Hua Hin Medical Journal

Carambola Nephrotoxicity: Clinical Toxicology and Management

Supawiwatch Rodjanasingha — Thu, 25 Dec 2025 00:00:00 +0700

Averrhoa carambola (Star fruit) is a commonly consumed tropical fruit in Southeast Asia and South America. Despite its nutritional benefits, several clinical and experimental studies have demonstrated its potential to cause severe nephrotoxicity and associated neurotoxic manifestations, particularly in individuals with impaired renal function. This article aims to review and synthesize updated evidence regarding the pathophysiology, clinical features, diagnosis, and management of carambola nephrotoxicity, along with practical preventive strategies for clinicians. Recent reports (within the past five years) indicate an increasing number of cases of acute kidney injury (AKI) following excessive or concentrated star fruit ingestion, both in healthy individuals and patients with chronic kidney disease (CKD). The primary mechanisms involve calcium oxalate crystal deposition within renal tubules and the accumulation of the neurotoxin caramboxin, leading to tubular obstruction, acute tubular necrosis, and neurological symptoms. Early recognition and early hemodialysis are key determinants for renal recovery and improve survival. This review highlights current clinical evidence, presents a representative case from Hua Hin Hospital and provides recommendations for early diagnosis, management, and public health prevention to reduce avoidable morbidity and mortality from star fruit toxicity, to increase awareness and reduce the incidence of preventable complication.

Risk Factors Associated with Acute Respiratory Failure in Hospitalized Community -Acquired Pneumonia at Bangsaphan Hospital; A Focus on Non-COVID-19 Pneumonia

Nawaphon Chopsaart — Thu, 25 Dec 2025 00:00:00 +0700

Background: Community-acquired pneumonia (CAP) is a leading cause of respiratory failure and septicemia, contributing to increased patient mortality and complications. These complications often prolong hospitalization. Identifying risk factors for respiratory failure is essential for surveillance, close monitoring of patients, with the goal of preventing respiratory failure in individuals with CAP.

Objective: To investigate the risk factors associated with the development of respiratory failure in patients with CAP.

Methodology: This study employed a retrospective cohort study. It included patients aged ≥ 18 years who were admitted with a diagnosis of CAP (excluding COVID-19 pneumonia) to the inpatient department of Bangsaphan Hospital between January 1, 2021, and December 31, 2021. Data were presented as mean ± standard deviation or median (interquartile range). Risk factors associated with respiratory failure in CAP patients were analyzed using multivariate logistic regression analysis.

Results: A total of 231 patients were included in the study, with 58.4% being male. The average age was 64.9 ± 19.2 years. The incidence of respiratory failure in CAP patients was 16.9%. The risk factors significantly associated with respiratory failure were: history of cerebrovascular disease (CVD) (adjusted OR = 3.51; 95% CI: 1.02-12.13; p = 0.047), respiratory rate (RR) ≥ 30 bpm (adjusted OR = 3.46; 95% CI: 1.60-7.48; p = 0.002), oxygen saturation < 90% (adjusted OR = 7.43; 95% CI: 3.08-17.96; p = 0.001), radiographic evidence of pneumonia involving more than two lobes (adjusted OR = 3.40; 95% CI: 1.50-7.72; p = 0.003), and septic shock (adjusted OR = 9.17; 95% CI: 2.06-40.83; p = 0.004).

Conclusion: The significant risk factors for acute respiratory failure in patients with community-acquired pneumonia were CVD, RR ≥ 30 bpm, oxygen saturation < 90%, multilobar involvement on chest radiographs, and septic shock.

Incidence and Factors Associated Among Continuous Ambulatory Peritoneal Patients Undergoing Dialysis with Hypokalemia in Hua-Hin Hospital

Supawiwatch Rodjanasingha — Thu, 25 Dec 2025 00:00:00 +0700

Background: Hypokalemia is a common electrolyte disturbance among patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and is associated with adverse clinical outcomes including malnutrition, catheter malfunction, peritonitis, and increased hospitalization. However, data on its incidence and contributing factors among Thai CAPD patients remain limited.

Objective: To determine the incidence of hypokalemia and identify associated clinical and dialysis-related factors among CAPD patients at Hua-Hin Hospital, Prachuap Khiri Khan Province, Thailand.

Methods: This retrospective analytic study reviewed medical records of 124 end-stage renal disease (ESRD) patients who received CAPD at Hua-Hin Hospital between January 2019 and December 2024. Demographic data, comorbidities, dialysis prescriptions, laboratory parameters, medications, and clinical complications were analyzed. Hypokalemia was defined as serum potassium < 3.5 mEq/L. Statistical analyses included chi-square test, t-test, and multiple logistic regression.

Results: The incidence of hypokalemia among CAPD patients was 36.3%. Most cases (84.4%) presented with mild to moderate hypokalemia (serum potassium 2.5-3.5 mEq/L), while 15.6% had severe hypokalemia (< 2.5mEq/L). Factors significantly associated with hypokalemia included presence of diabetes mellitus (P = 0.004), lower serum albumin (P = 0.001), reduced serum magnesium (p = 0.030), and decreased serum bicarbonate (P = 0.010). Higher peritoneal ultrafiltration volume and certain dialysis prescriptions were also correlated. However, use of diuretics, RAAS inhibitors, insulin, or alkali therapy showed no significant associations. Hypokalemia was significantly associated with increased rates of malnutrition (p < 0.001), catheter malfunction (p = 0.007), peritonitis (p = 0.012), and hospitalization (p = 0.005). Mortality was higher in the hypokalemia group (22.2% vs. 11.4%) though not statistically significant.

Conclusion: Hypokalemia is prevalent among CAPD patients and is associated with both clinical and dialysis-related complications. Nutritional status, electrolyte balance, and dialysis prescription should be closely monitored. Preventive strategies including early potassium supplementation and individualized dialysis planning may reduce complications and improve patient outcomes.

Clinical Outcomes and Medication Cost Analysis of Implementing an Intravenous-to-Oral Antibiotic Switch Program in Patients with Community-Acquired Pneumonia: A Case Study

Rungrat Liampetch — Thu, 25 Dec 2025 00:00:00 +0700

Background: Antimicrobial resistance is a global public health concern, including in Thailand. To address this issue, the Antimicrobial Stewardship Program (ASP) has been implemented to promote the rational use of antimicrobial agents. One of the strategies recommended by ASP is the conversion of antimicrobial administration from intravenous (IV) formulations to oral formulations, which supports appropriate antimicrobial use.

Objective: To study and evaluate clinical outcomes regarding the duration of intravenous (IV) antibiotic use, length of hospital stay, the rate of antibiotic switch from intravenous to oral administration, 28-day hospital readmission rate, 30-day post-discharge mortality rate. total antibiotic costs, and overall hospitalization expenses after implementing a decision-support form to guide physicians in switching from IV to oral antibiotics in patients with community-acquired pneumonia.

Methods: A retrospective study was conducted using medical records from U Thong Hospital. Data were compared before and after the implementation of the switching process during the same period (July 1 – December 31, 2023 and 2024). The study included inpatients aged 18 years and older who were diagnosed with community-acquired pneumonia, Sample size was calculated using the G*Power analysis program totaling 62 patients in each group who met the inclusion and exclusion criteria. Patients were divided into a group that switched to oral antibiotics and a group that continued IV administration. The collected data were analyzed using descriptive statistics, including frequency, percentage, and chi-square test. Data related to duration and cost were reported as medians. The distribution of data was assessed using the Kolmogorov-Smirnov test, which indicated non-normal distribution (p < 0.05); therefore, the Mann-Whitney U test was used for group comparisons.

Results: Following the implementation, the group that switched to oral antibiotics showed a statistically significant reduction in the median duration of IV antibiotic use and hospital stay (5 and 4 days, respectively; P = 0.026 and P = 0.022). The switching rate increased to 75.8% from 53.2%. There were no statistically significant differences in the 28-day readmission rate and the 30-day post-discharge mortality rate Although there was a slight increase in the median total antibiotic cost after the implementation compared to the period before (238.8 vs. 218.8 THB; P = 0.608), the overall hospitalization expenses were lower (3,654.4 vs. 4,125.4 THB; P = 0.119).

Conclusion: The implementation of the decision-support form to facilitate switching from IV to oral antibiotics in patients with community-acquired pneumonia helped reduce the duration of IV antibiotic use and hospital stay, increased the switching rate, and decreased overall hospitalization costs.

Development of Nursing Practice Guidelines for Patients with Postoperative Open-Heart Valve Surgery

Thu, 25 Dec 2025 00:00:00 +0700

Background: Open-heart surgery is a treatment option for patients with valvular heart disease; however, it is associated with postoperative complications, prolonged stays in Cardio-vascular-thoracic Intensive care unit (CVT ICU), and high healthcare costs. This study focused on developing and evaluating a nursing practice guideline for patients following open-heart valve surgery, considering perspectives of healthcare providers, patients, service quality, and organizational outcomes.

Objective: To develop and examine the outcomes of implementing a nursing practice guideline for patients after open-heart valve surgery.

Methods: This research employed a research and development design. Purposive sampling was used to recruit participants, including 10 registered nurses and 30 postoperative open-heart valve surgery patients admitted to CVT ICU. Research instruments consisted of the developed nursing practice guideline and accompanying manual, along with outcome assessment tools. Registered nurse data were collected using a nursing practice checklist, a nursing competency evaluation form, a test, and a perception survey. Patient-and service-related outcomes were assessed using clinical outcome records and patient satisfaction questionnaires. Data were analyzed using descriptive statistics.

Results: The developed nursing practice guideline for patients with postoperative open-heart valve surgery comprised three phases: (1) the critical phase within the first 2 hours after surgery, (2) the critical phase from 2-24 hours postoperatively, and (3) the postoperative phase from 24 hours until CVT ICU discharge. Outcomes after implementation showed that: (1) Registered nurses demonstrated increased knowledge and competency scores; adherence to the guideline was 96.73%, and nurses agreed with its application (mean = 4.20, SD = 0.53). (2) patients with postoperative open-heart valve surgery reported high satisfaction (mean = 4.77, SD = 0.44). (3) Service quality outcomes indicated no incidence of bloodstream infection, pneumonia, atelectasis post-estuation, surgical site infection, or mortality. (4) Organizational outcomes revealed a reduction in average CVT ICU length of stay and decreased treatment costs, with an average saving of 35,301.4 THB per patient.

Conclusion: Implementation of the nursing practice guideline for patients following open-heart valve surgery yielded positive outcomes across providers, patients, service quality, and organizational levels. Therefore, the guideline should be applied in similar clinical settings and continuously updated to enhance the efficiency of postoperative valve surgery care.

The Effects of Developing a Balance Rehabilitation Program for Elderly people at Risk of Falling in the Community: Phra Ajarn Fan Ajaro Hospital

Thu, 25 Dec 2025 00:00:00 +0700

Background: Falls are a major health concern among older adults, leading to injuries, loss of functional ability, and reduced quality of life.

Objective: To develop and evaluate the effects of a balance rehabilitation program (BRP) on balance performance among community-dwelling older adults at risk of falling, and to compare their fall-related knowledge and health belief patterns before and after participating in the developed program.

Methods: A quasi-experimental study was conducted with 80 community-dwelling older adults aged 60 years and above who were at risk of falling. Participants were randomly assigned into an experimental group (n = 40) and a control group (n = 40). The experimental group received the BRP, which integrated the Health Belief Model (HBM) to enhance motivation and promote consistent exercise behavior, while the control group received standard rehabilitation care. Both groups participated in an 8-week intervention. Data were collected using questionnaires on general information, fall-related knowledge, health beliefs, and balance assessments including the Time Up and Go Test (TUGT), Five-Time Sit-to-Stand Test (FTSST), and Four-Stage Balance Test (FSBT). Data were analyzed using ANCOVA and chi-square tests.

Results: After the intervention, the experimental group had significantly improved mean TUGT and FTSST scores (P < 0.05), indicating enhanced balance and lower-limb muscle strength. The proportion of older adults classified as low-risk according to the FSBT also increased significantly (x²= 20.82, df = 6, P < 0.05). In addition, fall-related knowledge and health belief patterns increased significantly (P < 0.05) compared to the control group.

Conclusion: The Balance Rehabilitation Program based on the Health Belief Model is effective in improving physical performance, strengthening health beliefs, and reducing fall risk among older adults in the community.

Development of Food sanitation Canteen Model in Hospital

Veerasak Rojanasrirat — Thu, 25 Dec 2025 00:00:00 +0700

Background: Development of food sanitation canteen model in hospital to improve the quality of canteen to be clean, safe, meet standards and have an appropriate model.

Objective: To study of knowledge, attitude, practice and participation of food handlers in hospital canteen, and to development of a food sanitation canteen model.

Methods: This participatory action research on the development of a model for food sanitation canteen in 5 hospitals. The study consists of 4 phases: 1) Reviewed, analyzed, study of the knowledge attitude practice and participation of food handlers. 2) Workshop on applying participatory planning processes to develop standard canteen model.3) Implementation of food sanitation canteen for developing a model and observation of practice results. 4) Evaluation of the results and reflection to stakeholders. Follow-up period was 6 months. Study limitations included small sample size (n = 50) and lack of control group. Data was collected using questionnaires, interview forms, interactive workshops and observation. Analyzed using descriptive statistics and content analysis.

Results: After implementation, the level of knowledge, attitude and practice of food handlers were at a good level; the level of food handler participation was at its highest level. Food handlers' practices and participation were statistically significantly (p < .01) Model development process of food sanitation canteen: Analyze the problem, development need, operating context, Workshop for standard canteen development plan, Implementation of food sanitation canteen development, Observation of practice results, and Evaluate implementation and reflection: 1. Announcement of the policy of food safety hospital and food sanitation in the canteen. 2. The executive board gives importance and supports the operations. 3. Health check and training for food handler. 4. Use safe water and raw materials. 5. Safe food sanitation system. 6. Campaign for canteen cleaning. 7. There is a guideline for hygiene and food sanitation canteen. 8. Network for food sanitation management.

Conclusions: There is an appropriate hospital food sanitation standards canteen model.