Recent Articles


    Background: This descriptive study aimed to study the relationship between administrative factors and the effectiveness of the referral system of patients with acute ischemic heart disease in Thai hospitals. Materials and methods: The target population was 1,180 hospitals that serving heart disease in Thailand. Data were collected by using a questionnaire. A total of 1,022 response data were obtained. Administrative factors were analyzed using descriptive statistics, and the relationship was analyzed using multiple regression analysis (MRA) methods. Results: The study showed that the administrative factors which consisted of personnel, finance, supporting, and management factors had overall average readiness at a high level (x̄ = 3.34, S.D. = 0.27). Except budget sufficiency was at a low level (x̄ = 2.43, S.D. = 0.43). All factors were related to the mortality rate significantly, as follows: management factor (Adjusted R2 = 0.433), personnel factor (Adjusted R2 = 0.231), supporting factor (Adjusted R2 = 0.092) and financial factor (Adjusted R2 = 0.035). All factors were also significantly related to the timely cardiac catheterization rate, as follows: management factor (Adjusted R2 = 0.442), personnel factor (Adjusted R2 = 0.244), supporting factor (Adjusted R2 = 0.212) and financial factor (Adjusted R2 = 0.091). Conclusion: Thai Ministry of Public Health should provide adequate support for administrative factors, especially in terms of management, personnel, supporting factors, and budget sufficiency.


    Objective: To study the correlation between various risk factors and coronary CTA calcification score ( CACS ) in young and middle-aged male patients with coronary heart disease by multiple linear regression, and to predict plaque properties by Mahalanobis distance discrimination method. This study provides evidence for early clinical evaluation of the extent of coronary artery calcification and the property of plaque in patients having suffered coronary heart disease. Methods: choose 98 male patients under 55 years old with coronary heart disease randomly and collecte relevant medical history data and test results while in hospital.Utilizing the theory of multiple linear regression and Mahalanobis distance discriminant to analyse these dates. Results: Factors including hypertension classification×years, number of cigarettes smoked(packs / week )×years,and time of diabetes(years) have a positive correlation between CACS respectively. Comparing calcified plaque and vulnerable plaque, mixed plaque and vulnerable plaque,there is a significant differences ( p < 0.01) while hs-CRP and IL-6 are as the indicator. Mahalanobis distance discrimination method has a discrimination accuracy of 91.83 % for the group wrih susceptible factors only. Conclusion: The model of predicting the extent of coronary artery calcification by multiple linear regression has high reliability. Vulnerable plaques can be distinguished from plaques of other properties efficiently using Mahalanobis distance discrimination method.

  • Myocardial infarction as initial presentation of polycythemia vera and its treatment challenges, a case report

    Polycythemia vera (PV) is one of Myeloproliferative neoplasm which has common and uncommon mode of presentations. Myocardial infarction (MI) is rare at initial presentation. Here we report 55-year-old women presented with MI and found to have PV in whom, coronary intervention was delayed as there is no evidence based literature guidance in cases of acute MI and PV.

  • The fall of conventional mechanical ventilation into the emergence of Veno -Venous Extracorporeal Membrane Oxygenation influenced Extreme Super Super obese patient survival with a COVID-19 ARDS

    The COVID-19 pandemic has unfolded and merged across 220 countries, territories worldwide. Recent studies conclude that obesity is an independent significant risk factor for COVID-19 infection. Thus, obesity is an epidemic disease. Any obesity allied with COVID-19 ARDS is life-threatening, heading to respiratory life support associated with several complications and mortality. In this clinical setting, the World health organization (WHO) and Extracorporeal Life Support Organization (ELSO) provide interim guidelines that Veno-Venous extracorporeal membrane oxygenation (VV- ECMO) can be beneficial in selective COVID-19 patients. However, the benefit of extracorporeal membrane oxygenation (ECMO) in Obesity and Severe Obesity remains controversial. Although a few studies favored ECMO in Obesity associated with COVID-19. In contrast, its benefit in extreme super-super obese (class v) is unknown to the present day. Herein we report our successful early VV- ECMO and its retrieval challenges in an extreme super-super obese of Body mass index (BMI >65 kg/m2). Our report describes our institutional practice, clinical characteristics, and early VV- ECMO induction to enhance patients’ speedy recovery and survival. ECMO is a limited resource and must be used selectively, particularly during a pandemic when all resources are scarce.

  • Appendiceal diverticulosis: Asymptomatic positive FDG-PET uptake in the appendix should prompt operative management

    Appendiceal diverticulosis is rarely diagnosed and presentation mimics acute appendicitis. It has a documented high malignant risk and increased complication rate and excision is recommended if suspected preoperatively. We report a case of an incidental FDG avid appendiceal lesion on PET scan which was suspected to be an appendiceal neoplasm, however histologically was appendiceal diverticulosis. This is the first case of appendiceal diverticulosis detected via PET scan and we discuss the implications of this.

  • The Interesting Link Between Neurocysticercosis and Glioblastoma in a 41-year-old Hispanic Female

    Neurocysticercosis (NC) is a common condition worldwide while glioblastoma is the most common brain cancer among adults but overall, a rare disease. NC is the most common cause of seizures in developing countries. Although no causal relationship is established, there have been an association previously reported between NC and glioblastoma. Here we present a case of a 41-year-old female who was diagnosed with NC, treated with antiparasitic medications who developed worsening neurologic deficits despite treatment, and was subsequently diagnosed with a large left frontotemporal mass consistent with glioblastoma. Patient then underwent treatment with concurrent radiation and temozolomide.

  • Complex Incisional Hernia – Easy To Diagnose But What To Do After?

    Introduction. Loss of domain represents a defect in abdominal wall or loss of continuity of fascial closure, with more than 20% of the peritoneal cavity content under the skin in a serous sac, where the reconstruction involves additional reconstructive techniques. Clinical Case. A 63-year-old active smoker with multiple comorbidities such as COPD severe form with the need for oxygen at home (may be an absolute contraindication) and surgical history of open umbilical hernia repair with a rapid development of loss of domain hernia (2 weeks after surgery) was prepared preoperatively with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum. Discussion. Despite comorbidities, by optimizing the abdominal wall with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum with the intraoperative use of the Rives-Stoppa technique or posterior separation of components, Abdominal Wall Strength Score improves significantly in a short time, with quick socio-economic reintegration and low-rate of complications. Conclusions. By preoperative preparation, with augmentation techniques of the abdominal wall, thus, even the barriers given by comorbidities (absolute contraindications) are overcame, with low postoperative risks, offering the patient a normal quality of life.

  • The emergence of bladder dysfunction secondary to lupus cystitis in a patient with established lupus nephritis: the first case from Pakistan

    Lupus cystitis is an uncommon manifestation of systemic lupus erythematosus (SLE). We describe the case of a 23-year-old woman with lupus that complained of abdominal pain, vomiting, and diarrhea for one week. Two years back, she was brought with an affirmative history that satisfied the clinical criteria of SLE which was renal biopsy-proven (class V membranous lupus nephritis). On radiologic workup, she was found to have bilateral hydronephrosis and a thick-walled bladder with diverticula. Immunosuppressive therapy was commenced however augmentation cystoplasty had to be opted for as the symptoms did not subside with medical therapy alone.


    Background: This clinical study sought to understand the knee range of motion (KROM) in an amputated stump during repeat voluntary knee extension with or without a 0.5 kg weight in the acute/early phase after amputation can vary between different target knee extension rhythm frequency (KER) levels in the amputated lower leg of a patient with severe diabetic sensory disorder and leg ischemia. Case Presentation: A 51-year-old male patient with severe diabetic neuropathy had a right lower leg amputation due to necrosis and ulcer lesion following a burn injury to the first toes and severe ischemic peripheral vascular disease. In a sitting position with the base of the foot of the non-amputated left leg on the ground, he performed repeat knee extension of the resected stump (knee active extension and passive flexion without a target KROM) for 1 min with both self-controlled free KER and different target KERs (30, 40, 50, 60, and 80 contractions per minute [cpm] using a metronome), with or without a 0.5 kg weight placed on the resected stump over 8 consecutive days. The KROM was measured using a goniometer placed between the resected stump and the thigh muscle with a continuous data acquisition system. The mean values achieved for KER, KROM, and angle rate during a 1 min session was determined during each daily session, and consecutively average values over sessions on 8 consecutive days was also evaluated. The achieved mean KER at all target KERs corresponded closely with the target KER. The average KROM was approximately 60 degrees over a range of targets between 30 and 60 cpm, but the value was lower at approximately 50 degrees at 80 cpm. The angle rate increased consistently with the increase from a target of 30 to 60 cpm, but it was reduced at 80 cpm. The mean…

  • Loneliness in Adults During a COVID-19 Lockdown

    Loneliness has been frequently reported in the COVID-19 literature but rarely in the context of potential comorbidities including depression, fatigue, and sleep problems. The present study assessed the relationships between self-reported loneliness, and the potential comorbidities based on an archival database called the COVID-19 Lockdown Activities Survey (N= 260 participants). Loneliness was endorsed by 67% of the participants. Greater loneliness was related to greater depression, fatigue, and sleep problems. A regression analysis revealed that depression contributed to 47.1% of the variance in loneliness. These results highlight the multidimensionality of loneliness. The generalizability of these results is limited by the homogeneity of the sample (predominantly non-Hispanic white females). Nonetheless, they highlight the importance of designing interventional protocols that address loneliness and the associated depression, fatigue, and sleep problems rather than loneliness alone.