Siriraj Medical Journal

สมเด็จพระมหิตลาธิเบศร อดุลยเดชวิกรม พระบรมราชชนก

2024-09-24T09:58:38+07:00

ท่านผู้มีเกียรติทั้งหลาย

ก่อนที่ข้าพเจ้าจะเริ่มต้น ข้าพเจ้าต้องขออภัยเสียก่อนว่าในระหว่างนี้จะเป็นเพราะประสาทหรือยาไม่ทราบ ทำให้ปากคอข้าพเจ้าแห้งเสมอ, และถ้าพูดมากบางครั้งถึงแห้งผาก พูดต่อไปไม่ได้ทีเดียว, จึงต้องขอน้ำมาเตรียมไว้. ถ้าข้าพเจ้าจิบน้ำในระหว่างพูด ขออภัยด้วย.

ข้าพเจ้ารู้สึกเป็นเกียรติอย่างยิ่งที่ได้รับเชิญมากล่าวสุทรพจน์ ณ ที่นี้

An Evaluation of the Precision of Ocular Trauma Score and Factors for Poor Visual Outcomes in Open Globe Injury: A Retrospective Analysis of Resourcelimited Hospital Settings

2024-10-09T16:42:59+07:00

Objective: To evaluate the accuracy and validity of ocular trauma scores (OTS) among patients with open globe injury (OGI) in rural hospital settings and to identify the determinants predicting poor visual outcomes.

Materials and Methods: A single-center retrospective cohort study was conducted through a chart review of OGI patients between July 2018 and June 2023 at Bueng Kan Hospital. Demographic and preoperative factors affecting the final visual outcome were evaluated. OTS score for each patient was calculated and categorized. Final VA after 6 months was compared to the predicted VA from OTS study. Poor visual outcome was defined as legal blindness after 6 months of treatment.

Results: Thirty-nine eyes from patients with a mean age of 44.05 years were evaluated. Most subjects were male (94.87%), and workplace injuries were the most common (78.38%). Compared to the OTS study, patients in OTS category 2 achieved a significantly higher percentage of better final VA, while categories 3 and 4 showed similar outcomes. OTS category 1 patients had a lower proportion of no light perception (NLP) outcomes, though the difference was not significant. Poor visual outcomes were predicted by initial VA (OR=4.64), wound extension ≥10 mm (OR=20.66), and lens injury (OR=7.44).

Conclusion: OTS is beneficial for predicting final vision in patients with OGI, particularly with less severe trauma. Severe cases often lead to better visual outcomes, emphasizing the need for cautious management and counseling by ophthalmologists. Factors that estimate poor visual outcomes involve poor initial VA, wound extension  10 mm, and lens damage.

Outcomes of Multidisciplinary Low-Vision Rehabilitation Using Two Questionnaires and the International Classification of Functioning, Disability, and Health

2024-10-09T16:43:05+07:00

Objective: To evaluate the effectiveness of a low-vision service by using three tools and to identify the specific outcomes obtained from each instrument.

Materials and Methods: Patients consecutively visiting the low-vision clinic at Siriraj Hospital, Bangkok, Thailand, were enrolled. The impact of the prescribed rehabilitation on patient quality of life was measured using three tools: the Low-Vision Quality-Of-Life Questionnaire (LVQOL); the generic EuroQol Five-Dimensional Questionnaire (EQ-5D); and the World Health Organization International Classification of Functioning, Disability, and Health (WHO-ICF).

Results: Out of the 104 patients recruited, 76 patients (mean age, 53 ± 16.2 years) completed the questionnaires before and after rehabilitation, which was assessed after 5.8 ± 2.0 months. Post-rehabilitation, the time of follow-up, patients had significant improvements in the mean scores of both the LVQOL scores and mean EQ-5D scores compared to before rehabilitation (P < 0.001), with Cohen’s effect sizes of 0.85 and 0.67, respectively. Subgroup analyses by age, severity, and cause of visual impairment also showed significant improvements in the LVQOL (P < 0.05), but not the EQ-5D score in the blindness severity subgroup. The ICF scores also showed significant improvement in most domains, including seeing functions, mobility across different locations, transportation use, meal preparation, economic self-sufficiency, community life, and recreational activities (P < 0.01).

Conclusion: Patients with low vision experienced significant improvements following vision rehabilitation, especially in terms of seeing functions and mobility. Evaluation by different questionnaire types could provide additional information. The WHO-ICF was effective in assessing each domain related to activity performance and participation.

Visual Prognosis in Craniosynostosis Patients: A 20-year Retrospective Cohort Study at a Tertiary Referral Center in Thailand

2024-10-09T16:43:02+07:00

Objective: This study aims to evaluate the visual prognosis in craniosynostosis patients in order to identify ophthalmologic manifestations in craniosynostosis patients and strabismus surgery outcomes in these patients.

Materials and Methods: The medical record charts of craniosynostosis patients were reviewed retrospectively from January 2000 to June 2023. All the relevant patient data, such as age, sex, visual acuity, ophthalmologic examinations, and strabismus surgery outcomes were recorded.

Results: In total, 123 patients were included in the study, among whom 65 (52.84%) were male. Overall, there were 70 cases (56.91%) of non-syndromic craniosynostosis, and 53 cases of syndromic craniosynostosis, comprising Crouzon syndrome (15 cases), Apert syndrome (8 cases), Pfeiffer syndrome (2 cases), and other syndromes (28 cases). The mean age at first examination was 3.11 years old. Out of 107 cases with visual impairment at the first visit, 92 (85.98%) showed no visual impairment at the last visit. Among the 87 patients with strabismus, 28 (32.18%) had strabismus at the primary position, with exotropia being the most common type (18 cases). Eight cases underwent strabismus surgery, and 4 cases achieved success (deviation < 10 prism diopters). Other ophthalmologic manifestations were lagophthalmos, exposure keratopathy, ptosis, proptosis, and nasolacrimal duct obstruction.

Conclusion: Among the craniosynostosis cases, 85.98% had no visual impairment, with the common ophthalmologic manifestations being refractive errors, strabismus, lagophthalmos, and exposure keratopathy. The syndromic craniosynostosis cases showed worse visual outcomes and a higher incidence of ocular diseases than non-syndromic cases. The success rate for strabismus surgery in craniosynostosis patients was 50%.

Development and Evaluation of the DMIND Questionnaire: Preparing for AI Integration into an Effective Depression Screening Tool

2024-06-05T12:48:49+07:00

Objective: Thailand’s mental health crisis is exacerbated by high demand and a shortage of mental health professionals. The research objective was to develop and validate the Detection and Monitoring Intelligence Network for Depression (DMIND) questionnaire, designed to be culturally relevant and easily administered in clinical settings. Crafted with expert input, items specifically conducive to artificial intelligence (AI) analysis were selected to facilitate the future development of an AI-assisted depression scoring model. This approach underscores the tool’s dual utility in both human-led and technology-enhanced diagnostics.

Materials and Methods: We enrolled 81 participants from psychiatric and tertiary care hospitals in Bangkok. Participants were assessed using the DMIND questionnaire, followed by the Hamilton Depression Rating Scale (HDRS-17). Statistical analyses included the content validity index (CVI), Cronbach’s alpha, Pearson’s correlation coefficient, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. The Liu method, Youden index, and nearest neighbor method were used to determine the optimal cut-off point

Results: The DMIND questionnaire showed strong validity, with an item-level CVI (I-CVI) and scale-level CVI (S-CVI) exceeding 1.0, indicating strong consensus on its relevance and utility. The tool also demonstrated high internal consistency (Cronbach’s alpha = 0.96). ROC analysis showed an AUC of 0.88, indicating high accuracy in depression screening. An optimal cut-off score of 11.5 was identified, balancing predictive value and sensitivity.

Conclusion: The DMIND questionnaire represents a significant advancement in innovative mental health diagnostics, addressing unmet clinical needs by providing accurate and efficient assessments capable of AI integration for further enhancing mental health service delivery in Thailand.