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 CMV Enteritis and Guillain-Barré Syndrome after Stem Cell Transplantation for Lymphoma <p>We report a 31-year-old male from Kuwait, diagnosis of advanced diffuse large B-cell lymphoma stage IV presented with extradural mass and spinal cord compression at T6 level. After T7-T8 laminectomy with 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) chemotherapy and high dose methotrexate (MTX) only one time then followed with 4 cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, and dexamethasone (R-Hyper CVAD)/high dose MTX and cytarabine (Ara-C). The non-myeloablative stem cell transplantation (NMSCT) was performed because of morbid obesity (body weight 135 kg). The conditioning regimen was thiotepa, fludarabine and cyclophosphamide. The graft versus host disease (GVHD) prophylaxis was short-course methotrexate and tacrolimus. The patient developed chronic diarrhea with abdominal pain caused by CMV colitis on day 57 post-transplant and was treated with ganciclovir. Subsequently he developed Guillain-Barré syndrome manifested with progressive weakness of lower extremity which successful treatment with intravenous immunoglobulin (IVIg) 2 g/kg. The recovery of motor power was starting 2 days later. By the same period, patient developed pancytopenia from stem cell rejection. The 0.95 x 106/kg of stem cell was re-infused on day 72 post-transplant and reachieved engraftment 13 days later. The motor power was recovered from grade I to grade IV and he was able to walk with walker support after 25 days treatment of IVIg</p> Wichean Mongkonsritragoon Wimwipa Mongkonsritragoon Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 55 60 Okra Jelly Affecting Self-Perceived Xerostomia and Oral Health Related Quality of Life in The Elderly: A Preliminary Study <p><strong>Background:</strong> The prevalence of xerostomia, the subjective sensation of dry mouth, is quite high in elder people. Okra contains mucilaginous substance which has moisturizing and lubricating properties similar to human natural saliva.</p> <p><strong>Objective:</strong> This study aimed to investigate if okra jelly can affect self-perceived xerostomia and oral health related quality of life in the elderly.</p> <p><strong>Methods:</strong> We used an experimental study. There were 12 participants. We allocated 2 groups: the experimental group used okra jelly and the control group used jelly without okra. Participants received jelly twice daily, between breakfast-lunch and lunch-dinner for 24 days. Self-reported visual analogue scale (VAS) for dry mouth and the Thai version of Oral Health Impact Profile-14 (OHIP-14-Th) had been done at before intervention, Day 12, and Day 24. Two-sample Wilcoxon rank-sum (Mann-Whitney) test, multilevel mixed-effects logistic regression and GEE population-averaged model were used for analyzing the differences between tests and controls at different studied times with p-value &lt; 0.05 was considered to be significant.</p> <p><strong>Results:</strong> After adjusting baseline VAS and OHIP-14-Th score, age and gender, the results showed that every 12-day, the VAS score of the experimental group decreased significantly (p &lt; 0.01) and the control group decreased insignificantly. Comparing the two groups, it was found that the experimental group had a greater score reduction significantly (p&lt; 0.01). The results of OHIP-14-Th score every 12-day showed that both the experimental and control groups decreased significantly (p &lt; 0.01). Comparing the two groups, it was found that the experimental group had a greater score reduction, however, insignificantly.</p> <p><strong>Conclusion:</strong> Okra jelly seems to have promising results on the reduction of self-perceived xerostomia and oral health related quality of life in the elderly.</p> Chaninard Wiriyaprasitchai Visarut Thangvaravut Witsuta Pongphaladisai Wilairat Worapamorn Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 43 53 Acupuncture in Medicine <p>Traditional Chinese Medicine (TCM) consists of herb, acupuncture, and Tuina (a kind of massage). Today TCM is very popular. In Thailand there are eight colleges of TCM. Threemonth course of training acupuncture for doctors was firstly opened in 1998. The course consists of basic theory of TCM e.g. Yin – Yang, Five Elements, Five Organs, Qi Blood and Essence, Twelve Meridians, Extra Meridians, Acupuncture Points, Tongue and Pulse Diagnosis, etc. After learning basic theory, the trainees have to practice needling and then treating patients with acupuncture.</p> Taksin Jiemthong Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 31 34 Implementation of Early Clinical Exposure (ECE) in Preclinical Teaching <p>Nowadays medical education for preclinical years is usually emphasizing on early exposure to clinical learning. This way of teaching can make medical students realize the importance of knowledge in the preclinical years for taking care real patients while on clinical years. This activity can lessen boring of medical students in the limited preclinical classroom and able to make correlation of preclinical and clinical. ECE can inspire medical students to pay more attention to learning in order to become physicians in the near future. ECE should have various ways, not be obligatory to medical teachers, can be blended with daily clinical service of the teachers, utilize existing hospital resources and should be modified to related curriculum in preclinical years. In this paper, the authors would like to share experience of implementing ECE in preclinical subject “Hematology and Lymphoreticular System” for medical students of Mae Fah Luang University.</p> Apichai Leelasiri Ubolwan Charoonruengrit Roger Callaghan Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 25 29 Melatonin Decreased Postoperative Pain after Abdominal Hysterectomy: A Randomized, Double-blind, Placebo-controlled Trial <p><strong>Background:</strong> Incidence of anxiety and pain in patients undergoing hysterectomy is significant and primarily due to postoperative pain. Most patients usually receive opioids for pain control. Melatonin is a natural hormone produced by the body. Synthetic melatonin is available over the counter for the management of insomnia and jetlag. Clinically, melatonin can also be used to reduce pain and analgesic requirement in patients undergoing surgery. The analgesic benefit of melatonin as primary or adjuvant agents has been reported in various studies.</p> <p><strong>Objective:</strong> We aimed to study whether melatonin could improve pain and other postoperative conditions after hysterectomy.</p> <p><strong>Methods:</strong> A randomized, double-blinded, placebo-controlled trial study was carried out on 54 women undergoing hysterectomy, with or without oophorectomy under spinal anesthesia. Patients were allocated randomly to receive either 4 mg prolonged-release melatonin at night and in the morning before surgery or 2 doses of placebo. Morphine consumption within 24 hours, visual analog scale (VAS) pain score, quality of sleep, anxiety level score, fatigue, general well-being and satisfaction score were measured.</p> <p><strong>Results:</strong> Morphine consumption in melatonin group was significantly low compared to placebo (33.04 ± 10.42 and 42.63 ± 8.21 mg, (p &lt; 0.001). Also, postoperative VAS pain scale was lower in the melatonin group at recovery room arrival (23.41 vs 8.07, p = 0.01). Postoperative fatigue, general well-being and satisfaction scores in the melatonin group were better than the placebo group.</p> <p><strong>Conclusion:</strong> Prolonged-release formulation of melatonin decreased pain intensity in post anesthetic care room and reduced morphine consumption within 24 hours after surgery. Melatonin may be an additional choice of multimodal analgesia for hysterectomy.</p> Prok Laosuwan Kamonwan Dechaworawut Oraluxna Rodanant Dhammika Wannigama Somrat Charuluxananan Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 1 13 In Silico Prediction of the Action of Ivermectin-like Compounds on Binding Sites of the SARS-CoV-2 Spike Protein and Receptor-binding Domain of ACE2 <p><strong>Background:</strong> Ivermectin (IVM), a macrocyclic lactone anthelmintic drug, is a promising lead compound that may disrupt the binding interface of the SARS-CoV-2 spike protein with the protein-binding domain of angiotensin-converting enzyme 2 (ACE2), and so could present an opportunity for further drug development of anti-COVID-19 medication.</p> <p><strong>Objective:</strong> This study aimed to determine and predict the most effective IVM-based analogs against the SARS-CoV-2 spike protein and human angiotensin-converting enzyme 2 by using computational analysis.</p> <p><strong>Method:</strong> This study performed a rational <em>in silico</em> study to screen ivermectin-like compounds with a similarity score less than 0.70 and then screened these for acceptable pharmacokinetic properties, to further examine molecular docking analysis of SARS-CoV-2 spike protein and protein-binding domain of angiotensin-converting enzyme 2.</p> <p><strong>Result:</strong> The results showed that compound <strong>14</strong>, with a similar score of 0.722, exerted the most binding affinity with both targets, with a binding energy of -8.32 and -7.98 kcal/mol to the SARS-CoV-2 spike protein and the protein-binding domain of angiotensin-converting enzyme 2 respectively, showing better values than that of ivermectin.</p> <p><strong>Conclusion:</strong> Our study confirms the possibility that the ivermectin-like compound <strong>14</strong> may be a most promising candidate drug, acting on the SARS-CoV-2 spike protein and angiotensin-converting enzyme 2, so should be studied further as part of a drug discovery and development process.</p> Shisanupong Anukanon Narudol Teerapatarakarn Chaiyong Rujjanawate Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 35 42 Cyclosporine and Prednisolone as First-line Treatment of Subcutaneous Panniculitis-like T Cell Lymphoma: Clinical Features and Outcomes in 4 Patients <p><strong>Background:</strong> Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous T-cell lymphoma that can present with subcutaneous nodules mimicking panniculitis. Treatment protocols for SPTCL are varied, due to lack of agreement on standard treatment. Recent publications showed good response to treatment with cyclosporine and/or prednisolone as first-line treatment for SPTCL.</p> <p><strong>Objective:</strong> We aimed to study the outcome of SPTCL patients treated using cyclosporine and prednisolone as a first-line treatment, and also describe clinical presentations, histopathology, immunophenotype, molecular, treatment protocol, and treatment outcomes.</p> <p><strong>Results:</strong> Our study reported 4 SPTCL patients that presented with multiple subcutaneous nodules or indurated plaques, associated with fever and weight loss. All patients received cyclosporine and prednisolone as first-line treatment and achieved complete remission within 4-8 weeks. Three patients are still in complete remission. Relapse of SPTCL was suspected in one patient.</p> <p><strong>Conclusion:</strong> Our results suggest that cyclosporine and prednisolone are beneficial and could be use as first-line treatment in SPTCL.</p> Natnicha Girdwichai Narumol Nolwachai Anan Promrattanakun Copyright (c) 2022 Greater Mekong Sub-region Medical Journal 2021-12-23 2021-12-23 2 1 15 23