Burapha Journal of Medicine

Cow’s milk protein allergy presenting as recurrent necrotizing enterocolitis in preterm neonates: A Case Report

Benjarat Dardaranonda — 2025-12-27

Introduction: Necrotizing enterocolitis (NEC) is a major cause of morbidity in preterm infants. Cow’s milk protein allergy (CMPA) may mimic NEC or predispose to intestinal injury, but recurrent NEC associated with CMPA is rarely reported.

Objective: This study reviewed recurrent NEC in a preterm female infant born at gestational
age (GA) 34 weeks presented with recurrent bloody stools at day of life (DOL) 27 despite prior recovery from the first NEC stage IIB on DOL 9. Given the temporal relationship with cow’s milk protein exposure and subsequent clinical improvement with cow’s milk protein elimination, CMPA was strongly suspected as a contributing factor.

Case presentation: A preterm female infant born at GA 34 weeks, birth weight 2030 g, with no perinatal complications was presented with grossly bloody stools on DOL 1 and empiric antibiotics were initiated. On DOL 9, the infant developed hypothermia and recurrent bloody stools. Laboratory tests revealed leukocytosis and metabolic acidosis, while abdominal radiographs demonstrated pneumatosis intestinalis and portal venous gas, consistent with NEC stage IIB. Management included bowel rest, and broad-spectrum antibiotics. Feeding was reintroduced with breast milk plus preterm formula after being kept nil per os (NPO) for 10 days. Feedings were advanced after NPO for 10 days. At DOL 27, after advanced with breast milk plus preterm formula for 8 days, the infant developed recurrent bloody stools despite prior recovery. Stool cultures were negative, and abdominal examination revealed marked distension with hypoactive bowel sounds. Recurrent NEC was diagnosed. After NPO 10 days and broad-spectrum antibiotics. Feeding with breast milk that maternal eliminated diary product
and extensive hydrolysate formula was reintroduced until full feed. After change of formula promptly showed resolution of symptoms with improved radiological findings. Given the temporal relationship with cow’s milk protein exposure and subsequent clinical improvement with cow’s milk protein elimination, CMPA was strongly suspected as a contributing factor.

Conclusion: This case highlights the complex interplay between NEC and CMPA. CMPA should be considered in preterm infants, our case most likely represents CMPA as a predisposing condition that increased intestinal vulnerability to true NEC episodes.

The psychosocial role for nurses responding to depression among cancer patients during palliative treatment

Thanaphon Sribencha — 2025-12-27

Depressive disorder (or depression) is a common psychiatric condition characterized by a persistent despondent mood and a prolonged loss of pleasure or interest in daily activities. This condition may lead to self-harm or suicide. Depression is frequently found among patients diagnosed with cancer, which is a chronic disease requiring long-term treatment. It has been reported that more than 50% of cancer patients experience symptoms of depression. Therefore, cancer patients undergoing palliative treatment should receive systematic assessments to identify depression risk factors, severity levels and be evaluated if their condition may result in self-harm.

Caring for cancer patients with depression presents a significant challenge for nurses, particularly in the context of palliative care, where patients experience complex health conditions affecting their physical, psychological and social dimensions. Key psychosocial roles for nurses include providing education and counseling, conducting psychotherapy through therapeutic relationships and therapeutic communication, managing the patient’s environment to reduce anxiety, and empowering patients while promoting self-care abilities to prevent the patient’s condition from becoming more severe. These interventions require the appropriate application of psychological theories tailored to the individual needs of each patient. This situation reflects a significant opportunity to develop the competencies of nurses by equipping them with specialized knowledge and expertise, particularly in psychosocial nursing. These applications will enable nurses to effectively respond to the complex needs of patients and adapt to future changes in the healthcare system.

Prevalence and ergonomic factors of musculoskeletal disorders arising from the manual handling of patients by nurses and nursing assistants in the adult intensive care units of Phra Nakhon Si Ayutthaya Hospital

Wisit Netirojjanakul — 2025-12-27

Introduction: Musculoskeletal disorders are common occupational health problems among nursing personnel, particularly in intensive care units where regular patient handling is required.

Objective: To determine the prevalence and ergonomic factors associated with musculoskeletal disorders (MSDs) resulting from the handling of patients by nursing and nurse assistants working in the adult intensive care units of Phra Nakhon Si Ayutthaya Hospital.

Methods: A cross-sectional descriptive study was conducted among 92 nurses and nurse assistants, with 88 valid responses (response rate 95.70%). Data were collected by using 1) a demographic questionnaire, 2) the Nordic Musculoskeletal Questionnaire, 3) the Rapid Entire Body Assessment (REBA) and 4) the ST-5 stress scale. Descriptive and inferential statistics, including the Chi-square test, Fisher’s exact test, Unpaired t-test, Mann–Whitney U test and Multiple logistic regression, were employed for data analysis.

Results: The prevalence of MSDs during the past 7 days and 12 months were 43.18% and 72.73%, respectively (i.e., nurses and nursing assistants). The most affected region was the
shoulders (46.59%), followed by the lower back (45.45%). The REBA indicated moderate to high risk levels of an improper working posture. Factors significantly associated with MSDs within the past 7 days (p ≤ 0.05) included marital status, high to very high stress levels and incorrect sitting-up postures of the patients. Within the past 12 months, a body mass index (BMI) greater than 24.99 kg/m² was significantly associated with MSDs.

Conclusion: Nurses and nursing assistants in intensive care units had a high prevalence of MSDs, influenced by ergonomic, physical and psychosocial factors. Implementing ergonomic interventions, training on the proper patient lifting techniques, the promotion of and use of assistive devices as well as strengthening physical and mental health programs were all essential strategies to prevent and reduce MSD-related risks.

The effects of local pigmented glutinous rice extracts to prevent renal pathology and inflammation in rats induced by ethylene glycol

Witoon Khawsuk — 2025-09-24

Introduction: Kidney stones are a common urological disorder that has been increasing in incidence worldwide. Current treatment still has a recurrence rate of the disease. As an alternative, several studies of natural products have been reported for the treatment and prevention of kidney stone disease. However, reports specific to local pigmented glutinous rice are still limited.

Objective: To investigate the effects of local pigmented glutinous rice extracts on renal pathology and inflammation, as induced by ethylene glycol on rats.

Methods: Male rats were divided into five groups. Group 1 was the control group, and received normal drinking water for four weeks. Group 2 was the ethylene glycol group, and received normal drinking water for two weeks, followed by 0.5% ethylene glycol for another 2 weeks. Group 3 was fed potassium citrate daily, at a dose of 100 mg/kg via gastric intubation for two weeks. Groups 4 and 5 were each fed a variety of glutinous rice daily – black glutinous rice and Sung Yod glutinous rice respectively, at a dose of 200 mg/kg by gastric intubation for two weeks. After two weeks of gastric intubation, groups 3-5 received 0.5% ethylene glycol for an
additional two weeks. The samples were then collected for pH, calcium oxalate, BUN and creatinine analyses. Pathohistological and MCP-1 and IL-6 expressions in the subject’s renal tissue were also observed. Statistical analysis with ANOVA at p<0.05.

Results: The potassium citrate, black glutinous rice and Sung Yod glutinous rice-treated groups exhibited a significant increase in pH levels at week 3, as compared to the ethylene glycol group; however, the levels returned to normal at week 4, as compared to the control group. The amount of calcium oxalate monohydrate crystals in urine samples were reduced by treatment with black glutinous rice and Sung Yod glutinous rice extracts. The levels of BUN and creatinine in the serum of all groups were within normal ranges, as compared with standard ranges. Pathological changes in the renal tissue (including distal tubular dilation, flattened renal tubular cells, and nuclear condensation, as well as the expression of MCP-1 and IL-6) were reduced by treatment with black glutinous rice and Sung Yod glutinous rice extracts, as compared with the ethylene glycol group.

Conclusion: Local pigmented glutinous rice extracts improved the pH and calcium oxalate crystals in urine. They also proved to have a protective effect on the ethylene glycol-induced inflammation and renal pathology.

The effectiveness of a program combined knee muscle exercise with Ayurvedic Kati Basti therapy by Num Man Kad Mon on reduceing the severeity of symptoms of knee osteoarthritis symptoms in older adults with knee osteoarthritis at Ban Klong Yor Village, Amphur Borai, Trat Province

Sirirat Leaungsomnapa — 2025-12-27

Introduction: Osteoarthritis of the knee is a major health problem among older adults. It causes pain and significantly impacts the daily functions of those afflicted by its symptoms. Management and care to reduce the severity of knee osteoarthritis symptoms is a crucial responsibility of primary care nurses.

Objective: This study aimed to compare the severity of symptoms in older adults with knee osteoarthritis before and after a therapeutic intervention.

Methods: A quasi-experimental study using a one-group pretest-posttest design was conducted. The participants were 33 older adults with knee osteoarthritis from the Ban Khlong Yor community, in the Borai District of Thailand’s Trat Province. The intervention involved a 9-week program that combined knee muscle strengthening exercises, together with Ayurvedic Kati Basti therapy by Num Man Kad Mon. Data were collected using a general information questionnaire, and the Knee injury and Osteoarthritis Outcome Score (KOOS). This study was conducted from March to May of 2024. Descriptive and nonparametric statistics were employed to analyze the data (Wilcoxon signed-rank test).

Results: After receiving the knee exercise program, in combination with the Basti therapy by Num Man Kad Mon, the older adults had a median score reduction in all domains of the KOOS with statistical significance: pain (58.33 vs 80.56, p < .001); knee stiffness (35.71 vs 75.00, p < .001); ease of daily living activities (51.47 vs 80.88, p < .001); sport and recreation functions (20.00 vs 55.00, p < .001); knee – related quality of life (31.25 vs 50.00, p < .001).

Conclusion: The findings of this study indicated that a knee muscle exercise program, in combination with Ayurvedic Kati Basti therapy by Num Man Kad Mon, significantly reduced the severity of symptoms in patients with moderate knee osteoarthritis, as evaluated across all subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS).

Localization of Advance Care Planning directives – assessing a reliable and quality translation

Nattanicha Pulperm — 2025-12-27

Introduction: Advance care planning is an inherent right of individuals to manage their own life and body, enabling them to participate in decisions about their future care according to their wishes. However, there is currently no assessment tool for advance care planning that can determine the extent to which patients have progressed through that care process.

Objectives: To translate the 15-item Advance Care Planning document into Thai language and to evaluate the content validity and reliability of the resulting Thai version.

Method: The research design is a descriptive study and was conducted in two phases. Phase 1 involved translating the original English version of the assessment into Thai language and then back into English using the translation and back-translation technique by a professional translator
from a university language institute. Both translations were conducted independently, and the validity of the content was verified by five qualified experts. Phase 2 assessed the reliability of the translated content with a sample of 30 patients aged 20 years and older with lung cancer. Phase 2 was conducted at a tertiary hospital in Bangkok between July and August 2025. The reliability of the assessment was analyzed using Cronbach’s alpha coefficient.

Results: The findings revealed that the back-translated version was consistent with the original English version. The Thai language version demonstrated good content validity (Content Validity Index = 0.87) and satisfactory internal consistency (Cronbach’s alpha = 0.86). The item–total correlation coefficients ranged from 0.27 to 0.77, which are considered acceptable.

Conclusions: The Thai language version demonstrated good quality and can be used to assess advance care planning among patients receiving palliative care in the Thai context.

Editor's Note

Somjit Prueksaritanond — 2025-12-27

วารสารบูรพาเวชสาร เป็นวารสารวิชาการที่ดำเนินการจัดทำโดยคณะแพทยศาสตร์มหาวิทยาลัยบูรพามีวัตถุประสงค์ เพื่อเผยแพร่องค์ความรู้และงานวิจัยด้านวิทยาศาสตร์การแพทย์ วิทยาศาสตร์สุขภาพ ด้านสาธารณสุข พฤติกรรมศาสตร์ และสังคมศาสตร์จากนักวิชาการ นักวิจัย หรือนิสิต นักศึกษา วารสารฉบับนี้สำเร็จได้ด้วยความร่วมมือจากคณะที่ปรึกษาวารสาร คณะทำงานวารสาร กองบรรณาธิการผู้ทรงคุณวุฒิภายในและภายนอก ที่กรุณาพิจารณาบทความให้มีความถูกต้องและสมบูรณ์มากขึ้นกองบรรณาธิการขอขอบพระคุณมา ณ โอกาสนี้ หวังว่าวารสารฉบับนี้จะเป็นประโยชน์ทางวิชาการสำหรับผู้อ่านทุกท่าน ถ้าท่านใดมีความประสงค์ส่งบทความเพื่อเผยแพร่ กองบรรณาธิการยินดีรับตีพิมพ์โดยต้องผ่านการพิจารณากลั่นกรองจากผู้ทรงคุณวุฒิทั้งภายในและภายนอก และกองบรรณาธิการยินดีน้อมรับคำแนะนำหากท่านใดมีข้อเสนอแนะเพื่อการนำไปปรับปรุงและพัฒนาคุณภาพวารสาร ให้มีมาตรฐานยิ่งขึ้นต่อไป