Vajira Medical Journal: Journal of Urban Medicine

1-12

Authors: Yutthana Apichatbutr

Introduction: The coronavirus outbreak which has spread across the world resulting in a significant shortage of the N 95 type of medical mask. For this reason, the University of Navamindradhiraj jointly developed a medical mask made from silicone type N 99 (Silicone Mask Respirator N 99) that filters more than 99% of bacteria and viruses. This research shows the study of respiratory physiology and the impact of using N 99 silicone mask in general volunteers. Methods: A prospective study was carried out by 20 volunteers breathing through a HEPA filter fitted with a silicone N 99 mask doing routine work and testing for breathing through volumetric capnography every 1 hour until at the end of 3-hours. The required measurements were measured dead space volume (Vd), dead space volume / tidal volume (Vd / Vt), end- tidal CO2 (EtCO2), alveolar CO2, oxygen saturation, airway resistance and a satisfaction questionnaire after all studies were performed. Results: Total 20 subjects were eight males and twelve females, mean age was 31 years (SD), mean body mass index was 21.60 ± 2.23 kg / m2 and no underlying disease. Volumetric capnography was used to calculate the respiratory parameters. With silicone N 99, the average dead space volume increased 27.57 ± 7.57 ml( p=0.001). The mean proportion of dead space volume / tidal volume before and after wearing the N 99 silicone mask was 0.22 ± 0.03 and 0.25 ± 0.03 respectively, with 0.03 increments (p = 0.011). End- tidal CO2 measurements before and after wearing the N 99 silicone mask were found to be 35.35 ± 2.32 mmHg and 36.71 ± 2.25 mmHg (p = 0.054). When calculating alveolar CO2 before and after wearing silicone N 99 was 32.94 ± 3.06 mmHg and 34.52 ± 2.64 mmHg respectively (p = 0.085). Respiratory resistance measurements before and after wearing the N 99 silicone mask was 2.53 ± 0.37 cmH2O/L/sec and 4.14 ± 0.8 cmH2O/L/sec increased by 1.53 ± 0.72 cmH2O/L/sec (p <0.001). The oxygenation value before and after using the mask is normal (p = 0.355). According to the user satisfaction questionnaire, there was no headache in the volunteers. Respiration heat and stinging, irritation, sweating, odor, scores were 1-2 points (not at all uncomfortable to a little uncomfortable), and masked communication and mask tightening were scored 2-3 points range (a little uncomfortable to moderately uncomfortable). Conclusion: When the silicone mask N 99 was continuously used for while it has shown that respiratory dead space and resistance were increased statistically significant but results of oxygenation and carbon dioxide levels were typical throughout use. It is therefore safe to use the N 99 silicone mask.

27-36

Authors: Kanoknan Somnuk, Kulrut Saytichai, Kittipong Ounkeaw, Rungnapha Siriphonphaibool, Arnon Thongkonghan

Objective: To study prevalence and factors related to metabolic syndrome in personnel of Somdejphrajaotaksinmaharaj Hospital Method: This was a descriptive research. The sample was 805 personnel of Somdejphrajaotaksinmaharaj hospital who received annual health checks up in2019.The data were collected from medical records and questionnaire which included general characteristics and personal behavioral factors. Descriptive statistics and inferential statistics were used. Univariate analysis and multiple logistic regressions were used for identifying risk factors and presenting adjusted odds ratio (ORadj). Results: The results showed that the prevalence of metabolic syndrome was 15.80% among Somdejphrajaotaksinmaharaj hospital personnel. The statistically significant factors related to the metabolic syndrome by using the univariate were the gender, age, disease, smoking, alcohol drinking and exercise frequency (p<0.05). Male were found to at risk of metabolic syndrome 3.10 times (95% CI: 1.71-5.63) more than female. Over 45 years of age were found to at risk of metabolic syndrome 2.35 times (95% CI: 1.27-4.33) more than lower than 45 years. Underlying diseases were found to at risk of metabolic syndrome 5.65 times (95% CI: 3.05-10.45) more than absence of underlying diseases. Smoking were found to at risk of metabolic syndrome 2.24 times (95% CI:1.05-4.78) more than non-smoking. Alcohols drinking were found to at risk of metabolic syndrome1.93times(95%CI:1.11-3.37)more than non-alcohols drinking. Exercise frequency lower than 3 day were found to at risk of metabolic syndrome 0.45 times (95% CI: 0.26-0.78) more than exercise frequency over 3 day. The factors related to the metabolic syndrome by using the multiple logistic regressions were gender, disease and exercise frequency (p<0.05). Male were found to at risk of metabolic syndrome 0.39 times (95% CI: 0.19-0.95) more than female. Underlying diseases were found to at risk of metabolic syndrome 0.20 times (95% CI: 0.10-0.39) more than absence of underlying diseases. Exercise frequency lower than 3 day were found to at risk of metabolic syndrome 1.34 times (95% CI: 0.70-2.55) more than exercise frequency over 3 day. Conclusion: This research showed the prevalence and factors related to metabolic syndrome of the personnel of Somdejphrajaotaksinmaharaj Hospital. This finding can be useful to plan the prevention and the treatment program in the future.

45-60

Authors: Sirinapa Saneemanomai, Suwat Srisuwannanukorn

Objectives: This study aimed to evaluate the sensitivity and specificity of the Thai versions of Scales for Outcomes in Parkinson’s Disease-Nighttime Sleep (SCOPA-NS) and Modified Parkinson’s Disease Sleep Scale (MPDSS) test for patients with Parkinson’s disease in comparison with the Pittsburgh Sleep Quality Index (PSQI) test. Methods: This cross-sectional study enrolled patients with Parkinson’s disease who sought treatment at the OPD department, Division of Neurology, Faculty of Medicine Vajira Hospital. The study was conducted from 1 March 2019 to 31 December 2019. Volunteers completed Thai SCOPA-NS and MPDSS sleep tests to obtain the sensitivity and specificity of each test, which was then compared with the PSQI test. Results: Of the 216 volunteers, 200 met the study criteria. To evaluate nighttime sleep, SCOPA-NS test and MPDSS test in Thai language were used. The prevalence rates of sleep disorders in volunteers using the SCOPA-NS test and MPDSS test were 62.5% (95% confidence interval [CI] 55.4–69.2) and 52.5% (95% CI 45.3–59.6), respectively. Youden’s index (1− (sensitivity + specificity)) was used to find the optimal cut-off points by comparing it with the PSQI test. SCOPA-NS test has a sensitivity of 83.1% (95%CI 75.3–89.2), specificity of 71.1% (95% CI 59.5–80.9), positive predictive value (PPV) of 82.4% (95% CI 74.6–88.6), and negative predictive value (NPV) of 72% (95% CI 60.4–81.8), whereas the MPDSS test has a sensitivity of 71.8% (95% CI 63.0–79.5), specificity of 78.9% (95% CI 68.1–87.5), PPV of 84.8% (95% CI 76.4–91.0), and NPV of 63.2% (95% CI 52.6–72.8). The volunteers preferred doing the SCOPA-NS test than the MPDSS test with preference rates of 65.5% and 34.5%, respectively. Conclusion: Thai SCOPA-NS test has higher sensitivity but lower specificity than the MPDSS test. However, patients significantly prefer doing the Thai SCOPA-NS test than the MPDSS test. Both tests can be used to evaluate patients with Parkinson’s disease at comparable accuracy. However, Thai SCOPA-NS test took shorter test, and patients with Parkinson’s disease prefer this test. We recommend using Thai SCOPA-NS in screening for sleep disorder in this patient population.

73-82

Authors: Krittima Phochanasomboon

Objectives: To study the outcomes of pharmaceutical care in the area of drug related problems, problem causes, intervention methods, intervention outcome and inhaler technique in the asthma and chronic obstructive pulmonary disease (COPD) patients. Methods: This study was retrospectively descriptive study in patients diagnosed with asthma and COPD who receives the first prescription of new inhaler device from the out-patient department of Faculty of Medicine Vajira Hospital, Navamindradhiraj University between January 1, 2014 to December 31, 2018. Each patient received pharmaceutical care during the treatment of asthma and COPD. The outcomes were analyzed by descriptive statistics. Results: There were 538 patients in this study, (282 females, 52.42%, and 257 males, 47.78%). This study identified 402 drug related problems (DRPs) in 311 patients (57.81%) with an average of 1.32 + 0.69 DRPs per patient. The most frequent problems were insufficient drug treatment [331 problems (82.34%)]. Most common causes were prescribing error (missing of necessary information) 219 causes (54.48%). The highest problem solving action was the change of drug prescription which was 235 times (58.46%). Pharmaceutical care interventions could resolve 395 problems (98.26%). From evaluation of inhaler technique, the most common misuse inhaler device by the patients were Respimat, Turbuhaler, Breezhaler, HandiHaler, Pressurized Metered-Dose Inhalers and Accuhaler, respectively. Conclusion: The pharmaceutical care in this study was found to be effective to identify and solve the problems relating to drug use, which can assist the patients to use their medications appropriately.