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Diabetic Retinopathy (DR)

Diabetic Retinopathy (DR) Diabetic retinopathy results from abnormalities related to sugar metabolism in the body, leading to higher than normal blood sugar levels. This affects various blood vessel systems in the body, such as those in the eyes, kidneys, and nervous system.   Diabetic retinopathy is caused by the body's long-term high blood sugar levels, which lead to damage to the tiny blood vessel walls in the eyes, causing blockages, swelling, leakage, bleeding spots, retinal swelling, and the growth of new, fragile blood vessels. This can eventually lead to blindness. There are two stages of diabetic retinopathy:   Early stage: Abnormalities are detected in the retina, with swollen blood vessel walls. This is followed by bleeding spots, leakage of lipoprotein substances, and retinal nerve fiber deprivation of blood supply. Retinal swelling may also be found. Advanced stage: New, fragile blood vessels are detected, which are prone to rupture and bleeding into the eye's vitreous fluid. Retinal detachment and eventual vision loss or blindness may occur due to tractional retinal detachment. If new blood vessels grow on the iris, it can obstruct the flow of fluid in the eye's anterior chamber, leading to increased eye pressure and neovascular glaucoma, which is difficult to treat and can cause blindness.   Treatment   Medication: Emphasis is placed on treating the underlying conditions of the patient. Patients must control their blood sugar levels, blood lipid levels, and blood pressure to prevent the progression of diabetic retinopathy. Laser treatment: Used for patients with retinal swelling or advanced-stage diabetic retinopathy with new blood vessels. Laser light is directly applied to the retina, causing the abnormal blood vessels to disappear and stopping the disease's progression. Some patients may require multiple laser treatments. Intraocular injections: Steroid and Anti-VEGF medications can be used to treat retinal swelling due to diabetes. The advantage is that vision may return to near-normal levels without damaging the retina, but the effect is temporary. Vitrectomy surgery: In severe cases with vitreous hemorrhage, tractional retinal detachment, or chronic macular edema unresponsive to laser treatment or injections, vitrectomy or retinal surgery may be required.   Self-care for diabetic patients to prevent blindness Diabetic patients should have regular eye exams with an ophthalmologist. Control diet and maintain blood sugar levels within the normal range, with a glycated hemoglobin (HbA1C) level of less than 7%. Manage high blood pressure to keep it within the normal range. Control blood lipid levels. Refrain from smoking. Engage in regular exercise, such as running, cycling, or swimming. Take medications as prescribed. Consult a doctor to better understand the disease. In conclusion, preventing diabetic retinopathy depends on the speed and consistency of treatment as well as controlling diet and blood sugar levels to prevent complications leading to blindness.

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Lifting

Lifting "Problems arising from skin sagging, such as drooping eyebrows and eyelids, sagging cheeks, lead to deeper nasolabial folds and under-eye bags. This is due to the weakening of the structural framework that helps to tighten the skin, combined with Earth's gravity pulling down every day, causing the face to sag."   1. Radiofrequency (RF) This is an energy wave from radio that transfers high heat to the deeper layer of the skin, stimulating collagen contraction and new collagen production. An example of this group is Thermage, which is one of the first versions and a prototype of radiofrequency devices. Later models use radiofrequency combined with lasers, which allow the heat to penetrate more superficially than Thermage, reducing the risk of damage to the deeper layers of the skin, but may have less lifting effect compared to Thermage.   However, skin tightening with radiofrequency may not provide as noticeable results as surgery. For instance, radiofrequency results in changes in millimeters rather than centimeters, as in surgery, which takes at least 4-6 weeks to see results and may not be effective for everyone. Particularly for those with more severe issues, surgery may be a better option.   2. Ultrasound Facelift High-intensity focused ultrasound (HIFU) is used, targeting the deep layers beneath the skin (SMAS: Superficial Muscular Aponeurotic System), which is adjacent to the muscle layer. This layer helps to prevent facial sagging. The heat applied will cause the tissue to tighten, lifting and tightening the sagging face, addressing drooping eyelids, tightening under-eye bags, and reshaping the face to be slimmer. The results gradually appear within 1-6 months after treatment.   Some lifting treatments may cause pain, requiring the application of an anesthetic before treatment. Before the procedure, avoid strong sunlight for about a week and avoid skin exfoliation, skin cell turnover, or other laser treatments for one to two weeks. Remove any metal jewelry (during radiofrequency treatments).   After treatment, the face may be slightly swollen and red for a few hours, after which makeup can be applied as usual. Avoid strong sunlight and high heat, such as saunas or hot yoga. Refrain from taking anti-inflammatory medications in the NSAIDs group, such as aspirin.   The results of treating skin sagging with radiofrequency Thermage and high-intensity focused ultrasound can last for years but can be painful and expensive compared to radiofrequency lasers, which cause less pain, are cheaper, but require multiple sessions, approximately 5-6 sessions, sparing one week between each session.

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Chronic Kidney Disease

Chronic Kidney Disease The kidneys are bean-shaped organs, about the size of a fist (150 grams) in a healthy person. There are two kidneys, located on either side of the spine, around the 12th rib.   Functions of the kidneys: Eliminating waste through urine; the kidneys can filter waste from the blood at a rate of about 120-125 ml per minute. Maintaining balance: Water balance Electrolyte balance Acid-base balance Helping to produce enzymes and hormones: Angiotensin Erythropoietin Vitamin D How to know when kidney function decreases: Feeling unwell due to an accumulation of waste in the blood Fatigue, confusion, nausea, and loss of appetite Anemia and easy exhaustion   Chronic kidney failure is a condition in which kidney function is impaired over a long period and progresses to end-stage renal disease (ESRD).   Kidney disease treatment methods Hemodialysis: blood purification using an artificial kidney machine CAPD (Continuous Ambulatory Peritoneal Dialysis): continuous peritoneal dialysis Kidney transplant surgery   Hemodialysis Blood is taken out of the body, passed through a filter in the artificial kidney machine to remove waste and excess water, and then returned to the body.   Advantages of hemodialysis   Quickly eliminates excess water and waste Allows for increased nutrition and medication delivery Lower risk of infection compared to peritoneal dialysis Convenient, fast, and efficient Requires a hemodialysis machine and an RO water system Must be performed in a hospital 2-3 times per week Requires blood-thinning medication Potential complications during the process, such as low blood pressure, headaches, cramps, etc.   Continuous Ambulatory Peritoneal Dialysis (CAPD) This method removes waste and excess water from the body by introducing fluid into the abdominal cavity. Blood vessels in the abdominal cavity absorb waste through the peritoneal membrane, which acts as a filter to exchange waste.   Advantages of CAPD Requires fewer personnel than hemodialysis Patients can eat all types of food Patients can walk and work normally, with full self-care capabilities Suitable for patients with heart disease and long-term diabetes Patients treated with this method usually do not have dark and dry skin like those treated with artificial kidney machines Can be performed at home Lower cost than hemodialysis Better residual kidney function Improved quality of life   Disadvantages of CAPD: Higher risk of abdominal infection Discomfort and bloating when fluid is in the abdomen   Nursing Pre-treatment: Administer medication according to the doctor's treatment plan. Ensure the patient's comfort, both physically and emotionally. Provide appropriate diet for the disease. During kidney replacement therapy: Administer medication according to the doctor's treatment plan. Provide nursing care based on symptoms. Monitor nutritional status.   Hemodialysis patients During treatment Complications can arise easily; nurses must provide close care. Measure vital signs every 15 minutes for 1 hour.   After treatment:   Monitor potential complications such as dizziness and fainting. Record vital signs periodically. Assess the level of discomfort. Weigh the patient and compare with pre-treatment weight. Check the needle insertion site for bleeding. If the patient experiences dizziness or fainting, report to the doctor.   Appropriate diet for chronic kidney disease patients undergoing dialysis:   Low-protein diet: 40 grams per day. Use egg whites and fish as protein sources. Avoid animal organs. Avoid animal fats and coconut milk. Avoid salty foods and limit water intake. Avoid fruits except on the mornings of dialysis days. Avoid high-phosphate foods such as seeds, fresh milk, butter, and egg yolks. Consume vitamin B complex, vitamin C, and folic acid. Take vitamin D as prescribed by the doctor.   Caring for CAPD patients: Care requires a team of doctors, nurses, and nutritionists to teach the patient or their relatives how to change the dialysis fluid. Maintain hygiene and cleanliness of the body. If the skin is dry, use lotion. Weigh the patient and measure blood pressure daily. Exercise according to individual capacity. The patient can eat all types of food.

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Psoriasis

Psoriasis Psoriasis is a chronic inflammatory skin disease, believed to result from a combination of genetic factors and abnormalities in the immune system. Various factors contribute to the development and triggering of the disease, such as scratching, friction, infections, or medications. Psoriasis affects approximately 2% of the global population. One in three patients may experience nail abnormalities and joint pain. The disease is most common in people aged 20-30 years and 50-60 years, affecting both men and women, with women developing it earlier.   Factors that trigger the disease include scratching, friction, pressure, infections, certain medications, pregnancy, alcohol consumption, and severe sunburn.   Clinical features Psoriasis presents as well-defined red patches with thick, silvery-white scales (silvery scale). The scales adhere quite firmly, and when removed, small bleeding points (Auspitz sign) may be visible. Rubbing the skin may induce new lesions in the area (Koebner's phenomenon). Commonly affected areas include the scalp, elbows, knees, buttocks, and shins. In severe cases, the rash may spread all over the body.   There are various forms of psoriasis. The most common form presents as thick, well-defined patches covered by firmly adhered white scales, which may be scattered all over the body, including the scalp and hairline. The size of the patches is variable.   Other types of lesions that may be seen include small, scattered (guttate) lesions, pustules, and rashes in body folds.   Nail abnormalities may include thickening of the nails (subungual hyperkeratosis), pitting, nail separation or detachment (distal onycholysis), and yellow discoloration (oil spot).   Some types of psoriasis may present with lesions in the mouth.   Joint pain occurs in 5-30% of chronic cases, often affecting the distal joints of the fingers or resembling rheumatoid arthritis.   Causes The exact cause is still unclear, but it is believed to result from a combination of genetic factors and external environmental triggers. This leads to a rapid cell division of skin cells, causing thickening and rapid shedding of skin cells, resulting in thick patches and abundant loose scales. Another contributing factor is the abnormality of T-lymphocyte white blood cells, which causes the release of various substances that lead to inflammation in the skin.   Treatment Psoriasis is a chronic disease with no cure, so the most important aspect of treatment is the patient's self-care to prevent or minimize flare-ups.   Factors that can worsen the disease include infections (such as bacterial infections of the upper respiratory tract), stress, certain medications (such as chloroquine, beta-blockers, alcohol, and lithium), scratching or rubbing, or skin wounds. Oral vitamin A derivatives, such as acitretin, may be used in conjunction with light therapy. When used alone, they are typically reserved for severe cases or those with pustular psoriasis. Significant side effects include dry, peeling skin, elevated blood lipid levels, and liver enzyme abnormalities. This drug is contraindicated for pregnant women and should not be used for at least two years after discontinuation before attempting pregnancy. Methotrexate is an effective and affordable treatment but has high side effects such as liver inflammation, elevated liver enzymes, and possible liver scarring. It is typically chosen for patients unresponsive to other treatments or safer alternatives. Therefore, blood tests should be performed regularly before, during, and after treatment. Cyclosporin is used for severe cases due to its side effects, such as high blood pressure, kidney, and liver inflammation. Other drugs: Currently, there are newer drug classes that show promising results, but they can be expensive and have side effects that still require further study and monitoring.   Since psoriasis is a chronic disease, medication use may sometimes cause side effects. Therefore, it is recommended to alternate medications periodically to avoid long-term side effects from using one drug consistently. In some cases, multiple drug classes may need to be combined, including topical and oral medications, to enhance treatment efficacy and reduce side effects.

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6 Ways to Keep Your Skin Moisturized Throughout the Winter

6 Ways to Keep Your Skin Moisturized Throughout the Winter   If your skin has maintained its beautiful, soft, and moisturized appearance throughout the past seasons, the arrival of winter may gradually strip away the moisture, leaving behind dry, flaky, and cracked skin. However, these 6 winter skincare tips we're sharing today can help preserve your skin's moisture and keep it looking beautiful all season long.   1. Avoid hot showers Stay away from hot or very warm showers, as the heat can strip away your skin's natural oils, leaving it dry and more prone to cracking. This is especially important for those with dry skin. If you really can't stand cold showers, adjust the water temperature to be slightly warm and limit your showers to no more than 15 minutes to help protect your skin from excessive dryness.   2. Limit skin exfoliation Reduce the frequency of skin exfoliation, as over-exfoliating can cause the outer skin layer to become thinner and more prone to cracking. If you usually exfoliate frequently, cut back to just once a week.   3. Moisturize with baby oil After showering, apply baby oil all over your body to lock in moisture and keep your skin extra hydrated.   4. Apply lotion immediately after showering After moisturizing your skin with baby oil, pat your skin dry and promptly apply a moisturizing lotion to both your face and body. This will keep your skin soft and moisturized throughout the day.   5. Massage with coconut oil Find some time to massage your body with coconut oil, especially if you have extremely dry skin. Simply apply a few drops of coconut oil and gently massage it into the dry areas. This method can also be used as an alternative to lotion.   6. Apply sunscreen daily Sunlight can not only darken your skin but also worsen dryness during the winter months. Before leaving home, don't forget to apply sunscreen with an SPF of 15-30 to help maintain your skin's moisture all day long.   To achieve healthy, soft, and moisturized skin during the winter, don't forget to pay attention to your diet. Consume nutrient-rich foods, particularly fruits and vegetables that are high in vitamins, and drink 8-10 glasses of clean water daily. These nutritious foods will help rejuvenate and nourish your skin, preventing dryness and premature aging during the winter months.   Best wishes from Vibhavadi Hospital

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10 Must-Visit Winter Destinations This Year

10 Must-Visit Winter Destinations This Year 10 Must-Visit Winter Destinations This Year Sometimes, it takes a bit of effort to find hidden beauty, but rest assured that it's worth it.   1. Doi Luang Chiang Dao: Located in the Chiang Dao Wildlife Sanctuary, Doi Chiang Dao is the highest peak of the Chiang Dao Mountain range. Known as Doi Luang Chiang Dao (meaning "as high as the stars"), it stands at 2,195 meters above sea level and is the third-highest peak in Thailand, after Doi Inthanon and Doi Pha Hom Pok. From the narrow flat summit, you can enjoy stunning panoramic views of the surrounding areas, including the sea of mist in Chiang Dao district, Doi Sam Phi Nong, the Chiang Dao mountain range, and the distant Doi Inthanon. The cool climate, strong winds, and abundant flora and fauna make this a must-visit destination. (Note: It's not suitable for large groups to stand on the summit, as it may damage the fragile vegetation). To access the area, you need to request permission from the Wildlife Conservation Division at least two weeks in advance. For more details, call +66 2561 2947. To reach Doi Chiang Dao, start at Chiang Dao Cave, where you can hire a local guide, porter, and transportation to the starting point. No facilities are available on Doi Chiang Dao, so visitors should bring their own sleeping gear, food, and water.   2. Khao Mokoju: Known for its cold climate, Khao Mokoju is the highest peak in the Mae Wong National Park and the highest in the western forest. At 1,964 meters above sea level, it's about 27 kilometers from the park office and takes 4-5 days for a round trip on foot. Despite the long and challenging journey, many travelers still make it their destination to create a once-in-a-lifetime memory.   The word "Mokoju" is from the Karen language and means "like it's about to rain," as the peak is often covered in mist and fog and has a cold climate. Those interested in experiencing Khao Mokoju should prepare for a physically demanding trek, as the incline is no less than 60 degrees and takes 5 days for a round trip. You'll need to camp in designated forest areas along the route. Additionally, study the trail conditions, weather, and contact park officials for guidance. The park allows treks to Khao Mokoju between November and February each year.   3. Phu Pa Poh, known as the "Thai Fuji," is located in Ban Pha Wai, Nong Hin District, Loei Province, within the Phu Kho-Phu Kradeung Wildlife Sanctuary. It is approximately 7 kilometers away from the beautiful Pha Hin Garden or Kun Ming of Thailand. The viewpoint on Phu Pa Poh is about 900 meters above sea level and offers four different viewing spots, each separated by about 200 meters.   4. Doi Pha Hom Pok, situated within Doi Pha Hom Pok National Park, is the second highest mountain in Thailand, with an elevation of approximately 2,285 meters above sea level. The summit features a vast plateau formed by shallow soil layers and granite bedrock, along with strong winds throughout the year. From the peak, visitors can enjoy stunning views, such as a sea of mist and a mountain road parallel to the Thai-Myanmar border, which was built for national security purposes. The forest environment consists of headwater forests and dense mountain forests, which are both diverse and ecologically balanced. Rare and interesting plant and animal species can be found here, such as Rhododendron, golden lotus, Kaiser-i-Hind butterfly, Doi Pha Hom Pok butterfly, white-dragontail butterfly, Talipot palm butterfly, Yellow-rumped flycatcher, and purple-winged roller, to name a few. During the winter, migratory birds such as Red-throated pipit, Gray-winged blackbird, and Chestnut thrush can be observed.   There are three routes to reach Doi Pha Hom Pok: Kiew Lom, Pang Mok, and the Mae Saw Headwater Management Unit. Tourists can set up camp at Kiew Lom, as camping on the summit is not permitted by the National Park due to the steep cliffs and potential danger. The hike to the summit covers a distance of about 3 kilometers and takes approximately 3 hours to complete both ascending and descending. Doi Pha Hom Pok National Park now allows visitors to drive pickup trucks up the mountain, but only before 3:30 PM. Sedans, vans, and buses are not allowed due to the rough terrain. If you do not have a vehicle, you can contact the park's visitor center for transportation services at Doi Pha Hom Pok National Park, 224 Moo 6, Pong Nam Ron Subdistrict, Fang District, Chiang Mai Province 50110, phone: 08 6430 9748, 0 5345 3517-8, fax: 0 5345 3517, email: [email protected].   5. Phu Soi Dao: Phu Soi Dao is located in Phu Soi Dao National Park and features high mountains along the Thai-Laos border with an elevation of 2,102 meters. The climate is cool and chilly almost year-round. The majority of the forest remains fertile, with large grasslands in areas that used to be farmland for the Hmong hill tribe. Attractions within the national park include pine forests, wildflower meadows, scenic cliff viewpoints, Sai Thip Waterfall, and Phu Soi Dao Waterfall. The three-leaf pine forest area is ideal for visiting during August-September, as you can witness sea mists and various wildflowers, especially the blooming Naga Creepers and wild orchids on the large branches. The journey from the base to the top is approximately 6.5 kilometers, with some steep sections, taking around 4-5 hours. There are designated tent sites and restroom facilities available. For more information, contact Phu Soi Dao National Park, Huay Mun Sub-district, Nam Pat District, Uttaradit Province 53110, Thailand. Telephone: +66 5543 6001-2   6. Mon Jong: Mon Jong is part of the Om Koi Wildlife Sanctuary, which covers areas in Om Koi District, Chiang Mai Province, and Sam Ngao District, Tak Province. The main attraction that draws nature lovers to Mon Jong is the presence of serow or celestial horses, as well as the stunning mountain scenery. If visiting between December and January, you can see the blossoming of the Thousand-year Rose, which is said to be the largest of its kind in Thailand. Doi Hua Sing is the highest peak in the area. The hike to Mon Jong can be done as a day trip, but it is quite tiring, requiring an early start at 06:30 at the latest. For a more leisurely pace, plan a 2-day, 1-night trip. Before hiking, obtain permission from the Om Koi Wildlife Sanctuary, Mu Sue Unit, where the sanctuary office is located. To get to the Om Koi Wildlife Sanctuary (Mu Sue Unit) from Chiang Mai, take Highway 108 and turn left at Hod District onto Highway 1099, which will lead you to Om Koi District. Continue on Highway 1099 for about 40 kilometers, and the Mu Sue Unit will be on your left. The remaining distance to the starting point of the hike is around 16 kilometers, requiring a four-wheel-drive vehicle and an experienced driver due to the rough, narrow, winding roads along the cliffs. Public transportation from Chiang Mai's city center is available at the Chang Phueak Bus Terminal to Om Koi, departing around 08:00. Mon Jong has no amenities, so if you plan to stay overnight, bring your own tent and food.   7. Phu Lom Lo is located in Kok Sathon subdistrict, Dansai district, Loei province, and is also a part of Phu Hin Rong Kla National Park, situated at the border of three provinces: Loei, Phetchabun, and Phitsanulok. The highest point, "Phu Lom Lo Peak," has an altitude of 1,680 meters above sea level, providing cool weather throughout the year. The highlight that attracts many visitors is the opportunity to see the largest number of blooming Nang Phaya Suea Khrong flowers in Thailand. In the past, Phu Lom Lo was a deforested mountain, but later, Phu Hin Rong Kla National Park developed the area and planted tens of thousands of Nang Phaya Suea Khrong trees on more than 1,200 acres. From December to January, the blooming Nang Phaya Suea Khrong flowers turn Phu Lom Lo into a beautiful pink paradise. For more information, visit the Facebook page of the Kok Sathon Tourism Promotion Association or contact them at 08 0791 4748 or 09 1373 0903.   8. Khao Luang National Park, an award-winning natural tourist attraction, covers eight districts in Nakhon Si Thammarat province and is considered one of the country's most important national parks with significant global biodiversity. More than 200 species of ferns have been discovered on Khao Luang, including ancient ferns like the water fern and the giant fern, which developed before the dinosaur era. The park is also known as the "ultimate southern orchid hub" with various orchids such as Tem's lion orchid, yellow-paddle leaf lion orchid, eyelash lion orchid, Srite's aerial orchid, and Kiriwong aerial orchid, among others. This forest is home to unique local flora and fauna, such as the Khao Luang thousand-year-old rose, the long-tailed green leaf-eater bird, and many more.   The highest peak in the southern region, Khao Luang, stands at 1,835 meters above sea level. The park offers various types of tourist attractions, including beautiful waterfalls such as Promlok waterfall, Aay Kiew waterfall, Karom waterfall, and Krung Ching waterfall. There are also several short and long nature trails for exploration. Adventurers should not miss the chance to conquer Khao Luang's peak during January to September, the most suitable time for the journey.   There’s only 8 places listed here…

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Dark Skin Spots from Melasma and Freckles

Dark Skin Spots from Melasma and Freckles Melasma and freckles are common issues that can affect both men and women, causing distress.   There are 3 types of freckles:   1. Seborrheic Keratosis Seborrheic keratosis is a brown, raised growth on the skin that can be large or small. The surface appears rough and usually affects older individuals. The frequency of occurrence varies with genetics. These growths are superficial and can be easily treated with carbon dioxide laser (CO2 Laser). After treatment, the area will scab for 4-7 days, depending on the depth of the growth. In people with darker skin or sun exposure, the treated area may have temporary light or dark spots. Other treatment methods include using electric current, liquid nitrogen, or acid. However, the cosmetic results of these methods may not be as good as laser treatment. After treatment, seborrheic keratosis can recur over time.   2. Superficial Dark Spots Freckles are small, well-defined brown spots that appear during adolescence, often in fair-skinned individuals. They tend to darken during sun exposure, such as during summer. Treatment includes using lasers, such as Q-switched Nd: YAG. After treatment, there may be temporary light spots, which usually do not recur. New spots may appear nearby if there is excessive sun exposure, and some spots can fade on their own.   Solar lentigines are age-related changes resulting from sun exposure (UV), often appearing on sun-exposed areas like cheeks, backs of hands, and arms. Treatment for superficial dark spots involves using lasers or intense pulsed light (IPL) targeting melanin granules. After treatment, scabs will form and peel off. If the spots are deep, repeated treatments may be necessary. After treatment, it is important to avoid intense sun exposure and use sunscreen to prevent dark spots from reappearing.   3. Deep Dark Spots Hori's Nevus appears as brown or gray spots or patches on the cheeks, caused by genetics. They are commonly found in women aged 20 and above, usually on both sides of the face. The color may intensify with age. Treatment with skin-lightening creams, chemical peels, or ablative lasers is typically ineffective.   Nevus of Ota usually appears at birth or during adolescence, presenting as brown or gray patches on one side of the cheek, temple, and forehead. Sometimes, the gray color may also appear on the white part of the eye.   Deep dark spots are difficult to treat and require a long treatment period using lasers with appropriate wavelengths to minimize damage to the top layer of skin and provide enough energy to destroy the pigment cells without harming surrounding tissue. Treatments are usually spaced 6-8 weeks apart, with more than 5 sessions typically required. Recurrence is possible after treatment. The treated area may have temporary scabs and light or dark spots. It is important to avoid intense sun exposure.   Lasers used for treatment include Q-switched Nd: YAG, Q-switched Alexandrite, and Q-switched Ruby.   Melasma   Melasma appears as light brown to dark brown or gray patches, depending on the depth, on both sides of the face. There are several factors causing melasma, including exposure to sunlight and heat, hormonal changes (such as pregnancy), intake of sex hormones, and genetics. Melasma treatment involves using topical medications in combination with oral intake, as well as treatments that facilitate the penetration of medication into the skin using electrical currents or sound waves, such as Ionto/Phonophoresis and Electroporation. Lasers targeting specific pigments can help fade melasma, but the results are better for superficial melasma cases. For deeper melasma, the treatment results are still uncertain. Fractional skin resurfacing lasers, such as Fraxel, fractional Erbium, and fractional CO2, are increasingly being used to treat stubborn melasma. The most important aspect of prevention and treatment is to avoid excessive sun exposure and to use sunscreen with an SPF greater than 30 and UVA PRO protection of more than 8, along with the application of medications.

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Paying Homage to Buddha at 9 Royal Temples (TAT)

Paying Homage to Buddha at 9 Royal Temples (TAT) "A good beginning is half the battle won." Based on this saying, the Tourism Authority of Thailand (TAT) has organized the "Paying Homage to Buddha at 9 Royal Temples" event for locals and tourists interested in visiting sacred sites for a peaceful and happy start according to Thai beliefs. Moreover, it is also an opportunity to learn about the value of important ancient sites on Rattanakosin Island and its surrounding areas.   The 9 Royal Temples are as follows:   1. Wat Kalayanamitr Varamahavihara Motto: Safe travels and good friendships Offerings: 3 incense sticks, 1 pair of red candles, flower garlands   History/Background: Wat Kalayanamitr Varamahavihara is a second-class royal temple founded by Chao Phraya Nikornbodin (Toh Kalayanamitr) who dedicated the land, formerly known as "Chinese Kudi Village." The temple was built in 1825 during the reign of King Rama III and was later designated as a royal temple, receiving the royal name "Wat Kalayanamitr." The main shrine was built to house the "Phra Phuttha Trairatnayok" (Luang Phor Toh) statue, which received a royal name from King Rama IV, or known in Chinese as "Cham Po Hud Kong" or "Cham Po Kong." Wat Kalayanamitr Varamahavihara is the only temple in Thailand with the principal Buddha statue in the "Pang Parilyayika" posture, located in the main chapel. Inside, there are mural paintings depicting the Buddha's life. Additionally, the temple houses the Dhamma Mandapa Theleng Phra Kiao Building, where Tripitaka and other religious texts are stored, constructed in 1845 by the royal command of King Rama IV.   How to get there: Wat Kalayanamitr Varamahavihara is located in Wat Kalayanamitr subdistrict, Thonburi district. You can take bus routes 40, 57, 149 or air-conditioned bus route 177. Alternatively, you can cross the Chao Phraya River by boat from Pak Khlong Talat pier to Wat Kalayanamitr pier.   2. Wat Chanasongkhram Ratchaworamahawihan Motto: Victory over all obstacles Offerings for the main Buddha statue in the chapel: 3 incense sticks, 1 candle, 1 lotus flower Offerings for the statue of Somdej Krom Phra Ratchawang Bowonmahasurasihan: 5 incense sticks, 1 candle, 1 lotus flower   History/Background: Wat Chanasongkhram Ratchaworamahawihan is a second-class royal temple built before the establishment of Rattanakosin era. Somdej Krom Phra Ratchawang Bowonmahasurasihan renovated the temple, and King Rama I later designated it as a royal commoner monks' temple to honor the common soldiers in the army of Somdej Krom Phra Ratchawang Bowonmahasurasihan. After achieving victory over the enemy army three times, the temple was granted the new royal name "Wat Chanasongkhram."   Directions: Wat Chana Songkhram Ratchaworamahawihan is located on Jakraphong Road, Bang Lamphu Sub-district, Phra Nakhon District. Bus lines 33, 64, 65 or air-conditioned buses, lines 3, 32, 33, 64, 65.   3. Wat Phra Chetuphon Vimolmangklaram Ratchaworamahawihan Motto: Cool shade brings happiness Offerings: 9 incense sticks, a pair of candles, 11 gold leaf sheets   History/Background: Wat Phra Chetuphon Vimolmangklaram Ratchaworamahawihan, also known as "Wat Pho," is a first-class royal temple. It was originally named "Wat Photharam." King Buddha Yodfa Chulaloke renovated the temple and commissioned the construction of a pagoda to enshrine the Buddha image, Phra Sri Sanphet, which was brought from Ayutthaya. Later, in 1834, King Rama III ordered the renovation of the pagoda and named it "Phra Maha Chedi Sri Sanphetdayarn" and built the "Phra Maha Chedi Dilok Dhammakhanit" to dedicate to King Rama II. King Rama III also wished for Wat Pho to serve as a "university for the public" and ordered the collection of knowledge inscribed on slate plates placed around the ordination hall for the public to study and gain knowledge.   Wat Pho houses the "Phra Buddha Theva Patimakorn" enshrined within the ordination hall, under the Chukchi pedestal, containing the royal relics of King Rama I. The temple's vihara enshrines the most beautiful and fourth-largest reclining Buddha statue in Thailand, made of bricks and plaster, decorated with mother-of-pearl, featuring 108 auspicious images. Additionally, Wat Pho has a total of 99 pagodas, making it the temple with the most pagodas in Thailand, and four large pagodas from the reigns of Kings Rama I to IV of Rattanakosin.   Currently, Wat Pho offers traditional Thai medicine courses, and those who complete the training will receive a traditional medicine practitioner certificate from the Ministry of Public Health.   How to get there: Wat Phra Chetuphon Vimolmangklaram Ratchaworamahawihan is located behind the Grand Palace on Sanam Chai Road, Phra Borom Maha Ratchawang Sub-district, Phra Nakhon District. You can get there by taking bus lines 12, 44, 82, 91, or air-conditioned buses, lines 12, 32, 44, 91, 51.   4. Wat Phra Si Rattana Satsadaram Motto: A pure mind like a gemstone Offerings: 3 incense sticks, 1 candle, and flowers   History/Background: Wat Phra Si Rattana Satsadaram, also known as Wat Phra Kaew, is a temple located within the grounds of the Grand Palace. King Rama I ordered its construction in 1783 to facilitate royal ceremonies and to enshrine the ashes of monarchs. The temple houses numerous attractions, including the Ubosot that enshrines the "Emerald Buddha" (Phra Kaew Morakot). The temple's gallery showcases the world's longest and most beautiful Ramayana mural. It also features the Prasat Phra Thep Bidon, the pagoda that enshrines the statues of Kings Rama I-VIII, the golden-tiled Phra Si Rattana Chedi, and the Royal Pantheon. The temple also has a bell tower, a monument to each king of the Rattanakosin era, and six pairs of giant statues from the Ramayana epic.   Getting There: Wat Phra Si Rattana Satsadaram is located near Sanam Luang, Na Phra Lan Road, in the Phra Nakhon District. You can take bus lines 1, 3, 25, 32, 33, 59, 60, 70, 82, 91, 201, 203 or air-conditioned buses Po. 2, 3, 6, 25, 32, 59, 60, 70, 82, 91, 201, 203, 512.   5. Wat Rakang Kositaram Woramahaviharn Motto: Famous and admired by people Offerings: 3 incense sticks, a pair of candles, and gold leaf   History/Background: Wat Rakang Kositaram Woramahaviharn, commonly known as Wat Rakang, is a second-class royal temple. Originally named "Wat Bang Wa Yai," it is an ancient temple dating back to the Ayutthaya period. The Ubosot exhibits architecture from the reign of King Rama I and features intricate Narayana reliefs. The temple houses a principal Buddha statue called "Phra Phuttha Yan Fa Lai" by King Rama V. Additionally, there are important murals on the doors and walls of the temple's tripartite scripture hall, as well as Ayutthaya-era Buddhist scripture cabinets. Somdej Phra Putthachan (To Promrangsi), a highly revered monk and scholar from the reign of King Rama IV, once resided at Wat Rakang. Visitors can pay respects and ask for blessings by reciting the Chinnabanchorn incantation, offering incense sticks, applying gold leaf to the statue, and sprinkling holy water for good fortune.   Getting There: Wat Rakang Kositaram Woramahaviharn is located on Arun Amarin Road, in the Siriraj Subdistrict, Bangkok Noi District. You can take bus lines 19 or 57. Alternatively, you can take the Chao Phraya Express Boat to either the Tha Rot Fai or Tha Wang Lang piers or take a cross-river ferry at Tha Chang Pier and disembark at Wat Rakang Pier.   6. Wat Suthat Thepwararam Motto: Broad vision, charming to the general public Offerings: 3 incense sticks, 1 candle   History/Background: Wat Suthat Thepwararam is a royal temple of the first class and is the designated temple for the 8th reign of the Rattanakosin Kingdom. Originally named "Wat Mahasuthawas," it was established in 1807 and completed in 1827 during the reign of King Rama III, who renamed it "Wat Suthat Thepwararam." The main hall houses the "Phra Sri Sakyamuni" Buddha image, which was brought from Sukhothai and is cast in the Mara Vichai posture. This image is based on the design of the Phra Mongkol Bophit temple in Ayutthaya. The main hall features beautiful wood carvings and a surrounding Chinese-style pagoda on a six-tiered base, consisting of 28 structures. The temple also houses the largest Mara Vichai Buddha image in Thailand, which is larger than any other cast during the Rattanakosin period. In addition, there is a scripture hall with a Phra Phutthasetthamuni Buddha image, cast in 1839 during the reign of King Rama III.   Getting there: Wat Suthat Thepwararam is located near Sao Chingcha, opposite Bangkok City Hall, in Phra Nakhon district. You can take bus lines 10, 12, or 42, or air-conditioned buses on lines 10, 12, or 42.   7. Wat Arun Ratchawararam Ratchawaramahawihan Motto: Prosperity day and night Offerings: 3 incense sticks, 1 pair of candles   History/Background: Wat Arun Ratchawararam Ratchawaramahawihan is a royal temple of the first class, established during the Ayutthaya period. Originally named Wat Makok, it was founded in 1767. When King Taksin the Great (the founder of Thonburi) arrived at Wat Makok early in the morning from Ayutthaya, he ordered the temple to be renovated and renamed "Wat Chaeng." Later, during the reign of King Rama II, the temple was renovated again and renamed "Wat Arun Ratchawararam." In the Thonburi era, Wat Arun housed the Emerald Buddha before it was moved to Wat Phra Kaew. The temple is also known for its two large plaster statues of giants, known as "Yak Wat Chaeng," guarding the entrance to the temple's ordination hall.   Wat Arun has many interesting features, including the world's largest prang (a Khmer-style tower), standing 33 meters tall and adorned with colorful glazed tiles. The prang is topped with a Nopburi-style pinnacle. The temple also has four smaller prangs, each housing a Buddha image in the birth, enlightenment, first sermon, and Nirvana postures. Circling the main prang three times clockwise is believed to bring blessings. The temple's main hall enshrines the "Phra Phuttha Dhammamisaririkathat Dilok" Buddha image, created by King Rama II himself, and houses the relics of the Buddha. The temple also has a vihara (hall) containing a Phra Arun or Phra Chaeng Buddha image, which was brought from Vientiane during the reign of King Rama IV.   Getting there: Wat Arun Ratchawararam Ratchaworamahawihan is located next to the Royal Thai Navy, Arun Amarin Road, Bang Kho Laem District. You can get there by bus lines 19, 57 or take a ferry across the river from Tha Tien pier and disembark at Wat Arun.   8. Wat Bowonniwet Vihara Motto: Encounter only the good things in life Sacred objects: 9 incense sticks, 1 candle, 3 lotus flowers   History/Background: Wat Bowonniwet Vihara is a first-class royal temple, also known as a Rajavaravihara temple. It was established by His Majesty King Rama III during the reign of King Rama III as the royal residence of the Bowonmahasakdiphonlasepgrom Royal Palace and the sacred site of the Bowonsathanmongkol Royal Palace between 2367 - 2375 B.E. Formerly known as Wat Mai, the temple was granted a new royal name during the reign of King Rama III, when he sponsored the ordination of His Royal Highness Prince Anuchathiraj. The temple gained prominence when the prince stayed there in 2375 B.E. Additionally, Wat Bowonniwet Vihara has been the place where King Rama VI, King Rama VII, and the current King have ordained as monks. The temple belongs to the faction of the Dhammayuttika Nikaya order's Kamavasi monks. Significant structures within Wat Bowonniwet Vihara include the main chapel (Ubosot), which is a three-tiered building adorned with glazed tiles. In the center, there is the emblem of the Great Crown. The presiding Buddha image in the main chapel and the Reclining Buddha are also noteworthy. The temple also houses the Vihara of the Holy Relics, the Great Pagoda, and the molded Buddha image hall.

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7 Healthcare Tips to Prepare You for Winter

7 Healthcare Tips to Prepare You for Winter   The approaching winter may cause many people to fall ill from fever, or experience dry, cracked skin. Here are 7 health tips to help you combat the cold weather this year.   Consume a balanced and nutritious diet, drink plenty of water, exercise regularly, get enough rest, and avoid overworking yourself. Maintaining good health will help you fight common winter illnesses such as colds, flu, and the new 2009 flu strain. Avoid smoking, alcohol, and drug use, as these can weaken your body's health and increase the likelihood of infection. Stay in well-ventilated areas and avoid crowded, congested public spaces, especially during flu outbreaks. Wash your hands frequently, as you may come into contact with germs on various surfaces, such as door handles, stair railings, elevator buttons, and public telephones. Avoid close contact with sick individuals and refrain from sharing personal items like towels, drinking glasses, plates, and utensils. If you are sick and experiencing coughing or sneezing, cover your mouth and nose with a cloth or wear a face mask. People with allergies and asthma may experience worsened symptoms during this season. In addition to the cold weather itself, increased dust or having pets indoors can trigger allergies. Longer periods spent in bed during the dark, cold winter months can also increase exposure to dust mites found in bedding, pillows, and blankets. Be mindful of these triggers and take steps to maintain a strong immune system.

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9 ข้อปฏิบัติการกินอาหาร เพื่อสุขภาพที่ดี

ข้อปฏิบัติการกินอาหาร 9 ข้อ จะช่วยได้ ถ้าท่านถือเป็นหลักปฏิบัติตาม ร่างกายเราต้องการสารอาหารที่มีอยู่ในอาหารต่างๆ เพื่อให้มีสุขภาพดี แต่เราจะต้องรู้ว่าจะกินอย่างไร กินอาหารอะไรบ้าง มากน้อยเพียงใดจึงจะได้สารอาหารครบและเพียงพอกับความต้องการของร่างกาย   ข้อปฏิบัติการกินอาหากเพื่อสุขภาพที่ดีของคนไทย 9 ข้อนี้ จะช่วยได้ ถ้าท่านถือเป็นหลักปฏิบัติตาม   กินอาหารครบ 5 หมู่ แต่ละหมู่ให้หลากหลายและหมั่นดูแลน้ำหนักตัว กินข้าวเป็นอาหารหลัก สลับกับอาหารประเภทแป้งเป็นบางมื้อ กินพืชผักให้มาก และกินผลไม้เป็นประจำ กินปลา เนื้อสัตว์ไม่ติดมัน ไข่ และถั่วเมล็ดแห้งเป็นประจำ ดื่มนมให้เหมาะสมตามวัย กินอาหารที่มีไขมันแต่พอควร หลีกเลี่ยงการกินอาหารรสหวานจัด และเค็มจัด กินอาหารที่สะอาด ปราศจากการปนเปื้อน งดหรือลดเครื่องดื่มที่มีแอลกอฮอล์   1.กินอาหารครบ 5 หมู่ แต่ละหมู่ให้หลากหลายและหมั่นดูแลน้ำหนักตัว   เนื่องจากร่างกายเราต้องการสารอาหารต่างๆ ที่มีอยู่ในอาหาร ได้แก่ โปรตีน คาร์โบไฮเดรต ไขมัน แร่ธาตุ วิตามิน น้ำ และใยอาหาร แต่ไม่มีอาหารชนิดใด ชนิดเดียวที่ให้สารอาหารต่างๆครบ ในปริมาณที่ร่างกายต้องการ จึงจำเป็น ต้องกินอาหารให้ครบ 5 หมู่ และกินแต่ละหมู่ให้หลากหลาย   จึงจะได้สารอาหารต่างๆครบถ้วน และเพียงพอ   น้ำหนักตัว เป็นเครื่องบ่งชี้บอกถึงสุขภาพของเรา จึงควรหมั่นดูแลโดยใช้ดัชนีมวลกาย(Body Mass Index) ซึ่งคำนวณจากสูตร   ดัชนีมวลกาย(BMI) =น้ำหนัก(กิโลกรัม)                                                                                                                             ส่วนสูง (เมตร)2   ค่าปกติจะอยู่ที่ 18.5-24.9 กก/ตร.ม.          2 .กินข้าวเป็นอาหารหลัก สลับกับอาหารประเภทแป้งเป็นบางมื้อ   ข้าวเป็นอาหารหลักของคนไทยที่ให้กำลังงาน มีสารอาหารคาร์โบไฮเดรต โปรตีน วิตามินกับแร่ธาตุ และใยอาหาร ควรกินข้าวที่ขัดสีแต่น้อย และกินสลับกับ อาหารประเภทแป้งอื่นๆ เช่น ก๋วยเตี๋ยว ขนมจีน ขนมปัง เผือกและมัน   3. กินพืชผักให้มาก และกินผลไม้เป็นประจำ    พืชผักและผลไม้ นอกจากให้วิตามินแร่ธาตุ และกากอาหารแล้ว ยังมีสารอื่นๆ ที่ช่วยป้องกันไม่ให้ไขมันไปเกาะตามหลอดเลือด และช่วยทำให้เยื่อบุของเซลล์ และอวัยวะต่างๆแข็งแรงอีกด้วย   4. กินปลา เนื้อสัตว์ไม่ติดมัน ไข่และถั่วเมล็ดแห้งเป็นประจำ   -เนื้อสัตว์ทุกชนิดมีโปรตีน แต่ควรกินชนิดไม่ติดมันเพื่อลดการสะสมไขมันในร่างกาย   -ไข่เป็นอาหารโปรตีนราคาถูก หาซื้อง่าย เด็กสามารถกินได้ทุกวัน แต่ผู้ใหญ่ควรกิน ไม่เกินสัปดาห์ละ 2-3 ฟอง   -ถั่วเมล็ดแห้งและผลิตภัณฑ์ เป็นโปรตีนที่ดี ราคาถูก ควรกินสลับกับเนื้อสัตว์เป็นประจำ   5. ดื่มนมให้เหมาะสมตามวัย   นมมีโปรตีน วิตามินบี และแคลเซียมซึ่งสำคัญต่อการเจริญเติบโต และเสริมสร้างความแข็งแรงให้กระดูกและฟัน จึงเป็นอาหารที่เหมาะสมกับบุคคลทุกวัย   ในคนอ้วนควรดื่มนมพร่องมันเนย                                  6. กินอาหารที่มีแต่ไขมันพอควร   ไขมันให้พลังงานและความอบอุ่นแก่ร่างกาย ทั้งช่วยดูดซึมวิตามิน เอ ดี อี และเค แต่ไม่ควรกินมากเกินไป จะทำให้อ้วน และเกิดโรคอื่นๆตามมา   การได้รับไขมันอิ่มตัวจากสัตว์ และอาหารที่มีโคเลสเตอรอลมากเกินไป จะทำให้โคเลสเตอรอลในเลือดสูง เสี่ยงต่อการเป็นโรคหัวใจ ควรกินอาหารประเภท ต้ม นึ่ง ย่าง อบ  จะช่วยลดปริมาณไขมันในอาหารได้   7.หลีกเลี่ยงการกินอาหารรสหวานจัดและเค็มจัด   การกินอาหารรสจัดมากจนเป็นนิสัย ให้โทษแก่ร่างกาย รสหวานจัดทำให้ได้พลังงานเพิ่มทำให้อ้วน รสเค็มจัดเสี่ยงต่อภาวะความดันโลหิตสูง   8. กินอาหารที่สะอาด ปราศจากการปนเปื้อน   อาหารที่สะอาด ปรุงสุกใหม่ๆ มีการปกปิดป้องกันแมลงวันและบรรจุในภาชนะที่สะอาด มีอุปกรณ์หยิบจับที่ถูกต้อง ย่อมทำให้ปลอดภัยจากการเจ็บป่วยด้วยระบบทางเดินอาหาร   9. งดหรือลดเครื่องดื่มที่มีแอลกอฮอล์   การดื่มเครื่องดื่มที่มีแอลกอฮอล์เป็นประจำ เป็นโทษแก่ร่างกาย ทำให้สมรรถภาพการทำงานลดลง ขาดสติ ทำให้เกิดอุบัติเหตุได้ง่าย สูญเสียทรัพย์สิน เงินทอง ตลอดจนชีวิต เสี่ยงต่อ การเป็นโรคตับแข็ง แผลในกระเพาะอาหารและลำไส้มะเร็งหลอดอาหารและโรคกระเพาะอาหาร จึงควรงด หรือลดเครื่องดื่มที่มีแอลกอฮอล์ และไม่ขับขี่ยานพาหนะในขณะมึนเมา   ด้วยความปรารถนาดี  รพ.วิภาวดี ที่มาข้อมูลจาก Thaiclinic.com

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