Chonburi Hospital Journal-วารสารโรงพยาบาลชลบุรี

The Efficacy of Low - Dose Intravenous Tranexamic Acid in Reducing Postoperative Blood Loss in Arthroscopic Anterior Cruciate Ligament Reconstruction

Thanatja Kittijarukajon — 2024-09-10

Purpose: This prospective, randomized, double-blind study aimed to assess the efficacy of single intravenous administration of low-dose tranexamic acid (TXA) in arthroscopic anterior cruciate ligament reconstruction (ACLR) for minimizing postoperative blood loss. Secondary objectives included assessing early postoperative pain levels, range of knee flexion, knee joint hemarthrosis, and TXA-associated complications.

Methods: Sixty patients undergoing arthroscopic ACLR were randomly assigned to either the treatment group (n = 30), receiving a single bolus dose of 10 mg/kg TXA intravenously 10 minutes before surgery, or the control group (n = 30), receiving an equal volume of normal saline via the same route. The volume of drained blood was measured at 3 and 24 hours postoperatively. Hemarthrosis grade was assessed in postoperative weeks 1 and 2. Pain levels were evaluated using a visual analog scale (VAS) at postoperative day 1, week 1, and week 2. Knee flexion range was recorded at the end of postoperative week 2 and week 4.

Results: Patient demographics were comparable between the two groups. Postoperative reductions in hemoglobin (TXA group 1.10 ± 0.52, control group 1.80 ± 0.71, p<0.001) and hematocrit (TXA group 3.42 ± 1.74, control group 5.41 ± 2.04, p<0.001) were statistically significant in favor of the TXA group. The mean postoperative VAS scores, range of knee flexion, and hemarthrosis grades were similar between the groups. No postoperative complications were reported.

Conclusion: Single intravenous administration of low-dose TXA effectively reduces postoperative blood loss in arthroscopic anterior cruciate ligament reconstruction (ACLR) surgery. However, this intervention did not demonstrate clinical benefits in terms of pain levels, range of motion, or knee hemarthrosis during the early postoperative period. Additional research may be warranted to explore optimal TXA dosing strategies and its impact on functional outcomes in ACLR patients.

Keywords : Tranexamic acid, arthroscopy, ACL reconstruction, hemarthrosis

The Randomized controlled trial compares Clinical Outcome between Negative Pressure Wound Therapy (NPWT) with CBH-KMITL Ambulatory Negative Pressuring Device (CKANPD) and Conventional Device in Open Traumatic Wound

chayut krualamai — 2024-09-10

Background: Open traumatic wounds often require Negative Pressure Wound Therapy (NPWT) for treatment. The CBH-KMITL Ambulatory Negative Pressuring Device (CKANPD), a cost-effective, portable NPWT device, has been developed to address the limitations of conventional devices.

Objective: This study of 48 patients aimed to compare the CKANPD and conventional NPWT devices in terms of granulation tissue formation rate and infection rates.

Methods: A double-blind randomized controlled trial was conducted. The primary outcome was the rate of granulation tissue formation, with secondary outcomes including infection rates and patient satisfaction.

Results: The CKANPD group demonstrated a significantly higher rate of granulation tissue formation after one week of NPWT (93.09 ±4.76% vs 88.41 ±5.71%, p=0.004). No significant difference was observed in wound size reduction between the two methods. Both methods had an infection rate of 0, indicating excellent safety profiles.

Conclusion: The CKANPD is a non-inferior alternative to conventional NPWT devices, promoting faster granulation tissue formation without increasing infection risk. These promising results pave the way for the next phase of study in outpatient settings, aligning with the primary goal of CKANPD development. Further research is needed to confirm these findings and assess long-term outcomes.

Keywords : Negative Pressure Wound Therapy (NPWT), Vacuum-Assisted Wound Closure (VAC), granulation tissue formation, open traumatic wounds, portable NPWT device, CBH-KMITL Ambulatory Negative Pressuring Device (CKANPD)

The Factors Influencing Caring Practices for Dependent Older Adult: Mueang District Chonburi

Soraya Wongwilai — 2024-09-10

This research is descriptive. The objective is to study the performance and factors that influence the performance of caregivers for dependent bedridden. The sample group was 134 caregivers for all dependent bedridden in Mueang Chonburi District. The instruments used for data collection were: questionnaires on internal personal factors, attitude measurements, knowledge, practice, family support, cooperation of the senior citizens and their families, support from local administrative organizations, and coordination with long-term care system providers in caring for the elderly. Data were collected between May and July 2023. Data were analyzed using descriptive statistics, regression analysis and multivariate quartiles were used to analyze the relationship between the primary and dependent variables. The results of the research found that the performance of caregivers of dependent elderly people was at a good level, with an average of 8.20 (SD 1.51) in the most practical areas. Exercise Average 8.55 (SD 1.49) and least practical side Excretion side Average 7.69 (SD 1.59) Factors influencing the work of caregivers for elderly people who are dependent on marital status, number of elderly care, support from families who provide care for the elderly and cooperation of the elderly and elderly families (95% CI: 0.53-11.29, 95% CI: -2.08- -0.35, 95% CI: 0.56- 2.14, 95% CI: 0.23, 1.82 and P value 0.032, 0.006, 0.001, 0.012, respectively).

From the research results The researcher has a suggestion that Administrators should proportionate the number of elderly persons assigned to care assistants. Promote empowerment to create cooperation among elderly care assistants, senior citizens, and their families, which will enable helpers who provide care for dependent elderly people to perform their work comprehensively. It meets the needs of the elderly who are dependent holistically.

Keywords : older adult caring, caring for the elderly, dependent older adult

The Acute Hematotoxicity in Cancer Patients Receiving Radiotherapy

Nattapatch Janhom — 2024-09-10

Objective: To evaluate factors associated with hematotoxicity during radiotherapy.

Patients and methods: Data of cancer patients, including age, sex, concurrent chemotherapy, radiotherapy dose, fraction, aim, fractionation and location, as well as baseline CBC were collected. CTCAE v.5.0 grade 3+ hematotoxicity was applied. Multiple logistic regression was used to analyze associations between variables and complications.

Results: Four hundred ninety-six patients were identified. There were 9 (1.8%), 3 (0.6%), 0 (0%) and 23 (5%) patients who had grade 3+ leukopenia, neutropenia, thrombocytopenia and anemia during radiation, consecutively. Palliative radiotherapy was significantly associated with grade 3+ leukopenia (adjusted OR 25.344; 95% CI 1.303-493.06; p-value 0.033). While pelvic radiotherapy and baseline Hb <8g/dL were associated with grade 3+ anemia, significantly (adjusted OR 18.479; 95% CI 3.999-85.381; p-value <0.001 and adjusted OR 45.119; 95% CI 4.952-411.079; p-value <0.001, respectively).

Conclusion: For radiation-related hematotoxicity, palliative treatment, pelvic radiation and preradiotherapy Hb <8g/dL were independent factors.

Keywords anemia, hematotoxicity, leukopenia, radiotherapy

The Osteomyelitis of the jaws: A retrospective analysis of risk factors affecting length of stay at Hatyai Hospital

Surachai Apinawathavornkul — 2024-09-10

The treatment of osteomyelitis of the jaws (OJ) is a combination of surgery consisting of debridement of the necrotic tissue and bone sequestrum and prolonged antimicrobial therapy. The duration of length stays for patients makes a difference. This study was a retrospective analysis of medical records. The objective is to find factors that are related to the length of stay of patients in Hatyai Hospital in the treatment of OJ. From the complete medical records of 39 patients, the sample was divided according to the length of stay into 3 groups: less than 7 days, 7-14 days, and more than 14 days. Data analysis was presented in frequencies and percentages, and the relation was analyzed using chi-square statistics. The results found that associated factors include the presence of age (p-value=0.003), comorbid diseases (p-value = 0.002), site of infection (p-value = 0.013), masticatory fascial space involvement (p-value = 0.018) and the surgical method (p-value = 0.002). Therefore, the surveillance and monitoring of patients with these factors can help assess the likelihood of a patient's length stays. This can help improve the efficiency of patient care.

Keywords: Osteomyelitis of the jaws, length of stay, retrospective analysis, risk factors

Table of content

Sittichai Tantipasawasin — 2024-08-31

Masthead

Sittichai Tantipasawasin — 2024-08-31

Letter from Editor

Sittichai Tantipasawasin — 2024-09-02

Dear readers,

The second issue of the Chonburi Hospital Journal of 2024 has been released to readers. This paper contains several interesting manuscripts, including the efficacy of intravenous low-dose tranexamic acid in reducing blood loss from laparoscopic anterior cruciate ligament surgery in the knee joint, and a comparative study of clinical outcomes during negative pressure incisions with a device. CBH-KMITL Ambulatory Negative Pressuring Device (CKANPD) and Traditional Devices in Open Wounds, Factors Influencing the Performance of Assisted Care Elderly Patients with Dependency Conditions Mueang Chonburi District, Acute Hematological Complications in Cancer Patients Undergoing Radiation, Osteoporitis in the Jawbone: A Retrospective Analysis of Risk Factors Affecting the Number of Days Lying in Hat Yai Hospital One case report : Ara-C Ears from Cytarabine: A case study report and review One academic revival article is an overview of lung cancer screening. One special article was about burnout and related factors in the staff of the Child and Women's Protection Center (Dependency Center) and ended with an interesting story of Ms. Nattara. Gentleman on Caring for the Elderly with Thai Traditional Medicine

Finally, the editorial staff would like to thank everyone who has paid attention and submitted articles for publication, as well as everyone who has supported and helped to make this journal of Chonburi Hospital successful in the eyes of readers.

Cyanide: Lethal Substances

Sittichai Tantipasawasin — 2024-08-31

Cyanide is a highly toxic chemical. Assembled from carbon and nitrogen When it enters the body, it inhibits cellular respiration. This makes cells unable to use oxygen to produce ATP (Adenosine Triphosphate), a substance that provides energy at the cellular level. Especially with organs that use high oxygen and energy, such as the brain and heart, the body increases anaerobic metabolism. It causes toxins to acidify the blood. It can cause sudden death of people who receive cyanide. Within a few minutes, depending on the amount and concentration of the substance that the body ingests.

Most people may think of cyanide as a distant thing, but in reality, cyanide is a toxic substance that circulates in our daily lives. Cyanide is found in plants and fruits, such as apple seeds. Apricot seeds, black cherry seeds, peaches Pears and bitter almonds We can also obtain cyanide by eating the tubers and leaves of cassava (cassava) and raw bamboo shoots. Linamarin, which is found in the tubers and leaves of raw cassava. The body converts linamarin into cyanide, so we should never eat the seeds of this type of fruit, including cassava or raw bamboo shoots. We can get rid of these cyanides in a simple way by boiling and cooking. According to research, the average blood level of cyanide in smokers is 2.5 times higher than that of non-smokers .

Cyanide is a chemical that is used in various industries. Many types, such as the metal smelting industry. Metal Plating Gold & Jewelry It is used in the production of paper, textiles, and plastics, and is a component of many types of products, such as pesticides. Metal Polishing In addition, cyanide can be found contaminated in the air, soil, water, and food, including hydrogen cyanide gas, potassium cyanide solution, which is caused by the burning of materials containing carbon and nitrogen, plastics, melanine, resins, nylon, silk, wool, polyurethane, and synthetic rubber .

When exposed to cyanide toxins Patients often begin to show symptoms after receiving cyanide within a few seconds. Energy-intensive organs such as the brain and heart will be affected, and the first symptoms are headache, restlessness, confusion, lethargy, loss of consciousness or seizures, and the heart system. Symptoms start with palpitations, high blood pressure, later bradycardia and a drop in blood pressure. He suffered from cardiac arrhythmias, blood circulation failure, and died quickly. Breathing is rapid at first, then slows down to the point of stopping breathing, and vomiting and abdominal pain may occur. The overall symptoms are similar to those of a person who has been poisoned by carbon monoxide from fumigating the exhaust pipe in the car.

Cyanide can enter the body through many channels, whether it is in contact with the skin. Inhalation into the respiratory tract and ingestion into the stomach. The symptoms of people who have been exposed to cyanide depend on the area of exposure to the toxin and the amount of the toxin they are exposed to. The physical examination of people exposed to cyanide poisoning has a special characteristic of cherry-red skin because of high intravenous oxygen or dark purple skin. Breath smells of almonds, if poisoning occurs from inhalation of hydrogen cyanide, the symptoms of a person who has been poisoned may be symptomatic. Acute cardiac arrest Arrhythmias, loss of consciousness, seizures, severe acidity, and death. An autopsy found cyanide in the bloodstream, and the effects of cyanide exposure may be divisible. 2 Types as follows

Acute cyanide poisoning is an immediate symptom such as shortness of breath. Abnormal blood circulation Heart arrest, brain swelling, seizures, and loss of consciousness, etc.

Chronic cyanide toxicity (continuous exposure to small amounts of cyanide) Initially, it may cause headaches, redness, taste disorders, drowsiness, nausea, vomiting, abdominal pain, and restlessness, and may cause other symptoms such as dilated pupils, coldness, weakness, and slow breathing. If left untreated, it can cause bradycardia or irregular heartbeats, skin on the face and limbs to become purple, lose consciousness, and eventually die. The accumulation of cyanide from eating excessive amounts of certain plants, such as cassava, causes numbness, loss of balance, loss of hearing, and optic nerve atrophy, which can lead to loss of vision, especially in people who smoke regularly.

The Cytarabine induced Ara-C Ears: A Case Report and Literature Review

Chalisa veerapong — 2024-08-31

Ara-C ears is a variant of toxic erythema of chemotherapy (TEC) presents with erythematous patches or edema on the pinnae of the ear with pain, burning, pruritus, paresthesias and tenderness. It was first reported in 1990 by Krulder et al. This condition cause by cytarabine also known as Ara-C directly toxic to the eccrine duct, the acrosyringium and the epidermis. Ara-C ears is a rare side effect because low density of eccrine gland on the ear.

We report a 39 year-old Thai male with Acute Myeloid Leukemia (AML). He was treated with 3+7 regimen of chemotherapy (cytarabine, idarubicin). He developed erythematous rash on both ears after 5 days of this regimen. He was diagnosed to be Ara-C ears. His symptom was resolve after discontinue cytarabine and supportive treatment with momethasone cream, loratadine and hydroxyzine. Then he was rechallenged with a high dose cytarabine without any symptom. If Ara-C ears is not severe, the chemotherapy will not discontinue. According to the most benefit of patient’s treatment.

Keywords : Cytarabine, Ara-C ears, rash

Chonburi Hospital Journal

Sittichai Tantipasawasin — 2024-08-31

The Instruction

Sittichai Tantipasawasin — 2024-08-31

How to treat the elderly with Thai traditional medicine

Natrada Burusliam — 2024-08-31

Thailand has entered an aged society since 2021 because the population aged 60 years and above accounts for 20% of the total population and is expected to enter a fully aged society (Super Aged society) in less than 20 years. Entering old age has caused many changes. There are regressive changes in physical, mental, economic, and social aspects, so it is important to prepare to be able to adapt and accept change.

Continuing Education Article

Woranart Ratanakorn — 2024-08-31

13 years old Thai boy had have a history of headache for 2 months. He present weakness at the left arm and leg. He denied a history of seizures.

The Burnout and Related factors of Officers in One Stop Crisis Center (OSCC)

Hathaipat Withayasakpunt — 2024-08-31

Objective: To determine the prevalence of Burnout in the One Stop Crisis Center (OSCC) and identify the associated factors.

Methods: A cross-sectional descriptive study was conducted in Officers in One Stop Crisis Center (OSCC), Chonburi province. Assessment by self-report questionnaire about work problems, Resilience Quotient (RQ), and Burnout Inventory for public health officers.

Results: Of the total 62 officers, 85.48% were female, the mean age was 42.6±10.45 years, 25.81% were nurses, and 17.74% were social workers. Most officers worked in hospitals and child welfare equally. 56.45% had moderate levels of burnout, 62.9% had low levels of emotional exhaustion subscale, 61.29% had low levels of depersonalization subscale, and 79.03% had high levels of personal accomplishment subscale. Under the bachelor, not the medical professions, and overlapping duties were the significant factors associated with higher burnout levels. Contrastingly, healthy colleague relationships and high hope and morale, RQ subscale, were associated with lower burnout levels significantly. After conducting a multivariate analysis, overlapping duties and high hope and morale, RQ subscale, were still associated with burnout levels (Odd ratio 8.10 and 0.07, respectively). Furthermore, multiple work problems were associated with increased emotional exhaustion subscore and depersonalization subscore significantly. RQ in every subscale and RQ overall had an inverse relationship with the emotional exhaustion subscore and depersonalization subscore significantly.

Conclusion: Overlapping duties was an important risk factor, meanwhile hope and morale act as protective factors for burnout in OSCC’s officers. In addition, multiple work problems were associated with increased emotional exhaustion subscore and depersonalization subscore significantly.

Keywords : burnout, OSCC, work problems, resilience

The Overview of Lung Cancer Screening

Chawalit Rungnaruethai — 2024-08-31

Lung cancer is a common cause of death among all cancers and its incidence has increased. Because it is related to smoking, which trend currently increases in the young population. Moreover, patiens with lung cancer in the early stages usually have no symptom. Lung cancer screening is therefore important to increase the chance of detecting lung cancer in the early stage. Effective early treatment increases survival rate. The first, lung cancer screening is chest x-ray with sputum cytology and nowadays use of low dose CT chest for screening lung cancer can increase detection rates of lung cancer. However, more pathologic findings are detected in low dose CT chest which leads to more treatment processes, increasing costs. There may be more complications. Indication determination to select high risk population is important to increase efficiency in screening.

Keywords : Lung cancer screening, Low dose CT chest, Artificial Intelligence