Scopus 2018
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Publication Metadata only Orthopedic problems in thai obese children(2018-03-01) Chanika Angsanuntsukh; Ukris Gunadham; Patarawan Woratanarat; Paphon Sa-Ngasoongsong; Suthawadee Sukcharoensin; Umaporn Suthutvoravut; Pornchai Mulpruek; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018, Medical Association of Thailand. All rights reserved. Objective: Overweight has reached epidemic proportions globally. The authors conducted a cross-sectional study aimed at describing the prevalence and characteristics of orthopedic problems in otherwise healthy Thai obese children. Materials and Methods: Obese children aged between 2 to 15 years with a high body mass index (BMI ≥95th percentile for age) were included in the study. Children with endocrine abnormalities were excluded. All eligible participants received physical and radiographic examinations to evaluate any deformity including dual-energy x-ray absorptiometry scans to measure bone mineral density (bone age). Results: Ninety-five obese children, mean age 9.7±3.7 years, were included of whom 61% were male. The average BMI was 31.7 kg/m2, and more than 50% of the children had a BMI above the 200th percentile. Orthopedic problems, i.e., pain, deformities, or injuries, were found in 60% of the children. The most common musculoskeletal problems were knee pain and knee deformities. The mean BMD Z-score was 2.36±1.2 and the mean bone age was 11.7±4.4 years. Conclusion: Orthopedic problems are common in obese children, especially those with a BMI exceeding the 150th percentile for their age. They also tend to have a higher BMD and advanced skeletal age. These factors may restrict their mobility and tolerance for physical activity. Health care providers should be aware of the higher risk of orthopedic problems in obese children, and the need to initiate interventions or programs to help the children lose weight and prevent complications.Publication Metadata only Sociocultural adjustment and coping strategies of Korean and Japanese students in a Thai international college(2018-01-01) Douglas Rhein; Mahidol University© Penerbit Universiti Sains Malaysia, 2018. This study is devoted to understanding the adjustment issues Japanese and Korean international students face in Thai international higher education. An exploratory study of 15 visiting Korean college students and 15 visiting Japanese college students in Thai international programs was conducted using qualitative methods. A series of 30 face-to-face in-depth interviews regarding the participants' sociocultural adjustment to their host community was conducted in 2015-2016. Participants responded to open-ended questions regarding their adjustment experiences and perceptions of the host culture. The interview data was thematically coded into several categories. Participants' experiences were diverse and ranged from very subtle forms of discrimination and stereotyping to sexual harassment. The most frequently reported impediments to sociocultural adjustment included Thai language issues, excessive undesirable attention from the host community, academic adjustment, and difficulty establishing friendships with the host nationals. The most commonly reported coping strategies reported were the use of social support networks and social isolation from the host community. Implications for international relations departments and international programs within a Thai context are discussed.Publication Metadata only Ice parties among young men who have sex with men in Thailand: Pleasures, secrecy and risks(2018-05-01) Thomas E. Guadamuz; Pimpawun Boonmongkon; Mahidol University© 2018 Elsevier B.V. Background: Crystal methamphetamine (ice) has become the substance of choice among young men who have sex with men (YMSM) in urban Thailand. Yet, there is scarce data on this phenomenon, partly due to the difficulty in accessing men who will disclose and openly discuss the social contexts, meanings and risks surrounding ice practice. We present an ethnography of ice parties, critically discussing the in-depth social meanings of ice; the sexual socialities and the secrecy surrounding its use; the transactions between older and younger men; and the role of the Internet and mobile technology. Methods: Forty repeated narrative interviews (life stories), ten focus group discussions, as well as systematic online and offline observations were conducted over a three-year period. Purposive sampling was used to recruit study participants in a variety of online and offline spaces and through working closely with local Thai community-based organizations serving MSM. To be eligible, participants had to be between 18 and 29 years, able to converse in Thai, had used ice, and had anal sex with another man in the past 6 months. We also strived for sample variability with respects to socio-demographic characteristics (e.g., age, educational attainment and living situation). Data analysis was conducted in Thai by two researchers using the constant comparative method based on grounded theory. Results: On surface, participants described ice parties as exclusive, in trend, luxurious, fun and pleasurable—a kind of modern camaraderie among beautiful men. In reality, however, this group phenomenon was a social hierarchy containing several important players with relational power to one another, to the ice itself and to the physical space where ice was being consumed. These players included ice suppliers, party hosts, party guests and “icetenders.” The paper also discusses the sociality of secrecy that surrounds ice parties as well as the power relations between older relatively rich men who provide ice and the younger men who crave for the chemical, pointing to the risks associated with engagement at ice parties, including instances of rape, violence and unsafe sex. For some participants, ice use was part of their “everyday life,” or even believed to be a “rites of passage.” For others, it involved sexual silence in cases where they were forced to have (unprotected) sex with certain persons or engage in high-risk activities against their will. Conclusions: Ice parties, where high-risk practices were common, power and agency quickly became relational and negotiable. This paper illuminated the secret sociality of ice so that public health efforts will be better equipped with understanding and reaching out to young men who may be at heightened risk for HIV, STI, violence and other health concerns. Ice parties can, for example, be seen as opportunities for harm-reduction strategies whereby young men are not judged for the activities they engage, but are instead respected and approached in a contextualized, non-judgmental way. Finally, icetenders and party hosts may be individuals where public health practitioners can target and include in the development of novel harm-reduction programs.Publication Metadata only The effect of changes in the powder liquid ratio of glass-ionomer sealant on the amount of fluoride released(2018-03-01) Woranun Prapansilp; Praphasri Rirattanapong; Rudee Surarit; Kadkao Vongsavan; Mahidol University© 2018, SEAMEO TROPMED Network. All rights reserved. Glass-ionomer sealant is used to seal teeth pits and fissures in order to prevent caries formation and release fluoride. It is made by mixing powder and liquid, where the powder contains fluoride and the liquid enables it to penetrate into small pits and fissures. The powder to liquid (P/L) ratio can determine the efficiency of the sealant. We aimed to determine the amount of fluoride released by varying P/L ratios in order to obtain the best penetration versus fluoride released ratio. The study was performed on 4 groups of 5 sealent specimens each: Group 1 – the P/L ratio was that recommended by the manufacturer; Groups 2, 3 and 4 had 25%, 50% and 75% less powder than recommended by the manufacturer. In each group the prepared sealant was placed in a mold and light cured for 20 seconds. Each group of specimens was placed in deionized water and the amount of fluoride released in each group was measured in the water on days 1, 7, 14 and 21. The measured results for each group at each time period were compared with the one-way ANOVA and Tukey’s tests. In all the groups the fluoride levels were highest on day 1 slowly decreased for 7 days and then remained the same after 7 days for the duration of the study. Group 4 released significantly more fluoride than Groups 1-3 on day 1 (p=0.000). Groups 3 and 4 were not significantly different from each other in fluoride release after 1 day (p>0.05) but both released significantly more fluoride than Groups 1 and 2 at all times sampled (p<0.05). There were no significant differences in fluoride release between Groups 1 and 2 (p>0.05). Reducing the amount of powder to lower than the manufacturer’s recommendations resulted in significantly greater release of fluoride. Further studies are needed to determine the duration of fluoride release is affected for greater than 21 days and whether the protective effect of the sealant is altered by the lower powder to liquid ratio.Publication Metadata only A paradigm shift on beta-thalassaemia treatment: How will we manage this old disease with new therapies?(2018-07-01) Maria Domenica Cappellini; John B. Porter; Vip Viprakasit; Ali T. Taher; American University of Beirut Medical Center; Università degli Studi di Milano; UCL; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018 The Authors Beta-thalassaemia causes defective haemoglobin synthesis leading to ineffective erythropoiesis, chronic haemolytic anaemia, and subsequent clinical complications. Blood transfusion and iron chelation allow long-term disease control, and haematopoietic stem cell transplantation offers a potential cure for some patients. Nonetheless, there are still many challenges in the management of beta-thalassaemia. The main treatment option for most patients is supportive care; furthermore, the long-term efficacy and safety of current therapeutic strategies are limited and adherence is suboptimal. An increasing understanding of the underlying molecular and cellular disease mechanisms plus an awareness of limitations of current management strategies are driving research into novel therapeutic options. Here we provide an overview of the current pathophysiology, clinical manifestations, and global burden of beta-thalassaemia. We reflect on what has been achieved to date, describe the challenges associated with currently available therapy, and discuss how these issues might be addressed by novel therapeutic approaches in development.Publication Metadata only Rituximab treatment for paraneoplastic pemphigus associated with follicular B-cell lymphoma: A case report and review of treatment outcome(2018-01-01) Waranaree Winayanuwattikun; Leena Chularojanamontri; Papapit Tuchinda; Penvadee Pattanaprichakul; Kanokvalai Kulthanan; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018 Siriraj Medical Journal. Objective: To report a case of paraneoplastic pemphigus (PNP), a rare disease, associated with follicular B-cell lymphoma. Treatment outcomes of PNP associated with follicular B-cell lymphoma following rituximab treatment were also reviewed in this article. Case presentation: We reported a PNP patient presenting with intractable stomatitis and erythema multiforme-like lesions. Skin biopsy from erythema multiforme-liked lesion revealed interface dermatitis and necrotic keratinocytes. Direct immunofluorescence demonstrated immunoglobulin G deposition at intercellular space, as well as complement deposition at dermo-epidermal junction. Indirect immunofluorescence using rat bladder substrate was helpful in confirming the diagnosis of PNP. Further investigations revealed an underlying disease of follicular B-cell lymphoma. He was treated with rituximab and systemic corticosteroids. Improvement of mucocutaneous lesions and lymphoma were noted. Nevertheless, he developed hospital-acquired pneumonia and died from septic shock shortly after receiving conventional chemotherapy. His survival duration was approximately 8 months after diagnosis of PNP. Conclusion: It seemed that rituximab might provide promising benefits for mucocutaneous lesions in PNP patients associated with follicular B-cell lymphoma.Publication Metadata only Outcomes of undercorrection in surgical management and binocular vision gained of adult intermittent exotropia(2018-01-01) Apatsa Lekskul; Tatha Supakitvilekarn; Tanyatuth Padungkiatsagul; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018 Lekskul et al. Purpose: To study the surgical outcomes of intended undercorrection on adult intermittent exotropia (X(T)) performed to avoid postopertively overcorrected diplopia. Patients and methods: A retrospective chart review was conducted for adult patients (age ≥18 years) with X(T) ≥15 prism diopter (PD) who underwent strabismus surgery by a single surgeon. Inclusion criteria were 1) corrected VA ≥20/40 in either eye; 2) monocular occlusion at least 30 minutes before deviation measurement; 3) difference of 10 PD between near and distance deviation; 4) absence of significant A or V pattern or vertical deviation; 5) lateral rectus recession and medial rectus resection procedure were performed unilaterally; and 6) intended surgical number for deviation correction was aimed at 5 PD undercorrection. Results: Of 234 patients who met the inclusion criteria, 122 were women (52.14%). Average age at the time of surgery was 27.56 years (range, 18–42 years). A total number of 197 patients (84.19%) had postoperative exodeviation under 10 PD. Twenty five (10.68%) and 12 patients (5.13%) had postoperative exodeviation within 10–15 PD and 15 PD, respectively. All patients who had postoperative exodeviation 15 PD exhibited initial deviation of 40 PD and had undergone re-operation. In 74 patients (46.25%) out of 160 who had no binocular vision in orthoptic examination before surgery, fusion or stereopsis was gained after good alignment. No postoperative diplopia was found in this study. Conclusion: Intended undercorrection in surgical management of adult X(T) showed good functional and cosmetic outcomes. No procedure resulted in consecutive esodeviation or persistent diplopia. Fusion or stereopsis could be gained after successful surgical alignment. Our recommendations are as follows: 5 PD undercorrection if deviation is 40 PD and regular correction if deviation is 40 PD.Publication Metadata only Implications of current therapeutic restrictions for primaquine and tafenoquine in the radical cure of vivax malaria(2018-04-20) James Watson; Walter R.J. Taylor; Germana Bancone; Cindy S. Chu; Podjanee Jittamala; Nicholas J. White; Mahidol University; Nuffield Department of Clinical Medicine© 2018 Watson et al. Background: The 8-aminoquinoline antimalarials, the only drugs which prevent relapse of vivax and ovale malaria (radical cure), cause dose-dependent oxidant haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Patients with <30% and <70% of normal G6PD activity are not given standard regimens of primaquine and tafenoquine, respectively. Both drugs are currently considered contraindicated in pregnant and lactating women. Methods: Quantitative G6PD enzyme activity data from 5198 individuals were used to estimate the proportions of heterozygous females who would be ineligible for treatment at the 30% and 70% activity thresholds, and the relationship with the severity of the deficiency. This was used to construct a simple model relating allele frequency in males to the potential population coverage of tafenoquine and primaquine under current prescribing restrictions. Findings: Independent of G6PD deficiency, the current pregnancy and lactation restrictions will exclude ~13% of females from radical cure treatment. This could be reduced to ~4% if 8-aminoquinolines can be prescribed to women breast-feeding infants older than 1 month. At a 30% activity threshold, approximately 8–19% of G6PD heterozygous women are ineligible for primaquine treatment; at a 70% threshold, 50–70% of heterozygous women and approximately 5% of G6PD wild type individuals are ineligible for tafenoquine treatment. Thus, overall in areas where the G6PDd allele frequency is >10% more than 15% of men and more than 25% of women would be unable to receive tafenoquine. In vivax malaria infected patients these proportions will be lowered by any protective effect against P. vivax conferred by G6PD deficiency. Conclusion: If tafenoquine is deployed for radical cure, primaquine will still be needed to obtain high population coverage. Better radical cure antimalarial regimens are needed.Publication Metadata only Estimating impact based on stages of mental illness on employment and earnings in Bangkok metropolitan region(2018-01-01) Tawanchai Jirapramukpitak; Keerati Pattanaseri; Kia Chong Chua; Patcharapim Takizawa; Thammasat University Hospital; University of Tsukuba; Mahidol University; Thammasat University; King's College LondonCopyright g 2018 ICMPE. Background: Evidence suggests mental disorders are associated with substantial economic burden. However, as the status of mental illness tends to change over time, estimating the burden based on cross-sectional presence or severity of illness may be problematic. An approach based on illness staging may provide a more stable estimate. Aims of the Study: We aim to explore whether three predefined stages of mental illness (i.e. early active, remitted, chronic) have differential impact on employment and earnings. Methods: A community survey of household population aged 18 and over in a university hospital’s catchment area within Bangkok Metropolitan Region (BMR) was conducted (N=3877). The third version of the World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) was administered to assess lifetime and 12-month common major mental disorders and the Kessler Psychological Distress Scale (K6) to assess current psychological distress. Multivariate approaches were used to estimate the observed and expected annual earnings and employment for persons with mental illness at each stage, controlling for sociodemographic variables. Results: Increasing level of chronicity, from the early active to the remitted and then to the chronic stage, was associated with increasing reduction in earnings (ß –0.14 95% CI -0.15 to –0.13, p = 0.004). All stages of illness were significantly associated with reduced earnings, with individuals at chronic stage having 12-month earnings averaging 78,522 Thai baht (US$2,356) less than those without a history of mental illness, followed by those at remitted (38,703 baht or US$1,161) and early active stages (25,870 baht or US$776), with the same values for control variables. Remitted and chronic stages, but not early active one, were associated with reduced odds of paid employment. The estimated societal-level loss in earnings was 26.9 billion baht (US$808.2 million) in the total BMR population. Discussion: The findings suggest that all stages of mental disorders, particularly chronic one, are associated with substantial individual- and societal-level burden, and highlight differences in employment and earnings gaps among individuals at each stage of illness. Implications for Health Care Provision and Use: Mental health service should be provided in close coordination with vocational and welfare services in order to alleviate financial and work difficulties faced by mentally ill people at various stages of illness. Implications for Health Policies: There is a need to tailor disability benefits and employment promotion schemes to the needs of mentally ill people at each stage in order to maximize their productivity and quality of life. Implications for Further Research: Direct and other indirect costs of mental illness should be further investigated. Longitudinal studies would help to clarify how much of the reported association is due to mental illness causing unemployment and reduced earnings or vice versa.Publication Metadata only Participatory evaluation of older adults’ self-neglect: A case study in crowded community, Bangkok(2018-07-01) Kingkaew Udomchaikul; Uthaithip Jiawiwatkul; Supavan Phlainoi; Sakda Arj Ong Vallibhakara; Noppawan Piaseu; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University© 2018, Medical Association of Thailand. All rights reserved. Objective: To define risks or basic factors associated with older adults’ self-neglect, clarify to appropriate meaning, and develop participatory self-neglect’s management methods in crowded community. Materials and Methods: Thirty-eight older adults including stakeholders were participated in focus group discussion to determine meaning older adults’ self-neglect and developing self-neglect evaluation questionnaire. Older adults were assessed by this self-neglect questionnaire and presented overall information in community forum to develop self-neglect’s management methods. Results: Self-neglect in older adults’ perspectives was defined as lack of physical and mental care in activity daily live. Twenty-one indicators were emerged and categorized into three key result areas: self-neglect risk factors, behaviors, and effects. Three first self-neglect risk factors were lack of self-care knowledge, older adults’ physical and mental health problems. Similarly, self-neglect behaviors were deficit interaction with other people, lack of exercises and healthy diets affecting older adults’ physical and psychological health, family’s finance and psychological health. After reporting self-neglect information in community forum, two management methods were suggested including volunteer groups for taking care older adults and illegal loan change into legal loans with lower interest rates. Conclusion: Older adults’ self-neglect is essential to evaluate and develop a management plan to solve impact of older adults’ self-neglect using community participation resulting in improving quality of life in older adults and their families.Publication Metadata only A 56-Year-Old-Man With Common Variable Immunodeficiency and Worsening Dyspnea(2018-07-01) Chok Limsuwat; Philip J. Daroca; Joseph A. Lasky; Tulane University School of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University; Tulane University Health Sciences Center© 2017 American College of Chest Physicians Case Presentation: A 56-year-old man with a history of common variable immunodeficiency (CVID), in addition to recurrent bronchitis and pneumonia, presented with progressively worsening shortness of breath over a period of a few months. He was able to conduct his activities of daily living at baseline; however, his condition declined over a period of months to the point of shortness of breath with climbing a flight of stairs. The patient also developed a frequent dry cough and wheezing. He denied fever, chest pain, weight loss, and hemoptysis. He had been diagnosed with CVID in 1968, at 7 years of age, after recurrent episodes of bronchitis and pneumonia, and was treated with IV immunoglobulin monthly for decades. The patient was a lifelong nonsmoker and had no significant environmental or occupational exposures. He was referred to our hospital for further management.Publication Metadata only Additional hyaluronic acid binding selection decreased sperm DNA damage after conventional semen preparation in infertile patient with abnormal semen analysis(2018-05-01) Roungsin Choavaratana; Isarin Thanaboonyawat; Yaowapa Chongpensuklert; Japarath Prechapanich; Suphadtra Phornwilardsiri; Morou Stavroula Maria; Ketsara Sitthirit; Faculty of Medicine, Siriraj Hospital, Mahidol University; Phyathai 3 Hospital; REA Maternity Hospital© 2018, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: To study the benefit of combining conventional sperm preparation methods with hyaluronic acid binding in selecting spermatozoa with less DNA damage in infertile patients with abnormal semen analysis. Methods: Forty-six semen samples obtained from infertile men, containing two or more abnormalities regarding concentration, motility or morphology, were enrolled in the study. Baseline semen analysis was performed and recorded for all samples. Each sample was divided into 3 aliquots, i.e. the control group / fresh sample before preparation (Group 1), the conventional sperm preparation group including both density gradient centrifugation and swim-up (Group 2), and the conventional method combined with hyaluronic acid selection group (Group 3). The DNA integrity of sperm obtained by each different test group was assessed using TUNEL assay. Results: Less sperm DNA damage was observed in Group 2 compared to Group 1, whereas Group 3 displayed significantly lower sperm DNA damage compared to Group 2 (9.4% vs. 27.0%, p < 0.001). Conclusion: Sperm DNA damage was significantly reduced after the inclusion of hyaluronic acid binding in conventional sperm preparation method in abnormal semen samples.Publication Metadata only Takayasu arteritis with an initial presentation of chronic monoarthritis mimicking oligoarticular juvenile idiopathic arthritis(2018-01-01) Maynart Sukharomana; Sorawit Viravan; Nuntawan Piyaphanee; Sirirat Charuvanij; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018 S. Watanabe et al., Licensee PAGEPress, Italy. Patients with Takayasu arteritis (TA) generally present with non-specific symptoms that, if unrecognized and untreated, may develop vessel stenosis and/or aneurysm. There is limited data regarding chronic monoarthritis as the initial presentation in children with TA. We report a 6-yearold girl diagnosed and treated as oligoarticular juvenile idiopathic arthritis (JIA). She later developed stroke with malignant hypertension and was definitively diagnosed with TA. She additionally developed proteinuria secondary to focal segmental glomerulosclerosis. This is the report of a patient with chronic monoarthritis mimicking oligoarticular JIA which chronic monoarthritis was the presentation of TA. Since JIA is a diagnosis of exclusion, any atypical features of oligoarticular JIA should illuminate the possibility of an alternative diagnosis. Our literature review focused on musculoskeletal presentations of children with TA.Publication Metadata only Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion(2018-06-01) Jatuporn Eiamcharoenwit; Phuping Akavipat; Thidarat Ariyanuchitkul; Nichawan Wirachpisit; Aksorn Pulnitiporn; Orawan Pongraweewan; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Maharaj Nakhon Ratchasima Hospital; Khon Kaen Regional Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; Prasat Neurological Institute© The Author(s) 2018. The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.Publication Metadata only Self-care management of Thai Buddhists and Muslims with type 2 diabetes after an empowerment education program(2018-09-01) Pranee C. Lundberg; Supunnee Thrakul; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Uppsala Universitet© 2018 John Wiley & Sons Australia, Ltd The aim of the present study was to explore self-care management of Thai Buddhists and Muslims with type 2 diabetes and inadequate blood glucose levels, after they had been subjected to a 6-month diabetes empowerment education program. Twenty-seven participants (male and female) were selected through purposive convenience sampling for an explorative qualitative study. Semistructured focus group interviews with four open-ended questions were used to study the participants’ self-care behavior at the beginning and the end of the program, and the data obtained were subjected to content analysis. At the end, one third of the participants had been able to reduce their blood glucose to acceptable levels. Most of the others had achieved reduced but irregular blood glucose levels; however, some did not achieve any reduction. Diet was the most difficult problem, and economic difficulties, incorrect knowledge, and misleading beliefs were barriers. In conclusion, an empowerment education program can substantially improve the outcome of self-care management for many people with type 2 diabetes. In the planning of such programs, barriers should be taken into account.Publication Metadata only Non-melanoma skin cancer treated with mohs micrographic surgery in Thailand(2018-01-01) Piyaroj Sethabutra; Rungsima Wanitphakdeedecha; Sasima Eimpunth; Woraphong Manuskiatti; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2018, Medical Association of Thailand. All rights reserved. Background: Long-term follow-up, complications, and patient satisfaction are essential outcome measures regarding the benefits of Mohs micrographic surgery [MMS] for treating non-melanoma skin cancers [NMSCs]. Objective: To report risk factors, clinical findings, and follow-up outcomes of all NMSC patients treated with MMS. Materials and Methods: The present retrospective study included all patients in the outpatient Dermatology Clinic of Siriraj Hospital, Bangkok, Thailand, with NMSC treated with MMS between 2008 and 2013. The outcomes measured were patient demographic data, duration of tumor, recurrence of tumor before MMS, number of lesions, risk factors for developing skin cancer, histological type and subtype, location of tumor, pre-operative and post-operative size, method of closure, operative time, 5-year recurrence rate after MMS, complications, and patient satisfaction. Results: The present study included 108 patients (63% females and 37% males) with a mean age of 70±12 years (range 36 to 93 years). The mean duration of tumor was 37±60 months (range 0.5 to 480 months). Basal cell carcinoma [BCC] comprised 95.1% of cases, whereas squamous cell carcinoma [SCC] was 4.9%. The significant risk factor for both BCC and SCC was sun exposure. The most common locations for both BCC and SCC were the head and neck regions. The most common subtype for BCC was a non-aggressive subtype, 47%. The most commonly used method of closure was second intention, 28 cases (22.8%). The mean operative time was 116.13 minutes (range: 30 to 360 minutes). During the longest follow-up time (60 months), the recurrence rate was 0.81%. There were no major complications. The majority (96.4%) of patients gave a 75% to 100% satisfaction rate after surgery. Conclusion: The present study demonstrates less than one percent recurrence rate in NMSCs treated with MMS and the necessity of margin control in high-risk tumors.Publication Metadata only Simulation modeling for facility allocation of outpatient department(2018-07-03) Duangpun Kritchanchai; Soriya Hoeur; Mahidol University© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. In the value chain model, activities of one firm can be classified into two types: primary activities and support activities. From such a concept, patient flow in outpatient departments (OPDs) is developed in this study as an outpatient flow value chain by classifying the OPD facilities into two types: primary and support facilities. This paper demonstrates how OPD facilities can be allocated based on the value chain concept. This process starts by describing patient flow at the OPD; then the new OPD is built, and some support facilities are moved to the new building. Discrete-event simulation technique is used to model the patient flow at the OPD and the new OPD. Simulation experimental results show that separating the primary and support facilities can reduce congestion in the floor area of the OPD’s clinics. More importantly, the results also claim that at the new building, the only processes which happen after clinical processes are worth for the capacity optimization.Publication Metadata only Potential Surgical Exposure of the Parapharyngeal Internal Carotid Artery by Endonasal, Transoral, and Transcervical Approaches(2018-06-01) Kangsadarn Tanjararak; Smita Upadhyay; Thanakorn Thiensri; Jun Muto; Boonsam Roongpuvapaht; Daniel M. Prevedello; Ricardo L. Carrau; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Ohio State University© 2018 Georg Thieme Verlag KG Stuttgart New York. Objectives Endoscopic and endoscopic-assisted approaches to the parapharyngeal space have been reported; however, their potential for vascular exposure has not been previously assessed. This study aims to compare the potential exposure and control of the parapharyngeal internal carotid artery (ppICA) via various approaches. Design and Main Outcome Measures Ten cadaveric specimens were dissected bilaterally, exposing the ppICA via endonasal, transoral, and transcervical approaches. Length of the exposed vessel and potential control were assessed (feasibility and time required to place an encircling suture). Results Endoscopic transoral and transcervical-transmandibular approaches expose a significantly longer segment of the ppICA (6.89 and 7.09 cm) than the transoral and endonasal approaches. Vascular control was achieved via endoscopic-endonasal, endoscopic-transoral, and open techniques in 121.6, 64.8, and 5.2 seconds, respectively. Conclusion Histopathology, goals of surgery, and familiarity of the surgeon with each technique may ultimately determine the choice of approach; however, this study suggests that exposure of the ppICA by endoscopic-assisted transoral approach is comparable to that of a transcervical-transmandibular approach. Vascular control was feasible under elective circumstances. However, the difficulty varied widely, potentially reflecting the challenges of controlling an injured ppICA. However, one must note that active bleeding obscures the surgical field in ways that may impair ppICA control. Furthermore, the results may not reflect clinical scenarios where tumor distorts the surgical field. Nonetheless, the study suggests that, in properly selected patients, the endoscopic-assisted transoral approach avoids problems associated with unsightly scars, mandibular osteotomy, and facial nerve manipulation, whereas, the transcervical-transmandibular approach offers the swiftest vascular control.Publication Metadata only Nipple-areola complex sensation after nipple-sparing mastectomy(2018-04-01) Prakasit Chirappapha; Pongsakorn Srichan; Panuwat Lertsithichai; Panya Thaweepworadej; Thongchai Sukarayothin; Monchai Leesombatpaiboon; Youwanush Kongdan; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018 The Authors. Published by Wolters Kluwer Health, Inc. Background: Nipple-sparing mastectomy (NSM) has been proven to be oncologically safe for treating breast cancer. This procedure had been developed to optimize the esthetic outcome and reduce feeling mutilation after mastectomy. Risks of necrotic complications and diminishing nipple-areola complex (NAC) sensation are common complications affecting the patient's satisfaction after the surgery. The evaluation of NAC sensation should be also investigated. Methods: We prospectively analyzed 55 NSMs that were performed on 52 patients for both therapeutic and prophylactic indications in Ramathibodi Hospital from May 2007 to September 2015. Patients' demographics, operative details, oncologic outcome, and postoperative complications, focusing on NAC sensation and necrotic complications, were analyzed. Results: Forty-seven NSMs (87%) were performed for therapeutic indications, and another 7 NSMs (13%) were risk-reducing operations. Of the 43 patients performing NSM for breast cancer treatment, 33 patients (77%) had invasive cancer and 11 patients (23%) had ductal carcinoma in situ. One subareola base tissue was found an occult cancer, and the NAC was then removed. There were 3 locoregional recurrences after a median follow-up time of 24 months (range, 2-104 months). The NAC sensation was evaluated in a total of 35 patients. Twenty-five patients (46%) underwent serial evaluation after 6 months of operation, and 10 patients were evaluated at more than 1 year after operation. In the first 6 months, 11 patients (44%) showed partial sensation recovery, and 3 more patients had partial recovery after 1-year follow-up. Only 1 patient (2%) had complete sensation recovery in all area of the NAC. In late evaluation group, 7 out of 10 patients had partial recovery. Most pain sensation remained in the lower aspect of the areola away from surgical incision. Conclusions: NSM is technically feasible in selected patients with low rates of NAC removal. Some patients can preserve the NAC sensation. Long-term outcome should receive follow-up.Publication Metadata only HBA as a potential alternative to the tunel assay for assessment of dna integrity in asthenozoospermic spermatozoa(2018-01-01) Pitak Laokirkkiat; Paweena Sarakarnkosol; Isarin Thanaboonyawat; Somsin Petyim; Japarath Prechapanich; Suphadtra Phornwilardsiri; Noira Nigmatova; Roungsin Choavaratana; Taksin Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; Genome Astana© 2018, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: This study was conducted to evaluate the appropriateness of the hyaluronan binding assay (HBA) for assessment of DNA integrity indirectly in asthenozoospermic spermatozoa, by studying its correlation with the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Methods: Thirty asthenozoospermic semen samples of infertile couples were recruited. Semen analysis was performed before being processed by HBA and the TUNEL assay. All the semen parameters were recorded and analyzed. Results: The mean age of the patients was 38.1 ± 6.4 years. The average total and progressive motility was 33.5 ± 11.0% and 21.9 ± 6.6%, respectively. The mean TUNEL-positive and hyaluronan-bound sperm were 17.8 ± 6.4% and 57.2 ± 14.5%, respectively. Pearson correlation coefficient showed a high negative correlation between HBA and the TUNEL assay (r = -0.73, p < 0.001). The intraclass correlation coefficients revealed a high level of agreement between two observers who evaluated the TUNEL-positive and hyaluronan-bound sperm [0.81 (95% CI: 0.65-0.91) and 0.92 (95% CI: 0.84-0.96)], respectively. Conclusion: The study results showed a high negative correlation between HBA and the TUNEL assay. This suggests that HBA may be used as a viable intact DNA spermatozoa identification method, as a potential alternative to the TUNEL assay, in asthenozoospermia sperm.