Journal of Associated Medical Sciences

Cut-off determination of HLA crossmatching by flow cytometry

2025-10-08T21:05:58+07:00

Background: Microlymphocytotoxicity test is a gold standard for HLA crossmatching but provides low sensitivity. Emerging flow cytometry crossmatching (FCXM) provides more sensitivity, however, suitable cut-off values for FCXM must still be established for crossmatching result interpretation.

Objectives: This study aimed to determine the appropriate cut-off value for FCXM in kidney transplant patients and donors.

Materials and methods: A total of 30 sample pairs with known HLA typing and known antibody specificity were analyzed. Median channel fluorescence (MCF) and median channel fluorescence shift (MFS) were used to determine cut-off value using three different approaches and % accuracy was determined.

Results: The result showed that the cut-off values from first approach using lowest MCF of positive control and highest MCF of negative control were 1655.99 MCF for T-cells (yielding 100% accuracy) and 43668.06 MCF for B-cells (yielding 36.67% accuracy). The cut-off values from second approach which calculated from standard deviation (SD) of negative control MCF showed SD of T-cells MCF as 203.81 (100% accuracy) and SD for B-cells MCF as 11109.30 (60% accuracy). The cut-off values from third approach derived from the lowest MFS of the expected positive results were 1753.50 for T-cells (100% accuracy) and 593.50 for B-cells (73.33% accuracy).

Conclusion: The cut-off values from the third approach exhibited the highest accuracy. However, FCXM still had false positives and false negatives, underscoring the necessity for continuous refinement and adjustment of cut-off values based on the data accumulated within the laboratory to be used further for routine laboratory practice.

Case report: Two cases of Hb Liuzhou-Yufeng (HBA1:c.334G>T) found in Northern Thailand

2025-12-03T10:53:55+07:00

Background: Hemoglobin (Hb) Liuzhou-Yufeng is an α-globin variant caused by a heterozygous HBA1 mutation (c.334G>T). However, its clinical significance is not well-defined. Moreover, it is hard to detect using standard capillary electrophoresis (CE) or high-performance liquid chromatography (HPLC) methods and often need molecular techniques like next-generation sequencing (NGS).

Objective: This study aims to describe genotype and hematological features of the first two cases with heterozygosity for Hb Liuzhou-Yufeng found in Northern Thailand and the diagnostic challenges faced.

Materials and methods: Two patients with anemia, a 51-year-old female and a 32-year-old male, underwent hematological evaluation, Hb analysis using CE for case 1 and HPLC for case 2, iron studies, and red cell morphology tests. The dichlorophenolindophenol (DCIP) and osmotic fragility (OF) tests were also conducted. The molecular work-up included multiplex real-time PCR for α-thalassemia deletions, followed by NGS.

Results: Both patients were confirmed by the NGS to carry Hb Liuzhou-Yufeng (ααLY/αα). Their total Hb levels were found within the ranges of mild anemia (10-12 g/dL). However, they had normocytic and normochromic red cells, and the morphology of the red blood cells appeared to be normal. In addition, the Hb analysis by HPLC and CE methods revealed normal peaks and levels of HbA, HbA2, and HbF.

Conclusion: Hb Liuzhou-Yufeng seems clinically harmless but is challenging to detect using conventional methods. This study highlights the importance of NGS in finding rare Hb variants. It improves diagnostic accuracy, genetic counseling, and personalized management of hemoglobinopathy.

Prevalence and risk factors of elevated urinary albumin-to-creatinine ratio in a Thai academic population

2025-11-28T12:51:00+07:00

Background: The urinary albumin–to–creatinine ratio (UACR) is a key marker for early kidney dysfunction. This study assessed UACR levels and their associations with demographic and clinical factors in a Thai university population.

Materials and methods: A cohort of 158 participants (53 males, 105 females) was recruited from Chiang Mai University between January and May 2024. Urinary albumin and creatinine were measured by turbidimetric immunoassay and creatininase method, respectively, and expressed as UACR (mg/gm creatinine). UACR was categorized as normoalbuminuria (<30 mg/gm creatinine), microalbuminuria (30-299 mg/gm creatinine), or clinical albuminuria (≥300 mg/gm creatinine). Data on body mass index (BMI), blood
pressure, fasting blood glucose, physical activity, use of supplements or
medications, and the presence of chronic conditions were also collected.

Results: Most participants (94.3%) had normoalbuminuria, whereas microalbuminuria and clinical albuminuria were observed in 4.4% and 1.3% of participants, respectively. Overall, 71.5% were normotensive and 28.5% hypertensive. Based on BMI, 41.1% had normal weight, 18.4% were overweight, and 34.8% were obese. Nearly half reported no regular exercise, and the majority were non–smokers (98.1%) and non–drinkers (83.5%). Regular supplement or medication use was reported by 57.0%, mainly vitamins/minerals and fish oil. Chronic diseases occurred in 37.3%, with hypercholesterolemia (10.8%) and hypertension (8.9%) being most common. Hypercholesterolemia, hypertension, allergy, type II diabetes, lifestyle factors, and supplement or medication use were not associated with albuminuria (Chisquare, p>0.05), whereas obesity class II, elevated fasting blood glucose (≥126 mg/dL) and systemic lupus erythematosus (SLE) were significantly associated with increased urinary albumin excretion (Chi-square, p<0.05).

Conclusion: Elevated blood glucose, obesity, and SLE were significantly linked to increased UACR, emphasizing the importance of early identification and management of these risk factors to prevent kidney disease progression.

Elevated Sall4 Expression Correlates with Prostate Cancer Gleason Score and Metastasis using Immunohistochemistry and RNAscope®

2025-06-01T16:03:58+07:00

Background: Prostate cancer lacks reliable biomarkers to distinguish between indolent and aggressive forms, posing diagnostic and prognostic challenges. Sall4, primarily found in embryonic stem cells, is reactivated in various cancers, but its role in prostate cancer remains unclear.

Objectives: This study aims to evaluate Sall4 protein and mRNA levels in malignant and normal prostate tissues and explore their association with clinical data.

Materials and methods: This study was conducted from December 2022 to April 2024 at Al-Hussein Teaching Hospital, Thi-Qar, Iraq. Sall4 protein and mRNA expression levels were assessed in 40 normal tissues and 194 malignant prostate tissues using immunohistochemistry and RNAscope® methods. The data were analyzed using unpaired t-tests.

Results: The study identified a significant increase in nuclear Sall4 protein expression, assessed by immunohistochemistry, in prostate cancer tissues compared to normal tissues (p=0.001). Similarly, Sall4 mRNA levels, measured using RNAscope®, were significantly higher in malignant tissues (p<0.001). Increased Sall4 expression at both protein and mRNA levels was significantly associated with higher Gleason scores (protein: p=0.003; mRNA: p=0.009), lymph node involvement (protein: p=0.002; mRNA: p=0.006), and metastasis (protein: p=0.001; mRNA: p=0.017). However, no significant correlation was found between Sall4 expression and tumor size.

Conclusion: Elevated Sall4 expression may be associated with prostate tumorigenesis and aggressiveness. Further studies are needed to clarify its role and evaluate its potential as a prognostic biomarker for prostate cancer.

Genomic insights into colistin-resistant Escherichia coli from clinical isolates in Thailand: Diversity of sequence types, plasmid-borne mcr variants, and One Health implications

2025-11-11T22:04:24+07:00

Background: Colistin is a last-resort antimicrobial agent for treating multidrugresistant Enterobacterales. However, resistance has emerged globally through plasmid-mediated mcr genes and chromosomal mutations. Reports of wholegenome sequencing of colistin-resistant Escherichia coli from clinical settings in Thailand remain limited.

Objectives: To characterize the molecular and phenotypic features of colistinresistant E. coli isolated from a tertiary hospital in Thailand using wholegenome sequencing (WGS).

Materials and methods: Fourteen colistin-resistant E. coli isolates were collected from clinical specimens between 2021 and 2022. Antimicrobial susceptibility testing was performed using broth microdilution. WGS was applied to identify resistance determinants, plasmid replicons, virulence genes, phylogroups, and sequence types.

Results: The prevalence of colistin-resistant E. coli was 1.2% (14/1203 isolates). Most isolates exhibited an ESBL-like multidrug-resistant profile with preserved carbapenem susceptibility. WGS revealed diverse sequence types (including ST131, ST95, ST58, ST69) and phylogroups, indicating polyclonal dissemination. Two mcr variants (mcr-1.1 and mcr-3.5) were identified on mobile plasmids (IncX4, IncI2, IncFII, IncHI2), with some isolates carrying both variants. Several isolates without mcr carried chromosomal mutations in mgrB, phoPQ, or pmrAB. Virulence genes, particularly adhesins, siderophore systems, and capsule- related determinants, were widely distributed. The detection of mcr-3.5, previously reported in livestock, within clinical isolates highlights potential zoonotic or foodborne transmission.

Conclusion: Colistin-resistant E. coli in Thailand shows significant genetic diversity and frequent coexistence of mcr and ESBL genes, often on plasmids with high potential for horizontal transfer. These findings emphasize the importance of antimicrobial stewardship, stricter control of drug use in animals, and integrated genomic surveillance under a One Health framework to mitigate the dissemination of colistin resistance.

Comparative evaluation and interpretability analysis of modern CNN architectures for brain tumor MRI classification

2025-11-11T11:17:19+07:00

Background:Accurate and interpretable brain tumor classification from MRI images remains a key challenge in medical image analysis, particularly when using publicly available datasets of moderate size.

Objectives:This study investigates the performance of a ConvNeXt-Tiny based framework for four-class brain tumor classification glioma, meningioma, pituitary tumor, and no tumor and compares it with established convolutional architectures.

Materials and methods:Using transfer learning and identical experimental settings, ConvNeXt-Tiny was evaluated against DenseNet169, Xception, MobileNetV3-Large, CNN+DenseNet169, and ResNet50. Standard evaluation metrics (accuracy, precision, recall, and F1-score) were used, and Grad-CAM was applied to visualize model attention for interpretability. Generalization was further assessed using an independent dataset.

Results:ConvNeXt-Tiny achieved high overall performance (accuracy = 0.9924, F1-score = 0.9918), comparable to DenseNet169 and Xception but with lower computational cost. The model maintained stable learning behavior, minimal overfitting, and consistent accuracy on unseen data. Grad-CAM visualizations confirmed that the network focused on clinically relevant tumor regions, improving transparency and reliability of predictions.

Conclusion:ConvNeXt-Tiny provides a strong and efficient baseline for interpretable brain tumor classification, balancing accuracy and computational efficiency. While the results are promising, differences among recent architectures were modest, and clinical validation using multi-center MRI datasets is necessary to confirm broader applicability.

Effects of core strengthening exercises on inspiratory muscle strength and functional capacity among obese college students

2025-12-26T13:41:49+07:00

Background: Obesity weakens core muscles, impacting posture, balance, and respiratory function. Central obesity is particularly harmful due to its effect on visceral organs. Exercises targeting the core and respiratory muscles, such as inspiratory muscle training, are essential for managing obesity and enhancing functional capacity.

Objectives: To investigate the impact of core strengthening exercises on the strength of inspiratory muscles and overall functional capacity among obese college students.

Materials and methods: A 6-week experimental study was carried out involving 34 participants selected using convenience sampling methods. Individuals aged 18-25 years, regardless of gender, with a BMI exceeding 25 kg/m² were included in the study. Maximal inspiratory pressure was measured using a respiratory pressure meter, and the 6-minute walk test was used to measure functional capacity.

Results: The mean age of subjects was 20.85±1.63. The mean value of maximal inspiratory pressure (cmH₂O) pre-test was 95.09±9.58 and post-test was 95.85±9.39. The mean six-minute walk distance (metres) pre-test was 399.15±38.62 and post-test was 412.18±35.25. Both improvements were statistically significant (p=0.003 for MIP and p<0.001 for 6-MWTD)

Conclusion: A six-week core strengthening exercise programmme significantly increases the strength of inspiratory muscles and overall functional capacity among obese college students. These results support the clinical use of core exercises in obesity rehabilitation to enhance respiratory strength and physical function.

Comprehensive benchmarking of machine learning models for blood glucose classification and prediction: new approach for improved hyperglycemia and hypoglycemia detection and prediction

2025-11-03T16:46:37+07:00

Background: Diabetes mellitus affects 463 million people worldwide and necessitates continuous blood glucose monitoring. Current glucose prediction systems often lack efficiency, and real-time prediction is essential for timely clinical intervention.

Objectives: This study aims to develop and validate a novel Convolutional Recurrent Neural Network (CRNN) enhanced with bio-inspired algorithms to improve blood glucose prediction and enable real-time detection of hypoglycemia and hyperglycemia.

Materials and methods: The proposed framework employs a CRNN architecture that combines Convolutional Neural Networks (CNNs) for feature extraction with Long Short-Term Memory (LSTM) layers for temporal sequence learning. The model was trained and evaluated using the HUPA-UCM diabetes dataset. Additionally, the study benchmarks the proposed model against 19 traditional Machine Learning (ML) algorithms and compares it with state-of-the-art methods from the literature.

Results: The proposed approach demonstrates superior predictive capability, consistently delivering promising results across multiple evaluation frameworks. The model achieves clinically acceptable prediction intervals, confirming its effectiveness in enhancing the accuracy and reliability of blood glucose prediction for diabetes management.

Conclusion: The findings demonstrate that the proposed CRNN model, enhanced with bio-inspired algorithms, provides an effective and reliable solution for real-time blood glucose prediction. By outperforming conventional ML methods and achieving clinically acceptable accuracy levels, the model shows strong potential for integration into intelligent diabetes management systems to support timely clinical decisions and improve patient outcomes.

Radiation protection in dental radiology: Compliance, continuing education and equipment audit in imaging clinics

2025-10-17T09:08:03+07:00

Background: Continuing education and the availability of protective equipment are two key factors that significantly influence compliance with radiation protection measures in imaging. Their absence could lead to practices that expose patients, staff, and the public to unnecessary risks. This study assessed compliance with respect to the continuing education of dental professionals and the availability of equipment in selected dental imaging clinics.

Materials and methods: A cross-sectional study. Questionnaires were shared to 55 dental professionals working in eight dental imaging clinics, to assess their level of compliance, specifically regarding continuing education and equipment availability (self-audit), and physical audit of the protective equipment in these clinics by the authors.

Results: About 25.5% of the respondents demonstrated a good level of compliance and equipment availability in their centres, while 50.9% received further training. The multi-level aggregate analysis showed that two clinics had high equipment score, good compliance score and compliance level. Spearman’s rank order correlation between compliance and equipment availability was statistically significant (p=0.001), while Cohen’s Kappa agreement between self and physical audit ranged from 38%-100% (K: 0.091-1.00).

Conclusion: This study showed that though continuing training is essential for compliance, equipment availability significantly influenced compliance with radiation protection measures.

Blood donation and blood components utilization in Suratthani Hospital

2025-12-13T21:45:06+07:00

Background: Blood and its components are essential, irreplaceable biological resources required for a wide range of medical interventions, including surgery, trauma care, and chronic disease management. Despite ongoing improvements in blood services, many hospitals continue to experience challenges related to fluctuating donation rates, shortages of specialized components, and inefficiencies in blood utilization such as excessive crossmatching without transfusion.

Objectives: This study aimed to evaluate the efficiency of blood-donation management and the adequacy of blood-component supply relative to clinical demand at Suratthani Hospital. Additionally, it assessed the appropriateness of blood utilization using the crossmatch-to-transfusion (C/T) ratio as a key performance indicator.

Materials and methods: A retrospective descriptive study was conducted using data collected at Suratthani Hospital from January 1, 2020, to December 31, 2024. Information on blood donation types, blood-component preparation, utilization patterns, and C/T ratios was analyzed to assess supply-demand dynamics and rational use of blood products.

Results: On-site donation was the primary source of blood supply (49.9-65.5%), followed by off-site donation (32.4-47.7%) and single-donor platelet (SDP) donations (2.1-3.2%). Both blood donations and component utilization increased notably in 2024. Packed red cells (PRC) were the most frequently used component (37.6-44.7%) and constituted most transfusion requests (38.0-43.9%). Over five years, platelet concentrate (PC), fresh frozen plasma (FFP), and cryoprecipitate were consistently adequate, whereas leukocytedepleted
PRC (LDPRC), leukocyte-poor PRC (LPRC), and SDP remained insufficient, requiring additional units from the Thai Red Cross blood center. A total of 18,348 units were crossmatched, with annual C/T ratios ranging from 1.5 to 1.8 and showing no significant variation (p=0.121), indicating appropriate utilization..

Conclusion: Blood bank management at Suratthani Hospital demonstrated overall effectiveness, with adequate supply of PRC, FFP, and cryoprecipitate and appropriate utilization reflected by acceptable C/T ratios. However, persistent shortages of LDPRC, LPRC, and SDP highlight critical gaps in meeting increasing clinical needs. Strengthening donor recruitment strategies, expanding apheresis capacity, and enhancing regional collaboration are essential to ensuring a sustainable blood supply for southern Thailand.

Association of Intron 22 inversion and HLA-DRB1*15:01 allele with inhibitor development in hemophilia A: A genetic analysis of risk factors

2025-12-13T21:46:19+07:00

Background: Inhibitor development in hemophilia A is a major clinical challenge, leading to severe bleeding complications and reduced quality of life. This multifactorial process is influenced by genetic, immunological, and treatmentrelated factors.

Objectives: To determine the association between intron 22 inversion (Inv22) and the HLA-DRB1*15:01 allele with inhibitor development.

Materials and methods: This study investigated inhibitor development during initial and subsequent treatments, assessing the association between Inv22 and HLA-DRB1*15:01 with inhibitor formation in 40 hemophilia A patients, 40 non-hemophilia A patients, and 40 healthy controls.

Results: The study found no significant association between Inv22 or HLADRB1*15:01 allele and inhibitor development during initial (odds ratio (OR): 0.60, 95% CI: 0.11-3.43, p=0.697) or subsequent treatments (OR: 1.33, 95% CI: 0.30-5.93, p=1.000). Similarly, HLA-DRB1*15:01 allele showed no significant correlation (initial: OR: 0.25, 95% CI: 0.06-1.13, p=0.089; subsequent: OR: 0.82, 95% CI: 0.24-2.84, p=1.000). However, patients with both genetic factors had a significantly higher risk of developing inhibitors (OR: 7.90, 95% CI: 1.88-33.06, p=0.007).

Conclusion: This study found no significant association between Inv22 or the HLA-DRB1*15:01 allele and inhibitor development in hemophilia A patients during initial or subsequent treatments. However, their combined presence significantly increased the risk of inhibitor formation, suggesting a potential interactive effect requiring further investigation.

Fall risk, fear of falling and their association with depressive symptoms among institutionalized older adults: A cross-sectional study

2025-12-07T18:26:56+07:00

Background: Falls, fear of falling, and depression are major geriatric syndromes that threaten independence and overall well-being. Older people living in institutions may be particularly vulnerable due to physical, environmental, and psychosocial factors. This study aimed to examine the association among fall risk, fear of falling and depressive symptoms among Institutionalized Older Adults.

Materials and methods: A cross-sectional study was carried out among 90 residents from two selected old age homes in Chennai. Participants aged more than 60 years were recruited using purposive sampling. Fall risk, fear of falling and depressive symptoms were assessed using the Berg Balance Scale (BBS), Falls Efficacy Scale-International (FES-I) and Geriatric Depression Scale (GDS-15), respectively. The data was analyzed with IBM SPSS Statistics version 27, employing descriptive statistics, ANOVA, Chi-Square test and Pearson correlation.

Results: High fear of falling was reported by 62% of participants while 67% were presented with depressive symptoms. The results obtained were statistically significant associations between fall risk and fear of falls (p=0.032), fall risk and depressive symptoms (p<0.001), and fear of falls and depressive symptoms (p=0.042). Age showed a significant association with fall risk and fear of falling,
but not with depression.

Conclusion: The study shows that fall risk and fear of falling are highly prevalent among the institutionalized older adults and are closely linked to depressive symptoms. These findings emphasize the need for integrated intervention addressing both physical balance and psychological well-being to reduce fall risk, alleviate fear of falling, and improve mental health in residential care settings.

Factors increasing telemedicine adoption across adult non-healthcare professionals: A systematic review of observational studies published between 2021 and 2025

2025-10-31T09:09:16+07:00

Background: Telemedicine has emerged as a key digital healthcare platform, offering convenient access to medical services for the public. Despite its potential, widespread adoption remains hindered by lingering consumer skepticism.

Objectives: The aim of this systematic review was to investigate the factors increasing telemedicine adoption across adult non-healthcare professionals.

Materials and methods: This was a systematic review conducted of primary observational studies published between 2021 and 2025. Adhering to PRISMA guidelines, the authors systematically searched three online databases (PubMed, ProQuest, and Science Direct) and screened articles using the PRISMA Flow Chart to identify eligible studies based on predefined inclusion criteria. The Joanna Briggs Institute’s (JBI) critical assessment techniques were used to evaluate the quality of the research findings.

Results: From the reviewed secondary data derived from primary studies, 22 original articles were selected for analysis. Four major themes emerged as drivers of telemedicine utilization, including: 1) socioeconomic-demographic, such as age, education, income, employment, marital status, and social influence, 2) user’s perceived benefits factors like perceived usefulness, benefits, ease of use, and trust, 3) health-related problems, such as frequent healthcare demands, caregiving responsibilities, having chronic disease, and
mental health conditions, and 4) internal factors or technological factors of telemedicine systems: price, service, and system quality.

Conclusion: In conclusion, telemedicine adoption is influenced by a multifaceted interplay of socioeconomic and demographic factors, a user’s perceived benefits, individual health needs, and systemic features.

The effects of motor-cognitive training on balance and working memory in young adult women with low physical activity: A randomized controlled trial

2026-01-22T13:31:26+07:00

Background: Young adult women with low physical activity levels often experience a decline in muscle mass and balance, which can negatively impact both physical and mental health. Cognitive functions, particularly working memory, play a crucial role in maintaining balance during various activities. A reduction in working memory capacity may impair the ability to manage dual-task activities, increasing the risk of instability and falls.

Objectives: To investigate the effects of motor-cognitive training combining balance exercises with working memory tasks on balance performance and working memory skills in women aged 18-25 years with low physical activity levels.

Materials and methods: A randomized controlled trial was conducted with 46 female participants aged 18-25 years who had low physical activity levels. Participants were randomly assigned to either an experimental group (N=23) or a control group (N=23). The experimental group underwent motor-cognitive training, which integrated balance training with working memory tasks, for three consecutive days. The control group received general information on improving balance and working memory. Pre- and post-training assessments were conducted using the Biodex Balance System to measure static balance (sway index values from the Balance Error Scoring System), dynamic balance (limit of stability), and working memory were assessed using the digit span test. Data were analyzed statistically, with significance set at p<0.05.

Results: Following the training, the experimental group exhibited significantly greater improvements in working memory skills compared to the control group. Additionally, the experimental group demonstrated enhanced dynamic balance performance, particularly in the forward/right and backward/left directions, compared to the control group.

Conclusion: Motor-cognitive training enhances balance and working memory in young adult women with low physical activity over the short period. This dual-task training approach presents a promising strategy for promoting balance and cognitive function in this population.

The study of maximum electromyogram of masseter muscle before and during modified electroconvulsive therapy in psychiatric patients

2026-02-04T08:27:43+07:00

Background: Electroconvulsive therapy (ECT) is generally used to treat various severe and treatment resistant psychiatric disorders. Nowadays modified ECT is used, injury to teeth and other oral structure remain a risk in ECT despite the use of muscle relaxants due to the electrodes are placed on the temporal, quite close to the masseter muscle. The use of a bite guard is essential to prevent dental and soft tissue injuries; however, limited evidence exists regarding electromyogram (EMG) of the masseter muscle before and during modified ECT.

Objectives: To compare the maximum EMG of the masseter muscle under three conditions: 1) maximal clenching without a bite guard, 2) maximal clenching with a bite guard, and 3) during modified ECT with anesthesia, muscle relaxants and a bite guard and to evaluate post procedural oral complications.

Materials and Methods: This cross-sectional study included 40 psychiatric inpatients who undergoing modified ECT at Suanprung Psychiatric Hospital. Surface EMG signals of the masseter muscle were recorded using the Thymatron® System IV (Somatics LLC, USA) under the three conditions: before anesthesia without a bite guard (NB), before anesthesia with a bite guard (B), and during ECT with anesthesia, muscle relaxants and a bite guard (ECT). Differences among conditions were analyzed using repeated measures ANOVA, and independent samples t-tests were used to compare EMG values between groups (<5,451.1 μV vs ≥5,451.1 μV). Significance was set at p<0.05. Post procedural oral examinations were performed to identify any trauma or soft-tissue injuries.

Results: All 40 participants completed the study (mean age 35.63±13.17 years). Schizophrenia was the most prevalent diagnosis (45%), and 67.5% of patients were classified as ASA Class II. The maximum EMG amplitude during ECT was significantly higher than in the NB and B conditions (p<0.001). No significant differences in EMG amplitude were found between the NB and B conditions (p>0.05). Across all participants, EMG values differed significantly among all three conditions (p<0.001). Notably, no oral complications were observed with the use of the newly designed silicone bite guard.

Conclusion: Modified ECT induces significantly higher masseter muscle EMG activity approximately 15-fold greater than pre-ECT clenching. The use of newly designed silicone bite guard effectively prevents oral injury during ECT, supporting its routine clinical application to enhance patient safety and minimize oral complications.

Fabrication and evaluation of 3D-printed customizable boluses for optimized radiotherapy applications

2025-11-24T18:00:54+07:00

Background: Commercial radiotherapy boluses often fail to conform accurately to patient anatomy, resulting in air gaps and surface dose inaccuracy. Threedimensional (3D) printing using fused deposition modeling with polylactic acid (PLA) offers a customizable alternative, but clinical implementation requires a reproducible fabrication workflow that ensures both radiological consistency and geometric conformity.

Objectives: To evaluate the effect of infill density on radiological properties and assess the feasibility of a consistent fabrication approach for both standard and patient-specific boluses.

Materials and methods: Standard PLA boluses (10×10×1 cm) were fabricated at 75-95% infill density using a line infill pattern, while customized boluses were created from a head-and-neck phantom and printed at 90-95% infill density. All boluses underwent CT imaging and were analyzed in the Eclipse treatment planning system (TPS) to determine Hounsfield unit (HU), mass density, and relative electron density (RED). Air gap measurements and dose distributions were evaluated in the TPS with a 6 MV photon beam.

Results: As infill density increased from 75%-95%, HU values rose from -184.6 to +48.5, with 90–94% infill yielding HU values within the acceptable ±50 HU range. Standard and customized boluses demonstrated comparable radiological behavior, with mass density and RED near unity. Customized boluses reduced air gaps (0.21±0.02 cm vs 0.54±0.16 cm) and improved surface-dose build-up and isodose coverage in complex regions.

Conclusion: Optimized infill density settings support a reproducible 3D printing workflow. Both standard and customized PLA boluses can achieve radiological accuracy and surface conformity suitable for clinical implementation.

Effectiveness of guided imagery to improve sleep quality among young adults with post-traumatic stress disorder (PTSD)

2026-02-02T14:08:02+07:00

Background: Post-traumatic stress disorder often leads to ongoing sleep difficulties such as insomnia and nightmares, which can interfere with mood, concentration, and daily activities. Guided imagery, a relaxation method that uses calming, multisensory visualizations, has shown potential to improve sleep and reduce distress in people experiencing high stress or trauma. This study evaluates the effectiveness of guided imagery in improving sleep quality among young adults with post-traumatic stress disorder (PTSD) compared to conventional occupational therapy.

Objectives: To evaluate and compare the effectiveness of guided imagery and conventional occupational therapy in improving sleep quality among young adults (18-25 years) with post-traumatic stress disorder.

Materials and methods: A quasi experimental design was conducted with 30 young adults aged 18-25 years, recruited through convenience sampling and divided into two groups: experimental (guided imagery intervention) and control (conventional occupational therapy). The potential of the post-traumatic stress disorder was accomplished by the diagnosis of PTSD using Clinician-
Administered PTSD Scale for DSM-5, Past-Month version. Both interventions were delivered over three months, with 36 sessions held three times per week, each lasting 45 minutes. The state of sleep prior to intervention and right after the intervention was critically explained with the aid of the Pittsburgh Sleep Quality Index (PSQI). Statistical analysis was performed to compare pre- and post-test scores within and between groups.

Results: The experimental group (N=15) had a mean pre-test PSQI score of 14.40 (SD=2.41) and a post-test score of 8.73 (SD=2.05), showing a highly significant improvement (t=15.707, p=0.000). The control group (N=15) had a mean pre-test PSQI score of 14.07 (SD=1.53) and a post-test score of 13.47 (SD=1.60), also showing significant improvement (t=2.358, p=0.033). Post-test scores between the groups revealed a significantly greater improvement in the experimental group compared to the control group (t=7.050, p=0.000).

Conclusion: Guided imagery was found to greatly improve sleep quality in young adults living with post-traumatic stress disorder, offering better results than conventional occupational therapy. These results highlight the value of using gentle, non-drug approaches like guided imagery to ease sleep difficulties and support overall well-being in this group.

Assessment of imaging radiation dose from tomotherapy systems

2025-11-27T16:18:35+07:00

Background: Tomotherapy systems employ image-guided radiotherapy (IGRT) using either megavoltage (MVCT) or kilovoltage (kVCT) computed tomography for daily patient positioning verification. However, these imaging procedures can deliver a non-negligible radiation dose to the patient. According to the American Association of Physicists in Medicine (AAPM) Task Group 180, this dose should be incorporated into the prescribed treatment dose if it exceeds 5%.

Objectives: This study aimed to assess IGRT imaging doses and determine whether the cumulative dose exceeded 5% of the prescribed treatment dose.

Materials and methods: Imaging doses from IGRT were evaluated under clinical scan protocols across four tomotherapy machines at three centers, including two MVCT systems and two kVCT systems. Doses were measured as Weighted Multiple Slice Average Dose (MSADw) using a CTDI phantom. Cumulative imaging dose was calculated by multiplying MSADw by the number of imaging sessions, then compared to the prescribed dose for each patient.

Results: The mean MSADw values for MVCT ranged from 0.85 to 0.86 cGy per scan, while for kVCT it ranged from 0.19 to 2.65 cGy per scan. Over the treatment course, cumulative imaging doses accounted for 0.34-0.44% of the prescribed dose for MVCT and 0.28-0.87% for kVCT. Notable inter-center variations were observed, with differences of up to 51.16% in breast cancer cases and 35.71% in prostate cancer cases.

Conclusion: Cumulative imaging doses from both MVCT and kVCT across all centers remained below the 5% threshold, indicating no need to adjust the prescribed dose in clinical practice. Nevertheless, further studies are required to identify the causes of inter-center variations and to develop optimized imaging protocols aimed at minimizing patient dose while maintaining adequate image quality.

Serum Klotho as a feasible diagnostic biomarker for metabolic syndrome in Iraqi adults aged over 50 years

2025-10-31T12:53:27+07:00

Background: Metabolic Syndrome (MetS) is a cluster of cardiometabolic risk factors primarily driven by insulin resistance, with a high prevalence in older adult populations.

Objectives: This study aimed to evaluate the diagnostic accuracy of serum Klotho Beta (KLB) and insulin as novel biomarkers for MetS in Iraqi adults over 50 years old.

Materials and methods: This case-control study included 60 MetS patients and 30 healthy controls, recruited from Iraqi hospitals. MetS was diagnosed using harmonized IDF/AHA/NCEP ATP III criteria. Serum Klotho Beta and insulin levels were measured by ELISA.

Results: Serum Klotho Beta levels were significantly lower in the MetS group (25.54±4.41 nmol/L) compared to controls (59.00±11.05 nmol/L, p<0.001). Klotho Beta was inversely correlated with HOMA-IR (r=-0.59, p<0.001), BMI, HbA1c, and triglycerides, and positively with HDL-C. ROC analysis showed an AUC of 0.997 for Klotho Beta (sensitivity 95%, specificity 100% at ≤35.248 nmol/L) and an AUC of 0.998 for insulin. Logistic regression confirmed Klotho Beta as a strong independent predictor of MetS (OR=1.85 per 1 nmol/L decrease).

Conclusion: Serum Klotho Beta and insulin are highly sensitive and specific biomarkers for MetS in older adults. Klotho Beta deficiency, coupled with hyperinsulinemia, reflects underlying insulin resistance and metabolic dysregulation, highlighting its potential for risk stratification and early diagnosis in high-risk populations.

Towards precision hematology: Machine learning-driven comparative feature importance analysis of hematologic parameters in newly diagnosed chronic myeloid leukemia vs healthy controls

2025-11-12T15:34:17+07:00

Background: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm characterized by uncontrolled granulocytic proliferation and is often initially suspected based on peripheral blood smear findings. Utilizing machine learning to analyze routinely available Complete Blood Count (CBC) parameters and derived inflammatory indices may facilitate early identification of CML at the time of initial diagnosis.

Objectives: The objective of this study is to evaluate the diagnostic value of routinely available Complete Blood Count (CBC) parameters and derived inflammatory indices for the early identification of chronic myeloid leukemia at the time of initial diagnosis, using machine learning–based models.

Materials and methods: This study was conducted on 295 newly diagnosed cases of CML and 340 normal control samples. A total of 49 factors were subjected to study, including the following: variables included in the CBC of patients, inflammatory indices, and demographic data. Logistic regression analysis was performed to identify relevant variables, resulting in the selection of 22 features. Subsequently, multiple machine learning algorithms, including Random Forest (RF), Recursive Feature Elimination (RFE), Simulated Annealing (SA), Decision Tree (DT), K-Nearest Neighbor (KNN), and Xg-Boost (XGB), were applied to evaluate the diagnostic performance pf the selected features.

Results: The findings of this study indicate that the factors most pertinent in initial diagnosis in comparison with normal control include the WBC count, the relative percentage of cells including neutrophils, monocytes, and lymphocytes, and a series of indicators related to RBC such as RBC count and RDW-CV, as well as the index of inflammatory NLR, and BLR and PDW.

Conclusion: This study demonstrates that machine learning models based solely on routinely available CBC parameters and derived inflammatory indices can support the early identification of CML at the time of initial diagnosis. In addition to leukocyte-related variables, RBC-related and inflammatory indices provided complementary diagnostic information, highlighting their potential value in early-stage CML detection. The application of machine learning techniques could prioritize the development of more user-friendly dashboards to facilitate the diagnosis of CML at initial diagnosis.

The usefulness of endometrial receptivity biomarkers as predictors of IVF outcome

2025-09-13T21:23:06+07:00

Background: Despite advances in assisted reproductive technology, predicting in vitro fertilization (IVF) success remains challenging.

Objectives: This study aimed to investigate the relationship between endometrial receptivity biomarkers and Ovarian Sensitivity Index (OSI) as predictors of IVF outcomes.

Materials and methods: A total of 72 women undergoing IVF treatment, between December 2023 and July 2024, participated in this study. Serum levels of MUC1, GDF-9, and HLA were measured, OSI was calculated, and pregnancy outcomes (β-hCG) were recorded. Participants were divided into two groups based on OSI (≤4 and >4), and biomarker levels were compared. Correlation analysis, ROC curves, and logistic regression models were used to assess predictive capabilities.

Results: OSI showed strong predictive value (AUC=0.751, 95% CI: 0.613-0.859, p<0.05) with a threshold of >8 (sensitivity=52.63%, specificity=94.12%). Endometrial biomarkers showed limited individual predictive capacity (AUCs: MUC1=0.625, GDF-9=0.507, HLA=0.589). OSI retained significant association with pregnancy outcomes across all regression models (OR=1.19-1.38, p<0.05). Combining hormonal parameters with OSI significantly improved model performance (AUC=0.867, R²=0.509). Significant correlations were observed between OSI and hormonal parameters, particularly AMH (r=0.66, p<0.05) and E2 (r=0.49, p<0.05).

Conclusion: While endometrial receptivity biomarkers showed limited individual predictive value, the incorporation of OSI with hormonal parameters provides better predictive value of IVF outcomes, suggesting the importance of a comprehensive assessment in assisted reproduction.

Examination of the validity and reliability of the Perceive, Recall, Plan, and Perform-long COVID (PRPP-Long COVID) self-report assessment for Thai adults with long COVID

2026-01-21T10:58:33+07:00

Background: Long COVID harms multiple aspects of occupational performance, affecting daily routines, academic pursuits, and work efficiency due to compromised physical, mental, and cognitive abilities. Notably, patients with long COVID commonly report persistent cognitive impairments.

Objectives: This study aims to adapt and evaluate the validity and reliability of the self-report assessment; the PRPP-Long COVID in Thai adults with long COVID.

Materials and methods: The Perceive, Recall, Plan, and Perform-Long COVID (PRPP-Long COVID) was adapted from the perceive, recall, plan, and perform (PRPP) System of Task Analysis: Thai version. This self-report assessment is used to assess the deficits of information processing capacity in individuals recovering from COVID-19. The psychometric properties of the PRPP-Long COVID were investigated, including content validity, internal consistency, and intra-rater reliability. Thirty individuals aged between 21 and 59 years had previously tested positive for COVID-19 by RT-PCR or Antigen Test Kit (ATK) and had recovered at least three months before participating in this study. All of them had an education level of at least secondary school. The PRPP-Long COVID was sent to three experts to examine for the Index of Item Objective Congruence (IOC). After that, the revised version of the PRPP-Long COVID was distributed to the participants. They were given the Google form link submission in 2 rounds, seven days apart, to test intra-rater reliability. For data analysis, descriptive statistics were utilized to calculate demographic characteristics, while the Cronbach alpha coefficient and the Intra-class Correlation Coefficients (ICCs) were used to estimate the internal consistency and intra-rater reliability of the PRPP-Long COVID, respectively.

Results: The IOC values for each question demonstrated a high level of agreement (IOC=0.67-1.00). The internal consistency of the 34 questions in the PRPP-Long COVID indicated a high level of reliability, with α=0.93. The intrarater
reliability of the PRPP-Long COVID was moderate to good (ICC=0.55-0.88).

Conclusion: The PRPP-Long COVID self-rated assessment has been determined to have acceptable validity and reliability.

Effect of acceptance and commitment therapy on psychological well-being and quality of life among individuals living with HIV

2026-01-05T11:59:55+07:00

Background: Psychiatric issues are notably common among individuals with HIV, heavily impacting the overall quality of life and the success of their treatment. Acceptance and Commitment Therapy (ACT) is a recent cognitivebehavioural therapy that puts great emphasis on psychological flexibility. However, while the model has been extensively studied in clinical settings, research on its application for psychological well-being and quality of life among individuals with HIV remains limited.

Objectives: This study aimed to evaluate the effect of acceptance and commitment therapy on psychological well-being and quality of life among individuals living with HIV.

Materials and methods: A total of 55 individuals with HIV met the inclusion criteria, from which 33 individuals with HIV provided consent to participate in the study. Before the randomization of the groups, 3 participants were dropped out of the study due to relocation from their living facility. The remaining 30 individuals with HIV were selected and assigned to either the experimental group (N=15) or the control group (N=15) through simple randomization using the lottery method in which participants retrieved sequentially numbered opaque sealed envelopes. The quality of life and psychological well-being were assessed using the WHOQOL HIV-BREF and Ryff’s psychological well-being scale. The experimental group received Acceptance and Commitment Therapy, while the control group underwent conventional occupational therapy for three months. Data analysis was performed using SPSS version 23.0, with paired and independent t-tests applied.

Results: Post-test scores showed statistically significant improvements in the experimental group than in the control group in both quality of life (p<0.001) and psychological well-being (p<0.001). The results of this study showed that Acceptance and Commitment Therapy was effective in enhancing both quality of life and psychological well-being among individuals with HIV.

Conclusion: The findings indicate that Acceptance and Commitment Therapy effectively enhanced quality of life and psychological well-being of Individuals living with HIV positive following intervention in experimental group.

Effectiveness of reminiscence therapy to improve sleep quality among older adults with hypertension

2026-02-04T08:34:00+07:00

Background: Sleep disturbances are highly prevalent among older adults with hypertension, further exacerbating cardiovascular risks and impairing quality of life. Reminiscence therapy, a psychosocial intervention, has shown promise in promoting psychological well-being and reducing stress, thereby improving sleep outcomes.

Objectives: To evaluate the effectiveness of reminiscence therapy In improving sleep quality among older adults with hypertension.

Materials and methods: The experimental study was conducted among 30 hypertensive older adults aged 60 years and above. Participants were allocated to the intervention (reminiscence therapy) and control groups, which received conventional occupational therapy focused on improving sleep quality. This included cognitive behavioural therapy for insomnia, sleep hygiene education, sensory modulation strategies, environmental adaptations, and activity scheduling. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results: Post-intervention analysis revealed a significant improvement in PSQI scores in the reminiscence therapy group compared to the control group (p<0.05). Subdomains, including sleep latency, sleep duration, and overall sleep efficiency, showed marked improvements.

Conclusion: Reminiscence therapy is effective in enhancing sleep quality among older adults with hypertension and can be integrated as a complementary non-pharmacological intervention in geriatric care.