50
Abstract no. 23
Risk factors associated with nutritional status in preschool children
aged 3-5 years old in Sa Kaeo province, Thailand: a cross-sectional
study
Thanapat C.¹, Khemjira S.¹, Chaiphatra P.¹, Nattharat I.¹, Thanapthip R.¹, Thanayut J.¹, Nonthakorn C.¹,
Phupha P.¹, Rasika S.¹, Veeraya M.¹, Hariwong C.¹, Ornprapa K.¹, Eakkanut N.¹, Picha S.², Nutchar H.²
¹Fifth Year Medical Student; ²Department of Community and Military Medicine, Phramongkutklao College of Medicine
Background: Not only children with undernutrition results in stunted shape and lower intelligence quotient,
but also children with overnutrition are likely to develop non-communicable diseases, such as hypertension,
dyslipidemia, and diabetes in their adulthood. Thus, children should eat well in order to have a proper
weight-for-age, height-for-age, and weight-for-height, especially in 5 years of birth since it is considered
a critical time for both brain and physical development in children. Our study aimed to determine the
prevalence and predictors of malnutrition among children aged under 5-year-old.
Methodology: Data were collected in 211 preschool-age children in Anuban Wat Sakaeo school using
the demographic questionnaire, containing 3 main factor categories: children’s factors, children’s eating
behavior factors, and parental factors. The primary outcomes are weight (kg.) and height (cm.) recorded
individually by homeroom teachers in school database. The outcomes were translated into height-for-age,
weight-for-age and weight-for-height by using the 3 of following growth curves; height-by-age growth
curve for children aged 0-5 years, weight-by-age growth curve for children aged 0-5 years and weight-
by-height growth curve for children aged 2-5 years both male and female using reference from Ministry
of Public health, Thailand.
Results: The prevalence of obesity among pre-school age children was 24.06% (95%CI: 17.88-30.25) and the
prevalence of short stature among pre-school age children was 8.76% (95%CI: 4.75-12.78). After controlling
other factors, low birth weight and history of breast milk intake less than 6 months were significantly
associated with short stature [adjusted odds ratio (aOR = 2.98, 95%CI: 1.00-9.99), (aOR = 3.58, 95%CI:
1.03-12.46), respectively. Moreover, maternal BMI > 25 kg/m2 was significantly associated with obesity
(aOR= 2.71, 95%CI: 1.07-4.39).
Conclusion: Malnutrition among pre-school children is, to date, still a problem in Thailand. Therefore, it
is imperative to define the risk factor of malnutrition to further minimize and prevent the problem.
Keyword: l Nutritional status l Preschool children l Thailand
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
51
Abstract no. 24
Quality of life among the Royal Thai Army Nursing students with
post covid
Nutcha Seanglamlers1, Chairat Khamkhodchakan1, Nattanit Kwanthong1, Nattha Artrit1,
Nutnicha Prasongchan1, Thatanapon Oundech1, Napatsakorn Amporndech1, Naruepohn Ruamcharoen1,
Pawanrat Buathet1, Panida Seeplad1, Praewa Kaewngern1, Ramonpatch Loruangsin1, Siriwut Saichit1
and Sasiporn Ounjaichon2
1Fourth Year Student Class 56; 2The Royal Thai Army Nursing College
Background: There has been an outbreak of infectious diseases caused by the COVID-19 virus worldwide,
which could rapidly spread severe illness. A COVID-19 can also produce long-term health problems and
symptoms in certain patients. A number of nursing students at the Royal Thai Army Nursing College
were also infected with COVID-19 and suffers from long COVID. This may have an impact on learning and
performance in nursing practice since nursing students must be physically and intellectually prepared for
caring the patients. The researchers acknowledge the importance of long COVID in physical performance
and quality of life. Research on the relationship between healthcare behaviors and quality of life should
be conducted. The results of the study should be utilized as a guideline to promote health behaviors
among nursing students with a history of COVID-19 infection at the Royal Thai Army Nursing College.
Objectives: 1) To investigate signs and symptoms of Long Covid among nursing students at the Royal Thai
Army Nursing College following COVID-19 infection; 2) To examine quality of life of nursing students at
the Royal Thai Army Nursing College following COVID-19 infection; 3) To study the relationship between
healthcare behaviors and quality of life of nursing students at the Royal Thai Army Nursing College
following COVID-19 infection.
Methodology: This is a descriptive research. The study included 205 nursing students at the Royal Thai
Army Nursing College who had a history of COVID-19 infection. Questionnaires were used for data
collection. Data analysis uses percentage, mean, standard deviation, and Pearson correlation statistical
analysis.
Research instruments: The questionnaires composed of 5 parts 1) Personal information; 2) long Covid
assessment form for those with a COVID-19 history; 3) A questionnaire to collect information on health
behaviors following COVID-19 infection; 4) a SF-36 Health Survey; 5) Open-ended questions on perceptions
toward quality of life following COVID-19 infection.
Keyword: l Quality of life l Post COVID l Royal Thai Army Nursing Students
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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Abstract no. 25
A preliminary study: the association of gut microbiota pattern and
blood pressure among population in a aural area in Thailand
Thanapoj Buakhao1, Nattapong Hongsimakul1, Ronnakorn Srikittayakorn1, Chanasorn Sucharitpraphakorn1,
Trai Arwusosakul 1, Panuwach Subbalekha1, Nutsinee Wangyongkulwattana1, Isaree Paipinit1,
Sirada Wittayachanyapong1, Nuttakit Pongtawigorn1, Padipon Prachammuang1, Peravas Panmekiate1,
Asst.Prof.Dr. Siam Popleuchai3, Thanakrit Wichaslip2, Kanlaya Jongcherdchootrakul4, Kachonsak Youngwatana5
and Monthalee Theeraapisakkun2
1Fifth Year Medical Student; 2Department of Biochemistry, Phramongkutklao College of Medicine; 3Department of Science, Mae Fah Luang
University; 4Department of Military and Community Medicine, Phramongkutklao College of Medicine; 5Department of Gastroenterology and
Hepatology, Phramongkutklao Hospital
Background: Gut microbiota are beneficial microorganisms, including bacteria and archaea, that live in
human digestive tract, which provide some short chain fatty acids and critical vitamins. According to
many studies, the unbalanced species of gut microbial community could lead to hypertension. The purpose
of this paper is to represent the association of gut microbiota pattern in participants with hypertension
and non-hypertension.
Methodology: A population in Nayao community, Mhoo 15, 18 and 19, Chachoengsao was selected,
including 19 hypertensive and 16 non-hypertensive participants with the age of 20-60 years old without
the history of known causes secondary hypertension, probiotics, laxatives, antidepressant, opioids, diet
restriction, vigorous exercise and pregnancy. All participants were requested to complete the questionnaire
and undergone a standardized medical examination, including blood pressure, weight, height, and waist
circumference measuring; blood testing for the result of lipid levels which could be the confounding
factors of hypertension; stool examination for the evaluation gut microbiota species in hypertensive and
non-hypertensive participants.
Results: This study revealed that there is significant negative correlation between the relation of Firmicutes
spp. and diastolic blood pressure (DBP) level in non-hypertension group (r = -0.66), positive correlation
between Firmicutes spp. and DBP level in hypertension group controlled with antihypertensive medication
(r = 0.70), significant positive correlation between Akkermansia spp. and DBP level in hypertension group
(r = 0.70), and Fusobacterium spp. shows significantly different in quantity between hypertension group
with and without obesity.
Conclusion: The data obtained from this study would show the pattern of gut micobiome that association
with hypertension in Thai urban population. However, we did not evaluate and identify different genus
and species, the actual results may vary, since different genus and species in the same phylum might
produce different outcome of blood pressure. Therefore, this research is a preliminary study which its
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
53
purpose is to be baseline information for further studies and intervention which could lead to additional
treatment for hypertensive patients in the future.
Keyword: l Gut microbiota l Fecal gut microbiome l Hypertension l Community l Thailand
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
54
Abstract no. 26
Knowledge and attitude towards cannabis for medical use among
people at Bang Rakam sub-district, Nakhon Chai Si district,
Nakhon Pathom province
Salinthip Siangwarn1, Kotchawan Rongyang1, Jirattiphorn Tapsangsri1, Natchayanee Taweethong1,
Tippawan Boonjing1, Taewasiri Klaithuk1, Thanatchaphon Chuchot1, Pornrada Kaewkham1, Pinatda Supakun1,
Munlika Klaysawee1, Sirawan Jaihaw1, Apisara Wongsubin1, Sirinya Akathin2
1Fourth Year Student Class 56; 2The Royal Thai Army Nursing College
Background: Thailand has a policy to change the use of cannabis. According to the announcement of
the Ministry of Public Health, cannabis can only be used in medicine for the treatment of patients. Using
extracts from domestically grown hemp or hemp plants and become liberal in cannabis on June 9, 2022.
From the liberalization that cannabis can be used for that benefit, there are many commercially available
products that contain cannabis. As a result, some people have misunderstandings about the benefits of
cannabis use, or they may be ignorant or lack of proper knowledge and understanding of cannabis use.
Therefore, it is necessary to disseminate important information about socially beneficial cannabis plants
including promoting knowledge and building confidence. To provide people with access to the correct
and safe use of cannabis plants, the researchers are interested in studying the knowledge and attitudes
about the cannabis for medical use among people at Bang Rakam Sub-District, Nakhon Chai Si District,
Nakhon pathom Province, which is a community where people are interested in the use of cannabis for
the treatment of several diseases. The results of the research can be used to develop a project to improve
knowledge and attitudes about cannabis for medical uses among people in the community in the future.
Objective: To study the level of knowledge and attitude about cannabis for medical use among people at
Bang Rakam Sub-District, Nakhon Chai Si District, Nakhon Pathom Province.
Methodology: This is a survey research. The population is 379 people who aged 18 and over in Bang
Rakum Subdistrict, Nakhon Chaisri District, Nakhon Pathom Province. The sample was selected by using
simple random sampling. The number of samples is 195 people calculated by using the Yamane formula.
Questionnaires were used for data collection. Data analysis uses frequency, percentage, mean and standard
deviation.
Research instruments: The questionnaires composed of 3 parts 1) Demographic data; 2) Knowledge of
cannabis for medical use among people at Bang Rakam Sub-District, Nakhon Chai Si District, Nakhon
pathom Province; 3) Attitude of cannabis for medical use questionnaire. The content validity of questionaires
were determined by 3 experts and the Index of Item-objective Congruence I (IOC) is between 0.50-1.00.
Keyword: l Cannabis for medical use
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
55
ผลงานโปสเตอรก์ ารประชมุ วชิ าการพระมงกฎุ เกลา้ ครง้ั ท่ี 50
1. A study of exhaled nitric oxide in allergic rhinitis and nonallergic rhinitis patients in
Phramongkutklao Hospital
Natchanon Ekpanithanpong (Department of Otolaryngology) บทคดั ย่อท่ี 27
2. Serious infections among Thai patients with systemic lupus erythematosus: data from
Phramongkutklao Hospital
Nichakorn Pidet (Department of Medicine) บทคดั ย่อท่ี 28
3. Comparison of outcomes between vertical and horizontal tracheostomy incisions;
A Randomized Controlled Trial
Apisit Jirawarnsirikul (Department of Otolaryngology) บทคดั ย่อท่ี 29
4. The reliability, validity, and agreement of the self-reported fibromyalgia questionnaire in
patients with chronic musculoskeletal pain
Natta Wongthanavimok กวฟ. (Department of Physical Medicine and Rehabilitation) บทคดั ย่อท่ี 30
5. Characteristic of penile cancer and prognostic factors for inguinal and pelvic lymph node
involvement
Kritanu Kultravut (Department of Surgery) บทคดั ย่อท่ี 31
6. Efficacy of the combination of curcuma longa and standard triple therapy in
the helicobacter pylori eradication therapy compared with standard triple therapy
with placebo: a multicenter, double-blind, randomized controlled clinical trial
Vutthikorn Khingmontri (Department of Medicine) บทคดั ย่อท่ี 32
7. Anatomical and clinical outcomes of endovascular treatment for
Dural Arteriovenous Fistulas (DAVFs) at Phramongkutklao Hospital, Thailand
Uprimporn Suthiwong (Department of Ophthalmology) บทคดั ย่อท่ี 33
8. The reliability and validity of the Thai version epworth sleepiness scale for children and
adolescents (ESS-CHAD) in pediatric obstructive sleep apnea
Thanyarat Ratanakoset (Department of Pediatrics) บทคดั ย่อท่ี 34
9. Comparison of the contraceptive knowledge between verbal counseling and verbal
counseling with a contraceptive educational video in postpartum women
at Phramongkutklao Hospital: a randomized control trial
Thansita Phothicharoenthanachok (Department of Obstetrics and Gynecology) บทคดั ย่อท่ี 35
10. Study of serum selenium level and thyroid eye disease
Phanuwat Sinthupaeng (Department of Ophthalmology) บทคดั ย่อท่ี 36
11. Prevalence of noncommunicable diseases in Royal Thai Army soldier
Sarun Poobunjirdkul (Department of Family Meddicine) บทคดั ย่อท่ี 37
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
56
12. The comparative pre-and postoperative clnical outcmes between mono axial and poly-axial
intermediate screw fixation at the fracture in thorcolumbar burst fracture :
A randomized controlled trial
Ratchaphon Khasemsiri (Department of Orthopedics) บทคดั ย่อท่ี 38
13. Accuracy and precision of alcoholic/nonalcoholic fatty liver disease index (ANI)
scoring system diagnostic test to distinguish between alcoholic liver disease (ALD)
and nonalcoholic fatty Liver disease (NAFLD)
Pongsakorn Tantigovit (Department of Medicine) บทคดั ย่อท่ี 39
14. Accuracy of vesical imaging-reporting and data system (VI-RADS) for muscle invasive
bladder cancer detection from multiparametric MRI
Chayanon Jai-ua (Department of Surgery) บทคดั ย่อท่ี 40
15. A study of callus area to determine healing progression of femoral shaft fractures
treated with intramedullary nail fixation using orthoRead program
Nipat Chantradilokrat (Department of Orthopedics) บทคดั ย่อท่ี 41
16. Intraocular pressure measurement using ICare rebound tonometer in different positions
of eye and different locations on cornea
Sirada Wongwanwatana (Department of Ophthalmology) บทคดั ย่อท่ี 42
17. Role of optical coherence tomography angiography in detecting early retinal changes
in systemic lupus erythematosus
Pornwalan Kiriyapong (Department of Ophthalmology) บทคดั ย่อท่ี 43
18. The effect of loop diameter on clinical failure in biomechanical suture testing
Thanapat Limchuchua (Department of Orthopedics) บทคดั ย่อท่ี 44
19. Comparison of perioperative outcomes of dual young surgeons versus single senior
surgeon approach for adolescent idiopathic scoliosis
Sirawit Valaiphatchara (Department of Orthopedics) บทคดั ย่อท่ี 45
20. Prevalence of sarcopenia and functional outcome following bipolar hemiarthroplasty
in elderly femoral neck fracture: a prospective cohort study
Thitiwat Ussadamongkol (Department of Orthopedics) บทคดั ย่อท่ี 46
21 The effect of perioperative hemoglobin change on functional outcome and complications
in patient with degenerative spinal disease
Kakanan Chiamdee (Department of Orthopedics) บทคดั ย่อท่ี 47
22. Clinical feature and clinical course of TAO in military Tertiary Military Hospital in Thailand
Kritima Tarunotai (Department of Ophthalmology) บทคดั ย่อท่ี 48
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
57
23. Studying the pain from injection treatment for trigger finger, carpal tunnel syndrome
and de Quervain disease
Katawut Kumplean (Department of Orthopedics) บทคดั ย่อท่ี 49
24. Reliability and validation of the Thai translation of questionnaire for assess quality
of life for Thai gouty arthritis patient
Thitipong Treewut (Department of Medicine) บทคดั ย่อท่ี 50
25. Association of vitamin D level and severty of chronic rhinosinusitis
Wanchai Wilaisakulnam (Department of Otolaryngology) บทคดั ย่อท่ี 51
26. Effectiveness of carbogen inhalation in sudden sensorineural hearing loss: systematic review
Poonyaporn Phankosol (Department of Otolaryngology) บทคดั ย่อท่ี 52
27. Analysis of tissue zinc levels in breast cancer subtypes
Vasin Chantaraponpun (Army Institute of Pathology) บทคดั ย่อท่ี 53
28. Histopathological characteristics of phyllodes tumor and cellular fibroadenoma
in core needle biopsy specimens in Army Institute of Pathology
Supasin Boocha (Army Institute of Pathology) บทคดั ย่อท่ี 54
29. AMFSS computer-based program: an individualized utility tool to analyze and evaluate
the reliability of multiple choice questions in Army Medical Field Service School
Adisorn Lumpaopong (Army Medical Field Service School, Royal Thai Army Medical Department)
บทคดั ย่อท่ี 55
30. Benefits of information technology as web based application to calculate pediatric
favipiravir dose and army physical test passing score.
Adisorn Lumpaopong (Army Medical Field Service School, Royal Thai Army Medical Department)
บทคดั ย่อท่ี 56
31. Prevalence and association of indoor environmental factors and sick building syndrome
among workers of army medicaldepartment headquarter, Bangkok
Metha Kannirun (Armed Forces Research Institute of Medical Sciences) บทคดั ย่อท่ี 57
32. Annual case report of rickettsiosis patients diagnosed at Armed Forces Research Institute
of Medical Sciences, Thailand during fiscal year 2008-2021
Maneerat Somsri (Armed Forces Research Institute of Medical Sciences) บทคดั ย่อท่ี 58
33. Generation of luciferase-secreting DENV2 reporter for the development of
Luc-based reduction neutralization
Krongkan Saipin (Armed Forces Research Institute of Medical Sciences) บทคดั ย่อท่ี 59
34. The study of the effect of using board game to enhance the tactical combat casualty care
learning for medical non-commissioned officer student, Army Medical Field Service School
Thanainan Piromjiew (Army Medical Field Service School, Royal Thai Army Medical Department)
บทคดั ย่อท่ี 60
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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35. Clinical scoring for prediction of oxygen use in patients with COVID 19 infection in
a community hospital, Thailand: a retrospective cohort study
Thanapat Vongchansathapat (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 61
36. A Comparative outcome of six-pack versus straight & full fist hand exercise following
open reduction and volar plate fixation in distal radius fracture. a prospective randomized
control trial
Pariphat Chompoonutprapa (Department of Orthopedics) บทคดั ย่อท่ี 62
37. Comparison of the sit-to-stand test with 6-minute walk test in post coronary artery
bypass graft patients
Radchaphoom Anukul (Department of Physical Medicine and Rehabilitation) บทคดั ย่อท่ี 63
38. Randomized control trial of pre-emptive medication between gabapentin (300 mg) and
none to control postoperative pain after hemorrhoidectomy by spinal anesthesia
Nattaporn Maneepairoj (Department of Surgery) บทคดั ย่อท่ี 64
39. Effectiveness of mobile phone application “Epilepsy care” for self-management of
epileptic children in Phramongkutklao Hospital: a randomized controlled trial
Pantira Chinsuwan (Department of Pediatrics) บทคดั ย่อท่ี 65
40. Practicality of total salpingectomy during cesarean sections
Kitinan Phichedwanichskul (Department of Obstetrics and Gynecology) บทคดั ย่อท่ี 66
41. Preoperative ultrasonography of neck anatomy evaluation for tracheostomy
Krissamon Limthornbenjapol (Department of Otolaryngology) บทคดั ย่อท่ี 67
42. Chest radiograph findings monitoring with time course of COVID-19 pediatric patients
Niracha Atanavanich (Department of Radiology) บทคดั ย่อท่ี 68
43. Efficacy of intravenous lidocaine infusion in propofol-based sedation for colonoscopy:
a randomized controlled trial
Soravish Sirilertworakul (Department of Anesthesiology) บทคดั ย่อท่ี 69
44. 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 Phetkee (Department of Medicine) บทคดั ย่อท่ี 70
45. 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 Takon (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 71
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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46. 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 Ajanant (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 72
47. Incidence and risk factor of stroke among patients in NCDs clinic, Phatthananikhom Hospital,
Lopburi Province, Thailand
Sakda Lawanwisut (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 73
48. Incidence and risk factors in diabetic foot ulcers in diabetes mellitus in
secondary care hospital, Lopburi
Kuntapon Puttarungsri (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 74
49. 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 Sompong (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 75
50. Prevalence and associated factors of ADHD in 6-12 years old children in psychosocial clinic,
Thawung Hospital, Lopburi.
Thunpimol Ekanaprach (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 76
51. 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 Polcharoensuk (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 77
52. Incidence and associated factors of hypoglycemia in type 2 diabetes patients in
Phatthana Nikhom Hospital, Lopburi Province, Thailand
Tatchamon Prasart-intara (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 78
53. Associations between obesity and severity condition of disease in COVID-19 patients
in Thawung Hospital, Thailand
Natnicha Pokaew (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 79
54. 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 Cheawdamrongchai (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 80
55. 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 Phiensuparp (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 81
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56. The prevalence of hypertension and its associated factors among type 2 diabetes mellitus
patients at Thalaung Hospital, Thailand
Poorin Surasansanee (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 82
57. 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 Petchsrikul (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 83
58. Prevalence and risk factors of asthmatic exacerbation among asthma patients in
Sanamchaikhet Hospital, Chachoengsao Province, Thailand
Phusit Peampetkul (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 84
59. Prevalence and trend of admission to emergency department during Covid-19
pandemic in Bang Khla Hospital, Bang Khla District, Chachoengsao
Krittanan Chanyou (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 85
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Abstract no. 27
A study of exhaled nitric oxide in allergic rhinitis and nonallergic
rhinitis patients in Phramongkutklao Hospital
Natchanon Ekpanithanpong and Thanit Chalermwatanachai
Department of Otolaryngology, Phramongkutklao hospital
Background: Rhinitis is a common disease in practice. According to the allergen skin prick test, rhinitis
can be classified into 2 types: allergic rhinitis and non-allergic rhinitis. From previous studies, they found
that rhinitis was associated with airway inflammation. Exhaling nitric oxide levels is one method that
can evaluate airway inflammation. We hypothesize that levels of exhaling nitric oxide can be used as
criteria for the diagnosis of allergic rhinitis.
Objective: To evaluate exhaled nitric oxide levels in allergic and nonallergic rhinitis patients.
Methodology: Rhinitis patients undergo a skin prick test using 8 types of allergens: cat hair, dog hair,
cockroaches, Hairy grass, spinach, Cladosporium fungal spores, and dust mites (Mite D.p, D.f) for diagnosis
of allergic rhinitis, and measured exhaled nitric oxide levels by the NIOX VERO® machine.
Result: A total of 111 rhinitis patients participated in this study. They are 82 allergic rhinitis patients and
29 nonallergic rhinitis patients. Patients with allergic rhinitis had exhaled nitric oxide levels of 19 (5-241)
ppb, whereas, with non-allergic rhinitis 16 (5-69) ppb were not reached statistically significant (p = 0.134).
Conclusions: The exhaled nitric oxide levels cannot be used as criteria diagnosis for allergic rhinitis.
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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Abstract no. 28
Serious infections among Thai patients with systemic lupus
erythematosus: data from Phramongkutklao Hospital lupus clinic
over 5 years (2018-2022)
Nichakorn Pidet and Rattapol Pakchotanon
Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine
Background: Despite the advances in the management of systemic lupus erythematosus (SLE), mortality
rate among patients with SLE significantly remained higher compared to non-SLE over time. Serious
infections (SIs) were likely one of the leading causes of death in SLE patients over the last few years.
Objective: The aim of this study was to evaluate the incidence and identify predictive factors of SIs over
time in Thai patients with SLE.
Methodology: A retrospective study of SLE patients followed up at Phramongkutklao Hospital Lupus
Clinic between March 2018 and September 2022 was conducted. SIs were defined as ones that received
intravenous antibiotic, required hospitalization or led to death. Multivariable regression analyses were
performed to identify factor predicting of SIs.
Results: Of the 237 patients included, 22 (9.28 %) had SIs at least once during the follow-up time. The
median (interquartile range) onset of SIs after enrollment was 29.75 (4.25-34) months. The incidence rate
of SIs was 2.4 events per 100 person-years. Pneumonia caused by gram-negative pathogens was the most
common cause of SIs. Multivariable analysis revealed that predictive factors of SIs were prednisolone
intake (hazard ratio (HR): 1.06; 95 % confidence interval (CI): 1.01-1.11; p = 0.15), doses of prednisone >
7.5 mg/day (HR: 3.08; 95%CI: 1.34-10.77; p = 0.012), and > 10 mg/day (HR: 3.61; 95%CI: 1.21-10.80; p =
0.021). In addition, use of mycophenolic acid was independent factor associated with increased risk of
SIs when adjusting prednisolone >
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 29
Comparison of outcomes between vertical and horizontal tracheostomy
incisions; a randomized controlled trial
Apisit Jirawarnsirikul, Jakkrit Chantavanich, Suthee Rattanathummawat and Pana Klamkam
Department of Otorhinolaryngology, Phramongkutklao Hospital
Backgrounds: Tracheostomy is performed in patients with prolonged ventilator support, upper airway
obstruction, and inability to excrete secretion. Nowadays, Otolaryngologists prefer to perform two surgical
incisions: vertical and horizontal.
Since the study and comparison of the results of tracheostomy in Thailand are unclear, the
authors were interested in conducting this research to help decide which tracheostomy incision is suitable
for the patient.
Objectives: To study and compare the results of vertical and horizontal tracheostomy incisions. To study
the factors affecting the success of tracheostomy
Study design: Randomized controlled trial
Material and methods: This study randomly divided 42 volunteers into two groups. The first group
undergoes vertical incisions and the second group undergoes horizontal incisions. Then, general data,
perioperative information, and follow-up information were recorded at 7 days and 3-6 months.
Results: There was no statistically significant difference in complications between the two incisions. The
delay bleeding grade 1 (< 2.5 mL) was 95.2% in vertical incisions and 100% in horizontal incisions. The
stomal infection cases were 0%, and 4.8%, respectively. Stomal ulcer, emphysema, pneumothorax, and
tube decannulation were 0% in both groups.
We found that hyperextend neck can reduce procedure time in the vertical incision group (p-value
= 0.0414). An average incision was 2.79 cm vertically and 3cm horizontally, and the larger surgical incision
size increased procedure time (p-value = 0.0434).
Conclusion: There was no statistically significant difference between vertical and horizontal incision
outcomes. Hyperextend neck reduced operative time in the vertical surgical incision group and larger
surgical incisions in both groups increased operative time.
Keyword: l Tracheostomy incision l Tracheostomy complication l Horizontal versus vertical incision
l Stomal granulation grading l Stomal ulcer
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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Abstract no. 30
The Reliability, Validity, and Agreement of the Self-reported
Fibromyalgia Questionnaire in Patients with Chronic
Musculoskeletal Pain
Nutta Wongthanavimok, Chalermpong Chewachutirungruang, Chanasak Hathaiareerug and
Chanwit Phongamwong
Department of Rehabilitation Medicine, Phramongkutklao Hospital
Background: Fibromyalgia is characterized by chronic widespread pain with somatosensory symptoms. It
is usually diagnosed using the 2016 American College of Rheumatology (ACR) fibromyalgia criteria, which
are based on clinical questions without a physician’s examination. Therefore, this assessment could be
completed by self-administration.
Objective: This study aimed to evaluate the internal consistency, construct validity, and agreement of the
Thai self-reported Fibromyalgia Questionnaire (SFQ) compared to the telephone interview of a physician
among patients with chronic musculoskeletal pain.
Methodology: The Thai SFQ consisting of 25 questions: 19 for widespread pain index (WPI) and 6 for
symptom severity scale (SSS) was established by three Thai physiatrists. The fibromyalgia severity (FS)
scale (the sum of WPI and SSS: 0 – 31) of 13 or more was used to diagnose fibromyalgia. All participants
first completed the Thai SFQ and EQ-5D-5L questionnaire on their own. Then 24-48 hours later, they were
telephone interviewed by a third-year resident in Rehabilitation Medicine using Thai SFQ. The internal
consistency and construct (divergent) validity of the Thai SFQ was assessed using Cronbach’s alpha and
Pearson’s correlation, respectively. The agreement between the Thai SFQ and the phone interview for
the diagnosis of fibromyalgia was evaluated using Cohen’s kappa.
Results: Of 89 participants, the majority were women (66.3%) with a mean age (standard deviation) of
53.5 (15.9) years and had an educational level of bachelor’s degree or higher (79.7%). Cronbach’s alpha
was 0.82, while the correlation between the FS scale and EQ-5D-5L utility was -0.48 (p < 0.001). Cohen’s
kappa for diagnosis agreement was 0.55 (Percent agreement 80.9%).
Conclusions: The Thai SFQ had good internal consistency and moderate construct validity. The agreement
of the Thai SFQ with the telephone interview was moderate. Although this questionnaire could be used
as a screening tool, physicians would need to confirm the diagnosis of fibromyalgia.
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 31
Characteristic of penile cancer and prognostic factors for inguinal
and pelvic lymph node involvement
Kritanu Kultravut
Department of Surgery, Phramongkutklao Hospital
Problem: Penile cancer is a rare malignancy which inguinal and pelvic lymph node involvement play a
major role in patient’s survival.
Objective: To evaluate the prognostic factors for inguinal and pelvic lymph node involvement.
Material and method: this was retrospective analytic study of medical records in Phramongkutklao Hospital
between January 2010 and December 2020.
Result: Thirty-nine patients were diagnosed as penile cancer, median age 59±14.898 (range 32-86 years
were included in analysis. 28 patients underwent inguinal lymph node dissection (ILND) , 13 patients
had inguinal lymph node metastasis (46.4%), 8 patients underwent pelvic lymph node dissection (PLND),
5 patients had pelvic lymph node metastasis (62.5%). Inguinal lymph node metastasis was associated
with tumor grading (OR = 2.92, 95%CI: 0.123-0.704), lymphovascular invasion (LVI) (OR = 5.182, 95%CI:
0.430-0.996), perineural invasion (PNI) (OR = 3.687, 95%CI: 0.277-0.975), fixation of inguinal node (OR =
2.463, 95%CI: 0.078-1.195), pelvic lymph node metastasis was associated with tumor grading (OR = 2.619,
95%CI: 0.033-0.967).
Conclusion and benefit: Grading, lymphovascular invasion and perineural invasion of primary tumor and
fixation of inguinal node are significantly associated with inguinal lymph node metastasis.
While primary tumor grading is significantly associated with pelvic lymph node metastasis.
These factors are associated with poorer prognosis.
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
66
Abstract no. 32
Efficacy of the combination of curcuma longa and standard triple
therapy in the Helicobacter pylori eradication therapy compared
with standard triple therapy with placebo: a multicenter, double-
blind, randomized controlled clinical trial
Vutthikorn Khingmontri, Krit Opuchar and Natchaporn Noppacroh
Division of Gastroenterology and Hepatology, Department of Medicine Phramongkutklao Hospital
Background: H. pylori causes gastric ulcers and other diseases. In 2015, the Thailand consensus on
H. pylori treatment recommended a standard PPI- based triple therapy to identify and treat H. pylori
infection. The first-line treatment is Standard PPI- based triple therapy. However, standard PPI- based
triple therapy is ineffective due to inconsistent treatment, side effects, unpredictable food intake, and the
drug resistance. In Thailand, H. pylori eradication is still a standard PPI- based triple therapy for 14 days.
Curcumin was used in the H. pylori research. At the end of this study, H. pylori eradication rates were
compared between patients on standard PPI- based triple therapy plus curcumin and patients on standard
PPI- based triple therapy plus placebo.
Objective: To compare the efficacy of the eradication rate of Helicobacter pylori infection with curcumin
plus 14 days of standard PPI- based triple therapy versus a standard PPI- based triple therapy.
Methods: A multicenter, double-blind, randomized controlled clinical trial was conducted at Phramongkutklao
Hospital, Anandamahidol Hospital, Suranari Hospital, and Wachirawut Hospital from August 2021 to January
2023. The sample was divided into two equal groups of 175 participants each (1:1 equal distribution). The
first group was treated with turmeric (curcumin) 500 mg every 8 hours plus a standard dose PPI every
12 hours plus amoxicillin 1 g every 12 hours and clarithromycin 500 mg or metronidazole 500 mg every 8
hours for 14 days. The second group was treated with a placebo in combination with the standard dose
PPI every 12 hours with amoxicillin 1 g every 12 hours and clarithromycin 500 mg or metronidazole 500 mg
every 8 hours for 14 days. The primary outcome was to compare the efficacy of eradication of H. pylori
infections with turmeric plus standard dose PPI, and the secondary outcome was to examine for rescued
abdominal pain before and after treatment and side effects.
Results: The Eradication rate was 85.9% in the standard PPI- based triple therapy plus curcumin group
(p-value 0.718), which was not a statistically significant difference between the two groups. For secondary
outcomes on the visual analog scale (VAS), the mean pain and abdominal discomfort scores before taking
the drugs were 3.72±3.21, and 2.98±3.17 in the placebo group (0.129), respectively. The mean pain scores
after taking medicine were 1.01±1.33 and 1.7±2.01 (p-value 0.009), respectively. There were no significant
differences in the erection rate between the three groups (p 0.05).
Conclusions: Curcumin was significantly more effective in relieving abdominal pain than in the standard
Triple Therapy group, with no difference in curcumin side effects.
Keyword: l Helicobacter pylori l Curcumin l Turmeric l Standard PPI base triple therapy
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 33
Anatomical and Clinical Outcomes of Endovascular Treatment for
Dural Arteriovenous Fistulas (DAVFs) at Phramongkutklao Hospital,
Thailand
Uprimporn Suthiwong, Raveewan Choontanom, Patcharaporn Chandraparnik and Sombat Tanaboonyawat
Department of Ophthalmology, Phramongkutklao Hospital
Background: Dural arteriovenous fistulas (DAVFs) are abnormal communication between the dural arteries
and dural venous sinus or cortical vein. Patients with signs and symptoms that are compatible with
DAVFs must be confirm diagnosis by further imaging. Cerebral catheter angiography is the gold standard
in diagnosis and also utilized in treatment of DAVFs. But time to embolization treatment was varied from
many factors.
Objective: To analyze the relationship between different duration to embolization treatment with the
anatomical and main clinical outcomes includimg intraocular pressure (IOP), proptosis and best-corrected
visual acuity (BCVA) in DAVFs patients.
Methodology: A retrospective cross-sectional study evaluation of 102 DAVFs eyes from 85 patients visited
Phramongkutklao Hospital and underwent embolization from 1st January 2009 to 31st August 2022.
Results: Forty-four females and 41 males with average age of 53.74±14.95 years were enrolled. Forty-two
point three-five percent had history of head/ocular injury, which median duration time was 2 months prior
to have DAVFs. Common clinical presentation including red eye, proptosis, dilated corkscrew vessels,
and limit extraocular muscles. Cognard’s type IIa and IIa+IIb were commonly found 32.4% and 31.4%
respectively. No significant difference between each treatment duration in clinical complete closure
outcomes. Mean IOP in < 4 weeks and 4-8 weeks group were improved significantly at the 1st day (p =
0.014, p = 0.043 respectively) and 3rd month (p = 0.001, p = 0.009 respectively) after treatment comparing
to > 8 weeks group. Best corrected visual acuity (BCVA) and proptosis were not significantly different
at each follow up time in each treatment duration. The 5 years survival rate in this study was 96.32%.
Conclusion: IOP improves significantly when treated within 8 weeks after the first presentation. Conversely,
each duration to treatment has no significant effect on BCVA and proptosis. IOP is the fastest improvement
of main clinical outcomes in this study. After 1 month follow up, BCVA and proptosis are significantly
improved compared with baseline before treatment.
Keyword: l Dural arteriovenous fistulas l Outcomes l Duration of treatment
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
68
Abstract no. 34
The reliability and validity of the Thai version Epworth sleepiness
scale for children and adolescents (ESS-CHAD) in pediatric
obstructive sleep apnea
Thanyarat Ratanakoset1, Khemika Khemakanok Sudnawa1, Piradee Suwanpakdee1, Pornprapa Chindamporn2
and Rasintra Jaroenying3
1Department of Pediatrics; 2Department of Medicine, Phramongkutklao Hospital
Purposes: To evaluate the reliability and validity between Epworth sleepiness scale for children and
adolescents (ESS-CHAD) in Thai pediatric obstructive sleep apnea (OSA) and to investigate the relationship
between ESS-CHAD and severity of pediatric obstructive sleep apnea.
Methods: The test-retest reliability was investigated in 41 subjects, to check the responsiveness properties
of the questionnaire and to check the discriminant validity of the ESS-CHAD. Twenty-six pediatric
patients with OSA confirmed by polysomnogram were analyzed to find the relationship with ESS-CHAD
(9 patients with mild, 10 patients with moderate and 7 patients with severe OSA).
Results: The internal consistency demonstrated by Cronbach’s alpha coefficients for standardized item
was 0.836. The test-retest reliability was shown by intra-class correlation coefficients of 0.982. There
was a statistically significant difference of mean ESS-CHAD scores between mild and severe pediatrics
OSA (3.33±1.87 vs 9.85±5.42; p < 0.05). Additionally, patients with positive Pediatric Sleep Questionnaire
(PSQ) have significant increase ESS-CHAD scores than those with negative PSQ (7.36±5.74 vs 4.31±2.72;
p < 0.05). However, there was no statistically significant difference between ESS-CHAD scores and others
polysomnographic parameters.
Conclusions: Our Thai version of the ESS-CHAD shows an excellent internal consistency and test-retest
reliability. It is able to discriminate between mild and severe OSA and tend to be the in the same way
with PSQ scores. Future study with higher number of participants should be warranted.
Keyword: l Epworth sleepiness scale for children and adolescent l Obstructive sleep apnea
l Reliability and validity l Thai version
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 35
Comparison of the contraceptive knowledge between verbal
counseling and verbal counseling with a contraceptive educational
video in postpartum women at Phramongkutklao hospital:
A randomized control trial
Thansita Phothicharoenthanachok1 and Pongrak Boonyanurak1
1Department of Obstetrics and Gynecology, Phramongkutklao Hospital
Background: Postpartum contraception is greatly important because of the recommended interpregnancy
interval. Short interval pregnancies are associated with increased neonatal risk as well as maternal risk.
There are many types of postpartum contraception nowadays that have different pros and cons, side
effect, efficacy, and instructions. Therefore, postpartum contraceptive knowledge is an important key for
postpartum women.
Objective: To compare two methods of educating postpartum women about postpartum contraception:
verbal counseling and verbal counseling with a contraceptive educational video
Methodology: A randomized control trial was conducted. Postpartum women are divided by block
randomization into two groups to receive verbal counseling (control group) and verbal counseling with
an educational video (experimental group) regarding contraception. Afterward, a questionnaire is used
to compare the contraceptive knowledge of the two groups. Moreover, a survey of contraception choice
and reasoning are administered.
Result: Two-hundred fifty women are enrolled in the study. The mean of the participants’ age is 29±5.64
years, and most of the participants have one child. The control group (125 participants) achieves the
mean contraceptive knowledge score of 17.30±3.33. Meanwhile, the experimental group (125 participants)
achieves the mean contraceptive knowledge test score of 19.98±2.878. The experimental group has the
higher mean contraceptive knowledge score than the control group (p < 0.001). The secondary questionnaire
reveals that the contraceptive method most frequently chosen is the contraceptive implant, and the factor
that affects contraceptive method choice the most is long-term birth control. There are no significant
differences between the two groups regarding the choices of postpartum contraceptive methods and
deciding factors.
Conclusion: Verbal counseling together with a contraceptive educational video are effective methods in
increasing postpartum contraceptive knowledge in postpartum women.
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
70
Abstract no. 36
Study of Serum Selenium Level and Thyroid Eye Disease
Phanuwat Sinthupaeng1, Chonpiti Siriwan2, Patcharaporn Chandraparnik1, Sombat Tanaboonyawat1 and
Raveewan Choontanom1
1Department of Ophthalmology; 2Department of Internal Medicine, Phramongkutklao Hospital
Background: A thyroid eye disease is a vision-threatening eye condition is. It can happen in persons with
thyroid disease. Selenium is the significant elements that regulates thyroid hormone metabolism. It is
found in foods like offal, seafood, red meat, and grains. According to a study, selenium supplementation
improves ocular symptoms in thyroid eye disease patients with mild symptoms. improved quality of life
and delayed disease progression. But the study was based on nations where the average population has
lower levels of selenium. There was no average serum selenium level that reflected the Thai patients.
Objective: To compare serum selenium in thyroid eye disease patients with healthy individuals.
Methodology: A cross sectional study was conducted. Serum selenium levels were measured in 25 healthy
participants and 16 patients with thyroid eye disease, and the results were compared. In thyroid eye
disease patients, the clinical activity score, quality of life, and biochemical factors were evaluated, and
their correlation with serum selenium level was determined.
Results: There was no statistically significant difference between TED patients and healthy individuals
regarding age and gender (p = 0.543, 0.444). All the patients had inactive disease activity, with the majority
having moderate to severe severity. The mean selenium level in TED patients were significantly higher
than the healthy individuals 120.73±16.6 µg/L vs. 107.68±13.03 µg/L, p = 0.008). There was no correlation
between serum selenium with clinical activity score, quality of life score, selenium-rich food consumption
score, Thyroid stimulating hormone, free thyroxine, and anti-thyroid stimulating hormone antibody.
Conclusions: Serum selenium level in inactive TED patients was higher than healthy participants.
Keyword: l Thyroid eye disease l Selenium
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
71
Abstract no. 37
Prevalence of noncommunicable diseases in Royal Thai Army soldier
Sarun Poobunjirdkul1, Kawin Wongthamarin2, Pongpisut Thakhampaeng3 and Kathawoot deepreecha4
1Occupational Medicine Unit, Department of Family Medicine, Phramongkutklao Hospital; 2Department of Physiology; 3Department of
Military and Community Medicine, Phramongkutklao College of Medicine; 4Health Promotion and Preventive Medicine Division, Royal Thai
Army Medical Department
Background: Non-communicable diseases are one of the leading causes of healthcare issues in Thailand,
costing more than 500 million baht per year in prevention and healthcare promotions.
Objective: To study the prevalence of five non-communicable diseases, including Diabetes Mellitus,
Hypertension, Dyslipidemia, Obesity and Central Obesity in five army areas.
Method: Data from the annual health checkup database of military personnel conducted in 2020 were
analyzed using the descriptive statistic (frequency, mean, standard deviation)
Result: The study shows 71,810 persons (60.23%) having at least one of non-communicable diseases.
Dyslipidemia is the most prevalent non-communicable diseases (74.5%). Distributed by army areas,
Bangkok and neighboring provinces have the highest number of personnel with non-communicable
diseases at 68.11%. Distributed by non-communicable diseases, Diabetes Mellitus is the most prevalent
at 3rd Army area (14.2%). Hypertension is the most prevalent at 2nd Army area (32.0%). Dyslipidemia is the
most prevalent at 3rd Army area (84.0%). Obesity is the most prevalent at 1st Army area (43.9%). Central
Obesity is the most prevalent at Bangkok and Neighboring Provinces (37.0%).
Conclusion: Non-communicable-diseases and other healthcare-related issues are different among different
habitat and behaviors in each Army Area. Healthcare promotion and disease-prevention policies should
be personalized in correlation with each Army area in terms of health promotion, medical screening and
healthcare prevention.
Keyword: l Non-communicable diseases l Soldiers l Royal Thai Army
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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Abstract no. 38
The comparative pre- and postoperative clinical outcomes between
mono-axial and poly-axial intermediate screw fixation at the fracture
in thoracolumbar burst fracture : a randomized controlled trial
Ratchaphon Khasemsiri, Chaisiri Chaichankul and Pawin Gajaseni
Department of Orthopedics, Phramongkutklao Hospital
Background: Thoracolumbar vertebral body fractures are common spinal injuries, and fractures of burst type account
for 20% of all thoracolumbar spinal fracture. Short segment posterior pedicle screw fixation with intermediate
screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains
unclear whether mono-axial screw or poly-axial screw fixation of index screw which type could improve clinical
and radiological outcomes.
Objective: To evaluate the efficacy of short-segment posterior fixation with mono-axial pedicle screws versus
poly-axial pedicle screws in treating thoracolumbar fracture
Method: A randomised controlled trial with double blinding of patients and the statistician, but not the clinicians
and researchers, will be conducted. A total of 12 patients with unstable tholacolumbar burst fracture (AO type A3
or A4 ) who treated with short-segment pedicle screws at the fractured vertebral level will be allocated randomly
to Mono-axial screw (group A) and Poly-axial screw (group B). The primary clinical outcome measures Visual
Analogue Scale scores for back pain, Oswestry Disability Index (Thai version). These parameters will be evaluated
preoperatively and postoperative day 3, and at 3, 6 and 12 months. Secondary outcome measures percentage
loss of vertebral body height, sagittal index of the injured vertebrae and kyphosis.
Result: A total of 12 patients with an average age of 51.2±18.8 years were finally recruited in this study. There
were no significant differences in age, sex, BMI, underlying disease, fracture level between the two groups (p >
0.05). ODI score was significantly improved when compared with preoperative at postoperative day 3, 3 months,
6 months and 1 year (p ≤ 0.001) but not different between group A and B (p = 0.762, 0.912, 0.439, 0.465). VAS
score was significantly improved when compared with preoperative at postoperative day 3, 3 months, 6 months
and 1 year (p ≤ 0.001) but not different between group A and B (p = 0.780, 0.664, 0.473, 0.568). Cobb angle,
vertebral height and sagittal index were increase but not significantly when compared with preoperative at
postoperative day 3, 3 months, 6 months and 1 year and comparable outcome between group A and B (p > 0.05)
Conclusions: Short segment posterior pedicle screw fixation with intermediate screw fixation with mono-axial or
poly-axial pedicle screw for unstable thoracolumbar burst fracture could improve clinical outcome in VAS and ODI
score postoperative at day3 , 3 months, 6 months and 1 year comparatively . Both mono-axial pedicle screw and
poly-axial pedicle screw can restoring injured vertebral height, increase Cobb’s angle and sagittal index equally.
Keyword: l Clinical outcome l Monoaxial pedicle screws l Polyaxial pedicle screws
l Thoracolumbar burst fracture
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 39
Accuracy and precision of alcoholic/nonalcoholic fatty liver disease
index (ANI) scoring system diagnostic test to distinguish between
alcoholic liver disease (ALD) and nonalcoholic fatty Liver disease
(NAFLD)
Pongsakorn Tantigovit, Noppamate Preechathammawong, Sombat Treeprasertsuk,
Mongkon Charoenpitakchai and Sakkarin Chirapongsathorn
Department of Medicine, Phramongkutklao Hospital
Background: Fatty liver disease is classified into two categories, alcoholic liver disease (ALD) and non-
alcohol fatty liver disease (NAFLD), which impact health problem worldwide. The gold standard for
diagnosis of fatty liver disease is liver biopsy but the procedure is an invasive procedure. In this study,
we aim to verify the alcoholic liver disease (ALD)/ nonalcoholic liver disease (NAFLD) scoring system
(ANI) as a non-invasive method to distinguish alcoholic liver disease (ALD) from nonalcoholic fatty liver
disease (NAFLD) and help for reducing risk of liver biopsy
Objective: To test an accuracy of ANI scoring system in distinguishing between alcoholic and nonalcoholic
fatty liver disease.
Methodology: This study was diagnostic study of patient with diagnosed fatty liver disease who underwent
liver biopsy and treatment in gastroenterology department, Phramongkutklao Hospital and King Chulalongkorn
memorial hospital, during 2010-2022. Seventy-three patients were Included and classified into two groups
of ALD and NAFLD. About 10 patients were excluded due to viral hepatitis, autoimmune hepatitis, drug-
induced hepatitis, other cause which met an exclusion criteria. Among them, 38 patients were diagnosed
with NAFLD (Group I) and 25 patients with ALD (Group II) ANI was calculated using an online calculator.
All parameter and ANI were analyzed using statistical method
Results: ANI, which calculated using laboratory parameter (aspartate aminotransferase, alanine aminotransferase,
mean corpuscular volume), age, body mass index, was significant higher in patient with ALD than NAFLD.
The cut-off point was -6.5. With ANI more than -6.5 favoring ALD, and ANI of less than -6.5 favoring a
diagnosis of NAFLD. The sensitivity, specificity, area under the receiver operating characteristic curve
(AUROC) of diagnosis between ALD and NAFLD cases was 84%, 73.6% and 0.879 (95% confidence interval,
0.794 to 0.964)
Conclusion: ANI scoring system may be used as non-invasive method and clinically distinguish between
ALD and NAFLD, avoiding unnecessary risk of liver biopsy
Keyword: l Alcoholic fatty liver disease l Non-alcoholic fatty liver disease l ANI score
l ALD/NAFLD index
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
74
Abstract no. 40
Accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) for
Muscle Invasive Bladder Cancer Detection from Multiparametric MRI.
Chayanon Jai-ua1, Chatwadee Limpaiboon2, Satit Siriboonrid1, Nattapong Binsri1, Sarayut Kanjanatarayon1,
Weerayut Wiriyabanditkul1 and Vittaya Jiraanankul1
1Division of Urology, Department of Surgery; 2Department of Radiology, Phramongkutklao Hospital
Background: The Vesical Imaging-Reporting and Data System (VI-RADS) from magnetic resonance imaging
(MRI) was used as a tool to distinguish the detrusor muscle invasion bladder mass before the surgery.
Muscle-invasive disease had a worse prognosis and required radical surgery. Approximately one-third of
the patients were understage at the first time of transurethral resection of bladder tumor (TUR-BT) and
required repeated TUR-BT. This imaging can be used to carefully select the patient who is a candidate
for repeated TUR-BT to skip the procedure when indicated after the first TUR-BT was done.
Objectives: To evaluate the discrimination accuracy between non-muscle-invasive bladder cancer and
muscle-invasive bladder cancer using VI-RADS.
Methodology: Patients with bladder mass from cystoscope who were assigned for TUR-BT were offered
multiparametric MRI for VI-RADS. TUR-BT reports were compared with preoperative VI-RADS scores to
evaluate the accuracy for discrimination of the muscle-invasive nature of bladder mass.
Results: The 68 bladder tumor lesions were included, 14 with muscle-invasive bladder cancer and 54 with
non-muscle-invasive bladder cancer. Sensitivity and specificity were 92.9% and 90.7%, respectively, when
the cutoff at VI-RADS equals 4 and more was used to define muscle-invasive bladder cancer. PPV and
NPV were 72.2% and 98%, with an accuracy of 91.2%. The ROC curve shows the area under the curve
at 0.95 (95%IC: 0.9-0.999), and the empirical optimal cut point from the Youden method was 2.5.
Conclusions: The VI-RADS is an accurate tool to differentiate muscle-invasive bladder cancer from non-
muscle invasive bladder cancer correctly. The clinical application can be implied from this study to
improve the selection of Re-TUR-BT candidates.
Keyword: l Bladder cancer l Muscle invasive l VIRADS l Magnetic resonance imaging
l Reporting and data system
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 41
A study of callus area to determine healing progression of femoral
shaft fractures treated with intramedullary nail fixation using
OrthoRead program
Nipat Chantradilokrat and Yanin Plumarom
Department of Orthopedics, Phramongkutklao Hospital
Background: Femoral shaft fractures treated with interlocking intramedullary nailing are widely accepted,
which depend upon the process of secondary bone healing. Radiographic callus is one of the most reliable
markers. Bridging callus formation represents radiographic union. However, there is no objective reliable
tool to predict femoral shaft fracture union after treated with interlocking intramedullary nail fixation.
Objectives: To find sensitivity, specificity and cut-off point of union of callus area in different follow up
time points by using OrthoRead program.
Methodology: Retrospective observational cohort study (diagnostic study), 86 femoral shaft fractures were
treated with interlocking intramedullary femoral nail. After excluding 36 patients due to insufficient follow
up data, fracture with comminution, open fracture and multiple injuries, 50 fractures were included for
analysis. ROC curve was performed to determine cut-off point of callus area to predict union.
Results: Non-union, union occurred 3, and 47 fractures, respectively. Incident of femoral non-union was
6% in patients with closed simple fracture underwent interlocking intramedullary nail. The cut-off points,
using OrthoRead program, of callus area (m2) of union of anteroposterior and mediolateral radiograph at
6 weeks; 484.5, 391.4 (sensitivity and specificity; 70.97%, 80%, 77.42% and 80%), at 12 weeks; 607.4, 544.9
(sensitivity and specificity; 80.65%, 73.33%, 80.65% and 80%), at 24 weeks; 607.4, 472 (sensitivity and
specificity; 80.65%, 73.33%, 80.65 and 73.33%), respectively, with all significantly (p < 0.017).
Conclusion: With high sensitivity and specificity, OrthoRead program can be used to predict radiographic
union in simple femoral shaft fracture treated with interlocking intramedullary nail by using callus area
with a specific cut-off point.
Keyword: l OrthoRead l Callus l Intramedullary nail l Femoral shaft fracture l Union l Non-union
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
76
Abstract no. 42
Intraocular pressure measurement using iCare rebound tonometer
in different positions of eye and different locations on cornea
Sirada Wongwanwatana, Isaraporn Treesit, Wallop Iemsomboon, Panrapee Funarunart and
Raveewan Choontanom
Department of Ophthalmology, Phramongkutklao Hospital
Background: Intraocular pressure (IOP) is one of the most crucial aspects for making a diagnosis and
treatment plan in patients with glaucoma. Although the gold standard for IOP measurement is Goldmann
applanation tonometer (GAT), it has to be mounted to a slit lamp biomicroscope. Rebound tonometer
has become popular worldwide due to its ease of operation and portable design. One of the advantages
is that the probe is small so this could be utilized when measurement cannot be taken from the central
cornea. Moreover, it can measure in different positions of eye. However, IOP results may affected due
to improper eye positions and locations.
Objective: To study the difference of IOP measurement with iCare IC200 in different angles of eye and
different locations on cornea.
Methodology: Cross-sectional study was conducted, IOP was measured using GAT and iCare rebound
tonometer in eye clinic, Phramongkutklao Hospital during May 2021 to August 2022. The IOP was measured
at 15 degrees angulated positions of eyes and at distance of 2 mm from limbus in superior, inferior, nasal,
and temporal regions.
Results: One hundred and sixty-eight eyes were recruited with a mean age of 62.15±12.34 years old. ICare
demonstrated IOP values statistical significantly lower than GAT about 0.7 mmHg (p < 0.001). The average
IOP was 0.6, 0.47, 0.91, and 0.44 mmHg lower than primary position in upgaze, downgaze, medial gaze,
and lateral gaze 15 degrees angulated positions respectively (p < 0.001). IOPs at 2 mm from limbus in
inferior, nasal, and temporal cornea were 0.5, 0.69, and 0.57 mmHg lower than center (p < 0.001).
Conclusion: IOP measurement with iCare in different angles of eye were statistical significantly lower
than in primary position. Likewise, IOP at different locations on cornea were lower than at central cornea.
Between iCare and GAT, IOP by iCare was not clinical significantly difference from GAT.
Keyword: l ICare rebound tonometer l IC200 l Intraocular pressure
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 43
Role of optical coherence tomography angiography in detecting
early retinal changes in systemic lupus erythematosus
Pornwalan Kiriyapong1, Sritatath Vongkulsiri2, Sumapa Chaiamnuay3 and Narumon Keorochana4
1 Department of Ophthalmology; 2 Retina division, Department of Ophthalmology; 3 Rheumatology Division, Department of Medicine; 4 Ocular
Immunology and Inflammation Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine
Background: Systemic lupus erythematosus (SLE) retinopathy is a marker of high disease activity of SLE
and poor visual outcome. Retinal vessel density evaluated by optical coherence tomography angiography
(OCTA) is a noninvasive tool, it could be used for early retinal changes detection.
Objective: To compare the retinal vessel density in the retinal superficial capillary plexus between SLE
patients and control patients and to find the correlation between vessel density and SLE disease activity.
Design: A cross-sectional study
Methods: Forty-one SLE patients were compared to the 41 eyes of the healthy volunteers. OCTA was
used to track the superficial capillary plexuses around the macula. Patients were evaluated in accordance
with the clinical SLE disease activity index 2000 (cSLEDAI-2K).
Results: None of the subjects had nonperfusion area evaluated by OCTA 8x8 mm area. Perfusion densities
of the superficial retinal capillary detected by OCTA 6x6 mm area showed no significant differences
between groups in almost all regions except the outer superior area (p = 0.027). No significant difference
was found in the circularity index (p > 0.05). The correlation of cSLEDAI-2k score with all parameters
including perfusion density data, FAZ area and circularity index reveal no significant correlation.
Conclusions: Outer superior region of macula might be the most susceptible area for retinal superficial
capillary plexus density detection in OCTA for subclinical retinal microvascular changes in SLE patients
and might serve as a screening tool to approach early diagnosis of lupus retinopathy.
Keyword: l Optical coherence tomography angiography l OCTA l Systemic lupus erythematosus l
Vessel density l Retinal capillaries l Retinal microvascular
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
78
Abstract no. 44
The effect of loop diameter on clinical failure in biomechanical
suture testing
Thanapat Limchuchua
Department of Orthopedics, Phramongkutklao Hospital
Background: Clinical failure (CF) was commonly defined as loop elongation of more than 3 mm from
initial point in the biomechanical suture testing. The purpose of this study is to assess the effect of loop
diameter on CF in biomechanical suture testing.
Methods: The biomechanical testing of the 2, 4 and 6 cm diameter loops of single-stranded suture (SSS)
tied with Surgeon’s knot (group A-C, respectively) and double-stranded sutures (DSS) tied with Nice knot
(group D-F, respectively) was performed. All loops were created using No. 2 FiberWire (Arthrex, Naples,
Florida, USA) and preloaded with 10 N to provide a well-starting point for data recording. Ten samples
of each group were subjected to single loaded to failure. The force at 3 mm displacement was recorded.
Ten samples of each group were tested with cyclic loads at a frequency of 1.8 Hz from 10 N to 45 N.
Loop elongation at the 50th and 1,000th cycles were measured. The displacement at data were compared
with analysis of variance and post hoc tests. Statistical significance was p < 0.05.
Results: In single loaded to failure test, the increased average forces producing CF was observed in smaller
loop diameter of both SSS and DSS. Statistically significant difference was found between 2 cm and 6
cm groups in both SSS (p = 0.025) and DSS (p = 0.010), and between 2 cm and 4 cm groups in DSS (p =
0.023). In cyclic loading test, CF was found only in SSS which was 1 sample of each diameter at the 50th,
1 sample of 2 cm loop, 2 samples of 4 cm loop and 2 samples of 6 cm loop at the 1,000th cycles. Maximal
loop elongation was revealed in 4 cm group in both SSS and DSS. There was statistically significant
difference between 4 cm and 2 cm groups, and 4 cm and 6 cm in both SSS (p = 0.03) and DSS (p < 0.001
both between 4cm and 2cm group and between 4cm and 6cm group) at the 50th and 1,000th cycles.
Conclusion: Different loop diameter affected the outcome of single loaded to failure testing. There was a
tendency to necessitate higher force to accomplish CF in the smaller diameter loop in both SSS and DSS.
In contrast, there was unclear relationship between the size of loop diameter and CF in cyclic loading test.
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 45
Comparison of perioperative outcomes of dual young surgeons versus
single senior surgeon approach for adolescent idiopathic scoliosis
Sirawit Valaiphatchara, Chaisiri Chaicharnkul and Pawin Gajaseni
Department of Orthopedics, Phramongkutklao Hospital
Background: Adolescent idiopathic scoliosis(AIS) is the most common form of idiopathic scoliosis. Correction
scoliosis is a complex surgery. Complications can be found in 5-15% of posterior spinal fusion surgery (PSF).
Previous studies have been found that surgeon experience and number of surgeons have an influence in
surgical outcomes. A dual attending surgeon resulted in reduction of blood loss and complication rate.
There was no comparison between a senior surgeon and young surgeons under the same surgical team
environment.
Objective: To compare intraoperative and postoperative outcomes after PSF for AIS between single senior
surgeon and two young surgeons.
Methods: A retrospective review of consecutive AIS patients undergoing PSF between 2011 and 2021 was
performed. All eligible patients met a minimum 2-year follow-up. Patients were divided into 2 groups
(group 1S: single senior surgeon, group 2Y: two young surgeons). Patient demographics and radiographical
parameters were recorded. The outcome measures included total blood loss, operative time, Hb change,
blood transfusion, percent of correction, post-operative hospital stay, complications and SRS-22 score. Chi
square test and Mann-Whitney U test were used for statistical analysis.
Results: Ninety-six patients (group 1S = 55 patients, group 2Y = 41 patients) were included. There were
no significant differences in age, sex, body weight, height, body mass index, Risser sign, pre-operative
cobb angle of major curve, between the two groups (p > 0.05). Total blood loss was comparable (p = 0.427)
between group 2Y (800 mL.) and group 1S (800 mL.). Operating time was comparable (p = 0.172) between
group 2Y (390 min.) and group 1S (367.5 min.). Length of stay and were also similar among 2 groups (p
= 0.497). Group 1S (76.69±10.37%) had better percent of correction (p = 0.043) compare with group 2Y
(72.02±11.91%). SRS-22 score was not significant between group (p > 0.05) but better self-image/appearance
in 1S group (1S VS 2Y, 4.10±0.29 VS 3.96±0.35) (p = 0.027). In group 1S, there was one superficial wound
infection and one spinal cord injury from screw penetration. In group 2Y, there was one revision because
of spinal cord injury from screw penetration.
Conclusions: Dual attending 2 young surgeons demonstrated total blood loss, operative time, Hb change,
blood transfusion, post-operative hospital stay and SRS-22 score comparable to a senior surgeon and
provided low complication. We recommend dual attending surgeon strategy for beginner young surgeons
who attempting PSF for AIS.
Keyword: l Adolescent idiopathic scoliosis (AIS) l Outcomes l Posterior spinal fusion l Experience
l Blood loss
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
80
Abstract no. 46
Prevalence of sarcopenia and functional outcome following bipolar
hemiarthroplasty in elderly femoral neck fracture: a prospective cohort
study
Thitiwat Ussadamongkol and Ong-art Phruetthiphat
Department of orthopedics, Phramongkutklao Hospital
Introduction: As the world’s populations is gradually transitioning to an aging society, osteoporotic hip
fractures have become more prevalent. Fragility hip fractures are also correlated with high mortality, loss
in disability-adjusted life year, high resource, and financial burden on the healthcare system. The femoral
neck fractures are common in elderly population and they often occur with sarcopenia. Currently, lack
of data demonstrating sarcopenia in elderly hip fracture in Thai population. The purpose of this study
is going to evaluate the prevalence of sarcopenia in elderly femoral neck fracture and to compare the
functional outcome following bipolar hemiarthroplasty between those patients with and without sarcopenia.
Material and methods: After the institutional review board (IRB) approval, a prospective study was
performed in our hospital during 2019-2020. Sixty Elderly patients with femoral neck fractures underwent
bipolar hemiarthroplasty were recruited. Sarcopenia was evaluated in all patients using the AWGS 2019
criteria: 1) muscle strength (hand grip strength), 2) muscle quantity (body composition by DXA scan), and
3) physical performance (Time Up and Go Test). Patients were classified into 2 groups: 1) femoral neck
fracture with sarcopenia and 2) femoral neck fracture without sarcopenia. The prevalence of sarcopenia
in elderly femoral neck fracture was identified and the 2-years functional outcome assessed by Harris Hip
Score (HHS) was compared in both groups.
Results: The prevalence of sarcopenia in elderly femoral neck fracture was 69.0% (Male was 20% and female
was 80%). The physical performance during short term follow-up (within 6 months) was significantly
lower in the sarcopenic group compared to the nonsarcopenic group (p = 0.03). However, there was no
difference in 2-years HHS and mortality rate between groups.
Conclusion: Elderly femoral neck fracture with sarcopenia is associated with lower physical activity
within 6 months after surgery and the risk of falling possibly occur more. This vulnerable group should
be monitored more closely during the rehabilitation period.
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
81
Abstract no. 47
The effect of perioperative hemoglobin change on functional outcome
and complications in patient with degenerative spinal disease
Kakanan Chiamdee, Chaisiri Chaichankul and Pawin Gajaseni
Department of Orthopedics, Phramongkutklao Hospital
Background: One of the common disease in middle-aged and older people is degenerative change of the
lumbar spine, caused by the degeneration of the lumbar intervertebral joint. Surgery is one modality of
curative treatment, although it might result in severe blood loss. Therefore, the goal of our study is to
determine the relationship between hemoglobin change and postoperative complication in order to improve
outcomes, lower costs, and shorten hospital stays
Objective: To study correlation of percentage hemoglobin change between preoperative and postoperative
with clinical outcome and surgical complications
Methodology: A prospective cohort study, 166 patients diagnosed with degenerative lumbar spinal disease
at the department of orthopaedics Phramongkutklao Hospital, are separated into three groups: group A
receives spinal fusions at 1-2 levels, group B receives spinal fusions at 3-4 levels, and group C receives
spinal fusions at 5 levels or more. A review was done of the clinical result (determined by the Oswestry
Disability Index questionnaire), surgical complications, hospital length of stay, ICU admission and hemoglobin
level in pre-and postoperative periods
Results: Perioperative blood loss is highest in patients getting 5 or more levels of lumbar spinal fusion
(group c) (25.41±10.73) and there is a significant difference between the 3 groups (group A 13.35±6.17,
group B 21.64±8.15; p value < 0.01). The length of hospitalization is also longest in patient group C (8
days), with a notable difference between the three groups (A = 5 days, B = 6 days; p 0.001). Group C had
the greatest rate of ICU admission, and there is a significant difference between the other two groups (p
= 0.001). Clinical outcome and other complications, however, failed to achieve a meaningful p-value. For
cutoff point of percentage hemoglobin change compared to ICU admission between 3 groups (group A
18.92% sensitivtiy 84.47 specificity 100) (group B 24.81% sensitivtiy 68.42 specificity 100) (group C 24.65%
sensitivtiy 55.56 specificity 64.29) and compared to length of hospital stay between 3 groups (group A
13.28% sensitivtiy 57.81 specificity 57.5) (group B 21.74% sensitivtiy 60 specificity 57.89) (group C 28.47%
sensitivtiy 69.23 specificity 60)
Conclusions: A greater level of perioperative blood loss during lumbar spinal fusion is significantly correlated
with a longer hospital length of stay and a higher rate of ICU admission
Keyword: l Clinical outcome l Percentage l Hemoglobin l Degenerative lumbar spine
l Postoperative complication
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
82
Abstract no. 48
Clinical feature and clinical course of thyroid-associated ophthalmopathy
in tertiary military hospital in Thailand
Kritima Tarunotai, Patcharaporn Chandraparnik, and Raweewan Choontanom
Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine
Background: Thyroid-associated Ophthalmopathy (TAO) known as graves’ ophthalmopathy (GO) or thyroid
eye disease (TED). TAO is one of potential sight-threatening ocular disease occurring in patient with
hyperthyroidism or Graves’disease (GD). For more clinical symptoms and signs early detected, the better
outcomes of treatment was achieved.
Objective: To determine the clinical features and clinical course of TAO and determine duration from first
diagnosis TAO to develop dysthyroid optic neuropathy (DON) in Tertiary Hospital in Thailand.
Methodology: Retrospective cohort study review of 104 patients diagnosed with TAO at Phramongkutklao
Hospital from 2005-2021, including demographic data, clinical manifestation, ophthalmology examination,
CAS score, EUGOGO score for severity, complication and treatment regimen and also duration from first
diagnosed TAO to develop DON.
Results: Age related TAO frequency found at 45 years (45.64±14.58). Female leaded in this clinical report
found out TAO 59 from 104 patients (Female:Male = 1.3:1). The most frequent symptom was proptosis and
the most frequent sign was limit extraocular muscle. TAO most frequently occurred with hyperthyroidism.
For the phenotype was asymmetric in 43 (41.35%) hyperthyroid patients, 34 (32.69%) Grave’s disease
patients, and 16 (15.38%) euthyroid patients. For clinical activity assessment (CAS score) was found active
in the first time visit or in months and severity assessment (EUGOGO) was mostly found in moderate
form (53.47%). The majority (82.6%) of patients had clinically inactive TAO and only 12 patients (11.8%)
of cases were sight-threatening. The most complication was DON (66.67%). For treatment regimen was
individual depending on CAS and EUGOGO. For duration from first diagnosis to develop DON was shown
in 50.75±83.42 days.
Conclusion: TAO most commonly develops in females and closely related to hyperthyroidism. Hyperthyroid
state in TAO often has an asymmetric clinical phenotype. Most clinical symptom was proptosis. And
most clinical sign was extraocular muscle limitation. CAS combined with computerized tomography (CT
scan) can improve detection of TAO. EUGOGO scores should be slightly refined regarding the criteria for
dysthyroid optic neuropathy (DON). Clinical management of TAO should be individualized according to
CAS and EUGOGO assessment. Beware complication such as TON due to duration from first diagnosis
of TAO to develop to DON was short. The treatment during time of active phase is focused on the optic
nerve function and preserving sights.
Keyword: l Thyroid associated ophthalmopathy (TAO) l CAS score l EUGOGO severity
l Dysthyroid optic neuropathy (DON)
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
83
Abstract no. 49
Studying the pain from injection treatment for trigger finger, carpal
tunnel syndrome and de Quervain disease
Katawut Kumplean and Arkaphat Kosiyatrakul
Department of Orthopedics, Phramongkutklao Hospital
Background : Trigger finger (TF), de Quervain disease (DQ) and carpal tunnel syndrome (CTS) are common
hand disorders. These 3 conditions share similar pathogenesis and result from the pressure or narrowing
of areas through which nerves and tendons pass. Currently, Steroid injection to reduce inflammation is
often recommended for people who would not like to undergo surgery. For this treatment, patients often
get pain during an injection. Therefore, the researcher decided to study pain from the injection treatment
to view how much pain from injection treatment and to seek factors affecting pain during an injection
for each of those diseases.
Objectives : To study pain levels from steroid injection treatment for TF, CTS, and DQ including comparing
the pain from steroid injection during penetration and medication administration of the treatment for TF,
CTS, and DQ.
Study Design & Methods: This study was conducted among patients diagnosed with TF, CTS, and DQ,
who underwent treatments at Phramongkutklao Hospital. There were 144 volunteers divided into 3 groups,
48 persons per group, based on a disease patients have. Patients in all 3 groups were given triamcinolone
acetonide injection. Patient perception of pain was evaluated during getting injected with a needle
(penetration), during medication administration(injection), and measured in the form of a numeric rating
scale (NRS) that ranges from 0 to 10.
Results : The findings from the study showed that the pain from injection treatment for each disease was
different. The injection treatment for CTS gave the lowest pain, while the injection treatment for TF and
DQ gave more and similar pain. Besides, it was found that the pain during injection was greater than
during penetration. Patients with TF and DQ had more pain during injection than during penetration, and
sex seemed to be a related factor for people with TF as women felt more pain than men during injection.
Conclusions: This study indicated the pain from steroid injection in people with CTS, TF, and DQ. It
made known that the pain from the injection treatment for each disease is different and it is possible that
there are other factors associated with the pain. The study showed that the injection treatment for CTS
gives the lowest pain while the pain occurs more during injection than during penetration. Sex tends to
be a related factor as women feel more pain from the injection than men. The research team hopes that
the study results shall be used as information supplementing patient decision making for undergoing a
treatment.
Keyword: l Steroid injection l Trigger finger l de Quervain l Carpal tunnel syndrome
l Randomized controlled trial
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
84
Abstract no. 50
Reliability and validation of the Thai translation of questionnaire
for assess quality of life for Thai gouty arthritis patient
Thitipong Treewut, Kanon Jatuworaprug, Patapong Towiwat and Sumapa Chaiamnuay.
Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine
Background: Despite gouty disease is the most common arthritis disease, there was no standard questionnaire
to assess the quality of life of Thai gout patients.
Objective: The aim of this study was to translate and validate the Gout Assessment Questionnaire version
2.0 (GAQ 2.0) which is a disease-specific patient-report outcome measure for gout into Thai version to
assess the quality of life for Thai gouty arthritis patients.
Methodology: A multicenter cross-sectional study of Thai gouty arthritis patients followed up at Rheumatic
clinic of Phramongkutklao Hospital, Thammasat University Hospital, Naresuan University hospital between
June 2021 to September 2022 was conducted. Content validity index (CVI), internal consistency reliability,
intraclass correlation coefficient, Pearson correlation coefficient were performed to determine the reliability
and validity of the questionnaire. Demographics, clinical manifestations, medications, laboratory parameters
were also recorded.
Results: Of the 150 patients included, 6% had active gouty arthritis and 94% had intercritical gout and
chronic tophaceous gout disease during the follow-up time. Internal consistency was sufficient for all
subscales (Cronbach’s alfa = 0.542, ICC = 0.967, 95%CI: 0.931-0.985, p < 0.001). Test-retest reliability and
validity of The Thai version is correlated with the GAQ2.0. The Gout impact subscale scores correlated
with SF-36.
Conclusion: The translation Thai version of the GAQ2.0 was acceptable internal consistency, reliability,
validity. It is significantly correlated with SF36 for the assessment of quality of life of Thai gout patients.
Keyword: l Gout l The Gout Assessment Questionnaire (GAQ 2.0) l Quality of life
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
85
Abstract no. 51
Association of vitamin D level and severity of chronic rhinosinusitis
Wanchai Wilaisakulnam and Ussana Promyothin
Department of Otolaryngology, Phramongkutklao Hospital
Background: Chronic rhinosinusitis is a inflammation of paranasal sinus mucosa more than 12 weeks.
Chronic rhinosinusitis can be classified into 2 types: Chronic rhinosinusitis with nasal polyp and Chronic
rhinosinusitis without nasal polyp. From previous studies, Vitamin D have to balance of calcium level
and bone density, that effect the immune system. From previous report found effect anti-inflammation
in chronic illness. The previous study found vitamin D level have relation Chronic rhinosinusitis with
nasal polyp
Objective: To study relation between severity of Chronic rhinosinusitis with nasal polyp and vitamin D
levels, that relation for improve proper management in these patients.
Methodology: Chronic rhinosinusitis patients (have symptom more than 3 month from EPOS 2020) had
age between 20-60 years old, have to treatment or surgery in Otolaryngology of Phramongkutklao Hospital
accept to undergo a vitamin D test using blood, answer the questionnaires, number of surgery, complete
ENT exam, evaluate VAS scale and evaluated Lund Mackay score from CT scan.
Result: A total of 25 Chronic rhinosinusitis with nasal polyp patient participated in this study. They are
17 Chronic rhinosinusitis with nasal polyp and 8 Chronic rhinosinusitis without nasal polyp. They are 4
vitamin D level was normal, 11 vitamin D level was insufficiency and 5 Vitamin D level was deficiency.
vitamin D level and Chronic rhinosinusitis with nasal polyp were found significant correlation in VAS
5,10,11,12,13 (p-value = 0.005, 0.003, 0.025, 0.017, 0.004) and significant negative correlation in Lund Mackay
score (p-value = 0.019, 0.013). Patients were endoscopic sinus surgery found significant correlation in VAS
5, 10, 11, 12, 13 (p-value = 0.017, 0.017, 0.034, 0.047, 0.005) and significant negative correlation in Lund
Mackay score (p-value = 0.020, 0.012) compared vitamin D level.
Conclusions: Vitamin D level have significant negative correlation of Lund Mackay score from CT scan
in chronic rhinosinusitis with nasal polyp patient. But have significant positive correlation of severity of
VAS scale question no.5, 10, 11, 12, 13.
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
86
Abstract no. 52
Effectiveness of carbogen inhalation in sudden sensorineural
hearing loss: systematic review
Poonyaporn Phankosol and Saisuree Nivatwongs
Department of Otolaryngology, Phramongkutklao Hospital
Background: Sensorineural hearing loss is one of the burden diseases that effect in daily life. There are
several theories of the etiology such as viral infection, inner ear ischemia/hypoxia, autoimmune disease,
intracochlear membrane ruptured etc. Fisch et al studied in experimental animals about carbogen inhalation
which could cause the vasodilation in inner ear and increased the oxygen tension in perilymphatic fluid.
Carbogen inhalation become one of choices of treatment in sensorineural hearing loss in some institutes.
Objective: To study the effectiveness of carbogen inhalation compare with other treatments and the side
effect of carbogen inhalation.
Study design: A systematic review Methods Full text, English and Thai language publicated articles in
MEDLINE (PubMed), Science direct, Cochrane library. These articles were selected from 2 independent
researchers.
Results: Eight articles were included in this review. There are 1 Randomized controlled trial, 4 non randomized
controlled study (one of them is a long-term follow-up study from the old one), 3 retrospective study. Most
studies found the carbogen inhalation therapy addition to steroid had higher hearing improvement than
the steroid alone with no statistically significant. There was no difference between group among the
steroid, carbogen or placebo as a single treatment. There was no difference in early treatment between
carbogen inhalation and anticoagulant therapy, but in long term study, the carbogen group had a higher
hearing improvement with statistically significant. The side-effect of carbogen inhalation found only
feeling of suffocation on starting of CO2 gas in first 10-15 seconds.
Conclusions: There are no article can clearly conclude the superior treatment effect of additional carbogen
inhalation therapy to steroid alone or carbogen alone to steroid alone or early effect of carbogen to
anticoagulant. Future randomized controlled trial should be included to summarize the potential of carbogen
inhalation as a treatment in sensorineural hearing loss.
Keyword: l Sensorineural hearing loss l Carbogen l Treatment l Hearing loss l Deafness
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
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Abstract no. 53
Analysis of tissue zinc levels in breast cancer subtypes
Vasin Chantaraponpun1 , Thirayost Nimmanon2 and Chetana Ruangpratheep2
1Division of Anatomical Pathology, Army Institute of Pathology; 2Department of Pathology, Phramongkutklao College of Medicine
Background: Our previous study has been discovered that zinc levels were significantly higher in the
surrounding normal breast tissue compared to the invasive breast carcinoma (IBC) tissue.
Objective: The objective of this study was to quantitatively analyse tissue zinc levels in molecular subtypes
of IBC.
Methods: Zinc concentrations were evaluated in 45 formalin-fixed, paraffin -embedded tissue sections of IBC
by the inductively coupled plasma optical emission spectrometry (ICP-OES) method. Molecular subtypes of
IBC were classified by immunohistochemical reactivities for estrogen receptor (ER), progesterone receptor
(PR), human epidermal growth factor receptor 2 (HER2) and Ki67 proteins. At the 95% confidence interval,
the correlation of tissue zinc levels had no significant relationship with hormone receptor (ER, PR and
HER2) status, KI67 proliferation index and molecular subtypes.
Results: Forty-five IBC cases were categorized into three main subtypes, i.e. luminal (14 cases), HER2-
positive (10cases) and triple-negative (17cases) breast cancers. Four cases were not classified because
they revealed an equivocal HER2 expression (score 2+). Tissue zinc levels had no significant relationship
with hormone receptor (ER, PR and HER2) status, KI67 proliferation index and molecular subtypes.
Conclusion: Intracellular zinc is possibly regulated by alternative transporters in the development of breast
cancer molecular subtypes
Keyword: l ICP-OES l Immunoexpression l Invasive breast carcinoma l Molecular subtypes
l Tissue zinc
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
88
Abstract no. 54
Histopathological characteristics of phyllodes tumor and cellular
fibroadenoma in core needle biopsy specimens in Army Institute of
Pathology
Supasin Boocha and Kittisak Wongchansom
Division of Anatomical Pathology, Army Institute of Pathology
Background: Fibroepithelial lesions of the breast encompass various groups of tumors, including fibroadenoma
and phyllodes tumor. Fibroadenoma can be clinically observed or complete excision with low recurrent
rate, while phyllodes tumor needs wide local excision with negative margins. The diagnosis requires core
biopsy assessment which is challenging especially between cellular fibroadenoma and phyllodes tumor.
Objective: The objective of this study was to differentiate histopathological features of phyllodes tumor
and cellular fibroadenoma on core needle biopsy.
Methods: The cellular fibroadenoma (n = 12) and phyllodes tumor (n = 24) slides from core needle biopsy
and subsequent excision in army institute of pathology has been assessed. Histopathological features,
including mitosis, stromal cellularity, stromal overgrowth, nuclear pleomorphism, tumor heterogeneity, stromal
fragmentation, fat trapping and subepithelial condensation, were evaluated on core needle biopsy slides.
Results: Twenty-four cases (66.7%) were diagnosed as phyllodes tumors. Twelve cases (33.3%) were
diagnosed as cellular fibroadenoma. The following three histopathological features were statistically
significant differences among the two groups: mitosis, stromal cellularity, subepithelial condensation.
Conclusion: Subepithelial condensation, stromal cellularity (moderate or more) and mitosis (more than 1
per 10HPF) were the most helpful features to distinguish phyllodes tumor from cellular fibroadenoma on
core needle biopsy.
Keyword: l Cellular fibroadenoma l Core needle biopsy l Fibroepithelial lesions l Phyllodes tumor
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
89
Abstract no. 55
AMFSS computer-based program: An individualized utility tool to
analyze and evaluate the reliability of multiple choice questions in
Army Medical Field Service School
Adisorn Lumpaopong1 and Kachar Ganyalong2
1Director of Education, Army Medical Field Service School, Royal Thai Army Medical Department; 2Computer programmers
Background: Multiple-choice questions (MCQs) are commonly used in assessments of undergraduate
and postgraduate examinations since this modality is convenience to measure examiners’ scores and
performance. Regarding the quality and reliability of MCQs, B-index, Livingston reliability and KR-20
are the parameters that usually be analyzed. Normally, commercial software is not only measure the
scores but also analyze the reliability of MCQs however most of the software is licensed which required
for the expenses. Army Medical Field Service School performs MCQs examination regularly to evaluate
students’ performance in the medical non-commissioned officer course, medical officer basic course and
medical officer advanced course. To analyze MCQs quality and reliability, we currently use the computer
software that is needed to be updated which requires more budgets. Regarding this issue, we create the
new software as AMFSS computer-based program which is individualized, cost-saving and compatible
with the context of the school.
Objective: To create the computer-based program to analyze and evaluate the quality and reliability of MCQs
Method: All quality and reliability parameters of MCQs are reviewed. The program is performed by using
Pascal computer language and Firebird software which is open-source SQL relational database management
system. The program can be run in Microsoft Window 7 to Window 11 platforms.
Results: The AMFSS computer-based program is created. The program is able to automatically analyze
MCQs scores from answer sheets. For quality and reliability of MCQs, this program demonstrates the level
of difficulty (p), power of discrimination (r), B-index, Livingston reliability and KR-20. Data from Moodle
platform can be imported through this program to measure quality and reliability of MCQs as well.
In conclusion: We created the AMFSS computer-based program which is individualized for Army Medical
Field Service School to measures MCQs scores. The quality and reliability parameters are analyzed in
this program which the instructors can edit the low quality items and select the high quality items to
MCQs hub.
Keyword: l Multiple choice questions l Reliability l B-index l KR-20
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
90
Abstract no. 56
Benefits of information technology as web based application to
calculate pediatric favipiravir dose and army physical test passing
score
Adisorn Lumpaopong1 and Kasom Bhangananda2
1Director of Education, Army Medical Field Service School, Royal Thai Army Medical Department; 2Head of Department of Pharmacology,
Phramongkutklao College of Medicine
Background: Nowadays, information technology is widely used in daily life especially during the outbreak
of COVID-19. In pediatrics, favipiravir is the antiviral drug for treating COVID-19 children however the
dose is calculated based on their body weight. Inappropriate favipiravir dose might provide the serious
side effects for infected children. Army physical test is another issue that army personnel must be tested
regularly as per army policy. Passing score is demonstrated based on the age and job activity. Regarding
these issues, we would like to use information technology to decrease the risk of medication error from
favipiravir calculation and convenience for army personnel to know their passing score, respectively.
Objective: To publish Pediatric Favipiravir Dose Calculator and Army Physical Test Passing Score Calculator
through web based application
Method: Pediatric Favipiravir Dose Calculator and Army Physical Test Passing Score Calculator are created
by using web based application that is developed with JavaScript on Oracle Database Express edition
platform. User can access these programs through the web link via computer PC or smart phone.
Results: Regarding Pediatric Favipiravir Dose Calculator, the web ink as https://wba.pmk.ac.th/ords/f?p=314:41
is forward and widely use among Thai pediatrician community to calculate favipiravir dose. For Army
Physical Test Passing Score Calculator, the web link as https://wba.pmk.ac.th/ords/f?p=301:9999 is useful
to evaluate passing score based on the age and job activity.
In conclusion: Pediatric Favipiravir Dose Calculator and Army Physical Test Passing Score Calculator are
convenience and useful web based application that provides the benefit for favipiravir dose calculation
and physical test passing level, respectively.
Keyword: l Information technology l Web based l Favipiravir l Physical test
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
91
Abstract no. 57
Prevalence and association of indoor environmental factors and sick
building syndrome among workers of Army Medical Department
Headquarter, Bangkok
Etha Kannirun, Vithawat Surawattanasakul, Thanapoom Rattananupong and Wiroj Jiamjarasrangsi
Armed Forces Research Institute of Medical Sciences
In the present, people tend to work in the building rather than outside, therefore increase the
chance of developing sick buildingsyndrome. The objectives of this study were to determinethe prevalence
and associated factors of sick building syndrome (SBS) among workers of Thai Army Medical Department
Headquarter in Bangkok. This study was conducted in Cross-sectional design. Personal data were collected
from 285 workers by using a structured questionnaire, and environmental data were collected by using
dedicated environmental meters. The overall and sub-group specific prevalence of SBS was determined,
and the SBS associated factors were then identified. Result showed that the overall SBS prevalence was
19.65% (95%CI: 15.04-24.26). Personal factors which were significantly associated with SBS were having
medical condition such as skin system [ORadj = 3.95 (95%CI: 1.48, 10.53)], circulatory system [ORadj =
6.64 (95%CI: 2. 03, 21. 71)] , and dissatisfaction to workplace [ORadj = 4. 56 (95%CI: 1.19, 17.51)], while
environmental factors which were significantly associated with SBS were temperature (for temperature
of higher than 26.5°C compared to lower than 24.7°C) [ORadj = 0.25 (95%CI: 0.09, 0.70)] and PM2.5 (for
PM2.5 concentration of 4-5.9 µg/m³ compared to concentration below 4 µg/m³) [ORadj = 3.20 (95%CI: 1.25,
8.21)]. In conclusion, SBS awareness among the workers of Thai Army Medical Department Headquarter
should be raised, and prompt investigation as well as proper environmental amelioration should be made
in case of higher-than-expected SBS occurrence in the workplace.
Keyword: l Sick building syndrome l Satisfaction l Environment l Particulate matter
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
92
Abstract no. 58
Annual case report of rickettsiosis patients diagnosed at Armed
Forces Research Institute of Medical Sciences, Thailand during
fiscal year 2008-2021
Maneerat Somsri, Khwananong Youngpakool, Chidchanok Saenkham, Kiatisak Somsri, Suchawadee Ueajai,
Chanoknun Thimhaipol, Sutchana Tabprasit and Kunakorn Kana
Armed Forces Research Institute of Medical Sciences
Rickettsiosis, arthropod-borne febrile illnesses remain health problem in Thailand, not only in
civilian but also in military troops. Precise laboratory result is required for proper diagnosis and treatment.
To response this problem, Armed Forces Research Institute of Medical Sciences (AFRIMS) has established
serological laboratory to diagnose rickettsial infection by Indirect Immunofluoresence Assay (IFA). Diagnosis
for scrub typhus, murine typhus and tick typhus were routinely conducted using in-house produced crude
cell antigens of Orientia tsutsugamushi, Rickettsia typhi and R. honei, TT118. AFRIMS rickettsial laboratory
has been accredited for national ISO 15189 and ISO 15190 since 2014 and also served as regional reference
laboratory appointed to WHO Collaborating Center. During October 2008 to September 2021, total 61,253
febrile patient sera were received to screen for rickettsial infection using IFA at 1:50 dilution and further
tested for final seropositive titer with the cut-off titer ≥ 1:400. Scrub typhus infection was detected 4.60%
(2,822/61,253) of febrile patient samples, while 1.40% (856/61,253) and 0.043% (17/61,253) were diagnosed
as murine typhus and tick typhus, respectively. Our data clearly demonstrated that rickettsiosis remains
public health problem in Thailand. Health education of disease specific information and self-protection
are crucial for disease control strategy.
Keyword: l Rickettsiosis l IFA l Serodiagnosis
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
93
Abstract no. 59
Generation of luciferase-secreting DENV2 reporter for the
development of Luc-based reduction neutralization
Krongkan Saipin1,2, Min Kramyoo1, Sutchana Tabprasit1, Khunakorn Kana1, Nattanon pukuka1 and
Jiraphan Junjhon2
1Armed Forces Research Institute of Medical Sciences (AFRIMS); 2Department of Microbiology, Faculty of Public Health, Mahidol University
Background: Dengue virus (DENV) neutralizing antibodies measurement was important to estimating
dengue disease prevention and pathogenesis. DENV reporters are gaining popularity in the evaluation of
these antibodies; their accessibility and acceptance may improve with more efficient production systems
and indications of their antigenic equivalence to the wild-type virus.
Objective: To generate luciferase-secreting DENV reporter (LucDENV2) for the development of neutralization
assay based on secreting-luciferase detection system.
Methodology: The cDNA reporter clone of DENV-2 strain 16681 was initially constructed to a template
for SP6-driven RNA transcription and transfected into mosquito (C6/36) cell with lipofectamine 2000.
Biological characterizations of LucDENV2 were compared to live DENV2, strain 1668. Luc-based reduction
neutralization was developed by using 30 DENV2 patient that were collected previously at Kamphaeng
Phet province, Thailand in the year 2013 (provided from US-AFRIMS).
Results: LucDENV2 could be produced successfully with antigenic equivalent to live DENV2 and replicated
to similarly high levels as that of the parent 16681 virus in a commonly used mosquito cell line. Parallel
analysis of LucDENV2 and wild-type revealed good agreement (ICC = 0.757) between the luciferase-based
and focus-based neutralization system in a 96-well microplate format when employed against a set of
clinical sera, suggesting comparable antigenic properties of LucDENV2 with those of the parent virus.
Conclusion: The high-titer, replication competent, luciferase-secreting DENV reporter presented here
should be a useful tool for fast and reliable quantitation of neutralizing antibodies in populations living in
DENV-endemic areas.
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
94
Abstract no. 60
The study of the effect of using board game to enhance the tactical
combat casualty care learning for medical non-commissioned officer
student, Army Medical Field Service School
Thanainan Piromjiew
Instructor of Army Medical Field Service School, Royal Thai Army Medical Department
Tactical Combat Casualty Care (TCCC) is a core competency of Medical non-commissioned
officer student to effectively treat combat casualties in battlefield. The learners must understand basically
clinical assessment, providing medical care in the limited situations as well as safely casualties evacuation.
The researcher designed learning with active learning. Divide the lesson into 2 parts, lecture guideline
and small group practice. Then integrated practice again in FTX. However, the learners are unable
tointegrate the knowledge to practice. Therefore, the researcher developed materials by using board
games to enhance learning.
The study objectives were
1. To study learning achievement before and after learning with board game
2. To survey the satisfaction level of learners who learned with board game.
Research methods Board game was developed that consist of 3 phases of TCCC include Care Under Fire,
Tactical Field Care and Tactical Evacuation Care. It was used by 145 learners.
The research found that learners’ learning achievement after learning with board game were higher than
before learning with a statistical significance level of 0.05. In addition, overall learners’ were satisfied with
learning with board game at a high level.
Conclusion Using board games has enhanced the learners to understand the lesson and can apply the
guideline to the practice in battlefield. And also be using recreational activity to enhance effectively learning.
Keyword: l Board game l Enhance learning l Active learning l Tactical combat casualty care
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
95
Abstract no. 61
Clinical scoring for prediction of oxygen use in patients with
COVID 19 infection in a community hospital, Thailand:
a retrospective cohort study
Thanapat Vongchansathapat1 and Wisit Kaewput2
16th Year Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine
Background: Oxygen therapy (OT) is widely used among COVID-19 patients and the modality applied
is varied depending on the spectrum of severity. Due to the emerging COVID-19 in recent years, many
countries have suffered the effects of this pandemic due to unprepared and limited medical equipment.
We aim to develop a prediction score for requiring oxygen treatment in COVID-19 subjects.
Methods: This study is retrospectively analyzed in confirmed COVID-19 subjects via COVID antigen test
or real-time polymerase chain reaction between the year 2020-2022 in patients from a rural hospital. The
patients were divided into two groups, including no oxygen use and oxygen use. The multiple logistic
regression with backward stepwise were performed to determine the risk factors.
Results: A total of 2,192 subjects was recruited. Two thousand one hundred forty people did not need OT
(97.6%), and 52 people (2.37%) received OT. Six significant predictors were identified: age group more
than or equal to 60 years old, male gender, alcohol use, diabetes mellitus, cardiovascular disease, and
number of covid-19 vaccinations. The score showed an area under the receiver operative characteristic
curve of 0.78 (95%CI: 0.71-0.85) and was well-calibrated. The cut point oxy-score at 2.5 was calculated
with AuROC of 69.7% (95%CI: 0.631-0.763). The oxy-score showed an acceptable predictive performance
and was potentially useful to help triage patients in a rural setting according to their necessity and provide
optimal preventive management.
Conclusion: We identified that general patient information can be used as clinical predictive for oxygen use.
Keyword: l COVID-19 l SARS-CoV-2 l Oxygen therapy l Oxy-score
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
96
Abstract no. 62
A comparative outcome of six-pack versus straight & full fist hand
exercise following open reduction and volar plate fixation in distal
radius fracture: a prospective randomized control trial
Pariphat Chompoonutprapa and Suriya Luenam
Department of Orthopaedics, Phramongkutklao Hospital
Background: Fractures of the distal radius are the most frequent fracture. Volar plate fixation is the mainstay
for treatment of unstable distal radius fracture but it comes with complications such as posttraumatic
arthritis, malunion, and hand stiffness. Six-pack exercise was used for preventing finger stiffness but this
exercise has low compliance at home due to number and complexity of exercise. Straight and full fist
hand exercise has 2 set of exercise and also have full range of motion of fingers and easy to do.
Objective: To compare hand functional outcome, Michigan Hand Questionnaire (Thai version), between
six-pack exercise and straight & full fist exercise in patients with distal radius fracture who underwent
volar locking plate fixation.
Methodology: A prospective, block of four, computerized-based randomized trial was conducted. After
underwent volar locking plate fixation via modified Henry’s approach, patients are applied volar short arm
slab for 4 weeks and started exercise six-pack or straight & full fist exercise at first postoperative date
until 6 weeks postoperatively.
Results: Twenty one patients were in the straight & full fist exercise group whereas 14 were in the six-
pack exercise group. The baseline characteristics of each group are similar. There were all no significant
different between 2 groups on total score of Michigan hand questionnaire and its subscale (p > 0.05 in
all domains). There’re some improvement of functional outcome over time in both groups. Other clinical
outcomes such as finger stiffness, Kapandji score and grip strength also had no significant different
between these 2 groups in each visit.
Conclusion: The straight & full fist exercise is good alternative postoperative rehabilitation program for
patient with distal radius fracutre, result in good short to middle term hand and finger function via Michigan
Hand Questionnaire (Thai version), finger stiffness including Kapandji score, grip strength compare to
six-pack hand exercise without significant increasing complications.
Keyword: l Distal radius fracture l Hand functional outcome l Hand rehabilitation l Finger stiffness
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
97
Abstract no. 63
Comparison of the sit-to-stand test with 6-minute walk test in post
coronary artery bypass graft patients
Radchaphoom Anukul., Phatra Meesuksabai and Patrawut Intarakamhang
Department of Physical Medicine and Rehabilitation, Phramongkutklao Hospital
Objective: to compare of the Sit-to-Stand Test with 6 Minute Walk Test in cardiac rehabilitation patients
whose undergone Coronary Artery Bypass Graft (CABG) surgery.
Study design: Cross-sectional study.
Setting: Cardiac rehabilitation clinic, Phramongkutklao Hospital.
Subjects:Post-CABG patients who visited cardiac rehabilitation clinic.
Methods: Theparticipants started with the6-minute walk test. After adequate resting, theparticipants start
the Sit-to-Stand Test. The 6-minute walk distance, Sit-to-Stand test repetitions, blood pressure heart rate
and rating of perceived exertion scale before and after the test were recorded.
Results: There were a total of 39 participants, the correlation coefficient (r) between the 6-minute walk
test and the Sit-to-Stand test was 0.56 (p < 0.001), indicating a moderately significant correlation. The
exercise intensities from both Sit-to-Stand test and 6-minute walk test were light.
Conclusions: The Sit-to-Stand Test demonstrated moderately significant correlation to 6-minute walk test
in post CABG patients. The test was light intensity and safe thus Sit-to-Stand test should be considered
as alternative submaximal exercise test in outpatient cardiac rehabilitation service.
Keyword: l Sit- to-Stand Test l 6-Minute Walk Test l Coronary Artery Bypass Graft (CABG)
l Cardiac rehabilitation
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
98
Abstract no. 64
Randomized control trial of pre-emptive medication between
gabapentin (300 mg) and none to control postoperative pain after
hemorrhoidectomy by spinal anesthesia
Nattaporn Maneepairoj and Chinakrit Boonvaussadorn
Division of General Surgery, Phramongkutklao Hospital
Background: Postoperative pain after anorectal surgery cause mor morbidity and delays discharge in many
patients. Gabapentin is a third-generation anti-epileptic drug that selectively affects the nociceptive
process, so it has been used for helped to control pain after many operation.
Objective: To prove the efficacy of pre-emptive used gabapentin (300 mg) before hemorrhoidectomy under
spinal anesthesia.
Material and Method: The single blind randomized control trial was undertaken at Phramongkutklao Hospital
between October 2020 to September 2022. After informed consent, 50 patients was randomly assigned
either to receive none medication (control) 25 patients or gabapentin 300 mg, 25 patients (experiment)
before performed closed technique hemorrhoidectomy under spinal anesthesia. All other aspects of surgery
and anesthesia were standardized. Postoperative pain score was recorded by blinded nurses at 2, 4, 12
and 24 hours using visual analog scale (VAS: 0-10, where 0 represent no pain, 10 represent the worst
pain). Other outcomes such as total morphine (mg) used in 24 hours, incidence of urinary retention and
nausea was also recorded.
Result: The VAS score at 24 hours and incidence of urinary retention was significantly less in gabapentin
group (p = 0.020), (p = 0.024) respectively but the VAS score 2,4,12 hours, total morphine used and incidence
of nausea was no significantly difference between two groups.
Conclusion: The used of pre-emptive gabapentin before hemorrhoidectomy is associated with significant
decrease pain at 24 hours after surgery and incidence of urinary retention.
Royal Thai Army Medical Journal Vol. 75 Supplement (1) November 2022
99
Abstract no. 65
Effectiveness of mobile phone application “Epilepsy care” for self-
management of epileptic children in Phramongkutklao Hospital: a
randomized controlled trial
Pantira Chinsuwan1, Wilawan W.Wilodjananunt1, Dittaya Wanvarie2, Nithipun Suksumek1,
Thitiwan Simasathien1, Charcrin Nabangchang1 and Piradee Suwanpakdee1
1Department of Pediatrics, Phramongkutklao Hospital; 2Department of Mathematics and Computer Science, Faculty of Science, Chulalongkorn
University
Background: Epilepsy is one of the most common chronic neurological disorders in children. Optimal
self-management can improve seizure control and increased quality of life. Recent studies have reported
that mobile applications improved the self-management of patients with chronic illnesses but lack data in
epileptic children. Therefore, we conducted the first Thai version of a mobile application called “Epilepsy
care” for epileptic children in Thailand.
Objective: To study the effectiveness of the mobile phone application “Epilepsy care” in the aspect of
self-management and seizure control in epileptic children.
Methodology: We performed a prospective, randomized controlled trial with 220 epileptic children who
had a smartphone and were treated at the pediatric neurology clinic. Patients were randomly allocated to
the control (epilepsy guidance) or intervention groups (epilepsy guidance with mobile application). The
primary outcome assessed epilepsy self-management by using the Pediatric Epilepsy self-management
Questionnaire (PEMSQ) in Thai version comprised 27 questions for determining the knowledge, adherence
to medications, belief about medication efficacy, and barriers to medication adherence. The secondary
outcome evaluated seizure frequency at baseline, 3, and 6 months after initiation of an application.
Results: Eligible participants who were randomized to a mobile application achieved significantly higher
PEMSQ scores in the domain of barriers to medication adherence (p < 0.05) at 6 months follow-up. Other
domains of PEMSQ showed no statistically significant difference. The median seizure frequency was 1.5,
1 and 2.5, 1 at 3 and 6 months in control group and intervention group, respectively (p <0.001). In addition,
the study revealed that 94.9% of the participants in a mobile application group were highly satisfied with
using application and 100% of the participants desire to promote this application to their epilepsy society.
Conclusion: The mobile phone application “Epilepsy care” significantly decreased barriers to medication
adherence, one of the important factors of epilepsy self-management, and improved seizure control with
more satisfaction compared with standard care. These findings suggest that using the mobile application
may be considered as an adjunctive therapy to improve self-management and seizure control in epileptic
children.
Keyword: l Mobile application l Epilepsy l Children l Self-management l Seizure control
เวชสารแพทยท์ หารบก ปีท่ี 75 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2565
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