Buddhachinaraj Medical Journal

Editor’s Note

Nanthiya Tanthachun — Mon, 25 Jan 2021 00:00:00 +0700

Relationship of Bullet Trajectory, Types of Bullet, Gunshot Residues in Suicide and Homicide from Forensic Autopsy

Wed, 30 Dec 2020 00:00:00 +0700

The autopsy results of firearm deaths from forensic doctors are very important and affect the cases.
However, the knowledge of the trajectory of ammunitions in relation to the manners of death in Thailand is
still partially studied. This study aimed to study bullet trajectory, bullet types, and gunshot residuals which
relate to manners of death from gunfire injuries. This retrospective case control study was carried out by
using documents from forensic identification data of gunfire injuries by the Forensic Department at Lampang
Hospital from Jan 1, 2015-June 9, 2019. We found 113 people died from gunfire injuries, 22 of them were
suicides which were all men and 91 were homicides, 78 people were male (85.7%). In the suicides, both
handguns and shotguns, most ranges of suicide were at contact range (81.8%) with probable found gunshot
residual in the wound. The trajectory fires from the front, passing through the upper left side of the body
compared to the normal position. As for homicides, more than half used handgun by shooting at a distance
and no gunshot residual were found. It also had a variety of trajectories. In conclusion, suicide may be used
trajectories to tell the manner of death

Therapeutic Effects between Lumbar Traction combined Hot Pack with Mckenzie Exercise versus Lumbar Traction combined Hot Pack in Low Back Pain from Lumbar Disc Herniation Patients

Nantawan Pinmas — Mon, 25 Jan 2021 00:00:00 +0700

Back pain is a common symptom. This experimental study aimed to compare therapeutic effects
between lumbar traction combined hot pack with McKenzie exercise and lumbar traction combined
hot pack in herniated nucleus pulposus patients, in Buddhachinaraj Phitsanulok Hospital during March
2020 to October 2020. These patients were divided into two groups, 30 patients in each group. The first
group underwent lumbar traction combined hot pack with McKenzie exercise. Another underwent lumbar
traction combined hot pack. The results of treatment were compared by chi-square test, chi-square test for
linear trend, Mann Whitney U test and Wilcoxon signed rank test with significant level at 0.05. There were no
difference in sex, age, education, occupation, average pre-treatment pain and disability scores in both
groups. Disability scores after treatment in group one was lower than group two with statistically significant.
The reduction of pain and disability scores between two groups were also statistically significant. The average
of pain and disability scores pre-post treatment in two groups were also statistically significant. In conclusion,
both groups are effective treatments for lumbar disc herniation patients, but lumbar traction combined
hot pack with McKenzie exercise is more effective than lumbar traction combined hot pack

Factors affecting Clinical Decision Making for Electrophysical Agents (EPAs) Usage

Mon, 25 Jan 2021 00:00:00 +0700

Electrophysical agents (EPAs) are core part of professional physical therapy and increases in the
new modalities over time. This study aimed to investigate availability, frequency of usage and factors on
decision for EPAs usage by physical therapists (PTs) at Health Region 2, Ministry of Public Health, Thailand
with electronic questionnaires. Questionnaires were randomly sent to PTs working at 58 hospitals. A total
of 151/221 (68%) questionnaires were returned. Frequency, percentage and correlation coefficient were used
to describe. The ultrasonic therapy machine and hydrocollator unit were the highest both availability
and frequency of usage. Decision making regarding the usage of EPAs was found to be multiple factors
especially, internal factors. The pathology knowledge, electrophysical agent knowledge and past clinical
experience were important internal factors affecting the use of EPAs application and found significant
positive relationship between internal factors. The external factors that influence the decision to use EPAs
were the availability of EPAs and research to support the use of treatment. In conclusion, Thai PTs are
likely to make decisions of the EPAs usage which are strongly impacted by knowledge, clinical experience,
available equipment and research evidence factors

Andrographis paniculata Replacement Antibiotics Used among Upper Respiratory Tract Infection Patients in Primary Care Cluster Network

Phattharit Tiloklurs, Wiroj Wannapira, Suthichart Mongkhol — Mon, 25 Jan 2021 00:00:00 +0700

Antibiotic-resistant bacteria has long been a serious health problem for Thai population. The main
cause is the excessive use of antibiotics. Having an appropriate treatment option is the ideal solution for
both patients and their providers. This survey study was to investigate the effects of Andrographis paniculata
in patients with upper respiratory tract infections (URI) in primary care three clusters network, Buddhachinaraj
Phitsanulok Hospital. In 120 patients with URI were studied from November 2019 to January 2020.
The research tool was questionnaire. The data were presented as frequency, percentage, mean and
standard deviation. The results from taking Andrographis paniculata for five days was 60.0%. After following
treatment for seven days found that cured rate was 58.4%, incurred rate was 40.8%. Coughing symptom
was the most frequency, 63.3%. For patients who did not heal and change the treatment, they were found
to continue treatment at the clinic, bought antibiotics from grocery stores and drugstores 28.6%, 22.4%,
and 14.3% respectively. In conclusion, Andrographis paniculata is suitable herb for URI. The knowledge
and understanding should be created for the public to be widely used in order to reduce the use of inappropriate
antibiotics.

Monitoring of Adverse Drug Reactions in Patients Receiving 2 types of RAS Blockage (ACEI/ARB) in the Treatment of Hypertension

Wanida Khanadnid — Mon, 25 Jan 2021 00:00:00 +0700

The combination of Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor
Blockers (ARBs) in hypertension treatment is one of indicators in hospital project promotes Rational Drugs
Use. The hypertensive treatment guidelines in general practice 2019 does not recommend combination
of ACEIs and ARBs because of increasing risk of adverse drug reactions. This research was to compare
occurrence of hyperkalemia in patients receiving ACEIs and ARBs compared with patients receiving only one
group of ACEIs or ARBs. Medical records database was collected, most of patients were female (49.6%),
older than 70 years (51%). About half (52.2%) of patients treated with ACEIs and ARBs had hypertension
alone while 35% of patients who received ACEIs had chronic kidney disease with hypertension and 52.9%
of patients receiving ARBs had chronic kidney disease with hypertension. About four-fifths of three groups
of patients had normal blood potassium levels. However, combination of ACEIs and ARBs group had one
quarter of incidence of mild hyperkalemia. Therefore, median of serum potassium levels in three groups
were not different. Patient's comorbidity and drug contraindications should be considered for appropriate
medication. ACEIs and ARBs should not be used together because of increasing risk of hyperkalemia rather
than using one group of ACEIs or ARBs.

The Associated Factors for Permanent Cerebrospinal Fluid Shunting in Thalamic Hemorrhage Patients with Intraventricular Extension

Warin Yuyangket — Mon, 25 Jan 2021 00:00:00 +0700

Thalamic hemorrhage with intraventricular hemorrhage may lead hydrocephalus. The surgical
treatment of choice is temporary external ventricular drainage and/or permanent cerebrospinal fluid
(CSF) shunting. The purpose of this comparative and analytic study from medical records was to
determine the associated factors which patients may need permanent CSF shunting procedure. Total of
81 patients had thalamic hemorrhage with intraventricular extension undergone surgical treatment at
Buddhachinaraj Phitsanulok Hospital between 1st October 2016 and 30th September 2019 were included.
The mean age of patients was 63.7 years, 42 patients (51.9%) were men and age less than 60 years
were 41 (50.6%). Procedure in 72 patients (88.9%) had temporary external ventricular drainage, permanent
CSF shunting in 16 patients (19.8%) and both procedures in seven patients (8.6%). On the first computerized
tomography of brain, mean Evans index and Bicaudate index were 0.30 and 0.25 in 33 patients (40.7%)
and 49 patients (60.5%) respectively. Thalamic obstruction was found 87.7% and panintraventricular
hemorrhage was occurred in most patients (90.1%). Blood leaked in ventricular more than 30 mL in 39 patients
(48.1%). In conclusion, the patients who had undergone temporary external ventricular drainage and volume
of blood leak in ventricular more than 30 mL are associated factors for permanent CSF shunting

Development of Diabetes and Hypertension Screening System with Community Network Participation in Urban Primary Care Cluster

Sasitorn Sripotong, Siriphan Theerakarn, Wiroj Wannapira — Tue, 26 Jan 2021 00:00:00 +0700

Ministry of Public Health has reformed the NCDs screening model to be congruent for general
population and also has developed an effective mechanism of community network participation. This action
research was conducted in P-A-O-R principle four step 1) Plan 2) Act 3) Observe 4) Reflect and aimed
to develop of diabetes and hypertensive screening system with community network participation between
fiscal year 2016-2018 in persons with diabetes and hypertension. Patient aged over 35 years who lived in
Phitsanulok Municipality were screened by blood sugar and blood pressure measure. The results of this
study showed that the screening system had been developed which increased coverage of screening
services and increased proactive screening service in communities both in office hours and out of office
hours by the participation of community network. In fiscal year 2016 and 2018 the percentage of receiving
blood sugar and blood pressure screening among persons aged over 35 years had increased from 6.3%
to 16.6% and from 5.4% to 18.9% respectively. Thus, this development of screening system increases
diabetes and hypertension screening rate of people in urban areas.

Complications of Cranioplasty Using Autologous Bone Graft versus Synthetic Bone Tissue following Decompressive Craniectomy for Traumatic Brain Injury

Anecha Poolsawat, Ekkapot Jitpun — Tue, 26 Jan 2021 00:00:00 +0700

Decompressive craniectomy is the essential surgical procedure to reduce intracranial pressure and
decrease mortality rate of the patients. Frontoparietotemporal craniectomy defect after wide decompressive
craniectomy was replaced with cranioplasty at the proper time. The purpose of this study was to compare
complication rates of cranioplasty between using autologous bone graft versus synthetic bone tissue
(polymethyl methacrylate: PMMA) in decompressive craniectomy patients. This retrospective study
was including skull defect patients from decompressive craniectomy in the Buddhachinaraj Phitsanulok
Hospital between July, 2013 to June, 2019. Ninety-one patients were included, 31 (34.1%) patients in
autologous bone graft group and 60 (65.9%) patients in synthetic bone tissue group. The overall
complication rate was statistically different in autologous bone graft group (8 patients out of 31: 28.5%)
compared with the synthetic bone tissue group (3 patients out of 60: 3%). There was higher rate of surgical
site infection in autologous bone flap group (6 patients: 19.3%) than synthetic bone tissue group (2 patients:
3.3%), which was also statistically different. In conclusion, cranioplasty using autologous bone graft shows
higher complications and rate of infection statically significant than synthetic bone tissue

Treatments of Common Cancers in Elderly Patients

Thapana Trakoolsirisak, Teerayuth Namkanisorn — Tue, 26 Jan 2021 00:00:00 +0700

Cancer is the disease characterized by uncontrolled growth of abnormal cells in the body. Cancer
cells can spread to surrounding tissues and adjacent organs. It is the second leading cause of death globally,
accounting for an estimated 9.6 million deaths in 2018. Since cancer is more common in elderly patients,
who are different from the younger patients in the sense of side effects caused by cancer treatment, the
selection of treatment in this age group is significant. The treatment of cancer in elderly patients should
require screening tools and comprehensive geriatric assessment. According to Prapokklao Hospital-based
Cancer Registry from 2015-2019, the top three cancers in men aged 60 and older were lung cancer, liver
cancer and colorectal cancer, respectively. For women, the top three cancers were breast cancer, colorectal
cancer and lung cancer, respectively. In this article, we reviewed samples of screening tools and treatments
of common cancers in the elderly patients consisted of lung cancer, colorectal cancer, breast cancer and liver
cancer

The Role of Peer in Assisting Their Friends with Adolescent Depression

Rawipat Pullarp, Archin Songthap — Tue, 26 Jan 2021 00:00:00 +0700

Depression is an increasing psychological problem in adolescents which causing violent behavior,
learning problem, emotional disorders, use of drugs, and finally leading to suicide. This article is intended to
show the importance of the role of friends in helping their friends with depression by using the MAST principle
(M: Monitor, A: Activity, S: Support, T: Treatment). According to the MAST which is presented information
about 1) the role of friends to help observing and monitoring depression (Monitor), 2) the role of friends in
promoting physical and mental activities (Activity), 3) the role of friends in supporting friends (Support),
and 4) the role of friends to encourage friends to receive treatment (Treatment). The adolescents are
those who have physical, emotional and social changes. These are the risk factors in depression. Since the
symptoms may be similar to general sad emotions which is difficult to notice. Therefore, they are unable to be
helped immediately. Moreover, the important problem is inaccessibility to adolescents with depression. Therefore,
the role of friends is important in supporting and influence their friends in various aspects more than others.
Including, the friends could notice, monitor, do the activities together, encourage each other, and support
friends to receive treatment. These contribute to those who have depression feel more self-valued and
continue living with the happiness