Hua Hin Medical Journal

CT findings of Cholangiocarcinoma in Debaratana Nakhonratchasima Hospital

2026-07-13T13:37:15+07:00

Background: Cholangiocarcinoma (CCA) remains a significant public health issue in Thailand, particularly in the Northeastern region, which is an area where liver fluke infections, a major risk factor for bile duct cancer, are found. Therefore, radiological imaging, such as computed tomography (CT), is crucial for characterizing lesions, differential diagnosis, pre-treatment evaluation, and assessing disease spread.

Objectives: To evaluate CT findings and pattern enhancement of cholangiocarcinoma and other associated findings at Debaratana Nakhonratchasima hospital.

Methods: A retrospective descriptive study collecting data from the patients diagnosed with cholangiocarcinoma, who had computed tomography (CT) scan at Debaratana Nakhonratchasima hospital, between August 2023 and August 2025. The data collection tool is a self-designed record form, with diagnostic CT image reviews conducted using the hospital's PACS system. The data were analyzed using descriptive statistics, including number and percentage.

Results: A total of 66 patients were identified, consisting of 43 males (65.2%) and 23 females (34.8%). The patients ranged in age from 38 to 93 years, with a mean age of 69.9 years. The most common type and location of bile duct cancer is intrahepatic mass-forming type (47%), followed by hilar and perihilar cholangiocarcinoma (27.3%), and distal extrahepatic type (7.5%). Overall, the enhancement patterns showed approximately 26.9% in the arterial phase, 66.7% in the portovenous phase, and 96.1% in the delayed phase. It was observed that the contrast media gradually accumulated within the mass over time, a characteristic known as progressive delayed contrast enhancement. Other radiological features include biliary dilatation (100%), lymph node metastasis (48.5%), hepatic artery involvement (39.4%), hepatic vein and portal vein involvement (66.7%), intrahepatic metastasis (25.7%), hepatic capsular retraction (32.4%), lobar atrophy (12.1%), and distant metastasis (19.6%), involving spread to the lungs, bones, peritoneum, and adrenal gland.

Conclusion: The most common type of cholangiocarcinoma in Debaratana Nakhonratchasima hospital is the intrahepatic mass-forming type. The finding of progressive enhancement, which becomes most prominent during the delayed phase, combined with biliary dilatation and the other aforementioned features, such as lymph node metastasis and vascular involvement, serves as the clue diagnostic indicators that assist in the diagnosis of the cholangiocarcinoma.

Accuracy of FAST in Detecting Blunt Abdominal Trauma Compared with CT, with Organ of Injury Characterization on CT in Hua-Hin hospital

2026-05-28T14:53:26+07:00

Background: Blunt Abdominal Trauma (BAT) is a common emergency condition and a major cause of morbidity and mortality. Focused Assessment with Sonography in Trauma (FAST) is widely used for rapid initial assessment, whereas computed tomography (CT) remains the gold standard for diagnosing intra-abdominal injuries.

Objectives: To evaluate the diagnostic accuracy of FAST compared with CT as the reference standard for intra-abdominal injury detection and to characterize organ injury patterns and severity identified on CT in patients with BAT at Hua Hin Hospital.

Methods: A retrospective cohort study was conducted in patients diagnosed with BAT who underwent both FAST and CT at Hua Hin Hospital from August 1, 2020 to August 1, 2025. CT was used as the reference standard. Diagnostic performance of FAST was assessed using sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results: A total of 218 patients were included. FAST demonstrated a sensitivity of 91.2%, specificity of 92.3%, and overall accuracy of 91.3%. The PPV was high (99.5%), whereas the NPV was low (40.0%). The liver (38.53%) and spleen (29.82%) were the most commonly injured organs, with grade III injuries being the most frequently observed. Pelvic fractures were significantly associated with bladder and rectal injuries (p < 0.001).

Conclusions: FAST is a useful screening tool for intra-abdominal injury and demonstrates high diagnostic value when findings are positive. However, due to its low NPV, negative FAST results cannot reliably exclude injury. Therefore, CT should be performed in patients with persistent clinical suspicion or high-risk features. CT remains essential for definitive diagnosis, injury grading, and treatment planning in patients with BAT. Although FAST demonstrated a high specificity of 84.62%, the estimate should be interpreted with caution due to the wide confidence interval resulting from the small number of CT-negative cases. Consequently, the specificity estimate may be unstable.

Computed Tomographic Assessment of Normal Pancreatic Dimensions and Associated Factors in Thai Adults at Chaoprayayommarat Hospital, Suphanburi

2026-07-15T13:47:39+07:00

Background: Knowledge of normal pancreatic size is important, as changes in pancreatic size are the feature used in conjunction with other findings to differentiate pathological conditions. Several studies conducted in other countries have investigated normal pancreatic size and volume, as well as factors influencing pancreatic dimensions. However, there is currently a lack of studies evaluating normal pancreatic size in the Thai population, which may differ from other populations due to variations in anatomical characteristics and ethnicity.

Objective: To determine normal pancreatic dimensions in the Thai population in Suphanburi and to assess factors associated with pancreatic size, including age, sex, abdominal diameter, and subcutaneous adipose tissue thickness.

Methods: This retrospective study was conducted in 200 subjects without known conditions affecting pancreatic size who underwent abdominal computed tomography (CT) at Chaoprayayommarat Hospital, Suphanburi, Thailand, between August 1, 2024, and July 31, 2025. Subjects were stratified into five age groups (20-29, 30-39, 40-49, 50-59, and ≥60 years) and further categorized by sex (male and female), resulting in a total of ten groups. The pancreatic size was measured in three regions: head, body, and tail. Abdominal diameter and subcutaneous adipose tissue thickness were measured. Data were analyzed using descriptive and inferential statistics, including two-way MANOVA, two-way ANOVA, Tukey’s HSD post hoc tests, Pearson’s correlation coefficient and multiple linear regression analysis.

Results: The mean sizes of the pancreatic head, body, and tail were 26.44±5.35, 19.74±4.54, and 22.09±4.81 mm, respectively. Age showed a significant negative association with pancreatic body and tail dimensions in multiple linear regression analysis (p<0.001), but not with the head. A positive correlation was observed between pancreatic size and abdominal diameter, with a moderate correlation in the pancreatic head (r=0.459–0.518, p<0.001). Multiple linear regression analysis demonstrated that sagittal abdominal diameter was an independent factor associated with pancreatic size in all regions. No significant difference in pancreatic size was found between males and females.

Conclusion: Pancreatic size in the Thai population in Suphanburi is associated with age and abdominal diameter. The reference values obtained from this study may be useful for evaluating pancreatic size and supporting clinical diagnosis in conjunction with clinical and imaging findings.

Clinical Outcome Study between Primary Percutaneous Coronary Intervention and Pharmacoinvasive Strategy in ST Segment Elevation Myocardial Infarction Patients

2026-07-27T11:24:18+07:00

Background: Rapid coronary artery opening is key to the treatment of patients with ST segment Elevation Myocardial Infarction (STEMI) with Primary PCI as the standard method. However, thrombolytic drugs are administered. Tenecteplase (TNK) combined with PCI (Pharmacoinvasive strategy) is an important option in hospitals that are unable to perform PCI in time. This study aimed to compare clinical outcomes between Primary PCI and Pharmacoinvasive strategies in STEMI patients.

Objectives: To evaluate and compare the clinical outcomes of STEMI patients treated with primary PCI versus a pharmacoinvasive strategy.

Methods: This is a retrospective study in patients. STEMI treated with primary PCI or pharmacoinvasive strategy using TNK followed by coronary artery injections and PCI during the period from January 1, 2024 to August 31, 2025. Clinical outcomes: Assess major adverse cardiovascular event (MACE) including death. Recurrent myocardial infarction Stroke and cardiac shock, and complications from abnormal bleeding, as well as following up with patients. 30 days to assess MACE

Results: Patients in the pharmacoinvasive strategy group compared with the primary PCI group found that there was no significant difference in MACE incidence and mortality and no bleeding disorders were observed in either group. After 30 days of follow-up in both groups of patients, it was found that the incidence rate of MACE does not differ significantly.

Conclusions: The Study was limited by a smaller sample size than initially calculated. Nevertheless, the findings suggested that the pharmacoinvasive strategy tended to yield outcomes comparable to primary PCI in terms of mortality, MACE and major bleeding.

Hospital-based Cost-Effectiveness of Semaglutide for Glycemic Control in Patients with Type 2 Diabetes Mellitus

2026-04-29T08:45:36+07:00

Background: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has demonstrated substantial efficacy in glycemic control among patients with type 2 diabetes mellitus (T2DM); However, it is associated with high treatment costs.

Objective: To evaluate the cost and effectiveness of Semaglutide in reducing glycated hemoglobin (HbA1c) levels among patients with T2DM from the healthcare provider perspective.

Methods: A retrospective cohort study was conducted in patients with T2DM who received Semaglutide between January 1, 2023, and December 31, 2024. Treatment costs and HbA1c levels were analyzed before and after 12 months of Semaglutide therapy from the healthcare provider perspective.

Results: A total of 52 patients were included, with a mean age of 59.48 ± 11.54 years; 59.6% were female. The mean duration of diabetes was 9.37 ± 5.52 years, and the mean body weight was 81.57 ± 15.17 kg. Hypertension was present in 92.3% of patients. After 12 months of Semaglutide treatment, a statistically significant reduction in HbA1c was observed (−1.53%, p<0.001). The number of patients achieving target HbA1c levels increased by 15 (p < 0.001), along with a significant decrease in body weight (−3.07 kg, p<0.001). Semaglutide use resulted in an average treatment cost increase of 36,518.58 THB per patient per year. Cost-effectiveness analysis revealed that reducing HbA1c by 1% required an additional cost of 23,868.35 THB per year, while achieving the target HbA1c level in one additional patient cost 2,434.57 THB per person per year.

Conclusion: Semaglutide therapy in patients with T2DM significantly improved glycemic control and reduced body weight. The incremental cost associated with a 1% reduction in HbA1c was 23,868.35 Thai Baht per patient per year.

Effects of a Health Literacy Enhancement Program on Self-Care Behaviors for Chronic Kidney Disease Prevention and Clinical Outcomes among Older Adults with Uncontrolled Type 2 Diabetes in Bang Krok Sub-district, Ban Laem District, Phetchaburi Province

2026-07-16T13:54:10+07:00

Background: Uncontrolled type 2 diabetes mellitus is a primary cause of chronic kidney disease, which imposes significant physical, psychological, social, and economic impacts. Therefore, promoting health literacy serves as a crucial approach to encouraging appropriate self-care behaviors for chronic kidney disease prevention.

Objective: To study the effect of a health literacy enhancement program on self-care behaviors for chronic kidney disease prevention and clinical outcomes in older adults with Uncontrolled Type 2 Diabetes in Bang Krok Sub-district, Ban Laem District, Phetchaburi Province.

Methods: This research is a quasi-experimental, one group pre-test post-test design. The sample consisted of 30 older adults with uncontrolled type 2 Diabetes. These individuals received a 10-week health literacy enhancement program. Data were collected using a self-care behavior questionnaire for chronic kidney disease prevention, alongside laboratory results of estimated glomerular filtration rate (eGFR) and hemoglobin A1c (HbA1c). Data analysis was performed using descriptive statistics and paired t-test.

Results: The findings revealed that the participants’ self-care behavior scores and estimated glomerular filtration rate were significantly higher than those before the intervention (p<0.05). Additionally, the mean hemoglobin A1c levels decreased after the intervention, but this change was not statistically significant.

Conclusion: A health literacy enhancement program was effective in improving self-care behaviors for chronic kidney disease prevention and enhancing the estimated glomerular filtration rate (eGFR) among older adults with uncontrolled type 2 diabetes.

Development of a Questionnaire on Predictive Factors of Stroke Preventive Behaviors among Patients with Hypertension Based on the Health Belief Model: A Case Study of Mueang District, Samut Songkhram Province, Thailand

2026-07-02T14:39:37+07:00

Background: The incidence of stroke among hypertensive patients remains a persistent concern. In Thailand, stroke is the third leading cause of mortality and long-term disability. A major contributing factor is patient health behavior, including high sodium intake, sedentary lifestyle, medication non-adherence, and a lack of awareness regarding stroke warning signs. Crucially, these are modifiable behaviors that can be effectively prevented or improved.

Objective: To assess the content validity of the questionnaire by evaluating the congruence between each questionnaire item and the operational definitions of the research variables, and to determine the reliability of the questionnaire measuring predictors of stroke prevention behaviors among patients with hypertension based on the Health Belief Model (HBM).

Methods: Descriptive research method was used in this study. The methods of study were to synthesize concepts, theories, and related research. Content validity was measured by using Index of Item-Objective Congruence (IOC), evaluated by three experts in public health and health behavior. All items yielded an IOC score of 0.94 or higher, indicating high content validity. The instrument's reliability was pre-tested with 30 individuals sharing similar characteristics to the target population. Internal consistency, measured by Cronbach’s alpha coefficient, was 0.92 for the entire questionnaire. Each HBM subscale also demonstrated acceptable reliability, confirming the instrument’s suitability for data collection.

Results: The synthesis of research results revealed that there were 5 dimensions of Health Belief Model including; (1) Perceived Susceptibility, (2) Perceived Severity, (3) Perceived Benefits, (4) Perceived Barriers, (5) Cues to Action. The questionnaire employs a 5-point Likert scale¹. As a questionnaire was developed based on those components, it was brought to test content validity. The results showed that the value of IOC for each item was .94 as well as the value of CVI = 0.81. Reliability of the questionnaire was tested by using Cronbach alpha coefficient and it was found that α = 0.92.

Conclusion: From the research findings, it be suggested that the questionnaire should be applied to hypertensive populations in other provinces to enhance the generalizability and breadth of the data analysis.

A Study on the Effectiveness of Traditional Thai and Folk Medicine in Treating Malayan Pit Viper Bite Wounds by the Local Healer, Thongkham Phlapyai

2026-08-10T15:56:26+07:00

Background The venom of the Malayan pit viper (Calloselasma rhodostoma) exerts its most severe impact on the hematological system, leading to snake venom-induced consumption coagulopathy (VICC). This condition disrupts blood coagulation mechanisms, resulting in systemic hemorrhage, and is a primary cause of mortality. Beyond systemic toxicity, local inflammation-characterized by pain, edema, and wound-related complications-frequently impairs the patient’s quality of life. In clinical practice, these localized symptoms are considered secondary manifestations that may be managed symptomatically or through integrative alternative medicine. Although modern medicine provides established clinical guidelines for antivenom administration, Thai Traditional Medicine (TTM) plays a significant role in managing local lesions, emphasizing detoxifying and anti-inflammatory herbal formulas such as topical herbal poultices and oral decoctions to alleviate pain, reduce swelling, and accelerate wound recovery. However, empirical evidence regarding the clinical efficacy of these traditional treatments remains limited.

Methods This evaluation research studied 12 patients (N=12) bitten by Malayan pit vipers who sought folk medicine treatment; participants were recruited by purposive sampling. Data were collected via questionnaires and in-depth interviews. Outcomes including swelling, pain scores, complications, recovery time, and satisfaction were assessed before and after treatment. Qualitative data were analyzed using content analysis and quantitative data using the paired t-test.

Results After three days of treatment, mean swelling scores decreased significantly from 1.67 ± 0.65 to 0.50 ± 0.52 (mean difference 1.17, 95% CI 0.70–1.63; t=5.513, p<0.001), and mean pain scores decreased from 5.42 ± 2.84 to 1.33 ± 2.15 (mean difference 4.08, 95% CI 2.98-5.19; t=8.150, p<0.001), with 66.7% of patients reporting complete pain relief. Both effect sizes were large (Cohen’s dz=1.59 and 2.35). No wound infection and no new or progressive necrosis were observed. Most patients (83.3%) recovered within two weeks, and all reported high satisfaction.

Conclusions Treatment of Malayan pit viper bite wounds by the local healer Thongkham Phlapyai was associated with rapid reduction of local pain and swelling and a favorable local safety profile. Given the small purposive sample, the absence of a control group, and the predominantly mild-to-moderate envenoming, these findings should be interpreted as preliminary evidence supporting further study of this practice as an adjuvant to, not a replacement for, standard antivenom care.