Lampang Medical Journal

Total Hip Arthroplasty in Ankylosing Spondylitis

2025-04-28T13:51:11+07:00

Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the spine, hip joints, and sacroiliac joints. Approximately 24–36% of patients develop hip ankylosis, severely limiting mobility and quality of life. Total Hip Arthroplasty (THA) is often necessary to restore function. However, THA in AS patients is complex due to spinal deformities, reduced spinopelvic mobility, and potential cardiopulmonary complications. Careful preoperative assessment, including evaluation of hip range of motion, spinal alignment, and systemic health, is critical. Surgical approach selection must address the specific type of hip deformity to enable effective soft tissue release. Potential complications include intraoperative fractures and heterotrophic ossification. Accurate positioning of the acetabular component, particularly minimizing anteversion, is essential to prevent instability. Postoperative outcomes are promising, with significant improvements in hip mobility and pain relief. A multidisciplinary team approach, involving orthopedic surgeons, anesthesiologists, and internists, is crucial to managing the complex needs of AS patients undergoing THA and achieving optimal surgical outcomes.

Outcomes After Implementing Sepsis Clinical Practice Guidelines in the Internal Medicine Department of Phraphutthabat Hospital

2025-04-23T10:41:58+07:00

Background: The implementation of clinical practice guidelines (CPG) for the treatment of sepsis plays can reduce patient mortality. Currently, updated guidelines based on the Surviving Sepsis Campaign 2021, which have demonstrated improved efficacy, have been adapted for use at Phraphutthabat Hospital.
Objective: To evaluate the outcomes of implementing an updated CPG based on the Surviving Sepsis Campaign, structured as a standing treatment order for the management of sepsis patients.
Materials and Methods: This was a retrospective analytical study of sepsis patients treated in the Department of Internal Medicine at Phraphutthabat Hospital. Patients were divided into two groups: pre-implementation (January–October 31, 2023) and post-implementation (November 2023 – August 2024) of the revised CPG. Data collected included patient demographics, antibiotic administration, fluid volume received, serum lactate levels, fluid reassessment, length of hospital stay, and mortality. Statistical analyses included Fisher’s exact test, t-test, and Mann-Whitney U test for group comparisons.
Results: A total of 304 patients were included, with 152 patients in each group. There were 73 cases (48.0%) and 71 cases (46.7%) of septic shock in the pre- and post-implementation groups, respectively. The 30-day mortality rate in the CPG group decreased from 36.2% to 24.3% (p = 0.025) among sepsis patients, and from 54.8% to 38.0% (p = 0.044) among patients with septic shock. Among the 292 patients who were hospitalized for no more than 30 days, the median length of stay decreased from 8 days [IQR 5,12] to 7 days [IQR 4,11] (p = 0.011). The most common infection site was the urinary tract, and the most frequently identified pathogen was Escherichia coli. After implementing the updated CPG, the percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured significantly increased. However, the percentage of patients who received antibiotics within one hour did not differ significantly.
Conclusion: The updated sepsis CPG implemented at Phraphutthabat Hospital effectively reduced 30 day mortality. The percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured increased.

Effects of Using Exercise Pamphlet Media Combined with Physical Therapy on Physical Performance and Fall Risk in Elderly Patients with Hip Fractures

2025-04-11T08:57:05+07:00

Background: Rehabilitation after hip fracture surgery in elderly improves physical performance and reduces fall risk. Providing a physical therapy educational pamphlet for continued home-based rehabilitation may help reduce fall risk, as assessed by the Short Physical Performance Battery (SPPB), a validated tool for hip fracture patients.
Objective: To compare fall risk–related physical performance in elderly patients following hip fracture surgery between those who received standard rehabilitation and those who additionally received an exercise pamphlet.
Materials and Methods: This retrospective cohort study included patients aged 60 years and over with hip fractures who underwent surgery at Lampang Hospital between October 2020 and September 2022. All patients received inpatient physical therapy until they could stand or walk before discharge. They were divided into two groups: the study group received a pamphlet titled “Physical Therapy for Patients with Hip fracture” featuring seven exercises targeting the ankle, knee, and hip; the control group received standard care without the pamphlet. General and clinical data were collected, and SPPB scores were assessed six weeks postoperatively.
The percentage of patients with SPPB scores ≤6, indicating fall risk, was calculated. Statistical comparisons between groups were made.
Results: A total of 100 patients (mean age 75.5±7.7 years, range 60–89; 77% female) were included. The intervention group had a significantly higher mean SPPB score than the control group (7.8±2.5 vs. 6.5±2.1, p=0.010). In subdomains, the intervention group had higher median scores in gait speed (2 [IQR 1, 3] vs. 1 [IQR 1, 2], p=0.009) and chair stand test (2 [IQR 1, 3] vs. 1 [IQR 1, 2], p=0.038), but no difference in balance scores (4 [IQR 4, 4] in both groups, p=0.492). Fewer patients in the intervention group had SPPB scores ≤6 (37.0%) compared to the control group (61.1%, p=0.027).
Conclusion: Using exercise pamphlet combined with physical therapy may help improve physical performance and reduce fall risk among elderly patients with hip fractures who have undergone surgery and physical therapy until able to stand or walk before discharge, as indicated by improved SPPB scores six weeks postoperatively

Prevalence of Abnormal Cervical Cancer Screening Results Among Pregnant Women at Lampang Hospital

2025-04-22T14:59:43+07:00

Background: Cervical cancer is the fourth most common cancer among Thai women. Lampang Hospital has implemented a policy of cervical cancer screening using liquid-based cytology (LBC) for all pregnant women attending antenatal care. However, data on the prevalence of abnormal screening results in this population remain limited.
Objective: To determine the prevalence of abnormal cervical cancer screening results in pregnant women and the prevalence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) among those with abnormal results who underwent postpartum cervical biopsy.
Materials and Methods: This retrospective study included pregnant women who attended antenatal care and underwent cervical cancer screening using LBC at Lampang Hospital between June 1, 2020, and March 31, 2023. Descriptive statistics were used to analyze the data, and comparisons were made between women with normal and abnormal screening results.
Results: A total of 1,163 pregnant women were screened. Abnormal results were found in 71 cases (6.1%), including: atypical squamous cells of undetermined significance (ASCUS) in 45 cases (3.8%), low-grade squamous intraepithelial lesion (LSIL) in 20 cases (1.7%), atypical squamous cells cannot exclude HSIL (ASC-H) in 2 cases (0.2%), highgrade squamous intraepithelial lesion (HSIL) in 3 cases (0.3%), and 1 case of cervical cancer detected through visible lesion biopsy (0.1%). A history of prior childbirth was observed in 57.2% of women with normal screening results, compared to 70.4% in the abnormal screening group (p = 0.034). Among women with abnormal results, 26 (37.1%) underwent postpartum colposcopy and cervical biopsy, revealing 8 cases of CIN1 and 2 cases of CIN2+. Including the one case of cervical cancer detected during pregnancy, there were a total of 3 CIN2+ cases among 27 women with abnormal screening results who underwent confirmatory biopsy, yielding a CIN2+ prevalence of 11.1%.
Conclusion: Cervical cancer screening during pregnancy detected abnormal results in 6.1% of cases. Among those with abnormal screening who underwent postpartum biopsy, 11.1% had high-grade precancerous lesions (CIN2+).

External Validation of the MAGENTA Model for Predicting In-Hospital Mortality in Patients with Acute Severe Exacerbation of Chronic Obstructive Pulmonary Disease at Lampang Hospital

2025-08-07T08:15:16+07:00

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with high mortality, especially among hospitalized patients. Although several prognostic tools exist, they are often difficult to apply in resource-limited settings. The MAGENTA model was therefore developed using easily accessible clinical variables to predict in-hospital mortality. If proven effective at Lampang Hospital, it could enhance the care of this high-risk population.
Objective: To externally validate the MAGENTA model for predicting in-hospital mortality in patients with AECOPD at Lampang Hospital. If the model demonstrates inadequate performance, it will be recalibrated for improved applicability.
Materials and Methods: This was a prognostic study involving patients aged >18 years with AECOPD admitted to Lampang Hospital between October 2019 and October 2023. The MAGENTA model uses seven variables collected on the first hospital day: age, body temperature, mean arterial pressure, endotracheal intubation, serum sodium, blood urea nitrogen, and serum albumin. The primary outcome was in-hospital mortality. Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AuROC). If miscalibration was detected, the model was recalibrated by adjusting the intercept and/or slope to address overfitting and derive an updated equation. The model’s performance in risk classification (low, intermediate, and high) was assessed using the positive predictive value (PPV) and positive likelihood ratio (LR+).
Results: A total of 115 patients (324 exacerbation episodes) were included. Most were male with a mean age of 75.6 years and had severe COPD. The original MAGENTA model showed excellent discrimination (AuROC = 0.926), but miscalibration was observed (observedto-expected ratio [O:E ratio] = 2.054, calibration-in-the-large [CITL] = 1.182, slope = 1.293). After recalibration (O:E ratio, CITL, and slope all = 1.000), the model maintained the same discrimination (AuROC = 0.926). The revised equation classified patients into low, intermediate, and high-risk groups with PPVs of 1.05%, 10.00%, and 53.01%, and LR+values of 0.06, 0.59, and 6.04, respectively.
Conclusion: The MAGENTA model accurately identified hospitalized AECOPD patients at risk of in-hospital mortality. Although miscalibration was observed with external data, statistical recalibration improved its predictive accuracy, making it suitable for clinical application in Lampang Hospital.