Hua Hin Medical Journal

Factors Associated with Severity of Acute Respiratory Tract Infection from Respiratory Syncytial Virus (RSV) in Pediatric Patients at Hua Hin Hospital

Jaruwan Stangthong — 2024-04-30

Background: Respiratory Syncytial Virus (RSV) is the second most common cause of lower respiratory tract infections in children. RSV could cause a severe respiratory distress in infants and children less than five years of age. Identifying the contributing factors associated with the severity of acute respiratory infection from RSV in pediatric patients is therefore crucial and thus will lead to more efficient care for the patients and subsequent guideline development to reduce the disease severity.Objectives: To study the factors associated with the severity of acute respiratory infection in pediatric patients with RSV virus at Hua Hin Hospital.Method: This is a retrospective analytical study. The population used in this study was pediatric patients from birth to 15 years of age whom were diagnosed with RSV infection, which was confirmed by laboratory testing and was not associated with other infections. The study was conducted at Hua Hin Hospital, Prachuap Khiri Khan, Thailand. A total of 300 patients from pediatric wards and pediatric intensive care units (PICU) were included into this study by reviewing the electronic medical records and patient register files for a period of 5 years from October 1, 2017 to September 30, 2022. The tool used in this study was the validated form recording factors associated with severity of acute respiratory infection among RSV-related pediatric patients. Frequency, Percentage, Chi-square test and Fisher's exact test were used for statistical analysis.Results: 51.3% of 300 pediatric patients had been found to develop severe symptoms of acute respiratory tract infection. The factors that correlated with the severity of acute respiratory infections in children with RSV were age, underlying disease asthma, home care (p-value <0.05). Other factors were not associated with the severity of acute respiratory infection among RSV-associated pediatric patients at Hua Hin Hospital.

Conclusion: The factors that correlated with the severity of acute respiratory infections in children with RSV were age, underlying disease asthma, home care. Other factors were not associated with the severity of acute respiratory infection among RSV-associated pediatric patients at Hua Hin Hospital.

Systemic Risk Factors of Diabetic Macular Edema among Patients with Type 2 Diabetes Mellitus in Hua Hin Hospital, Prachuap Khiri Khun Province

Sirinun Wisutthiratanakul — 2024-04-30

Background: Diabetes is a chronic disease that is commonly found and a significant public health problem in Thailand. Many peoples with diabetic mellitus have diabetic retinopathy. Patients with diabetic retinopathy may experience some cases with diabetic macular edema, which requires treatment through intraocular injections, leading to relatively high treatment costs. This has led to the study of risk factors associated with the development of diabetic macular edema to aid in its prevention or reduction.

Objective: The objective of this study is to investigate the risk factors for diabetic retinopathy (DR) in type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province.

Method: This study is an analytical retrospective study based on data collected from the medical records of type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province. The data was collected from January 1st, 2021 to December 31st, 2022, totaling 451 patients. Data collection form consists of variables such as gender, age, duration of diabetes, glycated hemoglobin levels (HbA1c), diabetic retinopathy severity levels based on fundus examination (NPDR and PDR), blood pressure levels, blood lipid levels, glomerular filtration rate (GFR), proteinuria status and statin medication use. Descriptive statistics including percentages (%), mean values and standard deviations were used to analyze the data. Additionally, t-test independent test, Chi-square test and Binary logistic regression analysis.

Results: Among the total of 451 type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province who were screened for Diabetic retinopathy using fundus examination; it was found that there was a prevalence of Diabetic macular edema (DME) in approximately 10.4%. From the study, when single variables were used for multivariate analysis (Binary logistic regression), a statistically significant relationship was found that the occurrence of macular swelling was related to the duration of diabetes and the level of diabetic retinopathy. Furthermore, the duration time being more than or equal to 10 years increased risk of DME development 9.76 times compared with those having diabetes only within a range from one year up to five years. Meanwhile, severe non-proliferative diabetic retinopathy (severe NPDR) degree and proliferative diabetic retinopathy (PDR) increased risk of DME development 55.43 and 42.53 times respectively, compared with mild non-proliferative diabetic retinopathy NPDR (Mild NPDR). On the other hand, glycated hemoglobin levels, blood pressure levels, blood lipid levels, glomerular filtration rate (GFR), proteinuria status and statin medication use did not show a significant relationship with the development of DME.

Conclusion: The prevalence of DME in type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province was 10.4%. Duration of diabetes disease onset period and diabetic retinopathy severity levels were significantly associated with the development of DME.

Comparison of Amniotic Membrane Transplantation and Intraoperative Mitomycin C 0.02% for Primary Pterygium Excision, Hua Hin Hospital

Tienchai Methanopphakhun — 2024-04-30

Background: Pterygium is one of the most common eye diseases around the world, especially in equatorial countries. There are many techniques used in pterygium surgery, which can affect recurrence and long-term complications. There was no study about pterygium surgery using amniotic membrane transplantation and intraoperative Mitomycin C 0.02% in Hua Hin Hospital.

Objective: To compare the recurrence rate and complications after primary pterygium surgery using amniotic membrane transplantation and intraoperative Mitomycin C 0.02%.

Methods: The retrospective cohort analytic study was evaluated patients with primary pterygium who underwent pterygium surgery using amniotic membrane transplantation and intraoperative Mitomycin C 0.02%, in Hua Hin Hospital between March 2021 and September 2022. The 80 patients were included. Data were analyzed through descriptive statistics (Frequency, Percentage, Mean, Standard Deviation) and inference statistics (Chi square test, Independent t–test and Odds ratio)

Results: Both groups were same demographic data. The recurrence rate after primary pterygium surgery using amniotic membrane transplantation and intraoperative Mitomycin C 0.02% at 6 months and 1 year were 15% and 15% respectively. There was no significant difference in the recurrence rate and complications between the 2 groups.

Conclusions: According to the research results, intraoperative Mitomycin C 0.02% concentration should be used in the treatment of pterygium because it is a cheap, safe, easy, convenient and low complications.

Factors Affecting The Severity of Epithelial Ovarian Cancer in Patients Undergoing Treatment at Hua Hin Hospital Prachuap Khiri Khan Province

Sucha Aryuwat — 2024-04-30

Background: Ovarian cancer is the most deadly form of cancer among reproductive organ cancers in women, and it ranks sixth in terms of incidence among Thai women. The five-year survival rate for ovarian cancer patients is only 46%, but if diagnosed at an early stage, the five-year survival rate can increase to 94%. It is widely accepted that the most effective treatment for ovarian cancer involves surgery and chemotherapy, provided by expert oncologists specializing in gynecologic oncology.

Objective: To study factors affecting the severity of epithelial ovarian cancer in patients undergoing treatment at Hua Hin Hospital Prachuap Khiri Khan Province

Method: A retrospective analytical study was conducted using data collected from electronic medical records and patient files from the outpatient department of Hua Hin Hospital between October 1, 2017, and September 30, 2022. The study included a total of 63 patients. The data collection tool consisted of age, CA125 levels, ultrasound findings (abnormal findings included 1) multiloculate 2) solid part 3) bilateral lesion 4) ascites 5) metastasis, if there is 1 or less categorized in minimal abnormal more than 1 are marked abnormal), menstrual status, tumor size, pregnancy history, body mass index (BMI), Risk of Malignancy Index (RMI) scores and severity of epithelial ovarian cancer. Descriptive statistics were used to analyze the data including mean values, frequencies, percentages and standard deviations. Chi-square tests and independent t-tests were used to determine statistical significance with a confidence interval of 95%.

Result: An early-stage group and an advanced-stage group consisting of 63 patients. It was found that CA125 levels in early-stage ovarian cancer (175.8+349.3 units/ml) were significantly lower than in advanced-stage ovarian cancer (2636.3+2793.2 units/ml.) (p<0.001). Additionally, RMI scores for early-stage ovarian cancer (2161+9) were significantly lower than those for advanced-stage ovarian cancer (56583+71796) (p<0.001). Furthermore, ultrasound results, menstrual status and tumor size showed significant correlation with the severity of epithelial ovarian cancer (p<0.05). Other factors did not show any significant correlation.

Conclusion: Based on the research findings, it is recommended to screen for epithelial ovarian cancer in women experiencing menopausal symptoms using CA125 levels and ultrasound findings. This will enable early detection and prompt surgical removal of the tumor, leading to improved patient survival rates.

Predictive Factors of Negative Appendectomy in Patients Diagnosed with Acute Appendicitis

Tawadchai Treeratanawikran — 2024-04-30

Background: Acute appendicitis is the most common cause of acute abdominal pain that leads the patients to the emergency room. The patients suspected of having appendicitis should be operated urgently to reduce the risk of complications. However, there are cases of patients undergoing unnecessary appendectomy as it has been observed that some individuals diagnosed preoperatively with acute appendicitis do not have histopathologic evidence of appendicitis.

Objective: The aim of this study is to evaluate the rate of negative appendectomy and the factors associated with negative appendectomy.

Methods: This case control study was conducted through a retrospective review of medical records. Data from the patients who were preoperatively diagnosed with acute appendicitis and underwent appendectomy from January 1, 2021 to June 30, 2023 were retrospectively collected. The patients were divided into two groups considering the pathological presence of inflammatory changes in the appendix. The patients with and without appendicitis on pathology were compared. Multivariate logistic regression model was used to identify predictors of negative appendectomies.

Results: The study population was 1,038 patients, with a negative appendectomy rate of 27.8%. The factors associated with increasing the negative appendectomy rate were age younger than 40 years (OR 1.84, P < 0.05), female gender (OR 1.97, P < 0.05), history of diarrhea (OR 1.69, P < 0.05) and no preoperative imaging (OR 2.38, P < 0.05). Whereas the factors associated with reducing the negative appendectomy rate were anorexia (OR 0.71, P < 0.05), migration of abdominal pain (OR 0.65, P < 0.05), white blood cell count greater than 10,000 cells/uL (OR 0.49, P < 0.05), neutrophil greater than 75% (OR 0.50, P < 0.05).

Conclusion: The diagnosis of acute appendicitis in female patients, in persons under 40 years of age or with concomitant diarrhea should be made with caution. Prudent use of comprehensive laboratory tests and diagnostic imaging study can reduce the rate of negative appendectomies.

Appropriateness and Efficacy of Atorvastatin Prescribing in Outpatients at U-thong Hospital

Nattaya Pansang — 2024-04-30

Background: Atorvastatin is a statin drug that is effective in treating dyslipidemia and reducing cardiovascular disease. According to prescription data from U-thong Hospital, the number of prescriptions for atorvastatin continues to increase and was the most commonly prescribed drug in 2021–2022, with a value of 2,374,833 baht and 2,637,646 baht, respectively.

Objective: To study the appropriateness of prescribing atorvastatin and its effectiveness in regulating blood lipid levels in outpatients with dyslipidemia.

Methods: This was a retrospective review of electronic medical records. The sample group consists of outpatients with dyslipidemia who took atorvastatin for the first time at U-Thong Hospital from October 1, 2021, to September 30, 2022. Descriptive statistics were used to analyze individual data and assess the appropriateness of the atorvastatin prescription, and inferential statistics were used to compare differences between mean lipid levels before and after taking atorvastatin.

Results: The results showed that there were 94 outpatients with dyslipidemia who met the inclusion criteria. Most of the patients used atorvastatin as primary prevention rather than secondary prevention of cardiovascular disease, accounting for 89.4% and 10.6%, respectively. This indicates an appropriate use rate of 60.7% for primary prevention and 100% for secondary prevention. Atorvastatin was statistically effective in reducing LDL-C levels with a p-value <0.05. Atorvastatin 20 mg reduced LDL-C levels by an average of 20.08% while atorvastatin 40 mg reduced LDL-C levels by an average of 38.73%. When monitoring adverse drug reactions with atorvastatin, no adverse drug reactions occurred in any patient taking atorvastatin 20 mg or 40 mg. However, the achievement rates of LDL-C goals in primary and secondary prevention were 60.7% and 20%, respectively.

Conclusion: The rationality of the initial prescription of atorvastatin for the primary and secondary prevention of cardiovascular disease is more than 60%. Atorvastatin is effective in lowering LDL-C levels. Atorvastatin 40 mg lowers LDL-C levels more than atorvastatin 20 mg. Adverse drug reactions were not found.

Factors Affecting Overweight Prevention Behavior of HuaHin Hospital Personnel

sunan lowcharoen — 2024-04-30

Background: Overweight can cause major health problems. It is also a risk factor for developing other non-communicable diseases such as diabetes, heart disease, high blood pressure, and cancer, as well as an increase in premature death.

Objectives: To study the behavior of Hua Hin Hospital personnel in preventing overweight and the factors that affect their behavior.

Method: A descriptive study was conducted among Hua Hin Hospital personnel. 300 people were sampled through a stratified random sampling method based on professional proportion. Data was collected using questionnaires. Descriptive statistics were used for analysis. Hypotheses were tested using the T-test, one-way analysis of variance, and Pearson’s correlation coefficient.

Results: Most personnel were female (78%), aged less than 35 years (53.3%), had a bachelor's degree (66%), and were single (53%). In terms of body mass index, 17.3% were overweight (BMI 23.00-24.99 kg/m²), 24.0% were in the first level of obesity (BMI 25.00-29.99 kg/m²), and 15.7% were in the second level of obesity (BMI 30.00 kg/m²). Overall, the level of prevention behavior for overweight is moderate. The level of social support overall is low. It was found that body mass index affects overweight prevention behavior (p=.046), and social support has a positive correlation with behavior to prevent overweight, r=.413 (p<0.01). The overweight prevention behavior is not affected by gender, age, education, or status.

Conclusions: Personnel should receive social support, which is positively related to overweight prevention behaviors, to promote their health status. In particular, increasing social support, emotional and informational support, which are at a low level, and material support, which is at a moderate level, can create behavioral changes to prevent overweight.