Journal of Southeast Asian Medical Research Journal of Southeast Asian Medical Research en-US <p><span style="color: #000000; font-family: Arial, sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Copyright to all published articles will be held by The Journal Medical Research. Copyright forms are handled by the production department of the publisher once a manuscript is accepted and scheduled for publication.</span></p> (Thanainit Chotanaphuti, M.D.) (Chatree Wongkaew) Wed, 10 Nov 2021 00:00:00 +0700 OJS 60 COMPARISON OF THE COBB ANGLE MEASUREMENT BETWEEN MANUAL AND DIGITAL METHODS AMONG FIVE MILITARY HOSPITALS <p><strong>Background:</strong> The Cobb angle measurement of the spine is an important parameter for assessing patients with scoliosis in terms of diagnosis, treatment planning, follow-up for severity and disease progression. This angle can be obtained from a plain X-ray film in an upright posteroanterior view or can be measured from digital images. A 5° curve progression is considered clinically significant.</p> <p><strong>Objective:</strong> This study aimed to compare the accuracy and difference of the Cobb angle measurements between manual and digital methods among 5 military hospitals located in the 1st area of command having orthopedic services and using different Picture Archiving and Communication (PACS).</p> <p><strong>Methods:</strong> Using plain X- ray films of patients diagnosed with scoliosis, a comparative study of the Cobb angle measurement was conducted. A total of 120 images were recorded in a compact disc in the Digital Imaging and Communications in Medicine (DICOM) system and was used to install in computer systems of 5 military hospitals (Hospitals A, B, C, D, and E), and then was interpreted using each hospital digital PACS. The mean difference of 5° is considered clinically significant. The validity of measurements was analyzed using paired t- test for the mean equivalence. The reliability of one time measurement was also performed using Intraclass Correlation Coefficient (ICC).</p> <p><strong>Results:</strong> Both one time and an average of three times of digital measurements among Hospitals A, B, C, D and E revealed significant differences when compared with the manual measurement (p &lt; 0.01). However, no clinical significance of both one time and the averaged three measurements were observed when the mean difference was less than 5°. In the combined process group (Hospitals C, D and E), a significant difference of the manual and digital measurements was observed (p&lt;0.01). However, no clinical significance using both one time and averaged three time measurements was found when the mean difference was less than 5°. The data of one time digital measurements were reliable (ICC= 0.9).</p> <p><strong>Conclusion:</strong> The use of digital Cobb angle measurement is a convenient practice. A significant difference using manual and digital methods was found using both one and combined processes; however, no clinical significance was observed. One time digital measurement revealed validity as those found in three time averaged measurements.</p> Chalermrit Kraturerk, Sompob Poopitaya, Roongrath Chitragran Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 11:47:16 +0700 PREVALENCE AND ASSOCIATED FACTORS IN THE DECLINE OF RENAL FUNCTION AMONG OUTPATIENTS ATTENDING A COMMUNITY HOSPITAL, CENTRAL THAILAND <p><strong>Introduction:</strong> Chronic kidney disease (CKD) is recognized as global public health issue especially affecting developing countries including Thailand. The epidemiologic data in the decline of renal function and the risk factors among Thai patients especially in community hospital settings were limited.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted to identify the prevalence and associated risk factors in the decline of renal function among outpatients in Thaluang Community Hospital, Lop Buri Province, central Thailand, between November 1, 2018 and October 31, 2019. The decline in renal function was defined by glomerular filtration rate (GFR) &lt;60 mL/min/1.73m2. Multivariate logistic regression analysis was performed to obtain the adjusted odds ratios (AOR) and 95% confidence interval (CI) of the factors related to the decline of renal function.</p> <p><strong>Results:</strong> A total of 874 outpatients participated in the study. The overall prevalence in the decline of renal function (eGFR &lt;60 mL/min/1.73m2) was 20.3% (95% CI; 17.5%-22.9%). Among male participants, the prevalence in the decline of renal function was 21.1% (95%CI; 16.7%-25.5%) while it totaled 19.7% (95%CI; 16.3%-23.1%) among females. The independent associated factors in the decline of renal function included greater age (AOR 1.07; 95% CI=1.05-1.09), history of NSAIDs used (AOR 2.97; 95% CI=1.85-4.79) and elevated pulse pressure (PP) &gt;75th percentile (AOR 1.64; 95% CI=1.07-2.53)</p> <p><strong>Conclusion:</strong> We reported the prevalence in the decline of renal function among outpatients in a Thai community hospital which was comparable with the national level. Advanced age, history of NSAIDs used and PP were related to reduced kidney function. Therefore, effective health interventions should be conducted especially, appropriate NSAIDs used among outpatients.</p> Chatchaya Chamnanmont, Napat Chaiyakham, Sittirat Kaensingh, Wisit Kaewput, Ram Rangsin, Boonsub Sakboonyarat Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 00:00:00 +0700 PASSIVE LEG RAISING EFFECT AT RESUSCITATION AMONG PATIENTS WITH VASOPLEGIC STATE <p><strong>Background:</strong> Several dynamic parameters have been used clinically to predict volume responsiveness and to guide fluid administration of which passive leg raising (PLR) is one of the most reliable techniques. PLR induces rising in cardiac output attributes through an unstressed volume mobilization from legs to heart causing autologous preload increment. Appropriate fluid resuscitation is essential and can be optimized by hemodynamic-based approach to vasodilatory hypotension.</p> <p><strong>Objective:</strong> This study aimed to evaluate the effectiveness and safety of PLR at early resuscitation among patients with vasoplegia.</p> <p><strong>Methods:</strong> We conducted a comparison study concerning an experimental design using a single blinded assessment of the outcomes that assigned patients with shock to be treated with PLR or flat position at early resuscitation. Forty patients with shock were included in this study. Twenty patients performed PLR at early resuscitation compared with the others that performed in the flat position and were measured for cardiac output (CO), mean arterial pressure (MAP), diastolic blood pressure (DBP), heart rate (HR), central venous pressure (CVP) and systemic vascular resistance (SVR) immediately after the procedures. The primary outcome was to evaluate the effect of early PLR on hemodynamic variables among hypotensive patients by comparing the difference in CO while the secondary outcomes were differences in MAP, DBP, HR, CVP, SVR, survival at hospital admission and the pulmonary complications of chest x-rays between the two groups.</p> <p><strong>Results:</strong> No difference was observed in baseline characteristics between the two groups of patients. Compared with the flat position, PLR at early resuscitation significantly increased CO (3.57 ± 0.27 vs. 2.2 ± 0.18 L/min, p = 0.037), MAP (22.48 ± 5.6 vs. 10.83 ± 4 mmHg, p&lt;0.001), DBP (19 ± 0.20 vs. 1.23 ± 0.12 mmHg, p=0.001) and CVP (4.52 ± 0.19 vs. 2.18 ± 0.13 mmHg, p=0.002). However, no differences were observed in HR, SVR, pulmonary complications of chest X-rays [2 (10%) vs. 1 (5%), p = 0.23] as well as survival at hospital admission [16 (80%) vs. 13 (65%), p = 0.48] between the two groups.</p> <p><strong>Conclusion:</strong> Among patients with shock, PLR at early resuscitation significantly increased CO, MAP, DBP and CVP than that of those performing the flat position. No differences were found in HR, SVR, pulmonary complications; PLR did not improve survival to hospital admission.</p> Panu Boontoterm, Pusit Feungfoo Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 12:30:30 +0700 COMPARISON OF PERCUTANEOUS PEDICLE SCREW FIXATION AND PEDICAL SCREW FIXATION IN CONVENTIONAL INCISION IN THORACOLUMBAR FRACTURE <p><strong>Background:</strong> Originally, patients with unstable thoracolumbar spine fracture were treated using pedicle screw fixation, a conventional incision. However, the small incision percutaneous pedicle screw fixation (PPSF), a new device, has been recently introduced which could save surgery time, reduce blood loss and improve clinical recovery.</p> <p><strong>Objective:</strong> This study aimed to evaluate postoperative outcomes of the PPSF, compared with the open pedicle screw fixation (OPSF) in conventional incision among patients with thoracolumbar fracture.</p> <p><strong>Methods:</strong> A retrospective study of 54 cases of patients with thoracolumbar spine fracture without neurological deficit was included in the study. The data were collected from medical records of patients admitted to Rayong Hospital from January 2017-December 2019. Results: Patients aged from 18-46 years (32.35+ 8.52) were mostly males (59.2%). Types of fracture included burst (72.22%). The most common level of thoracolumbar spine fracture was L1 (37.04%). Mostly, the cause of injury was fall from height (53.70%). The mean postoperative stays in the PPSF and OPSF groups were significant, 3.09±.59 and 6.16±1.003 days, respectively (p&lt;0.05). The mean intraoperative blood losses of the PPSF and OPSF groups significantly differed, 44.35±15.02 and 466.13±87.92 mL, respectively (p &lt; 0.01). However, the mean kyphotic angle reduction of the PPSF (24.43±2.74 degrees) and OPSF (24.87±2.55 degrees) groups did not significantly differ (p &gt; 0.1). The mean postoperative pain score (VAS) at the first day in the PPSF and OPSF groups were 6.43±.94 and 6.61±.98, respectively, which did not significantly differ (p &gt; 0.1).</p> <p><strong>Conclusion:</strong> PPSF spinal fracture treatment could reduce the amount of bleeding during surgery and reduce the length of hospital stay. However, the results of both types of surgery did not differ regarding postoperative pain, decreased kyphotic angle and surgical time.</p> Surojn Jeamanukulkit Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 12:54:10 +0700 ACTIVITY OF TRIAZOLES AND ECHINOCANDINS AGAINST CANDIDA BLOODSTREAM ISOLATES AT PHRAMONGKUTKLAO HOSPITAL, THAILAND <p><strong>Background:</strong> Candidemia is a major cause of morbidity and mortality which can be treated using antifungal agents, triazoles and echinocandins.</p> <p><strong>Objectives:</strong> We aimed to determine <em>Candida</em> species and their sensitivities to triazoles (fluconazole, itraconazole, voriconazole, and posaconazole) and echinocandins (caspofungin, micafungin, and anidulafungin) among patients with candidiasis to guide future treatment of patients with candidemia or invasive candidiasis.</p> <p><strong>Methods:</strong> All firstly isolated <em>Candida</em> spp. from patients admitted at Phramongkutklao Hospital, Bangkok, Thailand from January 2012 to December 2013 were included in this study. The antifungal susceptibility testing of Candida spp. isolates was assessed based on micro-dilution method.</p> <p><strong>Results:</strong> During the 24-month study period, a total of 66 <em>Candida</em> isolates from 66 patients were identified. Of the 66 isolates, 35 (53%) were <em>C. albicans</em>, 18 (27.3%) were <em>C. tropicalis</em>, 10 (15.2%) were <em>C. glabrata</em> and 3 (4.5%) were <em>C. parapsilosis</em>. Fluconazole resistant Candida isolates were found in <em>C. glabrata</em> (100%), <em>C. albicans</em> (14.3%), <em>C. tropicalis</em> (22.2%) and <em>C. parapsilosis</em> (66.7%). Most <em>Candida</em> spp. isolates were mainly susceptible to echinocandins (&gt;90%). Notably, 10%-20% of C. glabrata isolates showed resistance to echinocandins.</p> <p><strong>Conclusion:</strong> Fluconazole, an empirical therapy, has been cautiously used due to resistant non-albicans <em>Candida</em> species especially, <em>C. glabrata</em>, <em>C. tropicalis</em> and <em>C. parapsilosis</em>. However, the emerging echinocandins resistant <em>C. glabrata</em> isolates need to be closely monitored.</p> Sudaluck Thunyaharn, Wichai Santimaleeworagun, Chananan Khoprasert, Piyanate Kesakomol, Montalee Theeraapisakkun, Unchalee Visawapoka Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 13:16:31 +0700 BIOCHEMICAL FINITE ELEMENT ANALYSIS OF THE LOCKED KIRSCHNER WIRE SYSTEM VERSUS VOLAR PLATE FIXATION OF DISTAL RADIUS FRACTURE <p><strong>Background:</strong> Volar locking plate (VP) and Kirschner wire (K-wire) fixations of distal end radius fractures are the most frequently used techniques that produce similar long term clinical results. However, inadequate fixation strength of the K-wire may cause pin loosening or migration. Although these complications can be prevented by immobilization, joint stiffness and a prolonged recovery period can occur.</p> <p><strong> Objective:</strong> Herein, a technique that provided more stability, allowing immediate motion after fixation by linking the K-wires into a single system (locked K-wire system) was proposed.</p> <p><strong>Methods:</strong> We evaluated biomechanical responses of the locked K-wire system and a VP in extraarticular distal radius fracture models AO/OTAa type 23A2 and 23A3 using three-dimensional finite element analysis. All models were tested under axial, bending, and torsional loads.</p> <p><strong>Results:</strong> From the simulation results, the total displacement was greater in the dorsal wedge fracture than that from the simple fracture under all loads for both fixation systems. The locked K-wire system and the VP could withstand immediate physiologic load with maximum displacements of 1.15 mm and 1.39 mm, respectively.</p> <p><strong>Conclusion:</strong> Considering the immediate physiologic load resistance and the ability to preserve its position during the bone-healing period, the locked K-wire system might be used as an alternative to fix distal radius fractures.</p> Woraphon Jaroenporn, Wassapol Rerksanan, Vajarin Phiphobmongkol, Jaruwat Vechasilp, Samran Phukang, Wichit Siritattamrong, Natcha Ariyaprakai Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 13:29:18 +0700 ESOPHAGEAL IMPACTION OF FERTILIZED DUCK EGG ALBUMEN (HARDENED BALUT WHITE) IN A TERTIARY GOVERNMENT HOSPITAL IN THE PHILIPPINES: A CASE SERIES <p><strong>Background:</strong> This study described the clinical profile of patients who developed esophageal impaction after ingesting the hardened white portion (albumen) of a fertilized duck egg (colloquially termed balut).</p> <p><strong>Methods:</strong> A review of patients with foreign body impaction of hardened balut egg white was performed. These patients were admitted in the emergency room from November 2013 to November 2018. Clinical features analyzed included age, sex, clinical signs and symptoms, imaging performed, operative findings and complications.</p> <p><strong>Results:</strong> In all, 18 patients were included in the review. Seventeen were male with a majority in the 20- to 40-year-old age range. Dysphagia and neck tenderness were the most commonly presented symptoms and physical examination finding, respectively. Twelve cases were successfully extracted via rigid esophagoscopy under general anesthesia, while one case was resolved through spontaneous ejection. The most common site of impaction was at the cervical esophagus. One third of patients undergoing extraction had minor noncircumferential esophageal abrasions.</p> <p><strong>Conclusion:</strong> Ingestion of the entire hardened balut white can lead to esophageal impaction, necessitating admission and operative management. Young males are commonly affected. Due to its intrinsic characteristics as a foreign body, its removal can prove challenging. Push technique and extraction (both via piecemeal and wholly) were found to be effective, and when performed correctly, minimized complications. Nevertheless, this condition may be prevented with health education.</p> Emilio Raymund Claudio, Maria Angela Dealino, Anna Pamela Dela Cruz, Kimberly Mae Ong Copyright (c) 2021 Journal of Southeast Asian Medical Research Tue, 09 Nov 2021 14:02:23 +0700