Journal of Medicine and Health Sciences

Accuracy of neutrophil-lymphocyte and platelet-lymphocyte ratios as predictors of mortality in diabetic patients with necrotizing fasciitis

2024-09-03T14:12:33+07:00

The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are widely recognized markers of systemic inflammation and immune responsiveness to infection. Elevated NLR and PLR levels are associated with poor prognoses in various conditions, including necrotizing fasciitis (NF). However, their accuracy in predicting mortality in diabetic patients with NF, who often exhibit immune dysfunction, remains unclear. This study aimed to evaluate the predictive accuracy of NLR and PLR for mortality in diabetic patients with NF. The retrospectively reviewed the medical records of type-2 diabetic patients with lower extremity NF treated at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, and Samut Prakan Hospital from January 2016 to December 2021. A total of 180 patients were included in the study, comprising 90 men and 90 women, with a mean age of 63.7 ± 12.1 years. Univariate analysis identified significant factors associated with mortality, including age ≥60 years (p=0.017), renal disease (p=0.007), NLR (p=0.006), platelet count <150 × 10^3/μL (p=0.007), blood glucose >200 mg/dL (p=0.033), and creatinine >2 mg/dL (p<0.001). Receiver operating characteristic (ROC) curve analysis revealed that the optimal cut-off point for NLR was 14.3 (AUC 0.632; 95% CI 0.541–0.723, p=0.007), with a sensitivity of 60.6% and specificity of 66.7%. In contrast, PLR did not demonstrate predictive value for mortality (AUC 0.447; 95% CI 0.349–0.545, p=0.278). Multivariate analysis indicated that a platelet count <150 × 10^3/μL, NLR ≥14.3, and creatinine >2 mg/dL were significant risk factors for mortality. In conclusion, NLR ≥14.3 was independently associated with an increased risk of mortality in diabetic patients with NF; however, its low accuracy limits its usefulness as a reliable prognostic test. Conversely, PLR was not found to be a predictor of mortality.

Postoperative Pain Intensity in Pediatric Patients Following Orthopedic Extremity Surgery and the Effectiveness of Anesthetic Techniques at a Tertiary University Hospital

2024-09-02T23:17:27+07:00

Pain Management in Pediatrics is particularly challenging due to the vulnerability of patients and the need for specific considerations when administering analgesic medications, which can lead to inadequate pain management for some patients. As a tertiary university hospital, we care for many pediatric patients undergoing orthopedic extremity surgeries and have employed various methods for postoperative pain control. Therefore, this study aimed to evaluate postoperative pain and the effectiveness of anesthetic techniques in managing pain for this patient group. A retrospective descriptive study was conducted on pediatric patients who underwent orthopedic surgeries between October 2020 and September 2021. The study data included pain intensity at rest and during movement, fentanyl usage, and postoperative pain outcomes for each anesthetic technique. Descriptive statistics and a generalized linear model were used for statistical analysis. During the study period, 143 patients underwent orthopedic extremity surgery, with the majority being boys (62.2%) and an average age of 7 years. Most surgeries were on the lower extremities (84.6%), and the majority of patients received general anesthesia (GA) alone (55.9%). In the post-anesthetic care unit (PACU), over half of the patients reported mild or no pain at rest and during movement (52.4% and 50.3%, respectively), with a gradual decrease in pain on days 1 and 2. Compared to those who received GA alone, patients who received spinal block (SB) or combined regional anesthesia (RA) with GA experienced less pain at rest and during movement in the PACU, as well as a reduced need for fentanyl during both the intraoperative and postoperative periods. In conclusion, the regional anesthesia techniques, such as spinal block alone or in combination with general anesthesia, are effective in controlling postoperative acute pain and reducing opioid usage in pediatric patients undergoing orthopedic extremity surgeries.

Blood RNA expression of HSP70, GADD45a, and PA2G4 following somatic death in a mouse model for application in post-mortem interval estimation

2024-09-10T09:40:06+07:00

Current tools for post-mortem interval (PMI) estimation include algor mortis, livor mortis, rigor mortis, and supravital reactions. However, the accuracy of these methods can be influenced by external environmental factors and the characteristics of the deceased body. To enhance precision, several studies have explored gene expression-based tools, as specific genes may exhibit upregulation or downregulation correlated with the time since death. This study aimed to investigate the use of postmortem blood RNA expression for PMI estimation. Heart blood samples were collected at 0, 0.5, 1, 6, 12, 24, and 48 hours postmortem. Total RNA was extracted, and gene expression was analyzed using quantitative real-time polymerase chain reaction (qRT-PCR). Results revealed that RNA quality and quantity for samples collected at 0, 0.5, and 1 hour postmortem ranged from 2.04 to 2.23 (A260/A280) and 30.16 to 44.67 µg/ml, respectively. Notably, the expression of HSP70 was significantly elevated at 0.5 hours postmortem, while the expression of GADD45a significantly decreased at 0.5 hours postmortem. Moreover, a significant association was observed between PMI and changes in delta cycle time for HSP70 (increase) and GADD45a (decrease). These findings suggest that HSP70 and GADD45a may serve as potential biomarkers for PMI estimation. However, further studies are required to validate the use of these genes in human postmortem samples for accurate and reliable PMI determination.

The effect of a social support program on the psychological well-being among caregivers of schizophrenia patients

2024-09-09T11:08:21+07:00

Caregivers play a vital role in supporting individuals with schizophrenia, enabling them to lead fulfilling lives within society. However, the prolonged caregiving process can lead to feelings of fatigue and burden, negatively impacting the caregiver’s psychological well-being. So, this quasi-experimental study aimed to evaluate the effect of a social support program on the psychological well-being among caregivers of schizophrenia patients. The study involved 52 caregivers, who were randomly assigned to either an experimental group (26 participants) or a control group (26 participants). The experimental group participated in a social support program consisting of six sessions, each lasting 60–90 minutes, held twice a week over three weeks. In contrast, the control group received standard care. Data were collected using a demographic questionnaire, a psychological well-being questionnaire (reliability=0.94), and the social support program. Descriptive statistics, independent t-tests, two-way repeated measures ANOVA, and pairwise comparisons with the Bonferroni method were used for data analysis. The results indicated that the mean psychological well-being scores for the experimental group at post-test and the 4-week follow-up were significantly higher than those of the control group (p=0.01). Furthermore, within the experimental group, psychological well-being scores showed significant improvement at pre-test, post-test, and follow-up (p=0.001). These findings suggest that healthcare professionals may consider implementing this program to enhance the psychological well-being among caregivers of schizophrenia patients.

Bleeding events in atrial fibrillation patients treated with Warfarin or NOACs at Chaiyaphum Hospital

2024-09-01T14:18:25+07:00

Atrial fibrillation (AF) is a common heart condition that increases the risk of blood clots, which can lead to stroke, heart attack, and death. Warfarin and Non-vitamin K antagonist oral anticoagulants (NOACs) are medications used to reduce this risk. However, concerns remain regarding the risk of bleeding complications associated with these drugs. This retrospective cohort study investigated the incidence of bleeding complications in patients with AF who were prescribed either Warfarin or NOACs. The study included 2,171 patients with AF who were treated between 2016 and 2023. Data were collected from electronic medical records and analyzed using survival analysis, Kaplan-Meier curves, incidence rate ratios, and incidence differences. Over an 8-year period (2016–2023), the proportions of Warfarin and NOAC use were 85.8% and 14.2%, respectively. The overall incidence of bleeding complications in the study population was 54.8%. The most common bleeding events were hematoma ecchymosis (2.6%) and gum bleeding (2.2%). The incidence of bleeding in the NOAC group was 1.9 per 100 person-years (95% confidence interval (CI) = 1.1-3.2), with no statistically significant difference in bleeding incidence between the two groups. Warfarin had a longer event-free survival time than NOACs (3.61 years; 95% CI = 2.90-4.33). Rivaroxaban, one of the NOACs, was associated with an increased risk of early bleeding. While NOACs had a slightly higher bleeding incidence than Warfarin, they were associated with less severe bleeding events. Warfarin was linked to a wider range of bleeding events, including gastrointestinal and intracranial hemorrhage. NOACs have a slightly higher incidence of bleeding complications than Warfarin, but they cause less severe bleeding events and a narrower range of bleeding types. Therefore, NOACs should be considered as an alternative to Warfarin for patients with a history of Warfarin use. Further research is needed to evaluate the safety and efficacy of individual NOACs, particularly rivaroxaban.

Development of a nursing workload calculation model, productivity assessment, and mothers’ opinion on nursing workloads at a lactation clinic: A participatory action research study

2024-08-23T16:06:45+07:00

Lactation clinics are crucial in implementing the Ten Steps to Breastfeeding Success. This participatory action research aimed to develop a model for calculating nursing workloads, assessing clinical nursing productivity, and understanding postpartum mothers' opinions about nursing workloads at a lactation clinic. The study involved service providers at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), including nurses, nurse aides, and obstetricians, who participated in focus groups, reviews, and discussions. The actual work conditions were assessed using a nursing workload calculation method, and mothers' opinions about nursing workloads were surveyed. The collected data were synthesized to develop a model for calculating nursing workloads and clinical nursing productivity. Additionally, 150 postpartum mothers attending the lactation clinic participated in testing the nursing workload and clinical nursing productivity calculation, as well as providing feedback on nursing workloads. The results revealed that nursing workload could be determined by setting direct and indirect standards for nursing duration. For direct nursing duration, patients were categorized into five types: Type 1 (1-10 minutes), Type 2 (10-45 minutes), Type 3 (45-120 minutes), Type 4 (120-150 minutes), and Type 5 (more than 150 minutes). Clinical nursing productivity was calculated as the percentage of nursing workload managed by nurses compared to the standard workload for one nurse. Mothers expressed strong agreement with statements such as, “The nurses who provide services have heavy workloads,” “The number of nurses is insufficient for the nursing workload,” and “Nurses’ services are not fully appropriate due to excessive nursing workload.” Based on the lactation clinic's data, the nursing workload was calculated at 178.79%. The required personnel for adequate care was 5.78 full-time equivalents, but the clinic had only 1 nurse and 2 nurse aides. In conclusion, the nursing workload and clinical nursing productivity calculation method for the lactation clinic was developed and aligned with mothers’ feedback.

The association of mild thrombocytopenia that impact on increasing risk of postpartum hemorrhage

2024-09-19T13:49:29+07:00

Postpartum hemorrhage (PPH) is one of the three most common obstetric conditions leading to maternal mortality. Moreover, thrombocytopenia is a known risk factor for PPH, but the platelet count levels considered to be significant risk factors vary across institutions. Mild thrombocytopenia, defined as a platelet count between 100,000 and 149,999 cells/microliter, remains controversial as a potential risk factor for PPH. This study aimed to investigate the relationship between mild thrombocytopenia and the increased risk of postpartum hemorrhage. A retrospective cohort study was conducted among pregnant women of all ages who delivered at Trang Hospital between October 2019 and July 2024. The study included singleton pregnancies between 37 and 41 weeks and 6 days, with nulliparous women as participants. Participants were divided into two groups, comprising 1,200 women with normal platelet counts (≥150,000 cells/microliter) and 120 women with mild thrombocytopenia were included. The results showed that women with mild thrombocytopenia had a 2.195-fold higher likelihood (95% CI 1.094-4.406, p=0.025) of experiencing PPH compared to those with normal platelet counts. Furthermore, the mild thrombocytopenia group was 2.400 times more likely (95% CI 1.004-5.734, p=0.044) to have an estimated blood loss of 1,000 milliliters or more within 24 hours after childbirth. In conclusion, mild thrombocytopenia increases the risk of postpartum hemorrhage and the likelihood of blood loss ≥1,000 milliliters within 24 hours after delivery compared to women with normal platelet counts.

The factors associated with the 30-day mortality rate of patients with acute myocardial infarction in the intensive care unit

2024-11-25T15:21:38+07:00

Acute myocardial infarction is a significant health problem worldwide and is the leading cause of death globally and in Thailand. This study aimed to analyze factors affecting the 30-day mortality rate of acute myocardial infarction in the intensive care unit at Pranangklao Hospital. It was a retrospective cohort study, collecting data from January 1 to December 31, 2023, with a total of 116 cases. Data were analyzed using descriptive statistics and multivariate logistic regression analysis. The study results showed that the 30-day mortality rate for acute myocardial infarction was 13%. Statistically significant factors associated with mortality included age (Adj OR = 1.119, p=0.029), heart failure (Adj OR = 26.351, p=0.014), cardiogenic shock (Adj OR = 6.835, p=0.012), fasting blood glucose level (Adj OR = 1.021, p=0.008), VT/VF arrhythmia (Adj OR = 18.008, p=0.019), and treatment with Intra-Aortic Balloon Pump (IABP) support (Adj OR = 234.321, p=0.009). Meanwhile, systolic blood pressure was found to be a protective factor against mortality (Adj OR = 0.955, p=0.011). When analyzing the cut-off points of the ROC curve using the Youden Index, it was found that age above 64.5 years, blood pressure below 70 mmHg, and fasting blood glucose level above 178 mg/dL were associated with a higher risk of mortality. In conclusion, the key factors affecting 30-day mortality in AMI patients in the ICU include advanced age, heart failure, cardiogenic shock, low systolic blood pressure, high fasting blood glucose levels, VT/VF arrhythmias, and the use of IABP for cardiac support. To reduce mortality rates in acute myocardial infarction patients, it is important to focus on strict blood glucose control, vigilant monitoring of vital signs, heart failure symptoms, and ECG for arrhythmia detection, along with rapid and effective management. The use of IABP should be carefully considered, weighing the risks and benefits for each patient.

Development of a model for practicing venipuncture and intravenous fluid administration

2024-12-18T08:48:39+07:00

Quality and safe nursing practices, professional nurses and nursing students must possess accurate, precise, and proficient nursing skills. This developmental innovation research aimed to create and develop a model for practicing venipuncture and intravenous fluid administration made from natural rubber. The study was conducted in three phases: 1) assessing the needs for a skill training model among nursing students, newly graduated nurses, nursing instructors, and nursing laboratory staff 2) designing and developing the model, including formulating a latex compound, testing its initial properties, creating a prototype using the developed formula, assessing its quality and conducting trials, and 3) evaluating the model's effectiveness. The sample consisted of 45 second-year nursing students and 30 newly graduated professional nurses. Data were collected using questionnaires assessing the model's features and effectiveness. Instrument reliability was verified through the Index of Item-Objective Congruence (IOC), which ranged from 0.67 to 1.00, and Cronbach’s alpha coefficients, which were 0.81 and 0.83. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through content analysis. The results revealed that the model, made from natural rubber, had a rectangular shape (7 cm wide, 12 cm long, and 1 cm thick). Its base was supported by a thin steel plate to prevent needle penetration. The model included two blood vessels connected to a 20-50 milliliter syringe and was stitched onto a rubber cloth for attachment to body areas where skill practice was required. During the trial phase, fourth-year nursing students rated the model’s features at a very good level (M=4.59, SD=0.51), while professional nurses rated them at a good level (M=4.49, SD=0.50). For effectiveness, second-year nursing students rated the model at a very good level (M = 4.55, SD=0.51), while newly graduated professional nurses rated it at a good level (M=4.46, SD=0.56). This skill-training model can be used for three applications: as a part task trainer, with a full-body manikin, and with simulated patients by attaching it to relevant body areas for practice or hybrid simulator.

Mortality and renal recovery in acute kidney injury patients requiring dialysis: A single-center study

2024-07-30T19:31:25+07:00

Acute kidney injury requiring dialysis (AKI-D) is a medical emergency with reported incidence rates ranging from 3% to 20%, and associated mortality rates as high as 45% to 70%. This study aimed to investigate renal recovery rates and mortality in AKI-D patients. This single-center retrospective study included 50 adult patients diagnosed with AKI-D who were admitted between January 2019 and December 2023. Data were collected from medical records and statistically analyzed to identify factors influencing kidney recovery. During the 90-day follow-up period following the initiation of dialysis, 27 patients (54%) survived and achieved renal recovery, while 22 patients (44%) died, and one patient (2%) progressed to end-stage renal disease. In the subgroup of patients who achieved renal recovery, the average creatinine level at 90 days was 1.81 ± 1.04, and the mean estimated glomerular filtration rate (eGFR) was 52.77 ± 32.48. Compared to the non-recovery group, the renal recovery group had lower exposure to vasoactive drugs (33% vs. 65%; p = 0.025), fewer intradialytic hypotension events (15% vs. 52%; p = 0.005), longer renal replacement therapy duration (median 15 vs. 6 days; p < 0.001), and a longer hospital stay (mean 35.4 days vs. 17 days; p = 0.002). In conclusion, the renal recovery rate was 54%, and the mortality rate was 44%. Factors potentially impacting renal recovery include exposure to vasoactive drugs and the occurrence of intradialytic hypotension. Targeting these factors for therapeutic intervention may improve patient outcomes

Comparison of subject acceptance in electroretinographic testing using contact lens and DTL electrodes with RETI-port/scan 21 to establish normative data at Siriraj Hospital

2024-09-06T22:14:46+07:00

Electroretinography is a test that measures retinal impulses resulting from the activity of both neural and non-neural retinal cells, which can be recorded using various electrodes. However, there are no reports regarding the acceptance and sensations associated with the use of contact lens electrodes (CL electrodes) and Dawson-Trick-Litzkow electrodes (DTL electrodes). This study compares the acceptance and sensations of volunteers using CL and DTL electrodes with the RETI-port/scan 21 machine at Siriraj Hospital. A questionnaire was administered to 20 volunteers with no history of ocular conditions or medication affecting the eyes, as part of the Eye Checkup Project aimed at establishing normative data for electrophysiological tests at Siriraj Hospital. Eighty-five percent of volunteers reported no symptoms with the DTL electrode, while 25% experienced mild irritation and 15% found it annoying. With the CL electrode, 50% of volunteers reported no symptoms, 35% experienced irritation, and 25% felt annoyance. Additionally, some volunteers reported discomfort, difficulty blinking, and dryness with the CL electrode. Fifty-five percent preferred the DTL electrode over the CL electrode, while 20% were comfortable using both. Redness was observed in 15% of volunteers for both electrode types, but pain was reported only with the CL electrode (3%). Overall, volunteers showed greater acceptance of the DTL electrode due to less discomfort and difficulty blinking, with the differences being statistically significant.

Cryptococcal meningitis with cryptococcemia in a multiple sclerosis patient treated with Fingolimod: A case report

2024-08-26T10:39:24+07:00

Multiple sclerosis (MS) is one of the most common diseases of the human central nervous system, causing significant neurological disability. Fingolimod, a sphingosine-1-phosphate receptor modulator, is an approved oral therapy for relapsing-remitting multiple sclerosis (RRMS) that works by decreasing the egress of lymphocytes from lymph nodes to the central nervous system. Despite its effectiveness in treating MS, Fingolimod can increase the risk of opportunistic infections due to its immunosuppressive effects. A 34-year-old male was diagnosed with MS in 2017, presenting with spastic gait, paraparesis, and a history of left homonymous hemianopia. He was prescribed Fingolimod in September 2019 following a relapse. About four years after starting Fingolimod, he developed severe headaches and visual impairment. Initially treated for an MS relapse with methylprednisolone, he returned two weeks later with progressive loss of consciousness and confusion, and was subsequently diagnosed with disseminated cryptococcosis. Hemoculture and cerebrospinal fluid culture confirmed the presence of Cryptococcus neoformans. Due to clinical worsening and acute renal injury, the patient was treated with liposomal amphotericin B and fluconazole, after receiving routine induction therapy with amphotericin B and flucytosine. The patient underwent serial lumbar punctures every other day for intracranial pressure management. After two weeks of treatment, he was discharged with significant improvement and no major complaints.

Enhanced recovery after abdominal surgery in pediatric patients

2024-09-13T11:28:19+07:00

Enhanced Recovery After Surgery (ERAS) guidelines for pediatric patients have been developed over the past decade to reduce the stress responses associated with surgical procedures, preserve organ function, and promote early recovery. Key components of ERAS in pediatric surgery emphasize a multidisciplinary approach, requiring collaboration among pediatric surgeons, pediatricians, anesthesiologists, and nursing staff during the perioperative period. Preoperative management focuses on educating patients and guardians about the surgical procedure and the ERAS protocol, ensuring optimal medical conditions, and establishing appropriate fasting requirements. Intraoperative strategies prioritize minimally invasive techniques over exploratory laparotomy, while avoiding the use of abdominal drains and nasogastric tubes. Other essential practices include proper antibiotic prophylaxis, judicious fluid management, patient normothermia, prophylaxis for nausea and vomiting, and multimodal pain control. Postoperatively, protocols advocate for early ambulation, prompt initiation of enteral feeding, early removal of nasogastric tubes and Foley catheters, and avoidance of intravenous opioids, favoring multimodal pain management instead. The implementation of ERAS protocols in pediatric surgery offers significant benefits for patients, families, and healthcare providers by promoting early mobilization and encouraging parental involvement. ERAS enhances recovery, reduces the incidence of complications, and shortens the length of hospital stay. Additionally, ERAS in pediatrics has shown potential to lower healthcare costs, optimize resource utilization, and improve long-term outcomes for children undergoing surgery. This article presents data on the ERAS protocol for pediatric patients undergoing abdominal surgery, highlighting its advantages, management strategies, and significance in improving preoperative, perioperative, and postoperative care to promote early recovery in pediatric abdominal surgery.

Guidelines for developing nursing innovations for cardiac rehabilitation in patients with acute myocardial infarction towards a sustainable future in healthcare systems

2024-09-19T18:36:02+07:00

Acute myocardial infarction (AMI) is a significant global health issue, including in Thailand, with high mortality rates and a substantial number of patients requiring hospital care. Cardiac rehabilitation following AMI is essential for restoring heart function, modifying behaviors, and reducing the risk of long-term complications. It encompasses various components, including assessment and planning, exercise programs, nutritional management, psychological support, follow-up, and risk prevention and management. The goal is to help patients return to normal life while reducing the risk of recurrent heart disease. In an era of rapid technological and medical advancements, advancing nursing innovations in cardiac rehabilitation is critical. Technologies such as information and communication technology, artificial intelligence, big data analytics, personalized medicine, virtual reality, and augmented reality offer the potential to improve healthcare delivery and enhance the quality of life for patients. Through a six-step development process—1) Analysis of needs and problems, 2) Research and design of innovations, 3) Prototype development and testing, 4) Implementation and training, 5) Monitoring and evaluation, and 6) Improvement and scaling—this article aims to propose strategies for developing nursing innovations in cardiac rehabilitation. These innovations aim to enhance the effectiveness of AMI patient care and reduce the burden of complications. The advancement of nursing innovations is crucial to improving the quality of cardiac rehabilitation and creating a sustainable healthcare system that meets future patient needs.

Scedosporium species complex: The hidden and overlooked danger

2024-09-08T21:58:48+07:00

Scedosporiosis and Lomentosporiosis are fungal infections caused by species within the Scedosporium spp. and Lomentospora prolificans. These pathogens are notably resistant to multiple antifungal agents, with resistance rates exceeding 85%. Despite the severity of these infections, reports in Thailand remain limited, contrasting with global trends. This discrepancy may be due to diagnostic challenges, as these fungi closely resemble Aspergillus spp. in both clinical presentation and pathological features. While infections caused by these fungi are relatively rare, the mortality rate is alarmingly high, exceeding 75%. Individuals with compromised immune systems, such as cancer patients, organ transplant recipients, or those living with HIV/AIDS, are at the highest risk. However, infections have also been observed in immunocompetent individuals, especially those with a history of aspiration of contaminated water or injuries involving sharp objects. Additionally, these fungi are more commonly found in densely populated urban areas than in rural or forested regions, as they increasingly integrate into human environments. In Thailand, healthcare professionals have had limited exposure to these pathogens, with significant awareness emerging only after 2007, following reports of fatalities. In 2022, the World Health Organization (WHO) recognized the public health significance of these pathogens by classifying them within the medium priority group of the WHO Fungal Priority Pathogen List (FPPL). This classification highlights the urgent need for further research. This article aims to provide foundational knowledge on these human-pathogenic fungi, including historical patient cases, contamination reports in Thailand, clinical characteristics, laboratory diagnostic methods, and current antifungal treatments, to pave the way for future research and advancements in this critical area.