The Journal of Prapokklao Hospital Clinical Medical Education Center

Editorial Article

2024-03-14T16:33:44+07:00

Assessing Incidence of Patients with Secondary Infection in COVID-19 Pneumonia who was Received Corticosteroid Treatment in Samutprakarn Hospital

2023-10-12T16:59:12+07:00

BACKGROUND: Corticosteroids are an anti-inflammatory drug that plays an important role in the treatment and reduced death rate of patients with severe pneumonia from COVID-19. However, corticosteroids increase the chance of secondary infection due to reduced immunity. Therefore, using corticosteroids to treat patients with severe pneumonia from COVID-19 could have affected the rate of secondary infection and the death rate of patients at Samut Prakarn Hospital.

OBJECTIVE: This study aimed to determine the rate of secondary infection, death rate, and important risk factors affecting the death rate in patients with severe pneumonia from COVID-19 who received corticosteroids at Samut Prakarn Hospital. A secondary objective was to assess whether the different doses of corticosteroids these patients received had any effect on secondary infections or death rates.

METHODS: This study utilized a retrospective approach (retrospective cohort study) by selecting patients who met the criteria and reviewing information from medical records of patients diagnosed with severe pneumonia from COVID-19 who received corticosteroid medication. A total of 675 patients were admitted to Samut Prakarn Hospital from 1 June to 30 September 2021. Statistical analysis included descriptive statistics, univariable and multivariable logistic regression analysis, and chi-square test.

RESULTS: The total secondary infection rate was 26.8%. The most common secondary infection was in the respiratory system, accounting for 22.5%. The mortality rate was 42.2% (95%CI=38.5-46%). Corticosteroid doses of 10 mg, 16 mg, and 20 mg resulted in secondary infection rates of 5%, 56.9%, and 38.1%, respectively. Corticosteroid doses of 16 mg and 20 mg were associated with higher rates of secondary infections compared to the 10 mg dose, with p-values of 0.049 and 0.021, respectively. When secondary infections occurred, the mortality rate was significantly higher, with an adjusted odds ratio of 3.01 (95%CI=2.03-4.45). From this study, it was found that patients with severe pneumonia from COVID-19 who had risk factors such as being over 60 years old, a history of stroke, and chronic kidney failure had an increased death rate.

CONCLUSION: This study found that patients with severe pneumonia from COVID-19 receiving corticosteroids may experience secondary infections as a side effect. Further, the mortality rate is significantly higher when secondary infections occur. In this study, corticosteroid doses of 16 mg and 20 mg increased the chance of secondary infection compared to the 10 mg dose. However, the death rate did not differ among the different corticosteroid doses. Despite the findings, corticosteroids play an important role in treating patients with severe pneumonia from COVID-19, given the severe inflammatory process observed in these patients.

A Retrospective Study of Assault Victims Presented to the Clinical Forensic Medicine Unit, Hua Hin Hospital

2023-11-01T11:11:31+07:00

BACKGROUND: Body assault injuries are significant medical and social issues. Understanding the factors associated with body assault may be useful in both clinical and preventive aspects.

OBJECTIVES: This article aimed to compare the factors related to body assault between males and females and the factors associated with severe injury.

METHODS: A retrospective cross-sectional analytical study was conducted of assault victims presented to the Clinical Forensic Medicine Unit, Hua Hin Hospital, between 5 July 2021 and 5 September 2023. In each case, characteristics of victims and assailants, location and time of injury, mechanism of injury, and injury details were collected. The data were analyzed using descriptive and inferential statistics. Pearson’s chi-square and Fisher’s exact tests were used to compare the factors between males and females. In addition, Pearson’s chi-square test and univariable and multivariable logistic regression were performed to identify the factors associated with severe injury.

RESULTS: Of the 720 patients (mean age: 33.6±14.4 years), 51.7% were male. The majority were injured by bodily force (66.1%). Most female victims were assaulted by their partners in the residence. Contusion was common in patients. The face was the most affected body region. A study found that females are more likely to suffer from neck or lower extremity injuries than males (p≤0.01). Severe injury was found to be significantly associated with male gender (aOR 4.13; 95%CI, 1.99-8.59), age 51 years and over, blunt object injury (aOR 2.95; 95%CI, 1.50-5.81), sharp object injury (aOR 4.61; 95%CI, 2.10-10.11), and firearm injury (aOR 19.00; 95%CI, 3.67-98.34).

CONCLUSIONS: Male gender, victims aged 51 years and over, injuries from firearms, and blunt and sharp objects are associated with severe injury.

The Comparison of Tricuspid Inflow in Parasternal Short Axis Versus Apical Four Chambers View from Transthoracic Echocardiography

2023-11-08T11:25:41+07:00

BACKGROUND: Tricuspid inflow is a transthoracic echocardiographic TTE parameter used to describe the diastolic function of the right ventricle, which is related to the pressure and volume of venous blood entering the right side of the heart. It can be measured in the standard apical four-chambers view, A4C, and in the parasternal short-axis view at the level of the aortic valves, PSX. However, there have been no studies carried out to compare the values obtained from both angles view.

OBJECTIVE: The aim of this study was to compare tricuspid inflow from the A4C view versus that from the PSX view.

METHODS: In this retrospective study, TTE imaging data measuring tricuspid inflow, consisting of peak E wave velocity, peak A wave velocity, E duration, A duration, and the TV E/A ratio in PSX and A4C, were compared using a t-test and the Wilcoxon signed-rank test.

RESULTS: Of 60 children aged 4-15 years, 46% were male and 54% were female. It was found that the TV E/A ratio values measured from the PSX view and the A4C view were not different (1.48±0.46 VS. 1.43±0.40, p=0.48). However, it was found that the peak E velocity and peak A velocity values at the PSX view were higher than the values measured at the A4C view (peak E velocity=75.5±15.2 VS 66.8±16.8 cm/s, p<0.05) (peak A velocity=52.9±11.6 VS 48.6±12.5 cm/s, p<0.01).

CONCLUSION: RV diastolic function measured using the E/A ratio from tricuspid inflow from the PSX view was no different from that measured from the A4C view.

Results of Self-controlled Lifestyle Modification on Fatty Liver in Individual Outrange BMI and/or Hepatitis from Steatosis from 4 to 6 months

2023-11-15T10:57:09+07:00

BACKGROUND: Nowadays, overwhelming food habits and inactivity have caused fatty accumulation in urban populations, which necessitate lifestyle modification and exercise for improvement.

OBJECTIVE: This study aimed to compare changes in the Controlled Attenuation Parameter (CAP score) between a self-controlled lifestyle modification group and a traditional care group.

METHODS: Therapeutic research was conducted with a retrospective and prospective observational interrupted time design to screen participants who had fatty accumulation. The control group (between March 2020 and August 2023) received traditional care, while the study group (between September 2022 and March 2023) was asked to adopt a self-controlled lifestyle that included a diabetic diet and economically light exercise for 150 minutes per week with one follow-up. At the beginning and end of the follow-up period (4-6 months), data on each patient were obtained. Multivariable median difference regression was used to compare the CAP score changes between groups.

RESULTS: Only 39 of the 263 screened participants (16 controls and 23 study participants) were enrolled in the study. Most were women with the same age. Liver enzymes were higher in the study group. After correcting for inequitable factors between groups, the changes in the study group for CAP score were more reduced than those in the control group, decreasing by -24.98 dB/m (95%CI: -75.29, 25.34, p=0.32), notably in the group with decreasing body weight.

CONCLUSIONS: Self-control with a diabetic diet and exercises tended to reduce fat accumulation in the liver. Social and medical support should enhance people health.

Factors Affected Treatment with The CTF Program in Hip Fracture Patients at Phrae Hospital

2023-11-09T13:56:00+07:00

BACKGROUND: Hip fractures constitute a major health problem. The CTF program oversees support for Post-fracture Care. Better understanding of the clinical factors affecting poor outcomes in the CTF program will help address the medical management of treatment for hip fracture patients.

OBJECTIVE: To study the factors affecting treatment with the CTF program to assist hip fracture patients at Phrae Hospital.

METHODS: A retrospective cohort study was conducted of all hip fracture patients aged 50 years and older who underwent surgery between 2018 and 2022. Patients were grouped into good and poor treatment outcomes, and multivariable logistic regression was used to analyze the data.

RESULTS: Independent factors for poor treatment outcomes with the CTF program were found to include being 80 years of age or older (OR 9.59), female gender (OR 3.10), fall risk score 3 months after surgery ≥4 points (OR 3.61), balance test 3 and 6 months after surgery < 20 seconds (OR 4.26, 12.38), and a Charlson Comorbidity Index score of 1-2 points (OR 0.26). All factors could predict poor treatment outcomes at 90.85 %.

CONCLUSIONS: Orthopedic surgeons should consider six independent factors to reduce poor treatment outcomes among hip fracture patients.

Evaluating the Accuracy Index of Antigen Test Kits (ATK) Compared to Real-time Polymerase Chain Reaction (RT-PCR) Confirmation during COVID-19 Outbreaks in Special Areas: A Study on Diagnostic Accuracy During an Outbreak Investigation

2023-11-30T14:42:52+07:00

BACKGROUND: In late 2020, antigen test kits (ATKs) were developed for screening Coronavirus disease 2019 (COVID-19) infections with the aim of preliminary screening in both the public and various organizations. Nevertheless, the accuracy indices could vary depending not just on the test kits, but also on the characteristics of the area and the specific population group where these test kits were used.

OBJECTIVES: This study aimed to evaluate the accuracy index of ATK compared to the RT-PCR method for diagnosing COVID-19 infections in special areas during outbreaks.

METHODS: In this cross-sectional study design, the sample group consisted of individuals in a designated prison facility with a COVID-19 outbreak who underwent testing using both ATK and the RT-PCR method to validate the outcomes. The data were analyzed using statistical analysis and the accuracy indices were determined.

RESULTS: In the conducted study, the total population under examination comprised 954 individuals. Among them, 274 ATK results could not be interpreted, and 30 samples could not be confirmed using the RT-PCR method. In one instance; as such, the ATK interpretation and RT-PCR confirmation were not possible. Consequently, a total of 651 results were available for comprehensive analysis. The accuracy indices for ATK were calculated as follows: Sensitivity=83.4% (95%CI, 80.3-86.2), Specificity=100% (95%CI, 82.4-100), Positive Predictive Value=100% (95%CI, 99.3-100), Negative Predictive Value=15.3% (95%CI, 9.48-22.9). The average cycle threshold (Ct) values in the ATK-positive and negative groups were 20.5±3.2 and 22.6±5.6, respectively.

CONCLUSIONS: In contexts closely related to this study, when an ATK test yielded a positive result, it allowed for immediate classification and treatment within the infected group. Thus, the group maintained their isolation from the non-infected population and awaited confirmation through RT-PCR testing. Therefore, strict preventive measures should be practiced to avoid getting infected or spreading the virus further.

Dengue Fever Surveillance System Evaluation at Phanthong Hospital 2022

2023-11-30T11:46:08+07:00

BACKGROUND: Dengue fever is a significant public health problem in Thailand. There is a seasonal outbreak pattern that can be found throughout the year. Thus, an effective surveillance system is required. The situation of the COVID-19 pandemic has impacted the strength of disease surveillance. Therefore, the disease surveillance system was evaluated to check whether the system remains strengthened.

OBJECTIVES: To study the disease reporting process of the surveillance system, quantitative and qualitative characteristics were evaluated, and ways to develop the dengue fever surveillance system were determined.

METHODS: A cross-sectional descriptive approach was used by reviewing the medical records of patients who were diagnosed with dengue fever and similar disease groups from 1 January to 31 December 2022 and interviewing personnel via the created questionnaire. The data were analyzed using descriptive statistics and content analysis.

RESULTS: A total of 91 patients met the disease criteria, and 60 patients were reported in the surveillance system. It was found that the sensitivity of disease diagnosis was 65.9% and the accuracy of disease reporting or predictive positive value was 95.2%. The information in the surveillance system was recorded completely at 100%. The gender and age variables were correct at 100%, while the address at the time of illness was correct at 82.5%, and the date of illness onset was correct at 63.5%. The reporting data matched and could be representative. Cases were reported in a timely manner. Executives accepted and gave importance to using data to continuously monitor and supervise work. The staff understood the system and had backup staff. Disease codes were updated according to defined provisions. The hospital had a patient care system during official time, out time and emergency. The budget was sufficient.

CONCLUSIONS: The surveillance system reporting process follows provincial guidelines. All quantitative and qualitative characteristics were within acceptable limits. The results of the study could be used to develop the strength of disease surveillance, prevention and control in the area.

Synthesizing the Integrated Model for Promoting Elderly Health by Wellness Plan Application in Chonburi Province

2023-11-27T09:19:34+07:00

BACKGROUND: The implementation of a wellness plan to promote health among the elderly is regarded as a vital lesson in Chonburi province.

OBJECTIVE: To synthesize an integrated model for promoting health among older people through the implementation of a wellness plan.

METHODS: This applied research employed mixed-methods data collection, consisting of three phases: a situational analysis of activities promoting health among older people, the implementation of the wellness plan, and monitoring and evaluation. The sample groups consisted of 15 health promotion providers and 750 older people living in Chonburi. All research instruments met appropriate research tool quality standards. Data were collected between April and October 2023. Quantitative data were analyzed using descriptive statistics and paired t-test, while the qualitative data were analyzed using both content and thematic analysis.

RESULTS: The success of an integrated model for promoting health comprises three key components: health workforce, budget, and implementation based on the PIRAB principles at the district and sub-district levels. This model operates through a mechanism of planning, elderly health screening, individual wellness plan development, implementation, evaluation, and recommendations for development. The success factors are contingent upon collaboration within the healthcare network. The results of the wellness plan implementation revealed that 100% of the older people used the individual wellness plan. After utilization of this plan, 75.5% of the older people had a statistically significant reduction in risk along with an increase in health literacy (t=-7.103, p<0.001).

CONCLUSIONS: The integrated model for promoting health among older people in Chonburi province involves crucial processes driven by a network that includes government, local sectors, and older leaders. This collaborative approach fosters learning about the wellness plan through planning, implementing, and evaluation, aiming for sustainable development.

The Effectiveness of Anti-Fungal Air Filter Coating with Endophytic Fungi Extract Against Airborne Fungi

2023-12-14T17:16:52+07:00

BACKGROUND: Mold in the air may cause respiratory infections and worsen conditions in persons with weakened immune systems. Consequently, fungal contamination from the surrounding environment that inhibits pathogen development is not allowed in mycology laboratories. Due to this issue, an innovative portable air filter was created that reduces fungal contamination by coating the air filter with endophyte fungus extract.

OBJECTIVE: To investigate the effectiveness of an anti-fungal air filter coating with endophytic fungi extract against airborne fungi.

METHODS: An experimental study, comprising experimental and control groups. Experimental instruments included innovative petri dishes, culture media, transportable air filters, microscopes, and colors. The settle plate approach, which involves opening a plate of food and collecting the fungus, was evaluated in the lab to gather 25 areas. To extract natural products from endophytic fungi, the quantity and type of fungus in a portable air filter room with coating were compared with one without as natural products were extracted from endophytic fungi. Descriptive statistics were used to examine the data, which covers the period of 1 October 2022 to 30 September 2023, to determine the number, percentage, and type of fungus.

RESULTS: To extract natural products from endophytic fungus, the effectiveness of an innovative portable air filter was compared to its non-coated counterpart. Upon activating the machine, it achieved a maximum air filtration rate of 1,346.80 CMH/Hr. in 0, 10, 20, and 30 minutes. Next, by arranging 25 culture agar plates (SAD), 25 sample areas were collected. By identifying the type of fungus, it was found that the laboratory lacked a covering for extracting natural products from endophytic fungi containing 72, 20, 12, and 5 colonies, respectively: Penicillium spp., Alternaria spp., Aspergillus spp., Cladosporium spp., Mucor spp., and Rhizopus spp. In contrast, in the room in which a coating to extract natural substances from endophytic fungus was present, fungi were discovered to be present in 72, 1, 4, and 0 colonies, respectively. These included Penicillium spp., Alternaria spp., Aspergillus spp., Cladosporium spp., Mucor spp., and Rhizopus spp.

CONCLUSIONS: An air filtration rate of 1,346.8 CMH/Hr is the maximum capacity for investigating innovative mobile air filters. Endophytic fungi are extracted by coated air filters, which lowers the quantity and variety of fungal contamination.

The Effect of Phacoemulsification on Intraocular Pressure in Primary Angle Closure Glaucoma (PACG) Patients at Phanatnikhom Hospital, Chonburi Province

2023-12-04T08:27:15+07:00

BACKGROUND: Primary angle closure glaucoma (PACG) is a leading cause of blindness worldwide, including in Thailand. This problem impacts the overall health of populations and healthcare systems globally. Treatment guidelines for each stage are different. Therefore, the factors that affect treatment should be explored to plan for appropriate patient care in the future.

OBJECTIVES: The study aimed to examine the effects of cataract surgery by phaco-emulsification on intraocular pressure and to determine the factors associated with intraocular pressure among primary angle closure glaucoma patients.

METHODS: A retrospective descriptive study was conducted on 121 patients with primary angle closure glaucoma who had undergone phacoemulsification between October 1^st 2017 and September 30^th 2022. The preoperative and postoperative record forms were used as the research instrument. Information concerning visual acuity, intraocular pressure, the number of glaucoma medications and ocular biometric parameters was collected. Descriptive statistics, Paired sample t-test, Repeated measures ANOVA, and Multiple linear regression were used to analyze the outcomes. A p-value <0.05 was considered statistically significant.

RESULTS: From the total of 121 patients, most were female (79.3%), and the mean age was 67.9±8.4 years old. Mean postoperative Intraocular pressure (IOP) decreased significantly from 17.9±5.1 at baseline to 12.1±2.5 mmHg (p<0.001). Eyes with higher preoperative IOP had the greatest IOP-lowering effect (p<0.001), while visual acuity improved significantly (logMAR decreased 0.8, p<0.001) and the number of glaucoma medications decreased significantly (p<0.001). Preoperative IOP was the important factor affected by IOP reduction (β=0.86, p<0.001).

CONCLUSIONS: Phacoemulsification not only improves visual acuity but also enables a significant decrease in IOP and glaucoma medications. Preoperative IOP is associated with a decrease in postoperative IOP. However, other ocular biometric parameters should be examined to predict the association of preoperative IOP reduction and plan for patient care in the future.

Diagnosis Test of Real-time Polymerase Chain Reaction (RT-PCR) for Pulmonary Tuberculosis

2024-02-01T10:11:27+07:00

BACKGROUND: Pulmonary tuberculosis remains the leading cause of morbidity and mortality in Thailand. The microbiological detection of TB is important because of early and correct diagnosis, drug resistance testing and it ensures that the effective treatment can be achieved and in a timely manner. Mycobacterial culture is the gold standard diagnostic test. Currently, a real-time polymerase chain reaction (RT-PCR) assay, such as Allplex™ MTB/MDRe Detection, Seegene is commonly used.

OBJECTIVE: To evaluate the diagnosis value of the real-time multiplex PCR by using Allplex™ MTB/MDRe Detection kit to detect MTB from sputum specimens with a gold standard TB culture.

METHODS: A retrospective study design of adult patients (>15 years) with suspected pulmonary M. tuberculosis infection was conducted from January 2023 until October 2023, at Khon Kaen Hospital. The sample size was 101 cases. Sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV) of Allplex™ MTB/MDRe Detection, each with its respective 95% confidence interval (95%CI) were analysed and compared to MTB culture as the gold standard.

RESULTS: A total of 120 cases was included, and of these, 86 (71.6%) and 73 (60.8%) cases were diagnosed with pulmonary TB by Allplex™ MTB/MDRe and MTB culture, respectively. Sensitivity, specificity, and accuracy of Allplex™ MTB/MDRe for MTB detection were 97.3% (95%CI, 90.5-99.6), 68.1% (95%CI, 52.8-80.9) and 85.8% (95%CI, 78.3-91.5), respectively. The PPV and NPV were 82.5 % (95%CI, 75.7-87.8) and 94.1% (95%CI, 80.1-98.4). Positive (LR+) and Negative Likelihood Ratio (LR-) were 3.1 (95%CI, 2.0-4.6) and 0.04 (95%CI, 0.01-0.16).

CONCLUSIONS: The Allplex™ MTB/MDRe Detection kit is effective in detecting Mycobacterium tuberculosis to achieve standard treatment.

Black Galangal

2024-03-14T16:43:15+07:00

Black galangal has a scientific name: Kaempferia parviflora Wallich. Ex Baker., is a medicinal herb known for its properties in nourishing strength and enhancing sexual performance. According to the research studies, it has been found that black galangal extract can inhibit the activity of nitric oxide synthase. Moreover, using a black galangal compress can relieve muscle pain especially at shoulder region. And cream from black galangal extract that use in patients with osteoarthritis can reduced knee pain. However, study of the acute and chronic toxicity of black galangal in rats, no changes were found due to the toxicity of black galangal.

Clinical Quiz

2024-03-14T17:04:43+07:00

Jones fracture

Competencies for Future Executives and the Powerful Assessment Methods

2024-02-08T15:48:07+07:00

Executives serve as the primary driving force of the agency under the context of VUCA World that is constantly dependent on various factors. Objectives of the research are to study, analyze, and synthesize the picture of the world of management in the future, the competencies of executives that are consistent with the future landscape of management, and propose methods or tools for evaluating competencies and performance of executives. The research method used in this study is the mixed-method approach. Data were collected through 13 key informants’ in-depth interviews, and survey questionnaires were administered to 345 respondents.

The results indicate that the future of management will persist within a VUCA world characterized by climate change, geopolitics, population structure, health considerations, technological disruptions, and the concept of clean energy. Executives are expected to possess competencies in leadership, morals and ethics, technology and innovation literacy, change management, business acumen, and strategic prediction. Regarding methods and tools for evaluating competency, most organizations utilize in assessing employee competencies and performance by objective and key results (OKRs), key performance indicators (KPIs) and other competency assessment tools as appropriate.