Phetchabun Medical Journal

Malignant Struma Ovarii with a Small Occult Carcinoma Hidden within Thyroid-Like Tissue: A case Report in a 58-year-Old Thai Woman

Thararat Prasanwong — 2026-05-15

A 58-year-old Thai woman with symptomatic ovarian mass is reported herewith to highlight the diagnostic pitfalls of malignant struma ovarii, particularly the follicular variant papillary thyroid carcinoma (FVPTC)—an exceptionally rare subtype. She was found to have bilateral mature cystic teratomas with only focal papillary carcinoma hidden within struma ovarii tissue in the right ovary. The key to reaching the correct diagnosis lies in a meticulous search for a cancerous lesion that could explain the markedly elevated CA-125 level (1,251 IU/mL), which was disproportionate to the tumor size and benign-appearing imaging. The diagnostic challenge in this case is threefold: First, the malignant focus was minute and easily missed during routine sampling. Second, FVPTC exhibits follicular architecture mimicking benign thyroid tissue, where malignant criteria rely solely on subtle nuclear features (ground-glass chromatin, nuclear grooves, and pseudoinclusions) without papillary structures—requiring expertise to recognize. Third, systematic thyroid evaluation was essential to exclude metastatic thyroid carcinoma and confirm primary ovarian origin. An important management dilemma arose: treatment selection between thyroid cancer protocols (radioactive iodine) versus ovarian cancer protocols (chemotherapy). We opted for carboplatin-paclitaxel based on ovarian surface involvement, achieving excellent 4-year disease-free outcome. This case emphasizes critical lessons: exhaustive sampling when CA-125 is inexplicably elevated, mandatory recognition of FVPTC nuclear features, importance of excluding primary thyroid disease, and individualized treatment approach in this rare entity where standard guidelines are lacking.

Nursing Care for Patients with Guillain-Barré Syndrome Requiring Mechanical Ventilation during the Rehabilitation Phase and Continuous Home Care: A Comparative Case Study of Two Cases

Supanee Nilsa-ard — 2026-05-15

Guillain-Barré syndrome (GBS) is an immune-mediated disorder affecting the peripheral nervous system, resulting in progressive muscle weakness that may advance to paralysis and, in severe cases, respiratory failure requiring mechanical ventilation. Nursing care for patients with GBS who remain ventilator-dependent during the rehabilitation phase and continuing home care is therefore crucial for recovery and quality of life. This study aimed to compare nursing care in two patients with GBS requiring mechanical ventilation during rehabilitation and continuing home care. A comparative case study design was used. Data were collected from medical records and direct observation, and were analyzed by comparing pathophysiology, risk factors, clinical manifestations, treatment, and nursing diagnoses. The findings showed that Case 1 was a 48-year-old Thai man diagnosed with GBS with respiratory failure, whereas Case 2 was a 36-year-old Thai woman diagnosed with septic shock with acute respiratory distress syndrome (ARDS) and GBS. Although both patients had similar underlying pathophysiology, Case 2 was more severe and clinically complex because of concomitant ARDS and septic shock, which increased the complexity of respiratory management and rehabilitation. Nursing care in both cases focused on three phases: the acute phase, the rehabilitation phase, and the rehabilitation phase with continuing home care, particularly respiratory care, tracheostomy care, functional rehabilitation, and caregiver preparation before discharge. In conclusion, continuing home care is a key component of nursing care for ventilator-dependent patients with GBS. Caregiver preparation, ongoing rehabilitation, and regular home visits can help reduce complications and promote effective recovery.

Factors Associated with Early Mortality within 48 Hours among Deceased Patients with Community-Acquired Pneumonia at Lomkao Crown Prince Hospital, Phetchabun, Thailand

Suphitcha Sanyasamut — 2026-05-15

Community-acquired pneumonia (CAP) is a major cause of hospitalization and mortality, particularly during the early phase after admission. However, data regarding factors associated with early mortality within 48 hours remain limited. This study aimed to determine the case fatality rate and identify factors associated with early mortality within 48 hours among patients with CAP at Lom Kao Crown Prince Hospital. A retrospective cohort study was conducted by reviewing medical records of deceased CAP patients between April 1, 2018, and April 30, 2025. Data collected included demographic characteristics, clinical parameters at admission, laboratory findings, and treatment-related variables. Descriptive statistics and both univariate and multivariate logistic regression analyses were performed, with statistical significance defined as p < 0.05. The overall case fatality rate was 10.7%. Multivariate analysis demonstrated that tachypnea (respiratory rate >25 breaths per minute) and severe metabolic acidosis (pH <7.20) were significantly associated with early mortality within 48 hours, with adjusted odds ratios of 10.99 (95% CI: 1.95–61.95; p = 0.007) and 14.39 (95% CI: 3.78–54.82; p < 0.001), respectively. These findings suggest that tachypnea and severe metabolic acidosis may serve as early warning indicators for high-risk patients with CAP, supporting timely risk stratification and clinical management. Future prospective cohort studies are warranted to validate these findings and enhance the robustness of the evidence.

Effectiveness of a Nutritional Care Program on Hospitalized Pulmonary Tuberculosis Patients in Phetchabun Hospital

Natthida Rangsikanphum — 2026-05-15

Pulmonary tuberculosis remains a major public health problem in Thailand, with malnutrition being a key risk factor for mortality and treatment failure. This quasi-experimental two-group pretest–posttest study aimed to evaluate the effectiveness of a nutritional care program on body weight, body mass index, and nutritional status, and to compare these outcomes and sputum conversion with usual care. A total of 92 patients admitted to an isolation ward at Phetchabun Hospital were equally assigned to experimental and control groups (n=46 each) and followed for 2 months after discharge. Data were collected using the SPENT Nutrition Screening Tool, Nutritional Alert Form, and outcome assessment forms, and analyzed using Chi-square test, Fisher’s exact test, independent t-test, Paired t-test, and McNemar’s test. After 2 months, the experimental group showed significant increases in body weight (45.72 ± 8.33 to 48.86 ± 7.83 kg) and body mass index (17.33 ± 3.54 to 18.50 ± 3.41 kg/m²) (p < 0.001), along with improved nutritional status (p < 0.001), while the control group showed a significant decrease in body weight (p = 0.002). Between-group comparison demonstrated a significantly greater increase in body mass index (+1.09 ± 1.05 vs −0.36 ± 1.15 kg/m²; p < 0.001) and a higher proportion of improved nutritional status (p = 0.02) in the experimental group. No significant difference in sputum conversion was observed (p = 0.35). The nutritional care program effectively improves nutritional outcomes and should be integrated into multidisciplinary care.

Health Effects of Methamphetamine Used in Pregnant Women and Newborn in Sukhothai Hospital, Thailand

Preecha Pinyopornpanit — 2026-05-20

Methamphetamine use during pregnancy is an important public health concern because of its adverse effects on maternal and neonatal health. This study aimed to investigate maternal health outcomes among pregnant women with positive urine amphetamine screening, examine neonatal outcomes, compare outcomes between women with positive and negative urine amphetamine results, and provide recommendations for improving the care system. A matched case–control study with a 1:1 ratio was conducted among pregnant women attending antenatal care or delivery services at Sukhothai Hospital in 2024. The case group consisted of 17 pregnant women with positive urine methamphetamine results, and the control group included 17 pregnant women with negative results, matched by maternal age. Data were analyzed using descriptive statistics and odds ratios (ORs) with 95% confidence intervals (CIs). The median age was similar between groups: 30 years (IQR 25–36) in the case group and 29 years (IQR 22–37) in the control group. Women in the case group were more likely to initiate antenatal care within the first 12 weeks of gestation. Maternal complications in the case group included anemia in 8 women and pregnancy-induced hypertension in 2 women. Neonatal outcomes included 4 preterm births and 4 infants with birth weight below 2,500 grams. Women with positive methamphetamine screening had a significantly higher risk of anemia than controls (OR = 6.67; 95% CI: 1.15–38.59; p = 0.02). Higher odds of pregnancy-induced hypertension, cesarean delivery, preterm birth, and low birth weight were also observed in the exposed group, although these associations were not statistically significant. In conclusion, methamphetamine use during pregnancy was associated with adverse maternal and neonatal outcomes, particularly maternal anemia, and may increase the risk of other pregnancy complications. Comprehensive multidisciplinary screening, treatment, and continuity of care from antenatal to postpartum periods are recommended.