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/250430 <p>Nowadays, journal editors need to work harder. Not only journal editorial relating jobs, but also adapting to digital world that people read less, view and listen more. Recently, Deputy Editor Edward H. Livingston, MD, and Editor in Chief Howard Bauchner of the <em>Journal of American Medical Association</em> (<em>JAMA</em>) have resigned from the position. The cause is the uproar of people over the podcast called “Structural Racism for Doctors: What Is It?”<sup> 1, 2</sup> &nbsp;I will not go into the detail of racism issues that have been comprehensively covered elsewhere. This editorial note will discuss editorial jobs like creating a podcast.</p> <p>“Why journal editors who are supposed to be good at editorial jobs need to create a podcast?”</p> <p>I think this is the question that should be asked, not just the issue of racism. It has long been realized that medical journals need to be evolved.<sup>3</sup> At the 16th Annual Meeting of the International Society for Medical Publication Professionals (ISMPP)<sup>4</sup> in 2020, there are recommendations for publishing professionals from the meeting as follows:<br>- understand audiences’ unique content and channel preferences<br>- develop new systems to enable efficient tailoring of content across these audiences<br>- increased retention and understanding of information with visual communication<br>- expanding array of multichannel opportunities with emerging digital platforms to reach our audiences</p> <p>As we can see from the list of recommendations, a journal editor’s conventional skillset is unlikely to be enough for the future anymore. Traditional journal editors without appropriate skillsets who try to adapt to the digital world may fail, as the example of Dr. Livingston and Dr. Bauchner.</p> <p>&nbsp;</p> Chusak Okascharoen Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-04-08 2021-04-08 44 1 Association Between Vitamin D Levels and Vitamin D Receptor FokI Polymorphism in Thai Postmenopausal Women With Osteoporosis https://he02.tci-thaijo.org/index.php/ramajournal/article/view/246575 <p style="text-align: justify;"><strong>Background:</strong> Osteoporosis is a complex genetic disease, which is common among postmenopausal women. It is characterized by decreased bone mineral density (BMD) and increased bone fragility and fractures.</p> <p style="text-align: justify;"><strong>Objective:</strong> To study the association between serum vitamin D levels and vitamin D receptor (VDR) genetic <em>FokI</em> polymorphism in postmenopausal women with osteoporosis.</p> <p style="text-align: justify;"><strong>Methods:</strong> A total of 60 postmenopausal women who came for treatment at the menopausal clinic at Ramathibodi Hospital were enrolled. All of the patients had their BMD measured, and were determined serum vitamin D levels and VDR <em>FokI</em> polymorphism. Data were analyzed using chi-square and Fisher exact tests. The frequency of single nucleotide polymorphism (SNP) with risk of osteoporosis was compared.</p> <p style="text-align: justify;"><strong>Results:</strong> Among 60 postmenopausal women, 26 (43.3%) women were an osteoporotic group and 34 (56.7%) women were non-osteoporotic group. There were no significant differences in age, vitamin D levels, or VDR <em>FokI</em> polymorphism between the groups (<em>P</em> &gt; .05). However, the TT genotype of VDR <em>FokI</em> polymorphism was significantly associated with vitamin D deficiency (&lt; 20 ng/mL) (OR, 6.15; 95% CI, 1.51 - 25.14; <em>P</em> &lt; .05).</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Vitamin D levels and genotype of VDR <em>FokI</em> polymorphisms were similar between the osteoporotic and non-osteoporotic postmenopausal women. The TT genotype of VDR <em>FokI</em> polymorphism showed a significant association with vitamin D deficiency. Therefore, TT genotype of VDR <em>FokI</em> polymorphism may be used to predict risk of vitamin D deficiency.</p> <p style="text-align: justify;">&nbsp;</p> Napatsanant Rojanasrirat Somsak Suthutvoravut Pattamawadee Yanatatsaneejit Anna Wongkularb Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 1 10 10.33165/rmj.2021.44.1.246575 Comparison of the Overtime Fasting Plasma Glucose Between Patients Receiving Angiotensin Receptor Blocker (ARB) and Non-ARB Drugs https://he02.tci-thaijo.org/index.php/ramajournal/article/view/245230 <p style="text-align: justify;"><strong>Background:</strong> Previous studies have shown a relationship between renin angiotensin aldosterone system (RAAS) and insulin resistance. This in turn can delay the onset of diabetes mellitus (DM). The impact of angiotensin receptor blocker (ARB) on the fasting plasma glucose (FPG) level is not clear.</p> <p style="text-align: justify;"><strong>Objective:</strong> To compare the overtime FPG between ARB and non-ARB using.</p> <p style="text-align: justify;"><strong>Methods:</strong> A retrospective-longitudinal cohort study, data were collected from medical records of hypertensive patients who were not diagnosed DM in 2007 and 2008, each patient was followed up 10 years. The association between antihypertensive drugs and FPG by multilevel mixed-effects linear regression was evaluated. Multistate Markov chain model was used to evaluate the probability to become pre-DM or DM stage.</p> <p style="text-align: justify;"><strong>Results:</strong> Of 822 patients, 571 patients were excluded and 251 patients met criteria for analysis. From multilevel mixed-effects linear regression, ARB usage was associated with a nonsignificant decreased FPG when adjusted with visit (mean FPG change, -0.98; 95% CI, -2.65 to 0.69; <em>P</em> = .25) and with visit plus glomerular filtration rate (mean FPG change, -1.89, 95% CI, -4.88 to 1.19; <em>P</em> = .24). The probability of change in 10 years from normal to pre-DM stage was 0.41 and 0.38, normal to DM stage was 0.03 and 0.01, pre-DM to DM stage was 0.08 and 0.04, in non-ARB and ARB group, respectively.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> ARB tended to decrease probability to become DM. Thus, physicians should prescribe ARB in hypertensive patients to prevent new-onset DM.</p> <p style="text-align: justify;">&nbsp;</p> Namtip Burapakiat Tharntip Sangsuwan Silom Jamulitrat Thammasin Ingviya Napakkawat Buathong Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 11 20 10.33165/rmj.2021.44.1.245230 Comparison of Video Laryngoscope and Macintosh Laryngoscope for Face-to-Face Intubation in Sitting Manikin Model With Limitation of Neck Motion by Unexperienced Personnel https://he02.tci-thaijo.org/index.php/ramajournal/article/view/228125 <p style="text-align: justify;"><strong>Background:</strong> Trauma patients who entrapped in the accident vehicle are predispose to have cervical spine injuries and they needed to be intubated with face-to-face intubation technique using Macintosh laryngoscope. Nowadays, video laryngoscope has been introduced to improve the intubation technique.</p> <p style="text-align: justify;"><strong>Objective: </strong>To compare the effectiveness of video laryngoscope and Macintosh laryngoscope for face-to-face intubation in sitting manikin model with limitation of neck motion.</p> <p style="text-align: justify;"><strong>Methods:</strong> The study was performed in a randomized experimental study. Subjects were divided into 2 groups both did face-to-face intubation using video laryngoscope and Macintosh laryngoscope in a sitting manikin model with limitation of neck motion. The success rate of intubation, time to finish intubation, and vocal cord visualization were analyzed.</p> <p style="text-align: justify;"><strong>Results:</strong> Of 41 subjects including 2nd and 3rd year paramedic students, 21 subjects went to video laryngoscope group, and 20 subjects went to Macintosh laryngoscopes group. The Macintosh laryngoscope intubation technique showed significantly better success rate compared to video laryngoscope (100% and 25%, <em>P</em> &lt; .001). In addition, intubation time of Macintosh laryngoscope was significantly less than video laryngoscope (mean [SD], 27 [24.7] and 75 [66.3] seconds, <em>P</em> &lt; .001). However, vocal cord visualization from both laryngoscope techniques showed no statistically significant (<em>P</em> = .08).</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Intubation training of Macintosh laryngoscope for in sitting model with neck motion limitation showed better success rate and less time than video laryngoscope, with the same vocal cord visualization.</p> <p style="text-align: justify;">&nbsp;</p> Phatthranit Phattharapornjaroen Promphet Nuanprom Prayoot Suk-um Manina Thilarak Chaiyaporn Yuksen Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 21 28 10.33165/rmj.2021.44.1.228125 Comparison of Knowledge, Skills of Exercise and Ambulation, Outcome of Care and Quality of Life Before and After Implementing the Hospital to Homecare Pathway for Patients With Total Knee Arthroplasty https://he02.tci-thaijo.org/index.php/ramajournal/article/view/230145 <p style="text-align: justify;"><strong>Background: </strong>The hospital to homecare pathway for patients with total knee arthroplasty was developed and needed to be evaluated for effectiveness and improvement.</p> <p style="text-align: justify;"><strong>Objective: </strong>To compare knowledge, skills of exercise and ambulation, outcomes of nursing care and quality of life before and after implementing the hospital to homecare pathway for patients with total knee arthroplasty (HHPTKA).</p> <p style="text-align: justify;"><strong>Methods: </strong>This quasi-experimental study was purposively selected 50 cases referred to the home health care unit, ambulatory care nursing service, Ramathibodi Hospital. The HHPTKA included providing and evaluating the knowledge, exercise and ambulation skill, and other outcomes at day 0 (before operation), day 3 (post operation), day 10 (home visit), and day 14 (outpatient follow-up). Data were collected by questionnaire and assessment tools which analyzed by descriptive statistics, paired <em>t</em> test, and analysis of variance (ANOVA).</p> <p style="text-align: justify;"><strong>Results: </strong>There were statistically significant differences before and after the implementation of HHPTKA (<em>P</em> &lt; .001). Mean scores of knowledge, skills of exercise and ambulation, quality of life, and degree of range of motion of knee were higher than before, pain score was decreased, and knee extension was increased. Only 1 case faced with wound bleeding at day 14 post operation.</p> <p style="text-align: justify;"><strong>Conclusions: </strong>HHPTKA could direct standard practice for home care nurses.<br><br></p> Parichart Pronsawatchai Suchitra Auefuea Yothaga Phanyateaim Wannapa Yensirikul Anong Dittasung Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 29 39 10.33165/rmj.2021.44.1.230145 Evaluation of 3 Common Methods for Effective Housefly Allergen Extraction https://he02.tci-thaijo.org/index.php/ramajournal/article/view/245935 <p style="text-align: justify;"><strong>Background:</strong> Allergen extracts have been applied to treat allergic diseases. Accordingly, a housefly <em>(Musca domestica) </em>extract is commonly used to treat patients severely allergic to housefly.</p> <p style="text-align: justify;"><strong>Objective:</strong> To evaluate 3 common methods, including grinding, sonication, and homogenization, for effective preparation of housefly allergen extracts.</p> <p style="text-align: justify;"><strong>Methods:</strong> Housefly allergens were extracted from <em>Musca domestica </em>using 3 different methods, including grinding, sonication, and homogenization. Protein concentrations and profiles in the extracts were determined by Bradford assay and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), respectively.</p> <p style="text-align: justify;"><strong>Results:</strong> The protein concentrations of the extracts prepared by grinding (mean [SD], 911.3 [159.7] µg/µL) and sonication (mean [SD], 905.7 [188.6] µg/µL) as measured by Bradford assay were significantly higher than those prepared by homogenization (mean [SD], 674.5 [60.0] µg/µL). Moreover, SDS-PAGE showed more protein bands in the extracts prepared using grinding and sonication compared to those prepared using homogenization.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> In comparison to homogenization, both grinding and sonication methods are superior ways to prepare housefly allergen extracts as evidenced by the higher quantities and composition of proteins.</p> <p style="text-align: justify;">&nbsp;</p> Chonvara Chalermrujinanant Panwadee Pluangnooch Kitipong Soontrapa Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 40 45 10.33165/rmj.2021.44.1.245935 Innovation in Diabetes Clinic: Insulin Injection Teaching Aid https://he02.tci-thaijo.org/index.php/ramajournal/article/view/174964 <p style="text-align: justify;"><strong>Background: </strong>Insulin injection education is important in diabetes mellitus patients’ treatment in order to control blood glucose levels.</p> <p style="text-align: justify;"><strong>Objective: </strong>To present a new innovative teaching method for insulin injection.</p> <p style="text-align: justify;"><strong>Methods: </strong>Samples included diabetes patients, who were taught the first insulin injection at the diabetes clinic, Ramathibodi Hospital. They were divided into 2 groups (35 patients in each group): the experimental group was taught by the abdomen model for injections, and the control group was instructed by a traditional lecture style. Three evaluation forms were used: 1) injection observation sheet; 2) self-evaluation sheet of understanding and injection skill of the diabetes patients; and 3) evaluate efficiency form of teaching insulin injection model.</p> <p style="text-align: justify;"><strong>Results: </strong>The study revealed that the experimental group understood injection methods both in terms of injection skills and confidence in self-injection at more than 97% except for fear. The study found that trypanophobia decreased 70.2% and fear of pain reduced 82.8%. The abdomen model teaching method yielded effective results to increase injection skills, knowledge, and understanding of self-injection.</p> <p style="text-align: justify;"><strong>Conclusions: </strong>This abdomen model is now used to teach insulin injection as a commercial product sold at the Center of Excellent Innovation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. This model is currently used as one of the medical tools for teaching insulin injection at the diabetes mellitus clinic of the medical outpatient unit of Ramathibodi Hospital.</p> <p>&nbsp;</p> Nampeth Saibuathong Rattanaporn Jeerawatana Taratip Pumkompol Saisunee Tubtimtes Copyright (c) 2021 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2021-03-26 2021-03-26 44 1 46 52 10.33165/rmj.2021.44.1.174964