Vajira Medical Journal: Journal of Urban Medicine

S1-S14

Authors: Sireedhorn Kurathong, Kornwipa Hemarat, Seerung Noonpradej, Siriporn Manavathongchai

Objective: To evaluate the prevalence and risk factors of chloroquine and hydroxychloroquine retinopathy. Methods: Retrospective cohort study was conducted at Vajira hospital. Medical records of autoimmune patients who received chloroquine and hydroxychloroquine from January 2017 to December 2019 were reviewed. Results: Of the 177 enrolled patients, 19 patients developed retinopathy. The prevalence of chloroquine and hydroxychloroquine retinopathy was 10.7%. 17 patients had the pericentral pattern of retinal change, whereas only 2 patients had the classic parafoveal distribution of retinal damage. Factors associated with retinopathy were duration of chloroquine treatment (p=0.009), cumulative dose of chloroquine (p=0.009) and cumulative dose of chloroquine with hydroxychloroquine (p=0.015). After using multivariate analysis, duration of chloroquine treatment (adjusted OR=1.01; 95%CI 1.00-1.02, p=0.01) and liver disease (adjusted OR=23.72; 95%CI 1.25-448.68, p=0.035) were significant. Conclusions: The prevalence of chloroquine and hydroxychloroquine retinopathy was 10.7%. Factors associated with retinopathy were duration of chloroquine treatment and liver disease. Factors that may associated with retinopathy were cumulative dose of chloroquine, cumulative dose of chloroquine with hydroxychloroquine.

S27-S38

Authors: Nucharee Kiatsoongsong, Supharat Winitprichagul, Lakkana Boonyagars

Background: Human immunodeficiency virus (HIV) infection is an epidemic worldwide. Despite the combination of antiretroviral therapy to control disease, a higher rate of neurocognitive impairment has been reported. Because highly active antiretroviral therapy (HAART) may not prevent the entry of HIV into the central nervous system, neuronal damage can be affected. Therefore, we conduct the study to evaluate the prevalence and associated factors of HIV-associated neurocognitive disorder. Methods: We conducted a cross-sectional study in Vajira hospital, a 900-bed university hospital in Bangkok, Thailand. HIV-infected patients who on HAART routinely visit the infectious clinic from August 2019 to March 2021 were included in our study. We collected the MoCA-Thai test and search patient information from the electronic database. Then we analyze the prevalence and factors associated with HIV-associated neurocognitive disorder. Results: We enrolled 84 patients with HIV infection, (42 men and women). The mean age of our cohort is 63 years (SD, ± 3.9). The duration of HIV infection and duration of current HAART was 13 years (SD, ± 5.7) and 10 years (SD, ± 4.8), respectively. The median CD4 count before HAART was 187 cell/mm3 (IQR, 47.25-323). The median of the CD4 level at the time of enrollment was 507 cell/mm3 (IQR, 319.25-706.25). MoCA scores of less than 26 points were found in 77 (91.7%) patients. Dementia was diagnosed in 13 (15.5%) patients. In adjusted analysis, patients with age equal or more than 65 years were more likely to have dementia than younger patients (OR = 0.14, 95%CI 1.95-26.17: p-value = 0.002) also with years of education less than 9 years (OR = 0.18, 95%CI 1.17-27.38 : p-value = 0.031). Whereas the duration of HIV infection, CD4 level, CPE score, and PI-base regimen were not associated with dementia. Conclusion: The risk of dementia in HIV patients is significantly higher in older age (equal to or more than 65 years) or years of education less than 9 years.

S53-S62

Authors: Suppanat Charoenjit, Dussadee Ngernlangtawee

Background: Behavioral problem was the common problem that had long-term effects on child’s performance. This study aimed to investigate the association between parenting style and child behavioral problems. Methods: A cross-sectional study was conducted by using parenting style questionnaire and strengths and difficulties questionnaire (SDQ) to collect data from caretaker of children, aged 3-15 years old who were treated at Vajira Hospital. The prevalence of parenting styles and association between parenting styles and behavioral problems in children were analyzed by multiple linear regression. Results: 198 participants were enrolled. Male caretaker was 52%, mean age was 38.45 ± 11.6 years old. Boy was 55.6%, mean age was 8.19 ± 2.72 years old. The prevalence of authoritative, permissive and authoritarian parenting style was 59.6%, 23.2% and 17.2%, respectively. The study showed significantly difference of total difficulties score among parenting style groups (p-value = 0.034). Linear regression analysis showed difficult or slow-to-warm up temperament (β = 0.196, t = 2.805, p-value = 0.006), birth order (β = -0.145, t = -2.052, p-value = 0.041) and authoritarian parenting style (β = -0.149, t= -2.106, p-value = 0.036) were factors that impact to child’s total difficulties score. When cofactor was controlling, difficult or slow-to-warm up temperament (β = 0.20, 95% CI = 0.96-3.62, p-value = 0.004) and birth order (β = -0.15, 95% CI= -1.84,-0.06, p-value = 0.037) were factors that still be a great impact significantly. Conclusions: The most common parenting style was authoritative style. Parenting styles were associated with child behavioral score. Temperament and birth order were factor that impact to behavioral score.

S75-S90

Authors: Natphassorn Dermkhuntod, Ratchaneewan Kwancharoen, Charnwat Chuantantikamol, Pich Paholpak, Swangjit Suraamornkul

Background: Diabetes patients with poor glycemic control have increased risk to develop diabetes-related complications. Patients with diabetes need diabetes self-management education to achieve glycemic target treatment and continue long term care. The use of technology in health education (telehealth) is a convenient and uncomplicated option to monitor the blood sugar level, symptoms of hypoglycemic or hyperglycemic status and the emergence of diabetes. Diabetes patients can easily and quickly access to treatment in a timely manner. Objective: To evaluate the effects of telehealth monitoring on glycemic control and medication adherence in patients with poorly controlled type 2 diabetes who receive service in Comprehensive NCDs clinic Vajira Hospital. Method: An experimental study was conducted. A total of 60 subjects were divided into 30 experimental and 30 control groups. All patients receive diabetes self-management education: DSME and followed up for 1 year. The experimental group was followed up by phone using an application line to communicate, educate, evaluate, monitor self-monitoring blood glucose (SMBG) and resolve hypoglycemia or hyperglycemia symptom. The control group was served during the scheduled doctor’s visits. The effect of glycemic control and medication adherence were assessed periodically 3 months and after 12 months of follow-up. Results: Fasting blood glucose and HbA1C after the 1 year experiment were significantly reduced both in the experimental and control group. There were greater statistically significant reduction in the experimental group than the control group (p-value < 0.001). Comparison of medication adherence before the trial, 96.4% of both groups had low adherence score. At the end of trial, both groups had a statistically significant increase in medication adherence. While the experimental group who received telehealth monitoring was a greater increase in medication adherence than the control group. Conclusion: Applying telehealth as a tool for continuing diabetes care can facilitate patients to modify health behaviors. This telehealth enhance the ability of self-management and improve clinical outcomes.

S101-S116

Authors: Nitchawan Kerdcharoen, Varuna Kolkijkovin, Jomtian Thaworn

Objective: To study the level of resilience in medical students and how resilience is associated with mental health during COVID-19 epidemic. Method: This is a cross-sectional descriptive study. The participants are the medical students in the academic year of 2020 from Vajira Hospital. The outcome measures include 1) general personal data and the negative impact encountered during COVID-19 outbreak, 2) Resilience evaluation questionnaire and 3) depression anxiety stress scale (DASS-21). The statistical analyses used include descriptive statistics and analytical statistics, which are Pearson Chi-square, Pearson’s correlation and stepwise multiple regression analysis. Results: From the total participants of 255, most of them have normal level of resilience. The highest reported mental health impact from COVID-19 outbreak is anxiety. The COVID-19 related academic problems are associated with stress (p=0.002) and depression (p=0.001). Lacking of consultant is associated with anxiety (p=0.009). And personal financial problem is associated with stress (p=0.001). Resilience is inversely related to stress, anxiety and depression (r=-0.471, -0.493 and -0.545 respectively, p<0.01). From stepwise multiple regression analysis, resilience in the domain of will power together with emotional stability can predict stress and anxiety. The variance of stress is 24.5 percent (R2 = 0.245, p<0.01). And the variance of anxiety is 27.3 percent (R2 = 0.273, p<0.01). Will power domain is the key predictor of stress (β =-0.344, p<0.01) and anxiety (β =-0.321, p<0.01). Will power domain is also the only domain that can statistically predict depression (β =-0.626, p<0.01). The variance of depression is 39.1 percent (R2 = 0.391, p<0.01). Conclusion: Resilience in the domain of will power is the main protective factor against mental health problem in medical students, especially during the COVID-19 epidemic. Therefore, In order to strengthen the ability to cope with stress, medical school should promote resilience enhancing activities, particularly in the will power and emotional stability domains.

433-440

Authors: Adjima Soongsatitanon, Sasiwan Suthasmalee

Objective: To determine risk factors associated with birth asphyxia in pregnancies. Methods: A case control study was conducted by including 578 newborns delivered at Vajira Hospital between January 2018 and March 2020. Cases were 289 women who delivered the baby with Apgar score ≤ 7 at 1 minute, while the controls were 289 women who delivered the baby with Apgar score > 7 at 1 minute. The data was collected from medical records. Antepartum factors, intrapartum factors and newborn factors were analyzed with univariate analysis and binary logistic regression analysis. Results: Factors significantly associated with birth asphyxia included breech presentation (OR 3.18, 95% CI 1.10-9.22), vacuum extraction (OR 10.06, 95% CI 2.00-50.45), cesarean section (OR 2.53, 95% CI 1.59-4.03), preterm delivery (OR 6.62, 95% CI 3.26-13.46) and birthweight < 2500 grams (OR 3.49, 95% CI 1.54-7.90). Conclusion: The statistically significant risk factors associated with birth asphyxia were breech presentation, vacuum extraction, cesarean section, preterm delivery and birthweight < 2500 grams.

455-468

Authors: Natwipa Wanicharoen

Objective: To explore the health-related quality of life (HRQoL) of children with language impairment (LI), and to identify the factors that affect HRQoL in children with LI. Methods: This study was a cross-sectional descriptive study. The participants were 100 children with LI including specific language impairment (SLI), global developmental delay (GDD), autistic spectrum disorder (ASD), down syndrome (DS), and intellectual disability (ID), aged 2-7 years attending the Division of Developmental and Behavioral Pediatrics, Faculty of Medicine Vajira Hospital between November 2019 and October 2020. The HRQoL was assessed by the PedsQLTM 4.0– Thai version, parent proxy-report. Data were analyzed using the descriptive and inferential statistics. Results: Most of the children with LI were male (59%) with mean age of 3.96 ± 1.72 years old. Most of them were diagnosed with SLI, GDD, and ASD, accounting for 65%, 24%, and 24% respectively. The HRQoL of the children with LI were at high levels, accounting for 54% (67.87±14.53). The highest HRQoL score was in social functioning (69.25±18.94). The lowest score was in school functioning (58.90±22.44). Factor associated with HRQoL of the children with LI was behavior problems. Conclusion: Language impairment affects children’s HRQoL, especially in school functioning. Measuring HRQoL could serve as one of the methods used to provide the most appropriate and holistic care for children with LI.

479-484

Authors: Thitawat Wongampornpat, Bhapapak Na-songkla

Background: Laparoscopic living donor nephrectomy was performed in 2010 substituted open living donor nephrectomy in Vajira hospital. This study aims to present result of surgery. Method: A retrospective descriptive study was conducted. Eighty eight donors were performed laparoscopic living donor nephrectomy and 88 kidneys were transplanted to recipients between 2010 to 2020. Donor demographic data, number of renal vessels, operative time, warm ischemic time, operative blood loss, length of hospital stay, complication, serum creatinine after nephrectomy, serum creatinine of recipients and delay graft function were retrospectively review from medical record. Result: Mean operative time was 219±38 minutes, mean warm ischemic time was 192.2±39.8 seconds. Mean intraoperative blood loss was 66±56 milliliter, mean hospital stay length was 5.4±2.4 days. Complication rate of donor was 3.4%. There was no vascular or ureteral complication to recipients in this study. Conclusion: Laparoscopic living donor nephrectomy in Vajira hospital is safe and feasibility. Result of kidney function of the recipients at one year of follow up stilled good.

501-512

Authors: Nontawat Benjakul, Supasan Sripodok, Tanapong Tungjitsirisun, Pattara Pattaravoratham, Thararat Soiphet

Background: The Bethesda system for reporting thyroid cytopathology (TBSRTC) is a standardized and reproducible system. It is used worldwide to interpret fine-needle aspiration cytology (FNAC) of thyroid. A crucial issue of thyroid FNA is its accuracy comparing with the final histologic outcomes. This may vary on many factors e.g., nature of lesion, quality of the cytologic specimen, pathologist’s experience, etc. Aim: To evaluate the accuracy of TBSRTC from FNAC. Nature of lesion which may impact the accuracy was also studied. Method: A retrospective study evaluating data of TBSRTC in our hospital during January 2013 to June 2021 were reviewed and compared to its final histologic outcomes to determine diagnostic accuracy. Results: 3714 FNA procedures were done at Vajira Hospital from January 2013 to June 2021, consisting of 3,266 (87.94%) females and 448 (12.06%) males. The female: male incidence ratio was approximately 7:1. The age at diagnosis was ranged from 14 to 86 years (median 53 years). A total of 527 patients (461 female; 87.5%, and 66 male; 12.5%) underwent surgical resection with available histopathology evaluation. From those cases, the FNAC reports revealed 172 (32.6%) cases as non-diagnostic/unsatisfactory (ND/US), 216 (41.0%) cases as benign, 87 (16.5%) cases as atypical of undetermined significant or follicular lesion of undetermined significance (AUS/FLUS), 4 (0.8%) cases as follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 36 (6.8%) cases as suspicious for malignancy (SM), and 12 (2.3%) cases as malignant. The risk of malignancy (ROM) in operated thyroid specimen was 15.7%, 15.3%, 33.3%, 0%, 91.7%, and 91.7%, respectively Conclusions: The accuracy of thyroid FNAC at our hospital was high in malignant groups including category V and VI. However, the ROM in categories I, II, III, and V exceeded the suggested limit in TBSRTC. We strongly encourage medical practitioners in all professions to use TBSRTC because it is an international standard that shares a common understanding and helps guide patient management.

343-356

Authors: Suksan Kittisupakorn

Objectives: (1) study of the quality of life development plan for the elderly in Bangkok Phase II (2018–2021); (2) study of factors affecting on the quality of life development plan for the effective implementation of the elderly’s quality of life plan in Bangkok–Phase II (2018–2021); (3) present the model for the effective implementation of the elderly’s quality of life plan in Bangkok–Phase 2 (2018–2021) ; and (4) prediction equations of public administration’s quality criteria for the effective implementation of the elderly’s quality of life plan in Bangkok–Phase 2 (2018–2021). Study design: Mixed research methodologies: Qualitative, Quantitative and Documentary Research, were employed in this work. For qualitative research , the sample was selected by purposive sampling 10 persons from stakeholders engaging to new public management; that were executive, academic and media which data gathered by In-Depth Interview. For quantitative research, a simple questionnaire was used to survey through the elderly aged of 60 years old and above of 438 persons. Data gathered were analyzed based on descriptive statistics, Pearson’s correlation coefficient and multiple regression analysis. Results: (1) most population in the sample had high level of new public management with the public sector management quality award (PMQA) (x̄ = 3.74), and high level of the effective implementation of the elderly’s quality of life plan in Bangkok–Phase II (2018–2021) (x̄ = 3.41). (2) According to Pearson’s correlation coefficient and multiple regression analysis, it was found that (2.1) new public management with the public sector management quality award (PMQA) of 7 criteria had positive correlation with the effective implementation of the elderly’s quality of life plan in Bangkok–Phase II (2018–2021) and was statistically significant at the level of 0.01 (2.2) Category 1: leadership, Category 2: strategy and Category 7: outcome together with the foresight of the effective implementation of the elderly’s quality of life plan in Bangkok–Phase II (2018–2021) was statistically significant at the level of 0.01. (3) Model for implementing the plan into effective practice is “MOVING FORWARD TO SUPER–AGED SOCIETY” (4) The prediction equation as SOL equation = 0.410+0.342 (ZCategory2: Strategy) + 0.239 (Z Category 7: Outcome) + 0.234 (ZCategory 1: Leadership). Conclusion: The strategic host organizations must create integration between the various agencies, set directions, frameworks for projects/activities, and communicate public relations to ensure mutual understanding in order to create a consolidated outcome of Bangkok. Factors affecting the effective implementation of the elderly’s quality of life plan in Bangkok – Phase II (2018 – 2021) are leadership, strategy and outcome.

363-372

Authors: Naphat Wutilertcharoenwong, Korrakot Pornchaichanakit, Tanun Ngamvichchukorn

Objective: Vitamin D deficiency is a common condition among chronic kidney disease (CKD) patients. It is associated with cardiovascular mortality. Giving calciferol to CKD patients could help reduce vascular stiffness and decrease the risks of coronary artery disease and mortality. The current recommendation for treating vitamin D deficiency in CKD patients is using the same treatment strategies for the general population. However, there is no recommendation on the exact dose and duration. The purpose of this trial is to compare the effects of pulse dose versus continuous dose of calciferol on vascular stiffness in diabetic kidney patients. Methods: 31 patients with type 2 diabetes mellitus (T2DM), eGFR 15-59 mL/min/1.73 m2, and 25(OH) D level < 30 ng/mL, were enrolled in this randomized, open-label trial to receive either pulse dose (200,000 IU at the 0th and 8th weeks) or continuous dose (40,000 IU weekly for 8 weeks then 20,000 IU weekly for 2 weeks) of calciferol. The primary outcome was the vascular stiffness measured by the changes in carotid-femoral pulse wave velocity (cfPWV) at 10th week. Results: The mean 25(OH)D level at the baseline was 18.7 ng/mL in the pulse dose versus 19.9 ng/mL in the continuous dose. In the pulse dose, 10 patients (66.7%) achieved optimal vitamin D level while 6 patients (40%) did in the continuous dose. The mean change of cfPWV between the two groups, which was -0.5 (95%CI -3.15 to 2.15) (p=0.703), was not statistically significant. No adverse effect was reported. Conclusion: 10 weeks of calciferol given to CKD patients with T2DM and 25(OH)D < 30 ng/mL could achieve a higher reduction of Cardio-ankle vascular index in the pulse dose group than in the continuous dose group. Despite the lack of statistically significant change in Carotid-femoral pulse wave velocity (cfPWV), there seemed to be a higher cfPWV reduction in the pulse dose, with the achievement of 25(OH)D level.

387-398

Authors: Patiporn Bunyaphatkun, Anan Manomaipiboon, Thananda Trakarnvanich, Sujaree Pupipatpab, Pongsathorn Chomdee, Anusang Chitsomkasem, Yutthana Apichatbutr

Background: Since the rapid spread of SARs-CoV-2 worldwide, the surgical masks and N95 respirators were needed for personal protective equipment. The VJR-NMU-N99 half-piece respirator has invented. The provider satisfaction involved the sustainable invention used. If they satisfied or perceived positive attitude toward the invention, it was expected high quality regarding responsive to their need and want. The study of provider satisfaction will guide the opportunity to ongoing developing. Objective: The study of provider satisfaction with the product quality of VJR-NMU-N99 half-piece respirator. Method: A descriptive study was conducted in April 2020. Recruited into the study were 47 healthcare providers who wore the VJR-NMU half-piece respirator at Vajira hospital and Phra Nakhon Si Ayutthaya hospital. The research instrument was developed from Evidence-based Practice Attitude Scale 36. Data were collected on April 2020 and were analyzed with descriptive statistic. Results: Nurses were most participants (91.5%). The overall mean score for provider satisfaction with the VJR-NMU half-piece respirator was fair (3.08±0.34) including both Vajira hospital (3.08±0.35) and Phra Nakhon Si Ayutthaya hospital (3.06±0.32). The quality level based on mean total score was good (76.9%). Four items were excellent including advantage (94.3%), divergence (93.4%), requirements (92.3%) and job security (92.0%) while the items of burden and fit were modified (42.6%) and fair (67.3%) respectively. Conclusion: The opportunities for development with the VJR-NMU half-piece respirator should consider the composite material for need responses, as well as controlling humidity, supporting effective communication sounds, comfortable wearing and reducing workload.

415-424

Authors: Wanwisa Pattamawilai, Jiraporn Kespichayawattana, Pachanut Nunthaitaweekul

Objective: To compare level of constipation in stroke patients before and after receiving nursing process with abdominal massage and to compare level of constipation in stroke patients after receiving nursing process with abdominal massage with those who received routine nursing care. Method: This quasi-experimental research was used the pathophysiology of constipation and nursing care for constipation was used as the conceptual framework. Subjects consisted of 50 stroke patients (age 18-59 years) with constipation. Age, location of lesion and type of medication treatment were matched. Constipation was assessed using a Constipation Scoring System evaluation form which was tested for content validity and reliability = 0.74. Data were analyzed using descriptive statistics and t-test. Results: 1. The mean score of constipation in stroke patients after receiving the nursing process with abdominal massage was significantly lower than before receiving the nursing process with abdominal massage at the 0.5 level. 2. The mean score of constipation in stroke patients after receiving the nursing process with abdominal massage was significantly lower than before receiving the routine nursing care at the 0.5 level. Conclusions: The effect of nursing process with abdominal massage can reduce constipation with stroke patient more than regular nursing.

265-270

Authors: Thitawat Wongampornpat

Background: Fourteen core schematic transrectal ultrasound-guided biopsy prostate was started in Vajira hospital in 2017 substituted standard 12 core transrectal ultrasound-guided biopsy prostate. This study aims to present incidence of postoperative febrile urinary tract infection after this procedure and compared incidence of infection between preoperative antibiotic regimens. Method: A retrospective descriptive study was conducted. 346 patients who underwent 14 core schematic transrectal ultrasound (TRUS) -guided biopsy prostate between 2017-2020 were enrolled. Patients demographic data, prostate specific antigen (PSA), preoperative antibiotic regimen, post operative febrile urinary tract infection (UTI) data, and urine culture were retrospectively review from electronic medical record. Results: Three hundred and forty-six patients were included in this study. The incidence of febrile UTI after operation was 4.04%. Incidence of febrile UTI in Ciprofloxacin group was 7.1%, in Ceftriaxone group was 1.01%, in Cefixime group was 0%, and in Ofloxacin group was 1.8 %. There were no statistically different between Ciprofloxacin group and other groups (P>0.05). Compared between Quinolone groups and third generation Cephalosporin group, the incidence of febrile UTI was higher in quinolone group with statistically significant (P = 0.04). Conclusion: Fourteen core schematic TRUS-guided biopsy prostate is safe compared with other studies in the term of incidence of febrile UTI. Incidence of febrile UTI was higher in Ciprofloxacin group that should be monitored about rate of febrile UTI in the future in this group.

280-287

Authors: Intera Yimprasit, Chunlanee Sangketchon

Objective: This study has objectives to study the prevalence and factors associated with adverse outcomes in discharged patients with community-acquired pneumonia (CAP) at the emergency department, Vajira hospital. Method: This was a retrospective chart review from January to December 2014. Medical records of over 14-year-old CAP patients who were diagnosed and discharged at emergency department were reviewed in 130 records. The severity was categorized according to CRB-65. We analyzed factors that correlate to adverse outcomes. Results: Prevalence of adverse outcomes in discharged patients with CAP was 24 (18.5%). Eighteen of 24 (12.3%) revisited in outpatient clinic and six of 24 (6.2%) needed admission. Ten of 24 (7.7%) had adverse events within 72 hours. The factors that significantly related to adverse outcomes in patients with CAP were the severity at first ED presentation (p< 0.01) and chronic obstructive pulmonary disease (COPD) (p= 0.023). Conclusion: The factors associated to adverse outcomes in discharged CAP patients are moderate severity of CAP and COPD. The CAP patients who has either one of these factors need more assessment and close follow up.

300-309

Authors: Pimchanok Auypornrungrat, Rangsima Thiengthiantham

Objective: Current recommended diagnostic methods for diverticulitis include computed tomography (CT) and follow-up colonoscopy to exclude a cancer diagnosis. This study aimed to determine the prevalence of occult colon cancer in diverticulitis patients due to similar CT findings. Methods: This was a retrospective analysis of patients diagnosed with acute diverticulitis by CT at Vajira Hospital between 2012 and 2017. Data on sex, age, BMI, laboratory parameters, smoking status, alcohol consumption, clinical presentation, and modified Hinchey classification were collected. Risk factors for the discovery of colon cancer after an acute diverticulitis diagnosis by CT were identified by chi-squared test. Results: We included all 91 patients diagnosed with diverticulitis by CT scan and reported by a radiologist. Five patients were excluded because they had not undergone colonoscopy after their diverticulitis subsided. The mean age was 69.1 years (range, 35–96 years), and 54.7% were male. The main presenting symptom was abdominal pain (69.8%). Diverticulitis occurred most frequently in the sigmoid colon (52.3%). Colon cancer was observed in eight diverticulitis patients (9.3%). The factors associated with colon cancer occurrence were the location of the disease in the sigmoid colon (P = 0.038), clinical presentation of abdominal pain (P = 0.002), and Hinchey II score (P < 0.001). Conclusion: Occult colon cancer could be found in diverticulitis patients because of some mimicking imaging features in 9.3% of patients, and therefore, all patients diagnosed with diverticulitis should undergo colonoscopy after their disease has subsided, especially those at least 65 years of age, those with sigmoid diverticulitis, and those with Hinchey classification II, as they are at a higher risk for colon cancer.

320-331

Authors: Natwipa Wanicharoen

Objective: To explore the quality of life (QoL) and to investigate factors associated with QoL among caregivers of children with language impairment. Methods: This study design was a cross-sectional descriptive study. The participants in this study were the caregivers of children with language impairment aged 2-7 years attending the Division of Developmental and Behavioral Pediatrics, Faculty of Medicine Vajira Hospital between November 2019 and October 2020 by using a questionnaire for the general data and the World Health Organization Quality of Life Brief – Thai (WHOQOL-BREF-THAI). Data were analyzed using the descriptive and inferential statistics. Results: Most of the caregivers were female (84%) with mean age of 38.06±10.67 years old. Most of them were mother (65%), being housewives/husbands (33%), and having monthly income ≤15,000 (40%). The overall QoL, physical, and psychological aspects among caregivers of children with LI were at high levels, accounting for 51%, 51% and 54% of the sample respectively. While the QoL in the social relationships and environment aspects were at moderate levels, at 51% and 68% respectively. Factors associated with QoL were the gender of caregivers and self-help skills in daily activities of children. Conclusion: Children with LI may affect their caregivers’ QoL, especially in the social relationships and environment aspects. These findings provide new insights into QoL of caregivers of children with LI that may be important when professionals consider comprehensive intervention and more specific support to improve their situation. It is expected that if caregivers’ QoL improves, they would provide greater parental care, which will further improve their children’s well-being.

173-186

Authors: Suttipong Pearpleum, Yutthana Apichatbutr

Background: Driving pressure is associated with mortality in patients with acute respiratory distress syndrome (ARDS). However, whether driving pressure is associated with outcomes in mechanically ventilated patients without ARDS is unknown. Objective: This study primarily aimed to determine the association between driving pressure and severe lung injury (lung injury score ≥ 2.5). The secondary outcomes were to determine the cutoff point of driving pressure associated with severe lung injury and compare patient mortality between severe and non-severe lung injury score in mechanically ventilated patients without ARDS. Methods: Mechanically ventilated patients without ARDS admitted in the intensive care unit (ICU) of Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, between 2018 and 2020 were enrolled. Baseline characteristics including sex, age, diagnosis, sedative drug, and lung mechanic from the ventilator were recorded. Moreover, the patients’ driving pressure [plateau pressure–positive end expiratory pressure (PEEP)] and lung injury score were obtained. Multivariable logistic regression analysis was performed to determine associations between driving pressure and patient lung severity with lung injury score. The mechanically ventilated patients without ARDS were categorized according to lung injury score ≥ 2.5; then, a severe form of the area under the receiver operating characteristic (AuROC), as a dependent outcome, was observed to determine the association between driving pressure and severe lung injury. The optimal cutoff point of driving pressure that determined severe lung injury was calculated by Youden’s index. Result: In total, 155 mechanically ventilated patients without ARDS were enrolled. Overall mortality was 28.3%. Driving pressure was associated with severe lung injury (OR, 1.28; 95% CI, 1.15–1.42; p-value <0.001). A good discriminative ability of driving pressure to determine severe lung injury was noted (AuROC = 0.859; 95%CI, 0.768–0.950). The optimal cutoff point of driving pressure indicating severe lung injury was 16 cmH2O with, 89.5% sensitivity (95% CI, 66.9–98.7), 75% specificity (95% CI, 66.9–82.0), 33.3% positive predictive value (95% CI, 20.8–47.9), and 98.1% negative predictive value (95% CI, 93.2–99.8). Conclusion: In mechanically ventilated patients without ARDS, increased driving pressure was associated with severe lung injury. A driving pressure >16 cmH2O was associated with severe lung injury.

197-210

Authors: Charnwat Chuantantikamol, Petch Rawdaree

Background: Currently, the prevalence of congestive heart failure in type 2 diabetes mellitus (T2DM) worldwide is increasing continuously. However, risks and incidence of hospital readmission due to congestive heart failure in T2DM are no conclusion. Therefore, this study aimed to evaluate risks of hospital due to congestive heart failure in T2DM patients. Methods: A matched case-control study was conducted to discover risks of hospitalization because of congestive heart failure (CHF) in T2DM patients at Vajira Hospital. Clinical and laboratory data from medical record of diabetic patients hospitalized due to CHF, defined as a case, from 1st January, 2560 BE to 31st December, 2561 BE and T2DM patients who had no history of CHF which age and sex matched, defined as a control, were retrieved from hospital database. Univariate and multivariate analysis controlling for confounders were conducted to identify risk factors for hospitalization from CHF. Results: Among the 180 subjects the average age was 68.38 years and 50% was female. Ninety subjects who had heart failure were recruited as cases (50%) and others 90 subjects without heart failure were in control group. All of the cases were diagnosed congestive heart failure by Framingham criteria. Most of cases had heart failure with preserved ejection fraction (51.9%) and 22.2% were readmission due to heart failure. Risk factors for congestive heart failure in T2DM subjects were Body Mass Index (BMI) (OR = 1.18, 95%CI = 1.03-1.36, p-value = 0.02) but protective factor is statin (OR=0.03, 95%CI = 0.0001-0.71, p-value = 0.03) Conclusions: The risk of hospitalization for heart failure patients with type 2 diabetes mellitus is BMI and protective factor is statin. There was 22.2% of the subjects readmitted due to CHF and smoking is a risk factor for the readmission.

221-234

Authors: Pornertai Rattanamaytanon, Prasit Leewattanapat

Objective: To compared Fracture Risk Assessment Tool (FRAX) score in previous hip fracture patients with type 2 diabetes and non-diabetes patients and to ascertain accuracy of FRAX whether using Rheumatoid Arthritis (RA) substitution of diabetes. Methods: A retrospective study from medical record in patients aged 50 to 100 years with previous osteoporotic hip fracture in Vajira hospital between January 1st, 2014 to January 31st, 2019. Comparing mean of FRAX score between type 2 diabetes and non-diabetes group. Results: A total of 288 participants with previous osteoporotic hip fracture were included in the study, type 2 diabetes (T2DM) 144 patients (50.88%) and non-diabetic 139 patients (49.12%). The significant lower FRAX score between diabetic and control group was observed for both major osteoporotic (MOF) 6.68±4.66 vs. 8.53±5.26, p = 0.02 and hip fracture (HF) 2.42±2.69 vs. 3.96±3.71, p<0.01 respectively. Adjusted FRAX by substitution RA input for diabetes, the fracture risk estimates in both groups were approximately (MOF 9.09±6.32 vs. 8.53±5.26, p = 0.412 and HF 3.87±4.05 vs. 3.96±3.71, p = 0.888) Conclusions: The FRAX tool underestimated fracture risk in T2DM compared to non-diabetes patients. The introduction of a correction factor by selecting RA as equivalent variable for T2DM resulted in mean FRAX values no longer significant to those without diabetes subjects which can improve the performance of the FRAX prediction.

245-252

Authors: Panjit Phothong, Waraporn Somwong, Kongkaew Younboonhlim, Porntipa Kwanraj, Sompit Suvanboon

Objective: To assess nursing factors affecting the solution of dengue hemorrhagic fever patients. Methods: This research was descriptive research by collecting retrospective data from medical records. We studied dengue patients who were admitted to the wards in the Hospital for Tropical Medicine, Mahidol University .To record in case record form . Total 250 patients consisted of 125 DF patients and 125 DHF / DSS patients selected by Hospital number with an even number ending. Data collected from 1 January 2013 to 31 December 2017 from medical record. Results: Among 250 patients, there were 125 cases (50%) in the DF group, 115 (46%) in the DHF group, and 10 (4%) in the DSS group. 53.3 % of patients were female with overall mean age 28 years. Most patients (86.0%) were Thai, Burmese (10%), Lao (2.4%). Nursing Practice up to 99.5% of care could be managed by nurses such as vital sign monitoring, providing supporting care, etc. Only 0.5% of care must be managed by doctors, such as rise in hematocrit, and severely abnormal vital signs, or hepatic encephalopathy. Conclusion: The result of this study showed nurses were able to provide nursing practice to patients in due time, causing no complications and patients can go home as scheduled. Therefore, nurses play an important role in elementary evaluating the symptoms of patients and providing nursing care closely.