Srinagarind Medical Journal

Ginger Juice: Herb to Reduce Nausea and Vomiting from Chemotherapy

Chintana Suwittawat — 2024-06-24

This academic article is a review of the literature on cancer, cancer treatment with chemotherapy. The side effects of chemotherapy are nausea and vomiting. The role of ginger juice which helps reduce nausea and vomiting. It was found that 950 ml of ginger juice per day or 1,500 mg per day can reduce nausea and vomiting. The dose is more than 1,500 mg per day it is not effective in reducing nausea and vomiting, but causes side effects. Ginger juice is not effective in reducing nausea and vomiting in patients receiving high doses of Cisplatin. Caution should be exercised when concomitant use of ginger juice with Crizotinib increases the accumulation of Crizotinib, leading to hepatotoxicity. Including caution when using ginger juice with drugs or anticoagulant products, it can increase the risk of bleeding. Therefore, cancer patients receiving chemotherapy should drink ginger juice 30 minutes before receiving chemotherapy.

Pregnant Outcomes, Pregnancy Delivery, Risk Factors and Nursing Care in Pregnant Women with Placenta Accreta Spectrum in the Delivery Room Unit, Srinagarind Hospital, Khon Kaen Province, Thailand

Nittaya Panphet — 2024-06-24

Background and Objectives: Placenta accreta spectrum (PAS) was a high risk to pregnant woman and infant. The purposes of this research were to study pregnancy outcomes, childbirth, risk factors and nursing care in pregnant women with placenta accreta spectrum.

Results: A sample of 36 cases detected placenta accreta spectrum before birth (97.23%), detected during placental delivery (2.77%), gestational age at birth more than 34 weeks (52.80%), cesarean section and hysterectomy (91.67%), planned birth (72.24%), neonatal weight 1,001-2,500 grams (75.68%), neonatal resuscitation (68.86%), infants transferred to neonatal intensive care unit (56.76%). Risk factors include the number of pregnancies, cesarean section, curettage, miscarriage, and placental abruption. Pregnant women were cared according to the practice guidelines.

Conclusion: Pregnant women who were detected with PAS before birth underwent a cesarean section and hysterectomy. Most were premature births, neonatal resuscitation, infants transferred to neonatal intensive care unit. Risk factors include the number of pregnancies, cesarean section, curettage, miscarriage, and placental abruption. Pregnant women were cared according to the practice guidelines.

Knowledge, Attitude, and Practice toward Contraception and Pregnancy among Women of Reproductive Age with Systemic Lupus Erythematosus

Nattawut Mitmongkolyod — 2024-06-24

Background and Objectives: Women with systemic lupus erythematosus (SLE) may experience maternal and fetal complications during pregnancy. This study aimed at studying the knowledge, attitude, and behavior of women with SLE about pregnancy and contraception and factors that affect levels of knowledge about pregnancy and effectiveness of contraception.

Methods: This cross-sectional descriptive study was conducted in 132 women with SLE at the Internal Medicine department of Naresuan University Hospital, from October 2022 – March 2023. Data were collected by designed questionnaires which consisted of personal information and questions for assessment of knowledge, attitudes, behaviors and factors affected contraception. The data were analyzed using descriptive statistics and logistic regression.

Results: The mean score of knowledge was unsatisfied in 64.4% whereas 35.6% were classified as satisfied. Women with effective contraception use were 83.5%. Factors associated with high levels of knowledge were medical personnels (OR = 4.6, 95% CI 1.127-18.819), disease duration longer than 5 years (OR = 0.4, 95% CI 0.190-0.866). Factors promoting effective contraception were age range between 36-45 years (p = 0.004), and the disease duration longer than 5 years (p = 0.002) and receiving contraceptive counseling from obstetricians (p = 0.044). Most of female patients with SLE received counseling about contraception and plan for pregnancy from internal medicine physicians and obstetricians and used effective methods of contraception.

Conclusions: The basic knowledge of SLE and pregnancy of the studied group was unsatisfied. However, most of them chose effective methods of contraception and their attitude toward pregnancy was at the good level. Factors affected knowledge and appropriate behavior were medical personnels, disease duration longer than 5 years and receiving contraceptive counseling and SLE from obstetricians. The multidisciplinary approach will improve women with SLE receiving holistic care about reproductive health and decreasing complications in both pregnant women and newborns.

Treatment Outcomes of Patients with Cervical Intraepithelial Neoplasia with Loop Electrosurgical Excision Procedure in Yasothon Hospital

Kanjana Nonzee — 2024-06-24

Background and Objective: Yasothon Hospital utilized the loop electrical excision procedure (LEEP) to manage pre-cancerous lesions, typically performed by general obstetrician and gynecologist. Previous studies in Yasothon hospital there was no definite conclusion of the treatment outcomes of LEEP. This study aimed to evaluate the treatment outcomes, determine prevalence and identify factors associated with recurrence after LEEP.

Methods: We conducted a retrospective cohort study. The participants were all women undergoing LEEP in Yasothon hospital between January 2019 - June 2023. Data were collected from medical records.

Results: The mean age of participants was 45.0 year. Most cases were associated with HPV 16 (35.2%) and HPV 18 (16%), with cytology showing CIN 2/3 (66.4%). The histopathology results post LEEP indicated CIN 2/3 (57.6%) of case, with positive margin present in 46.4% and complications in 24.0%. The cytology after LEEP confirmed CIN 2/3 in 25.0% and cervical cancer in 5.7%. Prevalence of the persistence or recurrence was 36.4% (95%CI 26.4, 47.3). Factors significantly associated with recurrence of lesions after LEEP include positive margin and HPV DNA test results.

Conclusions: LEEP was good outcome and safety for women in this study. However, caution is advised regarding complications and recurrence screening, particularly in women with a positive margin and HPV DNA test result indicating HPV 16/18, who may require comprehensive follow-up after LEEP.

Accuracy of Intrapartum Fetal Weight Estimation Using Ultrasonography and Clinical Estimation in Excessive Weight Pregnant Women

Siraya Kitiyodom — 2024-06-24

Background and Objective: Predicting the expected fetal weight during pregnancy is crucial for determining the appropriate delivery techniques and the actual birth weight of the baby. Maternal weight is a significant factor that cause inaccurate assessment of intrapartum fetal weight, especially in women with excessive weight. This study aimed to investigate the accuracy of intrapartum fetal weight prediction in excessive weight pregnant women, four methods were compared namely: ultrasound, Leopold, Dare's formula and Johnson's formula.

Materials and Methods: A prospective cohort design (method-oriented study) was used to study excessive weight pregnant women (body mass index; BMI ≥ 23 Kg/m²), age 18 years or over, with a singleton pregnancy, at gestational age between 37^0/7to 41^6/7with vertex presentation without rupture of membrane in labor and deliver within 48 hours after admission, during July 2021 to January 2022, at Maharat Nakhon Ratchasima Hospital. The samplings were divided into 2 groups according to the weight of pregnant women on the day of delivery: 1) Overweight women (BMI = 23.0 – 27.5 Kg/ m²) 2) Obese women (BMI > 27.5 Kg/ m²). All women were measured bodyweight, height, height of fundus, abdominal circumference and per vagina examination. The intrapartum fetal wight was estimated by using the 4 methods: ultrasound, Leopold, Dare's formula, and Johnson's formula and recorded the actual birth weight of the fetus, analyzed with a mean squared error, mean difference, mean absolute relative difference and presented with modified Bland-Altman plot.

Results: From 205 excessive weight pregnant women with 63 overweight (average BMI 25.3 Kg/m²) and 142 obese (average BMI 33.7 Kg/m²), the research found that in excessive weight women the most accurate methods for predicting intrapartum fetal weight were ultrasound (mean difference (95% CI) -38.89 (-73.68, -4.10), mean absolute relative difference (MARD) 6.23 (5.56, 6.91)). While in clinical assessment, Johnson's formula method showed the highest accuracy (mean difference (95% CI) 194.20 (142.31, 246.27), MARD 10.43 (9.13, 11.72)), and followed by Leopold MARD (11.20 (9.97, 12.43) and Dare’s formula MARD 14.13 (12.38,15.87)), respectively. Moreover, when dividing women groups by weight, ultrasound was still the most accurate method for both overweight and obese women (meaning difference -67.32 (-124.08, -10.55), MARD 5.57 (4.37,6.78) and mean difference -26.82 (-70.01, 17.45), MARD (6.52 (5.70,7.34)), respectively. Lastly, for clinical fetal weight assessment, the most accurate predictive methods in overweight women were Dare's formula (mean difference 31.21 (-47.62, 110.03), MARD 8.27 (6.60, 9.95), and the most accurate predictive methods in obese women were Johnson 's formula (mean difference 237.05 (171.83, 302.27), MARD 11.08 (9.44, 12.73)).

Conclusion: Predicting the fetal weight of excessive weight pregnant women in places where equipped and personnel is available, it is recommended to make ultrasound predictions. In places without equipment or personnel, clinical estimate assessment Johnson's formula is recommended.

Effect of Etomidate Used as Induction Drug for Emergency Intubation on Post Intubation Hypotension in Elderly Patients

Porntipa Tantibundit — 2024-06-24

Background and Objective: Emergency tracheal intubation is a common lifesaving treatment in the emergency department, rapid sequence intubation is the standard method for performing this procedure. Etomidate is an induction drug which is commonly used due to minimal hemodynamic disturbance and having a short duration; however, the evidence of adverse effects in elderly patients are limit. The objective of this study was to evaluate the effect of etomidate used as induction drug for emergency intubation in elderly patients and post intubation hypotension.

Methods: This was a retrospective study in elderly patients who were intubated in the emergency department. The enrolled patients were divided into etomidate used group and non-etomidate used group according to induction drugs used for intubation. The primary outcome was post intubation hypotension and secondary outcomes included the initiation or increased doses of vasopressors within 24 hours, the initiation of hydrocortisone within 24 hours and in hospital mortality.

Results: A total of 231 elderly patients were enrolled in this study, 118 patients were in etomidate used group and 113 patients were in non-etomidate used group. In etomidate used group, 29 patients developed post intubation hypotension and 18 patients in non-etomidate used group experienced post intubation hypotension. Multivariable logistic regression showed no statistically significant association of etomidate used and post intubation hypotension in elderly patients adjusted odds ratio (AOR) 2.10 (0.94-2.71) p=0.070. However, etomidate was associated with the initiation or increased doses of vasopressors within 24 hours, the initiation of hydrocortisone within 24 hours and in hospital mortality.

Conclusions: The study demonstrated that etomidate used was not significantly associated with post intubation hypotension but significantly associated with initiation or increased doses of vasopressors within 24 hours, initiation of hydrocortisone within 24 hours and in hospital mortality in elderly patients.

Treatment Outcomes of Sofosbuvir in Combination with Peg-Interferon and Ribavirin in the Treatment of Chronic HCV Genotype 3 (Evidence from Real Clinical Practice)

Chalermbhol Borntrakulpipat — 2024-06-24

Background and Objective: Sofosbuvir is a nucleotide based NS5B polymerase inhibitor that exhibits PAN genotypic antiviral activity and has a high genetic barrier. This drug has been included in reimbursed universal health coverage in Thailand since 2018. The aim of this study was to report the results of this regimen in real life in Kalasin province, which has the third highest prevalence of HCV in Northeastern Thailand

Methods: In this retrospective descriptive study, patients with chronic HCV genotype 3 were recruited to receive triple therapy with sofosbuvir 400 mg once a day, plus Peg-interferon (either Pegasys^® or Peg-Intron^®) administered through subcutaneous injection weekly, and weight-based ribavirin (600-1,000 mg) daily, divided into 2 doses, one after breakfast and one in the evening. All patients were enrolled between April 2019 and February 2021, and were eligible for inclusion if they were aged 18–70 years, had an HCV RNA level of 5,000 IU/mL or greater, and had a liver stiffness measurement of ≥ 7.0 kPa as assessed by Fibroscan^®. The primary outcome was sustained virologic response at 12 weeks after discontinuation of antiviral drugs (SVR12). Secondary outcomes included safety, tolerance, and changes in laboratory values such as LFT, CBC, and creatinine.

Results: The study initially enrolled 103 patients. However, one patient did not comply with the protocol, resulting in a total of 102 patients available for analysis. The mean age was 52 ± 8 years old. The oldest patient was 70 years old, and the youngest was 22 years old. The SVR12 for SOF/PEG-IFN/RBV was 100 %. However, one patient died due to an event unrelated to treatment, and another discontinued early due to chest discomfort that was not associated with the regimen. Resulting in an SVR12 rate of 100 out of 102 patients (98%) per intention to treat. No serious adverse events were reported in this study.

Conclusion: The combination of Sofosbuvir, Peg-interferon, and even a low dose of Ribavirin (600 mg) for 12 weeks was highly efficacious, achieving an SVR12 rate of nearly 100% in Thai patients infected with genotype 3 HCV. This regimen was well-tolerated with excellent safety profiles.

Impact of Referring on Survival of Patients with Head and Neck Cancer Treated in Khon Kaen Hospital, Thailand

Khasaya Mongkolthawornchai — 2024-06-24

Background and Objective: Because of the limited treatment facilities in the primary hospital, most head and neck cancer (HNC) patients had to be referred to higher centers lead to long waiting time. The aim of this study was to compare the survival of patients with HNC treated at Khon Kaen Hospital, between those who resided in Khon Kaen and those who were referred from outside.

Methods: A retrospective cohort study was conducted. The data of HNC patients treated at Khon Kaen Hospital between 2012 and 2017 were obtained from a hospital-based cancer registry. Survival analysis was performed to compare the patients residing in Khon Kaen province with those referred from outside.

Results: A total of 927 cases were retrieved, with age between 40 and 80 years, 60% were male. Cancer of oral cavity was the most common site (38.2%), followed by nasopharynx (30.9%), larynx and hypopharynx combined (14.4%) and oropharynx (9.9%). More than half of the patients resided in Khon Kaen province (57.9%). For early-stage cancer, median survival time was significantly better in the residence group than in the referring group (7.21 and 3.96 years, respectively). Likewise, in the advanced stage, median survival time and observed survivals were not significantly different.

Conclusions: Referring of early-stage HNC cases results in a poorer survival for patients compared with those treated within the area of their residences. Therefore, the ability to treat at least an early-stage HNC should be improved in provincial hospital.

Proportion of Rights and Social Welfare Accessibility Among the Older Patients at Srinagarind Hospital

Suthikran Korsakul — 2024-06-24

Background and Objective: Thailand has transitioned to an aging society, and the government has implemented social welfare policies to enhance the quality of life of elderly persons. However, the varieties of access to these rights and welfare depend on the context and management capability of the relevant organizations. This research aimed to explore the proportion of accessibility to rights and social welfare and factors related to patients at Srinagarind Hospital.

Methods: Descriptive study, sample size 165 elderly persons. The time frame allocation method was used for sampling. The tool was a questionnaire, with Cronbach's alpha coefficient of 0.73. Data collection was conducted during July-august 2023 through the trained interviewer. Data analysis was descriptive statistics such as frequency, percentage, median (IQR), and inferential statistics was chi-square and 95%CI.

Results: The response rate was 100%. The majority of the elderly persons were female (56.4%), Median±IQR 68.78±11. More than half of elderly persons knew/used rights and social welfare for their health care, and only 1 in 4 knew about their other rights and social welfare. The factors that affect access to rights and social welfare were age, occupation, education level, and social interaction with statistically significant at p< 0.05.

Conclusions: The most rights and social welfare that the elderly persons access was the health care dimension. However, elderly persons still have limited access to other rights and social welfare such as social, economic, environmental, and social work, therefore the relevant organizations and the community leaders should give more information and public relations.

Effect of Using the Visiting and Consulting Program for High-risk Elderly with Dementia in Mueang District, Kalasin Province

Woradet Puengprasert — 2024-06-24

Background and Objective: This research was based on the home visits of the social medicine team at Kalasin Hospital. It was found that the number of elderly who were high-risk elderly with dementia was increasing in the community. As a result, the visiting team has established a counseling program and visits for elderly people who are at high risk of developing dementia. The purpose of this research was to study the effect of using the visiting and consulting program for high-risk elderly with dementia and compare the results.

Methods: A quasi-experimental study and simple sample sampling method was used, elderly people in Kalasin province, consisting of an experimental group and a control group, each of 153. Conducting on January - June 2023. Recording results from was used the tool in 8 parts, including personal information, montreal cognitive assessment, MMSE, Barthel activities of daily, living, karnofsky scale, MORSE, depressive scale and satisfaction scale. Data was analyzed by SPSS software compute programs. Statistics are frequency, percentage, arithmetic mean, standard deviation and Independent t-test.

Results: Dementia and brain function mean score were significantly different at the p=.01 level. Satisfaction, ability to activities daily living, care needs and depression were significantly different at the p=.05 level. The risk of falls was not different. The satisfaction of the experimental group was very high. Both groups had dementia, cognitive impairment, care needs, and the risk of falls is normal levels. Ability daily living does not require dependency.

Conclusion: Mean scores of dementia, brain function, satisfaction, ability to activities daily living, care needs and depression in the group using the program different from the control group.

Comparison of Clinical and Radiographic Outcome Between a Single- and Two-Distal Interlocking Screw in Reamed Antegrade Interlocking Intramedullary Nail of Femoral Shaft Fracture: A Retrospective Cohort Study

Pongsatorn Pholkerd — 2024-06-24

Background and Objective: Intramedullary nailing was used to treat femur shaft fractures. The strength of the nail is obtained by inserting the distal interlocking screw. The objective of this study was to find the union between 1- and 2-distal interlocking screws at 24 weeks.

Methods: This was a retrospective cohort study in 100 patients who were treated with a reamed antegrade intramedullary interlocking nailing at Roi-Et Hospital, during 2017–2023. Data were collected from medical records. Plain radiographs are used to evaluate fracture union using RUST scores and femoral alignment.

Results: Each group of 50 patients there is no statistical difference in age, gender, severity of injury, surgical procedures and types of implant (p>0.05). The 1-screw and 2-screw groups had RUST scores at 24 weeks of 9.7±1.1 and 9.4±1.3 (p=0.242), union rates were 86% and 84% (p=0.779), union times were 19.8±4.9 and 20.7±5.9 weeks (p=0.621). Coronal alignment was 1.6±2.6 and 1.7±2.1 degrees (p=0.899), and sagittal alignment was 4.6±3.9 and 3.5±3.4 degrees (p=0.151). Full weight-bearing walking was achieved at 9.0±4.1 and 9.2±4.5 weeks (p=0.844). Hardware complications was found in only group of the 2-screws, 8% (p=0.117). The cost of implant fixation was 12,380±1,288 and 13,140±1,367 baht (p=0.005).

Conclusion: The 1-distal interlocking screw may have the same result as the 2-distal interlocking screw in terms of fracture union, stable alignment and duration of walking with full weight bearing. There is a lower cost and tends to reduce hardware complications.

Prevalence and Factors Associated with Permanent Hypocalcemia Following Total Thyroidectomy

Theerayoot Jongsuebsit — 2024-06-24

Background and Objectives: Hypocalcemia is a complication commonly observed after thyroid surgery. Patients may require calcium replacement for the rest of their lives, and serious complications such as seizures and heart arrhythmias may arise, potentially leading to death. Various factors may contribute to the occurrence of hypocalcemia after thyroid surgery, including sex, age, surgery duration, disease pathology, and blood loss during surgery. This study aimed to yet these factors have not been thoroughly investigated at Surin hospital.

Methods: This retrospective descriptive study focused on patients who underwent total or completion thyroidectomy, with evidence of hypocalcemia after surgery. From October 2021 to September 2022, 118 cases were included. Data on sex, age, thyroid specimen weight, surgery duration, estimated blood loss, parathyroid hormone levels at 24-48 hours post-surgery, and occurrences of hypocalcemia during the first 6 months post-surgery were documented.

Results: Among 118 patients diagnosed, the average age was 48.33±17.44 years, and 83.05% were female. The majority of cases were thyroid cancer (69.20%), with 73.56% of patients developing permanent hypocalcemia. The study found that females had 3.04 times higher chance of developing permanent hypocalcemia (95% CI 1.019 - 9.078). Although blood loss 200 ml or more during surgery increased the chance of permanent hypocalcemia by 2.77 times (95% CI 0.289 - 26.597), statistical significance was not reached (p = 0.377). No association between low parathyroid hormone levels and the occurrence of permanent hypocalcemia.

Conclusion: This studied was found hypocalcemia following thyroid surgery in Surin Hospital was high prevalence, possibly due to a higher proportion of patients with thyroid cancer. Females have a greater likelihood of developing permanent hypocalcemia than males.