Srinagarind Medical Journal <p>Frequency : in every&nbsp;two months; on February, April, June, August, October&nbsp;and December. Policy is to encourage distribution of scientific information in medical and health sciences. It publishes seven types of article; medical innovation, original article, case report, review article, conference, symposium and letter to editor.</p> Faculty of Medical, Khon Kaen University en-US Srinagarind Medical Journal 0857-3123 Laparoscopic Versus Open Surgery in Children with Choledochal Cysts <p><strong><u>Background and Objective:</u></strong> Choledochal cyst is an abnormal cystic dilatation of the biliary system. Many literature showed the laparoscopic surgery is a safe procedure when compared with open approach. The objective of this study was to compare the clinical safety of laparoscopic surgery with conventional open surgery in our hospital.</p> <p><strong><u>Methods:</u></strong> A retrospective study was conducted on all patients younger than 18 years who presented with a choledochal cyst in Srinagarind hospital from January 2014 to November 2019. The data were collected from medical records. The clinical safety defined as the operative time, intraoperative blood transfusion, blood loss, postoperative complication, time of first food intake and length of hospital stay. Data were compared between the 2 groups.</p> <p><strong><u>Results:</u></strong> A total of 29 patients were reviewed. 25 patients underwent open surgery, whereas 4 patients underwent laparoscopic reconstruction. Operative time and the cystic size had significant difference. The operative time in Laparoscopic group was 663.8 ±67.5 minutes and open group was 326.4 ± 138.5 minutes (p &lt; 0.001). The cyst size in laparoscopic group was 1.5 cm. and in open surgery group was 4.5 cm. (p = 0.005). &nbsp;There were no significant difference among other factors of &nbsp;both groups.</p> <p><strong><u>Conclusions:</u></strong> Our initial experience indicates that the laparoscopic approach is safe and having no difference in the patient outcomes, including the complications when compared with the open operation.</p> Patchareeporn Tanming Kanokrat Thaiwatcharamas Ratiyaporn Phannua Copyright (c) 2020-04-08 2020-04-08 35 2 119 124 Accuracy of Ultrasound-Guided Core-Needle Biopsy of Non-Palpable Breast Masses <p>were found. Therefore, ultrasound-guided core-needle biopsy was also introduced to identify and get sample tissue, instead of open-excisional biopsy. This study aimed to evaluate the accuracy of ultrasound-guided core-needle biopsy compared to open-excisional biopsy.</p> <p><strong><u>Methods</u></strong><strong><u>:</u></strong> This was a retrospective descriptive study done in Maharat Nakhonratchasima hostpital breast-masses patients, after having both ultrasound-guided core-needle biopsy and open-excisional biopsy. Pathological examination results from both methods were compared.</p> <p><strong><u>Results</u></strong><strong><u>:</u></strong> From January, 2012 to July, 2015, there were 91 patients who had been biopsied by both methods. Most abnormal pathological results from ultrasound-guided core-needle biopsy were benign in 68.13%. Cancer-related results were found in 21.98%. 81 patients had results that were in consistent with open-excisional biopsy.</p> <p><strong><u>Conclusion</u></strong><strong><u>:</u></strong> In non-palpable breast masses, pathological examination results from ultrasound-guided core-needle biopsy had high accuracy rate of 89.1%(95%CI, 82.58-95.44%), when compared to open-excisional biopsy.</p> Siriprinya Poontananggoon Copyright (c) 2020-04-08 2020-04-08 35 2 125 128 Effect of Paraquat on Interferon-gamma Production by T cell <p><strong><u>Background and objective</u></strong>: Paraquat is one of the most widely used global herbicides for weed control. Recently, paraquat has been reported to have immune toxic effects in animal models, while effects on human T cell function remain undetermined. To resolve these issues, the effects of paraquat on IFN-g production by human T cells <em>in</em> <em>vitro </em>were evaluated<em>.</em></p> <p><strong><u>Methods:</u></strong><strong>&nbsp;</strong>Peripheral blood mononuclear cells were co-cultured with various concentrations of paraquat dichloride or phytohemagglutinin (PHA). Cell viability was determined by trypan blue exclusion and relative metabolic activity was assayed by MTT method. IFN-g production was measured after co-culture with phytohemagglutinin by ELISA.</p> <p><strong><u>Results:</u></strong><strong>&nbsp;</strong>Paraquat at 100 µg/mL did not affect cell viability, whereas 300 µg/mL paraquat significantly reduced the percentage of viable cells compared with the control (p&lt; 0.05). Addition of 100 and 300 µg/mL of paraquat significantly increased the percentage of IFN-g production inhibition compared with the control (p&lt; 0.05). Moreover, inhibition of IFN-g production by paraquat was observed after 24 h co-culture and showed a robust effect in all individuals after 48 h co-culture.</p> <p><strong><u>Conclusion:</u></strong>&nbsp;Data indicated that paraquat at the concentration of 100 and 300 µg/mL had an inhibitory effect on IFN-g production by T cells. Thus, direct contact with&nbsp;<em>paraquat</em> or paraquat contaminated environments and agricultural products increased risk of diseases caused by T cell dysfunction.</p> Surachat Buddhisa Patcharaporn Tippayawat Rungnapa Sranujit Nattaphol Prakobkaew Copyright (c) 2020-04-08 2020-04-08 35 2 129 134 Syzygium gratum Extract Attenuates Renal Fibrosis in L-NAME Induced-Hypertensive Rats <p><strong><u>Background and Objectives</u></strong><strong>: </strong><em>Syzygium gratum</em> (SG) extract has antioxidant, anticancer and vascular protective activities. This study aimed to investigate the effect of SG extract on blood pressure and renal remodeling in <em>N<sub>ω</sub></em>-Nitro-L-arginine methyl ester hydrochloride (L-NAME)-induced hypertensive rats.</p> <p><strong><u>Methods</u></strong><strong>:</strong> Male Sprague-Dawley rats were administered with L-NAME (40 mg/kg/day) in drinking water for 5 weeks in order to induce hypertension. Hypertensive rats were treated with SG extract (300 mg/kg/day) or vehicle for the last 2 weeks. Systolic blood pressure and renal fibrosis were evaluated.</p> <p><strong><u>Results</u></strong><strong>:</strong> Rats treated with L-NAME had high systolic blood pressure (187.8 ± 5.1 mmHg vs. 124.4 ± 2.8 mmHg) and increases in renal tubulointerstitial (3.8 ± 0.1 % vs. 2.1 ± 0.2 %) and corpuscular fibrosis (11.3 ± 1.1 % vs. 4.8 ± 0.4 %) compared with control rats (p&lt;0.05). Treatment of hypertensive rats with SG extract significantly reduced systolic blood pressure (154.7 ± 2.7 mmHg), and alleviated renal tubulointerstitial and corpuscular fibrosis (2.4 ± 0.1 % and 5.5 ± 0.4 % respectively) (p&lt;0.05).</p> <p><strong><u>Conclusion</u></strong><strong>: </strong>Our results indicate that SG extract decreased blood pressure and alleviated renal fibrosis in L-NAME-induced hypertensive rats.</p> Sarawoot Bunbupha Kwanjit Apaijit Sariya Meephat Putcharawipa Maneesai Parichat Prachaney Poungrat Pakdeechote Copyright (c) 2020-04-08 2020-04-08 35 2 135 140 Clinical Presentation and Outcome of Acute Pulmonary Embolism in Emergency Department, University Hospital, Northeast, Thailand <p><strong><u>Background and objective:</u></strong> The incidence of acute pulmonary embdism (APE) in Thailand are unknown. With new diagnostic tools and current advanced knowledge, APE was discovered to be much more frequent in Thailand than earlier believed.&nbsp; Clinical outcome of APE had not been previously firmly identified. The aim of this study was to evaluation signs, symptoms, laboratory data, treatments and outcomes of patients diagnosed with APE in emergency department (ED).</p> <p><strong><u>Methods</u></strong><strong>:</strong> The study design was retrospective descriptive study. We searched electronic databases (Jan. 2008 – Nov. 2018) for patients with suspected APE and diagnosed by computed tomographic pulmonary angiography (CTPA) in Srinagarind hospital.</p> <p><strong><u>Results</u></strong><strong>:</strong> A total of 110 patients with confirmed APE was enrolled from ED. 67 patients were female (60.91%). The age of patients varied from 22 to 91 years old. The mean age was 62.4 years old. Malignancy was the most frequent co-morbidity (48.18%). The most common presenting symptoms and signs were dyspnea (86.36%), followed by tachypnea (66.36%) and tachycardia (50.91%). The most frequent radiographic abnormalities were pulmonary parenchymal lesions (40.91%). Most electrocardiograms were sinus tachycardia (50%). Echocardiography findings were RV dilatation in most cases (48.44%). D-dimer, Troponin-T and NT pro-BNP were increased in patients with APE. The mortality rate at the hospital admission was 5 in 110 patients (4.55%).</p> <p><strong><u>Conclusion</u></strong><strong>:</strong> The most common clinical characteristics of APE patients in ED were dyspnea similar to previous reports in other countries. The mortality rate showed no difference when compared to previous studies.</p> Kamonwon Ienghong Chitchanok Piensee Korakot Apiratwarakul Praew Kotruchin Wutchara Ruttanaseha Pariwat Phungoen Copyright (c) 2020-04-08 2020-04-08 35 2 141 146 Outcome of Anaphylaxis Protocol at Emergency Department, Srinagarind Hospital <p><strong><u>Background and objective:</u></strong> Anaphylaxis is a serious condition. Under diagnosis or under treatment could lead to mortality. Srinagarind hospital has published protocol for anaphylaxis to improve the quality of treatment. The objective of this study was to determine percentage of patients who get adrenaline injection, route of adrenaline injection, time of adrenaline injection and emergency department length of stay after the anaphylaxis protocol used.</p> <p><strong><u>Methods:</u></strong> This was a &nbsp;retrospective descriptive study, with medical record review was conducted. All patients came to emergency room at Srinagarind hospital during January 1st, 2014 and December 31st, 2015 who met criteria for diagnosis of anaphylaxis were included.</p> <p><strong><u>Results</u></strong><strong>:</strong> From 136,266 visitors, the number of researched patients was 174 which was found with using the protocol for anaphylaxis in 99 cases (56.9%) and without using it in 75 cases (43.1%). All patients in each group (100%) were injected with adrenaline. Route of adrenaline injection was intramuscular injection (100%) The median of time of patients injected adrenaline were 12.5 and 15 minutes and the median of emergency department length of stay time were 53 and 69 minutes in group of the protocol for anaphylaxis usage and unusage, respectively.</p> <p><strong><u>Conclusions:</u></strong> After the protocol for anaphylaxis was established, all patients got adrenaline injection by using intramuscular injection as standard treatment. There were no statistical significant difference in time to receive adrenaline and emergency department length of stay when compared the protocol for anaphylaxis usage group with the protocol unusage group.</p> Kamonwon Ienghong Waranrat Saengpanasthada Korakot Apiratwarakul Wutchara Ruttanaseeha Marturod Buranasakda Copyright (c) 2020-04-08 2020-04-08 35 2 147 152 The Measurement Radiation Doses to the Lens of Eye and Thyroid Gland from Computed Tomography Brain Scans and Radiation Dose Around in CT Scan Room: Phantom Study <p><strong><u>Background and Objective:</u></strong> This study aimed to measure radiation dose to lens of eye and thyroid gland from three different computed tomography (CT) brain scanners, including of measuring the radiation dose with and without bismuth radiation shield. Moreover, the scatter radiation dose in the CT rooms was also measured.</p> <p><strong><u>Methods:</u></strong> Optically stimulated luminescence (OSL) dosimeters were placed on the phantom to measure the skin dose at eye lens and thyroid glands. The OSL dosimeters were also placed on the wall, door, lead glass inside and outside the CT rooms to measure the radiation dose in the supervised and controlled area.</p> <p><strong><u>Results:</u></strong> The radiation equivalent doses from the three CT scanners were significantly different. The use of bismuth eye shield could reduce the amount of radiation on the eye lens by 27 - 48 %. The radiation dose in the supervised area was within the relevant annual dose limit. However, there were two locations in the controlled area where radiation dose exceeded the dose limit. The investigation must be performed to reduce the radiation dose within the regulatory dose limits.</p> <p><strong><u>Conclusions:</u></strong> Radiographers should carefully adjust the exposure techniques in order to optimise the radiation doses, especially in pediatric patients. The bismuth radiation shield helps to reduce the scattered radiation. The efficiency of lead door, wall and lead glass must be routinely checked for radiation monitoring.</p> Jiranthanin Phaorod Wattana Wongsanon Petcharakorn Hanpanich Pattaraporn Dornsrichan Panatsada Awikunprasert Jutatip Sriwicha Vithit Pungkun Copyright (c) 2020-04-08 2020-04-08 35 2 153 160 Six-Minute Walk Test in Thai Cardiac-Surgery Elderly at Queen Sirikit Heart Center of the Northeast <p><strong><u>Background and objectives:</u></strong> &nbsp;Six-minute walk test (6MWT) was widely used to assess the patient’s status after cardiac surgery due to its feasibility. But the 6MWD studied in Thailand trended to have shorter lengths than of western countries. It could not be applied to Thais. And the data regarding 6MWD after surgery of the elderly patients in Thailand was lacking. This study aimed to evaluate the average distance of 6MWT in cardiac-surgery elderly to assess the patient’s capability and follow up.</p> <p><strong><u>Methods:</u></strong>&nbsp;The data included the age, gender, types of surgery, risk stratification, and 6MWD of cardiac-surgery elderly who visited the rehabilitation department were collected. Then the mean value of 6MWD was calculated, and the correlation of 6MWD among each factor were analyzed.</p> <p><strong><u>Results:</u></strong>&nbsp;98 patients with mean age of 67 years were included in the study, 55 patients underwent CABG, and 43 patients underwent valvular surgery. The overall mean 6MWD was 209.7±78.9 meters. 6MWD was significantly different in sex [95%CI (-65.4)-(-0.5), p=0.047] and type of surgery [5.6-67.8, p=0.021].&nbsp;</p> <p><strong><u>Conclusion:</u></strong>&nbsp;The normal 6MWD in Thai cardiac surgery elderly patients was 194-225 meters. This number could be used to represent the patient’s capability and further cardiac rehabilitation program.</p> Pajeemas Kittipanya-ngam Montri Yasud Copyright (c) 2020-04-08 2020-04-08 35 2 161 166 Efficacy and Safety of Imatinib in Patients with Unresectable or Metastatic Gastrointestinal Stromal Tumors (Gists): A Retrospective Cohort Study <p><strong><u>Background and Objective</u></strong><strong><u>:</u></strong> Imatinib is a standard treatment of unresectable or metastatic gastrointestinal stromal tumors (GISTs). In Thailand, the prevalence and effect of treatment in unresectable or metastatic GISTs who receiving imatinib are limited. This study was to assess efficacy and safety of imatinib in patients with unresectable or metastatic GISTs</p> <p><strong>Methods:</strong> The retrospective study collected data from medical records and electronic databases of unresectable or metastatic GISTs. Inclusion criteria were aged ≥18 years old with diagnosed unresectable or metastatic GISTs who received imatinib 400 mg/day as first-line treatment and performance status (ECOG) 0 – 2. Patients with no data for evaluation of efficacy or safety, pregnancy/lactation and terminally ill were excluded. Endpoints were efficacy evaluation included progression-free survival (PFS), overall survival (OS), response rate (RR) and safety evaluation.</p> <p><strong><u>Results:</u></strong> A total of 21 patients, but 1 patient is unable to analyze efficacy outcomes due to receiving less than 3 months of imatinib. Efficacy showed PFS 6.4 years (95% CI 3.0-9.8), OS 8.2 years (95% CI 4.0-12.3). 20% patients attained a partial response, 25% patients revealed a stable disease and 55% patients had a progressive disease. Hematologic toxicities were anemia (86%), neutropenia (38%), thrombocytopenia (29%). The most common non-hematologic toxicities were eyelid edema (71%), &nbsp;edema (43%), weight gain (43%), nausea/vomiting (38%), &nbsp;increasing liver function (33%). In addition, serious adverse events were deep vein thrombosis (5%) and 1 patient admitted with plural effusion and then lost follow up.</p> <p><strong><u>Conclusions:</u></strong> Unresectable or metastatic GISTs receiving imatinib at 400 mg/day had PFS 6.4 years, OS 8.2 years, and RR 20%. The most common adverse event were anemia and eyelid edema and the serious adverse event was plural effusion.</p> Kwanjit Danwilai Atcharapan Rintha Attapinya Monta Wittawat Jitpewngarm Kamonwipa Jitjarern Copyright (c) 2020-04-08 2020-04-08 35 2 167 172 A Systematic Review of Chemical Inventory Required Medical Surveillance in the Context of Occupational Medicine <p><strong><u>Rationale and objective</u></strong><u>:</u> Hazardous chemical accessed need to be on medical surveillance, which were different in each country but outnumber in Thailand. So as to be information for studying modified Delphi technique.</p> <p><strong><u>Methodology</u></strong><u> :</u> This was a systematic review , searching from international information between A.D. 2000 – 2018, focus on law/ rules/ guideline on medical surveillance for chemicals. Searching found the information from 13 organizations in 11 countries which analyzed by dividing into 2 parts due to mission : law formulation and information dissemination or academic supporting.</p> <p><strong><u>Results:</u></strong> Six organizations indicated the number of regulated chemical groups in bracket requiring medical surveillance included: OSHA (14), AMPATH (31), WHS (15), WSHC (14), OSH (35) and the Ministry of Labour Thailand (74) .There were 33 chemicals prescription matched by 1 – 5 organizations such as Benzene, Lead, Arsenic and there were 36 chemicals apparently only in Thailand.</p> <p><strong><u>Conclusion</u></strong><u>:</u> The number of regulated chemical groups&nbsp; requiring medical surveillance ranging from 14 – 74. The number of organization which matched with Thailand prescription ranging from 1 – 5 organizations matched with Thailand and the list for example were metals, fumigants and pesticides.</p> Pasinee Srisook Naesinee Chaiear Chatchai Ekpanyasakul Suda Vannaprasaht Copyright (c) 2020-04-08 2020-04-08 35 2 173 182 Incidence and Predictive Factors for Post-operative Delirium among Older People <p><strong><u>Background and objectives: </u></strong>Delirium&nbsp; is a common symptom in older people who undergo surgery. When this condition occurs, it affect not only older people, but also caregivers and health service systems.&nbsp; This study aimed to study incidence and predictive factors with post-operative delirium among older people who were admitted to the surgical ward.</p> <p><strong><u>Material and Method</u></strong><u>:</u> This was a retrospective study . The population were 522 older people which age 60 years or above, had surgery and were admitted to surgical ward at&nbsp; Srinagarind hospital,&nbsp; Faculty of&nbsp; Medicine,&nbsp; Khon Kaen university between January 2013 – December 2015. &nbsp;Data were collected by reviewing medical records and nurse note for personal information and illness history, Thai version of Confusion Assessment Method (CAM-algorithm), and the recorded form which was developed by the researcher with Cronbach's alpha coefficient as 0.83. Personal informations were analyzed by using descriptive statistics, however, correlation and prediction between factors were analyzed by using Pearson's product moment correlation coefficient and stepwise multiple regression analysis.&nbsp;&nbsp; The significance level at p≤ 0.05 was applied.</p> <p><strong><u>Results</u></strong><u>:</u> The study showed that the incidence of post-operative delirium in older people was low (4.78 %). Factors that can be used to predict the post-operative delirium among older people were blood loss more than 900 cc, surgery duration more than 300 minutes, receive blood/fluid more than 300 cc, General analgesia and post-operative pain level of 24 hours between 8-10 points. These five factors together joining to predict and explain the occurrence of post-operative delirium (p &lt;0.001) at 14% (R<sup>2</sup> = .140)</p> <p><strong><u>Conclusion</u></strong><u>:</u> The incidence of post-operative delirium in older people was (4.78 %). Factors that could&nbsp; be used to predict the post-operative delirium among older people were blood loss more than 900 cc, using Patient-Controlled Analgesia, surgery duration more than 300 minutes, and post-operative pain level of 24 hours between 8-10 points. These five factors together joining to predict and explain the occurrence of post-operative delirium at 14 % (R<sup>2</sup>=.140 ).</p> Kanokarn Kongpitee Darawan Augsornwan Wasitthe Setwong Natthawadee Boonrueng Parakorn Surakulprapa Copyright (c) 2020-04-08 2020-04-08 35 2 193 198 Association between Nutrition Literacy and the Consumption of Snacks and Sweetened Beverages among Undergraduate Students in the Health Sciences Faculties of Khon Kaen University <p><strong><u>Background and Objectives</u></strong><strong>: </strong>Nutrition literacy is one of the factors that affect the ability to choose the right snacks and drinks. This study aimed to analyze the association between ‘nutrition literacy’ and the consumption of snacks and sweetened beverages (SSBs) among undergraduate students of the health sciences faculties of Khon Kaen University.</p> <p><strong><u>Methods</u></strong>: A total of 304 students participated in this cross-sectional analytic study. A self-response questionnaire was used to collect data including general information, items of ‘nutrition literacy’ and SSBs consumption. Energy, sugar, fat and sodium intakes were calculated by the INMUCAL-N Version 4.0 Program. The association between nutrition literacy scores and energy intake from SSBs consumption was determined using multiple linear regression.</p> <p><strong><u>Results</u></strong><strong>: </strong>The ‘Nutrition literacy’ of the subjects &nbsp;were classified as high, moderate and low levels accounting for 0.3, 73.7 and 26.0%, &nbsp;respectively. The energy intake through SSBs consumption was 388 kcal/day. The intake of fat and sugar from SSBs amounted to 14.4 and 32.2 g/day, and sodium 262.8 mg/day. According to a multiple regression analysis the score of communication skill of ‘nutrition literacy’ was statistically significantly and negatively correlated with the energy intake from SSBs (coef.= -13.16, p = 0.04).</p> <p><strong><u>Conclusion:</u></strong> Those students who have higher score of communication skill of nutrition literacy have lower energy intakes from SSBs. Promoting communication skill regarding the consumption of SSBs among the students should be encouraged for healthy snacks and beverages choosing.&nbsp;</p> Kawinda Visedkaew Benja Muktabhant Copyright (c) 2020-04-08 2020-04-08 35 2 183 192 Effect of Coconut-Shell-Stepping Exercise on Balance Ability of Elders <p><strong><u>Background and objective:</u></strong> Muscle strength and endurance of the lower limb of the elders are decreased. &nbsp;Coconut shell tool can increase the lower limb muscle strength and endurance. This study aimed to investigate the effects of step up into coconut shell tool on balance ability of the elders.</p> <p><strong>Methods:</strong> The participants were 30 elders; 15 males and 15 females. All subjects were assessed balance ability by Time up and go (TUG) test . Assessed before step up into coconut shell tool and after step up into coconut shell tool for a stepping rate of 24 steps per minute, for a total of 3 minutes allow the beat of metronome, for 3 months.</p> <p><strong><u>Results:</u></strong> Theelders had an increase of balance ability significantly (p≤0.001) was statistical significance after the test including balance ability (p= 0.001). The after TUG test was 0.88 second less than before the TUG test.</p> <p><strong><u>Conclusion:</u></strong> The elders had higher&nbsp; balance ability more than before test in the coconut shell tool step.</p> Patchareeya Amput Sirima Wongphon Copyright (c) 2020-04-08 2020-04-08 35 2 199 202 Proportion of the Medical School Personnel Who Completely Resumed to Their Original Work after Sickness Absence <p><strong><u>Background</u></strong><strong><u> and </u></strong><strong><u>Objectives</u></strong><u>:</u> &nbsp;On occupational health service issues when personnel is injured or sick, fitness for work evaluation is necessary to assess the ability to return to work without risk to him/herself, others and the public. This study aimed to 1) study the proportion of personnels who completely resumed to their original work in the optimal time after sickness absence 2) study factors related to return to original work in the optimal time</p> <p><strong><u>Materials and Methods:</u></strong> A descriptive study was conducted in 104 personnels &nbsp;who were assessed for a returning to work from 1 October 2016 - 31 May 2018. Personal health and job informations were obtained together with the result of return to work assessment. Descriptive statistics and Inferential statistics were applied.&nbsp; <strong><u>Results:</u></strong> Personnel injured or sick could resume to original work in the optimal time at 79.8 percent (83/104). The most diseases which were assessed for&nbsp; returning to work were infectious diseases 45.2%, followed by musculoskeletal disease 25% and skin disease 8.7%. Factors related to resume to original work were female (OR 4.9, 95%CI: 1.7, 13.9, p&lt;0.01) and direct contact to patient (OR 3.8, 95%CI: 1.1,12.4, p-value=0.03).</p> <p><strong><u>Conclusion:</u></strong> The proportion of personnel who completely resumed to their original work was lower than previous studies. Female and direct contact with the patient were a possibility of resumed to original work. This might be caused by only statistical relationships because most personnels were female. The analytical design should be continued</p> Teerayut Kongsin Naesinee Chaiear Patimaporn Janpho Copyright (c) 2020-04-08 2020-04-08 35 2 203 209 Community Participation in Development of Models for Reducing Pesticide Contact of Agriculturist Group : Case Study of Tobacco Grower Group of Nayor Village, Nangam Sub-District, RaenuNakhon District, NakhonPhanom Province <p><strong><u>Background and Objective</u></strong> : The volume of pesticide using in the tobacco agriculturists&nbsp; are increasing and the impact from using pesticides are so much on the health of farmers, the environment, economic and society. The purpose of this research was to develop the &nbsp;models for reducing pesticide contact of agriculturists group growing tobacco at&nbsp; Nayor village tobacco growers group, Nangam sub-district, RaenuNakhon district, NakhonPhanom&nbsp; province.. <br><strong><u>Methods:</u></strong> This participation action research used the sample group collected by Purposive Sampling. There are 4 steps of procedure; 1) Community situation study, 2) Brainstorming and thought reflection, 3)Implementation of the models and 4)Performance evaluation. Data collection tools consisted of In-depth interview questions, Group discussion questions, Participatory and non-participatory observation items, Brainstorming and reflective thinking and Knowledge and behavior questionnaire of using chemical pesticide. Data was analyzed by content analysis and frequency percentage. <br><strong><u>Results</u></strong>: Most of the agriculturists were women, every one used pesticides 3-4 times a year, they were commitment with private tobacco&nbsp; company and, most of them are knowledgeable about chemicals&nbsp; at the high level. Behavior about using pesticides in before used, currently used and after used were at the high level. The model&nbsp; had 4 steps guideline to reducing pesticides contact of tobacco planting which were; 1) Seedling. 2) Tobacco care 3) Tobacco leaf harvesting and 4) Tobacco leaf packing. The results after implementation, it was found that most of the agriculturists followed the guidelines .However, The process is still tricky to implement and unsure of the effectiveness of the new guideline.<br><strong><u>Conclusion</u></strong>: agriculturists are perceive of the impact from pesticide exposure&nbsp;&nbsp; and importance&nbsp; to&nbsp; avoid pesticides exposure. but are not confident about the effectiveness of this&nbsp; guideline .</p> Charoenchai Muenhor Boonrod Donprapeng Copyright (c) 2020-04-08 2020-04-08 35 2 210 218 The Effect of Cold Herbal Gel Pack Compress to Release Post Traumatic Headache of Patients with Mild Traumatic Brain Injury <p><strong><u>Background and Objectives</u></strong><u>:</u> Post-traumatic headache (PTH) is the most prevalent type of pain after mild head injury (MHI) with the prevalence rate of 59.2-92%. &nbsp;PTH can be managed with medications and alternative medicines. The objectives of this research were to compare the differences of mean scores of PTH among patients with mild traumatic brain injury (mild TBI) by applying cold compression gel and herbal cold compression gel.</p> <p><strong><u>Methods:</u></strong>&nbsp; This study is a quasi-experimental research. The samples consisted of 70 patients with mild TBI. They were equally divided into two groups: 35 cases in the control group by applying cold compression gel and 35 cases in the experimental group by applying herbal cold compression gel. Purposive random sampling was used to collect data depending on inclusion criteria. Data collection was collected between 24-48 hours after patients were admitted in the hospital. The research instruments included; 1) the general information questionnaire, 2) the injury data recording form, 3) the questionnaire about the PTH and 4) the satisfaction assessment form of the patients with mild TBI towards the use of the innovation.&nbsp;&nbsp; <strong>&nbsp;</strong></p> <p><strong><u>Results:</u></strong> The PTH of experimental group was reduced with statistical significance at the level of p &lt;0.01.Moreover, PTH was lower than the control group with statistical significance at the level of p &lt;0.01. The satisfaction of the experimental group was at a high level. &nbsp;<strong>&nbsp;</strong></p> <p><strong><u>Conclusion:</u></strong>&nbsp; Herbal cold compression gel can be used as integrated care to alleviate post-traumatic headache in the patients with mild TBI.</p> Arunrat Uthaisang Praewa Kaewpolngam Kamonwan Sanlad Koranan Singthong Kanjana Jangsanam Kanchanapon Prompap Kwanruan Merndee Paweethida Kasemsuk Kawarin Sapimon Copyright (c) 2020-04-08 2020-04-08 35 2 217 223 Deceased Donor Kidney Transplantation in Pediatric Recipients: A Decade Results in Northeast Thailand <p><strong><u>Background and objective:</u></strong> Kidney transplantation (KT) is the best modality treatment in children with end-stage renal disease. Our center has performed KT mostly from deceased donors due to short waiting time. The induction therapy by interleukin 2 receptor antagonist (IL2-RA) was limited use due to financial issue. Therefore, this study aimed to report our experience in pediatric deceased donor KT with restricted use of induction therapy.</p> <p><strong><u>Methods:</u></strong> This retrospective descriptive study, review the results of KT over 10 years. Medical records of all pediatric KT recipients who were transplanted from 2003 to 2014 were reviewed. All patients received the same maintenance immunosuppressive drugs except the induction therapy by IL2-RA. We also reviewed the results of KT between two groups in a different period.</p> <p><strong><u>Results:</u></strong> Forty-eight pediatric KT recipients were included in this study. The mean age of the recipients was 12.8 years and the mean age of the deceased donor was 30.3 years. All recipients were non-sensitized patients and compatible crossmatch. Fourteen patients (29%) received induction therapy with IL2-RA and methylprednisolone, the rest received only methylprednisolone (non-induction group). The rate of rejection and infection between the induction and non-induction groups did not differ significantly. The graft survival rates at 1, 3, and 5 years after KT were 93.7%, 83.9%, and 74.8%, respectively. The graft survival rates between induction and non-induction groups were not significantly different. The mortality rate of this study was 16.7%.</p> <p><strong><u>Conclusion:</u></strong> The standard-risk pediatric deceased donor kidney transplantation in limited resources for induction therapy had satisfying results. However, the future study requires a greater data to support this outcome.</p> Sunee Panombualert Suwannee Wisanuyotin Apichat Jiravuttipong Copyright (c) 2020-04-08 2020-04-08 35 2 224 229 Update in Demodex Blepharitis <p>Nowadays chronic blepharitis that does not respond to conventional treatment is associated with increasing number of Demodex at eyelid. In human eye, there are two species of mites which are <em>Demodex folliculorum </em>and <em>Demodex brevis</em>. Due to their habitat of these 2 species are different which cause different kind of anterior and posterior blepharitis, respectively. Ocular symptoms of Demodex blepharitis are overlap to the other ocular surface disease but symptoms may worsen than the others. &nbsp;This reason may be the cause of delayed diagnosis and ineffective management of Demodex blepharitis. Pathognomonic sign of this disease is the cylindrical dandruff around lash follicle. There are many methods for confirm diagnosis which the most popular method is lash sampling and exam under microscope. Mode of common treatments presently, there are many commercial eyelid cleansers that contained tea tree oil in various concentration in the market or oral ivermectin but all of these cannot get rid of Demodex mite after 4 weeks of treatment. So Demodex blepharitis is the chronic disease that challenges both diagnosis and proper treatment for the quality of chronic blepharitis patients in the future.</p> Siripong Siramon Latiporn Udomsuk Tanit Wongwibulsin Copyright (c) 2020-04-08 2020-04-08 35 2 230 237 The Empowerment of Pregnant Women to Prevent the Risk of Preterm Labor: Nurse’s Roles <p>Preterm labor is a major cause of birth of preterm infants which results in perinatal mortality, disabilities and the relationship between parents and newborns because preterm infants are at risk of both physical and intellectual complications. It also physically and mentally affects pregnant women. It also has an impact on family economy and the health &nbsp;care system as it requires long-term care and high cost.&nbsp; This article aims to present magnifude of &nbsp;problems, impact and risk factors of preterm labor, concepts of health promotion &nbsp;and nurse’s roles in empowering pregnant women to prevent preterm labor. The results of the study could be developed as the guidelines for the care of pregnant women who are at risk of preterm labor.</p> Prapairat Kaewsiri Siriporn Hemadhulin Pimonpan Ansook Panyupa Naosrisorn Copyright (c) 2020-04-08 2020-04-08 35 2 238 245