Journal of Associated Medical Sciences

A comparison of aerobic and anaerobic capacities in different positional roles of basketball players aged 13-16 years

2026-09-01T10:08:57+07:00

Background: Basketball is a high-intensity intermittent sport that requires both aerobic and anaerobic energy systems. Physical demands vary across playing positions; however, evidence in adolescent players remains limited.

Objectives: To compare aerobic and anaerobic capacities across different playing positions in basketball players aged 13-16 years

Materials and methods: This cross-sectional study included 60 adolescent basketball players in Chiang Mai Province. Participants were categorized into five positional roles: point guard, shooting guard, small forward, power forward, and center. Aerobic capacity was assessed using estimated maximal oxygen consumption (VO₂max) from the 20-meter shuttle run test, while anaerobic capacity was evaluated using fatigue index (FI). The body composition variables were recorded, including body mass index, body fat percentage, and muscle mass percentage. Differences among groups were analyzed using one-way ANOVA with Bonferroni post hoc analysis.

Results: No significant differences in anaerobic capacity (FI) were found among the five positions (p>0.05). In contrast, aerobic capacity (VO₂max) differed significantly between positions (p<0.05), with point guards demonstrating significantly higher VO₂max compared to centers. Other positional comparisons were not statistically significant.

Conclusion: Aerobic capacity differed only between point guards and centers, with point guards demonstrating higher estimated VO₂max than centers, whereas anaerobic capacity appeared comparable across playing positions. These findings suggest that playing position may be associated with differences in aerobic performance and should be considered when designing training programs for adolescent basketball players.

A development of a conceptual model of occupational patterns promoting alcohol abstinence among northeastern Thais with alcohol use disorder

2026-09-09T14:25:19+07:00

Background: The difficulty of alcohol abstinence and recovery from unhealthy living patterns is influenced by individual context. There is still limited evidence to reveal concepts and processes of sustained alcohol abstinence in people with experienced alcohol use disorder, including Northeastern Thais.

Objectives: This study aimed to develop a conceptual model explaining how Thais with alcohol use disorder in the northeastern region sustain their alcohol abstinence.

Materials and methods: Charmaz’s constructivist grounded theory guided the development of a conceptual model. Data collection was done in Khon Kaen, Thailand. Fourteen participants who had sustained alcohol abstinence for at least one year voluntarily participated in semi-structured, in-depth interviews between December 2024 and December 2025. Constant comparative analysis was used on 27 transcripts, 23 observation notes, and memos. Co-researchers rechecked and agreed on the substantive model, and two participants confirmed their data in the model to strengthen trustworthiness.

Results: The conceptual model of a healthy pattern promoting alcohol abstinence was developed with four themes interlinking sequentially: acceptance of alcohol addiction, anchoring a better life’s goal, shifting identity formation, and self-determination on a health pattern. The first two concepts indicated initial awareness of the negative impacts of alcohol addiction, then the others emphasized maintaining the determination of a healthy routine without alcohol.

Conclusion: All concepts emerged from the first-hand experiences of alcohol abstinence, guided the development of a health pattern promoting sustained abstinence related to the context, and provided ideas for the healthcare providers in further development of a supportive clinical program to prevent addictive relapse.

HIV-1 drug resistance during the transition from NNRTI- to INSTI-based therapy in Thailand: prevalence, resistance-associated mutations, and antiretroviral

2026-09-04T08:48:59+07:00

Background: Antiretroviral therapy (ART) effectively suppresses HIV replication and reduces HIV-related morbidity and mortality; however, HIV drug resistance (HIVDR) remains a major challenge to long-term treatment success.

Objectives: This study investigated the prevalence of HIVDR, resistance-associated mutations (RAMs), antiretroviral susceptibility profiles, and factors associated with HIVDR among HIV-infected patients receiving ART at Queen Savang Vadhana Memorial Hospital, Thailand.

Materials and methods: A retrospective study was conducted among 261 HIV-infected patients with HIV RNA levels >1,000 copies/mL who underwent HIVDR testing between January 2020 and December 2024. Drug resistance was determined using next-generation sequencing (NGS)-based assay simultaneously analyzes the protease (codons 1-99), reverse transcriptase (codons 1-376), and integrase (codons 1-288) regions of the HIV-1 pol gene. Variant-calling thresholds were 20% was applied to samples with HIV RNA ≥1,000 copies/mL, 5% was used for samples with HIV RNA ≥15,000 copies/mL, and resistance interpreted using the Stanford HIV Drug Resistance Database (HIVdb version 9.4).

Results: Among 261 patients, 169 (64.8%) harbored genotypic drug resistance mutations. CRF01_AE was the predominant HIV-1 subtype (93.1%). Dual resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) was the most common resistance pattern (49.7%), followed by NNRTI-only resistance (24.3%). NNRTI resistance was the most prevalent resistance class (85.8%), followed by NRTI (65.1%), protease inhibitor (PI) (17.8%), and integrase strand transfer inhibitor (INSTI) resistance (4.1%). M184V and K103N were the most frequently detected NRTI- and NNRTI-associated mutations, respectively. Resistance to nevirapine, efavirenz, and abacavir was common, whereas susceptibility to darunavir/ritonavir, dolutegravir, and bictegravir remained high. Patients with CD4 counts <100 cells/μL and ART duration of 5-10 years were more likely to harbor drug resistant HIV strains, whereas second-line ART was associated with lower odds of HIVDR.

Conclusion: Combined NRTI-NNRTI resistance remained the predominant HIVDR pattern during 2020-2024. Although INSTI-associated resistance emerged following the implementation of INSTI-based therapy in Thailand, its prevalence remained low, supporting the continued effectiveness of dolutegravir-based regimens. Continuous HIVDR surveillance remains essential to optimize long-term treatment outcomes.

Machine learning with SMOTE-NC on routine hematology parameters for early identification of Hb E trait

2026-09-04T08:46:23+07:00

Background: The hemoglobin E (Hb E) trait, which is highly prevalent in Southeast Asia and may co-occur with α-thalassemia, often exhibits heterogeneous complete blood count profiles; notably, some individuals with the Hb E trait have near-normal MCV and MCH values, increasing the risk of misclassification during routine hematological screening.

Objective: This study aimed to develop and externally validate an interpretable machine-learning model to screen for Hb E trait using routine Complete Blood Count (CBC) data.

Materials and methods: We analyzed 5,787 standardized CBC records using two processing pipelines: a standard dataset and an SMOTE-NC oversampled dataset. We selected features using ReliefF and evaluated nine machinelearning algorithms. We interpreted the optimal model using SHAP values and validated it on an independent external cohort (n=625).

Results: Discrimination for Hb E trait was moderate-to-good and consistent between internal and external evaluation. Erythrocyte indices-Z-MCV, Z-MCH, and Z-RBC-were the most discriminative features. Among nine algorithms, a support vector machine gave the best combination of sensitivity and discrimination (internal AUC 0.881, sensitivity 70.66%, specificity 87.92%; external AUC 0.879, sensitivity 72.38%, specificity 87.39%). With the decision threshold tuned for screening, external sensitivity rose to approximately 91% with negative predictive value above 94%. SHAP analysis confirmed the model’s reliance on biologically plausible drivers (low MCV/MCH with a relatively preserved RBC count).

Conclusion: An explainable machine-learning model utilizing routine CBC parameters offers a viable, low-cost pre-screening tool for Hb E trait. Internal and external performance are concordant, and with local calibration and threshold tuning, the model triages patients for confirmatory testing and definitive genotyping rather than replacing them, supporting optimized diagnostic workflows in endemic regions.

Clinical effectiveness and cost-effectiveness analysis of home-based rehabilitation following hip fracture surgery: Study protocol

2026-09-09T15:37:14+07:00

Background: Hip fracture incidence has risen significantly with population aging. Postoperative rehabilitation plays an important role in patient recovery. Home-based rehabilitation promotes continuous care. However, evidence of clinical outcomes and cost-effectiveness is needed.

Objectives: To investigate the clinical effectiveness and cost-effectiveness of home-based rehabilitation compared with facility-based rehabilitation as the usual rehabilitation scheme after hip fracture surgery.

Materials and methods: This study was a quasi-experimental design with cost-effectiveness analysis. One hundred and four participants were recruited (52 participants per arm). Both groups received interventions for 8 weeks, either at the patient’s home or at the hospital. Outcome variables included physical performance, ability to perform daily activities, fall efficacy, and quality of life. These outcomes were evaluated at baseline, postintervention, and at the 6-month follow-up. Moreover, we performed a cost-effectiveness analysis after the 6-month follow-up period.

Results: The outcome variables would be evaluated and compared between groups and time points at baseline, after the 8-week intervention, and at the 6-month follow-up. The changes in clinical outcomes would be examined and reported for both between- and within-group comparisons. The cost-effectiveness at the 6-month follow-up would be specified as the incremental cost-effectiveness ratio (ICER), while also considering parameter uncertainty.

Conclusion: Home-based rehabilitation following hip fracture surgery was expected to enhance functional recovery, quality of life, and cost-effectiveness. Moreover, this intervention could help solve patients’ problems related to
accessibility and continuing care.

Iron-polyphenol complexes in cancer theranostics: Coordination chemistry, therapeutic mechanisms, and molecular imaging

2026-09-14T18:19:39+07:00

Background: Iron-polyphenol complexes have emerged as promising theranostic platforms by integrating the biological activity of polyphenols with the redox and coordination properties of iron. Their ability to form discrete molecular complexes and metal-phenolic networks (MPNs) provides tunable control over iron stability, redox activity, cargo delivery, and imaging performance. Since cancer cells exhibit altered iron metabolism and increased dependence on iron availability, these systems offer opportunities for exploiting tumor-specific vulnerabilities through ferroptosis, chemodynamic therapy, and multifunctional molecular imaging.

Objectives: This review aims to summarize recent advances in iron-polyphenol systems for cancer theranostics, focusing on the relationship between coordination chemistry, therapeutic mechanisms, and imaging applications. Particular emphasis is placed on discrete Fe-polyphenol complexes, metal-phenolic networks, coordination polymers, and iron-containing hybrid nanoplatforms, including their structural characteristics, anticancer mechanisms, imaging capabilities, biological limitations, and translational challenges.

Materials and methods: A structured literature search was conducted using PubMed, Scopus, and Web of Science from database inception to August 2026. Studies related to Fe(II)/Fe(III)-polyphenol coordination systems, including polyphenolic ligands such as catechol, tannic acid, gallic acid, quercetin, and related architectures, were evaluated. Eligible studies included original research investigating coordination chemistry, cancer therapy, molecular imaging, biodistribution, pharmacokinetics, safety, or translational aspects. Non-iron metal-polyphenol systems, iron materials lacking polyphenolic coordination, and unrelated applications were excluded.

Results: Iron-polyphenol platforms demonstrate diverse anticancer activities through coordination-controlled mechanisms, including ferroptosis induction, Fe-mediated chemodynamic therapy, photothermal therapy, drug delivery, and immune modulation. The therapeutic and imaging behavior of these systems is strongly influenced by ligand identity, Fe oxidation state, coordination stoichiometry, pH responsiveness, and supramolecular architecture. Iron-polyphenol complexes and MPNs also show potential as gadolinium-free MRI contrast agents, photoacoustic imaging platforms, and immune-cell tracking probes. However, clinical translation remains limited by structural heterogeneity, biological barriers such as protein corona formation and reticuloendothelial system uptake, incomplete biodistribution understanding, long-term iron toxicity concerns, and challenges in scalable manufacturing and quality control.

Conclusion: Iron-polyphenol complexes represent a versatile class of theranostic materials that bridge natural product chemistry, redox-regulated cancer therapy, and molecular imaging. Their tunable coordination chemistry enables rational development of multifunctional platforms; however, successful clinical translation requires improved structural standardization, reproducible manufacturing, comprehensive safety evaluation, and quality-controlled production strategies. Continued investigation into coordination-structure-function relationships will be essential for advancing iron-polyphenol systems toward clinically relevant precision cancer theranostics.

Urban-rural disparities in metabolic syndrome prevalence and risk factors among industrial workers in central Thailand: A cross-sectional comparative study

2026-09-14T18:19:42+07:00

Background: Metabolic syndrome (MetS) prevalence varies substantially between urban and rural settings, reflecting differences in access to healthcare services, food environments, and lifestyle patterns. Industrial workers in Thailand face distinct metabolic health challenges shaped by the geographical location of their workplaces and the associated policy contexts.

Objectives: To compare MetS prevalence, anthropometric profiles and metabolic risk factors between industrial workers in urban and rural areas of central Thailand, and to examine the influence of geographical location on MetS risk after adjustment for individual-level factors.

Materials and methods: This cross-sectional comparative study used stratified multistage random sampling to enroll 480 industrial workers (240 urban, 240 rural; 93.8% participation among eligible workers) aged 25-59 years from industrial estates in Health Service Region 4, Thailand, during December 2025, following institutional ethical approval granted on 28 November 2025. Data were collected using a validated mobile application and a LINE Official Account for appointment scheduling and information gathering. Anthropometric measurements, each taken in duplicate and averaged, included body mass index, waist circumference, torso-to-head ratio and umbilical waist circumference. Biochemical assessment comprised fasting plasma glucose, lipid profile and duplicate blood pressure measurements. MetS was diagnosed using the harmonized criteria. Logistic regression identified crude and adjusted predictors of MetS, adjusting for sociodemographic, lifestyle and occupational factors, including alcohol use, sleep duration, perceived stress, working hours, medication use, family history of cardiovascular disease, employment duration and occupational class.

Results: Overall MetS prevalence was 38.5% (N=185) and was significantly higher in urban workers (46.3%, 111/240) than in rural workers (30.8%, 74/240, p<0.001); both estimates exceeded the 28% national prevalence reported in the 6th Thai National Health Examination Survey. Urban workers had significantly higher mean body mass index (27.2±3.8 vs 25.1±3.2 kg/m², p<0.001), waist circumference (89.4±9.2 vs 84.6±8.5 cm, p<0.001), and prevalence of central obesity (58.3% vs 42.5%, p=0.001). After adjustment for age, sex, education, income, smoking, physical activity, dietary pattern, and additional occupational and psychosocial covariates, urban residence remained independently associated with MetS (adjusted OR 2.18, 95% CI 1.42-3.35, p<0.001, crude OR 1.93, 95% CI 1.33-2.81). Stratified analysis showed that urban workers had a higher prevalence of elevated triglycerides (51.7% vs 38.3%, p=0.004) and reduced HDL-cholesterol (44.2% vs 32.1%, p=0.008).

Conclusion: Substantial urban–rural disparities in MetS prevalence exist among industrial workers in central Thailand, with urban residence associated with higher metabolic risk independently of the individual characteristics measured. These findings highlight the need for geographically tailored workplace health interventions addressing area-specific food environments and physical activity infrastructure.

The validity and reliability of the SRS-22r questionnaire in patients with scoliosis receiving physical therapy

2026-09-16T13:02:02+07:00

Background: The malalignment of the spine affects both the physical and mental health of patients with scoliosis. The refined version of the Scoliosis Research Society questionnaire (SRS-22r) is a common tool used for assessing the health-related quality of life (HRQOL) in this patient population. However, the Thai version of this questionnaire has not been tested for psychometric properties in scoliosis patients receiving physical therapy.

Objective: This study aimed to evaluate the concurrent validity, internal consistency, and test-retest reliability of the SRS-22r in patients with scoliosis undergoing physical therapy.

Materials and methods: Twenty-nine patients diagnosed with scoliosis responded to three instruments, including the SRS-22r, Short Form 36 version2 (SF-36v2), and the Hospital Anxiety and Depression Scale (HAD). Participants also completed the SRS-22r again seven days later.

Results: The SRS-22r domains showed no floor or ceiling effects, except for treatment satisfaction, while the SF-36v2 and HAD showed greater ceiling or floor effects in many domains. A good to excellent correlation was observed between total scores and domain scores of SRS-22r and SF-36v2, as well as SRS-22r and HADS. The Cronbach’s alpha was satisfactory, with an average of 0.772 for all domains of SRS-22r. The ICCs for the two-time responses of the SRS-22r were excellent for the total score and the self-image, pain, mental health, and physical function domains, with average ICCs of 0.771. The treatment satisfaction domain had lower Cronbach’s alpha, Pearson correlation coefficient, and ICCs than the other domains.

Conclusion: The SRS-22r was valid and reliable when applied to patients receiving physical therapy. However, modifying the treatment satisfaction measure may be considered.

Automatic delineation of organs at risk for prostate cancer on computed tomography images using convolutional neural networks

2026-07-21T17:06:19+07:00

Background: Prostate cancer is the fourth most common cancer worldwide and the second most common in men. Accurate identification of organs at risk (OARs) is crucial for improving treatment planning, making the process faster and more efficient. Artificial intelligence has become a vital tool in medicine, reducing delays and improving treatment workflow by enabling precise, consistent automatic organ delineation.

Objectives: This study investigates and compares the performance of deep learning models for automatic OAR segmentation in CT images of prostate cancer patients.

Materials and methods: Using 2,011 CT images from the Prostate-Anatomical-Edge-Cases dataset, the U-Net, Dense V-Net, and DeepMedic models were evaluated under the same parameters for segmenting the bladder, rectum, and left and right femoral heads. Performance was assessed using the Dice Similarity Coefficient (DSC), 95th percentile Hausdorff Distance (HD95), and Mean Surface Distance (MSD).

Results: The Dense V-Net outperformed the other models, achieving the highest DSC (0.99) and the lowest HD95 (0.00) and MSD (0.00) for the bladder. U-Net performed well for well-defined structures, such as the femoral heads, while DeepMedic demonstrated the most stability.

Conclusion: Dense V-Net’s superior performance highlights its effectiveness in medical image segmentation, particularly in prostate cancer treatment.

Prevalence and factors associated with microalbuminuria: A structured narrative literature review

2026-07-06T21:42:36+07:00

Background: Microalbuminuria, defined as urinary albumin excretion of 30-300 mg/day, is an early marker of renal injury and an established predictor of cardiovascular disease. Its reported prevalence varies widely across populations, and determinants differ by clinical and demographic context.

Objectives: To provide a broad synthesis of the available literature rather than a systematic review or meta-analysis, formal risk-of-bias assessment, quality scoring, and quantitative meta-analysis were not performed.

Materials and methods: A structured narrative literature review was conducted, synthesizing data from 21 observational studies across diverse geographic regions and adult populations. Studies reporting the prevalence of microalbuminuria and/or associated factors using recognized diagnostic criteria were included.

Results: The prevalence of microalbuminuria ranged from 2.8% in normotensive, normoglycemic adults to 61% in diabetic populations. Higher prevalence was frequently associated with diabetes, hypertension, poor glycemic control, older age, obesity, and other cardiometabolic risk factors, although associations varied across populations. Substantial geographic variation was observed, reflecting differences in population characteristics and cardiometabolic risk profiles.

Conclusion: Microalbuminuria is common in high-risk cardiometabolic populations and is consistently associated with multiple modifiable risk factors. These findings are consistent with current clinical guidelines supporting screening in high-risk individuals and highlight the importance of early risk assessment and evidence-based management to reduce renal and cardiovascular complications.

Trends and patterns of laboratory utilization in a community hospital: A 10-year retrospective study for rational laboratory utilization development

2026-06-26T10:04:45+07:00

Background: Irrational use of laboratory services directly impacts hospital resources and financial management, particularly in community hospitals with limited resources. Analyzing long-term trends is a crucial first step in developing strategic policies for Rational Laboratory Utilization (RLU).

Objectives: To investigate trends in laboratory testing frequency and expenditure at Khok Pho Hospital and to analyze utilization patterns over a decade (2013-2022).

Materials and methods: A retrospective descriptive study using aggregate secondary data from the laboratory information system (LIS). Data were analyzed using descriptive statistics, Pareto analysis, simple linear regression for trend analysis, and the Pearson correlation coefficient to examine the relationship between the number of patients and test volume and cost.

Results: Over the ten years, total laboratory test volume increased by 79.1%, rising from 125,865 tests in 2013 to 225,400 tests in 2022. Total laboratory service costs increased 2.07-fold compared with the base year. Linear regression demonstrated significant increasing trends in both test volume (β=12,083 tests/year, R²=0.829, p<0.001) and total expenditure (β=1.32 million THB/year, R²=0.918, p<0.001). After test volume peaked in 2021 due to the expansion of COVID-19 screening, volume declined in 2022 to 225,400 tests, reflecting post-pandemic normalization. Pareto analysis showed that a small number of tests accounted for most total expenditure, particularly HbA1c and lipid profile testing. The number of patients tested correlated strongly with both test volume (r=0.90) and total cost (r=0.95, both p<0.001), indicating that growth in service users was a key driver of rising laboratory costs. The proportion of off-hour workload increased from 23.5% to 26.8%.

Conclusion: Laboratory utilization has grown steadily, driven by the prevalence of chronic diseases and the impact of COVID-19. These findings support implementing Rational Laboratory Utilization policies that focus on high-cost tests and optimize off-hour ordering to improve cost efficiency in community hospitals.