Srinagarind Medical Journal

Pregabalin in Epilepsy: Current Evidence and Clinical Perspectives

Sun, 26 Oct 2025 00:00:00 +0700

Epilepsy is a chronic neurological disorder that significantly impacts quality of life and poses a substantial public health burden, particularly among patients with drug-resistant epilepsy (DRE), which affects up to 30% of cases despite the availability of newer antiepileptic drugs. Pregabalin, a second-generation antiepileptic drug, exerts its therapeutic effects by binding to the α₂δ subunit of P/Q-type voltage-gated calcium channels, thereby reducing the release of excitatory neurotransmitters and contributing to seizure control. Additionally, pregabalin possesses anxiolytic and analgesic properties, and is therefore utilized in other clinical indications such as generalized anxiety disorder, neuropathic pain, and fibromyalgia. Clinical evidence from randomized controlled trials and observational studies supports the efficacy and tolerability of pregabalin as an adjunctive therapy for focal-onset seizures, with dose-dependent improvements in seizure response. Common adverse effects include dizziness, somnolence, ataxia, weight gain, and peripheral edema, which are generally dose-related and influenced by renal function. Pregabalin offers additional clinical advantages in patients with comorbidities, the elderly, post-liver transplantation patients, and individuals with alcohol use disorders due to its minimal hepatic metabolism and low potential for drug–drug interactions. However, its safety profile during pregnancy remains uncertain and warrants cautious use. This review article provides a comprehensive overview of the mechanism of action, pharmacokinetic profile, clinical applications, and evidence-based efficacy and safety of pregabalin, with the aim of supporting its appropriate use in the management of epilepsy.

Prevalence and Factors Associated with Abnormal Uterine Bleeding among Reproductive-Aged Women at Kaset Wisai Hospital : Retrospective Descriptive Study

Jiraporn Silaphongpaiboon — Wed, 29 Oct 2025 00:00:00 +0700

Background and Objective: Abnormal uterine bleeding (AUB) is a significant global health concern affecting reproductive-age women. Understanding its prevalence and risk factors is critical for targeted interventions. To determine the prevalence and identify risk factors associated with AUB among reproductive-age women seeking care at Kaset Wisai Hospital, Thailand.

Methods: A retrospective descriptive study was conducted using medical records of 281 eligible reproductive-age (15-49-years-old) women treated between October 1, 2022, and September 30, 2024. Data were analyzed using descriptive statistics and multivariate logistic regression

Results: The prevalence of abnormal uterine bleeding among women of reproductive age (15–49 years) was 75.1% (95% CI: 70.00–80.15). Statistically significant associations (p < 0.05) were observed with obesity, defined as body mass index (BMI ≥ 35 kg/m²) (AOR = 3.53; 95% CI: 1.61–7.73). In contrast, endometriosis was identified as a protective factor against abnormal uterine bleeding (AOR = 0.28; 95% CI: 0.15–0.54).

Conclusion: The findings of this study highlight the significance of body mass index as factors associated with abnormal uterine bleeding. These results underscore the importance of accurate etiological diagnosis to support effective assessment and management of abnormal uterine bleeding among reproductive-aged women at risk.

Prevalence and Associated Factors of Birth Asphyxia in Term Neonate: A Multicenter Retrospective Case-Control Study

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objectives: Birth asphyxia is a major cause of neonatal morbidity, long-term disability, and mortality. Therefore, this study aimed to investigate the prevalence and associated factors of intrapartum asphyxia among term newborns in multiple hospitals across Thailand. The findings from this study may be used to support surveillance and preventive strategies to reduce the incidence of birth asphyxia in newborns.

Materials and Methods: This retrospective case-control study utilized data from the electronic medical records of Wanon Niwat Hospital, Udon Thani Hospital, Ang Thong Hospital, Ban Phue Hospital, Ban Dung Hospital, and Nong Han Hospital. The study investigated birth asphyxia among 25,366 term infants delivered between January 1, 2018, and December 31, 2022. Mothers of term infants diagnosed with birth asphyxia were identified as the case group and compared with mothers of term infants without asphyxia, who served as the control group. The prevalence and associated factors of birth asphyxia were analyzed using multiple logistic regression.

Results The prevalence of birth asphyxia was 2.43%. Statistically significant risk factors included maternal age 35 years or older (adjusted odds ratio [AOR] 1.41; 95% CI: 1.05–1.88), nulliparity (AOR 1.91; 95% CI: 1.52–2.40), maternal education at the undergraduate level (AOR 1.90; 95% CI: 1.26–2.87), maternal overweight (AOR 1.39; 95% CI: 1.08–1.79), maternal obesity (AOR 1.54; 95% CI: 1.07–2.23), pregnancy-induced hypertension (AOR 1.68; 95% CI: 1.18–2.40), cesarean delivery (AOR 1.30; 95% CI: 1.04–1.63), small for gestational age (AOR 2.43; 95% CI: 1.83–3.24), and non-vertex presentation (AOR 2.16; 95% CI: 1.45–3.21).

Conclusion: The prevalence of birth asphyxia in this study was 2.43%. The most significant risk factor identified was small for gestational age, a condition that is potentially preventable. Early and consistent monitoring for intrauterine growth restriction (IUGR), accurate diagnosis, and timely intervention in the high risk cases are essential in reducing the prevalence of birth asphyxia.

Prevalence and Associated Factors of Fall Risk among Older Adult Patients at the Outpatient Department of Srinagarind Hospital, Khon Kaen Province

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objectives: Falls among the older adults are a significant issue in Thailand, being the second leading cause of death due to unintentional injuries after road traffic accidents. This study aimed to investigate the prevalence of fall risk and its associated factors among older adult patients at the outpatient department of Srinagarind Hospital in Khon Kaen Province. The findings will provide recommendations for elderly patients and their caregivers on preventing future falls.

Methods: This descriptive cross-sectional study involved 276 older adult patients who visited at the outpatient department of Srinagarind Hospital during office hours in April 2023. Participants were selected using a time-based sampling method. Data were collected using a self-administered questionnaire that consisted of three sections: demographic information, fall risk assessment, and identification of risk factors for falls. The data were analyzed using descriptive statistics, chi-square tests, odds ratios (OR), and multiple logistic regression.

Results: The response rate was 100% (276/276). The majority of participants were female (56.5%). Prevalence of fall risk among older adult patients was 42.40% (95% CI: 36.50%-48.30%). Factors significantly associated with the risk of falls are a history of falls within the past year (Adjusted Odds Ratio [AOR] = 4.32, 95% CI: 2.24-8.30), muscle weakness not related to cerebrovascular disease (AOR = 4.05, 95% CI: 1.80-9.16), syncope due to cardiovascular problems (AOR = 3.02, 95% CI: 1.20-7.63), diabetes mellitus (AOR = 1.88, 95% CI: 1.01-3.48), no living on the first floor of the house (AOR = 2.38, 95% CI: 1.04-5.48), and housing characteristics (AOR = 0.47, 95% CI: 0.25-0.90).

Conclusion: Approximately 4 in 10 older adult outpatients were at risk of falling. The factors significantly associated with this risk include a history of falls within the past year, non-stroke-related muscle weakness, cardiovascular-related syncope, diabetes mellitus, living on the first floor of the house, and housing characteristics.

Quality of Life of Patient with Major Depressive Disorder at Psychiatric Out-Patient Services in Srinagarind Hospital

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objective: Patients with major depressive disorder (MDD) experience significantly deteriorated quality of life (QOL), causing numerous negative impacts across various domains. The objectives of this study were to explore the QOL among patients with MDD in domains of physical, psychological, social relationships, and environment and to investigate factors associated with QOL scores in MDD.
Methods: A retrospective descriptive study among the first-visited MDD patients aged 15–60 was conducted between June 2020 and June 2021 at psychiatric outpatient services in Srinagarind Hospital. The instruments used in the study included a general information questionnaire, the 9-question depressive symptoms screening (9Q), the 8-question suicidal risk evaluation (8Q), and the World Health Organization Quality of Life Brief–Thai (WHOQOL-BREF-THAI). The variables that statistically significant associated with QOL scores were included in the multiple linear regression model to analyse the predictive factors for QOL in MDD.
Results: Out of 96 MDD patients, 68 (70.8%) had overall QOL at a moderate level, and 23 (24.0%) had poor QOL. The QOL in the psychological domain was more frequently scored at a poor level compared to other domains in most MDD patients (53.1%). Depressive severity (9Q) and suicidal risk (8Q) scores were significantly negatively associated with QOL scores (β=-1.120, p<0.001 and β=-0.310, p<0.017). However, results from the multiple linear regression analysis showed that depressive severity was the only significant predictive factor for QOL level in MDD (β=-1.220, p<0.001; adjusted R²=0.310, F(2,91)=21.846, p<0.001).
Conclusion: Most of the MDD patients had overall QOL at a moderate level and the psychological domain of QOL was scored at a poor level more than others. The severity of depressive symptoms was the significant predictive factor for QOL level in MDD.

Prevalence and Factors Associated with Depression in Elderly Patients with Chronic Diseases in Primary Care Unit, Khon Kaen Province

Wed, 29 Oct 2025 00:00:00 +0700

Background and objective: The prevalence of depression among elderly individuals in Thailand in 2025 was 0.08 percent. However, this prevalence demonstrated a notable increase among elderly populations with chronic diseases in Thailand, reaching 22-37 percent. Depression may significantly impact the quality of life and healthcare management of elderly individuals. This study aims to determine the prevalence of depression and factors associated with depression in elderly patients with chronic diseases receiving care at primary healthcare facilities in Khon Kaen Province.

Methods: A descriptive cross-sectional study was conducted among 300 patients aged 60 years or older with chronic diseases who received care at primary healthcare units in Khon Kaen Province. Data were collected using questionnaires that assessed personal information, physical health, health behaviors, activities of daily living, the patient health questionnaire (PHQ-2 and PHQ-9), and family and social health. Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression analysis.

Results: Two hundred ninety-eight patients were recruited. The response rate was 99.3%, with 69.8% female (208 individuals). The prevalence of depression among the participants was 13.8%. Significant factors associated with depression included poor health status (adjusted odds ratio (AOR) = 5.05, 95% CI = 1.91 - 13.20), family conflict (AOR = 3.14, 95% CI = 1.16 - 8.52), and lack of participation in social activities (AOR = 4.73, 95% CI = 1.89 - 11.86).

Conclusion: Approximately one in seven elderly patients with chronic diseases receiving services at primary care units experiences depression. The statistically significant factors influencing depression were poor health status, family conflict, and lack of participation in social activities. Therefore, public health personnel should prioritize screening, prevention, assessments, and management of depression in elderly patients with chronic diseases, especially in those having health and/or social problems.

The Effects of Breathing and Aerobic Exercises on Physical Fitness and Quality of Life in Patients with Asthma

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objective: Breathing and aerobic exercises are known to be beneficial for patients with asthma. However, research on combining these exercises is limited. Therefore, this study investigated the effects of a combining breathing with aerobic exercise on physical fitness and quality of life in asthmatic patients.

Methods: This study was a single-blind, randomized controlled trial. Thirty patients with asthma were randomly allocated to either a control group (CG) or a training group (TG) in 1:1 ratio. Participants in the CG performed aerobic exercise only, whereas those in the TG participated in both aerobic exercise and breathing exercise program. Both groups exercised for 50 minutes per session, 3 times per week, for a duration of 12 weeks. Physical fitness parameters including static balance (one leg stand test; OLST), dynamic balance (time up and go test; TUGT), and lower limb strength (five-time sit to stand test; FTSST), along with quality of life (mini asthma quality of life questionnaire; mini-AQLQ) were evaluated at baseline, mid-intervention (6 weeks), and post-intervention (12 weeks).

Results: Both exercise interventions significantly increased OLST, TUGT, FTSST, and mini-AQLQ scores at both 6 and 12 weeks of the study period when compared with baseline (p < 0.05). Interestingly, the TG showed significantly greater improvements in OLST, TUGT, FTSST, and mini-AQLQ (total scores and symptom domain) compared to the CG at 12 weeks (p < 0.05).

Conclusions: These results suggest that the combination of breathing and aerobic exercises effectively improve physical fitness and quality of life in asthmatic patients.

The Area to Avoid in the Ear Canal to Prevent a Cough Reflex During Ear Suction

Parapat Jeungchotipat — Tue, 28 Oct 2025 00:00:00 +0700

Background and Objective: Ear suction is a commonly performed procedure for both diagnostic and therapeutic purposes in the management of ear disorders. However, some patients may experience involuntary coughing or discomfort during the procedure, which is believed to result from stimulation of the sensory nerves supplying the external auditory canal. The external auditory canal receives sensory innervation from several nerves, including the auriculotemporal nerve from the trigeminal nerve (cranial nerve V), the auricular branch of the vagus nerve, the facial nerve, the glossopharyngeal nerve, and the great auricular nerve from the cervical plexus (C2–C3). Variations in the distribution of these nerves among individuals may lead to differences in sensitivity across the external auditory canal. Stimulation at certain sites may induce a more pronounced cough reflex or immediate pain than at others. This study aimed to identify the specific anatomical areas of the external auditory canal that should be approached with caution during ear suction due to their tendency to provoke an immediate cough reflex, as well as to assess the level of pain associated with each site. The findings may help clinicians determine safer suction areas, minimize unnecessary stimulation, improve patient comfort, and enhance the overall safety of otologic procedures.

Methods: This descriptive cross-sectional study was conducted among patients undergoing ear suction at the Department of Otolaryngology, Vachira Phuket Hospital, between June 1 and July 7, 2025. The objective was to evaluate the anatomical sites within the external auditory canal associated with immediate induction of the cough reflex and the corresponding pain level. Suctioning was performed in the asymptomatic ear at four sites: anterior canal wall, posterior canal wall, superior canal wall, and inferior canal wall. The order of stimulation was randomized. Cough reflex occurrence and pain intensity were recorded using the Numeric Rating Scale (NRS, 0–10), and differences in mean scores across sites were analyzed using independent t-tests.

Results: Among 43 patients, 15 (34.9%) exhibited an immediate cough reflex during ear suction. The inferior wall of the external auditory canal was the most frequent trigger site (7/15 cases, 46.7%), followed by the posterior (5/15), anterior (2/15), and superior walls (1/15). The highest mean cough score (8.0 ± 1.2) was observed following inferior wall stimulation, whereas posterior wall stimulation resulted in the highest mean pain score (2.0 ± 0.8). Differences in both cough and pain scores across stimulation sites were statistically significant (p < 0.01 and p = 0.02, respectively), based on independent t-tests.

Conclusion: The inferior wall of the external auditory canal appears to be the most frequent anatomical site triggering an immediate cough reflex during ear suction, possibly due to vagal innervation via Arnold’s nerve. Awareness of this sensitivity and minimizing stimulation at this site may help improve patient comfort and enhance procedural safety.

Development of Postpartum Care Model for Pregnant Women with Methamphetamine Use in Kalasin Province

Natkritta Thumwong — Sun, 26 Oct 2025 00:00:00 +0700

Background and Objective: Methamphetamine use during pregnancy severely impacts both mothers and infants. Effective postpartum care is crucial for methamphetamine relapse prevention and promoting maternal and infant health. This study aimed to develop and evaluate the effectiveness of a postpartum care model for pregnant women with methamphetamine use in Kalasin Province.

Methods: This research and development (R & D) followed Kemmis and McTaggart's framework, comprising planning, action, observation, and reflection phases. The sample consisted of 88 postpartum women with a history of methamphetamine use in Kalasin Province. The care model included hospital assessment on the second day postpartum, home visits within one week after discharge, postpartum examination at 4-6 weeks with group therapy, home visits at 8-12 weeks, and hospital assessment at 24 weeks. Data collection instruments included a personal information interview form, family readiness assessment (FRA), and relapse risk assessment form. Data were analyzed using frequency, percentage, mean, standard deviation, Kolmogorov-Smirnov, and ANOVA.

Results: Comparing before and after intervention, significant improvements were observed in home environment, family bonding, acceptance and forgiveness, and social networking (p<0.01). The risk of relapse significantly decreased (p=0.02), with high-risk cases reducing from 68.20% to 25.00%. Family readiness for patient care showed the greatest improvement in problem-solving capacity (from 21.20% to 87.90%), role recognition and performance (from 42.40% to 97.00%), and knowledge of patient care (from 27.30% to 54.50%).

Conclusion: The developed postpartum care model for pregnant women with methamphetamine use effectively reduced relapse risk and enhanced family readiness for patient care, with significant improvements in environmental conditions, family relationships, and social support. This model can be applied to the care of postpartum women with a history of methamphetamine use in other areas to improve the quality of life for both mothers and infants.

Usage Patterns and Bleeding Complications of Non-vitamin K Antagonist Oral Anticoagulants in Patients at Srinagarind Hospital: A Retrospective Descriptive Study

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objective: Stroke and thromboembolism represent major public health concerns, especially for patients with atrial fibrillation (AF) who are at high risk. Although non-vitamin K antagonist oral anticoagulants (NOACs) have advantages over warfarin, real-world data on their usage patterns and safety, particularly the risk of bleeding in the Thai population, are still limited. Therefore, this study aimed to investigate the utilization patterns of NOACs, patient characteristics, the incidence of bleeding, and factors associated with bleeding events. The findings will contribute to the development of enhanced pharmaceutical care and patient management guidelines.

Methods: This retrospective descriptive study included 1,654 patients treated with NOACs at Srinagarind Hospital from 1 December 2014 to 31 December 2023. We collected data on patient demographics, diagnoses, comorbidities, CHA₂DS₂-VASc and HAS-BLED scores, renal and hepatic function, medication type and dosage, concomitant medications, and the occurrence of bleeding events.

Results: Of the 1,654 patients who received NOACs between December 2014 and December 2023 at Srinagarind Hospital, 54.8% were male, with a mean age of 70.6 years. A significant portion of the patients (43.2%) was aged 75 years or older. The primary diagnosis was atrial fibrillation (AF) in 65.1% of patients. Hypertension and diabetes were common comorbidities. The mean CHA₂DS₂-VASc score was 2.9, and the mean HAS-BLED score was 1.2. Apixaban 5 mg/tab was the most frequently prescribed NOAC (27.5%). Bleeding events occurred in 34 patients (2.1%), with the majority being gastrointestinal bleeding (85.3%). Of those who experienced bleeding, 25 had one primary diagnosis, while 9 had two or more. There were no bleeding-related deaths. A higher HAS-BLED score was identified as a significant risk factor for bleeding (p < 0.05). The use and dosing of NOACs were generally appropriate for patients' renal function. Notably, the group receiving edoxaban 30 mg had the lowest mean creatinine clearance (CrCl) of approximately 48 mL/min, reflecting its selection for patients with renal impairment. Overall hepatic function was within normal limits, with a mean aspartate Aminotransferase: AST of 32.9 U/L and a mean Alanine aminotransferase: ALT of 27.9 U/L. Although 17.2% of patients had an AST ≥40 U/L and 11.7% had an ALT ≥41 U/L, no significant signals of hepatotoxicity were observed.

Conclusion: NOACs demonstrate excellent safety profile in real-world clinical practice with a low bleeding incidence rate (2.1%). However, individual risk assessment remains crucial. Pharmacists and multidisciplinary healthcare teams play essential roles in optimizing medication management and ensuring patient safety.

Analytic Statistics of Type A Pharmacological Adverse Drug Reactions at Srinagarind Hospital

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objectives: Adverse drug reactions (ADRs) are clinical issues that affect patient safety and can be classified into two types: A and B. Type A reactions, which relate to pharmacological effects, are usually preventable or their severity can be reduced. This study aimed to analyze the characteristics of Type A ADR reports in detail, identify patterns of severity and causative drugs, and explore opportunities for developing proactive strategies to create a prevention system and enhance patient safety.

Methods: This retrospective descriptive study was conducted among patients who experienced ADRs. Data were collected from Srinagarind hospital's information system between 2020 and 2024. Descriptive statistics, including frequency distributions and percentages, were used for data analysis.

Results: Over the 5-year study period, a total of 1,280 Type A ADRs were reported, making up 8.38% of all ADR reports (95% CI: 7.94–8.82). Most occurred in female patients (924 cases, 72.19%) and outpatients (914 cases, 71.41%). Among the causative drugs, amlodipine ranked first with 156 events (12.19%), mainly presenting as edema, followed by tramadol with 122 events (9.53%), which often caused nausea and vomiting. Importantly, the main concern was not just the most frequently reported drugs but the severity of the reactions. While most cases (1,221 events, 95.39%) were non-serious, 59 serious events (4.61%) were reported. Metformin was the primary cause of these serious events (15 events, 1.17%), leading to life-threatening metformin-induced lactic acidosis (MALA). Among patients without previous ADR history (new cases), serious events were not linked to drugs classified as high-risk but were instead caused by drugs not typically included in high-risk categories. Notably, dapsone had the highest incidence relative to its use, with one case (0.33%) of methemoglobinemia.

Conclusion: A total of 1,280 Type A ADRs (8.38%) were reported, which is lower than in other studies, and the quality of available data was insufficient for further detailed analysis and review. There is a need to establish a systematic ADR surveillance system, especially focusing on high-risk drugs, drugs linked to severe Type A ADRs, and preventable incidents, to improve medication safety.

The Effects of Kiwi Ice Cream Development as A Healthy Alternative Food

Sun, 26 Oct 2025 00:00:00 +0700

Background and Objective: Kiwi is a highly nutritious fruit, rich in vitamin C, dietary fiber, and antioxidants. It offers health benefits by boosting the immune system and preventing cellular degeneration. Developing kiwi into a health food product in the form of ice cream could serve as a beneficial alternative for individuals with health concerns. Therefore, the objective of this study is to investigate the effects of kiwi ice cream development as a healthy food alternative.

Methods: This study is an experimental study. The researcher developed kiwi into a health product in the form of kiwi ice cream. Then, 30 healthy volunteers participated in the experiment using a blind test method to compare the developed kiwi ice cream with a control formula. Taste acceptance was evaluated using three types of questionnaires: the 9-point hedonic scale, a descriptive evaluation form, and a labeled scale evaluation form. The questionnaires were content-validated by experts (index of item objective congruence [IOC] ranging from 0.67 to 1.00) and showed good reliability (with a Cronbach’s alpha of 0.87). The data were analyzed using paired t-test statistics with the significance level set at p < 0.05.

Results: Sensory acceptance evaluation using the 9-point hedonic scale revealed that the developed kiwi ice cream showed no significant difference in appearance compared to the control formula (p = 0.209). However, it scored significantly lower in aroma, taste, texture, and overall liking (p < 0.05). In the descriptive evaluation, there were no significant differences between the kiwi ice cream and the control in terms of appearance, color, aroma, taste, and texture (p = 0.107, p = 0.625, p = 0.831, p = 0.107 and p = 0.102, respectively). According to the labeled scale evaluation, the kiwi ice cream had significantly lower scores in sweetness, creaminess, and intensity (p < 0.05), but showed no significant difference in fragrance and stickiness (p = 0.769 and p = 0.489, respectively). Therefore, the developed kiwi ice cream differs from the control in aroma, taste, sweetness, creaminess, intensity, texture, and overall preference—falling within the range of “slightly liked”. This suggests that although kiwi ice cream was not rated as highly as the control, it remains within an acceptable range, particularly for health-conscious consumers seeking alternative food options.

Conclusion: The developed kiwi ice cream has potential as a health food product; however, the formulation should be refined in terms of sweetness, greasiness, and extreme flavor to enhance consumer taste acceptance.