Greater Mekong Subregion Medical Journal

The Clinical Study of Poly-D, L-Lactic Acid (PDLLA) Biostimulator Injection for Improving Facial Rejuvenation Markers in Young Thai Individuals

Chaichana Srituravanich, Paisal Rummaneethorn — Thu, 10 Jul 2025 00:00:00 +0700

Background: Aging is an inescapable and complex biological phenomenon that affects the skin, leading to changes such as wrinkles, sagging, pigmentation irregularities, and decreased elasticity. The latest trend in biostimulators has had a significant impact on facial rejuvenation, with poly-D, L-lactic acid (PDLLA) standing out. However, clinical trials on its long-term effects and safety remain limited, especially in Thailand.

Objective: The objective of this study was to investigate the effects of PDLLA injection in young Thai individuals for facial rejuvenation.

Materials and Method: In this quasi-experimental design, fifteen participants with mild to moderate facial aging signs enrolled at Mae Fah Luang University Hospital Asoke, Bangkok, Thailand. Each participant underwent subdermal PDLLA injections over a six-month period. Skin quality was evaluated at baseline and at 2, 4, and 6 months using validated instruments that measured eight facial rejuvenation parameters including sebum level, elasticity, skin hydration, transepidermal water loss (TEWL), spots, pores, wrinkles and texture. The study also evaluated the Global Aesthetic Improvement Scale (GAIS), patient satisfaction scores and any treatment-related side effects.

Results: All 15 participants showed significant improvement in elasticity, skin hydration, transepidermal water loss, pore size, and wrinkles from baseline to 6 months (p < 0.001). However, no significant differences were observed in sebum levels, spots, or texture. Mild skin erythema was observed in only one case (6.67%), which was spontaneously reversible over time.

Conclusion: Our study shows that PDLLA offers promising results for facial rejuvenation and can be an alternative for skin aging prevention, especially in young individuals, with no serious side effects when proper injection and reconstitution techniques are followed.

Association between Antimicrobial Administration and Nasal Carriage of Pseudomonas aeruginosa and Candida Species in ICU Patients

Thu, 10 Jul 2025 00:00:00 +0700

Background: Patients admitted to the intensive care unit (ICU) often develop hospitalacquired infections (HAI).

Objective: We started an active surveillance culture (ASC) to monitor bacterial or fungal carriage in the ICU of our hospital and retrospectively evaluated in this study.

Materials and Method: ASC was performed using a nasal swab culture when the patients were admitted to the ICU, regardless of whether the patients had any infectious diseases. If the patients continued to stay in the ICU for the following week or later, ASC was performed regularly once a week until discharge.

Results: When comparing the bacteria isolated from nasal swab cultures at the time of ICU admission, Pseudomonas aeruginosa, which sometimes develops drug resistance and can cause HAI, was isolated more frequently from ASC the following factors for increased isolation of Pseudomonas aeruginosa week or later. Antipseudomonal penicillin and antifungals were independent risk for increased isolation of Candida species. Considering that most ICU patients are administered antimicrobials, it was suggested that using antimicrobials during long-term ICU stays affects the nasal bacterial flora of ICU patients.

Conclusion: ASC would help understand the nasal carriage status and changes in the bacterial flora of ICU patients, supporting taking measures against drug-resistant bacteria.

Prevalence of Antiphospholipid Antibodies in Patients with Venous Thromboembolism at Chonburi Hospital

Penpun Piwbuakum — Thu, 10 Jul 2025 00:00:00 +0700

Background: Venous thromboembolism (VTE) is a common condition in clinical practice. Antiphospholipid antibodies (APAs) have been investigated for the causes of thrombosis, which affect anticoagulant duration. The prevalence and association between VTE and APAs influenced the decision to investigate.

Objective: To investigate the prevalence and association between venous thromboembolism (VTE) and antiphospholipid antibodies (APAs).

Materials and Method: A retrospective cross-sectional study was conducted to analyze the medical records of patients with VTE at Chonburi Hospital from January 1, 2021, to April 30, 2024. The data collected included age, sex, body mass index (BMI), location of thrombosis, pregnancy status, underlying diseases, episodes of thrombosis, and presence of APAs. The binary logistic regression analysis focused on the prevalence and risk factors associated with APAs.

Result: In study of 189 venous thromboembolism patients, 42 (22.2%) tested positive for antiphospholipid antibodies. The average age was 46 years, with 54.8% being female. Multivariate analysis showed that these antiphospholipid antibody positive patients had a significant association with unprovoked thrombosis, with an adjusted odds ratio of 4.01 (p-value 0.03).

Conclusion: The prevalence of APAs in patients with VTE at Chonburi Hospital was 22.2%. The presence of APAs was significantly associated with unprovoked thrombosis. However, further studies are required to better understand this association.

Incidence of Adjuvant Radiation Therapy after Radical Hysterectomy and Preoperative Prognostic Factors in Cervical Cancer Patients (Stage IA2-IIA1) in Lampang Hospital, Ten Years’ Experience

Thu, 10 Jul 2025 00:00:00 +0700

Introduction: For early-stage cervical cancer (IA2–IIA1), radical hysterectomy with pelvic lymphadenectomy and primary chemoradiation offer comparable cure rates. However, some patients require adjuvant radiation therapy after surgery. Combined modality therapy can lead to significant long-term complications.

Objectives: The objective of this study is to evaluate the incidence of adjuvant radiation therapy after radical hysterectomy and to identify preoperative prognostic factors in early-stage cervical cancer (stages IA2–IIA1) at Lampang Hospital.

Materials and Method: This retrospective cohort study included early-stage cervical cancer patients who underwent radical hysterectomy with pelvic lymphadenectomy (2014–2023). Preoperative risk factors for adjuvant radiotherapy, including tumor size, diagnostic method, tumor type, vaginal bleeding, and suspected vaginal invasion, were analyzed using univariate and multivariate logistic regression in Stata 18.0.

Results: Out of 173 patients, 69 (39.9%) received postoperative adjuvant radiotherapy. Preoperative vaginal bleeding (aOR 2.48, 95% CI: 1.21-5.06; p = 0.013) and suspected vaginal invasion (aOR 10.92, 95% CI: 1.23-97.09; p = 0.032) were significantly associated with the need for adjuvant radiation therapy after radical hysterectomy. Tumor size > 4 cm was associated with an increased risk in the univariable analysis (OR 2.76, p = 0.016). Other factors, including non-SCCA histology and gross lesions, showed trends toward increased risk but did not reach statistical significance.

Conclusion: At Lampang Hospital, 39.9% of patients received postoperative radiation therapy after radical hysterectomy. Preoperative clinical examinations alone are insufficient to predict radiation therapy needs. Advanced imaging techniques, such as CT or MRI, are used to aid in treatment planning. In resource-limited settings, evaluations should focus on high-risk patients with vaginal bleeding, suspected vaginal invasion, or tumors > 4 cm.

Prevalence of Psychiatric Symptoms Associated with Vitamin D Level in Long COVID: Preliminary Study

Thu, 10 Jul 2025 00:00:00 +0700

Background: Long COVID is a condition where individuals continue to experience persistent symptoms after recovering from the initial COVID-19 infection. Vitamin D is one of the vital minerals for maintaining normal health conditions and may be associated with the psychiatric symptoms of long COVID.

Objective: To examine the prevalence of psychiatric symptoms in long COVID-19 patients in association with vitamin D levels.

Materials and Methods: This study employed a cross-sectional descriptive design, focusing on 170 patients who had previously contracted the COVID-19 virus at Foresta Clinic. The data collected included demographic data, vitamin D levels, and psychiatric symptoms in long COVID (anxiety, depression, and sleep disorders).

Result: The study results indicated a female-to-male ratio of 1.1:1 among the patients, with a mean age of 45.87 ± 8.65 years. Additionally, 62.4% had received three doses of the COVID-19 vaccine. The median blood vitamin D level was 22.96 ng/mL (IQR 18.77, 31.7), with 41.2% of participants showing insufficiency, 30.6% showing deficiency, and 28.2% having sufficient levels. Overall, psychiatric symptoms were found in 30.0% of the patients, with anxiety occurring in 15.3%, depression in 7.1%, and sleep disorders in 21.2%. Participants with psychiatric symptoms had significantly lower blood vitamin D levels
compared to those without symptoms (p < 0.05). The prevalence of psychiatric symptoms was highest among those with vitamin D deficiency (46.2%), followed by those with vitamin D insufficiency (25.7%), and it was lowest in the vitamin D sufficient group (18.8%).

Conclusion: Maintaining and assessing vitamin D levels in long-term COVID patients may help prevent or reduce the severity of psychiatric symptoms. Further research is needed to evaluate the effectiveness of vitamin D supplementation in long COVID patients with low vitamin D levels, as well as to monitor and assess psychological tests continuously.

A Study of Behavior of Applying Knowledge of Learners from the Course SIID 529 Effective Clinical Teaching of Faculty of Medicine Siriraj Hospital, Mahidol University

Pattaraporn Naknagraed, Arisara Thongnopphakhun — Thu, 10 Jul 2025 00:00:00 +0700

Background: SIID 529 is a course at Siriraj Hospital, Mahidol University, designed to enhance clinical teaching skills among medical residents. This study evaluates how learners apply teaching knowledge in practice through self- and peer-assessments. The results aim to inform future instructional strategies and educational policies.

Objective: To assess and compare learners’ knowledge application behavior following participation in SIID 529 using self-assessment and peer-assessment tools.

Materials and Method: The study involved 840 participants, including medical residents, fellows, and their colleagues. Two validated questionnaires assessed knowledge application across four domains: clinical supervision, ward rounds, giving feedback, and teaching on the run. A total of 268 self-assessments and 240 peer assessments were collected (response rates: 31.40% and 28.54%). Data were analyzed using descriptive and non-parametric comparative statistics.

Results: Overall knowledge application was rated at a high level (Self-assessment: = 3.73; Peer-assessment: = 3.77). Statistically significant differences (p < 0.05) were observed based on academic year, study status, academic performance, and learning environment. The highest application levels were found among graduates and fellows, especially those from the academic year 2021, while current residents in 2023 reported lower application. Learners with an A+ grade and those in supportive environments showed significantly higher behavior scores.

Conclusion: The SIID 529 course has a substantial impact on enhancing physicians’ teaching behaviors. Institutions should support knowledge application by providing structured training opportunities, reducing teaching barriers, and fostering environments that encourage clinical education. These findings support the importance of faculty development for medical educators and suggest areas for future improvement in training programs.