Phetchabun Medical Journal

Association of BI-RADS Category 4 Subcategories and Breast Imaging Findings with Pathological Outcomes among Patients at Phetchabun Hospital, Phetchabun Province, Thailand

2026-06-02T12:17:30+07:00

Breast cancer remains an important public health problem, and breast imaging plays a key role in evaluating lesions suspected of malignancy, particularly BI-RADS category 4 lesions, which carry varying probabilities of malignancy according to their subcategories. This retrospective analytical study aimed to determine the proportion of malignant pathological outcomes, examine the association between BI-RADS category 4 subcategories and breast imaging findings with pathological outcomes, and assess the positive predictive value of BI-RADS 4A, 4B, and 4C among patients at Phetchabun Hospital. Data were collected from medical records, breast imaging reports, pathology reports, and the hospital medical database between 2017 and 2024. The study included 128 patients who underwent mammography and breast ultrasound, were classified as BI-RADS category 4, and had pathological confirmation. Data were analyzed using descriptive statistics, Chi-square test or Fisher’s exact test, Mann–Whitney U test, Kappa statistic, and odds ratios with 95% confidence intervals. The mean age of patients was 52.5 ± 10.4 years. Malignant pathological outcomes were found in 51.6% of patients, with invasive ductal carcinoma being the most common subtype. BI-RADS category 4 subcategories were significantly associated with pathological outcomes (p <0.001). The positive predictive values of BI-RADS 4A, 4B, and 4C were 30.4%, 37.0%, and 76.4%, respectively. The agreement between BI-RADS subcategories and pathological outcomes was fair, with a Kappa value of 0.302. Breast ultrasound findings significantly associated with malignancy included irregular shape, non-parallel orientation, and not circumscribed margin, whereas most mammographic findings were not significantly associated with malignancy. These findings support the use of BI-RADS category 4 subcategories together with key breast ultrasound features to assist in risk assessment and planning for pathological confirmation in patients with suspicious breast lesions.

Prevalence of Abnormal Cervical Cells among Women Undergoing Cervical Cancer Screening with HPV DNA Testing in Phon District, Khon Kaen Province

2026-07-21T09:10:08+07:00

Cervical cancer screening, combined with appropriate treatment of precancerous lesions, is an effective and cost-effective strategy for reducing the incidence of cervical cancer. Thailand currently uses HPV DNA testing for cervical cancer screening. However, up-to-date data on the prevalence of cervical cytological abnormalities in individual geographic areas remain limited. Therefore, this study aimed to evaluate the prevalence of high-risk HPV infection and its genotypes, as well as the prevalence of detected abnormal cervical lesions, and to classify the types of abnormal cervical cells found among women undergoing cervical cancer screening via HPV DNA testing in Phon District, Khon Kaen Province. This retrospective cross-sectional study collected data from women who underwent HPV DNA screening in Phon District between October 2022 and September 2024. From an initial sample of 1,939 cases, 1,885 women met the inclusion criteria. The research instruments included data recording forms for HPV DNA, cytology, and pathology results. The results revealed an overall prevalence of HR-HPV infection of 7.43% (95% CI: 6.24 - 8.61) and a prevalence of detected abnormal cervical cells of 2.81% (95% CI: 2.07 - 3.56). The HPV non-16/18 genotypes were the most frequently detected (110 cases); however, abnormal cervical cells were found in only 30.00% of these cases. In contrast, women testing positive for HPV 16 and 18 exhibited a high proportion of abnormal cells at 68.42% and 63.64%, respectively. HR-HPV infection was inversely associated with age; younger women (30–39 years) had the highest infection prevalence at 12.50%, and the infection rate significantly decreased with advancing age (p < 0.001). Furthermore, the infection rate among pre-menopausal women (8.65%) was significantly higher than that in post-menopausal women (5.80%) (p = 0.025). Data regarding the prevalence of abnormal cervical cells can facilitate the planning of expanded cervical cancer screening programs and the management of resources for patients requiring colposcopy in the area.

Determination of Radiographic Exposure Parameters Based on Chest Thickness for Mobile Chest Radiography in Pediatric Patients at Phetchabun Hospital

2026-03-16T09:57:24+07:00

This prospective analytical study aimed to determine the Exposure Index (EI), Deviation Index (DI), and Entrance Surface Air Kerma (ESAK), evaluate the appropriateness of EI, DI, and ESAK, investigate the relationships between chest thickness and radiographic exposure parameters, and develop predictive equations for kilovoltage peak (kVp) and milliampere-second (mAs) based on chest thickness in pediatric mobile chest radiography. A total of 106 pediatric inpatients aged 1–14 years who underwent mobile chest radiography at Phetchabun Hospital between June and September 2025 were enrolled. Chest thickness, kVp, mAs, EI, DI, and ESAK were collected and analyzed using descriptive statistics, Chi-square test, and simple linear regression. The mean EI, DI, and ESAK were 377.9 ± 249.0, −0.05 ± 3.2, and 0.08 ± 0.07 mGy, respectively. EI and DI were outside the recommended ranges in 56.6% and 60.4% of patients, respectively, whereas 62.3% of patients had ESAK values within the Thai National Diagnostic Reference
Levels. Chest thickness was significantly and positively associated with kVp, mAs, and ESAK (p < 0.001). The predictive equations were kVp = 54.378 + 1.016 × chest thickness (cm) and mAs = 0.455 + 0.117 × chest thickness (cm). These findings indicate that chest thickness is a useful predictor of radiographic exposure parameters and may be applied to develop an exposure chart for pediatric mobile chest radiography, thereby reducing variation in exposure parameter selection and promoting radiation dose optimization according to the ALARA principle.

Outcomes of Palliative Care and Caregiver Satisfaction in a Palliative Care Ward at Phetchabun Hospital

2026-08-25T15:02:26+07:00

This study aimed to describe the clinical characteristics and outcomes of palliative care, assess changes in pain scores among end-of-life patients, and evaluate caregiver satisfaction with palliative care services at Phetchabun Hospital. A retrospective study was conducted among 168 end-of-life patients admitted between July 1 and December 31, 2025, and 40 key caregivers. Data on clinical characteristics, symptom management, family meetings, advance care planning (ACP), pain scores, length of hospital stay, and discharge outcomes were collected and analyzed using descriptive statistics, paired t-test, and independent t-test. The mean patient age was 65.4 years; 54.2% were male and 55.4% had non-cancer diagnoses. All patients received morphine and participated in family meetings with ACP (100.0%), while 13.1% received midazolam. In-hospital mortality was 64.3%, and the mean length of stay was 5.4 days. The mean pain score decreased significantly from 6.4 at admission to 6.1 before discharge or death (p=0.01). A significant reduction was observed among patients with cancer, but not among those with non-cancer diagnoses. Caregiver satisfaction was very high overall (mean=4.6, S.D.=0.4), with information provision and communication receiving the highest score (mean=4.7, S.D.=0.4). The findings indicate that the palliative care ward provided comprehensive care and was associated with reduced pain and high caregiver satisfaction, providing useful information for further service development.

Nursing Care for Patients with Leptospirosis and Acute Kidney Injury Requiring Hemodialysis: 2 Case Studies

2026-05-28T10:44:03+07:00

Leptospirosis is an infectious disease that can cause acute kidney injury (AKI), a critical condition affecting multiple organ systems and potentially requiring renal replacement therapy with hemodialysis. This comparative case study aimed to examine nursing care approaches for two patients with leptospirosis-associated AKI who underwent hemodialysis and were admitted to the intermediate medical care unit at Songkhla Hospital during 2023–2024. Data were collected from medical records, patient and family interviews, clinical observations, laboratory investigations, and treatment plans, and were analyzed using the nursing process framework. The findings revealed that both patients developed severe infection with AKI requiring hemodialysis. However, the second case presented with greater disease severity and clinical complexity, including respiratory failure, hyperkalemia, and severe metabolic acidosis, requiring intensive respiratory care and close monitoring of acid–base balance and electrolyte disturbances. In contrast, the first case showed better renal recovery and was able to discontinue hemodialysis before discharge. Nursing care in both cases emphasized continuous care throughout the critical phase, continuing care phase, and discharge planning phase. Rapid patient assessment, close monitoring for complications, and systematic nursing management played important roles in reducing complications and improving nursing outcomes.