หนังสือประชุม ปี 2022

100

Abstract no. 66

Practicality of total salpingectomy during cesarean sections

Kitinan Phichedwanichskul and Supreechaya Phansenee

Department of Obstetrics and Gynecology, Phramongkutklao Hospital

Objective: To determine the practicality of total salpingectomy compared with standard tubal ligation
during cesarean section.
Material and methods: A randomized controlled trial was conducted at a tertiary care center. Pregnant
women older than 20 years scheduled for cesarean delivery and sterilization were signed to salpingectomy
or tubal ligation group. The primary outcome was total operative time. The secondary outcomes
included procedure time, completion of procedure, estimated blood loss (EBL), and surgical complications.
Results: Fifty-one of the 102 participants underwent salpingectomy, and 51 participants underwent tubal
ligation. The average total operative time of the salpingectomy group was 5 minutes longer than the
tubal ligation group, but the difference was not statistically significant [85.00 minutes (65.00-95.00) vs
80.00 minutes (60.00-105.00), p = 0.511]. The procedure times of salpingectomy and tubal ligation were
12.33 minutes (8.67-16.67) and 6.95 minutes (5.00-7.87) respectively (difference 5.38 minutes, p < 0.001).
The EBL of salpingectomy group was significantly higher than tubal ligation group [3.00 mL (2.00-5.00) vs
2.00 mL (1.00-5.00), p = 0.041]. The completion rate of the procedure was comparable between the two
groups (96.1% vs 98%, p = 0.558). Both groups had similar total operative EBL and surgical complications.
According to subgroup analysis, the staff group outperformed the resident group in terms of operative
time and EBL.
Conclusion: The total operative time and the completion rate between the two procedures were not
statistically different. The procedure time and EBL were slightly increased with the salpingectomy group.
Keyword: l Cesarean section l Sterilization l Salpingectomy l Tubal ligation

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

101

Abstract no. 67

Preoperative Ultrasonography of Neck Anatomy Evaluation for
Tracheostomy

Krissamon Limthornbenjapol1, Pana Klamkam1, Metha Aungaphinant2, Ekasak Chantrapannik3 and
Suthee Rattanathummawat1

1Department of Otorhinolaryngology; 2Department of Radiology; 3Department of Anesthesiology, Phramongkutklao Hospital

Backgrounds: Tracheostomy is creation of an opening in anterior tracheal wall to formalize a permanent
stoma of trachea to aid respiration. Indications of tracheostomy vary from prolonged mechanical ventilation,
pulmonary toilet, surgical access, and airway obstruction. At Phramongkutklao Hospital, tracheostomy is
the most common procedure of Otorhinolaryngology Department, 150 operations in 2019 and 124 operations
in 2020. Operative time and complication vary in each patient according to anatomy at surgical site.
Nowadays, ultrasound is widely used because it is available in most hospitals, non-invasive, mobile,
affordable, and easy to perform. Performing pre-operative ultrasound to study subcutaneous tissue and
thyroid isthmus thickness at surgical site, tracheal ring width might be helpful to estimate operative time
and intraoperative blood loss. It may also guide us to select surgical incision as well.
Objectives: The main purpose of this study is to evaluate anatomy of tracheostomy surgical site including
subcutaneous tissue and thyroid isthmus thickness and tracheal ring width by ultrasound. The secondary
purpose is to study correlation between aforementioned factors and operative time and intraoperative
blood loss.
Study design: Prospective descriptive study
Material and methods: Forty-one patients were included in this study, when they were about to undergo
tracheostomy operation, patient’s history would be collected and physical examination was done.
Indication for tracheostomy was collected and pre-operative ultrasound at surgical site was performed
at otorhinolaryngology operative room. Subcutaneous tissue and thyroid isthmus thickness and tracheal
ring width were measured by ultrasound and recorded, then patient underwent surgery - operative time
and intraoperative blood loss were recorded.
Results: There were 41 patients included in this study which was male 53.7% and female 46.3%. The
comorbidities were hypertension 73.2%, dyslipidemia 51.2%, diabetes mellitus 39%, chronic kidney disease
31.7% and old cerebrovascular disease 14.6%. The most common indication was prolonged mechanical
ventilation 87.8%. Mean subcutaneous tissue thickness was 0.55 cm ± 0.2, mean thyroid isthmus thickness
was 0.32 cm ± 0.23, and mean tracheal ring width was 2.22 cm ± 0.41. Mean operative time was 38.41
minutes ± 20.36 and mean intraoperative blood loss was 15.61 milliliters ± 12.05. Correlation between
ultrasound outcome and operative time is that subcutaneous tissue greater than 0.5 centimeter is risk factor

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

102
of operative time more than 30 minutes (OR = 1.077; p-value = 0.91). Greater thyroid isthmus thickness
is also risk factor of longer operative time (OR = 12.485; p-value = 0.103).
Conclusion: The use of ultrasound to study anatomical structure at tracheostomy site before the procedure
is superior to physical examination alone that surgeon can measure subcutaneous tissue and thyroid
isthmus (if present) thickness and locate the trachea especially in patients whose trachea cannot be
palpated or tracheal shift. Also surgeon can predict operative time in such cases and be aware of anatomy
and surgical complications.
Keyword: l Tracheostomy l Ultrasound l Subcutaneous tissue l Thyroid isthmus
l Tracheal ring width

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

103

Abstract no. 68

Chest radiograph findings monitoring with time course of COVID-19
pediatrics patients

Niracha Atanavanich, Sutiporn Khampunnip and Suvicha Khampunnip

Department of Radiology, Phramongkutklao Hospital

Background: Coronavirus disease 2019 (COVID-19) originated in Wuhan, China and then has spread
worldwide1. According to the epidemiological study report, infected pediatric patients were 1.7 percent8.
The use of radiological modalities including chest radiograph (CXR) and computed tomography plays an
important role in diagnosis, post-treatment follow-up and prognosis prediction. The radiation dose in
pediatric patients is being concerned because of their long-life expectancy. The appropriate radiological
diagnostic modality, time of examination and frequency of follow- up should be carefully selected19.
Objective: To determine radiographic findings of the initial CXR and follow-up CXR in COVID-19 pediatric
patients using Brixia score or CXR scoring system for COVID-19 pneumonia, and to find out correlation
between time-radiographic finding progression.
Methodology: This retrospective descriptive study was conducted in all pediatric patients aged 0-18 years
who were diagnosed as COVID-19 infection and admitted at Phramongkutklao Hospital during July 1,
2021 to April 30, 2022. Image findings were reviewed by an experienced pediatric radiologist and using
Brixia score or CXR scoring system for COVID-19 pneumonia. The maximum severity score and timing
to reach this score were calculated and recorded in all patients.
Results: During the study period, 428 total CXRs were collected from 170 pediatric patients. Most patients
were male (60%) with a mean age of 9.89 years. The most common presenting symptom was fever
(75.3%). One-fourth of the included patients had underlying illnesses. Most patients were symptomatic
patients (156 patients, 91.8%). The first CXR showed abnormalities, 64.7% in the symptomatic group and
42.9% in the asymptomatic group. Common CXR finding was interstitial opacity and distribution mostly
involved middle to lower lung zones and located at perihilar region. Mean maximum severity score was
2.79±3.56 (0-12) and 2.97±2.87 (0-14) in asymptomatic and symptomatic patients respectively, which was
not significantly different. Time to maximum severity score in these two groups was phase 1 (0-4 days)
and followed by phase 2 (5-8 days). For patients with normal first CXR, abnormalities could be detected
on later CXRs, mostly in phase 1 and 2. There was a significant correlation of maximum severity score
and severe final diagnosis.

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

104
Conclusion: Chest radiograph should be the screening modality at the time of diagnosis due to the
high rate of abnormality detection regardless of the symptoms. For the patients with normal first CXR,
abnormalities could be detected on the later follow-up CXR mostly in phase 1 (0-4 days) and phase 2
(5-8 days) of disease. Additionally, the maximum severity score are also mostly detected in phase 1 and
phase 2 of disease, so the follow-up CXRs in phase 1 and phase 2 of disease are appropriated although the
baseline CXR was negative in order to increase chance for detecting late presentation of lung abnormality
and evaluating the maximal progression of lung involvement.
Keyword: l COVID19 X-ray l COVID in children l X-ray of pediatric COVID

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

105

Abstract no. 69

Efficacy of intravenous lidocaine infusion in propofol-based sedation
for colonoscopy: a randomized controlled trial

Siriluk Chumnanvej, Soravish Sirilertworakul, Kiattisak Kosakarn, Sutira Siripoonyothai and
Natthaphong Phuvachoterojanaphokin

Department of Anesthesiology, Phramongkutklao Hospital

Background: Propofol has been widely used for procedural sedation and analgesia especially colonoscope
as it has fast onset and recovery time. However, a high dose of propofol can lead to many adverse effects
e.g., respiratory depression and cardiovascular compromise. This study aims to test the additive effect of
intravenous lidocaine could lead to a decrease in total propofol and its adverse effects during colonoscopy.
Methodology: One hundred and twenty-six patients, who were scheduled for an elective colonoscopy
under intravenous sedation, were randomly enrolled into control group (Group C), intravenous lidocaine
(1.5 mg/kg then 1 mg/kg/h, Group L1) and intravenous lidocaine (1.5 mg/kg then 2 mg/kg/h, Group
L2). Anesthesia was induced with propofol 0.5 mg/kg, midazolam 0.01 mg/kg, fentanyl 1 mcg/kg then
maintenance with 25 mcg/kg/h of propofol. In L1 and L2 groups were received bolus intravenous
lidocaine 1.5 mg/kg then 1 mg/kg/h and 2 mg/kg/h respectively. A single supplement bolus of propofol
20 mg and increase maintenance rate by 10 mcg/kg/h when MOAS/S > 3. The primary outcomes were
total propofol dose and frequency of bolus dose. The secondary outcomes include hypotension, apnea,
desaturation events, surgeon satisfaction score, pain score, and recovery time.
Results: A total of 126 patients were included in the final analysis. Both intravenous lidocaine group
(L1, L2) were significantly reduced total propofol dose compared to control group (176.00±45.54 mg (C) vs
152.45±51.40 mg (L1), p = 0.048) and (176.00±45.54 mg (C) vs 139.98±37.23 mg (L2), p = 0.001). But there
was no different in total propofol dose between L1 and L2 group (152.45±51.40 mg vs 139.98±37.23 mg,
p = 0.416). The incidence of hypotension, apnea, and desaturation events, surgeon satisfaction score,
pain score and recovery time were similar in three groups.
Conclusion: The addition of intravenous lidocaine to propofol-based sedation effectively reduces propofol
requirement without adverse effects during colonoscopy.
Keyword: l Lidocaine l Propofol l Colonoscopy

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

106

Abstract no. 70

Efficacy of 7-day and 10-day of VAB (Vonoprazan, Amoxicillin, and
Bismuth subsalicylate) versus 14-day standard triple therapy for
first-line Helicobacter pylori eradication: a multicenter Randomized
controlled trial

Thitiwat Phetkee1, Veerayut Anansawat2, Anuchit Suksamai3, Sukhum Songserm4 and Kachonsak Yongwatana1

1Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital; 2Ananda Mahidol Hospital; 3Fort Suranari
Hospital; 4Fort Somdej Phranaresuan Maharaj Hospital

Background: Helicobacter pylori (HP) infection causes gastritis, and chronic inflammation and may eventually
result in gastric cancer. Eradication of H. pylori is recommended by global guidelines. The H. pylori
eradication rate with Vonoprazan, a potassium-competitive acid blocker, was found to be higher than that
with PPIs. This study aimed to investigate the efficacy of the 7-day and 10-day Vonoprazan, Amoxicillin,
and Bismuth subsalicylate therapy for first-line H. pylori treatment and compared it with standard triple
therapy in order to shorten the duration.
Methods: From September 2021 to September 2022, patients diagnosed with HP infection were enrolled.
Patients were randomized into 14-OAC (Omeprazole 20 mg bid, Amoxicillin 1,000 mg bid, and Clarithromycin
500 mg bid for 14 days), 7-VAB (Vonoprazan 20 mg bid, Amoxicillin 1,000 mg bid, and Bismuth subsalicylate
1,048 mg bid for 7 days) and 10-VAB (Vonoprazan 20 mg bid, Amoxicillin 1,000 mg bid, and Bismuth
subsalicylate 1,048 mg bid for 10 days) group. The primary outcome was eradication rates and factors that
affected successful eradication. The secondary outcome was adverse events in each group.
Results: A total of 1,286 patients were screened and 344 patients were randomized. One hundred and
fifteen, 114, and 115 patients were in 14-OAC, 7-VAB, and 10-VAB groups respectively. At least 4 weeks
after complete treatment, C-13 Urea Breath Test (UBT) was done to confirm eradication. The eradication
rate was higher significantly in 10-VAB group compared with the traditional 14-OAC group (92.9% vs
82.7%; p = 0.010). The eradication rate was higher in 7-VAB group compared with the traditional 14-OAC
group but without statistically significant. (89.1% vs 82.7%; p = 0.087). The total adverse event rates were
similar between the 14-OAC, 7-VAB, and 10-VAB groups (27.4% vs 30.5% vs , p = 0.524).
Conclusions: The 10-VAB regimen was well tolerated and achieved statistically higher successful eradication
rate to those of 14-OAC regimen. The 7-VAB regimen was also well tolerated and tended to achieve
higher successful eradication rate to those of 14-OAC regimen but without statistically significant. The
VAB regimen may be an alternative regimen for H. pylori treatment with the advantage of shorter duration
and avoid unneccessary antibiotics.
Keyword: l Helicobacter pylori l Vonoprazan l P-CAB l Bismuth subsalicylate l Triple therapy

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

107

Abstract no. 71

Prevalence and associated factors of acute exacerbation of chronic
obstructive pulmonary disease (AECOPD) in type 2 diabetes
mellitus patients in Sanamchaikhet Hospital, Sanamchaikhet
district, Chachoengsao Province, Thailand

Tippadisorn Takon1, Poonyawee Dechkraisorn1, Rachanon Pibulniyom1, Kawin Wongthamarin2 and
Phutsapong Srisawat2

¹6th Year Medical Cadet Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Chronic obstructive pulmonary disease (COPD) is an important problem of healthcare system
worldwide. In 2019, according to World Health Organization ranking about leading causes of death globally,
COPD is in the 3rd place. It can present with acute exacerbation of COPD known as AECOPD which
lowers quality of life, prognosis, pulmonary function and increases mortality rate among COPD patients.
Moreover, COPD patients, who have diabetes mellitus type 2, tend to come with AECOPD sooner and
more severe than the others. Consequently, the aim of this study is to find prevalence and associated
factors of AECOPD in type 2 diabetes mellitus patients.
Materials and methods: We conducted a Cross-sectional study to quantitatively measure the prevalence
and associated factors of AECOPD in type 2 diabetes mellitus patients in Sanamchaikhet Hospital,
Sanamchaikhet district, Chachoengsao Province, Thailand. The data was collected from 1 January 2016
to 30 September 2021.
Results: Seventy-seven people of COPD patients who have type 2 diabetes mellitus were included in the
study. We found that the prevalence of AECOPD is 24.7 percent among participants. Unfortunately, we
cannot complete the number of participants of 113 people then no risk factors can be presumed with
statistical significance.
Conclusions: This study shows that prevalence of AECOPD among COPD patient with T2DM in
Sanamchaikhet district is lower rate than other COPD patients which experience first episode of AECOPD
about 46 percent within the first year after diagnosed. It means good standard of care and treatment in
Sanamchaikhet district. However, our study is not strong enough due to lack of participants number to
conclude the associated factors in statistical way.
Keyword: l Chronic obstructive pulmonary disease l Acute exacerbation of COPD
l Type 2 diabetes mellitus

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

108

Abstract no. 72

Comparing the incidence and association of adverse kidney
outcomes in long-term PPI and non-PPI users in a Thawung
Hospital, Lopburi province, Thailand

Anchana Ajanant1, Rawisara Ploypairoj1, Teeraboon Lertwanichwattana2 and Phutsapong Srisawat2

¹6th Year Medical Cadet Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Proton pump inhibitors (PPIs) are widely used for acid suppression therapy which result in
over-prescription with 50-86% was reported in hospital setting. Many medical reports found that PPIs
use have been linked to acute kidney injury (AKI) and chronic kidney disease (CKD), and progression to
end-stage renal disease (ESRD). This study aimed to compare the incidence and find the association of
adverse kidney outcomes in terms of rapid declining kidney function in long-term PPI and non-PPI users
among patients with preserved kidney function (eGFR above 60 mL/min/1.73m²) from years 2015 through
2020 at Thawung Hospital, Lopburi province, Thailand
Materials and methods: Participants aged 18 years old and older diagnosed with preserved kidney function
of greater than 60 mL/min/1.73m² having more than two creatinine values taken more than a year apart
at Thawung Hospital from years 2015 through 2020. Cases with diagnosis of pregnancy are excluded.
We use SPSS version 22.0 to calculate the prevalence of rapid decline eGFR more than 5 mL/min/1.73m²
per year and use Cox regression to identify associated risk factors that may contribute to having rapid
decline eGFR and Kaplan-Meier curves to finding the median survival time compared PPI to non-PPIs users
Results: From univariate analysis, male, using Enalapril and Losartan, dyslipidemia, and fasting blood
sugar greater than 126 mg/dL is risk for development of rapid decline eGFR. From multivariate analysis,
there is statistical significance in groups with fasting blood sugar less than 126 mg/dL to be a protective
factor. The total of 1,837 patients, 35.71% of whom were exposed to PPIs, the incidence rate of rapid eGFR
decline was not different to the PPI. In adjusted models, PPIs were not associated with a higher risk of
renal progression compared with controls (aHR 1.065, 95% CI: 0.916-1.239, p = 0.419). From Kaplan-Meier
curves shows eGFR drop was found in all participants fifty percent survival time for PPI group was 1.09
months and non-PPI group was 1.058 months. If we compare the two group, there is not statistically
significant different with p-value of 0.37.
Conclusions and recommendations: There were a statistically significant not association between regular use
of omeprazole and rapid declining of eGFR preserved with renal function in adult and elderly at Thawung
Hospital. Moreover, there might be an association between gender, fasting blood glucose, dyslipidemia,
Losartan, Enalapril and having rapid decline eGFR from univariate and multivariate analysis. However, a
larger sample size is needed to make clearer assumptions.
Keyword: l Acute kidney injury l Proton pump inhibitors l Rapid decline kidney function
l Incidence l Risk factors
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

109

Abstract no. 73

Incidence and risk factor of stroke among patients in NCDs clinic,
Phatthananikhom Hospital, Lopburi province, Thailand

Sakda Lawanwisut1, Fakkhwan Sengsong1, Petrapee Pimolpattarakul1 , Boonsub Sakboonyarat2,
Phutsapong Srisawat2 and Ram Rangsin2

16th Year Medical Cadet Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Stroke is the major health issues globally and is the second most common cause of death each
year. Its sequelae contribute to multiple disabilities which impact qualities of live. Non-communicable
diseases (NCDs) are considered as potential risk factors of stroke and causes major cardiovascular death in
Thailand. Lowering the incidence of stroke then should emphasized on controlling NCDs and associating
risk factors. This study aims to determine incidence of stroke and risk factors among patients in NCDs
clinic, Phatthananikhom Hospital.
Materials and methods: The retrospective cohort study was conducted using Phatthananikhom Hospital’s
database during Jan 1st, 2011, until May 31st, 2021. There are 232 patients in NCDs clinic who was
diagnosed stroke. The result will demonstrate incidence and risk factors associated with stroke in
quantitative method. Cox proportional hazards regression model was used to determine the adjusted
hazard ratio of stroke for each main baseline predictor variable with 95%CI, and p-value < 0.05 was used
to declare statistical significance.
Results: We documented stroke patient of 232 cases of a total 5,474 patient among NCDs patient in
Phatthananikhom Hospital was 0.054 per 100 person-months. For univariate analysis, age above 45 years
old, male gender, hypertension either controlled or uncontrolled, diabetes mellitus, heart disease, systolic
blood pressure, diastolic blood pressure, creatinine and triglyceride are the risk factors of developing
stroke. After adjusting confounding factors in multivariate analysis, this study indicates that being male
(AHR 2.254, 95%CI: 1.67-3.04, p-value < 0.05), diabetes (AHR 1.446, 95%CI: 1.05-1.99, p-value < 0.023) and
uncontrolled hypertension (AHR 1.612, 95%CI: 1.19-2.19, p-value < 0.002) are risk factors associated with
stroke.
Conclusion: The reported incidence introduces new idea of stroke in community and highlighting the
need for efficient stroke prevention and treatment strategies.
Keyword: l Stroke l Non-communicable diseases l Incidence l Risk factors

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

110

Abstract no. 74

Incidence and risk factors in Diabetic foot ulcers in Diabetes
mellitus in secondary care hospital, Lopburi

Kuntapon Puttarungsri¹, Phattharika Tanareesuchoti¹, Watakarn Yooprasert¹, Phutsapong Srisawat2 and
Ram Rangsin²

¹6th Year Medical Cadet Student; ²Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Diabetes mellitus is one of the major public health problems. Patients with diabetes have
higher risk of complications such as retinopathy, nephropathy, cardiovascular disease, and diabetic foot
complications. Reducing the incidence of diabetic foot ulcers and amputation should mainly focus on
primary prevention. Screening and intensive follow-up are the key to reduce these numbers. This study
aims to determine the incidence and risk factors of diabetic foot ulcers in patients with diabetes mellitus
in secondary care hospital, Lopburi.
Materials and methods: A retrospective cohort study was conducted in Thaluang Hospital, Lopburi,
Thailand between 1 January 2011 to 31 December 2020
Result: From the study, we found that the incidence of diabetic foot ulcers among diabetic patients in
Tha Luang Hospital is 23.14/1,000 person-years. In the final multivariate Cox regression analysis, the
variables which had a statistically significant relationship with diabetic foot ulcers were male gender,
age, and obesity.
Conclusion: This study showed the association of risk factors with diabetic foot ulcers that can be utilized
as a part of the management to help improve the quality of life and generate the intervention that can
be applied to general hospitals.
Keyword: l Diabetic mellitus l Diabetes foot ulcer l Incidence l Risk factors
l Secondary care hospital l Thailand

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

111

Abstract no. 75

Prevalence of diabetic nephropathy and factors related to diabetic
nephropathy among type 2 diabetes mellitus patients with
overweight and obesity in department of Sanam Chai Khet Hospital,
Sanam Chai Khet district, Chachoengsao Province, Thailand

Watcharapan Sompong1, Nuttachai Raweerotwiboon1 and Wisit Kaewput2

16th Year Medical Cadet; ²Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Chronic non-communicable disease is currently one of the top health problems in the world.
One of the important chronic non-communicable diseases is diabetes, the trend of diabetes is increasing in
the population aged 15 years and over in Thailand. Diabetes has many complications, the most common
is diabetic nephropathy which turns into chronic kidney disease and end-stage renal disease. Overweight
and obesity are common health problems and associated with various diseases, one of which is chronic
kidney disease. This study aims determine the prevalence and factors affecting kidney complications of
type 2 diabetes in patients with a body mass index greater than the normal range in Sanam Chai Khet
Hospital, Chachoengsao Province, Thailand.
Materials and Methods: Quantitative study by analytic cross-sectional study using secondary data from
secondary data of the target population from the database in the medical record from department of Sanam
Chai Khet Hospital to find prevalence of diabetic nephropathy and factors related to diabetic nephropathy
among type 2 diabetes mellitus patients with overweight and obesity in department of Sanam Chai Khet
Hospital, Sanam Chai Khet district, Chachoengsao Province, Thailand and selecting the data of patients
diagnosed with diabetes from 2002-2019
Results: A total of population of this research is 1,314 patients with type 2 diabetes from 2002-2019. There
were 204 patients with diabetic nephropathy accounted for 16%. We found that the risk factors affecting
patients with diabetic nephropathy including every increased-1-year in age increase risk of diabetic
nephropathy 1.13 times with a statistically significant increase, and the duration of diabetes is increasing
every 1-year risk of diabetic nephropathy increased by 1.031 times with a statistically significant increase.
Conclusion: Prevalence of patients with diabetic nephropathy in Sanam Chaikhet Hospital from 2002
to 2019 is 16% compared with type 2 diabetic patients during this period and factors associated with
diabetic nephropathy in diabetic patients. The risk factors were increasing age every 1 year and duration
of diabetes mellitus every 1 year.
Keyword: l Diabetic nephropathy l Type 2 diabetes mellitus l Overweight l Obesity

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

112

Abstract no. 76

Prevalence and associated factors of ADHD in 6-12 years old
children in Psychosocial clinic, Thawung Hospital, Lopburi

Thunpimol Ekanaprach1, Kulpatsorn Asavasuwansutee1, Ratinan Chiddee1, Pongpisut Thakhampang2 and
Wisit Kaewput2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental
disorders of childhood. There are three different types of ADHD including attention deficit, impulsivity,
and hyperactivity. It is usually first diagnosed in childhood before 12 years old. Children with ADHD may
have trouble paying attention, controlling impulsive behaviors, or be overly active. Deciding if a child has
ADHD is a process with several steps. The objective of this study was to study the prevalence and risk
factors of ADHD among children aged 6-12 years. The scale of the problems will be useful in policies and
further development of ADHD prevention
Materials and methods: A cross-sectional quantitative study was conducted using Thawung Hospital’s
database during January 1st, 2011, until September 15th, 2021. The result will demonstrate prevalence and
associated factors of ADHD in 6-12 years old children in Psychosocial clinic, Thawung Hospital, Lopburi.
Results: According to data collection, a total 179 participants were enrolled in the study. Considering
characteristics of the study participants as shown in table 1, we found that 59 out of 179 participants
tended to be ADHD. Overall prevalence of ADHD in this study was 32.96%. Among male and female,
prevalence of ADHD was 40.84% and 15.09% respectively. According to age group, prevalence of ADHD
in age group between 6-9 years old was 39.45% and in age group between 10-12 years old was 22.86%.
Univariate and multivariate logistic regression analysis were performed to determine the factors associated
with ADHD. After adjusted for the potential confounders, the risk factors associated with ADHD were
male gender (Adjusted odds ratio (AORs); 4.03, 95%CI: 1.70-9.57), age group 6-9 (Adjusted odds ratio
(AORs); 2.31, 95%CI: 1.12-4.78), and Learning Disorder (Adjusted odds ratio (AORs); 0.44, 95%CI: 0.21-0.90).
Conclusion: This study presented the situation of ADHD in psychosocial clinic, Thawung Hospital, Lopburi.
The prevalence of ADHD in our setting was 32.96% and the associated factors are gender, age group, and
learning disorder. Our study promotes the early screening of ADHD in patients with learning impairment
especially in boys before age of 10. Early detection and instituting proper care are important to reduce
the impact of ADHD on these young children.
Keyword: l ADHD l Prevalence l Associated factors l The SNAP-IV questionnaire

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

113

Abstract no. 77

A comparison of the incidence of acute coronary syndrome during
COVID-19 pandemic and non-COVID-19 pandemic periods among adult
patients visiting in a community hospital, Lop Buri Province, Thailand

Jessadakorn Polcharoensuk1, Kittipong Yasan1, Thanapat Ananthanawat1, Wisit Kaewput2 , Ram Rangsin2,
and Boonsub Sakboonyarat2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: The evidence of ACS incidence during COVID-19 pandemic in community hospital in
Thailand was limited. The objectives of present study were aimed to determine the incidence of ACS
among patients with NCDs during COVID-19 pandemic period as well as comparing to that during non-
COVID-19 pandemic period. Furthermore, the investigator determined the risk factors for ACS among
patients with NCDs.
Materials and methods: A retrospective cohort study was conducted in Tha Luang community hospital,
Lop Buri Province in Thailand. The eligible criteria for participants were patients with NCDs aged ≥ 35
years visiting in Tha Luang Hospital during February 1, 2019 to February 29, 2020 (during non-COVID-19
pandemic period) and Mar 1, 2020 to Mar 1, 2021 (during the COVID-19 pandemic period). The Patients
with NCDs including type 2 diabetes (T2D), hypertension (HT) and dyslipidemia (DLP) were defined by
according to the International Classification of Diseases, Tenth Revision codes (ICD-10) which presented
in medical record. ACS data was determined by the ICD-10; I20-24. Multivariable cox proportional hazard
regression analysis was used to determine the risk factors for ACS and the magnitude of association was
presented as adjusted hazard ratio (aHR) with 95% confidence interval (95%CI).
Results: A total of 4,962 patients were enrolled in the study. In all, there was 3,049 females (61.45%). The
average age of participants at baseline was 62.28±12.16 years. The cumulative incidences of ACS among
patients with NCDs were 0.48% and 0.50% during non-COVID-19 pandemic and COVID-19 pandemic
periods, respectively (p-value = 0.999). The incidence rate of ACS was 4.7 cases/1,000person-years. The
risk factors of ACS included age ≥ 62 years (aHR 2.09, 95%CI: 1.06-4.12), DLP (aHR 6.42, 95%CI: 3.39-12.17),
having systolic blood pressure (BP) ≥ 149 mmHg or diastolic BP ≥ 90mmHg (aHR 3.86, 95%CI: 1.93-7.71),
pulse pressure < 56 mmHg (aHR 2.33, 95%CI: 1.14-4.78).
Conclusion: The incidences of ACS among patients with NCDs visiting in community hospital between
COVID-19 pandemic and non-COVID-19 pandemic periods were not different. The ACS among patients
with older age should be closed monitored. The modifiable risk factors including high BP and high
cholesterol should be attenuated.
Keyword: l Acute coronary syndrome l COVID-19 l Incidence l Risk factors l Tha Luang Hospital
l Thailand

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

114

Abstract no. 78

Incidence and associated factors of hypoglycemia in type 2 diabetes
patients in Phatthana Nikhom Hospital, Lopburi Province, Thailand

Tatchamon Prasart-intara1, Tanyaporn Suktippayaroj1, Pichayanin Booneam1, Wisit Kaewput2 and
Pongpisut Thakhampaeng2

16th Year Medical Cadet Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Hypoglycemia is one of the most common medical conditions that should be early diagnosed
and treated to prevent life-threatening events and to prevent potentially long-term consequences. It is
one of the complications of diabetes. Hypoglycemia has impact on the quality of life for people with type
2 diabetes. This study aims to determine the incidence and risk factors of hypoglycemia in patients with
type 2 diabetes who follow-up at Phatthana Nikhom Hospital, Lopburi province.
Materials and methods: The retrospective cohort study was conducted using Phatthana Nikhom Hospital’s
database during Sep 1st, 2011, until Aug 31st, 2021. There are 38 diabetic patients in Phatthana Nikhom
Hospital who were diagnosed hypoglycemia. The result will demonstrate incidence and risk factors
associated with hypoglycemic events in type 2 diabetic patients in quantitative method. Poisson regression
was used to determine the incidence rate of hypoglycemia for each main baseline predictor variable with
95%CI, and p-value < 0.05 was used to declare statistical significance.
Results: According to the study, 38 cases of total 802 type 2 diabetic patients were diagnosed as
hypoglycemia in Phatthana Nikhom Hospital. Incidence rate of hypoglycemia among type 2 diabetes was
23.97 people per 1,000 person-years. For univariate analysis, age increased by 1-year, underlying disease
as heart diseases, increasing 1 unit of fasting blood sugar and cholesterol, and the use of insulin, aspirin
and haloperidol are risk factors associated with hypoglycemia among type 2 diabetes. However, after
adjusting confounding factors in multivariate analysis, it was found that the risk factors associated with
hypoglycemia among type 2 diabetes were found that age increased by 1 year (IRR 1.04, 95%CI: 1.01-1.07,
p-value = 0.003), cholesterol increased by 1 unit (IRR 1.01, 95%CI: 1.002-1.012, p-value = 0.002) and the
use of insulin (IRR 1.98, 95%CI: 1.01-3.87, p-value = 0.047) and aspirin (IRR 2.52, 95%CI: 1.24-5.13, p-value
= 0.011) are risk factors associated with hypoglycemia among type 2 diabetes.
Conclusion: According to this study on the incidence of hypoglycemia in type 2 diabetes patients in
Phatthana Nikhom Hospital, Aging, blood cholesterol levels, the use of insulin, and aspirin are risk factors
of hypoglycemia. The patient usually comes to a hospital due to hypoglycemia during 00.00-07.59. The
result from this can use to further monitor and increase awareness about hypoglycemia occurrence.
Keyword: l Hypoglycemia l Type 2 diabetes l Non-communicable diseases l Incidence
l Risk factors
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

115

Abstract no. 79

Associations between obesity and severity condition of disease in
COVID-19 patients in Thawung Hospital, Thailand

Natnicha Pokaew1, Thawaporn Chintanasonthi1, Kanlaya Jongcherdchootrakul2 and Pongpisut Thakhampaeng2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background and Objectives: Obesity is one of serious medical condition and ranked as the fifth foremost
reason for death worldwide. COVID-19 is a new pandemic infectious disease in the world. Factors affecting
severity of COVID-19 conditions are hypertension, type 2 diabetes mellitus, dyslipidemia, obesity, and
cardiovascular disease. The aim of this study is to define the prevalence and the relationship between
obesity and severity condition of disease in COVID-19 patients in Thawung Hospital, Lopburi province,
Thailand.
Materials and methods: Demographic data, laboratory results and possible risk factors were collected from
hospital databases of Thawung Hospital, who visited out-patient clinic and received the test for COVID-19
infection in Thawung hospital. A cross-sectional study was conducted. Data was analyzed using chi-
square test. Multivariate logistic regression was done to determine the relationship between obesity and
another risk factor with severity condition of disease of COVID-19.
Results: From a total of 1,420 patients who were enrolled into the study, 849 of them are female. The
average age was 43.82±16.41. The prevalence of COVID-19 infection among patient who was tested at
the OPD was 71.84%. Multivariate logistic regression analysis found that overweight (95%CI: 1.22-2.75) and
obesity (95%CI: 1.14-2.02) correlation with COVID-19 disease as risk factor were significantly accounted
for COVID-19 infection and also found that female(95%CI: 0.47-0.77) , age of 60 years and older (95%CI:
0.44-0.89), diabetes mellitus (95%CI: 0.24-0.67), hypertension (95%CI: 0.24-0.57) and cardiovascular disease
(95%CI: 0.09-0.69) correlation with COVID-19 disease as protective factor. As for the severity of COVID-19
infection among COVID-19 patient, we found that severe COVID-19 patients who had been treated with
Favipiravir (98.67%). Severe COVID-19 patient also had been treating by using Dexamethasone (4.18%),
had film chest X-ray for more investigation (0.61%) and had been treat with oxygen cannular (1.73%) which
is slightly lower that it should be.
Conclusion: The prevalence of COVID-19 infection in this study is 71.84%. Associated factors with
COVID-19 infection are overweight and obesity were statistically significant as risk factor and female,
age of 60 years and older, diabetes mellitus, hypertension and cardiovascular disease were statistically
significant as protective factor. As for the severity of COVID-19 infection, severe COVID-19 patient had
been treated by using dexamethasone, oxygen cannular and had film chest X-ray for more investigation
is slightly lower that it should be. Therefore, it is further recommended to in spect people who have high
risk closely and recommend more strict use of medication according to guidelines for severe COVID-19.
Keyword: l Obesity l COVID-19 disease l Community Hospital

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

116

Abstract no. 80

Period prevalence and risk factors for rapid decline kidney function
among hypertensive patients in Sanam Chai Khet Hospital, Sanam
Chai Khet district, Chachoengsao province, Thailand

Usakorn Cheawdamrongchai1, Punyaporn Norraratputti1, Paphatsorn Chantarapitak1 and Wisit Kaewput2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Hypertension is the important leading cause of premature morbidity and mortality worldwide.
It is also an important risk factor for chronic kidney disease in the long run. Many medical reports
found that the prevalence of hypertensive patients and the incidence of rapid decline kidney function in
hypertensive patients increased year by year and tends to increase steadily. More importantly, since rapid
decline eGFR is associated with increased morbidity and mortality, it is important to identify associated
factors and prevent further decline eGFR. This study aimed to find the period prevalence and identify
the associated risk factors for rapid decline kidney function among hypertensive patients with preserved
kidney function (eGFR above 60 mL/min/1.73m²) from years 2011 through 2021 at Sanam Chai Khet Hospital,
Chachoengsao province, Thailand.
Materials and methods: Study design is a quantitative retrospective analytic study. Participants aged 18
years old and older diagnosed with hypertension with preserved kidney function of greater than 60 mL/
min/1.73m² having more than two creatinine values taken more than a year apart at Sanam Chai Khet
Hospital from years 2011 through 2021. Cases with diagnosis of pregnancy, or meeting criteria for AKI by
KDIGO are excluded. We use SPSS version 22.0 to calculate the prevalence of rapid decline eGFR more
than 5 mL/min/1.73m² per year and use logistic regression to identify associated risk factors that may
contribute to having rapid decline eGFR.
Results: The period prevalence of rapid decline eGFR in renal preserved patients is 21.75%. From univariate
analysis, having comorbidities such as diabetes mellitus, dyslipidemia, and fasting blood sugar greater than
180 mg/dL is risk for development of rapid decline eGFR. From multivariate analysis, there is statistical
significance in groups with fasting blood sugar 140-180 mg/dL to be a protective factor.
Conclusions and recommendations: One fifth of the hypertensive with preserved kidney function develop
rapid decline eGFR. Programmed add-ons hospital databases for detection of rapid decline eGFR might
be useful for early detection. Moreover, aggressive intervention regarding hypertensive patients with
comorbidity might reduce the period prevalence of rapid decline eGFR. Since, having rapid decline eGFR
has shown to be associated with increased morbidity and mortality.
Keyword: l Hypertension l Rapid decline kidney function l Period prevalence l Risk factors

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

117

Abstract no. 81

Prevalence and associated factors of severe COVID-19 pneumonia of
COVID-19 patients admitted to a field hospital in a rural community,
Lopburi province, Thailand

Pathomphon Phiensuparp1, Peranut Kitjakrancharoensin1, Warath Prasobvitaya1, Kanlaya Jongcherdchootrakul2,
and Pongpisut Thakhampaeng2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: COVID-19 infection has raised concerns in worldwide. Despite implication of various
measure to reduce or prevent the transmission of the COVID-19 virus, but the number of new case report
is still increasing continuously. The severe illness leading to hospitalization, including ICU admission
and death that can occur in adults of any age with COVID-19. The present study aimed to determine the
prevalence and risk factors associated with severe COVID-19 pneumonia among Thai people in a remote
rural community in Lopburi Province, central Thailand.
Materials and methods: A cross-sectional study was conducted from 1 January 2021 to 31 September 2021.
Data related to medical records was retrieved Tha-Wung Hospital database to obtain essential information
included demographic characteristics, vital signs, smoking history, alcohol drinking history, underlying
disease, and treatment history of receiving favipiravir and dexamethasone. Multivariable logistic regression
analysis was used to determine the risk factors of severe COVID-19 pneumonia, and the magnitude of
association was presented as adjusted odds ratio (AOR) with 95% confidence interval (95%CI).
Results: A total of 2221 COVID-19 patients were enrolled into the study. The overall prevalence of severe
COVID-19 pneumonia was 5.3%. The prevalence of severe COVID-19 pneumonia among males was 4.2%,
and 5.9% among females. The risk factors of severe COVID-19 pneumonia included age 40-59 years old
(AOR 1.864, 95%CI: 1.15-3.03), age > 59 years old (AOR 2.733, 95%CI: 1.48-5.05), higher intensity of alcohol
(AOR 3.257, 95%CI: 1.66-6.40), higher intensity of smoking (AOR 2.233, 95%CI: 1.20-4.16), underlying diabetic
(AOR 4.614, 95%CI: 2.80-7.62)
Conclusion: The present study identified a few modifiable risk factors for severe covid pneumonia which
would be useful for prevention and control strategies at the community level including age ≥ 40 years,
having diabetes mellitus, alcohol abuse and smoking. The authorities in the rural communities should
be aware of COVID-19 infection in elderly and people with comorbidities to prevent severity progression
of COVID-19 pneumonia.
Keyword: l COVID-19 l Severe COVID-19 pneumonia l Rural area l Thailand

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

118

Abstract no. 82

The prevalence of hypertension and its associated factors among type
2 diabetes mellitus patients at Thalaung Hospital, Thailand

Poorin Surasansanee1, Rawisut Jittakarm1, Sirapop Saywizard1, Picha Suwannahitatorn2 and
Phutsapong Srisawat3

16th Year Medical Student; 2Department of Parasitology, Academic Affairs; 3Department of Military and Community Medicine, Phramongkutklao
College of Medicine

Background: Since there are many hypertension and diabetes patients in Thailand and still increasing
rapidly every year. The Division of Non-communicable disease shown that the prevalence of raised
blood pressure in the patient who is above 18-year-old raised from 22.6% in 2009 to 26.9% in 2014 and
the prevalence of diabetes mellitus in the patient who is above 15-year-old raised from 7.3% in 2009 to
9.6% 2014. However, the non-communicable disease cannot be completely cured, so the division was
focused on controlling and prevention the complication which comes from the disease. We focused on
the prevalence and their associated factors among type 2 diabetes mellitus patients which will result in
prevention and reduce the complication from the disease, the death.
Materials and methods: This study used a cross-sectional analysis research model by using medical records
of type 2 diabetic patients admitted to Thaluang Hospital from 2015 to 2021 with concomitant hypertension.
They were used to determine the prevalence of hypertension in patients with type 2 diabetes and to
determine associated factors for hypertension in patients with type 2 diabetes.
Results: From the data collection of medical records in Thaluang Hospital, Thaluang, Lopburi, Thailand,
from 2015 to 2021, there were 720 people. The prevalence of hypertension among people with type 2
diabetes was 53.47%. The associated factors with the development of hypertension in people with type
2 diabetes, which were evaluated in a multivariate logistic regression analysis, were gender, age groups,
district, and body mass index. The gender study found that being a female was 0.695 times less likely to
develop hypertension when compared to being male (95%CI: 0.486-0.994). The results showed that at the
40-59 age group was 3.17 times more likely to be associated with hypertension compared to those under
40 (95%CI: 1.343-7.484) and the age group greater than or equal to 60 was 6.242 times more associated
with hypertension compared to the age group less than 40 (95%CI: 2.601-14.982). The district found that
residents in Thaluang district were 3.538 times more associated with hypertension when compared with
those who did not live (95%CI: 1.687-7.421). The overweight patients were 1.925 times more associated
with hypertension when compared with non-obese patients (95%CI: 1.317-2.811).
Conclusion: The results showed that factors associated with hypertension in patients with type 2 diabetes
at Thaluang Hospital by using the multivariate logistic regression analysis are gender, age groups, district,
and body mass index of patients. This makes the community in Thaluang district aware the associated
factors of hypertension in type 2 diabetes mellitus and prevents it happened.
Keyword: l Hypertension l Type 2 diabetes mellitus l Poor glycemic controlled l Thaluang Hospital
l Thailand
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

119

Abstract no. 83

Predictive readmission rate using MELD-Na, PALBI, CiMM and
associated factors of decompensated cirrhosis in primary health care
center Phatthananikhom Hospital, Lop Buri, Thailand

Napat Petchsrikul1, Bunlung Pongpitpitak1 and Wisit Kaewput2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Cirrhosis is a disease that occurs in the late stages of many chronic liver diseases and
can lead to deaths worldwide. In Thailand in 2010, it was discovered that cirrhotic patients who were
hospitalized had a mortality rate of 10.7%, compared with the overall hospital mortality rate. Patients with
cirrhosis who were hospitalized had a death rate ranging from 3.3% to 40%, depending on complications
and co-morbidities. If there are complications, the mortality rate will rise and if a cirrhotic patient with
a complication is admitted to the hospital once, the rate of re-hospitalization with the same or other
complications will be higher. The aim of this research is to use MELD-Na, PALBI, CiMM score and
associated factors for predicting readmission rate of decompensated cirrhosis as tools that appropriate for
primary health care center.
Materials and methods: Retrospective cohort study collecting data from database over the 10-year study
period (January 2011 to December 2020) at Phatthananikhom Hospital, 235 patient diagnoses as cirrhosis
were considered. Included 606 admissions from 133 patient who develop acute decompensation of liver
cirrhosis at the time of admission and laboratory test such as electrolyte, coagulogram, complete blood
count, Liver function test, BUN, creatinine was obtained to calcute MELD, MELD-Na, ALBI, PALBI, and
Cimm score.
Results: In the multivariable logistic regression, the factors significantly associated with readmission
of patient who presented with decompensated cirrhosis eg. ascites, SBP, Hepatic encephalopathy etc.
within 1, 3, 6 months were Cimm year 1 (Odds ratio 1.064, 95%CI: 1.029-1.101, p-value < 0.001), (OR 1.041,
95%CI: 1.041-1.074, p-value = 0.012), and (OR 1.04, 95%CI: 1.01-1.072, p-value = 0.01), respectively. Within
1 year, the only factor independently associated with readmission were ALBI Grade 2 (OR 4.641, 95%CI:
1.092-19.727, p-value = 0.038) and ALBI Grade 3 (OR 4.222, 95%CI: 1.017-17.529, p-value = 0.047) when
compared with ALBI Grade 1
Conclusion: Cimm score might be a better indicator for predict readmission of patients who has history
of acute decompensated cirrhosis in primary health care within 1, 3, 6 months compare to MELD, MELD-
Na, ALBI and PALBI score
Keyword: l Cimm score l MELD l MELD-Na l ALBI l PALBI score

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565

120

Abstract no. 84

Prevalence and risk factors of asthmatic exacerbation among asthma
patients in Sanamchaikhet Hospital, Chachoengsao province, Thailand

Phusit Peampetkul1, Chatri Chintana1, Pornperm Khamvirat1, Kanlaya Jongcherdchutrakul2 and
Pongpisut Thakhampaeng2

16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Asthma exacerbation is a condition of respiratory system which occurred in lungs that
could be life threatening. The mentioned condition is usually acute and could be fatal, occurs in both
children and adults, results in lowering patients’ quality of life. Moreover, the symptoms itself may cost
the patients’ fortune in both physically and economically, and one of the main causes of the expenses of
public health system.

This study aims to determine the prevalence and identify the associated risk factors of asthma
exacerbation from years 2011 through 2021 at Sanamchaikhet Hospital, Chachoemgsao province, Thailand.
Materials and methods: Study design is a quantitative study, retrospective analytic study. Participants’
information acquired from hospital’s database which inclusion criteria are 7 years old or above, diagnosed
with asthma with FEV1/FVC<0.7 and lastly having the examination taken between years 2011 through
2021. Cases with diagnosis of other lung diseases are excluded. We use SPSS version 22.0 to calculate
the prevalence and risk factors of asthma exacerbation.
Results: The period prevalence of asthma exacerbation in asthma patients is 8.2%. From univariate
and multivariate analysis, turns out that the increasing of patients’ age or having comorbidities such as
gastroesophageal reflux disease (GERD) and viral infection could be one of the risk factors of asthmatic
exacerbation.
Conclusions: This study has shown that the prevalence of asthma exacerbation is quite high even though
we are aware about the risk factor of it which includes allergic rhinitis, gastroesophageal reflux disease
and senior are all need to be taken care and treat their disease while keep beware the occurrence of
asthmatic exacerbation.
Keyword: l Asthma l Asthmatic exacerbation l Period prevalence l Risk factors

Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022

121

Abstract no. 85

Prevalence and trend of admission to emergency department during
Covid-19 pandemic in Bang Khla hospital, Bang Khla District, Chachoengsao

Krittanan Chanyou1, Pisit Klumnaimuaeng1, Sirapat Prakiatpongsa1, Sakarn Charoensakulchai2,
Teeraboon Lertwanichwattana3 and Pongpisut Thakhampaeng3

16th Year Medical Student; 2Department of Parasitology; 3Department of Military and Community Medicine, Phramongkutklao College of Medicine

Background: Coronavirus Disease 2019 (COVID-19) has affected tremendously to Thai’s healthcare system.
Extra people, equipment, and building resources needed for managing these patients may left others to
be treated ineffectively or untreated. During the COVID-19 pandemic, The Ministry of Public Health and
government has been applying policies and rules to help prevent transmitting of the virus. This study
aims to determine the prevalence and trend of admission to emergency department during Covid-19
pandemic in Bang Khla hospital, Bang Khla District, Chachoengsao.
Materials and methods: The study is a cross-sectional descriptive study in Bang Khla Hospital, Chachoengsao,
which gather data of all cases visited to emergency department from January 2019 to November 2021.
The patients must be 20 of age or above and can be triaged into color green or above.
Results: Overall number of cases visited to emergency department during COVID-19 pandemic in morning
shift, evening shift and night shift has decreased, of which, evening and night shift has decreased
significantly.

Cases of cellulitis has been increased significantly during COVID-19 pandemic and currently is the
highest rank of 2021. In contrast, those which decreased significantly include bronchitis, upper respiratory
tract infection, asthma, COPD, dyspepsia, muscle strain, alteration of consciousness, hypoglycemia, and
trauma.
Conclusions: Overall numbers of patients visited to emergency department has been dropping since
COVID-19 pandemic, of which, evening shift and night shift had dropped significantly. Cases of cellulitis
has increased significantly, on the other hand, cases of bronchitis, upper respiratory tract infection, asthma,
COPD, dyspepsia, muscle strain, alteration of consciousness, hypoglycemia, and trauma has decreased
significantly.
Keyword: l COVID-19 l Pandemic l Emergency department l Admission

เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565