Ramathibodi Medical Journal https://www.tci-thaijo.org/index.php/ramajournal <p>Ramathibodi Medical Journal (RMJ) publishes article on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics. We welcome submissions from authors worldwide.</p> <p>ISSN 0125-3611 (Print)&nbsp;</p> <p>ISSN 2651-0561 (Online)</p> <p>Indexed in:&nbsp;&nbsp;<strong>&nbsp;&nbsp;<a title="ASEAN CITATION INDEX" href="https://www.asean-cites.org/" target="_blank" rel="noopener"><img width="100" height="40" src="/public/site/images/nuanphan_cha2/aci-logo-v41.png"></a>&nbsp; &nbsp;&nbsp;</strong><a title="ศูนย์ดัชนีการอ้างอิงวารสารไทย:Thai Citation Index (TCI) centre" href="https://www.kmutt.ac.th/jif/public_html/" target="_blank" rel="noopener"><img width="86" height="38" title="tci" src="/public/site/images/tci_admin/tci.png" border="0"></a></p> Faculty of Medicine Ramathibodi Hospital, Mahidol University, THAILAND en-US Ramathibodi Medical Journal 0125-3611 Editor's Note https://www.tci-thaijo.org/index.php/ramajournal/article/view/176681 <p>During the past few months, the news that shocked all science and medical societies was the first gene editing babies. In late November 2018, a scientist in China named He Jiankui claimed he had created the world’s first “CRISPR babies”.<sup>1</sup> Twin girls were born on November 2018 and their genomes, during their period of IVF embryos, had been edited by the DNA editing technology called CRISPR-Cas9. CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is a genome technique that utilize a modified bacterial protein and a RNA that guides it to a specific DNA sequence. CRISPR-Cas9 uses a specially designed RNA molecule to guide an enzyme called Cas9 to a specific sequence of DNA. Cas9 cuts the strands of DNA at that sequence point and removes a small piece, creating a gap in the DNA where a new segment of DNA is added.<sup>2</sup></p> <p>He Jiankui, a biophysics researcher and associate professor in the Department of Biology of the Southern University of Science and Technology (SUSTech) in Shenzhen, China, said he altered embryos for seven couples during fertility treatments, with one pregnancy resulting thus far. He said his goal was not to cure or prevent an inherited disease, but to try to bestow a trait that few people naturally have - an ability to resist possible future infection with HIV, the virus that causes AIDS. He sought to disable a gene called CCR5 that forms a protein doorway that allows HIV, the virus that causes AIDS, to enter a cell.<sup>3</sup></p> <p>Whatever He Jiankui’s intention was, most people in science and medical communities responded to He’s claim grimly, especially China Government. There were more investigation and many hidden issues were revealed. He Jiankui and his team have no experience in clinical trial. Document of Ethics Approval is faked. China Government is currently working on regulation to tighten research on gene editing in Human.<sup>4</sup></p> <p>He and his colleagues had submitted results of “CRISPR babies” to <em>Nature</em> and <em>Science</em> on November 2018. Both journals have rejected the paper outright on the basis of unethical experiment on Human.<sup>5</sup> Editors of both high-regarded journal have demonstrated the role of Journal Editor to keep ethical standard in Human research.</p> Chusak Okascharoen ##submission.copyrightStatement## 2019-03-29 2019-03-29 42 1 Editorial Expression of Concern https://www.tci-thaijo.org/index.php/ramajournal/article/view/185154 <p>April 25, 2019</p> <p>In the January - March 2019 issue, RMJ published a study “Learning Outcomes of Basic Life Support in Primary School Children (RAMAkids Club)” by Aramvanitch K, et al.</p> <p>A concern was raised from a whistleblower that the study was conducted with unethical manners. To response from this concern, a confidential investigation is currently being conducted by Faculty of Medicine Ramathibodi Hospital, Mahidol University.</p> <p>Pending the conclusion of the investigation, RMJ is publishing this Editorial Expression of Concern to alert our readers to the fact that serious questions have been raised about Ethical issues of Aramvanitch et al. paper.</p> Chusak Okascharoen ##submission.copyrightStatement## 2019-04-25 2019-04-25 42 1 Aesthetic Outcomes of Intra-Umbilical Incision vs Infra-Umbilical Incision in Postpartum Tubal Sterilization: A Randomized Controlled Trial https://www.tci-thaijo.org/index.php/ramajournal/article/view/109492 <p style="text-align: justify;"><strong>Background</strong>: An incision inside the umbilicus is popular used in single port surgery intra-umbilical skin incision surgeries have been proven efficient and safe. When compared to infra-umbilical skin incisions, an incision wound was invisible after the operation. Why not use intra-umbilical skin incision in postpartum tubal sterilization.</p> <p style="text-align: justify;"><strong>Objective:</strong> To compare aesthetic scores of an incision wound, surgical time and complications in postpartum sterilization under infra-umbilical and intra-umbilical skin incision.</p> <p style="text-align: justify;"><strong>Methods:</strong> This was a randomized controlled trial conducted in Prapokkhlo Hospital, Chanthaburi, Thailand. Patients (n = 58) with informed consents were randomly assigned to one of the two skin incision techniques for postpartum sterilization (n = 29 for each arm). Surgical times were recorded. Both the patients and an independent physician made wound aesthetic assessments one week after the operation using the Patient and Observer Scar Assessment Scores (POSAS), which compares the wound to the nearby skin. <em>T</em> tests and exact probability statistical tests were used for statistical analysis.</p> <p style="text-align: justify;"><strong>Results: </strong>The surgeon’s POSAS scores in intra-umbilical incisions were significantly closer to normal skin than those in infra-umbilical incisions (6.8 ± 1.5 vs 12.5 ± 5.0; <em>P</em> &lt; .001). A similar finding was observed for patient POSAS scores (6.5 ± 1.2 vs 15.4 ± 5.0; <em>P</em> &lt; .001). The operation times were also shorter (9.1 ± 2.8 vs 11.8 ± 4.7 minutes; <em>P</em> = .009). Neither intra-abdominal injuries nor wound infections were observed.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Postpartum sterilization using intra-umbilical skin incision was more efficient in regard to aesthetic concerns and operation time.</p> Watcharin Chirdchim Preecha Wanichsetakul Jayanton Patumanond ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 1 9 10.33165/rmj.2019.42.1.109492 Does a Single Low Dose Preoperative Intravenous Erythropoietin Affect Postoperative Blood Loss and Transfusion in Elderly Hip Fracture Patients Receiving Intravenous Iron Therapy: A Randomized Controlled Trial https://www.tci-thaijo.org/index.php/ramajournal/article/view/139879 <p style="text-align: justify;"><strong>Background: </strong>Combined recombinant human erythropoietin (rHuEPO) and iron therapy significantly reduced postoperative blood loss (PBL) and allogeneic blood transfusion (ABT) in elderly hip fracture (HF) patients. However, the minimum effective rHuEPO dosage and route had not been studied before.</p> <p style="text-align: justify;"><strong>Objective: </strong>To evaluate the efficacy of single low dose preoperative intravenous rHuEPO on PBL and ABT in elderly HF.</p> <p style="text-align: justify;"><strong>Methods: </strong>A randomized controlled trial (RCT) in 32 elderly HF underwent surgical intervention was conducted. The patients were randomly assigned to receive a single dose of 10 000 IU rHuEPO (EPO group, n = 16) or placebo (control group, n = 16) on admission. All patients were given 200-mg iron sucrose intravenously for 3 days after admission. Perioperative data, outcome related to PBL, ABT, rHuEPO adverse effects, and functional outcome during 1-year period were collected and analyzed.</p> <p style="text-align: justify;"><strong>Results: </strong>There was no significant difference in demographic data, postoperative complication, and functional outcome between both groups (<em>P</em> &lt; .05). Total hemoglobin loss (THL) and the number of patients receiving ABT in EPO group (2.1 ± 1.0 g/dL and 12 patients) did not significant differ from those in control group (2.2 ± 0.8 g/dL and 10 patients) (<em>P</em> = .81 and <em>P</em> = .44, respectively). However, EPO group demonstrated a nonsignificant greater in hemoglobin recovery (<em>P</em> = .07) and increase in reticulocyte count (<em>P</em> = .10).</p> <p style="text-align: justify;"><strong>Conclusion: </strong>Combined single low dose preoperative intravenous rHuEPO with iron therapy does not significantly reduce PBL and ABT in elderly HF compared to who received intravenous iron therapy alone. However, this adjunct rHuEPO may hasten the hemoglobin recovery and helpful for the patients’ outcome.</p> Chavarat Jarungvittayakon Paphon Sa-ngasoongsong Kitchai Luksameearunothai Norachart Sirisreetreerux Noratep Kulachote Thumanoon Ruangchaijatuporn Sasivimol Rattanasiri Suporn Chuncharunee Patarawan Woratanarat Pongsthorn Chanplakorn ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 10 18 10.33165/rmj.2019.42.1.139879 Health Promotion Education for Elderly Patients by Using Structured Self-Health Records to Enhance Knowledge and Attitudes Toward Fall Prevention https://www.tci-thaijo.org/index.php/ramajournal/article/view/125623 <p style="text-align: justify;"><strong>Background:</strong> Health promotion education in elderly is the most important key to successful implementation of fall prevention program in primary care practice. The Ministry of Public Health in Thailand has encouraged the hospital in community to use the self-health records which were found to enhance healthy behaviors.</p> <p style="text-align: justify;"><strong>Objective:</strong> To compare the knowledge and attitudes on fall prevention among elderly patients and their caregivers before and after the education program that employed using self-health records and receiving the counseling from nurses and pharmacists.</p> <p style="text-align: justify;"><strong>Methods</strong>: This embedded mixed methods study was designed by using the structured questionnaires including demographic data and measuring the knowledge and attitude on fall prevention for quantitative arm (143 elderly patients and 42 caregivers). The open-ended questions about the advantages and disadvantages of self-health records were used in qualitative part among 106 elderly patients and 29 caregivers after 6 months of using their records.</p> <p style="text-align: justify;"><strong>Results</strong>: Knowledge and attitude scores were statistically higher in all parts, including appropriate use of the medications, following vaccination schedule, and getting information about fall prevention from their primary care physicians. All participants in qualitative study required to have their self-health records to improve their understanding about their medications and health information.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Self-health records and receiving the counseling from nurses and pharmacists not only enhances the knowledge and attitude toward fall prevention program in older adults but also helps patients to communicate with the specialists about their health information.</p> Siriporn Khongrang Chitima Boongird Soontraporn Phiphadthakusolkul Krongtong Putthipokin ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 19 28 10.33165/rmj.2019.42.1.125623 Learning Outcomes of Basic Life Support in Primary School Children (RAMAkids Club) https://www.tci-thaijo.org/index.php/ramajournal/article/view/132460 <p><strong>Background:</strong> Rapid initiation of basic life support (BLS) significantly associate with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). In Thailand, only 15.8% of OHCA receive bystander cardiopulmonary resuscitation (CPR).</p> <p><strong>Objective</strong><strong>: </strong>To study learning outcome in BLS and effective skill of BLS in primary school children.</p> <p><strong>Methods</strong><strong>:</strong> Data was collected retrospectively in BLS training. The training provided for RAMAkids club which participants were primary school children during summer (October 2015). Pretest, posttest, and practical exams were applied to evaluate BLS training.</p> <p><strong>Results</strong><strong>:</strong> All 63 students completed all the steps, 26 students were boys, and almost students studied in grade 1-4. Primary school children had ability to learn from pretest, posttest, and practice skill evaluation. The effectiveness of chest compression in BLS were average in depth and speed of 3.3 cm and 106.9 time/minute, respectively.</p> <p style="text-align: justify;"><strong>Conclusions: </strong>This study showed that primary school children had ability to learn BLS skill and could be initiated basic rescue properly. Early training BLS for primary school children enhances their alertness in recognizing a cardiac arrest and knowledge of BLS procedures.</p> Kasamon Aramvanitch Yuwares Sittichanbuncha Panvilai Tangkulpanich Jarupol Tuangsirisup ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 29 35 10.33165/rmj.2019.42.1.132460 Study of Factors Associated With Missed Appointments of Patients in Adult Allergy Clinic at Ramathibodi Hospital https://www.tci-thaijo.org/index.php/ramajournal/article/view/115287 <p style="text-align: justify;"><strong>Background:</strong> The incidence of missed appointment of the patients who were waiting more than 1 month was 22.0%. Therefore, this study was designed to identify factors associated with missed appointment which may lead to better system development.</p> <p style="text-align: justify;"><strong>Objective:</strong> To study factors that affect missed appointments.</p> <p style="text-align: justify;"><strong>Methods:</strong> This was a survey research using the questionnaire demonstrated factors associated with missed appointments. This study included 330 patients who had been serving from October 2016 to March 2017 in allergy clinic at Ramathibodi Hospital.</p> <p style="text-align: justify;"><strong>Results</strong><strong>: </strong>Of the 330 patients, 71.5% were female, 57.0% graduated a bachelor degree, 76.7% lived in Bangkok and nearby provinces, and 37.9% used civil servant medical benefit. Among 75.5% of patients had general appointments, 24.5% had intervention appointment, 72.1% experienced missed appointments, and only 27.9% never been defaulted. Factors associated with never been defaulted appointments were degree graduation higher than bachelor degree, appointment for intervention, conveniency of commuted methods, and lesser waiting time at the hospital. While factors affecting missed appointments were error checking for dates, forgotten the dates, the good condition of the illness, remission of disease activities, still exist much of medicine, and boring with the service system of the hospital. Approximately 83.3% of patients did not use Rama Appointment, a mobile application for appointment management.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> There are many factors associated with missed appointments which provide opportunity for quality improvement.</p> Thanuchporn Kafaksom Nichapha Dechapaphapitak Malinee Tongdee Supa Oncham Umaporn Udomsubpayakul Wannada Laisuan ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 36 42 10.33165/rmj.2019.42.1.115287 The Guidelines for Supervisor on Pre-Review Academic Work for Employee’s Career Advancement https://www.tci-thaijo.org/index.php/ramajournal/article/view/113710 <p style="text-align: justify;">Pre-review employee’s academic work should be performed&nbsp;before propose to the career-advancing promotion review committee. Pre-review is a key success for employee’s career promotion, and the first important person in this process is a supervisor. By exampling the applicant’s qualification, work load and quality of work along with the regulation and guideline, supervisor can prevent some mistakes of documents and required process.</p> Hatairat Pobchaiyaphum Rattana Permpech ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 43 54 10.33165/rmj.2019.42.1.113710 Speech Therapy for Childhood Apraxia of Speech https://www.tci-thaijo.org/index.php/ramajournal/article/view/113728 <p style="text-align: justify;">Childhood apraxia of speech is a neurological speech sound disorder in which the child has inadequate the precision and consistency of movements underlying speech production in the absence of neuromuscular deficits. Children with apraxia of speech require intensive and specialized training in order to enable them to communicate effectively. The principles of the speech therapy program include stimulating speaking and communicating in daily life as well as practicing to speak clearly. The purpose of this article is to discuss the principles of speech therapy based on motor learning, speech stimulation and daily life communication, exercises to promote oral motor planning for each speech sound, and inclusion of the family into the team working with the child.</p> Worawan Wattanawongsawang ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 55 64 10.33165/rmj.2019.42.1.113728 Tuberculosis in the Bone Marrow: A Case Report https://www.tci-thaijo.org/index.php/ramajournal/article/view/136329 <p style="text-align: justify;"><em>Mycobacterium tuberculosis</em> of&nbsp;bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.</p> Lickhasit Saenglootong Somchai Insiripong ##submission.copyrightStatement## https://creativecommons.org/licenses/by-nc-nd/4.0 2019-03-18 2019-03-18 42 1 65 70 10.33165/rmj.2019.42.1.136329