Srinagarind Medical Journal

Factors Related to Term Singleton Low Birthweight: A Multicenter Case - Control Study

2024-02-03T20:46:42+07:00

Background and Objectives: Low birthweight (<2,500 gram) is a crucial world health problem that still needs much more knowledge and the understanding. This study aimed to the factors associated with term singleton low birthweight infants. The knowledge gain will be use for the prevention and treatment of this condition.

Methods: A multicenter case - control study was conducted. The subjects were mothers and infants who delivered in Udon thani Hospital, Nonghan Hospital, Ban phue Hospital, Wanonniwat Hospital, Ban dung Hospital, Lom sak Hospital, and Ang thong Hospital during January 1, 2018 to December 31, 2022 and met the study criteria. Data were collected from the electronic database then analyzed using descriptive statistics and multiple logistic regression analysis.

Results: There were 22,489 term singleton infants with 1,138 term low birth weight infants (5.06%). The multiple logistic regression was conducted, the factors associated with the term low birthweight were nulliparous, low body mass index mother, poor pregnancy weight gain, maternal anemia, hypertensive disorder during pregnancy and female infant. The pregnancy outcomes of term low birthweight group had significantly higher stillbirth rate, birth asphyxia rate and neonatal intensive care ward admission rate. The term low birthweight neonatal intensive care ward admission rate was 12.74% and the birth asphyxia rate was 6.33%. The tenth percentile cut off point for the term low birthweight determination was 2,625 grams and 2,500 grams in low body mass index mother group. The infant weight < 2,300 grams significantly increased the birth asphyxia and neonatal intensive care unit admission rate.

Conclusion: The associated factors that affects the term low birthweight were nulliparous, low body mass index mother, poor pregnancy weight gain, maternal anemia, hypertensive disorder during pregnancy, and female infant. The mother with these conditions should be closely monitored and treated prenatally to prevent the serious complications. The cut point for term low birthweight determination was 2,625 grams and 2,500 grams in low body mass index mother. The risk of birth asphyxia and neonatal intensive care admission increased when the birth weight was < 2,300 gram.

Study of Local Diagnostic Reference Levels (DRLs) and Evaluation of Patient Radiation Doses of SPECT/CT Parathyroid Scan at Suppasitthiprasong Hospital

2024-02-03T20:54:26+07:00

Background and Objectives: Parathyroid scintigraphy is the predominant nuclear medicine procedure used to identify abnormally hyperactive parathyroid tissue. Its utilization is increasing in various medical settings. This examination can be performed with precision to determine the function and location of the parathyroid minor lesion. Currently, Suppasitthiprasong Hospital does not have established local DRLs for parathyroid scans. Hence, the aim of this study was to conduct a survey and establish the local DRLs for the administered activity of parathyroid scans. Additionally, it aimed to assess the radiation dose received by patients from hybrid SPECT/CT scans and compare the obtained DRLs with the Thai national DRLs and those of other countries.

Methods: The retrospective descriptive study was conducted by collecting. parathyroid scan data included one hundred patients (44 females and 56 males) in 2022. The 75^th percentiles of the administered activities and volumetric computed tomography dose index; CTDI_vol, dose length product; DLP were obtained from the GE Discovery670 NM/CT Scanner (hybrid CT Optima 540 model). The effective dose (D_eff) was then determined for each CT study.

Results: The DRLs for ^99mTc-O^-4 and ^99mTc-MIBI were 159.1 MBq and 814 MBq, respectively. The radiation doses for volumetric computed tomography dose index, dose length product and D_efffrom the hybrid CT neck were 14.41 mGy, 577.42 mGy-cm, and 3.12 mSv, respectively.

Conclusion: The ^99mTc-MIBI levels exceeded the Thai National DRLs, but remained below those of other countries. Hence, it is necessary to modify the local DRLs for activities of ^99mTc-MIBI in future. The assessment of the radiation dose that patients receive from hybrid CT scans of the neck indicates that it is greater compared to the standards set by the Thai National and other nations. Consequently, it is necessary to review and adjust the parameters (kVp, mAs) of the hybrid CT neck protocol in order to reduce the radiation dose experienced by patients.

Effects of Modified Foot Abduction Brace in Maintaining the Foot Position after Ponseti Treatment Method in Congenital Clubfoot

2023-12-14T10:05:09+07:00

Objective: Modify the Foot Abduction Brace (FAB) and measure the slippage of the FAB to obtain a suitable FAB for maintaining the position of the patient's foot and to study of parents' satisfaction with modified FAB.

Methods: An action research was conducted in 2 stage stage 1 Modify the FAB according to interdisciplinary consensus. Stage 2 twenty-nine patients with congenital clubfoot who have been treated with the Ponseti method will receive FAB from the outpatient rehabilitation department at Srinagarind Hospital to maintain foot shape for 7 days. Parents record FAB slippage, satisfaction, and problems encountered in using the modified FAB in the diary and telephone interviews.

Results: Of the 29 congenital clubfoot patients, 21 were male (72.4%), with a mean age of 10.6 ± 7.9 months. The mean age at initiation of FAB usage was 21.2 ± 2.7 weeks. Fourteen patients (48.3%) started using the FAB for the first time. The study found that 69.0% - 79.3% of patients had no FAB slippage during usage. The average number of FAB slippages were 1.2 ± 2.4 times/day (median = 0, interquartile range 0-1). Parental satisfaction was reported at 4.7 ± 0.6 points, with the highest satisfaction regarding fit and durability (4.6 ± 0.6 and 4.6 ± 0.8, respectively).

Conclusion: By modifying both the shoe and strapping of the FAB found minimal instances of FAB slippage. Moreover, the parents expressed high satisfaction in using the FAB, which was also cost-effective and covered by government reimbursement.

A Comparison of Disk Diffusion and Etest with Broth Microdilution Methods for Susceptibility Testing of Ceftazidime and Trimethoprim/Sulfamethoxazole Against Clinical Isolates of Burkholderia pseudomallei in Northeast Thailand

2024-02-01T15:23:37+07:00

Background and Objective: Melioidosis caused by Burkholderia pseudomallei, is a neglected infectious disease with a high mortality rate in endemic areas. Antimicrobial susceptibility testing (AST) offers crucial guidance for effective treatment to mitigate the severity of the disease and improve the survival rates. This study aimed to compare the cost-effectiveness and pragmatic viability of two ASTs, disk diffusion and Etest methods, to an automated broth microdilution method (BMD), against ceftazidime (CAZ) and trimethoprim/sulfamethoxazole (TMP-SMX).

Methods: A total of 199 clinical isolates of B. pseudomallei from melioidosis patients with culture-confirmed, were obtained from 3 collection sources in Northeast Thailand. These isolates were assessed using disk diffusion and Etest methods compared with an automated BMD based on the criteria set by the Clinical and Laboratory Standards Institute.

Results: The results revealed non-resistance isolates to CAZ and TMP-SMX by BMD. The disk diffusion for CAZ (30 μg) demonstrated a categorical agreement (CA) of 96% (191/199), with a major error (ME) of 0.5% (1/199) and minor error (MIE) of 3.5% (7/199) compared to the BMD. The Etest for CAZ demonstrated a CA of 98.5% (196/199), with no ME, and an MIE of 1.5% (3/199) compared to the BMD. However, the disk diffusion for TMP-SMX (1.25/23.75 μg) demonstrated the CA, ME, and MIE of 13.6% (27/199), 76.4% (152/199), and 10.1% (20/199) compared to the BMD, respectively. While the Etest for TMP-SMX demonstrated a CA of 46.2% (92/199), ME of 53.8% (107/199), and no MIE compared to the BMD. No very major error (VME) was detected in either test.

Conclusion: Disk diffusion and Etest methods for CAZ could be beneficial in areas with limited resources for the management of melioidosis. However, BMD is still recommended for TMP-SMX to assess the antibiotic’s efficacy and guide appropriate treatment decisions for melioidosis.

The Incidence of Falls and The Correlation between Fear of Falling and Physical Performance in Postmenopausal Women

2024-02-27T14:33:18+07:00

Background and Objective: Postmenopausal women often experience a decline in physical performance, increasing their risk of falls. While numerous studies have addressed falls and the fear of falling in older adults, there is a gap in understanding these phenomena specifically in the postmenopausal population. This study aims to investigate the incidence of falls and fear of falling, compare physical performance, and explore the relationship between physical performance and fear of falling in postmenopausal women.

Methods: A total of 120 postmenopausal women aged 40-59 years participated in this study. Participants were evaluated using the falls efficacy scale-international (Thai FES-I) to assess fear of falling. Physical performance was measured through the hand grip test (HG) to assess hand and forearm muscle strength, the timed up and go test (TUGT) to evaluate balance ability, and the five times sit to stand test (FTSST) to assess lower extremity strength.

Results: The average age of postmenopausal participants was approximately 55.03 ± 3.26 years, with a reported incidence of falls in the previous year at approximately 7.50% and a fear of falling incidence of about 45.00%. Stumbling was the most common cause of falls (55.56%), predominantly occurring in the forward direction (44.44%) and indoors (66.67%). The results of physical performance showed that the fear of falling group took more time to perform the TUGT and FTSST compared to the group without fear of falling (p < 0.05). The fear of falling group also had significantly reduced HG compared to the group without fear of falling (p < 0.05). Furthermore, Thai FES-I scores were significantly positively correlated with FTSST and TUGT, and negatively correlated with HG (p < 0.05).

Conclusions: Postmenopausal women had fallen in the previous years by about 7.50% and fear of falling by about 45.00%. The fear of falling was correlated with physical performance, resulting in decreased physical performance. Therefore, the assessment of fear of falling in postmenopausal women is importance. This information may help to develop the prevention program and reduce risk of falls.

Outcome of Hyperthyroidism Therapy by Radioactive Iodine (I-131) Using a Fixed Dose in Combination with a Radioactive Iodine Uptake

2024-01-19T16:39:19+07:00

Background and Objective: The treatment of thyroid toxicity using iodine-131 (I-131) radioiodine therapy is an efficient and economically viable approach for patient care. The adjustment of radiation dosage for patients depends on the specific abnormalities of their thyroid glands. The study aimed to investigate outcomes of treating thyroid toxicity with I-131 at Surin Hospital, emphasizing the significance of optimizing radiation dosage for effective and economical patient care.

Methods: This study was descriptive retrospectively analyzed 195 hyperthyroid patients treated with radioactive iodine treatment (RAIT); 183 of whom underwent radioactive iodine uptake test (RAIU).

Results: At a first year, the remission rate was 78.14% (p < 0.001). The mean ± SD dose of I-131 was 20.36 ± 5.74 mCi. Age, sex, and RAIU were not associated with the remission (p > 0.05). However, males tended to have a lower remission rate than females (p = 0.07). In one patient, the results of the RAIU changed the diagnosis to thyroiditis, thus avoiding unnecessary RAIT.

Conclusions: The treatment for hyperthyroidism at Surin Hospital has a high success rate during the first year. This is because the amount of radiation used is quite high and measuring the amount of radiation on the neck helps in diagnosing patients with thyroiditis. This prevents patients from being exposed to unnecessary radiation.

Development of LAMP-Lateral Flow Immunoassay for diagnosis of melioidosis

2024-03-12T09:09:21+07:00

Background and Objective: Melioidosis is a fatal disease caused by a gram-negative bacterium, Burkholderia pseudomallei. Patients with septicemic melioidosis die within 48 hours, the rapid diagnosis using blood samples is essential. The aim of this study was to develop a loop-mediated isothermal amplification (LAMP) combined with a lateral flow dipstick (LFD) assays for the detection of B. pseudomallei.

Methods: The wcbG gene, a putative capsular polysaccharide biosynthesis protein gene of B. pseudomallei was selected for LAMP primers design. Four primers and 1 probe were considered using Primer Explorer software. The conditions for LAMP-LFD were optimized. The sensitivity of LAMP-LFD was investigated with 50 ng to 500 fg of B. pseudomallei genomic DNA while the specificity was evaluated by using 50 ng of 12 bacterial strains. The LAMP-LFD method was evaluated by the spiked 106 CFU to 1 CFU of B. pseudomallei into the normal EDTA blood samples.

Results: The LAMP-LFD was successfully developed using 1M betaine, 60°C for 60 min for LAMP cycles and conditions for hybridization with FITC-probe were at 60°C for 5 min. It gave sensitivity of 5 pg/ml and 100% specificity when tested with B. thailandensis, Staphylococcus aureus, S. epidermidis, Escherichia coli, Salmonella group B, Pseudomonas aeruginosa and Klebsiella pneumonia. The detection limit was genomic DNA of 102 CFU per 200 μl of EDTA blood.

Conclusion: Our LAMP-LFD assay provided a highly sensitive and specific method to detect B. pseudomallei in the blood based on wcbG gene. It will be another approach for rapid diagnosis of melioidosis.

Risk Factors of Metastatic Invasive Ductal Carcinoma in Thai Women at Surin Hospital

2024-01-02T16:43:26+07:00

Background and Objective: Breast cancer is the leading cause of cancer death in Thailand. Pathology result affects both treatment and survival outcome which varied by factors of age, hormone receptor type, histopathology of cancer, size of the tumor, and axillary lymph node metastasis including estrogen receptor (ER) with progesterone receptor (PR) and human epidermal growth factor receptor (HER2) receptors status. This study aimed to verify pathological and related factors associated with axillary lymph node metastasis in patients breast cancer.

Methods: A retrospective descriptive study was performed in a group of patients who underwent a total mastectomy in which pathology reported invasive ductal carcinoma from October 2020 to September 2021.

Results: The study group had an average age of 59.01±12.67 years of which 93.81% of these were over 40 years. The average tumor size was 3.66±2.44 cm, HER2 receptor-positive 24.23%, ER/PR receptor-positive 43.3%, and Ki-67 expression (over 20%) was 64.77%. Factors correlated with axillary lymph node metastasis were 1) size of biopsy tissue between 2-5 cm, odds ratio (OR) was 2.16 with 95%CI 1.05-4.44 2) size of biopsy tissue over 5 cm, OR was 4.19 (95%CI 1.55-11.39 and 3) ER/PR receptor-positive, OR was 2.25 with 95%CI 1.09-4.61. While factors of age, positive HER2 receptor, severity of cellular pathology, and Ki-67 expression were not found relationship with axillary lymph node metastasis.

Conclusion: In a group of patients aged over 40 years; the size of the tumor and positive ER/PR receptor increased the risk of axillary lymph node metastasis. However, the severity of cellular pathology, Ki-67 expression, and positive HER2 receptor did not associate with axillary lymph node metastasis.

Beneficial Effect of Rosmarinic Acid on Neurobehavioral Deficits Induced by L-methionine in Adult Rats

2024-02-16T10:26:47+07:00

Background and Objective: Food consumption that contains large quantities of L-methionine (L-met), an essential amino acid can cause oxidative stress by increasing levels of homocysteine. High levels of homocysteine contribute to neuronal cell damage, which can lead to memory impairment. Rosmarinic acid (RA) is a phenolic compound widely distributed in rosemary, thyme and basil. Several studies revealed that rosmarinic acid has the ability to enhance learning and memory function. Therefore, this study was designed to determine the neuroprotective effect of rosmarinic acid against L-methionine-induced memory impairments.

Methods: Male Sprague Dawley rats were divided into 6 groups: control, L-met (1.7 g/kg), RA (10 and 30 mg/kg) and L-met + RA (10 and 30 mg/kg) groups. Subjects were treated once a time per day for 28 days. Body weight was recorded every day. Before and after drug administration, spatial and recognition memory were investigated using the novel object location (NOL) and the novel object recognition (NOR) tests, respectively.

Results: The results revealed that rosmarinic acid and L-met did not have a negative effect on the body weight and locomotor activity. Whereas NOL and NOR tests revealed that control, RA (10 and 30 mg/kg), L-met + RA (10 and 30 mg/kg) groups were significantly different in the time spent exploring between the familiar and novel location or object compared with the L-met group.

Conclusion: This study demonstrates that rosmarinic acid had a protective effect against memory impairment induced by L-met.

Shock Index Predicts Mortality in Children with Severe Sepsis and Septic Shock

2023-12-28T11:01:36+07:00

Background and Objective: The shock index (SI) is a ratio of heart rate (HR) to systolic blood pressure (SBP) per minute. It has been found to be correlated with mortality in pediatric severe sepsis and septic shock. This study aimed to investigate whether the persistent abnormal SI at 6 hours after diagnosis (SI6) was associated with mortality.

Methods: This retrospective cohort study involved pediatric patients aged 1 month to 15 years admitted to the Pediatric Intensive Care Unit (PICU) with severe sepsis and septic shock. The SI was assessed at the time of diagnosis (SI0). Patients with normal SI0 were excluded, while those with abnormal SI0 were included and assessed for the SI at 6 hours after diagnosis (SI6). Subsequently, they were classified into the group with resolution of abnormal SI (normal SI6) and the group with persistent abnormal SI (abnormal SI6) at 6 hours, based on age-specific shock index cut-offs. Mortality at 48 hours was the primary outcome, while in-hospital mortality was the secondary outcome. The age-specific shock index cut-offs at the time of diagnosis indicate a SI greater than or equal to 1.98, 1.50, and 1.25 in children aged under 1, 1-6, and 6-15 years, respectively. Similarly, age-specific shock index cut-offs at 6 hours after diagnosis represent a SI greater than or equal to 1.66, 1.36, and 1.30 in children aged under 1, 1-6, and 6-15 years, respectively.

Results: All 60 patients with severe sepsis and septic shock were enrolled and assessed for the SI at the time of diagnosis (SI0). Subsequently, 44 patients with abnormal SI0 were assessed for the SI at 6 hours after diagnosis (SI6). There were 21 patients in the group with resolution of abnormal SI (normal SI6) and demonstrated a significantly decreased risk of in-hospital mortality compared to the group with persistent abnormal SI (abnormal SI6) at 6 hours (OR 0.07, 95% CI 0.01-0.36, p<0.001). However, there was no significant difference in mortality at 48 hours between the two groups. Furthermore, factors such as immunocompromise (AOR 23.88, 95% CI 1.32-431.31, p=0.032), nosocomial infection (AOR 45.21, 95% CI 2.28-898.55, p=0.012), and persistent abnormal SI at 6 hours after diagnosis (SI6) (AOR 86.59, 95% CI 3.01-2491.98, p=0.009) were found to be associated with an increased risk of in-hospital mortality.

Conclusion: A persistent abnormal SI at 6 hours after diagnosis (SI6) was significantly associated with increased in-hospital mortality, indicating potential inadequate hemodynamic resuscitation and the need for additional stabilization.

Effect of Self-Management Program on Health Related Quality of Life in Patients with Diabetic Retinopathy

2023-07-17T21:50:59+07:00

Background and Objective: Diabetic retinopathy can lead to ocular disturbances and loss of vision. The evidence showed that self-management program could increase quality of life in patients with diabetic retinopathy. This study aimed to investigate the effect of self-management program on health-related quality of life in patients with diabetic retinopathy.

Materials and Methods: Quasi-experimental research with two group pretest-posttest design. The subjects were type2 diabetes’s adult between 18-59 years old patients with diabetic retinopathy in the Eye clinic at Out patients department, Srinagarind Hospital. The 72 samples with purposive sampling were equally divided into control and experimental group of 36 persons each. The control group received routine nursing care only, but the experimental group received the self-management program. The self-management program was based on Lorig and Holman’s concept of self-management combined with Diabetes Self-Management Education. The duration time of the program was conducted over a period of 12 weeks. The instrumentation for collecting data were a demographic data form and Thai Visual Function Questionnaire. The instrumentation was tested for reliability with Cronbrach’s alpha coefficient at .82. The data were analyzed by using frequency, percentage, mean, and standard deviation. The hypotheses were test using paired sample t- test and independent sample t –test

Result: The mean score level of health-related quality of life after experiment of experimental group were statistically significant higher (84.61±6.22) than before experiment (82.19±9.42) (t-test = 2.61) and also higher than control group (73.99±12.56) (t-test = 4.55) at the level of p< .05

Conclusion: The self-management program could increase health-related quality of life in patients with diabetic retinopathy.

TK's 5 Factors Model for Explaining the Incidence of Suicide and Suicide Attempt

2024-03-18T08:37:39+07:00

This article aims to present TK’s 5 Factors model of suicide, which is a hypothesis explaining suicidal behavior and factors leading to suicide and suicide attempts among Thai people. TK’s 5 Factors model of suicide was developed through a thorough review of the literature with strong and reliable evidence. The model was also based on the results of data analysis from several consecutive years of self-harm surveillance reports (506S database), as well as the results of data analysis from suicide and suicide attempts incidence investigation reports submitted from various provinces throughout the country.

The model assumes that suicide or attempted suicide, which is not an act of devotion to one’s faith, belief, religion, or sacrifice for one’s nation, group, or race, occurs under the following five conditions: 1) having risk factors that make the person physically or mentally weak, 2) having precipitating factors that lead to suicidal thoughts and actions, 3) experiencing failure of surveillance, where warning signs of suicide are overlooked and responded to adequately and promptly, 4) experiencing failure of barriers, where access to lethal means, toxic substances, or places used for suicide is not effectively restricted or blocked, and 5) having weak protective factors. If all five conditions are not met, the incident of suicide or suicidal attempt is less likely to occur.

The principles outlined in TK’s 5 Factors model of suicide serve as a guide for suicide investigation teams to gather information from various sources. These principles can be used to form hypotheses, which help prove the causes and factors of suicide and attempted suicide cases under investigation. Additionally, the TK’s 5 Factors model is useful in planning care and treatment for suicide survivors, as well as determining measures to prevent suicide at the provincial or national level.