The Bangkok Medical Journal

Bridging Life: The Science and Practice of ECMO in Severe Cardiopulmonary Failure

Permyos Ruengsakulrach, MD, PhD, FRCST, FCCP, AFEEAT — 2025-02-28

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving intervention for patients with severe cardiopulmonary failure, providing critical support when conventional therapies are inadequate. This review aims to offer a concise, comprehensive overview of ECMO, covering its theoretical foundations, clinical applications, and recent advancements. Designed as a practical resource for medical professionals involved in ECMO care, this review also serves as a guide for those interested in exploring ECMO’s role in managing respiratory and heart failure, including post-ECMO care. The review discusses the physiological mechanisms of ECMO, key clinical indications, patient selection criteria, and its evolving role in modern critical care. Common ECMO-related complications, such as thrombosis, bleeding, and mechanical failure, are highlighted, along with strategies for management and troubleshooting. Ethical considerations, including resource allocation and end-of-life decisions, are explored, as well as the psychosocial impacts on patients and their families. This review also contextualizes ECMO within current clinical practices, identifying global disparities in access to ECMO services. Looking ahead, it discusses the future of ECMO, including technological innovations and the potential for personalized treatments. By bridging theoretical principles with practical applications, this article aims to enhance understanding of ECMO’s pivotal role in saving lives and improving patient outcomes.

The Role of Air Pollution in Metabolic Syndrome: Mechanisms, Epidemiology, and Policy Implications

Artitaya Khajornpisitsak — 2025-02-28

Metabolic Syndrome (MetS) is a cluster of conditions, including insulin resistance, obesity, dyslipidemia, and hypertension, and together pose a major risk of developing cardiovascular disease and type 2 diabetes. Recent research throws light on air pollution as one of the most important environmental factors contributing to the increase in MetS prevalence. MetS is pathophysiologically linked to key pollutants such as particulate matter (PM2.5 and PM10), nitrogen dioxide (NO₂), and ozone (O₃), via various pathways, including oxidative stress, systemic inflam- mation, endothelial dysfunction, deoxyribonucleic acid (DNA) methylation, and others. Disruption of metabolic dysregulation via these pathways leads to abnormal lipid and glucose metabolism tolerance and hormonal regulation.

Epidemiological studies confirm a very high correlation between total exposure to air pollutants and MetS prevalence, especially among urban and disadvantaged populations. Co-exposure to air and noise pollution can potentiate MetS risk, and this adds evidence to the need for environmental health strategies that integrate air, food, and noise pollution exposures. In fact, pollution exposure is also un- equally distributed to vulnerable groups, such as children, poor, and minority communities, suggesting that quick and comprehensive public health action is urgently required. Strict air quality standards, innovative urban planning, and targeted policy measures are necessary to mitigate the health burden of air pollu- tion. Individual vulnerability may be further reduced with public health campaigns regarding protective behaviors and dietary strategies. To inform future interven- tions, it is critical to bridge gaps in our understanding of the complex interactions between air pollution and metabolic health.

Understanding the Effects and Clinical Potential of Kratom (Mitragyna speciosa): A Narrative Review

Sitthiphon Bunman — 2025-02-28

OBJECTIVES: The rising use of kratom across Southeast Asia has driven interest in its potential applications while also raising questions about its safety.

Materials and Methods: A comprehensive review spanning the past two decades was conducted, encompassing peer-reviewed articles and data issued by Southeast Asian health agencies.

RESULTS: Kratom’s stimulant- and opioid-like properties have been associated with both potentially beneficial and adverse effects, including applications in managing alcohol and opioid use disorders, pain, depression, and anxiety, as well as risks involving dependence and withdrawal. Although preliminary animal studies and limited human case reports suggest a possible therapeutic role, the absence of well-controlled, standardized trials prevents definitive conclusions regarding its efficacy and safety.

Conclusion: Historically, kratom has been utilized in medical treatments and substance use disorder management. Present evidence points to a similar clinical potential; however, without clear regulations and robust clinical research, kratom carries significant health risks and warrants further rigorous study.

An Unusual Case Report of Asbestos-Related Visceral Pleural Plaques

Nuttakarn Tontiruck — 2025-02-28

Asbestos, a group of minerals known for their fibrous structure and heat- resistant properties, has been widely used in construction and automotive industries. Predominantly derived from chrysotile and amphiboles such as amosite and crocidolite, asbestos is associated with significant health risks due to exposure to airborne fibers, particularly during construction and demolition. Asbestos can cause both malignant and non-malignant chest diseases, including conditions such as pleural effusion, pleural plaques, asbestosis, lung cancer, and malignant mesothelioma. Even though asbestos has been in use in Thailand for over 70 years, only a limited number of asbestos-related disease (ARD) cases have been officially reported. The authors present an unusual case of asbestos-related visceral pleural plaques in a resort owner, likely exposed during the demolition of old houses. Additionally, the present study aims to raise awareness of the ongoing hazards posed by asbestos and to call for stronger asbestos regulation and controls to prevent future ARD cases.

Concurrent Interdigitating Dendritic Cell Sarcoma and T-Lymphoblastic Leukemia/Lymphoma: A Case Report and Review of Literature

Chutima Pinnark Surintrspanont — 2025-02-28

Interdigitating dendritic cell sarcoma (IDCS) is a rare tumor that arises from classical dendritic cells within the bone marrow. Typically, it is observed subsequent to the development of low-grade B-cell lymphoma. However, there has been only one documented case following T-acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/LBL). The presence of these synchronous tumors with a clonal relationship, indicating a potential transdifferentiation of the tumor. We report a case of concurrent IDCS and T-ALL/LBL. A middle-aged male presented with painful cervical node enlargement. Biopsy revealed parafollicular proliferation of pleomorphic epithelioid cells expressing S100. Immunohistochemistry excluded alternative dendritic cell tumors and melanoma, confirming IDCS diagnosis. Four months post-treatment, generalized lymphadenopathy emerged, revealing small immature T cells clustering amidst IDCS cells in both lymph nodes and bone marrow. Genetic analysis identified NRAS mutation in IDCS but not in T-ALL/LBL, whereas TCR gene rearrangement was detected in T-ALL/LBL but absent in IDCS. Unfortunately, we lack conclusive evidence regarding the clonal relationship or transdifferentiation between these two tumors. They could be unrelated and incidentally develop at the same time.

Effectiveness of CT Scans in Trauma Patient at the Emergency Room, Bangkok Hospital Pattaya, Chonburi Province

Seksit Suthiso,MD — 2025-02-28

OBJECTIVES: To study the safety of radiation doses, comparing radiation exposure between whole body and divided into sections of computed tomography (CT) scan performed. Assess the safety of the amount of radiopaque contrast received and the effect on kidney function, Creatinine Glomerular Filtration Rate (GFR), in each type of CT scan. The under-covered diagnosis among trauma patients who were not sent for CT Trauma Body examination from the first time at the emergency room in order to find the cost-effectiveness of CT scans.

MATERIALS AND METHODS: Retrospective descriptive research study to answer research questions and study trauma patients who received whole-body scan and divided into sections, such as CT Brain, CT Cervical Spine (C-Spine), CT Chest, CT Abdomen. Between 1 January 2018 - 30 September 2023 records sourced from the X-ray department Bangkok Hospital Pattaya (BHP), Chonburi Province. The number of trauma patients: 5,507 cases from 5,833 records.

RESULTS: 1) Safety of radiation dose received from whole body and segmental CT scans. It can be concluded that, 1) segmental CT scans receive less radiation than whole body CT scans. While the in-patient department (IPD) examination results of trauma patients who underwent whole body CT scans had radiation doses that trauma patients received equal to 124.53 milligray (mGy), and segmental examinations received less radiation than whole body examinations, namely, brain CT equal to 62 mGy, total abdominal CT equal to 20 mGy, chest CT equal to 18 mGy, and spine CT equal to 24.53 mGy. 2) Safety of radiation doses affects the GFR of kidney creatinine from each type of CT scan. It was found that most trauma patients who were referred for examination received 370 nanometers of ultraviolet radiation. 3) Safety from incomplete diagnosis in patients who did not receive the first CT Trauma Body examination in the emergency room. It was found that injured patients were at risk from incomplete diagnosis from the first examination in the emergency room. leading to a repeat referral from the IPD and 4) the cost-effectiveness in terms of the cost of sending a CT Trauma Body examination. It was found that injured patients who underwent a CT Trauma Body examination had an average total cost of 28,640.26 baht (842.36 United States dollar (USD)), while the cost of sending a separate examination averaged 51,727.63 baht (1,521.40 USD). When considering the cost- effectiveness of a CT scan, it was found that a whole-body examination was more worthwhile than a separate examination because these were expensive (when all the costs were added together).

CONCLUSION: Therefore, trauma patients who undergo a CT Trauma Body scan from the emergency room will benefit from comprehensive diagnostics, the absence of complications, rapid and complete recovery, and the avoidance of repeat scans. Additionally, the cost is lower compared to multiple, separate CT scans. However, the assessment for each type of radiological examination depends on the severity of the injury, the patient’s vital signs, level of consciousness, medical history, physical examination, physician’s judgment, and other precautions taken into consideration before ordering the scan.

Accuracy of Contrast Enhanced CT Portal Venous Phase Alone Compared with Multiphase for Follow Up Liver Metastases of Various Primary Malignancies

Busabong Noola MD — 2025-02-28

OBJECTIVES: This study was designed to evaluate the accuracy of portovenous phase-computed tomography (CT) scanning compared with the conventional multiphase scanning in post-treatment imaging of metastatic liver lesions.

MATERIALS AND METHODS: Medical records and imaging of patients with metastatic liver disease were obtained by searching an ICD-10 coding. Imaging was first retrospectively reviewed only in portovenous phase (PVP). After a 7 days interval, imaging was reviewed again in all phases [Multiphase; non-contrasted (NECT), portovenous phase (PVP), hepatic arterial phase (HAP) and delayed phase (DP)]. Imaging of each patient was interpreted by consensus of two advanced diagnostic body imaging radiologists. All data were recorded and analyzed by the researcher.

RESULTS: A total of 274 patients were diagnosed with secondary malignant neoplasm of the liver and intrahepatic bile duct by ICD-10 coding during the study period. After reviewing the medical records, 127 patients were excluded. Among the 147 patients included, the lesions were further categorized as isolated-lesion group (80 patients, 245 lesions) and overall-lesion group (67 patients). Most patients had colorectal primary site (84 patients, 57.14%). For the isolated-lesion group, PVP showed the highest performance to detect metastatic lesion and the highest conspicuity (90.2%, 221 lesions) followed by HAP (26.5%, 65 lesions). Similar findings were noted in the overall-lesion group, PVP had the highest detection rate of 85.1% (57 patients) followed by HAP (10 patients, 14.9%) while NECT and DP showed no superiority over the other phases in lesion detection. About one-third of breast cancer patients had better visualized lesions in HAP than PVP.

CONCLUSION: In most malignancies, PVP was the best phase of CT scan both in terms of detection rate and conspicuity, particularly in colorectal primary. However, HAP should be added in some specific kinds of malignancies to increase the lesion detection rate, especially in breast cancer (about one-third of patients). NECT and DP had no superiority over other phases in term of lesion detection rate in follow-up CT scan of metastatic liver disease. However, there were some limitations in this study due to a small number of patients of some primary sites.

Road Traffic Injuries and Associated Factors among Older Adults Using Motorcycles with Sidecars in Chachoengsao Province

Sirinun Kumsri — 2025-02-28

OBJECTIVES: This research aimed to study the factors related to the occurrence of accidents from using motorcycles with sidecars among Older Adults in Chachoengsao Province.

MATERIALS AND METHODS: This cross-sectional study collected data from older adults using motorcycles with sidecars (MwS) in Chachoengsao province. Eligible participants were 60 or older, lived in Chachoengsao, and used MwS. This study includes participants’ demographic characteristics, traffic knowledge, perceptions towards environmental safety and vehicle safety conditions. A multivariate logistic regression analysis was used to examine factors associated with a road traffic injuries (RTIs).

RESULTS: Of 600 participants, 53.3% reported RTIs in the past year. Factors associated with RTIs included primary education level (aOR 1.96, 95%CI 1.05-3.64), monthly incomes below 10,000 baht (aOR 2. 23, 95%CI 1.25-3.99), presence of at least one chronic disease (aOR 2.48, 95%CI 1. 53-4.02), not wearing a helmet (aOR 4.12, 95%CI 2.21-7.69), and inadequate knowledge of traffic signs and sidecar driving (aOR 18.19, 95%CI 11. 23-29.48).

CONCLUSION: Key findings indicate that lower education levels, lower monthly incomes, chronic diseases, and inadequate knowledge of road safety significantly increase the risk of RTIs. Moreover, despite self-reported safety checks, a substantial number of MwS did not meet safety standards during official inspections. These results underscore the need for targeted interventions to improve road safety knowledge and vehicle safety among older adults.

The Effectiveness of Charge Nurse Role Development at Bangkok Hospital Headquarters

Thitaree Yongprawat — 2025-02-28

OBJECTIVES: To evaluate the efficacy of charge nurse (CN) role development at Bangkok Hospital Headquarters (BHQ) and to assess the satisfaction of other professional nurses who are working alongside registered nurses (RNs) enrolled in the advanced charge nurse development program (ACNDP) after one month training.

MATERIALS AND METHODS: This cross-sectional survey study selected participants through purposive sampling and specific criteria. Professional nurses from level 2 to level 4 of nursing staff attended the ACNDP at BHQ between 1st September 2023 to 30th April 2024. Data were collected using confidence questionnaires completed by participants’ self-assessment to compare their confidence pre and post 20-hour of training and again one month after course completion. Additionally, one month after the training, other nurses assessed their satisfaction with the CN roles’ performance of participants. Data were analyzed using descriptive statistics, One-Way ANOVA, and repeated measures ANOVA.

RESULTS: Of 109 participants who met the inclusion criteria, most were female (95.41%). Three-quarters of them were ≤ 35 years old (69.73%), and single (69.72%). The majority held a bachelor’s degree (97.2%). Competency levels included RNs level 4 (48.62%), level 2 (26.61%), and level 3 (24.77%), respectively. Forty percent had ≤ 5 years of work experience at BHQ and 93.58% had ≤ 5 years of the CN role experience. Half of participants were affiliated with the Bangkok Hospital (54.13%), Bangkok International Hospital (27.52%), and Bangkok Heart Hospital (12.58%), respectively. Their work locations were the intensive care unit (ICU) and emergency department-ER (35.78%), in-patient department-IPD (34.86%), and out-patient department-OPD (29.36%). Post-training, participants’ self-confidence in CN role significantly increased (F = 19.59, p < .01). Confidence scores varied by competency level, with significant differences observed (F = 11.88, p < 0.01). RNs level 4 had higher confidence than levels 3 and 2 (p < 0.01). Nevertheless, there was no significant difference between levels 3 and 2. Other nurses expressed high satisfaction with CNperformance of participants after one month of training (mean ± SD =2.75 ± 0.30).

CONCLUSION: The ACNDP training could increase nurses’ self-confidence after they completed this training.

Factors Associated with Self-Management Behaviors among Individuals with Recurrent Stroke in Wenzhou, China

Fang He — 2025-02-28

OBJECTIVES: The study aimed to describe self-management behaviors and determine the relationships between stroke prevention knowledge, illness representation, hope and self-management behaviors among recurrent stroke persons.

MATERIALS AND METHODS: The study used a correlational cross-sectional design among 100 randomly selected persons who were admitted at eight neurology out-patient departments of one hospital in Wenzhou, China. Each participant completed a demographic questionnaire and four reliable and validated questionnaires: the Chinese Version of the Stroke Self-management Scale, the Stroke Prevention Knowledge Questionnaire, the Brief Illness Perceptions Questionnaire, and the Herth Hope Index. Data were analyzed by using descriptive statistics and Pearson correlation.

RESULTS: The results of this study showed that the level of self-management behaviors among participants was moderate (106.32 ± 15.15). Stroke prevention knowledge, illness representation, and hope showed a significant and positive correlation with self-management behaviors (r = 0.627, p < 0.001, r = 0.273, p < 0.001, r = 0.518, p < 0.001) respectively.

CONCLUSION: The findings provide evidence for nurses and nursing researchers to develop intervention programs aimed at promoting stroke prevention knowledge, illness representation, and hope among recurrent stroke patients, thereby improving their self-management behaviors.

A Survey of Japanese Children with Atopic Dermatitis in Bangkok, Thailand

Varatda Plainetr — 2025-02-28

OBJECTIVES: This study aims to evaluate the understanding of atopic dermatitis (AD) among Japanese families living in Thailand.

MATERIALS AND METHODS: We performed a descriptive study collecting data through an online survey. The survey was sent to parents of children aged 0-15 years with atopic dermatitis in Bangkok, Thailand from 2018 – 2021.

RESULTS: Of the 65 responses, 33 children had 1 allergic condition and 32 had 2-4 conditions. Conditions included atopic dermatitis (n = 48), food allergy (n = 28), allergic rhinitis (n = 19), and asthma (n = 6). Furthermore, 49.2% felt they lacked sufficient knowledge to care for their children. Many respondents had limited knowledge of oral food challenge tests (61.6%) and oral immunotherapy treatment (58.4%). 26.2% were aware of the fingertip unit, 41.7% were unaware of the impact of water temperature on atopic dermatitis flare-ups, and 71.2% were unaware of the proactive drug use to prevent disease flare-ups. Notably, all respondents used bath water at a higher temperature than recommended. 41.0% encountered difficulties finding allergists despite having no trouble scheduling hospital visits for other concerns.

CONCLUSION: Many families would benefit from receiving accurate and useful information about usual care and a list of nearby allergists in taking care of their children’s AD.

Factors Associated with Stress Levels among Elderly Workers in the Bang Saen Beach Trading Occupation Group in Saen Suk Municipality, Muang District, Chonburi Province

Srirat Lormpongs — 2025-02-28

OBJECTIVES: The purpose of this study was to examine the relationship between various factors, including personal factors, environmental factors, uncertain attitudes regarding stress, and knowledge about stress.

MATERIALS AND METHODS: This is cross-sectional, descriptive research. The sample group comprises 104 elderly workers who are aged 60 or older from the Bang Saen beach trade group in Saen Suk Municipality. Data was collected using questionnaires from November 2023 to February 2024. The relationship was examined using correlation and chi-square statistical method

RESULTS: The study results reveal that most participants are female (59.6%) and range in age from 60 to 73 years, with an average age of 64.55 years. In terms of marital status, 45.2% are married. Additionally, 70.2% have an education level below high school, and 54.8% earn a monthly income between 10,001 and 20,000 baht. Most participants do not have an underlying medical condition (51.9%). Environmental uncertainty is generally at a moderate level (54.8%), with 44.2% experiencing high levels. Overall stress perception is moderate (51.0%) or high (49.0%), while stress management knowledge is either sufficient (51.0%) or high (49.0%). In terms of workplace stress, very high stress is reported by 60.6%, followed by high (36.5%), moderate (2.9%), and low (0.0%) levels. Statistical analysis indicates significant relationships between environmental uncertainty, stress perception, stress management knowledge, and workplace stress levels at a 0.01 level (r = 0.247, p = 0.012, r = 0.765, p < 0.001, r = -0.196, p = 0.046).

CONCLUSION: The research suggests providing information on stress and modifying stress management practices to reduce potential stress occurrences.