The Bangkok Medical Journal

Minimally Invasive Cardiac Surgery: A Practical Overview for Clinicians

Permyos Ruengsakulrach — 2026-02-28

Minimally invasive cardiac surgery (MICS) has become an integral component of contemporary cardiovascular care, offering effective surgical treatment while reducing the physical and physiological burden associated with conventional median sternotomy. Through the use of smaller incisions, endoscopic visualization, and refined perioperative management, a broad spectrum of cardiac procedures can now be performed with safety and durability comparable to conventional approaches. These include coronary artery bypass grafting (CABG), mitral and aortic valve surgery, selected congenital heart defect repairs, and other intracardiac interventions.

This review provides a practical overview of minimally invasive cardiac surgery for clinicians involved in the diagnosis, referral, and longitudinal management of patients with heart disease. Key topics include the range of procedures amenable to minimally invasive approaches, fundamental principles underlying their performance, and critical considerations for patient selection. The clinical benefits of MICS—such as reduced postoperative pain, faster recovery, shorter hospital stay, and improved quality of life—are discussed alongside important risks and limitations that may influence procedural choice.

By emphasizing clinically relevant concepts rather than technical operative detail, this article aims to facilitate informed referral, shared decision-making, and effective multidisciplinary collaboration, supporting the appropriate integration of minimally invasive strategies into modern cardiac care.

10-year Surgical Outcomes of Percutaneous Nephrolithotomy, A Single-Center Retrospective Study from Thailand

Harit Tunnukij — 2026-02-27

OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is an effective procedure for treating renal stones, particularly when the stone size is a staghorn stone or larger than 20 millimeters, or when it is between 10 and 20 millimeters in size and located in the lower calyx. Previous studies of PCNL have shown high stone-free rates (SFR) with minimal complications. Although previous studies have examined SFRs following PCNL in Thailand, the objective of this research is to expand the national database on PCNL outcomes. This study aims to evaluate the outcomes, including the efficacy and safety, of PCNL performed at Vajira Hospital.

MATERIALS AND METHODS: We conducted a single-center, retrospective descriptive study that enrolled patients who underwent PCNL at Vajira Hospital, Thailand, between January 2012 and December 2022. SFR was defined as a residual stone size of less than 4 millimeters on imaging. Perioperative bleeding and postoperative urinary tract infections (UTIs) were recorded.

RESULTS: A total of 203 patients underwent PCNL. Among these, the types of stones were staghorn (n = 96, 47.3%), small non-staghorn stones sized between 10-20 millimeters (n = 23, 11.3%), and large non-staghorn stones larger than 20 millimeters (n = 84, 41.4%). The median preoperative glomerular filtration rate (GFR) was 84 mL/min/1.73 m² (range: 5-132). Preoperative UTI was present in 38.4% (n=78) of patients. SFR was 43.3%. Patients with non-staghorn stones had a significantly higher SFR compared to those with staghorn stones (56.1% vs. 29.2%, respectively, p < 0.01). There was no significant difference in SFR between the small and large non-staghorn stone groups (p = 0.601). Postoperative GFR were comparable between the stone-free group and the residual stone group. Postoperative UTI and bleeding were recorded at rates of 13.8% and 8.4%, respectively. CONCLUSION: In this study, SFR following PCNL was 43.3%. Patients with non-staghorn stones exhibited a higher SFR compared to those with staghorn stones. Additionally, the postoperative complication rates were considered acceptable.

Social Media-Based Cognitive Restructuring for Stress Reduction among Nursing Assistants at a Hospital in Chonburi Province: A Quasi-Experimental Study

Pattarapon Jammin — 2026-02-27

OBJECTIVES: This secondary analysis examines the effects of social media-based cognitive restructuring for stress reduction (SM-CS) among nursing assistants.

MATERIALS AND METHODS: Research was conducted at a tertiary care hospital in Chonburi Province between September 2023 and March 2024. The SM-CS program composed of three modules: 1) mental health education on stress and cognitive behavioral therapy; 2) self-formulation; and 3) cognitive restructuring, with a 4-week program participation period. Quality assessment revealed that the SM-CS program had content validity with Index of Item-Objective Congruence (IOC) values above 0.5. Subsequently, the program was tested using a single-group pre-post experimental design with 12 nursing assistants. Data was collected by personal information questionnaire, the stress component of the Depression Anxiety Stress Scales-21 (DASS-21), and satisfaction assessment. Data was statistically analyzed by Wilcoxon matched-pairs signed-rank testing.

RESULTS: From 12 participants who completed the program showed that after program participation, mean stress level scores decreased by a statistically significant degree (p < 0.05).

CONCLUSION: The SM-CS program can reduce stress level among nursing assistants.

Beyond Teledentistry: From Video Consultation to a Digital Oral Health Ecosystem

Arnun Jukisalapong — 2026-02-27

OBJECTIVES: This review aims to synthesize the current evidence on the clinical, economic, and service quality outcomes of teledentistry and to explore emerging technological trends that are expected to drive future development, including interoperability, artificial intelligence (AI), the Internet of Dental Things (IoDT), and value-based oral health care models.

MATERIALS AND METHODS: A narrative review was conducted by searching PubMed, Scopus, and Web of Science for studies published between 2015 and 2025 using the keywords “teledentistry,” “digital health,” “AI in dentistry,” “remote monitoring,” and “interoperability.” Eligible studies included clinical trials, systematic and narrative reviews, and relevant professional guidelines. Data were synthesized narratively and grouped thematically.

RESULTS: Current evidence supports that teledentistry improves access to care, reduces costs, and yields clinical outcomes comparable to or better than conventional care in several contexts. The integration of AI and IoDT shows promise for enhancing diagnostic accuracy and longitudinal monitoring, while the adoption of interoperability standards such as fast healthcare interoperability resources (FHIR) and digital imaging and communications in medicine (DICOM) facilitates secure and efficient clinical data exchange. Most available studies are concentrated in high-income countries, highlighting the need for further research in low- and middle-income settings to guide policy and implementation strategies.

CONCLUSION: This review highlights the importance of moving beyond conventional teledentistry toward a digitally integrated ecosystem that incorporates AI, IoDT, and standardized data exchange. Ethical frameworks, data protection regulations, and sustainable reimbursement policies will be critical to achieving equitable and scalable teledentistry services worldwide.

Comparison between Health Status and Self-Health Perception of Health Promotion Leader Volunteers, Urban Communities, Thailand

Puangpaka Kongvattananon — 2026-02-27

OBJECTIVES: The aim of this study is to compare the health status and self-health perception of the Health Promotion Leader Volunteers living in the urban community.

MATERIALS AND METHODS: This study includes simple random sampling of 143 participants, urban communities in Pathum Thani province, Thailand. Data were collected by two record forms: 1) a health examination record form completed by healthcare providers, and 2) a self-health perception record form completed by the participants. Data analysis were descriptive statistics, Chi-square test and Fisher’s exact test

RESULTS: The age participants were between 26 and 86 years. Their physical examinations were as follows: 62.9% had an underlying disease, 60.8% showed abnormal results on a chest x-ray and completed blood count, 33.6% were farsighted, 30.8% had high cholesterol, 28.7% were overweight, and 21.7 a high level of stress. However, 94.23% of the participants perceived their healthy condition, 69.23% was physical examination that were the healthy. The results on their physical examination and their self-health perception were significantly different (ꭓ2 = 8.654, p < .05).

CONCLUSION: The self-health perception and the results of the participants’ physical examination were inconsistent. Healthcare providers should implement self-awareness and health education programs that are suitable for them.

Effectiveness of 3-1-5 Model in ST-Elevation Myocardial Infarction (STEMI) Patients in Bangkok Heart Hospital

Siwimon Koteruecha — 2026-02-27

OBJECTIVES: To assess treatment timeliness using the 3-1-5 model in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) and to identify factors associated with delayed reperfusion and adverse clinical outcomes.

MATERIALS AND METHODS: This retrospective observational study included adults (≥18 years) with STEMI undergoing primary PCI between June 2020 and December 2023. Patients who declined reperfusion, required interhospital transfer, or died before PCI were excluded. After Institutional Review Board approval, data were collected using a standardized case record form. Timeliness was assessed using the 3-1-5 model (≤ 90 minutes from first medical contact (FMC) to PCI). Outcomes included in-hospital and 30-day mortality and hospital readmission. RESULTS: Among 52 patients (mean age 59.83 ± 10.97 years; 88.46% male), FMC-to-device time ≤ 90 minutes was achieved in 69.23%. In-hospital mortality was 3.85%, with no mortality at 30 days or 6 months. Complications included cardiogenic shock (7.69%), arrhythmia, and intra-aortic balloon pump use (3.85%). Hospital readmission within 6 months occurred in 7.50%. The median door-in–door-out time was 35 minutes, exceeding the recommended 30 minutes. Delays were mainly attributed to system- and patient-related factors, including atypical or absent chest pain, delayed diagnosis, poor communication, and hemodynamic instability.

CONCLUSION: Although the key performance indicator (KPI) for achieving coronary reperfusion time within 90 minutes was not met, this study identified key contributors to treatment delays, particularly during the door-in door-out (DIDO) time. These delays were related to both system delay and patient delay. The door in door out interval is a critical early phase that directly affects timely diagnosis and subsequent reperfusion. System delay improvements in triage, diagnostic workflows and continuous training of healthcare personnel may help optimize this process and facilitate timely care across subsequent stages. In addition, enhancing public awareness of STEMI symptoms and the importance of early hospital presentation may reduce patient delay.

Prevalence of TERT Promoter Mutations in Thai Patients with CNS WHO Grade 2 Meningiomas

Kan-anek Jiranaparat — 2026-02-27

OBJECTIVES: To determine the prevalence of telomerase reverse transcriptase (TERT) promoter mutations in Thai patients with atypical meningiomas and assess associations with clinical and histopathological features.

MATERIALS AND METHODS: A retrospective review was conducted. Demographic, clinical, and histopathological data were collected. TERT promoter mutations were identified and analyzed for associations with features such as chordoid or clear cell variants, mitosis ≥ 4, brain invasion, necrosis, and hypercellularity.

RESULTS: The cohort comprised 92 patients, 29 males and 63 females (median age 58). TERT promoter mutations were present in 5.43% of cases, most commonly C250T (60% of mutated cases). No significant associations were found between the mutation status and the assessed pathological features.

CONCLUSION: TERT promoter mutations were detected in a small proportion of Thai WHO Grade 2 meningiomas. While no significant correlations with pathological features were observed, these mutations may contribute to tumor biology, warranting further study on their prognostic and therapeutic relevance.

Prevalence of and Factors Associated with Sarcopenic Obesity in People Living with HIV

Petchvilai Noppornpanth — 2026-02-27

Objective:
To determine the prevalence and identify factors associated with sarcopenic obesity (SO) among people living with HIV (PLWH).

Material and Methods:
A cross-sectional study was conducted between September 2024 and May 2025 among 312 PLWH aged 20–79 years attending Siriraj Hospital. All participants had been diagnosed with HIV for at least 12 months. Sarcopenia was assessed using handgrip strength and the five-time chair stand test, while body composition was evaluated by bioelectrical impedance analysis.

Results:
The prevalence of SO was 7.3% (95% CI: 4.87–10.81%). While no significant associations were found in initial multivariable analyses, dose–response analysis revealed relationships between cumulative exposure to specific antiretroviral therapy (ART) and SO. A significant trend was observed with protease inhibitors (PIs). Stavudine (d4T) exposure was significantly associated with SO in the highest quartile, suggesting a threshold effect. Abacavir (ABC) also showed a strong association, particularly at the third quartile, with a significant dose–response trend.

Conclusions:
The findings suggest that certain ART regimens, especially prolonged exposure to PIs, stavudine, and abacavir, may contribute to the development of SO in PLWH. These insights underscore the importance of individualized ART management and the need for further longitudinal studies to understand the long-term metabolic impact of ART.

Multidomain Correlates of Telomere Shortening in Adults Receiving Advanced Wellness Programs in Thailand

Tanupol Virunhagarun — 2026-02-27

OBJECTIVES: To characterize telomere length (TL) and determine biological and clinical factors associated with telomere shortening among individuals leukocyte telomere length (LTL) receiving an advanced wellness program at a clinical wellness institution in Thailand.

MATERIALS AND METHODS: This retrospective study included adults aged ≥18 years who underwent TL assessment as part of advanced wellness programs at two clinical wellness institutions in Thailand. Demographic, hormonal, micronutrient, metabolic, and clinical laboratory data were extracted from electronic medical records and laboratory databases within two weeks before or after TL measurement. Associations between TL and related demographic, hormonal, micronutrient, metabolic, and clinical variables were assessed using Pearson’s correlation coefficient. A two-sided p-value < 0.05 was considered statistically significant.

RESULTS: Among 1,684 records, TL –derived biological aging was significantly associated with multiple biological domains. Higher levels of insulin-like growth factor 1 (IGF-1) and dehydroepiandrosterone sulfate (DHEA-S) were positively correlated with slower aging, while cortisol showed no significant association. Markers of glucose metabolism, including fasting glucose, HbA1c, and insulin, demonstrated consistent inverse correlations with TL, indicating accelerated aging with poorer glycemic control. Lipid parameters showed modest associations: total cholesterol and low-density lipoprotein cholesterol (LDL-C) were positively associated with slower aging, whereas triglycerides were inversely associated with faster aging. Ferritin levels were negatively correlated with telomere-related aging, while C-reactive protein (CRP) showed no consistent relationship. Several micronutrients and antioxidants, particularly magnesium, selenium, folate, vitamin D, and coenzyme Q10, exhibited significant inverse associations with accelerated aging, most prominently in the fast-aging group.

CONCLUSION: Telomere shortening was associated with specific biological domains, particularly metabolic regulation and endocrine function, followed by micronutrient status, whereas associations with acute inflammatory markers were limited. These findings support the role of TL as a contextual biomarker for investigating biological aging within clinical wellness institutions in Thailand settings.

Asbestosis or Not? A Call for Accurate Identification of Asbestos- Related Diseases in Thailand

Thanasin Jarubandit — 2026-02-27

Asbestos exposure can cause several pulmonary and pleural diseases, known as asbestos-related diseases (ARDs). Pleural plaque (PP) is the most common manifes- tation of asbestos exposure. In Thailand, asbestosis is rarely reported despite ongoing asbestos use. Accurate diagnosis of ARDs is crucial, especially in countries where asbestos consumption remains high but the number of confirmed cases is disproportionately low.

We reported a 76-year-old male with an initial diagnosis of pleural plaque (PP) and early asbestosis. However, after a complete investigation utilising prone computed tomography, the final diagnosis was rectified to isolated PP without evidence of asbestosis. This case highlights the importance of accurate case identification for better national reporting, stronger prevention programs, and more effective policies on asbestos control in Thailand.

The First Orbital Atherectomy in a Heavily Calcified Angulated Mid Left Anterior Descending Segment in Bangkok Dusit Medical Services.

Damras Tresukosol — 2026-02-27

We report the first case of Orbital Atherectomy with heavily calcified, angulated segment of mid left anterior descending artery (LAD) at the Bangkok Heart Hospital, using a new innovation to prepare the lesion, as this condition is difficult to treat with conventional percutaneous coronary intervention such as coronary balloons and coronary stents. Currently, there are multiple modalities of treatment such as cutting balloon angioplasty, rotational atherectomy, intravascular lithotripsy or orbital atherectomy. We describe the step by step management of this heavily calcified lesion with the use of an infrared optical coherence tomography to identify calcium thickness, calcium length and calcium arc before introducing the new innovation strategy, using Diamondback 360 for orbital sanding on the circumferential vessel wall, both retrograde and antegrade, at both low and high speed, before larger balloon angioplasty and stent implantation with the proper stent sizing and stent length.