Srinagarind Medical Journal

Secondary Basal Cell Carcinoma after Hematopoiectic Cell Transplantation with Total-Body Irradiation: Case Report

Phonnapas Sukprasert — 2025-12-25

Background and objective: Basal cell carcinoma is the most common skin cancer in the world. Patients who received radiation to the skin a higher risk of developing skin than the general population. That can occur after radiation exposure, even if more than 10-yrs have passed. The long-term follow-up is necessary. The study aimed to study the risk factor and the time to development of secondary malignant neoplasm in patient who has history of a Hematopoietic cell transplantation (HCT) with total body irradiation (TBI) in Khon Kaen Hospital.

Materials and Method: This is a report on a 35-year-old Thai man who underwent surgical treatment in Khon Kaen Hospital for multiple basal cell carcinoma in the area that was previously irradiated.

Results: A 35-year-old Thai man developed multiple basal cell carcinomas on his scalp and pubic area, along with multiple meningiomas in his brain. This is noteworthy because these areas correspond to the sites where he received total body irradiation (TBI), chemotherapy, hematopoietic cell transplantation (HCT) and immunosuppressive drug for acute lymphoblastic leukemia (ALL).

Conclusions: This study reinforces that secondary basal cell carcinoma can occur more than 25-years after radiation exposure, emphasizing the need for long-term surveillance and patient education.

Management of Psychosocial Problems in Patients with Cleft Lip and Palate

Hattakorn Samretdee — 2025-12-25

Cleft lip and palate (CLP) is the most common congenital craniofacial disorder, affecting individuals physically and psychologically. Physically, it impacts essential functions such as sucking, swallowing, speech articulation, hearing, and dental development. Psychologically, if children struggle with adaptation due to personal or social factors, they may face challenges in social functioning, behavioral issues, and emotional disturbances such as anxiety or depression. This review article aims to examine psychosocial problem management in patients with CLP, covering key areas including: psychosocial challenges, psychosocial theory, psychosocial health promotion, psychosocial model, psychosocial problem management strategies, and the role of clinical psychologists in CLP patient care. The study seeks to establish a structured framework for psychosocial intervention, providing valuable insights for multidisciplinary teams involved in treatment. The ultimate goal is to support patients in achieving holistic well-being and restoring their quality of life.

Outcomes of Intermediate-Phase Rehabilitation for Fragility Hip Fractures Treated Non-operatively: A Descriptive Study at Kalasin Hospital

Nada Chantathai — 2025-12-25

Background and Objective: Fragility hip fractures are significant problems in elderly population. This study aimed to evaluate outcomes of intermediate-phase rehabilitation in patients with fragility hip fractures treated non-operatively.

Methods: A prospective descriptive study in 60 patients compared outcomes at baseline, 3 and 6 months. The rehabilitation program consisted of three phases: Phase 1 (weeks 1-4) joint mobilization and isometric exercises 30 minutes, 3 times/week; Phase 2 (weeks 5-12) progressive resistance training and balance exercises 45 minutes, 2-3 times/week; Phase 3 (weeks 13-24) functional activities 60 minutes, 1-2 times/week. Outcomes: Harris hip score (HHS), visual analog scale (VAS), activities of daily living (ADL), and EuroQol-5D (EQ-5D). Data analysis was conducted using statistical software, including descriptive statistics (means, standard deviations, minimum-maximum values) and categorical data analysis (frequencies, percentages), repeated measures analysis of variance, Bonferroni post-hoc test for pairwise comparisons, and Cohen's d for effect size calculation.

Results: Mean scores at 6 months showed significant improvements across all outcome measures: HHS increased from 40.68 to 99.83 points (indicating good functional outcome), VAS decreased from 8.23 to 2.18 points (representing mild pain levels), ADL scores improved from 48.38 to 89.90 points (demonstrating good self-care capabilities), and EQoL enhanced from 0.65 to 0.92 (reflecting complete health status). Repeated measures analysis of variance revealed statistically significant differences across all variables at p < .001.

Conclusion: A structured intermediate-phase rehabilitation program significantly improves functional outcomes, reduces pain, enhances activities of daily living, and improves quality of life in patients with fragility hip fractures treated non-operatively.

The Development of Palliative Care Capacity for Village Health Volunteers for Terminally Ill Patients in Khaen Yai Sub-district, Roi Et Province: An Action Research Study

Weerajit Tipprasert — 2025-12-25

Background and Objectives: As Thai society rapidly ages, demand for Palliative Care (PC) for terminally ill patients is rising. While PC enhances quality of life (QoL), community services lack continuity and specialists. Developing village health volunteers (VHV) capacity is crucial to bridge this gap. This action research aimed to 1) develop a model for VHV capacity enhancement in PC and 2) examine its outcomes on VHV knowledge, attitude, and self-efficacy, and the overall QoL of patients and families.

Methods: This action research utilized the planning, action, observation, reflection (PAOR) cycle with a sample of 33 VHVs (28.45% of 116) from 11 villages in Khaen Yai Sub-district, Roi Et Province. Data were collected from May 2022 to December 2024 using questionnaires for knowledge, attitude, self-efficacy, and the WHOQOL-BREF-THAI (26 items). Analysis employed descriptive statistics and the paired t-test.

Results: Post-intervention, VHV mean scores for knowledge, attitude, and self-efficacy increased significantly (p < 0.05). Knowledge rose from 10.5 to 18.2, attitude from 45.3 to 52.8, and self-efficacy from 15.6 to 22.1. Additionally, the overall QoL for patients and families under VHV care improved from a moderate to a good level.

Conclusion: The VHV capacity enhancement model in PC proved highly effective, positively impacting VHV competencies and patient QoL. This successful intervention serves as a valuable model for replication.

Overall Survival and Associated Clinical Factors in Unresectable Locally Advanced or Metastatic Gastric Cancer: A Retrospective Analysis from the Single Institute Cancer Registry (The CARES-GC Study)

Jirawat Thanestada — 2025-12-25

Background and Objective: Gastric cancer (GC) remains a primary global health concern with poor survival outcomes, especially in Thailand, where real-world data are limited. This study aimed to evaluate the 1-year overall survival (OS) and identify prognostic factors among Thai patients with advanced GC.

Materials and Methods: A retrospective, single-center cohort study was conducted using the Cancer Registry and Survival (CARES) database of Maharat Nakhon Ratchasima Hospital. Patients diagnosed with advanced GC from 2018 to 2023 were included and followed up until December 31, 2024. The primary outcome was 1-year OS, and prognostic factors related to 1-year OS were analyzed using univariable and multivariable logistic regression. The median OS was planned to be analyzed using Kaplan-Meier estimation as an exploratory analysis.

Results: Among 306 patients, the crude 1-year OS rate was 10.5%, with a median OS of 2.6 months (95% CI: 2.03–3.16). Patients who received both surgery and chemotherapy had the longest median survival (12.95 months, 95% CI: 5.57–20.32), while those on best supportive care had the shortest (1.81 months, 95% CI: 1.45–2.16). Independent predictors of 1-year survival included symptom duration (OR: 0.87, 95% CI: 0.76–1.00, p = 0.042), chemotherapy (OR: 0.28, 95% CI: 0.11–0.76, p = 0.012), and curative surgery (OR: 0.15, 95% CI: 0.05–0.45, p = 0.001).

Conclusion: The 1-year survival rate for advanced GC in our study was 10.5%, with a median OS of 2.6 months, which is lower than in other studies. Chemotherapy, curative surgical intent, and earlier symptom detection were linked to better survival outcomes. While both treatment options have demonstrated benefits in enhancing survival rates, the percentage of patients receiving these treatments remains low, highlighting the need to identify barriers to care and improve management strategies for this population.

Echocardiographic Assessment for Early Detection of Cardiac Abnormalities in Patients with End-Stage Renal Disease Undergoing Renal Replacement Therapy

Yutthapong Temtanakitpaisan — 2025-12-25

Backgrounds and Objective: Cardiovascular disease is highly prevalent among patients with end-stage renal disease (ESRD) undergoing long-term renal replacement therapy (RRT). Early detection of abnormal cardiac structure may facilitate timely intervention and improve clinical outcomes.

Methods: This cross-sectional descriptive study analyzed echocardiographic data from 66 ESRD patients in a hemodialysis unit between March 15^th, 2020, and December 31^th, 2021. A total of 66 patients were included. Two-dimensional echocardiographic parameters were assessed to evaluate cardiac structure and function.

Results: The mean age of the patients was 63.5 years (57.3–72). Among the 66 patients, 36 (54.5%) were male, and 30 (45.5%) were female. Hypertension was present in 83.3% of patients, while 43.9% had diabetes. Left ventricular (LV) dilation was diagnosed in 7.6% of patients, LV systolic dysfunction in 16.7%, and LV hypertrophy (LVH) in 54.5%. Diastolic dysfunction was detected in 44 patients (66.7%) and valvular heart disease was observed in 20 patients (30.3%).

Conclusions: Echocardiography plays a crucial role in identifying cardiac abnormalities in patients with ESRD. The high prevalence of LVH and diastolic dysfunction underscores the need for routine cardiac evaluation in this population. Future research should focus on long-term follow-up to better understand the progression of cardiac dysfunction and its impact on patient outcomes.

Prevalence and Risk Factors of Dysmenorrhea in Adolescent and Young Adult Women: A Hospital-Based Retrospective Case–Control Study

Veeraphol Srinil — 2025-12-25

Background and Objective: Dysmenorrhea is a common gynecologic condition that significantly affects women's quality of life. Variations in prevalence across age groups and challenges in distinguishing primary from secondary dysmenorrhea remain concerns, particularly in guiding appropriate management. This study aims to assess the prevalence, risk factors, and underlying causes of dysmenorrhea among individuals in a defined age group seeking care at a hospital.

Methods: A retrospective case-control study (1:3) was conducted at a tertiary hospital by reviewing electronic medical records from January 1 to December 31, 2024. Records of 1,160 patients aged 10–25 with gynecologic conditions were analyzed. Logistic regression was used to identify associated risk factors, with a significance level of 0.05.

Results: Dysmenorrhea prevalence in this age group was 10.5% (290/2,752). Among these cases, 73.4% (213/290) were diagnosed with primary dysmenorrhea, while 26.6% (77/290) had endometriosis. The youngest age of onset was 12 for dysmenorrhea and 16 for endometriosis. Of the affected individuals, 110 (38.7%) were students, with the majority—75 (68.2%)—enrolled in primary and secondary school. Nulliparity (AOR = 2.04; 95% CI: 1.05–3.95; p = 0.034), smoking (AOR = 3.67; 95% CI: 1.28–10.59; p = 0.017), menstrual irregularity (AOR = 1.47; 95% CI: 1.07–2.00; p = 0.016) and heavy menstrual bleeding (AOR = 3.26; 95% CI: 1.77–6.01; p < 0.001) were significant risk factors.

Conclusions: The study highlights the prevalence of dysmenorrhea, as well as key risk factors, among adolescents and young adults. The findings support the need for targeted clinical management and school-based health education and counseling initiatives.

Relationship Between Maternal Health Literacy and Early Postnatal Health Outcome: Nopparat Rajathanee Hospital

Watcharee Dankul — 2025-12-25

Background and Objective: Health literacy significantly impact maternal and neonatal outcomes. Neonates of mothers with low health literacy face increased risks of complications and poor postpartum health. To assess maternal health literacy levels and examine their association with early postpartum neonatal health outcomes.

Methods: A cross-section study was conducted among 148 postpartum mothers (with neonates aged 1-3 days) at Nopparat Rajathanee Hospital between May and June 2025. Participants were selected through systematic random sampling, a probability-based sampling technique. Data were analyzed using descriptive statistics and ordinal logistic regression.

Results: Mothers demonstrated moderate health literacy levels (OR = 3.41, p = 0.020). Factors associated with favorable neonatal outcomes included marital status (OR = 9.14, p = 0.037), government/private employment (OR = 15.57, p = 0.020), online work (OR = 139.49, p = 0.002). In Contrast, maternal obesity was significantly inversely associated with favorable neonatal outcomes (OR 0.36, p=0.033).

Conclusion: Mothers with moderate health literacy were more likely to have favorable neonatal health outcomes in the early postpartum period compared to those with low health literacy. Marital status, occupation, and body mass index were associated with neonatal health outcomes. These finding highlight the need to develop health literacy promotion interventions for mothers, taking into account sociodemographic factors, to enhance neonatal health outcomes in the early postpartum.

Influence of Oral Health Literacy and Attitudes on Dental Service Utilization Decisions among Hospital Personnel in Chattrakarn Hospital, Chattrakarn District, Phitsanulok Province

Kittikhun Khamthalaeng — 2025-12-25

Background and Objectives: Oral health is an essential determinant of overall health and quality of life. Understanding the factors that influence the decision to utilize dental services among healthcare personnel is crucial for planning effective interventions. This study aimed to examine personal factors, oral health literacy, and attitudes toward oral health, as well as their influence on decision-making regarding dental service utilization among personnel at Chattrakarn Hospital, Phitsanulok Province.

Methods: A descriptive cross-sectional study was conducted among 246 hospital personnel, with a sample of 151 selected using simple random sampling. Data were collected using a structured questionnaire covering personal factors, oral health literacy, attitudes toward oral health, and decision-making about dental service utilization. The instrument showed content validity indices ranging from 0.67–1.00 and Cronbach’s alpha coefficients of 0.96 (oral health literacy), 0.87 (attitudes), and 0.96 (decision-making). Data were analyzed using descriptive statistics and multiple linear regression.

Results: Most respondents were female (69.5%) with a mean age of 38.79±10.15 years. Oral health literacy (3.78±0.57), attitudes toward oral health (4.28±0.41), and decision-making regarding dental service utilization (4.17±0.45) were all at high levels. After adjusting for other variables, oral health literacy (p=0.036) and attitudes toward oral health (p<0.001) were found to significantly influence decision-making. The model explained 46% of the variance in dental service utilization (Adjusted R² = 0.46, p<0.05).

Conclusion: Oral health literacy and positive attitudes toward oral health play a critical role in influencing dental service utilization among hospital personnel. Strategies and interventions that strengthen knowledge and attitudes toward oral health could enhance dental service use, ultimately improving oral health outcomes and quality of life.

Development of a 360-Degree Virtual Reality Media-Based Information to Prepare Cardiovascular Patients for Cardiac Catheterization: A Case Study

Jamjuree Phuduangjit — 2025-12-25

Background and Objectives: Cardiac catheterization is an invasive procedure that often induces anxiety in patients and may negatively affect their cooperation during the procedure. This article aims to present a case study illustrating the application of a 360-degree virtual reality information-delivery approach to prepare patients for cardiac catheterization.

Methods: The development of a 360-degree virtual reality information-delivery approach to prepare patients with cardiovascular disease for cardiac catheterization was conducted in three phases, guided by Sukup’s conceptual framework and evidence-based practice. The process consisted of four key activities: (1) assessing patients’ problems and information needs; (2) providing 360-degree virtual reality information regarding the cardiac catheterization procedure and required patient preparation; (3) delivering a patient preparation handbook; and (4) offering individualized counseling. The virtual reality media and patient handbook were evaluated for quality by five experts, yielding content validity index (CVI) scores of .95 and .90, respectively. The approach was then tested with two patients.

Results: The anxiety scores of both patients showed a consistent decreasing trend, with a mean score of 87.05 prior to receiving the information, decreasing to 45.18 after the information session, and further declining to 23.83 before undergoing the procedure. Both patients demonstrated excellent cooperation during the cardiac catheterization and reported the highest level of satisfaction with the information provided (100%).

Conclusion: Providing preparatory information through 360-degree virtual reality media for cardiovascular patients prior to cardiac catheterization was found to reduce anxiety levels, enhance cooperation during the procedure, and achieve a high level of patient satisfaction. Therefore, the application of 360-degree virtual reality–based information is recommended as a strategy for preparing patients before cardiac catheterization to further improve the quality of nursing care in the future.

Modulation of Intrarenal eNOS and p47phox Expression by Galangin Attenuates Kidney Injury in Diabetic Rats

Pimsiri Buahombura — 2025-12-25

Background and Objective: Diabetic nephropathy (DN) develops as a consequence of chronic hyperglycemia, which triggers the overexpression of p47phox while simultaneously suppressing endothelial nitric oxide synthase (eNOS) expression. This dual mechanism promotes oxidative stress, inflammation, and disrupts renal function, leading to kidney injury that represents the initial pathological step in DN progression. The objective of this study was to investigate the therapeutic potential of galangin (GA) in addressing kidney injury in diabetic rats.

Methods: Male Wistar rats were divided into two main groups: non-diabetic and diabetic. The non-diabetic group comprised a vehicle-treated control and a GA-treated (50 mg/kg) subgroup. The diabetic group comprised a vehicle-treated control, a GA 25 mg/kg subgroup, and a GA 50 mg/kg subgroup (n = 6-8 per group). Type 2 diabetes was induced in male Wistar rats by a single intraperitoneal injection of nicotinamide (110 mg/kg/day), followed by a single intraperitoneal injection of streptozotocin (55 mg/kg/day). After eight weeks of diabetes induction, rats received GA supplementation at doses 25 or 50 mg/kg/day for four weeks. Metabolic parameters and renal functions, kidney tissue of p47phox and eNOS proteins, oxidative stress markers, and glomerular morphology by light microscopy and ultrastructure by transmission electron microscopy were evaluated.

Results: GA supplementation significantly reduced elevated fasting blood glucose and insulin resistance while improving kidney function compared to diabetic controls (p < 0.05). Excessive superoxide production and oxidative stress in diabetic kidneys were markedly attenuated following GA treatment (p < 0.05). GA administration, particularly at 50 mg/kg/day, significantly inhibited glomerular hypertrophy and ultrastructural kidney changes. Additionally, GA suppressed renal p47phox expression while upregulating eNOS expression in diabetic kidney tissues.

Conclusions: GA provides renoprotection in diabetic rats through glucose-lowering and antioxidant mechanisms that suppress p47phox-mediated reactive oxygen species generation, restore eNOS expression, normalize renal function, and preserve glomerular architecture. These findings support GA's therapeutic potential for preventing or delaying early diabetic nephropathy.

Incidence of Hypersensitivity Reactions from Monoclonal Antibody Use in Cancer Patients at Srinagarind Hospital

Nipitha Jullanithi — 2025-12-25

Background and Objective: Monoclonal antibodies (mAbs) are therapeutic agents widely used in the treatment of various malignancies. Despite their efficacy, these agents are associated with hypersensitivity reactions (HSRs), which may lead to temporary suspension or discontinuation of treatment. HSRs are considered preventable adverse drug reactions. This study aimed to investigate the prevalence, clinical manifestations, severity, and management strategies of HSRs among cancer patients receiving mAbs therapy at Srinagarind Hospital.

Methods: A retrospective descriptive study was conducted by reviewing electronic medical records from the Health Object (HO) system at Srinagarind Hospital. Data were collected from cancer patients who developed HSRs during treatment with monoclonal antibodies between January 1, 2020, and December 31, 2024. The data were obtained from both inpatient and outpatient departments.

Results: Of 1,838 patients who received mAbs, 47 patients (2.56%; 95% CI: 1.89–3.39) experienced a total of 59 HSR events. Most patients were female (68.09%) with a mean age of 59.70 ± 11.21 years. The most common malignancy was lymphoma (40.43%). A majority of patients (89.36%) had no prior history of drug allergy. The highest incidence of HSRs was associated with daratumumab (13.51%, 95% CI: 5.91-27.97), followed by rituximab (4.09%, 95% CI: 2.69–6.17) and cetuximab (3.85%, 95% CI: 0.68-18.90). Most reactions occurred during the first cycle of administration (59.32%), followed by the second cycle (10.17%). Based on CTCAE v5.0, grade 1 and 2 reactions were most commonly observed (37.29% and 28.81%, respectively), while grade 4 reactions accounted for 18.64%. The most frequently reported symptoms included chills (25.26%), followed by fever, chest tightness, and tachycardia (8.42%). Anaphylaxis occurred in 10.53% of the events. The most commonly used management strategy was temporary cessation of the infusion combined with symptom assessment, prolonged infusion time, and administration of premedications (45.76%), which enabled continuation of treatment in 71.19% of patients.

Conclusion: Monoclonal antibodies may induce HSRs as early as the first dose, with severity ranging from mild to life-threatening. Daratumumab and rituximab, in particular, require careful monitoring during initial administration. Preparedness of healthcare personnel and the implementation of appropriate treatment protocols are essential to reduce the risk and ensure safe monoclonal antibodies administration.