Ramathibodi Medical Journal https://he02.tci-thaijo.org/index.php/ramajournal <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="https://www.asean-cites.org/" 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="https://tci-thailand.org/" 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="https://search.crossref.org/?q=ramathibodi&amp;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="https://scholar.google.co.th/citations?user=N7b2p9MAAAAJ&amp;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> Faculty of Medicine Ramathibodi Hospital, Mahidol University, THAILAND en-US Ramathibodi Medical Journal 0125-3611 Editor's Note https://he02.tci-thaijo.org/index.php/ramajournal/article/view/246252 <p style="text-align: justify;">As the end of third quarter of 2020, the coronavirus disease 2019 (COVID-19) situation is still worsening in many countries especially overcrowded country like India. Controlling of infection in overcrowded communities are quite challenging. Several clinical trials of vaccine of COVID-19 are ongoing with few candidates have already go to phase 3 trial. It needs to be noted that the first COVID-19 vaccine has been registered in Russia since August.<sup>1</sup> The data of safety and efficacy of this COVID-19 vaccine came from only 38 subjects.<sup>2</sup> This fact makes scientists around the world expressed some doubt of the data.<sup>3</sup> However, the lead author of the report denied all the suspicions.</p> <p style="text-align: justify;">In term of scientific publication of COVID-19, recent searching in PubMed reveal over 58 000 results and 3489 clinical trials registered in ClinicalTrials.gov. This is a huge number for the period of less than 10 months. We all realize that COVID-19 has change the world in many aspects, and scientific publication is one of those.</p> <p>&nbsp;</p> Chusak Okascharoen Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-10-01 2020-10-01 43 3 Prevalence of Influenza Virus Type and Subtype at Siriraj Hospital, Bangkok, Thailand During 2013 - 2017 https://he02.tci-thaijo.org/index.php/ramajournal/article/view/241918 <p style="text-align: justify;"><strong>Background:</strong> Influenza A (pandemic and seasonal H1/H3) and influenza B viruses were the predominant circulating seasonal influenza strains. Following its massive outbreak in 2009 globally, including Thailand, influenza A (H1N1) pdm09 viruses have replaced the previous seasonal H1 strain and become one of the circulating strains ever since. Both influenza A and B viruses are highly contagious and potentially cause respiratory illness ranging from mild to severe.</p> <p style="text-align: justify;"><strong>Objective:</strong> To determine the prevalence of types and subtypes of circulating influenza virus strains in Bangkok, Thailand during 2013 - 2017.</p> <p style="text-align: justify;"><strong>Methods:</strong> The 4385 nasopharyngeal wash specimens were collected from patients presented with influenza-like illness from January 2013 to December 2017 at Siriraj Hospital, Bangkok, Thailand. Influenza virus types and subtypes were determined using real-time RT-PCR technique. Clinical characteristics of patients infected with influenza A viruses and influenza B virus were compared and analyzed.</p> <p style="text-align: justify;"><strong>Results:</strong> Of 4385 nasopharyngeal wash specimens, the prevalence of influenza virus infection during 2013 - 2017 was 18.22% (n = 799). Of 799 influenza-positive samples, 608 (76.09%) and 191 (23.90%) samples were positive for influenza A and influenza B viruses, respectively. Most patients were presented with fever, cough, and runny nose; however, patients infected with influenza A virus generally had higher severity than those with influenza B virus infection (<em>P</em> &lt; .05).</p> <p style="text-align: justify;"><strong>Conclusions:</strong> The findings provided the characteristics of influenza virus types and subtypes at Siriraj Hospital, Bangkok, Thailand during 2013 - 2017. Sporadic cases of influenza occurred all year round, but the incidence peaked in March 2014 and August 2017. The outcomes of this study are potentially useful for prevention, treatment, and disease monitoring.</p> <p style="text-align: justify;">&nbsp;</p> Nattapol Narong Siriwat Manajit Sirikarn Athipanyasil Niracha Athipanyasilp Ruengpung Sutthent Wannee Kantakamalakul Navin Horthongkham Chutikarn Chaimayo Archiraya Pattama Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 1 7 10.33165/rmj.2020.43.3.241918 The Timing of Umbilical Cord Clamping and Its Effect on Maternal and Neonatal Outcomes in a Private Hospital, Bangkok, Thailand https://he02.tci-thaijo.org/index.php/ramajournal/article/view/234597 <p style="text-align: justify;"><strong>Background:</strong> The timing of umbilical cord clamping after birth is important to neonatal health, and immediate umbilical cord clamping may have negative effects on the newborn’s health. In 2017, the American College of Obstetricians and Gynecologists recommended a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30 to 60 seconds after birth.</p> <p style="text-align: justify;"><strong>Objective:</strong> To study the timing of umbilical cord clamping after birth and its effects on mothers and newborns in a private hospital.</p> <p style="text-align: justify;"><strong>Methods:</strong> The descriptive prospective observational study was conducted in the labor ward of a private hospital in Bangkok, Thailand. A total of 159 pregnant women were purposively recruited during August 1, 2017, to September 30, 2017. The time after the birth of the umbilical cord clamping was observed and recorded without the knowledge of the obstetricians. Data were analyzed using descriptive statistics.</p> <p style="text-align: justify;"><strong>Results:</strong> The mean time of the umbilical cord clamping was 6.20 ± 1.42 seconds (range, 2 - 10 seconds) after the birth which was shorter than the recommendation. No significant association was found between variables and the timing of the umbilical cord clamping. No significant adverse neonatal condition was found.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> This study found that time of umbilical cord clamping in a private hospital was shorter than the recommendation and no known side effect to newborns.</p> <p style="text-align: justify;">&nbsp;</p> Chatchada Janngiab Somsak Suthutvoravut Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 8 14 10.33165/rmj.2020.43.3.234597 Factors Influencing on the Duration of Breastfeeding in Ramathibodi Hospital Personnel https://he02.tci-thaijo.org/index.php/ramajournal/article/view/218806 <p style="text-align: justify;"><strong>Background:</strong> Breast milk is the best food for newborn and the important base in physical mental intellectual and emotional development.</p> <p style="text-align: justify;"><strong>Objective:</strong> To identify rate of exclusive breastfeeding at least 6 months and to influencing factors on duration of breastfeeding in Ramathibodi Hospital personnel.</p> <p style="text-align: justify;"><strong>Methods:</strong> This study was a cross-sectional study. Participants were 483 Ramathibodi Hospital personnels who gave birth at Ramathibodi Hospital from October 1, 2012, to September 30, 2015. Instruments were demographic data and breastfeeding history questionnaires. Data were analyzed by descriptive statistics and the correlation between the factors associated with breastfeeding used chi-square test and multiple logistic regression analysis.</p> <p style="text-align: justify;"><strong>Results:</strong> Questionnaires were returned 329 (68%). Exclusive breastfeeding for first 6 months was 20%. The finding showed that age, level of education, occupation, average family income per month, duration of breastfeeding intention, breastfeeding instruction at antenatal care clinic, and personnel have breast milk before discharge were related to the duration of breastfeeding for more than or equal 6 months (<em>P</em> &lt; .05). Occupation and duration of breastfeeding intention predicted the duration of breastfeeding in Ramathibodi Hospital personnel 17.2%.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> This study showed that high age, high level of education, maternal occupation, high family income, duration of breastfeeding intention, breastfeeding instruction at antenatal care clinic, and personnel having breast milk before discharge related to the duration of breastfeeding for equal or more than 6 months. The predictable factors on the duration of breastfeeding for equal or more than 6 months were occupation and duration of breastfeeding intention.</p> Matthana Sangwarn Kanjana Naromrum Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 15 26 10.33165/rmj.2020.43.3.218806 Patient Transportation During the COVID-19 Pandemic https://he02.tci-thaijo.org/index.php/ramajournal/article/view/241347 <p style="text-align: justify;">Coronavirus disease 2019 or COVID-19 can be transmitted by several methods, which are droplet, contact, and aerosol transmission. This emerging infectious disease has no specific treatment, vaccines, or medical prophylaxis. As a result, health care workers have a higher risk of infection, especially on inter-hospital patient transferring, which causes the close-contact situation in confined space without good ventilating airflow. Proper pre-transferring evaluation of the patient and equipment preparation is essential for preventing unpredicted events that cause aerosol-generating procedures (AGP). Thus, if a patient is at risk of deterioration between transferring, early intubation in hospital is preferred due to better infection controls. Bronchodilators should be given by metered-dose inhaler (MDI) via spacer instead of nebulization. Furthermore, considering the safety of health care personnel, suitable personal protective equipment (PPE) is critical in the scarce situation, which is as vital as the standard of practice and training on the operations, communications, and cleanings.</p> <p style="text-align: justify;">&nbsp;</p> Panvilai Tangkulpanich Jeeranun Boriboon Kasamon Ararmvanich Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 27 33 10.33165/rmj.2020.43.3.241347 Histology Study in Undergraduate Medical Education https://he02.tci-thaijo.org/index.php/ramajournal/article/view/242429 <p style="text-align: justify;">Histology is an essential field in the education of medical students, and competent knowledge in histology is very important when studying pathology. Current teaching methods for histology in medical schools involve using a conventional light microscope (CM) with or without a virtual microscope (VM). This review aims to present advantages and disadvantages of using CM and VM in terms of teaching and learning histology in the context of undergraduate medical education. One major advantage of the traditional CM histology learning method in laboratory practice is that this allows students to practice using a light microscope; however, study flexibility is limited as the students cannot take the microscope back home for self-study after the histology class has finished. Costly repairs and maintenance must also be considered when using CM. By contrast, VM technology can provide flexibility and convenience for both students and staffs. This method allows students to both self-study and group-study almost anywhere at any time. This review emphasizes that histology learning in undergraduate medical education using VM is no longer confined to the classroom. However, the basic skill of how to operate a conventional light microscope is still important for medical students because CM is commonly used in the hospital laboratories and some hospitals may not be equipped with VM technology.</p> <p style="text-align: justify;">&nbsp;</p> Pakpoom Thintharua Permphan Dharmasaroja Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 34 40 10.33165/rmj.2020.43.3.242429 Intractable Bronchopleural Fistula After Lung Resection in Mycobacterial Infection; Surgical and Endoscopic Treatment With Fibrin Glue Application Followed by Latissimus Dorsi Musculocutaneous Flap Coverage: A Case Report https://he02.tci-thaijo.org/index.php/ramajournal/article/view/240586 <p style="text-align: justify;">Postoperative bronchopleural fistula (BPF) is a challenging and complicated problem to cope with. Involving with multidisciplinary care team is essential for the best outcome. This report provides our experiences in intractable BPF after lung resection surgery which fail to completely heal after received surgical and endoscopic treatment. A 56-year-old female with no known underlying disease presented with nonmassive hemoptysis, productive cough, low-grade fever, and significant weight loss for 3 years. Her sputum consisted of <em>Mycobacterium abscessus</em> with multidrug resistant. Radiological examination revealed reticulonodular infiltration at middle lobe of the right lung and lingular lobe of the left lung, also a bronchiectatic change of both lungs. After 3 years of medical treatment, neither of her symptoms nor radiological findings improved. Therefore, a video-assisted thoracoscopic surgery (VATS) with middle lung lobectomy and lingulectomy was performed. After that, BPF at lingular stump occurred. Many surgical and endoscopic techniques followed by latissimus dorsi musculocutaneous flap along with vacuum dressing were introduced to encourage the complete healing of the BPF. One month later, the patient’s clinical was improved and endoscopic findings showed nearly complete healing of the BPF. In conclusion, surgical and endoscopic treatments combined with postoperative vacuum dressing encourage patient’s symptoms to be subsided.</p> Kanit Wittayavanichai Kollawat Jaruniphakul Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-09-30 2020-09-30 43 3 41 47 10.33165/rmj.2020.43.3.240586