in P1 group, 80 cases in P2 group and 45 cases in P3 group. The findings on hematoma revealed 1 case (1.3%) among the P2 group and no hematoma among the P1 and P3 groups, respectively, 6 hours after the sheath was taken off. The number of cases of bleeding were discovered as follows: 2 cases (25.0%), 33 cases (41.2%) and 13 cases (28.9%) among P1, P2 and P3 groups, respectively, 6 hours after sheath was taken off. There were no significant differences on the proportion of bleeding among three groups (p = 0.307). The demographic data differences between the three groups were not statistically significant, except for dyslipidemia which was significantly different (p = 0.023). In this study, wrist support Prototype 3 users was 45 cases, and the overall patient satisfaction average score was 4.96 ± 0.23. The wrist support Prototype 3’s ease of use and patient satisfaction average scores were 5.00 at the highest possible level.

CONCLUSION: Wrist support is used for support and limited moving of the wrist after a patient has undergone PCI. P3 group had the highest satisfaction rating for wrist support among users. This study revealed that the differences in bleeding post-PCI between P1, P2 and P3 groups were not statistically significant (p = 0.307). The hematoma results were not deemed sufficient for statistical analysis.

Prevalence of Calcified Coronary Plaque burden in Thais

2024-09-02T08:17:50+07:00

OBJECTIVES: Although quantification of calcified coronary artery plaque burden by computerized tomography scan (coronary artery calcium score, CACS or CAC) has been validated in western populations as a tool to predict future cardiovascular events, its role in cardiovascular disease (CVD) risk assessment remains to be established in Thais. A 10-yr prospective study in asymptomatic Thais with zero CACS has shown a rate of four times higher in CVD events compared with a report on western subjects. In addition, the mean CACS in patients with acute coronary syndrome (ACS) or stroke was quite low, less than 50 AU. This suggests that plaque calcification may have unique drivers and predictive value in Thais. To explore this, we studied the distribution of calcified coronary plaque among male and female Thais of different ages, and with or without history of CVD.

MATERIALS AND METHODS: We retrospectively retrieved CACS (Agaston-130 method) results of a total of 4,104 Thai patients (men 62%, median age 61 years, range 30-96 years) who underwent CACS screening between 2012 and 2021, from eight Bangkok Dusit Medical Service (BDMS) chain hospitals. Median and percentile of CACS were calculated in each age range of both genders. Patients were divided in two groups, those with and those without CVD, by use of diagnostic ICD code (I20-25 for coronary artery disease and I63-69 for cerebrovascular disease). Additionally, CACS results in subjects without prior CVD were compared with those published for asymptomatic US and Korean populations.

RESULTS: Overall, CACS scores were significantly higher in Thai men than Thai women in the same age range, with significant CAC detected ten years earlier, beginning at age of 40 years. There were 1,764 cases among those who had prior diagnosis of CVD (CAD 85.5%, stroke 15.5%), and these subjects were significantly older, with more males, and had higher CACS severity in comparison with those without CVD (CAC = 0: 14.8% vs 40.0%, CAC > 0: 85.2% vs 60.0%, respectively; p < 0.001). In unmatched comparisons between asymptomatic populations, absolute CACS severity (>100 AU) was highest among US subjects (23.7%), followed by Thais (14.9%) and then Koreans (11.6%). On the other hand, zero CACS was highest in Koreans (47.5%), followed by Thais (40%), and lowest in US cases (13.8%). In unmatched comparisons with results from a pooled analysis of CAC studies involving 134,336 Western subjects and 33,488 Asians, Thai men had higher CACS percentiles of 50 and 75 than those of Asians but lower than those of western men. For Thai women, the p-50 and p-75were higher than those of Asians butclose to that of Western subjects and even higher after age of 65. However, the 90th percentile in Thai men and women was closer to that of the western group and highest among Thai women older than 65 years.

CONCLUSION: Our cross-sectional data support CVD prediction by CACS in Thais, with the higher CACS detected, the higher the likelihood of having CVD. However, the lesser severity of CACS and higher proportion of zero CACS in Thai men in comparison with asymptomatic US subjects suggest the existence of differences between ethnic groups and the need for local CVD screening and prevention guidelines.