Journal of Health Science and Medical Research <div class="container-fluid"> <div class="row"> <div class="col-sm-9"><a title="The official website of JHSMR" href=""><img style="display: block; margin-left: auto; margin-right: auto;" src="/public/site/images/somjot/redirect.jpg" width="829" height="587"></a><br> <table> <tbody> <tr> <td style="width: 20px;">&nbsp;</td> <td> <p style="text-align: center;"><strong>Journal Summary</strong></p> <p>Journal of Health Science and Medical Research is an online, quarterly peer reviewed scientific journal published by Prince of Songkla University. This journal aims to publish original article, review article, case reports in all aspects of basic and applied medical and health sciences. Manuscripts submitted to Journal of Health Science and Medical Research will be accepted on the understanding that the author must not have previously submitted the paper to another journal or have published the material elsewhere. The journal does not charge for submission, processing or publication of manuscripts and even for color reproduction of photographs.</p> <p><strong>Frequency: </strong>4 issues per year (Jan-Mar, Apr-Jun, Jul-Sep and Oct-Dec)</p> </td> </tr> </tbody> </table> </div> </div> </div> Journal of Health Science and Medical Research, Faculty of Medicine, Prince of Songkla University, Thailand en-US Journal of Health Science and Medical Research 2586-9981 The Functional Tests after ACL Reconstruction with and without Meniscal Repair <p><strong>Objective:</strong>&nbsp;This study aims to compare the functional tests after anterior cruciate ligament reconstruction (ACLR) with and without meniscal repair after the rehabilitation program and before returning to sports.<br><strong>Material and Methods:</strong>&nbsp;Patients who underwent ACLR using hamstring tendon autograft during 2016-2017 were invited to participate in this study and divided into 2 groups including with and without meniscal repairs according to the surgical reports. A group of ACLR with meniscal repair required the conservative anterior cruciate ligament (ACL) rehabilitation program because the non-weight-bearing approach should be applied during the first 6 weeks. These patients were followed up clinically until the rehabilitation program finished. The functional tests were applied with the 4 single-leg hop tests, as reported in the limb symmetry index (LSI).<br><strong>Results:</strong>&nbsp;Forty-three patients were enrolled in the program. These patients were divided into 2 groups: ACLR with meniscal repair (n=20) and ACLR without meniscal repair (n=23). It was found that there was no statistically significant difference between the two groups with respect to duration for completing the rehabilitation program (p-value=0.38). Also, there was no statistically significant difference between the two groups with respect to the LSI of all 4 singleleg hop tests of duration for completing the rehabilitation program.<br><strong>Conclusion:</strong>&nbsp;The conservative ACL rehabilitation program after meniscal repair surgery did not affect the function tests in terms of duration for completing the rehabilitation program before return to sports (RTS).</p> Sineenad Janewanitsataporn Copyright (c) 2020-02-20 2020-02-20 73 79 10.31584/jhsmr.2020726 Determination of Colistin and Tigecycline Resistance Profile of Acinetobacter Baumannii Strains from Different Clinical Samples in a Territory Hospital in Turkey <p><strong>Objective:</strong>&nbsp;Acinetobacter baumannii (A. baumannii) can develop resistance to various antimicrobial agents via different mechanisms. Hence, the aim of this study was to investigate, by using different methods, the resistance profiles of A. baumannii strains isolated from different clinical specimens; from colistin and tigecycline antibiotics, and also the distribution of this resistance according to the clinical samples.<br><strong>Material and Methods:</strong>&nbsp;For this study, 1,265 clinical samples (a samples from each patient) were obtained from various clinics, between; January 2015/December 2018. Identification was conducted by VITEK® 2 compact (bioMerieux, USA) and conventional biochemical tests. Antibiotic susceptibility tests were performed by VITEK 2, and the results of colistin and tigecycline were confirmed by E test and the broth microdilution method.<br><strong>Results:</strong>&nbsp;A. baumannii strains (1,265) were most frequently isolated from tracheal aspirate, sputum and blood samples. At the same time, strains were obtained from intensive care units (70.4%) as well as other clinics (29.6%). The rates of colistin and tigecycline-resistant strains were determined using VITEK 2, E test and the broth microdilution methods as: 3.0%, 5.7%, 9.0% and 21.7%, 24.5%, 33.0%, respectively.<br><strong>Conclusion:</strong>&nbsp;The determination of appropriate antibioticis are important for empirical treatment. Colistin and tigecycline have become prominent as an important, alternative agent in the treatment of A. baumannii-related infections. The results of this study show that colistin and tigecycline resistance rates in intensive care units have been increasing gradually over the years. Monitoring of resistance patterns of nonfermentative bacteria, isolated from intensive care units, is important for the immediate initiation of appropriate empirical treatment. In-vitro studies with A. baumannii strains should also be supported by clinical trials.</p> Merih Şimşek Cengiz Demir Copyright (c) 2020-02-26 2020-02-26 81 91 10.31584/jhsmr.2020727 Duration after Malayan Pit Viper Bite to Detect Coagulopathy in Songklanagarind Hospital <p><strong>Objective:</strong> The main objective was to determine the duration from the bite of a Malayan pit viper (MPV) until a prolonged clotting time in order to create a practice protocol for the Emergency Department (ED) of a university hospital in southern Thailand. The secondary objective was to know the incidence of adverse reactions from the MPV antivenom.<br><strong>Material and Methods:</strong>&nbsp;This was a retrospective descriptive study of patients with MPV bite from 1 January 2006 to 30 November 2017 in the ED at Songklanagarind Hospital.<br><strong>Results:</strong>&nbsp;The study included 153 patients. The average age was 45 years. The median elapsed time from bite to the ED was 40 minutes (interquartile range 30, 80). Fifty nine patients (38.6%) had coagulopathy. The median elapsed time from bite to coagulopathy was 5 hours 30 minutes (range, 40 minutes to 48 hours 40 minutes). Four patients (6.8%) had coagulopathy within the first 2 hours. Thirty patients (50.8%) had coagulopathy within the first 6 hours. Coagulopathy was detected in most of the patients (83.1%) within the first 24 hours. Fifty patients (84.8%) received antivenom. Four patients had immediate hypersensitivity reactions.<br><strong>Conclusion:</strong>&nbsp;The ED protocol should follow-up with a 20-minute whole blood clotting test at 6 hours after a bite to determine the appropriate disposition. If the patients do not have coagulopathy after 6 hours from snake bite, it is safe to follow-up at 24 hours, 48 hours and 72 hours after the bite. The incidence of antivenom hypersensitivity was low</p> Kanthika Kraisawat Nattaya Promwang Copyright (c) 2020-03-09 2020-03-09 93 101 10.31584/jhsmr.2020728 Health Problems among Disciplines at a Regional University in Southern Thailand: A Descriptive Study <p><strong>Objective:</strong>&nbsp;To determine incidence of various health problems among Prince of Songkla University (PSU) students, and its distribution among disciplines.<br><strong>Material and Methods:</strong>&nbsp;A Retrospective study, collecting secondary de-identified hospital records of 45,093 PSU students, over the 6-year period of study; from 1st, January 2012 to 31st, December 2017.<br><strong>Results:</strong>&nbsp;According to data from 45,093 students, there were 8 groups of influential health problems that were shared in approximately 80 percent of all diagnoses. Acute upper respiratory tract infections played the greatest incidence among all disease groups. Apart from that, common health issues found in adolescence consisted of; common skin diseases, traffic accidents, and diseases of the digestive system also played a part as the most common problems. Even if the traffic accidents rate seemed to be overlooked by its number, its incidence rate was 17.41 per 1,000, which was above the provincial rate as well as country rate. Disciplines in the medical group and freshmen group were the highest of patients having most of the common problems. Each health problem incidence rate, which varied within the university campus, seemed to be from the difference of disease burden among disciplines; rather than the ease of facility accessibility.<br><strong>Conclusion:</strong>&nbsp;The collegians experienced wide ranges of common health problems, which were predominated in adolescents, and adults. Medical sciences students and freshmen were the highest number of patients for almost all health issues. Overall, health problems among the collegians probably varied in the campus due to specific characteristics in each disciplines, and differed as to the different context in other universities.</p> Supakorn Sripaew Chanon Kongkamol Copyright (c) 2020-03-12 2020-03-12 103 114 10.31584/jhsmr.2020729 Assessment of Average Glandular Dose Received in Full-field Digital Mammography and Digital Breast Tomosynthesis <p><strong>Objective:</strong>&nbsp;To assess the average glandular doses (AGD) from full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT).<br><strong>Material and Methods:</strong>&nbsp;Radiographic exposure parameters target/filter, tube voltage, and tube current were collected from 50 patients. Patient information including age, breast thickness, entrance surface air kerma (ESAK) and AGD from the monitor display were also recorded. The tube outputs (tube voltage and tube loadings) at the reference points in both FFDM and DBT modes were measured. The AGD was calculated from ESAK by using the correction factors following the Technical Report Series no. 457 protocol. For the DBT mode, the AGD was calculated and corrected for the X-ray gantry rotation following the Dance et al. method.<br><strong>Results:</strong>&nbsp;The radiation doses to breasts in terms of ESAK and AGD from FFDM were 4.97±2.29 and 1.36±0.48 milligray (mGy) respectively. The third quartiles were 6.5 mGy and 1.67 mGy, findings which were lower than the standard Dose Reference Levels reported by the International Atomic Energy Agency recommendation (AGD 3 mGy/view for standard breast thickness with grid). For the DBT mode, ESAK and AGD were 6.49±2.10 mGy and 1.63±0.51 mGy. The third quartiles were 7.68 mGy and 1.81 mGy which were more than the FFDM mode by 23.0% and 17.0%, respectively.<br><strong>Conclusion:</strong>&nbsp;This study found that the AGD received from the DBT mode was higher than from the FFDM mode. Patients who underwent combination modes of mammographic examination increasingly received AGD up to 1.74 mGy. However, the AGD in our institute was still lower than the standard AGD recommendations.</p> Napat Ritlumlert Sutthirak Tangruangkiat Supannika Kawvised Copyright (c) 2020-03-19 2020-03-19 115 123 10.31584/jhsmr.2020730 Perceived Barrier in Accessing Emergency Medical Services of Ethnic Groups in the Highlands of Chiang Rai Province, Thailand <p><strong>Objective:</strong>&nbsp;To explore the barriers of accessing emergency medical services among several ethnic groups, including the Hmong, Lisu, Lahu and Akha people.<br><strong>Material and Methods:</strong>&nbsp;The qualitative study was conducted to interview 43 participants, including the Akha, Lahu, Lisu and Hmong people. Purposive sampling was used to select participants for in-depth interviews, from February to March, 2019. The data were analyzed using content analysis.<br><strong>Results:</strong>&nbsp;The results show that the barriers of using emergency medical service (EMS) can be divided into the following five categories: the barrier to effectively communication, response to the symptoms of emergency illnesses, transportation facilities to support patients with emergency illnesses, fear to contact healthcare providers and the individual’s perception of emergency medical symptoms.<br><strong>Conclusion:</strong>&nbsp;The barriers of using EMS among different cultures, ethnicities and languages are a concern and obstacles to the increase appropriate pre-hospital management and reducing pre-hospital delay. A community collaboration partnership should be the goal of improving pre-hospital care among ethnic people.</p> Songwut Sungbun Thitiarpha Tangkawanich Orruethai Thanakumma Alongkorn Sukrueangkul Copyright (c) 2020-03-26 2020-03-26 125 133 10.31584/jhsmr.2020731 Radiation Dose from Computed Tomography Scanning in Patients at Songklanagarind Hospital: Diagnostic Reference Levels <p><strong>Objective:</strong>&nbsp;To determine diagnostic reference levels (DRLs) of computed tomography (CT) radiation doses in terms of CT dose index volume (CTDIvol) and dose length product (DLP) of CT scans of the head, chest and abdomen for patients at Songklanagarind Hospital, Thailand.<br><strong>Material and Methods:</strong>&nbsp;This was a retrospective analysis of 463 randomly selected head, chest and abdominal CT stuides from 416 patients enrolled from July 1st to 31st 2017. The CTDIvol, DLP and clinical indication for each CT study were conducted. The median and third quartile values were analysed and compared to the standard international DRLs. The DRL was defined as the third quartile value.<br><strong>Results:</strong>&nbsp;The DRLs for CTDIvol, and DLP of head, chest and whole abdominal CT were 57.5, 11.6 and 13.1 milliGray (mGy), and 1,102.6, 474.7 and 624.4 milliGray x centimetre (, respectively. The most common clinical indications were stroke (29.1%) for head CT and malignancy for both chest (73.6%) and abdominal CTs (49.6%).<br><strong>Conclusion:</strong>&nbsp;The DRLs of each CT region were mostly below standard international DRLs of Australia, Europe, Japan, the United Kingdom and the United States. The clinical indication for malignancy had significant difference in the DLP values than other clinical indications in head and chest CT.</p> Dechen Pema Supika Kritsaneepaiboon Copyright (c) 2020-03-27 2020-03-27 135 143 Unusual Chief Complaint of Patient with History of Vaccination Leading to Unrecognized Human Rabies with Extreme Risk of Saliva Exposure for Medical Personnel-A Case Report and Literature Review <p>The aim of this case report is to present an unrecognized case of human rabies with an unusual chief complaint-chest pain-at presentation. The patient had been vaccinated for rabies, presented multiple times at the emergency room, was discharged each time, and was eventually found dead at his house with an unknown cause of death. A post-mortem examination along with a trans-orbital necropsy and real-time reverse transcription polymerase chain reaction test were performed. The results showed rabies virus in the brain tissue.</p> Kittisak Sripong Copyright (c) 2020-01-15 2020-01-15 145 152 10.31584/jhsmr.2020725 Uncommon Atypical Presentations of COVID-19: Important and Should Not be Under Recognized! <p>Coronavirus disease 2019 (COVID-19) is a new viral disease that has become a global public health concern in 2020. This disease is caused by a novel coronavirus firstly detected in the People’s Republic of China. This viral infection can cause febrile illness and respiratory problems. There are other uncommon clinical presentations of COVID-19 such as afebrile illness, diarrhea, non-coughing and confusion. These atypical presentations can result in difficulty in diagnosing the disease. In this short review, the authors specifically discuss the important uncommon atypical presentations of COVID-19.</p> Sim Sai Tin Viroj Wiwanitkit Copyright (c) 2020-03-30 2020-03-30 153 158 10.31584/jhsmr.2020733