Journal of Southeast Asian Medical Research
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VALIDITY AND AGREEMENT OF THE THAI SELF-REPORTED QUESTIONNAIRE BASED ON THE ACTTION-APS PAIN TAXONOMY FIBROMYALGIA DIAGNOSTIC CRITERIA IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN
Background: Fibromyalgia (FM) is a chronic widespread pain syndrome that leads to functional impairment and poor quality of life. The American College of Rheumatology (ACR) diagnostic criteria, introduced in 2016, have been widely used. However, the ACTTION-American Pain Society Pain Taxonomy (AAPT) group introduced new, shorter criteria in 2018 to simplify the diagnosis. The FM self-administered questionnaire (FSQ), based on the ACR 2016, had good validity; however, studies on the shorter and more user-friendly AAPT criteria were needed. Objectives: This study aimed to develop a Thai version of the short AAPT criteria for the FM self-administered questionnaire (AAPT-FSQ) and to assess its validity and agreement with the ACR 2016. Methods: AAPT criteria were translated into Thai. Of the 128 patients with chronic musculoskeletal pain for more than three months at the Rehabilitation Medicine outpatient clinic were asked to complete a self-questionnaire that included the Thai AAPT-FSQ, Thai Fatigue Severity Scale (FSS), and Thai Pittsburgh Sleep Quality Index (PSQI). Lastly, FM diagnosis for each participant was done by physiatrists based on the ACR 2016 diagnostic criteria. Results: Construct validity showed strong correlations between AAPT pain sites and Widespread Pain Index (rs = 0.78, p < 0.001); AAPT sleep problems and Thai PSQI (rs = 0.64, p < 0.001), and AAPT fatigue problems and Thai FSS (rs = 0.67, p < 0.001). Diagnosis agreement between the AAPT and ACR 2016 criteria was 90.6%, with a substantial Kappa coefficient of 0.67 (p < 0.001), indicating good concordance. The sensitivity and specificity were 48.3% (95% CI: 29.4%–67.5%) and 99.0% (95% CI: 94.5%–100.0%), respectively. Conclusion: The Thai AAPT-FSQ had good construct validity and agreement in patients with chronic musculoskeletal pain. Due to its shorter criteria and simplicity, it may serve as a practical self-administered questionnaire for FM.
Copyright (c) 2025 Journal of Southeast Asian Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
AIRFLOW, BEHAVIORS AND DELAYED DETECTION: DRIVERS OF A COVID-19 OUTBREAK IN A THAI MILITARY RECRUIT TRAINING UNIT, MAY-JUNE 2025
Background: On May 6, 2025, the Epidemiology Unit of Phramongkutklao Hospital was notified of a probable COVID-19 outbreak among recruits and instructors at a recruit training unit in Samut Sakhon Province, Thailand. A joint field investigation was conducted in collaboration with the 11th Medical Unit, the Epidemiology Unit of Phramongkutklao Hospital, and the Armed Forces Research Institute of Medical Sciences (AFRIMS). Objective: To confirm and characterize the COVID-19 outbreak, identify critical gaps in the existing protocol and transmission factors, and provide recommendations for control and prevention. Methods: A retrospective cohort study was conducted from May 1 to June 3, 2025. Cases included individuals with at least two COVID-19–compatible symptoms, a positive antigen test kit (ATK) result, or laboratory confirmation by real-time RT-PCR. Structured interviews and standardized questionnaires collected exposure and behavior data. A walk-through survey assessed environmental conditions, including airflow, temperature, and humidity in the dormitory. Outbreak control measures, including cohorting based on ATK results, were documented. Results: Among 114 personnel, 47 cases were identified (attack rate 41.2%), with 97.9% symptomatic. Of these, 95.7% had received prior COVID-19 vaccination. Common symptoms were sore throat, headache, and cough. The environmental assessment showed elevated temperatures, humidity, and west-to-east airflow, which correlated with higher attack rates in the eastern sleeping zones. Behavioral factors included shared drinking glasses and proximity during meals; sharing glasses showed the lowest p-value (adjusted OR = 1.99, 95% CI: 0.89–4.48). Delayed detection due to a lack of systematic screening facilitated transmission. Conclusions: The outbreak was driven by multifactorial causes, including delayed detection and environmental and behavioral factors. Alignment between airflow and attack rates highlights the role of ventilation. Proactive surveillance, systematic ATK screening for all respiratory symptoms, and enforcement of physical distancing are recommended to prevent similar outbreaks in congregate military settings.
Copyright (c) 2026 Journal of Southeast Asian Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
ANNUAL REPORT 2024: SURVEY OF DEMOGRAPHIC DATA AND PREVALENCE OF HEALTH RISK FACTORS IN NAYAO, CHACHOENGSAO PROVINCE, THAILAND
Background: Rural communities in Thailand continue to face a dual burden of chronic noncommunicable diseases (NCDs), mental health concerns, and preventable infectious diseases. Annual community surveys provide essential evidence for local health planning. Methods: A cross-sectional survey was conducted in December 2024 in Na Yao, Tha Kradan Subdistrict, Chachoengsao Province. Standardized electronic questionnaires (REDCap), physical examinations, and laboratory investigations were used to assess demographic characteristics, metabolic risk factors, accidents, cancer screening, osteoporosis, musculoskeletal symptoms, mental health, and parasitic infections. Statistical analyses included descriptive statistics, Chi-square or Fisher’s exact tests, and prevalence rate ratios. Results: Of 730 participants, 594 were adults aged ≥20 years. Hypertension (36.1%), obesity (32.8%), dyslipidemia (16.8%), and diabetes (13.3%) were the most common NCDs, with hypertension more prevalent among those with lower educational attainment (44.1% vs. 27.9%, p < 0.05). Cancer screening uptake was highest for cervical (28.3%) and lung cancer (27.6%), but lower for colorectal (14.2%) and hepatobiliary cancers (13.3%). Osteoporosis risk varied across villages (7.4–13.0% by FRAX®; 6.8–18.7% high risk by OSTA). Musculoskeletal pain was common, with chronic knee pain affecting over half of adults in some clusters. Stress affected nearly one-third of participants and was significantly associated with female sex, smoking, lower educational attainment, and limited mental health care access. Parasitic infections were rare, but hookworm was associated with a lack of footwear, and Taenia spp. with the consumption of raw vegetables. Conclusion: This Annual Report 2024 highlights substantial burdens of NCDs, stress, musculoskeletal disorders, and preventable injuries, alongside persistent gaps in cancer screening and parasitic infection risks. Targeted, community-based interventions are urgently needed to address both chronic and communicable health challenges in rural Thailand.
ACCURACY OF THE APPLE WATCH SE IN MEASURING DISTANCE AND MAXIMUM HEART RATE DURING A 6-MINUTE WALK TEST IN CARDIAC REHABILITATION PATIENTS
Background: A 6-Minute Walk Test (6MWT), a submaximal functional test, is widely used in cardiac rehabilitation. Wearable devices, such as a smartwatch, offer a substantial benefit by potentially replacing manual processes. Objectives: This study aimed to assess the accuracy of a smartwatch in measuring distance and maximum heart rate during a 6MWT. Methods: The study was conducted at the Cardiac Rehabilitation Clinic, Phramongkutklao Hospital, Bangkok, Thailand. Fifty-five Thai adults aged 20 to 75 years with cardiovascular diseases who attended an outpatient Cardiac Rehabilitation Program were enrolled into the study. Before the 6MWT, participants were fitted with a smartwatch and monitored via EKG telemetry. Upon completing the test, the distance and the maximum heart rate from the smartwatch were recorded. A standard measuring wheel and EKG telemetry were used as reference standards to assess the smart watch’s accuracy. Results: The mean distances recorded by the measuring wheel and the smart watch were 415.15 ± 72.26 meters and 475.29 ± 88.1 meters, respectively (p < 0.001). The intraclass correlation coefficient (ICC) for distance was 0.897 (95% CI: 0.823–0.94, p < 0.001). The maximum heart rates measured by EKG telemetry and the smart watch were 103.09 ± 13.19 bpm and 101.67 ± 13.93 bpm (p = 0.172), respectively, with an ICC of 0.915 (95% CI: 0.854–0.95, p < 0.001). Conclusion: The smartwatch provides accurate maximum heart rate measurements and reliable distance measurements during 6MWTs in an indoor cardiac rehabilitation setting. However, calibration for the distance measured by the smart watch may be necessary.
A COMPREHENSIVE REVIEW OF EPIDEMIOLOGY, RESISTANCE AND TREATMENT OF PEDICULUS CAPITIS IN THAILAND
Background: Pediculosis capitis, or head lice infestation, is a significant public health issue in Thailand, particularly among school-aged children. Prevalences are high, ranging from 23% to over 80% in various communities. A significant challenge to control efforts is the widespread resistance to common chemical treatments, such as permethrin, caused by knockdown resistance (kdr) mutations. This situation calls for a review to address these challenges to guide public health policies. Objective: This review aims to consolidate the current literature on the epidemiology, resistance, and treatment strategies for pediculosis capitis in Thailand, highlighting key findings and ongoing challenges. Methods: A comprehensive search was conducted across five bibliographic databases: PubMed, Scopus, Web of Science, Thai Journals Online (ThaiJO), and Google Scholar, from which 15 relevant articles were selected for this review. Results: Epidemiological studies confirm a high prevalence of head lice among Thai schoolchildren, reaching up to 83.9% in some areas, with girls being more frequently affected. Molecular studies detected a high frequency of kdr mutations (97.4%) in lice populations across Thailand, which are strongly linked to treatment failure for 1% permethrin lotion (failure rate of 47.5%). Alternative treatments have shown high effectiveness; oral ivermectin achieved a 94.8% cure rate, and 4% dimeticone demonstrated 100% mortality in ex vivo tests. A herbal shampoo demonstrated a 100% cure rate (compared to 3.3% for the placebo), and health education programs reduced the prevalence from 59.2% to 44.1%, while also improving knowledge and practices. Conclusion: Pediculosis capitis remains a persistent challenge in Thailand, characterized by a high prevalence and significant resistance to permethrin. Alternative treatments, such as ivermectin and dimeticone, combined with health education, are effective ways to control the condition. Future efforts should focus on integrated strategies that combine molecular surveillance and community-based education to tackle drug resistance and the social factors that sustain infestations.
ASSOCIATION WITH INCIDENCE OF ISCHEMIC HEART DISEASE BASED ON THE ESTIMATED GLOMERULAR FILTRATION RATE IN THE POPULATION OF THE THREE SOUTHERN BORDER PROVINCES OF THAILAND
Background: Declining kidney function, as reflected by a reduced estimated glomerular filtration rate (eGFR), has been associated with an increased risk of ischemic heart disease (IHD). However, limited evidence is available in the population residing in Thailand’s three southern border provinces. Objective: This study aimed to examine the association between estimated eGFR and the incidence of IHD in the population of Thailand’s three southern border provinces. Methods: A retrospective cohort study was conducted using electronic medical records from three government hospitals between October 1, 2018, and September 30, 2023. Adults aged 30 years or older with baseline eGFR data were categorized into five groups based on their eGFR levels. The outcome was incident IHD, identified using ICD-10 codes. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for relevant covariates. Results: Among 16,763 participants followed for a total of 53,360 person-years, 746 developed IHD. The cumulative incidence was 4.5% (95% CI: 4.0–5.0%), and the incidence density was 13.98 cases per 1,000 person-years. A significant inverse relationship was observed between eGFR and IHD incidence (p < 0.001). Compared with participants with eGFR ≥90.00 mL/min/1.73 m², the adjusted HRs for IHD were 1.89 (95% CI: 1.58-2.25) for eGFR 60.00-89.99, 2.65 (95% CI: 2.16-3.24) for 30.00–59.99, 4.96 (95% CI: 3.62-6.81) for 15.00-29.99, and 3.74 (95% CI: 2.34-5.99) for <15.00 mL/min/1.73 m². A graded increase in IHD risk was observed across lower eGFR groups. Other significant risk factors included older age, sex, higher systolic blood pressure, and atrial fibrillation, while higher high-density lipoprotein cholesterol (HDL-C) levels were associated with a reduced risk of IHD. Conclusion: Reduced eGFR was independently associated with a higher risk of IHD, even among individuals with mildly impaired kidney function. These findings support the potential role of eGFR in cardiovascular risk assessment and the development of targeted prevention strategies in high-risk populations.
ANALYZING THE EARLY CLINICAL AND IMAGING OUTCOMES OF STA-MCA BYPASS SURGERY VIA THREE-DIMENSIONAL VOLUMETRIC MEASUREMENT IN PATIENTS WITH INTRACRANIAL ATHEROSCLEROSIS
Background: Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke and remains associated with high morbidity and mortality. Although recent studies suggest that superficial temporal artery to middle cerebral artery (STA–MCA) bypass may benefit patients with hemodynamic compromise, its clinical efficacy remains a matter of controversy. Objective: We aimed to evaluate the effectiveness of STA-MCA bypass surgery in patients with ICAD, focusing on both clinical outcomes and cerebral hemodynamic imaging using 3D volumetric analysis. Methods: Six patients with ICAD who underwent STA-MCA bypass surgery were selected using predefined criteria. Clinical outcomes were retrospectively reviewed using the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS). Imaging outcomes were examined by analyzing the brain lesion area and perfusion using computed tomography perfusion (CTP). Statistical significance was analyzed using paired rank-sum and Friedman tests. Results: In all cases, the primary diagnosis was ischemic stroke with significant stenosis of the internal carotid or middle cerebral artery. All patients demonstrated patent grafts, and no ischemic events occurred within 30 days after surgery. However, one patient had a postoperative asymptomatic acute subdural hematoma. All patients showed stable or improved neurological and functional outcomes after 30 days. Median NIHSS scores remained stable (pre-op 1.50 [0.00–7.50] vs. 30 days 1.50 [0.00–5.25], p = 0.368), while median mRS scores showed a non-significant trend toward improvement (pre-op 1.50 [0.75–3.50] vs. 30 days 1.00 [0.00–3.00], p = 0.082). Volumetric perfusion analysis demonstrated reductions in lesion volumes for CBF (66.40 [43.35-145.70] → 28.55 [19.85-111.28] mL), MTT (220.75 [101.60-337.05] → 143.00 [39.93-242.35] mL), and Tmax (265.45 [145.53-333.63] → 212.40 [101.08-260.20] mL) on CT perfusion immediately postoperatively and at short-term follow-up, although these changes did not reach statistical significance (p = 0.068 for all). CBV lesion volume also decreased slightly (1.15 [0.25–5.51] → 0.00 [0.00–2.54] mL, p = 0.109). Conclusion: Our results suggest that STA-MCA bypass surgery may offer clinical and hemodynamic benefits for ICAD patients who are unresponsive to medical and endovascular treatments. In this study, improved NIHSS and mRS scores, as well as hemodynamic parameters, were observed using CTP. Performing volumetric measurements may support the assessment of imaging outcomes. Given the small sample size and short follow-up period, these findings should be interpreted with caution. Large-scale and long-term studies are warranted to validate our findings and optimize ICAD treatment strategies.
ARTIFICIAL INTELLIGENCE PREDICTION MODELS FOR POSTPARTUM HEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality globally, with the highest burden in low- and middle-income countries, including regions of Southeast Asia. Given the limited predictive accuracy of traditional risk assessment models, artificial intelligence (AI)-based predictive models have emerged as a promising approach to enhance early detection and prevention. Objectives: To evaluate the effectiveness of AI-based predictive models for PPH through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search of multiple databases (EMBASE, MEDLINE, ScienceDirect, CINAHL, Google Scholar, and Thai-specific resources) for studies published from 2015 to 2025. Conference abstracts, reviews, and studies without specific PPH outcomes were excluded. Two independent reviewers screened studies, extracted data using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) and PROBLAST. Statistical analysis was performed using R version 4.4.3. Results: Eleven studies were included, employing algorithms such as XGBoost, Logistic Regression, Random Forest, and Gradient Boosting. The pooled AUROC was 0.850 (95% CI: 0.789–0.912), indicating good predictive performance. However, there was substantial heterogeneity (I2=99.6%), primarily due to differences in populations, PPH definitions, and modeling approaches. Most studies relied on internal validation and did not originate from Southeast Asia, highlighting a significant regional evidence gap. The risk of bias was largely unclear due to inadequate reporting on blinded predictor assessment and validation methods. Furthermore, a funnel plot analysis suggested potential publication bias, especially among smaller studies. Conclusion: AI-based models show promise for predicting PPH but require external validation to confirm generalizability. The absence of studies from Southeast Asia underscores the need for region-specific research, including in Thailand, to develop and validate context-appropriate models for clinical use.
CLINICAL MANAGEMENT OF SNAKEBITES IN COMMUNITY CARE UNIT: A SINGLE-CENTER RETROSPECTIVE STUDY IN LOPBURI, CENTRAL THAILAND
Background: Snakebite, a neglected tropical disease, might result in severe clinical outcomes. Objectives: This study presents a retrospective analysis of snakebite data from a community hospital in Lopburi, Central Thailand, and also assesses snakebite distribution and clinical management to lower mortality and morbidity in the community setting. Methods: A cross-sectional retrospective study used data from October 1, 2014, to August 30, 2023, to determine the epidemiology, clinical profile, and management of snakebite patients who visited Pattananikom Hospital. Results: The study included 225 snakebite patients with a median age of 39 (IQR 26-53 years), and 64.4% were male. The responsible species for half of the bite cases were unidentified (54.2%). Among 103 confirmed snakebites with identified species, there were 24 cobras (23.3%), 23 Russell’s vipers (22.3%), 16 green pit vipers (15.5%), 4 Malayan pit vipers (3.9%), 2 Malayan kraits (1.9%), and 34 (33.0%) other nonvenomous snakes. Notably, 10 out of 24 patients (41.7%) encountering cobras were diagnosed with venom ophthalmia. For bites caused by unknown snakes, two patients experienced compartment syndrome, one had dyspnea, and one had ptosis. Thirteen patients, also bitten by unidentified snakes and eligible for antivenom, went untreated due to a shortage of polyvalent antivenom, resulting in referrals. From 2021 to 2023, 20 patients (55.6% of 36) were referred (p=0.026). Of the patients with thrombocytopenia, eight (57.1% of 14) were referred (p=0.001), as were all cases with systemic bleeding, dyspnea, ptosis, or compartment syndrome. Moreover, prophylactic antibiotics (amoxicillin-clavulanate) were routinely prescribed (82.7%). Conclusion: Snakebites have been referred to more frequently in the last three years. Even though the origins of most cases are unknown and often lead to referrals, there is a notable shortage of polyvalent antivenoms. This scarcity has the potential to delay treatment and increase the risk of mortality. This study highlights the need for improved antivenom access in community hospitals to mitigate delays and reduce mortality.
A COMPARISON OF AUTOMATED COMPLETE BLOOD COUNT PARAMETERS AND HEMOLYSIS OCCURRENCE FROM VACUUM AND NON-VACUUM K2EDTA TUBES
Background: The preanalytical factors, including tube type and storage duration, may influence CBC results and hemolysis. Nowadays, blood collection using K₂EDTA, both vacuum and non-vacuum tubes, is widely utilized in clinical laboratories for complete blood count (CBC) analysis. However, the impact of vacuum-induced negative pressure and the anticoagulant-to-blood ratio in under-filled tubes on sample integrity remains a concern. Objective: This study aimed to compare the performance of K₂EDTA vacuum and non-vacuum blood collection tubes, including under-filled non-vacuum tubes, in automated CBC parameters and to assess hemolysis occurrence at different time points. Methods: Blood samples from 30 healthy subjects were collected into three different K₂EDTA blood collection tubes: vacuum, non-vacuum, and non-vacuum tubes with under-filled volumes. CBC parameters, including RBC, Hb, Hct, MCV, MCH, MCHC, RDW, WBC, PLT, and MPV, were analyzed at 0 hours, 3 hours, and 24 hours post-collection. Hemolysis was assessed via spectrophotometry at 540 nm. Results: No statistically significant differences were observed in CBC parameters among the three groups at 0 hours. However, significant differences occurred at 3 hours post-collection, including WBC and PLT in vacuum tubes, MCV in non-vacuum tubes, RDW in under-filled tubes, and MPV in all tube types. At 24 hours, all tube types showed significant changes in MCV, MCHC, RDW, and MPV, while RBC showed only changes in vacuum tubes. The highest hemolysis levels occurred in vacuum tubes at 0 hours, whereas under-filled tubes exhibited increased hemolysis at 3 and 24 hours. Conclusion: The results indicated that all three tube types are suitable for hematological analysis if processed within 3 hours. However, the risk of hemolysis in vacuum tubes should be carefully considered, particularly in individuals with suspected hemolysis.
IMPROVING QUALITY OF LIFE IN LOCALLY ADVANCED OR ADVANCED HEAD AND NECK CANCER WITH CURCUMIN ADD-ON TO STANDARD NUTRITION SUPPORT: A SECONDARY ANALYSIS OF THE CURCHEXIA STUDY
Background: Patients with head and neck cancer often suffer from cancer anorexia and cachexia syndrome (CAS), which severely impacts their quality of life (QoL). The primary CurChexia study showed that curcumin improved muscle mass. Objectives: This pre-planned secondary analysis evaluated the effect of curcumin add-on therapy on the QoL of these patients. Methods: In this secondary analysis of a randomized, placebo-controlled trial, twenty patients with locally advanced or advanced head and neck cancer undergoing treatment and diagnosed with CAS were randomized to receive either 4,000 mg of curcumin daily or a placebo, in addition to standard nutritional support for eight weeks. QoL was assessed at baseline, week 4, and week 8 using the EORTC QLQ-C30 questionnaire. A linear mixed-effects model was used to analyze changes in QoL scores over time between the two groups. A retrospective power calculation was conducted for key QoL domains. Results: The curcumin add-on group showed statistically significant improvements compared to the control group in physical functioning (p = 0.001), emotional functioning (p = 0.023), appetite loss (p = 0.001), and pain (p = 0.033). No significant differences were observed in global health status or other functional and symptom scales. The study was adequately powered (>80%) to detect the observed significant differences, but was underpowered for non-significant outcomes like global health status. Conclusion: In patients with locally advanced or advanced head and neck cancer experiencing cancer anorexia-cachexia syndrome (CAS) during treatment, the addition of a daily 4,000 mg dose of curcumin to standard nutritional intervention significantly improves quality of life and body composition. These findings suggest that curcumin may serve as an effective pharmaconutrient, providing both clinical benefits and supportive care.
PREVALENCE AND FACTORS ASSOCIATED WITH FOREIGN BODY ASSOCIATED OCULAR INJURY AMONG OCULAR INJURY PATIENTS IN FOUR COMMUNITY HOSPITALS, CENTRAL, THAILAND: A MULTICENTER STUDY
Background: Foreign body (FB) associated ocular injury is a common cause of eye trauma. Understanding the prevalence and associated factors of FB-associated ocular injuries is essential for developing targeted prevention strategies and improving healthcare access for ocular trauma in community areas. Objectives: This study aimed to determine the prevalence and associated factors of FB-associated ocular injuries among patients presenting with ocular trauma at four community hospitals in central Thailand. Methods: This cross-sectional multicenter study reviewed ocular injury cases in four community hospitals in central Thailand, identified by ICD-10 codes from October 1, 2018, to September 17, 2024. Characteristics of FB-associated ocular injury, defined as ocular trauma with history or examination indicating a foreign body as the causative agent, were reviewed from medical records. Descriptive statistics and chi-square tests were used to analyze the differences between groups. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were estimated using Poisson regression with robust variance to assess associations. Temporal trends were examined by fiscal year periods. Results: Of 7,189 participants (60.8% male; mean age 45 years), 62% (n=4,456) had FB-associated ocular injuries. Male gender (aPR 1.12, 95% CI 1.08–1.16), metal/stone objects (aPR 1.53, 95% CI 1.46–1.59), and injury onset ≥24 hours (aPR 1.24, 95% CI 1.17–1.32) were associated with a higher risk. Trend analysis by fiscal year showed that health-seeking behavior shifted toward OPD visits (p<0.001). Conclusion: The prevalence of FB-associated ocular injuries in community hospitals was high, with male gender, mechanical work, metallic objects, and delayed healthcare access (>24 hours) identified as significant risk factors. Preventive strategies such as promoting protective measures in industrial sectors and emphasizing the importance of seeking timely healthcare are essential to reducing the injury burden. Since 2019, a shift in healthcare access from ER to OPD has been observed, underscoring the need for a flexible healthcare system that can adapt to changing health-seeking behaviors.
COMPARATIVE RANDOMIZED CONTROLLED STUDY OF ANALGESIC EFFECT BETWEEN ORAL COMBINATION ANALGESIA AND INTRAVENOUS ANALGESIA IN PATIENTS UNDERGOING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AT PHRAMONGKUTKLAO HOSPITAL
Background: Extracorporeal Shockwave Lithotripsy (ESWL) is a widely used, noninvasive treatment for upper urinary tract stones. Despite its routine use, patients often experience significant pain during the procedure, and opioid-based analgesia such as intravenous fentanyl may lead to adverse effects. Optimizing pain control while minimizing opioid exposure remains a clinical challenge. Objectives: To compare the analgesic efficacy and side effect profiles of three analgesic regimens during ESWL: intravenous fentanyl alone, a combination of oral and intravenous analgesics, and oral analgesics alone. Methods: This randomized clinical trial included 78 ESWL sessions from 72 patients with renal or ureteric stones. Patients were randomized into three groups: Group A received intravenous fentanyl (50 µg); Group B received oral paracetamol (500 mg) and ibuprofen (400 mg) plus intravenous fentanyl (50 µg); Group C received oral tramadol (50 mg), paracetamol (500 mg), and ibuprofen (400 mg). A rescue dose of intravenous fentanyl 50 µg was offered when a patient reported an NRS score > 8 or was unable to tolerate the pain. The primary outcome was pain intensity, measured using the 11-point Numeric Rating Scale (NRS; 0 = no pain, 10 = worst possible pain), administered every 15 minutes during the procedure. Patients verbally rated their pain by choosing a number between 0 and 10. The secondary outcomes were the occurrence of adverse effects and the need for a rescue dose of intravenous fentanyl (50 µg, if NRS > 8 or intolerable pain). The stone-free rate was assessed at 2–4 weeks. Results: Baseline characteristics were comparable between groups, except for body mass index. The mean pain scores were 6.39 ± 1.26 in Group A, 5.38 ± 1.85 in Group B, and 5.88 ± 1.34 in Group C. Group B reported significantly lower pain scores than Group A at 15 minutes (2.5 ± 1.96 vs. 3.77 ± 1.95, p = 0.018) and 30 minutes (4.73 ± 2.24 vs. 6.08 ± 1.81, p = 0.016). Group C had significantly lower pain scores at 60 minutes (6.73 ± 1.59 vs. 7.88 ± 1.99, p = 0.034) and 75 minutes (7 ± 1.39 vs. 7.94 ± 1.3, p = 0.040) compared to Group A. The incidence of adverse effects was lowest in Group C (dizziness: 23.1%). A rescue intravenous fentanyl dose was required among 6 (23.1%) of Group A, 6 (23.1%) of Group B, and 11 (42.3%) of Group C; these differences were not statistically significant. Conclusion: Combining oral and intravenous analgesics offers superior early pain control during ESWL compared to intravenous fentanyl alone. Oral-only multimodal analgesia, with provision for a rescue intravenous fentanyl dose, administered when needed, provided comparable pain relief with fewer side effects and may reduce routine opioid use during ESWL. The inclusion and reporting of the rescue dose are essential for a consistent and practical analgesic strategy.
PERCEPTIONS, ATTITUDES, BEHAVIORS, AND BARRIERS OF PEOPLE WITH OBESITY AND HEALTH CARE PROFESSIONALS ABOUT OBESITY AND ITS MANAGEMENT: THAILAND PERSPECTIVE FROM THE ACTION APAC SURVEY STUDY
Background: Obesity rates are increasing in Thailand, with their impact extending beyond the healthcare system, conferring a substantial burden on the individual, society, and the economy. Objectives: The ACTION APAC (Awareness, Care and Treatment In Obesity Management Asia Pacific) study aimed to identify perceptions and attitudes towards obesity among people with obesity (PwO) and healthcare professionals (HCPs) in the Asia Pacific (APAC) region. Here, we report the findings of the Thailand data set. Methods: An online, cross-sectional survey was conducted across nine countries, including Thailand, recruiting respondents (PwO, HCPs) through online, telephone, and public intercept methods. PwO participants aged 18 years and older (body mass index ≥25 kg/m²) were included based on self-reported height and weight. Eligible HCPs had over two years of direct patient care experience. Data were analyzed using descriptive statistics. Results: In total, 1,503 PwO and 200 HCPs completed the survey. Most PwO (74%) and HCPs (92%) recognize obesity as a chronic disease; however, only 49% of PwO discussed weight with their HCP, and 51% felt weight loss was their responsibility. The primary reasons for not discussing weight included self-responsibility (PwO, 34%) and HCPs perceiving the patient as uninterested (39%). Most PwO (78%) liked HCPs discussing weight, with only 11% feeling offended. While 48% of PwO relied on the Internet for weight management information, only 28% consulted HCPs. PwO and HCPs identified a lack of exercise and unhealthy eating habits as significant barriers to weight loss and preferred a healthy diet and exercise to lose weight. Conclusions: Recognizing that most Thai PwO appreciate HCPs initiating weight discussions presents an opportunity for proactive, open, and collaborative dialogue by HCPs. Further, there is a nationwide need to improve awareness about obesity and obesity-specific interventions to improve its management.
PREVALENCE OF ZINC DEFICIENCY AND OXIDATIVE STRESS IN PEDIATRIC KIDNEY TRANSPLANTATION RECIPIENTS
Background: Zinc (Zn) is a cofactor of essential enzymes involved in the antioxidant defense system. Increased oxidative stress affects the function of the transplanted kidney. Objectives: We aimed to determine the prevalence of Zn deficiency and evaluate the relationship between Zn deficiency and oxidative stress. Additionally, we investigated the associated oxidative stress factors among pediatric kidney transplant recipients. Methods: In this cross-sectional descriptive study, we enrolled children (1 to 21 years of age) who underwent kidney transplantation and were actively followed up at Phramongkutklao Hospital, Bangkok, Thailand, between December 2022 and May 2023. Patients’ characteristics were reviewed; blood samples were collected for serum zinc (Zn) level, superoxide dismutase (SOD), malondialdehyde (MDA), lipid profile, hemoglobin A1C, fasting blood sugar, and serum creatinine. Results: Twenty-four patients were included in the study. No differences in baseline characteristics between the two groups were observed. Zn deficiency was identified in eight patients. The prevalence of Zn deficiency in pediatric kidney transplant recipients was 33.33% (95% CI: 15.6%-55.3%). The median Zn level in the patients with and without Zn deficiency was 67 (49-72) and 83 (74-111) mcg/ dL, respectively. The median percentage of Zn intake per dietary reference intake (DRI) in Zn-deficient patients was 88.57 (47.56-115.8) compared with 97.5 (62.89-120.6) in the non-Zn-deficient group. However, these were not statistically significant. One patient (1/1, 100%) who had a history of chronic allograft rejection revealed a significantly high SOD level in red blood cells (RBC) (p=0.026). Six patients with dyslipidemia (6/6, 100%), on the other hand, exhibited low SOD level in RBC (p=0.034). Conclusion: We could not demonstrate an association between Zn deficiency and SOD or MDA levels. Regarding a role in pediatric kidney transplantation, Zn supplementation may benefit patients with low Zn intake.
EXPERIENCES AND PERCEPTIONS OF LIVING WITH TYPE 1 DIABETES AMONG YOUTH PATIENTS, PARENTS, AND PEERS: A QUALITATIVE STUDY
Background: The incidence of type 1 diabetes mellitus (T1D) among the youth is a global concern. This disease not only poses physical health challenges but also creates emotional and social stigmas. Objectives: The present study aimed to explore the perceptions and experiences of patients with T1D, their guardians, and peers, a topic that has not been extensively investigated in this context. Methods: Between March and July 2023, an in-depth semi-structured interview was conducted with eight T1D patients aged 10–20 at Phramongkutklao Hospital. Seven mothers and a group of close friends were chosen by the patients and were included in another in-depth interview. Additionally, six groups and one in-depth interview involving 20 participants were held with the youth unrelated to T1D patients at an international private school. The interviews covered general knowledge of T1D, perceptions, daily life experiences, relationships with individuals with T1D, and interpersonal relationships. Thematic analysis was used to analyze the data. Results: Patients and parents viewed T1D as both severe and manageable, with significant lifestyle challenges, particularly in diet and daily activities, that influenced their life choices and financial stability. Although the patient experienced sudden adaptation to T1D, they developed effective self-care strategies and appreciated the supportive adjustments made by their family. Furthermore, despite proactive management of their condition through new treatments and enhanced knowledge, they encountered social challenges, including support mixed with misunderstandings and stigma. Meanwhile, guardians experienced stress from caregiving and advocated for better treatment access and support. Peers recognized that patients could lead everyday lives with proper management, but they often lacked a comprehensive understanding of T1D, highlighting substantial gaps in societal awareness. Conclusion: The findings underscore the need for improved diabetes education and support systems to reduce stigma and enhance the quality of life among youth with T1D, particularly through peer and guardian engagement.
HEMATOHIDROSIS-LIKE SYMPTOMS OF SKIN-PICKING DISORDER
Hematohidrosis, also known as hematidrosis, is a rare condition characterized by the presence of blood in sweat, with an unknown etiology. Although pathophysiology is poorly understood, psychological stress is undoubtedly linked to the condition. The diagnosis of hematohidrosis is complex, and it is only after bleeding disorders, vasculitis, trauma, and other disorders are ruled out. We describe a 12-year-old girl with a history of spontaneous bleeding on all fingernail folds. The patient and her mother denied trauma, picking, and provoking situations. The bleeding on all fingernail folds even occurred at the hospital. However, histopathology supported the diagnosis of hematohidrosis-like symptoms from skin-picking disorder. This case demonstrates that unusual bleeding on the fingernail folds can be associated with skin-picking or self-induced nail disorders. Careful history-taking and a thorough physical examination are essential to avoid unnecessary skin biopsies.
ENDOMETRIAL GASTRIC-TYPE ADENOCARCINOMA ARISING IN THE BACKGROUND OF MUCINOUS METAPLASIA: A CASE REPORT
Endometrial gastric-type adenocarcinoma was recently included in the WHO Classification of Female Genital Tumors, 5th edition, as a very rare tumor. Some cases are linked to mucinous metaplasia, and histologic grade does not correlate with prognosis. Currently, there is no standard treatment available. This report describes a 70-year-old female patient who presented with leukorrhea. An endometrial biopsy revealed atypical mucinous glands and a positive result of p16, initially diagnosed as cervical adenocarcinoma. However, after a hysterectomy, a polypoid mass was identified in the endometrial cavity, leading to a revised diagnosis of endometrial gastric-type adenocarcinoma associated with mucinous metaplasia. Immunohistochemical staining showed positive results for CK20, CDX2, and MUC6 in the mucinous metaplasia region, whereas MUC6 was negative in the adenocarcinoma. The tumor was confined to the endometrium with no invasion or spread to lymph nodes. One-year postoperative follow-up showed no recurrence. This cancer is rare and has histological features that overlap with other tumors, underscoring the importance of differential diagnosis for accurate identification.
HOMOZYGOUS CHST14 MUTATION IN AN ADOLESCENT GIRL WITH MUSCULOCONTRACTURAL EHLERS-DANLOS SYNDROME: A FIRST REPORT IN THAILAND
Musculocontractural Ehlers-Danlos Syndrome (mcEDS) is a rare subtype of EDS, recognized as a multisystem congenital malformation characterized by multiple congenital contractures, distinctive craniofacial features, and characteristic skin manifestations. Most mcEDS is caused by biallelic loss-of-function mutations in the carbohydrate sulfotransferase 14 (CHST14) gene. This study reports a 15-year-old girl with classical clinical features of mcEDS who was first presented at Phramongkutklao Hospital in Thailand. The whole exome sequencing identified a homozygous frameshift, c.1033dup or p. Arg345ProfsTer10, mutation in exon 1 of the CHST14 gene. Sanger sequencing verified that this mutation was inherited from second-degree consanguineous parents. This study is the first to establish this frameshift mutation as a pathogenic mutation, thereby contributing to the literature on the CHST14 gene and enhancing our understanding of this rare condition. Our patient represents the first reported case of mcEDS in Thailand.