Trang Hospital

Purpose: To evaluate the clinical and radiographic outcomes of tibiocalcaneal arthrodesis using patient-matched modular 3D-printed porous titanium implants combined with locked intramedullary nails for advanced ankle arthropathy with substantial bone loss. Methods: This prospective cohort study included seven consecutive patients who underwent tibiocalcaneal arthrodesis using patient-matched modular 3D-printed porous titanium implants between January 2024 and December 2025. Functional outcomes were assessed using the Foot and Ankle Ability Measure (FAAM). Osseous union, alignment, and implant position were evaluated using radiographs and computed tomography at 1 year. Results: The mean patient age was 58.4 years (71.4% female). Mean follow-up was 12 months. Median reconstruction volume was 9,862 mm³ (interquartile range, 4,049–11,118 mm³). The median FAAM score improved from 60 preoperatively to 80 at 1 year (p = 0.018). At 1 year, complete osseous union was observed in two patients (28.6%), partial union in four (57.1%), and nonunion in one (14.3%). Complications occurred in three patients (42.9%): persistent nonunion with mechanical instability (n = 1), transient instability requiring supplemental fixation (n = 1), and superficial wound maceration that resolved with conservative care (n = 1). No major complications were reported. Conclusions: Patient-matched modular 3D-printed porous titanium implants combined with locked intramedullary nails may offer a limb-salvage option for advanced ankle arthropathy with massive bone loss. However, the high complication rate (42.9%) and low complete union rate (28.6%) at 1 year highlight the limitations of this approach. Long-term postoperative mechanical protection and regular monitoring are essential to prevent late structural failure.

INTRODUCTION:Acquired methemoglobinemia results from exposure to various oxidizing agents; however, data remain limited in Asia, including Thailand, where certain drugs and agricultural chemicals are widely used. Local epidemiologic data are essential for early recognition and clinical management. METHODS:A 10-year retrospective cohort study of poison center - identified cases of acquired methemoglobinemia (2013-2022). Patients were included if they had a methemoglobinemia (concentration >3%) or a characteristic oxygen saturation gap with subsequent clinical recovery. Demographic, exposure, clinical, treatment, and outcome data were collected, and factors associated with mortality were analyzed using a multivariate binary regression model. RESULTS:Among 169 patients (median age 43 years; 59.17% male), the leading causes were dapsone (30.18%) and propanil (27.22%), followed by herbal and food-related agents. In some patients (19.53%), the specific oxidizing agents could not be identified. Neurological, cardiovascular, and hematologic manifestations occurred in 24.26%, 33.73%, and 40.24% of cases, respectively. The median and highest methemoglobin concentrations were 11.50% and 48.85%. Most patients (88.76%) were hospitalized, with 40.24% requiring admission to the intensive care unit. Treatments included administering oxygen (95.86%), intravenous fluids (81.07%), and methylthioninium chloride (31.36%; median dose: 1 mg/kg), as well as blood transfusion (43.20%) and intubation (33.73%). Complications occurred in 29.59% of cases, most commonly sepsis and pneumonia. The mortality rate was 11.24%. DISCUSSION:Mortality was driven not only by the severity of methemoglobinemia but also by systemic complications that occurred during hospitalization. Shock at presentation was the sole prognostic factor and likely reflected severe concurrent complications rather than a direct effect of methemoglobinemia, emphasizing the prognostic importance of early systemic illness. Early recognition, prompt resuscitation, and timely management of complications are essential for improving survival rates. CONCLUSIONS:Acquired methemoglobinemia is most often caused by dapsone and propanil. Shock at presentation may prognosticate a fatal outcome. Early diagnosis, timely therapy, and aggressive management of systemic complications are required to improve the patients' clinical outcomes.

Objectives: To determine the correlation between 6-minute walk distance (6MWD) and severity of airflow limitation as well as modified Medical Research Council (mMRC) dyspnea score in Chronic obstructive pulmonary disease (COPD) patients Study design: Retrospective study Setting: Outpatient Rehabilitation Clinic, Trang Hospital. Subjects: Patients diagnosed with COPD who completed the 6-minute walk test (6MWT) between January 1, 2022 and December 31, 2023. Methods: The patients’ baseline characteristics were obtained from medical records. The Forced Expiratory Volume in one second (FEV1), 6MWD, and mMRC dyspnea scores were collected and analyzed. Results: One hundred and ninety-seven patients with COPD were recruited, of whom 91.9% were male. The average 6MWD was 403.4 meters (SD=78.4). Half the patients had moderate COPD. The majority of the patients had an mMRC dyspnea score of 1. There was a weak positive correlation between 6MWD and FEV1 (r = 0.299, p < 0.001) and a weak negative correlation between 6MWD and mMRC dyspnea score (r = -0.266, p < 0.001). However, there was a strong negative correlation between 6MWD and the mMRC dyspnea score (r = -0.727, p < 0.05) in patients with very severe degree COPD. Conclusions: The study showed a significant weak correlation between 6MWD and FEV1 as well as 6MWD and mMRC dyspnea score. However, in patients with very severe COPD, the correlation between 6MWD and mMRC dyspnea score was stronger than in others. This suggests that 6MWT and mMRC dyspnea score should be routinely evaluated in patients with COPD to monitor clinical change.

Objectives: To compare the effects of the five-point hands free (FPHF) exercise program and standard eye exercises on computer vision syndrome (CVS) and vestibulo-ocular symptoms among Trang Hospital staff. Study design: A prospective, comparative, cluster-randomized study Setting: Trang Hospital, Trang, Thailand Subjects: Sixty-two office workers with CVS symptoms Methods: Participants were divided into a standard exercise group (n=31) and a FPHF group (n=31). CVS symptoms were assessed using the CVS questionnaire. Vestibular ocular motor function was evaluated using the Vestibular/Ocular Motor Screening (VOMS) tool before and after a 3-week intervention. Results: After three weeks, both the FPHF and the standard group improved CVS and VOMS scores. The FPHF group had a reduction in almost all symptoms, similar to the standard group. The FPHF group significantly reduced headaches, dizziness, and fogginess during VOMS (p < 0.05). However, between-group differences in CVS and VOMS cumulative scores were not statistically significant. Conclusions: The FPHF program demonstrated potential benefits in reducing CVS and vestibulo-ocular symptoms, suggesting that it may be a viable alternative intervention for managing CVS. However, further research is needed to establish its long-term effectiveness compared to standard exercises.

This study is a cross-sectional survey aimed at examining the factors influencing smoking behavior among hospital personnel in Trang Province. The study population consisted of personnel working in a hospital in Trang Province. A sample of 344 individuals was obtained through stratified random sampling, proportional to the personnel distribution based on job position and work characteristics within the hospital. The research instrument was a questionnaire. Data were analyzed using percentages, means, standard deviations, the Chi-square test, and multiple logistic regression. The study found that the majority of the samples (86.34%) did not engage in smoking behavior. Several risk factors influenced smoking among hospital personnel. Males were approximately 54 times more likely to smoke than females (95% CI = 11.03 - 266.04). Those with an education level of junior high school or lower had a 10.07 times higher likelihood of smoking compared to those with a bachelor's degree or higher (95% CI = 2.12 - 47.57). Individuals whose income was just sufficient to cover expenses were about 3 times more likely to smoke than those with insufficient income and debt (95% CI = 1.101 - 9.25). Having friends who smoked increased the likelihood of smoking by approximately 6 times compared to those without friends who smoked (95% CI = 1.52 - 24.05). Additionally, for every one-unit increase in overall attitude score, smoking behavior decreased by 12%. The study found that addressing smoking behavior among hospital personnel relied on strategies aimed at changing attitudes toward smoking among those who continued to smoke. Additionally, providing education and raising awareness about the dangers of smoking and its impact on those around them were key approaches to encouraging behavior change.