Lampang Medical Journal

Results and success-rated factors for tympanoplasty at Chom Thong Hospital

2024-12-23T13:03:28+07:00

Background: The prevalence of chronic otitis media in Thailand is reported to be 0.2–0.3% and is among the top five conditions seen in the outpatient department at Chom Thong Hospital. This condition can lead to infections and tympanic membrane perforation. Tympanoplasty is a surgical procedure used to repair perforated tympanic membranes.
Objective: To evaluate the outcomes of tympanoplasty and identify factors predicting surgical success.
Materials and Methods: A retrospective study was conducted using medical records of patients who underwent tympanoplasty for tympanic membrane perforation at Chom Thong Hospital from January 1, 2014, to December 31, 2022. Data were analyzed to identify factors associated with successful surgical outcomes using a regression analysis.
Results: A total of 76 patients met the inclusion criteria, with 7.9% aged ≥55 years and 23.7% experiencing tympanic membrane perforations for more than 60 months. Post-surgery, 72% of patients achieved successful outcomes. The median perforation size of the tympanic membrane decreased from 50% to 0% (p<0.001), and the median air-bone gap conduction improved from 20.5 dB to 8.5 dB (p<0.001). Additionally, 80.3% of patients showed improved air conduction. Factors associated with successful surgical outcomes included age ≥55 years (relative risk (RR) 1.42, 95% confidence interval (CI) 1.07 −1.89) and perforation size smaller than 25% (RR 1.49, 95%CI 1.22–1.81). Surgical techniques, the type of graft used, and intraoperative pathological findings did not significantly influence surgical outcomes.
Conclusion: Tympanoplasty achieved a success rate of 72.4%, with significant improvements in hearing. Factors contributing to favorable surgical outcomes were age ≥55 years and a tympanic membrane perforation size smaller than 25%.

The Prevalence and Associated Factors of Frailty Among Hemodialysis Patients

2025-03-06T14:39:54+07:00

Background: Frailty is a multidimensional syndrome of decline that increases the risk of disability, hospitalization, and mortality. Although it is most commonly observed in older adults, chronic kidney disease can precipitate frailty even in younger patients.
Objective: To determine the prevalence of frailty and its associated factors in patients with chronic kidney disease receiving hemodialysis.
Materials and Methods: In this cross-sectional study, patients undergoing hemodialysis at the Lampang Hospital Dialysis Center from June to December 2020 were assessed for frailty using modified Fried frailty phenotype criteria. Participants were classified as frail or non-frail, and factors associated with frailty were identified by logistic regression.
Results: A total of 131 patients were enrolled (38 women, 29.0%), with a mean age of 56.1 ± 11.6 years and a median dialysis vintage of 3.8 [IQR 2.8–4.9] years. Twenty-three patients (17.6%) were frail, 95 (72.5%) were pre-frail, and 13 (9.9%) were robust. The frail group had a higher Charlson Comorbidity Index (CCI) (3.8 ± 1.9 vs. 2.9 ± 1.4; p = 0.01) and lower Karnofsky Performance Status Scale (KPSS) score (70.4 ± 15.5 vs. 86.6 ± 12.6; p < 0.01) than the non-frail group. They also had significantly lower serum hemoglobin (9.2 ± 1.6 vs. 10.2 ± 1.8 g/dL; p = 0.01), serum albumin (3.8 ± 0.4 vs. 4.0 ± 0.4 g/dL; p = 0.02), and serum magnesium (2.1 ±
0.4 vs. 2.4 ± 0.4 mg/dL; p = 0.01). In multivariate analysis, higher CCI (OR 1.47; 95%CI 1.05–2.05; p = 0.03), lower KPSS (OR 0.92; 95% CI 0.89–0.96; p < 0.01), and lower hemoglobin (OR 0.68; 95% CI 0.47–0.99; p = 0.04) were independently associated with frailty.
Conclusion: Frailty and pre-frailty are common among hemodialysis patients. CCI, KPSS, and hemoglobin level are key factors associated with frailty in this population.

Prevalence of Helicobacter pylori Infection Among Cirrhotic Patients Undergoing Endoscopic Screening for Esophageal Varices at Lampang Hospital

2025-03-28T09:48:29+07:00

Background: Helicobacter pylori (H. pylori) infection in patients with chronic liver disease has been associated with the exacerbation of complications. However, to date, no studies have assessed the prevalence and risk factors of H. pylori infection specifically in cirrhotic patients in Thailand.
Objective: To determine the prevalence of H. pylori infection and identify associated risk factors among cirrhotic patients.
Methods: A cross-sectional study was conducted at Lampang Hospital, including cirrhotic patients undergoing esophagogastroduodenoscopy (EGD) for esophageal varices screening. H. pylori infection was diagnosed using either a rapid urease test or histopathological examination. Patients were classified into H. pylori-infected and non-infected groups.
Results: Of the 108 cirrhotic patients included in the study, 32 (29.6%) were diagnosed with H. pylori infection. Alcoholic cirrhosis was the most common etiology, followed by cirrhosis due to hepatitis B virus and hepatitis C virus. Univariate analysis revealed no significant associations between the examined risk factors and H. pylori infection in cirrhotic patients.
Conclusion: Among cirrhotic patients undergoing EGD for esophageal varices screening, the prevalence of H. pylori infection was 29.6%.

Prediction of Neonatal Intensive Care Unit Admission in Late Preterm Infants

2025-03-19T14:01:50+07:00

Background: Late preterm infants, born between 34 0/7 and 36 6/7 weeks of gestation, have higher rates of complications compared to full-term infants and often require admission to the neonatal intensive care unit (NICU).
Objective: To identify antenatal factors predicting NICU admission among late preterm infants born at Chaiyaphum Hospital.
Materials and Methods: This case-control study included late preterm infants born at Chaiyaphum Hospital between June 1, 2022, and December 31, 2023. Data were retrospectively collected, and infants were categorized into two groups: those who required NICU admission and those who did not. Descriptive statistics were used, and comparisons between groups were performed using the exact probability test, independent t-test, and Mann-Whitney U test. Multivariable risk ratio regression was used to identify predictors of NICU admission.
Results: A total of 244 late preterm infants were included in the study, with 48 cases (19.7%) requiring NICU admission due to respiratory distress. Infants admitted to the NICU had significantly lower birth weight, gestational age, and APGAR scores at 1 and 5 minutes compared to those not admitted. Multivariable regression analysis revealed that maternal syphilis infection during pregnancy and gestational age at 34 and 35 weeks were significant predictors of NICU admission, with adjusted risk ratios of 3.48 (95% CI: 1.32–9.19, p=0.012), 4.56 (95% CI: 2.47–8.42, p<0.001), and 2.07 (95% CI: 1.03–4.16, p=0.041), respectively.
Conclusion: Maternal syphilis infection and gestational age of 34 and 35 weeks were significant predictors of NICU admission in late preterm infants.

Correlation Between Ethanol Concentrations in Postmortem Blood and Vitreous Humor

2025-04-02T15:29:03+07:00

Background: In forensic autopsy investigations related to traffic accidents, alcohol levels (ethanol) are often implicated. Measuring blood alcohol concentration (BAC) is crucial in determining the cause of death in traffic accident victims, as alcohol levels impact driving ability. However, in cases where post-mortem physiological changes have occurred, vitreous alcohol concentration (VAC) may be a more reliable alternative for determining alcohol levels.
Objective: To investigate the correlation between BAC and VAC in deceased individuals who underwent autopsy within 24 hours postmortem, and to determine the optimal sample collection time for the most accurate measurement of alcohol concentration, given the reliability of VAC in reflecting alcohol levels.
Materials and Methods: This retrospective analytical study reviewed autopsy cases of 108 traffic accident fatalities at Chiang Rai Prachanukroh Hospital between January 2020 and December 2023. Subjects were classified into two groups: those with a BAC-to-VAC ratio greater than 1 (B/V ratio >1) and those with a ratio of 1 or less (B/V ratio ≤1). The correlation between BAC and VAC was analyzed using linear regression analysis. The sample collection time, BAC, and VAC were compared between the two groups using t-tests and the Mann-Whitney U test.
Results: Of the deceased, 92 (85.2%) were male, with a mean age of 38.5±16.5 years (range: 15–75 years). The mean BAC and VAC were 182±107 mg/dL and 192±93 mg/dL, respectively. BAC and VAC showed a very strong correlation (r=0.92, p<0.001). The mean B/V ratio was 1.1±0.2. The B/V ratio >1 group (n=68) had a median sample collection time of 761 minutes (IQR 620, 933 minutes), approximately 12 hours, which was longer than the B/V ratio ≤1 group (n=40) with a median of 525 minutes (IQR 306, 768 minutes, p=0.001). The B/V ratio >1 group also had a higher BAC (214±96 vs. 163±94 mg/dL, p=0.016), while VAC levels were not significantly different (196±92 vs. 183±96 mg/dL, p=0.525).
Conclusion: BAC and VAC have a very strong correlation. Vitreous humor sampling should be considered in addition to blood sampling for cases where the deceased has been postmortem for more than 12 hours to enhance the accuracy of alcohol concentration assessment.