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 Quercetin Enhances Phenformin in Inhibition of Cholangiocarcinoma Cell Growth <p><strong><u>Background and Objective</u></strong><strong>: </strong>Phenformin, and flavonoid compounds, quercetin and myricetin are effective against many types of cancers. This study evaluated the treatments of phenformin in combination with quercetin or myricetin in the inhibition of cholangiocarcinoma (CCA) cells.</p> <p><strong><u>Methods</u></strong><strong>: </strong>Cholangiocarcinoma cells, KKU-156, were used in this study. Cell cytotoxicity was evaluated by sulforhodamine-B assay (SRB). Mitochondrial membrane potential (Dym) was analyzed by JC-1 assay.</p> <p><strong><u>Results</u></strong><strong>: </strong>Phenformin significantly inhibited proliferation of cancer cells. Phenformin in combination with quercetin, but not myricetin, could increase the cytotoxicity of cancer cells. Phenformin, quercetin or in the combination induced the loss of mitochondrial transmembrane potential<strong>.</strong></p> <p><strong><u>Conclusions</u></strong><strong>: </strong>Quercetin increased phenformin in inhibition of cancer cell growth. The mechanism may be by the increase of induction of mitochondrial damage leading to cell death.&nbsp; This finding suggests that phenformin in combination with quercetin has potential to increase efficacy of chemotherapy of cholangiocarcinoma.</p> Rattanaporn Jaidee Sarinya Kongpetch Auemduan Prawan Laddawan Senggunprai Upa Kukongviriyapan Veerapol Kukongviriyapan Copyright (c) 2020-05-25 2020-05-25 35 3 249 254 Effect of Lisinopril on Left Ventricular and Vascular Function in Nitric Oxide-Deficient Rats <p><strong><u>Background and Objective</u></strong><strong><u>:</u></strong> Lisinopril, angiotensin-converting enzyme inhibitors (ACEIs), is widely used to treat hypertension and heart failure. This study investigated whether lisinopril could prevent N<sup>ω</sup>-Nitrol-arginine methyl ester (L-NAME)-induced hypertension, left ventricular (LV) and vascular dysfunction in rats.</p> <p><strong><u>Methods</u></strong><strong><u>:</u></strong> Male Sprague-Dawley rats were treated with L-NAME (40 mg/kg/day) in drinking water only or together with lisinopril (2.5 mg/kg/day) for five weeks while control rats received distilled water (n=5). Blood pressure and cardiac function were measured. Aortic rings were isolated for vascular function test.</p> <p><strong><u>Results</u></strong><strong><u>:</u></strong> Rats treated with L-NAME had high blood pressure and impairment of cardiac function and acetylcholine (ACh)-induced vasorelaxation in isolated aortic rings. Vascular response to sodium nitroprusside (SNP) did not differ among groups. Interestingly, lisinopril significantly prevented L-NAME-induced hypertension and alleviated L-NAME-induced cardiac and vascular dysfunction (p&lt;0.05).</p> <p><strong><u>Conclusion</u></strong><u>: </u>These findings suggested that lisinopril prevented the development of hypertension and partially prevented cardiac and vascular endothelial dysfunction induced by L-NAME.</p> Metee Iampanichakul Nisita Chaihongsa Benchaporn Saengak Weerapon Sangartit Putcharawipa Maneesa Parichat Prachaney Poungrat Pakdeechote Copyright (c) 2020-05-25 2020-05-25 35 3 255 260 Effectiveness Screening of Hemoglobin E Using KKU-DCIP in HIV Infected Patients <p><strong><u>Background and Objective</u></strong><strong><u>:</u></strong> Human immunodeficiency virus (HIV) is a cause of acquired immunodeficiency syndrome.&nbsp; Hematological abnormalities are common manifestations in persons with HIV infection. <em>HIV infection can</em>&nbsp;occur during&nbsp;<em>pregnancy and </em>may be affected on the screening for hemoglobin E (Hb E) by false positives or false negatives. In this study, we aimed to investigate the effectiveness of Hb E screening using KKU-DCIP test in HIV positive subjects.</p> <p><strong><u>Methods</u></strong><strong><u>:</u></strong> Two hundred subjects of HIV infected patients and healthy donors were enrolled to this study. &nbsp;Hb E screening using KKU-DCIP test and allele specific-PCR for Hb E gene confirmation were performed in all samples.</p> <p><strong><u>Results</u></strong><strong><u>:</u></strong> The result in HIV infected patients showed that the false positive, sensitivity, specificity, positive predictive value and negative predictive value using KKU-DCIP test were 22.58%, 100%, 96.0%, 77.4%, and 100%, respectively. In non-HIV infected group, false positive rate of Hb E screening using KKU-DCIP test was 28.13. All of sample, false negative was not detected. Sensitivity, specificity, positive predictive value and negative predictive value were calculated, the results were 100%, 94.9%, 71.9% and 100%, respectively.</p> <p><strong><u>Conclusion</u></strong><u>:</u> The results indicate that KKU-DCIP test still has effectiveness for screening of Hb E in HIV infected patients.</p> Nattaphol Prakobkaew Kanokporn Rittisang Sitthichai Panyasai Surachat Buddhisa Orrathai Pongtussanaham Narin Pongtussanaham Copyright (c) 2020-05-25 2020-05-25 35 3 261 265 Effect of Nelumbo nucifera Stamen Extract on Memory Deficits in Aβ-induced Rat <p><strong><u>Background and Objectives:</u></strong><em>&nbsp; </em><em>Nelumbo nucifera</em> (lotus) is a key plant in Thai traditional medicine that has anti-diabetic and anti-oxidant activities, and inhibits acetylcholinesterase enzyme. It is widely consumed as functional food. This study investigated the effect of <em>N. nucifera</em> stamen extract (NNSE) on memory deficit in amyloid beta (Aβ)-induced rat.</p> <p><strong><u>Methods:</u></strong> Forty adult male Sprague Dawley rats were divided into 5 groups, each group consisting of 8 rats as follows: Group 1, the normal control group. Group 2, the vehicle plus Aβ group (V+Aβ), received 0.5% sodium carboxymethyl cellulose<span style="text-decoration: line-through;">,</span> orally and was injected with amyloid-β via the lateral ventricles. Group 3, the vitamin C plus Aβ group (Vit C+Aβ), received vitamin C orally at 200 mg/kgBW., and was injected with Aβ via the lateral ventricles. Group 4, and 5, the NNSE plus Aβ groups (NNSE250+Aβ, NNSE500+Aβ), received NNSE orally at doses of 250, and 500 mg/kgBW, respectively, and were injected with Aβ via the lateral ventricles. All treatments were performed for 33 consecutive days. At day 21, Aβ (1-42) was injected via both sides of lateral ventricles. Ten days after Aβ1-42 injection, the rats were tested for locomotor activity and recognition memory by using the open field and novel object recognition tasks, respectively.</p> <p><strong><u>Results:</u></strong> The NNSE at dose of 500 mg/kg BW significantly increase the velocity and moving distance in locomotor activity in rats after induced with Ab. Moreover, NNSE at doses of 250 and 500 mg/kgBW significantly improve short-term recognition in cognitively impaired rats. These doses of NNSE also tend to improve long-term recognition in memory impaired rats.</p> <p>Conclusions: NNSE improve memory impairments induced by Ab, especially short-term memory. Furthermore, the high doses of NNSE stimulates muscle function by increasing speed and movement distance.</p> Jenjiralai Phanphak Chantana Boonyarat Ploenthip Puthongking Jariya Umka Welbat Komsun Bunreungthong Nutchareeporn Nillert Wanassanun Pannangrong Copyright (c) 2020-06-04 2020-06-04 35 3 261 265 Development of the Warfarin Knowledge Test in Patients Receiving Warfarin at Pathumthani Hospital <p><strong><u>Background and Objective</u></strong><strong>:&nbsp; </strong>Assessing patient’s knowledge on warfarin therapy is one of the key strategies for anticoagulation management. It helps pharmacist to identify patient’s knowledge deficits that can lead to improve the efficacy and safety of anticoagulation therapy. The objectives of this study aimed to develop a warfarin knowledge test for patient to complete the questionnaires at the clinic and to validate the quality of test in aspects of content validity, item difficulty, item discrimination, reliability and construct validity.</p> <p><strong><u>Method</u></strong><strong>:&nbsp; </strong>Research and development study including 2 steps: First step was to construct and develop a warfarin knowledge test using 6 experts. Step 2 was to validate the quality of a test. Warfarin knowledge test was administered to two groups of participants comprising of 67 patients who were taking warfarin at Pathumthani hospital and 100 general public. Item difficulty and item discrimination, reliability and construct validity were analyzed by using Brennan Index, Lovette, and Carver methods, respectively.</p> <p><strong><u>Result</u></strong><strong>:&nbsp; </strong>Thirty multiple-choice questionnaires of warfarin knowledge test for patients to complete at the clinic had item content validity index between 0.83-1.00, the difficulty index between 0.20-0.90, the discrimination index between 0.20-0.80 with the reliability of 0.76 and the construct validity of 0.76.</p> <p><strong><u>Conclusion</u></strong><strong>: </strong>&nbsp;The results shows that the developed warfarin knowledge test has acceptable level of quality for self-assessing the patient’s knowledge in routine clinical practice</p> Pornsiri Udomdachanut Apiruk Wongruttanachai Itsarawan Sakunrag Copyright (c) 2020-06-04 2020-06-04 35 3 272 277 Risk Factors for Birth Asphyxia in Newborns Delivered at Nongkhai Hospital <p><strong><u>Background and Objectives:</u></strong> Birth asphyxia is an important cause of perinatal death. The causes of birth asphyxia are mostly could be prevented or corrected in advance. This retrospective case-control study was undertaken to identify risk factors for birth asphyxia in Nongkhai hospital.</p> <p><strong><u>Methods:</u></strong> The medical records and birth registration database of 873 women giving birth at Nongkhai hospital during January 2018 to June 2019 were reviewed.. The study group&nbsp; comprised of 129 women who delivered newborns with an APGAR score at 1 minute equal to 7 or less, while the control group comprised of &nbsp;258 women who delivered newborns with an APGAR score at 1 minute more than 7. The potential factors affecting the risk of birth asphyxia &nbsp;were determined &nbsp;using the t-test and Chi-square. Multiple logistic regression was used to analyze the variables that were independently associated with birth asphyxia.</p> <p><strong><u>Results:</u></strong> Significant risk factors for birth asphyxia included fetal distress (OR=27.20, 95%CI=5.75-128.82), placenta previa (OR=13.49 , 95%CI=1.28-142.13), premature rupture of the membranes (OR=5.83, 95%CI=1.56-21.80), pregnancy induce hypertension (OR=4.49, 95%CI=1.55-12.98), and birth weight lower than 2,500 grams (OR=1.94, 95%CI=1.07-6.26), respectively.</p> <p><strong><u>Conclusion:</u></strong> Risk factors of birth asphyxia could be prevented. The early diagnosis and proper management will decrease birth asphyxia during delivery.</p> Sunida Panna Copyright (c) 2020-06-04 2020-06-04 35 3 278 286 Stress and Medication Adherence among Continuous Ambulatory Peritoneal Dialysis Patients <p><strong><u>Background and Objectives</u></strong><strong>:</strong> This study aimed to investigate the prevalence of stress and medication adherence and to analyze the relationship between stress and medication adherence among continuous ambulatory peritoneal dialysis (CAPD) patients at HRH Princess Maha Chakri Sirindhorn medical center. <strong><u>Methods</u>:</strong> This cross-sectional descriptive study was performed in 115 patients with CAPD. Research questionnaire included stress test of Department of Mental Health, Ministry of Public Health and Medication taking behavior tool in Thai patient (MTB-Thai).</p> <p><strong>&nbsp;<u>Results</u>:</strong> The prevalence of stress was 6.96% (slightly high-level of stress 5.22%; more high-level of stress 1.74%). CAPD patients with high, moderate and low level of medication adherence were 41.74%, 41.74% and 16.52%, respectively. &nbsp;However, no relationship between stress and medication adherence was found (p=1.000).</p> <p><strong><u>Conclusion</u></strong><strong>:</strong> CAPD patients at HRH Princess Maha Chakri Sirindhorn medical center had a low rate of stress and that was not associated with medication adherence.</p> Kantapat Puanglai Chanon Jarupaktranonth Siribha Changsirikulchai Jirayut Janma Wannakon Chuemongkon Copyright (c) 2020-06-04 2020-06-04 35 3 278 295 The Effect of Foot Reflexology Program to Relieve Pain in Patients with Cancer <p><strong><u>Background and Objectives:</u></strong> Pain in cancer is an important symptom of suffering that affects the overall health.&nbsp;&nbsp; The objective of this study was &nbsp;to study&nbsp;The effect of the foot reflexology program to reduce pain in cancer patients</p> <p><strong><u>Method:</u></strong> &nbsp;This was a quasi-experimental reseach.&nbsp; The studied subjects were 30 randomized sampling of cancer patients with pain at every stage of treatment in the special ward 6B, special nursing department.&nbsp;Srinagarind hospital&nbsp;Khon Kaen university.&nbsp;To use the method of massage according to the foot reflexology program to reduce pain in cancer patients developed by the researchers, 30 minutes each, 15 minutes on each side, consisting of a 4-minute basic leg massage, foot reflexology, basic points 26. 5-minute points and highlight 4 key points (3,15,16,&nbsp;17) 1/2 minute each point, total 2 sessions, total 4 minutes and basic massage to relax muscles 2 minutes. Data were collected by means of concealing in one way.&nbsp;(single-blind technique) use descriptive statistics in analysis by means of frequency distribution, percentage, mean, standard deviation&nbsp;And use Paired - Samples T - Test to compare the differences between the pain scores before and after receiving the foot reflexology program to reduce pain in cancer patients.</p> <p><strong><u>Results:</u></strong> Most of the patients, 66.6%, had colon cancer.&nbsp;The mean score of pain before and after receiving the foot reflexology program for pain reduction was 4.47 and 1.90 points, respectively.&nbsp;With statistically significant differences (t = 22.455, sig &lt;0.01)</p> <p><strong><u>Conclusion:</u></strong> Foot Reflexology Program can reduce pain in cancer patients.&nbsp;Which should be considered as an additional option in pain management&nbsp;And should massage with a massage specialist to maintain the effectiveness of the massage&nbsp;And prevent side effects from massage</p> Onanong Srisongmuang Apinya Karomprat Monpicha Chinrat Jarin Chindaprasirt Copyright (c) 2020-06-04 2020-06-04 35 3 296 303 Health Status and Health Behaviors among Elderly in Kham Kwang Sub-district, Warin Chamrap District, Ubon Ratchathani Province <p><strong><u>Background and Objective</u></strong><u>:</u> Good health behaviors could affect physical and mental health status. This study aimed to explore health status, health behaviors level and the relationship between health behaviors level and health status among elderly in Kham Kwang Sub-district, Warin Chamrap District, Ubon Ratchathani Province.</p> <p><strong><u>Method</u></strong><u>:</u> This was a survey study in a sample of 200 elderly, aged 60 year and older by purposive sampling. Data were collected by an interview form assessing health behaviors in the elderly and Thai GHQ-28 form developed by the Department of Mental Health with the Cornbrach’s alpha of 0.79 and 0.92 respectively, and access physical health status with general health check up. The descriptive statistics (frequency and percentage), Chi-square test and Fisher's Exact Test were used to analyze the data.</p> <p><strong><u>Results:</u></strong> &nbsp;Results revealed that the elderly had chronic illness 50.5% (the top 3 were hypertension, diabetes and hyperlipidemia, 30.7%, 23.8% and 8.4% respectively). There were 40.0% of the elderly being overweight and obesity 53.3% , 86.5% had normal metal health.The overall health behaviors were good level (88.5%) and correlated with mental health status statistically significant (p&lt;0.02). Health behaviors regarding physical activity and stress management needed to be improved.</p> <p><strong><u>Conclusion:</u></strong>&nbsp; Health behaviors level and health status of the elderly should be promoted in the form of health promotion and disease prevention.</p> Mintra Sararuk Thitirat Nganchamung Nantaya Krasuaythong Copyright (c) 2020-06-04 2020-06-04 35 3 304 310 Efficacy and Safety of Dispensing System by Pharmacy Robot and Handset Electronic Picking in Hospitalized Patients at Srinagarind Hospital <p><strong><u>Background and Objective</u></strong><strong>: </strong>The technology machines was used for filling the medicines for hospitalized patients at Srinagarind Hospital. The objective of this study was to evaluate efficacy and safety of dispensing system by pharmacy robot and handset electronic picking.</p> <p><strong><u>Methods</u></strong><strong>: </strong>This &nbsp;was a retrospective descriptive study. Drug prescriptions, dispensing items, waiting time, and dispensing errors were compared between before and after implementation of the robotic medicine and handset electronic picking for continued order items, narcotics and psychotropics category 2 items while other items were filled manually for hospitalized patients.</p> <p><strong><u>Results</u></strong><strong>: </strong>Mean waiting time for overall prescriptions was not significantly different between pre- and post- intervention (15.9 vs. 15.5 minutes per prescription). The mean waiting time for continued order prescriptions significantly increased 21.5% (0.7 vs. 0.8 minutes per item). The increased waiting time for continued order items occurred in the process of pharmacist checking since the continued order items increased 51.4% in the post- intervention period (666,888 vs. 1,009,667 items) and drug distribution system was changed from three days dose to one day dose which led to decreasing time for nurse to prepare medications for patients. The mean waiting time for stat order item significantly decreased 14.4% (14.9 vs. 12.8 minutes per item). For other subtype of prescription, no significant change of waiting time was found. Dispensing error significantly decreased 51.1% of prescriptions or 52.3% of items. The largest decrease in dispensing error was found in continued order items (77% decreased). Dispensing errors with severity category B and C decreased 50.3% and 89.1% of items.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong><u>Conclusions:</u></strong> Implementation of pharmacy robot and handset electronic picking of drug dispensing improved efficacy, dispensing errors, and patient safety for hospitalized patients.</p> Piangpen Chanatepaporn Copyright (c) 2020-06-04 2020-06-04 35 3 311 319 Quality of Life among Persons with Prostate Cancer <p><strong><u>Background and Objectives</u></strong><strong>: </strong>Cancer and its treatment often negatively affect patients’ quality of life (QOL). A study of QOL among persons with prostate cancer may help healthcare professionals in making an appropriate care plan for promoting patients’ QOL. This research aimed to explore quality of life among persons with prostate cancer and to compare their QOL classified by age, educational level, staging of disease, and treatments.</p> <p><strong><u>Methods</u></strong><strong>: </strong>This cross-sectional descriptive design recruited 127 participants from persons with prostate cancer admitted at a university hospital between January and June 2017. The research instrument used was a set of questionnaires, which consisted of the Demographic data questionnaire and the Functional Assessment of Cancer Therapy-Prostate<em>-</em><em>Thai questionnaire</em><em>&nbsp;</em>(<em>FACT</em><em>-</em>P). Data were analyzed using descriptive statistics and the Kruskal-Wallis test.</p> <p><strong><u>Results</u></strong>: The mean score of an overall QOL among persons with prostate cancer was at a high level (120.78±14.72). Based on the test, the participants receiving chemotherapy had an overall significantly different QOL from the participants treated with other methods (p=.039) by accounted was at a moderate level (100.33±19.22). Considering each aspect, the mean scores of QOL in physical well-being aspect and cancer specific aspect were at a moderate level (17.67±4.04, 28.00±4.59, respectively).</p> <p><strong><u>Conclusion</u></strong>: The result of this study revealed that the participants receiving chemotherapy had an overall QOL less than the participants treated with other methods. This finding suggests healthcare professionals should focus on care planning in order to reduce symptoms in persons with prostate cancer undergoing chemotherapy to improve the patients’ QOL.</p> Lalida Noppakun Rujadhorn Indratula Nuttamon Vuttanon Copyright (c) 2020-06-04 2020-06-04 35 3 320 325 The Satisfaction of Clinical Year Medical Students and Associated Factors Toward the E-portfolio System at Faculty of Medicine, Khon kaen University <p><strong><u>Background</u></strong> <strong><u>and objectives</u></strong>: &nbsp;The Faculty of Medicine at Khon Kaen University has established an outstandingly featured electronic portfolio (E-portfolio) system for completely recording the online databases of medical students’ academic performance across the whole undergraduate medical curriculum. The objective of this study were &nbsp;to assess the proportion of the fourth-to sixth-year medical students at Khon Kean University who expressed satisfaction with the E-portfolio system and&nbsp; to explore which factors influence student satisfaction.&nbsp;&nbsp;</p> <p><strong><u>Methods</u></strong>: An anonymous online satisfaction survey was conducted for 151 randomly selected medical students entering clinical rotations at Srinagarind Hospital during the 2019/20 academic years. Satisfaction was measured in a 4-point scale with the following responses: 1 being Poor, 2 being Average, 3 being Good, and 4 being Excellent. The analysis of factors related to student satisfaction was performed between satisfied (at least 3 points) and dissatisfied (2 points and below) groups.&nbsp; &nbsp;</p> <p><strong><u>Results</u></strong>: Approximately 76.8 (116/151) of the participants were satisfied overall with the E-portfolio system they used. An awareness of the academic purpose of using an E-portfolio which is to reflect the learning outcomes was significantly associated with participants’ satisfaction (p = 0.005).</p> <p><strong><u>Conclusion</u></strong><strong>:</strong> A large portion of the clinical year medical students at Khon Kaen University is satisfied with the use of E-portfolios in the educational contexts. The most important factor influencing students’ satisfaction is a clear understanding of E-portfolio implementation for learning achievements.</p> Sonphalot Santiworawut Kanticha Piriyametha Nathawat Chaisuwirat Tuangporn Pornchai Sirilak Chalongkodchakon Sompong Srisaenpang Somdej Pinitsoontorn Saipin Simsakaew Copyright (c) 2020-06-04 2020-06-04 35 3 326 331 Sleep Pattern among Students in Khon Kaen University <p><strong><u>Background and Objective</u></strong><strong>: </strong>Undergraduate students have many changes in their life, which may affect the sleep patterns causing several health problems<strong>. </strong>This study aims to study the perception of problems and the sleep patterns of undergraduate students who attended Primary Care Unit 123 Khon Kaen University.</p> <p><strong><u>Methods</u></strong>:&nbsp; This study was a descriptive study. Population were the undergraduate students attending at Primary Care Unit 123 Khon Kaen University. The calculated sample size was 120. The samples were recruited by time frame allocation. The self-administered questionnaire information including demographic data, sleep information during the past 1 year and additional needs information about sleep problems. The results were analyzed by descriptive statistics and inferential statistics.</p> <p><strong><u>Results</u></strong><strong>: </strong>Among 120 college students, most of them (47.5%, 95%CI: 38.38 - 56.78) thought that they had problems in sleeping. Most of them start sleeping at 0.00 - 2.00 a.m., awaking during 6.00 - 8.00 a.m., the number of hours of sleeping was more than 5 hours per day. In college students who thought that they had problems in sleeping, 52.6 percent spent more than 30 minutes for falling asleep, 29.8 percent into bed after 2:00 a.m. and 33.3 percent sleeping less than 5 hours per day.</p> <p><strong><u>Conclusion</u></strong><strong>:</strong> Most of college students thought that they had trouble in sleeping. The college students who thought that they had problems in sleeping often had problems at the beginning of sleep and the number of sleeping hours in each day less than 5 hours. Therefore, caring of this such population should include screening and education of sleeping problems.</p> Nisachon Butsathon Varisara Luvira Pat Nonjui Phahurat Deenok Wilawan Aunruean Copyright (c) 2020-06-04 2020-06-04 35 3 332 339 Non-AIDS defining illness and mortality in HIV patients <p>HIV is the virus destroying body immune system especially, white blood cell named CD-4 cell. This cell can protect the body from many infectious diseases. Early antiretroviral therapy (ART) and continuing will make people living with HIV (PLWHIV) healthy, improve quality of life and prolonged life. Thailand national guideline on HIV/AIDS treatment and prevention 2017 was recommended the first line ART; 2 nucleoside reverse transcriptase inhibitor plus 1 non-nucleoside reverse transcriptase inhibitor. It was called highly active ART (HAART) leading to a long life. However, antiretroviral drugs (ARV) are associated with lipid profile, insulin resistance and lipodystrophy resulting in high risk of non-AIDs illness such as cardiovascular disease and metabolic syndrome. Though immune&nbsp;system was improved after ART but it is not full restoration increasing risk of cancer and mortality rate from non-AIDs illness. According to privilege for PLWHIV and AIDS by national health security, laboratory and special investigations did not cover all non-AIDs illness. Then, screening and diagnosis could not be performed and accessing to prophylaxis and treatment will be delayed. Reconsideration of their privilege will improve patient care and promote quality and prolong their life.</p> Duangjai - Duangrithi Copyright (c) 2020 Srinagarind Medical Journal 2020-05-25 2020-05-25 35 3 346 352 Elevating the Autophagic Process by Balancing the Biological Clock <p>Autophagy or self-eating is a cellular process that facilitates the elimination of deteriorated cellular components to prevent cellular dysfunction and disease development. This mechanism interrelates with the biological clock, the controlling system in the living organism through sleep-wake cycle. During sleep, biological clock stimulates tissue repairing hormone secretion, while the autophagy acts mainly on the clearance of metabolic wests. In the sleep deprivation state, the biological clock will be interfered and this could lead to several diseases such as neurodegenerative diseases, diabetes, fatty liver, cardiovascular diseases and cancers. Therefore, the healthy sleep habits combined with healthy diet and exercise will improve the biological clock and the activation of autophagy mechanism for better life and longevity.</p> Phichamon Phetchahwang Worasak Kaewkong Copyright (c) 2020-06-04 2020-06-04 35 3 340 345 Rehabilitation after Anterior Cruciate Ligament Reconstruction <p>Anterior cruciate ligament reconstruction is a surgical method of treating patients who have had an injury to the anterior cruciate ligament. Rehabilitation after this surgery is important, and its main goal is to enable a patient to return to his or her common activities. This post-surgical rehabilitation has various stages, each of which has its own methods especially choosing bone-patellar tendon-bone grafts, which is a gold standard method. These stages include reducing pain, decreasing swelling or effusion, increasing range of motion, using aid devices, bearing weight on the involved leg, proprioception exercises, and physical performance training, which includes muscle strength, flexibility, and endurance. Then come functional movement training and rehabilitation for return to sport. For a full recovery, should be accompanied by training aimed at improving core strength, upper-body strength, and cardiovascular strength.</p> Sompiya Somthavil Onuma Boonyarom Kanokwan Srisupornkornkool Copyright (c) 2020-06-04 2020-06-04 35 3 353 361 Oral Health Promotion and Diabetes Prevention in the Elder <p>Thailand will become completed aged society in 2021, found that 1 in every 5 elderly people has diabetes. Long-term&nbsp; complications&nbsp; in poorly controlled sugar levels in elderly<em> diabetic</em>&nbsp;patients were retinopathy, neuropathy, nephropathy, cardiovascular disease and periodontitis. Periodontitis in elderly <em>diabetic</em>&nbsp;patients need the treatment from dentists, otherwise it will affect the glycemic control because periodontitis and diabetes were bidirectional relationship.&nbsp;The aim of this article was to review the effective measures on oral health promotion and diabetes prevention in the elder. The data were gathered from an electronic database that published in Thai and English. The result concluded that it was absolutely necessary to prepare for facing with elderly <em>diabetic</em>&nbsp;patients by focusing on working as&nbsp; multidisciplinary team and rapid screening in risk groups of the elderly for early detection of diabetes. Furthermore, emphasize on promoting oral health in elderly <em>diabetic</em>&nbsp;patients for reducing tooth loss and to have a good quality of life.</p> Worrawan Asawakun Copyright (c) 2020-06-04 2020-06-04 35 3 362 370