Srinagarind Medical Journal

Vonoprazan, New Drug for Acid Inhibition: Efficacy and Safety

2024-07-11T15:11:18+07:00

When discussing medications for the treatment of peptic ulcers, uncomplicated gastric ulcers, complications of gastric ulcers, or gastroesophageal reflux disease (GERD), the commonly used and widely accepted class of drugs is proton pump inhibitors (PPIs). However, there are some limitations and potential side effects associated with PPIs for certain patients. Currently, new classes of drugs are being developed, such as potassium-competitive acid blockers (P-CABs). vonoprazan (VZN) is a drug within the P-CABs category that was approved in Japan in 2014 and became available for use in Japan in 2015. It was approved in Thailand in 2018, for the treatment and prevention of conditions caused by excessive gastric acid secretion. VZN is primarily metabolized by CYP3A4, which differs from PPIs that are primarily metabolized by CYP2C19. Therefore, VZN can cause adverse effects in patients with abnormalities of CYP3A4. When comparing other aspects, VZN has several advantages, including acid resistance and a longer duration of action, as well as effectiveness in treating GERD. The effectiveness of VZN in triple therapy, used in combination with antibiotics to assess the eradication rate of Helicobacter pylori (H. pylori) and the treatment of gastric ulcers, has shown favorable results. Additionally, in patients who smoke, VZN does not affect the eradication rate of H. pylori and demonstrates safety with side effects comparable to those of PPIs.

Outcomes of Pediatric Peritoneal Dialysis Care in Srinagarind Hospital Between 2017 to 2022

2024-11-11T13:18:24+07:00

Background and Objectives: Pediatric patients undergoing peritoneal dialysis represent a complex group requiring specialized care to minimize complications and enhance survival rates. This study aimed to evaluate the outcomes of pediatric peritoneal dialysis care at Srinagarind Hospital.

Methods: A retrospective study was conducted using medical records, care documentation, and information systems. The sample included medical records of pediatric patients first diagnosed with end-stage renal disease and treated with peritoneal dialysis, aged < 18 years, who received care at the pediatric dialysis clinic of Srinagarind Hospital between January 1^st, 2017, and December 31^st, 2022. Data were analyed by comparinged outcomes of two time periods: 2017-2020 and 2021-2022, focusing on patient survival rates and complications.

Results: The sample included 22 pediatric patients undergoing peritoneal dialysis, with 15 patients from the period 2017-2020 and 7 patients from the period 2021-2022, with a mean age of 10.61 ± 4.71 years. The leading cause of end-stage renal disease was lupus nephritis, accounting for 22.73% of cases. The one-year survival rate was 93.33% for the period of 2017-2020, which was not statistically different from the 85.71% in 2021-2022. However However, incidence of peritonitis decreased from 0.67 episodes per patient per year during 2017 - 2022 to 0.24 episodes per patient per year during 2021 - 2022.. There were no occurrences of exit-site infections in 2021-2022, down from an incidence of 0.22 episodes per patient per year in 2017-2020. The rate reductions of both peritonitis and exit-site infections were not statistically significant. In the years 2021-2022, no instances of volume overload were observed, and only a single occurrence of catheter displacement, occlusion, or rupture was reported.

Conclusion: The incidence of peritonitis serves as a critical indicator of care quality in pediatric peritoneal dialysis. This study demonstrates an improvement in both the rates of peritonitis and catheter-related infections during the period of 2021-2022 compared to 2017-2020, attributed to advancements in the management of pediatric patients undergoing peritoneal dialysis.

Effectiveness of External Vibrating Device on Children’s Anxiety and Pain Perception During Dental Anesthetic Injections

2024-11-11T15:16:25+07:00

Background and Objective: Fear and anxiety-related behavior, especially during dental procedures, can be a significant impediment to child's dental care, injections remain
a source of discomfort and concern. This study aimed to study the effectiveness of external vibrating device on children’s anxiety and pain perception during dental anesthetic injections.

Material and method: This was a quasi experimental research. Thirty children aged 5–12 years, requiring dental anesthetic injections, were recruited and allocated equally into two groups. Based on the interventions used: Group 1 (n = 15) first week received topical anesthesia (Precaine^®) before dental anesthetic injections and second week received vibration using a Buzzy^® device during dental anesthetic injections. Group 2 (n = 15)
first week received a Buzzy^® device during dental anesthetic injections and second week received topical anesthesia (Precaine^®) before dental anesthetic injections. Venham clinical anxiety scale (VCAS), Venham picture test (VPT), Pulse rate (PR) and pain perception [Wong-baker faces pain rating scale (WBFPS), Children’s Hospital of Eastern Ontario pain scale (CHEOPS)] were evaluated immediately after injection in first week and second week. Statistical analysis was performed using wilcoxon sign-ranked test to assess the mean difference before and after study, and mann-whitney u test to assess the mean difference between the two groups. Statistical significance was set at p< 0.05.

Results: The mean age of the participants was 6.96±1.60 years, with 63.33% boys. After applying the two methods. The results showed a statistically significant reduction in children’s anxiety and pain perception during dental anesthetic injections (p<0.05).

Conclusions: The external vibrating device seems to be an easy, useful, and might be effective in reducing discomfort and fear in children undergoing infiltration dental anaesthesia.

Factor Influencing E-cigarette use During Pregnancy: A Convergent Analysis Review

2024-11-28T07:35:47+07:00

Background and Objectives: The use of electronic cigarettes (e-cigarettes) among pregnant women is rising globally. However, the health impacts on both mothers and fetuses remain insufficiently explored. This study aims to conduct a systematic review focused on identifying factors influencing e-cigarette use in pregnant women.
Methods: This systematic review gathered research articles published between 2014 and 2024 from major academic databases such as PubMed, Google Scholar, and CINAHL using keywords relevant to e-cigarette use in pregnancy. Selected studies were analyzed through convergent synthesis methods, combining quantitative and qualitative approaches to identify factors associated with e-cigarette use decisions during pregnancy.
Results: A review of 17 studies, including 13 quantitative studies and 4 qualitative studies, revealed five primary factors influencing e-cigarette use among pregnant women: individual factors (such as age and attitudes), beliefs about the risks and benefits of e-cigarettes, social influences (including family and peer effects), perceptions shaped by online media, and recommendations from healthcare professionals.
Conclusion: Findings underscore the need for comprehensive and accurate information dissemination to pregnant women regarding the risks associated with e-cigarette use. Developing targeted interventions to reduce e-cigarette usage in this population is essential.

A Comparative Diagnostic Performance of Non-contrast and Contrast Enhanced CT for Diagnosis of Acute Appendicitis

2024-11-11T15:19:21+07:00

Objective: The main purpose of this study was to compare the diagnostic performance of non-contrast enhanced CT (NECT) and contrast enhanced CT (CECT) for diagnosis of acute appendicitis.

Material and Method: A diagnostic test study design was conducted, 129 patients were enrolled in the study, admitted with abdominal pain and underwent abdominal CT scan during January to March 2024. Retrospectively reviewed the computed tomographic findings and made an imaging diagnosis based on first with NECT and second with CECT. Accuracy and sensitivity of diagnosis was calculated compare to a pathological result or a final diagnosis written in the summary discharge.

Results: The respective sensitivity, specificity, and accuracy for NECT and CECT the diagnosis of acute appendicitis were 98%, 100%, and 99.22%; 98%, 97.47% and 97.67% There was no significant difference in the diagnosis of acute appendicitis among the 2 techniques (p=0.3472).

Conclusions: This study allowed direct comparison between NECT and CECT. There was no difference in the ability of each CT technique for diagnosing patients with acute appendicitis. For a patient whom iodinated contrast media is contraindicated or a patient who has an increased risk of severe adverse reaction, we would encourage the use of NECT because it provides comparable diagnostic performance without further exposing such patient to the contrast media.

Effectiveness of the Innovative Cushion for Head and Arm Support Sideways Pose for Kidney Position Surgery

2024-08-20T08:41:04+07:00

Background and Objectives: Positioning for kidney surgery (kidney position) is a complicated position for surgery. There is a risk of complications from incorrect posture and it increases the cost of more materials being used to help with posture. Thus, the study team developed the innovative cushion for head and arm support for kidney position surgery and assessed the effectiveness of this new innovative cushion to enhance patient care.

Methods: This study is a descriptive retrospective design that collected data from June 2016 to December 2020. The innovative cushion was implemented as a standard practice in anesthetic services during this period. The study comprises demographic information of patients undergoing kidney surgery, a questionnaire assessing the effectiveness of innovative cushion based on user feedback, report on incidence data resulting from the use of innovative cushion from anesthesia records, post-anesthesia visits within 24 hours after surgery and the quantity of clean green cloths used for patient positioning per patient.

Results: A total of 79 patients undergoing kidney surgery were 51% male with an average weight of 62.16 ± 11.44 kilograms; the mean of BMI ± SD and median (min-max) were 23.78 ± 3.68 and 23.52 (16.38 ± 31.60). Mostly ASA classification II was 62%; the mean and median time required for surgical positioning were 20.31 ± 4.56 and 20.00 (15–30) minutes. The effectiveness of the innovative cushion was evaluated by users in terms of reducing hassle, reducing time while posing and helping to maintain proper posture, and users that rated satisfied with the use of innovative cushions at the high to highest level in every topic was more than 95%, and no incidence of complications was found. Reducing the number of large, clean green cloths used on average for each patient from six to two pieces.

Conclusions: Innovative cushion for head and arm support used for positioning patients undergoing kidney surgery help to position the patient appropriately, safely, and with satisfaction when using them for kidney surgery. Reducing the workload of personnel and the cost of materials that can be used to position the patient.

Cardiovascular Disease Risk in Patients with Type 2 Diabetes in The Sub-district Health Promoting Hospital, Health Region 6

2024-12-12T16:19:33+07:00

Background and Objectives: Type 2 diabetes is a chronic non-communicable disease that increases the risk of cardiovascular diseases. This study aimed to investigate the risk level and factors associated with the risk of cardiovascular diseases in type 2 diabetic patients without a history of cardiovascular diseases, who are receiving treatment at sub-district health promotion hospital, health region 6.

Methods: This descriptive study collected retrospective data from medical records of 383 type 2 diabetic patients who regularly attended health promotion hospitals. Health data from annual health check-ups were gathered and cardiovascular disease risk was assessed using the Thai CV Risk Score.

Results: The study found that 44.91% of type 2 diabetic patients were at high risk for cardiovascular diseases. Males were at higher risk than females (54.5%, OR=1.81, 95%CI=1.19-2.77, p=0.004), and individuals aged 60 years and above were at a higher risk than those under 60 years (63.5%, OR=20.56, 95%CI=10.27-41.15, p<0.001). Factors significantly associated with cardiovascular risk levels included smoking, hypertension, and low HDL-C levels.

Conclusion: Patients with type 2 diabetes are at risk of developing cardiovascular diseases. Therefore, long-term care planning to prevent related risk factors is of most importance.

Factors Affecting the Time to Diagnosis of Tuberculosis in the Head and Neck Region

2024-10-10T13:32:03+07:00

Background and Objective: Tuberculosis in the head and neck regions present with a variety of symptoms and signs, making diagnosis challenging. Delayed diagnosis could impact patients, leading to decrease quality of life, increase complications, and mortality. This study aimed to determine factors influencing the time to diagnosis of tuberculosis in the head and neck regions within 15 days and beyond 15 days.

Methods: A retrospective cohort study was conducted on patients diagnosed with tuberculosis in the head and neck region at Chaiyaphum hospital from January 1, 2017, to December 31, 2023. Data were collected from medical records. Patients were divided into two groups: those diagnosed within 15 days and those diagnosed beyond 15 days. Factors influencing the diagnosis were analyzed.

Results: Among the 241 patients with head and neck tuberculosis, factors influencing diagnosis statistically significant within 15 days included male gender, body temperature ≥ 37.8°C, symptom duration less than 60 days, HIV infection, multiple site infections, mass size ≥ 3 cm, neutrophil count greater than 80%, and abnormal chest x-ray. Multivariable logistic regression analysis identified symptom duration less than 60 days (AOR 3.51, 95% CI 1.64-7.52), HIV infection (AOR 3.38, 95% CI 1.63-7.03), and multiple site infections (AOR 2.88, 95% CI 1.54-5.39) as factors influencing diagnosis within 15 days.

Conclusion: Factors influencing the time to diagnosis within 15 days include symptom duration less than 60 days, HIV infection, and multiple site infections. These factors can be used to predict the likelihood of head and neck tuberculosis, facilitating further confirmatory testing and leading to prompt and appropriate treatment.

A Survey of Radiation Dose Around the X-Rays Room Using Optically Stimulated Luminescence (OSL) Dosimeter

2024-11-11T15:19:52+07:00

Background and Objective: This study aimed to measure cumulative radiation doses around diagnostic radiology rooms using optically stimulated luminescence (OSL) dosimeters. Diagnostic radiology rooms where X-rays are used require carefully monitoring of both controlled and supervised areas to ensure radiation doses comply with established safety standards for both workers and the public. This study measured cumulative radiation doses across different types of diagnostic radiology rooms to assess exposure levels in these areas.

Methods: A total of 73 locations were monitored, with two dosimeters placed inside light-protective plastic bags at each monitoring point, located in 29 controlled and 44 supervised locations. Dosimeters were attached to various surfaces, including concrete walls, radiation shielding glass, lead doors, and radiation shielding partitions. The study covered six general X-ray rooms, two computed tomography rooms, one fluoroscopy room, one mammography room, and two dental X-ray rooms, with measurements taken over a 98-day period.

Results: In supervised areas, the annual cumulative radiation dose ranged from 0.46 to 2.92 millisieverts, while in controlled areas, it ranged from 0.43 to 8.94 millisieverts. Notably, nine supervised locations were found to have radiation doses exceeding 1 millisievert per year.

Conclusions: Further investigation is warranted to determine the factors contributing to elevated radiation dose levels in these nine locations. It is essential to enhance radiation safety measures and to conduct follow-up dose assessments to maintain compliance with safety thresholds. Regular radiation surveys of diagnostic radiology rooms, including both supervised and controlled areas, should be performed to ensure worker exposure remains within safe limits and to verify the efficacy of room shielding elements such as walls, doors, and radiation barriers.

Evaluation of Radiation Dose to the Skin, Eye Lens and Thyroid Gland from Abdominal Computed Tomography (Pilot Study)

2024-08-26T09:33:59+07:00

Background and Objective: The abdominal examination using computed tomography (CT) is essential for diagnosis of abdominal abnormalities and this trend has gradually increased. Since x-radiation in CT is harmful, the monitoring of patient radiation dose has been concerned. This study aimed to assess the radiation dose from upper abdomen CT, lower abdomen CT and whole abdomen CT examination and compare with national diagnostic reference levels (NDRLs). Moreover, the skin radiation, eyes lens and thyroid from these CT examinations were also compared.

Methods: The study was cross sectional descriptive study divided into 2 groups. Group 1 was a prospective radiation dose assessment in 30 patients who underwent CT examination of upper, lower and whole abdomen and met inclusion criteria during July 2022-March 2023. Group 2 was a radiation dose assessment in phantom study. Radiation dose assessment at eyes, thyroid and abdominal skin were performed using nanoDot optically stimulating luminescence dosimeters (OSLDs). Then, the radiation dose parameters including volumetric CT dose index (CTDIvol), dose length product (DLP) and calculated effective dose were recorded.

Results: For group1, the highest CTDIvol (8.46 mGy), DLP (1,171 mGy·cm) and effective dose (17.5 mSv) were observed from CT whole abdomen examination. These radiation parameters from all CT abdomen examinations were within the NDRLs. The mean radiation dose at eyes lens (0.21±0.06 mGy), thyroid (0.69±0.28 mGy) and abdomen (25.34±7.85 mGy) were observed with highest value from CT whole abdomen examination. For group2, the highest radiation dose measurement was observed at abdominal skin (39.19±2.38 mGy). The radiation dose at right side of abdomen was slightly higher than left side. The radiation dose at left and right thyroid from CT whole abdomen examination was found with the highest value (0.90±0.14, 0.92±0.04 mGy). In addition, the left eye lens dose was obtained with the highest value from CT whole abdomen examination (0.43±0.04 mGy)

Conclusion: CTDIvol and DLP from this study were lower than NDRLs and data of United State of America. The data from this study can be used for alteration CT examination to optimize patient radiation and preserve the image quality for precise diagnosis.

Comparison of Set-up Errors between Two Different Thermoplastic Masks for Brain Tumors Using Image-Guided Radiation Therapy

2024-11-01T18:43:50+07:00

Background and Objective: Thermoplastic masks serve as immobilization devices that improve the precision of patient positioning in radiation therapy for brain tumor radiation. In the Radiation Oncology Department of Srinagarind Hospital, two types of short thermoplastic masks are utilized: the U-shape head mask and the S-type head mask. The S-type head mask is compatible with the existing base utilized by the S-type head & shoulder mask within the department. This research were evaluated the differences in radiation setup errors and staff satisfaction associated with two types of masks.

Methods: This retrospective descriptive study involved 41 patients with brain tumors who received brain tumor radiation. Patients were categorized into two groups according to the type of mask. Treatments were delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) from November 2022 to November 2023. Treatment verification was confirmed through image-guided radiation therapy (IGRT). Total vector errors (TVE) were evaluated using kV orthogonal (kV-kV) and cone beam computed tomography (kV-CBCT). The clinical target volume to planning target volume margin was determined utilizing Van Herk equation. Furthermore, average staff satisfaction scores concerning mask preparation and usage were assessed for both types.

Results: The average setup errors of the two mask types presented no statistically significant differences. The TVE for kV-kV imaging was measured at 0.25 cm for the S-type head mask and 0.24 cm for the U-shape head mask. The TVE for kV-CBCT imaging was measured at 0.07 cm and 0.08 cm, respectively. The CTV to PTV margin was determinded to be less than 0.5 cm, which is within the acceptable limits for treatment planning at Srinagarind Hospital. The average staff satisfaction scores were 3.68 for the U-shape head mask and 3.43 for the S-type head mask.

Conclusion: Both mask types are appropriate for patient positioning in radiation therapy, as their setup errors remain within the established limits of the department. IGRT protocols, such as daily kV-kV and weekly kV-CBCT imaging, must be adhered to rigorously. The U-shape head mask was preferred by the staff over the S-type head mask, which is likely due to their increased familiarity with its application.

Effectiveness and Safety of a Single-tablet Regimen of Antiretroviral Drugs Containing Dolutegravir (DTG), Lamivudine (3TC) and Tenofovir Disoproxil fumarate (TDF) in Adult Patients with HIV Infection and AIDS at Srinagarind Hospital: A Retrospective Cohort Study

2024-11-29T10:45:05+07:00

Background and Objectives: According to the “Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2021/2022”, a first-line recommended a single-tablet regimen of antiretroviral drugs containing dolutegravir (DTG), lamivudine (3TC) and tenofovir disoproxil fumarate (TDF) in a single tablet. However, there is limited data on the efficacy and safety of single-tablet antiretroviral regimens. This study aimed to evaluate the effectiveness and safety of a single-tablet regimen of antiretroviral drugs to be a guidance of following up and maintenance of adult HIV- infect patients’ treatments.

Methods: A retrospective cohort study was conducted among HIV-infected patients receiving single-tablet antiretroviral therapy at the Adult Infectious Diseases and AIDS Clinic, Srinagarind Hospital, from October 1, 2023 to March 31, 2024. Data collection was divided into two parts: Part 1 was about general informations, disease-related details, and health behaviors gathered by self-administered questionnaires. Part 2 consisted of monitoring medication use, treatment efficacy evaluation, and drug safety using medical records and the hospital’s electronic database. Descriptive statistics were used for data analysis.

Results: A total of 292 patients participated in the study. The majority was male (61.3%). The mean age was 43.98 ± 12.75 years, and the average duration of a single tablet regimen antiretroviral therapy (DTG, 3TC and TDF) use was 15.0 ± 6.97 months. In terms of treatment efficacy, 272 patients (93.2%) had an undetectable HIV viral load in the bloodstream after at least six months of treatment, cluster of differentiation 4 (CD4) counts significantly increased from 517.0 ± 261.7 cells/mm³ to 601.7 ± 256.6 cells/mm³ (p < 0.001). Average viral load (VL), VL also significantly decreased (p < 0.001). Regarding safety, there were 37 patients (12.7%) who reported adverse effects, most of the symptoms were mild such as headaches, fatigue, weakness, and nausea/vomiting. Laboratory findings showed an increasing in serum creatinine (Scr) from 0.89 ± 0.17 mg/dL to 1.02 ± 0.20 mg/dL along with a decreasing in estimated glomerular filtration rate (eGFR) from 96.22 ± 15.82 mL/min/1.73m² to 82.51 ± 15.60 mL/min/1.73m². Moreover, 76.5% of patients experienced a rising of both body weight and body mass index (BMI).

Conclusion: The single-tablet antiretroviral regimen including TDF, 3TC, and DTG has demonstrated good efficacy in HIV treatment by showing effective control in viral replication with minimal side effects. However, the safety profile on renal function remains a limitation, further investigation is still needed in future studies.