Journal of Medicine and Urban Health

Reviewer Acknowledgement, 2026

Jitti Hanprasertpong — Fri, 25 Sep 2026 00:00:00 +0700

In order to maintain the high standards of Journal of Medicine and Urban Health, our editorial team relies on the expertise of numerous professionals. They play a pivotal role in determining the topics to explore, deciding which manuscripts to publish, and making necessary adjustments to ensure the scientific integrity and reliability of the information provided. This fosters the growth and advancement of medical and health science research. I deeply appreciative of the dedication and proficiency exhibited by the individuals who reviewed manuscripts for the journal from September 1^st, 2025, through August 31^st, 2026.

Effect of Lumbar Flexion on Prone Positioning of Patient for Endoscopic Lumbar Spine Surgery: Narrative Review

Piya Chavalparit, Ali lu Guven Yorukog — Thu, 09 Jul 2026 00:00:00 +0700

Endoscopic spine surgery offers significant advantages over conventional techniques, but its success depends on careful attention to many intraoperative factors, particularly patient positioning. This review highlights the importance of understanding spinal anatomy and common variations, as well as the biomechanical effects of the positioning during surgery. Lumbar flexion increases posterior disc height and intradiscal pressure, enhancing disc bulging and widening the interlaminar window, which facilitates safer and more effective discectomy and decompression. These changes, especially over 20-40 degrees of flexion, also increase foraminal dimensions and surgical access, particularly in lower lumbar levels or cases with foraminal stenosis. Regarding positioning for endoscopic lumbar surgery, preoperative imaging and anatomical assessment are crucial to guide the approach and positioning strategy. Lumbar flexion of approximately 40 degrees is recommended for discectomy and decompression, as it improves access and reduces bone resection in both interlaminar and transforaminal approaches. In certain cases, especially central or foraminal pathology, intraoperative repositioning may be necessary to ensure complete decompression and prevent recurrence. Optimal patient positioning in endoscopic lumbar surgery enhances surgical access, ensures safety, and minimizes tissue trauma.

Impact of a Type and Screen Protocol on Surgical Blood Utilization Indices: A Retrospective Pre- and Post-Implementation Study at Vajira Hospital

Wed, 17 Jun 2026 00:00:00 +0700

Objectives: To evaluated the impact of type and screen protocol for surgical blood management by comparing three blood utilization indices, the proportion of inadequate preoperative crossmatches, and the incidence of blood incompatibility before and after protocol implementation.
Materials and Methods: This retrospective pre- and post-protocol study analyzed anesthetic records and blood reservation data of adult inpatients in 11 departments who underwent elective surgeries at Vajira Hospital between November 2020 and April 2021 (pre-protocol group) and between August 2021 and January 2022 (post-protocol group). Three blood utilization indices, namely, crossmatch-to-transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (Ti), were calculated for each department and overall, then compared to international benchmarks. Multilevel mean difference regression was utilized to investigate the protocol’s impact on three indices, as well as on the percentage of inadequate preoperative crossmatch and transfusion mismatches.
Results: The study included 1533 patients in the pre-protocol group and 1404 patients in the post-protocol group. Multivariable analysis adjusted for patient demographics, preoperative laboratory results, and intraoperative blood loss demonstrated significant improvements in the C/T ratio (mean difference (MD) -0.65, p < 0.01), %T (MD 34.1%, p < 0.01), and Ti (MD 0.5, p < 0.01) following protocol implementation. However, C/T ratios across all departments still failed to meet international benchmark. The proportion of inadequate preoperative crossmatches did not differ significantly between the two periods (MD -0.73, p = 0.15) and no blood incompatibilities were recorded in either group.
Conclusion: The type and screen protocol were associated with improved blood utilization efficiency for elective surgeries at Vajira Hospital without difference in percentages of underordering. While these observational findings are promising, C/T ratios failed to reach international standard. Further refinement of the protocol or the development of an institute-specific maximum surgical blood-order schedule is recommended.

Association between Fasting Blood Sugar Levels and Psoriasis Severity using the PASI Score: A Single-Center Cross-Sectional Study

Tue, 23 Jun 2026 00:00:00 +0700

Objectives: Psoriasis is a chronic immune-mediated inflammatory skin disease characterized by dry, thick, raised patches. The Psoriasis Area and Severity Index (PASI) measures disease severity body surface area and treatment efficacy. Psoriasis can increase the risk of diabetes and worsen insulin resistance, resulting in increased fasting blood sugar (FBS) and worsening diabetic symptoms. This study aimed to study the correlation between FBS and PASI score in psoriasis patients.
Materials and Methods: This retrospective study analyzed the relationship between PASI scores and FBS levels in psoriasis patients who visited the Dermatology Outpatient Clinic between 2019 and 2023. PASI scores were assessed by dermatologists, and FBS levels collected within a month of PASI evaluation were analyzed. Patients were categorized into diabetes mellitus (DM) and non- diabetes mellitus (non-DM) groups. Those on systemic therapy or without FBS were excluded.
Results: Data from 65 psoriasis patients were analyzed (non-DM (n = 58), DM (n = 7)). The average PASI score was 8.4 (5.9, 10.9) in non-DM patients and 7 (2.7, 4) in DM patients, respectively. Mean FBS levels were evaluated based on PASI severity: mild (n = 36) - 109.4 (100.1, 118.8), moderate (n = 13) - 103.6 (95.9, 111.4), and severe (n = 16) - 96.8 (92.9, 100.6). Comparison of mean FBS across PASI severity categories showed no statistically significant differences (mild vs. moderate: mean difference 5.7 milligrams (mg)/ deciliter (dL), p = 0.416, 95% confidence interval (CI) −8.3 to 19.8; moderate vs. severe: mean difference 6.8 mg/dL, p = 0.402, 95% CI −9.4 to 23.1; mild vs. severe: mean difference 12.6 mg/dL, p = 0.058, 95% CI −0.4 to 25.7).
Conclusion: No significant correlation was found between FBS levels and PASI scores in either the DM or non-DM groups.

Factors Associated With COVID-19 Vaccination Among Medical Students

Warrissara Punthong, Basmon Manomaipiboon — Thu, 09 Jul 2026 00:00:00 +0700

Objectives: This study aims to evaluate the factors associated with vaccine hesitancy and acceptance of COVID-19 vaccination among medical students at the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University.
Materials and Methods: A cross-sectional study was conducted among medical students. Data were collected using a structured, self-administered online questionnaire developed based on Lucia et al. The questionnaire included sections on demographic characteristics, perceptions and attitudes toward COVID-19 and COVID-19 vaccination, experience with COVID-19 infection, and vaccination behavior. Binary logistic regression analysis was performed to identify factors associated with vaccine hesitancy with the significant level of p < 0.05.
Results: A total of 298 medical students participated in the survey, a response rate of 54.3%. Among the participants, 57.7% were male, 77.9% were in the preclinic, and 60.7% had a Grade Point Average classified as very good. Most of
the participants (81.5%) reported to take the COVID-19 vaccine as soon as Food and Drug Administration approved is available. Almost all the participants would recommend the COVID-19 vaccine to family and friends (98.7%), to their patients (96.6%), and to the communities (98.3%). The vaccine acceptance group is significantly associated with the participants views that the COVID-19 vaccination is important for them as a healthcare provider (adjust odd ratio (OR) = 10.82, 95% confidence interval (CI) 1.09-107.08, p-value = 0.042*) and the trust of information related to COVID-19 vaccine from public health experts (adjust OR = 2.58, 95% CI 1.23-5.20, p-value = 0.009*) However, the serious side effects of the vaccine is significantly associated with the vaccine hesitancy (adjust OR = 0.31, 95% CI 0.14-0.69, p-value = 0.004*).
Conclusion: Medical students exhibited a positive attitude toward the COVID-19 vaccine. However, the serious effects of the vaccine also associated with the vaccine hesitancy. Medical schools could emphasis vaccine-related education, focusing on the safety and potential consequences of vaccines to ensure students are confident in addressing vaccine-related issues.

Restoration of Preoperative Coronal Plane Alignment of the Knee Phenotypes and Clinical Outcomes Following Mechanically Aligned Total Knee Arthroplasty

Pichayut Wattanapreechanon, Natthapong Hongku, Ittiwat Onklin — Tue, 11 Aug 2026 00:00:00 +0700

Objectives: This study aimed to determine the proportion of patients who exhibited a change in their coronal plane alignment of the knee (CPAK) classification after mechanically aligned (MA) total knee arthroplasty (TKA) and compare postoperative clinical outcomes between patients who restored their preoperative CPAK classification and those who did not.
Materials and Methods: This was a retrospective cohort study including 194 knees from 143 patients who underwent MA TKA between December 2021 and June 2024. Radiographic parameters, including pre- and postoperative lateral distal femoral angle and medial proximal tibial angle, were measured using long-leg standing radiographs to determine the CPAK classification. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion (ROM), and surgical complications were recorded.
Results: The most common preoperative CPAK classification was type I (40.7%), followed by type II (22.7%) and type IV (14.9%). Furthermore, 36 (18.6%) knees were restored to their preoperative CPAK classification. No significant differences in postoperative ROM (flexion: 115° vs. 110°, p = 0.445; extension: 5° vs. 5°, p = 0.770) and WOMAC scores (13.56 ± 9.58 vs. 18.12 ± 10.64, p = 0.251) were observed between the restored and non-restored groups. The surgical complication rates were 2.7% and 5.7% in the restored and non-restored groups, respectively.
Conclusion: A fixed MA TKA target may alter patients’ CPAK classification postoperatively, with only a limited proportion achieving restoration of their preoperative CPAK classification. Restoration of the preoperative CPAK classification did not significantly influence clinical outcomes.

Metastatic Prostate Cancer Presented with Stauffer Syndrome-Like Paraneoplastic Cholestasis: A Case Report

Vorraaud Kunnavuttivanich — Tue, 23 Jun 2026 00:00:00 +0700

Prostate cancer is common cancer diagnosed in men, primarily affecting those older than 60 years. Bone metastasis, which is the most frequent metastatic site, significantly reduce survival time. We present the case of an 83-year-old Thai male diagnosed with advanced prostate cancer and bone marrow metastasis who developed jaundice. Laboratory results show anemia, thrombocytopenia, and unexplained cholestasis. Viral hepatitis and autoimmune hepatitis were excluded. Magnetic resonance imaging with magnetic resonance cholangiopancreatography showed no biliary obstruction. Bone marrow biopsy confirmed metastatic prostate cancer. Due to anemic symptoms and fatigue, only medical castration was chosen as first-line treatment. 2 months after treatment, the patient had significantly improved in anemia, thrombocytopenia, bilirubin level, prostate-specific antigen levels, and clinical status. The patient can well tolerate the treatment. This improvement is consistent with Stauffer syndrome-like; a paraneoplastic syndrome most often associated with renal cell carcinoma but rarely reported in prostate cancer.

Bangkok's Emerging Health Megacluster: Opportunities and Implications for Thailand's Healthcare Future

Thanasak Sueblinvong , Surasak Sangkhathat — Tue, 25 Aug 2026 00:00:00 +0700

Bangkok is increasingly developing into a health megacluster characterized by the geographic concentration and functional integration of academic medical centers, private hospital networks, government specialist institutions, research and educational organizations, biomedical industries, and wellness enterprises. This transformation is being driven by demographic aging, medical tourism, geopolitical mobility, biomedical innovation, government incentives, and the rapid expansion of wellness and longevity markets.
The emerging megacluster offers important opportunities for economic growth, regional competitiveness, biomedical innovation, and the development of high-value health services. However, it also creates substantial health-system risks. Competition for specialist personnel may intensify the internal migration of physicians, nurses, and other health professionals toward Bangkok and premium-service institutions, thereby worsening existing geographic disparities. At the same time, competition in advanced technologies and specialized care may contribute to medical inflation, particularly when adoption occurs without sufficient evidence of population-level benefit. The growing convergence of healthcare and wellness may further expand healthcare consumption through the medicalization of aging, risk, and preventive health management.
Bangkok’s health megacluster therefore represents a policy paradox: it may strengthen Thailand’s position as a regional medical and wellness hub while placing additional pressure on the equity and sustainability of universal health coverage. Realizing its benefits while limiting adverse consequences will require coordinated governance, including workforce-retention strategies, health technology assessment, appropriate financing and cross-subsidization mechanisms, support for domestic biomedical innovation, and integration of health policy with urban planning.