Journal of Medicine and Health Sciences

Effects of the program to promote food and water consumption behaviors on the level serum phosphorus and interdialytic weight gain in patients with end-stage renal disease undergoing hemodialysis in Nakhon Nayok Province

Supaporn Srisa-ard, Jirawan Inkoom, Siripa Changsirikulchai — Wed, 31 Dec 2025 00:00:00 +0700

This experimental study employed a two-group pretest and posttest design to evaluate the impact of a behavioral promotion program on dietary and fluid consumption, serum phosphorus levels, and intradialytic weight gain (IDWG) in end-stage renal disease (ESRD) patients undergoing hemodialysis in Nakhon Nayok Province, Thailand. The sample comprised 60 ESRD patients receiving treatment at three hemodialysis units: the Hemodialysis Unit three Hospital. Participants were randomly assigned to the experimental group (n = 30) and the control group (n = 30) based on criteria such as age, duration of hemodialysis treatment, and use of phosphorusbinding medications. Data collection tools included a personal and clinical data record form, a guidebook for food and fluid consumption in hemodialysis patients, and a behavioral promotion program developed from literature reviews and evidence-based practices. Data were analyzed using descriptive statistics, Chi-square, t-test, Mann–Whitney U test. Results showed that the experimental group demonstrated significantly lower serum phosphorus levels compared to the control group after the intervention (p=0.024). Intradialytic weight gain was significantly lower in the experimental group than in the control group after the intervention (p<0.001). Conclusion the behavioral promotion program for dietary and fluid intake was effective in modifying health behaviors and in reducing serum phosphorus levels and interdialytic weight gain to appropriate clinical ranges among ESRD patients undergoing hemodialysis. Recommendations hemodialysis units should adopt this program as a standard practice for promoting appropriate dietary and fluid intake among ESRD patients undergoing hemodialysis. Continuous training on dietary and fluid management should be provided for nurses and healthcare professionals to ensure sustainable and effective patient care.

The effect of nurse-driven ventilation weaning program with social support on the success rate and duration of weaning from ventilators in critically ill medical patients

Chittima Ekkachat, Jirawan Inkoom, Chatchai Ekpanyaskul — Wed, 31 Dec 2025 00:00:00 +0700

This study is quasi-experimental research using a two-group post-test design aimed at investigating the effects of a professional nurse-led weaning program combined with social support on the success rate and duration of ventilator weaning in critically ill medical patients. The sample included 60 critically ill medical patients who had undergone tracheal intubation and were on mechanical ventilation in a medical intensive care unit. They were divided into an experimental group and a control group, 30 patients each. The control group data were retrospectively reviewed from medical records of patients who received standard weaning care between December 2024 and January 2025. The experimental group received a ventilator weaning program developed based on the framework of the American Association of Critical-Care and social support based on the social support theory of Thoits. The sample was selected according to inclusion criteria and matched the control and experimental groups by age, gender, and physiological severity level (APACHE II Score). Data were collected using a personal information form, pre-weaning readiness assessment form, ventilator weaning success assessment form and weaning social support activities assessment form for relatives. The content validity was checked by 3 experts. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used. The difference in weaning success rate was compared with Chi-square test and the difference in weaning time after using the program compared with usual care was compared with the independent t-test.The results showed that the experimental group had a significantly higher ventilator weaning success rate (96.67 %) than the control group (70.00 %) (p=0.006) and had a statistically significant shorter mean duration of weaning (17.71 hours) than the control group (125.62 hours) (p<0.001).Therefore, the medical intensive care unit should implement a nurse-driven ventilation weaning program with social support, train and monitor and evaluate nurses’ use of these guidelines to enhance weaning success and reduce weaning duration.

Optimal admission NT-proBNP cutoff value for predicting in-hospital mortality in patients with acute heart failure

Natthawat Aranyawat, Kanavut Baiphukthong — Wed, 31 Dec 2025 00:00:00 +0700

Previous research has demonstrated the relationship between NT-proBNP levels and mortality risk in heart failure patients, and optimal cutoff values have been established for mortality prediction. However, these cutoff values vary among different ethnic populations. This single-center study therefore aims to investigate the relationship between admission NT-proBNP levels and the risk of in-hospital mortality, and to determine the optimal cutoff value for predicting mortality among patients with acute heart failure at Nopparat Rajathanee Hospital. This retrospective study was conducted by recording admission NT-proBNP levels and other baseline clinical characteristics from medical records of 88 acute heart failure patients (44 deceased, 44 survived) admitted to Nopparat Rajathanee Hospital. The study results showed that the median NT-proBNP levels in patients who died were significantly higher than those who survived (28,197 and 2,648 pg/mL respectively, p=0.001), and found that elevated NT-proBNP levels were significantly associated with increased risk of mortality (adjusted OR 1.046 [95% CI: 1.016-1.077], p=0.002). The optimal cutoff value of admission NT-proBNP for predicting in-hospital mortality was 9,020 pg/mL (sensitivity 81.8%, specificity 97.7%, negative predictive value 84.3%, and positive predictive value 97.3%) with an overall test accuracy of 89.8%. This study demonstrates that admission NT-proBNP levels are significantly associated with in-hospital mortality risk, and the cutoff value of admission NT-proBNP at 9,020 pg/mL is a reliable and useful parameter for assessing the risk of in-hospital mortality in patients with acute heart failure. However, it should be considered in conjunction with other clinical indicators.

Microalbuminuria and associated factors in type 2 diabetes patients at Phrayuen hospital, Khon Kaen province

Pattanan Rattanathara, Niracha Somya, Monpat Chamnanphon — Wed, 31 Dec 2025 00:00:00 +0700

Diabetes mellitus is a non-communicable disease with a steadily increasing prevalence worldwide and is a major cause of complications in multiple organ systems, especially chronic kidney disease (CKD), which significantly impacts patients' quality of life and imposes a burden on public health systems. This study aimed to assess the prevalence and trends of proteinuria in type 2 diabetes patients using the urine albumin-to-creatinine ratio (UACR) and dipstick urine test results from retrospective medical records of 499 patients attending Phrayuen hospital, Khon Kaen province, between 2022 and 2024. This descriptive cross-sectional study involved mostly female patients (64.93%) with a median age of 61 years (IQR: 55-68). The analysis revealed that 31.26% had abnormal UACR levels (≥30 mg/g Cr). Median UACR increased significantly from 10 mg/g Cr in 2022 and 2023 to 20 mg/g Cr in 2024 (p<0.001). Factors significantly associated with abnormal UACR included male gender (OR=2.09, p<0.001), HbA1c ≥7.0% (OR=1.66, p=0.044), and elevated serum creatinine (OR=1.89, p=0.003). Although systolic blood pressure tended to increase with abnormal UACR, it was not statistically significant (p=0.079). Other variables such as age, body mass index, smoking status, diabetes duration, blood lipid levels, and estimated glomerular filtration rate (eGFR) showed no significant associations. Logistic regression identified male gender, high HbA1c, and elevated serum creatinine as important predictors of early-stage kidney damage. The findings emphasize the importance of regular UACR screening, especially in rural or regional type 2 diabetes populations, to facilitate effective planning and prevention of chronic kidney disease at the community level.

Diagnostic performance of the SASIT kit for Parkinson’s disease patients in Thailand

Wed, 31 Dec 2025 00:00:00 +0700

Olfactory dysfunction is found in 75-90% of patients in the early stages of Parkinson's disease (PD). Despite its widespread occurrence in PD, many patients remain unaware of their olfactory dysfunction until they undergo standardized smell testing. The self-administered smell identification test kit (SASIT kit) was developed for use in diagnosing olfactory dysfunction in Thai individuals. This study aims to evaluate the diagnostic performance of the SASIT kit in differentiating PD patients from healthy individuals. This observational, cross-sectional diagnostic accuracy study was conducted at the outpatient departments of Pattani Hospital and Songkhla Hospital. Age-matched healthy volunteers who could perceive the normal n-butanol threshold, and Parkinson’s disease patients with Hoehn & Yahr Stage (H&Y stage) 1-3, aged 50 years and older, were included. The study was conducted between January and October 2024. Participants were screened using PHQ-2/PHQ-9, MMSE-Thai 2002, and anterior rhinoscopy. Subsequently, they performed the self-administered smell identification test (SASIT), and the SASIT scores were recorded. Baseline clinical characteristics and SASIT scores (n, %, mean ±SD, or median [IQR]) were compared using a t-test. Diagnostic accuracy was assessed using the area under the receiver operating characteristic (ROC) curve. The optimal SASIT score cutoff for distinguishing PD patients from healthy volunteers was determined and presented with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The study included 60 PD patients (mean age 67.6±7.9 years) and 60 healthy volunteers (mean age 69.5±10.9 years) with mean SASIT scores of 9.2±3.6 and 13.7±1.9, respectively (p<0.001). The SASIT kit showed an AuROC of 0.88 (95% CI: 0.82, 0.94). A cut-off score of ≤13 yielded 79.2% accuracy in differentiating PD patients from healthy individuals, with 90.0% sensitivity and 68.3% specificity. Therefore, the SASIT kit can be used as part of a multimodal diagnostic approach alongside clinical evaluation for diagnosing PD. Further studies with broader population samples are recommended to validate and expand upon the results gained by this study.

The study of the correlation between the waiting day before surgery and the walking ability with a 4-leg-walker in bipolar hemiarthroplasty elderly patients

Nithi Kanjanasingh, Pronrumpa Kanjanasingh, Pishyaporn Sritangos — Wed, 31 Dec 2025 00:00:00 +0700

Femoral neck fracture is one of the most prevalent problems affecting elderly patients’ quality of life. In Thailand, presurgical processes in public hospitals may lead to delays, subsequently resulting in long waiting times for surgery, which often exceed the 48 hours post-admission per recommendation by the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults. Since the average waiting duration for hip replacement surgery was 4.95±3.05 days with 45.54% of patients receiving surgery within 3-4 days of admission at Buddhasothorn Hospital, this study aimed to examine whether prolonged waiting duration before bipolar hemiarthroplasty surgery impacts the patient’s outcome in terms of walking ability with a 4-leg-walker before discharge from the hospital and length of stay post-surgery (LOS). Retrospective analysis of the data registry of 112 patients at Buddhasothorn Hospital between 2017-2022 suggested that bipolar hemiarthroplasty delayed by up to 4 days post-admission had walking outcomes and average LOS statistically equivalent to those who had surgery within 2 days post-admission. Although Fisher’s exact test showed proportions of patients who could walk before hospital discharge were similar, Log-Rank analysis suggests 1.65-fold of patients who had surgery ≤4 days could walk with a gait aid before hospital discharge compared to patients who had surgery after 4 days (p=0.005). Kruskal-Wallis test and Dunn’s post-hoc test revealed that LOS of groups that had surgery within ≤2 days, day 3-4, and ≤4 days showed no significant differences with the mean±SD of 6.61±3.13, 6.67±3.24, and 6.65±3.19 days, respectively. However, delays of more than 4 days post-admission led to a significant increase in average LOS of 8.40±3.46 compared to groups that had surgery within ≤4 days (p=0.015). Furthermore, Log-Rank hazard ratio analysis of relationships between ≤4 days and over >4 days pre-surgery waiting period showed 1.56-fold faster recovery of walking ability with gait aid (p=0.043) and reduced LOS by 1.57-fold (p=0.037). These findings provided data suggesting that potential delays of more than 4 days post-admission before bipolar hemiarthroplasty adversely affected patient outcomes. Furthermore, delays of up to 4 days post-admission had negligible effects on walking outcomes with favorable LOS and duration to walking, and this extended period may enable physicians to perform necessary investigations to ensure the patient’s safety before proceeding with hip surgery.

Cut-off points of parathyroid hormone and serum calcium for post-thyroidectomy hypocalcemia prediction and early management

Kunkanya Chansomboon — Wed, 31 Dec 2025 00:00:00 +0700

Postoperative parathyroid hormone (PTH) cut-off points with high sensitivity and specificity can predict post-thyroidectomy hypocalcemia (PTHC) early and accurately, leading to timely decisions regarding calcium supplementation. This retrospective chart review primarily aimed to determine the optimal cut-off point of PTH levels within the first 24 hours after total or completion thyroidectomy (PTH-24) for predicting PTHC, categorizing patients into low, intermediate, and high-risk groups. The secondary objective was to find the optimal cut-off point for calcium levels on postoperative day 1 (CCL-POD1) to predict PTHC in the intermediate-risk group. This study included inpatients at Chumphon Khet Udomsak Hospital from May 1, 2023, to April 30, 2025. The study included 86 eligible patients, with 43 (50.0%) developing PTHC. ROC analysis of PTH-24 levels to predict PTHC yielded an AUC of 0.943 (p<0.001). The optimal cut-off point is 9.04 pg/ml (with 93.02% sensitivity and 86.05% specificity). However, a cut-off value of 7.83 pg/ml yields a higher specificity of 95.35% and a positive predictive value of 94.70%. Meanwhile, a cut-off point of 19.35 pg/ml provides a higher sensitivity of 97.67% and a negative predictive value of 95.45%. In the intermediate-risk group PTH-24 between 7.84-19.35 pg/ml), ROC analysis of CCL-POD1 to predict PTHC resulted in an AUC of 1 (p<0.001). The optimal cut-off point was 8.18 mg/dl. In conclusion, patients with PTH-24 ≥19.36 pg/ml combined with CCL-POD1 ≥8.0 mg/dl, and those with PTH-24 between 7.84 - 19.35 pg/ml combined with CCL-POD1 ≥8.18 mg/dl, can safely be ruled out for postoperative hypocalcemia and discharged. Conversely, for PTH-24 ≤7.83 pg/ml, immediate initiation of calcium and calcitriol supplementation is recommended.

Probiotic Limosilactobacillus reuteri TF7 protects against dyslipidemia and inflammation via modulating gut microbiota in high-fat-diet-induced obese rats

Wed, 31 Dec 2025 00:00:00 +0700

Dyslipidemia is a condition characterized by abnormally high levels of cholesterol and triglycerides. It has numerous negative health effects, which are partly due to increased levels of oxidative stress and inflammation. The resulting health problems include obesity, diabetes, and non-alcoholic fatty liver disease (NAFLD). Several studies have shown that probiotics are beneficial live microorganisms that can promote overall health and well-being, particularly through their lipid-lowering properties and supportive role in maintaining metabolic balance. Thus, this study aimed to investigate the effects of the probiotic Limosilactobacillus reuteri TF7 on lipid-lowering; inflammatory mediators; antioxidant activities; intestinal local immunity; and gut microbiota balance in high-fat-diet-induced obese rats. The study showed that oral administration of the probiotic resulted in body weight loss, lower blood glucose and lipid levels, and elevated cholesterol-7α-hydroxylase activity. In addition, L. reuteri TF7 reduced liver enzyme levels and pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), which led to decreased liver fat accumulation. The probiotic reduced oxidative stress by boosting antioxidant enzyme production, including superoxide dismutase (SOD) and glutathione peroxidase (GPX). The research demonstrated two approaches to enhancing intestinal local immunity: increased expression of the zonula occludens-1 (ZO-1) protein and reduced expression of TLR proteins. The gut microbiota achieved balance through L. reuteri TF7, which promoted the growth of beneficial bacteria. Our findings indicate that the probiotic strain L. reuteri TF7 has the potential to effectively reduce risk factors associated with dyslipidemia.

Postoperative pain in the recovery room among patients undergoing lumbar spine surgery after implementing Khon Kaen University Procedure-Specific Pain Management (KKU PROSPECT) Guidelines

Wed, 31 Dec 2025 00:00:00 +0700

Lumbar spine surgery commonly causes significant acute postoperative pain due to soft tissue, joint, and muscle injury. An institutional internal audit (2017–2019) showed that 70.5–74.4% of patients experienced moderate-to-severe pain (NRS ≥4) in the PACU. In 2020, we introduced the Khon Kaen University Procedure-Specific Pain Management for Spine Surgery (KKU PROSPECT) pathway to standardize analgesia for this population. We conducted a retrospective descriptive study of 179 adults undergoing elective lumbar spine surgery at Srinagarind Hospital to assess early postoperative analgesic outcomes following pathway implementation. Data collected included baseline and operative variables, NRS scores on PACU arrival and before discharge, morphine consumption, analgesic modalities used, protocol adherence, and complications. On arrival, the median NRS was 3 (IQR 0–7), with 45.8% reporting NRS ≥4; before discharge, 82.1% had none-to-mild pain. Median PACU morphine use was 6 mg (IQR 3–8), significantly lower in patients arriving with none-to-mild pain compared with those with moderate-to-severe pain (3 [1–6] vs 8 [6–10] mg; p<0.0001). No opioid-related complications were observed. Pathway adherence was complete in 38.6% of cases, incomplete due to contraindications in 29.1%, and incomplete without contraindications in 32.4%. Implementation of the KKU PROSPECT pathway was associated with improved early postoperative pain control. Further gains may be achieved by increasing adherence (e.g., using prescriber prompts and simplified order sets), strengthening patient education, updating recommendations to reflect current evidence, and continuing systematic quality monitoring.

Effect of a mobile application–based preoperative preparation program on anxiety and self-care ability among cataract surgery patients

Orapan Mangdee, Utthawit Jansiri, Sunee Sinthuwongsanon — Wed, 31 Dec 2025 00:00:00 +0700

Cataract is a major cause of visual impairment in the elderly, making preoperative preparation crucial for patient outcomes and self-care. This quasi-experimental study employed a two-group pre-test and post-test design to examine the effects of a mobile application-based preoperative preparation program on anxiety and self-care ability among cataract surgery patients. The sample consisted of 60 patients diagnosed with cataracts by physicians and scheduled for elective cataract surgery at Nakornping Hospital. Participants were divided into an experimental group (n=30) and a control group (n=30) using purposive sampling. The control group received standard hospital care, while the experimental group received the mobile application-based preoperative preparation program for two weeks. Data were collected using anxiety and self-care ability questionnaires with content validity indices of 1.0 and Cronbach's alpha coefficients of 0.87 and 0.92, respectively. Data were analyzed using descriptive statistics, paired t-test and independent t-test. The results revealed that the experimental group demonstrated significantly lower anxiety scores (p=0.007) and significantly higher self-care ability scores (p<0.001) compared to baseline. Furthermore, the experimental group exhibited significantly lower anxiety scores and higher self-care ability scores than the control group (p<0.001). Effect sizes ranged from medium to very large (Cohen's d=0.76–2.96), indicating strong practical significance. These findings demonstrate that the mobile application-based preoperative preparation program effectively reduces anxiety and enhances self-care ability among cataract surgery patients. Continuous implementation of this program in clinical practice is therefore recommended.

Effectiveness of acute ischemic stroke patients care before and after the development of a fast track system at Suratthani Hospital

Nutthapong Kanokkawinwong, Ratchakorn Hongkul, Tassanapan weschasat — Wed, 31 Dec 2025 00:00:00 +0700

Currently, acute ischemic stroke was a condition in which the brain stops functioning due to destruction of brain tissue and disruption of normal brain activity. The patient can lead to death or cause disability. However, if the patient receives a door-to-CT brain followed by administration of door-to-needle time (rt-PA) within 3 - 4.5 hours, it can help save their life and reduce disability. The objective of this study was to compare the effectiveness of acute ischemic stroke patient’s care, before and after the developing of a fast track system at Suratthani Hospital. This study was a retrospective descriptive study with acute ischemic stroke patients who received rt-PA treatment before the developing of stroke fast tract service system in 2018-2019 from January 2018 to December 2019, and those who received rt-PA after the development of stroke fast tract service system from January 2020 to December 2021. Samples were purposively select, consisting of 260 patients diagnosed with acute ischemic stroke patients. Data were collected through a review from the hospital's electronic medical record system includes: onset-to-ER, door-to-CT brain, door-to-needle time, ER-to-Ward, National Institutes of Health Stroke Scale and Barthel Activities of Daily Living. The results of the study showed that between before and after the developing of fast track system of acute ischemic stroke patients, the average time of door-to-needle decreased (39.53±18.54 - 28.08±15.61, minutes) and the average time of emergency room-to-ward decreased (87.75±42.37 - 47.02±34.85, minutes) with a statistically significant difference (p<0.001). As a result of after the developing of fast track system, National Institutes of Health Stroke Scale after receiving rt-PA of patients had mild impairment. The assessment of daily living activities using the Barthel Activities of Daily Living, after receiving rt-PA of patients had physically independent but not necessary normal or social independent. Therefore, if patients receive rt-PA as quickly as possible, it may reduce mortality and disability rates, leading to more effective medical treatment.

A pilot study on a role-play chatbot for enhancing patient history-taking knowledge in nursing students

Supawan Tanupabrungsun, Masarat Pariyanonth, Kulpicha Vecharatpimon — Wed, 31 Dec 2025 00:00:00 +0700

Taking patients’ history is a fundamental skill for nursing students, yet opportunities for hands-on practice are often limited, particularly in the early years of training. While AI-powered chatbots have gained attention in healthcare education globally, their specific application in systematic history-taking training for Thai first-year nursing students remains underexplored. This study evaluates the feasibility of a role-play chatbot developed using the ChatGPT platform to enhance history-taking knowledge among first-year nursing students at a nursing college in Bangkok, Thailand. Thirty volunteer students interacted with three clinical scenarios: appendicitis, chronic kidney disease, and non-ST elevation myocardial infarction (NSTEMI), completing at least one session per scenario over a one-week period. A pre-post design was employed to measure knowledge changes, with tests administered before and after the intervention, along with a post-intervention satisfaction survey. The results showed that the post-test knowledge scores (mean = 9.37, SD = 1.25) were significantly higher than the pre-test scores (mean = 8.47, SD = 1.31), p=0.005, with a mean difference of 0.90 (95% CI = 0.31-1.49). Students reported high levels of acceptance across all technology acceptance model dimensions, including perceived usefulness, perceived ease of use, attitude toward using, behavioral intention, and facilitating conditions, with mean scores ranging from 4.35 to 4.58 on a 5-point Likert scale. This indicates that the chatbot was well-accepted as a potential supplementary learning tool. However, this study has several limitations, including a small sample size, a short experimental duration, and its conduction at a single institution. Despite these limitations, the findings provide preliminary evidence of the feasibility and potential of using the ChatGPT chatbot to enhance patient history-taking knowledge among Thai nursing students. Future research should expand to multiple institutions, employ a longer duration, and include long-term evaluation to confirm these findings and establish the sustainable effectiveness of this technology in nursing education.

Cytomegalovirus-induced chronic intestinal pseudo-obstruction in an immunocompetent host

Wed, 31 Dec 2025 00:00:00 +0700

Chronic intestinal pseudo-obstruction (CIPO) is an uncommon presentation of cytomegalovirus (CMV) colitis. We present a case with CIPO caused by CMV in an immunocompetent host. A 45-year-old woman presented with chronic constipation and abdominal distension. A plain abdominal X-ray showed colonic dilatation, while a CT scan demonstrated circumferential wall thickening at the hepatic flexure of the colon and marked dilatation of the transverse colon. Colonoscopy revealed circumferential ulcers at the hepatic flexure and transverse colon, with pathology confirming positive immunostaining for CMV. The patient showed clinical improvement after treatment with ganciclovir and prucalopride. Secondary causes, including CMV infection, should be investigated in cases of CIPO. Dysmotility caused by CMV may represent the essential pathophysiology.

Persistent left superior vena cava detected during central venous catheterization for continuous renal replacement therapy in acute kidney injury: A case report

Yingluk Watcharananan — Wed, 31 Dec 2025 00:00:00 +0700

Persistent left superior vena cava (PLSVC) is an uncommon anatomical anomaly of the venous system with a prevalence of approximately 0.3%-0.5% in the general population and a higher incidence in patients with congenital heart disease. This condition is usually asymptomatic and often discovered incidentally during imaging studies or cardiovascular procedures. However, PLSVC may pose challenges or lead to complications in certain interventions, such as central venous catheter insertion, permanent pacemaker implantation, or cardiac surgery. This case report and review of the literature concerns a patient with a history of scrub typhus complicated by pulmonary hemorrhage and acute kidney injury, who required insertion of a double-lumen catheter and continuous renal replacement therapy. During catheter placement, a PLSVC was incidentally identified, highlighting a rare but clinically relevant finding. This report underscores the importance of PLSVC awareness in critically ill patients, as its presence may have implications for treatment planning, procedural safety, and the prevention of potential complications.

Sirenomelia (Mermaid syndrome) with bilateral renal agenesis and a single umbilical artery: An autopsy case report with embryological insights

Phirasit Chaijitrawan, Pornchai Sooksaen, Natcha Poungmeechai, Nawaluk Atiroj — Wed, 31 Dec 2025 00:00:00 +0700

Sirenomelia, also known as mermaid syndrome, is a rare and typically lethal congenital anomaly characterized by the fusion of the lower extremities and multiple visceral malformations. Its pathogenesis remains debated, with proposed mechanisms including abnormal vascular development (vitelline artery steal) and defective caudal mesoderm formation (defective blastogenesis). We describe a full-term female fetus (gestational age of 37+1 weeks) born to a 21-year-old primigravida, in whom prenatal ultrasonography revealed growth restriction, anhydramnios, and bilateral renal agenesis. At delivery, the neonate showed fused lower limbs, imperforate anus, absent external genitalia, dysmorphic facial features consistent with Potter’s facies, and a two-vessel umbilical cord, and died two hours after birth. Autopsy confirmed bilateral renal agenesis, pulmonary hypoplasia, an absent urinary tract, and multiple dysmorphic features. Placental examination revealed delayed villous maturation with a single umbilical artery, and histology revealed lung immaturity inconsistent with gestational age. This case illustrates the classical presentation of sirenomelia associated with the Potter sequence and underscores the role of autopsy in clarifying its anomaly spectrum, supporting embryological hypotheses, and guiding prenatal counseling.