Royal Thai Army Medical Journal

Editorial

2024-06-30T19:49:18+07:00

Anatomy of Hip Joint

2022-06-29T16:00:16+07:00

Literature review: acquired comitant esotropia

2023-10-22T19:20:41+07:00

Strabismus is a condition in which both eyes do not correctly align. It could be either a congenital or acquired condition. The acquired squint causes double vision and headaches, which may interfere with daily activity. The acquired comitant esotropia is prominently found in the present era. There is usually no relationship with other abnormalities. However, we can find the abnormalities in the brain from previous literature. Treatment focuses on finding the cause and treating the etiology. It may need to look for a more severe disease, such as abducens nerve palsy. Symptomatic treatment includes wearing prism glasses, botulinum toxin injection, or even strabismus surgery. These modalities aim to treat double vision and restore stereo acuity.

The prevalence and factors associated with vitamin D deficiency among patients at the primary clinic of Pranangklao Hospital

2023-08-03T16:16:10+07:00

Background: Vitamin D, in addition to its role in controlling calcium and phosphate, still plays an important role in the treatment of cardiovascular disease, cancer, and non-communicable diseases (NCDs). Previous studies conducted abroad have revealed a high prevalence of vitamin D deficiency in patients attending primary care clinics. Estimating the magnitude of this problem in Thai primary care clinics can help develop appropriate support plans for affected individuals.

Objective: This study aimed to investigate the prevalence and factors associated with vitamin deficiency in patients attending primary care clinics.

Methods: A cross-sectional study was conducted at Pranangklao Hospital's primary care clinic from 1^st January to 31^st December 2022. Data on the vitamin D levels of 514 patients were collected and analyzed using multiple logistic regression in STATA version 14.

Results: Most of the patients were female, with an average age of 62.42 years, and dyslipidemia was the most common diagnosis. The prevalence of vitamin D insufficiency and deficiency was 46.69% and 34.24%, respectively. Hypertensive patients had a lower likelihood of vitamin D deficiency, with an odds ratio of 0.53.

Conclusion: The study highlights a high prevalence of vitamin D insufficiency and deficiency among primary care clinic patients. Effective strategies are needed to identify and provide appropriate treatment for these conditions.keywords: Vitamin D deficiency, Non-communicable disease, Primary care clinic

THE RELATIONSHIP BETWEEN INDOOR AIR QUALITY AND VENTILATION RATE, THE PREVALENCE OF SICK BUILDING SYNDROME, AND OCCUPANTS’ SATISFACTION IN NEW BUILDINGS

2024-02-07T18:29:26+07:00

Background The problem of air quality in new buildings is very important. People spend most of their time inside a building. Air pollution exposure through skin or breathing may occur within these structures. air quality exposure due to inadequate airflow may have an impact on sick building syndrome (SBS) incidences.

Objectives This cross-sectional study aimed to explore the relationship among IAQ, ventilation rate, the prevalence of sick building syndrome (SBS), and occupants’ satisfaction in two new buildings: an office building and outpatient building. IAQ parameters, i.e., temperature, humidity, velocity, light, Carbon dioxide (CO₂), formaldehyde, Total volatile organic compounds (TVOCs), and respirable dust concentrations, were measured. The demographic data, work experience, job information, SBS symptoms, and occupants’ satisfaction in IAQ were collected using a questionnaire. Chi-Square Test and Fisher's exact Test were used to test the relationship between the parameters mentioned above.

Results The highest prevalence rate was 47.3% for tiredness. Most of these occupants work in an area where the ventilation rates were lower than the recommended standard of ASHRAE 62.1-2019, Ventilation for Acceptable Indoor Air Quality, standard of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers. Furthermore, it was found that non-complied IAQ parameters were significantly associated with symptoms (p < 0.05), e.g., temperature and CO₂were correlated with headaches, while sickness was correlated with satisfaction of inappropriate temperature (p < 0.05).

Conclusion IAQ indicators, namely, temperature, CO2, and ventilation rate were associated with occupations’ symptoms and their IAQ satisfaction levels.

Reliability and Validity of a 2-Minute Walk Test in Coronary Artery Bypass Graft Patients

2024-04-26T13:23:18+07:00

Background: The 2-minute walk test (2MWT) has been studied to demonstrate its relationship and sensitivity to physical functions in coronary artery bypass graft (CABG) patients, however, the data on its reliability and validity in this group of patients compared to a 6-minute walk test (6MWT) are limited. Objective: This study aimed to determine the reliability and validity of the 2MWT compared with the 6MWT in CABG patients. Methods: This analytical study was conducted in 15 CABG patients at the outpatient cardiac rehabilitation clinic, Phramongkutklao Hospital. The patients were divided into two groups to participate in both the 2MWT and the 6MWT trials. The first group started with a trial of 2 times of 2MWT, then 1 time of 6MWT. The second group began with a trial of 1 time of 6MWT, then 2 times of 2MWT. The measurement of walking distance and maximum heart rate was recorded. Results: The reliability of two trials of 2MWT was 149.43 ± 30.96 meters and 148.12 ± 28.55 meters, respectively, with the intraclass correlation coefficient equal to 0.985 (p <0.001). Whereas, the validity of the first and second trials plus an average of 2MWT in both trials had a significant correlation with the 6MWT (r = 0.957, 0.931, and 0.951, respectively; p <0.001). The exercise intensity of 2MWT and 6MWT was 32.37 and 39.41 percent, respectively. Conclusion: The 2-minute walk test yields a high reliability and validity among CABG patients in outpatient cardiac rehabilitation clinic.

Effect of oral anti-coagulant on 12-month overall mortality rate in admitted elderly patient with newly diagnosed atrial fibrillation and atrial flutter

2024-06-25T15:30:08+07:00

Background: Atrial fibrillation increases the risk of ischemic stroke, contributing to increased disability and mortality. Nevertheless, the benefit of early initiation of oral anticoagulant (OAC) for stroke prevention in elderly with newly diagnosed atrial fibrillation (AF) during hospitalization for non-cardiac causes remains questionable.

Objective: To study the effect of OAC on the 12-month overall mortality rate in admitted elderly patient with newly diagnosed atrial fibrillation and atrial flutter

Methods: We conducted a retrospective cohort study involving hospitalized patients with non-cardiac causes at Siriraj Hospital in Thailand between 2003-2019. Participants aged more than 75 years and newly diagnosed AF were included. The primary outcome was overall mortality. Secondary outcomes were cardiovascular death, non-cardiovascular death, non-fatal stroke, bleeding events, and rehospitalization.

Results: We enrolled a total of 216 participants, with 24 in the OAC group and 192 in the non-OAC group. The predominant OAC used was warfarin (91.7%). Throughout the 1-year follow-up period, 6 deaths were observed in the OAC group, compared to 107 deaths in the non-OAC group. The hazard ratio (HR) for overall mortality was 0.33 (95% confidence interval [CI], 0.15-0.75; p-value = 0.08). Post-hoc power was 84% with an alpha of 0.05. However, non-cardiovascular deaths accounted for 96.4% of all deaths. There were 4 non-fatal strokes only in the non-OAC group. The HR for bleeding events was 6.11 (95% CI, 1.37-27.32; p-value = 0.018).

Conclusions: Non-cardiovascular death emerged as the primarily cause of death. The potential benefits of initiating OAC in elderly patients newly diagnosed with AF during hospitalization might be constrained by patients' active medical conditions. Nevertheless, the consideration of stroke prevention post-hospitalization in elderly remains warranted. Further prospective studies are required to determine the optimal timing for initiating OAC therapy, mainly warfarin to maximize the benefit of stroke prevention while minimizing bleeding risks.

Development of Special Study Module for Medical Curriculum based on Adaptive Curriculum Concept

2024-04-23T11:15:25+07:00

Introduction: The special study modules (SSM) of the Doctor of Medicine program is an educational program in the medical professional subject group aimed at developing learning skills based on medical students’ interest and competencies through a systematic adaptive learning framework. This research aims at studying the expectations towards educational management and developing of SSM in the medical degree program based on the adaptive curriculum concept.

Methods: This study utilized questionnaires to collect data on expectations of faculty members responsible for curriculum development and medical students regarding the SSM. The questionnaires were designed to focused on the priority order of modules within these two domains, the expectations for each module component and the adaptability method, with seven items per module. The data collected was then subjected to descriptive analysis, which aided in developing five SSM: Basic Medical Sciences (BMS), Clinical Medical Sciences (CMS), Community Medicine (CM), Specialty Clinical Practice (SCP), and Health Systems Science (HSS).

Results: Sixty-nine samples were collected from the total of 95 samples using simple random sampling technique, which is comprised of 38 sixth-year medical students (55.07%) and 31 faculty members (44.93%) from 19 medical faculties out of 22 institutions. The study revealed that faculty members and medical students gave the highest priority to the CMS module (Median = 5) across all institutions. Meanwhile, modules in BMC, CM, SCP, and HSS were rated highly important (Median = 4) across all regions, unlike from medical faculties in Bangkok, which rated all modules as the highest importance. In analyzing SSM components, it was found that the CMS module required the highest number of credits (at least 15 credits in years 4-6) compared to other modules: CM, SCP, HSS, and BMS, which should be allocated at least 14, 12, 12, and 10 credits, respectively. CM and HSS modules should be studied throughout the curriculum, unlike SCP, specific to clinical years, and BMS, confined to pre-clinical years. Most participants suggested these subjects integrate with the core curriculum (40.58% to 56.52%) and employ a mixed-learning approach. All modules should promote content-specific customization and provide module navigation for tailoring learning to the levels of learners under continuous guidance from an advising mentor.

Conclusion: Special study modules for specific subject areas that enhance students’ potential in accordance with their interests must organize subjects and module components specifically aiming to develop essential medical professional skills. Moreover, the SSMs should be adaptable to support medical students in selecting learning processes that match their interests and systematically correspond to their potentials.

The Development of an Oral Health Promotion Model using a Comprehensive Dental Care Application for the Army in the Thai Third Army Area

2024-05-11T12:32:12+07:00

Background: Oral health represents a global concern that has garnered significant attention from nations worldwide. The integration of information technology within healthcare constitutes a vital aspect in fostering well-being. Objectives: To develop an oral health promotion model using a comprehensive dental care application. The specific objectives are: 1) to diagnose the situation and needs for oral health promotion, 2) to develop the model using dental care application, and 3) to do a pilot test and evaluate the model. Material and methods: The research consists of three phases: Phase 1: Situation analysis, Phase 2: Model development based on data collected, and Phase 3 Model Testing and Evaluation. Phase 1, data were collected from two sample groups: Group 1 (270 participants) and Group 2 (15 participants), quantitative data collection was done using a set of questionnaires measuring oral health beliefs, oral health care behaviors, digital skills, and oral health status. And the guideline for in-depth interview was used to collect qualitative data from Group 2. Phase 2, a comprehensive dental care application was developed. Phase 3, the model was tested and evaluated with the sampled group of 60 individuals, experimental and comparison groups of 30 individuals each. Results: After the experiment, according to the statistical analysis employing Chi-square Test, Cross-tabulation, Fisher’s Exact test, t-test and Welch t-test, it was found that the experimental group had a significantly higher level of oral health beliefs, oral health care behaviors, and keeping appointment rate than the comparison group (P<0.05) and held the highest level of satisfaction of application using (Mean=4.61). Conclusions: With this oral health promotion model, patients can learn oral health care by themselves, resulting in improved oral health beliefs, oral health care behaviors, and oral health status.

The reliability and validity of the Thai version Epworth sleepiness scale for children and adolescents (ESS-CHAD) in pediatric obstructive sleep apnea

2024-01-02T16:39:06+07:00

Background : OSA, a condition that the upper airway collapsed momentarily while sleeping, consist of many symptoms, e.g. snoring, excessive daytime sleepiness. Because of high global prevalence, many questionnaires were developed. Epworth sleepiness scale was used for screening in adults. Subsequently, ESS-CHAD was created.

Objective : The objectives of this study are to evaluate the reliability and validity between ESS-CHAD and pediatric OSA, and to investigate the relationship between ESS-CHAD and severity of OSA.

Methods : 41 subjects (31 males and 10 females) were recruited and investigated for the reliability.. To check the discriminant validity of the ESS-CHAD, we included 26 OSA patients, 9 mild OSA, 10 moderate OSA and 7 severe OSA patients,confirmed by polysomnography.

Results : The internal consistency demonstrated by Cronbach’s alpha coefficients was 0.836. The test–retest reliability demonstrated by intra-class correlation coefficients of 0.982. There were statistically significant difference between the ESS-CHAD scores in mild OSA (3.33± 1.87) and severe OSA patients (9.85± 5.43) (p < 0.05), and between ESS-CHAD scores and Pediatric Sleep Questionnairre (p < 0.05). It had the highest sensitivity and specificity of 70.59% and 77.78% with a cut-off score ³ 5. There was no correlation between ESS-CHAD and polysomnogram parameters.

Conclusions : Our first Thai version of the ESS-CHAD showed an excellent internal consistency and test–retest reliability. It is able to discriminate between mild OSA patients and severe OSA patients with a cut-off value ³ 5; however, it does not have a relationship with the polysomnogram parameters.

Preventive Cardiology in Childhood

2024-04-26T10:50:27+07:00

ถามตอบข้อควรรู้เรื่องยาแก้อักเสบ

2024-04-26T10:30:51+07:00