Ramathibodi Medical Journal 2021-01-19T12:41:29+07:00 Assist. Prof. Dr. Chusak Okascharoen Open Journal Systems <p>Ramathibodi Medical Journal (RMJ) publishes article on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics. We welcome submissions from authors worldwide.</p> <p>ISSN 0125-3611 (Print)&nbsp;</p> <p>ISSN 2651-0561 (Online)</p> <p>Indexed in:&nbsp;&nbsp;<strong>&nbsp;&nbsp;<a title="ASEAN CITATION INDEX" href="" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/aci-logo-v41.png" width="100" height="40"></a>&nbsp; &nbsp;&nbsp;</strong><a title="ศูนย์ดัชนีการอ้างอิงวารสารไทย:Thai Citation Index (TCI) centre" href="" target="_blank" rel="noopener"><img title="tci" src="/public/site/images/tci_admin/tci.png" width="86" height="38" border="0"></a>&nbsp;&nbsp; &nbsp;<a title="Crossref" href=";container-title=Ramathibodi+Medical+Journal" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/images.png" width="77" height="50">&nbsp;</a>&nbsp; &nbsp;&nbsp;<a title="Google Scholar" href=";hl=th&amp;authuser=1" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/scholar_logo_64dp_(1).png" width="155" height="26"></a></p> Editor's Note 2020-12-24T09:10:55+07:00 Chusak Okascharoen <p>As the end of the year 2020 is coming, many things happened in this memorable year. We would like to summarize the changes that affect most of the biomedical publication community.</p> <p>The first phenomenon is the growth of preprints. Coronavirus disease 2019 (COVID-19) is indeed the potent stimulus of preprints. The evidence is the data from <em>medRxiv</em><sup>1</sup>, an Internet site distributing unpublished eprints about health science. In 2020 alone, more than two-thirds of articles in <em>medRxiv</em> (approximately 11 500 articles) are related to COVID-19.<sup>2</sup></p> <p>The second phenomenon is the changing of medical conferences as a result of social distancing and travel-banning policy. The majority of medical conferences have been canceled or moved to virtual conferences.<sup>3, 4</sup> The most significant impact of the change from in-person meeting to virtual meeting is the accessibility of audiences due to reduced time, financial burden, and resources needed.</p> <p>The last phenomenon is the exposure of faults in the peer-review process. This scandal comes from retractions of articles about COVID-19 by <em>The Lancet</em> and <em>The New England Journal of Medicine</em>, which are both the highest impact medical journals.<sup>5</sup> Both journals now require submission of the database as a data sharing policy for further inspection.</p> <p>In our views, these phenomena have permanently shaped biomedical publication into a new era.</p> <p>&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal Quantitative Differentiation of Renal Cell Carcinoma From Fat-Poor Angiomyolipoma and Between Renal Cell Carcinoma Subtypes by Using Three-Phase MDCT 2021-01-15T15:43:48+07:00 Sasiprapa Rongthong Tanakorn Pisutkawin Sith Phongkitkarun <p style="text-align: justify;"><strong>Background: </strong>Renal cell carcinoma (RCC) can be differentiated from angiomyolipoma by detection of macroscopic fat at multidetector computed tomography (MDCT). Measurement of enhancement at MDCT help classifying between RCC subtypes, which possibly predict tumor prognosis.</p> <p style="text-align: justify;"><strong>Objective: </strong>Retrospectively assess whether quantitative measurements (percentage enhancement ratio [PER] and absolute washout ratio [AWR]) of renal mass enhancement during three-phase MDCT help differentiating RCC from fat-poor angiomyolipoma and other RCC subtypes.</p> <p style="text-align: justify;"><strong>Methods: </strong>The retrospective review of the preoperative three-phase MDCT (unenhanced, corticomedullary, and early excretory phases) performed between January 2008 and July 2017, a total of 75 renal lesions (74 consecutive patients) were assessed for attenuation values in each phase. The enhancement values (PER and AWR) were compared by ANOVA tests. Cutoff analysis of enhancement values was performed to determine optimal threshold for each histologic subtype.</p> <p style="text-align: justify;"><strong>Results:</strong> The attenuation value of fat-poor angiomyolipoma was significantly higher than clear cell RCCs in unenhanced phase (<em>P</em> = .02). The PER of the clear cell RCCs was significantly lower than that of papillary RCCs, chromophobe RCCs, and fat-poor angiomyolipomas (<em>P</em> &lt; .001). The AWR of the clear cell RCCs showed significantly greater than that of papillary RCCs and fat-poor angiomyolipoma (<em>P</em> &lt; .001). The PER and AWR thresholds for differentiating RCCs from fat-poor angiomyolipoma were 93.0 and 31.6 with accuracy of 74.7% and 77.3%, respectively.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Quantitative measurement of enhancement (PER and AWR) might help differentiating RCCs from fat-poor angiomyolipoma, and differentiating clear cell RCCs from papillary RCCs.</p> <p style="text-align: justify;">&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal NoduleNet: A Lung Nodule Classification Using Deep Learning 2021-01-19T12:41:29+07:00 Ganesh Shah Ratchainant Thammasudjarit Ammarin Thakkinstian Thitiporn Suwatanapongched <p><strong>Background:</strong> Accurate detection and classification of lung nodules at an early stage can help physicians to improve the treatment outcomes of lung cancer. Several lung nodule classifications using deep learning have been proposed but they are lag of external validation to Thai patient data.</p> <p><strong>Objective:</strong> To propose a deep learning model called NoduleNet for lung nodule classification and perform internal and external validation of the proposed model.</p> <p><strong>Methods:</strong> Two datasets were performed; internal validation using LUNA16 (the public lung CT database), and external validation using ChestRama (37 chest CT scans retrospectively identified from the CT database of Ramathibodi Hospital between 2017 and 2019). The NoduleNet was built on top of pretrained architecture, VGG16, and VGG19 with customization.</p> <p><strong>Results:</strong> The NoduleNet showed impressive results in nodule classification. The best model achieved accuracy of 0.95 (0.94 - 0.96), sensitivity of 0.84 (0.82 - 0.86), and specificity of 0.97 (0.97 - 0.98) for internal validation, where the external validation results was accuracy of 0.95 (0.87 - 1.00), sensitivity of 0.91 (0.82 - 1.00), and specificity of 1.00 (1.00 - 1.00). There were 3 misclassified samples in external validation which are all false-negative.</p> <p><strong>Conclusions:</strong> The NoduleNet is able to generalize from non-Thai patient data to Thai patient data. It could be further improved by taking sequence of images into account, integrating with an automatic nodule detection algorithm, and adding more nodule types.</p> <p>&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal Rates and Factors Associated With Laxative Prescription Among Type 2 Diabetes Patients in Primary Care 2021-01-13T11:19:20+07:00 Kantapong Thamcharoensak Narucha Komolsuradej Napakkawat Buathong Kittisak Choomalee <p style="text-align: justify;"><strong>Background:</strong> Diabetes mellitus (DM) is a common noncommunicable disease. Several gastrointestinal symptoms such as diarrhea, chronic constipation, and fecal incontinence are often observed in DM patients; among these, chronic constipation is the most commonly reported. Given the growing prevalence of diabetes-associated chronic constipation, the problem of laxative prescribed without diagnosis of constipation among type 2 diabetes patients has been found in the primary care unit. Therefore, it should attend to investigate the rate and factors associated with laxative prescription in type 2 diabetes.</p> <p style="text-align: justify;"><strong>Objective:</strong> To evaluate the rate and factors associated with laxative prescription in type 2 diabetic patients at the primary care unit and general practitioner outpatient clinic at Songklanagarind Hospital.</p> <p style="text-align: justify;"><strong>Results:</strong> Overall, 386 patients diagnosed with type 2 diabetes were enrolled (55.7% female; mean age, 63.3 years; median duration of type 2 diabetes, 7 years; median visit in 5 years of each patient, 44 visits). Prevalence of laxative prescriptions was 16.6%. Rate of laxative prescriptions was 1.7% within 5 years. Patients with no diagnosis constipation according to ICD-10 about 81.2%. The statistically significant factors associated with laxative prescriptions in diabetic patients were age, number of hospital visit in 5 years, duration of type 2 DM disease, height, diastolic blood pressure, hemoglobin, hematocrit, serum uric acid, and glomerular filtration rate.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Most laxative prescribed diabetic patients were without written diagnosis of constipation. Factors associated with laxative prescriptions were age, number of hospital visit, duration of type 2 DM disease, height, diastolic blood pressure, hemoglobin, hematocrit, serum uric acid, and glomerular filtration rate.</p> <p>&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal Study of Side Effects of Patients Receiving Cisplatin in the Treatment of Cervical Cancer by Age Group 2021-01-13T11:19:57+07:00 Rachadapan Chaitosa Worathida Maskasame <p style="text-align: justify;"><strong>Background:</strong> Cisplatin is one of the options of chemotherapy used to treat cervical cancer. Patient can experience side effects from drugs frequently with many factors as a catalyst including the age of the patient.</p> <p style="text-align: justify;"><strong>Objective:</strong> To compare the side effects of cervical cancer patients receiving concurrent chemoradiotherapy (Cisplatin) 2 rounds between patients ≤ 60 years and &gt; 60 years.</p> <p style="text-align: justify;"><strong>Methods:</strong> A retrospective study, 70 cervical cancer patients undergoing concurrent chemoradiotherapy at Ramathibodi Hospital were investigated. Questionnaires about adverse effects were completed by patients at home 7 days after 1st and 2nd courses of combined therapy. The side effects of cervical cancer patients between groups was analyzed.</p> <p style="text-align: justify;"><strong>Results:</strong> Of 70 patients, there were 47 patients ≤ 60 years and 23 patients &gt; 60 years. After the 1st course, life-threatening side effects occurred in 9 patient’s ≤ 60 years but none occurred in patients &gt; 60 years. Younger patients also had significant more nausea than older patients (<em>P</em> &lt; .05). After the 2nd course, younger patients also had significant more vomiting than older patients (<em>P</em> &lt; .05). The most common side effects for both age groups were fatigue and anorexia respectively.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Patients younger than 60 year would experience significantly more symptoms of nausea and vomiting after the 1st and 2nd courses of concurrent chemoradiotherapy.</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal Role of Nutritional Support in Head and Neck Cancer Patients 2021-01-13T11:19:42+07:00 Chanita Unhapipatpong Daruneewan Warodomwichit <p style="text-align: justify;">Malnutrition could occur in patients with head and neck cancer due to the disease itself and the side effects of treatment. The consequences of malnutrition lead to the discontinuity of treatment and the deterioration of quality of life and prognosis. Nowadays, there are available tools for nutrition screening and assessment which could early identify the patient at risk malnutrition and give them the prompt nutritional interventions. Nutritional anagements, including nutrition counseling, modification of the diet, the supplement of oral nutritional supplement, enteral nutrition, and parenteral nutrition, have roles from the beginning to the end of head and neck cancer treatment and the proper nutritional interventions were associated with the better results. Nutrition interventions were an essential part in prevention and treatment of the postoperative complications such as chyle leakage and pharyngocutaneous fistula. The research involving in immunonutrients showed the efficacy in improvement of the clinical outcome of patients undergoing treatment for head and neck cancer. Therefore, appropriate nutrition interventions were important and required the multidisciplinary team approach.</p> <p style="text-align: justify;">&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal Integration of the WFME Standards and AUN-QA Criteria for Student Assessment in Undergraduate Medical Education 2021-01-13T11:20:11+07:00 Permphan Dharmasaroja <p style="text-align: justify;">Quality assurance (QA) is a broad-based activity, which encompasses both quality management and quality control, and requires all the policies, standards, systems and processes in place to maintain and improve medical education quality. QA can be managed through an institutional monitoring that should include the evaluation of teaching and learning approaches, and the assessment. Accreditation standards by international agencies such as the World Federation for Medical Education (WFME) are to be followed for an external quality assurance. In addition, the ASEAN University Network-Quality Assurance (AUN-QA) is the assessment criteria for promoting QA in higher educational programs in ASEAN countries. Both WFME and AUN-QA require that teaching and learning approaches and assessment methods be aligned to the program learning outcomes. The purpose of this review is to compare the WFME standards and the AUN-QA criteria on teaching and learning approaches and methods of assessment to encourage <br>the integration of these two QA systems for undergraduate medical education.</p> <p style="text-align: justify;">&nbsp;</p> 2020-12-24T00:00:00+07:00 Copyright (c) 2020 Ramathibodi Medical Journal