Vajira Medical Journal: Journal of Urban Medicine

271-279

Authors: Punnawat Chandrachamnong

Background: Colorectal cancer (CRC) is the third most common cancer diagnosed in men and the second most common in women from global cancer statistics1. In 2014, there were an estimated 1,317,427 people living with colon and rectum cancer in worldwide. Approximately 4.3 percent of people will be diagnosed with colon and rectum cancer during their lifetime. However colorectal cancer is one of the cancers that can be prevented by secondary prevention and it can be cured by the detection at earlier stage and early removal tumor. In the past of Thailand, colorectal cancer mostly founded after their complications such as obstruction, perforation or bleeding2 resulting in poorer operative outcome and shorter survival rate than western country. Objective: The aim of this study was to evaluate the incidence of colorectal cancer survival rate within 5 years after surgery, 5 years disease free survival rate and risk factors associated survival outcome in Vajira hospital. Methods: A retrospective study on 5 year-over all survival rate of patients who underwent major surgical procedure of CRC in Colorectal surgery unit, Department of surgery, Faculty of Medicine Vajira Hospital between January 2010 - December 2011 were reviewed. Overall survival and disease free survival rate of colorectal cancer within 5 years after operation and their risk factors were evaluated. P value less than 0.05 were considered significant. All analysis was done using SPSS software. Results: A total 185 patients underwent resection of CRC during the study period 111 patients were enrolled, with mean age of 73 ± 19 years. Sixty-six patients (59.5%) were diagnosed with colon cancer and 45 patients (40.5%) were diagnosed with rectal cancer. Stage III colorectal cancer was the most common stage : 57 patients (51.3%). Five year-overall survival rate of 72% (stage I : 89% ,stage II : 80% , stage III : 59%) and median survival time of 84 month. Five year-disease free survival rate of 68% (stage I : 89% ,stage II : 75% , stage III : 57%). N Staging was prognosis factors of disease free survival. Conclusion: The 5 year-over all survival rate was 72% and median survival time was 84 months. The 5 year-disease free survival rate was 68%. The prognostic factors of disease free survival were associated with N staging.

288-299

Authors: Thanakorn Witsawaphaisan, Wilailuk Teepprasan

Objectives: To study the optimal cut-off point of hand grip strength for evaluation risk of malnutrition, and factors associated with malnutrition in elderly out-patient clinic, Faculty of Medicine Vajira Hospital. Methods: This research is cross-sectional study in volunteers aged 60 years and over, who came to family medicine out-patient clinic Vajira Hospital. The total number of volunteers were 243 patients, male 68 patients, female 175 patients. All volunteers have been taking history, screening for MNA and hand grip strength. Results: Optimal cut-off point for hand grip strength in male patients is 28.75 kgF, which sensitivity 100%, specificity 44%. Optimal cut-off point for hand grip strength in female patients is 17.22 kgF, which sensitivity 66%, specificity 54%. In male, there were 3 factors associated with risk of malnutrition; over ages 80-89 years (p-value 0.030), psychiatric disease (p-value 0.004), right hand grip strength below 23.07 ± 4.48 (p-value 0.015). In female, there were 4 factors associated with risk of malnutrition; no education (p-value 0.025), cardiovascular disease (p value 0.042), low BMI < 18.5 (p value 0.003) and left hand grip strength below 15.88 ± 4.3 p value 0.027). Conclusion: Optimal cut-off point for hand grip strength in male patients is 28.75 kgF. Optimal cut-off point for hand grip strength in female patients is 17.22 kgF. It can be use in screening for patients who are at risk of malnutrition.

310-319

Authors: Sarida Nithipradistgul

Objective: To determine prevalence and related factor of people with high risk of fracture in next 10 year. Methods: Descriptive study of 299 people aged 40-90 years was studied in Bangsitong subdistrict, Nonthaburi. Data was obtained using FRAX® to predict 10-year probability of fracture and calculate prevalence of people with high risk of fracture. Related factors associated people with high risk of fracture was obtained using general information questionnaire and were assessed by Binary logistic regression with Forward stepwise. Results : The prevalence of people with high risk of fracture in the next 10-year was 19.7 percent. The related factors that have statistically significant were female sex (adj.Odds ratio 3.41, 95%CI 1.43-8.13), the population aged 80 and over (adj.OR 20.69, 95%CI 7.31-58.56), high BMI (adj.OR 0.44, 95%CI 0.21-0.91) and unemployed or retired person (adj.OR 3.09, 95%CI 1.47-6.51). Conclusions : The prevalence of people with high risk of fracture in the next 10-year in Bangsitong subdistrict was 19.7 percent. Risk factors of people with high risk of fracture were female sex, aged 80 and over and unemployed or retired person, whereas the protective factor of people with high risk of fracture was high body mass index (BMI).

332-342

Authors: Chotiman Chinvararak, Pantri Kirdchok, Wisarat Pruttithavorn, Jidapha Tiamungkornpan, Chaniporn Leelaprasertwong, Nicharee Wongsrinant, Thanakit Malaikritsanachalee, Tharadon Mungkhantiwongsakul, Theerameth Pruangmethangkul, Parichat Ditsomboon, Pornpailin Thammasupapong, Ratchapong Thongpool, Wongsathorn Seehirunwong

Objective: To study the prevalence and associated factors of poor sleep quality in pre-clinical-year medical students, Faculty of Medicine Vajira Hospital, Navamindradhiraj University. Method: A cross-sectional descriptive study was conducted on preclinical-year medical students in 2015. Self-reported questionnaires consisted of demographic data, Thai version of the Pittsburgh sleep quality index, Stress-5 questionnaires, sleep hygiene questionnaires and 1-year life stress event questionnaire. Descriptive statistics were presented as frequency, percent and mean. The chi-square test, Fisher’s Exact test and logistic regression analysis were used to find the associated factors of poor sleep quality. Results: There were 204 preclinical medical-student participants; 54.9% were female. Prevalence of poor sleep quality was 77.9%. Majority of participants had moderate level of stress (41.2%). Poor sleep hygiene consisted of late meal and evening caffeine consumption were found (75.5% and 43.6%, respectively). Associated factors of poor sleep quality were the severe to very severe level of stress (ORAdj= 11.50, 95%CI = 2.54-51.99), severity of life stress events, and evening caffeine consumption. Conclusion: Prevalence of poor sleep quality in preclinical medical students was substantial. Its associated factors were stress level, severity of life stress events, and evening caffeine consumption. Surveillance and relevant preventive measures should be taken.