Royal Thai Army Medical Journal

12-month overall mortality in ST-elevation myocardial infarction with newly diagnosed atrial fibrillation and atrial flutter compared between early oral anti-coagulant initiation and delayed oral anti-coagulant initiation

Narongchai Wattanawongwon — 2024-09-29

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia after ST elevation myocardial infarction (STEMI) leading to increased short-term and long-term mortality. Recent guidelines recommend starting oral anticoagulant (OAC) based on CHA₂DS₂-VASc in patients with STEMI and newly diagnosed AF without mentioning a proper time of the OAC initiation.

Objective: To study the effect of early and delayed OAC initiation on 12-month overall mortality rate in patients with STEMI and newly diagnosed AF or atrial flutter.

Methods: We conducted a retrospective cohort study involving hospitalized patients at Siriraj Hospital in Thailand spanning from January 2008 to 2022. Participants with STEMI and newly diagnosed AF or atrial flutter were included. Participants were divided into two groups: the "early OAC group" comprising individuals initiating OAC treatment within index hospitalization, and the "delayed OAC group" including those who did not.

Results: We enrolled a total of 65 participants, with 16 in the early OAC group and 49 in the delayed OAC group. Warfarin is the primary OAC, with only 8.2% of participants in the delayed OAC group receiving warfarin. During the 1-year follow-up period, two deaths (12.5%) occurred in the early OAC group compared to sixteen deaths (32.7%) in the delayed OAC group. The hazard ratio for overall mortality was 0.35 (95% confidence interval [CI], 0.80-1.51; p-value = 0.16). There were 4 nonfatal strokes, all of which occurred before OAC initiation.

Conclusion: Due to limited sample size, we were unable to demonstrate a difference in 12-month overall mortality between early and delayed OAC initiation in patients with STEMI and newly diagnosed AF or atrial flutter. Therefore, the timing of OAC initiation in these patients remains at the discretion of the attending physician.

The Effects of Maxillary Movement on Nasal Septum and Internal Nasal Valve Following Le Fort I Osteotomy: A CBCT study

Pornpop Rattana-arpha — 2024-09-29

Abstract

Objective: Le Fort I osteotomy (LF-IO) is a technique for the correction of dentofacial deformities, resulting in significant anterior nasal change. This study aimed to investigate the effect of different maxillary movements on the nasal septum (NS) and internal nasal valve (INV) after LF-IO with cone beam computed tomography (CBCT) images. Materials and Methods: A retrospective study including 39 patients who underwent LF-IO and received CBCT
pre-operatively and 6-to-12-month post-operative evaluation was performed. All patients were divided into three groups according to their maxillary movement direction. Group 1 underwent maxillary advancement, group 2 underwent maxillary impaction, and group 3 (combination) underwent both maxillary advancement and impaction. NS angle at nasion level, INV angle, and INV area at pre-operative and post-operative period on CBCT images were measured and evaluated. Results: The median of NS angle and the mean INV angle had a significant increase post-operatively in all three groups. However, INV area showed no statistically significant change after surgery. When the amount of the changes among the three groups were compared, the results revealed no statistically significant change in all three groups. Correlation between changes of NS angle and the magnitude of maxillary advancement was moderately positive with statistically significant difference. Conclusions: Advancement and impaction of maxilla in LF-IO influenced an increase in the NS angle and INV angle. A moderately positive correlation between changes of NS angle and the magnitude of maxillary advancement was found.

Factors Related to Record Ill-defined Cause of Death in the Death Summary

Aiya Wongwanna — 2024-09-29

Background: The cause of death (COD) can provide valuable information for national health policy. The World Health Organization (WHO) recommended avoiding ill-defined CODs as they do not give any utility. Thai Ministry of Public Health (MoPH) sets the goal that ill-defined CODs should not exceed 25%. However, there is still a high proportion of ill-defined CODs. Objective: To analyze the quality of the CODs recorded by doctors using WHO criteria. Method: A cross-sectional study was conducted in a community hospital in Lopburi province using data retrieved between October 1, 2018, and September 30, 2023. The medical records were reviewed to determine the CODs according to WHO criteria. Then descriptive statistics, chi-square tests, and logistic regression analyses were used at the 0.05 level of significance. Lastly, in-depth interviews were conducted to identify the root of problems. Results: Of 519 records, 73 records (14.1%) were ill-defined; there were 56.6% in outpatients and 6.8% in inpatients. Most of ill-defined CODs were cardiac arrest (21.9%), congestive heart failure (19.2%), and unattended death (16.4%). Being over 80 of age (aOR=2.55, 95%CI 1.28-5.08), being in 2020 (aOR=2.53, 95%CI 1.03-6.23), and being an outpatient (aOR=27.67, 95%CI 13.55-56.49) were the associated factors of ill-defined CODs. The interviews revealed that most of these cases arrived with an unknown medical history and refused an autopsy, except when they encountered some legal or insurance issues. Additionally, the study discovered some misunderstandings about defined CODs. Conclusion: This community hospital’s quality of CODs is good. However, ill-defined CODs in outpatient departments were still high; this was caused by unclear medical history and the refusal to autopsy from relatives. Therefore, it is necessary to develop a central medical database, making it possible to request medical records between hospitals, and raising the awareness of writing defined CODs.

Advance Care Planning among Medical Students: Perceptions, Practices, and Associated factors

Aiya Wongwanna — 2024-09-29

Background : Understanding how medical students perceive the nature of death and how they put this concept into practice is important in the development of palliative care and advance care plan (ACP) within the medical curriculum to improve the quality of patient-centered medical service.

Objective : to study attitudes and behaviors regarding advance planning for end-of-life care among medical students at Phramongkutklao College of Medicine (PCM), including related factors.

Method : A mixed research model was used with quantitative data collection and interviews to collect qualitative data. The sample group consisted of first-to-sixth-year medical students.

Result : It was found that the volunteers had an attitude that agreed with the word good death according to the definition that the researcher had compiled, and had an attitude that agreed with the view that death is a natural thing. Meanwhile, other views on death are more polarizing. The lower academic performance group (GPAX lower than 3.50) was significantly more likely to view death as an escape acceptance compared to those with higher grades (GPAX 3.50 and above) (p<0.01). Qualitative data from interviews with 12 volunteers of mixed years revealed that educational levels and academic performances may affect views on death. Almost all volunteers had not yet prepared a written plan for their end-of-life care, even though it was considered important.

Conclusion and discussion : From the result that educational levels and academic performances may affect views on death, further studies should be conducted that focus on the psychosocial factors of medical students to help plan teaching about advance care planning in the medical education curriculum to be more appropriate for students

The Study of Stakeholders’ Needs on the Development of Desirable Attributes of the Graduates of the Royal Thai Army Nursing College

ฺBussarin Arayathanitkul — 2024-09-29

Abstract

This mixed-methods research was conducted to study the needs assessment for developing graduates' desirable attributes of the Royal Thai Army Nursing College. The qualitative study in phase 1 aimed to study the desirable attributes of nurses who graduated from the Royal Thai Army Nursing College. The samples included employers, graduates from the 51st - 55th batches, current instructors, alumni, and current students, 40 in total. In-depth interviews found that the desirable attributes of graduates included military leadership, military nursing, and nursing professional aspects. The quantitative study in phase 2 studied the needs assessment for the development of graduate nurses’ desirable attributes. The samples consisted of 98 employers and 165 graduates from the 51st - 55th batches. The research questionnaire was a dual response, which was tested for reliability with Cronbach’s alpha coefficients of .98, and .97 for the expectation and the reality of the desirable attributes of nurses, respectively. The overall Priority of Needs Index (PNI_Modified) for developing the desirable attributes included the military nursing (PNI_Modified = 0.115), military leadership (PNI_Modified = 0.087), and nursing professional (PNI_Modified = 0.074).

Pharmacogenetic of donepezil for Alzheimer's disease treatment

รุ่งรัตน์ ปิยนันท์จรัสศรี — 2024-09-29

Inclisiran: A Small Interfering RNA for Treating Hypercholesterolemia

Wuttichai Lertwattanachai — 2024-09-29

Hyperlipidemia is one of important risk factors for cardiovascular diseases (CVDs), which are among main causes of death. Lipid-lowering drugs play a crucial role in reducing cholesterol levels and the risk of CVDs. However, there are some patients who received lipid-lowering drugs but did not achieve their target cholesterol levels or may not tolerate the side effects of current lipid-lowering drugs. Recently, efforts in drug discovery and development have focused on developing new drugs to improve the effectiveness of treatment and provide alternative regimens for patients who cannot tolerate existing drugs.

Inclisiran is a novel lipid-lowering drug that inhibits the production of proprotein convertase subtilisin/kexin type 9 (PCSK9) at the genetic level by using small interfering RNA (siRNA). It is effective in reducing low-density lipoprotein cholesterol (LDL-C) levels in patients who have CVDs or familial hypercholesterolemia and have reached the maximum dose of statins but are still unable to achieve their LDL-C target levels or cannot tolerate statins side effect. Inclisiran can be administered as a subcutaneous injection every six months, and no serious side effects have been observed. However, injection site pain, redness, or swelling are the most commonly reported local adverse reactions.

Editorial

Sarawut jindarat — 2024-09-30