Journal of Medicine and Health Sciences

Nevoid basal cell carcinoma syndrome: A case report

Sumitra Chanpeng — Tue, 30 Apr 2024 00:00:00 +0700

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, is a rare autosomal dominant inherited condition mainly caused by mutations in the patched tumor suppressor gene (PTCH1). Prevalence rates vary by region. This syndrome is characterized by multiple basal cell carcinomas, as well as odontogenic keratocysts (OKC) in the jaw and other abnormalities involving the skeletal, central nervous system, ophthalmic, endocrine, and genital systems. This syndrome may be diagnosed by a plastic surgeon or dermatologist in patients who present with multiple basal cell carcinomas or by a dentist in patients who present with OKC. Early diagnosis and a multidisciplinary approach to treatment are important for decreasing the progression and severity of this syndrome, as well as improving the patient’s quality of life. Here, we report a case of nevoid basal cell carcinoma syndrome with a suspected high-grade glioma in a 38-year-old Thai man.

Problems of end stage cancer patients: Challenges for development of palliative care

Tue, 30 Apr 2024 00:00:00 +0700

This review article research addresses palliative care within the context of end-stage cancer care. It highlights the challenges and constraints faced by palliative teams providing care to patients at the advanced stages of cancer and presents innovative solutions to navigate these complex issues. The first section explores physical challenges, with a focus on pain management, symptom control, and the intricacies of medication management. Psychological and emotional challenges, emphasizing the significance of coping with grief and loss, addressing anxiety and depression, and facilitating difficult conversations, while preserving patient dignity are explored. The ethical and moral dilemmas of end-of-life decision-making, advance care planning, and the imperative of maintaining patient dignity are discussed. Issues of effective communication, encompassing breaking bad news, facilitating challenging conversations, and managing family dynamics and conflicts are explored. Furthermore, the profound impact of end-stage cancer care on palliative care, emphasizing the risk of burnout and compassion fatigue are examined. Practices and solutions, showcasing innovative pain management techniques, psychosocial support interventions, ethics consultation services, communication skills training, and holistic approaches to end-of-life care are explained. These strategies not only alleviate patient suffering but also nurture the well-being of palliative care. Finally, the article touches on future directions and research needs, highlighting emerging trends in palliative care and areas requiring further investigation. The conclusion underscores the vital role of palliative care, emphasizing the importance of education, interdisciplinary collaboration, support, and research in achieving improved end-of-life care for cancer patients.

Obesity and cardiovascular diseases

Sarawuth Limprasert — Tue, 30 Apr 2024 00:00:00 +0700

The global obesity crisis remains a pressing issue, contributing to various cardiovascular risk factors such as dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Moreover, obesity independently escalates the risk of cardiovascular disease and related mortality. Recent findings emphasize the significance of abdominal obesity, assessed by waist circumference, as an independent marker for cardiovascular disease risk, distinct from body mass index. There have been notable advancements in characterizing body composition, including visceral adiposity, which highlight its role as a crucial factor in predicting poor cardiovascular outcomes. Lifestyle changes and subsequent weight loss can improve metabolic syndrome, systemic inflammation, and endothelial dysfunction. However, clinical trials focusing on medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, comparative studies between individuals undergoing bariatric surgery and those with obesity not undergoing surgery have shown a decreased risk of coronary artery disease with surgery. This article provides a comprehensive overview of how obesity impacts the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, including sudden cardiac death and atrial fibrillation. It also discusses the effects of lifestyle changes and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.

Telemedicine and telenursing: Revolutionizing remote healthcare delivery

Jiraporn Voraraksa, Araya Ongiem, Ruechuta Molek, Phongthara Vichitvejpaisal — Tue, 30 Apr 2024 00:00:00 +0700

Telemedicine, encompassing various remote healthcare services, has witnessed rapid evolution with Telenursing care standing out as a crucial component. Leveraging advanced telecommunication technologies, telemedicine transcends geographical barriers, offering improved accessibility, patient convenience, and satisfaction. This transformative approach contributes to reduced healthcare costs, expanded outreach to underserved populations, and the efficient monitoring and management of chronic conditions. This article extensively explores the array of telecommunication technologies integral to telemedicine, including video conferencing, remote monitoring devices, and mobile health applications. By delving into the functionalities and benefits of these technologies, the narrative emphasizes their pivotal role in delivering remote healthcare services. Moreover, it scrutinizes Telenursing care's significance in providing health education and self-management support, underscoring its role in empowering patients to effectively manage their health conditions. The exploration extends to the challenges associated with telemedicine, addressing issues such as privacy and security concerns, technological disparities, legal and regulatory considerations, and patient acceptance and adoption. As the article concludes, it propels the discourse towards the future of telemedicine. This encompasses potential technological advancements, the integration of artificial intelligence and machine learning, the global expansion of telemedicine within healthcare systems, and collaborative initiatives between healthcare professionals and technology experts. In summary, telemedicine, driven by Telenursing care, has metamorphosed healthcare delivery, promising a future marked by enhanced accessibility, quality, and outcomes.

Factors associated with mortality among patients admitted to King Narai Hospital due to acute upper gastrointestinal bleeding

Pavapol Sirisunhirun — Tue, 30 Apr 2024 00:00:00 +0700

Acute upper gastrointestinal bleeding (UGIB) is a significant public health concern and a leading cause of death worldwide. Data from King Narai Hospital over the past 5 years reveals that the mortality rate ranged between 9-14%. This study aimed to investigate the factors associated with mortality among patients admitted to King Narai Hospital due to acute UGIB. The study group consisted of 204 individuals diagnosed with acute upper gastrointestinal bleeding between January 2023 and December 2023. The research tool used was a data recording form that included demographic and clinical data, laboratory parameters, endoscopic findings, and treatment outcomes. Data were analyzed using descriptive statistics and multiple logistic regression. The results revealed that there were 204 cases of patients with acute UGIB, with 122 patients (59.8%) being male. The median age was 61 ± 15.06 years. A history of aspirin use was found in 30.4% of cases. Most patients presented with melena, accounting for 110 cases (53.9%), while hematemesis was found in a total of 94 cases (46.1%). Mortality occurred in 35 cases (17.15%). Of those who died, 51.4% had undergone esophagogastroduodenoscopy. Esophageal varices and peptic ulcers were found in 9 cases (50%) and 8 cases (44%), respectively. Significant factors associated with mortality in acute UGIB patients included a pulse rate higher than 100 beats per minute, a systolic blood pressure lower than 90 mmHg, a white blood cell count greater than 12.00x10⁹ cells per liter, lack of access to endoscopy, and provision of more than 3 units of fresh-frozen plasma (FFP). In conclusion, esophageal varices and peptic ulcers were the main causes of death. Factors that increase the risk of mortality include a pulse rate of more than 100 beats per minute, a systolic blood pressure lower than 90 mmHg, a white blood cell count of more than 12.00x10⁹ cells per liter, lack of access to endoscopy, and the delivery of more than 3 units of FFP.

The predictability of health literacy, pre-discharge teaching, care coordination before discharge on readiness for hospital discharge among older medical patients

Panta Faosap, Mayuree Leethong-in — Tue, 30 Apr 2024 00:00:00 +0700

The readiness for hospital discharge enhances the transition of older medical patients from the hospital to their homes or health service facilities smoothly. This predictive correlational research aimed to investigate the predictability of health literacy, pre-discharge teaching, and care coordination before discharge on readiness for hospital discharge among older medical patients. The sample comprised 85 older medical patients admitted to a super tertiary hospital. Data were collected through an interview form assessing older medical patients' health literacy, discharge teaching quality, care coordination before discharge, and readiness for hospital discharge. Analysis involved descriptive statistics, Pearson’s product-moment correlation, and multiple regression analysis. The research revealed that the samples scored high in readiness for hospital discharge, with a mean of 8.34 points (SD = 0.85). Health literacy, encompassing understanding health information, communication skills, decision-making skills, self-management skills, discharge teaching, and care coordination before discharge, collectively explained 39.1% of the variance in readiness for hospital discharge among older medical patients (Adjusted R2 = .391). Significant predictors of readiness for hospital discharge included care coordination before discharge (ß = .375, p<0.001) and discharge teaching (ß = .321, p=0.002). These findings provide essential information and guidelines for multidisciplinary teams to develop programs or guidelines for preparing older medical patients before hospital discharge.

Pathogenic bacteria and fungi from bat guano in restricted access caves, Kanchanaburi Province

Tue, 30 Apr 2024 00:00:00 +0700

Bats serve as carriers for various pathogens, with bat guano acting as a reservoir for microorganisms that can spread to the environment and cause infectious diseases in humans. This study aims to investigate the bacteria and fungi present in bat guano. Samples of bat guano were collected from restricted access cave areas and diluted using 10-fold dilutions into culture media. Initially, the researchers focused on studying fungi in bat guano, using Sabouraud Dextrose Agar supplemented with Chloramphenicol, and incubating at 37°C for 48-72 hours. Colonies were isolated, and pure cultures were obtained for analysis using MALDI-TOF MS. No fungal growth was observed at dilutions of 10^-4 to 10^-7, but growth occurred at dilutions of 10^-1, 10^-2, and 10^-3. Additionally, the variety of culture media was expanded to include Sabouraud Dextrose Agar, Potato Dextrose Agar, and Malt Extract Agar, supplemented with Chloramphenicol, and incubated at 25 and 37°C. Analysis revealed 28 isolates after selective culturing, comprising both bacteria and fungi. MALDI-TOF MS identified 9 bacterial isolates, including Providencia stuartii, Bacillus subtilis, Bacillus amyloliquefaciens, Alcaligenes faecalis, Proteus mirabilis, Ochrobactrum intermedium, Achromobacter xylosoxidans, and Stenotrophomonas maltophilia. One fungal isolate was identified as Aspergillus versicolor. Unidentified isolates underwent DNA sequencing, revealing Cladosporium perangustum. This study highlights that the majority of microorganisms present in bat guano are naturally occurring bacteria, some of which are known to cause infectious diseases in humans. These findings contribute to further research and can be used to warn individuals at risk of bat guano exposure.

Perfusion index as a predictor of hypotension after Propofol induction of general anesthesia in elderly patients undergoing elective surgery

Rungruedee Wichapong — Tue, 30 Apr 2024 00:00:00 +0700

Anesthesia with Propofol is often associated with hypotension, particularly in the elderly population. Hypotension can lead to perioperative organ hypoperfusion, increasing the risk of postoperative complications and mortality. This study aimed to determine the cutoff value of baseline perfusion index that can predict the incidence of hypotension after receiving Propofol under general anesthesia in elderly patients. It was a prospective observational study involving 29 patients scheduled for general anesthesia for elective surgery at Mahasarakham Hospital. A perfusion index measurement device with a soft-tip device (model PHILIPS M1191B2) and a PHILIPS pulse oximeter for measuring oxygen saturation were used. Perfusion index, heart rate, blood pressure, and oxygen saturation were recorded every minute until 10 minutes after intubation. The data were analyzed to identify the relationship between baseline perfusion index and the occurrence of hypotension using the Receiver Operating Characteristic (ROC) Curve. The study found that within the first 10 minutes after induction, the incidence of hypotension was 65.52%. The baseline perfusion index value was significantly associated with the occurrence of hypotension (p<0.001), with a baseline perfusion index value ≤ 1.6 indicating a risk of hypotension after receiving Propofol under general anesthesia in elderly patients. The sensitivity was 100.00 (76.8-100.0) and specificity was 66.67 (38.4-88.2). A baseline perfusion index ≤ 1.6 is correlated with the incidence of hypotension and can be used to predict its occurrence after Propofol administration under general anesthesia in elderly patients.

Development of a medical assessment guide for cardiac disease patients when returning to work using a modified Delphi technique

Metawee Puybandit, Naesinee Chaiear, Pattarapong Makarawate, Montri Yasud — Tue, 30 Apr 2024 00:00:00 +0700

When considering the return-to-work (RTW) of patients with cardiac diseases, it is essential to take into account the intricacies of their conditions and workplace safety. While a few evidence-based standard guidelines exist in developing countries, they are not well-established. This study aims to develop a medical assessment guide for physicians involved in RTW evaluation. A Modified Delphi technique was utilized to gather the necessary components for the medical evaluation of workers with cardiac diseases returning to work. The process involved constructing a questionnaire and recruiting experts, followed by expert agreement on the completed questionnaire regarding the essential components of the RTW guide. Subsequently, a second round of expert agreement was conducted to address additional information and questions. Consensus was reached on the essential components of the RTW guide. After two rounds of agreement, the necessary components included history taking, physical examination, cardiac investigation, management information, and evaluation of metabolic equivalents (METs) for the patient and their physical work demands. For instance, in the case of non-strenuous work, RTW can be conducted without a cardiorespiratory fitness (CRF) test to calculate METs in patients with ischemic heart disease, post-open-heart surgery, and some types of cardiac arrhythmia, though there was no consensus on heart failure patients in non-strenuous work. For patients engaged in safety-sensitive work, a multidisciplinary team (MDT) assessment was suggested for those with post-open-heart surgery, cardiac arrhythmia, or heart failure. In conclusion, return-to-work evaluation could be conducted by predicting non-exercise cardiorespiratory fitness based on the New York Heart Association classification for non-strenuous work, except in patients with heart failure. MDT assessment is recommended for patients involved in safety-sensitive work.

Isolation and identification of bile salt hydrolase-producing lactic acid bacteria with cholesterol-lowering potential probiotics in raw milk from dairy farms in Thailand

Tue, 30 Apr 2024 00:00:00 +0700

Currently, probiotics are widely available and used in daily life, with lactic acid bacteria being the most common source found in fermented foods, the normal microbiota of humans and animals, plants, or in the environment. This study aimed to discover lactic acid bacteria with positive bile salt hydrolase (BSH) activity, an enzyme with the potential mechanism of decreasing cholesterol levels, from 21 raw milk samples collected from dairy farms or dairy cooperatives in Thailand. From these samples, 103 lactic bacteria were isolated, and 15 isolates exhibited bile salt hydrolase activity. Among them, three isolates with the highest BSH activities, namely TM1, TM7, and TM14, were selected for further screening. Molecular identification using 16S rDNA sequences revealed that TM1 was closely related to Lactobacillus gasseri ATCC33323, while TM7 and TM14 were closely related to Lacticaseibacillus rhamnosus strain NBRC 3425. The phylogenetic tree confirmed these results. Additionally, TM7 was notably distant from TM14 and other L. rhamnosus clade members, suggesting a possible new strain of L. rhamnosus. Acid tolerance tests showed that all strains were tolerant to acidity at pH 3.0 and pH 4.0 for the duration of normal gastric emptying, with TM14 even exhibiting an increase in viable cell population at pH 4.0. In the bile salt challenge test, TM1 showed an increase in growth rate with increasing bile salt concentration, indicating its preference for bile salts in its growth conditions. At a bile salt concentration of 0.3%, viable cells of TM7 and TM14 could be detected, suggesting bile salt tolerance. Moreover, all three isolates exhibited inhibition of pathogenic bacteria such as Vibrio parahaemolyticus, Klebsiella pneumoniae, Escherichia coli, and Serratia marcescens, without showing signs of antibiotic resistance to ampicillin, chloramphenicol, and tetracycline. These findings advocate further assessment and consider them as candidates for probiotic product development.

An example analysis of network meta-analysis using R software for medical and health science research contexts

Tue, 30 Apr 2024 00:00:00 +0700

Research utilizing network meta-analysis (NMA) is widely published internationally. In the Thai context, some Thai researchers have published traditional meta-analysis works, referring to univariate meta-analysis. However, few researchers have published their works using NMA, particularly in the field of medical and health science. Additionally, few Thai researchers (if any) utilize the R software to conduct NMA for their research and publications. This indicates a notable practice gap. Therefore, the objective of this study is to demonstrate how to conduct NMA using the R software. R is freely available, globally accepted, and fully capable of analyzing NMA. Methodologically, secondary data is employed to illustrate our analysis. The dataset utilized is Dogliotti2014, which is freely available in R. NMA serves as the statistical method to analyze the data. In terms of analysis, the R procedures and codes are provided to demonstrate how to conduct NMA. Regarding results, different treatments (medications) yield varying outcomes. This leads to the conclusion that Antithrombotic drugs are the most effective in preventing strokes and should be considered for patients at risk of thromboembolism. In conclusion, the R software is fully capable of conducting comprehensive NMA. It is recommended that Thai medical and health science researchers utilize the R software for conducting NMA in their research and publications at both national and international levels.

Prevalence and pathological characteristics of benign and sarcomatous lesions in the abdominal cavity and retroperitoneum among adult at Thammasat University Hospital

Natcha Poungmeechai, Jutatip Kintarak — Tue, 30 Apr 2024 00:00:00 +0700

Soft tissue tumors pose a challenge due to their rarity and complex diagnostic process. This pilot study aimed to investigate the prevalence and clinicopathological features of soft tissue tumors in the abdominal cavity and retroperitoneum in adults at Thammasat University Hospital. This descriptive retrospective study included patients aged at least 15 years who had undergone core needle biopsy and were diagnosed with soft tissue tumors according to the WHO classification of soft tissue and bone 2020. A total of 56 cases were collected by the Department of Pathology over 5 years from January 2017 to December 2021. Benign tumors accounted for 41.1% and sarcomas for 58.9% of the cases. The mean age of the patients was 53.5 years, ranging from 15 to 92 years, with 25 (44.6%) cases being female and 31 (55.4%) cases male. Most tumors were located in the abdominal cavity, with the majority being larger than 5 cm. Among sarcomas, 21.2% exhibited multiple foci. The most common sarcoma identified was gastrointestinal stromal tumor (GIST), while the most common benign tumor was PEComa. Incidental findings were observed in 35.7% of cases. The prevalence and clinicopathological findings of this study were consistent with previous research findings.