Buddhasothorn Hospital Journal

A A case study of pseudocholinesterase deficiency

2025-06-16T22:48:18+07:00

Pseudocholinesterase deficiency is an uncommon anesthetic problem relevant to standard anesthetic drugs that once occurred it requires systematic approach and step-by-step management, it also implicates in patients’ and his/her relatives’ future operation. The purpose of this study is to demonstrate clinical presentation, comprehensive management steps, and knowledge of this pathology.

Effects of behavior modification on lifestyle related to dry eye syndrome in working age groups

2025-05-06T11:05:15+07:00

Background: Dry eye syndrome is a common condition that can occur at any age. Its prevalence is increasing globally due to prolonged screen use on digital devices. These behaviors can cause eye irritation, burning sensations, and dryness, ultimately affecting quality of life and work performance. Current treatment approaches not only involve addressing the underlying causes and using eye drops but also emphasize the importance of lifestyle and environmental modifications to help prevent worsening symptoms and complications of dry eye disease.

Objectives: To study the effects of behavioral modifications on dry eye syndrome in working-age groups

Methods: This quasi-experimental, single-group study compared clinical outcomes before and after a 3-month behavioral modification program using the motivational interviewing (MI) technique in patients diagnosed with dry eye disease. The study was conducted at Sanamchaikhet Hospital between September 1, 2024, and February 28, 2025. Data were collected using the Ocular Surface Disease Index (OSDI) questionnaire to assess the severity of dry eye symptoms, and the Tear Break-Up Time (TBUT) test to evaluate tear film stability. Statistical analyses were performed using the paired t-test and the Wilcoxon signed-rank test depending on the distribution of the data as determined by the Shapiro-Wilk test, with a significance level set at p < 0.05.

Results: A total of 39 working-age participants aged 24-58 years (average age 43) met the inclusion criteria. After 3 months of behavioral and environmental modifications, there was a statistically significant reduction in the severity of dry eye symptoms (p<0.05) and a significant improvement in tear film stability (p<0.05).

Conclusions: A 3-month behavioral modification program using the Motivational Interviewing technique significantly improved both the severity of dry eye symptoms and the stability of the tear film in working-age patients with dry eye syndrome. These findings support the concept that behavioral and environmental modifications can be effectively integrated with conventional treatment to reduce symptom severity and enhance the quality of life in individuals with dry eye syndrome.

The difference in the false positive rate of the quadruple test for Down syndrome screening between advanced maternal age group and the young age group at Bangplee hospital

2025-07-09T22:14:06+07:00

Background: Thailand’s policy recommends screening all pregnant Thai women for Down syndrome using the quadruple test. While this increases the detection rate, it also raises false positives, leading to unnecessary amniocentesis

Objectives: To compare the false positive rate of the quadruple test between advanced maternal age (≥35 years) and younger age (<35 years) pregnant women.

Methods: This retrospective chart review analyzed data from pregnant women screened for Down syndrome using the quadruple test. Results were reported as means, percentages, sensitivity, specificity, and false positive rates. A Z-test for two proportions was used to compare the groups.

Results: Among 393 women screened, 327 (83.2%) were <35 years, and 66 (16.8%) were ≥35 years. The overall false positive rate was 5.3%. The false positive rate was significantly higher in the advanced maternal age group (18.1%) compared to the younger group (2.7%) (Z = 5.08, p < 0.0001).

Conclusion: Women of advanced maternal age show a significantly higher false positive rate in Down syndrome screening using the quadruple test. Adjusting screening strategies for this group may reduce unnecessary procedures and resource wastage.

The Effectiveness of Pharmaceutical Care through Home Visits and Telepharmacy in Warfarin Patients with Out-of-Range INR.

2025-06-15T20:57:57+07:00

Background: Warfarin is a medication with a narrow therapeutic index, and the therapeutic response varies among individual patients. Regular monitoring of the International Normalized Ratio (INR) is necessary to ensure safe and effective outcomes. Patients with INR values outside the target range are at high risk of complications. Pharmaceutical care through home visits and Telepharmacy may improve INR control.

Objective: To evaluate the effectiveness of pharmaceutical care through home visits and Telepharmacy among patients receiving warfarin therapy with INR values outside the target range at the outpatient department of Bangpakong Hospital, Chachoengsao Province, from September 2024 to January 2025.

Methods: This quasi-experimental study divided participants into an intervention group, which received pharmaceutical care through home visits and Telepharmacy services, and a control group, which received standard care. Inferential statistics were used to compare differences between groups at a 95% confidence level.

Results: Patients in the intervention group achieved target INR values significantly more often than those in the control group (62.07% vs. 33.33%, p = 0.027). The percentage of time in therapeutic range (%TTR) was higher in the intervention group (51.56 vs. 25.81, p = 0.023). Knowledge about warfarin increased more in the intervention group (92.72% vs. 69.61%, p < 0.001), medication adherence improved (99.55% vs. 97.32%, p = 0.001), and drug-related problems were reduced (3.12% vs. 10.48%, p = 0.001). Health-related quality of life scores were significantly higher (0.865 vs. 0.802, p < 0.001), and overall patient satisfaction with the service model was rated at the highest level.

Conclusion: Pharmaceutical care through home visits and/or Telepharmacy significantly improved INR control, clinical outcomes, and quality of life among patients receiving warfarin. This approach may be applied to further enhance the effectiveness of healthcare service systems.

Outcomes of surgical correction of penile deformities following the injection of foreign substances (penile paraffinoma)

2025-06-17T23:34:24+07:00

Background

Penile augmentation using injectable foreign substances has gained popularity among specific populations seeking aesthetic enhancement. However, when such procedures are performed by untrained individuals or with non-medical-grade materials, they may result in serious complications. These include local inflammation, chronic ulceration, penile deformity, and severe infections. According to a public health advisory issued by the Department of Medical Services of Thailand, the penile tissue often mounts an immune response to eliminate these foreign substances, leading to tissue fibrosis, granuloma formation, and in some cases, irreversible penile deformities. In cases where the injected substances are not sterile, serious infections can occur, sometimes necessitating penile amputation. Surgical intervention is often necessary to manage such complications. Nonetheless, surgical outcomes vary, and secondary complications may occur. Therefore, a thorough evaluation of surgical results is essential for optimizing clinical management and improving patient safety.

Objective

To evaluate surgical outcomes and associated factors in patients undergoing corrective surgery for penile paraffinoma.

Materials and methods

This was a retrospective descriptive study of patients diagnosed with penile paraffinoma and treated surgically at Bhuddhasothon Hospital between October 1, 2018, and September 30, 2023. Data were collected from medical records, including demographic information, type of foreign substance, clinical presentation, operative details, and postoperative outcomes. Statistical analysis was performed to identify factors associated with complications.

Results

Out of 92 cases, 63 patients had complete data for analysis. The mean age was 40.48 ± 11.80 years, and the mean BMI was 23.31 ± 3.70 kg/m². The most commonly injected substances were liquid paraffin (33.33%) and olive oil (23.81%). The most frequent presenting symptom was penile infection or inflammation (73.02%). Most patients (96.83%) underwent two-stage surgical excision using a scrotal skin flap. The mean operative time was 38.41 ± 18.11 minutes. Postoperative complications included severe pain requiring injectable analgesics (22.22%), wound dehiscence (4.76%), and tissue necrosis (3.17%). Erectile function was preserved in 98.41% of patients. Patients with complications had significantly longer operative times and hospital stays than those without complications (p < 0.001). Other variables such as age, BMI, type of substance, and presenting symptoms were not statistically different between groups.

Conclusions

Penile paraffinoma remains a challenging public health issue. While surgical outcomes are generally favorable, longer operative times are significantly associated with an increased risk of postoperative complications. Thorough preoperative evaluation and patient education regarding the dangers of illicit penile augmentation are crucial to improving outcomes and reducing the long-term healthcare burden.

Association between neutrophil to lymphocyte ratio and older patient with dementia in Buddhasothorn hospital

2025-07-14T22:15:55+07:00

Background: Alzheimer’s disease is the most common cause of dementia in the elderly and is becoming increasingly prevalent in Thailand. It leads to progressive decline in cognition, memory, and behavior, significantly impacting patients, caregivers, and legal or financial management. Recent evidence suggests that the neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammation, may be associated with the pathophysiology of Alzheimer’s disease.

Objectives: To investigate the association between NLR and dementia, and to compare NLR values among patients with Alzheimer’s disease (AD), vascular dementia (VaD), and non-dementia individuals.

Methods: A retrospective study was conducted from October 1, 2019, to September 30, 2023, including patients aged 60 years and older diagnosed with dementia at Buddhasothorn Hospital by neurologists. Demographic data, risk factors (such as diabetes, hypertension, and atrial fibrillation), and NLR values were collected and analyzed.

Results: A total of 83 dementia and 106 non-dementia patients were included. The dementia group was older (74.38 ± 8.89 vs. 70.21 ± 7.49 years, p<0.001) and had significantly higher NLR values (3.36 ± 4.97 vs. 1.53 ± 0.58, p=0.001). Subgroup analysis revealed that patients with AD, VaD, and other types of dementia all had significantly higher NLR compared to the non-dementia group. However, no significant differences in NLR were observed among the dementia subtypes.

Conclusion: NLR was significantly elevated in dementia patients compared to non-dementia individuals (p<0.001). Elevated NLR was consistently observed across all dementia subtypes, including AD and VaD, suggesting a potential role of systemic inflammation in the pathogenesis of dementia.