A Rare Variation of Retroaortic Left Renal Vein Draining into Left Common Iliac Vein

A 24-year-old woman without underlying disease presented with right lower abdominal pain for a day. The patient’s clinical symptoms were suspected acute appendicitis and underwent multidetector computed tomography. There is diffuse enlarged appendix with diffuse wall thickening and enhancement as well as minimal surrounding fat stranding. Mild thickened peritoneum is also observed. There is no fluid collection or free air. The radiologist diagnosed acute appendicitis without complication. Incidentally, the patient was found a rare anatomical variation of the retroaortic left renal vein draining into left common iliac vein. Patient underwent appendectomy. We would like to present a characteristic imaging of the renal vein variations.

Drug Use Evaluation Among Elderly Patients With History of Falling in Geriatric Assessment Clinic, Ramathibodi Hospital

Background: Drug use evaluation as an intervention approach for fall prevention has an effect on most drug-related outcomes. Geriatric assessment clinic provides comprehensive care in elderly patients. All prescribed or non-prescribed medications were evaluated by pharmacists. Objective: To study the drug and drug-related problem among elderly patients with history of falling. Methods: This is a cross-sectional study of elderly patients with history of fallings. Demographic data, health information, history of falls, and drugs use evaluation were obtained from their medical records in year 2010 to 2020. Linear regression model was used to examine the multivariate correlates to number of fallings. Results: A total of 183 patients with history of falling were studied. Of this, 97 had recurrent falls. Most patients (77%) had more than 5 underlying diseases and over half (55%) had dementia. Drug-related problem were found 69.4%, 4 in 5 of patients used 5 types of the medications or more. The diabetes drugs were found to increase risk of recurrent falls significantly (OR [95% CI], 2.11 [1.03 - 4.33]; P < .05). Conclusions: Most elderly patient with history of falling have drug-related problem (69.4%) and multiple morbidities including dementia. The diabetes drugs were 2 times significantly increased risk of recurrent falls. This study highlights the important of drugs management in this vulnerable group of elderly patients.

Technologies-enhanced Anatomical Study in Undergraduate Medical Students

Anatomy is an essential pre-clinical subject of undergraduate medical education. The traditional practical studies on cadavers are widely used in medical schools. It enhances active and deep learning, preparing students for clinical practice. However, the high costs, the time-consuming, and the health problems, which the staff exposed to chemical hazards are considered. Computer-based learning (CBL) technologies can increase the efficiency of students in understanding anatomy. This review provides an overview of CBL technologies such as Anatomage table 7.0, zSpace, Complete Anatomy app, and 4D Interactive Anatomy that prepare Ramathibodi (RA) medical students for enhanced anatomical understanding and self-learning. The integration methods between traditional cadaveric dissection and the CBL in the curriculum can enhance the classroom experience, student engagement, learning, retention, and improvement of RA medical student's knowledge in anatomy.

Efficacy of RAMA Mobile Video Laryngoscope (RAMA-mVL) Versus McGrath® for Tracheal Intubation in Manikin. A Randomized Study

Background: Video laryngoscope (VL) has increased the success rate of intubation but the commercial VL is unaffordable for community hospitals. Therefore, Ramathibodi mobile VL (RAMA-mVL) was invented to close the gap and expected that it would be equivalent to the current device and lower price.Objective: To determine the effectiveness of intubation, compare by using RAMA-mVL and McGrath®Methods: The randomized, single-blinded study of the success intubation between RAMA-mVL and McGrath® was conducted in a manikin. Medical personnel with intubation experiences was included and trained before performing the procedure. The success rate for one best shot of intubation, time to intubation, satisfaction, and value between both VL were recorded and analyzedResults: A total of 208 persons entered the research, 104 in each group. The success rate for intubation by using both VL is 100%. The mean of time to intubation using RAMA-mVL was significantly less than that of McGrath®, which were 9.12 (±4.28) and 11.19 (±5.04) seconds, respectively (95% CI 0.001 - 0.9, P = .002). The satisfaction with innovation that is easy to build between RAMA-mVL and McGrath® was 4.88 (±0.32) and 4.23 (±0.96) points (95% CI 0.46 - 0.85, P < .001). Additionally, the cost of RAMA-mVL was cheaper than McGrath®.Conclusions: RAMA-mVL performed equivalent and even better than McGrath® compared by intubation success rate, mean intubation time, satisfaction, and cost-effectiveness.

Factors Related to Muscle Cramps during Hemodialysis in End Stage Renal Disease Patients

Background: Muscle cramps are a common complication during hemodialysis that can cause patients extremely painful.Objective: To determine factors related to muscle cramps during hemodialysis in patients with end-stage renal disease.Methods: A descriptive correlational study was conducted in end-stage renal disease patients undergoing hemodialysis at Hemodialysis center, Faculty of Medicine Ramathibodi Hospital between February and March 2020. The data collection instruments included muscle cramps report form, demographic questionnaire, and factors related to muscle cramps questionnaire. The data were analyzed using descriptive statistics and multiple logistic regression.Results: A total of 44 patients were recruited in the study. The mean age was 63.3 years. A total of 458 muscle cramps during hemodialysis assessments were recorded in the one month. The result showed that 45 muscle cramps (9.8%) occurred during hemodialysis. Factors significantly related to muscle cramps during hemodialysis included interdialytic weight gain ≥ 3.5 kilograms (OR = 4.5, P < .05), experiencing cramps before hemodialysis (OR = 25.5, P < .05), and high serum bicarbonate concentration (OR = 5.6, P < .05).Conclusions: This study found that 9.8% of patients reported muscle cramps during hemodialysis. Interdialytic weight gain, having cramps before hemodialysis, and serum bicarbonate concentration were significantly related to muscle cramps during hemodialysis in patients with end-stage renal disease.

Comparison of Machine Learning With Logistic Regression for Prediction of Chronic Kidney Disease in the Thai Adult Population

Background: Chronic kidney disease (CKD) takes huge amounts of resources for treatments. Early detection of patients by risk prediction model should be useful in identifying risk patients and providing early treatments. Objective: To compare the performance of traditional logistic regression with machine learning (ML) in predicting the risk of CKD in Thai population. Methods: This study used Thai Screening and Early Evaluation of Kidney Disease (SEEK) data. Seventeen features were firstly considered in constructing prediction models using logistic regression and 4 MLs (Random Forest, Naïve Bayes, Decision Tree, and Neural Network). Data were split into train and test data with a ratio of 70:30. Performances of the model were assessed by estimating recall, C statistics, accuracy, F1, and precision. Results: Seven out of 17 features were included in the prediction models. A logistic regression model could well discriminate CKD from non-CKD patients with the C statistics of 0.79 and 0.78 in the train and test data. The Neural Network performed best among ML followed by a Random Forest, Naïve Bayes, and a Decision Tree with the corresponding C statistics of 0.82, 0.80, 0.78, and 0.77 in training data set. Performance of these corresponding models in testing data decreased about 5%, 3%, 1%, and 2% relative to the logistic model by 2%. Conclusions: Risk prediction model of CKD constructed by the logit equation may yield better discrimination and lower tendency to get overfitting relative to ML models including the Neural Network and Random Forest.

Development of Antenatal Care Pamphlet in Burmese

Background: Currently, there are many foreign workers working in Thailand. Majority of them are Myanmar. Providing information on antenatal care to Burmese women is one of the guidelines in providing knowledge for antenatal care. Objective: To develop a pamphlet on antenatal care in Burmese language. Methods: This study was on research and development. The tools used in the research were the pamphlet development and pamphlet evaluation forms. The back translation method was used for translation by using Thai language pamphlet that modifies for the optimal features and information appropriate for the clients. Results: The process of translating and developing research tools was started from Step 1: translating the contents of pamphlet from Thai to Burmese, obtaining the pamphlets B1 and B2. Step 2: conducting a preliminary test by bringing the two Burmese language pamphlets to test with the participants that can communicate in Burmese language and evaluate the pamphlet features. It was found that the majority of 3 in 5 people were satisfied with the B2 pamphlet at an excellent level. This step aimed to consider the clarity of the language idioms used. Step 3: reviewing the suitability of the culture by introducing the Burmese pamphlet and preliminary tests checked by experts who understand the context and culture of Myanmar. Step 4: synthesizing the translated version of the tool by collecting information that is appropriate for the context and culture of the Burmese people to synthesize as a new Burmese pamphlet. Step 5: translating the contents of the pamphlet back from Burmese to Thai language. And Step 6: checking the equality of translation and draw conclusions. Conclusions: From all processes mentioned above, we got the Burmese antenatal care pamphlet that is appropriate in terms of content and culture.

Correlation of Composite Indices and COPD Assessment Test in Thai COPD Patients

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable chronic respiratory diseases. The BODE, ADO, DOSE are the composite indices taking into consideration for prognostication. In addition, COPD assessment test (CAT) score is associated with quality of life, taken for assessing symptoms severity and for personalizing treatments. Objective: To investigate the CAT score in Thai COPD patients according to their BODE, ADO, and DOSE in the influence of clinical parameters and outcomes. Methods: Medical records were reviewed between January 2016 and December 2016. BODE, ADO and DOSE was calculated based on their individual components. Results: Total 125 consecutive COPD patients were recruited. There was difference between CAT score among the GOLD stages classified (P = .02). There was significant difference of CAT between 4 BODE quartiles in cohort (P = .001).Thai COPD patients had the higher ADO index exhibit the higher CAT score than those with the lower ADO index (P = .001). There was no difference in CAT score between COPD with the higher and the lower DOSE index (P = .05). Conclusions: The higher CAT score found in Thai COPD patients with the higher composite indices of BODE and ADO. However, there was no difference in the DOSE index.

Leukemoid Reaction in a Case of Chronic Cholecystitis With Focal Mild Acute Inflammation

Leukemoid reaction is a rare condition of marked increase of the white blood cells (WBC) in the peripheral blood, mostly more than 50 × 109/L. Although its most common cause is infection, acute or chronic cholecystitis has been hardly mentioned. This report aimed to present the leukemoid reaction found in a Thai who had chronic cholecystitis with focal acute inflammation. A 74-year-old woman had low-graded fever and generalized vague abdominal discomfort for 2 days. The physical examination showed the body temperature 37.7 °C and unremarkable abdominal signs. Her blood tests showed: hemoglobin 9.0 g/L, WBC 52.48 × 109/L, neutrophil 91%, band form 1%, platelet 434 × 109/L, and alkaline phosphatase (ALP) 290 U/L. The blood cultures yielded no growth. The computed tomography of the abdomen revealed 2 stones in the common bile duct (CBD) causing obstruction; the gall bladder (GB) showed mild dilatation with thin wall containing multiple small gall stones; no pericholecystic fluid and normal size of spleen. She promptly underwent operative cholecystectomy, CBD choledochoscopy, stones removal and T-tube choledochostomy. Along with the surgery, intravenous ertapenem was also administered. The pathology of the gall bladder was chronic cholecystitis with focal mild acute inflammation. With these therapies, fever daily decreased and finally disappeared within 5 days meanwhile the WBC count also gradually diminished every day till 8.04 × 109/L within 7 days. The WBC count was still normal one month later. The diagnosis of leukemoid reaction was concluded and it was presumably be associated with chronic calculous cholecystitis with focal acute inflammation although the BCR-ABL translocation had never been explored.

Prevalence, Types, and Factors of HPV Infection Among Women With Abnormal Cervical Cytology Screening at Ramathibodi Hospital

Background: Cervical cancer is the second leading cancer among Thai women. Human papillomavirus (HPV) is the most common cause of cervical cancer. HPV16 and HPV18 are the most prevalence types in women with cervical cancer. Objectives: To study the prevalence and types of HPV infection and its associated risk factors among women with abnormal cervical cytology screening. Methods: This cross-sectional study purposively recruited 376 women who had abnormal cervical cytology screening by liquid-based cytology at the outpatient clinic, Ramathibodi Hospital from August 2015 until March 2016. HPV genotyping was done by the polymerase chain reaction (PCR). Analysis of the personal characteristics was done using descriptive statistics. Results: The prevalence of HPV infection was 41.5%. Among them, a single infection was found in 78.8% of women. The most common genotypes were HPV16 (8.5%) and HPV52 (7.7%). But HPV18 was found in only 1.9%. The characteristic which was significantly associated with HPV infection was age, nulliparity, and high-graded dysplasia (P < .05). Conclusions: High prevalence rate of HPV infection was found among women with abnormal cytology. High-risk HPV prevalence and type distribution may be useful for public health authorities in assessing the cervical screening program.