Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 50 Abstract no. 21 What sustain mask-wearing behavior among elders in a rural community in the post-COVID-19 era: an exploratory mixed-methods study Pinyada Kittisarapong, Chanunpisut Wichaiboon, Thakornphong Lortharaprasert, Nattasit Subwongcharoen, Bannawit Luksanasup, Bavorn Tieantanyatip, Pree Pusyapaibul, Phitchayut Petcharat, Fasai Amornchatchawankul, Sirikorn Pikulkaew, Suranuch Marsook, Supakrit Mahaisawariya, Apisit Tangtongsoonthorn, Kanlaya Jongcherdchootrakul and Sethapong Lertsakulbunlue Phramongkutklao College of Medicine Background: COVID-19 leads to mortality worldwide, especially among vulnerable patients, notably the elderly. Despite the efficacy of masks in preventing disease transmission, their use is no longer mandatory. Nevertheless, the sustained adoption of mask-wearing as an intervention to protect against COVID-19 remains insufficient among the elderly residing in rural areas of Thailand. Objectives: The study aims to identify the factors influencing mask-wearing among the elderly in rural areas of Thailand. Methods: This research employed an exploratory mixed-method design with elderly individuals aged 60 and above in Ban Phra Phloeng, Amphor Khao Chakan, Sa Kaeo. It included qualitative interviews with 15 participants and a subsequent survey of 201 elders. Themes, codes, and quotes from the interviews was used to create the questionnaire. Content validity was confirmed by five experts, and a pilot study was conducted to assess internal reliability. Quantitative data analysis employed independent t-tests, Chi-square tests, and the Mann-Whitney U test as appropriate. Additionally, exploratory factor analysis and structural equation modeling (SEM) were conducted to identify factors influencing mask-wearing practices. Results: Seven sub-themes were identified, including perceived benefits of mask-wearing, perceived threat of COVID-19, mask-wearing enhancing attractiveness and self-confidence, social norms, misconceptions about COVID-19 prevention tools, perceived barriers to mask-wearing, and resources to afford face masks. The survey revealed the adherence of 81.1% of the participants to mask-wearing. SEM analysis demonstrated that motivation, comprising (1) the perceived threat of COVID-19, (2) alternative threats aside from COVID-19, and (3) the perceived benefits of a face mask strongly affected mask-wearing practices (β = 0.68, p < 0.001) and the willingness to wear a face mask (β = 0.61, p < 0.001). Social norms had a negative direct effect on the perceived barrier (β = -0.48, p < 0.001) and a positive direct effect on mask-wearing practices (β = 0.25, p = 0.001).
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 51 Conclusion: The study highlights that motivation and social norms play pivotal roles in sustaining mask-wearing behavior among rural elderly populations. Encouraging local cooperative actions through community rules could initiate behavioral changes within the community. These findings contribute to the understanding of factors influencing mask-wearing and provide insights for designing effective interventions to promote mask-wearing among elderly individuals in rural areas. Keyword: l COVID-19 l Face masks l Association factors l Behavior l Elderly l Community l Rural l Thailand
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 52 Abstract no. 22 Developing a prototype of health care program for patients with post-operative total knee arthroplasty: line official healmotion Chananchida Biangklang1 , Wannaporn Lueng-on1 , Kanokpon Choeychom1 , Keanika Pongpanit1 , Jiratsupha Sukmaphian1 , Chananchida Jitboon1 , Wantiyaporn Yangyuen1 , Sarunya Tewasukon1 , Sasitorn Chaichana1 , Suparaksa Kokan1 , Sukanlaya Rung-amonrat1 , Nattapong Promstitgun1 and Sasiporn Ounjaichon2 1 4 th year Nursing Students; 2 Advisors, Royal Thai Army Nursing College Background: Osteoarthritis of the knee (OA Knee) is a common health issue among the elderly. In 2020, there were 595 million people worldwide suffering from OA knee, accounting for 7.6% of the global population. By the year 2030, it is estimated that the prevalence of OA knee will increase to 74.9%. The onset of OA knee results from an imbalance between tissue breakdown and repair in the joint. This condition leads to chronic pain and reduced mobility. Surgical intervention is often chosen when other treatment methods prove ineffective. The success of surgery depends on the surgical technique, the age of the original knee implant, and appropriate postoperative care programs. Previous studies have shown that patients who underwent knee replacement surgery may experience a significant reduction in muscle strength of the quadriceps, up to 80% within the first week of hospitalization, compared to their preoperative strength. When comparing muscle strength between patients who had knee replacement surgery for over a year and patients with knee osteoarthritis who did not undergo surgery, it was found that the post-surgery patients had greater muscle strength. Considering these concepts and challenges, the researchers are interested in developing a postoperative care program for knee replacement patients using the Line Official HealMotion application to prevent postoperative knee stiffness. This program aims to facilitate convenient postoperative patient assessment, improve knee mobility, prevent stiffness, enhance patient confidence in postoperative activities, and promote a quicker return to normal life. Objective: To develop a prototype of health care program for patients with post-operative total knee arthroplasty using Line Official HealMotion and to examine the satisfaction of using Line Official HealMotion in patients with post-operative total knee arthroplasty. Methodology: This research is a developmental research. The samples are patients with post-operative total knee arthroplasty at Phramongkutklao Hospital who volunteer to participate. Data will be collected using an interview. Qualitative data will be analyzed using content analysis. Quantitative data will be analyzed using descriptive statistics. Keyword: l Knee osteoarthritis l Total knee arthroplasty l Range of motion
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 53 Abstract no. 23 Prevalence and risk factors of the infestation of head lice with Permethrin resistance in Juvenile, eastern Thailand Yossaphong Aitthiphitchayarat, Nattanunt Utarwuthipong, Thanathat Chokthanasawas, Bulporn Lerdsakviman, Pakteema Duriyapatsorn, Patthira Anusas-amornkul, Rujipart Rattanapak, Verasu Tangnapakorn, Supawit Nakrit, Suvijak Phuretipibooltham, Wasupol Rungsiri, Picha Suwannahitatorn, Phunlerd Piyaraj, and Toon Ruang-areerate Phramongkutklao College of Medicine Background: Head pediculosis, a non-life-threatening problem that is the most unsolved problem worldwide, may still cause unwanted complications afterward. The lice infestation can be found in any age group; however, many researchers have speculated that the prevalence is high in school-age children. Moreover, the traditional method of treatment, such as using permethrin shampoo in suburban areas, is beginning to decrease in efficacy due to insufficient treatment, drug resistance, or any environmental causes. This study aims to identify the prevalence of head pediculosis and risk factors associated with head lice infestation at Ban Na Yao Border Patrol Police School, as well as study the prevalence of the resistance gene of permethrin for future usage plans. Objectives: A cross-sectional study of 308 students aged 5 to 15 in a school collected lice samples and administered questionnaires. These samples were analyzed for genetic factors (VSSC and GluCl genes) using RFLP-PCR. The study employed regression analysis to identify associations between demographic factors, lice infestation prevalence, and gene resistance. Results: Of the 308 participants included, 53.6% were girls. The mean age was 9.4±2.16 years old. Among participants, 35% have head lice infestations, and 90.8% of lice infestation participants were females, which has 8.54 times (95%CI: 3.21-22.74, p < 0.001) increased risk of infection compared to male participants. Factors that substantially increase this risk are the history of head lice in the previous month 1.61 times (95%CI: 1.48-8.65, p = 0.008) than those who are not. According to the PCR-RFLP analysis, it was determined that 91.23% of the examined samples exhibited resistance to permethrin genetic profiles, while the rest of the samples manifested a genetic susceptibility to permethrin. Conclusion: Among primary schools located in rural areas, girls exhibit a notable vulnerability to lice infestations. Additionally, a prior history of infestations increases the likelihood of experiencing a current infestation. Most samples have resistance profiles to permethrin. Researchers recommend exploring alternative strategies for more effective head lice treatment, including higher-dose and more frequent Permethrin shampoo usage and the investigation of Ivermectin, a proven off-label medication. Keyword: l Head lice l Rural health l Community-based study l Juvenile l Thailand
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 54 Abstract no. 24 Development of a prototype “aging healthy knees” exercise sets to prevent knee osteoarthritis in the elderly living in urban community Anuradee Mabua1 , Amornrat Ratchatarungsee1 , Kullaporn Vongdown1 , Penpansa Tubtieng1 , Suchada Khokdiew1 , Suthida Tawanna1 , Suphawan Na Songkhla1 , Amonrat Thongkumnerd1 , Onpawi Channarong1 , Onpairin Phetsang1 , Onratcha Kanchanadit1 , Atitaya Chiang-ngern1 , Saranunt Anuchon2 and Kantika Saipanya2 1 4 th year Nursing Students; 2 Advisors, Royal Thai Army Nursing College Background: Thailand is entering an aging society, with a population of 10.2 million people over the age of 60, accounting for 15% of the total population. Osteoarthritis of the knew (OA Knee) is a major problem in the elderly, and the number of patients with OA Knee is increasing steadily. Risk factors for OA knee include increasing age, excessive weight, and behaviors that involve bending the knee for long periods of time. Treatment for OA knee includes medication, surgery, and non-drug treatments, such as losing weight, exercising, and adjusting activities in daily life. Exercise can help improve the flexibility of the muscles around the knee, increase joint strength, endurance, and flexibility. These exercises include yoga, tai chi, and walking, which are low-impact exercises that reduce stress on the knee joint. The researchers are interested in developing a prototype set of exercises to strengthen the muscles around the knee joint, in order to promote health and potential of the elderly to change their behaviors, reduce risk factors for severity of the disease, and restore the strength of the muscles around the knee. Objective: To develop a prototype set of exercises to prevent OA knee in the elderly and to explore the effects of using the set of exercises to prevent OA knee in the elderly. Methodology: This research is a developmental research that applies design thinking. The target population is healthy elderly from the Elderly Club at Phramongkutklao Hospital who volunteer to participate, with a total of five people. Data will be collected using an interview. Qualitative data will be analyzed using content analysis. Quantitative data will be analyzed using descriptive statistics, including frequency, percentage, range, mean, and standard deviation. Research instruments: This research used four tools, including: 1) Patient interview form about daily activities, exercise, and knee care; 2) The revised Thai version of the Western Ontario and McMaster University Osteoarthritis (WOMAC) Assessment Questionnaire; 3) Physical fitness test for leg muscle strength, balance, and risk of falls in the elderly; 4) Satisfaction survey after using the prototype set of exercises. Keyword: l Exercise sets l Exercise effectiveness l Design thinking l Elderly
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 55 Abstract no. 25 Prevalence and factors associated with falling among elderly in rural area, Thailand Sirawich Karuna, Kachasa Sangwan, Punyada Sakultaweewat, Janewit Sangjae, Ted Boonyachai, Panod Alongkotpatay, Foyfon Sengsong, Patcharapa Larbrangsirat, Romchut Ingkutanonta, Papawit Pokamat, Nutchar Hempatawee and Kulachade Gesakomol Phramongkutklao College of Medicine Background: Falls in the elderly is a significant health concern due to the burden of current aging society. Falls can lead to severe injuries and long-term consequences, including hip fractures, head injuries, and disability. The factors that contribute to falls in the elderly can be external, such as inadequate light and obstacles in movement, or internal, such as age-related changes in the body and medication use. Effective preventions to reduce the burden of falls in elderly are essential. The project aims to study the prevalence and factors related to falls among the elderly in Sa Kaeo province, Thailand. Objective: Methods: A cross sectional study were conducted using structured questionnaire to screen falling conditions. The questionnaire was applied to collect information on demographic characteristics, medical history, physical activity, home environment, and falls-related information such as frequency, cause, and frequency of falls. Results: The study included 199 elderly with a mean age of 70.39±7.14 years. Among the participants, 131 (65.83%) were female. A majority of the subjects were either retired (57.83%) or engaged in agricultural occupations (36.14%). The prevalence of falls among the elderly was 50.25%. Factors associated with falling in elderly included female (OR = 2.10, 95%CI: [0.72, 3.89]), skipping breakfast (OR = 2.67, 95%CI: [0.71, 6.27]), fear of falling (OR = 1.09, 95%CI: [1.3, 6.13]), and cattle owning (OR = 3.55, 95%CI: [1.13, 25.35]). Conclusion: This study showed a high prevalence rate of falls among the elderly in Sa Kaeo province, Thailand. Along with factors associated, with older aging, skipping breakfast, and fear of falling, Cattle owning, had been found and identified. Further studies should explore the mechanism of the associated factors of fall. Keyword: l Falling l Prevalence l Associated factors l Elderly l Thailand
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 56 Abstract no. 26 The study of health behaviors and health effects associated with Kratom use among patients with type 2 diabetes at Khlong Sam Community, Khlong Luang district, Pathum Thani province Yanaporn Methaburanapirin1 , Nathamon Fanthaworn1 , Kankunlanat Koonchon1 , Kanyarat Wongsomboon1 , Jinnipa Suksong1 , Nicha Nootim1 , Piyathida Chukua1 , Piyathida Sriphrom1 , Phimchanok Charoennuch1 , Bhudthida Kaewsaentor1 , Waritsara Sudluek1 , Apichaya thaebsornchai1 , Sirinya Akathin2 and Sirada Laosena2 1 4 th year Nursing Students; 2 Advisors, Royal Thai Army Nursing College Background: The group of non-communicable diseases, especially diabetes, has a tendency to continually increase in Thailand. In 2020, there was an increase of 300,000 new patients with diabetes per year and there were more than 3.3 million patients in the treatment system and approximately 16,388 people died from diabetes. Conventional medicine is common for diabetes. Alternative treatments, such as herbal medicine, are also used, Currently, some patients with diabetes are interested in using Kratom to lower blood sugar levels. After Kratom has been canceled as a category five narcotic in Thailand and the Ministry of Interior has designated 135 pilot villages where Kratom can be used without breaking the law. This makes the use of Kratom is freely available. The researcher therefore sees the importance of studying the behaviors and health effects associated with Kratom use among patients with type 2 diabetes in Khlong Sam Community, Khlong Luang District, Pathum Thani Province. The results of this study can be used as health information for patients with type 2 diabetes in order to plan further educational services, regarding the use of kratom. Objective: To study behaviors and health effects among patients with type 2 diabetes who use kratom at Khlong Sam community, Khlong Luang District, Pathum Thani Province. Research Methodology: This research is a retrospective descriptive study. The populations are patients with type 2 diabetes at Khlong Sam Community, Khlong Luang District, Pathum Thani Province. The sample will be selected using purposive sampling and snowball sampling. Data will be collected using questionnaires, including general information, health information, Kratom use behaviors, and health effects. Data will be analyzed using frequency distribution, percentage, mean, and standard deviation. Research tools: 1. The questionnaire consists of three parts: 1) General information; 2) Behaviors associated with using Kratom among patients with type 2 diabetes; 3) Effects associated with using Kratom among patients with type 2 diabetes. Keyword: l Kratom l Behaviors in using Kratom l Health effects l Type 2 diabetic patients
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 57 ผลงานโปสเตอร์การประชุมวิชาการพระมงกุฎเกล้า ครั้งที่ 51 l Can red blood cell distribution width predict positive colonoscopy in FIT-positive patients? Thaweechai Saiwongse (Department of Surgery) Abstract no. 27 l Conservative versus surgical treatment for the displaced, distal diaphyseal-metaphyseal fifth metatarsal fractures: a prospective, randomized controlled study Pitchapat Sukonpatip (Department of Orthopedics) Abstract no. 28 l Impact of fine particulate matter (PM) 2.5 on clinical symptoms and fraction of exhaled nitric oxide (FeNO) in allergic rhinitis patients Kittipob Worakundamrong (Department of Otolaryngology) Abstract no. 29 l Retrobulbar Block Simulator Theejuti Suanoi (Department of Ophthalmology) Abstract no. 30 l The Satisfaction and Effectiveness of Development of Microsuction for Eye Surgery Suphisara Yanmongkol (Department of Ophthalmology) Abstract no. 31 l Incidence and Risk Factors of Noise-Induced Hearing Loss in Young Thai Army Musical Students Pichaya Arjariyanond (Department of Otolaryngology) Abstract no. 32 l Comparison of outcomes between using Colorado needle electrocautery and scalpel for lower eyelid blepharoplasty incision: a randomized controlled trial Kolid Siriwattana (Department of Surgery) Abstract no. 33 l Smartphone-based artificial intelligence-assisted prediction for eye gaze measurement Suthicha Chuntranapaporn (Department of Ophthalmology) Abstract no. 34 l Radial Versus Standard Approach for Trigger Thumb Release: a Randomized Control Trial: A Randomized Controlled Trial Sakdinun Imsuwan (Department of Orthopedics) Abstract no. 35 l Incidence and neonatal outcomes of preterm birth at gestational age 34-36+6 weeks in Phramongkutklao Hospital Aphisara Kositwongsakul (Department of Obstetrics and Gynecology) Abstract no. 36 l Comparative Study Between Anti-Osteoporosis Drugs and Time to Union of Osteoporotic Intertrochanteric Fracture in Elderly Sutthirak Singhasema (Department of Orthopedics) Abstract no. 37 l Secondary attack rate of household transmission among Covid 19 infection patients aged 0 18 years old in Phramongkutklao Hospital Panu Piyachon (Department of Pediatrics) Abstract no. 38
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 58 l Functional outcomes after lumbar epidural steroid injection in diabetic versus non-diabetic patients Wisuta Ruamkiatkhachon (Department of Orthopedics) Abstract no. 39 l An innovative scoring system for predicting a poor outcome after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture Panukorn Pinijprapa (Department of Pediatrics) Abstract no. 40 l Comparison of IOP change during traditional hemodialysis between normal open angle and occludable angle Krischon Euswas (Department of Ophthalmology) Abstract no. 41 l Comparative short-term recovery and functional outcome after PFNA fixation for Intertrochanteric fracture between CKD and Non-CKD in Elderly: A prospective cohort study Suppakit Paiboonrungroj (Department of Orthopedics) Abstract no. 42 l Efficacy of artificial intelligence method for impending pathological fracture estimationin long bone metastasis Pongsom Luanghirun (Department of Orthopedics) Abstract no. 43 l Accuracy of the combination of Thai SRBD-PSQ and examination of adenotonsillar hypertrophy to predict moderate to severe pediatric obstructive sleep apnea Panon Srithanetsakul (Department of Otolaryngology) Abstract no. 44 l The effectiveness of Pre-arrival Video-call assisted bystander cardiopulmonary resuscitation in prehospital setting Dusita Luwichitbanchong (Department of Emergency Medicine) Abstract no. 45 l Comparison between flap-flap and flap-subcutaneous tissue techniques in external dacryocystorhinostomy, randomized controlled study Tunjira Chokjutha (Department of Ophthalmology) Abstract no. 46 l Sensitivity and specificity of Yubi-wakka (Finger-ring) screening method for sarcopenia among older Thai adults Kasidid Lawongsa (Department of Ambulatory and Family Medicine) Abstract no. 47 l Effects of FAVIPIRAVIR monitoring program of COVID-19 infected patients in Fort Pichai Dab Hak Hospital, Uttaradit province Thananchai Juapprasop (Pichai Dab Hak Hospital) Abstract no. 48 l Safe zone of supraclavicular nerve during clavicle fixation and its anatomical variations, a cadaveric study Natcha Lorsuwannarat (Phramongkutklao College of Medicine) Abstract no. 49
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 59 l Therapeutic drug monitoring and the pharmacokinetic parameter of aminoglycosides in infected patients estimated by using bayesian forecasting Suvadee Supreeyasakon (Silpakorn University) Abstract no. 50 l Case report on antimicrobial resistance of Neisseria gonorrhoeae infection who serviced at Phramongkutklao Hospital during fiscal year 2022 Maneerat Somsri (Armed Forces Research Institute of Medical Sciences) Abstract no. 51 l Therapeutic drug monitoring and Pharmacokinetic parameter of vancomycin in febrile neutropenic patients at Phramongkutklao Hospital Piyawadee Tangvichitrerk (Silpakorn University) Abstract no. 52 l A comparative study of the efficiency of K2EDTA and K3EDTA evacuated tubes in circulating cell-free DNA collection Chetana Ruangpratheep (Phramongkutklao College of Medicine) Abstract no. 53 l Analysis of copy number variations of ER, PR, HER2 and MKI67 genes in circulating cell-free DNA released from cancer cells in Thai patients with invasive breast carcinoma Chetana Ruangpratheep (Phramongkutklao College of Medicine) Abstract no. 54 l Accuracy of heart-rate monitoring in budget smart bands among healthy subjects Parameth Pongpripoom (Department of Physical Medicine and Rehabilitation) Abstract no. 55 l Efficiency of barrier box for prevention of droplet spreading during tracheostomy tube change Patteera Suriyalaksh (Department of Otolaryngology) Abstract no. 56 l The Incident of Rickettsia in Military along Border of Thai - Myanmar and Thai - Cambodia Watcharee Yokanit (Armed Forces Research Institute of Medical Sciences) Abstract no. 57 l Analysis of immunohistochemical expression of cyclin B1 (CCNB1) in invasive breast carcinoma tissue Jirawat Phongmuenwai (Phramongkutklao College of Medicine) Abstract no. 58 l Clinicopathological characteristics of chondrosarcoma: A retrospective analysis of Thai patients in Army Institute of Pathology Wirin Sangpanich (Army Institute of Pathology) Abstract no. 59 l Seroprevalence of hepatitis B viral infection and associated factors in pregnant women on antenatal care follow-up at Tha Wung community hospital, central of Thailand Ketmanee Keawmanee-aim (Phramongkutklao College of Medicine) Abstract no. 60 l Mortality of ST-elevation myocardial infarction (STEMI) patients and risk factors in Tha Luang, Lop Buri: retrospective cohort study Naphat Wongkliawrian (Phramongkutklao College of Medicine) Abstract no. 61
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 60 l Prevalence and associated factors of diabetic kidney disease in type 2 diabetic patients, Bangkhla Hospital, Chachoengsao Province, Thailand: Analytic cross-sectional studies Bhoom Tumrongteppitux (Phramongkutklao College of Medicine) Abstract no. 62 l Self-care behaviors and glycemic control in diabetes mellitus patients at Tha Luang Hospital, Lopburi province Sakharin Kanjana (Phramongkutklao College of Medicine) Abstract no. 63 l Prevalence and associated factors of osteoarthritis in type 2 diabetic patients, Phatthana Nikhom Hospital, Lopburi Province, Thailand: Analytic cross-sectional study Saranphruk Kiengsiri (Phramongkutklao College of Medicine) Abstract no. 64 l The mortality rate and risk factor among patients with upper gastrointestinal bleeding in a Thawung hospital, Lopburi, Thailand Puttaratep Muangsombut (Phramongkutklao College of Medicine) Abstract no. 65 l 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 (Phramongkutklao College of Medicine) Abstract no. 66 l Prevalence and associated factors of depression during pandemic of COVID-19 among visiting patients in outpatient department of Pattananikom Hospital, Lopburi province Thanathorn Thaiphanish (Phramongkutklao College of Medicine) Abstract no. 67 l 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 (Phramongkutklao College of Medicine) Abstract no. 68 l Prevalence and associated factors of urinary tract infections among diabetes mellitus patients in Thawung, Community hospital, Central of Thailand 2016-2021 Supattanasak Budsuwan (Phramongkutklao College of Medicine) Abstract no. 69 l Prevalence and associated factors of incomplete post-exposure course of rabies vaccination in Bang Khla Hospital, Chachoengsao Nattaphat Injumpa (Phramongkutklao College of Medicine) Abstract no. 70 l Mortality and associated risk factors among hospitalized Covid-19 infected patients in Sanamchaikate Hospital, Chacheongsao province of Thailand. Nitipong Dolkulchai (Phramongkutklao College of Medicine) Abstract no. 71
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 61 Abstract no. 27 Can red blood cell distribution width predict positive colonoscopy in FIT-positive patients? Thaweechai Saiwongse and Chanyawat Sangsomwong Department of Surgery, Pharamongkutklao Hospital Background: Fecal Immunochemical Test (FIT) is currently the most cost-effective screening tool for colorectal cancer. However, there is a risk of false positive FIT leading to unnecessary colonoscopies. Long waiting time for colonoscopy may result in delay diagnosis of cancer in some patients. Multiple studies reported that high red blood cell distribution width correlated with present of colonic polyp, colorectal cancer and pathologic stage of colon cancer. This study aimed to determine if RDW could be used as an effective tool to predict positive colonoscopy in FIT positive patients. Methods: This retrospective study collected data in patients with FIT positive and subsequently underwent colonoscopy at Phramongkutklao Hospital from January 2016 to December 2020. Complete blood count was taken as preoperative evaluation. Hemoglobin, Hematocrit, RDW, colonoscopy findings and pathological reports were recorded. Positive colonoscopy was defined as patients with adenomatous polyp or colorectal cancer from pathological report. The Receiver Operating Characteristic (ROC) curve was employed to determine the optimal “cut off” value for RDW to predict positive colonoscopy. Results: A total of 383 patients with FIT positive and underwent colonoscopy were studied. There were 143 patients with positive colonoscopy results (37.33%) and 240 patients had negative results (62.66%). The best “cut off” value for RDW as a screening tool was determined to be 14.3 with sensitivity and specificity of 72.7% and 72.5% respectively. The PPV was 61.2% and the NPV was 81.7%. The average RDW for the positive group was 15.55±2.21, and for the negative group was 13.75±1.21. Conclusion: RDW can be a potential predictor for positive colonoscopy in FIT positive patients. Patients with high RDW level should be considered as a priority group for early colonoscopy. This RDW criteria may be beneficial for reducing unnecessary colonoscopy from false positive FIT. Keyword: l Red blood cells distribution width l Colonic polyps l Colorectal cancer l Fecal immunochemical test
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 62 Abstract no. 28 Conservative versus surgical treatment for the displaced, distal diaphyseal-metaphyseal fifth metatarsal fractures: A prospective, randomized controlled study Pitchapat Sukonpatip Department of Orthopedics, Phramongkutklao Hospital and Collage of Medicine Background: Fifth metatarsal distal diaphyseal-metaphyseal fractures, also called Dancer’s fractures, are common injuries treated by orthopedic surgeon. Favorable outcomes of non-surgical and surgical treatments have been reported, however, the most appropriate treatment remains controversial. Recently, there is no prospective study comparing outcomes between non-surgical and surgical treatments. Objective: This study aimed to compared the time to union of non-surgical versus surgical treatment for the displaced Dancer’s fractures. Study design & Methods: We had created a prospective randomized controlled trial of thirty-two volunteers who had acute, displaced Dancer’s fractures visiting Phramongkutklao hospital between 2021-2022. Two volunteers were excluded due to unable to follow-up. We randomized these volunteers in to two groups. The non-surgical group had been treated with casting. The surgical group had been treated with open reduction and internal fixation with mini locking plate and screws. We compared the union time as a primary outcome using weight-bearing computer tomography of the foot at 8 weeks after treatment, then repeated every 3 weeks until union. We also compared the recovery time, functional outcomes included of visual analog scale (VAS), Short Form Health Survey (SF-36) score, and Foot and Ankle Ability Measure (FAAM) score, and complications. Results: The non-surgical and surgical group had no significant difference in demographic characteristics. The mean union time of non-surgical group was 16.7±4.5 weeks and surgical group was 8.7±1.9 weeks, with a p-value < 0.001. Recovery time of surgical group was significant faster. In functional outcomes, the significant improvements among pre- and post-treatment in each group were observed, however, no significant difference between two groups except SF-36 physical component subscale (PCS) in final follow-up. The overall complication rate tended to be higher in non-surgical group but no significant difference was observed. Conclusion: Surgical treatment for displaced Dancer’s fracture provided a significant shorter union time and faster recovery time compared to non-surgical group, without the difference in functional outcomes improvement except SF-36-PCS, and no different in complication. Keyword: l Dancer’s fracture l Fifth metatarsal fracture l Union time l Functional outcomes l Nonsurgical treatment l Internal fixation.
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 63 Abstract no. 29 Impact of fine particulate matter (PM) 2.5 on clinical symptoms and fraction of exhaled nitric oxide (FeNO) in allergic rhinitis patients Kittipob Worakundamrong and Thanit Chalermwatanachai Department of Otolaryngology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Allergy and Clinical Immunology Backgound: PM2.5 refers to fine-particulate matter with a diameter of 2.5 micrometers or smaller. Breathing in unhealthy levels of PM2.5 can increase the risk of health problems. In Thailand, the level of PM2.5 reaches a hazardous level during the dry season, particularly from November to April. Exposure to PM2.5 may be associated with an increased exacerbation of allergic rhinitis (AR), however, evidence and mechanism are under investigation. Methods: This study aims to identify the impact of PM2.5 on clinical symptoms and inflammation of AR patients. We used a visual analog scale (VAS) to evaluate the severity of the symptoms. The Fraction of Exhaled Nitric Oxide (FeNO) and Complete Blood Count (CBC) were employed to check inflammation. Results: Forty-one patients with allergic rhinitis participated in a research study. It was found that when the PM2.5 levels were high, allergic rhinitis patients experienced statistically significant symptoms such as nasal itching, nasal congestion, and a substantial negative impact on their quality of life. However, when the PM2.5 level were low, these patients had statistically significant relief from these symptoms. Furthermore, high PM2.5 levels were associated with a statistically significant decrease in absolute neutrophil count and platelet count. There was a positive correlation trend between PM2.5 levels and FeNO levels and between PM2.5 levels and absolute eosinophil count, but there relationships were not statistically significant. Conclusion: Increased levels of PM2.5 are associated with the exacerbation of nasal itching and nasal congestion symptoms in severe allergic rhinitis patients, significantly affecting their overall quality of life. Furthermore, elevated PM2.5 levels are statistically significantly correlated with a reduction in both absolute neutrophil count and platelet count. However, this study did not establish statistically significant relationships between PM2.5 levels and FeNO levels or absolute eosinophil count. Keyword: l Associated PM2.5 l FeNO l Eosinophilia l VAS l Absolute eosinophil count
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 64 Abstract no. 30 Retrobulbar block simulator Theejuti Suanoi and Raveewan Choontanom Department of Ophthalmology, Phramongkutklao Hospital Objectives: To develops a training retrobulbar block model that can provide precise anatomical structure, anatomical variation, naturalized texture, and sensation. To prevent complication that is the consequence from injury of crucial structures. Methods: Develop simulator model that similar to human anatomy and appearance. evaluate satisfaction after testing the model compare to performing retrobulbar block with patient and receive feedback and suggestion from participants. Results: Four aspects consist of anatomical structure and sensation, anatomical variation, alert of complications, and application for practice, reported in median value. The median results of anatomical structure and sensation are 4 in anatomical structure, 4 in external texture of model, 4 in sensation similar to the real patient. The second aspect is anatomical variation (varies in axial length) median score is 4, the third aspect of result is simulation of complication, 5 in ocular perforation, 5 in optic nerve injection, 5 in muscle injury, 2 in retrobulbar hemorrhage. The last aspect is application for practice, 4 in contribute to self-better perform the retrobulbar procedure, 4 in assist resident training program. Conclusion: Retrobulbar block simulator receive good satisfaction in every aspect as anatomical structure, variation, texture, and sensation compared to the real patient and provide alert signs of serious complications that injection needle deal with, such as the globe, optic nerve, and extraocular muscles. This simulator is the equipment that promotes better self-performance and provides practical and safe residency training program from individual opinion.
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 65 Abstract no. 31 The satisfaction and effectiveness of development of microsuction for eye surgery Suphisara Yanmongkol, Kanaspana Klanarongran, Newin Tapaotong, High Voc. Cert. and Chavalit Sontisombat Department of Ophthalmology, Phramongkutklao Hospital Objective: - To develop a microsuction device for eye surgery with a motor that allows for adjustable suction rates and can be controlled by the surgeon during surgery which are user-friendly and portable. - To study the effectiveness and satisfaction of the suction device in Phacoemulsification cataract surgery. Methods: Phase 1: The development and the effectiveness testing of a microsuction device were conducted. Phase 2: The results of satisfaction assessment from 33 participants (surgeons and assistants) performing phacoemulsification cataract surgery and using the microsuction device in Phramongkutklao Hospital compared to the traditional method of fluid absorption using materials like gauze or cotton swabs were analzed and the recommendations were received. Results: The mean capability of suction rate with the 20G, 23G, 25G tip was 18.83±9.57, 12.06±7.18, 4.64±3.44 mL/min respectively. The suction rates between the 20G tip and the 25G tip, as well as between the 23G tip and the 25G tip showed statistically significant difference. The satisfaction result of microsuction device was significantly higher in all categories when compared to the traditional method (gauze/cotton swabs). These categories included characteristics of the material used, prevention of device slippage, ability to drain fluids, adjustability of suction rate, non-obstructiveness to the surgical field, assistance in reducing surgical duration, overall satisfaction, and convenience in operation. Conclusion: The new equipment “Microsuction for eye surgery” was developed with excellent suction capabilities, achieving very high statistically significant satisfaction ratings compared to the traditional method.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 66 Abstract no. 32 Incidence and risk factors of noise-induced hearing loss in young Thai Army musical students Pichaya Arjariyanond, Pana Klamkam and Nuanthip Tangsitchanakun Department of Otolaryngology, Phramongkutklao Hospital Background: Noise-induced hearing loss (NIHL) is the most common type of hearing impairment after presbycusis. It is a public health issue in Thailand and worldwide. According to the WHO, exposure to high levels of noise in the workplace ranks as the second most prominent contributing factor to occupational injuries, comprising up to 16% of work-related illnesses. It is more prevalent in developing countries than in developed counterparts. This study aims to investigate the incidence and risk factors associated with noise-induced hearing loss in young Thai army musical students. Methods: A prospective cohort study was conducted. The Institutional Review Board of the Royal Thai Army (IRBRTA) approved the research protocol. The epidemiological data were recorded from January 2023 to August 2023. In this study, 110 participants were enrolled. However, two participants were excluded from the study due to functional and conductive hearing loss. Otologic symptoms, otoscope, audiogram with extended high frequency, and DPOAE have been recorded. The incidence and risk factors associated with noise-induced hearing loss were statistically analyzed. Results: The study revealed a prevalence of 54.6% of NIHL, comprising 23.73% for temporary threshold shift and 72.27% for permanent threshold shift. Subsequently, the incidence of NIHL was 44.9%. Abnormal DPOAE was not associated with notching on the audiometry. Gender, academic year, otologic symptoms, type of musical instrument, duration of daily musical practice, and duration of exposure to other types of sounds per day were not statistically associated with NIHL. Conclusion: Exposure to loud noise among young musical students has resulted in a high incidence of noise-induced hearing loss at 44.9%, which can lead to temporary and permanent threshold shifts. Notably, this study did not identify any statistically significant risk factors associated with the development of NIHL. Keyword: l Noise-induced hearing loss l Musical student
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 67 Abstract no. 33 Comparison of outcomes between using Colorado needle electrocautery and scalpel for lower eyelid blepharoplasty incision: a randomized controlled trial Kolid Siriwattana Department of Surgery, Phramongkutklao Hospital Background: Lower eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, especially in Asian skin types. We aimed to compare the Colorado needle electrocautery pure cutting mode and the traditional scalpel to determine their efficacy, complications, and cosmetic outcomes. Methods: A prospective randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in lower blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis. Results: The prospective randomized controlled trial study included 25 patients; the electrocautery side had less blood loss during incision than the scalpel side (2.6 versus 5.28) using average cotton bud sticks, respectively) (p < 0.001). The electrocautery side had less postoperative ecchymosis than the scalpel side (p < 0.001). Hypopigmented and hyperpigmented scarring occurred more frequently on the electrocautery side; however, the difference was not statistically significant. Conclusions: Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for lower eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site and decrease postoperative ecchymosis.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 68 Abstract no. 34 Smartphone-based artificial intelligence-assisted prediction for eye gaze measurement Suthicha Chuntranapaporn1 , Worapot Srimanan1 , Yutthaphong Eimsuwan1 , Raveewan Choontanom1 and Narit Hnoohom2 1 Ophthalmology Division, Phramongkutklao Hospital; 2 Department of computer engineering, Faculty of Engineering, Mahidol University Objective: This research aims to invent an accurate and standardized tool for precise gaze positions compared to an ophthalmologist’s measurement. Methods: The images of eye gaze were taken in both eyes of all subjects with standard protocols. Image processing artificial intelligence (AI) was introduced to classify the gaze of both eyes. The gaze is arranged into 4 types: 30 prism diopters (PD), 60 PD,90 PD, and full gaze deviation from the primary position. The predictive ability of the gaze was presented with an Area Under the Curve of the Receiver Operating Characteristic curve (AUC ROC) conducted by three main types of AI models. The whole data was separated into 3 groups: 650 pictures as training data, 91 pictures as Evaluation data and 190 pictures for testing data. A database was reconstructed from routine follow-up data of patients in the Phramongkutklao ophthalmology department from 7 February 2023 to 24 June 2023. Results: In the evaluation data aspect, the AI models named mobilenet_v3_large, resnet101, and efficientnet_ b5 perform. All the models measure eye gaze: 30 gaze ROC area (0.7, 0.5,0.55), 60 gaze ROC area (0.82, 0.86,0.85), 90 gaze ROC area (0.78, 0.61,0.87) and full gaze ROC area (0.95, 0.95,0.97) respectively. In the other test data, all 3 AI models measure 30 gaze ROC area (0.77, 0.5,0.58), 60 gaze ROC area (0.71,0.83,0.81), 90 gaze ROC area (0.7, 0.73,0.81) and full gaze ROC area (0.91, 0.93,0.94) respectively. Conclusions: Our study revealed a significant correlation between AI interpretation and clinician measurements. Developing AI may be a new assisting device for ophthalmologists for gaze measurement and interpretation. Keyword: l Artificial intelligence l Musical student l Duction l Measurement l Photography l Device
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 69 Abstract no. 35 Radial versus standard approach for trigger thumb release: a randomized control trial Sakdinun Imsuwan Department of Orthopedics, Phramongkutklao Hospital Background: Trigger finger is one of the commonly encountered diseases that can cause pain and difficulty in using the hand. Some studies have found that the thumb is the finger most commonly affected by this condition. The current treatment for the trigger finger includes both conservative management and surgery. Surgery can be performed through an open technique or a percutaneous technique. Due to the unique anatomy of the thumb, especially the treatment of the trigger thumb using the percutaneous technique, this research report focuses on the injury to the radial digital nerve. This study presents the treatment of trigger thumb using a technique developed from the conventional surgical approach. This technique is a new approach that has not been performed by anyone before, both locally and internationally. It is based on convenience during surgery to prevent nerve injury, reduce pain, and shorten the recovery time. Method: The study was conducted using a randomized controlled trial design in patients diagnosed with trigger thumb who received treatment at the Orthopedics Department of Phramongkutklao Hospital between the years 2021 and 2023. A total of 114 thumbs were included in the study, with 57 thumbs in the control group, which underwent surgery using the standard approach, and 57 thumbs in the experimental group, which underwent surgery using the radial approach. After the surgery, various parameters were assessed and recorded, including the duration of the surgical procedure, wound pain assessed by the Visual Analog Scale (VAS), range of motion of the interphalangeal (IP) joint of the thumb, evaluation of thumb motion using the Kapandji score, pinch strength of the thumb, pain assessment during thumb motion using the VAS, post-operative care recommendations, assessment of complications, and follow-up appointments at weeks 2, 6, and 12. Results: There were no significant differences in general information between the experimental group and the control group. The surgical success rate in the experimental group, which underwent surgery using the radial approach, was 100% for all 33 thumbs. In the control group, which received surgery using the standard approach, the success rate was 100% for all 29 thumbs. The duration of the surgical procedure did not differ significantly between the two groups, and no postoperative complications were observed in either group. Regarding wound pain assessed by the Visual Analog Scale (VAS), the average VAS score in the experimental group at 2 weeks, 6 weeks, and 12 weeks post-surgery was 1.5, 0, and 0, respectively. This was lower than the control group, which had an average VAS score of 3, 1.5, and 0 at the same time points, respectively. These differences in pain levels were statistically significant in
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 70 both groups during the entire follow-up period. Furthermore, the assessment of thumb motion using the Kapandji score showed a significant improvement in both groups at week 6 after surgery. The VAS score for pain during thumb motion was 2 (0-5) at 2 weeks and 0 (0-2) at 12 weeks in the experimental group, which was lower than the control group with VAS scores of 3 (0-8) at 2 weeks and 0 (0-4) at 12 weeks. These differences in pain levels were statistically significant in both groups. Conclusion: Surgery for trigger thumb using the radial approach is a convenient, effective, and lowcomplication technique that provides safety and good outcomes for patients. Patients experience minimal pain, quick recovery, and a rapid return to hand functionality. The study aims to provide valuable information to assist patients in making informed decisions about treatment and serve as a foundational resource for further research in the future. Keyword: l Trigger thumb l Percutaneous trigger finger surgery l Open trigger finger surgery
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 71 Abstract no. 36 Incidence and neonatal outcomes of preterm birth at gestational age 34-36+6 weeks in Phramongkutklao Hospital Aphisara Kositwongsakul and Suphitcha Raksakulkiat Department of Obstetrics and Gynecology, Phramongkutklao Hospital Objective: The study aimed to determine the incidence of preterm birth at gestational age 34-36+6 weeks in Phramongkutklao Hospital. The secondary outcome was neonatal result. Materials and Methods: The retrospective descriptive study was conducted using the secondary data of pregnant women delivery and their neonates in Phramongkutklao Hospital from 1 January to 30 September 2022 to determine the result. Results: The incidence of preterm birth at gestational age 34-36+6 weeks was 6.65%. The most common cause of preterm birth was preterm labor (47.69%). Neonatal complication rate was 70.3%. The common neonatal problems comprised hyperbilirubinemia (53.85%), respiratory complication (18.46%) and hypoglycemia (10.77%). The neonatal complication rate achieved statistical difference (p < 0.001). However, the duration of respiratory support was not statistically significant (p = 0.814). Conclusion: Late preterm birth, often caused by spontaneous preterm labor, is the most common reason for preterm birth. These newborns experienced a risk for prematurity related comorbidities. Neonatal complication are higher among neonates than among term infants. The need for respiratory support in late preterm was higher. However, the length for respiratory support did not differ significantly, implying that neonatal complications were moderate. When necessary, termination of pregnancy in late preterm may be reasonable. Keyword: l Late preterm birth l Neonatal outcomes
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 72 Abstract no. 37 Comparative study between anti-osteoporosis drugs and time to union of osteoporotic intertrochanteric fracture in elderly Sutthirak Singhasema Department of Orthopedics, Phramongkutklao Hospital Background: Osteoporotic (fragility) fracture is defined by the World Health Organization (WHO) as a fracture caused by injury that would be insufficient to fracture a normal bone. Much evidence shown that osteoporotic fracture effect to delayed or imperfect recovery after fracture can be related with poor consequences elderly with osteoporotic fracture need anti osteoporotic agents to prevent repetitive fracture due to repetitive fracture is increase both mortality and disability. Anti-osteoporosis agents must have high potency to accelerate bone healing, not resulting in good quality of life but also prevent mortality and disability. There is currently no study that compare between anti-osteoporosis agents and osseous union time in osteoporotic intertrochanteric fracture in elderly. Objectives: To compare between anti-osteoporosis agents and osseous union time in osteoporotic intertrochanteric fracture in elderly and to compare between anti-osteoporosis agents and functional outcome in osteoporotic intertrochanteric fracture in elderly. Methodology: This is an Observational Retrospective Cohort Study conducted using medical registry data of patients with osteoporotic fractures in the intertrochanteric region who underwent surgery with cephalo-medullary nails at Phramongkutklao Hospital, involving a total of 503 cases. The study selected 125 cases based on certain criteria. These 125 cases were divided into three groups, each receiving different osteoporosis treatments. Group 1 received Bisphosphonate (54 cases), Group 2 received Denosumab (35 cases), and Group 3 received Teriparatide (36 cases). The evaluation of bone union was performed using RUST scores, and the time to bone union was compared among the three groups based on X-ray images taken at follow-up appointments at 4, 8, 16, and 24 weeks. A p-value of less than 0.05 was considered statistically significant. Additionally, the study compared the average values of hip pain score and mobility score among the three groups, and a p-value of less than 0.05 was considered statistically significant. Results: In the group that received Teriparatide, the time to bone union occurred at 8 weeks for 19 participants and at 16 weeks for 17 participants, with a p-value of less than 0.001. At 4 weeks, the rate of bone union in the bisphosphonate and denosumab groups showed a callus formation of 1%, while Teriparatide had a 50% callus formation (p-value < 0.001).
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 73 At 8 weeks, the bisphosphonate group had a callus formation of 51%, along with a bridging callus of 3%. In the Denosumab group, callus formation was 19%, and there was a 19% bridging callus. Teriparatide showed a callus formation of 6% and a bridging callus of 11%, along with a 19% bone union rate (p-value < 0.001). It was also found that at weeks 16 and 24, all three groups had a 100% bone union rate. In terms of Hip pain score, it was observed that at 8 weeks and 16 weeks, the Teriparatide group had the lowest hip pain score (1.56±0.5 and 1.06±0.23, respectively), compared to the other groups (p-value <0.001). The Mobility score at 8 weeks in the Teriparatide group was the lowest compared to the other groups (3.02±0.14) (p-value < 0.001). Conclusions: Elderly patients with osteoporotic fractures in the intertrochanteric region who received Teriparatide treatment demonstrated a significantly shorter time to bone union at 8-16 weeks (p-value < 0.001) compared to other groups. They also had lower hip pain scores at 8 and 16 weeks and lower mobility scores at 8 weeks compared to the other groups, with statistical significance (p-value < 0.001). Keyword: l Osteoporotic intertrochanteric fracture l Anti-osteoporosis drugs l Time to union
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 74 Abstract no. 38 Secondary attack rate of household transmission among Covid-19 infection patients aged 0-18 years old in Phramongkutklao Hospital Panu Piyachon, Kanlaya Jongcherdchootrakul and Thirapa Nivesvivat Pediatrics Department, Phramongkutklao Hospital Background: The role of pediatric cases in secondary transmission of COVID-19 is not well understood in Thailand or nationwide. We aim to study the secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from the pediatrics department of Phramongkutklao Hospital. Methods: For this retrospective cohort study, details of 199 pediatric patients were collected from the Novelcorona 3 record form. All index cases were selected for the study and were telephonically contacted to obtain the details of household secondary infections; 199 pediatric index cases with 43 household contacts as secondary cases were included in the study. Results: The SAR in household contacts of pediatric index cases was 18.6 (95%CI: 9.1-19.1%). The majority of the index cases were average age 8 years, 109 families (57%) have been infected with children as the last people in the house, and 114 families (60%) found a Corona virus infection for everyone in the family, considering the number of infections to most close household contacts (secondary attack case) is four people. Most children living in single houses accounted for 40 percent and 33.6 percent for flats or condominiums, most of which are not vaccine-protected by 97.99 percent. Substitutionary education groups were 33.67 percent, with a total of 72.8 percent being symptomatic patients. Conclusions: The household SAR of pediatric patients in our study is higher than the others. The SAR of this study is associated with the age group of the index cases and the symptoms of the index cases. Hence, the next sequence should be multicenter education. Keyword: l COVID-19 l Pediatrics l Secondary attack rate l Thailand
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 75 Abstract no. 39 Functional outcomes after lumbar epidural steroid injection in diabetic versus non-diabetic patients Wisuta Ruamkiatkhachon, Pawin Gajaseni and Chaisiri Chaichankul Department of Orthopedics, Phramongkutklao Hospital and College of Medicine Background: Lumbar epidural steroid injection (ESI) is a prevalent procedure used to manage back and leg pain resulting from lumbosacral radiculopathy. Corticosteroids are employed to mitigate the inflammatory process, demonstrating an ability to enhance function (as measured by the Oswestry Disability Index, ODI) and alleviate pain. Diabetes mellitus is a chronic condition characterized by prolonged hyperglycemia, contributing to neurodegeneration, particularly peripheral neuropathy that leads to sensory loss. However, the influence of concurrent diabetes and glycemic control on outcomes following ESI remains uncertain. This study aims to assess the efficacy of ESI in terms of functional outcomes (ODI) for both non-diabetic and diabetic patients. Objective: The objective of this study is to determine whether there are differences in functional outcomes (ODI) between non-diabetic and diabetic patients after undergoing ESI. Study Design & Methods: This study is a prospective analysis of patients with lumbosacral radiculopathy who underwent ESI in the Department of Orthopedics at Phramongkutklao Hospital. Diabetic and nondiabetic groups were compared based on demographic data, pain scores, ODI, and treatment outcomes at pre-injection, 1 month, 3 months and 6 months after ESI. In the diabetic group, we also investigated the association between HbA1c levels and pain reduction as well as ODI. Results: A total of 100 patients who underwent ESI between June 2021 and January 2023, and completed a 6-month follow-up, were included in the study. Out of these, 50% had diabetes (DM), while the remaining patients were non-diabetic (Non-DM). Regarding the primary outcome, the DM group had a mean pre-injection ODI of 35.06±7.4, and ODI scores after injection at 1, 3, and 6 months were 23.44±8.59, 22.94±8.19, and 22.88±8.34, respectively. The non-DM group had a mean pre-injection ODI of 34.32±10.37, and ODI scores after injection at 1, 3, and 6 months were 21.70±9.38, 19.82±9.28, and 20.68±9.25, respectively. The Fisher’s exact test and independent T-test revealed no statistically significant difference in ODI between the diabetic and nondiabetic groups (p > 0.05). For secondary outcomes, there was no statistically significant difference observed between the two groups regarding pain reduction (NRS) and treatment failure (p > 0.05). The failure of treatment after ESI occurred in 6% of patients who needed repeat ESI and 10% who required conversion to surgery in the DM group. In the non-DM group, the failure rates were 2% and 4%, respectively. Moreover, the study
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 76 comparing well-controlled (HbA1c < 7) and poorly controlled (HbA1c > 7) diabetes showed no significant differences in ODI, pain reduction, or treatment failure (p > 0.05) Conclusion: The effectiveness of ESI in treating both diabetic and non-diabetic groups was highly satisfactory, with no significant differences observed in ODI, pain reduction (NRS), or treatment failure. Additionally, diabetes appeared to exert an independent effect on outcomes after ESI, irrespective of HbA1c levels. Keyword: l Epidural steroid injection l ESI l ODI l Functional outcome l Diabetic l DM l Back pain l Radiculopathy l Lumbar spinal stenosis
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 77 Abstract no. 40 An innovative scoring system for predicting a poor outcome after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture Panukorn Pinijprapa and Ong-art Phruetthiphat Department of Orthopedics, Phramongkutklao Hospital and college of Medicine Background: Intramedullary nail and dynamic hip screws with plate are used to treat elderly patients with intertrochanteric fractures. Previous studies have shown that inappropriate surgical factors are associated with mechanical failure after internal fixation. However, there is limited evidence to demonstrate the association between functional outcomes after proximal femoral nail anti-rotation (PFNA) fixation and the non-surgical factors such as patient’s comorbidities. The purpose of this study is to evaluate the predictive factors associated with a poor outcome, and to develop an integrated scoring system to predict the poor outcome after PFNA fixation in elderly with an intertrochanteric fracture. Method: Elderly patients with low-energy intertrochanteric fractures who underwent PFNA fixation between January 2012 and December 2018 and at least one-year follow-up were recruited. Patients’ Demography, Charlson comorbidity index, time to surgery, time of early ambulation, and surgical parameters were reviewed. Poor and non-poor outcomes were evaluated by Harris Hip Score (HHS) after a one-year follow up. Regression analysis was applied to determine the predictors for a poor functional outcome. A new integrate scoring system (PISSI; Poor Integrate Scoring System in elderly patients with Intertrochanteric fracture) was developed. Result: Four-hundred-fifty elderly patients were used to identify predictive factors for a poor outcome after PFNA fixation and the poor scoring system (PISSI) was developed. In this study, Charlson comorbidity index (CCI) > 5, a modified AO/OTA 31A2.2 or 2.3, time to surgery > 5 days, time to walk > 5 days, Poor quality of reduction, Tip Apex Distance out of appropriate range (< 20 or > 30 millimeters), Nail shaft axis out of appropriate range (< -2 or > 2), and inappropriate Cleveland zone (zone 1, 2, 3, 4, or 6) were significantly associated with the poor outcome after PFNA fixation. The range of PISSI score was between 0 to 39 and the cut-off score of 24 was found to have the highest discriminatory power to determine the poor functional outcome where the area of ROC was 0.95. Conclusion: Orthopedic surgeons can easily applied the PISSI score for predicting an outcome in elderly with intertrochanteric fracture after PFNA fixation. Level of Evidence: Prognostic level III. Keyword: l Elderly l Intertrochanteric fracture l Proximal femoral nail anti-rotation l Scoring system l Poor outcome
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 78 Abstract no. 41 Comparison of IOP change during traditional hemodialysis between normal open angle and occludable angle Krischon Euswas, Panhatai Yaisiri, Isaraporn Treesit, Panrapee Funarunart and Raveewan Choontanom Department of Ophthalmology, Phramongkutklao Hospital Background: Elevated intraocular pressure (IOP) is a risk factor for the development and progression of glaucoma. During hemodialysis, differences in iridocorneal angle, such as those seen in glaucoma, narrowangle conditions, or impaired aqueous outflow, can also act as moderating factors leading to an increase in IOP. Therefore, it is essential to identify the risk factors associated with high IOP in hemodialysis patients. Objective: Cross-sectional study is to compare IOP change during hemodialysis between normal open angle and occludable angle, and to determine the risk factor for high IOP in hemodialysis patients. Methods: The participants were encounters to eye examination by glaucoma specialist. Documented visual acuity (VA), IOP by GAT twice during 10 o’clock to 12 o’clock, indentation gonioscopy and cup/disc ratio. Ocular investigations corrects central corneal thickness (CCT), computerized visual field (CTVF) 24-2, optical coherent topography (OCT). We appointed to measure IOP by iCare tonometer(IC200) before started hemodialysis (15 minutes prior), measured again every hour until the end (4 hours) by a single physician. Results: A total of 26 eyes from 13 participants with a mean age of 60±15.39 years old. The mean IOP measured by GAT was 12.4±4.66 mmHg (7.74-17.06) and at 2 hours of dialysis IOP was changed 2±2.73 mmHg (-0.73 to 4.73) and mean difference of 2.004 mmHg (p = .01). The lower SBP at start of dialysis lead to increasing IOP -0.201(-0.341,-0.062) (p = .005) Conclusion: Intradialytic IOP is gradual increase with peak around 2 hours. In these eyes, the IOP tended to gradually elevate throughout the hemodialysis even in non occludable eyes. The lower SBP is relate to rising intradialytic IOP. Keyword: l Intraocular pressure l Hemodialysis
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 79 Abstract no. 42 Comparative short-term recovery and functional outcome after PFNA fixation for intertrochanteric fracture between CKD and non-CKD in elderly: A prospective cohort study Suppakit Paiboonrungroj, Panukorn Pinijprapa and Ong-art Phruetthiphat Department of Orthopedics, Phramongkutklao Hospital Introduction: Osteoporotic hip fracture is becoming the world’s major health issue as the majority of population ages. The fragility hip fracture has been shown to affect ambulatory status, quality of life, functional outcomes, mortality, resource and financial cost spent in health care system. Previous literatures demonstrated that older age, male gender, comorbidities such as chronic kidney disease (CKD), heart pathology and Charlson index more than 2 were associated with increased mortality. Objective: The purpose of this study is to identify short term recover, and to compare functional outcome, complication, and mortality in both groups. Methods: After Institutional Research Board Approval, patients over 60 years old who sustained intertrochanteric fractures with modified AO/OTA Type 31A1.3, 31A2.2, and 31A2.3 from low energy trauma underwent PFNA fixation were prospectively collected. All patients were categorized into 2 groups based on glomerular filtration rate (GFR): those patients without chronic kidney disease [GFR at least 90 milliliters per minute (mL/min)] and those patients with CKD [GFR less than 90 milliliters per minute(mL/min)]. Patients’ demography and comorbidities were reviewed in both groups. Koval score was used for assessment the functional status at preoperative period, and postoperative period at 3 months, 6 months, and one year. Three months, 6 months and one year time up and go test (TUG) were used to identify the short term recover and physical performance. Three months, 6 months, and one-year functional outcome were evaluated by Harris hip score (HHS). Any complication and mortality rate were compared in both groups. Results: This prospective study enrolled 69 participants, including 24 patients with CKD and 45 patients without CKD. There was no significant in length of stay, operative time and blood loss, fracture union, Koval scores, and HHS in both groups. However, the 6 months TUG in CKD group was significantly longer than the Non-CKD group (41.6 vs 32.8, p = 0.035), and almost statistical significance at 3 months (51.8 vs 42.2, p = 0.05) between groups. In addition, the mortality rate of CKD group was significantly higher than the Non-CKD group (20.8% vs 2.2%, p = 0.017). Conclusion: Those elderly patients with CKD who sustained intertrochanteric fracture treated with PFNA were significantly associated with longer short-term recovery, and higher mortality rate. While CKD is an uncontrollable risk factor, reducing the incidence of hip fracture through fall prevention and hip strengthening exercises, is essential for improvement the patient outcomes.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 80 Abstract no. 43 Efficacy of artificial intelligence method for impending pathological fracture estimationin long bone metastasis Pongsom Luanghirun and Phutsapong Srisawat Department of Orthopaedics, Phramongkutklao Hospital Background: In the United States, the prevalence of all types of cancer is as high as 1.2 million people per year, Bone is among the top three sites of metastases. Radiograph is a basic tool used in every hospital, even in community hospitals. Artificial Intelligence (AI) has an increasingly important role in medicine and is used in the field of radiographic analysis. This study will develop a tool to detect metastatic bone tumor that helps doctors gain confidence in the diagnosis and quickly refer the patient to a subspecialist orthopedist. Objectives: Accuracy of AI in distinguishing between metastatic bone tumor and normal radiograph in the plain radiograph of the shoulder and shoulder and compare performance with musculoskeletal oncology subspecialists as gold and 1st-year orthopedic residents. Study design and methods: A retrospective diagnostic study collected patients in Phramongkutklao Hospital with histopathologically confirmed metastatic bone tumors around the shoulder and proximal femur which had plain radiograph without fracture and foreign material. We trained AI with 400 radiographic images and tested with another 120 images, which were also evaluated by subspecialists and residents to distinguish between metastatic bone tumors or not. Results: The AI model had sensitivity and specificity in distinguishing bone tumor lesions 77.78% and 80.00% respectively. While residents had a sensitivity and specificity 82.22% and 73.33%. Accuracy of AI and residents were 78.33 and 80.00% respectively. We found that resident performance was not statistically significantly different from AI (p = 0.077). Conclusions: This machine learning model can detect metastatic bone tumor lesions in plain radiographs with comparable performance as residents but not enough performance to evaluate Mirel score. Further model development and a lot of data are required for better outcomes. Keyword: l Metastatic tumor l Artificial intelligence l Plain radiograph
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 81 Abstract no. 44 Accuracy of the combination of Thai SRBD-PSQ and examination of adenotonsillar hypertrophy to predict moderate to severe pediatric obstructive sleep apnea Panon Srithanetsakul, Jakkrit Chantavanich and Paloch Hongtongdang Department of Otolaryngology, Phramongkutklao Hospital Background: Obstructive sleep apnea (OSA) is a common sleep disorder in children. Although The pathophysiology of pediatric OSA is multifactorial but adenotonsillar hypertrophy is the most common cause. The gold standard for diagnosis of OSA remains Polysomnography (PSG). However, standard PSG is limited due to cost and availability. Less than 10% of children with OSA can perform PSG before treatment with Adenotonsillectomy. A pediatric sleep questionnaire (PSQ) was developed for screening pediatric OSA. The accuracy of combination of questionnaire with clinical and radiologic evaluation of tonsils and adenoid could be a diagnostic method in pediatric OSA. Objective: To evaluate the accuracy of the Thai Sleep-Related Breathing Disordered-Pediatric Sleep Questionnaire (Thai SRBD-PSQ) and adenotonsillar hypertrophy for diagnosis of moderate to severe pediatric OSA. Methods: A total of 57 children between 2-12 years old with moderated to severe OSA were enrolled in a clinical study between January 2018 to October 2023. All patients underwent physical examination to assess tonsillar size and performed radiographic evaluation of adenoid size by adenoid nasopharynx ratio (AN ratio) by otolaryngologist. The Thai SRBD-PSQ was carried out by parents before polysomnography. Children with craniofacial abnormalities, genetic disorders, neuromuscular diseases, chronic lung diseases and cardiovascular diseases were excluded. Results: Thirty-five (61.4%) were boys and twenty-two (38.6%) were girls with mean (SD) age of 7.79 (2.53). Twenty-four (42.11%) with allergic rhinitis. Twenty (60.61%) were obesity. Five (15.15%) were morbid obesity. Nineteen (33.33%) have tonsil grade 3 and two (3.51%) have tonsil grade 4. Twenty (35.09%) have adenoid hypertrophy. Thirty-three (40.36%) were diagnosed with moderated to severe OSA (AHI > 5). Thirty-two (56.14%) have positive questionnaire. Sensitivity and specificity of positive PSQ (PSQ > 8) were 52.2% and 41.2%. Sensitivity and specificity of positive PSQ and tonsillar hypertrophy were 39.1% and 85.3%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of combined positive PSQ with tonsillar hypertrophy(grade3-4) and adenoid hypertrophy (AN ratio > 0.8) were 13%, 97.1%, 75%, 62.3% and 63.16% respectively.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 82 Conclusions: The combination of Thai SRBD-PSQ with adenotonsillar hypertrophy are highly specificity to diagnose moderated to severe pediatric OSA. The specificity and positive predictive value for diagnosis of moderated to severe pediatric OSA are increased when combined Thai SRBD-PSQ with adenotonsillar hypertrophy and radiographic evaluation of adenoid size. Keyword: l Pediatric obstructive sleep apnea l Adenotonsillar hypertrophy l Thai SRBD-PSQ
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 83 Abstract no. 45 The effectiveness of pre-arrival video-call assisted bystander cardiopulmonary resuscitation in prehospital setting Dusita Luwichitbanchong, Woranis Amornsongchai and Suthee Intharachat. Department of Emergency, Phramongkutklao Hospital Background: Out-of-hospital cardiac arrest has low survival rate and opportunity of recovery. Cardiopulmonary resuscitation can begin before rescuers arrive by communicating with rescuers(telemedicine), therefore they can provide better pre-arrival instruction. Objective: To study the effectiveness of pre-arrival instruction basic life support through video communication with bystander before the rescuers arrived and to compare the survival rate (ROSC,1-day survival,30-day survival) and neurological outcome after cardiopulmonary resuscitation between video-dispatcher assisted CPR and audio-dispatcher assisted CPR of out-of-hospital cardiac arrest patients. Methods: When cardiac arrest outside the hospital was notified, Phramongkutklao Hospital Emergency Medical Service Center (EMS) will begin contacting to assist by giving instructions via voice and video communication to begin bystander CPR from the mobile phone. The cardiopulmonary resuscitation (CPR) and external defibrillation (AED) are used in pre-arrival instruction of basic life support before the rescuer arrives. Results: From dispatcher assisted-CPR resuscitation, there were 8 patients returning of spontaneous circulation (ROSC) in the audio-dispatcher group (7.48%) and 34 people (50%) in the video-dispatcher group. The survival rate of VDO-dispatcher group was 8.76 times higher than the group audio-dispatcher. From the results of resuscitation and follow-up over a period of 30 days, we found that patients in the group video-dispatcher assisted CPR also had a significantly higher survival rate than audio-dispatcher assisted CPR. (p-value < 0.05) Conclusion: The video-dispatcher assisted of cardiopulmonary resuscitation is guided before EMS team arriving use shorter time than audio-dispatcher, Furthermore outcome of recovery including 1-day, 30-day survival and neurological outcome are better than audio-dispatcher assisted cardiopulmonary resuscitation group. Keyword: l Bystander l Basic life support l Pre-arrival instructions l Audio-dispatcher assisted CPR l Video-dispatcher assisted CPR l Telemedicine.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 84 Abstract no. 46 Comparison between flap-flap and flap-subcutaneous tissue techniques in external dacryocystorhinostomy, randomized controlled study Tunjira Chokjutha, Sombat Thanaboonyawat and Raveewan Choontanom Department of Ophthalmology, Phramongkutklao Hospital Background: Epiphora is a significant symptom of nasolacrimal duct obstruction (NLDO), a common eye condition in medical practice. External dacryocystorhinostomy (DCR) with flap anastomosis is the standard treatment. However, a new surgical approach called flapless DCR, performed without the need for anastomosis of the lacrimal flap and nasal flap, has gained attention in recent years due to its high success rate. Nevertheless, studies comparing flapless techniques to traditional procedures are limited, with most existing researches being retrospective studies. Objective: To compare the anatomical and functional outcomes between standard technique (with flap anastomosis, lacrimal flap-nasal flap) and new surgical technique (without flap anastomosis, lacrimal or nasal flap-subcutaneous tissue) in external DCR. Methodology: Twenty-seven patients with a total of 30 eyes of acquired nasolacrimal duct obstruction (NLDO) were randomized and operated with external DCR (14 eyes had standard technique and 16 eyes had flap-subcutaneous tissue technique). Regular follow-up settings were done to document the patient’s subjective improvement, ostium patency on lacrimal irrigation, and any complications. Results: The mean (SD) age of patients was 66.4 (12.7) years, and there was a predominance of women [20 (74.1%)]. The mean (SD) operative time in flap-subcutaneous technique group was shorter at 70.6 (35.7) minutes compared with 114.6 (37.4) minutes in standard technique group (p = 0.03). Flap-subcutaneous technique group had a higher (92.9%) success rate when compared with standard group (87.5%) but there was no significant difference in both success rates and complications. Conclusions: The external DCR with flap-subcutaneous tissue technique is easy to perform, safe, and provides a high success rate comparable to the standard technique. Keyword: l Nasolacrimal duct obstruction l External dacryocystorhinostomy
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 85 Abstract no. 47 Sensitivity and specificity of Yubi-wakka (Finger-ring) screening method for sarcopenia among older Thai adults Kasidid Lawongsa1 , Patsri Srisuwan1 , Sirakarn Tejavanija2 and Kulachade Gesakomol1 1 Family Practice Outpatient Department; 2 Division of Clinical Nutrition, Department of Medicine, Phramongkutklao Hospital Background: Measurements of muscle mass are considered to be a gold standard for testing for sarcopenia; such measurements are typically attained using Bioelectrical Impedance Analysis (BIA) or Dual-energy X-ray Absorptiometry (DXA). However, the Yubi-wakka test is a simple assessment that can also be used to screen for sarcopenia. Methods: An analytic cross-sectional study was conducted to determine the sensitivity and specificity of the Yubi-wakka test. The study cohort included 230 adults older than 60 who had no disabilities or handicaps and who visited the outpatient department of Phramongkutklao Hospital. Each participant underwent the Yubi-wakka test, a handgrip strength test, the 5-chair stand test, and BIA. We analyzed the associations between the Yubi-wakka test results and sarcopenia. We also analyzed the accuracy of the Yubi-wakka test for sarcopenia screening using the area under the receiver operating characteristic curves (AUROC). The findings were compared with diagnoses that followed from the Asian Working Group for Sarcopenia (AWGS) 2019. Results: The test results were statistically associated with sarcopenia (“just fits” OR = 8.55, 95%CI: 3.29- 22.18 and “smaller” OR = 10.73, 95%CI: 4.31-26.73) relative to “bigger”. The sensitivity and specificity of the Yubi-wakka test in men were 85.7% and 71.2% (AUC = 0.785, 95%CI: 0.618-0.952), respectively. On the other hand, the sensitivity and specificity of the test in women were 87.5% and 80.8% (AUC = 0.842, 95%CI: 0.764-0.919), respectively. Conclusions: The Yubi-wakka test is a practical way of identifying the risk of sarcopenia among the elderly; it exhibits promising sensitivity and specificity.
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 86 Abstract no. 48 Effects of FAVIPIRAVIR monitoring program of COVID-19 infected patients in Fort Pichai Dab Hak Hospital, Uttaradit province. Madeehah Wa-ngoh1 , Chanakan Meerod1 , Chanathip Homthong1 , Patcharee Meeyen1 and Thananchai Juapprasop2 1 Public Health Program, Faculty of Science and Technology, Uttaradit Rajabhat University; 2 Fort Pichai Dab Hak Hospital This study is a quasi-experimental one groups pre-post test design. The research aimed to study the effects of FAVIPIRAVIR monitoring program of Covid-19 patients in Fort Pichai Dab Hak Hospital, Uttaradit province, between 1st February and 30th April 2022. The sample was 1) males and females, aged 18 years and over, 2) diagnosed by RT-PCR, with mild - moderate symptoms, 3) was treated with FAVIPIRAVIR and 4) medical professional team. The research tool was the FAVIPIRAVIR monitoring program was created by the researcher consisted of FAVIPIRAVIR knowledge questionnaires, medication behavior record, medication error record and user satisfaction survey. The data were analyzed by using percentages, means, standard deviations and paired-samples t-test. The results of the study showed that 271 patients infected with the novel coronavirus (2019-nCoV) after using the FAVIPIRAVIR monitoring program had significantly higher average scores of FAVIPIRAVIR knowledge than before receiving the FAVIPIRAVIR monitoring program (p < .05). There were 239 participants (88.19%) who recorded completed medication behaviors and 31 participants (11.44%) reported incomplete medication behaviors. No medication errors were found after finished program. Monitoring for FAVIPIRAVIR side effects of 20 patients (7.38%) were nausea, vomiting and diarrhea, respectively. The satisfaction of participants were at the high level (X = 4.70, S.D. = 0.43). The satisfaction of Medical Professional Team was at the highest level (X = 4.84, S.D. = 0.46). Keyword: l Favipiravir monitoring program l Covid-19 patients l Medical professional team
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 87 Abstract no. 49 Safe zone of supraclavicular nerve during clavicle fixation and its anatomical variations, a cadaveric study Natcha Lorsuwannarat1 and Puripun Jirangkul2 1 Department of Anatomy; 2 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine Background: Supraclavicular nerve injury is usually at risk during clavicular fracture fixation. This study aimed to examine the anatomical features and estimate the precise location of supraclavicular nerve branches related to adjacent structural landmarks and to evaluate the differences between sex and side. To highlight the clinical purposes and surgical relevance, this study attempted to define a surgical safe zone that would probably protect the supraclavicular nerve during clavicle fixation. Methodology: A total of 64 shoulders obtained from 15 female and 17 male adult cadavers were examined, identifying the branching patterns of the supraclavicular nerve, measuring the clavicle length and the course of the supraclavicular nerve referring to the sternoclavicular (SC) and acromioclavicular (AC) joint. Data were categorized by sex and side, and their differences were evaluated using student t-test and Mann Whitney U Test. Clinically relevant predictable safe zones were also statistically analyzed. Results: The results revealed 7 branching patterns of the supraclavicular nerve. The medial and lateral nerve branches formed a shared trunk, and the medial nerve branches separated to form the intermediate branch, i.e., the most frequent pattern (67.19%). The safe zones were determined to be 6.1 mm among both sexes of the SC joint medially, and 0.7 mm among females and 0 mm among males of the AC joint laterally. Surgical incisions between 29.3 to 51.2% and 60.5 to 79.7% of the clavicle length from the SC joint were the safe zones at the midclavicular shaft among both sexes. Conclusion: The findings of this study have provided new insights into the anatomy of the supraclavicular nerve and its variations. It has been revealed that the terminal branches of the nerve consistently pass over the clavicle in a predictable pattern, emphasizing the importance of considering the supraclavicular nerve’s safe zones during clinically relevant surgeries. Nevertheless, due to individual anatomical variations, meticulous dissection between these safe zones is necessary to avoid iatrogenic nerve injury among patients. Keyword: l Safe zone l Supraclavicular nerve l Clavicular fixation l Iatrogenic nerve injury
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 88 Abstract no. 50 Therapeutic drug monitoring and the pharmacokinetic parameter of aminoglycosides in infected patients estimated by using bayesian forecasting Suvadee Supreeyasakon, Wichai Santimaleeworagun and Chutchawan Ungthammakhun Department of Infection Disease, Department of Medicine, Phramongkutklao Hospital; The Collage of Pharmacotherapy of Thailand, Silpakorn University Background: Aminoglycosides are one of the antimicrobial agents that have been recommended to perform routine therapeutic drug monitoring (TDM). Currently there is no evidence about the pharmacokinetic parameters of amikacin and gentamicin based on Bayes’ s probability principle in Thailand. Objective: This study aimed to determine the pharmacokinetic parameters of amikacin and gentamicin based on Bayes’ s probability principle and to evaluate precision of predicted concentration generated by pharmacokinetic forecasting software. Methodology: An aminoglycoside drug levels in patients receiving amikacin and gentamicin at Phramongkutklao Hospital between January 2019 and December 2021 were included. The first peak and trough levels and patient-specific pharmacokinetic parameters were generated by PrecisePK® . The precision of the predictions was evaluated through a mean absolute error and root mean-squared error. Results: Seventeen and twenty-one patients received amikacin and gentamicin, respectively. For Amikacin, pharmacokinetic parameters (mean±SD) were volume of distribution (Vd) 0.35±0.084 L/kg, clearance (CL) 2.34±2.644 L/hr, half-life 13.73±9.681 hr, Cpeak24 39.24±9.412, Ctrough24 7.68±8.008, CpeakSS 40.8±16.529, CtroughSS 5.29±8.626, AUC12 305.69±123.716, AUC24 461.31±235.733 and AUCSS 535.02±387.33. For Gentamicin, pharmacokinetic parameters (mean±SD) were: Vd 0.35±0.851 L/kg, CL 2.15±1.255 L/hr, half-life 8.49±4.014 hr, Cpeak24 14.27±3.975, Ctrough24 1.08±1.009, CpeakSS 14.86±3.656, CtroughSS 1.05±1.005, AUC12 105.35 ±35.15, AUC24 147.62±55.790, and AUCSS 154.42±59.307. The precision of using C4hr to predict C10hr assessed by mean absolute error were 6.783 and 1.578, root mean-squared error was 8.043 and 1.998 for amikacin and gentamicin, respectively. The precision of using C10hr to predict C4hr assess by mean absolute error were 10.605 and 2.619, root mean-squared error were 14.449 and 3.436 for amikacin and gentamicin, respectively. Conclusion: Most of the patients in this study has longer half-life than normal population which can be explained by declined renal function in our participants. Additionally, when using C4hr to predict C10hr, PrecisePK® calculated more precisely than using C10hr to predict C4hr.
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 89 Abstract no. 51 Case report on antimicrobial resistance of Neisseria gonorrhoeae infection who serviced at Phramongkutklao Hospital during fiscal year 2022 Maneerat Somsri, Krit Harncharoenkul, Daniel Boudreaux, Jeffrey Livezey, Sutchana Tabprasit, Darunee Utennam and Nithinart Chaitaveep Armed Forces Research Institute of Medical Sciences Background: Antimicrobial resistance in Neisseria gonorrhoeae (GC) remains an important classic sexually transmitted disease problem. There are a variety of antibiotic and the useof condom are effective treatment and preventive disease, respectively. However, emerging antibiotic resistant N. gonorrhoeae strains are still an obstacle for treatment efficiency. Therefore, the monitoring of antimicrobial resistance GC strains is crucial for curing and control the disease. Methodology: To monitor antimicrobial resistant GC strains, surveillance program has been carried on in urethral infection adult patients attending Royal Thai Army (RTA) hospitals since 2014. The suspected NG isolates are subcultured and presumptively identified using conventional microbiology techniques. Minimum Inhibitory Concentrations (MICs) of antimicrobials are determined to cefepime, cefixime, azithromycin, ciprofloxacin, spectinomycin, ceftriaxone, penicillin and tetracycline using Liofilchem® MIC Test Strip with cut-off reference of Clinical & laboratory Standard Institute (CLSI). This study was approved by Institutional Review Board, Royal Thai Army Medical Department under protocol number S036b/56 and Walter Reed Army Institute of Research, and Silver Spring, MD under protocol number WR #2039. Results: During October 2022 to September 2023, total 80 urinary swabs of gram-negative diplococci specimens were received from Phramongkutklao Hospital. Seventy out of 80, 87.5% were identified as GC and 88.57% (62/70) were isolated from soldiers. Using Liofilchem® MIC Test Strips, NG isolates were resistance to following antibiotics: tetracycline (95.72%), penicillin (94.28%) and ciprofloxacin (97.14%). All isolates were sensitive to spectinomycin and azithromycin. Importantly, one patient was non-susceptible to cefepime and cefixime and showed decreased ceftriaxone susceptibility (MICs of 0.25 µg/mL). Conclusion: Ceftriaxone and cefixime are the third-generation cephalosporin that are recommended treatment of GC in Thailand. Cefepime is the fourth-generation cephalosporin with documented high activity against GC strains. This study showed case report who decreased ceftriaxone susceptibility with cefixime and cefepime resistance. Moreover, he has to repeat the treatment and needs time to cure. Thus, the GC surveillance would be needed for further Force Health Protection and public health authorities in response to the drug-resistant GC threats. Keyword: l Neisseria gonorrhoeae l Antimicrobial resistance l MICs
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 90 Abstract no. 52 Therapeutic drug monitoring and Pharmacokinetic parameter of vancomycin in febrile neutropenic patients at Phramongkutklao Hospital Piyawadee Tangvichitrerk, Wichai Santimaleeworagun and Worawong Chueansuwan College of Pharmacotherapy Thailand; Department of Pharmaceutical Care, Faculty of Pharmacy, Silpakorn University; Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine Background: Vancomycin is a narrow therapeutic range achieving area under the curve during 24 hours (AUC24h) within 400-600 mg.h/L to improve clinical outcomes and prevent toxicity. Febrile neutropenia is a special condition changing the pharmacokinetics parameters of vancomycin. This problem might result to treatment failure and clinical outcomes in immunocompromised hosts. Objective: To evaluate the vancomycin levels in patients with febrile neutropenia and to determine the vancomycin pharmacokinetic parameters and optimal vancomycin doses estimated by software based on Bayesian theory. Methodology: This retrospective study included the data from patients with age ≥ 20 years, having absolute neutrophil count < 500 cells/mm3 , receiving IV vancomycin, and having vancomycin at least 2 plasma concentrations in the first vancomycin dose. The Pharmacokinetics parameters of individual patients were determined by the PrecisePK program. Results: During January 2018 to June 2023, a total of 38 neutropenic patients were included. For vancomycin TDM, the vancomycin AUC24h among studied participants achieves target within 400-600 mg.h/L was only 21.1%. The most cases (78.9%) were classified into subtherapeutic vancomycin levels (< 400 mg.h/L). For vancomycin pharmacokinetic parameters, the clearance (CL), half-life (T1/2), and volume of distribution (Vd) were 6.18±1.6 L/h, 5.19±1.2 h, and 0.72±0.1 L/kg, respectively. According to estimated vancomycin pharmacokinetic parameters above, the dose of vancomycin at 46 mg/kg/day was recommended. Conclusion: Febrile neutropenia condition has augmented clearance of vancomycin. Our findings revealed that the normal vancomycin dose was not achievable the target AUC24h. A higher dose of vancomycin and therapeutic drug monitoring have to be used. Keyword: l Vancomycin l Febrile neutropenia l Bayesian
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 91 Abstract no. 53 A comparative study of the efficiency of K2EDTA and K3EDTA evacuated tubes in circulating cell-free DNA collection Montalee Theeraapisakkun1 , Wittawat Chantkran2 , Pasra Arnutti1 and Chetana Ruangpratheep2 1 Department of Biochemistry; 2 Department of Pathology, Phramongkutklao College of Medicine Background: According to circulating cell-free DNA (ccfDNA) analysis, the evacuated blood collection tubes containing di- and tripotassium (K2 and K3) salts of ethylenediaminetetraacetic acid (EDTA) have been reported to be used instead of the high-priced ccfDNA collection tubes. However, the quality of ccfDNA samples in EDTA tubes remains unclear which tube is better. Objective: This study was to compare the quantity and quality of ccfDNA samples collected in K2EDTA and K3EDTA evacuated tubes. Methodology: Whole blood samples from 27 healthy female volunteers were collected in both tubes. The ccfDNA was isolated by the Triton/Heat/Phenol protocol within 2 hours after blood draw for preventing DNA degradation. An ultraviolet spectrophotometry was used for determining the concentration and the purity of the isolated ccfDNA. A conventional polymerase chain reaction (PCR) assay and a SYBR Green based real-time PCR assay were applied for estimating the isolated ccfDNA quality from the amplification of 3 endogenous reference genes (GAPDH, HPRT1 and TFRC). Results: The levels of ccfDNA concentration in K2EDTA tube (235.40±404.00 ng/µL) were significantly lower than K3EDTA tube (473.60±954.70 ng/µL) (p = 0.0499). The A260/A230 and A260/A280 ratios of ccfDNA in K2EDTA tube were not significantly different from K3EDTA tube (p > 0.05). Therefore, the ccfDNA samples were contaminated with phenol during the isolation process. However, they had a suitable quality for PCR amplification because the PCR product sizes of 3 endogenous reference genes were the same as the designed amplicon sizes. There was no significant difference in the cycle threshold (Ct) values for GAPDH gene in isolated ccfDNA between K2EDTA (23.99±2.21 cycles) and K3EDTA (23.68±1.47 cycles) tubes (p = 0.6353). The ccfDNA isolated from K2EDTA tube yielded the significantly lower Ct values for HPRT1 (22.73±2.18 cycles) and TFRC (24.36±1.94 cycles) genes than the ccfDNA of K3EDTA tube (24.38±1.91 cycles and 25.35±1.46 cycles, respectively) (p = 0.0002 and 0.0227, respectively). Conclusion: Regarding the standard deviation of ccfDNA concentration and the Ct value in real-time PCR, K2EDTA evacuated blood collection tube is better than K3EDTA tube for collecting ccfDNA samples. Keyword: l Circulating cell-free DNA l Evacuated blood collection tube l K2EDTA l K3EDTA
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 92 Abstract no. 54 Analysis of copy number variations of ER, PR, HER2 and MKI67 genes in circulating cell-free DNA released from cancer cells in Thai patients with invasive breast carcinoma Montalee Theeraapisakkun1 , Dollapak Apipongrat2 , Wittawat Chantkran3 , Pasra Arnutti1 and Chetana Ruangpratheep3 1 Department of Biochemistry, Phramongkutklao College of Medicine; 2 Special Haematology Laboratory, Division of Medicine, Phramongkutklao Hospital; 3 Department of Pathology, Phramongkutklao College of Medicine Background: Circulating cell-free DNA (ccfDNA) is currently detectable in the blood of cancer patients. The copy number variations (CNVs) of ccfDNA have been reported to infer dormancy/minimal residual disease in the majority of breast cancer patients on follow-up. Objective: This study was to evaluate alterations in copy number (CN) of genes correlated with cellular proliferation and growth in ccfDNA derived from Thai women with invasive breast carcinoma (IBC). Methodology: Whole blood samples were collected in K2EDTA evacuated tubes and derived from healthy female volunteers (165 cases) and IBC patients at two different time points, i.e. before surgery (165 cases) and at 7-12 months after surgery (101 matched cases). A commercial normal human genomic DNA (200 ng/µL) was used as the experimental calibrator. The ccfDNA was isolated by the Triton/Heat/Phenol protocol within 2 hours after blood draw for preventing DNA degradation. A SYBR Green based real-time polymerase chain reaction (PCR) assay was applied for analysing CNVs of 4 target genes (ER, PR, HER2 and MKI67) and 3 endogenous reference genes (GAPDH, HPRT1 and TFRC) in the isolated ccfDNA. Results: The various CNs of ER, PR, HER2 and MKI67 genes were detected in ccfDNA of healthy women (HW) and pre- and post-operative IBC patients (PrSx-IBC and PoSx-IBC, respectively). All 4 genes showed normal diploid (CN = 2) and high-level amplification (CN ≥ 8) in the majority of HW and PrSx-IBC, respectively (p < 0.05). The matched PoSx-IBC revealed the average CN value of 3 (single copy gene) for PR and MKI67 genes and of 5 (amplification) for ER and HER2 genes. The PrSx-IBC had significantly higher CN values for these genes compared to the matched PoSx-IBC (p < 0.0001). In addition, twentyfive (24.752%) matched PoSx-IBC cases still had CN amplification (CN ≥ 5) of 2 to 3 genes. Conclusion: CNVs of ER, PR, HER2 and MKI67 genes in ccfDNA are plausibly used as a personalised biomarker for monitoring a post-operative recurrence of IBC in patients on routine follow-up. Keyword: l Circulating cell-free DNA l Copy number variations l Invasive breast carcinoma
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 93 Abstract no. 55 Accuracy of heart-rate monitoring in budget smart bands among healthy subjects Parameth Pongpripoom, Kollatee Buranarach and Chanwit Phongamwong Department of Physical Medicine and Rehabilitation, Phramongkutklao Hospital Background: Wearable heart rate monitors have been widely used to determine exercise intensity. Studies on the accuracy of smart watches for athletes, individuals with cardiovascular disease, and healthy individuals have been conducted. The majority of studies focused on expensive smart watches such as Apple watch or Garmin. However, the accuracy of budget smart bands remains uncertain. Objective: To investigate the accuracy of heart-rate monitoring in budget smart bands among healthy subjects. Methodology: The study design was an observational cross-sectional study, conducted Phramongkutklao Hospital’s cardiac rehabilitation clinic. A total of 43 healthy subjects, aged ranging from 20-40 years old were included to the study. The participant’s heart rates were measured using an electrocardiogram telemetry and two budget smart bands (Huawei Band 6 and Samsung Fit 2) on both wrists while they were at rest, walking (3 km/hr), and jogging on a treadmill (6 km/hr). Results: The results showed the Samsung Fit 2 had good to excellent reliability in all activity conditions (rest, walking, jogging, ICC = 0.783, 0.934, and 0.958 respectively with p < 0.001) but the Huawei Band 6 had varied reliability in different activity conditions. At rest, it had good reliability (ICC = 0.863, p < 0.001). However, during running, it had moderate reliability (ICC = 0.513, p = 0.011), while jogging it had poor reliability (ICC = -0.948, p = 0.983). Conclusion: The Samsung Fit 2 had a high level of accuracy for heart rate measurement in all activity conditions among healthy subjects. However, the Huawei Band 6 had only high level of accuracy for heart rate measurement at rest; while running and jogging, its accuracy was decreased. Keyword: l Heart rate, Budget smart band l Fitness band l Electrocardiogram telemetry
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 94 Abstract no. 56 Efficiency of barrier box for prevention of droplet spreading during tracheostomy tube change Patteera Suriyalaksh, Pana Klamkam, Anisong Pilakasiri and Jakkrit Chantavanich Department of Otolaryngology, Phramongkutklao Hospital Background: Tracheostomy is a surgical procedure to establish an airway connecting the trachea to the anterior surface of the neck. Patients with tracheostomy tubes necessitate care, particularly for regular tracheostomy tube changes. The importance is underscored by the stimulation of patients to cough, which invariably results in the spreading of mucus secretion in the surrounding environment. With the rise of contagious diseases like COVID-19, the need for preventing droplet spreading has been brought to the forefront. This has led to an increased emphasis on aerosol containment devices. Objectives: To evaluate the efficacy of barrier boxes to prevent the spreading of droplet secretion and to study the maximum potential distance of droplet spreading during tracheostomy tube change. Methods: This experimental study included 28 adults who underwent tracheostomy tube change with barrier box (n = 14) and without the device (n = 14) from May 1, 2023, to October 31, 2023. Results were analyzed using Mann-Whitney U test Results: Among 28 patients who had undergone tracheostomy tube change with and without barrier box. Each group showed the mean [±SD] age of 71.93 [±15.48] and 79.79 [±12.47] years, respectively. There were nine male participants (64.29%) in the first group and six male participants (42.86%) in the other. The maximum potential distance of droplet spreading during tracheostomy tube change with the barrier box group was lesser than another group [median (min-max) distance, 35 cm (0-44) vs 62.5 cm (7-96)], (p = .01). Subgroup analysis between the cuff and uncuff tracheostomy tube while using barrier box indicated that no significant difference in type of tracheostomy tube [36 cm (5-42) vs 33 cm (0-44)]. Conclusion: The findings of this experimental study suggest that a barrier box can be considered an effective and even superior device for preventing droplet secretion from spreading during tracheostomy tube change. We describe a novel, helpful barrier box device for the present and upcoming era. Advantages associated with the device includeprotecting healthcare personnel in the surrounding vicinity and reducing the need for individualized personal protective equipment. Keywords: l Tracheostomy l Tracheostomy tube change l Droplet l Spreading l Barrier box
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 95 Abstract no. 57 The incident of rickettsia in military along border of Thai - Myanmar and Thai - Cambodia Narupon Kutasingkee, Min Kramyuu, Sutchana Tabprasit, Watcharee Yokanit, Khuananong Yangpakoon, Maneerat Somsri, Wuttikone Rodkhamtok, Jariyanart Gavee and Kunakon kana Armed Forces Research Institute of Medical Sciences Background: Rickettsia, a vector born disease, is high incident in soldier who have mission along Thaiborder. Rickettsiae bacteria are usually spread to people through the bites of ticks, mites, fleas, or lice that previously fed on an infected animal. Ticks, mites, fleas, and lice are called vectors because they spread (transmit) organisms that cause disease from one host to another. Soldier has symptoms for example; fever, severe headache, a characteristic rash, fatigue and general feeling of illness. Some soldier got severe infection and cause of death which is affecting military operations. Objective: 1. To study the incident of Rickettsia infection in soldier along border of Thai-Myanmar and Thai-Cambodia 2. To study effect of Rickettsia disease to soldiers health in risk area Method: Six hundred eighty-five participants in this study was random from soldiers who got mission in Suranaree Fort, Narasaun Fort and Phameag Fort. Blood sample were test by the Indirect Immunofluorescence Assay (IFA) method to identified the immune response to Rickettsia infection. The demographic data, level of immune response to Rickettsia infection, health effect of soldier ware describe by descriptive statistics. Result: The result reveal that 6.72% of blood sample have antibody respond to Rickettsia disease. Four point five-three percent of blood sample found antibody respond to Scrub typhus. Six point six-one percent of blood sample to Murine typhus and 0.15% of blood sample to Tick typhus. Point one-five percent of blood samples found immune respond to both Scrub typhus and Murine typhus and 0.29% of blood samples found immune respond to both Murine typhus and Tick typhus. Forty-eight point six-one percent of participants were bit by chigger, ticks, mites, fleas, or lice. The most common symptoms were rash and itchy (38.23%) eschar scar, fever and general feeling of illness respectively. From this, Rickettsia cases were found in Mae Hong Son, Chiang Rai, Si Sa Ket respectively. Conclusion : Border area, it’s an risk area of Rickettsia infection. These medical intelligences are important for strategies plan to control and prevent Rickettsia disease. Keywords: l Rickettsia l Vector born disease l Rickettsiae bacteria
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 96 Abstract no. 58 Analysis of immunohistochemical expression of cyclin B1 (CCNB1) in invasive breast carcinoma tissue Jirawat Phongmuenwai1 , Montalee Theeraapisakkun2 , Pasra Arnutti2 , Mongkon Charoenpitakchai3 and Chetana Ruangpratheep3 1 Third-Year Anatomical Pathology Resident, Division of Anatomical Pathology, Army Institute of Pathology; 2 Department of Biochemistry; 3 Department of Pathology, Phramongkutklao College of Medicine Background: Cyclin B1 (CCNB1) protein has been reported to show high expression in breast cancer tissue and also suggested as a prognostic biomarker for breast cancer patients. Objective: The objective of this study was to assess the correlation between CCNB1 immunoexpression in breast carcinoma tissue and clinicopathological data. Methods: An immunohistochemical expression of CCNB1 was evaluated in 21 formalin-fixed, paraffinembedded tissue sections of invasive ductal carcinoma of the breast. The intracytoplasmic staining intensity was scored as follows: 0 (none), 1 (weak), 2 (moderate) and 3 (strong). The percentage of positively stained cells was scored according to the following criteria: 0 (0%), 1 (1%-25%), 2 (26%-50%), 3 (51%-75%) and 4 (76%-100%). Both scores were summed to obtain the final score, with a total score of 0-2 defined as negative expression and of 3-7 defined as positive expression. Results: At the 95% confidence interval, CCNB1 immunoexpression had no significant relationship with the patient’s age, tumour size, tumour grade, axillary lymph node metastasis, nottingham prognostic index, hormone receptor (ER, PR and HER2) status, Ki67 proliferation index and molecular subtypes. Conclusion: Intracellular CCNB1 protein may not alter significantly during the progression of invasive breast carcinoma. Keywords: l CCNB1 l Cyclin B1 l Immunohistochemistry l Invasive breast carcinoma
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 97 Abstract no. 59 Clinicopathological characteristics of chondrosarcoma: A retrospective analysis of Thai patients in Army Institute of Pathology Wirin Sangpanich1 and Chayanit Jumniensuk2 1 Third-Year Anatomical Pathology Resident, Division of Anatomical Pathology; 2 Department of Pathology, Army Institute of Pathology Background: Chondrosarcoma, a rare malignant cartilaginous neoplasm, is the second most common malignant bone tumor. Objective: This study aimed at understanding the clinico-pathological characteristics of the tumor, identifying factors influencing recurrences and metastatic diseases, and analyzing overall survival. Methodology: The clinical, survival, and pathological records of 48 patients diagnosed with chondrosarcoma at Army Institute of Pathology, Thailand, from 2003 to 2022 were retrospectively reviewed. Recurrence-free survival (RFS), metastasis-free survival (MFS), and overall survival (OS) were calculated. Results: Ages of the patients ranged from 8 to 73 years, with a median age of 43 years (41.3 years on average, M:F = 1.8:1). Most patients presented with swelling (43.8%). The tumors predominate at appendicular skeletons (60.4%), especially at femurs. Their size ranged from 1.6 to 35.0 cm (median of 9.8 cm, average of 10.5 cm). Histological variants were conventional (89.6%), clear cell (4.2%), mesenchymal (4.2%) and dedifferentiated (2.0%). Tumor necrosis was found in 10.4%, myxoid change was found in 66.7% and 90.0% of the tumors showed less than two mitoses per 10 high-power fields. Eight (16.7%) patients developed local recurrences after diagnosis, and 6 (12.5%) patients were observed with metastatic diseases. Among them, 3 (6.3%) patients developed both recurrences and metastatic diseases. The 5-year RFS, MFS, and OS were 78.9%, 86.3%, and 71.4%, respectively. Axial skeletons had a greater negative impact on RFS than appendicular skeletons (p = 0.047). The R2 resection showed a significant association with lower RFS (p < 0.001) and OS (p = 0.006). Conclusion: Both tumor locations and resection margins affected RFS and OS, in agreement with the previous studies, and could be regarded as prognostic factors of chondrosarcoma. This study, however, could not statistically verify other promising factors, such as patient age and tumor grade, due to the study’s small population size. This vital obstacle could be overcome by means of multicenter studies or meta-analyses. Keywords: l Chondrosarcoma l Clinicopathological characteristics l Metastasis l Recurrence
Royal Thai Army Medical Journal Vol. 76 Supplement (1) November 2023 98 Abstract no. 60 Seroprevalence of hepatitis B viral infection and associated factors in pregnant women on antenatal care follow-up at Tha Wung community hospital, central of Thailand Ketmanee Keawmanee-aim, Palida Worasittichokchai and Wisit Kaewput Phramongkutklao College of Medicine Background: Hepatitis B infection is a serious liver disease caused by the hepatitis B virus, is a major public health problem in all countries around the world. The most common hepatitis B infection is from mother to child. Therefore, it is important to screen and care for pregnant women infected with hepatitis B to reduce the rate of mother-to-child transmission based on HBsAg. Objective: To determine the seroprevalence and associated factors of Hepatitis B viral infection in pregnancy women on antenatal care follow-up at Tha Wung community hospital, central of Thailand. Materials and Methods: Quantitative study by analytic cross-sectional study using secondary data from secondary data of the target population from the database in the medical record from department of Tha Wung hospital to find seroprevalence of hepatitis B viral infection and factors related to hepatitis B viral infection among pregnancy women on antenatal care follow-up at Tha Wung community hospital, central of Thailand and selecting the data of patients screened HBsAg from 1 August 2012 to 31 August 2022 Results: A total of population of this research is 621 pregnancies with screening HBsAg from 1 August 2012 to 31 August 2022. There were 13 pregnancies with HBsAg positive accounted for 2.09%. The multivariable analysis found that the protective factors affecting pregnant women with hepatitis B infections 0.198 times with a statistically significant decrease. Conclusion: Prevalence of HBsAg positive in pregnant women on antenatal care follow-up at Tha Wung community hospital patients from 1 August 2012 to 31 August 2022 is 2.09% compared with pregnant women on antenatal care with HBsAg screening during this period and factors associated with hepatitis B infection. The protective factors were non-Thai. Keywords: l Hepatitis B infection l Pregnant women
เวชสารแพทย์ทหารบก ปีที่ 76 ฉบับพิเศษ (1) พฤศจิกายน 2566 99 Abstract no. 61 Mortality of ST-elevation myocardial infarction (STEMI) patients and risk factors in Tha Luang, Lop Buri: Retrospective cohort study Naphat Wongkliawrian, Visavabhak Mahapol and Teeraboon Lertwanichwattana Phramongkutklao College of Medicine Background: Population around the world is going to be older, aging society is coming. Thailand is also going to have this problem. One global health problem that has a lot of disability-adjusted life years (DALYs) is ischemic heart disease (IHD). It has the highest DALYs in older-than-50-year-old population. ST elevation myocardial infarction is a type of the disease which is the most severe type of IHD. There are few studies conducted in Thailand in term of mortality rate of IHD; especially in local hospitals, which don’t have much potential in STEMI management by themselves. The result from these hospitals may be different from the result obtained from greater hospitals. Objectives: To determine mortality rate and risk factors involving in the mortality rate of STEMI patients in Tha Luang Hospital, Lopburi. Methods: We conducted a retrospective cohort study of 107 patients who are 18 years at least, diagnosed as STEMI by Tha Luang Hospital, Lopburi in period of January 1st, 2010 to May 31st, 2022, and have evidence whether they died by 30 days after diagnosis. Independent variables consist of pre-hospital and in-hospital variables. The former are age, gender, pain-to-door, comorbidity (diabetes, hypertension, dyslipidemia), smoking, alcohol drinking, and symptoms (chest pain, dyspepsia, dyspnea). The latter are door-to-EKG, Door-in Door-out, Fibrinolytics by Tha Luang Hospital, Dual Antiplatelet therapy by Tha Luang Hospital, and Troponin T. Dependent variables is 30-day mortality rate after STEMI diagnosis. Results: Thirty-day mortality rate of STEMI patients in Tha Luang Hospital is 13.7% or 4.80 person-days per 1,000 people. Univariate cox proportional hazard model indicated that significant risk factors are age (more than 75 years old) (HR = 4.83; 95%CI: 1.57-14.82; p-value = 0.01), male (HR = 0.32; 95%CI: 0.11-0.92; p-value = 0.04), and DAPT in Tha Luang Hospital (HR = 0.28; 95%CI: 0.10-0.81; p-value = 0.02) Conclusion: STEMI management in Tha Luang Hospital is good in term of mortality rate, compared to Thai STEMI mortality rate. (13.7% vs 17.0%) Risk factors we found are concordant with previous studies. However, we can’t conclude whether other factors, that are not significant, have no relationship with STEMI, due to small sample size. Keywords: l Myocardial infarction l STEMI l Mortality rate l Risk factors l Local hospital