Greater Mekong Sub-region Medical Journal <p>Greater Mekong Sub-region Medicine Journal is an online, peer reviewed international scientific journal published by School of Medicine, Mae Fah Luang University. The journal aims to publish articles in the field of basic and advanced clinical research in medicine and related health sciences, medical education as well as community medicine in Thailand, international and especially in countries of Greater Mekong Sub-region.</p> School of medicine, Mae Fah Luang University en-US Greater Mekong Sub-region Medical Journal 2730-3446 Closed Suction Drain to Prevent Postoperative Seroma after Lichtenstein Hernioplasty in Complete Inguinal Hernia: A Comparative Study <p><strong>Background:</strong> There is 5-12% chance of postoperative scrotal hematoma and seroma formation after Lichtenstein hernioplasty, which is attributed to complete hernia sacs, extensive dissection, and the foreign body reaction due to polypropylene mesh.</p> <p><strong>Objective:</strong> The aim of the study is to evaluate the efficacy of closed suction drain to prevent postoperative seroma after Lichtenstein Hernioplasty.</p> <p><strong>Methods:</strong> This prospective study was conducted in 80 patients of complete inguino-scrotal hernia. We compared incidence of post-operative seroma/hematoma and surgical site infection in drain vs. drainless group.</p> <p><strong>Results:</strong> Incidence of hematoma, seroma and surgical site infection in drain and drainless group was 2.5% vs 17.5%, 2.5% vs 22.5% and 2.5% vs 17.5% respectively.</p> <p><strong>Conclusion:</strong> Closed suction drain placement in the distal sac prevents formation of seroma/ hematoma after Lichtenstein hernioplasty of complete inguino-scrotal hernia.</p> Vipin Sahu Arjun Saxena Pawan Agarwal Vikesh Agrawal Dhananjaya Sharma Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 109 114 The Study of Association between COVID-19 Pandemic and Blood Pressure Control among Hypertensive Patients in Tha Luang Hospital, Lopburi Province, Thailand <p><strong>Background:</strong> COVID-19 infection, a coronavirus (SARS-CoV-2) infection causing severe acute respiratory distress syndrome is pandemic starting in December 2019 in Wuhan, China and then spreading rapidly throughout the world. This has an impact on every aspect of people life. In Thailand, the first case report was in January 2020 and spreading to the whole country rapidly. Due to the policy of Thai government to control this infection such as staying home, wearing masks, social distancing and limited going to any crowded places including hospitals. This would impact on people’s health because many underlying diseases needed medical attention and regular medication, one of which was hypertension. However, during this situation, there was hospital service called ‘home delivery pharmacy’ of which the patients can register their preference with the hospital to deliver their routine medications to their home in order to reduce their risk of exposure to crowded places. However, there was still lack of the studies on the effects of COVID-19 pandemic on blood pressure control as well as efficacy of ‘home delivery pharmacy’ service.</p> <p><strong>Objective:</strong> The study aimed to study the impact of the COVID-19 pandemic on blood pressure control in hypertensive patients at Tha Luang Hospital, Lopburi Province.</p> <p><strong>Methods:</strong> This was a cross-sectional study conducted in Tha Luang Hospital, Lopburi Province between 2019 and 2020. Demographic data and blood pressure level of hypertensive patients were retrieved from the electronic medical records under the hospital permission. The data was collected into 2 durations 2019 (normal situation) and 2020 (COVID-19 pandemic). Uncontrolled blood pressure (BP) was defined by systolic BP &gt; 140 mmHg, or diastolic BP &gt; 90 mmHg in the latest visit. The demographic and prevalence of uncontrolled blood pressure was analyzed by descriptive statistics. The average of SBP and DBP of hypertensive patients between in normal situation and COVID-19 pandemic were compared and analyzed by independent t-test.</p> <p><strong>Results:</strong> There were 4,045 and 4,063 hypertensive patients attended Tha Luang Hospital in 2019 and 2020 respectively. The prevalence of uncontrolled BP among these patients during 2 durations was 28.00% and 25.00% respectively (P = 0.003). The mean SBP was 132.87 mmHg in 2019 and 132.94 mmHg in 2020 (P &lt; 0.05) and DBP was 74.96 mmHg in 2019 and 75.63 mmHg in 2020 (P &lt; 0.05). The patients with a higher BMI tended to have better control of their blood pressure (P &lt; 0.05).</p> <p><strong>Conclusion:</strong> During COVID-19 pandemic, the prevalence of uncontrolled BP in hypertensive patients attended at Tha Luang Hospital was lower than in 2019. This could be explained by the policy of Tha Luang Hospital that had a home delivery pharmacy to NCD patients, which made it more convenient for patients to access public health services. But during the pandemic, patients tended to have unhealthy lifestyle compared to the normal situation due to the government policy interfering healthy lifestyle such as confinement in home and closed public health care service which could affect blood pressure level. However, the patients with hypertension should have weight reduction for good blood pressure control and decreased further complication.</p> Chutawat Kookanok Piyapon Rojndumronggarn Sakarn Charoensakulchai Ram Rangsin Boonsub Sakboonyarat Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 115 124 Vaccinating against COVID-19 in Allergic Patients <p>It is over a year since the outbreak of coronavirus (COVID-19) and we are still facing an ongoing pandemic. Whilst the number of infected patients and death rates are increasing everyday, newly developed vaccines are the main hope for humanity to end this misery. From December 2020, emergency authorized vaccines had been distributed to many parts of the world. Studies of the vaccine have confirmed effectiveness with only very rare severe adverse reactions. There are no absolute contraindications for use of the vaccines in people with a history of allergy and preexisting allergic diseases. However, risk assessment and stratification are crucial to ensure ongoing safety for vaccine injection services. The precautions in place for use of the COVID-19 vaccines within high-risk populations include patients with a history of anaphylaxis to previous vaccinations, severe/uncontrolled asthma, and underlying mast cell disorders. These patients should have their vaccine injections under healthcare provider supervision. A consultation with an expert will provide deeper evaluation and shared decision-making for use of the appropriate vaccine. The observation period for the patients with risks of allergic reactions should be at least 15-30 minutes. If anaphylaxis occurs, prompt treatment improves the survival outcomes. Anaphylaxis is a treatable condition without long-term effects. Taking all of this into account, we encourage everybody to join the immunization campaign. Do not let the fear of the reactions outweigh the advantages of being vaccinated.</p> Pisuttikan Rangkakulnuwat Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 125 138 Diabetic Striatopathy: A Rare Microvascular Neurological Diabetic Complication <p>Diabetic striatopathy is a rare neurological diabetic complication which has an incidence of 1:100,000 population. This report presents a female with poorly controlled type 2 diabetes and hypertension, who presented with right sided choreoathetosis. No other neurological abnormalities were found on physical examination. Brain imaging showed hyperdensity of the left caudate and left lentiform nuclei on non-contrast CT scan. The patient made a complete recovery from the abnormal movements following tight glucose control and introduction of trihexyphenidyl and haloperidol. A follow up CT scan 6 months following presentation revealed resolution of the previous striatal abnormalities.</p> Kaset Chimplee Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 151 156 Rapid Antibiotics Guideline for Treatment and Management of COVID-19 Pneumonia with Bacterial Co-infection <p><strong>Background:</strong> There are many patients having serious or critical illness will require hospital admission due to SARS-CoV-2 pneumonia. While antibiotics are ineffective for treatment of viral infections, they are prescribed in patients with suspected or documented SARS-CoV-2 for a variety of reasons. This raises concerns of antibiotic overuse or receiving unnecessary antibiotics and increase antimicrobial resistance (AMR).</p> <p><strong>Objective:</strong> The authors would like to develop a rapid antibiotic guideline for the treatment of patients with SARS-CoV-2 who have coinfections. These recommendations are intended to ensure the better antibiotic management of suspected or confirmed bacterial pneumonia in adults during the SARS-CoV-2 pandemic.</p> <p><strong>Methods:</strong> We used MEDLINE, OVID Epub and EMBASE searches complemented with extensive use of Web engine to identify guidelines on empirical treatment of community and hospital-acquired pneumonia in the last 10 years.</p> <p><strong>Results:</strong> We could develop antibiotic prescribing recommendation for patients with suspected community-acquired pneumonia, that has developed before or within 48 hours and patients with suspected hospital acquired pneumonia at more than 48 hours of admission.</p> <p><strong>Conclusion:</strong> Patients who develop SARS-CoV-2 pneumonia can have guideline for antibiotic prescription in case of suspected secondary superimp</p> Dhammika Wannigama Parichart Hongsing Phatthranit Phattharapornjaroen Shuichi Abe Apichai Leelasiri Tanittha Chatsuwan Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 139 144 Developing on Implant Biorubber Materials without Using Acid for Coagulation <p><strong>Background:</strong> Natural rubber latex (NRL) from Hevea brasiliensis is a colloidal anionic system formed by rubber particles (1,4-cis-polyisoprene) stabilized by phospholipids and protein molecules. Rubber biomaterials using as a novel technology could develop to apply as biomaterial based on a new manufacturing process, several new biomedical applications have been proposed since NRL is very biocompatible, stimulating cellular adhesion, the formation of the extracellular matrix, and promoting the replacement and regeneration of tissue. Objective: This study aimed to deproteinization from fresh natural rubber latex (NRL) and to coagulate the deproteinized natural rubber latex (DNRL) for using as implant biomaterials with novel technology without using acid for coagulation.</p> <p><strong>Methods:</strong> Coagulated DNRL films is often used to prepare the blended films by solutioncasting technique. Its films presents interesting physical properties in elasticity.</p> <p><strong>Results:</strong> The deproteinized NRL containing various CaO gave lower modulus values comparing with the control films.</p> <p><strong>Conclusion:</strong> In this experiment, the blended films of DNRL and various CaO could form appropriate films. The physical and mechanical properties of the blended films depended on type and content of CaO addition. From the good elasticity of blended films, they could develop to apply as the production of a biomaterial of NRL that has been used to replace vessels, esophagus, pericardium, and abdominal wall.</p> Sittiporn Punyanitya Rungsarid Koonawut Tiwasawat Sirisoam Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 145 149 An Uncommon Presentation of Hypercalcemia in Chronic Lymphocytic Leukemia <p>Hypercalcemia is a common paraneoplastic syndrome in both solid and hematologic malignancies. There are three mechanisms involving in hypercalcemia. Firstly, the cancer increases the resorption of bone minerals resulting in releasing calcium and phosphate into plasma. Secondly, parathyroid hormone-related peptide (PTHrP) increases a reabsorption of calcium and excretion of phosphate at kidneys. Finally, calcitriol (1,25 dihydroxy vitamin D) induces vitamin D absorption in small bowel. Multiple myeloma or T-cell leukemia-lymphoma are usually presented with a symptomatic hypercalcemia. However, chronic lymphocytic leukemia (CLL) is uncommonly associated with hypercalcemia. Hypercalcemia occurring in CLL patients mostly indicates a relapsed or a refractory disease. In addition, it may imply an advanced stage as well as the transformation of disease to Richter’s syndrome. This report presents an 81-year-old woman diagnosed with CLL, Rai stage III. She developed symptomatic hypercalcemia with an osteolytic lesion at left iliac wing together with an increased absolute lymphocyte count.</p> Anan Promrattanakun Pongrat Niramitmahapanya Copyright (c) 2021 Greater Mekong Sub-region Medical Journal 2021-08-26 2021-08-26 1 3 157 162