Srinagarind Medical Journal

Tip-Apex Distance and Other Predictors of Outcome in Intertrochanteric Femoral Fractures Managed with Proximal Femur Nail Antirotation (PFNA)

Phannakij Wanaseangsagul — Fri, 23 Oct 2026 00:00:00 +0700

Backgroundand objective: Intertrochanteric femoral fractures are a significant public health issue among the elderly. While Proximal Femoral Nail Antirotation (PFNA) is the standard treatment, screw cutout remains a major complication. Traditionally, Tip-Apex Distance (TAD) is used to predict failure, but its predictive value for modern PFNA implants remains controversial. This study aimed to investigate the association between TAD and other clinical and radiological predictors with the incidence of screw cutout in patients treated with PFNA.

Methods: A retrospective cohort study was conducted at Surin Hospital (2019–2023). 163 patients aged ≥ 55 years treated with PFNA were analyzed. Risk factors were identified using univariable and multivariable logistic regression.

Results: Among 163 patients included, screw cutout occurred in 10 cases (6.1%). The mean age was 80.0 years. There was no statistically significant association between TAD and screw cutout (p=0.389). However, univariable analysis indicated that the cutout group had significantly lower hip bone mineral density (BMD) (p=0.005), higher screw-neck ratios (p=0.0006), and a higher prevalence of superior screw positioning (p=0.012) compared to the success group. Penalized Multivariable analysis identified a higher screw-neck ratio as the only independent predictor for screw cutout (p=0.0050).

Conclusion: TAD alone was not a reliable predictor of PFNA failure in this study.Fixation failure appears to be more closely related to poor bone quality and technical factors, specifically superior screw placement and high screw-neck ratios.

Outcomes of Horizontal Strabismus Surgery Performed by a Single General Ophthalmologist and Predictors of Success: A Retrospective Study

Panwad Uthiyo — Fri, 23 Oct 2026 00:00:00 +0700

Background and objective: Most published reports on strabismus surgery outcomes originate from specialist centers, including tertiary referral hospitals and academic institutions. In Thailand, however, strabismus surgery may also be performed by general ophthalmologists in general hospitals. Evidence regarding surgical outcomes in this real-world setting remains scarce, especially data stratified by strabismus subtype. This study aimed to evaluate the surgical outcomes of horizontal strabismus and identify factors associated with surgical success in a general ophthalmology setting.

Methods: This retrospective cohort study included 80 consecutive patients who underwent primary horizontal strabismus surgery performed by a single general ophthalmologist (not a strabismus specialist) in Thailand between 2019 and 2025. Surgical success was defined as postoperative alignment within 10 prism diopters (PD) of orthotropia at final follow-up. Outcomes were analyzed by strabismus subtype. Univariable logistic regression was performed, followed by Firth penalized logistic regression to account for complete separation.

Results: The overall short- to intermediate-term surgical success rate was 68.8% (55/80). Success rates differed significantly by subtype (p<0.001): esotropia (ET) 83.3%, exotropia intermittent basic (XT-IB) 83.3%, XT convergence insufficiency 75.0%, XT sensory 44.4%, XT constant 37.5%, and XT divergence excess (XT-DE) 0.0%. On multivariate analysis using Firth penalized logistic regression (n=75), only XT constant and sensory subtypes remained independently associated with lower odds of success compared with ET (adjusted OR 0.17, 95% CI 0.03–0.97, p=0.046). All XT-DE cases (0/5) failed and were excluded due to complete separation.

Conclusions: In strabismus surgery performed by a general ophthalmologist, strabismus subtype—particularly XT constant and sensory—was the primary determinant of surgical outcome after adjustment, whereas deviation magnitude and surgical dose were not independently associated. The uniformly poor outcomes in XT divergence excess highlight the importance of accurate preoperative subtype classification and appropriate referral to strabismus specialists for selected subtypes.

Associated Factors of Liver Stiffness in Psoriatic Patients Receiving Methotrexate

Manasalak Ariyachaipanich — Fri, 23 Oct 2026 00:00:00 +0700

Objective: To study the clinical factors independently associated with Liver Stiffness Measurement (LSM) by Transient Elastography among psoriatic patients receiving Methotrexate at tertiary care hospital.

Methods: A retrospective cross-sectional study was conducted among 26 patients treated with MTX who underwent Transient Elastography examination between 2020-2026. Descriptive statistics were used to characterize the baseline data, and Multiple Linear Regression was employed to identify independent predictors of liver stiffness. Clinical confounders were controlled, with statistical significance set at < 0.05.

Results: The majority of the sample was male (57.7%), with a median age of 49 years and a median weight of 74 kg. Most patients (61.5%) had a cumulative dose ≤ 1.5 g. The median liver stiffness was 5.8 kPa (IQR: 4.6–6.6). Multivariable analysis revealed that total bilirubin showed the strongest positive association (beta = 24.6, 95% CI: 17.8–31.5, p < 0.001), followed by aspartate aminotransferase (AST) levels (beta = 0.3, 95% CI: 0.1–0.5, p = 0.004). This model explained 91.9% of the variance in LSM (adjusted R2 = 0.919). However, total cumulative dose and duration of treatment showed no statistically significant association with liver stiffness (p = 0.738 and 0.381, respectively).

Conclusion: Serum total bilirubin and AST levels showed stronger association with liver stiffness than cumulative MTX dose in this study. However, given the high adjusted R² in a small sample, these findings should be interpreted with caution and confirmed in larger prospective studies

Incidence of N-acetyltransferase 2 Genotype Testing of Tuberculosis Patients in a Provincial Hospital, Northeastern of Thailand

Thamarerk Sangngean, Wanida Sanmuang — Fri, 23 Oct 2026 00:00:00 +0700

Background and objectives: Genetic polymorphisms of the N-acetyltransferase 2 (NAT-2 gene) gene play a crucial role in the metabolism of isoniazid and are associated with adverse drug reactions, particularly hepatotoxicity in patients with tuberculosis. This study aimed to investigate the incidence and distribution of NAT2 genotypes, as well as their association with hepatotoxicity among tuberculosis patients.

Methods: A retrospective study was conducted using medical records of tuberculosis patients who underwent NAT-2 gene at Roi Et Hospital between October 2021 and December 2023. A total of 343 patients were included. Descriptive statistics and Chi-square test.

Results: Among the 343 patients, the distribution of acetylator phenotypes was as follows: intermediate acetylators 43.1%, ultra-slow acetylators 34.4%, rapid acetylators 13.7%, and slow acetylators 8.7%. The incidence of hepatotoxicity was lower in rapid and intermediate acetylators 11.9% and 15.5%, respectively, whereas it was markedly higher in slow and ultra-slow acetylators 51.9% and 50.4%, respectively. In terms of treatment outcomes, most patients in the rapid and intermediate acetylator groups were able to tolerate standard dosing regimens. In contrast, patients in the slow and ultra-slow acetylator groups were more likely to require dose adjustments, particularly dose reduction of isoniazid or modification of treatment regimens, due to hepatotoxicity.

Conclusions: This study demonstrates that genetic polymorphisms of the NAT2 gene are strongly associated with the development of hepatotoxicity in patients with tuberculosis receiving isoniazid. The incidence of hepatotoxicity varies significantly across acetylator phenotypes. Specifically, the slow and ultra-slow acetylator groups showed markedly higher incidence rates (51.9% and 50.4%, respectively), whereas the rapid and intermediate acetylator groups had substantially lower incidence rates (11.9% and 15.5%, respectively). In addition, the distribution of acetylator phenotypes in this population was predominantly intermediate and ultra-slow, highlighting the importance of close monitoring for hepatotoxicity in these patient groups.

Influence of Comorbidities on Treatment Costs and Development of a Cost Prediction Model for Pneumonia Patients in a Community Hospital

Methawee Watcharakul, Akemat Wongpairin — Fri, 23 Oct 2026 00:00:00 +0700

Background and objectives: Pneumonia is a major cause of hospitalization, and comorbidities are an important component in determining medical costs under the diagnosis-Related Groups (DRGs) reimbursement system. However, empirical evidence remains limited regarding the structural role of comorbidities in influencing inpatient medical costs among pneumonia patients, as well as the potential for developing medical cost prediction models in the context of community hospitals. This study aimed to analyze the factors influencing inpatient treatment costs among pneumonia patients and to compare prediction models for medical costs in the community hospital setting.

Methods: This retrospective analytical cross-sectional study used data from 874 hospitalized pneumonia patients obtained from the hospital information system of a community hospital in southern Thailand during 2020–2024. Associations between variables and medical costs were examined using multiple linear regression. Three prediction models were developed and compared: Linear Regression (LR), Support Vector Machine (SVM), and Neural Network (NNET).

Results: The average treatment cost was 25,222 Thai baht. The multiple linear regression model explained approximately 50.0% of the variance in treatment costs (R² = 0.50). Chronic respiratory comorbidities, particularly chronic obstructive pulmonary disease and asthma, were significantly associated with treatment costs as modifiers of baseline cost levels. In contrast, bacterial or viral infection status was the principal driver of costs within a single episode of care. Among the three prediction approaches, the linear regression model demonstrated the best predictive performance and showed substantially greater consistency than both SVM and NNET.

Conclusions: Comorbidities exert a contextual influence on treatment costs among pneumonia patients by increasing the complexity of care rather than serving as the primary determinant of cost. Linear models appear to be the most appropriate approach for cost prediction in community hospitals. These findings may provide empirical evidence to support further development of the DRGs system in Thailand.

Prevalence, Clinical Factors, and Confirmatory Diagnostic Outcomes in Newborns with Abnormal Hearing Screening Results

Jutarat Thangthong, Pornthip Jungwattanavanit — Fri, 23 Oct 2026 00:00:00 +0700

Background and objective: Congenital hearing loss is a common congenital condition in newborns, undetectable on routine physical examination, and affects speech, language, and cognitive development if not identified early. Universal Newborn Hearing Screening (UNHS) is essential for timely diagnosis and intervention within the JCIH 1-3-6-month benchmark. This study was conducted to determine the prevalence and clinical risk factors of abnormal newborn hearing screening results and evaluate confirmatory outcomes among referred neonates.

Methods: A retrospective observational study of live-born neonates who underwent otoacoustic emission (OAE) screening at Kranuan Crown Prince Hospital between February 2021 and January 2025. Infants failing three consecutive OAE screenings were referred to Khon Kaen Hospital for confirmatory evaluation, and follow-up outcomes were recorded. Risk factors for initial OAE screening failure were analyzed using logistic regression.

Results: One thousand forty-nine births who underwent OAE screening; 129 (12.3%) failed the initial screen. After repeat testing, 17 (1.6%) were referred, with one lost to follow-up. Among 16 who completed follow-up, 15 (93.8%) had normal hearing. One neonate had suspected sensorineural hearing loss on initial AABR but was lost to follow-up; no confirmed permanent hearing loss was identified among infants completing diagnostic follow-up. Birth asphyxia and neonatal sepsis were independent factors associated with abnormal initial OAE results.

Conclusions: Prevalence of failed initial OAE screens was 12.3%. Birth asphyxia and neonatal sepsis were associated with abnormal initial screening results. No confirmed permanent congenital hearing loss was identified among infants completing diagnostic follow-up. Strengthening follow-up systems may help reduce loss to follow-up and ensure complete diagnostic confirmation among at-risk infants.

A Prospective Randomized Controlled Study Comparing Three-dimensional and Two-dimensional Laparoscopic Cholecystectomy: Operative Efficiency and Safety

Chalermpol Boonpromteerakul, Satchachon Changthom, Thanissara Namboonruang — Fri, 23 Oct 2026 00:00:00 +0700

Background and objective: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. However, conventional two-dimensional (2D) laparoscopic systems have limitations in depth perception, which may affect surgical precision. Three-dimensional (3D) laparoscopic systems have been developed to improve visualization and spatial perception during surgery. This study aimed to compare the operative efficiency and safety of three-dimensional and conventional two-dimensional laparoscopic cholecystectomy.

Methods: A prospective randomized controlled trial was conducted in patients undergoing elective laparoscopic cholecystectomy at Mahasarakham Hospital between October 2068 - Feburay 2026. Patients were randomized into either the 3D or 2D laparoscopic group. Operative time, intraoperative blood loss, postoperative pain scores, surgeon difficulty score, image quality score, and postoperative complications were evaluated.

Results: Seventy patients were equally randomized into the 3D and 2D groups. Baseline characteristics, including age and body mass index (BMI), were comparable between groups. The mean operative time tended to be slightly shorter in the 3D group (41.83 vs. 43.94 minutes, p = 0.20), and intraoperative blood loss was lower (9.69 vs. 11.03 mL, p = 0.27), although these differences were not statistically significant. The image quality score was significantly higher in the 3D group (4.37 ± 0.49 vs. 4.09 ± 0.37, p = 0.008). Postoperative pain scores were significantly lower in the 3D group on postoperative day 1 (p = 0.017) and postoperative day 2 (p = 0.004). No major complications, conversion to open surgery, or readmissions were observed in either group.

Conclusion: Three-dimensional laparoscopic cholecystectomy may improve visualization and reduce postoperative pain without increasing operative risk. Further multicenter studies with larger sample sizes are required to confirm these findings.

The Outcomes of Antenatal Nursing Care for Pregnant Women Receiving Tocolytic Therapy with Terbutaline for Preterm Labor Inhibition in the Labor Room Unit at Srinagarind Hospital

Fri, 23 Oct 2026 00:00:00 +0700

Background and objectives: Preterm birth is a major cause of perinatal mortality and infant morbidity. Terbutaline is an important medication used to suppress preterm labor. This study aimed to evaluate the outcomes of antenatal nursing care among pregnant women receiving terbutaline for the suppression of preterm labor, focusing on the medication administration process, adverse effects, and duration of treatment.

Methods: This retrospective descriptive study collected data from the medical records of pregnant women who received inpatient terbutaline therapy between January 1, 2024, and December 31, 2025. Data were gathered using a four-part data collection form with established content validity (IOC = 1.00). Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used for data analysis.

Results: A total of 163 cases were included in the study. Most participants were multiparous (53.37%), had no previous history of preterm labor (90.18%), and were at a gestational age of 28–31 weeks (30.06%). Regarding medication administration, nurses demonstrated complete adherence (100%) to 13 of the 14 medication administration steps. The only step with lower compliance was attaching the medication dosage label, which achieved a compliance rate of 84.66%. The most common adverse effects were palpitations, fatigue, and maternal and fetal tachycardia. The most frequent duration of terbutaline administration was 2 days (19.02%), followed by more than 7 days and 1 day, respectively.

Conclusion: Continuous nursing care and monitoring of medication administration contribute to effectivemedication management. However, communication regarding medication dosage among members of the multidisciplinary team requires improvement. Patients receiving continuous terbutaline therapy for more than 72 hours should be closely monitored to prevent serious complications.

Implementation of Nursing Ethics Promotion Activities in Inpatient Wards at Srinagarind Hospital

Fri, 23 Oct 2026 00:00:00 +0700

Background and objective: Promoting nursing ethics is a crucial mechanism for improving patient care quality. The Thailand Nursing and Midwifery Council mandates that nursing organizations establish systematic ethics promotion mechanisms through ethics committees at both organizational and ward levels. Although the Division of Nursing at Srinagarind Hospital has implemented an ethics promotion policy since 2014, empirical data on activity implementation at the ward level remains limited. The objective of this study was to describe the outcomes of nursing ethics promotion activities in inpatient wards at Srinagarind Hospital.

Methods: Retrospective cross-sectional descriptive study was conducted in 60 inpatient wards between January and June 2024. Data were collected using a nursing ethics promotion activity recording form (CVI = 0.85) covering five activities: Ethics Risk Profile, Ethics Morning Talk, Ethics Round, Ethics Conference, and development of new practice guidelines. Descriptive statistics were used for analysis.

Results: All wards (100%) acknowledged the ethics policy. Forty-three wards (71.67%) implemented ethics promotion activities. The most frequently conducted activity was developing new practice guidelines (81.66%), followed by Ethics Morning Talk (78.33%), Ethics Round (70.00%), Ethics Conference (68.33%), and Ethics Risk Profile (66.67%).

Conclusion: Most wards have implemented comprehensive nursing ethics promotion activities, but further efforts are needed to enhance the continuity and quality of these activities. Furthermore, the study results can be used as a guideline to develop a system for driving nursing ethics, thereby improving the quality and standards of patient care in terms of nursing ethics.

Drug-related Problems Identified through Routine Prescription Review in Cardiovascular Outpatients: A 3-year Retrospective Study

Fri, 23 Oct 2026 00:00:00 +0700

Background and objectives: Patients with cardiovascular diseases commonly have complex treatment regimens, which increase the risk of drug-related problems (DRPs). This study aimed to collect and describe the characteristics of DRPs identified by pharmacists in the outpatient department.

Methods: This retrospective descriptive study collected data on DRP events identified in the outpatient at the Queen Sirikit Heart Center of the Northeast between October 1, 2022 and September 30, 2025.

Results: A total of 3,777 patients with DRPs were included. Patients were male (2,017 patients; 53.4%), with a mean age of 64.1 ± 13.1 years. A total of 6,722 DRP events were identified. The most common DRP was noncompliance (1,173 events; 17.5%). The majority of DRPs were identified through routine prescription review, followed by medication reconciliation. Most DRPs severity levels were categorized as category B according to the National Coordinating Council for Medication Error Reporting and Prevention criteria. (5,119 events; 76.2%). Warfarin was the drug most commonly associated with DRPs (2,176 events; 32.4%). Most DRPs were managed in accordance with the type of problem identified.

Conclusion: Routine outpatient prescription review by pharmacists can identify DRPs, and the most common problem was noncompliance. Most DRPs severity were categorized as level B. The methods used to identify most DRPs were prescription review and medication reconciliation, respectively. The management of DRPs was consistent with the type of problem identified. Findings from this study may support the development of DRP surveillance and management processes in outpatient pharmaceutical care services.

Appropriateness of Stat Medication Orders across Emergency Department, Intensive, and Non-intensive Care Units at Srinagarind Hospital, Khon Kaen University

Fri, 23 Oct 2026 00:00:00 +0700

Background and objective: Stat medication orders are intended for emergency situations requiring drug administration within 30 minutes. However, inappropriate overuse has increasingly been observed. This study evaluated the patterns and appropriateness of stat medication orders across the emergency department, intensive care units, and non-critical care wards. The findings are intended to inform the optimization of stat medication criteria and urgent medication management systems.

Methods: A retrospective descriptive study was conducted at Srinagarind Hospital from January to June 2024. The study specifically focused on stat order data recorded in the hospital information system, and evaluated appropriateness based on the statdrug formulary criteria of Srinagarind Hospital (not based on individual clinical indications)

Results: A total of 327,361 stat medication orders were identified: 15,235 orders (%4.65) from the emergency department, 138,069 orders (%42.18) from intensive care units, and 174,057 orders (%53.17) from non-critical care wards. Overall, 167,148 orders (%51.06) met the established criteria, with the highest proportion observed in intensive care units. A total of 160,213 orders (%48.94) were deemed inappropriate, most commonly in the emergency department. Non-critical care wards had the highest proportion of inappropriate medication items. Workload analysis revealed a marked disparity across shifts: the morning shift had the lowest burden at 45orders per pharmacist, whereas the afternoon and night shifts carried substantially higher workloads at322 and 272 orders per pharmacist, respectively.

Conclusions: Stat medication orders were extensively utilized, with nearly half failing to meet established criteria, this may impact workload, particularly during off-hours. Revision of stat medication criteria and implementation of clinical decision support systems are recommended to reduce inappropriate use.

Capivasertib: First Targeted Therapy Drug for Luminal A Breast Cancer Treatment in AKT Inhibitors

Fri, 23 Oct 2026 00:00:00 +0700

Breast cancer is very important because it is the most common cancer that leading to cause of death among women worldwide. It can be divided into four subtypes by using molecular subtype including luminal A (ER positive/PR positive/HER2 negative), luminal B (ER positive/PR negative/HER2 negative), HER2 enriched and basal like or triple negative. Capivasertib is the targeted chemotherapy drug in AKT inhibitor group used in breast cancer treatment. This drug is also the first targeted therapy drug in AKT inhibitor group that has been approved by US Food and Drug Administration (US-FDA). It has efficacy in inhibiting tumor in advanced stage that have metastasis potential to nearby lymph node. This article is written to review basic knowledge and an application for further treatment in the future.