Journal of Medicine and Health Sciences

Endoscopic endonasal approach transsphenoidal repair of a defective skull base in a CSF leak-infected patient: The first case at Phrapokklao hospital, Chanthaburi province

Adisak Tanpun — 2024-08-31

Cerebrospinal fluid leaks are rare conditions but can be life-threatening. They can lead to dangerous complications, such as meningitis and brain abscess. Cerebrospinal fluid leaks can be divided into three main causes: Trauma or surgery: This includes head accidents or surgeries involving the skull base or sinus area, such as sinus surgery that penetrates the base of the skull, failed skull base repair surgery, and post-operative complications. Non-traumatic causes: These can be caused by conditions like tumors that have spread to the base of the skull. Unknown causes: In some cases, the cause of a cerebrospinal fluid leak remains unknown. This case report describes a cerebrospinal fluid leak at the base of the skull caused by a head injury from a fall. The patient experienced cerebrospinal fluid leaking from their nose and throat. The leak eventually led to an abscess in the sphenoid sinus and cavernous sinus. The patient underwent endoscopic endonasal approach (EEA) surgery to remove the abscess and administer intravenous antibiotics for fourteen days. A second EEA procedure was performed to repair the leak using a naso-septal flap and free tissue graft from the fascia lata. The surgery was successful, and the patient recovered without complications. This is the first reported case at Phrapokklao Hospital in Chanthaburi Province where a cerebrospinal fluid leak was treated using this method.

Effects of cassumunar ginger extract on the vascular tone of rat aortic rings

Patcharin Tep-areenan — 2024-08-31

Cassumunar ginger has been widely used in Thai traditional medicine to treat various diseases. A recent study has reported that the extract of cassumunar ginger (CGE) could decrease mean arterial blood pressure. However, there is no evidence for the effects of CGE on vascular tone and underlying mechanisms. The present study aims to investigate the effects of CGE on vascular tone and vascular responses to some vasoactive agents in the rat aorta. It was found that CGE (0.1-10 mg/ml) could induce relaxation of rat aortic rings. Moreover, pretreatment with CGE reduced methoxamine- and CaCl₂-induced contraction. However, vasorelaxant responses to carbachol and sodium nitroprusside were not affected by pretreatment with CGE. The present findings in the rat aorta suggest that the vasorelaxant effects of CGE are mediated, at least in part, via inhibition of Ca²⁺ influx from extracellular space. Results from this study will be fundamental data to support the clinical use of CGE in Thai traditional medicine to reduce arterial blood pressure.

Effects of a learning enhancement program on knowledge, self-care behavior, blood coagulation levels, and abnormal bleeding among patients receiving warfarin at Mae Lao hospital, Chiang Rai province

Nutwaranee Sangchunwattana — 2024-08-31

Warfarin is a high-risk anticoagulant. Patients receiving warfarin need to be controlled keep blood coagulation levels within the target range to prevent complications from receiving medicine. The research was a quasi-experiment design, two groups measured before and after the experiment. The objective was to examine the effects of the learning enhancement program on knowledge, self-care behaviors, blood coagulation levels, and abnormal bleeding in patients receiving warfarin. The sample consisted of 52 patients aged 18 years and over receiving treatment at Mae Lao Hospital. They were divided into an experimental group of 26 and a control group of 26. Simple random sampling with math pair was conducted to ensure similarity between the two groups. The control group received standard care, while the experimental group underwent a six-week learning enhancement program. Data were collected using a knowledge assessment form, self-care behavior assessment in warfarin use, and an abnormal bleeding questionnaire. The reliability coefficients for knowledge and behavior assessment instruments were 1.00 and 0.67-1.00, respectively, with Cronbach's alpha coefficients of 0.80 and 0.78, respectively. The study revealed that after participating in the program, the experimental group significantly increased mean scores in knowledge, self-care behaviors regarding warfarin use, and blood coagulation levels within the target range (p< 0.001, p<0.000, p=0.000, respectively), and higher than the control group (p=0.038, p<0.001, p=0.026, respectively). There was no significant difference in abnormal bleeding between the experimental and control groups. These findings demonstrate that the learning program enhances knowledge and self-care behaviors among patients receiving warfarin. Therefore, it should be continously used.

Effects of the competency promotion program on dementia prevention competency for community-dwelling older people among village health volunteers

Chonlathorn Mongkonsri — 2024-08-31

Dementia in elders tends to increase. It greatly affects the daily activities living of the elders and the burden of caring for caregivers. Village health volunteers play an important role in participating in the prevention of dementia for elders in the community. This research is a quasi-experimental research with a two-group pretest-posttest design. The purpose is to study the effect of the competency promotion program on the competency in preventing dementia for community-dwelling elders of village health volunteers by applying experiential learning theory together with the concept of participatory learning. The samples consisted of 58 village health volunteers, divided into an experimental group and a control group, 29 elders per group. The research instruments were: 1) a competency promotion program for dementia prevention in elders, 2) a demographic data questionnaire, 3) a questionnaire of knowledge about dementia in elders, 4) a questionnaire of attitude towards caring for the elders to prevent dementia, and 5) a questionnaire of skills in caring for the elders to prevent dementia. Data were analyzed using descriptive statistics, Chi-Square test, Fisher’s exact test, Mann-Whitney U test, Pair t-test, and Analysis of Covariance (ANCOVA). The research results revealed that after the intervention, the experimental group had a significantly higher mean scores of knowledge, skills, and attitudes toward in preventing dementia for the community-dwelling elders than before the experiment. Additionally, the experimental group had a significantly higher mean scores of knowledge, skills, and attitudes in dementia prevention for community-dwelling elders than the control group. In conclusion, the program to promote competency in dementia prevention for the elders in the community can enhance their knowledges, skills, and attitudes.

Comparison of gastric insufflation during anesthetic induction between pressure-controlled and manual facemask ventilation in patients undergoing laparoscopic cholecystectomy

Janjira Kawattikul — 2024-08-31

For laparoscopic cholecystectomy good visibility of the surgical site is essential, therefore the prevention of gastric insufflation is important. In present study, we compared the incidence of gastric insufflation between pressure controlled and manual facemask ventilation during anesthetic induction. The research participants were 60 patients undergoing laparoscopic cholecystectomy were randomly allocated to pressure controlled facemask ventilation (PCV group) or manual facemask ventilation (MV group). In PCV group (n=30) received pressure controlled facemask ventilation at an inspiratory pressure of 13 cmH₂O. In the MV group (n=30), the adjustable pressure limiting valve was set at 13 cmH₂O. The incidence of gastric insufflation after ventilation was assessed by gastric ultrasonography and assessing through endoscopic view after started operation by surgeon. The tidal volume during facemask ventilation was also evaluated. The results of the study found the incidence of gastric insufflation assessed by ultrasonography was higher in manual facemask ventilation group than in pressure controlled facemask ventilation group (16.6% vs 6.6%, p-value = 1.45). However, there were not statistically different between the two groups. The tidal volume at 30s and 60s was significantly larger and adequate ventilation in the PCV group (461.5±76.7, 513.9±85.9) than in MV group (366.4±94.5, 400.3±101.6; p-value = 0.001, <0.001, respectively). Additionally, there were no significant differences between the two groups in surgical grade according to surgeon’s judgement. In conclusion pressure controlled facemask ventilation provide appropriate tidal volume compared with manual facemask ventilation at the same inspiratory pressure of 13 cmH₂O. However, there was no significant difference in the incidence of gastric insufflation diagnosed with ultrasonography and laparoscopic view between these two ventilation methods.

Prognostic factors for 28-day survival following treatment in individuals with septic shock

Thanawadee Chalongkulsak — 2024-08-31

Septic shock is a condition commonly encountered in emergency rooms, and the survival of patients in this state depends on various factors, including both patient-related factors and emergency room treatment processes. From the research study, data were collected from November 1, 2022, to July 31, 2023, focusing on patients with septic shock who were aged 18 years or older and received treatment in the emergency department. A total of 111 individuals were included, comprising 68 survivors and 43 non-survivors. The data were analyzed using univariable logistic regression to identify factors influencing the 28-day survival outcome. It was found that age under 60 years OR=3.17 (95% CI=1.09-9.22, p-value 0.034), lower weight OR=0.96 (95% CI=0.92-0.99, p-value 0.036), lower initial NEWS score OR=0.88 (95% CI=0.79-0.99, p-value 0.028), and lower initial lactate level OR=0.90 (95% CI=0.81-0.99, p-value 0.028), as well as not requiring mechanical ventilation OR=0.29 (95% CI=0.13-0.65, p-value 0.003) and not receiving central venous catheterization for vasopressor administration OR=0.28 (95% CI=0.10-0.73, p-value 0.010), were statistically significant predictors of survival. These factors could be utilized for prognosticating 28-day survival significantly. However, when analyzed using multivariable logistic regression, only the factor of not requiring central venous catheterization for vasopressor administration remained statistically significant adjusted odds ratio 0.24 (95% CI=0.07-0.87, p-value = 0.029). Therefore, it can be concluded that patients who do not require central venous catheterization for vasopressor administration have a better prognosis compared to the other group.

Comparison of efficacy and recurrence of intralesional Verapamil and Triamcinolone injection for postoperative ear keloid treatment: A randomized controlled trial

Sumitra Chanpeng — 2024-08-31

Keloids are abnormal scars caused by an excessive repair process without interruption and extend beyond the original boundary. There is no single effective treatment modality and surgical removal has a recurrence rate of 45 to 100%. Multimodality therapy combining steroid injections with surgery decreases recurrence. Verapamil is now included as an alternative treatment for keloids in European guidelines due to its ability to improve keloids appearance by reducing and modifying the scar, with low adverse effects. This clinical trial investigated the efficacy of two treatment methods for ear keloid excision. Fifty-two patients who met the inclusion criteria underwent ear keloid excision. They were then divided into two groups: 26 patients received an intralesional triamcinolone injection (group T), and the other 26 patients received an intralesional verapamil injection (group V). The injections were administered immediately after surgical excision and repeated 4 weeks later. Patients were regularly followed up every 8 weeks for one year. The results revealed that the recurrence of ear keloid scars was observed in 4 patients (15.4%) in group T and 6 patients (23.1%) in group V at 44 weeks after surgery. Both groups showed significant improvements in the Vancouver Scar Scale (VSS) scores. Group T experienced quicker resolution of skin redness or vascularity, pliability, and total VSS scores while pigmentation in group V demonstrated a faster response. Significantly more complications were recorded in group T compared to group V such as telangiectasia and dermal atrophy. In Conclusions, intralesional verapamil injection after ear keloid excision was an effective and non-inferior treatment compared intralesional triamcinolone injection, resulting in reduced post-treatment complications.

Effects of a self-efficacy promoting program on the knowledge and perceived self-efficacy of palliative care ward nurses for elderly with terminal illnesses

Phanida Chumrasbun — 2024-08-31

This quasi-experimental research with one-group pretest-posttest design aimed to investigate effects of a self-efficacy promoting program on palliative care for older adults with terminal illnesses on knowledge and perceived self-efficacy of palliative care ward nurses. The samples were 15 palliative care ward nurses working in the Medical and Surgical Nursing Department providing palliative care for older adults with terminal illnesses at a tertiary level hospital. The research instrument was the effects of a self-efficacy promoting program on palliative care for older adults with terminal illnesses for palliative care ward nurses developed based on the Bandura’s self-efficacy theory and Knowles’ adult learning theory. It was a 4-week activity program. The activities included providing theoretical and practical knowledge through learning stations and practical training in the ward. Data were analyzed by paired t-test. The findings revealed that the palliative care ward nurses’ mean knowledge score after receiving the program was significantly higher than that of before receiving the program (95% CI: 3.42 - 6.05, p<0.001). Their mean self-efficacy score after receiving the program was also significantly higher than that of before receiving the program (95% CI: 14.06 - 31.54, p<0.001). Therefore, this developed program can be used as a guide to promote knowledge and self-efficiency in providing palliative care for older adults with terminal illnesses among palliative care ward nurses. In addition, a long-term follow-up study should be conducted to assess the knowledge, self-efficacy in providing palliative care for older adults with terminal illnesses. A comparison group should also be added to see the effectiveness of the program compared to the group not receiving the program.

Effect of using nursing guides for monitoring symptom changes and warning signs of pre-critical conditions in the accident and emergency department at Phan hospital, Chiang Rai province

Orawan Khawelamoon — 2024-08-31

Monitoring symptoms and warning signs leading to life-threatening condition in patients receiving services in trauma and emergency department is importance to manage patient. The study was a quasi-experimental research. The objective was to examine the effect of using nursing guides for monitoring symptom changes and warning signs of pre-critical in the emergency department. The sample of 406 individuals was selected purposively and divided into an experimental group receiving surveillance variations change and early warning signs monitoring, and a control group receiving routine nursing care. Data were analyzed using descriptive statistics, chi-square and independent t-test. The results indicated that 1) The experimental group showed statistically significant increase in early detection (temperature assessed, Glasgow coma score assessed, NEWS assessed and NEWS score interpreted) compare to control group (p<0.001). 2) The experimental group showed statistically significant increase in continuous monitoring (vital signs reassessed according to NEWS level and NEWS reassessed according to NEWS level) compare to control group (p<0.001). 3) The experimental group showed statistically significant increase in nursing response to clinical deterioration (nursing response according to NEWS level and evaluation) compare to control group (p<0.001). Number of ET-tube insertion are statistically significant different between experimental and control group (p=0.008). Number of unexpected death are not statistically significant different between experimental and control group (p=0317). The overall level of satisfaction with the implementation of nursing guides for monitoring symptom changes and warning signs of pre-critical in the accident and emergency department is high ( = 4.20, SD = 0.77). Therefore, it can be concluded that using nursing guides for monitoring symptom changes and warning signs of pre-critical in the emergency department leads to increased detection of changes, proper nursing care, and reduction of unexpected deterioration incidents.

Risk factors for atrial fibrillation in elderly patients with severe atherosclerotic cardiovascular disease

Thanuphong Aiemworakit — 2024-08-31

Atrial fibrillation (AF) is common cardiac arrhythmia with a prevalence of approximately 0.5 to 15% and increased with the aging population. However, there have been limited studies about risk factors of AF in elderly patients with dangerously high atherosclerotic cardiovascular disease (ASCVD) risk in Thailand. This study aimed to determine prevalence and risk factors of AF in elderly patients with dangerously high ASCVD risk. This was a single-center cross-sectional study enrolled 720 patients with dangerously high ASCVD risk (Thai CVD risk > 40%) aged at least 60 years old at Kantharalak district, Sisaket province. Data was collected from Health Data Center 43 files (HDC) database (Tenth regional health center information system) including 12-leads electrocardiography (ECG) and demographic data during 31^st August to 30^th November 2023. The primary outcomes were prevalence and risk factors of AF. The results revealed that there were 720 patients were enrolled. Of 720 patients, 47 patients (6.5%) had AF. An average age was 79.6±7.7 years. A multivariate logistic regression model showed that AF was associated with a history of heart failure (adjusted odds ratio [aOR] 16.2, 95% Confidence interval [CI] 4.6-57.2, p<0.001), a history of valvular heart disease (adjusted odds ratio [aOR] 72.8, 95% CI 5.8-91.2, p<0.001) and beta-blockers use (aOR 6.6, 95%CI 2.9-14.8, p<0.001) in elderly patients with dangerously high ASCVD risk. In conclusion, prevalence of AF in elderly patients with dangerously high ASCVD risk were 6.5%. Risk factors associated with AF were a history of heart failure, valvular heart disease and beta-blockers use. Elderly patients with dangerously high ASCVD risk and these risk factors should be performed AF screening.

Radiation dose measurement for patients undergoing nuclear medicine diagnostic studies and for medical staff

Parita Usongtham — 2024-08-31

Nuclear medicine tests involve injecting radioactive substances into the patient's body to provide information about organ function and pathology. This raises concerns about radiation safety when managing or caring for patients exposed to radiation. The objective of this study was to measure the radiation dose rate emitted by patients during various nuclear medicine diagnostic tests. A gas-filled dosimeter was used to measure the radiation dose rate at three key times: immediately after the radiopharmaceutical injection, during the nuclear medicine examination, and before the patient was discharged. Measurements were taken at distances of 0, 0.25, 0.5, 1, and 2 meters from the patient. The study involved 385 patients undergoing 21 different nuclear medicine examinations. Six types of examinations exhibited an average radiation dose rate higher than 10 µSv/hr at 0 meters immediately after radiopharmaceutical injection. During the examination, five types of tests showed similar rates, and before discharge, only two types did. The highest radiation dose rate, observed immediately after injection during a PET/CT scan, reached 248 µSv/hr. This rate decreased during subsequent examinations and before the patients were discharged. The radiation dose rate consistently diminished as the distance from the patient increased. Notably, no examination recorded a radiation dose rate exceeding 50 µSv/hr at a distance of 1 meter from the patient before discharge. In conclusion, nuclear medicine diagnostic tests involve the use of radioactive tracers, leading to the highest radiation dose rates immediately after injection, which then decrease over time and distance. These radiation levels remain within safe limits for both medical staff and patients.

The Antioxidant and biological activity of Dillenia parviflora Griff. Fruits

Narin Kakatum — 2024-08-31

This study aimed to evaluate the antioxidant and biological activities of Dillenia parviflora Griff. (Dp) extract through various analyses, including determination of total phenolic content, DPPH radical scavenging assay for antioxidant activity, and inhibition of elastase, tyrosinase, and hyaluronidase enzymes. The study also assessed the inhibition of nitric oxide production in lipopolysaccharide (LPS)-stimulated macrophage (RAW 264.7) cells and evaluated the wound healing efficacy in human keratinocyte (HaCaT) cells. The results showed that the average total phenolic content in Dp was 28.14±0.97 mg GAE/g. Dp exhibited significantly lower compared to vitamin C (p = 0.019). A concentration 1 mg/mL of Dp demonstrated anti-inflammatory effects in RAW 264.7 cells, which were significantly less potent than triamcinolone acetonide (p = 0.003). It has an inhibitory effect on tyrosinase IC50 >1000 (mg/ml) less than vitamin C. Dp also showed slight inhibition of elastase activities, with the latter being significantly weaker than that of EGCG (p = 0.016). However, Dp did not inhibit hyaluronidase activity. The wound healing assay indicated that 1 mg/mL Dp could stimulate human skin cell migration faster than the control but slower than vitamin C (p = 0.49). Future studies should focus on identifying the active compounds responsible for these effects and conducting clinical trials to explore the potential application to herbal innovations.

Effects of innovation device on the recovery of upper limb movement and function: A pilot study in stroke patients

Woraphon Aramrussameekul — 2024-08-31

The objective of this research was to investigate the effects of an innovative device on the rehabilitation of movement and function in the upper limbs of stroke patients at the Department of Physical Medicine and Rehabilitation, HRH Princess Maha Chakri Sirindhorn Medical Center. This study employed a one-group pretest-posttest design, utilizing purposive sampling with criteria-based selection of participants, followed by simple random sampling. The rehabilitation intervention involved using the innovation device developed by Pun-apai N. et al. ^[12] This device was administered for 1 hour per session, 3 times a week, over a period of 4 weeks. The research findings indicated that among the 10 patients, 6 were male and 4 were female, with an average age of 61.80±16.50 years. The average duration of stroke among the participants was 4.9±1.728 months. The results of comparing data before and after using the innovation device alongside traditional rehabilitation methods indicate that the Fugl-Meyer Assessment scores for upper limb showed a statistically significant increase. Specifically, the average score and standard deviation before using the innovation were 79±16.181, and after using the innovation, they were 98.50±15.582, with a statistically significant increase at p<0.05. The Action Research Arm Test revealed that before using the innovation device, the average score and standard deviation were 17.30±16.310. After using the innovation, the average score and standard deviation were 25.20±19.759, with a statistically significant increase at p<0.05. Proximal muscle strength of upper limb also improved, with average scores and standard deviations before the innovation device being 8.00±2.867, and after the innovation, 9.80±3.615 and distal muscle strength of upper limb, the average scores and standard deviations before the innovation were 5.60±3.950, and after the innovation, 7.40±4.789. It was found that there was a statistically significant increase in the range of motion p<0.05 for shoulder flexion and abduction, as well as elbow flexion. These findings support the benefits of innovation device in the rehabilitation of movement and function in the upper limbs of stroke patients.

Effects of a family participation program on quality of life in colorectal cancer patients receiving home chemotherapy

Lakkana Gongmuang — 2024-08-31

The purpose of this quasi-experimental research was to study the effects of family participation program on quality of Life in colorectal cancer patients receiving home chemotherapy based on the family participation of Schepp theory (1995) and patients and family centered care (Institute for patients and family center care, 2023). The samples consisted of 20 colorectal cancer patients receiving home chemotherapy and 20 family and were recruited based on an inclusion criteria including an experimental group. Data collection tools included 1) Personal demographic questionnaire 2) Family demographic questionnaire 3) The record for hospital discharge 4) Family support assessment (Cronbach’s alpha coefficient = 0.97) and 5) Quality of life assessment (FACT-C) Cronbach’s alpha coefficient was 0.98. The obtained questionnaire data were analyzed by using descriptive statistics, chi-squared test, and repeated measures ANOVA. The findings indicated that the mean score of the quality of life from the 1^st time to the 4^th time were 81.25, 66.00, 71.65 and 78.00, respectively. It also showed that the mean scores of qualities of life of colorectal cancer patients undergoing home chemotherapy at the 1^st time, compared to the 2^nd time and the 2^nd time, compared to the 4^th time were statistically significantly different. (p<0.05). However, the comparison, which were the 1^st time and the 3^rd time, the 1^st time and the 4^th time, the 2^nd time and the 3^rd time, and the 3^rd and the 4^th time was not different statistically (p>0.05). In conclusion, the study results indicate that the family participation program increase patient care efficiency, which has a positive impact on patients' quality of life.