หนังสือประชุมปี 2021

50

Abstract no. 22

Factors Predicting Coronavirus 2019 Preventive Behaviors of Army
Personnel in Military Communities, Bangkok Metropolitan

Udomphrueksa Y, et al.

Royal Thai Army Nursing College, Year 2021

The purpose of this predictive correlational research were identify coronavirus 2019 preventive
behaviors and factor predicting Coronavirus 2019 preventive behaviors among army personnel in military
communities. The Protection Motivation Theory (PMT) was use as a conceptual framework. The samples
were 200 army personnel in military communities and recruited by purposive sampling. Data were collected
in October 2021 via Google form. The questionnaire consisted of demographic data, factors related to
PMT constructs in 8 aspects: 1) perceived severity, 2) perceived vulnerability, 3) perceived rewards, 4)
response efficacy, 5) self-efficacy, 6) perceived response cost, 7) fear and 8) protection motivation and
Coronavirus 2019 preventive behavior. The Cronbach’s alpha of the questionnaire was 0.95. Data were
analyzed by Descriptive statistic, Pearson’s correlation coefficient, and Multiple liner regression analysis.
The finding revealed that average score of Coronavirus 2019 preventive behaviors among army personnel
were a good level. All of the PMT constructs and preventive behaviors were statistically correlated in the
same direction with the correlation coefficients between 0.338-0.804. The percentage of total variance
explained by protection motivation and self-efficacy was 67 percent (β = 0.505, β = 0.231, p < .01,
respectively). Military commanders or stakeholders should promote internal motivation of army personnel
by emphasizing the importance of preventing Coronavirus 2019 as well as strengthening their self-efficacy
by ensuring there competences in physical, mental, and intellectual aspects to perform the prevention of
Coronavirus 2019. Moreover, promoting the potential of personnel to act in order to prevent the spread
of COVID-19 by supporting resources to be readily available and sufficient.
Keyword: l Coronavirus disease 2019 l COVID-19 l Protection Motivation Theory
l Military communities l Army personnel

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

51

Abstract no. 23

Prevalence and Associated Factors of Alcohol Consumption among
Secondary School Students in Rural Community, Thailand

Pichak Pramaunururut1, Kullanith Romsaithong1, Jareewan Rangwanich1, Nuttamon Nukaeow1,
Thanapat Vongchansathapat1, Piti Wangroongsarb1, Poonyawee Chansaenwilai1, Ploynaphat Greeviroj1,
Pijak Anuntakulnathee1, Pimchanok Worawitrattanakul1, Pamornwat Rojanaprapai1, Veerapatra Tuntisirirux1,
Pongpisut Thakhampaeng2, Mathirut Mungthin3, Wanida Rattanasumawong4, and Boonsub Sakboonyarat2

1Medical Student; 2Department of Military and Community Medicine, Phramongkutklao College of Medicine; 3Department of Pharmacology,
Phramongkutklao College of Medicine, Phramongkutklao Hospital; 4Department of Psychiatry and Neurology, Phramongkutklao Hospital

Background: Alcohol consumption is one of the important causes of population health problems, globally. This problem
affects both physical and mental health of the individuals as well as their families and communities. The previous
evidence demonstrated that there is an increase in the trend in the alcohol consumption among Thai adolescents which
may contribute the problems when they grow up to be adults. Therefore, the investigators aimed to determine the
prevalence of alcohol consumption and its associated factors among adolescents in a rural community.
Methods: A mix-methods study was conducted in Na-Yao rural community, Chachoengsao Province, Thailand in 2020. A
cross-sectional survey using a standard questionnaire was performed among adolescent aged 13 to 18 years. Multivariable
logistic regression analysis was used to determine the associated factors for alcohol consumption. Subsequently,
qualitative method was conducted using focus groups discussion and in-depth interview. Potential stakeholders in the
community were selected from the purposive sampling in order to participate the session to define the possible causes
of alcohol consumption among adolescents.
Results: A total of 425 participants were enrolled in the quantitative study, in which 250 (60.4%) were female. The
average age of participants was 15.5±1.6 years. The prevalence of current alcohol consumption in the last 12 months
was 52.3%. After adjusting for potential confounders, the study found that female gender (AOR 1.94 95%CI: 1.01-3.78),
age (AOR: 1.42, 95%CI: 1.18-1.71), relationship problems (AOR: 2.82, 95%CI: 1.51-5.28), nights out (AOR: 3.47, 95%CI: 1.89-
6.38), active smoking (AOR: 4.39, 95%CI: 1.62-11.88), and social media use 6 hours/day (AOR: 2.08, 95%CI: 1.14-3.81) were
associated with current alcohol used. The focus group discussion and in-depth interview found that the main factors
for alcohol consumption were convenient stores, family, friends, having financial problems, knowledge, and personal
judgement, as well as social and environment.
Conclusion: Alcohol consumption was an essential health issues among adolescents residing in a rural community.
Social and behavioral risk factors played a major role for this issue. Therefore, the essential interventions, such as
empower health literacy and awareness, should be implemented in order to attenuate the modifiable risk factors.
Keyword: l Alcohol consumption l Adolescents l Mixed-methods study l Community

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 24

The Correlation between the Image of Professional Nurses in
the Mid of Covid-19 Crisis and the Decision to Enroll in the Faculty
of Nursing among High School Students

Soraya Niamsaard, Kunlanun Khunprasert, Nathanit Davivongs Na Ayudhaya, Natakit Sonkam,
Thunyapon Withitsutthikun, Narisara Doncharpai, Rattiyaporn Khotprom, Rujira Phoolperm,
Worameth Rangkarassamee, Supansa Kanthama, Supawan Pimankham, Arisa Asvakittimakul and
Chayaluck Siripukdeekan

The Royal Thai Army Nursing College

The purpose of this research was to study the image of professional nurses in the mid covid-19
crisis, according to the perceptions of high school students and to study the correlation between the
image of professional nurses and the decision to study in the Faculty of Nursing in the covid-19 situation
of high school students. The population used in the study was high school students, in 2021 in 6 sectors.
The sample group was students in grade 12, Science-Mathematics, in 2021 in 15 provinces. The sample
of 588 people was calculated by G*Power program, used 600 people and the sample was randomized
using a multi-stage random sampling method by dividing Thailand into 6 sectors, randomly selected 15
from 77 provinces, and selected 1 school in each province to obtain 40 students from each school. Data
were collected using an online survey (google form). The research in the image of professional nurse
aspect uses Strasen’s model and the decision aspect uses Simon’s theory. The reliability of the entire
questionnaire was checked by Cronbach’s alpha Coefficient (= .914). The statistics used for data analysis
were frequency distribution, percentage, mean, standard deviation and Pearson correlation coefficient.

The result showed that: 1) The image of professional nurses in the mid covid-19 crisis according
to the perceptions of high school students in all aspects, the top 3 rankings were level of education
and basic knowledge (X = 4.69, SD = .56), professional practice (X = 4.67, SD = .57), professional
communication (X = 4.64, SD = .60) and the aspect with the lowest value was the compensation aspect
(X = 3.90, SD = .61). 2) The correlation between the image of professional nurses and the decision to
enroll in faculty of nursing among high school students was a statistically insignificant correlation at the
.05 level. (r = .024, p = .563)

In this research, nursing organizations can be used for policy benefits, improve the image of
professional nurses and presenting the positive image of professional nurses to outsiders for a public
relations and can be used to instill a good conscience among students to create awareness and professional
pride, and it can also be used for high school students as a guideline for deciding to enroll in the Faculty
of Nursing.
Keyword: l The image of professional nurse l Covid-19 situation l High school students
Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

53

Abstract no. 25

Prevalence and Associated Factors of the Utilization of Traditional,
Complementary and Alternative Medicine among Hypertensive
Patients in Rural Community, Thailand

Nitipong Dolkulchai1 and Picha Suwannahitatorn2

1Medical Student; 2Department of Parasitology, Phramongkutklao College of Medicine

Background: The aim of this study was to determine the prevalence and associated factors of traditional,
complementary and alternative medicine (TCAM) use among hypertensive patients in a rural community
of Thailand.
Methods: A cross-sectional survey in with all hypertensive patients who live in Baan Na Yao, Baan Na
Ngarm, Tung Heang, Tung Sor Hong Sar, Sanamchaikhet district, Chachoengsao province, Thailand.
Results: A total of 207 participants diagnosed with hypertension. The majority of participants was
Buddhism, primary school, uncontrolled blood pressure and had been married. Prevalence of TCAM use
was 69.1%, herb was the most method used. Education level at high school, Buddhism, uncontrolled blood
pressure, married and no antihypertensive drugs use was more likely use TCAM. Multivariate analysis
found that TCAM use was significantly associated with to be married.
Conclusion: TCAM use among hypertensive patients in a rural community of Thailand was quietly high.
Herb is the most popular method had been used especially Thai basil. To be married was associated to
TCAM use. Better knowledge on the use of different TCAM modalities in this population may improve
patient management.
Keyword: l Traditional medicine l Complementary medicine l Alternative medicine
l Rural community

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

54

Abstract no. 26

The Relationship between Perception, Knowledge, Work Experience
toward COVID-19 Preventive Behaviors among Hospital Support
Staff at Phramongkutklao Hospital

Nutthaporn Dokkhem1, Kanyanat Phutrakun1, Kedkamol Buranaphong1, Janenisa Bintapanya1,
Chayanit Sukanthawarat1, Chatchadaporn Nirunsopon1, Nutchaya Kongkalai1, Natnicha Chaiwong1
Natacha Painirun1, Thipkesorn Mahasuk1, Pontip Thaengthong1, Amornrada Foosang1 and
Suwaluck Eaksamai2

1Senior nursing student; 2Nursing instructor of Pediatric Nursing Department, Royal Thai Army Nursing College

The Coronavirus disease 2019 (COVID-19) pandemic has affected several healthcare workers in
all levels, especially being infected from caring the COVID-19 patients. However, hospital support staffs
also at risk to be infected with COVID-19 virus from serving the patients. The statistics of COVID-19
infection rate of Phramongkutklao Hospital staffs, from April to July 2021, revealed that 13.94 percent
of the hospital support staffs had been infected with COVID-19 virus, which had a main effect on staff
shortage. This descriptive research aimed to study perception and knowledge levels about COVID-19 and
to study the relationship between perception, knowledge, work experience toward COVID-19 preventive
behaviors among hospital support staff at Phramongkutklao Hospital. One hundred and fifty-four staff
were enrolled by using the stratified random sampling. A questionnaire, yielding a value of Chronbach’s
alpha = 0.897, was used in this research. The data was analyzed by using both descriptive statistics
including frequency, percentage, mean, and standard deviation and inferential statistics, Spearman’s rank
correlation.

According to the findings, the average of work experience of the participants was 11 years
(X =1.078, SD=10.72). The perception level of COVID-19 was favorable (X = 3.95, SD = 0.54). Most of
participants had intermediate knowledge level of COVID-19, accounting for 77%. The majority of the staffs
demonstrated the highest level of COVID-19 preventive behaviors (X = 4.37, SD = 0.55). The perception
of COVID-19 had a positive correlation with COVID-19 preventive behaviors at the intermediate level (r =
.442, p < 0.001). Furthermore, there was a low level of positive correlation between COVID-19 knowledge
and COVID-19 preventive behaviors (r = .321, p < 0.001). Besides that, there was no correlation between
work experience and COVID-19 preventive behaviors. With regard to the findings, promoting COVID-19
preventive behaviors among hospital support staff by raising awareness and providing motivational
support should be focused. This study should be replicated with additional factors influencing COVID-19
preventive behaviors.
Keyword: l Perception l Knowledge l Work experience l COVID-19 preventive behavior

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

55

ผลงานโปสเตอรก์ ารประชมุ วชิ าการพระมงกฎุ เกลา้ ครง้ั ท่ี 49

01. How many attempt to improve arthroscopic skill via arthroscopic simulator in orthopedic
resident of Phramongkutklao Hospital: experimental study
Warunyu Limmaneevichitr (Department of Orthopedics) บทคดั ย่อท่ี 27
02. Correlation between neck circumference and fat proportion in liver
Pakapop Jinatongthai (Department of Medicine) บทคดั ย่อท่ี 28
03. Pediatric hemophagocytic lymphohistiocytosis in a tropical country: results of a multicenter
study in Thailand
Nattapol Rungrojjananon (Department of Pediatrics) บทคดั ย่อท่ี 29
04. Characteristic, etiology and clinical outcome of retinal vasculitis in tertiary military hospital
in Thailand
Sujaree Vanichseni (Department of Ophthalmology) บทคดั ย่อท่ี 30
05. Comparison outcomes between using Colorado needle electrocautery and scalpel for
upper eyelid blepharoplasty incision: A randomized controlled trial and systematic review
Peeraya Techasatian (Department of Surgery) บทคดั ย่อท่ี 31
06. Efficacy of carbogen inhalation with steroid in patient with sudden sensorineural
hearing loss
Krittapon Wongnaya (Department of Otolaryngology) บทคดั ย่อท่ี 32
07. An evaluation of the neutrophil to lymphocyte count ratio to predict the severity of the
disease in COVID-19 pneumonia patients at Phramongkutklao Hospital
Teeranad Srichantamit (Department of Trauma and Emergency Medicine) บทคดั ย่อท่ี 33
08. อตั ราความสำ� เรจ็ ในการเจาะช้ินเน้ือไตผ่านทางผิวหนงั โดยใชอ้ ลั ตรา้ ซาวนน์ �ำทางเพอ่ื ใหไ้ ดผ้ ลช้ินเน้ือ
ท่เี หมาะสมต่อการแปลผลทางพยาธวิ ทิ ยา ณ โรงพยาบาลพระมงกฎุ เกลา้
ศิรวิ รรณ นพคณุ (กองรงั สกี รรม) บทคดั ย่อท่ี 34
09. Caudal hypertonic saline for lumbar spinal stenosis: A double blinded, randomized,
controlled trial
Ponlawut Wongrawung (Department of Orthopedics) บทคดั ย่อท่ี 35
10. 0.075% capsaicin lotion for the treatment of peripheral neuropathy in ESRD patient:
A randomized double-blind placebo-controlled, cross over trial
Parinada Kittidanairuk (Department of Medicine) บทคดั ย่อท่ี 36
11. Clinical manifestations of intraocular tuberculosis in a tertiary hospital in Thailand
Sitrapa Janthayanont (Department of Ophthalmology ) บทคดั ย่อท่ี 37
12. Pelvic binding device from resistance band and bed sheet
Piriya Treerattanapan (Department of Trauma and Emergency Medicine) บทคดั ย่อท่ี 38

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

56

13. The effects of rice from starch-removing rice cooker on postprandial glucose and
insulin levels in healthy adults: A randomized double-blind, crossover study
Apanaree Bhekasuta (Department of Medicine) บทคดั ย่อท่ี 39
14. The study of quality of life in Thai patient with obstructive sleep apnea before and
after CPAP use
Sawanya Prammanakul (Department of Otolaryngology) บทคดั ย่อท่ี 40
15. Quilting suture for dead space obliteration versus conventional closure for the prevention
seroma after mastectomy for breast cancer
Witchuta Klom-on (Department of Surgery) บทคดั ย่อท่ี 41
16. Characteristics of drug-induced liver injury in chronic liver disease: Results from
the Thai association for the study of the liver (THASL) DILI registry
Pichaporn Surawongsin (Department of Medicine) บทคดั ย่อท่ี 42
17. New customized 3-dimentional printed exophthalmometer
Rungroj Angwatcharaprakan (Department of Ophthalmology) บทคดั ย่อท่ี 43
18. The impact of Covid-19 on physical and mental health of patients with
drug-resistant focal epilepsy
Pholpipat Bunluesin (Department of Medicine) บทคดั ย่อท่ี 44
19. Staphylococcus aureus nasal carriage and staphylococcus aureus blood stream
infection among conventional hemodialysis patients in Royal Thai Army Tertiary Hospital:
A prospective multicenter cohort study
Tanyanop Techasuphaboon (Department of Medicine) บทคดั ย่อท่ี 45
20. Correlation between giving total parenteral nutrition via peripheral vascular access
device and candidemia
Kritapas Chulakadabba (Department of Medicine) บทคดั ย่อท่ี 46
21. Validation & reliability of Thai version of the Mayo Elbow Performance Score (MEPS)
in patients with elbow pathology
Tanachot Singsuwit (Department of Orthopedic) บทคดั ย่อท่ี 47
22. A comparison of lateral collateral elbow ligament repair using transosseous fixation
versus anchorfixation in elbow dislocation
Pisitthisak Wongrapeephan (Department of Orthopedics) บทคดั ย่อท่ี 48
23. Comparison of clinical and radiographic outcomes between filling and non-filling of
the radial head fracture gap with autogenous bone graft following the open reduction
and internal fixation with plate and screw
Supanut Tantivorawong (Department of Orthopedics) บทคดั ย่อท่ี 49

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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24. The anatomical course of the infrapatellar branch of saphenous nerve and
the antero-inferior branch of femoral nerve in Thai people knee: a cadaveric study
Somchai Taosuwan (Department of Orthopaedics) บทคดั ย่อท่ี 50
25. Unilateral posterior lumbar interbody fusion for coronal balance correction in patients
with degenerative lumbar scoliosis
Sitthirat Thongsukkaeo (Department of Orthopedics) บทคดั ย่อท่ี 51
26. Anterior skin numbness and functional outcome after total knee replacement
between lateral and medial parapatellar approach: a randomized controlled trial
Krissada Mokmongkolkul (Department of Orthopedics) บทคดั ย่อท่ี 52
27. Risk factors for complications associated with post tonsillectomy in Phramongkutklao Hospital
during 2011-2020
Juthamard Moungthong (Department of Otolaryngology) บทคดั ย่อท่ี 53
28. Inflammatory patterns of chronic rhinosinusitis with nasal polyp based on
histopathologic profiles
Worranaree Charoenrungrat (Department of Otolaryngology) บทคดั ย่อท่ี 54
29. Parathyroidectomy in early severe secondary hyperparathyroidism: the comparison of
surgical outcomes
Prachaya Wattana (Department of Surgery) บทคดั ย่อท่ี 55
30. Single high-sensitivity cardiac troponin T (hs-cTnT) and chest pain score for early
detection of myocardial infarction among patients with low-level hs-cTnT in emergency
department
Thanadet Phongchomporn (Department of Trauma and Emergency Medicine) บทคดั ย่อท่ี 56
31. Critical inhaler technique errors in asthma and COPD patients in Phramongkutklao Hospital
Sasathorn Tharapoom (Department of Internal Medicine) บทคดั ย่อท่ี 57
32. Effect of tuna snack fortified with vitamins on pre-albumin in patients with chronic dialysis
Paramat Thimachai (Department of Medicine) บทคดั ย่อท่ี 58
33. Difference of story reading with virtual reality , basic eBooks and printed book on
parent-preschool interaction and reading comprehension
Suvamatha Singhaveerasamorn (Somdej Phranaresuan Maharaj Hospital) บทคดั ย่อท่ี 59
34. ถอดบทเรยี นความสำ� เรจ็ ในการพฒั นาพฤตกิ รรมสขุ ภาพของบคุ ลากรท่มี ีภาวะอว้ นลงพงุ
จฬุ ารตั น์ ดวงตาผา (โรงพยาบาลค่ายประจกั ษศ์ ิลปาคม) บทคดั ย่อท่ี 60
35. Application of artificial intelligence for assistance the diagnosis of hip fractures
on plain radiographs
Phichai Udombuathong (Ananthamahidol Hospital) บทคดั ย่อท่ี 61

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

58

36. A Comparative study on the effect of palliative care between palliative care team
and medical oncologists in patients with advanced cancer at Phramongkutklao Hospital
Pitchayapa Pornrattanakavee (Department of Medicine) บทคดั ย่อท่ี 62
37. การพฒั นาประสทิ ธภิ าพการฝึกภาคสนาม แบบออนไลน์ ในสถานการณ์การระบาดของโรคไวรสั โคโรน่า
สายพนั ธใ์ หม่ (COVID 19)ในการฝึกชดุ ปฏบิ ตั กิ ารของหน่วยทหารขนาดเลก็ ของนกั เรยี นนายสบิ ทหารบก
1 ปี 6 เดือน เหลา่ ทหารแพทย์ รุน่ ท่ี 24
นภสั ภรณ ์ วงษจ์ าด (โรงเรยี นเสนารกั ษ์ กรมแพทยท์ หารบก) บทคดั ย่อท่ี 63
38. การสอนแบบสรา้ งสรรคเ์ ป็นฐาน เร่อื ง การบรรยายสรุปทางทหาร รายวชิ า ฝ่ ายอำ� นวยการ 1
หลกั สูตรชน้ั นายพนั เหลา่ ทหารแพทย์
กลุ รศิ า เลก็ ใจกลา้ (โรงเรยี นเสนารกั ษ์ กรมแพทยท์ หารบก) บทคดั ย่อท่ี 64
39. นววถิ ี (New Normal) ของนายทหารนกั เรยี นท่เี ขา้ รบั การศึกษาตามแนวทางการรบั ราชการ
โรงเรยี นเสนารกั ษ์ กรมแพทยท์ หารบก
ยุทธพงษ ์ อม่ิ สุวรรณ (โรงเรยี นเสนารกั ษ์ กรมแพทยท์ หารบก) บทคดั ย่อท่ี 65
40. Prevalence of cryptococcus neoformans from avian droppingsin Nakhon Ratchasima Zoo;
Nakhon Ratchasima Province Thailand
Sudaluck Thunyaharn (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 66
41. The Study of Infant Sleep Problems and Affecting Factors in Phramongkutklao Hospital, Thailand
Thitinon Nimkatawuth (Department of Pediatrics, Phramongkutkao Hospital) บทคดั ย่อท่ี 67
42. ผลของรูปแบบการจดั การลดน้�ำหนกั ในบคุ ลากรกลมุ่ เสย่ี งและกลมุ่ ป่วยเป็นโรคอว้ น
โรงพยาบาลค่ายสมเด็จพระนเรศวรมหาราช จงั หวดั พษิ ณุโลก ท่มี ีค่าดชั นีมวลกายมากกว่า 23
ธดิ าพร สุขเกดิ (โรงพยาบาลค่ายสมเดจ็ พระนเรศวรมหาราช) บทคดั ย่อท่ี 68
43. Prevalence and risk factors of Gastroesophageal Reflux Disease in Bangkhla Hospital,
Bangkhla district, Chachoengsao province
Kaophiphat Thammasoon (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 69
44. Incidence of hypoglycemia in Diabetic Mellitus patients in Pattananikom Hospital
Wichayada Dachoviboon (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 70
45. Association of dyslipidemia and the progression of the disease in chronic kidney disease
patient in Thawung hospital, Thawung district, Lopburi province, Thailand
Jaturapat Sathitpat (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 71
46. Prevalence and risk factors of hyperglycemic crisis in diabetic patients at
Sanam Chai Khet Hospital, Sanam Chai Khet District, Chachoengsao Province, Thailand
Jirantanin Thanopajaisittikul (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 72
47. Prevalence and associated factors of macrovascular complications in patients with
hypertension; in Patthana Nikhom hospital, Lopburi province
Ratchasit Nawawat (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 73

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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48. Prevalence and Associated Factors of Osteoarthritis of the Knee and Knee Arthroplasty
in Patients Aged 60 Years and Older in Sanam Chai Khet Hospital, Chachoengsao Province
Petcharat Lertliewtrakool (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 74
49. Prevalence of Lumbosacral Transition Vertebrae and Its association with Lumbrosacral
Disc Height in Patients with Low back pain in Bangkhla Hospital, Chacheongsao, Thailand
Paris Marukatat (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 75
50. Progression, incidence of end stage renal disease, and mortality rate of chronic
kidney disease patients in Thaluang hospital, Thaluang district, Lopburi province
Natnitchakan Paha (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 76
51. Incidence and associated factor of diabetic kidney disease among Type 2 diabetic
patients in Thawung hospital, Thawung district, Lopburi province
Juthamas Sirivikul (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 77
52. Prevalence and associated factors of acute stroke in hypertension patient at
Thawung hospital, Lopburi province
Teerachot Thadmalai (Phramongkutklao College of Medicine) บทคดั ย่อท่ี 78

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564



61

Abstract no. 27

How Many Attempt to Improve Arthroscopic Skill Via Arthroscopic
Simulator in Orthopedic Resident of Phramongkutklao Hospital:
Experimental Study

Limmaneevichitr Warunyu and Heebthamai

Department of Orthopedics, Phramongkutklao Hospital

Purpose: Arthroscopic surgery is now one of the most common procedures performed in modern
orthopedics. surgeons-in-training must develop the technical skills necessary to perform surgery. These
2 modules were designed to address 3 basic arthroscopic skills. Box simulator showed that these 2
exercises are able to distinguish between the triangulation, visualization, and object manipulation skills.
The aim of this study is to evaluate how many attempt to training with Box simulator for improvement
of surgical skill.
Method: An Experimental study.Box simulator were created to test fundamental arthroscopic skills. 39
orthopedic resident performed 2 modules. Repeat each exercise for 10 times. Finish time for each
examination was recorded.Data analysis using the Generalizability theory for evaluation how many
attempt to improve arthroscopic skill that G-coefficient > 0.70
Result: All 39 orthopedic resident completed 10 attempt for each 2 modules. The median age was 29
(range, 27-32) years. There were 2 female and 37 male. Modules 1, minimum of finish time was 29 second
and maximum of finish time was 7.43 minute. Mean of finish time was 1.3 minute. modules 2, minimum
of finish time was 22 second and maximum of finish times was 5.48 minute. Mean of finish time was
1.10 minute. Results from the G-study about the generalisability of attempt that decreased finish time to
plateau time. The G-coefficient indicates more than 0.70 was 5 attempt (G-coefficient = 0.73)
Conclusion: Box simulator improve basic arthroscopic skills (triangulation, visualization, and object
manipulation) at 5 attempt for examination of 2 modules of this study design. From observation, this
model increase agility performance and hand-eye coordination skill that requirement basic skill for
arthroscopic surgery. Although Box simulator is inexpensive equipment but this design can improve
basic arthroscopic skill.
Keyword: l Box simulator l Fundamental arthroscopic skill

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 28

Correlation between Neck Circumference and Fat Proportion in Liver

Pakapop Jinatongthai1, Nakarin Sansanayudh1, Sudatip Sirichana2 and Sakkarin Chirapongsathorn1

1Department of Medicine, Phramongkutklao College of Medicine; 2Department of Family Medicine, Phramongkutklao College of Medicine

Background: Neck circumference (NC) is an attractive method for determining many of metabolic profile
and has many advantages over waist circumference (WC). Many studies show correlation between NC
and WC. We already know that WC is correlated with fat proportion in liver (hepatic steatosis). But the
correlation between NC and fat proportion in liver determine by CAP-TE haven’t been evaluated.
Objective: The primary outcome was the correlation between NC and hepatic steatosis. The secondary
outcomes were the correlation between WC and hepatic steatosis, the correlation between NC and NC
and the optimal cutoff of NC to determine hepatic steatosis
Methods: The data were collected from 18 years old or older male and female healthcare worker in
Phramongkutklao Hospital who got an annual healthy checkup between 14-29 September 2020. We
collected the age, sex, comorbidity, drinking history by using questionnaire. NC and WC were measure
by well-trained healthcare practitioner. CAP-TE was used to measure the degree of hepatic steatosis and
fibrosis by experienced operator. The result of liver stiffness result was reported in kPa, using the median
value of 10 measurements whereas the degrees of fatty liver were reported in dB/m.
Results: Three hundred thirty one subjects were included to the study. Two hundred ninety seven of 331
(87.92%) were female. We found the positive correlation between NC and hepatic steatosis (CAP >215
dB/m) (r = 0.581, p-value <0.001), between WC and hepatic steatosis (r = 0.522, p-value <0.001) and found
a strong, positive correlation between NC and WC (r = 0.744, p-value <0.001). Analysis of the ROC curve
for males and females NC were good and fair instrument for diagnosed hepatic steatosis (AUC = 0.8229;
95%CI: 0.66468-0.98115 and 0.7718; 95%CI: 0.71771- 0.82589)
Conclusion: NC is moderately correlated with hepatic steatosis
Keyword: l Neck circumference l Waist circumference l Hepatic steatosis l CAP-TE

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Abstract no. 29

Pediatric Hemophagocytic Lymphohistiocytosis in a Tropical
country: Results of a Multicenter Study in Thailand

Nattapol Rungrojjananon1,2, Samart Pakakasama3, Angkana Winaichatsak4, Rapee Siriwanawong4,
Piya Rujkijyanont5, Chanchai Traivaree5, Apichat Photia5 and Chalinee Monsereenusorn5

1Department of Pediatrics, Phramongkutklao Hospital; 2Department of Pediatrics, Charoenkrung Pracharak Hospital; 3Department of
Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; 4Department of Pediatrics, Maharat Nakhon Ratchasima Hospital
5Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition caused by
genetic mutation or various triggers disturbing the immune system.
Objective: To explore the clinical characteristics and determine prognostic factors associated with
outcomes among Thai children.
Methods: A multicenter retrospective study of pediatric patients with HLH receiving a diagnosis between
January 2005 and December 2019 from 3 pediatric oncology centers was conducted.
Results: In all, 78 patients with HLH with a median age at diagnosis of 3.17 (range, 0.08-17.83) years
were enrolled. The male to female ratio was 1.2:1. The most common type of HLH was infection-
associated hemophagocytic syndrome (IAHS) (n = 59, 75%) of which Epstein-Barr virus was the most
common pathogen. Thrombocytopenia, hyperbilirubinemia, and treatment response at weeks 2 and 8
after initiating treatment were associated with mortality. Platelet count < 50,000 cells/mm3 was the only
independent prognostic factor to define survival outcome (p-value 0.035). Two-year overall survival rate
was 71.3% (95% confidence interval, 59.2-80.3%). Survival rates between HLH types did not significantly
differ (p-value 0.571).
Conclusion: IAHS was the most common cause among pediatric HLH in Thailand. The outcomes of Thai
children with HLH were comparable to those of developed countries. Platelet count < 50,000 cells/mm3
was the only independent prognostic factor to define survival outcome.
Keyword: l Hemophagocytic lymphohistiocytosis l Thailand l Prognostic factors l Platelet count
l Outcome

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 30

Characteristic, Etiology and Clinical Outcome of Retinal Vasculitis in
Tertiary Military Hospital in Thailand

Sujaree Vanichseni, Sritatath Vongkulsiri, Raveewan Choontanom and Narumon Keorochana

Department of Ophthalmology, Phramongkutklao Hospital

Background: Retinal vasculitis leads to significant visual loss and complications.
Objective: To analyze the characteristic, etiology, and visual outcome of retinal vasculitis.
Design: Retrospective Cohort study.
Methodology: Retrospective review of 74 patients (106 eyes) with retinal vasculitis who had been treated
in Phramongkutklao Hospital from January 2013 to December 2020.
Results: Retinal vasculitis was found in 10% of uveitis patients, 74 patients (106 eyes) from 741 uveitis
patients, dividing into noninfectious group (64.9%) and infectious group (35.1%). The three most
common causes were Behcet’s disease (48.6%), ocular tuberculosis (20.3%), and viral infection (12.2%).
Behcet’s disease was the most common cause of all types of vascular leakage, shown on fluorescein
angiography, including venous leakage (56.3%), arterial leakage (56%), and capillary leakage (80.4%). The
other fluorescein angiography findings in retinal vasculitis were optic disc hyperfluorescence (73.7%),
capillary nonperfusion (43.2%), and macular nonperfusion (21.1%). Final best-corrected visual acuity was
0.86±0.97 logMAR (mean±SD). Cataract was the most frequent complications (42.5%) followed by cystoid
macular edema (40.6%) and elevation of intraocular pressure (34%). Acute clinical course (p = 0.025) and
retinal neovascularization (p = 0.031) were associated with infectious group. Forty-three percent of retinal
vasculitis was complicated by peripheral retinal ischemia requiring interventions including panretinal
photocoagulation (32%) and anti-vascular endothelial growth factor (17%), furthermore, 17% of the patients
underwent pars plana vitrectomy.
Conclusion: Nearly half of retinal vasculitis causes by Bechet’s disease. Clinical presentations of acute
onset and retinal neovascularization suggest infectious etiology. Retinal ischemia should be cautioned
and underwent early treatment to prevent further sight threatening complications.
Keyword: l Characteristic l Etiology l Complications l Retinal vasculitis l Thailand

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Abstract no. 31

Comparison Outcomes between Using Colorado Needle Electrocautery
and Scalpel for Upper Eyelid Blepharoplasty Incision: A Randomized
Controlled Trial and Systematic Review

Chatchai Pruksapong, Suttisun Jankajorn, Chairat Burusapat, Nutthapong Wanichjaroen,
Nuttadon Wongprakob and Peeraya Techasatian

Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine

Background: Upper eyelids blepharoplasty is one of the most popular aesthetic surgery in Thailand
and worldwide. Electrocautery has hemostasis benefit for skin incision but still question about its scar
cosmesis effect.
Objectives: The aims of our study are to compare Colorado needle electrocautery and scalpel in upper
eyelid blepharoplasty regarding incisional time, bleeding during incision, post operative ecchymosis and
scar.
Methods: Our prospective randomized control trial study included 25 patients undergoing upper
blepharoplasty incision by electrocautery and scalpel on each eyelid side. Intraoperative incisional time
and bleeding during incision were recorded. Patients follow up on day 3, day 7 and 1 month post
operative for ecchymosis evaluation by using Wound Doc application, measure ecchymosis area as
centimeter square and they have appointment at 1 month, 3 months and 1 years post operative for scar
evaluation by Vancouver scar scale, POSAS scale and Hollander wound evaluation scale. Additionally, we
conducted systematic review study about Colorado needle electrocautery in upper eyelid skin incision.
Results: Five articles were found in the systematic review. From RCT study, Electrocautery side produced
less bleeding during incision than scalpel side 2.54 vs. 3.04 average cotton bud sticks respectively (p =
0.003) and less hypopigmented scar but nostatistically significant.
Conclusions: Colorado needle electrocautery in cutting mode can replace performance traditional scalpel
for upper eyelid blepharoplasty incision and has equal scar effect, moreover the electrocautery has benefit
in hemostasis lead to decrease of bleeding that can obscure incisional site.
Keyword: l Colorado needle electrocautery l Scalpel l Upper blepharoplasty

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 32

Efficacy of Carbogen Inhalation with Steroid in Patient with
Sudden Sensorineural Hearing Loss

Krittapon Wongnaya and Saisuree Nivatwongs

Department of Otorhinolaryngology, Phramongkutklao Hospital

Background: Sudden sensorineural hearing loss is a rapid hearing impairment that required immediate
and careful treatment. The etiology of this disease is unknown. Vascular insufficiency caused by
Cochlear ischemia has been considered as the cause of SSNHL. Systemic steroids were used as a
standard treatment by decreased inflammation and cell death in the Cochlear. Many vasodilators and
vasoactive substances have been used to increase the success rate of treatment. Carbogen inhalation
(Mixed 95% Oxygen and 5% Carbon dioxide) results in increased Perilymphatic oxygen tension in the
Cochlear. This study tries to evaluate the efficacy of Carbogen inhalation as an additional treatment with
systemic steroids.
Objectives: To evaluate the efficacy of combined therapy of Carbogen inhalation with steroid in patients
with sudden sensorineural hearing loss.
Study design: Retrospective and prospective descriptive study
Materials and methods: Reviewed the medical records of all patients with SSNHL who visited the
Otorhinolaryngology department, Phramongkutklao Hospital from 1 January 2016 to 30 June 2021. The
study group consisted of 204 patients diagnosed with unilateral sensorineural hearing loss confirmed by
audiometry. Ninety patients were treated with systemic steroid only (S group) and 114 patients with
systemic steroid and Carbogen inhalation (SC group). All patients were undergone laboratory tests
to detected the cause of SSNHL. The therapeutic effects of the treatment groups were evaluated by
audiometry at 1-week and 1-month after treatment, using pure tone averages. Hearing threshold (dB) and
Siegel’s criteria for hearing improvement were used for the assessments.
Results: The baseline hearing threshold between the S group (54.96 dB) and the SC group (71.22 dB) was
a statistically significant difference, p-value < 0.0001). At 1-week post-treatment, hearing improvement is
12.23 dB in the SC group and 13.78 dB in the S group. At 1-month post-treatment, hearing improvement
is 25.15 dB in the SC group more than 17.61 dB in the S group. Even the SC group (46.01 dB) has a
poorer hearing threshold than the S group (37.35 dB) but there is no difference in hearing recovery when
evaluated by Siegel’s criteria. In patients with a baseline hearing threshold ≤ 90 dB (n = 165), the results
show that the baseline hearing threshold in the SC group (60.62 dB) was statistically significantly poorer
than the S group (48.81 dB), p-value = 0.0001. However, at 1-month post-treatment, hearing improvement

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

67
in the SC group is 23.77 dB more than 14.73 dB in the S group. So there is no statistically significant
difference in hearing threshold between 2 groups at 1 -month post-treatment. (34.08 dB in S group vs
36.86 dB in SC group, p-value = 0.3857)
Conclusion: Carbogen inhalation has high efficacy as an additional treatment to systemic steroids in the
treatment of SSNHL. We suggest using Carbogen inhalation added to systemic steroid in patients with
SSNHL that have no contraindication.
Keyword: l Sudden sensorineural hearing loss l Carbogen

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 33

An Evaluation of the Neutrophil to Lymphocyte Count Ratio
to Predict the Severity of the Disease in COVID-19 Pneumonia
Patients at Phramongkutklao Hospital

Teeranad Srichantamit and Kitisak Sanprasert

Department of Trauma and Emergency Medicine, Phramongkutklao Hospital

Background: At present, there has been a situation of rising COVID-19 infection in Thailand. The large
amounts of medical resources are required for COVID-19 infection patients. Most patients infected with
COVID-19 have co-morbid pneumonia (COVID-19 pneumonia) which requires urgent diagnosis and the
appropriate treatment to reduce the severity of the disease. However, when the infection enters into
the body, it produces a physiological response to inflammation by stimulating neutrophils, lymphocytes,
C-reactive protein (CRP), procalcitonin, and other cytokines. We would like to determine whether these
values can be used to predict the severity of COVID-19 pneumonia.
Objective: To study the accuracy and the cut-off point of the neutrophil to lymphocyte count ratio (NLCR)
as a predictor of the severity of the disease in COVID-19 pneumonia patients.
Methods: This study was a retrospective observational study performed by collecting data from
Phramongkutklao Hospital medical records between May 1st to December 31st, 2021. One hundred patients,
aged more than 18 years old at emergency department, were recruited. Receiver operating characteristics
(ROC) curve of NLCR was used to predict the severity of the disease in COVID-19 pneumonia patients.
Results: Of the 100 patients with the mean age of 69.8 years, there were 53 males (53%) and 47 females
(47%). Based on ROC curve of the NLCR, it was shown that NLCR test had a sensitivity of 72.3% and
specificity of 56.6%, with the cut-off point of ≥ 5.93.
Conclusion: NLCR is able to predict the severity of the disease in COVID-19 pneumonia patients. It is a
low-cost basic blood test that could get the result very quickly and universally available in every hospital.
Keyword: l Covid-19 l Neutrophil-lymphocyte count ratio l Severe pneumonia

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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บทคดั ย่อท่ี 34

อตั ราความสำ� เรจ็ ในการเจาะช้ินเน้ือไตผ่านทางผิวหนงั โดยใชอ้ ลั ตรา้ ซาวน์
น�ำทางเพอ่ื ใหไ้ ดผ้ ลช้ินเน้ือท่เี หมาะสมต่อการแปลผลทางพยาธวิ ทิ ยา
ณ โรงพยาบาลพระมงกฎุ เกลา้

ศิรวิ รรณ นพคุณ อนุชติ รวมธารทอง มงคล เจรญิ พทิ กั ษช์ ยั ศุภขจี แสงเรอื งอ่อน และ ไพบูลย์ คูหเพญ็ แสง

กองรงั สกี รรม โรงพยาบาลพระมงกฎุ เกลา้

ความเป็นมา ปจั จบุ นั ผูป้ ่วยในกลมุ่ โรค glomerular disease, renal failure (unknown cause) และ กลมุ่ graft rejection
มกั ถกู ส่งมาตรวจช้นิ เน้ือไต เพอ่ื ช่วยในการวนิ จิ ฉยั โรคทถ่ี กู ตอ้ งและแมน่ ยำ� ดงั นนั้ การทำ� หตั ถการเจาะช้นิ เน้ือไตเพอ่ื ใหไ้ ดผ้ ล
วนิ จิ ฉยั ทางพยาธวิ ทิ ยาทแ่ี มน่ ยำ� จงึ มคี วามสำ� คญั ต่อการรกั ษาและพยากรณโ์ รคต่อผูป้ ่วยกลมุ่ ดงั กลา่ ว
วตั ถปุ ระสงค์ เพอ่ื ศึกษาอตั ราความสำ� เรจ็ ในการเจาะช้นิ เน้ือไตโดยใชอ้ ลั ตรา้ ซาวนน์ ำ� ทาง เพอ่ื ใหไ้ ดผ้ ลช้นิ เน้ือทเ่ี หมาะสมต่อ
การแปลผลทางพยาธวิ ทิ ยา
วธิ กี าร เป็นการศึกษาวจิ ยั เชงิ พรรณนา (descriptive study) ในผูป้ ่วยทไ่ี ดร้ บั การวนิ จิ ฉยั ในกลมุ่ โรคขา้ งตน้ และส่งมาเจาะ
ช้นิ เน้ือโดยแพทยผ์ ูเ้ชย่ี วชาญดา้ นโรคไต จำ� นวน 65 ราย ตง้ั แต่เดอื นมกราคม พ.ศ. 2562 ถงึ สงิ หาคม พ.ศ. 2564
ผลการศึกษา พบวา่ มอี ตั ราความสำ� เรจ็ ในการเจาะช้นิ เน้ือไตทต่ี ำ� แหน่ง upper pole คดิ เป็นรอ้ ยละ 93.9 โดยมภี าวะแทรกซอ้ น
ทไ่ี มร่ ุนแรงคดิ เป็นรอ้ ยละ 6.2 และยงั พบวา่ อตั ราความสำ� เรจ็ และภาวะแทรกซอ้ นทเ่ี กดิ ข้นึ ระหวา่ งเขม็ 16G และ 18G ไมม่ ี
ความแตกต่างกนั ทางสถติ ิ (p-value = 1.0 และ p-value = 0.589 ตามลำ� ดบั )
สรุป การทำ� หตั ถการเจาะช้นิ เน้ือไตทต่ี ำ� แหน่ง upper pole มอี ตั ราความสำ� เรจ็ ในระดบั ทน่ี ่าพอใจพบภาวะแทรกซอ้ นทไ่ี มร่ ุนแรง
ตำ�่ โดยไมพ่ บภาวะแทรกซอ้ นทร่ี ุนแรงถงึ แก่ชวี ติ และขนาดเขม็ 16G และ 18G ไมม่ คี วามแตกต่างกนั ทางสถติ ิ
คำ� สำ� คญั l หตั ถการการเจาะช้นิ เน้ือไตโดยใชอ้ ลั ตรา้ ซาวน์ l Glomerular disease l Renal failure
l Graft rejection l ขนาดเข็ม

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

70

Abstract no. 35

Caudal Hypertonic Saline for Lumbar Spinal Stenosis: A double
blinded, Randomized, Controlled Trial

Ponlawut Wongrawung, Chaisiri Chaichankul and Pawin Gajaseni
Purpose: Degenerative lumbar spinal stenosis is an important problem. The presentation is chronic lower
back pain with or without radiculopathy. Many treatment modalities including surgery and epidural
administration of steroids, have been used to manage this pain. Hypertonic saline, which has been used
as a percutaneous epidural adhesiolysis, can be injected in expectation of longer-lasting effects. Limited
literature exists reporting outcomes of hypertonic saline injection with conventional epidural steroid
injection (ESI). This study aimed to determine the effect of adding hypertonic saline to conventional ESI
to provide pain relief for chronic radiculopathy patients.
Methods: A prospective double blinded, randomized control study were studied between January 2019
and December 2020, A total of 68 patients with central canal stenosis were randomly allocated into either
2 groups by a computer generated randomization program.

The 56 patients (26 in the hypertonic group, 30 in the control group) were reviewed and analyzed.
Both groups had similar etiological characteristics. The hypertonic group received 10% sodium chloride
solution added to 0.5% bupivacaine, and 80 mg. of methylprednisolone. The control group received
0.9% sodium chloride solution added to 0.5% bupivacaine and 80 mg. of methylprednisolone. Outcome
measures were taken at baseline, one, 3, and 6 months after procedure. The primary outcome measures
included the numerical rating scale (NRS) and Oswestry disability index (ODI). We considered a 50%
change of NRS and a 40% of ODI as the minimum clinically important difference (MCID). The changes
from baseline at each time point between 2 groups were compared using the Mann-Whitney U test.
Results: Caudal epidural steroid injection, with or without the addition of 10% hypertonic saline, was
effective and provided significant pain relief with the improvement of functional outcome within 1
months after the procedure (p < 0.001). The estimated difference in NRS scores from baseline throughout
a 6-month follow-up period in the hypertonic group were not clinically significantly higher than control
group (p = 0.60). The ODI was not different between the groups (p = 0.33).
Conclusion: Caudal ESI is a useful modality in treating pain secondary to central canal spinal stenosis,
and the short-term functional outcomes were also improved significantly. Based on these results, we
found no difference in the type of saline used for caudal ESI.
Keyword: l Caudal epidural steroid injection l Lumbar spinal stenosis l Hypertonic saline

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Abstract no. 36

0.075% Capsaicin Lotion for the Treatment of Peripheral Neuropathy
in ESRD Patient: A Randomized Double-blind Placebo-controlled,
Cross Over Trial

Parinada Kittidanairuk1, Narittaya Varothai2 and Veerapatr Nimkietkajorn3

1Internal Medicine Department; 2Nephrology Division, Internal Medicine Department, Phramongkutklao Hospital; 3Buddhachinaraj Hospital

Background: Neuropathic pain is one of the common symptom in chronic kidney disease (CKD) patients
leads to problems in physical, mental and quality of life. Pain medications are also limited in CKD. This
study aims to evaluate the effect of 0.075% capsaicin lotion in neuropathic pain, quality of life and side
effect of End Stage Renal Disease (ESRD) patient required Renal Replacement Therapy (RRT).
Methods: We conducted a multicenter randomized, double-blinded, crossover, placebo controlled trial
included 55 ESRD patients required RRT who had peripheral neuropathy in dialysis units in Bangkok
and Phitsanulok province. The participants were randomized to received 0.075% capsaicin/placebo for 8
weeks, then crossing over to the other treatment for 8 weeks after a 2-weeks washout period. Primary
outcome was the change in visual analog scale (VAS) score of pain severity. Secondary outcomes were
changes in neuropathic pain scale, short-form McGill Pain questionnaire, quality of life in kidney disease
using KDQOL-36 and adverse event.
Results: A total of 55 participants were enrolled, baseline VAS pain score was 6.05. After 8 weeks of
capsaicin lotion, VAS score decrease 1.75 (p = 0.615) after 8 weeks. Proportions of patients with pain
score reductions of 50% significantly decreased in capsaicin group 23 (41%) and 14 (25.45%) in control
group (p = 0.022). KDQOL-36, the mean score in daily activity trend to decrease 0.25 in capsaicin group
compare to 0.05 in control group (p = 0.094). Capsaicin lotion was well tolerated with some local skin
reactions.
Conclusion: In ESRD patients with peripheral neuropathy, 0.075% capsaicin lotion can significantly
decrease pain score 50% and trend to improve daily activity aspect of quality of life in kidney disease.
Keyword: l Capsaicin l Peripheral neuropathy l End stage renal disease

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 37

Clinical Manifestations of Intraocular Tuberculosis in a Tertiary
Hospital in Thailand

Sitrapa Janthayanont, Raveewan Choontanom and Yaninsiri Ngathaweesuk

Department of Ophthalmology, Phramongkutklao Hospital

Background: Tuberculosis (TB) has been ranked worldwide as the the 10th leading causes of all-cause
mortality and the leading cause of death by a single infectious agent. According to WHO in 2020,
Thailand is classified as the top 30 of high TB burden countries. In Thailand, ocular tuberculosis is
a major cause of uveitis and is associated with many eye problems. However, there are few studies
about intraocular tuberculosis in Thailand despite high endemicity. This study attempts to improve our
knowledge of ocular tuberculosis and compares clinical outcomes in management with the use of anti-
tuberculosis treatment (ATT) with or without systemic corticosteroids.
Objective: To report the clinical characteristics of intraocular tuberculosis (OTB), treatment regimen and
outcome in a Tertiary hospital in Thailand.
Design: Retrospective cohort study
Methodology: Retrospective review of 49 OTB-diagnosed patients (63 affected eyes) treated with ATT at
Phramongkutklao Hospital during 2013-2020.
Results: The most common clinical presentation of OTB was panuveitis (38.1%) followed by retinal
vasculitis and posterior uveitis (30.2 and 20.63% respectively). Patients were treated with ATT in 2
different duration, which is 6 months (49%), and minimum 9 months (51%). The 6 months treatment
group had better Best Corrected Visual Acuity (BCVA) than the 9 months group, both at the first
presentation (log MAR 0.65, 0.98) and at 6th month observation (log MAR 0.3, 0.62) (p = 0.037, p = 0.02). 33
eyes (52.4%) were treated with ATT and 30 eyes (47.6%) were using a combination of ATT with regional
and/or systemic steroids. Final BCVA increased similarly between these two groups (p = 0.35).
Conclusion: OTB is one of the common infectious uveitis in Thailand. Panuveitis was the most common
presentation of OTB in this study. Treatment duration varied but treatment more than 9 months in poorer
BCVA was preferred. Six-month treatment duration may produce less side effects while getting a good
result of BCVA gain. Treatment with ATT combined with corticosteroids were favored in the presence
of vitritis in order to resolve inflammation. Using the final BCVA as comparison, steroid-combined and
steroidless groups both gained better vision, with no statistical difference in BCVA.
Keyword: l Intraocular tuberculosis l Clinical presentations l Steroid

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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Abstract no. 38

Pelvic Binding Device from Resistance Band and Bed Sheet

Piriya Treerattanapan and Nat Krairojananan

Department of Trauma and Emergency Medicine, Phramongkutklao Hospital

Background: Pelvic injuries are common in blunt injury mechanisms, such as fall from height, traffic
accidents. Unstable pelvis fracture results in an increased pelvic volume that can accommodate a
large volume of blood and rapid death. The pelvis can be stabilized with a binder or sheet to limit this
expansion and control hemorrhage
Objective: To compare a pelvic binding device from resistance band and bed sheet and compare its
effectiveness with commercial pelvic binding device
Method: Experimental study for comparing pelvic binding device from resistance band and bedsheet,
twenty-four emergency medicine residents of Phramongkutklao Hospital were enroll. This study was
done in two consecutive parts. Firstly, the volunteers pulled the 25 kg resistance exercise band until
reach an appropriate tension 150 Newton (N) that able to hold the fracture. The stretching length were
recorded. Secondly, the resistance band was assembled to bed sheet for creating a pelvic binding device.
Then the volunteers were asked to apply the device to simulated patient with appropriate length. The
time of applying was recorded comparing with commercial pelvic binding device
Results: The length that volunteers pulled the resistance band to reach 150 N was 12.22±0.04 cm.
The mean time for applying the pelvic binding device made from resistance band was 68.21 seconds,
comparing to commercial device at 68.61 seconds (p-value = 0.290)
Conclusion: The pelvic binding device made from resistance band and bed sheet is effective for holding
the pelvic fracture. The time use for applying this device comparing to commercial device was not
different
Keyword: l Bed sheet l Pelvic binding device l Resistance band

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 39

The Effects of Rice from Starch-removing Rice Cooker on
Postprandial Glucose and Insulin Levels in Healthy Adults: A
Randomized Double-blind, Crossover Study

Apanaree Bhekasuta1, Rattanawan Jansasithorn2 and Chonpiti Siriwan1

1Endocrinology and Metabolism unit, Department of Medicine, Phramongkutklao Hospital and College of Medicine; 2Rice Department,
Thailand Rice Science Institute

Background: The starch-removing rice cooker (SRR) is an innovative kitchen appliance which uses
multiple water drainage techniques passing the rice to reduce starch from rice. Many manufacturers
claimed their success in starch reduction from the rice. We hypothesized that the rice from SRR cooker
might have a lower postprandial glucose than normal rice cooker.
Objective: To assess acute glycemic and insulin responses after ingesting rice from SRR versus normal
rice cooker in healthy adults.
Material and Methods: We conducted a first pilot randomized crossover study to compare the postprandial
glucose and insulin levels between rice from SRR versus normal rice cooker in healthy adults. This
randomized crossover study was done in healthy volunteers aged 18 years and older. The participants
were instructed to ingest 150 grams of rice which were randomly assigned to ingest rice from SRR or
rice from normal rice cooker. Plasma glucose and insulin measurements were taken at 30, 60 and 120
minutes. After 1 week, the participants were cross over to another rice and plasma glucose and insulin
levels were obtained as the same. The other metabolic parameters, satisfaction score and fullness were
recorded to compare between SRR and normal rice
Results: Plasma glucose at 30 minutes was significantly lower in the SRR group compared with the
control group (120.45±14.48 vs 137.27±22.21; p < 0.05). And Likewise, Plasma glucose at 60 minutes was
also significantly lower in the SRR group compared with the control group (110.82±18.08, 122.64±21.08; p
< 0.05). However, there is no statistically significant difference in insulin and triglyceride levels between
the SRR and control groups. Furthermore, there was no significant difference in appetite survey between
SRR and control groups.
Conclusion: Lower post prandial glucose has been observed in rice from SRR compared with normal rice
in healthy volunteers
Keyword: l Starch-removing rice cooker l Type 2 diabetes l Rice consumption
l Postprandial glucose

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

75

Abstract no. 40

The Study of Quality of Life in Thai Patient with Obstructive Sleep
Apnea before and after CPAP Use

Sawanya Prammanakul, Rutti Chumthong, Anisong Pilakasiri and Prasit Mahakit

Department of Otorhinolaryngology, Phramongkutklao Hospital

Background: Patients with obstructive sleep apnea (OSA) may be at risk for complications and medical
consequences such as cardiovascular and neurobehavioral disorders as well as the quality of life and
society activities. Polysomnogram is the gold standard for diagnosis of OSA. In case of moderate to
severe OSA and mild OSA with significant co-morbidities, Positive airway pressure (PAP) is considered
as the gold standard of treatment. There are many questionnaires used to assess quality of life, but
Sleep apnea quality of life index (SAQLI) was reported to has a good measurement property and the short
form of SAQLI has been validated into the Thai language (SAQLI-T). Treatment success is generally
the primary measure of AHI reduction, but some studies have found that AHI levels are relatively low in
correlation to quality of life. Therefore, the SAQLI-T questionnaire was directly used to assess the quality
of life of Thai patients with OSA before and after CPAP use.
Objective: The main purpose of this study is to compare the level of quality of life in Thai patient with
OSA before and after CPAP use. The secondary purpose is to determine whether there is the correlation
between quality of life and severity of OSA.
Study design: Observational Descriptive study
Material and methods: Seventy-eight patients with OSA diagnosed by PSG who had been using CPAP
adequately were enrolled to this study. The patients were asked to complete SAQLI-T three times,
before, 1-month, and 3-month after treatment initiation.
Result: Study included 78 cases (62 male and 12 females) with a mean age, weight, height, and body
mass index were 55.32±12.16 years, 82.1±19.05 kg, 167.19±8.97cm, and 29.27±5.88 kg/m2. The median
score of SAQLI-T before, after 1-month and 3-month CPAP usage were 41 (4-83), 23 (0-47), 9.50 (0-42)
respectively. The median AHI before, after 1-month and 3-month CPAP usage were 41.8 (15-113.6), 2
(0.07-13.5) and 1.55 (0-11.4) respectively. From spearman’s correlation, no correlation between SAQLI-T
and AHI (r = 0.202, p-value = 0.077, r = 0.099 p-value = 0.387, r = 0.131 p-value = 0.272)
Conclusion: Patients with OSA who use CPAP adequately have improved in quality of life after 1-month
of therapy. AHI also decreased statistical significance, but no correlation between quality of life score
and degree of severity of OSA.
Keyword: l Quality of life l SAQLI l Obstructive sleep apnea l CPAP

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 41

Quilting Suture for Dead Space Obliteration Versus Conventional
Closure for the Prevention Seroma after Mastectomy for Breast
Cancer

Witchuta Klom-on and Viriya Keowkangsadan

Department of Surgery, Phramongkutklao Hospital

Background: Breast cancer is the most common cancer in Thai women and mastectomy is one of the
major treatments. Seroma is one of the complications after mastectomy, which can worry the patient
and lead to further complications, namely wound infection or wound separation. The quilting suture
technique to close the dead space is not widely used in Thailand to prevent the formation of seromas and
shorten the time of drain removal. The aim of this study is to evaluate the significance of dead space
closure technique after mastectomy in terms of incidence of postoperative seroma and time of drain
removal.
Methodology: Study included patients with diagnosed breast cancer. Mastectomy with axillary clearance
surgery or total mastectomy and sentinel lymph node biopsy was done for them. Patients were divided
according to the technique of closure of mastectomyflap in to quilting and non-quilting group. Primary
outcomes were the presence of seroma complicationand the time for drain removal. Secondary outcome
were the mean differencesof fluid drained, stage of disease, level of axillary clearance, distribution of
patients according to type of malignancy, estrogen, progesterone and Her2/Neu receptor status.
Result: Results of the study showed that there was an association between type of operation and
presence of seroma, more seroma occurs among patients treated with non-quilting technique (11%), and
need to aspirated (mean = 65 mL), in comparison to quilting technique (no seroma formation among this
group) and more time needed to remove drain amongpatients treated with non-quilting technique (with
mean 11.8 d) in comparison to quilting technique (with mean 9.25 d).
Conclusion: Quilting or tacking mastectomy flap to the underlying muscles and fascia to obliterate the
surgical dead space is effectiveness in prevention of seroma formation and reduction time for drain
removal.

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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Abstract no. 42

Characteristics of Drug-induced Liver Injury in Chronic Liver Disease:
Results from the Thai Association for the Study of the Liver (THASL)
DILI registry

Sakkarin Chirapongsathorn1, Wattana Sukeepaisarnjaroen2, Sombat Treeprasertsuk3,
Roonguedee Chaiteerakij3, Pichaporn Surawongsin1, Chanunta Hongthanakorn4, Sith Siramolpiwat5,
Naichaya Chamroonkul6, Chalermrat Bunchorntavakul7, Watcharasak Chotiyaputta8, Kittiyod Poovorawan9,
Rattana Boonsirichan10, Saranath Lawpoolsri Niyom11, Chinnavat Sutivana4, Abhasnee Sobhonslidsuk12

1Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital, College of Medicine; 2Division
of Gastroenterology and Hepatology, Faculty of Medicine, Khon Kaen University; 3Division of Gastroenterology, Faculty of Medicine,
Chulalongkorn University; 4Division of Gastroenterology, Bhumibol Adulyadej Hospital; 5Division of Gastroenterology, Faculty of Medicine,
Thammasat University; 6Division of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University; 7Division of
Gastroenterology and Hepatology, Rajavithi Hospital, College of Medicine, Rangsit University; 8Division of Gastroenterology, Faculty of
Medicine, Siriraj Hospital, Mahidol University; 9Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University
10Division of Gastroenterology, Faculty of Medicine, Vajira Hospital; 11Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol
University; 12Division of Gastroenterology and Hepatology, Faculty of Medicine, Ramathibodi Hospital. Mahidol University

Background: Impact of drug-induced liver injury (DILI) on patients with chronic liver disease also remain
controversial because most reports were retrospective and unclear. This study aimed to determine the
incidence and seriousness of DILI focusing on a patient with chronic liver disease.
Method: We collected data on eligible individuals with suspected DILI during 2018 to 2020. Subjects were
evaluated systematically for other etiologies, causes, and severity of DILI.
Results: A total of 200 confirmed subjects were enrolled in the DILI registry. Among these, 41 subjects
were diagnosed chronic liver disease and 159 subjects were considered to show no evidence of chronic
liver disease in background. CAM products were identified as the most common class of DILI agents,
accounting for 24 (58.5%) cases. Individuals with pre-existing chronic liver disease had similar severity
including mortality. Twelve patients (6%) developed fatal outcome related to the DILI.
Conclusion: Patients with chronic liver disease and DILI experienced similar outcome in general, but
results may need to be confirmed using a large sample size.
Keyword: l DILI l DILI Network l Toxicity l Medication

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 43

New Customized 3-Dimentional Printed Exophthalmometer

Rungroj Angwatcharaprakan, Raveewan Choontanom and Sombat Tanaboonyawat

Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine

Background: The exophthalmometer invention has been developed for a century. Its benefits are
helping diagnose and monitor eyeball protrusion and return more objective data than direct observation.
In Thailand, the cost of an exophthalmometer is relatively expensive. With 3-Dimensional printing
technology, we could develop a cheaper, user-based, and practicable exophthalmometer model.
Objective: To develop an exophthalmometer by 3-D printing technology. To analyze validity and reliability
of 3-D printed exophthalmometer and compare to the original exophthalmometer.
Methodology: Our study reviewed, designed, and developed an exophthalmometer with 3-D printing
technology. The model was calibrated and compared with the original exophthalmometer. Then validity
and reliability were analyzed.
Result: Data of 20 eyes indicate the validity of the produced model by Pearson’s coefficient correlation
right eye 0.869 (p-value = 0.001), left eye 0.907 (p-value < 0.001). Paired T-test between the examiners
shown no statistical difference (Base width 0.3 mm ± 3.53, p-value = 0.794; Right eye 0.3 mm ± 2.06,
p-value = 0.656; Left eye 0.30 mm ± 2.58, p-value = 0.656).
Conclusion: The new customized 3-D printed exophthalmometer showed good validity and reliability.
Further development of this prototype with a variety of material selection might be better respond to user
needs and lower the cost of production.
Keyword: l Exophthalmos l Exophthalmometer l Proptosis measurement
l Computer aided design in ophthalmology l 3-D Model l 3-D Printer

Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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Abstract no. 44

The Impact of Covid-19 on Physical and Mental Health of Patients
with Drug-Resistant Focal Epilepsy

Pholpipat Bunluesin1, Siriphong Thanapatphakin2 and Pasiri Sithinamsuwan1

1Division of Neurology, Department of Medicine, Phramongkutklao Hospital; 2Faculty of Pharmaceutical Science, Burapha University

Objective: During the third wave of COVID-19 in Thailand, researchers aimed to see how people with
drug resistant focal epilepsy (DRE) experienced about anxiety, depression, seizure frequency, and quality
of life.
Method: At visit-1 (baseline) and visit-2 (1-month follow-up), we asked patients with DRE who visited
our Neurology Clinic Phramongkutklao Hospital to complete questionnaires to assess anxiety (Hamilton
Anxiety Rating Scale; HAM-A), depression (Patient Health Questionaire-9 Thai version; PHQ-9T), and
quality of life (Patient Weighted Quality Of Life in Epilepsy-10; QOLIE-10). In addition, a seizure diary
was collected in order to determine seizure frequency.
Result: From July to September 2021, nine individuals with DRE (five males, average age 37.7 years)
took part in the study and performed evaluations twice, one month apart. The median monthly seizure
frequency was decreased from 3 to 1 after a one-month survey, p = 0.257. The HAM-A average and
range were increased slightly from 10.44 to 11.33, with a p-value of 0.859. PHQ-9 averages were 6.22 and
6.44, respectively, with a p-value of 0.609. The QOLIE-10T score was lowered from 41.33 to 40.79, with
a p-value of 0.622.
Conclusion: The third wave of COVID-19 in Thailand had no effect on the physical or emotional wellbeing
of individuals with drug-resistant focal epilepsy.

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 45

Staphylococcus aureus Nasal Carriage and Staphylococcus aureus
Blood Stream Infection among Conventional Hemodialysis Patients
in Royal Thai Army Tertiary Hospital: A Prospective Multicenter
Cohort Study

Tanyanop Techasuphaboon1, Narittaya Varothai1, Vasin Vasiksin1,2, Navee Rak Nai Sil2 and
Worapong Nasomsong1

1Department of Internal Medicine, Phramongkutklao Hospital; 2Department of Internal Medicine, Ananda Mahidol Hospital

Background: In Thailand, hemodialysis is the principally renal replacement therapy among end-stage
renal disease patient. Infection is a major complication of hemodialysis, lead to morbidity and mortality.
The most common infection is blood stream infection and S. aureus is the mainly causative pathogen. S.
aureus nasal carriage recognized as important risk factor for S. aureus blood stream infection and screening
of S. aureus nasal carriage among hemodyalysis patient is routinely practice in several countries. In
Thailand, S. aureus nasal carriage screening is not a standard practice and lack of the data in prevalence
and correlation with nasal carriage and S. aureus invasive disease. Thus, we aim to investigate the
prevalence of S. aureus nasal carriers and the relationship between nasal S. aureus carriers and S. aureus
blood stream infection among ESRD patients at the dialysis center of Royal Thai Army Tertiary Hospital
(Phramongkutklao Hospital and Ananda Mahidol Hospital).
Method: Prospective multicenter cohort study was conducted. Anterior-nares nasal swab was performed
once a week for 2 weeks in each participant. Participants who had S. aureus nasal carriage were
classified in to two groups: transient and persistent colonization. Incidence of S. aureus bloodstream
infection in six months after the last sample collection was observed. The obtained data were statistically
analyzed and odd ratios with 95% CIs were used to declare statistical significance.
Results: The prevalence of S. aureus nasal carriage in hemodialysis patients in both hospitals was 11.67%
(14/120), 10 cases classified as intermittent, and 4 cases classified as persistent S. aureus nasal carriage.
Incidence of S. aureus bacteremia among hemodialysis patients was 3.3%. Among participants who had
S. aureus nasal carriage, one participant had S. aureus bacteremia (7.1%; 1/14) and 3 participants who
were not carriers had S. aureus bacteremia (2.8%; 3/106). Participants with S. aureus nasal carriage were
2.64 times likely to develop S. aureus bacteremia than participants who were not colonized with S. aureus
at 6 months (p = 0.398), but not statistically significant.
Conclusion: Prevalence of S. aureus nasal carriage among hemodialysis patients at Royal Thai Army
tertiary hospitals were 11.67% and patients who has S. aureus nasal carriage increase risk to develop to
S. aureus bacteremia at 6 months, but not statistically significant.
Keyword: l End-stage chronic kidney disease l Hemodialysis l S. aureus nasal carriage
l S. aureus bloodstream infection
Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

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Abstract no. 46

Correlation between Giving Total Parenteral Nutrition via Peripheral
Vascular Access Device and Candidemia

Kritapas Chulakadabba and Bhagawat Tangaturonrasme

Department of Medicine, Phramongkutklao Hospital

Background: Candidemia has been the most common cause of fungal infection in hospitals, a problem
in every healthcare setting worldwide. Risk factors included ICU admission, central venous catheter
insertion, use of total parenteral nutrition, etc. However, most of the candidemia risk factor studies
used TPN via a central venous catheter, and the risk of using TPN via peripheral vascular access was
inconclusive.
Objectives: To study the relationship between using TPN via peripheral vascular access and candidemia
in hospitalized patients.
Methods: Analytic observational, retrospective matched case-control study. We identified the population
from the ICU of Phramongkutklao hospital. The study team collected the possible risk factors, route, total
calories, and nutrient composition in TPN. STATA14 was used for data analysis.
Results: There were 42 patients in the disease group and 84 In the control group. The mean age of the
patient was 65-year-old. Most patients were male gender (68%) died in hospital (81%) and were admitted
to Medical ICU (85.7%). The risk factors of candidemia included recent abdominal thoracic surgery (OR
4.61, p = 0.005), prolonged use of antibiotics (OR 5.01, p = 0.015), using TPN (OR 2.20, p = 0.041), and
using TPN via peripheral vascular access (OR 3.60, p = 0.024). Using TPN via peripheral vascular access
over central venous catheter did not reduce candidemia risk (HR 0.88, p = 0.78). Type of TPN (HR 1.21, p
= 0.684), total calories from TPN (HR 1.10, p = 0.878) also did not increase the risk of candidemia.
Conclusion: Recent abdominal/thoracic surgery, prolonged use of antibiotics, using TPN via a central
venous catheter, and via peripheral venous access were associated with candidemia. Nevertheless,
using the TPN via peripheral venous access over a central venous catheter did not decrease the risk
of candidemia. Moreover, changing the type of TPN or the amount of total calories from TPN did not
increase candidemia risk.
Keyword: l Candidemia l Total parenteral nutrition l Peripheral parenteral nutrition

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

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Abstract no. 47

Validation & Reliability of Thai version of the Mayo Elbow Performance
Score (MEPS) in Patients with Elbow Pathology

Tanachot Singsuwit, Arkaphat Kosiyatrakul and Suriya Luenam

Department of Orthopedic Surgery, Phramongkutklao Hospital and College of Medicine

Background: Nowadays, Many scoring systems have been used for elbow disorders, but there is no
universal agreement regarding which system should be used, because many of them lack reliability data
and many assess only some aspects of elbow function. The Mayo Elbow Performance Score (MEPS)
is a widely used performance index for evaluation of clinical outcomes for a variety of elbow disorders.
Because there are few subjects assessed compared to other elbow function outcomes questionnaires. It
is an easy to understand question in clinical practice. Thailand, However, has not yet developed its own
evaluation test for outcomes of elbow pathology; therefore, this study aims to assess the precision and
the accuracy in order to develop an official Thai version of MEPS (MEPS-Th)
Objective: To develop and test the validity and reliability of Thai version of the Mayo Elbow Performance
Score (MEPS-Th) in patients with elbow pathology assessed by Thai patient with elbow pathology and
explore whether it had (1) sufficient reliability and external consistency, (2) adequate construct validity,
and (3) reasonable criterion validity compared with the Disabilities of the Arm, Shoulder and Hand
(DASH) score and the Short Form (36) Health Survey (SF-36) using psychometric analysis.
Materials and Methods: Original English version of the Mayo Elbow Performance Score (MEPS) in
patients with elbow pathology only was cultural adapted into Thai language through forward-translation,
backward-translation, and consent review. Thai version of MEPS (MEPS-Th) was content validated for
content validity index (CVI) by 5 orthopaedic upper extremity specialists. The criterion validity comparing
with The Disabilities of the Arm, Shoulder and Hand (DASH) score and the Short Form (36) Health
Survey (SF-36) for Pearson’s correlation coefficient (r) and reliability test in terms of external consistency
(intraclass coefficient-ICC) were assessed. Correlation analysis between Thai version of MEPS (MEPS-Th)
and other physical functional and quality of life assessment were done.
Results: Seventy-three patients with elbow pathology with mean age of 45.93 years old was recruited
in study. Data was collected during May 2019 to February 2021 at Outpatient Orthopaedic Clinic,
Phramongkutklao Hospital. Most were diagnosed for elbow dislocation (32.88%), lateral epicondylitis
(28.77) and radial head fracture (20.55%). Of total, 42 patients (57.53%) received operative treatment and
31 patients (42.47%) received nonoperative treatment. The validity of Thai version of MEPS (MEPS-Th) in
patients with elbow pathology only was rated as acceptance for construct validity and content validity
with CVI of 1.00, Excellent for criterion validity with r value of 0.903 related with the Disabilities of the
Royal Thai Army Medical Journal Vol. 74 Supplement (1) November 2021

83
Arm, Shoulder and Hand (DASH) score and acceptable for criterion validity with r value of 0.501 related
with physical health summary scale of the Short Form (36) Health Survey (SF-36). Reliability test of study
instrument was assessed as excellent (ICC = 0.902) for external consistency.
Conclusion: Thai version of MEPS (MEPS-Th) in patients with elbow pathology was valid and reliable to
evaluate functional outcome in Thai patients with elbow pathology. It also related well with Thai version
DASH score and physical health summary scale of Thai version SF-36.
Keyword: l Mayo elbow performance Score (MEPS) l Thai version- the disabilities of the arm
l Shoulder and hand (DASH) score l Functional outcome
l Thai version- the short form (36) health survey (SF-36) l Rating scale l Quality of life
l Elbow pathology l Validity l Reliability

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

84

Abstract no. 48

A Comparison of Lateral Collateral Elbow Ligament Repair Using
Transosseous Fixation Versus Anchor Fixation in Elbow Dislocation

Pisitthisak Wongrapeephan and Suriya Luenam

Department of Orthopedics, Phramongkutklao Hospital and College of Medicine

Background: The lateral collateral ligament (LCL) complex of the elbow is a ligament with a complex
structure. The main reason for LCL injury is elbow dislocation. Patients experience failed support healing
procedures due to instability or moving the joint after the bone has been pulled in place. These patients
need surgery for the fastest movement of the elbow wherein the repair of LCL is the appropriate method
for repairing lateral collateral elbow ligament. There are two widespread and standardized methods
including transosseous fixation and anchor fixation which are healing methods that allow the elbow
to be functional again but there is no clear comparative study on the results and complications of the
procedures. This research, therefore, has the purpose to study the comparative results in stability after a
lateral collateral elbow ligament repair via a transosseous fixation and an anchor fixation.
Objectives: 1) To study the comparative results in stability after a lateral collateral elbow ligament repair
via a transosseous fixation and an anchor fixation. 2) To study the comparative complications after a
lateral collateral elbow ligament repair via a transosseous fixation and an anchor fixation. 3) To study the
difference in radiographic measurements after a lateral collateral elbow ligament repair via a transosseous
fixation and an anchor fixation.
Methods: This study is an ambidirectional cohort study by selecting patients diagnosed with fractures and
elbow dislocations who are healed through a lateral collateral elbow ligament repair via a transosseous
fixation or an anchor fixation at Phramongkutklao Hospital between 2010-2019.

The main objective is to study the comparative results in stability after a lateral collateral elbow
ligament repair via a transosseous fixation and an anchor fixation. The minor objectives are to study
the comparative complications after a lateral collateral elbow ligament repair via a transosseous fixation
and an anchor fixation and to study the difference in radiographic measurements after a lateral collateral
elbow ligament repair via a transosseous fixation and an anchor fixation.
Results: There are 107 research participants with 55 lateral collateral elbow ligament repairs via
transosseous fixation patients and 52 lateral collateral elbow ligament repair via anchor fixations.
The MAYO Elbow Performance Score Imaging Results (widening, joint congruency, Arthritic change)
instability, joint stiffness, non-infected joint, bone regeneration in tissues, arthritis, osteoarthritis, articular
fibrosis, misaligned bone, and nerve dysfunction after surgery found that the group treated for lateral
collateral elbow ligament repair by transosseous fixation was more common than those who received
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85
lateral collateral elbow ligament repair by anchor fixation but the difference is not statistically significant.
Conclusions: There are two widespread and standardized lateral collateral elbow ligament repairs including
transosseous fixation and anchor fixation. In patients diagnosed with fractures and elbow dislocations,
there were no significant differences in stability, complications, and radiographic outcomes following
lateral collateral elbow ligament repair surgery that is statistically significant.
Level of evidence: Level III, Ambidirectional Cohort Study
Keyword: l Lateral collateral elbow ligament l Elbow dislocation l Transosseous fixation
l Anchor fixation

เวชสารแพทยท์ หารบก ปีท่ี 74 ฉบบั พเิ ศษ (1) พฤศจกิ ายน 2564

86

Abstract no. 49

Comparison of Clinical and Radiographic Outcomes Between filling
and Non-filling of the Radial Head Fracture Gap with Autogenous
Bone Graft Following the Open Reduction and Internal Fixation with
Plate and Screw

Supanut Tantivorawong and Suriya Luenam

Department of Orthopedics, Phramongkutklao Hospital

Purpose: The use of bone graft for Mason type II,III radial head fracture with gap is not widely recognized
since there was no previously research comparing the outcome between use of bone graft and non-bone
graft. Therefore, this paper is the first comparative study. Hence, the purpose of this study is going to
identify clinical and radiographic outcome of intraoperative capitellar bone graft compared to the patients
treated with non-bone graft.
Method: A retrospective cohort study was done for closed Mason type II,III radial head fracture with bone
gap who underwent open reduction and internal fixation with plate and screws from 2011 until 2020.
Patients were classified into two groups: Used intraoperative capitellar bone graft augmentation and Non-
used intraoperative capitellar bone graft augmentation. All patients were recorded fracture union after 12
months surgery, Mayo elbow performance score (MEPS) at 3,6 and12 months.
Results: There was no difference in demography, Mason classification in both groups. Fracture union
was no difference at 12 months. Mayo elbow performance score(MEPS) at 3, 6 and 12 months in used
intraoperative capitellar bone graft augmentation was significantly higher than non-used intraoperative
capitellar bone graft (p = 0.028, p = 0.005, p = 0.01 retrospectively).
Conclusion: Open reduction and internal fixation with plate and screws with capitellar bone graft
augmentation in radial head fracture with bone gap can be improved clinical outcome at 3, 6 and 12
months after surgery but on difference in fracture union.
Level of evidence: Level II, retrospective cohort studies
Keyword: l Autogenous bone graft l Open reduction and internal fixation with plate and screws
l Clinical outcome l Radiographic outcome l Radial head neck fracture

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Abstract no. 50

The Anatomical Course of the Infrapatellar Branch of Saphenous
Nerve and the Antero-Inferior Branch of Femoral Nerve in Thai
people knee: a Cadaveric Study

Somchai Taosuwan and Ong-art Phruetthiphat

Department of Orthopaedics, Phramongkutklao Hospital

Background: Total knee replacement (TKR) is one of the most successful procedures for patients with
severe knee osteoarthritis (OA) demonstrating pain relief, functional improvement, and better quality of
life. Recently, Tanavalee et al. demonstrated that there was no difference of skin numbness between
minimally invasive and standard approach for TKR (1) while Phruetthiphat et al. demonstrated that the
duration of numbness recovery following TKR was significantly longer in diabetic patients (p = 0.001) and
the involvement of supero-lateral skin numbness (p = 0.007) significantly correlated with the proximally
extended skin incision above upper pole of patella more than 4.0 centimeters. (2) However, current
literature lacks data demonstrated why some patients have large skin numbness including the superior-
lateral area adjacent to the patella that was not be innervated by the infrapatellar branch of saphenous
nerve (IPBSN). We hypothesized that the superior-lateral area was possibly supplied by anterior-inferior
branch of the femoral nerve (AIBFN).
Objective: To define course and distribution of IPBSN and AIBFN.
Methods: We performed a cadaveric study of 32 cadaveric knees between April 2019 and June 2019.
Normal lower limb and knee profile were carefully dissected by a single surgeon to evaluate the course
and distribution of the AIBFN and the IPBSN. Data description was based on means and standard
deviation for continuous variables and absolute and relative frequencies for categorical variables.
Results: The IPBSN was classified into 2 types, cross midline (68.8%) and uncross midline (31.2%). The
cross-midline type defined as the main branch of IPBSN (Green color line) extend crossing the vertical
imagination line (Black line) from the middle of patella straight down into the tibial tubercle while the
uncross-midline type defined as the main branch of IPBSN did not touch the vertical line. The number
of branches were categorized into 3 types, one main branch (13.3%), 2 branches (40.0%), and at least 3
branches (46.7%).

The AIBFN was dissected and it was classified into 3 types: Quadricep type (50%), Medial type
(43.8%), and Variant type (6.2%). The Quadricep type defines as this nerve distribute along the Rectus
femoris muscle, the Medial type defines as the main branch goes along the vastus medialis muscle while
the Variant type defines as this nerve originated from the distal part of the Lateral Femoral Cutaneous
Nerve of Thigh (LFCN)

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Conclusion: Any skin incision during TKR through medial parapatellar approach cannot reduce the area
of skin numbness. In addition, the extended skin incision above the upper pole of patella possibly causes
the superolateral skin numbness of the knee.
Keyword: l Total knee replacement l Cadaveric study l Infrapatellar branch of saphenous nerve
l Anterior-inferior branch of the femoral nerve

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Abstract no. 51

Unilateral Posterior Lumbar Interbody Fusion for Coronal Balance
Correction in Patients with Degenerative Lumbar Scoliosis

Sitthirat Thongsukkaeo, Pawin Gajaseni and Chaisiri Chaichankul
Department of Orthopedics, Phramongkutklao Hospital
Study Design: A retrospective radiographic study.
Background: Sagittal imbalance have been extensively described in the literature during the past decade,
whereas there was paucity of literature paying attention to coronal imbalance. The unilateral posterior
interbody fusion (PLIF) was performed at the most tilting region on concave side of the curve. The current
study reports radiological outcomes in patients with degenerative lumbar scoliosis (DLS) undergoing
multilevel instrumented fusion and unilateral PLIF.
Objective: To study the radiological outcome in Unilateral Posterior Lumbar Interbody Fusion for coronal
balance correction in patients with Degenerative Lumbar Scoliosis.
Methodology: The study included 20 consecutive patients with DLS who underwent instrumentation and
unilateral PLIF. All eligible patients meeting a minimum 2-year follow up criteria were included. The
radiological parameters, measured on the pre- and post-operative anteroposterior and lateral radiographs,
were compared and analyzed. Patients were classified into three groups (group A, B, and C) according
to coronal balance (shifting of C7 plumb line) and the convex of curvature. In Group C (convex type), we
inserted PLIF cage unilaterally on concave side of the curve paying attention to the fractional curve to
correct tilting of L4 vertebral body. The primary outcome was postoperative improvements in radiological
parameters at 6-week and last follow up, assessed using the paired t test to compare the differences. A
p < 0.05 was considered statistically significant.
Result: Differences of the radiological parameters between pre- and post-operation concerning Cobb
angles both the main curve and fractional curve, degree of apical vertebra rotation, TK, LL, SS, PT, and
SVA, were significant improved (p < 0.05). Main TL/L Cobbs was improved from 25.87 degree to 8.99
degree (p < 0.05). Fractional curve (L4-S1) Cobb was improved from 10.14 degree to 5.08 degree (p
< 0.05). Coronal imbalance was improved from 3.28 cm to 1.30 cm. (p < 0.05). In our cohort, we found
the group C was also improved in curve correction, coronal and sagittal balance after surgery.
Conclusion: The posterior instrumented fusion and unilateral PLIF might provide the improvement of
coronal balance in DLS. Although interbody cage was inserted unilaterally, the sagittal parameters were
also improved effectively.

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Abstract no. 52

Anterior Skin Numbness and Functional Outcome after Total Knee
Replacement between Lateral and Medial Parapatellar Approach: A
Randomized Controlled Trial

Ong-Art Phruetthiphat, Krissada Mokmongkolkul and Rit Apinyankul

Orthopedics, Phramongkutklao Hospital

Introduction: Anterior skin numbness from injury of the infrapatellar branch of saphenous nerve (IPBSN)
has been reported as a common occurrence after TKR, and may affect the patients’ outcome. A
prospective study showed that there was no difference in anterior skin numbness between minimally
invasive and standard approach TKR while the anterolateral skin incision had a significantly smaller area
of skin numbness postoperatively compared to the anterior midline incision. Additionally, TKR in diabetic
patients had a higher rate of global anterior numbness and a longer time of numbness recovery than
non-diabetic patients. However, no study has compared the skin numbness between lateral parapatellar
and medial parapatellar approach undergoing TKR. The purposes of our study were to 1) compare the
prevalence of skin numbness between lateral and medial parapatellar approach undergoing TKR, 2)
compare the numbness recovery time after TKR between groups, and 3) identify the patients’ satisfaction
and functional outcome assessed by KOOS (Knee Injury and Osteoarthritis Outcome Score) in both groups.
Methods: After Institutional Review Board approval, a prospective randomized controlled trial of 64 patients
underwent TKRs at our arthroplasty center was performed between June 2017 and December 2019.
Exclusion criteria was 1) severe osteoarthritic (OA) knee in diabetic patients undergo TKR, and 2) patients
with follow up less than 2 years. Sample size calculation was performed after the literature review. The
most correlated study that provides enough data for sample size calculation is the randomized controlled
trial conducted by Laffosse JM, et al. They found that the anterolateral skin incision had a significantly
smaller area of skin numbness postoperatively compared to the anterior midline incision. Finally, 64 patients
undergoing TKRs were recruited in this study. Using block of four randomizing method. The former
group (n = 32) defines that those patients underwent TKR through lateral parapatellar approach (Lateral
group) and the latter group (n = 32) is those patients underwent TKR through medial parapatellar approach
(Medial group). Patients’ variables reviewed were demographic data, comorbidity including American
Society Anesthesiologist (ASA) classification and Charlson comorbidity index (CCI), range of motion, and
visual analogue scale (VAS) were recorded. The primary outcome was a comparison of the prevalence of
skin numbness and the numbness recovery time between lateral and medial approach undergoing TKR.
The secondary outcome was a comparison of patients’ satisfaction and functional outcome in both groups
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assessed by KOOS (Knee Injury and Osteoarthritis Outcome Score) at 1 year and 2 years postoperatively.
Measurement of skin numbness: Area of skin numbness was measured by Semmes-Weinstein
Monofilaments (10 g) on the affected knee postoperatively with 29 reference points at 2 weeks, 6 weeks,
3 months, 6 months, 1 year and 2 years. The area of hypesthesia was calculated by SketchAndCalc®
softwear. Area of anterior skin numbness (Square centimeters; Sq.cm.) was periodically evaluated
and was compared between the two groups, to a minimum 2- year follow-up (FU). Measurements of
numbness was performed by two physicians who were not involved in the surgery. Measurements by
the 2 physicians were averaged.
Results: The smaller area of anterior skin numbness was occurred in the lateral group compared to those
in the medial group: 11.2 versus 20.2 at 2 weeks (< 0.001), 8.2 versus 17.2 at 6 weeks (< 0.001), 7.8 versus
14.4 at 3 months (< 0.001), 5.6 versus 8.9 at 6 months, 1.7 versus 4.7 at 1 year and 0.0 versus 1.0 square-
centimeters at 2 years, respectively. In addition, Satisfaction score (p = 0.027) and Symptom subscale
of KOOS (p = 0.018) were significantly higher in the lateral group. However, there was no difference in
knee range of motion and the other subscales of KOOS (Pain, Activity of daily living, Sport and recreation
function, and Quality of life) in both groups.
Discussion and Conclusion: Lateral parapatellar approach provided a significantly smaller area of skin
numbness and shorter recovery time of skin numbness. In addition, they had significantly higher
patients’ satisfaction score and symptom subscale of KOFOS. This should be considered as a good
alternative approach for TKR in hypesthesia-concerned patients.

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Abstract no. 53

Risk Factors for Complications Associated with Post Tonsillectomy
in Phramongkutklao Hospital During 2011-2020

Juthamard Moungthong and Anisong Pilakasiri

Department of Otolaryngology, Phramongkutklao Hospital

Backgrounds: Tonsillectomy is a commonly performed procedure that could be founded in the Department
of Otolaryngology. As a procedure, many factors could cause post-tonsillectomy haemorrhage as most
patients need to be anaesthetised before the procedure. Therefore, researches and studies are being
reviewed to find the relationship of factors that could cause post-tonsillectomy haemorrhage.
Objective: To find the relationship of factors that could cause post-tonsillectomy haemorrhage.
Study design: A retrospective descriptive study
Material and methods: Data have been collected from 549 patients through the records at Phramongkutklao
Hospital during 2011-2020. The illustration of the data before the procedure, indications for evaluation
before the operation, during operation, and post-tonsillectomy have been reviewed to evaluate the risk
factors causing the haemorrhage.
Results: From the researches and studies, the average age was 26.89±15.69 years and overall post-
tonsillectomy haemorrhage was 56 (10.2%) patients that occurred often in post-operative day 6. The
multiple logistic regression analysis was used to evaluate the factors that caused such haemorrhages.
There were male sex 13.27% (p = 0.039, odds ratio 2.11; 95%CI: 1.04 - 4.30), age below 18 years 7.14% (p
= 0.016, odds ratio 7.96; 95%CI: 1.46-43.27), age between 18-45 years 13.44% (p = 0.024, odds ratio 5.74;
95%CI: 1.26-26.11), surgeons experience that were lower than fifth-teen years 14% (p = 0.023, odds ratio
2.85; 95%CI: 1.16-7.01), and post-operative pain score in first date over 5 scores. 18.67% (p = 0.037, odds
ratio 2.25; 95%CI: 1.05-4.81). All of these factors were statistical significance related. (p < 0.05)
Conclusion: Patients admitted for tonsillectomy, especially those male sex, age below 45 years, and patient
who performed tonsillectomy by surgeons experience lower than fifth-teen years should be carefully
monitored for post-tonsillectomy haemorrhage. In addition, record should be collected post-operative pain
scores and other medical records delicately along with instructions for post-operative nursing to prevent
incidents of post-tonsillectomy haemorrhage at Phramongkutklao Hospital.
Keyword: l Tonsil l Tonsillitis l Tonsillectomy l Complications l Haemorrhage l Bleeding

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Abstract no. 54

Inflammatory Patterns of Chronic Rhinosinusitis with Nasal Polyp
Based on Histopathologic Profiles

Worranaree Charoenrungrat, Nutthawat Wongsason and Thanit Chalermwatanachai

Department of Otolaryngology, Phramongkutklao Hospital

Background: Chronic rhinosinusitis with nasal polyp (CRSwNP) is a challenging disease. CRSwNP is
difficult to treat and recurrences are frequent, despite medical treatment and surgical interventions. With
the advent of endotype, the diagnostic approach of Chronic rhinosinusitis (CRS) needs to be adjusted to
respect pathobiological mechanisms.
Objective: This study aims to determine inflammatory patterns of CRSwNP by differentiating inflammatory
cells in nasal polyp (NP) tissues.
Method: We review the NP tissues from a tissue collection at the Army Institute of Pathology between
2016 and 2020. In the NP tissues, inflammatory cells were classified according to their morphology on a
light microscope.
Result: After reviewing a total of 236 samples, of which 160 samples were taken from male patients and
76 samples were taken from female patients. The mean age of CRSwNP patients was 48.72 years. The
prevalence of comorbid asthma in CRSwNP patients is 14.83%. The delineation of inflammatory cells in
the NP tissues revealed that 40.68% of NP tissues were a lymphocyte-predominant pattern, 32.62% of NP
tissues were an eosinophil-predominant pattern, 16.10% of NP tissues were a plasma cell-predominant
pattern, and 10.17% of NP tissues were a neutrophil-predominant pattern. A neglectable positive
correlation was found between the proportion of eosinophils of the NP tissue and the proportion of
eosinophils of the blood (r = 0.19, p = 0.049). There was no correlation of other inflammatory cells between
NP tissue and blood. Eosinophils in NP tissue and blood of CRSwNP patients with comorbid asthma
had significantly higher than Eosinophils in NP tissue and blood of non-asthmatic CRSwNP patients (p <
0.001 and p = 0.016, respectively).
Conclusion: This study identifies the inflammatory patterns of CRSwNP, suggesting that lymphocytes
may be a major player in inflammation in CRSwNP. Additional investigation is needed to further identify
the role of lymphocytes in the pathogenesis of CRSwNP.

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Abstract no. 55

Parathyroidectomy in Early Severe Secondary Hyperparathyroidism:
the Comparison of Surgical Outcomes

Prachaya Wattana and Jirat Leelapatanadit

Department of Surgery, Phramongkutklao Hospital

Background: Secondary hyperparathyroidism (SHPT) in patients with advanced stage of chronic kidney
disease is characterised by increased parathyroid hormone (PTH) synthesis and secretion. Medical
therapy is an initial choice of treatment for controlling SHPT. However, when SHPT is refactory to
medical therapy, parathyroidectomy is indicated. More than 300 patients underwent parathyroidectomy
during last decade for treatment of severe SHPT in Phramongkutklao Hospital. The indications for para-
thyroidectomy in SHPT are PTH > 800 pg/mL and/or symptomatic hypercalcemia. Recently, the surgery
is traditionally performed in case of PTH level ≥ 1,000 pg/mL for reducing rates of missing parathyroid
gland and re-operation.
Objective: This study aims to compare the rate of missing parathyroid gland between groups of patients
with PTH < 1,000 pg/mL and PTH ≥ 1,000 pg/mL. In addition, the operative times, relationship between
size of parathyroid gland and PTH level and post-operative complications are also evaluated.
Methodology: We retrospectively evaluated the surgical outcomes of parathyroidectomy in patients with
severe SHPT. A total of 345 cases, from 1 January, 2000 to 31 December, 2020, were included. Patients
who had PTH level < 1,000 pg/ml and had PTH level ≥ 1,000 pg/ml were 171 and 174 patients respectively.
The clinical characteristics and preoperative laboratories from 2 groups of patients had been compared
by using logistic regression analysis and Chi square test with p-value < 0.05 as a statistic significance.
Results: There was no significant difference in rate of missing parathyroid gland (p = 0.803), operation
time (0.281) or rate of post-operative hoarseness (p = 0.824) between parathyroid hormone ≥ 1,000 and
< 1,000 pg/mL. groups. However, it showed a significant association between size of parathyroid gland
and level of parathyroid hormone. Group of parathyroid hormone < 1,000 pg/ml had a smaller size of para-
thyroid gland (p < 0.001). In subgroup analyses, group of parathyroid hormone > 1,500 pg/mL. had a less
missing gland rate butit did not reach statistically significant.
Conclusion: Parathyroidectomy in patients with parathyroid hormone level < 1,000 pg/mL were safe for
surgery. There was no difference of complication rate compared with patients whose parathyroid hor-
mone ≥ 1,000 pg/mL.

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Abstract no. 56

Single High-sensitivity Cardiac Troponin T (hs-cTnT) and Chest
Pain Score for Early Detection of Myocardial Infarction Among
Patients with Low-level hs-cTnT in Emergency Department

Thanadet Phongchomporn and Kittisak Sanprasert

Department of Trauma and Emergency Medicine, Phramongkutklao Hospital

Background: Chest pain is among the most common complaints for emergency department (ED) visits.
However, most patients are at low risk for acute coronary syndrome (ACS). The cardiac biomarker
testing with high-sensitivity cardiac troponin T (hs-cTnT) level is the key in the initial assessment for
ACS. Recently, serial troponin testing has been proven to be effectively rule in and rule out the diagnosis
of ACS in clinical practice. However, the process is time consuming and needs repeating blood tests.
Therefore, the combination of a single hs-troponin T and the Emergency Department Assessment of
Chest pain Score (EDACS) is of interest.
Objective: To study the cut-off point of a single high-sensitivity cardiac troponin T level and the EDACS
for predicting non-ST-elevation myocardial infarction (NSTEMI) among low-level hs-cardiac troponin T
patients, presenting with chest pain, in the emergency department (ED).
Methodology: This is a retrospective observational study of ED visits from January 1, 2017, to January
1, 2019, in Phramongkutklao hospital, Bangkok, Thailand. The study included 2,054 low-level hs-cardiac
troponin T tests (< 14 ng/L), among adults in ED. After the exclusion, 420 patients were enrolled in the
study. In order to evaluate for suspected ACS among the low-level hs-cardiac troponin T group, the single
hs-cardiac troponin T levels were combined with EDACS using ROC curve to determine the sensitivity,
the specificity, the positive predictive value (PPV), and the negative predictive value (NPV).
Results: The primary outcome was to predict NSTEMI among the low-level hs-cardiac troponin T patients.
The preliminary result was analyzed with a total of 100 patients [60 men (60%)]. According to the result,
the combination of the low-level hs-cardiac troponin T and EDACS showed the AUC of 66% (95%CI: 56.7-
75.3%) with the p-value of 0.44. The cut-off point could not be evaluated at this moment. The sensitivity,
specificity, PPV, and NPV are to be fulfilled.
Conclusion: This preliminary analysis showed no statistically significant outcome for the use of combination
of initial hs-cardiac troponin T and EDACS to potentially predict NSTEMI among the patients with initial
low-level hs-cardiac troponin T in ED.
Keyword: l Emergency Department Assessment of Chest pain Score (EDACS)
l High-sensitivity cardiac troponin T (hs-cTnT)
l Non-ST-elevation myocardial infarction (NSTEMI)

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Abstract no. 57

Critical Inhaler Technique Errors in Asthma and COPD Patients in
Phramongkutklao Hospital

Sasathorn Tharapoom1 and Amornchai Lertamornpong2

1Department of Internal Medicine; 2Division of Pulmonary and Critical care, Department of Internal Medicine, Phramongkutklao Hospital

Background: Incorrect inhaler techniques used in patients with asthma and chronic obstructive pulmonary
disease (COPD) can result in inadequate amount of drugs inhaled and lower therapeutic level. These
often trigger more frequent asthmatic attacks and COPD exacerbations, leading to higher mortality.
Studies on the wrong inhalation techniques are limited in Thailand. Thus, this observational study is
designed to evaluate the prevalence of the inhaler technique errors and the incorrect steps in asthma
and COPD patients
Objective: To determine the prevalence of the inhaler technique errors in the asthma and COPD patients
Methodology: In this observational study, the asthmatic and COPD patients who used inhaler devices in
Phramongkutklao Hospital were recruited, interviewed with questionnaires, and observed their inhaler
techniques with video record. The data were analyzed for the prevalence of the incorrect inhaler
techniques in different respiratory inhalers and the factors affecting the wrong techniques.
Results: There were a total of 224 asthma and COPD patients in Phramongkutklao Hospital. 154 (68.75%)
patients had at least one incorrect technique. One hundred forty one (62.9%) patients had critical step
errors. There was no statistically difference in subgroup analysis for asthma and COPD patients (p-value
= 0.827). The device associated with the most mistakes was Handihaler (75%). Others were MDI (68.4%),
Turbuhaler (67.1%), MDI with spacer (66.7%), SMI (64.7%) and Accuhaler (55.4%) respectively. The most
common errors made include failure to perform a breath-hold for 10 seconds after inhaling and failure
to exhale before inhalation. The sociodemographic characteristics, duration of the diseases, inhaler
instructors and duration of device usage had no effect on the misuse.
Conclusion: The prevalence of the critical inhaler techniques in asthma and COPD patients was 62.9%
and the majority of the errors were critical steps. The sociodemographic characteristics, duration of the
diseases, inhaler instructors and duration of device usage had no effect on the misuse.
Keyword: l Asthma l Chronic obstructive pulmonary disease l Inhaler device l Inhaler technique

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Abstract no. 58

Effect of Tuna Snack Fortified with Vitamins on Pre-albumin in
Patients with Chronic Dialysis

Paramat Thimachai, Bancha Satirapoj and Ouppatham Supasyndh

1Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine

Introduction: Malnutrition among patients undergoing dialysis is a major risk of morbidity and mortality.
To increase protein intake, consuming protein between meals was an interesting proposal. Tuna snack
fortified with vitamins is an innovative source of high biological value protein for patients on dialysis to
improve nutritional status.
Objective: We aimed to investigate the effect of tuna snack fortified with vitamins on pre-albumin levels
among patients receiving chronic longterm dialysis over 4 weeks.
Methods: A prospective intervention study examined the effects of tuna snack fortified with vitamins on
nutritional biomarkers in patients with chronic dialysis. All participants were advised to take standard
diet for patients on dialysis with daily tuna snack fortified with vitamin over 4 weeks. Pre-albumin was
used as the primary endpoint of the study. Secondary endpoints were nutritional assessment score and
other blood chemistries. At baseline and 4 weeks, intake, anthropometry, laboratory results, healthcare
use and satisfaction were measured.
Results: Of the 180 dialysis patients evaluated, 57.8% were male. The median age of the patients was
56.6±14.0 years. Regarding modes of dialysis, one half of patients underwent hemodialysis and the
remainders underwent peritoneal dialysis. Pre-albumin significantly improved from 33.2±8.2 to 35.1±8.1
mg/dL (p = 0.027) in hemodialysis, and from 36.87±8.97 to 39±9.84 mg/dL (p = 0.002) in peritoneal dialysis
over time. Blood urea nitrogen (49.82±19.11 to 53.05±21.05 mg/dL, p = 0.001) and serum creatinine
levels (9.13±3.39 to 9.39±3.52 mg/dL, p = 0.006) also significantly increased among total dialysis patients
especially in patients undergoing hemodialysis. Body weight, malnutrition-inflammation score (MIS)
and serum albumin level did not significantly differ after intervention. No adverse events were reported
throughout the study period.
Conclusion: This trial among patients undergoing dialysis indicated tuna snacks were acceptable, made a
difference to patients, and significantly improved nutritional markers in short term period without adverse
events.
Keyword: l Protein supplement l Tuna snack l Dialysis l Malnutrition l Oral nutritional supplement

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Abstract no. 59

Difference of Story Reading with Virtual Reality, Basic eBooks and
Printed Book on Parent-preschool Interaction and Reading
Comprehension

Suvamatha Singhaveerasamorn, Wirongrong Arunyanart, Chakriya Theeranate and
Khemika Khemakanok Sudnawa*

Division of Developmental and Behavioral Pediatrics, Department of pediatrics, Phramongkutklao Hospital and College of Medicine

Background: Share reading encourages communication and early literacy skills. The reading equipment
has been used including printed books, tablets, and virtual reality glasses. Virtual reality equipment data
regarding interpersonal interaction and reading comprehension were limited.
Objectives: (1) To compare parent-child interaction during share reading between equipment. (2) To
compare reading comprehension after reading.
Methods: We performed videotaping, laboratory-based, counterbalanced study of 36 parent-preschool
dyads reading on three book formats (printed books, basic electronic and virtual reality). We coded ver-
balizations in 15-second intervals for parents (dialogic, non-dialogic, text reading, format related, negative
format-related directives, and off task) and children (book related, negative, and off task). Non-verbaliza-
tions of shared positive affect and collaborative book reading was coded. Interpersonal relatedness was
coded including frequency of touching and seeking methods. Reading comprehension was tested after
reading.
Result: Preschools showed significantly less book-related verbalizations in [VR 2.22; Book 5.56 (p = .016);
basic eBooks 5.11 (p = .025)], more off-task verbalizations [VR 2.86; book 1.19 (p = .017); basic eBooks
0.81 (p = .003)], lower collaboration scores [VR 3.06; Book 3.50 (p = .043); and share positive affect (VR
3.22 ; Book 3.64 (p = .027)]. Parents’ verbalization mostly did not show a difference between any media.
Comprehension score showed less in virtual reality compared with book (VR 3.78; Book 4.92) (p = .043).
Conclusion: Parent-child interaction rating score and comprehension score was lower in virtual reality
equipment than book. For shared reading, print books are the most efficient equipment, particularly for
younger children.

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Abstract no. 60

Lessons Learned on Success in Health Behaviors Development
of Personnel with Abdominal Obesity Fort Prachaksinlapakom
Hospital, Udon Thani Province

จฬุ ารตั น์ ดวงตาผา กาญจนา ปญั ญาธร ขนิษฐา แกว้ กลั ยา และ รุ่งวสิ า สวา่ งเนตร

โรงพยาบาลค่ายประจกั ษศ์ ิลปาคม

This mixed-methodology research aimed to study 1) the results of health behaviors development
of personnel with abdominal obesity. 2) to examine the lessons learned on the success in losing abdominal
obesity, 3) to investigate factors affecting the success in losing abdominal obesity, and 4) to recommend
guidelines for health behaviors development of personnel. The participants were 6 team managers and
47 personals with abdominal obesity. The data were collected from July to December 2020 with a total
of 6 months by document analysis, weighing, waist measurement, in-depth interview, group discussion,
and non-participative observation. Data were analyzed using descriptive statistics and content analysis.
The results revealed that 1) 8.51% of the sample group were able to achieve their goal of losing weight
at an average of 1 kilogram per month with a total of 6 kilogram, and their average waist circumference
decreased from the original about 10.75 centimeter. For those who failed to achieve their goal of losing
weight were at 91.49% with the average weight increased from 0.41 kilogram, but the average waist
circumference decreased at 2.43 centimeter. 2) The lessons learned on the success in losing abdominal
obesity was motivation, they faced with problems of illness and a negative image from abdominal
obesity. Therefore, it pushed them taking care of their health seriously, together with colleagues support
and agencies has policies to focus on health care as a role model for people. 3) Factors influencing
success in losing abdominal obesity were personal who suffered from abdominal obesity had a decisive
goal to lose weight as well as they had intention, discipline, and well management of time. Being given
mental support from colleagues and supporting team could also help them achieve their goal. Agencies
supported and had a clear policy or used a prize as an incentive and the environment that is accessible
to exercise. From the results suggest that agencies should organize activities to develop health behaviors
of personnel, keep constant monitoring and evaluation.
Keyword: l Abdominal obesity l Health behaviors development l Health personnel

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