The Journal of Chulabhorn Royal Academy 2023-10-01T00:00:00+07:00 ศาสตราจารย์เกียรติคุณ นายแพทย์รัชตะ รัชตะนาวิน Open Journal Systems <p>วารสารวิชาการราชวิทยาลัยจุฬาภรณ์ เป็นวารสารของ ราชวิทยาลัยจุฬาภรณ์ (Chulabhorn Royal Academy) รับตีพิมพ์บทความวิจัย และบทความวิชาการ ในสาขาวิชา แพทยศาสตร์ พยาบาลศาสตร์ วิทยาศาสตร์สุขภาพ สัตวแพทยศาสตร์และสัตววิทยา สิ่งแวดล้อม วิทยาศาสตร์และเทคโนโลยี การสาธารณสุขศาสตร์ และสาขาที่เกี่ยวข้อง</p> Effectiveness and Safety of Polymer-free Biolimus-eluting Stents (PF-BES): a 1-year Single-center Study 2023-08-18T16:01:25+07:00 Wongsakorn Luangphiphat Thamarath Chantadansuwan Janekij Yamkasikorn Akaphol Kaladee <p><strong>Background:</strong> An estimated one-fifth of patients undergoing percutaneous coronary intervention are at high bleeding risk (HBR), which has a high mortality rate. Most of these HBR patients are excluded from stent trials. In response, many studies have used polymer-free Biolimus-eluting stents (PF-BESs), mainly for HBR patients. However, there is a lack of data on the clinical outcomes of the effectiveness and safety of PF-BESs in Thailand. <strong>Objectives:</strong> To evaluate the effectiveness and safety profile of PF-BES in real-world, all-comer patients with coronary artery disease undergoing percutaneous coronary intervention at the Central Chest Institute of Thailand. <strong>Methods: </strong>An observational, retrospective (chart review), single-arm study was conducted. All consecutive patients who were implanted with a PF-BES at the Central Chest Institute of Thailand were included in the analysis. <strong>Results:</strong> A total of 208 patients were enrolled. Half of these patients (54.3%) had an HBR according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. Within 1 year following the indexing procedure, the primary endpoint (a composite of cardiac death, target-vessel myocardial infarction, and clinically driven target lesion revascularization) was reached by 3.8% of the patients. Notably, there was no occurrence of stent thrombosis. Bleeding per the Bleeding Academic Research Consortium 5 definition was not seen for any patient. <strong>Conclusion: The </strong>PF-BES is safe and effective for real-world patients, irrespective of HBR status.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy Health symptoms from exposure to low benzene concentration in workers at gasoline station area, Rayong province 2023-07-06T07:53:56+07:00 Chan Pattama Polyong Anamai Thetkathuek <p><strong>Background:</strong> People who work at gasoline stations are likely to be exposed to benzene and health effects. However, exposure to low benzene concentrations has unclear health symptom effects <strong>Objective:</strong> To determine the health effects from exposure to low benzene concentrations in workers at gasoline stations, Rayong Province. <strong>Methods:</strong> The cross-sectional design using sample consisted of 108 subjects from five gasoline stations. Interview questions were used to gather information about 13 symptoms of fore body systems, the respiratory, nervous, skin, and eye system. Trans, trans-muconic acid (t,t-MA) levels were analyzed by high performance liquid chromatography. <strong>Result:</strong> Found that the median of t, t-MA for workers was 169.56 µg/g Cr (Interquartile range was 256.81 µg/g Cr). The top three health symptoms were headache, dizziness, and wheezing, accounting for 42.6, 37.0, and 25.9 percent of all symptoms, respectively. The comparison revealed that the abnormal symptoms group had significantly higher t,t-MA levels than the non-symptoms group (<em>p</em>&lt;0.05), which included headaches, dizziness, wheezing, blurred vision, mucus-producing cough, fatigue easily, difficulty breathing, nausea, and skin rash. Correlation tests revealed a significant relationship between the t,t-MA and the number of abnormal symptoms (<em>p</em>&lt;0.05) (R<sup>2</sup> = 0.251). <strong>Conclusion:</strong> Nine abnormal symptoms were associated with benzene exposure. Such abnormal symptoms may be interpreted as an indication of self-observed health screening for benzene exposure. Additional studies should could be conducted to aid in the development of questionnaire-based standard screenings for those with low-level benzene exposure groups.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy Establishment of MOPH X-ray standard and the approach for the quality system development of diagnostic radiology laboratory 2023-07-17T09:48:56+07:00 Raevadee Siritunyanont Anong Singkavongsay <p><strong>Background: </strong>The Diagnostic radiology laboratory is a healthcare service unit that requires to meet quality systems and standards.<strong>Objectives: </strong>To present how to set up the MOPH X-ray standard and the result of the standard implementation. <strong>Methods:</strong> There are two parts: part 1 setting the standard by descriptive research and part 2 the implementation of standards is carried out by laboratories applying for quality management system certification. The laboratories will be audited by the auditor team and reports of non-compliance with requirements will be analyzed and evaluated according to Pareto principle <strong>Results: </strong>The Standard of Diagnostic Radiation Laboratory, Ministry of Public Health, calling MOPH X-ray standard 2562 consists of 10 topics: 1.Organization and management. 2.Personnel 3.Tools and equipment 4.Quality assurance 5.Document control 6.Location and environment 7.Safety 8.Radiation service process 9.Reporting results 10.Internal audit and evaluation, with a checklist of 114 items for laboratory quality assessment. The 204 diagnostic radiology laboratories was found nonconformities of the requirements, with an average of 9 items per laboratory<strong>. </strong>The development topic should be focused on 7.Safety, 4.Quality assurance, 6.Location and environment and 3.Tools and equipment. <strong>Conclusion: </strong>The MOPH X-ray standard can be applicable to all levels of diagnostic radiology laboratories and be beneficial to the health service system of Thailand.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy Determination radiation exposure rate at various distances and time for myocardial blood flow study using oxygen-15 water PET/CT imaging 2023-07-17T10:06:50+07:00 Natphimol Boonkawin Chanisa Chotipanich <p><strong>Background:</strong> Oxygen-15-labelled water is considered a gold standard for myocardial blood flow quantification. The present study aimed to measure radiation exposure rates from patients study with <sup>15</sup>O-water myocardial blood flow (MBF) positron emission tomography/computed tomography (PET/CT) scans, and to assess occupational and public exposure. <strong>Methods:</strong> Radiation exposure rates from <sup>15</sup>O-water were measured during both rest and stress study. The measurements were obtained at 2.15 min after <sup>15</sup>O-water synthesis 1m away from the generator and 5 cm from the xiphoid level of each patient at time-points of 3.0, 8.30, and 15.0 min. Radiation exposure in the adjacent PET/CT imaging rooms was also surveyed. <strong>Results:</strong> The mean administered activities were 552.27±30.87MBq and 548.59±35.77MBq during rest and stress, respectively. During the <sup>15</sup>O-water synthesis, the mean radiation exposure rates were 242.90±63.68µSv/h at rest and 254.60±56.92µSv/h during stress. The mean radiation exposure rates at 3.0, 8.30, and 15.0 min were 1305.90±419.64 µSv/h, 121.82±22.89 µSv/h, and 14.62±3.44µSv/h at rest, and 1320.07±451.83µSv/h, 124.49±24.48µSv/h, and 12.50±3.76µSv/h during stress, respectively. Radiation exposure rates in the PET/CT control room and at all locations outside the imaging room were within the background range. <strong>Conclusion:</strong> During<sup>15</sup>O-water PET/CT examinations of MBF patients. The radiation exposure rates from the patients provided the radiation safety for both radiation worker and the public according to the guidelines provided by the International Commission on Radiological Protection and the Office of Atoms for Peace. However the staff should be spend less time near the radiowater generator (this includes the patients after injected radiotracer and imaging), and increasing distance from the radioactive source and patients during diagnosis for deceasing the radiation exposure.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy Evaluating effect of a community-based participatory action program on knowledge of melioidosis in Northeastern Thailand 2023-09-04T14:07:37+07:00 Narisara Chantratita Rungnapa Phunpang Atchara Yarasai Niratta Yarasai Sadeep Medhasi Arphatsara Thamdip Prakat Charearnrad Wirun Limsawar T. Eoin West <p><strong>Background and Purpose</strong>: Melioidosis is a public health problem in northeast Thailand, where it is associated with high mortality. We aimed to determine awareness and knowledge of melioidosis among the community in this region to inform prevention and education work. We also aimed to develop and implement an appropriate educational campaign using focus group discussions. <strong>Methods:</strong> We carried out community-based participatory action research in the Thawat Buri district of Roi Et Province in northeastern Thailand. We administered a structured pre-test questionnaire on knowledge and awareness of melioidosis to 372 residents. We also held five focus group discussions with a total of 39 participants to develop a strategy to increase knowledge of melioidosis in their community. After implementing the campaign, we re-assessed knowledge of melioidosis among the same 372 residents using the post-test questionnaire. <strong>Results: </strong>Overall,36% of respondents had heard of melioidosis, mainly from healthcare providers (35.1%). Of those unaware of melioidosis, 61.8% had only elementary education, and 73.9% worked in agriculture. The focus group discussions suggested using local songs (Mor-Lam music) to raise awareness of melioidosis. A Mor-Lam song was created to describe the symptoms, transmission, and prevention of melioidosis, and it was broadcast daily. Residents’ knowledge about melioidosis improved significantly from 14% to 80% after the campaign. <strong>Conclusion: </strong>This community’s baseline knowledge and awareness of melioidosis were poor. We recommend providing information about melioidosis and strengthening engagement of stakeholders at different levels in the health system. Using Mor-Lam music may be helpful to educate people about this disease.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy Development of Guidelines Buddhist Health Charter at the Area Level of a Sub-district in Nakhon Nayok Province 2023-08-04T08:25:01+07:00 Sarunya Wanjararat Jirawan Torit <p><strong>Background: </strong>The National Buddhist Monk Health Charter B.E. 2560 serves as a comprehensive framework for establishing policies and collaborative agreements among monks, societies, communities, and network partners from all sectors, used as a guideline for the promotion of monks' well-being at all levels. <strong>Objectives: </strong>To develop regional guidelines for the Buddhist Monk Health Charter. <strong>Methods:</strong> The qualitative case study used the National Buddhist Monk Health Charter B.E. 2560, as a framework. The study involved 131 purposively selected participants: 9 monks, 23 key informants, and 99 stakeholders. Data was gathered through health screening, in-depth interviews, focus group discussions, and public hearings, and analyzed using content analysis. The study process had 2 steps: Step 1 studied monks' health problems and healthcare needs<strong>, </strong>and step 2 developed the Buddhist Monk Health Charter’s guideline. <strong>Results: </strong>Step 1 found that 5 healthy and 3 ailing monks. The 7 monks had Cholinesterase enzyme levels in their blood deemed unsafe, with 2 monks at a risk level, advocating for biannual health checks by health officials. Step 2 showed that this guideline encompassed 5 categories; 1) Buddhist Monk’s Health Charter: Key Philosophies and Concepts; 2) Monks and their own health care according to the Buddhist principles of discipline; 3) Community and proper health care for monks according to Buddhist principles and discipline; 4) The monks’ role in being a leader in the health of communities; and 5) Driving the Buddhist Monk’s Health Charter into practice, and 23 practices that largely aligned with the National Buddhist Health Charter.<strong>Conclusions: </strong>The formulation of a Buddhist Monk Health Charter at the local level should be adapted to align with the specific context and constraints of the area. It should place a strong emphasis on the active involvement of diverse sectors. The guidelines for this sub-district had not yet reached the promulgation stage. Therefore, it was recommended that the Sub-District Administrative Organization promulgated them as a public policy for the community to use as a practical guideline for caring and health promotion of monks, thus ensuring their further sustainability.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy BCOR-CCNB3 fusion-positive soft tissue sarcoma: A case report and literature review 2023-08-04T13:18:25+07:00 Siripuk Sawetchaikul Tasama Pusongchai Utairat Chaumrattanakul Jutatip Kintarak Artit Jinawath Pacharapan Surapolchai Pakatip Sinlapamongkolkul <p>BCOR-CCNB3 sarcoma is one of a group of undifferentiated sarcomas. The objective of this case report was to describe the clinical and pathological data of a patient with this tumor. Our patient was a 14-year-old male adolescent with right flank pain. Imaging revealed a psoas muscle mass lesion. Histology and gene expression were suggestive of BCOR-CCNB3 sarcoma. Chemotherapy, surgery, and radiotherapy were used according to the Ewing sarcoma protocol in Thailand. Unfortunately, our patient died from acute myeloblastic leukemia (M5) without remission despite chemotherapy.</p> 2023-10-01T00:00:00+07:00 Copyright (c) 2023 Chulabhorn Royal Academy