Journal of Medicine and Urban Health

Heart Failure Outcomes with Predischarge Guideline Directed Medical Therapy Prescribing Patterns among Hospitalized Patients with Heart Failure with Reduced Ejection Fraction

Wasawat Srikaseatsrakul — 2026-02-05

Objective: To assess the rates of heart failure (HF) readmission or all-cause mortality at 6 months among hospitalized patients with heart failure with reduced ejection fraction (HFrEF) based on the comprehensiveness of guideline-directed medical therapy (GDMT) prescribed at discharge.
Materials and Methods: This therapeutic study with a retrospective cohort design included patients with a first-time hospitalized diagnosis of HFrEF at Vajira Hospital, Faculty of Medicine, Navamindradhiraj University, between January 1, 2018, and May 30, 2022. Patients were categorized into three groups according to the number of GDMT prescribed: GDMT1 (none or one agent), GDMT2 (two agents), and GDMT3 (three agents). The primary outcome is 6-month HF readmission or all-cause mortality were retrospectively collected.
Results: A total of 382 patients (65.2% male, mean age 64.4 ± 14.6 years) were included. Most patients had ischemic cardiomyopathy (43.7%), and the distribution of patients into the three groups was 31.4%, 39.3%, and 29.3% in GDMT1, 2, and 3, respectively. HF readmission or all-cause mortality were significantly lower in patients receiving more comprehensive GDMT: hazard ratio (HR) 0.32 (95% confidence interval (CI): 0.16-0.65, p = 0.001) for GDMT3 versus GDMT1 and HR 0.42 (95% CI: 0.24-0.72, p = 0.002) for GDMT2 versus GDMT1. However, there was no statistically significant difference in the rate of 6-month all-cause mortality among the three groups.
Conclusion: Achieving three GDMT agents before discharge in patients hospitalized with HFrEF is associated with a significant reduction in 6-month HF readmission or all-cause mortality.

Factors Associated with Nomophobia among First-Year Students at Navamindradhiraj University

Kanala Chanvirat — 2026-02-17

Objective: This study aimed to examine the factors associated with nomophobia, the fear or anxiety of being without a mobile phone, including prevalence, sociodemographic, behavioral, psychosocial factors among first-year students at Navamindradhiraj University.
Materials and Methods: A descriptive cross-sectional study was conducted among 605 first-year undergraduate students from 13 academic programs at Navamindradhiraj University between January and May 2025. Data were collected via a structured online questionnaire, which included items on demographics, mobile phone usage behaviors, family relationship quality, and the Nomophobia Questionnaire. Descriptive statistics were used to assess prevalence. Chi-squared tests and binary logistic regression were employed to examine associations and to identify significant factor of moderate to severe nomophobia.
Results: The majority of participants experienced moderate (56.20%) or severe (21.70%) levels of nomophobia. The severity of nomophobia was significantly associated with daily phone usage (p = 0.021) and frequency of phone checking (p = 0.006). Logistic regression analysis further indicated that students who spent more time using their phones (p < 0.001), frequent phone checking (p < 0.001), and lower family relationship scores (p = 0.005) were significant factors associated with of moderate-to-severe nomophobia. Demographic variables such as gender, income, and gaming were not significant.
Conclusion: Nomophobia is alarmingly prevalent among first-year university students, with behavioral and psychosocial factors, especially patterns of phone use and perceived family support, playing a more critical role than demographic characteristics. Targeted interventions that promote digital well-being, strengthen emotional resilience, and enhance family support are essential to reduce its psychological impact and encourage healthier digital habits.

The Study of Causative Organisms Affecting Fungal Nail Perforation Test

Akkarapong Plengpanich — 2026-02-17

Objective: To evaluate the capacity of dermatophytes, non-dermatophyte, and yeast to invade nails.
Materials and Methods: Nine normal nails were clipped from healthy volunteers and sterilized in an autoclave. Each nail was inoculated with one of nine fungal species, including dermatophytes, non-dermatophyte (Neoscytalidium dimidiatum, N. dimidiatum), and yeast (Candida albicans, C. albicans) for two, four, and eight weeks at 26 °C. A positive result was determined by the presence of fungal hyphae or pseudohyphae penetrating the nail plate.
Results: Fungal penetration increased with longer durations. At two weeks, Trichophyton mentagrophytes (T. mentagrophytes) variety mentagrophytes, Nannizzia gypsea, Microsporum canis, and N. dimidiatum showed positive nail perforation. At four weeks, T. mentagrophytes variety interdigitale also tested positive. The remaining fungi (Trichophyton rubrum, Trichophyton tonsurans, Epidermophyton floccosum, and C. albicans) demonstrated negative test results at eight weeks.
Conclusion: This in vitro study confirmed the highly virulent dermatophytes can penetrate the nail plate in a short time. Furthermore, this study highlighted the significant virulence of N. dimidiatum in nail invasion

Prevalence and Associated Factors of Mild Cognitive Impairment in Parkinson’s Disease: A Single-Center Study in Thailand

Surapong Saravutthikul — 2026-03-02

Objectives: Mild cognitive impairment ( MCI) is a frequent non-motor complication and a strong predictor of dementia in patients with Parkinson’s disease ( PD). Reported prevalence rates vary considerably due to differences in diagnostic criteria and study populations, with limited data available from Thai cohorts. This study aimed to determine the prevalence of PD-MCI and identify associated factors among Thai patients with PD.
Materials and Methods: A cross-sectional study was conducted involving 100 patients with mild to moderate PD who attended the Movement Disorders Clinic at Vajira Hospital, Bangkok, between February and October 2023. Patients with disabilities, dementia, or major neurological comorbidities were excluded. Cognitive function was assessed using the Thai version of the Montreal Cognitive Assessment in patients with PD who reported cognitive concerns, as reported by patients, caregivers, or both, applying a cutoff score of < 25 points and adding one point for participants with ≤ 6 years of education. Demographic, clinical, and comorbidity data were collected. Independent predictors of PD-MCI were analyzed using univariate and multivariate logistic regression models.
Results: Among 100 patients with PD, 54% were female. Nearly one-third of participants (31%) had completed education beyond grade 12, and the median disease duration was 3 years. The prevalence of PD-MCI was 81%. Patients with PD-MCI were significantly older (74.3 ± 8.3 vs. 66.5 ± 8.7 years, p < 0.001), had lower educational attainment (45.7% vs. 10.5% below grade 6, p = 0.005), and lower body mass index (BMI) (23.2 ± 4.1 vs. 25.5 ± 4.2 kg/m², p = 0.035). Hypertension, hyperlipidemia, later age at onset, and mixed phenotype were also associated in univariate analyses. In multivariate regression, age ≥ 70 years (adjusted odds ratio (OR), 6.77; 95% confidence interval (CI), 1.35-34.08), education below grade 6 (adjusted OR, 10.35; 95% CI, 1.68-63.88), and obesity (BMI ≥ 25 kg/m²; adjusted OR, 0.07; 95% CI, 0.01-0.55) remained independent predictors.
Conclusion: PD-MCI is highly prevalent among Thai patients with PD. Older age, low education level, and lower BMI independently increased risk, whereas obesity appeared protective. Routine cognitive screening and targeted interventions are essential for this population. Further longitudinal studies are warranted to explore causal mechanisms.

Long COVID’s Gender-Specific Determinants: 3- and 6-Month Evidence from Thai Females During the Delta and Omicron Waves

Chonlawat Chaichan — 2026-03-24

Objectives: To prospectively identify determinants of Long COVID in Thai females and compare outcomes across the Delta and Omicron periods through structured follow-up assessments at 3 and 6 months post-infection.
Materials and Methods: From May 2021 through June 2022, this prospective cohort study was conducted in Thailand at Thammasat University Hospital and its field hospital. We enrolled 1,484 females aged 18 and older with laboratory-confirmed SARS-CoV-2 infection. Using a standardized questionnaire and trained interviewers to assess Long COVID symptoms, we followed up with participants via telephone interviews at 3- and 6-months post-diagnosis. Multivariable logistic regression was used to identify independent risk factors for Long COVID.
Results: At the 3-month follow-up, 806 participants (54.3%) reported Long COVID symptoms, which persisted in 418 (38.6%) at 6 months. At 3 months, infection during the Omicron-dominant wave (adjusted odds ratio (OR) 1.75, 95% confidence interval (CI): 1.26–2.43) and acute myalgia (adjusted OR 1.52, 95% CI: 1.04–2.22) were significant predictors. At the 6-month follow-up, moderate-to-critical initial illness severity (adjusted OR 2.17, 95% CI: 1.01–4.69) and loss of smell during the acute phase (adjusted OR 1.61, 95% CI: 1.04–2.49) were significant predictors of persistent Long COVID.
Conclusion: In Thai females, determinants for Long COVID shift between 3 and 6 months post-infection. While acute myalgia and the Omicron variant are early predictors, initial illness severity and loss of smell better indicate symptom persistence at 6 months. These findings highlight Long COVID’s dynamic nature and can help identify female patients at higher risk for prolonged symptoms.

Wide-Awake Local Anesthesia No Tourniquet for Hand and Wrist Procedures: A Narrative Review of Current Concepts and Evidence

Sitthiphong Suwannaphisit — 2026-03-27

Wide-awake local anesthesia no tourniquet (WALANT) has emerged as an important anesthetic and surgical approach in hand and upper extremity surgery. By combining local anesthetic with epinephrine, WALANT enables procedures to be performed without sedation or tourniquet while allowing intraoperative communication and functional assessment. Beyond its anesthetic role, this technique has implications for surgical precision, patient-centered care, training environments, and health-system efficiency. This narrative review synthesizes current evidence and expert perspectives on WALANT, with emphasis on common procedures, expanding indications (e.g., fracture fixation and tendon repair), patient selection, safety considerations, and economic impact in urban healthcare settings. Available evidence indicates that WALANT achieves clinical outcomes comparable to those of conventional anesthesia techniques, with favorable patient-reported experiences, shorter recovery times, and reduced resource utilization. WALANT may be considered a suitable first-line option for selected upper extremity procedures when applied in appropriately chosen patients.

Mpox in Neonates and Children: A Review Article

Thiraporn Kanjanaphan — 2026-03-20

Mpox, caused by the monkeypox virus, has expanded beyond its historical African boundaries, with significant global outbreaks, including a 2022 surge. While traditionally affecting adults, recent cases in neonates and children show more severe complications, including respiratory failure, encephalitis, and sepsis. Children are more vulnerable due to an immature immune system and at higher risk for multi-organ involvement. Prevention focuses on vaccination, personal hygiene, and safe sexual practices, with JYNNEOS® and ACAM2000® vaccines recommended for high-risk groups. Early diagnosis, supportive care, and antiviral treatment are crucial in managing severe cases. This review highlights differences in disease severity between adults and children and outlines key prevention and treatment strategies