Biomedical Sciences and Clinical Medicine

Assessment of second trimester genetic amniocentesis: 6 years experiences at Sanpatong hospital

2024-02-06T08:30:13+07:00

OBJECTIVE This study aims to assess the indications, complications, and outcomes of second-trimester genetic amniocentesis performed at Sanpatong Hospital, Chiang Mai, Thailand.

METHODS A cross-sectional descriptive study analyzed data collected from high-risk pregnant women who underwent second-trimester genetic amniocentesis at Sanpatong Hospital between October 1st, 2016 and September 30th, 2022. The data include indications for the procedure, complications, and pregnancy outcomes.

RESULTS A study of 451 women with high-risk pregnancies who underwent amniocentesis found that the most common indications for second trimester genetic amniocentesis were advanced maternal age (49.4%) and a high-risk Quad test (49.4%). Abnormal chromosomes were detected in 3.1% of cases, with aneuploidy the most common type (2.1%), primarily
trisomy 21 (1.3%). The overall aspiration success rate was 100%. The only complications related to the procedure were pelvic pain (0.6%) and placental hematoma (0.2%). There were no fetal losses within 30 days after amniocentesis. The culture failure rate was 1.1%. Pregnancy outcomes included preterm delivery (12.3%) and normal term delivery (87.7%).

CONCLUSIONS Performing second trimester genetic amniocentesis at Sanpatong Hospital, a mid-level secondary hospital, over a six-year period resulted in no fetal losses.

Clinical Characteristics and Outcomes of Primary Vitreoretinal Lymphoma in Northern Thailand

2024-02-05T11:00:49+07:00

OBJECTIVE This study aims to describe clinical characteristics and outcomes after treatment of primary vitreoretinal lymphoma (PVRL).

METHODS Fifteen patients with a proven diagnosis of PVRL by histology, cytology and/or flow cytometry were analyzed.
RESULTS The median age of the 15 patients was 59 years (range 41-71). Median follow-up time was 37 months (IQR 22.5-80) (range 4-106). Ophthalmic presentations of 25 eyes included vitritis (72%), chorioretinal infiltrations (60%), and retinal vasculitis (20%). Bilateral involvement was observed in 10 patients at presentation and in 4 patients during follow up. Ten patients (67%) developed brain involvement after ocular presentation with a median time of 22.5 months (range 2-84). Treatment modalities were included: 1) isolated intravitreal (IVT) methotrexate (6/15 patients; 40%) with a median number of injections of 4 (IQR 1,6) (range 1-16) 2) combined with IVT metho-trexate and/or rituximab and systemic chemotherapy and/or radiation
(8/15; 53%) with a median of 6 injections (IQR 1,11) (range 1-16) and 3) systemic chemotherapy alone (1/15; 7%). Whole brain radiotherapy (WBRT) was performed in 10 of 15 patients (67%). Among the 6 patients who received isolated IVT methotrexate, 3 patients had complete remission (3/6; 50%), one died at 96 months after treatment, and one was lost to follow up after
a single injection. Nine of 15 patients who received systemic chemotherapy with or without IVT chemotherapy and/or WBRT had complete remission (8/9; 89%).

CONCLUSIONS Vitritis and chorioretinal infiltrations were the main ocular presentations of PVRL. Two-thirds of the patients developed brain involvement which resolved after treatment. Systemic chemotherapy tends to provide a higher rate of complete remission compared to local therapy alone.

Hippocampal Avoidance Prophylactic Cranial Irradiation using Helical Tomotherapy in Small Cell Lung Cancer

2024-01-08T15:46:08+07:00

OBJECTIVE Prophylactic cranial irradiation (PCI) is a standard treatment for small cell lung cancer (SCLC). Reduced radiation doses at the hippocampal region during PCI might protect against neurocognitive decline after radiotherapy (RT). The purpose of this study is to report the outcome of hippocampal avoidance PCI (HA-PCI) in our center.

METHODS After the initial treatment of SCLC, patients whose radiographic data confirmed the absence of intracranial metastasis and controlled of the primary disease received HA-PCI. Thai Mental State Examination (TMSE) and bilateral hippocampal volumes were recorded and analyzed using the Wilcoxon Singed Rank test to compare baseline and two time points (3 and 6 months). The two-year overall survival (OS) and brain control rates were estimated using the Kaplan Meier method.

RESULTS Between 2018 and 2021, a total of 10 patients were included in the analysis. The median TMSE and bilateral hippocampal volumes showed no statistically significant difference between baseline and 3 and 6 months. Two-year OS and brain control rates were 78.8% and 71.4%, respectively. Three patients developed intracranial relapses after HA-PCI which were located outside the hippocampal region.

CONCLUSIONS HA-PCI did not increase intracranial relapse in this study. HA-PCI should be considered as a treatment option which can potentially protect neurocognitive functions.

Blood Plasma as a Sampling Model during Drug-induced Thrombocytopenia: Effects of Antioxidants

2024-02-05T12:21:09+07:00

OBJECTIVE Blood plasma, a complex biological mixture, plays a part in a variety of roles including clotting, defense, and transport, and reflects the overall status of blood components. Drug-induced thrombocytopenia (DIT) is characterized by abnormally low platelet count (below ~150,000 per μL) which can be caused by adverse effects of medications. This study aims to address a basic question, can plasma be employed as a sampling model to assess the oxidative stress (OS) changes and antioxidant status during DIT? The objective was to analyze the antioxidant status and OS in plasma during DIT, and to determine the effects of antioxidant supplementation such as Caripill™, L-Carnitine (LC), and vanillic acid (VA) during DIT.

METHODS Male Wistar rats were used as animal models and grouped into control groups (n=5) and thrombocytopenia groups (n=5). Antioxidants were given to the thrombocytopenic and the control rats (50 mg/kg body weight) once a day for 7 days. Blood plasma from both groups was evaluated for total antioxidant capacity, antioxidant enzymes, markers of lipid peroxidation, protein oxidation, and OS.

RESULTS The antioxidants significantly increased the total antioxidant capacity (CUPRAC) and ferric-reducing antioxidant power (FRAP) of the plasma and decreased the levels of conjugate dienes. Caripill™ also reduced lipid peroxidation, significantly elevated protein sulfhydryl and nitrite/nitrate levels, LC elevated lactate dehydrogenase levels, and VA increased superoxide dismutase activity and attenuated lipid peroxidation during DIT.

CONCLUSIONS The antioxidants Caripill™, vanillic acid, and L-carnitine were demonstrated to be beneficial during DIT and to have prospects in alternate therapeutics. This study confirms that plasma can be utilized as a sampling model to study changes during OS situations.

Estimation of Post-mortem Interval Based on Livor Mortis using a Colorimeter in Thai Populations

2024-02-09T11:33:25+07:00

OBJECTIVE Livor mortis is a helpful and widely used method of estimating postmortem interval (PMI) in Thailand. This study aimed to investigate the value of a colorimeter as a tool for estimating the PMI.

METHODS The color of livor mortis and control skin in 80 cadavers whose PMI was within 12 hours was measured by a colorimeter. The L* (brightness), a*b* (chroma and hue), and ΔE* values were compared to the control skin values. Statistical analysis was performed to determine the relationship between PMI and skin color before and after application of a specific pressure.

RESULTS The results showed that colorimetric parameters were only weakly correlated with the PMI. An univariable analysis of ΔE* values was performed and showed good discriminatory power, with an area under the ROC curve of 0.82. The recommended cut-off value of ΔE* was 14 for the discrimination between early PMI (less than 6 hours) and late PMI (6-12 hours), in which the sensitivity and specificity were 72.5% and 80%.

CONCLUSIONS The findings in this study reinforce the utility of colorimetric measurements in PMI estimation. With additional study and a larger sample size, the estimation of PMI could be established for general use in forensic practice.

Fetal Anemia in Northern Thailand: Etiologies and Outcomes

2024-02-13T14:11:14+07:00

OBJECTIVE In Southeast Asia, hemoglobin (Hb) Bart’s disease is the primary cause of fetal anemia, although other causes are increasingly being identified. This study aimed to characterize the etiologies and outcomes of fetal anemia in northern Thailand.

METHODS A retrospective chart review was conducted, involving pregnant women who attended antenatal care at Chiang Mai University Hospital between 2014 and 2021 and had a diagnosis by ultrasound findings of fetal anemia, or a fetal diagnosis of Hb Bart’s disease or other known hereditary anemias.

RESULTS Among 71 fetuses from 64 pregnancies, 45 (63.4%) had Hb Bart’s disease. Twelve cases (16.9%) of fetal anemia were from other causes, including three cases of homozygous Hb Constant Spring, three cases of hereditary pyropoikilocytosis, one case of suspected red cell membrane disorder, one case each of Rh(D) alloimmunization, Hb H/Hb Pakse disease, transient abnormal myelopoiesis, syphilis infection, and one of unknown cause. All of the seven sets of twins (19.7%) had twin-to-twin transfusion syndrome (TTTS). Intrauterine transfusion was given in four cases of fetal hemolytic anemia which rendered good outcomes. Overall, 12 cases (16.9%) survived beyond the neonatal period.

CONCLUSIONS Hb Bart’s disease remains the leading cause of fetal anemia in northern Thailand. Increasingly, frequently diagnosed causes include hemoglobinopathies and red cell membrane disorders.

Knowledge and Awareness of Human Papillomavirus Infection and Vaccination in Thai Male Youth, Including Men Who Have Sex With Men

2024-02-13T08:38:22+07:00

OBJECTIVE There is currently a lack of human papillomavirus (HPV) vaccination policy and education for male youth in Thailand. This study aimed to evaluate Thai male youth’s knowledge and awareness of HPV infection and vaccination, determine their HPV vaccination rate, and factors related to the vaccination rate and the level of awareness of HPV.

METHODS A questionnaire survey on HPV vaccination was distributed to educational institutions across different regions of Thailand. Inclusion criteria included Thai male youth aged between 15 and 24 years, regardless of sexual orientation. Exclusion criteria were inability to access the internet, individuals whose responses were unintelligible, and those who did not complete the questionnaire. The trends of the association between participant characteristics and their HPV knowledge/awareness scores was analyzed using linear regression.

RESULTS A total of 594 individuals responded to the questionnaire. The median score for knowledge was 11 out of 18 and the awareness level was 80%. Higher education level, higher family income, bisexuality, and prior receipt of HPV information were statistically significantly linked to higher HPV knowledge scores. However, only previous receipt of HPV information was associated with an increased awareness level.

CONCLUSIONS Although the level of HPV knowledge and awareness among Thai males was acceptable, less than 50% of participants expressed an intention to get vaccinated. This indicates there is a need to improve the promotion of the HPV vaccine in order to achieve herd immunity.

Exploring Synergies of Lotus Seed Extract-Hyaluronic Acid Gel for Enhanced Local Drug Delivery

2024-01-26T14:23:13+07:00

OBJECTIVE The plant species Nelumbo nucifera (lotus) is widely used in traditional medicine and is known to contain flavonoids, alkaloids, and other polyphenols which contribute to its potent antioxidant, anti-inflam-matory properties in addition to its being a remedy for cardiac diseases. Hyaluronic acid, present in skin and connective tissue, is well known for its tissue regeneration and wound healing properties. The present study aimed to determine the antioxidant and anti-inflammatory effect of the hyaluronic acid gel combined with lotus seed extract and how this com-bination could be used as an effective local drug delivery system for the treatment of periodontitis.

METHODS A 2% solution of hyaluronic acid gel was combined with increasing concentrations of prepared lotus seed extract. A DPPH test was conducted to determine the antioxidant activity of the resultant mixture at increasing concentrations. Additionally, anti-inflammatory activity was assessed using a UV spectrometer, and the spreadability of the gel was measured using the sliding glass slide method. The values obtained were plotted on graphs.

RESULTS The DPPH scavenging assay revealed that lotus seed extract with 2% hyaluronic acid gel exhibited increased antioxidant activity in a dose-dependent manner with IC50 at 76 μL. The lotus seed extract with 2% hyaluronic acid gel also showed increased anti-inflammatory properties in a dose-dependent manner with IC50 at 271 μL. Moreover, the spreadability of the lotus seed extract with 2% hyaluronic acid gel was found to be 42 mm.

CONCLUSIONS Lotus seed extract shows potent antioxidant and anti- inflammatory activities which vary with the concentration of the extract, and can serve as an effective local drug delivery system.