Phetchabun Medical Journal

A Descriptive Study of the Clinical Practice Guideline and Patient Profiles of Chronic Obstructive Pulmonary Disease at Phetchabun Hospital

Techinphat Thansetthawanit — 2025-12-30

This study aimed to describe the actual clinical practices and general characteristics of patients with chronic obstructive pulmonary disease (COPD) attending Phetchabun Hospital. Data were collected through interviews with a multidisciplinary team and review of patient medical records in the COPD clinic, using a structured interview guide and data collection form. Data were analyzed using content and descriptive analyses. The COPD clinic operated as a multidisciplinary service, beginning with screening through history taking and risk factor assessment. Suspected COPD patients underwent pulmonary function testing, and those with post-bronchodilator FEV1/FVC < 0.7 were registered and followed up by the multidisciplinary team. Patients were assessed for dyspnea using the Modified Medical Research Council Dyspnea Scale (mMRC) and COPD Assessment Test (CAT), and evaluations included medication use, exacerbations, comorbidities, and smoking status. Physiotherapists conducted the Six-Minute Walk Test (6MWT) and provided pulmonary rehabilitation, including pursed-lip and diaphragmatic breathing, chest mobility exercises, muscle training, and endurance-enhancing exercise, supplemented with a home exercise guide. Between May 2015 and May 2023, 156 patients attended the clinic, most of whom were male (74.35%) and over 70 years old (52.56%). The majority had COPD for ≤5 years (60.26%) and no comorbidities (78.20%). The mean FEV1/FVC was 50.23±18.18, and disease severity was predominantly severe (41.08%). The mean CAT and mMRC scores were 8±6.56 and 1±0.76, respectively. Overall, 24.66% of patients participated in the 6MWT and received pulmonary rehabilitation. The findings reflected actual COPD care and provided essential information to support the development of more effective service models and clinical practice guidelines.

Diagnostic Performance of Ultrasonography with ACR TI-RADS in Thyroid Mass in Phetchabun Hospital

Phattarawan Jaimook — 2025-12-30

Current clinical practice guidelines recommend thyroid ultrasonography for all patients presenting with thyroid masses to assess malignancy risk and to guide the decision for Fine-Needle Aspiration (FNA). This study aimed to evaluate the diagnostic performance of thyroid ultrasonography reported according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in predicting thyroid malignancy, using cytopathological findings as the reference standard. A retrospective descriptive study was conducted among outpatients with thyroid masses at Phetchabun Hospital between June 1, 2018, and April 30, 2024. A total of 120 patients who underwent thyroid ultrasonography and had definitive cytopathological results from FNA were included. The majority of patients were female (93.3%), with a mean age of 51.8 ± 13.1 years. The diagnostic performance of ACR TI-RADS demonstrated a sensitivity of 100.0%, a specificity of 17.6%, a positive predictive value of 11.9%, a negative predictive value of 100.0%, and an overall accuracy of 25.8%. These findings indicate that thyroid ultrasonography using the ACR TI-RADS classification showed excellent sensitivity and negative predictive value for excluding malignancy in thyroid masses. In conclusion, ACR TI-RADS is an effective screening tool for differentiating malignant from benign thyroid masses and may contribute to reducing unnecessary FNA procedures in clinical practice.

Epithelioid Angiosarcoma Presenting as a Huge Cystic Mass in the Right Hemithorax: A Rare Case Report and Diagnostic Pitfall

Tanyasorn Sutthipongsupa — 2025-12-30

Epithelioid angiosarcoma (EAS) is a rare, highly aggressive vascular malignancy arising from endothelial cells, characterized by variable morphology and challenging diagnosis. Involvement of the chest wall or hemithorax was uncommon and posed diagnostic difficulties due to morphological heterogeneity and overlap with other epithelioid tumors. This case report described the clinical and histopathological features of a malignant vascular tumor occurring in the right hemithorax. Clinical data were collected from electronic medical records using the electronic public health information system (e-Phis) of Chonburi Hospital. The patient was a 42-year-old man who presented with right-sided chest pain and pleural effusion. Imaging revealed a large cystic and hemorrhagic lesion occupying the right hemithorax. The initial thoracotomy specimen demonstrated a fibrous-walled pseudocyst with organized hematoma and calcification, without evidence of malignancy. After a two-year follow-up, repeat biopsy revealed epithelioid cells with abundant amphophilic cytoplasm, vesicular pleomorphic nuclei, and prominent nucleoli, accompanied by hemorrhage, necrosis, and high mitotic activity. Immunohistochemistry showed diffuse positivity for CD31, CD34, FLI-1, AE1/AE3, Vimentin, and cytoplasmic WT1, and negativity for D2-40, calretinin, SALL4, and TTF-1, confirming high-grade EAS. After diagnosis, the patient deteriorated rapidly, and he died despite aggressive management. This case highlighted the diagnostic pitfalls of EAS presenting as a benign-appearing cystic lesion. Initial sampling may have miss the malignant component, delaying diagnosis. Thorough histopathological evaluation, repeat biopsy, and comprehensive immunohistochemistry were essential to distinguish EAS from morphologically similar epithelioid neoplasms. Early recognition and prompt pathological diagnosis were crucial, but prognosis remained poor even with aggressive management.

Nursing Care in Patients with Diabetes Mellitus and Diabetic Nephropathy: A Two-Case Report

Jeamadeena Pantoom — 2025-12-30

This study was conducted as a case study with the objective of applying the nursing process systematically to the nursing care of patients with diabetes mellitus and diabetic nephropathy. Patients were selected using purposive sampling. Data were collected from patients’ medical histories during hospitalization and assessed using Gordon’s 11 Functional Health Patterns to identify individual patient problems. The findings were then used to formulate nursing diagnoses, plan and implement nursing interventions, and summarize and evaluate nursing outcomes. The study reports two cases of patients with diabetes mellitus and diabetic nephropathy. Both patients were female, had hypertension as a comorbidity, and developed respiratory failure requiring endotracheal intubation. However, both patients lacked knowledge regarding complication surveillance and self-management and demonstrated inappropriate self-care behaviors, including dietary management, medication adherence, physical activity, and monitoring for disease-related complications. The findings highlight the importance of individualized and holistic nursing care, comprehensive patient assessment, and appropriate nursing care planning, which can help reduce complications, improve health outcomes, and serve as an effective guideline for the nursing care of patients with diabetes mellitus and diabetic nephropathy.