Journal of Medicine and Urban Health

Fungal Ball of the Sphenoid Lateral Recess with Infraorbital Nerve Hypoesthesia: A Case Report and Literature Review

2025-12-17T14:40:27+07:00

A fungal ball in the lateral recess of the sphenoid sinus (LRSS) is a rare entity, particularly when it presents atypically as facial hypoesthesia. Due to its deep location and proximity to critical neurovascular structures, it can present with atypical symptoms and radiological features that can mimic skull base malignancy, complicating diagnosis. Only one similar case has been previously reported in the literature. We report a case of a 59-year-old male who presented with a one-month history of progressive headache and left facial numbness. Neurological examination revealed diminished pinprick sensation in the infraorbital nerve distribution. A computed tomography showed a hypodense mass with rim calcification and pterygoid bone erosion adjacent to the left sphenoid sinus, raising suspicion of an invasive skull base lesion. The patient underwent endoscopic transpterygoid sphenoidotomy, which revealed fungal concretions encased within a bony partition in the LRSS. Histopathological analysis confirmed Aspergillus spp. without mucosal invasion or malignancy. Postoperatively, the patient recovered from facial numbness and had an uneventful one-year follow-up.

The First Issue of Journal of Medicine and Urban Health

2025-12-19T09:39:13+07:00

It is with great pride that we present the inaugural issue of the Journal of Medicine and Urban Health (JMUH), marking a new era in our legacy as the Vajira Medical Journal: Journal of Urban Medicine. This transformation signifies a timely expansion of the Journal’s vision—to serve not only as a reputable scientific publication, but also as a bridge for Thai researchers to connect and collaborate with the international research community under our new identity.
We are honored to welcome a newly appointed editorial board composed of leading experts from Thailand and around the world. Their collective expertise will guide our commitment to publishing impactful, peer-reviewed research across a wide range of disciplines—including clinical and basic sciences, public health (especially in urban settings), health policy, and medical innovation.
Our goal is to position the journal as a prominent international platform that contributes to medical and public health knowledge and informs policies relevant to health—particularly in urban contexts. We also aspire to be indexed in Scopus and other high-visibility international databases in the coming years, ensuring the widest possible reach for our authors’ work.
As Editor-in-Chief, I invite researchers worldwide to contribute to and engage with the JMUH. Together, we aim to advance knowledge that improves medical and public health outcomes for populations globally, especially in urban environments.

Systemic Medications and Their Effects on the Retina and Choroid: An Updated Review

2025-12-17T13:37:41+07:00

This review provides a comprehensive analysis of systemic medications and illicit substances that can lead to various forms of retinal and choroidal toxicity. Accurate diagnosis requires a detailed medication history and the identification of characteristic retinal changes using multimodal imaging techniques. The discussion includes drugs associated with retinal pigment epithelial disruption, vascular alterations, cystoid macular edema, crystalline deposits, drug-induced retinal folds, and uveitis. The ocular effects of emerging chemotherapeutic and immunotherapeutic agents are also examined. Key mechanisms of action, preventive strategies, and available treatment options are explored in detail. The focus is on medications frequently encountered in ophthalmic practice and important considerations for eye care professionals. Many drug-induced retinal toxicities are reversible with discontinuation of the medication, especially when detected early before causing significant visual impairment. However, certain agents may lead to permanent and progressive retinal damage. Close monitoring and timely intervention by ophthalmologists are essential. This review highlights the importance of early detection and proper management of medication-induced retinal and choroidal toxicity to reduce the risk of vision loss and related complications.

Meaning in Life Among Urban Palliative Patients in Thailand

2025-12-17T14:04:40+07:00

Objective: Explore the prevalence and factors influencing the sense of meaning in life among palliative care patients.
Materials and Methods: A mixed method study was conducted using the Meaning in Life Questionnaire to assess the presence and search for meaning among palliative patients. Demographic data, including age, sex, and medical history, were descriptively analyzed. In-depth interviews were performed to explore the personal interpretations of the meaning of life of the patients, and qualitative data was analyzed using content analysis.
Results: A total of 107 palliative care patients participated in the study, comprising 41.1% males and 58.9% females. The findings revealed that 76.6% of the participants reported experiencing a sense of meaning in life, which was highly individualized. Although the concept of life’s meaning varies from person to person, commonalities can still be observed. Through content analysis, these personal interpretations were categorized into eight key themes: family (77.6%), occupation (21.5%), society (15.9%), religion (11.2%), health (9.3%), finance (6.5%), education (4.7%), and specific life issues (16.8%).
Conclusion: A sense of meaning in life is integral to the well-being of palliative patients, and the family is the most influential factor. Holistic and person-centered palliative care interventions must integrate spiritual and existential dimensions to improve the quality of life of patients during their final stages.

The Role of Mitotic Count and Ki-67 Index in Identifying Likely Benign Salivary Gland Tumors to Avoid Overtreatment

2025-12-17T11:18:27+07:00

Objective: This study evaluated and compared the utility of mitotic count and Ki-67 index in distinguishing benign and malignant salivary gland tumors. The primary objective was to identify optimal cut-off points for these proliferative indices to help guide diagnosis and avoid overtreatment in cases where definitive histomorphology is challenging, especially in small biopsy specimens.
Materials and Methods: A total of 88 salivary gland tumor specimens were evaluated, including 56 benign and 32 malignant cases. Mitotic count and Ki-67 index were quantified for all cases. The diagnostic performance of each marker was assessed by determining sensitivity, specificity, and the area under the receiver operating characteristic curve the Area Under the Curve (AUC).
Results: Benign tumors exhibited consistently low mitotic counts (average < 1) and Ki-67 indices (average < 2.00%). In contrast, malignant tumors showed significantly higher values. A mitotic count ≥ 2 and a Ki-67 index ≥ 5.00% were determined as optimal cut-off points. The Ki-67 index (AUC = 0.76) demonstrated a higher sensitivity (68.80%) than the mitotic count (50.00%), performing slightly better than the mitotic count (AUC = 0.73).
Conclusion: Diagnosing benign and malignant salivary gland tumors based on morphology alone in small biopsies can be challenging. A mitotic count ≥ 2 and a Ki-67 index ≥ 5.00% are linked with malignancy, and these proliferation markers serve as valuable adjuncts to improve diagnostic accuracy and guide appropriate patient management. This approach is particularly useful in preventing overtreatment.

Prevalence of Abnormal Health Check-Up Status in Bangkok Metropolitan Administration Officers

2025-12-17T14:48:40+07:00

Objective: Non-communicable diseases (NCDs) are a growing concern among urban workers. This study aimed to determine the prevalence and associated factors of abnormal health screening results among Bangkok Metropolitan Administration (BMA) employees.
Materials and Methods: A retrospective cross-sectional study was conducted among 3,652 BMA employees who underwent a health screening at Charoenkrung Pracharak Hospital in 2024. Data on laboratory results, chest X-rays, and behavioral risk factors were analyzed using multivariable logistic regression.
Results: The most common abnormalities were obesity (61.8%), hyperuricemia (32.9%), anemia (22.8%), and elevated liver enzymes (12.2%). Diabetes and hypertension were found in 8.0% and 11.3%, respectively. Chest X-ray findings included old pulmonary tuberculosis (4.9%) and active tuberculosis (1.5%). Male gender and obesity were significantly associated with hypertension (odds ratio (OR) = 2.08 and 4.75) and elevated liver enzymes (OR = 4.29 and 2.59).
Conclusion: A high burden of modifiable metabolic risk was observed among BMA employees, reflecting the health impact of urbanized lifestyles. These findings emphasize the importance of urban health strategies tailored to the metropolitan workforce, including routine screenings, early interventions, and city-based wellness initiatives that integrate lifestyle medicine into workplace settings to prevent the long-term burden of NCDs.

Impact of COVID-19 Pandemic on Open Fracture Management at Vajira Hospital

2025-12-17T10:04:08+07:00

Objectives: Patients with open fractures were often treated later than usual during the COVID-19 pandemic, which could impact their outcomes, particularly regarding infection risks. However, some studies suggest that the timing of surgery does not directly influence infection rates. We aimed to examine how the COVID-19 pandemic affected the way open fractures were managed, focusing on any changes in treatment timing and patient outcomes before and during the pandemic.
Materials and Methods: Retrospective data at Vajira Hospital were collected and divided into two groups: one group received treatment before the COVID-19 pandemic (pre-COVID group), and the other group during the COVID-19 pandemic (COVID group). Key factors such as injury time, time to first surgery, and time to first dose of antibiotics were considered. The primary outcome was the difference in waiting times for surgery. Secondary outcomes included infection rate, nonunion rate, and reoperation rate.
Results: The researchers collected data from a total of 76 patients for each of the pre-COVID and COVID groups. No significant differences were found in waiting times for surgery or in the time to the first dose of antibiotics between the two groups. The mean waiting time for surgery was shorter in the COVID group (587.2 min) compared to the pre-COVID group (683.4 min), but this difference was not statistically significant. The mean time to the first dose of antibiotics in the COVID group (183.8 min) was shorter than in the pre-COVID group (212.2 min), but did not meet the statistically significant threshold. There were no significant differences in complication rate (infection rates, nonunion rates, and reoperation rates) between groups.
Conclusion: COVID-19 did not affect the waiting time for the treatment of open fractures and did not impact the outcomes or complications of open fracture treatment at Vajira Hospital. This may be attributed to the hospital’s strict criteria for emergency surgeries, prioritizing critically needed cases, ensuring timely and standard treatment.