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SIRIRAJ MEDICAL BULLETIN
ISSN 2697-4436
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Siriraj Medical Bulletin
Physician Fellows of the Royal
Society of Thailand: From Past
to Present and Future Roles for
Thai Society
Associate Fellow in Investigative Medicine, Field of Medicine and Dentistry, Academy of Science, The Royal
Society of Thailand
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 209-220
Professor Dr. Sanya Sukpanichnant
Abstract
Thirty Physician Fellows of the Royal Society of Thailand at the Academy of Science in the Royal Society
of Thailand have been bestowed during the past 80 years from 1942 to 2022. They have performed their
assigned duties according to the Royal Institute Act (B.E. 2476, 2485, 2544) and the Royal Society Act (B.E.
2558), especially academic aspects, for the government, governmental services, private sectors, and Thai
people in general – worth as the Fellows of the Royal Society of Thailand. They play an important role in coin-
age for medical terminology in Thai to keep the standard of Thai language usage in medical field so that Thai
people can understand these medical terms properly, facilitating the medical knowledge dissemination to the
public. Nevertheless, advance in technologies and communication through various facilities are challenging
for not only Physician Fellows but also all Fellows of the Royal Society of Thailand. The future roles of Physician
Fellows for Thai society needs participation from all stakeholders in the society that should better concern
more toward our living world.
Keywords: Physician Fellow of the Royal Society of Thailand, Academy of Science, Royal Society of Thailand,
Royal Institute Act, Royal Society Act, coinage for medical terminology in Thai
Correspondence to: Professor Dr. Sanya Sukpanichnant
Email: sanya.suk@mahidol.ac.th
Received: 17 May 2022
Revised: 17 May 2022
Accepted: 6 June 2022
http://dx.doi.org/10.33192/smb.v15i4.257713
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Medical History
Demographics, Precipitating
Factors and Treatment in Acute
Decompensated Heart Failure
Department of Medicine, Buriram Hospital, Buriram, Thailand
Siriraj Medical Bulletin 2022;15(4): 221-227
Rudeekorn Ue-sethasakdhi*, Achiraya Pakngao**, Patarasaya Roekrat**
Abstract
Background: Heart failure is a common cause of hospitalization and has a high mortality rate. Data from
Internal Medicine Department Buriram Hospital for the past 1 year in 2020-2021 found that the patients being
admitted and diagnosed acute decompensated heart failure was 7% of all admissions, 5th ranked among all
inpatients. The clinical features of patients with acute decompensated heart failure are therefore important.
Objective: To study the clinical features, precipitating factors, treatment, mortality rate, in acute decompen-
sated heart failure patients.
Material & Methods: A descriptive study, prospective observational cohort design which included acute
decompensated heart failure patients at internal medicine ward Buriram Hospital between January 2021 and
August 2021 by interviewing history. Clinical features, causes, precipitating factors, treatment, mortality were
collected from medical records.
Results: 132 patients, mean age 64 years, 55% male, 53% had ≥3 atherosclerotic cardiovascular risk factors.
87% had New York Heart Association Functional Classification IV. 47% were heart failure with reduced ejection
fraction. 30% were acute myocardial infarction. 42% developed acute kidney injury. 29% had clinical sepsis.
In-hospital mortality rate was 7.5%. Advanced stage kidney disease is a predictor of in-hospital mortality.
Conclusion: From this study, the acute decompensated heart failure patients were clinically more severe
and had a higher mortality than those in the Thai ADHERE Registry. Encourage follow up treatment, modify
atherosclerotic risk factors and advice patient educations to reduce infection are recommended to prevent
hospitalization and reduce death.
Keywords: heart failure; precipitating factors; mortality
Correspondence to: Rudeekorn Ue-sethasakdhi
Email address: doctorrudeekorn@gmail.com
Received: 11 May 2022
Revised: 27 July 2022
Accepted: 26 August 2022
http://dx.doi.org/10.33192/smb.v15i4.257749
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Physical Activity in Low-Risk
Pregnant Women in Siriraj Hospital
*Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, ** Department of Obstetrics
and Gynecology, Faculty of Nursing, Mahidol University, ***Department of Nursing, Sirindhorn Hospital,
Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 228-237
Maria asad-Dehghan*, Tanchanok Chaiperm*, Chayawat Phatihattakorn*, Dittakarn Boriboonhirunsarn*,
Orrawan Pintlertsakun**, Angsuma Chuprakong***
Abstract
There are many forms of physical activity, such as activities of daily living, taking care of family members,
housework, outdoor recreational activities, leisure activities, and exercise1 previous studies revealed that
women usually had decreased physical activity and exercise during pregnancy. However, there are no studies
that focused on low-risk pregnant women during second trimester yet. This study aimed to assess the level of
physical activity and to advise the correct information about physical activities and exercise during pregnancy
to second trimester low-risk Thai pregnant women at Siriraj Hospital.
Objectives: To assess the level of physical activity in low-risk Thai pregnant women during the second trimester
of pregnancy, to identify associated factors with, and to assess knowledge about physical activity during preg-
nancy
Materials & Methods: This observational study was conducted during April 2020 to January 2021. Second
trimester pregnant women were consecutively enrolled. Included patients were informed about the study
questionnaires, which included demographic and obstetric characteristic, a physical activity, and knowledge
and attitude about physical activity during pregnancy. After completing the questionnaires, the participants
were given appropriate knowledge about physical activity or exercise during pregnancy.
Results: A total of 290 women were included. The mean total score on the physical activity questionnaire was
47.58 out of 64. Multiparous women were significantly more active during pregnancy than nulliparous women
(P = 0.072). Regarding occupation, housewives and unemployed women had less physical activity during
pregnancy than employed women (P = 0.057). Concerning education, between women with education below
bachelor's degree and higher, a significant difference was found in physical activity or exercise during preg-
nancy( P=0.042). The mean total score on knowledge was 4.8 out of 10. However, the score was significantly
associated with physical activity level (P=0.042).
Conclusion: Second trimester pregnant women demonstrated moderate level of physical activity during
pregnancy. Multipara status, and employment status were not significantly associated with physical activity.
The factors that significantly associated with physical activity during pregnancy were education level and
knowledge about physical activity.
Keywords: physical activity; low-risk pregnant women; second trimester; factors, pregnancy
Correspondence to: Maria asad-Dehghan
Email: maria131asad@gmail.com
Received: 17 June 2022
Revised: 13 September 2022
Accepted: 21 September 2022
http://dx.doi.org/10.33192/smb.v15i4.258114
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Online House Modication
to Prevent Falls for Elderly Patients
in the Community
*Department of Physical Therapy, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital,
Mahidol University, Nakhon Pathom, **Department of Physical Therapy, Maesot Hospital, Tak, Thailand
Siriraj Medical Bulletin 2022;15(4): 238-245
Pattipon Kao-ngampanich*, Sangrawee Puttason**
Abstract
Home with several hazards could considerably lead to indoor falls in elderly patients with dementia,
cerebrovascular disease, and undergone hip or knee replacements resulting in disability and death from falls
more than other age groups. Appropriate and safe house modification represents an important role for indoor
fall prevention in elderly patients by decreasing the rate of falls compared to hazardous houses without any
modification. During the SARS-CoV-2 pandemic, the home visit program for house modification was canceled
for several years. Then, online house modification was developed by the cooperation of assistive technologists
for disabilities and physical therapists to access three dangerous sites for falls at home including bathroom,
bedroom, and stairs. Checklists and recommendations for house modification are advised through the online
communication system to relatives or caregivers with the goals of promoting elders’ independence, fall pre-
vention, well physical and mental health, and improved quality of life of elderly patients and their families.
Keywords: online house modification; fall prevention; physical therapy
Correspondence to: Pattipon Kao-ngampanich
Email: pattipon.kao@mahidol.edu
Received: 27 February 2022
Revised: 11 April 2022
Accepted: 29 April 2022
http://dx.doi.org/10.33192/smb.v15i4.256369
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Nursing Care for Urinary
Incontinence in Elderly
*Division of Perioperative Nursing, Department of Nursing, Siriraj Hospital, **Bhumibol Adulyadej Hospital,
Bangkok, ***Yala Hospital, Yala, ****Taksin Hospital, Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 246-253
Wimol Saekoui*, Supawit Luangphattarawong**, Sukree Semmard***, Sakolrat Titaram****
Abstract
Urinary incontinence is the involuntary leakage of urine which is considered a serious health issue in
the elderly. Major contributing factor is physiological decline. Urinary incontinence can become chronic and
affect the physical, psychological, social, and economic conditions of the elderly. It can have a negative impact
on quality of life in a variety of ways such as skin irritation from urine exposure which can cause rashes and
infection; sleep deprivation; and psychological issues such as lack of self-confidence, embarrassment, de-
pression, and eventually social avoidance. Information from comprehensive assessment of the elderly can be
used to solve the problems, cure them, and prevent complications. This article aims to equip nurses with the
knowledge and understanding needed to provide holistic care, advice patients with urinary incontinence and
their families, systematically implement health promotion and disease prevention, and optimize environment
and other factors affecting quality of life of the elderly in order to help the elderly engage in social activity and
adapt to their physiological changes with comfort.
Keywords: nursing care; elderly; urinary incontinence
Correspondence to: Wimol Saekoui
Email: wimolsae@hotmail.com
Received: 1 June 2022
Revised: 20 September 2022
Accepted: 28 September 2022
http://dx.doi.org/10.33192/smb.v15i4.258125
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Robotic Assisted Total Knee
Arthroplasty
*Department of Orthopedic Surgery, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital,
Mahidol University, Nakhon Pathom, **Orthopedic Department, Rachaphiphat Hospital, Medical Service
Department Bangkok Metropolitan Administration, Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 254-259
Tawan Intiyanaravut*, Chaiwat Achawakulthep*, Sutee Klomchitcharoen**
Abstract
Total Knee Arthroplasty (TKA) is considered the gold standard of treatment for patients with severe
knee arthrosis who failed conservative treatment. Conventional TKA is generally accepted as the standard
technique which shows excellent long-term result. Whereas, robotic assisted TKA, has become an interesting
technique recently. Main goal of robotic assisted TKA is to minimize human errors in surgical technique. Theo-
retically advantages are ability to plan the size and position of implants based on preoperative imaging and by
assisting surgeons to more precisely and more accurately prepare the bone, minimized soft tissue injury, the
physiological kinematics of the joint and the overall alignment of lower limb are also better restored. In this
article, we demonstrate basic principles, basic instruments and summarize basic steps of robotic assisted TKA
into four main steps; preoperative imaging process, bone registration process, preoperative planning process
and bone cutting process. We review various robotic systems and categorize into different groups base on re-
quirements of preoperative imaging usage and level of interaction of the surgeon in operations. The different
robotic systems were subdivided into image-based/imageless and active/passive/ semi-active. We also report
outcomes of this technology from literatures reviews.
Keywords: robotic surgery; robotic assisted surgery; total knee arthroplasty; TKA
Correspondence to: Tawan Intiyanaravut
Email: tawan.int@mahidol.ac.th
Received: 19 April 2022
Revised: 28 June 2022
Accepted: 17 August 2022
http://dx.doi.org/10.33192/smb.v15i4.257389
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Presbyopia And Near Reading
*Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
**Department of Ophthalmology, Chonburi Hospital, Chonburi, Thailand
Siriraj Medical Bulletin 2022;15(4): 260-265
Prapasson Sangsre*, Weeraya Watcharaphalakorn**, Thammanoon Surachatkumtonekul*
Abstract
Presbyopia is a condition that eyes cannot focus on near objects clearly even with people who has em-
metropic eyes (visual acuity equals 6/6) because of the changing of ocular physiology that usually begins after 40
years of age. The characteristic of crystalline lens is soft and flexible at young age, then the lens becomes more
rigid after age 40. This degeneration is a normal part of aging which isn’t stopped or reversed. Additionally, when
focusing on the near objects there are not only lens’s changing but also the pupil’s constriction (miosis) as well as
inward movement of both eyes. These functions are called “accommodation”. However, the crystalline lens is a
transparent and flexible structure that can gradually lose function over time. As a result, the eye loses its ability
to focus on the near object. This condition is known as “loss of accommodation”. People might notice symptoms
of presbyopia when they need to hold a book or a mobile phone at arm’s length, when reading. Also, having a
headache or eye strain while working. Moreover, some medical conditions can increase risk of presbyopia such
as diabetes mellitus, multiple sclerosis and cardiovascular disease, taking some medicines such as antihista-
mine, antipsychotic drug or diuretic drug. Presbyopia is diagnosed by near chart reading “Rosenbaum near vision
card”. Patient will hold the card at 14-inches distance. The treatment options include wearing glasses (reading
lenses, bifocal lenses or progressive lenses), wearing contact lenses (mono-vision or multifocal), corneal inlay,
laser surgery or eyedrops. In 2021 the pilocarpine 1.25% was approved by U.S. Food and Drug Administration
(FDA) for presbyopia treatment.
Keywords: near reading; accommodation; presbyopia; near vision card
Correspondence to: Thammanoon Surachatkumtonekul
Email: si95thim@gmail.com
Received: 4 February 2022
Revised: 1 July 2022
Accepted: 25 July 2022
http://dx.doi.org/10.33192/smb.v15i4.256055
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Cannabis, Kratom and Kariyat: Issues
of Concern in Perianesthetic Care
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 266-274
Angkana Prawatviteesuk, Wilaiporn Supan, Pattharaporn Sombood, Khanittha Vorasanon,
Phongthara Vichitvejpaisal$
Abstract
Cannabis, Kratom, and Kariyat have long been used as herbal medicine. Cannabinoids in Cannabis
have effects on moods, pain sensation and memories. It is often administered to end-stage patients as
comforting and palliative treatment. While Kratom yields Mitragynine which has analgesic properties like
Morphine, it is frequently used to counteract withdrawal symptoms after giving up Cannabis and Opium.
Interestingly, Andrographolide in Kariyat can alleviate the acute phase of upper respiratory tract infection.
Since the period of new pandemic prevalence of disease and the possibility to take these herbs over the
counter, they are consequently consumed as alternative medicine with carelessness and negligence. As
Cannabis, Kratom, and Kariyat have an effect on inhibiting enzyme Cytochrome P-450 in the liver; therefore,
the drug interaction with other preparations particularly the anesthetics results in the synergistic, additive
and some adverse effects. Thus, anesthesia personnel have to handle these vulnerable subjects like ones
with the problem of chronic alcoholism or drug addiction. For example, patients must be checked up on
laboratory tests including liver, kidney and coagulation profiles. Moreover, they should be advised to stop
Marijuana 72 hours prior to surgery owing to its toxicity and adverse effects have the lookalike signs and
symptoms of clinically anesthetic manifestation.
Keywords: cannabis; kratom; kariyat; anesthesia; Cytochrome P-450
$Correspondence to: Phongthara Vichitvejpaisal
Email: phongthara@gmail.com
Received: 11 April 2022
Revised: 10 June 2022
Accepted: 1 July 2022
http://dx.doi.org/10.33192/smb.v15i4.257313
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The Integration of Health Promotion
and Articial Intelligence to Helmet
Wearing Behavior Modication
*Division of Health Promotion, Department Office of Dean, **Siriraj Informatics and Data Innovation Center,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ***Division of International Disease Control
Ports and Quarantine, Department of Disease Control, Nonthaburi, Thailand
Siriraj Medical Bulletin 2022;15(4): 275-280
Tanarach Paochang*, Patranuch Namdee*, Jedsada Suwanwaree*, Piyalitt Ittichaiwong**,
Kamonwan Wannakham***
Abstract
Siriraj Hospital is a public medical institution offering health care service for university staff, students
and also the general public. Increasing volume of traffic in the hospital area leads to traffic control and safety
problems, especially from motorcycles. To response to these problems, Siriraj Health Promotion Division has
introduced “We Care We Save” campaign since 2019 to prevent the risks of traffic accidents caused by riding
motorcycles without safety helmets in the hospital area. The main purposes of this campaign are to promote
traffic safety protocols and to facilitate the drivers to recognize the benefits of wearing safety helmets. To strive
for an accident-free environment, this article demonstrated the five core components of health promotion model
according to the First International Conference on Health Promotion held in Ottawa: building of healthy policy,
creation of supportive environments for health, strengthening of community actions for health, development of
personal skills, and reorientation of health services. Furthermore, artificial intelligence (AI) was used as one of
the effective tools to track changes in helmet use behavior. The result of this study represented the important
data analysis that could be used for improving safety helmet wearing behavior. Finally, the result from this study
is allowed for modification and use according to various contexts from all of interested personnel.
Keywords: helmet; artificial intelligence; health promotion
Correspondence to: Patranuch Namdee
Email: patranuch.nd@gmail.com
Received: 3 February 2022
Revised: 10 June 2022
Accepted: 1 July 2022
http://dx.doi.org/10.33192/smb.v15i4.256019
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The Development of Spirituality
of Medical Teachers
*Department of Education, **Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Siriraj Medical Bulletin 2022;15(4): 281-288
Pattaraporn Naknagraed*, Kaittiyos Kuldejchaichan*, Cherdsak Iramaneerat**
Abstract
A medical teacher is a person who teaches doctors by transferring professional knowledge to students.
In addition, medical teachers also help raise the mindset and spirit of a doctor to make students become
quality members of society through the process of teaching and learning. Therefore, the development of a
medical teacher's spirit is an important tool in preparing personnel to have the characteristics or elements
of a medical teacher's spirit. Faculty development must start by stimulating the importance and need to be
driven both at the individual level, such as the gathering of people with passion, giving feedback and reflection,
and making changes at the policy level, such as setting clear directions, listening to problems, assessment
criteria, motivation. Guidelines for faculty development include formal teaching such as short course training,
elective courses, seminars, educational projects, and informal teaching such as exchanging experiences from
role models, mentoring, peer teaching. This can be done for both novice and senior teachers or can be started
from residents or medical students, but the content to be developed should be chosen according to the level
of learners and continuous development. In addition, there must be various support such as policy, the budget
and agencies that support the faculty development to have the spirit of medical teachers such as the Faculty
of Medicine Siriraj Hospital established SHEE and developed it through the SHEE programs.
Keywords: Faculty development; the spirituality of medical teachers; medical teacher
Correspondence to: Pattaraporn Naknagraed
Email: pattaraporn.nak@mahidol.edu
Received: 16 May 2022
Revised: 1 August 2022
Accepted: 8 August 2022
http://dx.doi.org/10.33192/smb.v15i4.257931
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