ประชุมพระมงกุฎเกล้า ครั้งที่ 51

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 100 Abstract no. 62 Prevalence and associated factors of diabetic kidney disease in type 2 diabetic patients, Bangkhla Hospital, Chachoengsao Province, Thailand: Analytic cross-sectional studies Bhoom Tumrongteppitux, Napatthawan Panichnantho, Maneepatsorn Sirisereewan and Kanlaya Jongcherdchootrakul Phramongkutklao College of Medicine Background: Type II diabetes is a chronic disease with a number of patients continuing to increase. This results from the body’s inability to use the hormone insulin effectively. Insulin hormone plays an important role in lowering blood sugar levels. Hyperglycemia is an important consequence of poor glycemic control in diabetic patients. It also leads to unfavorable impact on bodily systems. Diabetic kidney disease is one of them. If left untreated, renal pathology will develop resulting in severely reducing of glomerular filtration. Finally, can lead to end stage renal disease. Objective: To estimate the prevalence of diabetic kidney disease in T2DM patients. To know associated factors of diabetic kidney disease in T2DM patients. Study design: Analytic cross-sectional studies Methods: An analytic cross-sectional study was conducted among 1,806 participants. Data were collected from the patient database of Bangkhla hospital from 30 August 2561 to 30 August 2565. Patients who were diagnosed with type 2 diabetes mellitus base on ICD-10 (E11) were collected information of all services type for the period of study. Information was obtained including general information and medical information such as underlying disease, diabetic kidney disease. hypertension, dyslipidemia, cardiovascular disease, duration of diabetes mellitus, body weight, height, body mass index, smoking history, alcohol drinking history, fasting blood sugar, HbA1C, Blood pressure, LDL, Cholesterol, HDL, Triglyceride and complication from diabetes mellitus. Then data were analyzed using descriptive statistics and logistic regression analysis. Results: The prevalence of diabetic kidney disease in type 2 diabetic patients in this study is relatively low compared to the related studies in Thailand. Factors that are associated with kidney complications in type 2 diabetic patients in this study include age, long duration of diabetes, hypertension and HDL level. Conclusion: Information about associating factors of diabetic kidney disease from this study will benefits in generating health policy in order to prevent diabetic kidney disease in diabetic patients in the future and help improving quality of life of diabetic patients. However, further prospective studies using cohort study is needed. Keywords: l Diabetic kidney disease l Diabetic nephropathy

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 101 Abstract no. 63 Self-care behaviors and glycemic control in diabetes mellitus patients at Tha Luang hospital, Lopburi province Sakharin Kanjana, Techarit Saksakulwiriya, Teeraboon Lertwanichwattana and Wisit Kaewput Phramongkutklao College of Medicine Background: Diabetes mellitus is one of the most common non-communicable diseases and will eventually have higher incidences in the near future. The most important danger from Diabetes is its complications when plasma glucose isn’t properly controlled. Causes for Diabetes can be varied from aging society, sedentary lifestyle, changes of dietary containing high sugar and calories combining all of these will lead to becoming Diabetes patient. The best prevention for diabetes is increasing awareness about disease and change of self-care behaviors which is a part of the goal of care for Tha-Luang hospital and the focus of this research. Objective: The objectives are to study about the relevance between self-care behaviors and glycemic control in Diabetes mellitus at Tha-Luang hospital, Lopburi province in the Diabetes patients that are 20 years old or more and under Tha-Luang hospital care. Methods: This research is cross-sectional research. This research uses modified questionnaire from Summary of Diabetes Self-Care Activities (SDSCA) divided into 2 parts 1) Demographic data 2) Evaluation for selfcare behaviors after combining this data will be calculated into score, compared to average of 3 recently documented fasting plasma glucose (FPG) and analyzed for the relevance by SPSS with multivariate analysis. Results: This research has 184 participants which from the calculation required a minimum participant of 172. The result shows 53.26% with good glycemic control the factor that is statistically significant for good glycemic control is dietary control (adjusted odds ratio 0.74, p 0.019) Conclusion: In summary, most patients with good glycemic control have good dietary control and plan. But, aside from this there are other several important self-care behaviors affecting glycemic control as well as dietary control thus, the proper self-care behaviors can effectively reduce the complications from Diabetes and better long-term care result in the future. Keywords: l Glycemic control l Self-care behaviors l Diabetes mellitus

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 102 Abstract no. 64 Prevalence and associated factors of osteoarthritis in type 2 diabetic patients, Phatthana Nikhom Hospital, Lopburi Province, Thailand: Analytic cross-sectional study Saranphruk Kiengsiri, Thanyaphat Jaroenwattanamongkol and Kanlaya Jongcherdchootrakul Phramongkutklao College of Medicine Background: Osteoarthritis is a degenerative disease; it is caused by the degenerative of bone cartilage which causing destruction of bone lead to the disease. Osteoarthritis has many associated factors like weight gaining, Trauma accidents, diabetes, dyslipidemia, aging, osteoporosis, etc. WHO shows that in 2020, Patient who has joint and bone involve disease have been increased from 400 m to 570 m people especially osteoarthritis disease which count as 2,693 for 100,000 people. Diabetes affected the cartilage of bone by fastening the degenerative phase. Type II diabetes is a chronic disease with a number of patients continuing to increase. This results from the body’s inability to use the hormone insulin effectively. Insulin hormone plays an important role in lowering blood sugar levels. Hyperglycemia is an important consequence of poor glycemic control in diabetic patients. It also leads to unfavorable impact on bodily systems. Objectives: To estimate the prevalence of osteoarthritis disease in T2DM patients. To know associated factors of osteoarthritis disease in T2DM patients. Methods: An analytic cross-sectional study was conducted among 5,122 participants. Data were collected from the patient database of Phatthana Nikhom hospital from 1 January 2017 to 31 December 2021. Patients who were diagnosed with type 2 diabetes mellitus base on ICD-10 (E11) were collected information of all services type for the period of study. Information was obtained including general information and medical information such as underlying disease, hypertension, dyslipidemia, body weight, height, body mass index, smoking history, alcohol drinking history. Then data were analyzed using descriptive statistics and logistic regression analysis. Results: The prevalence of osteoarthritis disease in type 2 diabetic patients in this study is relatively low compared to the related studies in Thailand. Factors that associated with osteoarthritis in type 2 diabetic patients in this study include sex, age, BMI, dyslipidemia, metformin used. Conclusion: Information about associating factors of osteoarthritis disease from this study will benefits in generating health policy in order to prevent osteoarthritis disease in diabetic patients in the future and help improving quality of life of diabetic patients. However, further prospective studies using cohort study is needed. Keywords: l Osteoarthritis disease l Diabetes mellitus l Metformin

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 103 Abstract no. 65 The mortality rate and risk factor among patients with upper gastrointestinal bleeding in a Thawung hospital, Lopburi, Thailand Puttaratep Muangsombut, Siriphong Phaophong and Teeraboon Lertwanichwattana Phramongkutklao College of Medicine Background: Upper gastrointestinal bleeding is one of the most typical gastrointestinal emergencies, with a mortality rate of between 2 and 15%. Despite improvements in better diagnosis and treatment, the mortality rate for patients with GI bleeding has not decreased over the past 50 years. The classification of patients with primary GI bleeding as high-risk or low risk is crucial to their care. by grouping patients using various tools or screening techniques in order to follow treatment recommendations and keep track of side effects. Other factors, such as sex, a history of painkiller use, a history of antiplatelet use, and a prior history of upper gastrointestinal bleeding, can also contribute to bleeding in the upper gastrointestinal tract in addition to those already mentioned. Objectives: To examine the mortality rate and risk factors for patients with upper gastrointestinal bleeding by conduced from Thawung hospital’s database from 2011-2021 Methods: This study was conducted in a Thawung Hospital, Lopburi, Thailand. A retrospective cohort study was conducted from October 2011 to September 2022 by collecting data from Thawung Hospital’s database. Inclusion criteria of the study consisted of Thai nationality patients that presented to Thawung Hospital with evidence of upper gastrointestinal bleeding. The patients would have been excluded from the study if they are < 18 years or they have evidence of other bleedings. Results: The overall mortality rate within 60 days of admission was 13.1%. This is normally compared to the overall mortality rate (2-15%) from upper GI bleeding, worldwide. The study found that in comparison to patients with a BMI of 18.5 kg/m2 , patients with BMI 18.5-22.9 kg/m2 and BMI 25-29.9 kg/m2 are protective factors for 0.26 and 0.1 times respectively. In comparison to patients with initial serum albumin less than 3 g/dL, patients with initial serum albumin levels of 3 g/dL or higher are protective factors for 0.3 times. statistically significant when controlling for other relevant translators. Conclusion: Hypoalbuminemia (< 3g/dL) and low BMI (< 18.5 kg/m2 ) may be a useful prognostic indicator for predicting high risk of mortality in patient presented with upper gastrointestinal bleeding. Keywords: l Upper gastrointestinal bleeding l Mortality rate l Hypoalbuminemia

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 104 Abstract no. 66 The 10-year trends, prevalence, and associated factors of obesity among NCDs’ patients in a community hospital of Thailand: serial cross-sectional studies, 2011 to 2021 Saharat Liampeng, Tanat Ruenwongsa, Boonsub Sakboonyarat and Wisit Kaewput Phramongkutklao College of Medicine Background: Obesity is a multifactorial disease and a preventable disease. Today obesity affects more than a third of the global population which is a large and ongoing public health problem. Obesity can cause diseases in the group of chronic non-communicable diseases (non-communicable diseases, NCDs) such as Diabetes, Cardiovascular diseases which leading cause of death worldwide with 41 million deaths per year or accounted for 71% of all deaths worldwide. As the structure of Thailand shifts from rural communities to urban communities which impact on lifestyle such as diet and exercise patterns, which are major contributors to obesity. Objectives: To compare the prevalence of and risk factors of obesity among non-communicable disease patients in the community in the past 10 years Methods: The research is analytical cross-sectional study. The participant consists of patients aged 20 years or older which diagnosed as chronic non-communicable diseases at the Outpatient Department of Bang Khla Hospital between 1 January and 31 December of 2011,2016 and 2021. The results of the research were measured by using secondary data from the database of Bangkhla Hospital, Chachoengsao Province, by using demographic data and analyzing the prevalence and risk factors of obesity. Results: A total of 2956, 4283, 4349 adults with NCDs in 2011, 2016 and 2021 respectively were included in this study. For demographic characteristics, Female prone to be NCDs more than male, about 40% male and 60% female. The average age of NCDs is 60 years old and above with increasing trend of 62.63%, 64.04% and 65.15% in 2011, 2016 and 2021 respectively. The average BMI increases each year from 25.33, 25.36 and 26.32. The prevalence of obesity among NCDs patients was 49.32%, 48.67% and 55.28% in 2011, 2016 and 2021 respectively which significantly increasing in 2016 to 2021. The most common NCDs are CVDs which are 85-87% of cases. The most important among CVDs is Hypertension which has the greatest number of people. The second most common NCDs is diabetes, which is found in about 34-38% of cases, followed by Chronic lung diseases was found about 5% of cases. After adjustment for confounders, it was found that increased age and stroke were statistically significant protective factors. The presence of HT was a statistically significant risk factor. In which people with hypertension are 2.18 times more likely to encounter obesity. Elevation of HbA1c is a risk factor associated with obesity and increased in HDL is a protective factor with statistically significant.

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 105 Conclusion: The prevalence of Obesity among NCDs patients at community hospitals trends to increased especially in the last five years. Effective public health intervention, especially modifying dietary behavior should be provided to reduce BMI, HbA1c and increased HDL level, to avoid the obesity condition in NCDs patients. Keywords: l Obesity l Non-communicable diseases (NCDs) l Community hospital

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 106 Abstract no. 67 Prevalence and associated factors of depression during pandemic of COVID-19 among visiting patients in outpatient department of Pattananikom Hospital, Lopburi province Thanathorn Thaiphanish, Wasu Wachiranoppasul, Napat jainpinit, Picha Suwannahitatorn, Pogpisut Thakhampaeng and Wisit Kaewput Phramongkutklao College of Medicine Background: The impact of the spread of the Covid-19 virus is world-wide. In addition to causing health effects to the hosts’ body, it also leads to mental health problems, especially stress and depression. Some studies found that there is psychological impact of COVID-19 on patients during the epidemic period. Objectives: To study prevalence and associated factors of depression during pandemic of COVID-19 among visiting patients in outpatient department of Pattananikom Hospital, Lopburi province, Thailand Methods: A cross-sectional study was conducted in November 2022 in Phatthana Nikhom Hospital, Lopburi province, Thailand by collecting the information from medical record to study prevalence and associated factors of depression during July 2021 to September 2022 in visiting outpatient department patients. Descriptive statistics were used to summarize the study and outcome variables. Analytical statistics, including Chi-square and Student t-test, were used to study associated factors among the depressive and non-depressive sample. The results were presented in the form of p-value. Logistics regressions were used to study the size of the relationship between risk factors and depression. The results were presented in the form of a prevalence ratio and 95% confidence interval. Results: Overall prevalence of depression during pandemic of COVID-19 in visiting OPD patients of Pattananikom Hospital is 2.5%. From multivariate logistic regression analysis indicated that significant risk factor of depression is females (adjusted Odds ratio = 2.72; 95%CI: 1.45-5.09; p-value = 0.02) and significant protective factor of depression are age 30-44 (adjusted Odds ratio = 0.29; 95%CI: 0.12-0.71; p-value = 0.06), age 45-59 (adjusted Odds ratio = 0.24; 95%CI: 0.11-0.49; p-value = < 0.01), age 60-74 (adjusted Odds ratio = 0.24; 95%CI: 0.12-0.50; p-value = < 0.01), age ≥ 75 (adjusted Odds ratio = 0.16; 95%CI: 0.06-0.43; p-value = < 0.01) and BMI 25.0-29.9 (adjusted Odds ratio = 0.48; 95%CI: 0.26-0.89; p-value = 0.02). Conclusion: During pandemic of COVID-19 prevalence of depression in visiting OPD patients of Pattananikom Hospital was 2.5%. Age, BMI and Sex were associated with depression. Patients older than 30 years old and BMI 25.0-29.9 were protective factors of depression. Females has risk of depression more than males. No association between the history associated with COVID-19 and depression. Keywords: l COVID-19 Depression Associated factors of depression Local hospital

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 107 Abstract no. 68 Morbidity and mortality rate of Covid-19 infection in hospitalized patient with and without diabetes in Sanam Chai Khet hospital, Chachoengsao province of Thailand: Retrospective cohort study, March 2020 to September 2022 Jareewan Rangvanich, Nuttamon Nukaeow, Wisit Kaewput and Teeraboon Lertwanichwattana Phramongkutklao College of Medicine Background: Covid-19 infection caused by SARS-CoV2 (severe acute respiratory syndrome coronavirus 2) has shown epidemiological and clinical characteristics that appear worsened in diabetic patients. Diabetes patients are at risk of severe symptoms and having more complication from covid-19 infection 2 times higher than patients without diabetes, moreover the risk of death are 3 times higher in diabetes patients. Objectives: To compare morbidity and mortality rate of covid-19 infection in hospitalized patient with and without diabetes in Sanam Chai Khet Hospital, Chachoengsao Province, Thailand. Methods: This research is a retrospective cohort study. The participants consist of hospitalized patients admitted with Covid-19 infection in Sanam Chai Khet Hospital from March 2020 to September 2022. The study was conducted using data collected from 4,953 patients (≥ 18 years of age and not pregnant) admitted with Covid-19 infection in Sanam Chai Khet Hospital. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted. Outcomes included dying, being discharged after recovery, being evacuated/transferred, going against advice, and escaping. Descriptive statistics consider proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan-Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among Diabetes with COVID-19 and adjust for confounders. p-value ≤ 0.05 was considered statistically significant. Results: A total of 4,953 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 8.48% followed by diabetes (4.91%) and Obesity (2.48%). Overall mortality was 0.4% while mortality among diabetes was 1.65%. A significant proportion of the diabetes cohort suffered the worse forms of COVID-19; severe (74.90% Vs 36.99%) and critical (6.58% Vs 0.91%), compared to the non-diabetes cohort (p < 0.001). After adjustment for confounders (age and sex), severe COVID-19 were higher for diabetes (severe/critical illness: aHR = 3.16, p = 0.01, 95%CI: 1.40-7.14, for those with diabetes only) the diabetic only patients were about 3.16 times as likely as patients without diabetes to develop severe disease.

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 108 Conclusion: This study highlighted that diabetic could increase morbidity risk but not with mortality (relative to non-diabetic patients) which means covid-19 infected patient with diabetic could have more severe symptoms than patient without diabetic. This recognition of the potential morbidity risks of diabetes, especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. Keywords: l COVID-19 l Diabetes l Comorbidities

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 109 Abstract no. 69 Prevalence and associated factors of urinary tract infections among diabetes mellitus patients in Thawung, Community hospital, Central of Thailand 2016-2021 Supattanasak Budsuwan, Sarin Thammultri and Teeraboon Lertwanichwattana Phramongkutklao College of Medicine Background: Diabetes mellitus (DM) is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Hyperglycemia is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. DM patients are prone to have various kinds of infections more than non-diabetics. This high incidence rate of infections is attributed to altered immune functions. Patients with DM have more chances of getting urinary tract infections (UTIs) than non-diabetics. UTIs are five times higher among diabetics than non-diabetics. Objectives: To assess the prevalence of UTIs among DM patients in Thawung, Community hospital, Central of Thailand, and associated factors that link with UTIs. Methods: This cross-sectional study was carried out using secondary data from the Thawung hospital’s database. The targeted population was DM patients who came to the hospital between 2016-2020. A total of 3,612 patients, comprising females 2,313 and males 1,269 which are 64.1% and 35.9% respectively. Data entry and analysis were done using IBM SPSS Statistics for Windows Version 25. Results: The study shows that the prevalence of UTIs among DM patients in Thawung was 8.4%. Furthermore, females were significantly associated with UTIs (adjusted OR = 1.696, 95%CI: 1.287-2.234). the prevalence of UTIs was higher in female DM patients, compared to the prevalence of UTIs in male patients (9.8% and 5.8% respectively). Also, comorbid ischemic heart disease was shown to be associated with increased UTIs in DM patients (adjusted OR = 1.937, 95%CI: 1.39-2.7). The prevalence of UTIs in DM patients with ischemic heart disease was higher than in DM patients without ischemic heart disease (17.7 and 7.7 respectively). Conclusion: female and ischemic heart disease were identified to be associated with increased prevalence of UTIs. We suggest that healthcare professionals should pay special attention to these specific groups of patients. Keywords: l Diabetes mellitus l Urinary tract infections l Ischemic heart disease

Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 110 Abstract no. 70 Prevalence and associated factors of incomplete post-exposure course of rabies vaccination in Bang Khla Hospital, Chachoengsao Nattaphat Injumpa, Jakkaphop Anantawat and Nutchar Hempatawee Phramongkutklao College of Medicine Background: Rabies is an avertable viral disease caused by the rabid animal to the warm-blooded animals (zoonotic) especially human. Rabies occurs in more than 150 countries and territories. Dogs are the major reason behind this, approximately 99% of human deaths are caused by dog bites. Developing and under developing countries, both are the victims of rabies. With the post-exposure preventive regimes, 327,000 people can prevent this disease annually. The prevalence of rabies infection remains high in various parts of the country, Chachoengsao also has a high rate of Rabies infection. Objectives: To determine the factors affecting rabies prevention behaviors to apply in a way to promote, prevent and control diseases that match the context of the area regarding rabies. Methods: This research is a cross-sectional study from January 2022 to April 2022 accessed secondary data in the form of Rama 36 from Bang Khla Hospital based on basic data and clinical data to analyze factors affecting rabies vaccination after rabies vaccination. did not meet the criteria for exposure to the disease. Results: Studies have shown that the plating of those vaccinated Rabies after exposure to the disease did not meet the criteria of Bang Khla Hospital, Bang Khla District, Chachoengsao Province, from January to April 2022, equal to 67 people, or 22.41%. Factors found to be related to rabies vaccination after exposure. Those who did not meet the criteria were 21 - 40 years of age (aOR = 2.517, 95%CI: 1.082-5.855) and those with improperly cleaned wounds (aOR = 2.143, 95%CI: 1.196- 3.838) Conclusions: Of the 299 participants, from January to April 2022, the prevalence of 67 post-exposure rabies vaccinations was 22.41%. The risk factors associated with post-exposure rabies vaccination were not met the criteria were 21-40 years of age and the group with incorrect wound cleaning according to the principle in terms of cleaning wounds, when studying previous research, it can be concluded that knowledge and understanding of self-protection before being admitted to the hospital influences the correct treatment or prevention of rabies. This research may create surveillance for staff or use research data to lead to a reduction in the amount of post-exposure rabies vaccination that does not meet the criteria. Keywords: l Post-exposure rabies vaccination l Rabies l QSMI guideline

เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 111 Abstract no. 71 Mortality and associated risk factors among hospitalized Covid-19 infected patients in Sanamchaikate hospital, Chacheongsao province of Thailand Nitipong Dolkulchai, Kullanith Romsaithong, Nattaporn Jantarawattanawanich, Wisit Kaewput and Teeraboon Lertwanichwattana Phramongkutklao College of Medicine Background: Thailand is endemic area of coronavirus disease 2019 or COVID-19. There are still cases of infected people who have severe symptoms and death. There are still many people who refusing vaccination (12-23), especially in rural areas such as Sanamchaikate district. Objectives: To study mortality and associated risk factors among hospitalized Covid-19 infected patients in Sanamchaikate hospital, Chacheongsao province. Methods: Retrospective cohort study by using secondary data from the database in patient medical records of Sanamchaikate hospital. All data were analyzed using statistical software programs, SPSS and Stata, by determining frequency, percentage, mean (M) and standard deviation (SD), and mortality. Including using Chi-square statistics, Hazard ratio and Cox regression to identify risk factors. Results: The sample size included 1,299 patients from hospitalized Covid-19 infected patients of Sanamchaikate Hospital, Chacheongsao province. A total of 10 patients was died, representing a mortality rate of 0.77%. The multivariable Cox analysis was found that the factors affecting death in patients infected with the Covid-19 virus were included age group, index body mass being diagnosed with cardiovascular disease being diagnosed with chronic kidney disease and unvaccinated with COVID-19. When all factors were analyzed together using Cox regression statistics, it was found that patients diagnosed with concomitant chronic kidney disease were at increased risk of mortality in Those diagnosed with COVID-19 who were admitted as inpatients at Sanamchaikate Hospital were 34.36 times (95%CI: 5.29-223.32) statistically significant. Conclusion: being diagnosed with chronic kidney disease and not being vaccinated against COVID-19, whose results were similar to other studies. and is a risk group reported by the Department of Medical Services (Disease Group 608) Keywords: l COVID-19 infection l Pneumonia l Mortality