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.

Optimization of the Use of the DOTATATE Kit Manufactured by the Thailand Institute of Nuclear Technology Using a SiO2-based 68Ge/68Ga Generator

2024-08-29T14:07:29+07:00

Objective: The presence of somatostatin receptors on neuroendocrine tumours enables 68Ga-DOTATATE to precisely detect lesion localization and staging. Thailand Institute of Nuclear Technology (TINT) recently developed a DOTATATE kit for labelling with Ga-68, which is compatible with a TiO2-based 68Ge/68Ga generator eluted with 0.1 M HCl, but presents a discrepancy with other types of 68Ge/68Ga generators. This research aimed to optimize a radiolabelling method using TINT’s kit with a SiO2-based 68Ge/68Ga generator eluting Ga-68 in 0.05 M HCl. Additionally, a quality control protocol was developed to ensure the formulation’s efficacy and reliability in compliance with the 10th edition of the European Pharmacopoeia.

Material and Methods: The SiO2-based 68Ge/68Ga generator was eluted with 2–4 ml of 0.05 M HCl, added into a lyophilized kit, heated in a dried-block heater at 100 ºC for 15 min, cooled down at room temperature, and finally purified using Sep-Pak C18 cartridge. The radiochemical purity was determined by radio thin-layer chromatography and the radioactivity was measured by a gamma well counter. Reproducibility and stability tests were conducted three times.

Results: Employing 4 ml of eluted material, comprising the second and fifth millilitres of 68GaCl3, provided a radiochemical purity (RCP) exceeding 95% after purification. Also, 68Ga-DOTATATE remained stable in refrigerator for at least 4 half-lives.

Conclusion: TINT’s DOTATATE kit can be successfully labelled with a SiO2-based 68Ge/68Ga generator, providing 68Ga-DOTATATE with an RCP > 95% for at least 4 half-lives when stored in refrigerator after production. This radiolabelling procedure is suitable for routine clinical application.

Improvement in the Youthfulness of Facial Skin after a Single Treatment with Platelet Rich Plasma

2024-07-25T11:19:25+07:00

Objective: Platelet rich plasma (PRP) is an autologous substance widely used to stimulate dermal collagen synthesis. This study aimed to investigate the efficacy of a single PRP treatment for facial rejuvenation.

Materials and Methods: This study was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from August 2020 to March 2021. Enrolled patients underwent a single intradermal injection treatment of 0.1 mL PRP at 30 locations on the face. Outcomes were assessed at 1, 2, and 4 weeks post-intervention using the patient-perceived age visual analog scale (VAS), FACE-Q assessment, and elasticity index (EI) with a Cutometer.

Results: Forty Thai patients with an average age of 36.4 years, Fitzpatrick skin type 3-4 were enrolled. The mean Patient-perceived Age VAS significantly decreased one month after treatment (-2.71±2.42, p<0.001). FACE-Q satisfaction with facial skin was 74.29±14.49, and satisfaction with the outcome was 73.41±16.26 (scale 0-100). The PRP significantly affected skin EI, with the peak improvement observed at 1-2 weeks post-injection, predominantly at the cheek, crow’s feet, and perioral area (all p<0.05). All patients had an overall improvement in satisfaction scores throughout the study.

Conclusion: A single treatment of PRP injection resulted in overall satisfaction in facial skin rejuvenation as measured by patient-perceived age VAS and FACE-Q assessment. The PRP showed positive outcomes in EI with peak performance at 1-2 weeks post-treatment.