Chulalongkorn Medical Journal

Proactive use of perturbation training for balance and posture control in geriatric rehabilitation: An experimental study

2024-12-26T08:36:11+07:00

Background: Aging is a complex process involving several variables that interact to cause deterioration of various physiological functions, such as low motor function and slow protective reflex.

Objectives: This study aimed to determine the effect of perturbation training on balance and postural control upon center of gravity (COG) sway velocity in the older population using the modified clinical test of sensory integration on balance (m-CTSIB) component of the Neuro Com Balance Master^® and Timed Up and Go (TUG) test.

Methods: An experimental study, using a pre-post intervention model, involving 30 individuals aged 65–85 years with mild to moderate fall risk, was conducted at the Pune Tertiary Hospital from August 2022 to January 2023. Perturbation training was given using a tilt board along with conventional exercises for 3 days per week for 4 weeks (12 sessions). Pre–post assessment was done using the M-CTSIB test on the Neuro Com Balance Master^® and the TUG test. The paired samples t-test was used for comparing the pre and postintervention measures.

Results: Pre- and postintervention measures on the TUG test and M-CTSIB test on the Neuro Com Balance Master^® showed a statistically significant improvement in the TUG values (P < 0.0001) and COG sway velocity under all conditions except on the firm surface with eyes open, with FIEO (P = 0.1208), FIEC (P = 0.0011), FOEO (P = 0.0013), FOEC (P < 0.0001), and composite COG sway velocity (P < 0.0001).

Conclusion: To achieve postural control along with conventional exercises, perturbation training can be effective on proprioception, thus promoting the muscle recruitment pattern, which minimizes loss of balance and increases sway velocity, thereby eventually reducing episodes of fall.

Effects of progressive neuromuscular control training on the functional mobility in stroke with bilateral osteoarthritic knee

2024-12-26T16:11:56+07:00

Background: In low- and middle-income nations such as India, cases of stroke are increasingly being reported to contribute to premature mortality and disability. In fact, 29.0–32.0% of individuals impacted by stroke experience musculoskeletal problems. Musculoskeletal disabilities such as osteoarthritis (OA) limit functional mobility and interfere with rehabilitation. In addition to reduced muscle strength, patients with degenerative pathology of the knee have impaired proprioceptive acuity, damaged sensory receptors, and a deficiency in muscle activation.

Objective: To determine the effects of progressive neuromuscular control training on functional mobility in stroke patients with bilateral knee OA (KOA)

Methods: A total of 100 participants aged 45–75 years were randomly assigned to two equal groups for this case-control study: the experimental group received an 8-week neuromuscular control training program, while the control group received the standard therapy. The participants were all stroke survivors in the third stage of the Brunnstrom stages of recovery and had either Grade 1 or 2 OA of both knees.

Results: Both the Visual analog scale (VAS) at rest and the VAS during activity in the intervention group were significantly lower than in the control group (P < 0.0001). The range of knee flexion of the hemiparetic side was not significant between the two groups (P = 0.8532), but that of the nonhemiparetic limb in the intervention group was significantly lower than that in the control group (P = 0.0029). The hemiparetic limb’s foot progression angle showed no significance, whereas the nonhemiparetic limb’s foot progression angle was significantly lower in the intervention group than in the control group (P < 0.0001). The walking velocity, voluntary control grading, and the elderly mobility scale in the postintervention group were significantly greater than those in the control group (P < 0.0001).

Conclusion: Progressive neuromuscular control training was observed to improve pain, spatial and temporal gait parameters, voluntary control, and functional mobility. There was a lack of effect on the range of knee flexion and the degree of toe out of the hemiparetic limb and only a little effect on the range of knee flexion and the degree of toe out of the nonhemiparetic side.

Comparison of the efficacy of Smart Litho Plus and standard extracorporeal shock wave lithotripsy for renal calculi treatment

2024-12-26T16:26:28+07:00

Background: Urinary stones are one of the most common urological problems in Thailand. Extracorporeal shock wave lithotripsy (ESWL) is one of the most frequently used treatments because it is noninvasive and widely available. However, how the effectiveness of lithotripters with power sources produced in Thailand (Smart Litho Plus) compares with that of standard machines is poorly established.

Objective: This study aimed to evaluate how the effectiveness of Thai-manufactured replacement components compared to those of conventional electromagnetic shock wave systems used in the treatment of kidney stones.

Methods: We conducted a multicenter retrospective cohort study involving 121 patients with renal stones across three sites in Thailand. All subjects underwent urinary tract imaging at their initial visit and were followed up four weeks after stone treatment. A patient was considered stone-free if residual stones measured less than 4 mm.

Results: A significant difference in stone-free rates was recorded between the two groups. The smart Litho Plus group showed a 44.0% stone-free rate, whereas the standard machine group achieved a 64.0% stone-free rate (P = 0.048). However, we noted a difference in the number of shock waves used in the standard machine group.The treatments did not differ significantly in number of adverse events. One patient in the standard machine group developed sepsis after ESWL. Additionally, one patient in the standard machine group and three patients in the Smart Litho Plus group experienced stone street. No findings of renal injury were observed in either group during a follow-up four weeks after imaging.

Conclusion: The standard electromagnetic lithotripter had a higher stone-free rate than the Smart Litho Plus system for renal stone treatment. The Smart Litho Plus system has demonstrated effectiveness and good tolerability. It offers effective and promising stone fragmentation coupled with low adverse event rates.

Reliability and validation of the Thai version of the cosmetic procedure screening (COPS) questionnaire in Thai women

2024-12-26T16:39:01+07:00

Background: Body dysmorphic syndrome (BDD) is a psychiatric disorder characterized by dissatisfaction with and disapproval of cosmetic surgery outcome.

Objective: The aim of this study was to study the reliability and validate the Thai version of the cosmetic procedure screening (COPS) questionnaire.

Methods: Fifty-six Thai women attending the gynecologic outpatient clinic at King Chulalongkorn Memorial Hospital were recruited into the study between July 2017 and June 2018. Four participants dropped out because they did not answer the second questionnaire. The original English-version of COPS was translated into the Thai version and back-translated by another linguist. The content of the questionnaire was validated by two urogynecologists. After signing their informed consent forms, the patients were asked to complete the Thai version of the COPS questionnaire at first visit. Thereafter, at two-week intervals they completed and sent back the questionnaires by mail.

Results: The average age of participants was 34.1 + 6.4 years. The correlation coefficient of each item (Q) score with the total score of the Thai version COPS questionnaire ranged from 0.17 to 0.74. The internal consistency (Cronbach’s alpha) of the questionnaire was 0.9. The weighted Kappa of each score ranged from 0.6–1.0. The mean total scores of the 1st and 2nd assessments (points) were 22.9 + 8.7 and 23.9 + 8.0. The intraclass correlation coefficient (ICC) (95% confidence interval (CI)) of the total score was 0.9 (0.9–1.0).

Conclusion: The findings of this study indicate that the Thai version of the COPS questionnaire is reliable and valid. It can be used for screening for BDD in Thai women before cosmetic surgery.

Relationship between parathyroid levels and the size and number of the parathyroid glands in renal hyperparathyroidism

2024-12-27T09:05:10+07:00

Background: The gold standard for diagnosing renal hyperparathyroidism (RH) is serum parathyroid hormone (PTH). Parathyroid gland (PTG) hyperplasia is a result of persistent hyperparathyroidism in patients with chronic kidney disease. Consequently, the PTG size could serve as a substitute indicator for determining the degree of hyperparathyroidism.

Objective: Our study aimed to investigate the relationship between serum PTH levels and the size and number of PTGs in patients with RH.

Methods: We retrospectively identified patients from August 1, 2010, to June 30, 2019, with RH who underwent ultrasonography of the PTGs at our institution. The summations of the maximal diameters and number of enlarged PTGs were collected and compared with the serum PTH levels.

Results: We explored 110 PTGs in 40 patients. Serum PTH levels and the summations of the maximal diameters of the PTGs correlated positively (r = 0.397, P <0.05). There was statistical significance in the prediction of parathyroid enlargement (³3 glands) (AUC = 0.659, 95% CI: 0.482–0.836, P = 0.085). High specificity (>81.0%) was obtained for detecting ³3 parathyroid gland enlargements at a cut-off PTH level of >2,100 pg/ml.

Conclusion: There was a positive correlation between the size of the PTG and the serum PTH levels in RH patients. Individuals with higher PTH levels also had more number of PTGs. The discrepancy between the PTG size and the serum PTH level may indicate further exploration for additional PTGs.

Association of socio-demographic profile and the underlying risk factors of hypertension among the locals of Prosperidad, Agusan del Sur, Philippines

2024-12-27T09:23:23+07:00

Background: Hypertension is a leading risk factor for cardiovascular diseases, including heart disease and stroke, which are significant causes of morbidity and mortality worldwide. Its prevalence varies across regions and is influenced by genetic, environmental, and lifestyle factors.

Objectives: This study aimed to determine the socio-demographic profile, the prevalence of hypertension, and the risk factors and associate these with the prevalence of hypertension in Prosperidad, Agusan del Sur.

Methods: Data were gathered through a survey involving respondents aged 25–75 years from November 2022 to February 2023. Multivariate logistic regression was used to determine the association between the socio-demographic profile and the risk factors for the prevalence of hypertension.

Results: The study identified several key factors significantly associated with hypertension, including non- indigenous status (P < 0.01), marital status (P < 0.05), occupation (P < 0.01), educational attainment (P < 0.05), and monthly income (P < 0.01). Whereas there was no significant correlation between hypertension and variables such as alcohol consumption (P = 0.85), physical activity (P = 0.67), and dietary salt reduction (P = 0.45), a strong association was recorded between hypertension and factors such as dietary habits (P < 0.01), recreational activities (P <0.05), personal history of elevated blood pressure and cardiovascular diseases (P < 0.01), tobacco cessation (P < 0.01), and reduced intake of sugary beverages (P < 0.01).

Conclusion: The study revealed a high prevalence of hypertension (89.7%) in Prosperidad, Agusan del Sur, with significant socio-demographic and lifestyle risk factors, including poor dietary habits and lack of lifestyle changes. These findings emphasize the urgent need for targeted public health interventions to promote healthier behaviors and reduce the burden of hypertension in the community.

Treatment gaps in migraine preventive treatment-eligible patients: A hospital-based study in Thailand

2024-12-27T09:38:45+07:00

Background: Preventive treatment of migraine is necessary for patients with frequent attacks to avoid progression and medication overuse. Only a few studies have demonstrated the low prevalence of preventive- eligible migraine patients having received migraine preventive treatments.

Objective: To investigate the prevalence of preventive migraine treatments in eligible patients in Thailand.

Methods: A hospital registry-based cross-sectional study was conducted between January 2007 and June 2022 in migraine patients at the Chulalongkorn Comprehensive Headache Center, King Chulalongkorn Memorial Hospital, and Thai Red Cross Society. Data collected at the first visit were extracted from the patient registry. The proportion of preventive treatments among patients with variable migraine severity classified by the number of monthly migraine days was evaluated.

Results: Of the 681 patients in the registry, 572 aged ³15 years were included. The prevalence of patients with a history of ever using migraine preventive treatment was 14.7%. There was no significant difference in the prevalence of receiving preventive treatment among the patients with variable migraine severity classified by the number of migraine days per month. Among the treatment-eligible participants, the prevalence of preventive treatment was 12.9%.

Conclusion: This was the first hospital-based study in any Eastern country that revealed a prevailing low prevalence of preventive treatments among migraine patients. Preventive treatment is critical to migraine progression. Health education on existing preventive treatments is needed to raise awareness among patients. More relevant studies are needed in Asian countries to replicate these findings. To improve the scientific quality of relevant studies, future research should be conducted by gathering data from primary sources and retrieving previous treatments from medical records.

An omphalocele containing a surprised congenital segmental intestinal dilatation: A case report and literature review

2024-12-27T09:48:37+07:00

This report describes the characteristics and management of segmental dilated small intestine, a rare condition that resembles the liver in an omphalocele. After the dilated intestine was resected and end-to-end anastomosis was performed, the abdomen could be closed simultaneously without immediate complications. Our review of the literature on this condition shows that although its nature is still unknown, it is associated with excellent operative outcomes. Finally, awareness of congenital segmental intestinal dilatation in omphalocele leads to proper management.