Srinagarind Medical Journal

Comparative Study of Operative Outcomes between Two and Single Incision Laparoscopic Cholecystectomy in Benign Gallbladder Diseases

2023-12-06T15:30:48+07:00

Background and Objective: Building on previous studies on reduced port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy (SILC) and two-incision laparoscopic cholecystectomy (TILC), it was observed that TILC resulted in a shorter operative time compared to SILC whereas similar levels of operative blood loss, post-operative pain score at 24 hours, length of hospital stay and treatment cost. To further investigate these findings and establish clear statistical differences, This research aimed to continue the study by comparing two types of reduced port LC.

Method: A parallel randomized clinical trial was conducted at Mahasarakham hospital between June 1,2021 and May 31,2022. Eighty patients with benign gallbladder disease who underwent reduced port LC using conventional instruments and handmade glove port, were divided into TILC and SILC group equcelly.

Results: The majority of patients were female (57.55 : 75.0 %).There were no statistically significant differences of age (53.48 : 57.03 years p=0.176), body mass index (24.14 : 24.08 Kg/m2 p=0.95), length of hospital stay (2.05 : 2.13 days p=306), cost (25,883.81 : 26,196.04 Bahts p=0.611), cosmetic satisfaction score (9.2 : 9.15 p=0.805) and time to return to normal activity (5.2 : 5.08 days p=0.73), on the other hand operative time (31.15 : 47.08 minutes p=0.000), estimated blood loss (6.13 : 8.98 ml p=0.003) and post-operative pain score at 24 hours (1.53 : 2.15 p=0.025) were significantly differences.

Conclusion: TILC was more applicability and efficacy than SILC, be a preferred choice for reduced port LC using conventional instruments.

Outcome of Vessel Sealing System Tonsillectomy vs Electrocautery Tonsillectomy, Kalasin Hospital

2023-11-01T12:47:12+07:00

Background and Objective: Tonsillectomy is performed due to recurring infections and inflammation. The upper respiratory tract obstruction and tonsil cancer may be present due to the size of the tonsils. There are many different surgical procedures, but problems still occur. The outcomes of vessel sealing system tonsillectomy and electrocautery tonsillectomy in this study are compared about operative time, intraoperative blood loss, postoperative bleeding, length of hospital stay and medical expense.

Methods: Retrospective descriptive analysis of 95 individuals who were done tonsillectomy from 1 January 2020 to 31 May 2023.

Results: The mean values of vessel sealing system tonsillectomy and electrocautery tonsillectomy are contrasted. The mean operative time 24.34±6.49 and 30.59±10.28 minutes. Intraoperative blood loss 5.97±4.11 and 9.71±5.50 cc. Length of hospital stay 3.48±0.67 and 3.41±0.56 days. Medical expense 17,556.90±2,854.60 and 13,249.02±2,800.40 Bahts, respectively. Statistically significant shows that the surgical method is related to the operative time, intraoperative blood loss and medical expense. (p< 0.05).

Conclusion: As the results, there are less operative time and intraoperative blood loss after vessel sealing system tonsillectomy. When comparing the two surgical procedures, nearby results of tonsillectomy were obtained. Selecting treatment options and choosing between surgical treatment is what makes tonsillectomy safe and beneficial for patients.

Factors Affecting Major and Minor Lower Extremity Amputation in Diabetic Patients in Somdejphrajaotaksin Maharaj Hospital

2023-11-20T14:20:04+07:00

Objective: To study the factors affecting major amputation versus minor amputation in diabetic patients, Somdejphrajaotaksin Maharaj Hospital.

Methods: An retrospective descriptive study was conducted on 150 diabetic patients undergoing major and minor amputations between October 1, 2012 and September 30, 2021. Retrospective data was obtained from medical records. Data were analyzed using descriptive and inferential statistics, Chi-square and Fisher's exact test, statistically significant at p≤ 0.05 and univariate logistic regression analysis.

Results: Among the 150 samples, 120 (80%) and 30 (20%) of minor and major amputations were involved, respectively. The factors associated significantly (p<0.05) with amputation were gender, smoking history, and gangrene. In logistic regression analysis found that factors significantly increased in major amputation were smoking history (OR = 4.035, 95%CI = 1.707–9.538, p = 0.001) and gangrene (OR=0.31, 95%CI = 0.13-0.75, p=0.009).

Conclusion: Factors contributing to amputation in diabetic patients include smoking history and gangrene. To reduce the risk of major amputation in diabetic patients, should seek treatment as soon as possible.

Effects of Cannabis Leaf Tea on Sleep Onset Latency, Total Sleep Time, and Wake after Sleep Onset Tracked by a Smartwatch

2023-08-11T10:07:51+07:00

Background and Objective: Cannabis possesses many medicinal properties. Recent studies reported positive results using cannabis derivatives as a sleep aid. This study investigated the effects of cannabis leaf tea on sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) in medical personnel using a smartwatch as a sleep tracker.

Methods: This study was designed as a single-arm quasi-experimental trial. The eligible volunteers wore Fitbit Inspire 2 to track their sleep at home for four days, one week apart. On the first day, SOL, TST, and WASO were recorded as baseline data. On the second, third, and fourth days, the volunteers drank low, medium, and high concentrations of cannabis leaf tea approximately 30 minutes before bedtime. The statistical analysis was the Wilcoxon Matched-pairs Signed-rank test.

Result: Sixty-three volunteers were eligible for the trial. The findings revealed that the SOL baseline was different from the SOL of low concentration, the SOL of medium concentration, and the SOL of high concentration with statistical significance (95%CI: 0.00-5.79, p = 0.005, 95%CI: 0.00-8.79, p = 0.002 and 95%CI: 3.21-12.79, p < 0.001, respectively). Only the TST of medium concentration significantly differed from the TST baseline (95%CI: 9.76-42.00, p = 0.037). There was no significant difference between the WASO baseline and the WASO of the three concentrations.

Conclusion: All concentrations of cannabis tea shortened the SOL. However, the medium concentration decreased TST. In addition, all three concentrations could not reduce WASO.

Asiatic Acid Alleviates Diabetic Kidney Injury Through Suppression of Renal Oxidative Stress

2023-12-06T15:39:24+07:00

Background and Objective: Diabetes mellitus is a well-established risk factor for kidney injury. Chronic hyperglycemia in diabetes can potentially impair kidney function and structural changes through promotion of oxidative stress. The present study aimed to investigate the effect of asiatic acid (AA), an antioxidant on kidney injury and oxidative stress in diabetic rats.

Methods: Eight-week-old male Wistar rats weighing between 180 to 200 grams were induced to have type 2 diabetes by a single intraperitoneal injection of streptozotocin (STZ; 55 mg/kg) and nicotinamide (NA; 110 mg/kg). AA at doses of 10 or 20 mg/kg/day was administered intragastrically for 8 weeks. Metabolic changes in these rats were monitored during the experimental period. At the end of the experiment, kidney tissues and blood were collected from all rats for further experiments.

Results: Diabetic rats exhibited hyperglycemia, impaired insulin secretion, insulin insensitivity, an increased rate of kidney superoxide anion production. Moreover, diabetic rats also exhibited glomerular hypertrophy and glomerular ultrastructural changes. Treatment with AA, especially at a dose of 20 mg/kg/day, significantly attenuated insulin resistance, and kidney malondialdehyde (MDA) levels. AA also exerted a beneficial effect on renal protection by reducing glomerular hypertrophy and thickening of glomerular basement membranes.

Conclusions: AA alleviates kidney injury in diabetic rats through its glucose-lowering effect and antioxidant activity. These findings suggest the beneficial effects of AA as a potent antioxidant that could help prevent the progression of diabetic kidney complications.

Survival Rate and Factors Affecting on Survival of Early-Stage Epithelial Ovarian Cancer Patients at Sawanpracharak Hospital

2024-01-29T16:12:44+07:00

Background and Objective: Although the survival rate of early-stage epithelial ovarian cancer is higher than advanced-stage cancer, approximately 20% to 30% of these patients succumb to the disease. The main objective is to study the 5-year survival rate, with secondary objectives focusing on factors influencing the survival of patients with early-stage epithelial ovarian cancer.

Methods: This research is a retrospective cohort study of a population comprising patients diagnosed with early-stage epithelial ovarian cancer who received treatment at Sawanpracharak Hospital between January 1, 2008, and December 31, 2018. Data were collected from medical records, and statistical analysis involved descriptive statistics, Kaplan-Meier survival curve, Log-rank test, and Cox proportional hazard model with a significance level set at p < 0.05.

Results: Among 151 patients with early-stage epithelial ovarian cancer, with a median follow-up time of 101 months, the 5-year disease-free and overall survival rates were 79.3% and 80.2%, respectively. Stage 1 ovarian cancer had a 5-year disease-free and overall survival rate of 81.3% and 83.4%, while stage 2 had rates of 71.9% and 71.7%, respectively. In the multivariate analysis, the results indicate that ECOG PS 2,3 (HR 8.84, 95% CI 2.88-27.07, p=0.001), (HR 10.68, 95% CI 3.99-28.57, p<0.001), and clear cell cancer (HR 9.01, 95% CI 1.91-42.39, p=0.005), (HR 5.16, 95% CI 1.44-18.49, p=0.012), serve as independent predictive factors for a poorer 5-year disease-free survival (DFS) and overall survival (OS). Women who were administered the carboplatin regimen (HR 5.79, 95% CI 1.12-29.61, p=0.036) and the carboplatin plus cyclophosphamide regimen (HR 3.64, 95% CI 1.22-10.89, p=0.021) exhibited lower 5-year progression-free survival (PFS) and 5-year OS compared to those who received the carboplatin plus paclitaxel regimen, respectively.

Conclusion: Early-stage epithelial ovarian cancer demonstrates favorable disease-free and overall survival rates when treated with adequate surgery and chemotherapy.

A Comparative Study on the Efficacy of Budesonide versus Saline Nasal Irrigation in Post Endoscopic Sinus Surgery of Patients with Rhinosinusitis

2023-11-10T10:00:53+07:00

Background and Objective:Nasal irrigation with normal saline is an important role in rhinosinusitis. However, few reports of Thailand have examined whether its use for normal saline nasal irrigations (NNI) compared with budesonide nasal irrigations (BNI). This study aimed to compare the efficacy of BNI versus NNI in post endoscopic sinus surgery (ESS) of patients with rhinosinusitis (RS).

Methods: Sixty-six RS patients who had post ESS were randomly divided into an experimental group (33patients), which used BNI, and a control group (33patients), which used NNI. All patients received regular follow-up evaluations and were assessed via questionnaires, including the lund–kennedy endoscopic score (LKES), the symptom visual analog scale (VAS) and Thai sinonasal outcome test-22 (Thai SNOT-22). Patients were followed up post-ESS at 2, 4 and 12 weeks. Pearson chi-square test, Student t-test and Wilcoxon rank-sum test were used for statistical analysis.

Results: BNI group showed statistical significant improvements at 2,4 and 12 weeks after ESS. scores of LKES better than in NNI (p=0.005, p=0.010, p=0.009). At 12 weeks after ESS, scores of polyp and edema and total score of LKES in BNI group were significantly better than in NNI group (p=0.001, p=0.022), The median scores of VAS: 7 (IQR 3-9) vs 3 (IQR 1-5) and Thai SNOT-22 : 20 (IQR 10-24) vs 11 (IQR 7-15) in the NNI and BNI groups respectively, showed significant differences between 2 groups (p=0.001, p=0.001)

Conclusion: Budesonide in saline sinonasal irrigations improved nasal symptoms and reduce polyp and edema grading more effective than saline nasal irrigation alone.

Proportion of Workers Exposed to Heat Stress Having Rising Urine Neutrophil Gela Tinase Associated Protein Level in a Steel Manufacturing Factory in Khon Kaen Province

2023-11-28T15:45:39+07:00

Background and objective: Chronic kidney disease occurs globally and is related to increasing age. One of the causes of kidney disease in working age is exposure to heat in the workplace. Metal smelting factories are one area where high temperatures are common. Employees have to work close to the melting furnaces. This study aims to find the proportion of employees with rising of neutrophil gelatinase-associated protein; NGAL in urine, which can predict acute kidney injury in one steel production factory.

Methods: A cross-sectional descriptive study was conducted. All 93 workers whom exposed to heat in steel factory were recruited as a study population. Collected data from whole study population. Wet bulb globe temperature; WBGT was measured. Dehydration was determined as urine specific gravity via urine strip. NGAL was measured by enzyme-linked immunosorbent assay; ELISA technique to determine early acute kidney injury. Data were collected in November 2019.

Results: Workers experienced dehydration on the first day and the last day of working, with percentages of 27.7% and 35.4%, respectively. The proportion of employees with increased NGAL levels between the first and last days of working were 40.0% and 46.6%, respectively. No workers suffered with kidney impairment due to working exposed to heat were found.

Conclusions: Dehydration and an increase in NGAL levels after work may indicate that these workers are at risk of developing acute kidney injury. Although no worker was found kidney impairment due to working in heat.

Inter-observer Reliability for Chest X-Ray Interpretation in COVID-19 Patients of Radiologists with Different Experiences

2024-01-02T16:56:55+07:00

Background and Objectives: Radiographs play a very important role in diagnosing and planning patient care. This study aimed to assess the inter- and intraobserver reliability among radiologists, particularly between new and experienced radiologists, in evaluating the extent of pulmonary abnormalities in COVID-19 patients on chest X-rays (CXRs).

Methodology: Cross-sectional study used retrospective data from August 2021 to February 2022, 119 chest radiographs from PCR confirmed COVID-19 patients in Chaiyaphum hospital were reviewed by 3 radiologists. Three radiologists, with 11 and 9 years of experience, as well as one new radiologist, independently reviewed all chest X-rays using the Brixia scoring system, which divides the CXR into six lung zones. One radiologist reviewed all CXRs twice to evaluate intra-observer reliability. The inter-observer agreement was use weighted Cohen’s Kappa, the Intra-class correlation coefficients in the overall and zone-specific were calculated and along with 95% confidence interval (95%CI).

Results: This study found the overall inter-observer agreement between radiologist show substantial to almost perfect (weighted Cohen’s κ = 0.79-0.90). Concordance in interpretation between experienced radiologists was slightly better than concordance in interpretation between experienced and new radiologists. Intra-class correlation coefficients (ICC) in the overall show good correlation (ICC 0.88:95%CI=0.84-0.91). The intra-observer reliability of one experienced radiologist shows very good correlation (ICC 0.97: 95%CI=0.95-0.98 and Pearson correlation coefficient =0.97, p <0.001).

Conclusions: Substantial to almost perfect inter-observer agreement between experience and new radiologist in COVID-19 chest radiograph interpretation.

Effectiveness of Telemedicine for Treating Asthmatic Patients at Chumphae Hospital

2023-11-13T14:47:00+07:00

Objective: This study aimed to investigate the effectiveness of treating pediatric asthma patients at Chumphae Hospital by comparing pre- and post-treatment outcomes using telemedicine, following the asthma treatment guidelines.

Methods: This is a retrospective cohort study of analytical comparison of treatment outcomes between two different approaches over two time periods. It uses the initial period as the control group and employs retrospective data collection in patients under 15 years old who received treatment at the Easy Asthma Clinic of Chumphae Hospital. The study involved 150 outpatient cases (OPD) who received treatment between May 1, 2020, and May 1, 2021. These patients were regularly monitored every 2-3 months, and during the COVID-19 pandemic situation, their treatment was shifted to telemedicine. Physicians conducted symptom assessments through phone calls every 2-3 months based on the initial appointments, resulting in continuous treatment for one year from May 1, 2021, to May 1, 2022.

Results: The study involved 150 pediatric patients who sought treatment at Chumphae Hospital due to asthma. Out of these, 105 (70%) were male and 45 (30%) were female. The average age was found to be 7.2 ± 2.5 years, with an average age of first asthma onset at 3.7 years. Upon comparing the treatment outcomes of asthma patients in both outpatient and telemedicine settings, it was found that telemedicine yielded significantly better treatment results in terms of disease control, the occurrence of asthma exacerbations over a 12-month period, wheezing episodes, daily-life symptoms, and hospitalizations within the past 12 months (p< 0.05), except for medication compliance where the difference was not statistically significant (p=0.086).

Conclusion: Telemedicine, involving regular phone consultations with physicians, is a more effective approach for managing asthma symptoms in pediatric patients, particularly during the COVID-19 pandemic.

Nutritional Status by Weight for Height and Body Mass Index in Children with Cleft Lip and Cleft Palate from 2 to 5 Years

2023-09-26T17:43:02+07:00

Background and Objective: Patients with cleft lip and cleft palate are risky to malnutrition because of sucking and swallowing problems. Even though the surgery might improve sucking problem, the evaluation of nutritional status could enhance the appropriate care plan. This study aimed to evaluate the nutritional status and compare the nutritional status using the weight for height measurement to the body mass index (BMI).

Methods: The retrospective descriptive study collected the data of the children with cleft lip and cleft palate aged 2 - 5 years old who participated in the Tawanchai Cleft Center during 2016 – 2020. The weight for height and BMI were used to measure the nutritional status.

Results: 96 participants were evaluated the nutritional status. When the weight for height were used, there were underweight 20.80%, normal weight 76.00%, overweight 3.10% and obesity was not found. When the BMI were used, there were underweight 43.80%, normal weight 41.70%, overweight 11.50% and obesity 3.10%. And when the participants were categorized into groups of gender, ages, and types of clefts, the groups of underweight by the weight for height measurement have lesser numbers than the BMI measurement groups.

Conclusion: The nutritional status measurement of children with cleft lip and cleft palate by the weight for height were found the lesser number of underweight participants than the BMI measurement in the categorical of gender, ages and types of cleft lip and cleft palate group.

Surgical Outcomes of Patients with Cleft Lips and Palate: A 10-Year Experience from the Northeastern Thailand

2023-10-24T07:46:35+07:00

Background and Objective: Tawanchai Center is the center for providing diagnosis, treatment, including surgery and rehabilitation for patients with cleft lip and palate in Thailand, has partnered with the Smile Train organization (ST), USA to help patients receive good surgical care. Therefore, it is important to study the outcome of surgery on cleft lip and palate patients and prepare timing of surgery with key performance indicator (KPI).

Methods: A retrospective cohorts study conducted in patients undergoing surgery at Tawanchai Center for 10 years (2010 to 2019) with 1,085 cases. The research tool was the patient form collected from the Smile Train Express base, classified by gender, age, diagnosis, weight, type and the number of surgery, and KPI form of treatment care in 2 aspects. The data were collected for 6 months using percentage, descriptive statistics for analysis.

Results: The number of surgeries were 1,422 including 551 males (50.78%), 412/224 left/right cleft lip and palate (37.97/20.64 percent). There were patients under age 3-6 months received cheiloplasty 318 out of 412 cases (77.18 percent), and 290 out of 370 (78.38 percent) for palatoplasty in patients aging between 10-18 months, showed that it did not reach the target value. The number of patients aging between 8-12 years undergoing alveolar bone graft were 102 out of 242 cases (42.15%). 118 cases (10.87 percent) were born in Srinagarind Hospital.

Conclusions: Based on 10 years of experience in caring for patients at Tawanchai Center the timing age of cheiloplasty and palatoplasty did not meet the target value. The fistula rate is decreased. Overall satisfaction has increased by nearly 100 percent. However, the quality of care team needs to be improved continuously.