Blog
993 posts on clinical medicine, epidemiology, research methodology, statistics and code — in English and Thai. Filter by category and language, or search.
เพศสัมพันธ์ การช่วยตัวเอง ADHD และ early BPH: อะไรปลอดภัย และอะไรคือสัญญาณเตือน?
บทนำ เพศสัมพันธ์และการช่วยตัวเองเป็นพฤติกรรมทางเพศที่พบได้ทั่วไปในมนุษย์ สำหรับคนส่วนใหญ่ สิ่งเหล่านี้ ไม่เป็นอันตราย และ ไม่ได้เป็นสาเหตุของ ADHD หรือ benign prostatic hyperplasia (BPH) ประเด็นสำคัญทางคลินิกไม่ใช่คำถามว่า “ทำบ่อยแค่ไหนถึงมากเกินไป?” แต่ควรถามว่า: พฤติกรรมนั้นยังควบคุมได้หรือไม่? ไม่มีอาการเจ็บหรือไม่? และไม่ได้รบกวนชีวิตประจำวันหรือสุขภาพทางเดินปัสสาวะหรือไม่? สำหรับผู้ชายที่มี ADHD และ early BPH การมีเพศสัมพันธ์และการช่วยตัวเองโดยทั่วไปถือว่าปลอดภัย...
Sex, Masturbation, ADHD, and Early BPH: What Is Safe and What Is a Warning Sign?
Introduction Sex and masturbation are common parts of human sexual behavior. For most people, they are not harmful and do not cause ADHD or benign prostatic hyperplasia (BPH). The important clinical question is not “How many times is too much?” but rather: Is it controlled, painless, and not interfering with life or urinary health? For a male with ADHD and early BPH, sex and masturbation are generally safe when they do not cause pain, urinary worsening, compulsive behavior, or functional...
Warfarin/DOAC vs Aspirin: เหตุใดผู้ป่วย Stroke บางรายได้รับยาต่างกัน
แนวคิดหลัก ความสับสนเกิดขึ้นเพราะคำว่า "มีประวัติ stroke" ไม่ได้หมายความว่าผู้ป่วยทุกคนต้องได้รับยาป้องกันชนิดเดียวกัน ผู้ป่วย 2 รายอาจมีประวัติ ischemic stroke เหมือนกัน แต่ สาเหตุของ stroke อาจต่างกัน ✅ ประวัติเหมือนกัน: ischemic stroke ❌ กลไกไม่จำเป็นต้องเหมือนกัน: AF embolus vs atherosclerotic platelet clot ✅ ดังนั้นยาป้องกันจึงไม่จำเป็นต้องเหมือนกัน: anticoagulant vs antiplatelet หลักสำคัญคือ การป้องกัน stroke ซ้ำต้องดูว่า stroke ครั้งก่อนเกิดจากอะไร แนวทาง AHA/ASA ด้าน secondary stroke...
Warfarin/DOAC vs Aspirin: Why Stroke Patients Receive Different Blood Thinners
Core idea The confusion happens because "stroke history" is not one single treatment category. Two patients may both have a history of ischemic stroke, but the cause of the stroke may be different. ✅ Same history: ischemic stroke ❌ Not always same mechanism: AF embolus vs atherosclerotic platelet clot ✅ Therefore, not always same prevention drug: anticoagulant vs antiplatelet AHA/ASA secondary stroke prevention guidance emphasizes that prevention should be based on the cause of the first...
Community-Acquired Pneumonia (CAP): Severity Assessment, Antibiotic Selection, and ICU Management
1️⃣ SITE OF CARE CURB-65 Decision 0–1 ✅ OPD 2 ✅ IPD ≥3 🚨 ICU eval 2️⃣ OPD MANAGEMENT Patient Antibiotic Healthy Amoxicillin 1 g tid OR Doxy 100 mg bid Comorbidity Augmentin + Azithro/Doxy Thailand note ❌ Avoid FQ mono (TB risk) 3️⃣ IPD (WARD) Severity Antibiotic Non-severe Ceftriaxone + Azithromycin Alternative Amp/Sulbactam + Macrolide 4️⃣ ICU (SEVERE CAP) Rule Regimen 🔥 Always combo β-lactam + macrolide Example Ceftriaxone + Azithro 5️⃣ ADD-ON COVERAGE Condition Add MRSA risk Vancomycin /...
Non-Occlusive Mesenteric Ischemia (NOMI): Diagnosis, ICU Management, and Clinical Pitfalls
Introduction Non-occlusive mesenteric ischemia, or NOMI, is a life-threatening form of acute mesenteric ischemia in which the bowel becomes ischemic without an obstructing thrombus or embolus in the mesenteric vessels. The core problem is low intestinal blood flow, usually from shock, severe cardiac dysfunction, hypovolemia, sepsis, or excessive vasoconstriction from vasopressors. The World Society of Emergency Surgery describes NOMI as a condition commonly caused by superior mesenteric...
Marked Troponin Elevation with Normal ECG: A Practical Article on Type 2 MI and Myocardial Injury
Case: “Ms. A” Ms. A presented with shoulder pain for 2 days. Her initial ECG looked normal, with no ST elevation. She did not have active chest pain at the time of reassessment and clinically looked well. However, her laboratory results were striking: Troponin I: 56 → 54 WBC: 18,000 BUN: 27 Creatinine: 0.6 CXR: normal lungs, mild cardiomegaly Serial ECG: completely normal At first glance, this creates a difficult clinical question: Is this NSTEMI, Type 2 MI, myocarditis, pulmonary embolism,...
Epstein–Barr Virus (EBV): Pathophysiology, Infectious Mononucleosis, and Management
Introduction Epstein–Barr Virus (EBV) is a double-stranded DNA virus from the Herpesviridae family (HHV-4). It is one of the most common human viruses worldwide and is the primary cause of infectious mononucleosis (IM). 💡 High-yield fact (exam): EBV = “Kissing disease” → transmitted via saliva → infects B cells → triggers reactive CD8+ T cells (atypical lymphocytes) EBV is normally found in which patients? ✅ 1. Age group (MOST IMPORTANT) Adolescents & young adults (15–25 years)👉 This group...
Vibrio cholerae (Cholera): Pathophysiology, Diagnosis, and WHO-Recommended Treatment
✅ First-line (WHO / CDC guidelines) 1. Doxycycline (preferred in adults) Doxycycline (300 mg), single dose, po ✔️ First-line in adults ✔️ Reduces duration of diarrhea and bacterial shedding 2. Azithromycin (preferred in children & pregnant women) Azithromycin (1 g), single dose, po (adult) Children: 20 mg/kg single dose ✔️ Safe in pregnancy ✔️ Good for areas with tetracycline resistance 3. Ciprofloxacin (alternative) Ciprofloxacin (1 g), single dose, po OR Ciprofloxacin (500 mg), 1×2 po, for...
Hiccups (Singultus): Pathophysiology and Clinical Management
Introduction Hiccups (singultus) are involuntary, repetitive contractions of the diaphragm and intercostal muscles , followed by sudden closure of the glottis, producing the characteristic “hic” sound. While most cases are benign and self-limited, persistent (>48 hours) or intractable (>1 month) hiccups may indicate serious underlying pathology and require systematic evaluation and management. Pathophysiology of Hiccups The Hiccup Reflex Arc Hiccups occur due to dysfunction in a reflex arc ,...
Alcohol Intoxication (เมาเหล้า เมาสุรา) Management: ER Approach, Red Flags, and Safe Discharge Criteria
📄 ER Order Sheet: Suspected Alcohol Intoxication 🧾 Initial Orders DTX (capillary blood glucose) – stat Vital signs monitoring Observe in ER (serial mental status + airway monitoring) 💉 Medications Thiamine 100 mg IV stat OR Vitamin B complex (containing thiamine 100 mg) IV stat 💧 IV Fluids (ONLY if indicated) 0.9% NSS 1000 mL IV Rate: 80–100 mL/hr OR adjust based on clinical status Indication: dehydration / vomiting / poor oral intake 🧪 Labs (ONLY if clinically indicated) (Do NOT send...
Tonsillitis Management: Practical Step-Up Approach from OPD to Emergency
Tonsillitis Management Sheet Situation Setting Key findings Treatment Follow-up / next step Likely viral tonsillitis OPD mild sore throat, cough/rhinorrhea present, able to swallow, no red flags No antibiotic . Supportive care: Paracetamol (500 mg), 1–2 tab po q6h prn , warm saline gargle, hydration, rest Return if worse, high fever, cannot swallow, unilateral swelling Likely bacterial tonsillitis (GAS pattern) OPD fever, tonsillar exudate, tender anterior cervical nodes, no cough, able to...
Fingernail vs Toenail Onychomycosis: Diagnosis, Treatment & Key Differences
Focus: Fingernail vs Toenail 1) Diagnosis Onychomycosis = fungal infection of the nail (dermatophytes most common) Clinical features Yellow / white discoloration Thickened nail Subungual debris Onycholysis (nail lifting) Starts distal → proximal Confirmation (IMPORTANT before long treatment) KOH preparation Fungal culture Nail clipping + PAS stain 👉 Exam pearl: Not every abnormal nail = fungus → confirm before oral antifungal 2) Pathophysiology Fungus invades nail bed → nail plate Uses...