Region 3 Medical and Public Health Journal - วารสารวิชาการแพทย์และสาธารณสุข เขตสุขภาพที่ 3

The The Effect of Obesity on the Cutaneous Severity of Psoriatic Patients

Donlaporn Chuenwipasakul — 2025-11-19

Objective: Psoriasis is a chronic inflammatory skin disease that significantly impacts patients' quality of life, with a link to obesity and metabolic syndrome. This study aimed to investigate the relationship between body mass index (BMI) and disease severity.

Method: This cross-sectional descriptive study included 187 patients with chronic plaque-type psoriasis treated at the Dermatology Clinic, Chonburi Hospital, from October 1, 2023, to September 30, 2024. Statistical analyses included the Chi-square test, t-test, and multivariable logistic regression to assess the association of various factors with disease severity.

Results: When comparing by disease severity, the proportion of obese patients (BMI ≥ 25.0) in the severe group (PASI ≥ 10) was a significantly higher (71.2% compared to 34.2% in the mild-to-moderate group, p-value < 0.01). Multivariable analysis using BMI categories revealed that Obesity Class II (BMI ≥ 30.0kg/m²) was significantly associated with severe disease, with 4.54 times the odds of severe disease compared to the BMI<22.9 kg/m²group (non-overweight) (aOR: 4.54, 95% CI: 1.24-16.64, p-value = 0.02).

Conclusions: The findings suggest that obesity (especially BMI ≥ 30.0kg/m²) is significantly associated with the severity of psoriasis. Therefore, weight management should be a part of standard care, including nutritional counseling and exercise, to improve treatment outcomes for psoriasis patients.

Keywords: Psoriasis, Obesity, Body Mass Index, Disease Severity, Metabolic Syndrome

5 Years Survival Analysis of Outcomes after Total Laryngectomy in Patients with Advance Stage Laryngeal Cancer with Regional Metastasis in Krathumbean Hospital

Weerapol Kimsiri — 2025-10-15

Objective: To investigate the 5-year survival rate of patients with advanced stage laryngeal cancer who underwent total laryngectomy at Krathum Baen Hospital.

Method: This study is a retrospective cohort study that examines historical data collected from medical records. The sample group consists of medical records of patients with laryngeal cancer who underwent laryngectomy from January 1, 2018, to December 31, 2022, at Krathumban Hospital, Samut Sakhon Province, with a total of 30 patients. The patients were followed up until December 2027. The purposive sampling method was used, selecting only patients with laryngeal cancer in the stage of invasion to adjacent organs who had not received radiation therapy before and had undergone total laryngectomy at Krathumban Hospital, and who continued to have follow-up records. Data collection was done through a medical record data sheet that included gender, age, cancer stage, history of postoperative radiation therapy, time to recurrence after surgery, time to second primary cancer after surgery, and time to death after surgery. The data were analyzed using Kaplan-Meier (KM) survival curves, and factors associated with survival were analyzed using Cox's proportional hazard regression.

Results: The 5-year survival rate of patients with advanced stage laryngeal cancer who underwent total laryngectomy at Krathum Baen Hospital was 60%. Cox’s proportional hazards regression analysis indicated that patients who did not complete postoperative radiotherapy had a 14.88 times higher risk of death compared to those who completed the treatment. Additionally, patients without recurrence after surgery had a 91% lower risk of death compared to those who experienced recurrence.

Conclusion: Adjuvant postoperative radiotherapy significantly improved survival rates in patients with advanced laryngeal cancer. Furthermore, cancer recurrence significantly reduced survival rates in these patients.

Keywords: Survival rate, total laryngectomy, laryngeal cancer

Factors Associated to Control Blood Sugar Levels of Patients with Uncontrolled Type 2 Diabetes Mellitus at Watchongkirisrisitthiwararam Primary Care Unit in Sawanpracharak Hospital, Nakhon Sawan Province

Nutchanat Meemuk — 2025-10-14

Objective: To study factors affecting blood sugar control in uncontrolled type 2 diabetes patients receiving services at Wat Chong Khiri Sri Sithi Wararam Primary Care Unit, Sawanpracharak Hospital, Nakhon Sawan Province.

Methods: This study was a predictive relationship study. The sample consisted of 177 patients with type 2 diabetes who could not control their blood sugar level and received services at Wat Chong Khiri Sri Sitthi Wararam Primary Care Unit, Sawanpracharak Hospital, Nakhon Sawan Province during October 2024-April 2025. The research tools included a personal data questionnaire, a diabetes knowledge questionnaire, a diabetes severity perception questionnaire, a diabetes treatment benefit perception questionnaire, and a blood sugar control behavior questionnaire. Data were analyzed using descriptive statistics and multiple regression by including all variables simultaneously.

Results: The sample group had an average HbA1c of 8.44% (S.D.=1.87). 10 variables, namely BMI, age, education, occupation, income, comorbidities, knowledge about diabetes, perceived severity of diabetes, perceived benefits of diabetes treatment, and blood sugar control behavior, could together significantly predict the variability of HbA1c levels by 73% (R2 = .73, F10, 166 = 45.09, p-value < .01). When considering each variable, it was found that perceived benefits of diabetes treatment (B = -.13, p-value < .001) and blood sugar control behavior (ß = -.26, p-value < .001) had a statistically significant negative relationship with HbA1c levels.

Conclusion: Perceived treatment benefits and glycemic control behaviors are important factors affecting HbA1c control in patients with poor glycemic control of type 2 diabetes. The study results support the development of nursing interventions that emphasize enhancing awareness and modifying health behaviors to improve treatment outcomes.

Keywords: Type 2 diabetes, factors controlling blood sugar levels, glycemic control levels

Prevalence and Associated Factors of Online Medical Direction in Emergency Medical Services at Sawanpracharak Hospital, Nakhonsawan

Pimchanok Pinthong — 2025-10-06

Objectives: To determine the prevalence of online medical direction (OLMD) in emergency medical services (EMS). and identify factors associated with OLMD in EMS.

Methods: This cross-sectional analytical study examined all critical patients who received EMS at Sawanpracharak Hospital between June 1, 2024, and June 1, 2025. A total of 1,095 patients were included. Descriptive statistics were used to describe the prevalence. Factors related to OLMD were analyzed using independent t-tests, chi-square tests, or Fisher's exact tests. Multivariable logistic regression was used to determine factors associated with OLMD, with statistical significance set at p-value< 0.05.

Results: Of the 1,095 patients, 291 (26.6%) received OLMD. Patients with respiratory distress were 1.65 times more likely to receive OLMD than those without (p = 0.003, aOR = 1.65, 95%CI: 1.19 - 2.30) An on-scene NEWS of 7 or more resulted in a 51% reduction in the chance of a patient receiving OLMD (p = 0.012, aOR = 0.49, 95%CI: 0.28 - 0.85). A distance of more than 10 km from the hospital was associated with a 1.54-fold increase in the likelihood of receiving OLMD (p = 0.013, aOR = 1.54, 95%CI: 1.10 - 2.15). Patients with an on-scene time greater than 10 minutes were 5.53 times more likely to receive OLMD (p < 0.001, aOR = 5.53, 95%CI: 3.84 - 7.97).

Conclusion: The prevalence of OLMD use in EMS is approximately one-fourth. Significant factors associated with OLMD included respiratory distress, an on-scene NEWS of 7 or more, distance from the hospital to the scene greater than 10 kilometers, and on-scene time exceeding 10 minutes.

Keywords: Online Medical Direction, Emergency Medical Services, National Early Warning Score

Nursing Care of Laparoscopic Low Anterior Resection: Case Study

Benjamas Piluk — 2025-12-04

Colorectal cancer is the third most common cancer worldwide and the fourth leading cause of cancer-related mortality. It can occur in any part of the large intestine, including the colon, located within the abdominal cavity, and the rectum, situated in the pelvic cavity. Prompt and appropriate treatment significantly reduces mortality rates. Laparoscopic surgery has been widely accepted across the global medical field as a highly effective procedure. Its advantages include a faster recovery period, reduced postoperative pain, smaller incisions compared to open surgery, quicker restoration of gastrointestinal function, and shorter hospital stays.

As treatment guidelines continue to evolve, operating room nurses must continuously enhance their competencies, particularly in providing expert surgical nursing care and ensuring proper preparation of the operating room and specialized instruments required for the procedure. Therefore, this study focuses on caring for a patient undergoing laparoscopic colorectal cancer surgery, aiming to identify problems and provide comprehensive nursing care during the preoperative, intraoperative, and postoperative phases to ensure patient safety, prevent complications, and promote a return to normal daily activities.

This case study involves a 65-year-old female patient who presented with abdominal bloating, abnormal bowel movements, and weight loss for four months. She was diagnosed with rectosigmoid adenocarcinoma with bowel obstruction, and had previously undergone loop transverse colostomy in April 2024. The patient was scheduled for laparoscopic low anterior resection. Throughout the period of care, the full nursing process was utilized, addressing both physical and psychological needs before, during, and after surgery. The patient received complete nursing care in accordance with professional standards, ensuring safety, preventing complications, and enabling her to return to normal daily life.

Laparoscopic surgery is a complex procedure requiring expert knowledge and nursing proficiency. Operating room nurses must accurately prepare surgical instruments and equipment and possess an understanding of each surgical step. The application of the nursing process to assess and solve problems contributes to a smooth surgical procedure, patient safety, and prevention of complications.

Keywords: colorectal cancer, laparoscopic colorectal cancer surgery

Surgical Removal of Bilateral Torus Mandibularis for Preventing Soft Tissues Injuries form Masticatory Trauma: a Case Report

Kumsit Taranamai — 2025-11-28

A 40-year-old female patient with no underlying disease presented with the problem of pain on chewing and difficulty in cleaning her teeth. Intraoral examination revealed bilateral torus mandibularis. They were lobulated with the size about 1.5 cm. x2 cm x1.5 cm. The ulcerated mucosa was also found on the left torus mandibularis. The torectomy was planned to performed one side at a time in order that the complications such as excessive bleeding, infection could be reduced. The patient underwent torectomy on the left torus torectomy after 1 month of torectomy on the right one has been operated. Two months post-operative follow-up, there were no complications. The patient was able to chew and clean her teeth well.

Keywords: Torus Mandibularis

Nursing Care for Intracerebral Hemorrhage Patient in Fast Track System: Case Study

Chatchawal Tiabtiam — 2025-10-03

Background: Stroke is a major global public health concern. The World Health Organization (WHO, 2023) reported that there are approximately 15 million new stroke cases annually, with about 5 million deaths and another 5 million resulting in permanent disability. In Thailand, the incidence of stroke is 517.26 per 100,000 population and has shown a rising trend. Intracerebral hemorrhage (ICH) accounts for 10–15% of all stroke cases and carries a high mortality rate of 40–50% within the first 30 days. Early management through the Stroke Fast Track system, which emphasizes multidisciplinary collaboration, is crucial to improving survival and reducing disability.

Objective: This study aimed to explore the nursing process and treatment outcomes of patient with ICH managed through the Stroke Fast Track system.

Methods: A targeted case study was conducted using three-year retrospective hospital data from Sawanpracharak Hospital, which Showed a continuous increase in patients admitted to the Fast Track system and an annual average of 20–25 patients requiring neurosurgery.

Case Presentation: The case involved a 33-year-old Thai male presenting with decreased consciousness and limb weakness. Brain Computed tomography revealed a cerebellar hemorrhage. The patient underwent right suboccipital craniectomy with hematoma removal and was admitted to the Sub-ICU. Nurses care included screening, coordination, postoperative management, and rehabilitation.

Results: The patient demonstrated good recovery without complications, was hospitalized for 12 days, and was discharged with normal motor power.

conclusion: integration of the Stroke Fast Track system with effective nursing competencies played a crucial role in reducing disease severity and improving the patient’s quality of life. These findings can inform quality improvement initiatives and service management for stroke care.

Keywords : Stroke, Intracerebral hemorrhage, Fast Track system, Nursing care