The Journal of Chulabhorn Royal Academy

Atrial Fibrillation Screening

2024-05-03T08:06:40+07:00

Atrial fibrillation (AF) is the most common arrhythmia resulting in the burden of healthcare. Screening for AF can lead to stroke prevention with oral anticoagulants in selected patients. Opportunistic screening for AF should be performed in people aged ≥65 years by pulse palpation. Systematic screening for AF should be introduced in people aged ≥75 years or those at high risk for ischemic stroke. Patients with cardiac implantable electronic devices who have atrial high-rate episodes (AHREs) should be further investigated for the diagnosis of AF. Oral anticoagulant should be prescribed if AHREs ≥5.5 hours in patients with a high risk of ischemic stroke (CHA₂DS₂-VASc score >1 in males or >2 in females). AF screening following ischemic stroke should be done with pulse palpation and 12-lead electrocardiography, as well as ECG monitoring for 24-72 hours to increase the chance of detecting AF. The devices with new technologies are promising tools for AF screening with ease. Even though AF screening is cost-effective, higher costs for more investigation and treatment are often a concern after AF diagnosis. The appropriate strategy for AF screening in Thailand should be investigated for the cost-effectiveness.

Nursing care for people with Neuroendocrine Tumor (NETs) receiving 177Lu-DOTATATE Therapy

2024-03-18T08:15:07+07:00

Neuroendocrine tumors (NETs) are cancers of the endocrine cells, originating in organs such as lungs, stomach, small intestine, colon, or pancreas and spreading to other organs. Whilst, treatment modalities of NETs comprise surgery, chemotherapy and novel innovative drugs to targeted organs, including the use of radiopharmaceutical agents. ¹⁷⁷Lu-DOTATATE is an alternative and efficacious treatment with increasing survival rates and few side effects. Nursing care of NETs patients with ¹⁷⁷Lu-DOTATATE therapy based on a specialized knowledge on disease pathology and radiation in order to increase patient safety and enhance efficiency effectiveness of ¹⁷⁷Lu-DOTATATE therapy.

Diagnostic agreement between a commercial AI system and radiologists in interpreting checkup chest radiographs

2024-04-19T11:03:52+07:00

Background: Chest radiography is widely used to screen for thoracic diseases. Recent artificial intelligence (AI) systems have demonstrated outstanding standalone performance in diagnostic tasks concerning chest radiographs (CXRs), often comparable to that of radiologists. However, few studies have evaluated AI performance in real-world clinical practice settings, especially with regard to checkup examinations and diagnostic agreement with humans. Objective: To evaluate the diagnostic agreement between AI and radiologists in evaluating checkup CXRs. Methods: An AI system and radiologists independently evaluated 500 checkup CXRs from a retrospective review period. We then quantified their diagnostic agreement. Results: When our analysis was restricted to lesions identified by the AI (AI-target lesions), we found fair agreement. If we regard the diagnoses of the radiologists as ground truth, the AI produced false-negative and false-positive rates of 8.0% and 8.7%, respectively. When extended to include lesions that had not been identified by the AI (both AI-target and AI-non-target lesions), our analysis showed a reduced agreement (76.0%) and an increased false-negative rate (16.7%). The AI demonstrated low sensitivity (26.5–36.8) but high specificity (90.1–90.5), with a significant number of AI-non-target lesions. Conclusions: Our results demonstrate fair to slight agreement between automatic AI diagnoses and the assessments of radiologists for checkup CXRs. Radiologists often reported numerous AI-non-target lesions. Despite certain limitations, our findings suggest that AI may play a valuable role as a diagnostic aid to enhance radiological evaluations. Further research is warranted to comprehensively assess AI performance in broader clinical contexts.

Epidemiology of Frailty, Sarcopenia, Dementia among Community - Dwelling Older Persons in Lak Si District, Bangkok

2024-01-29T13:13:37+07:00

Introduction: Older persons are at higher risks for frailty, sarcopenia and dementia. These are major health problems among Thai older persons. The Research in Thailand is quite limited. Objective: The aims to explore the epidemiology on frailty, sarcopenia and dementia among community - dwelling older persons in Lak Si District, Bangkok. Methods: Use descriptive study among 560 older people in their community-dwelling. Interviews and self-reports were conducted for data collection. Interviews included demographic, The Tilburg Frailty Indicator (TFI) part B Components for frailty, SARC-F test for sarcopenia and dementia test. All data was analyzed by descriptive statistics. Results: The study found that the average age of the sample was 69.3 with 1) prevalence of frailty (21.07%); reduced eye vision, fatigue, body unbalancing, and walking difficulty including walking upstairs 2) prevalence of sarcopenia (15.18%); holding and lifting difficulties (36.1%), and falling during the year (31.1%) and3)dementia(4.83%) ;memory and cognitive system problems. Conclusion: From the study, it is suggested that health personnel should concern and manage about frailty, sarcopenia and dementia in the older persons and help the clients in every dimension; health promotion, prevention, caring, rehabilitation and referring system for their good quality of life.

Bell’s palsy after inactivated COVID-19 vaccination in an adolescent: A case report

2024-04-09T13:27:54+07:00

Bell’s palsy has been reported following COVID-19 vaccination in adults. Here, we report a case of an adolescent male with unilateral peripheral facial palsy after receiving the BBIBP-CorV vaccine. An electrodiagnostic study confirmed the diagnosis. The patient made a complete recovery after medical and rehabilitation treatment. Objectives: This is the first case report of Bell’s palsy following the administration of an inactivated COVID-19 vaccine in an adolescent. Study design: A case report. Setting: Chulabhorn Hospital, Lak Si, Bangkok, Thailand. Subject: An adolescent male with unilateral peripheral facial palsy after receiving the BBIBP-CorV vaccine. Methods: We reviewed the patient’s medical record and electrodiagnostic report. Results: A 14-year-old, previously healthy, adolescent male received his 1^st dose of inactivated BBIBP-CorV (Sinopharm) COVID-19 vaccine. Five days later, he developed right peripheral facial palsy. He was diagnosed with Bell’s palsy. Clinical signs and symptoms combined with initial and follow-up electrodiagnostic studies confirmed the diagnosis. He was treated for 5 days with oral prednisolone and vitamin B-complex. He received eye care with artificial tears and underwent a rehabilitation program using the bio-stimulation mode of high-power laser therapy (MLS®) combined with standard physiotherapy. Conclusions: Bell’s palsy might be an adverse event associated with the inactivated BBIBP-CorV COVID-19 vaccine in adolescents.

The Effects of Prehabilitation Program on Shoulder Range of Motion, Arm Circumference, Physical Capacity and Quality of Life in Breast Cancer Undergoing Surgery

2024-03-20T08:27:07+07:00

Background: Prehabilitation program before surgery can reduce shoulder joint stiffness, upper extremity lymphedema and increase physical capacity, quality of life in breast cancer patients Objective: To study the effect of a pre and postoperative rehabilitation program in breast cancer patients undergoing surgery. Study design: Retrospective descriptive study; there was 1 group of 50 people, observed from August 2020-March 2021, divided in to 5 periods: before surgery, after surgery, the 2^ndweek, the 4^th week and the 3^rd month by comparative assessment of shoulder range of motion, arm circumference, 6-Minute Walk Test and quality of life. Results: The angle of motion of the shoulder joint in the flexion and abduction directions at 2 weeks was significantly reduced, and there was a statistically significant increased after the surgery at 1 month and 3 months when compared to 2 weeks. Arm circumference at before and 3 months after surgery was not statistically different. Physical performance after 1 month of surgery tested with 6-Minute Walk Test was significantly increased compared to before surgery. There was a tendency to increase at 3 month follow-up period. Quality of life from the Functional Assessment of Cancer Therapy- Breast questionnaire found no statistically significant difference. Conclusion: Prehabilitation program on shoulder range of motion, arm circumference, physical capacity and quality of life in breast cancer patients are found good direction, no complications and no worsening symptoms when compare with the results of baseline.

The establishment of Diagnostic Reference Levels for Diagnostic radiology at Chulabhorn Hospital

2024-04-19T14:26:41+07:00

Objective: To establish the typical dose for diagnostic radiography at Chulabhorn Hospital compared with the diagnostic reference level of Thailand and international diagnostic reference levels. Method: The collected data include kerma area product (KAP) from general X-rays, mean glandular dose from mammography, kerma area product (KAP) from interventional procedures, volume computed tomography dose index (CTDIvol), and dose length product (DLP) values from computed tomography (CT) studies. Our sample comprised 850 patients categorized as follows: 400 underwent general X-ray examination, 50 underwent mammography, 200 underwent interventional radiology procedures, and 200 underwent CT scans. Data were collected retrospectively from January to December 2021. The median was analyzed to yield the DRLs. The DRLs were compared to the Thai national DRL and international DRLs. Results: The diagnostic reference levels for general X-ray examination are as follows: 0.38 mGy.cm²for AP skull, 0.60 mGy.cm²for LAT skull, 0.10 mGy.cm²for PA chest, 0.69 mGy.cm²for AP abdomen, 0.70 mGy.cm²for AP pelvis, 1.82 mGy.cm²for AP lumbar spine, and 2.30 mGy.cm²for LAT lumbar spine. The MGD was 2.02 mGy from mammography. The DRLs of TACE and PTBD were 329.07 Gy.cm²and 3.58 Gy.cm², respectively. The DRLs of head, chest, and abdominal CT were CTDI_vol 46.35, CTDI_vol 8.83, and CTDI_vol8.91 mGy, respectively. Conclusion: The majority of radiation doses at Chulabhorn Hospital are lower compared to the diagnostic reference levels of the Medical Sciences Department of Thailand in the years 2021 and 2023, as well as international reference levels.