Burapha Journal of Medicine

Asian-type DEL: prevalence, clinical significance, and transfusion safety

Chirapond Chonanant, Nattaphol Prakobkaew, Worapong Khaodee, Surachat Buddhisa — Tue, 28 Apr 2026 00:00:00 +0700

Introduction: RhDel is a variant of the RhD-positive blood group, with an extremely low D antigen expression which cannot be detected by standard serological methods, resulting in its misclassification as RhD-negative. Further specialized techniques such as adsorption-elution or
molecular biological testing are required to distinguish RhDel from true RhD-negative individuals. Asian-type DEL is highly prevalent among RhD-negative individuals in Asian populations, and can induce anti-D alloimmunization in truly RhD-negative recipients, potentially leading to hemolytic transfusion reactions (HTR) and hemolytic disease of the fetus and newborn (HDFN). Therefore, understanding the prevalence, clinical significance, and means of accurate laboratory identification of Asian-type DEL is essential for safe blood transfusion practices.

Objective: To review and analyze data on the prevalence, clinical significance, and safe transfusion practices of the Asian-type DEL blood group.

Methods: A systematic literature review and analysis of research articles related to the Asiantype DEL from PubMed and Google Scholar, covering publications from 2000 to 2025.

Results: The Asian-type DEL has a high prevalence among RhD-negative individuals in East Asia and Southeast Asia, including Thailand. Clinical evidence demonstrates that individuals with Asian-type DEL do not develop anti-D after receiving a transfusion with RhD-positive blood, or from carrying RhD-positive fetuses. In contrast, blood donated from individuals with the Asiantype DEL has been reported to stimulate anti-D production in RhD-negative patients.

Conclusion: The Asian-type DEL is a crucial consideration for transfusion management in Asia. Molecular biological techniques must be combined with standard serological methods to ensure an accurate identification. Patients with Asian-type DEL can safely be transfused with RhD-positive blood, while donated blood from Asian-type DEL individuals should be managed as RhD-positive and restricted to RhD-positive recipients only.

The association of anticoagulant-related nephropathy with clinical outcomes

Supawiwatch Rodjanasingha , Sirigunya Rodjanasingha — Tue, 28 Apr 2026 00:00:00 +0700

Introduction: Anticoagulant-related nephropathy (ARN) is a significant and often under-recognized complication that leads to acute kidney injury (AKI) and an accelerated chronic kidney disease (CKD) progression.

Objective: To systematically review the epidemiology, pathophysiology, risk factors, diagnosis, management and preventive strategies for ARN.

Methods: A literature review was conducted by synthesizing data from studies published in the PubMed and Scopus databases between 2009 and 2024, regarding ARN in patients receiving Warfarin and other direct oral anticoagulants (DOACs).

Results: ARN results from two primary mechanisms: 1) glomerular hemorrhage due to the loss of thrombin's cytoprotective signaling, and 2) the tubular obstruction by red blood cell casts, leading to AKI. The key risk factor is excessive anticoagulation, particularly in patients with pre-existing CKD. Although DOACs are associated with a lower overall risk of AKI as compared to Warfarin, they can still induce ARN. Diagnosis is primarily based on clinical criteria due to the high risk of renal biopsy. The cornerstone of management is the prompt cessation of anticoagulation and reversal of coagulopathy.

Conclusion: ARN is a serious but preventable complication. Rigorous monitoring of renal functions and coagulation levels, along with the appropriate adjustments to dosage are crucial to mitigate risk and reduce patient mortality.

Rational laboratory use in a tertiary care hospital: a case study of Burapha University Hospital

Tue, 28 Apr 2026 00:00:00 +0700

Introduction: Laboratory testing is a critical component of patient diagnosis and clinical management. A substantial body of evidence indicates widespread overutilization of laboratory investigations across various healthcare settings, leading to increased costs, higher workload for healthcare personnel, and potential patient harm. The concept of Rational Laboratory Use (RLU) has therefore been developed to promote evidence‑based and appropriate use of laboratory resources.

Objectives: The goal is to propose system‑level recommendations for developing rational laboratory utilization guidelines within the Department of Internal Medicine Burapha University Hospital (BUH).

Methods: RLU principles at both international and national levels were reviewed, survey data were analyzed from questionnaires completed by medical personnel at BUH. Both qualitative and quantitative analyses were conducted to identify factors contributing to laboratory overutilization and to determine high‑risk tests prone to inappropriate use.

Results: Key factors driving unnecessary laboratory ordering included defensive medicine, habitual practice, overly broad order sets, user‑friendly HIS interfaces that facilitate excessive clicking, and hierarchical pressure from senior staff. Frequently cited laboratory tests included HbA1c, blood gas, CBC, electrolytes, creatinine, LFT panel, troponin, NT‑proBNP, culture, and TFT. System‑level recommendations include developing test‑specific clinical practice guidelines, implementing HIS soft‑stop/hard‑stop mechanisms, restructuring order sets, and providing ongoing education combined with audit and feedback.

Conclusion: The development of RLU at BUH represents an important example of translating evidence into practice. The next step is to implement a three‑month roadmap with clear KPIs to reduce unnecessary testing, lower hospital costs, and strengthen the sustainability of the healthcare service system.

Cranial computed tomography abnormalities, complications and therapeutic outcomes in mild traumatic brain injury patients

Pakpume Bumrungrachpukdee, Pongtrip Unprasert — Tue, 28 Apr 2026 00:00:00 +0700

Background: Traumatic brain injury (TBI) is a major cause of death and disability in Thailand, primarily due to motorcycle accidents.

Objectives: This study examines the characteristics, incidence, cranial CT abnormalities, complications, and outcomes of mild TBI (mTBI) patients

Materials and Methods: This retrospective cross-sectional study analyzed mTBI patients treated at Burapha University Hospital from June 2020 to August 2021. Data on patient demographics, injury mechanisms, cranial CT findings, outcomes, and complications were collected and analyzed. The study aimed to determine the incidence of cranial CT abnormalities, clinical outcomes, and risk factors for cranial CT abnormality in mTBI patients with Canadian CT head rule combined with New Orleans Criteria.

Results: Analyzed 665 mTBI patients. Cranial CT abnormalities were found in 15.8% of patients, with subarachnoid hemorrhage (46.7%) and subdural hematoma (33.3%) being the most common findings. Risk factors significantly associated with abnormal cranial CT included motorcycle accidents (p = 0.0002), falls (p = 0.0002), loss of consciousness (p = 0.00003), amnesia (p < 0.00001), and lower GCS scores (p < 0.00001). Three patients (0.45%) required neurosurgical intervention, all of whom were young males involved in motorcycle accidents with alcohol intoxication. The overall favorable outcome rate was 99.85%, with only one mortality (0.15%) due to associated thoracoabdominal injuries with hypotension.

Conclusion: This study highlights key risk factors for intracranial abnormalities in mTBI patients and underscores the importance of targeted cranial CT criteria, preventive measures, and timely management of associated injuries. Further research is needed to explore long-term outcomes and optimize management strategies for mTBI patients.

Comparison of total hip arthroplasty and bipolar hemiarthroplasty: on the length of hospital stay in elderly patients with displaced femoral neck fractures

Tue, 28 Apr 2026 00:00:00 +0700

Introduction: Femoral neck fractures in the elderly are a critical impairment due to their association with high mortality and disability rates. Bipolar Hemiarthroplasty (BH) and Total Hip Arthroplasty (THA) are the standard surgical interventions for femoral neck fractures. Typically,
BH is selected for patients with a higher comorbidity burden, whereas THA is preferred for younger, more active patients.

Objective: To compare the mean length of hospital stay (LOS), hospital costs, and postoperative complications between elderly patients treated with BH and THA.

Methods: This retrospective comparative study analyzed data from 98 patients at Burapha University Hospital from July 2017 to December 2023. Baseline characteristics, LOS, costs, and complications were evaluated.

Results: The BH group was significantly older and had a higher comorbidity burden than the THA group. No significant difference was found in LOS between BH (13.98 ± 9.75 days) and THA (13.33 ± 8.31 days) (p = 0.722). However, BH was associated with significantly lower hospital
costs (122,012 vs. 149,275 THB; p = 0.004) and shorter operative time (p < 0.001). Furthermore, the BH group presented more complications compared to the THA group (9 vs. 5 cases).

Conclusion: While BH does not significantly reduce the length of hospital stay as compared with THA, the procedure does offer lower treatment costs. The increased complication rate in the BH group likely reflects the patients’ underlying health conditions rather than the surgical
technique itself.

The effectiveness of a surveillance system for severe cutaneous adverse reactions including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as induced by aromatic antiepileptic drugs at Udon Thani Hospital

Parinya Khonyang , Danklai Purimart — Tue, 28 Apr 2026 00:00:00 +0700

Context: Aromatic antiepileptic drugs (AEDs) may cause severe cutaneous adverse reactions (SCARs), including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), necessitating a close pharmacovigilance surveillance system.

Objective: To evaluate the effectiveness of a pharmacovigilance surveillance system for SJS and TEN in patients newly initiated on aromatic AEDs.

Methodology: This was a quasi-experimental study conducted at Udon Thani Hospital. The sample was divided into two groups: a Control Group and an Experimental Group. The Control Group’s data was collected from the hospital medical records of 502 patients treated between November 2022 and September 2023. This group received standard pharmaceutical care and medication counseling from pharmacists. The Experimental Group’s data was collected from 482 patients treated between November 2023 and September 2024. These patients received counseling and were monitored under a developed surveillance system for severe cutaneous adverse reactions (SJS and TEN), specifically designed for patients receiving aromatic AEDs for the first time. Data were analyzed using descriptive statistics. The differences between the Experimental and Control Groups were compared using the Mann-Whitney U test and the Independent t-test.

Results: Of the Control Group, 3 patients (0.60%) out of 502 developed severe cutaneous adverse reactions (SJS/TEN). From the Experimental Group 0 patients (0%) out of 482 developed SJS/TEN. The difference between the two groups was found to be not statistically significant (likely due to the overall low incidence rate or sample size). In the Experimental Group, a total of 20 adverse drug reactions (ADRs) were reported, with 15 patients experiencing non-severe reactions (mild ADRs) related to the aromatic AEDs. The remaining 5 patients experienced symptoms that were determined not to be related to the aromatic AEDs (non-drug related).

Conclusion: The surveillance system is effective in enabling an early detection of SJS/TEN, reducing the severity of the reactions. Consequently, this system should be implemented for all patients receiving aromatic AEDs for the first time.

The effects of propofol–fentanyl versus propofol–ketamine on lower limb movement response in patients undergoing outpatient loop electrosurgical excision procedure (LEEP): a randomized double-blind controlled trial

Polatouch Dulyakupt, Thirayada Wattanamongkol, Supattra Jongkolklang — Tue, 28 Apr 2026 00:00:00 +0700

Introduction: Cervical cancer is the second most common cancer among Thai women. Lesions are often diagnosed and treated by Loop Electrosurgical Excision Procedure (LEEP), which is typically performed as a one-day surgery. Patient safety is our concern.

Objective: To compare the effects of propofol combined with fentanyl (PF) versus propofol combined with ketamine (PK) administered on patients undergoing outpatient Loop
Electrosurgical Excision Procedures (LEEP) at Pattaya Patthamakun Hospital, and receiving lower limb movement response assessments.

Methods: This randomized double-blind study enrolled 54 patients undergoing outpatient LEEP. Patients were randomly assigned to receive either propofol combined with fentanyl (n = 27) or propofol combined with ketamine (n = 27). The fentanyl dose was 1 mcg/kg and the ketamine dose was 0.75 mg/kg, and was administered intravenously. The primary outcome of this study was to elicit a lower limb movement response. Secondary outcomes included total
propofol dosage, total intravenous fluid, the incidence of hypotension, oxygen desaturation, cough, apnea and the need for jaw-thrust airway interventions, time to emergence and time to recovery. Postoperative pain scores were measured by the visual analog scale (VAS), and included nausea, vomiting and dizziness.
Results: The incidence of lower limb movement response showed no significant difference between the PK group and PF group: (8[29.63%] vs 10[37.04%] respectively, p-value = 0.56). However, the PF group demonstrated significantly lower blood pressure (6[22.22%] vs 0[0.00%],
p-value = 0.01) and required a significantly higher propofol dose per body weight per minutes (0.31[0.23;0.39] vs 0.22[0.19;0.26], p-value = 0.01). The volume of intravenous fluid, incidence of hypotension, oxygen desaturation, cough, apnea, the need for jaw-thrust maneuvers, time to emergence, recovery time and postoperative VAS pain scores were not significantly different between two groups.

Conclusion: The propofol–ketamine combination maintained a more stable blood pressure compared with propofol–fentanyl during LEEP without increasing other adverse effects. However,there was no difference in lower limb movement response between the two groups. The incidence of hypotension in the propofol–fentanyl group was associated with a higher propofol dose per body weight per minutes.

Editor's Note

Somjit Prueksaritanond — Tue, 28 Apr 2026 00:00:00 +0700

ในวาระที่คณะแพทยศาสตร์ มหาวิทยาลัยบูรพา เดินทางมาถึงจุดหมายแห่งความภาคภูมิ ในการครบรอบ 24 ปีแห่งการก่อตั้ง ถือเป็นช่วงเวลาที่สถาบันของเรามีความเข้มแข็งและเติบโตสู่ความมั่นคงอย่างเต็มตัว หากเปรียบกับวัยของมนุษย์ เลข 24 คือวัยแห่งพละกำลังและความรับผิดชอบที่พร้อมจะอุทิศตนเพื่อสังคม เช่นเดียวกับคณะแพทยศาสตร์ฯ ที่ยังคงยึดมั่นในปณิธานการผลิตบุคลากรทางการแพทย์ที่เปี่ยมด้วยทักษะและจิตวิญญาณ เพื่อเป็นที่พึ่งทางสุขภาพให้แก่ประชาชนทั้งในภูมิภาคตะวันออกและระดับประเทศมาตลอดสองทศวรรษ

ความสำเร็จที่จับต้องได้นี้ สะท้อนผ่านการเติบโตของจำนวนนิสิตแพทย์ที่ก้าวเข้าสู่รั้วเทา-ทองอย่างต่อเนื่อง โดยปัจจุบันคณะฯ ได้รับนิสิตมาแล้วถึง 19 รุ่น (ปี พ.ศ. 2569) เริ่มต้นจากช่วงก่อตั้ง รุ่นที่ 1–3 ที่รับจำนวน 32 คน ขยับเพิ่มเป็น 48 คนในรุ่นที่ 4–16 และขยายศักยภาพสู่ความมั่นคงอย่างก้าวกระโดดสู่จำนวน 72 คนในรุ่นที่ 17–18 จนกระทั่งปัจจุบันในรุ่นที่ 19 ล่าสุด เรามีความพร้อมในการดูแลนิสิตถึง 88 คน เพื่อเตรียมพร้อมเป็นกำลังสำคัญของระบบสาธารณสุขไทยในอนาคต

ในวาระพิเศษนี้ "บูรพาเวชสาร" (Burapha Journal of Medicine) ได้ก้าวเข้าสู่ปีที่ 13 ด้วยพัฒนาการที่น่าประทับใจ จากจุดเริ่มต้นที่เป็นสื่อกลางแลกเปลี่ยนองค์ความรู้ภายในสู่การเป็นวารสารวิชาการที่ได้รับการจัดอันดับอยู่ในระดับ TCI กลุ่มที่ 2 เพื่อตอบรับความไว้วางใจและปริมาณบทความที่เพิ่มขึ้น กองบรรณาธิการมีความยินดีที่จะแจ้งการเปลี่ยนแปลงสำคัญ โดยปรับเพิ่มรอบการเผยแพร่จากปีละ 2 ฉบับ เป็น ปีละ 3 ฉบับ (ฉบับที่ 1 มกราคม–เมษายน, ฉบับที่ 2 พฤษภาคม–สิงหาคม และฉบับที่ 3 กันยายน–ธันวาคม) เพื่อขับเคลื่อนองค์ความรู้ให้เท่าทันต่อสถานการณ์โลกทางการแพทย์ที่เปลี่ยนแปลงไปอย่างก้าวกระโดด