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 Journal of Southeast Asian 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) Thu, 17 Feb 2022 10:24:45 +0700 OJS 60 FREQUENCIES OF PREDICTED MIA ANTIGEN AMONG SOUTHERN THAI BLOOD DONORS <p><strong>Background:</strong> The Mi<sup>a</sup> antigen (MNS7) of the MNS blood group system is clinically important in Asian populations. Anti-Mi<sup>a</sup> has been implicated in hemolytic transfusion reactions and hemolytic disease of the fetus and newborn in Thai populations. However, data of this antigen frequency among southern Thais remains unknown.</p> <p><strong>Objective:</strong> This study aimed to determine and predict Mi<sup>a</sup> antigen frequencies among southern Thai blood donors and to estimate the risk of alloimmunization among Thais.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted. Altogether, 400 southern and 500 central Thai blood samples were genotyped for <em>GYP(B-A-B)</em> and <em>GYP(A-B-A)</em> MNS hybrids using polymerase chain reaction with sequence-specific primer (PCR-SSP).</p> <p><strong>Results:</strong> Among them, 19 of 400 (4.45%), and 28 of 500 (9.33%) were positive with the set of GP. Hut, GP.HF, GP.Mur, GP.Hop, and GP.Bun. No GP.Vw phenotype was found among southern and central Thais. The predicted Mi(a+)frequency among southern Thais was significantly lower than among central and northern Thais (<em>p</em>&lt;0.05). Its frequency was similar to Vietnamese, Taiwanese, and Southern Han Chinese populations (<em>p</em>&gt;0.05) but significantly differed from Indonesian, Filipino, and Chinese (Guangzhou) populations (<em>p</em>&lt;0.05). The risk of Mi<sup>a</sup> alloimmunization among southern Thais was significantly lower than among both Thai groups (<em>p</em>&lt;0.05).</p> <p><strong>Conclusion:</strong> This constitutes the first study to report Mi(a+) frequencies among southern Thais, supporting the estimation risk of alloimmunization and providing transfusion safety among Thai populations.</p> Warunrat Khosidworachet, Supratta Mitundee, Kamphon Intharanut, Sasitorn Bejrachandra, Oytip Nathalang Copyright (c) 2022 Journal of Southeast Asian Medical Research Thu, 17 Feb 2022 00:00:00 +0700 ZERO-PROFILE DEVICE IMPLANTATION IN ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SINGLE INSTITUTE EXPERIENCE <p><strong>Background:</strong> A surgical procedure, anterior cervical discectomy and fusion (ACDF), is used for neural decompression in degenerative cervical disk disease and cervical spondylosis. A new type of cervical interbody cage, the Zero-profile device (ZPD), has been developed which could reduce postoperative complications among patients.</p> <p><strong>Objectives:</strong> The study aimed to examine the effect of ZPD on clinical outcomes and cervical spine alignment of enrolled patients at 1-year follow-up in the management of ADCF.</p> <p><strong>Methods:</strong> This study retrospectively evaluated the clinical and radiographic outcomes using the Zero-profile device (ZPD) in the anterior cervical discectomy and fusion (ACDF). All patients who underwent ACDF at Vajira Hospital between May 2017 and June 2021 were included in this study. Radiographic images obtained from picture archiving and communication systems (PACS) were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), and intervertebral disk height. The Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) were obtained from the patients’ medical records. The preoperative DLCA, SCA, GCA, SVA, and intervertebral disk height measurements were compared with the postoperative measurements at 1 year.</p> <p><strong>Results:</strong> A total of 31 patients (45 disks) who underwent ACDF with the ZPD were included in this study. A significant improvement was found in JOA, VAS, DLCA, SCA, GCA, SVA, and intervertebral disk height after ACDF with ZPD (<em>p</em>&lt;0.001). Immediate postoperative dysphagia occurred in two patients (6.5%), which resolved after 3 months. No subsidence was reported at 1-year follow-up. Age, BMI as well as the preoperative cervical alignment did not affect outcomes in this study.</p> <p><strong>Conclusion:</strong> The use of the ZPD in ACDF improved clinical and radiographic outcomes in the correction of cervical spine alignment, and minimized postoperative complications of dysphagia. No device-related failure occurred, and favorable outcomes persisted at 1-year follow-up.</p> Nattawut Niljianskul Copyright (c) 2022 Journal of Southeast Asian Medical Research Fri, 18 Feb 2022 00:00:00 +0700 CUT OFF VALUE OF GOOD PRONOSTIC FACTOR OUTCOMES IN LARGE TERRITORY ISCHEMIC STROKE UNDERGOING EARLY DECOMPRESSIVE CRANIECTOMY <p><strong>Background:</strong> Decompressive craniectomy (DC) significantly reduces mortality in large territory ischemic strokes that develop intractable cerebral edema. However, evidence for functional benefit remains sparse and contradictory.</p> <p><strong>Objective:</strong> This study aimed to assess cut-off value for predictor outcomes of early DC.</p> <p><strong>Methods:</strong> We conducted a prospective, observational cohort study from December 2016 to June 2021. Patients were screened for ischemic stroke involving the middle cerebral, internal carotid artery or both using the National Institutes of Health Stroke Scale score. All patients underwent DC. Multivariate analysis was performed for an array of clinical variables in relation to functional outcomes according to the modified Rankin Scale (mRS) and Pearson’s correlation coefficient analysis. Clinical outcome was assessed after 3- and 6-month follow-up.</p> <p><strong>Results:</strong> In total, 243 patients were included in this study. Age ≤71 years (AUC=0.955, <em>p</em> &lt;0.001 accuracy 89.7%), onset to DC ≤9 hours (AUC=0.824, <em>p</em> &lt;0.001 accuracy 78.8%), volume of infarction ≤155 cm3 (AUC=0.939, <em>p</em> &lt;0.001 accuracy 93.6%) and the Alberta Stroke Program Early CT Score or ASPECT score ≥6 (AUC = 1, <em>p</em> &lt;0.001 accuracy 100%) were significantly associated with good clinical outcomes in early DC (mRS 0 to 3).</p> <p><strong>Conclusion:</strong> Among patients with large territory ischemic strokes undergoing early DC, age ≤71 years, onset to DC ≤9 hours, volume of infarction ≤155 cm3 and ASPECT score ≥6 was significantly associated with good clinical outcomes. All prognostic factors in early DC correlated well with functional outcomes at 6 months which could be used to predict outcome, and consider clinical indications and informed postoperative complications among patients with large territory ischemic stroke.</p> Panu Boontoterm, Siraruj Sakoolnamarka, Pusit Feungfoo, Chesda Udommongkol Copyright (c) 2022 Journal of Southeast Asian Medical Research Thu, 17 Mar 2022 12:44:41 +0700 PREVALENCE AND RISK FACTORS OF VITAMIN D INADEQUACY AMONG THAI ELDERLY PATIENTS WITH OSTEOPOROTIC HIP FRACTURE <p><strong>Background: </strong>Vitamin D deficiency directly impacts bone biology, eventually resulting in elevated risk of fragility fracture. Despite its global abundance, data concerning its prevalence and risk factors among Thai patients with osteoporotic hip fractures remains lacking.</p> <p><strong>Objectives</strong>: This study aimed to evaluate the average level of serum vitamin D, prevalence of hypovitaminosis D and its risk factor among Thai elderly patients with fragility hip fractures.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among Thai patients with fragility hip fractures aged 60 years or older in a single center from April 2016-April 2020. The patients were divided according to serum 25-hydroxy vitamin D (25-(OH)D) levels. Demographic data were compared to identify risk factors of vitamin D inadequacy.</p> <p><strong>Results: </strong>Of 258 patients, 74.81% were females with mean age of 78.76 years. The average serum 25(OH)D level was 19.64 ng/mL. Prevalences of vitamin D inadequacy, vitamin D insufficiency and vitamin D deficiency were 86.05, 28.69 and 57.36%, respectively. When compared with the vitamin D sufficiency group, the vitamin D inadequacy group had a history of frequent falls, higher body mass index (BMI) as well as high parathyroid hormone (PTH) levels.</p> <p>&nbsp;Risk factors associated with vitamin D inadequacy were BMI <u>&gt;</u>23 kg/m<sup>2</sup> (AOR= 4.67, 95%CI=1.24-17.73), and two or more falls within a year (AOR= 3.96, 95%CI=1.38-11.33). Moreover, risk factors associated with vitamin D deficiency were being female (AOR= 2.87, 95%CI=1.06-7.78), BMI <u>&gt;</u>23 kg/m (AOR=7.20, 95%CI =1.67-31.02), two or more falls within one year (AOR=7.32, 95%CI =2.17-24.69) and elevated PTH level (AOR= 3.38, 95%CI=1.17-0.74).</p> <p><strong>Conclusion: </strong>Most elderly patients with fragility hip fractures had hypovitaminosis D. Risk factors included high BMI, frequent falls for vitamin D inadequacy, being female and high PTH levels for vitamin D deficiency. Serum 25(OH)D assessment and appropriate supplement are recommended, especially for patients with fragility hip fractures and aforementioned risk factors.</p> Tanawat Amphansap, Pipat Wongthanakitcharoen, Nitirat Stitkitti , Worawut Chaiyosburana, Atiporn Therdyothin Copyright (c) 2022 Journal of Southeast Asian Medical Research Thu, 17 Mar 2022 12:46:06 +0700 USE OF TENSION BAND WIRING TECHNIQUE IN PROXIMAL ULNAR FRACTURES: A FINITE ELEMENT BIOMECHANICAL ANALYSIS <p><strong>Background:</strong> Tension band wiring is considered the standard treatment for olecranon fracture. A recentstudy proved that it can be used for the fracture as distal to the coronoid process.</p> <p><strong>Objective:</strong> The study aimed to investigate whether tension band wiring can be used in proximal ulnarfracture fixation up to and distal to the coronoid process.</p> <p><strong>Methods:</strong> Models of simple proximal ulnar fracture including 4 intraarticular and 2 extraarticularfractures were created. Fixation was completed using tension band wiring technique, and biomechanicalresponses were evaluated using finite element analysis. After a physiologic load was applied, thefracture displacement, von Mises stress, and stiffness were recorded.</p> <p><strong>Results:</strong> All fracture models were able to withstand the load of daily activities with a maximumdisplacement of 50% of the articular surface. In addition, the von Mises stress was the highest in themiddle articular fracture. The mean transcortical K-wire tension band wiring stiffness of the intraarticular and extra-articular fractures was 1144.89 N/mm and 1231.45 N/mm, respectively.</p> <p><strong>Conclusion:</strong> Tension band wiring is another option to treat proximal ulnar fractures with the ability towithstand immediate postoperative load.</p> Woraphon Jaroenporn, Vajarin Phiphobmongkol, Jaruwat Vechasilp, Thanupat Kulsinsap Copyright (c) 2022 Journal of Southeast Asian Medical Research Thu, 17 Mar 2022 23:08:07 +0700 THE PSYCHOLOGICAL IMPACT AND COPING AMONG MEDICAL STUDENTS IN PHRAMONGKUTKLAO COLLEGE OF MEDICINE DURING THE COVID-19 PANDEMIC <p><strong>Background:</strong> The COVID-19 pandemic has impacted on medical education and other areas of life causing psychological distress.</p> <p><strong>Objectives:</strong> The study aimed to assess psychological impact and coping and to identify factors associated psychological impact among medical students.</p> <p><strong>Methods:</strong> An online cross-sectional study was conducted at Phramongkutklao College of Medicine (PCM) in April 2021. All medical students were invited to complete a standardized online questionnaire for demographics data, impact of COVID-19, coping, fear of illness and virus evaluation (FIVE). The Depression Anxiety Stress Scales (DASS-21) Thai version was used to assess the psychological impact. The factors associated with depression, anxiety and stress were analyzed using logistic regression analysis.</p> <p><strong>Results:</strong> In total, 256 medical students completed the questionnaire. Of these, 54.7% reported having psychological impact, 43.4% depression, 36.7% anxiety and 29.7% stress. Depression was associated with preclinical students (adjusted OR(AOR) =3.03, 95% confidence interval (95% CI) =1.54-5.97), sleep problem (AOR =2.20, 95% CI=1.16-4.16) and extreme deterioration of family income (AOR =7.27, 95% CI=1.81-29.29). Anxiety was associated with preclinical students (AOR =3.20, 95% CI=1.52-6.72), COVID-19 like symptoms (AOR =2.93, 95% CI=1.26-6.83), slight problems adjusting to new learning methods (AOR =6.11, 95% CI=1.54-24.24) and extreme deterioration of family income (AOR =8.29, 95% CI=1.44-47.59). Stress was associated with preclinical students (AOR =3.84, 95% CI=1.75-8.40), COVID-19-like symptoms (AOR =3.54, 95% CI=1.53-8.19), and no confidence in COVID-19 policy of PCM (AOR =2.3, 95% CI=1.06-4.98). A positive correlation between Fear of Illness and Virus Evaluation (FIVE) and psychological impact was observed (r=0.449; <em>p</em>&lt;0.001). Common coping activities were the use of social media, video chats and exercise.</p> <p><strong>Conclusion:</strong> A high prevalence of psychological impact was observed among medical students during the COVID-19 pandemic. To establish psychological support and resilience, training is needed to improve mental wellbeing and prepare medical students to cope with unprecedented situations.</p> Poomwit Puttakiaw, Thiraporn Tangjittiporn, Boonsub Sakboonyarat, Nawaporn Hirunviwatgul, Wantipa Wittayasai Copyright (c) 2022 Journal of Southeast Asian Medical Research Wed, 23 Mar 2022 01:42:33 +0700 CORRELATION BETWEEN CLINICAL AND PATHOLOGIC FEATURES OF DIABETIC NEPHROPATHY <p><strong>Background:</strong> Diabetic nephropathy is the most common cause of end stage renal disease in Thailand. Renal biopsy remains the gold standard investigation to diagnose and classify diabetic nephropathy.</p> <p><strong>Objectives:</strong> In this study, we aimed to evaluate the correlation between clinical parameters and renal pathology classification among patients with type 2 diabetic and nephropathy.</p> <p><strong>Methods:</strong> We conducted an observational study and enrolled 63 patients undergoing renal biopsy between 1 January 2014 and 31 December 2018. Pathologic classification established by the Renal Pathology Society was used to assess the severity of histologic lesions in diabetic nephropathy. Clinical parameters including age, sex, duration, presence of diabetic retinopathy, blood urea nitrogen, creatinine, urine protein creatinine ratio, fasting plasma glucose and hemoglobin A1C were collected.</p> <p><strong>Results:</strong> At the time of biopsy, mean age was 50.25±11.46 years. Median duration of diabetes mellitus was 10 years with interquartile range (IQR) 3.75-12.00 years, mean serum creatinine was 2.44 ± 1.31 mg/dL and estimated glomerular filtration rate was 22.41±12.16 mL/min/1.73 m2. Based on the glomerular classification, 1 patient (1.6%) was in class I, 16 (25.3%) in class II, 25 (39.7%) in class III and 21 (33.3%) in class IV. Using multivariate analysis, class IV was associated with rising serum creatinine compared with class II [adjusted odds ratio (AOR)= 2.58; 95% CI= 1.13-5.89]. Patients with interstitial fibrosis and tubular atrophy (IFTA) &lt;25%, 25-50% and &gt;50% were observed in 10, 27 and 22 patients, respectively. Patients with IFTA &gt;50% were significantly associated with duration of diabetes (OR=1.27; 95%CI=1.21-1.57), serum creatinine (OR=3.92; 95%CI=1.34-11.48) and urine protein (OR= 1.25; 95%CI=1.01-1.55) compared with patients with IFA&lt;25%. Using multivariate analysis, only serum creatinine (AOR=3.48; 95%CI=1.23-12.65) was confirmed as independently correlated to IFTA &gt;50% compared with IFTA &lt;25%. A univariate analysis revealed no significant correlation between vascular indexes and renal function.</p> <p><strong>Conclusion:</strong> The results revealed that advanced glomerular lesions and high IFTA &gt;50% correlated with impaired renal function in type 2 diabetic nephropathy</p> Paramat Thimachai, Nichamon Suttitossatam, Naowanit Nata, Ouppatham Supasyndh, Bancha Satirapoj Copyright (c) 2022 Journal of Southeast Asian Medical Research Mon, 28 Mar 2022 09:26:47 +0700 The EFFECT OF PULMONARY HYPERTENSION ON INTRADIALYTIC HYPOTENSION AMONG PATIENTS WITH END STAGE RENAL DISEASE <p><strong>Background:</strong> Intradialytic hypotension (IDH) is an important problem in end stage renal disease (ESRD). Therefore, this study aimed to assess the effect of pulmonary hypertension (PHT) on IDH among patients with ESRD using transthoracic echocardiography.</p> <p><strong>Methods:</strong> In this prospective etiognostic study, transthoracic echocardiography was performed among patients with ESRD in Burapha University Hospital, Thailand. The hemodialytic flow chart data of patients in the hemodialysis unit was collected to ascertain whether these patients presented IDH. The baseline clinical hemodialysis profiles and echocardiographic findings were analyzed using univariate predictors of IDH. Multivariate risk regression was used to identify independent predictors of IDH.</p> <p><strong>Results:</strong> A total of 35 patients with ESRD were enrolled between June 2020 and March 2021. Of these, 16 had PHT (45.7%). The incidence of IDH was 48.5%. All patients exhibited a normal left ventricular ejection fraction. No significant difference was observed of RVSP between frequent-IDH group and occasional-IDH group (45.33 ± 11.62 mmHg and 41.06 ± 13.78 mmHg, respectively, <em>p</em>=0.401). Using univariate analysis, being female, left ventricular mass index, left ventricular ejection fraction and PHT were significantly associated with IDH. No factors were indicated related to IDH occurrence using multivariate analysis. Nevertheless, female patients with ESRD presenting PHT illustrated a tendency to have IDH. This was evidenced by the risk ratio of being female and patients with PHT being 3.13 (95% CI: 0.74-13.30) and 2.18 (95% CI: 0.34-7.06), respectively.</p> <p><strong>Conclusion:</strong> Patients with ESRD presenting PHT showed a higher tendency of developing IDH during hemodialysis than patients with ESRD without PHT. The difference however was statistically insignificant.</p> Sukrisd Koowattanatianchai, Akaphol Kaladee, Patchara Kochaiyapatana, Thammaporn Kajornsin, Raweewan Witoon Copyright (c) 2022 Journal of Southeast Asian Medical Research Thu, 31 Mar 2022 12:16:13 +0700 APPLICATION OF ARTIFICIAL INTELLIGENCE TO ASSIST HIP FRACTURE DIAGNOSIS USING PLAIN RADIOGRAPHS <p><strong>Background:</strong> Most hip fractures occur among elderly people. They are usually treated in the emergency room where orthopedic surgeons may not be readily available. The problem of delayed diagnosis and treatment results increase risks of further complications and mortality rate. Thus, applying artificial intelligence (AI) can assist physicians having limited experience to rapidly and confidently diagnose hip fractures using radiographs.</p> <p><strong>Objective:</strong> This study aimed to validate AI programs to assist diagnosing of hip fractures on plain radiographs.</p> <p><strong>Methods:</strong> This study employed a retrospective diagnostic study design. From 1 January 2015 to 31 December 2019, compiled ortho pelvis, anterior-posterior (AP) films from the diagnosis of hip fractures at Ananthamahidol Hospital were performed. The performance of the AI program was compared with one orthopedic surgeon who reviewed the same images. The accuracy, sensitivity and specificity of the diagnosis of hip fractures between the orthopedic surgeon and AI program were analyzed.</p> <p><strong> Results:</strong> In total, 217 patients were enrolled in this study. Of these, 56 (28.5%) were male and 161 (74.2%) female. Areas of hip fractures were as follow: intertrochanteric (108, 49.8%), femoral neck (102, 47.0%), subtrochanteric (6, 2.7%) and femoral head (1, 0.5%). The orthopedic surgeon and AI program revealed an accuracy of 93.59% (95%CI 90.8-95.73) vs. 81.24% (95% CI 77.17-84.85), sensitivity of 90.30% (95% CI 85.60-93.90) vs. 89.40% (95%CI 84.50-93.20) and specificity of 97.10% (95%CI 93.60-98.90) vs. 72.5% (95%CI 65.90-78.50), respectively.</p> <p><strong>Conclusion:</strong> Our results showed that the AI model (VGG16) showed a sensitivity of 89.40% vs. 90.30% obtained from the orthopedic surgeon. Thus, improvement in the sensitivity and specificity of AI software is further required. In the future, AI models have the potential as useful tools for emergent screening and evaluation of patients with hip fractures using plain radiographs, especially in the Emergency Department where orthopedic surgeons may not be readily available.</p> Phichai Udombuathong, Ruthasiri Srisawasdi, Waravut Kesornsukhon, San Ratanasanya Copyright (c) 2022 Journal of Southeast Asian Medical Research Fri, 08 Apr 2022 00:15:36 +0700 OUTCOME OF USING PLATELET, PLASMA AND GROWTH FACTORS AS AN ORTHOBIOLOGIC DERIVATIVE TO AVOID INVASIVE SURGICAL PROCEDURES FOR TREATING KNEE OSTEOARTHRITIS AMONG ELDERLY PATIENTS <p><strong>Background:</strong> The application of platelet, plasma and growth factors (PP&amp;GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&amp;GF has yet to be well established.</p> <p><strong>Objectives:</strong> This study aimed to report the survival analysis of 24-month follow-up treatment using PP&amp;GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score.</p> <p><strong>Methods:</strong> A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&amp;GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&amp;GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed.</p> <p><strong>Results:</strong> A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&amp;GF products contained 6-10 times higher platelet concentration than those in the peripheral blood.</p> <p><strong>Conclusion:</strong> Intra-articular injection of PP&amp;GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&amp;GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.</p> Thana Turjane, Pamok Saengsirinavin, Chaivat Sriratanavudhi, Vorasilp Cheeva-akrapan, Wanpen Larpaiwong, Jongjate Aojanepong Copyright (c) 2022 Journal of Southeast Asian Medical Research Tue, 12 Apr 2022 14:44:27 +0700