Pub Date : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13849
Objective: To evaluate the effectiveness of intravitreal bevacizumab (IVB) injection in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR). Materials and Methods: A retrospective cohort study was performed by reviewing medical charts at Nongkhai Hospital between October 1, 2019 and February 28, 2022. VH in PDR patients was divided into two groups as IVB and observation. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and at 4, 8, and 12 weeks. The main outcome, as the success rate of vitrectomy at 12 weeks, and the secondary outcome as mean change in best-corrected visual acuity (BCVA) were recorded. Results: There were no significant differences among 73 consecutive patients, with 76 eyes, with VH due to PDR between the IVB injection and the observation groups with respect to gender, age, BMI, type of diabetes, hypertension, dyslipidemia, and BCVA at baseline, and no statistically significant differences in pars plana vitrectomy (PPV) rate between the IVB and the observation groups at 5.40% versus 13.50% (p=0.22). A statistically significant improvement in mean BCVA change was recorded from the baseline to the 12-week follow-up visit as 29.70±2.78 letters in the IVB group compared with 20.17±2.73 letters in the observation group (p=0.02). Complete panretinal photocoagulation (PRP) treatment was performed at 71.4% in the IVB group and 58.1% in the observation group in one visit. Conclusion: IVB injection in patients suffering from PDR with VH reduced the need for vitrectomy. Results suggested no clinically important differences between the IVB and the observation groups on the rate of vitrectomy. IVB injection rapidly improved BCVA and reduced the number of patient follow-up visits required to achieve full PRP. Keywords: Bevacizumab; Proliferative diabetic retinopathy; Vitreous hemorrhage; Retinal neovascularization
{"title":"Efficacy of Intravitreal Bevacizumab Injection for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage at Nongkhai Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.05.13849","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13849","url":null,"abstract":"Objective: To evaluate the effectiveness of intravitreal bevacizumab (IVB) injection in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR).\u0000\u0000Materials and Methods: A retrospective cohort study was performed by reviewing medical charts at Nongkhai Hospital between October 1, 2019 and February 28, 2022. VH in PDR patients was divided into two groups as IVB and observation. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and at 4, 8, and 12 weeks. The main outcome, as the success rate of vitrectomy at 12 weeks, and the secondary outcome as mean change in best-corrected visual acuity (BCVA) were recorded.\u0000\u0000Results: There were no significant differences among 73 consecutive patients, with 76 eyes, with VH due to PDR between the IVB injection and the observation groups with respect to gender, age, BMI, type of diabetes, hypertension, dyslipidemia, and BCVA at baseline, and no statistically significant differences in pars plana vitrectomy (PPV) rate between the IVB and the observation groups at 5.40% versus 13.50% (p=0.22). A statistically significant improvement in mean BCVA change was recorded from the baseline to the 12-week follow-up visit as 29.70±2.78 letters in the IVB group compared with 20.17±2.73 letters in the observation group (p=0.02). Complete panretinal photocoagulation (PRP) treatment was performed at 71.4% in the IVB group and 58.1% in the observation group in one visit.\u0000\u0000Conclusion: IVB injection in patients suffering from PDR with VH reduced the need for vitrectomy. Results suggested no clinically important differences between the IVB and the observation groups on the rate of vitrectomy. IVB injection rapidly improved BCVA and reduced the number of patient follow-up visits required to achieve full PRP.\u0000\u0000Keywords: Bevacizumab; Proliferative diabetic retinopathy; Vitreous hemorrhage; Retinal neovascularization","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82796272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13768
Objective: Hypertension is the leading cause of morbidity and mortality, and blood pressure (BP) control is shown to reduce the risk of cardiovascular events. The present study aimed to investigate the efficacy and safety of chlorthalidone and hydrochlorothiazide for reducing systolic and diastolic BP in patients with mild-to-moderate hypertension. Materials and Methods: The present study was a randomized clinical trial. Patients 18 years or older with mild-to-moderate hypertension with or without prior antihypertensive medications were enrolled. Patients were randomly assigned to the chlorthalidone or hydrochlorothiazide group. The dose of study medication could be up-titrated at the 6-week. The primary outcomes were the reduction in systolic and diastolic BP, the rate of office BP control at 12 weeks, and the rate of adverse events. Results: Fifty-six patients (mean age of 49.8±11.1 years) and 42.9% male, were included. Forty-three patients (76.8%) had known hypertension. Mean sitting office systolic BP (SBP) and diastolic BP (DBP) at baseline was 153.2±9.6 and 91.8±9.2 mmHg, respectively. The average daily dose of chlorthalidone and hydrochlorothiazide was 16.1±5.8 and 32.4±11.6 mg. The mean reduction in SBP in the chlorthalidone and hydrochlorothiazide groups was 28.7±12.2 and 22.8±13.7 mmHg (p=0.118), and DBP was 14.4±7.5 and 9.1±6.6 mmHg (p=0.011), respectively. The rate of office BP control was significantly greater in the chlorthalidone group at 91.7% versus 61.5% (p=0.013). There was no significant difference in the rate of adverse events between the groups. Conclusion: Chlorthalidone was shown to be more effective than hydrochlorothiazide for office BP control. There was no difference in adverse events. Trial registration: The trial had been registered with the Thai Clinical Trials Registry (TCTR) which complied with WHO International Clinical Trials Registry Platform dataset. The registration number was TCTR20191006002 (06/10/2019). Keywords: Efficacy; Safety; Chlorthalidone; Hydrochlorothiazide; Reducing; Systolic and diastolic blood pressure; Patients with mild to moderate hypertension
{"title":"Efficacy and Safety Compared between Chlorthalidone and Hydrochlorothiazide for Reducing Systolic and Diastolic Blood Pressure in Patients with Mild-to- Moderate Hypertension: A Randomized Clinical Trial","authors":"","doi":"10.35755/jmedassocthai.2023.05.13768","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13768","url":null,"abstract":"Objective: Hypertension is the leading cause of morbidity and mortality, and blood pressure (BP) control is shown to reduce the risk of cardiovascular events. The present study aimed to investigate the efficacy and safety of chlorthalidone and hydrochlorothiazide for reducing systolic and diastolic BP in patients with mild-to-moderate hypertension.\u0000\u0000Materials and Methods: The present study was a randomized clinical trial. Patients 18 years or older with mild-to-moderate hypertension with or without prior antihypertensive medications were enrolled. Patients were randomly assigned to the chlorthalidone or hydrochlorothiazide group. The dose of study medication could be up-titrated at the 6-week. The primary outcomes were the reduction in systolic and diastolic BP, the rate of office BP control at 12 weeks, and the rate of adverse events.\u0000\u0000Results: Fifty-six patients (mean age of 49.8±11.1 years) and 42.9% male, were included. Forty-three patients (76.8%) had known hypertension. Mean sitting office systolic BP (SBP) and diastolic BP (DBP) at baseline was 153.2±9.6 and 91.8±9.2 mmHg, respectively. The average daily dose of chlorthalidone and hydrochlorothiazide was 16.1±5.8 and 32.4±11.6 mg. The mean reduction in SBP in the chlorthalidone and hydrochlorothiazide groups was 28.7±12.2 and 22.8±13.7 mmHg (p=0.118), and DBP was 14.4±7.5 and 9.1±6.6 mmHg (p=0.011), respectively. The rate of office BP control was significantly greater in the chlorthalidone group at 91.7% versus 61.5% (p=0.013). There was no significant difference in the rate of adverse events between the groups.\u0000\u0000Conclusion: Chlorthalidone was shown to be more effective than hydrochlorothiazide for office BP control. There was no difference in adverse events. Trial registration: The trial had been registered with the Thai Clinical Trials Registry (TCTR) which complied with WHO International Clinical Trials Registry Platform dataset. The registration number was TCTR20191006002 (06/10/2019).\u0000\u0000Keywords: Efficacy; Safety; Chlorthalidone; Hydrochlorothiazide; Reducing; Systolic and diastolic blood pressure; Patients with mild to moderate hypertension","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80107859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13848
Background: Long-term oxygen therapy (LTOT) is recommended to be used in stable chronic obstructive pulmonary disease (COPD) patients with severe resting hypoxemia. High-flow nasal oxygen cannula (HFNC) demonstrated benefits in acute hypoxemic respiratory failure. The mechanisms of HFNC by washing out dead space and decreasing work of breathing may be also beneficial in COPD patient who has an indication for LTOT. Objective: To compare the effect of HFNC versus conventional oxygen therapy (COT) in terms of respiratory rate, gas exchange, and health-related quality of life. Materials and Methods: A pilot randomized crossover study was conducted in eleven stable COPD patients. Subjects were randomly assigned to HFNC at a flow rate of 30 L/minute or simple nasal cannula at 2 to 4 L/minute for two weeks in a cross-over fashion. The primary outcome was respiratory rate. The secondary outcomes included blood pressure, heart rate, oxygen saturation (SpO₂), transcutaneous carbon dioxide pressure (PtcCO₂), and St.George’s Respiratory Questionnaire (SGRQ) score. Results: The duration of HFNC and COT use was 8 (IQR 3 to 13) and 14 (IQR 10 to 20) hours/day, respectively (p=0.039). Respiratory rate was significantly lower with HFNC compared to COT at 18 breaths/minute (IQR 16 to 20) versus 22 breaths/minute (IQR 20 to 25) , respectively (p=0.018). SpO₂ was significantly higher with HFNC compared to COT (p=0.046). No differences in blood pressure, heart rate, PtcCO₂, and SGRQ score were observed between the two groups. No serious adverse event from HFNC was observed. Conclusion: The present pilot study demonstrated that HFNC was tolerable in patients with stable COPD who had an indication for LTOT. Respiratory rate was significantly lower and SpO₂ was significantly higher with HFNC compared to COT. Another study with larger sample size is needed to further clarify the efficacy of HFNC in stable COPD patients. Keywords: Chronic obstructive pulmonary disease; Dyspnea; High-flow nasal cannula; Oxygen therapy; Respiratory rate
{"title":"The Effect of High Flow Nasal Oxygen Cannula Versus Conventional Oxygen Therapy in COPD Patients with Indication for Long-term Oxygen Therapy: A Pilot Randomized Crossover Study","authors":"","doi":"10.35755/jmedassocthai.2023.05.13848","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13848","url":null,"abstract":"Background: Long-term oxygen therapy (LTOT) is recommended to be used in stable chronic obstructive pulmonary disease (COPD) patients with severe resting hypoxemia. High-flow nasal oxygen cannula (HFNC) demonstrated benefits in acute hypoxemic respiratory failure. The mechanisms of HFNC by washing out dead space and decreasing work of breathing may be also beneficial in COPD patient who has an indication for LTOT.\u0000\u0000Objective: To compare the effect of HFNC versus conventional oxygen therapy (COT) in terms of respiratory rate, gas exchange, and health-related quality of life.\u0000\u0000Materials and Methods: A pilot randomized crossover study was conducted in eleven stable COPD patients. Subjects were randomly assigned to HFNC at a flow rate of 30 L/minute or simple nasal cannula at 2 to 4 L/minute for two weeks in a cross-over fashion. The primary outcome was respiratory rate. The secondary outcomes included blood pressure, heart rate, oxygen saturation (SpO₂), transcutaneous carbon dioxide pressure (PtcCO₂), and St.George’s Respiratory Questionnaire (SGRQ) score.\u0000\u0000Results: The duration of HFNC and COT use was 8 (IQR 3 to 13) and 14 (IQR 10 to 20) hours/day, respectively (p=0.039). Respiratory rate was significantly lower with HFNC compared to COT at 18 breaths/minute (IQR 16 to 20) versus 22 breaths/minute (IQR 20 to 25) , respectively (p=0.018). SpO₂ was significantly higher with HFNC compared to COT (p=0.046). No differences in blood pressure, heart rate, PtcCO₂, and SGRQ score were observed between the two groups. No serious adverse event from HFNC was observed.\u0000\u0000Conclusion: The present pilot study demonstrated that HFNC was tolerable in patients with stable COPD who had an indication for LTOT. Respiratory rate was significantly lower and SpO₂ was significantly higher with HFNC compared to COT. Another study with larger sample size is needed to further clarify the efficacy of HFNC in stable COPD patients.\u0000\u0000Keywords: Chronic obstructive pulmonary disease; Dyspnea; High-flow nasal cannula; Oxygen therapy; Respiratory rate","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74280989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13838
Objective: To compare the success rate between adjustable suture technique and conventional technique in rectus muscle surgery. Materials and Methods: The present study was a retrospective review of patients aged 10 and above underwent rectus muscle surgery between 2010 and 2018. Patients were classified into two groups according to the surgical techniques, the adjustable group and the conventional group. Preoperative and postoperative orthoptic evaluation including angle of deviation, sensory outcomes, and reoperation rate were collected. The primary outcome was surgical success rate at two years postoperatively, with success defined as ocular alignment within 10 prism diopters (PD) for horizontal rectus muscle surgery or within 5 PD for vertical rectus muscle surgery. The secondary outcome was reoperation rate and binocular functions improvement two years post-operation. Results: One hundred fifteen cases in the adjustable group and 90 in the conventional group were identified. Patients in the adjustable group had a higher success rate achieving the target angle after six months, one year, and two years post-operation compared to the conventional group at 77.4% versus 70% (p=0.23), 73.9% versus 65.6% (p=0.19), and 72.2% versus 60% (p=0.066), respectively, but there was no statistically significant difference. Sensory improvement was seen in 43.4% of patients in the conventional group and 42.6% in the adjustable group (p=0.54). Median stereopsis improvement was seen in both groups at 80 to 45 seconds of arc in the adjustable group and 100 to 60 seconds of arc in the conventional group (p=0.67). The reoperation rate was 18.9% in the conventional group and 19.1% in the adjustable group (p=0.97). Conclusion: The adjustable suture technique presented a superior success rate compared to conventional technique though there was no statistically significant difference. A longer follow-up period and larger sample size might be needed to demonstrate statistically significant difference between the two techniques. No significant difference in binocular functions, sensory improvement, or reoperation rate was seen in the present study. Keywords: Strabismus surgery; Adjustable suture; Conventional suture; Surgical outcome
{"title":"A Comparative Study of Surgical Outcomes between the Adjustable Suture Technique and Conventional Technique in Strabismus Surgery","authors":"","doi":"10.35755/jmedassocthai.2023.04.13838","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13838","url":null,"abstract":"Objective: To compare the success rate between adjustable suture technique and conventional technique in rectus muscle surgery.\u0000\u0000Materials and Methods: The present study was a retrospective review of patients aged 10 and above underwent rectus muscle surgery between 2010 and 2018. Patients were classified into two groups according to the surgical techniques, the adjustable group and the conventional group. Preoperative and postoperative orthoptic evaluation including angle of deviation, sensory outcomes, and reoperation rate were collected. The primary outcome was surgical success rate at two years postoperatively, with success defined as ocular alignment within 10 prism diopters (PD) for horizontal rectus muscle surgery or within 5 PD for vertical rectus muscle surgery. The secondary outcome was reoperation rate and binocular functions improvement two years post-operation.\u0000\u0000Results: One hundred fifteen cases in the adjustable group and 90 in the conventional group were identified. Patients in the adjustable group had a higher success rate achieving the target angle after six months, one year, and two years post-operation compared to the conventional group at 77.4% versus 70% (p=0.23), 73.9% versus 65.6% (p=0.19), and 72.2% versus 60% (p=0.066), respectively, but there was no statistically significant difference. Sensory improvement was seen in 43.4% of patients in the conventional group and 42.6% in the adjustable group (p=0.54). Median stereopsis improvement was seen in both groups at 80 to 45 seconds of arc in the adjustable group and 100 to 60 seconds of arc in the conventional group (p=0.67). The reoperation rate was 18.9% in the conventional group and 19.1% in the adjustable group (p=0.97).\u0000\u0000Conclusion: The adjustable suture technique presented a superior success rate compared to conventional technique though there was no statistically significant difference. A longer follow-up period and larger sample size might be needed to demonstrate statistically significant difference between the two techniques. No significant difference in binocular functions, sensory improvement, or reoperation rate was seen in the present study.\u0000\u0000Keywords: Strabismus surgery; Adjustable suture; Conventional suture; Surgical outcome","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79159338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13824
Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that leads to significant disability and economic burden for patients, families, the health system, and society. Objective: To describe the demographics, natural history, and effectiveness of disease-modifying therapies (DMTs) in MS patients. Materials and Methods: The present study was a retrospective cohort study of patients diagnosed with MS at the Prasat Neurological Institute, a tertiary referral neurological center in Bangkok, Thailand, between June 1, 2010 and June 30, 2020. Demographic data, clinical characteristics, and disease course of MS patients were explored. The primary outcome of the present study was a comparison of time to events of clinical relapse, new magnetic resonance image (MRI) T2W activity, new MRI T1W with gadolinium (Gd) enhancement, and time to disability progression between patients who received DMT and patients without DMT. Results: There were 102 patients diagnosed with MS. The female-to-male ratio was 2.4-to-1. The mean age at onset was 29.61±11.62 years. The phenotypic features of these patients were classified as RRMS 80.4%, SPMS 8.8%, PPMS 3.9%, and tumefactive demyelination 6.9%. Forty-eight patients (47.1%) received DMT, 28 (58.3%) received IFN-beta, 11 (22.9%) received fingolimod, seven (14.6%) received teriflunomide, and two (4.2%) received rituximab. Results demonstrated that patients who did not received DMT had significantly more clinical disability compared to patients who received DMT (HR 2.97; 95% CI 1.01 to 8.73; p=0.048). However, the times to clinical relapse and MRI activity, including new T2W and new T1W Gd enhancing lesion, were not significantly different between the two groups. Conclusion: Patients with a relapsing-remitting phenotype tended to progress to severe disability within ten years. Treatment with DMT may delay disability progression in patients with MS. Keywords: Multiple sclerosis (MS); Disease-modifying therapy (DMT)
{"title":"The Use of Disease-Modifying Therapy (DMT) to Prevent Disability Progression in Patients with Multiple Sclerosis (MS) in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.04.13824","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13824","url":null,"abstract":"Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that leads to significant disability and economic burden for patients, families, the health system, and society.\u0000\u0000Objective: To describe the demographics, natural history, and effectiveness of disease-modifying therapies (DMTs) in MS patients.\u0000\u0000Materials and Methods: The present study was a retrospective cohort study of patients diagnosed with MS at the Prasat Neurological Institute, a tertiary referral neurological center in Bangkok, Thailand, between June 1, 2010 and June 30, 2020. Demographic data, clinical characteristics, and disease course of MS patients were explored. The primary outcome of the present study was a comparison of time to events of clinical relapse, new magnetic resonance image (MRI) T2W activity, new MRI T1W with gadolinium (Gd) enhancement, and time to disability progression between patients who received DMT and patients without DMT.\u0000\u0000Results: There were 102 patients diagnosed with MS. The female-to-male ratio was 2.4-to-1. The mean age at onset was 29.61±11.62 years. The phenotypic features of these patients were classified as RRMS 80.4%, SPMS 8.8%, PPMS 3.9%, and tumefactive demyelination 6.9%. Forty-eight patients (47.1%) received DMT, 28 (58.3%) received IFN-beta, 11 (22.9%) received fingolimod, seven (14.6%) received teriflunomide, and two (4.2%) received rituximab. Results demonstrated that patients who did not received DMT had significantly more clinical disability compared to patients who received DMT (HR 2.97; 95% CI 1.01 to 8.73; p=0.048). However, the times to clinical relapse and MRI activity, including new T2W and new T1W Gd enhancing lesion, were not significantly different between the two groups.\u0000\u0000Conclusion: Patients with a relapsing-remitting phenotype tended to progress to severe disability within ten years. Treatment with DMT may delay disability progression in patients with MS.\u0000\u0000Keywords: Multiple sclerosis (MS); Disease-modifying therapy (DMT)","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83998521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13841
Objective: To evaluate the clinical usefulness of preoperative computed tomography (CT)-guided needle localization of small pulmonary nodules for video-assisted thoracic surgery (VATS). Materials and Methods: Between October 2018 and June 2021, 32 consecutive small pulmonary nodules were treated with preoperative CTguided needle localization of less than 2 cm pulmonary nodules for VATS. All basic characteristic and Procedural success, technical success, and complication rates were evaluated from the medical record. Results: The procedures were blue-dye needle localization by isosulfan blue (94%), and hook-wire needle localization (6%). The median size of the tumor was 9 mm (range 2 to 17 mm). The initial procedural success rate of the CT-guided needle localization procedure was 100%. The technical success rate was 90.6%. Approximately 73% of the resected lung nodules were pathologically proven malignancies. Minor complications, such as minimal pneumothorax (34%) and minimal parenchymal hemorrhage (13%), occurred at the needle access site. Conclusion: Preoperative CT-guided needle localization in VATS for small pulmonary nodules was feasible and safe. Keywords: Thoracic surgery; Video-assisted; Multiple pulmonary nodules; Tomography; X-Ray computed
{"title":"Clinical Usefulness of Preoperative Computed Tomography-Guided Needle Localization of Small Pulmonary Nodules for Video-Assisted Thoracic Surgery","authors":"","doi":"10.35755/jmedassocthai.2023.04.13841","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13841","url":null,"abstract":"Objective: To evaluate the clinical usefulness of preoperative computed tomography (CT)-guided needle localization of small pulmonary nodules for video-assisted thoracic surgery (VATS).\u0000\u0000Materials and Methods: Between October 2018 and June 2021, 32 consecutive small pulmonary nodules were treated with preoperative CTguided needle localization of less than 2 cm pulmonary nodules for VATS. All basic characteristic and Procedural success, technical success, and complication rates were evaluated from the medical record.\u0000\u0000Results: The procedures were blue-dye needle localization by isosulfan blue (94%), and hook-wire needle localization (6%). The median size of the tumor was 9 mm (range 2 to 17 mm). The initial procedural success rate of the CT-guided needle localization procedure was 100%. The technical success rate was 90.6%. Approximately 73% of the resected lung nodules were pathologically proven malignancies. Minor complications, such as minimal pneumothorax (34%) and minimal parenchymal hemorrhage (13%), occurred at the needle access site.\u0000\u0000Conclusion: Preoperative CT-guided needle localization in VATS for small pulmonary nodules was feasible and safe.\u0000\u0000Keywords: Thoracic surgery; Video-assisted; Multiple pulmonary nodules; Tomography; X-Ray computed","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83711440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13840
Background: The prevalence of metabolic syndrome (MetS) is increasing in the Thai working population. Thus, there is a need for an analysis of factors relevant to metabolic syndrome comparing the differences between females and males to improve, prevent, and reduce the risk of metabolic syndrome in the working population. Objective: To investigate the factors and the prevalence to identify gender-specific risk factors for MetS. Materials and Methods: The authors performed a cross-sectional study of 2,076 working adults living in the Phetchaburi Province in Central Thailand, defining MetS according to the International Diabetes Federation criteria. The authors used a self-administered structured questionnaire to collect the data, and calculated odds ratios (OR) with 95% confidence intervals (CI) stratified by gender. Results: The median age of participants was 50 years. The overall prevalence of MetS was higher in females (28.13%) than males (22.25%). MetS was associated with high body mass index (BMI), education, and exercise in both genders. Advanced age was a MetS risk factor in males (adjusted OR 3.22, 95% CI 1.42 to 7.32, p=0.005). The main MetS protective factors in females were nutrition literacy (adjusted OR 0.65, 95% CI 0.43 to 0.99, p=0.046) and behavior (adjusted OR 0.40, 95% CI 0.27 to 0.62, p<0.001). Conclusion: MetS risk factors are gender specific. Therefore, gender-specific public health strategies are required to prevent MetS. Keywords: Metabolic syndrome; Gender differences; Thai working
背景:泰国工作人群中代谢综合征(MetS)的患病率正在上升。因此，有必要分析代谢综合征的相关因素，比较男女之间的差异，以改善、预防和降低工作人群中代谢综合征的风险。目的:探讨MetS的危险因素及其患病率，以确定性别特异性的危险因素。材料和方法:作者对居住在泰国中部碧武里省的2076名工作成年人进行了横断面研究，根据国际糖尿病联合会的标准定义MetS。作者使用自我管理的结构化问卷收集数据，并按性别计算95%可信区间(CI)的优势比(OR)。结果:参与者的中位年龄为50岁。MetS的总体患病率女性(28.13%)高于男性(22.25%)。无论男女，met都与高身体质量指数(BMI)、教育和锻炼有关。高龄是男性met的危险因素(校正OR 3.22, 95% CI 1.42 ~ 7.32, p=0.005)。女性met的主要保护因素是营养素养(调整后OR 0.65, 95% CI 0.43 ~ 0.99, p=0.046)和行为(调整后OR 0.40, 95% CI 0.27 ~ 0.62, p<0.001)。结论:MetS危险因素具有性别特异性。因此，需要有针对性别的公共卫生战略来预防MetS。关键词:代谢综合征;性别差异;泰国工作
{"title":"Gender Differences Relevant to Metabolic Syndrome in a Working Population in Phetchaburi Province, Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.04.13840","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13840","url":null,"abstract":"Background: The prevalence of metabolic syndrome (MetS) is increasing in the Thai working population. Thus, there is a need for an analysis of factors relevant to metabolic syndrome comparing the differences between females and males to improve, prevent, and reduce the risk of metabolic syndrome in the working population.\u0000\u0000Objective: To investigate the factors and the prevalence to identify gender-specific risk factors for MetS.\u0000\u0000Materials and Methods: The authors performed a cross-sectional study of 2,076 working adults living in the Phetchaburi Province in Central Thailand, defining MetS according to the International Diabetes Federation criteria. The authors used a self-administered structured questionnaire to collect the data, and calculated odds ratios (OR) with 95% confidence intervals (CI) stratified by gender.\u0000\u0000Results: The median age of participants was 50 years. The overall prevalence of MetS was higher in females (28.13%) than males (22.25%). MetS was associated with high body mass index (BMI), education, and exercise in both genders. Advanced age was a MetS risk factor in males (adjusted OR 3.22, 95% CI 1.42 to 7.32, p=0.005). The main MetS protective factors in females were nutrition literacy (adjusted OR 0.65, 95% CI 0.43 to 0.99, p=0.046) and behavior (adjusted OR 0.40, 95% CI 0.27 to 0.62, p<0.001).\u0000\u0000Conclusion: MetS risk factors are gender specific. Therefore, gender-specific public health strategies are required to prevent MetS.\u0000\u0000Keywords: Metabolic syndrome; Gender differences; Thai working","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83832853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13831
Background: Perineal and uterine pain are common postpartum complaint. Objective: To compare the efficacy of steamed ginger extract, paracetamol, a stand analgesic used in Western medicine, and placebo for pain relief at the perineum and uterus in first normal postpartum women. Materials and Methods: First pregnancy, postpartum women, who had a normal vaginal delivery, were given 3-day 200 mg tid of ginger extract/placebo capsules, or up to 500 mg qid paracetamol in an open randomized (1:1:1) trial. All drugs were given within two hours of delivery. The Numerical Rating Scale was used for pain assessment at 2, 24, 48, 72 hours postpartum. Ninety-nine women were recruited with similar demographic characteristics at the postnatal ward of Thammasat University Hospital. Results: All groups showed decreasing mean perineal and uterine pain scores over time. The only significant differences in mean scores were seen for perineal pain at 24, 48, and 72 hours in the ginger extract versus the placebo arms at 3.97 versus 6.3, 2.48 versus 6.09, and 1.42 versus 2.61, respectively. There were no adverse drug reactions reported in any of the three arms. Conclusion: Ginger extract capsules showed promising results and having no adverse reactions, so this should be developed further. Keywords; Steamed Ginger Extract; Perineum Pain; Postpartum Women
{"title":"The Efficacy of Steamed Ginger Extract versus Placebo for Pain Relief at the Perineum and Uterus in First Normal Postpartum Women","authors":"","doi":"10.35755/jmedassocthai.2023.04.13831","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13831","url":null,"abstract":"Background: Perineal and uterine pain are common postpartum complaint.\u0000\u0000Objective: To compare the efficacy of steamed ginger extract, paracetamol, a stand analgesic used in Western medicine, and placebo for pain relief at the perineum and uterus in first normal postpartum women.\u0000\u0000Materials and Methods: First pregnancy, postpartum women, who had a normal vaginal delivery, were given 3-day 200 mg tid of ginger extract/placebo capsules, or up to 500 mg qid paracetamol in an open randomized (1:1:1) trial. All drugs were given within two hours of delivery. The Numerical Rating Scale was used for pain assessment at 2, 24, 48, 72 hours postpartum. Ninety-nine women were recruited with similar demographic characteristics at the postnatal ward of Thammasat University Hospital.\u0000\u0000Results: All groups showed decreasing mean perineal and uterine pain scores over time. The only significant differences in mean scores were seen for perineal pain at 24, 48, and 72 hours in the ginger extract versus the placebo arms at 3.97 versus 6.3, 2.48 versus 6.09, and 1.42 versus 2.61, respectively. There were no adverse drug reactions reported in any of the three arms.\u0000\u0000Conclusion: Ginger extract capsules showed promising results and having no adverse reactions, so this should be developed further.\u0000\u0000Keywords; Steamed Ginger Extract; Perineum Pain; Postpartum Women","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85357842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13836
Background: Intracerebral hemorrhage (ICH) is a complex medical condition found to be associated with various factors, including advanced age, male gender, Asian ethnicity, tobacco use, hypertension, and chronic renal insufficiency. Despite the aforementioned associations, the relationship between lipid fractions and ICH remains ambiguous and has received limited attention in the literature, particularly with respect to Thai populations. Objective: To investigate the potential association between lipid levels and primary ICH. Materials and Methods: The present study employed a retrospective case-control design and enrolled 314 primary ICH cases presented at Rajavithi Hospital between 2012 and 2022. A control group of 366 subjects was established using an age-matching procedure and computer-generated randomization. Participants with coagulopathies or those receiving anticoagulant therapy were excluded. Statistical analysis was performed using binomial and multivariate logistic regression to evaluate the relationship between ICH and the various factors. Results: The present study identified six factors that were independently associated with ICH through bivariate analysis, including male gender (odd ratio [OR] 2.497, 95% confidence interval [CI] 1.829 to 3.407; p<0.001), systolic blood pressure (SBP) (OR 1.023, 95% CI 1.016 to 1.029; p<0.001), diastolic blood pressure (DBP) (OR 1.050, 95% CI 1.037 to 1.062; p<0.001), total cholesterol (OR 0.994, 95% CI 0.991 to 0.998; p=0.001), high-density lipoprotein cholesterol (HDL) (OR 0.985, 95% CI 0.975 to 0.995; p=0.003), and low-density lipoprotein cholesterol (LDL) (OR 0.994, 95% CI 0.991 to 0.998; p=0.002). Multivariate logistic regression revealed five factors to be associated with ICH, including male gender (adjusted OR 1.904, 95% CI 1.293 to 2.803; p=0.001), elevated SBP (adj. OR 1.024, 95% CI 1.017 to 1.032; p<0.001), elevated DBP (adj. OR 1.051, 95% CI 1.037 to 1.064; p<0.001), decreased total cholesterol levels (adj. OR 0.993, 95% CI 0.988 to 0.997; p=0.001), and decreased LDL (adj. OR 0.994, 95% CI 0.990 to0.999; p=0.010). HDL was found to not be significantly associated with ICH (adj. OR 1.003, 95% CI 0.990 to 1.016; p=0.643). Conclusion: The results of the present study suggest that male gender and elevated levels of SBP and DBP were independently associated with ICH, as were decreased levels of total cholesterol and LDL. Keywords: Lipid; Cholesterol; LDL; HDL; Intracerebral hemorrhage
背景:脑出血(ICH)是一种复杂的疾病，与多种因素有关，包括高龄、男性、亚裔、吸烟、高血压和慢性肾功能不全。尽管有上述关联，脂质部分和ICH之间的关系仍然不明确，在文献中受到的关注有限，特别是在泰国人群中。目的:探讨血脂水平与原发性脑出血的潜在关系。材料和方法:本研究采用回顾性病例对照设计，纳入2012年至2022年在Rajavithi医院就诊的314例原发性脑出血病例。使用年龄匹配程序和计算机生成的随机化方法建立了366名受试者的对照组。排除有凝血功能障碍或接受抗凝治疗的参与者。采用二项和多因素logistic回归进行统计分析，评价脑出血与各因素的关系。结果:本研究通过双变量分析确定了6个与脑出血独立相关的因素，包括男性(奇比[OR] 2.497, 95%可信区间[CI] 1.829 ~ 3.407;p<0.001)，收缩压(SBP) (OR 1.023, 95% CI 1.016 ~ 1.029;p<0.001)，舒张压(DBP) (OR 1.050, 95% CI 1.037 ~ 1.062;p<0.001)，总胆固醇(OR 0.994, 95% CI 0.991 ~ 0.998;p=0.001)，高密度脂蛋白胆固醇(HDL) (OR 0.985, 95% CI 0.975 ~ 0.995;p=0.003)，低密度脂蛋白胆固醇(LDL) (OR 0.994, 95% CI 0.991 ~ 0.998;p = 0.002)。多因素logistic回归显示与脑出血相关的因素有5个，包括男性(调整后OR为1.904,95% CI为1.293 ~ 2.803;p=0.001)，收缩压升高(OR 1.024, 95% CI 1.017 ~ 1.032;p<0.001)，舒张压升高(OR 1.051, 95% CI 1.037 ~ 1.064;p<0.001)，总胆固醇水平降低(OR 0.993, 95% CI 0.988 ~ 0.997;p=0.001)， LDL降低(OR 0.994, 95% CI 0.990 ~ 0.999;p = 0.010)。HDL与ICH无显著相关性(OR 1.003, 95% CI 0.990 ~ 1.016;p = 0.643)。结论:本研究结果提示，男性、收缩压和舒张压升高与脑出血独立相关，总胆固醇和低密度脂蛋白水平降低与脑出血独立相关。关键词:脂质;胆固醇;低密度脂蛋白;高密度脂蛋白;脑内出血
{"title":"Associations between Lipid Levels and Intracerebral Hemorrhage","authors":"","doi":"10.35755/jmedassocthai.2023.04.13836","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13836","url":null,"abstract":"Background: Intracerebral hemorrhage (ICH) is a complex medical condition found to be associated with various factors, including advanced age, male gender, Asian ethnicity, tobacco use, hypertension, and chronic renal insufficiency. Despite the aforementioned associations, the relationship between lipid fractions and ICH remains ambiguous and has received limited attention in the literature, particularly with respect to Thai populations.\u0000\u0000Objective: To investigate the potential association between lipid levels and primary ICH.\u0000\u0000Materials and Methods: The present study employed a retrospective case-control design and enrolled 314 primary ICH cases presented at Rajavithi Hospital between 2012 and 2022. A control group of 366 subjects was established using an age-matching procedure and computer-generated randomization. Participants with coagulopathies or those receiving anticoagulant therapy were excluded. Statistical analysis was performed using binomial and multivariate logistic regression to evaluate the relationship between ICH and the various factors.\u0000\u0000Results: The present study identified six factors that were independently associated with ICH through bivariate analysis, including male gender (odd ratio [OR] 2.497, 95% confidence interval [CI] 1.829 to 3.407; p<0.001), systolic blood pressure (SBP) (OR 1.023, 95% CI 1.016 to 1.029; p<0.001), diastolic blood pressure (DBP) (OR 1.050, 95% CI 1.037 to 1.062; p<0.001), total cholesterol (OR 0.994, 95% CI 0.991 to 0.998; p=0.001), high-density lipoprotein cholesterol (HDL) (OR 0.985, 95% CI 0.975 to 0.995; p=0.003), and low-density lipoprotein cholesterol (LDL) (OR 0.994, 95% CI 0.991 to 0.998; p=0.002). Multivariate logistic regression revealed five factors to be associated with ICH, including male gender (adjusted OR 1.904, 95% CI 1.293 to 2.803; p=0.001), elevated SBP (adj. OR 1.024, 95% CI 1.017 to 1.032; p<0.001), elevated DBP (adj. OR 1.051, 95% CI 1.037 to 1.064; p<0.001), decreased total cholesterol levels (adj. OR 0.993, 95% CI 0.988 to 0.997; p=0.001), and decreased LDL (adj. OR 0.994, 95% CI 0.990 to0.999; p=0.010). HDL was found to not be significantly associated with ICH (adj. OR 1.003, 95% CI 0.990 to 1.016; p=0.643).\u0000\u0000Conclusion: The results of the present study suggest that male gender and elevated levels of SBP and DBP were independently associated with ICH, as were decreased levels of total cholesterol and LDL.\u0000\u0000Keywords: Lipid; Cholesterol; LDL; HDL; Intracerebral hemorrhage","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82695481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-15DOI: 10.35755/jmedassocthai.2023.04.13833
Objective: To determine the prevalence of and to assess factors associated with diabetic foot in type 2 diabetes mellitus (DM) patients in the primary care unit (PCU) of Songklanagarind Hospital. Materials and Methods: The present study was a cross-sectional study that collected the data of 160 type 2 DM patients attending the PCU of Songklanagarind Hospital between March and July 2020 using a questionnaire and face-to-face interviews. The classification of diabetic foot severity was based on foot examination using the 2017 Guideline of the Diabetes Association of Thailand. Results: There were 160 participants in the present study, 44.4% were male and 55.6% were female. There were 58.1% aged less than 60 years and 41.9% aged more than or equal to 60 years. The diabetic patients who had foot ulcer were not found in the present study. There were 31.2%, 63.1%, and 5.6% of the patients had low, medium, and high risk of diabetic foot, respectively. In multivariate analysis, the adjusted odds ratios (ORs) with 95% confidence intervals (CI) found the factors associated with positively increased diabetic foot risk were some occupations including self-employed 5.19 (1.53 to 18.91) and agriculturist 4.82 (1.38 to 18.44), chronic kidney disease (CKD) 18.17 (2.46 to 131.32), longer duration of DM 3.14 (1.40 to 7.40), diabetic retinopathy (DR) 11.90 (3.44 to 50.00). Some factors negatively increased the risk were low-density lipoprotein (LDL) less than 100 mh/dL 0.37 (0.16 to 0.81), self-care behavior including asking others to check blind areas of the foot 0.21 (0.07 to 0.63), and foot exercise 0.29 (0.12 to 0.68) (p<0.05). Conclusion: Diabetic foot in type 2 DM patients at the PCU of Songklanagarind Hospital was not found. However, it is important to establish PCU to identify feet at risk included occupations, CKD, longer duration of DM, LDL more than 100 mh/dL, DR, and lack of self-care practices for primary and secondary prevention in DM patients. Keywords: Diabetes mellitus; Diabetic foot; Primary care
{"title":"Prevalence and Factors Associated with the Stratified Risk to Develop Diabetic Foot Ulcer in Type 2 Diabetes Mellitus Patients in Primary Care Unit of Songklanagarind Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.04.13833","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.04.13833","url":null,"abstract":"Objective: To determine the prevalence of and to assess factors associated with diabetic foot in type 2 diabetes mellitus (DM) patients in the primary care unit (PCU) of Songklanagarind Hospital.\u0000\u0000Materials and Methods: The present study was a cross-sectional study that collected the data of 160 type 2 DM patients attending the PCU of Songklanagarind Hospital between March and July 2020 using a questionnaire and face-to-face interviews. The classification of diabetic foot severity was based on foot examination using the 2017 Guideline of the Diabetes Association of Thailand.\u0000\u0000Results: There were 160 participants in the present study, 44.4% were male and 55.6% were female. There were 58.1% aged less than 60 years and 41.9% aged more than or equal to 60 years. The diabetic patients who had foot ulcer were not found in the present study. There were 31.2%, 63.1%, and 5.6% of the patients had low, medium, and high risk of diabetic foot, respectively. In multivariate analysis, the adjusted odds ratios (ORs) with 95% confidence intervals (CI) found the factors associated with positively increased diabetic foot risk were some occupations including self-employed 5.19 (1.53 to 18.91) and agriculturist 4.82 (1.38 to 18.44), chronic kidney disease (CKD) 18.17 (2.46 to 131.32), longer duration of DM 3.14 (1.40 to 7.40), diabetic retinopathy (DR) 11.90 (3.44 to 50.00). Some factors negatively increased the risk were low-density lipoprotein (LDL) less than 100 mh/dL 0.37 (0.16 to 0.81), self-care behavior including asking others to check blind areas of the foot 0.21 (0.07 to 0.63), and foot exercise 0.29 (0.12 to 0.68) (p<0.05).\u0000\u0000Conclusion: Diabetic foot in type 2 DM patients at the PCU of Songklanagarind Hospital was not found. However, it is important to establish PCU to identify feet at risk included occupations, CKD, longer duration of DM, LDL more than 100 mh/dL, DR, and lack of self-care practices for primary and secondary prevention in DM patients.\u0000\u0000Keywords: Diabetes mellitus; Diabetic foot; Primary care","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85108083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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