ภาควิชาเวชศาสตร์ชุมชน

Abstract

Background and Objectives: Women with systemic lupus erythematosus (SLE) may experien .

Abstract

Background and Objectives: Women with systemic lupus erythematosus (SLE) may experience maternal and fetal complications during pregnancy. This study aimed at studying the knowledge, attitude, and behavior of women with SLE about pregnancy and contraception and factors that affect levels of knowledge about pregnancy and effectiveness of contraception.

Methods:  This cross-sectional descriptive study was conducted in 132 women with SLE at the Internal Medicine department of Naresuan University Hospital, from October 2022 – March 2023. Data were collected by designed questionnaires which consisted of personal information and questions for assessment of knowledge, attitudes, behaviors and factors affected contraception. The data were analyzed using descriptive statistics and logistic regression.

Results: The mean score of knowledge was unsatisfied in 64.4% whereas 35.6% were classified as satisfied. Women with effective contraception use were 83.5%. Factors associated with high levels of knowledge were medical personnels (OR = 4.6, 95% CI 1.127-18.819), disease duration longer than 5 years (OR = 0.4, 95% CI 0.190-0.866).  Factors promoting effective contraception were age range between 36-45 years (p = 0.004), and the disease duration longer than 5 years (p = 0.002) and receiving contraceptive counseling from obstetricians (p = 0.044). Most of female patients with SLE received counseling about contraception and plan for pregnancy from internal medicine physicians and obstetricians and used effective methods of contraception.

Conclusions: The basic knowledge of SLE and pregnancy of the studied group was unsatisfied. However, most of them chose effective methods of contraception and their attitude toward pregnancy was at the good level. Factors affected knowledge and appropriate behavior were medical personnels, disease duration longer than 5 years and receiving contraceptive counseling and SLE from obstetricians. The multidisciplinary approach will improve women with SLE receiving holistic care about reproductive health and decreasing complications in both pregnant women and newborns.

Abstract

Objective: Pemphigoid and pemphigus are skin diseases with high morbidity and mortality. The .

Abstract

Objective: Pemphigoid and pemphigus are skin diseases with high morbidity and mortality. The research aims to study the clinical presentations, comorbidities, and medications used prior to diagnosis, as well as the survival rates and prognostic factors for pemphigoid and pemphigus patients.

Materials and Methods: The cohort study was conducted on retrospective data of patients who were treated at Naresuan University Hospital between 1 October 2012 and 30 September 2022.

Results: There were 30 pemphigoid patients and 44 pemphigus patients. Pemphigoid patients were on average older than pemphigus patients (76 years vs 52 years), have more skin blisters, and less oral cavity lesions. Neurological disease increases risk of being diagnosed as a bullous pemphigoid (odds ratio=4.6, p-value =0.051). After adjustment by neurologic disease and age at diagnosis, pemphigoid was not significantly associated with the use of any medications. The survival rate of pemphigus was 91.1% at 1 year and 82.2% at 5 years, while the survival rate of pemphigoid was 69.9% at 1 year, and 47.7% at 5 years. In multivariable Cox regression analysis, there was worse prognosis among pemphigoid and pemphigus patients that have comorbidity disease (adjusted HR= 3.13, p-value=0.057) and were older than 70 years (adj HR= 6.93, p-value=0.015).

Conclusion: Clinical characteristics of bullous pemphigoid and pemphigus were different such as age of onset, presence of blister and oral lesion. Neurological disease was a risk factor for developing bullous pemphigoid than pemphigus. Survival of pemphigoid patients was worse than pemphigus patients. However, this finding could be confounded by older age of pemphigoid patients.

Abstract

COVID-19 patients may have different disease progression depending on certain factors such as age and underlying m .

Abstract

COVID-19 patients may have different disease progression depending on certain factors such as age and underlying medical conditions, which also affect the severity and progression of COVID-19. Our study objective is to study the relationship between SARS-CoV-2 cycle threshold (Ct) and other factors associated with the severity of COVID-19. The data were collected from a total of 196 COVID-19 patients aged >18 years, who were hospitalized between 1 August and 31 December 2021 at Naresuan University Hospital. Of the 196 patients, 54 (27.5%) were suffering from severe covid. Based on multivariate analysis, Ct of N gene (p-value=0.721) and Ct of ORF1ab gene (p-value=0.490) were not associated with severe illness. Nonetheless, risk factors contributing to severity and progression of COVID-19 are age >60 years (aOR=6.81 (2.79-16.62), p-value<0.001) and having any one of comorbidities, e.g. obesity, chronic kidney disease, chronic obstructive pulmonary disease (COPD), cardiovascular disease, cerebrovascular disease, uncontrolled diabetes, and cirrhosis (aOR=2.30 (1.03-5.11), p-value=0.042). The protective factor against severe covid is having received >2 doses of vaccination (aOR=0.22 (0.08-0.64), p-value=0.005). It is therefore important to closely monitor potential severe illness among the elderly population and those with underlying medical conditions, as well as encouraging these high-risk groups to receive at least two doses of vaccine to reduce the risk of severe COVID-19 infections.

Abstract

Abstract

Background: Balloon dilators for percutaneous nephrolithotomy (PCNL) have been adopted in various countries worldwide. However, its utilization remains limited in Thailand due to the equipment cost and the country's higher morbidity and complexity of renal stones. We performed a comparative study between the out-comes of balloon dilators (BD) and the commonly used metal telescopic dilators (MTDs) in Thai patients who underwent PCNL.

Methods: We conducted a retrospective review of 199 patients who underwent PCNL between Jan 2011 and July 2022. We excluded patients with risk for bleeding and active infection from our study. 144 patients were recruited in our study: 74 patients in the MTD group and 70 patients in the BD group. The success rate and complication of both methods of dilation were compared. Continuous demographic data was compared with an independent t-test. A generalized linear model was applied to assess the multivariable analysis's mean differences and risk differences.

Results: Demographic data of patients in both groups were not significantly different in size of stone, age, and history of kidney surgery. The success rate of dilatation was 95.5% and 98.6% for MTD and BD, respectively (p = 0.331). Renal pelvic injury was 8.1% for MTD and 10% for BD (p = 0.692). Stone clearance rates were 100% and 82.48% for MTD and BD, respectively (p = 0.098). LOS of both groups was not significantly different by multivariate analysis.

Conclusion: Both dilatation methods demonstrated comparable success rates, blood loss, and hospital stays in PCNL for renal stones. In the Thai population with a high prevalence of large renal stones, BD remains an effective option in most situations.

บทคัดย่อ
วัตถุประสงค์: เพื่อศึกษาควา� .

บทคัดย่อ
วัตถุประสงค์: เพื่อศึกษาความชุก พฤติกรรมการใช้และปัจจัยที่เกี่ยวข้องกับการใช้สมาร์ตโฟนและแท็บเล็ตในเด็กเล็กอายุต่่ากว่า 7 ปี

วัสดุและวิธีการ: เป็นการศึกษาเชิงส่ารวจโดยใช้แบบสอบถามเก็บข้อมูลเกี่ยวกับ การใช้และระยะเวลาการใช้สมาร์ตโฟนและแท็บเล็ตในเด็กเล็ก เหตุผลการใช้ ทัศนคติ ปัจจัยด้านเด็กและผู้ปกครอง กลุ่มตัวอย่างเป็นผู้ปกครองของเด็กอายุต่่ากว่า 7 ปี ที่เข้ารับบริการผู้ป่วยนอกแผนกกุมารเวชกรรมโรงพยาบาลมหาวิทยาลัยนเรศวร ระหว่างเดือนมกราคม-มีนาคม 2564

ผล: ความชุกการใช้สมาร์ตโฟนและแท็บเล็ตเท่ากับร้อยละ 70.9 ในเด็กอายุต่่ากว่า 7 ปี และร้อยละ 14.9 ในเด็กอายุต่่ากว่า 2 ปี
กิจกรรมที่เด็กเลือกท่าผ่านสมาร์ตโฟนและแท็บเล็ตมากที่สุด คือ ดูวิดีโอและภาพเคลื่อนไหวเท่ากับร้อยละ 96.8
เหตุผลหลักที่ผู้ปกครองให้เด็กใช้ คือ เพื่อการศึกษาและเสริมสร้างพัฒนาการคิดเป็นร้อยละ 54.5
ผู้ปกครองร้อยละ 87.9 เห็นด้วยว่าเด็กอายุน้อยกว่า 2 ปี ไม่ควรใช้สื่ออิเล็กทรอนิกส์ทุกชนิด
การใช้และระยะเวลาการใช้สมาร์ตโฟนและแท็บเล็ตมากขึ้นตามกลุ่มอายุของเด็กที่มากขึ้น โดยมีความสัมพันธ์อย่างมีนัยส่าคัญทางสถิติ (p-value < 0.01)
ในด้านปัจจัยผู้ปกครอง กลุ่มอายุผู้ปกครองที่สูงขึ้นและรายได้ครอบครัวน้อย มีอัตราการเป็นเจ้าของสมาร์ตโฟนและแท็บเล็ตของเด็กสูงกว่า โดยมีความสัมพันธ์อย่างมีนัยส่าคัญทางสถิติ

สรุป: การใช้สมาร์ตโฟนและแท็บเล็ตในเด็กเล็กมีอัตราที่สูง จึงควรให้ค่าแนะน่า เฝ้าะวังและติดตามผลเสียที่อาจเกิดการใช้สมาร์ตโฟนและแท็บเล็ตที่เร็วและมากเกินไปในกลุ่มเด็กเล็ก

Abstract

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob-Gyn) is an important skill for me .

Abstract

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob-Gyn) is an important skill for medical students. Because it involves a physical assessment of the patients' genitalia, patients may refuse medical students to participate in the examination, affecting the medical students' clinical skills.

Methods: This cross-sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations. A total of 198 out-patients from the Ob-Gyn department were included. A Likert scale questionnaire was designed which featured topics on patients’ attitudes and circumstances related to medical student involvement in gynaecological procedures.

Results: The majority of outpatients (71.7%) accepted the participation of medical students in pelvic examinations. Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients' acceptance (Pvalue<0.001). The patients’ impressions had an influence on the decision to accept students in pelvic exam participation. Approximately 40% of patients were concerned about the breach of confidentiality. However, most patients strongly agreed that allowing medical students to perform pelvic examination would benefit their medical education.

Conclusion: Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients’ impressions of medical students were crucial factors that significantly influence their decision whether to allow or deny them to participate in the procedure. Disclosure of confidentiality was found to be matters of concern to most patients.

ABSTRACT
Objective: Information on the population-based prevalence study of skin diseases is still lacking. The study explores the prevalence .

ABSTRACT
Objective: Information on the population-based prevalence study of skin diseases is still lacking. The study explores the prevalence and pattern of diagnosed skin diseases of the population in a primary care area of a university hospital in Thailand.

Materials and Methods: Skin disease patients were identified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes (L00-L99). Retrospective data were obtained from the hospital electronic medical record between 2015-2019. The number of clinic visits and the number of skin disease diagnoses were counted. The five-year period prevalence was calculated by dividing the number of cases by the population in the primary care area.

Results: During the five-year period, in a population of 29,969, we found 3,770 patients (12.6% of 29,969 population) who made 7,433 outpatient visits with the diagnoses o skin diseases. Infections of the skin and subcutaneous tissues were the most common (37.3%) followed by dermatitis (29.7%), urticaria and erythema (13.9%), other disorders of the skin and subcutaneous tissue (8.6%), and papulosquamous disorders (1.7%). The five-year period prevalence of skin diseases per 100,000 persons was as following: cellulitis (2,296), urticaria (1,682), psoriasis (177), atopic dermatitis (420), seborrheic dermatitis (227), alopecia areata (50), vitiligo (23), and pemphigus (10). 

Conclusion: Infection and dermatitis were the two most common skin diseases in the primary care area population. Atopic dermatitis, psoriasis, seborrheic dermatitis, and decubitus ulcer were less commonly found. Our prevalence data should be the “at least” prevalence of skin diseases due to possible underreporting.

Abstract
Background: Psoriasis is a chronic dermatological illness with a high burden of morbidity. There is no collective data on its prevale .

Abstract
Background: Psoriasis is a chronic dermatological illness with a high burden of morbidity. There is no collective data on its prevalence and incidence in Thailand to date.

Objective: To explore the prevalence and patient characteristics in a primary care area with a population of approximately 30,000 under the Universal Health Care Coverage Scheme serviced by the authors' university hospital.

Materials and Methods: The authors conducted a retrospective database analysis from the hospital electronic medical record system on patients seen between January 2015 and December 2019. Psoriasis patients were identified by using the International Statistical Classification of Diseases and Related Health Problems Tenth Revision codes containing L40 (L40.0 to L40.9). The diagnosis for each patient was then confirmed from the medical chart review. The number of visits and number of psoriasis patients in the Universal Health Care Coverage Scheme in the primary care setting was counted, and a five-year period prevalence was calculated. Characteristics of psoriasis patients were analyzed including their ages, gender, comorbidity, and systemic treatment received.

Results: During the five-year period, there were 338 visits from 40 individual psoriasis patients. The five-year period prevalence of psoriasis was 0.13% or 133 per 100,000 persons. The mean age of psoriasis patients was 50 years. Male consisted of 47% of patients. Forty-two percent of patients required systemic treatment.

Conclusion: The five-year period prevalence of psoriasis was 0.13%, which is less than the prevalence in the western countries but similar to other east Asian countries. The limitation of the present study was the relatively small geographic area and the possibility of underestimating prevalence due to some patients may not have sought treatment or were treated at other health facilities. After adjusting for underreporting bias, the adjusted prevalence is 0.43%.

Abstract

Syphilis incidence per 100,000 population in Thailand increased five times from 2.16 in year 2008 to 11.51 in year 2018. Early dia .

Abstract

Syphilis incidence per 100,000 population in Thailand increased five times from 2.16 in year 2008 to 11.51 in year 2018. Early diagnosis and treatment of syphilis reduce the transmissions, morbidity and mortality from syphilis and congenital syphilis. Diagnosis is by using medical history, signs and symptoms, epidemiological data, and serologic testing for syphilis infection. Penicillin is a drug of choice. Syphilis can be prevented and controlled by early diagnosis and treatment, diagnosis and treatment of sexual partners, screening in pregnant women, and high-risk groups such as men having sex with men (MSM), teenagers and commercial sex workers. Condom use is still the effective way in prevent sexually transmitted diseases. This article presents a knowledge review on diagnosis and treatment of syphilis which are essential part of syphilis prevention and control.

บทคัดย่อ
ภาวะตกเลือดหลังคลอดในระยะแรกเป็นสาเหตุก .

บทคัดย่อ
ภาวะตกเลือดหลังคลอดในระยะแรกเป็นสาเหตุการเสียชีวิตที่สำคัญของหญิงคลอดบุตร มีหลายปัจจัยที่มีผลต่อภาวะตกเลือด การ ศึกษาแบบกลุ่มตัวอย่าง-กลุ่มควบคุมนี้ สำรวจปัจจัยเสี่ยงต่อการเกิดภาวะตกเลือดหลังคลอดในโรงพยาบาลมหาวิทยาลัยนเรศวร พิษณุโลก โดยเก็บข้อมูลจากเวชระเบียนผู้ที่มาคลอด ระหว่างเดือนเมษายน พ.ศ. 2557 ถึงเดือน กรกฎาคม พ.ศ. 2560 ประกอบ ด้วยกลุ่มผู้ที่มีภาวะตกเลือดหลังคลอด จำนวน 118 คนและกลุ่มควบคุม 236 คน พบว่า สาเหตุของการตกเลือดเกิดจากภาวะมดลูก ไม่หดรัดตัวมากที่สุด (ร้อยละ 45.8) รองลงมาคือการฉีกขาดของช่องทางคลอด (ร้อยละ 27.1) สาเหตุซึ่งเกิดจากรกพบร้อยละ 14.4 และเกิดจากสาเหตุอื่นๆ หรือพบหลายสาเหตุร่วมกันอีกร้อยละ 12.7 ปัจจัยที่สัมพันธ์กับการตกเลือดหลังคลอดอย่างมีนัย สำคัญทางสถิติได้แก่ การคลอดบุตรตั้งแต่ 4 ครั้งขึ้นไป (OR 2.753; 95%CI 1.209-6.272, p-value 0.013) การตั้งครรภ์แฝด (OR 6.268; 95%CI 1.245-31.548, p-value 0.019) การใช้หัตถการช่วยคลอด (OR 3.142; 95%CI1.447-6.823, p-value 0.003) รก ค้าง (OR 12.142; 95%CI 2.645-55.737) รกเกาะต่ำ (p-value < 0.001) และการคลอดระยะที่สองนานผิดปกติ (OR 2.734;95%CI 2.250-3.324, p-value 0.003) ผลการศึกษาที่ได้สามารถนำไปใช้เฝ้าระวังหญิงตั้งครรภ์ที่มีปัจจัยเสี่ยงดังกล่าวเพื่อ ป้องกันการตกเลือดหลังคลอดและรักษาการตกเลือดหลังคลอดอย่างทันที

บทคัดย่อ:
รายงานผู้ป่วยโรค CHROMOBLASTOMYCOSIS ที่พบร่วมกับโรค D .

บทคัดย่อ:
รายงานผู้ป่วยโรค CHROMOBLASTOMYCOSIS ที่พบร่วมกับโรค DISSEMINATED SUPERFICIAL POROKERATOSIS ที่มี AMYLOID ในชั้นหนังแท้

คณะแพทยศาสตร์ มหาวิทยาลัยนเรศวร จังหวัดพิษณุโลก Chromoblastomycosis เป็นโรคผิวหนังซึ่งพบได้ไม่บ่อยและอาจทําให้ได้รับการวินิจฉัยช้าและมีรอยโรคลุกลามได้ ผู้ป่วยมีลักษณะทางคลินิกของผื่นบริเวณแขนซ้ายที่หนาตัวและมีจุดดํา การตรวจเชื้อราด้วยสารละลายโปตัสเซียมไฮดรอกไซด์ โดยขูดจากบริเวณจุดดําพบเชื้อราลักษณะกลมสีน้ําตาล ตรวจพยาธิสภาพผิวหนังพบการอักเสบของผิวหนังแท้แบบแกรนูโลม่า ชนิดเซลล์ผสม และพบเชื้อราลักษณะกลมติดสีน้ําตาล

Disseminated Superficial Porokeratosis เป็นโรคที่พบได้ไม่บ่อยและมีลักษณะรอยโรคเป็นตุ่ม ผื่นเล็กๆ จํานวนมาก บริเวณลําตัว แขนขา เมื่อคลํารอยโรคจะมีลักษณะนูนบริเวณขอบ การตรวจพยาธิสภาพผิวหนังพบ Cornoid lamella
รายงานฉบับนี้เป็นการนําเสนอผู้ป่วยชายไทยอายุ 70 ปี ซึ่งพบการเกิดโรค Chromoblastomycosis ในผู้ป่วย Disseminated superficial porokeratosis และ มี amyloid ฝังในชั้นหนังแท้

Abstract:
Traveling causes imbalances in the triad of epidemiology (i.e. host, agent and environment), thus making travelers more vulnerable t .

Abstract:
Traveling causes imbalances in the triad of epidemiology (i.e. host, agent and environment), thus making travelers more vulnerable to illness. Skin diseases commonly found among travelers include infectious diseases, sting and bites, dermatitis, and diseases caused by a number of physical factors. Skin symptoms can be a leading symptom of an outbreak, which allows us to diagnose and promptly and effectively control the spread of the disease. Epidemiological information on the disease situation is very useful in the diagnosis of the disease. The diseases can be prevented by focusing on hygiene practices and use of appropriate protective equipment.