Journal of Medicine and Health Sciences

Severe Masseter Muscle Rigidity Following Succinylcholine Administration in a Patient with Inconclusive Pharmacogenetic Results for Susceptibility to Malignant Hyperthermia: A Case Report

2026-01-27T13:49:38+07:00

Masseter muscle rigidity following succinylcholine is traditionally viewed as a potential early indicator of malignant hyperthermia (MH), although most adult cases remain isolated without systemic progression. We report a 50-year-old woman who developed immediate, severe bilateral masseter rigidity after succinylcholine during induction of general anesthesia. Despite profound limitation in mouth opening of approximately 1.5 cm, videolaryngoscopic intubation was achieved on the first attempt, and mask ventilation remained uncomplicated. The rigidity persisted even after administration of cisatracurium, yet the patient demonstrated no systemic signs of MH, with normal hemodynamics, end-tidal CO₂, temperature, and laboratory values. Surgery was cancelled, and the rigidity gradually resolved during recovery in the intensive care unit. Targeted genetic testing for RYR1 and CACNA1S variants did not identify pathogenic mutations. However, given the limited scope of the tested variants, the result was considered inconclusive for determining MH susceptibility. This case illustrates that marked succinylcholine-induced masseter rigidity can occur without progression to systemic MH. It also highlights that nondiagnostic targeted genetic testing reflects current limitations in variant detection and should not be interpreted as definitively excluding susceptibility. In patients presenting with significant isolated masseter rigidity, continued MH preparedness remains warranted despite the absence of systemic manifestations during the initial event.

Successful Reconstruction of Post-Hepatectomy Bile Duct Injury Using Magnetic Compression Anastomosis: A Case Report

2026-03-27T10:23:31+07:00

Iatrogenic bile duct injuries (BDI) following hepatectomy represent a serious and potentially life-threatening complication. Magnetic compression anastomosis (MCA) is an emerging minimally invasive technique that can restore biliary continuity when conventional endoscopic or percutaneous methods fail. We report the case of a 68-year-old man with a history of sigmoid colon cancer and liver metastases underwent right hepatectomy with wedge resection of segment 4a. Postoperatively, he developed persistent jaundice. Imaging demonstrated left intrahepatic duct dilatation with abrupt narrowing at the hepatic confluence. Percutaneous transhepatic biliary drainage (PTBD) was established; however, guidewire cannulation via both ERCP and PTBD failed due to complete biliary obstruction. The patient subsequently underwent MCA. The magnets approximated across the stenosis, creating a neo-anastomosis. After successful biliary recanalization and stenting were achieved. At the six-month follow-up, the patient remained clinically stable with normal liver function. In conclusion, this case demonstrates the feasibility and clinical success of MCA for biliary reconstruction following iatrogenic bile duct injury post-hepatectomy. MCA offers a safe, effective, and less invasive alternative to surgical reconstruction.

Comparative Outcomes of Endoscopic and Microscopic Tympanoplasty in Patients with Tympanic Membrane Perforation at HRH Princess Maha Chakri Sirindhorn Medical Center

2025-10-20T11:42:57+07:00

Chronic otitis media with perforated eardrum is a common disease. Treatment involves tympanoplasty to heal the perforated eardrum. Traditionally, microscopic tympanoplasty (postauricular approach) has been used as the conventional method, but since the 1990s, endoscopic tympanoplasty (transcanal approach) have been used in tympanic membrane surgery. However, endoscopic-assisted surgery compels the doctor to use only one hand to perform the procedure since the other hand is used to hold the camera. Also, the operation area is small, and if bleeding occurs, it may easily obscure the surgical site. A total of 20 patients with tympanic membrane perforation were enrolled in this study and divided into two groups: endoscopic tympanoplasty using tragal perichondrium graft (n=10) and microscopic tympanoplasty using temporalis fascia graft (n=10). Graft success rates and patient satisfaction were evaluated. Clinical outcomes and complications were followed for at least 6 months postoperatively. Independent t-test, Mann–Whitney U test were used to analyze the outcomes and repeated measures analysis of variance was used to analyze pain score. The mean operation time and length of hospital stay were significantly longer in the microscopic tympanoplasty group (145 minutes, 70 hours) than the endoscopic tympanoplasty groups (90 minutes, 47 hours) (p<0.001). Graft success rates, clinical outcomes, and satisfaction scores were not significantly different between the two groups. No major complications were observed in either group.

Effectiveness of a Developed Workshop Compared with Interactive Lectures on Psychiatric Interviewing among Medical Students at the School of Medicine, Mae Fah Luang University

2025-08-06T13:57:12+07:00

Psychiatric interviewing is a crucial component in the care of patients with mental health conditions, requiring both theoretical knowledge and practical skills. This necessity underpins the ongoing efforts to explore and develop the most effective teaching methods to enhance medical students’ competencies in this area. The present study was driven by the objective to compare the effectiveness of a developed workshop-based instructional model and the conventional interactive lecture format in teaching psychiatric interviewing. This research employed a retrospective observational design, utilizing data from a total of 264 fourth-year medical students at Mae Fah Luang University. Assessment tools included a post-instruction satisfaction questionnaire and a structured evaluation of students’ knowledge and skills in psychiatric history-taking. Data were collected from two student groups: those who participated in interactive lectures between 2016 and 2019, and those who received workshop-based instruction between 2020 and 2024. Data analysis was performed using independent t-tests. The findings revealed that students in the workshop group scored significantly higher than those in the interactive lecture group in terms of rapport-building skills and active listening (p<0.001). However, the demonstrating empathy toward patients remained relatively low in both groups. In contrast, students in the interactive lecture group demonstrated significantly better theoretical knowledge (p<0.001). In conclusion, the workshop model proved more effective in developing practical skills, while the interactive lecture format was superior for enhancing theoretical understanding. These results suggest that an integrated approach, combining workshop-based learning with interactive lectures, may more effectively equip medical students with both the skills and knowledge required for competent psychiatric interviewing. Nevertheless, further attention is needed to improve students’ abilities in empathic understanding. This study provides valuable insights for the future development of psychiatric education curricula.

Validity and Reliability of the Res-Rhythm: A Prototype Portable Respiratory Rate Measurement System in Healthy Subjects

2025-10-29T13:38:47+07:00

Respiratory rate is one of the important vital signs, typically assessed by observing the number of breaths per minute. This can result in measurement errors and variability between observers. Furthermore, commercially available respiratory rate measurement devices tend to be expensive. This study aimed to develop a portable prototype system for measuring respiratory rate, consisting of a chest belt sensor and a display application. Validity was tested by comparing it with a BIOPAC device, and reliability was tested using the retest method in 29 healthy volunteers with an average age of 21.61 ± 2.24 years. The test was conducted during a 5-minute rest period and a 5-minute exercise period, which involved marching in place, for a total of 10 minutes, repeated twice. Validity was analyzed using Pearson's correlation coefficient (r), and reliability was analyzed using the intraclass correlation coefficient (ICC) at the 95% confidence interval. The study found that the prototype device demonstrated very high validity during both rest (r=0.94, p<0.001) and exercise (r= 0.90, p<0.001) when compared to the BIOPAC device. The average difference between the two devices was -0.35 ± 1.5 breaths per minute (2.01%) during rest and -0.81 ± 1.90 breaths per minute (4.18%) during exercise. When analyzing test-retest reliability, the prototype system showed good reliability (ICC=0.75, p<0.01) at rest and moderate reliability (ICC=0.57, p<0.01) during exercise. The average difference between the two measurements was -1.11 ± 3.89 breaths per minute (6.78%) at rest and -0.70 ± 4.50 breaths per minute (3.81%) during exercise. In conclusion, the prototype system demonstrated acceptable levels of validity and reliability. Additionally, it can be further developed into a portable respiratory rate measurement device for clinical and research applications.

Effect of General Anesthesia Induction with a Combination of Propofol and Etomidate Versus Propofol Alone on I-gel Laryngeal Mask Airway Insertion

2026-01-28T16:11:52+07:00

Propofol is one of the most commonly used anesthetic agents for laryngeal mask airway (LMA) insertion, but it is associated with unwanted complications such as hemodynamic instability and cardiovascular complications. Various intravenous anesthetic agents in combination with propofol have been studied in an attempt to minimize these complications. This prospective, randomized, double-blind, controlled study aimed to compare the effect of a combination of propofol and etomidate versus propofol alone on hemodynamics, LMA insertion conditions, and first- attempt success rate for I-gel LMA insertion. The participants comprised 62 adults aged 18–64 years of either sex with American Society of Anesthesiologists (ASA) physical status I-II who underwent elective surgery under general anesthesia at Kumphawapi Hospital, Udon Thani, Thailand, between May 2025 and August 2025. Patients were randomly allocated to the propofol (P) group (n=31), which received propofol 2 mg/kg, or the propofol + etomidate (PE) group, which received propofol 1 mg/kg plus etomidate 0.2 mg/kg for induction. Hemodynamic parameters were recorded before induction, 1 minute after induction, after successful LMA insertion, and 3, 5 and 10 minutes after LMA insertion. Jaw relaxation, LMA insertion conditions, and first-attempt success rate were also assessed and recorded. The results showed no significant differences in mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), or heart rate (HR) at various time points following induction between the two groups (p>0.050). Good jaw relaxation was observed in 23/31 patients (74.19%) in group P versus 19/31 patients (61.29%) in group PE (p=0.277). Overall LMA insertion conditions were comparable between groups (p=0.785). The first-attempt success rate of I-gel LMA insertion was 83.37% in group P and 90.32% in group PE (p=0.307). In conclusion, there were no significant differences between the effects of propofol 1 mg/kg combined with etomidate 0.2 mg/kg and propofol 2 mg/kg on hemodynamic stability, jaw relaxation, LMA insertion conditions, or first-attempt success rate.

Prevalence of Bone Metastases Detected by Bone Scan in Patients with Hepatocellular Carcinoma

2026-03-10T21:34:19+07:00

Early-stage hepatocellular carcinoma (HCC) is curable by liver transplantation (LTx). However, donor scarcity necessitates a meticulous selection via Milan criteria. Although updated guidelines omit routine bone scans (BS) for staging, most Thai tertiary care centers still standardly perform them for LTx candidates with HCC. The aim of this study was to determine the prevalence of bone metastasis (BM) detected by BS among patients with HCC in northeastern Thailand and to assess the potential role of BS in the preoperative evaluation for LTx. This was a retrospective cross-sectional descriptive study of BS images of 101 patients with HCC who were referred to the Division of Nuclear Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The prevalence of BS positivity and its potential associated factors were analyzed. A total of 16 patients had a positive BS (15.8%; 95% CI: 8.6–23.1) across multiple Barcelona Clinic Liver Cancer (BCLC) stages, including one patient in the very early stage (14.3%; 95% CI: 1.6–62.8). Among the 43 patients meeting the Milan criteria for LTx, three were found with positive BS (7.0%; 95% CI: 2.2–20.0). Bivariate analyses to determine the association between BS positivity and BCLC stage, Milan criteria, macrovascular invasion, largest tumor size, lymph node metastasis, and alpha-fetoprotein (AFP) level were performed, and tumors beyond the Milan criteria (crude OR 3.85; 95% CI: 1.02–14.5; p=0.046), the presence of macrovascular invasion (crude OR 3.05; 95% CI: 1.02–14.5; p=0.046), and N1 stage (crude OR 9.11; 95% CI: 1.81–45.8; p=0.007) demonstrated a statistically significant association with BS positivity. However, upon further evaluation using multivariable logistic regression to adjust for potential confounders, no factors remained statistically significant in association with positive BS. These findings suggest that BS may still have a role in the preoperative evaluation of patients with HCC being considered for LTx.

Effect of a Symptom Management Program Combined with Acupressure Massage on Recovery of Bowel Function after Open Abdominal Surgery in Colorectal Cancer Patients in the Intensive Care Unit

2025-11-12T10:06:21+07:00

Postoperative gastrointestinal dysfunction can affect bowel function recovery, particularly in patients undergoing open abdominal surgery for colorectal cancer who are treated in the intensive care unit. This can lead to serious complications and increased treatment costs. This Quasi-Experimental Study aimed to compare bowel functional recovery after open abdominal surgery among patients with colorectal cancer between an experimental group receiving an acupressure massage program combined with symptom management and a control group receiving traditional nursing care. The sample group consisted of 44 colorectal cancer patients
(≥20 years) who underwent open abdominal surgery and were admitted to the surgical intensive care unit at Thammasat University Hospital. They were divided into a control group (n=22) and an experimental group
(n=22) using convenience sampling. The experimental group received a symptom management program combined with acupressure massage for 5 days after surgery. This involved daily trunk and leg movements for 10–15 minutes, combined with acupressure massage at Zusanli (ST36) twice daily for 10 minutes each time. The control group received standard nursing care. The research instruments included a program of acupressure massage combined with symptom management, a personal information questionnaire, bowel function recovery assessment, and a behavioral assessment for managing postoperative bowel dysfunction. Data were analyzed using the Mann–Whitney U test and Friedman test. The study found that Patients with colorectal cancer who underwent open abdominal surgery and subsequently received a symptom management program combined with acupressure massage had significantly higher average scores for bowel function recovery on days 3 to 5 post-operatively compared to the control group receiving only conventional nursing care (p < 0.05). Research results show that this program can effectively aid in the rehabilitation of bowel function after surgery in patients receiving treatment in the critical care unit.

Mortality Rate and Associated Factors Among Patients with Septic Arthritis at Pranangklao Hospital

2026-03-18T15:16:06+07:00

Septic arthritis is a medical emergency resulting from infection within a joint. Delayed diagnosis can lead to irreversible joint damage, permanent disability, or dissemination of the infection into the bloodstream, which can ultimately result in death. Despite significant advancements in modern medical care, the mortality rate in patients with septic arthritis remains high. This retrospective cohort study aimed to determine the mortality rate and prognostic factors associated with septic arthritis in hospitalized patients in Pranangklao Hospital between January 1, 2020, and December 31, 2024. Patients aged 15 years and older who were admitted with a diagnosis of septic arthritis were included. Factors associated with mortality were analyzed using univariate analysis and multivariate logistic regression. Mortality was defined as death occurring during hospital admission. A total of 130 patients were enrolled, 124 cases of bacterial arthritis alone, 4 cases of tuberculous arthritis alone, and 2 cases of concurrent bacterial and tuberculous arthritis. No cases of viral, fungal, or parasitic arthritis were identified. The overall in-hospital mortality rate was 12 patients (9.3%). Factors significantly associated with mortality through multivariate logistic regression included chronic kidney disease stage 4–5 (p=0.002), oligoarticular or polyarticular involvement (p=0.015), hip joint infection (p=0.03), and concurrent bloodstream infection (p=0.012). While patients who underwent surgical drainage demonstrated a significant association with reduced mortality in the univariate analysis (p=0.009), this association was no longer statistically significant after adjustment in the multivariate logistic regression. The findings of this study provide valuable insight into the prognostic factors influencing mortality among patients with septic arthritis. Awareness and early recognition of these risk factors, followed by timely and appropriate treatment, may help reduce mortality rates and improve quality of life in patients affected by this condition.

Effects of a Health Behavior Modification Program Based on the Transtheoretical Model Among Overweight Healthcare Personnel at Amnatcharoen Hospital

2025-12-23T23:29:50+07:00

Overweight and obesity are major public health problems leading to non-communicable diseases. As key role models in health promotion, public health personnel must manage their own health to maintain credibility and effectively promote healthy behaviors in communities. A health behavior modification program can help improve personnel's overall health. Therefore, this quasi-experimental study aimed to examine the effects of a health behavior modification program on overweight personnel at Amnatcharoen Hospital, using the Stages of Change Theory. The sample included 70 overweight personnel (BMI ≥ 23 kg/m²), evenly assigned to the experimental and control groups, with 35 participants in each group. The experimental group received a 12-week health behavior modification program that included awareness-raising, reinforcement, training in diet and exercise skills, and monitoring and feedback. In contrast, the control group received regular care. The research instruments consisted of a program tested for content validity and a questionnaire with a reliability of 0.76. The data was analyzed using descriptive statistics and Analysis of Covariance (ANCOVA), with p<0.05 for statistical significance. The study found that after participating in the health behavior modification program, statistically significant between-group differences were observed in knowledge of health behavior modification (F(1, 64)=17.415, p<0.001, η²=0.214) and body fat percentage (F(1, 64)=6.297, p=0.015, η²=0.090), with the experimental group demonstrating more favorable outcomes than the comparison group. No statistically significant differences were found in health behaviors (F(1, 64)=1.396, p=0.242), attitudes toward health behavior modification (F(1, 64)=1.700, p=0.197), or body mass index (BMI) (F(1, 64)=2.329, p=0.132). In conclusion, the program based on the stages of change theory was effective in enhancing knowledge and reducing body fat percentage among overweight personnel. However, no significant differences were observed in health behaviors, attitudes, or BMI during the study period. This study highlights the feasibility of applying the proposed approach within health promotion systems, particularly in the systematic development of workplace health promotion programs for personnel. Furthermore, the findings support the formulation of policies or practical guidelines for healthcare institutions to implement staff health promotion initiatives alongside the provision of services to the public.