Srinagarind Medical Journal

Pharmacotherapy for Methamphetamine Use Disorder: From Conventional to Current Advances

Charshawn Lahnwong — 2026-04-24

Background and objectives: Methamphetamine use disorder currently lacks officially approved pharmacotherapy. This study aimed to review evidence-based pharmacotherapy using evolutionary synthesis to analyze the transition from conventional approaches to contemporary advances and novel mechanistic innovations during 2020–2026.

Methods: A systematic literature review was conducted via PubMed, Scopus, and Cochrane Library. Forty-four documents were selected, comprising systematic reviews, meta-analyses, and randomized controlled trials. The evidence was categorized into three phases: conventional pharmacotherapy, contemporary advances, and future innovations.

Results: Evidence supports the efficacy of injectable naltrexone combined with oral bupropion, which increased the response rate to 13.6% compared to 2.5% in the placebo group (p < 0.001). Oral mirtazapine also demonstrated a significant reduction in substance use (p = 0.004), whereas most other drug classes showed limitations in achieving sustained abstinence. Future directions focus on the development of immunotherapy and novel technologies with increased specificity toward brain mechanisms.

Conclusion: Injectable naltrexone combined with oral bupropion and oral mirtazapine are the most viable options currently available. However, achieving maximum treatment efficacy may require the systematic integration of pharmacotherapy and psychosocial interventions to enhance treatment retention and sustainable clinical outcomes.

Development of Fast Track Surgery (FTS) System among Hand and Foot Injury in Yasothon Hospital

Santi Sirirattanapan — 2026-04-24

Background and Objective: Fast-track surgery is a critical process in the management of patients with hand and foot injuries, aiming to reduce the risk of complications. This study aimed to develop and evaluate the effectiveness of a fast-track surgical system.

Methods: An action research design was conducted from July to December 2025, comprising four stages: planning, acting, observing, and reflecting. Qualitative data were collected through literature review and focus group discussions with a multidisciplinary team, while quantitative data were obtained from medical records. A total of 128 patients with hand and foot injuries were equally assigned to intervention and control groups. Data were analyzed using content analysis, descriptive statistics, Chi-square test, Fisher’s exact test and the Mann–Whitney U test.

Results: The development resulted in a fast-track surgical pathway comprising multidisciplinary team coordination, emergency department triage, and operating room prioritization. Evaluation of the system showed that the intervention group had significantly shorter ranked mean times from the emergency department to the ward (median time decreased from 1.9 to 1.0 hr.), from the emergency department to the operating room (median time decreased from 6.3 to 5.4 hr.), and to surgery within 24 hours (proportion increased from 65.6% to 81.3%) compared with the control group (p<0.001, p =0.018, and p=0.044). No significant differences were observed in time from the ward to the operating room, length of hospital stay, treatment costs, or complications (p>0.05).

Conclusions: The fast-track surgery system improved early surgical process efficiency and access to urgent surgery without increasing hospital stay, costs, or complications.

A Comparative Study of HbA1c and Fasting Plasma Glucose in Annual Health Check-Up Participants

Jirasak Piyapromdee — 2026-04-24

Background and Objective: The number of diabetes patients is escalating worldwide. Currently criterion for diagnosing diabetes used fasting plasma glucose or HbA1c. In Thailand, especially the northeast region had high prevalence of HbE. Hemoglobinopathies affect the immunoassays used for HbA1c measurement. In this study, we evaluate the concordance between HbA1c and FPG criteria in the diagnosis of diabetes and explores the prevalence of hemoglobinopathies that may affect HbA1c interpretation.

Methods: A cross-sectional analytical study was conducted on Khon Kaen Hospital staff undergoing annual health check-ups between September and December 2018. Total 893 participants were evaluated both FPG and HbA1c. Statistical analyses were performed using Stata version 6.0 by percentages, means, standard deviations, Pearson Chi-square test, two-tailed tests, and logistic regression.

Results: A total of 893 participants, 57.7% were female, mean ages of 47.6 years, and mean BMI was 24.5 kg/m². Most participants had no underlying disease (78.5%) and were not taking medication regularly (89.5%). When using FPG criteria, the prevalence of diabetes was 4.6% and prediabetes was 13.2%. There were relatively higher prevalence using HbA1c criteria, with diabetes was 10.1% and prediabetes was 18.0%. However, the correlation between these 2 diagnostic criteria was fair by kappa coefficient of 0.38, 95%CI; 0.35 to 0.40. Prevalence of hemoglobinopathies was 37.8% with high prevalence of homozygous Hb E (3.6%) and Hb E trait (30.2%). Diabetes diagnosis did not differ significantly by hemoglobinopathy status for both FPG (OR 1.29; 95% CI 0.67–2.47, p=0.44) and HbA1c (OR 1.61; 95% CI 0.85–3.05, p=0.15) criteria.

Conclusions: HbA1c and FPG showed fair to moderate agreement for diabetes diagnosis, unaffected by hemoglobinopathy status. However, due to the high prevalence of HbE and higher costs, HbA1c is more suitable as a confirmatory test than a screening tool.

Risk Factors for Developing De Novo Stress Urinary Incontinence Following Pelvic Organ Prolapse Surgery: A Case-Control Study

Teerapan Seehanantawong — 2026-04-24

Objective: To identify risk factors associated with the development of de novo stress urinary incontinence (SUI) in continent women undergoing pelvic organ prolapse (POP) surgery.

Methods: A retrospective case-control study was conducted at Maharaj Nakhon Ratchasima Hospital, a tertiary care center. Medical records of women who underwent POP surgery between June 2014 and June 2024 were reviewed. A total of 411 patients were included. Cases (n = 137) were defined as women who developed de novo SUI after surgery, whereas controls (n = 274) were continent women matched at a 2:1 ratio. Logistic regression analyses were performed to evaluate associations between clinical and demographic variables and the occurrence of postoperative de novo SUI. The main outcome measures are identification of clinical and demographic factors associated with the development of de novo SUI following POP surgery in previously continent women.

Results: In univariate analysis, age <65 years, BMI >27 kg/m², chronic obstructive pulmonary disease (COPD), chronic constipation, and voiding dysfunction symptoms were significantly associated with de novo SUI. In the multivariate model, BMI >27 kg/m² (adjusted OR 2.62; 95% CI 1.04–6.60; p = 0.041) and chronic constipation (adjusted OR 2.65; 95% CI 1.67–4.21; p < 0.001) remained independent predictors, whereas other variables did not retain statistical significance.

Conclusions: High BMI and chronic constipation were identified as significant risk factors for postoperative de novo SUI, underscoring the importance of tailored preoperative risk assessment. These predictors may inform surgical decision-making, including selective consideration of concomitant anti-incontinence procedures in high-risk individuals. Addressing modifiable risk factors prior to surgery may reduce the occurrence of de novo SUI and improve quality of life in women undergoing pelvic reconstructive surgery.

Survival Outcome and Prognostic Factors of Spontaneous Rupture of Hepatocellular Carcinoma Treated with Transarterial Embolization: A Single-center Experience

Anucha Ahooja — 2026-04-24

Background and objective: Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening complication requiring urgent intervention. Existing studies have identified prognostic factors for ruptured HCC, but a gap exists in understanding these factors in Northeast Thailand. This research aims to investigate survival outcomes and prognostic factors in patients with spontaneous rupture of HCC treated with transarterial embolization (TAE) in the Northeastern region.

Methods: This was a retrospective study including 163 patients with spontaneous rupture of HCC who were treated with TAE at Srinagarind Hospital from January 2018 to December 2022. The diagnosis of spontaneous rupture of HCC was based on clinical presentation and dynamic liver computed tomography findings. Survival outcomes were evaluated using the Kaplan-Meier method, and Cox regression analysis was used to identify associated prognostic factors.

Results: The median overall survival was 143 days. The 3-month, 6-month, and 12-month cumulative overall survival rates were 60.14%, 40.06%, and 29.37%, respectively. In multivariable analysis, factors significantly associated with improved survival included absence of comorbidity (adjusted HR 0.64; 95% CI 0.44–0.93; p=0.018), higher estimated glomerular filtration rate (eGFR) (adjusted HR 0.98; 95% CI 0.98–0.99; p<0.001), lower Model for End-Stage Liver Disease (MELD) score (adjusted HR 0.96; 95% CI 0.93–0.99; p=0.034), and tumor location at hepatic segment 7 (adjusted HR 0.63; 95% CI 0.40–0.99; p=0.043). Tumor location at segment 6 was associated with poorer survival (adjusted HR 1.60; 95% CI 1.05–2.44; p=0.028). The absence of inotropic or vasopressor drug use was not significantly associated with survival in multivariable analysis.

Conclusion: TAE is an effective initial treatment for patients with spontaneous rupture of HCC. Favorable prognostic factors identified in this study included absence of comorbidity, higher eGFR, lower MELD score, and tumor location in hepatic segment 7, whereas tumor location in segment 6 was associated with poorer survival. Early TAE (≤24 hours) demonstrated a trend toward improved survival.

A Problem-based Health System Framework for Promoting Diabetes Remission: Systematic Outcomes of the Roi-Et Health Network

Wittaya Kotrtan — 2026-04-24

Background and objectives: Diabetes mellitus is a chronic condition characterized by the body's inability to effectively regulate blood glucose levels, which, if left unmanaged, can lead to severe systemic complications. This study aimed to investigate operational problems, develop and implement a problem-based model, and evaluate the effectiveness of an intervention program designed to promote Diabetes Remission.

Methods: This study employed a Research and Development (R&D) design. The sample consisted of 220 multidisciplinary team members and health volunteers, along with 4,031 diabetic patients participating in the project. Data were collected using questionnaires, record forms, and semi-structured interview guides. Statistical analysis included frequency, percentage, mean, standard deviation, and paired t-test (at a 95% confidence interval), supplemented by content analysis for qualitative data.

Results: 1) The situational analysis of diabetes care in Roi-Et Province identified challenges across four dimensions: patient and social context, service providers, service management systems, and resources/medical supplies. 2) The developed "Problem-Based Diabetes Remission Model" comprised key activities: identifying eligible candidates, collaborative goal setting, skill-building schools, technology-assisted monitoring, clinical multidisciplinary teams for medication adjustment, motivation and network building, and intensive follow-up. 3) Post-intervention results showed that patients’ self-care behavior scores were significantly higher than pre-intervention levels across all domains (p<0.001). Among the participants who completed the 3-month evaluation (n = 2,261), 1,004 patients (24.91% of total participants) achieved Diabetes Remission, defined as maintaining an HbA1c < 6.5% without medication for at least 3 months. Furthermore, 30.22% (1,218 patients) achieved Medication Reduction. Regarding clinical stability and safety, 30.79% maintained stable medication levels, while only 0.45% required a dosage increase, and the loss-to-follow-up rate was remarkably low at 0.27%.

Conclusion: Promoting diabetes remission through intensive skill training and close monitoring significantly improves self-care behaviors. This approach effectively enables patients to achieve disease remission and reduce reliance on pharmacological treatments.

Effect of Transcranial Direct Current Stimulation on Functional Fitness in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Control Pilot Study

Chalermkiat Sawasdee — 2026-04-24

Background and objective: Transcranial direct current stimulation (tDCS) has been shown to increase physical performance in both healthy adults and older individuals. However, research on tDCS in COPD is limited. Therefore, the objective of this study was to investigate the effects of tDCS on functional fitness in patients with COPD.

Methods: A randomized, double-blind, sham-controlled trial was conducted. Participants received either active or sham tDCS applied over the primary motor cortex for 20 minutes daily for five consecutive days. Functional fitness outcomes including Single-Leg Stance (SLS), Time Up and GO test (TUG), Five-Times Sit-to-Stand tests (FTSST), 4-meter gait speed test (4MGS), and hand-grip strength (HGS) were assessed at baseline, post-treatment, and at 1-week follow-up.

Results: Compared with the sham group, the active tDCS group demonstrated significantly greater improvements in the SLS, FTSST, and HGS of right hand at post-treatment (p < 0.05). Improvement in the FTSST was maintained at follow-up. 4MGS also improved in the active tDCS group (p < 0.05). However, the TUG did not demonstrate statistically significant changes following the intervention in either within-group or between-group analyses (p > 0.05).

Conclusion: Multi-session tDCS applied over the primary motor cortex enhanced functional fitness, particularly balance, lower-limb functional strength, and gait speed in patients with COPD.

Validity and Reliability Study of the Thai Version of the Functional Assessment Staging Test (FAST) for Dementia Patients

Parichart Piasupun — 2026-04-24

Background and objective: The Functional Assessment Staging Test (FAST) is an internationally validated tool for evaluating the severity of Alzheimer's disease — the most common cause of dementia — across 7 stages and 16 sub-levels. This study aimed to translate and examine the content validity and inter-rater reliability of the Thai version of the FAST.

Methods: The translation process followed ISPOR guidelines, comprising forward translation, review by three experts, back-translation by two specialists, and inter-rater reliability testing by two raters in 30 patients with dementia at Srinagarind Hospital between August 2024 and January 2025. Data were analyzed using the Content Validity Index (CVI) and Intraclass Correlation Coefficient (ICC).

Results: The Thai version of the FAST demonstrated a CVI of 0.89 and an ICC of 0.995 (95% CI: 0.990–0.997, p < 0.001). The majority of patients were classified in FAST stages 6–7 (90.0%).

Conclusion: The Thai version of the FAST demonstrates excellent content validity and inter-rater reliability, making it suitable for staging dementia in the Thai context — particularly in patients with advanced disease — to support prognosis, care planning, and timely referral to palliative care.

Evaluation of Galactomannan Antigen Detection by ELISA and CLIA

Thipaporn Jaroonsirimaneekul — 2026-04-24

Background and Objective: Invasive Aspergillus spp. has a high mortality rate. Early-stage diagnosis is crucial for effective treatment. This study aimed to compare the detection results of Aspergillus galactomannan antigen between two methods: enzyme-linked immunoassay (ELISA) by Analyzer I-2P and chemiluminescence immunoassay (CLIA) by VirClia® monotest.

Methods: A total of 22 samples were tested for Aspergillus galactomannan antigen according to the specific interpretation criteria of each platform. Statistical differences were analyzed using Fisher’s exact test and Chi-square test. Specificity and the degree of agreement (concordance) were also evaluated.

Results: ELISA yielded 3 positive and 19 negative results. In comparison, CLIA produced 3 positive, 17 negative, and 2 equivocal (borderline) results. Statistical analysis via Fisher’s exact and Chi-square tests showed no significant differences between the two methods, with p-values of 0.561 and 0.508, respectively (p > 0.05). The specificity was 89.4%, and the overall agreement was 81.8%, which is considered a good level of concordance.

Conclusions: The comparison between ELISA and CLIA for Aspergillus galactomannan antigen detection showed no statistically significant differences. Both methods demonstrated good specificity and agreement. Clinical application of these test results should be interpreted in conjunction with the patient’s clinical symptoms.

Development and Evaluation of a Mobile Learning Application in Computed Tomography Imaging Techniques for Radiological Technology Students

Petdao Petchuay — 2026-04-24

Background and Objectives: Computed tomography (CT) is a widely used technology in diagnostic radiology, and radiologic technology students must acquire sufficient knowledge and practical skills to operate it properly. However, CT equipment is expensive and has limited availability, resulting in insufficient opportunities for hands-on practice. Developing a mobile application to support learning in CT imaging techniques could enhance access to knowledge and promote ongoing self-guided learning. This study aimed to develop such a mobile application, evaluate its functionality, and assess radiological technology students’ satisfaction with its use.

Methods: The application was developed using the Thunkable web-based platform. Its effectiveness and user satisfaction were evaluated across four dimensions: design, content, usability, and overall performance. Satisfaction was assessed using a Likert-scale questionnaire. The sample included 32 fourth-year radiologic technology students from Navamindradhiraj University.

Results: The developed VJR RTtech CT application performed effectively, showing proper installation and display performance in accordance with the testing criteria. The average scores for design, content, usability, and application performance were 4.38 ± 0.93, 4.50 ± 0.60, 4.47 ± 0.73, and 4.38 ± 0.70, respectively. The overall evaluation across all four dimensions indicated the highest level of satisfaction, with a mean score of 4.43 ± 0.74.

Conclusion: The developed application satisfied the specified performance standards, demonstrating successful installation and correct display across various mobile devices. The content was regarded as useful and practical, enhancing radiological technology students' knowledge of computed tomography imaging techniques. Overall, user satisfaction received the highest rating.

Evaluation of Hypersensitivity Reactions Associated with Different Non-Iodinated Contrast Media (NICM) at a Tertiary Care Hospital: A Retrospective Cohort Study

Pranee Suecharoen — 2026-04-24

Background and objective: Non-ionic iodinated contrast media (NICM) are widely used in computed tomography (CT) to enhance imaging of internal structures. Although NICMs reduce hypersensitivity reactions (HSRs) compared with conventional ionic formulations, adverse events including rash, urticaria, and rarely anaphylaxis remain clinically important. This study aimed to evaluate the incidence, clinical characteristics, and severity of HSRs associated with various NICMs.

Methods: A retrospective cohort study included patients undergoing contrast-enhanced CT between January 1, 2021, and December 31, 2023. Immediate HSRs were assessed using the Naranjo algorithm. Descriptive statistics summarized demographics and HSR features, and Fisher’s exact test evaluated differences in severity between contrast agents.

Results: Among 412 patients (42.5% male; median age 60 years, IQR 52–67), most had normal or mildly impaired renal function. Seven NICMs were used. HSRs were predominantly mild-to-moderate cutaneous reactions, mainly rash with itching and urticaria. While anaphylaxis and angioedema were observed in only eight patients. Highest HSR incidences were observed with iomeprol (100.00%), iohexol (88.60%), and iobitridol (88.00%) which severity distribution did not differ significantly among NICMs (p > 0.05). In addition, most reactions were classified as “probable” or “possible” by the Naranjo algorithm.

Conclusion: HSR to NICMs were predominantly mild and largely limited to cutaneous manifestations, while moderate and severe reactions are rare but clinically significant. Although numerical differences in reaction rates were observed among individual contrast agents, no statistically significant association was identified between type of contrast media and severity.

Incidence and Clinical Characteristics of Nonsteroidal Anti-inflammatory Drugs (NSAIDS)-Induced Hypersensitivity Reactions: A Retrospective Cross-sectional Study

Surangrat Jaikong — 2026-04-24

Background and objective: Widespread self-medication for minor pain has led to extensive use of nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes for inappropriate indications, potentially increasing the risk of hypersensitivity reactions (HSRs). Real-world data on the incidence and clinical characteristics of NSAID-induced HSRs remain limited. This study aimed to estimate the incidence and characterize the clinical patterns of NSAID-induced HSRs at Srinagarind Hospital.

Methods: A retrospective cross-sectional study was conducted using electronic medical records from January 1, 2021, to December 31, 2023. Patients with documented immediate HSRs following NSAID exposure were identified. Causality was assessed using the Naranjo algorithm. Descriptive and inferential analyses were performed to estimate incidence and evaluate associations between NSAID type and reaction severity.

Results: Total of 1,349 patients with NSAID-associated HSRs were included; 70.5% were female, with a mean age of 51.96 ± 16.32 years. Ibuprofen accounted for the largest proportion of reactions (491, 36.40%), followed by diclofenac (254, 18.83%), naproxen (119, 8.82%), aspirin (97, 7.19%), and celecoxib (90, 6.67%). Most reactions were moderate (1,213, 89.90%), with severe events in 82 cases (6.07%). The majority were non-serious (1,232, 91.33%), with hospitalization in 70 cases (5.19%) and life-threatening reactions in 2 (0.14%). Causality was mainly classified as probable (685, 50.78%) or possible (649, 48.11%), while definite reactions were rare (14, 1.04%) and only one case (0.07%) was classified as doubtful. Cutaneous manifestations predominated, particularly rash and itching (24.54%) and angioedema (24.46%); anaphylaxis occurred in 82 cases (6.07%). Severe cutaneous adverse reactions were uncommon (SJS 0.44%, DRESS 0.29%, AGEP 0.29%). No significant associations were observed between NSAID type and reaction severity (p > 0.05).

Conclusions: NSAID-induced HSRs were predominantly moderate and non-serious. Ibuprofen was the most frequently implicated drug, followed by diclofenac and naproxen, underscoring the importance of vigilant monitoring and preventive strategies to reduce NSAID-related hypersensitivity.