Journal of Associated Medical Sciences

Phrenic nerve and cervical functional interdependence and its sensorimotor anomalies: A musculoskeletal pain consideration review

2025-06-10T14:35:39+07:00

Background: Optimal breathing occurs when using the diaphragm muscle, which is known as diaphragmatic breathing. Any disruption or faulty habit of this breathing pattern would result in breathing pattern disorders (BPDs).

Objectives: The aim of this review is to shed light on the importance of detecting the presence and extent of asymptomatic functional anomalies of cervical segments among individuals with breathing pattern disorders.

Materials and methods: This narrative review was performed by searching in MEDLINE using terms related to phrenic nerve and cervical functional, interdependence, and sensorimotor anomalies. Additionally, articles regarding this topic were extracted in full for a comprehensive and critical analysis. Any study design, such as observational studies, systematic reviews, or narrative reviews, was included. The results were narratively synthesized and described.

Results: Breathing is a physiological process that occurs without any conscious effort. Optimal breathing utilizes the deep diaphragmatic muscles, which lead to filling the lungs with air more efficiently. However, breathing pattern disorders may result from inadequate diaphragm use. BPDs can lead to structural musculoskeletal pathologies, including neck, low back, temporomandibular joint pain, and/or scapular dyskinesis. BPDs cause motor reflexive changes in the cervical spine, which may contribute to pain, restriction, and functional impairments.

Conclusion: Early identification of this faulty habitual suboptimal breathing is required to minimize its adverse effect, which can be disruptive to the motor control mechanism.

Single time-point kidney dosimetry in 177Lu-PSMA therapy: A comparison between AI-based and manual segmentation approaches

2025-05-26T18:02:18+07:00

Background: Single time-point (STP) dosimetry has become a practical and efficient approach for personalised radioligand therapy (RLT), with 48-hours post-injection identified as optimal for kidney dose estimation in ¹⁷⁷Lu-PSMA therapy for prostate cancer. However, segmentation accuracy remains a critical factor affecting dosimetry reliability. AI-based segmentation has recently been integrated into commercial software to improve efficiency and reduce variability. Objectives: This study aims to quantify kidney absorbed doses in patients receiving ¹⁷⁷Lu-PSMA therapy using STP dosimetry and to compare the accuracy and consistency of AI-based segmentation versus manual segmentation techniques.

Materials and methods: Eight treatment cycles from 5 patients of ¹⁷⁷Lu-PSMA were retrospectively analysed. In this work, whole-body SPECT/CT imaging was performed approximately 48 hours post-injection. Then, kidney dosimetry was calculated using voxel-based STP (Hänscheid method) within MIM SurePlan™ MRT software. Kidney volumes of interest (VOIs) were segmented using three approaches: 1) AI-based automatic segmentation, 2) AI-based with manual refinement, and 3) fully manual segmentation. Mean absorbed doses and VOI volumes were compared across methods. Statistical analyses included ANOVA, Dice Similarity Coefficient (DSC), and Jaccard Similarity Coefficient (JSC).

Results: No significant differences in mean kidney absorbed doses were found across segmentation methods (p=0.964), while kidney VOI volumes showed significant variation (p<0.05). AI-based segmentation achieved high concordance with manual delineation (DSC: 0.898±0.019; JSC: 0.816±0.031).

Conclusion: AI-based segmentation provides comparable absorbed dose results to manual segmentation, with reduced time and inter-observer variability.

Prevalence and hematological characteristics of bacterial vaginosis in postmenopausal women

2025-06-12T08:40:19+07:00

Background: Bacterial vaginosis (BV) is a common vaginal dysbiosis associated with systemic inflammatory responses. However, its hematological impact in postmenopausal women remains unclear. This study investigates hematological parameters in postmenopausal women with BV to assess potential systemic inflammatory alterations.

Objectives: This study aimed to investigate various hematological parameters across different BV conditions to better understand their potential role in BV diagnosis and pathophysiology.

Materials and methods: A total of twenty-five postmenopausal women were recruited and categorized into three groups: bacterial vaginosis (BV), intermediate vaginal microbiota, and healthy vaginal microbiota based on Nugent scoring. Vaginal samples were collected aseptically with the participants in the lithotomy position by swabbing the vaginal walls circumferentially near the cervical fornix. Nugent scoring was performed on Gram-stained smears to classify the subjects. Subsequently, Verify® urinalysis reagent strips were directly applied to the vaginal wall to measure pH, protein, and glucose levels. Additionally, hematological parameters including leukocyte count, lymphocyte, eosinophil, neutrophil, monocyte, basophil, platelet counts, and platelet-to-lymphocyte ratio (PLR) were assessed from peripheral blood samples. All data were statistically analysed and compared among the three groups using ANOVA and Kruskal–Wallis tests, with a significance level set at p<0.05.

Results: The prevalence of BV in postmenopausal women was 72%. Hematology parameters did not show significant differences across BV, intermediate, and healthy groups (p>0.05). Leukocyte, neutrophil, and PLR values were slightly higher in BV cases, but not to a statistically significant degree. These findings suggest that BV in postmenopausal women may not elicit strong systemic inflammatory responses compared to premenopausal populations. Additionally, pH, glucose, and protein levels did not differ significantly among the groups, highlighting the need to reconsider standard vaginal health biomarkers in postmenopausal women due to physiological changes induced by menopause.

Conclusion: The prevalence of bacterial vaginosis (BV) in this study was higher than that reported in previous studies; however, it was not associated with significant hematological alterations. Further research is needed to identify reliable systemic and vaginal biomarkers for BV diagnosis in this population, considering the potential influence of hormonal and immunological factors.

Monoclonal antibodies against hemoglobins for detecting thalassemia

2025-06-12T08:06:19+07:00

Background: Hemoglobin is composed of globin polypeptide chains, which serve as immunogens to induce the production of antibodies.

Objectives: This review article aims to describe the use of antibodies against human hemoglobins for the identification of thalassemia and hemoglobinopathies.

Materials and methods: Literature review to discusses the nature of normal human hemoglobin, hemoglobin switching, thalassemia and hemoglobinopathies, laboratory diagnosis, general properties of antibodies, production of antibodies against human hemoglobins, and clinical applications of these antibodies in identifying thalassemia and hemoglobinopathies.Antibody-based detection of hemoglobin is highly useful in diagnosing thalassemia and hemoglobinopathies.

Results: Polyclonal antibodies against HbF have been applied in sandwich ELISA to accurately detect HbF levels. Monoclonal antibodies against HbH and Hb Bart’s have been produced and utilized in sandwich ELISA for detecting α-thalassemia. In addition, monoclonal antibodies against hemoglobin containing α-globin chains were developed and applied in sandwich ELISA to identify infants with Hb Bart’s hydrops fetalis, a condition in which no α-globin chains are produced. For detecting β-thalassemia carriers, monoclonal antibodies against HbA2 were produced, and sandwich ELISA was employed to measure HbA2 levels, which are elevated in these individuals.

Conclusion: Antibody-based diagnosis of thalassemia and hemoglobinopathies enhances the quality of screening platforms and makes diagnosis of these disorders more reliable.

Analytical errors in the laboratory of a general hospital of the Thai Red Cross Society: A 3-year experience

2025-08-25T22:31:45+07:00

Background:Laboratory test results are critical to clinical decision-making, including patient screening, diagnosis, treatment planning, and monitoring therapeutic responses. Therefore, laboratory errors can significantly impact patient care and outcomes.

Objectives:To identify and quantify the types and frequencies of errors in the total testing process of the medical laboratory department, with the goal of reducing preventable errors and improving overall quality.

Materials and Methods:This retrospective descriptive study analyzed error records, incident reports and nonconformities from January 2021, to December, 2023. Errors were categorized by testing phase: pre-analytical, analytical and post-analytical. Specimen sources were classified as outpatient, inpatient, or external (outside hospital). Data were summarized using descriptive statistics, including frequencies, percentages and Six Sigma performance scale values.

Results:A total of 2,261,729 specimens were received during the study period. The overall error rate was 0.197% (4,460 errors). Error rates by phase were 0.116% for pre-analytical, 0.077% for analytical, and 0.004% for postanalytical. Six Sigma performance scores were 4.60 (pre-analytical), 4.70 (analytical), and 5.50 (post-analytical), all within acceptable quality thresholds (>4.15, >3.85 and >4.80, respectively). The most common pre-analytical error was clotted samples (1,233 cases). Analytical errors were dominated by unacceptable internal quality control results (1,088 cases). The most frequent post-analytical error was excessive turnaround time (54 cases). Pre-analytical errors occurred most frequently in inpatient specimens (76.90%), with clotted samples accounting for 41.49% of those cases. Six Sigma values by specimen source were 4.20 for inpatients, 4.90 for outpatients and 4.90 for external sources.

Conclusion: Most laboratory errors occurred in the pre-analytical phase, primarily due to specimen collection issues related to quality and volume, particularly in the inpatient setting. Targeted preventative measures-especially in pre-analytical processes-are essential to minimize errors and improve patient safety. Analytical errors were primarily due to unacceptable IQC, EQA. For quality control improvement, training program laboratory staff on quality control, sigma metrics, risk assessment and quality goal index (QGI), including selection and application of Westgard’s rules, is important. The integration of sigma metrics with QGI, risk management and systematic quality control can enhance laboratory performance and reliability of analytical results.enhance laboratory performance and reliability of analytical results.

The relationship between tinnitus characteristics, stress and depression in patients with subjective tinnitus

2025-07-13T11:17:14+07:00

Background: Tinnitus is a perception of a noise in the ears. Individuals with tinnitus symptoms may experience disrupt daily life activities and mental health issues such as stress and depression.

Objectives: This study aimed to examine the relationship between the tinnitus symptoms and mental health conditions – stress and depression – in individuals with subjective tinnitus.

Materials and methods: This was an analytical cross-sectional study, involved 139 participants with subjective tinnitus aged between 18 and 70 years. All participants underwent clinical hearing tests. The tinnitus severity level was assessed by the Tinnitus Handicap Inventory in Thai version (THI), while the Stress Test 5 (ST-5) and the nine-question depression screening test (9Q) were used to assess stress and depression, respectively.

Results: After adjusting for tinnitus-related variables, the overall THI scores showed significantly positively associated with both the ST-5 and 9Q scores. Additionally, gender was also significantly positively associated with the 9Q scores. In contrast, other tinnitus-related factors including age, affected ear, tinnitus pattern and duration and average hearing thresholds in the affected ear, showed no statistically significant correlations with the ST-5 and 9Q scores.

Conclusion: This study highlights a significant association between the THI scores and both ST-5 and 9Q, indicating that tinnitus severity is closely linked to the development of stress and depression. Therefore, it is essential to monitor and manage psychological distress in patients with tinnitus.

Performance comparisons of three rapid screening methods for the G6PD deficiency test in newborns

2025-08-18T14:20:24+07:00

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive disorder that affects over 400 million people worldwide. The deficit causes individuals susceptible to hemolysis during oxidative stress. In newborns, G6PD deficiency can lead to hyperbilirubinemia, bilirubin-induced neurologic dysfunction, and kernicterus, making early detection and screening crucial.

Objectives: This study aimed to compare the diagnostic performance of three rapid screening tests for G6PD deficiency in newborns: the fluorescent spot test (FST), G6PD rapid test kit, and SD Biosensor, using spectrophotometry as the gold standard.

Materials and methods: Blood samples from 70 newborns were tested using these three methods. The diagnostic performances, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and efficiency of each method were analyzed.

Results: Both the FST and G6PD rapid test kit exhibited higher specificity, PPV, and efficiency compared to the SD Biosensor. Nonetheless, the SD Biosensor exhibited superior sensitivity and NPV, but it was unable to identify G6PD activity in 16.4% of instances due to elevated hemoglobin concentrations.

Conclusion: The FST and G6PD rapid test kit are reliable and suitable for G6PD deficiency screening in newborns, especially in settings with limited resources, due to their high efficiency, specificity, and rapid results. The SD Biosensor remains a valuable tool in clinical contexts requiring high sensitivity. For newborns with high hemoglobin levels, the FST or G6PD rapid test is recommended for accurate screening. Further studies with larger sample sizes are necessary to confirm the reliability of these tests in diverse populations.

The effect of exergaming on balance among children with intellectual disability

2025-07-18T15:20:02+07:00

Background: Intellectual disability (ID) is associated with balance and motor coordination challenges, leading to increased fall risk and limitations in daily activities. Traditional occupational therapy interventions have shown efficacy in addressing these issues, but there is a growing interest in integrating modern technologies, such as exergaming, into therapeutic programs. Exergaming combines physical activity with interactive video games, potentially enhancing motivation and engagement among children with ID. This study focuses on
assessing the impact of exergaming on improving balance in children with ID, an area that remains underexplored in the Indian context.

Objectives: This study aimed to determine the effect of an exergaming intervention on improving balance in clients with intellectual disabilities. Materials and methods: The study involved 30 children aged 6-12 years diagnosed with mild to moderate ID. Participants were randomly divided into two groups: the experimental group (N=15) received exergaming-based balance training, and the control group (N=15) underwent conventional occupational therapy. Both groups participated in 36 sessions over three months, each lasting 45 minutes. Balance was assessed using the Pediatric Balance Scale (PBS) before and after the intervention. The PBS includes 14 tasks that evaluate balance through various daily activities, with scores ranging from 0 (unable to perform) to 4 (independent).

Results: The results demonstrated a significant improvement in balance for both groups. However, the experimental group, which engaged in exergaming, showed a more substantial improvement in PBS scores, increasing from a mean of 29.07 to 41.93. In contrast, the control group’s mean PBS score increased from 28.13 to 33.73. Statistical analysis confirmed that the improvement in the experimental group was significantly more significant (p<0.001), indicating the added benefit of exergaming in enhancing balance among children with ID.

Conclusion: The results indicate that exergaming is an effective intervention for improving balance in children with intellectual disabilities, as it offers engaging, challenging, and play-based therapy. Enhancing balance and postural control may also lead to broader physical and cognitive benefits, such as improved cardiovascular health, muscular strength, and cognitive processing.
These improvements can further support functional independence, promoting inclusivity and better community engagement. Ultimately, this study highlights the potential of exergaming to empower individuals with intellectual disabilities, fostering their overall well-being and quality of life.

Gamma ray interaction of germanoborate glasses for radiation shielding applications

2025-06-30T13:54:29+07:00

Background: Ionizing radiation is essential in medical imaging and therapy, but it also poses health risks to medical staff and patients. Traditional shielding materials like lead are effective but toxic, while concrete lacks transparency. Therefore, glass systems incorporating high-Z oxides offer a promising alternative by combining optical clarity with enhanced radiation shielding performance.

Objectives: This study aims to develop and investigate germanoborate glasses doped with Gd2O3, with a particular focus on their photon attenuation properties. The findings are intended to development of transparent, lead-free radiation shielding materials suitable for medical and industrial applications.

Materials and methods: The Gd2O3 added germanoborate glasses in the system (60-x)B2O3-GeO2-x Gd2O3 (with x=10, 20, 30 and 40 mol%) were synthesized via melting at 1400 oC followed by melt quenching method. The densities were measured by Archimedes’ method. The mass attenuation coefficients (μm), the effective atomic number (Zeff), the effective electron density (Neff), and half-value layers (HVL) were computed using the WinXCom program (NIST XCOM Database) to assess shielding properties. PHITS Monte Carlo simulations were employed to calculate the effective dose rate.

Results: The addition of Gd2O3 increased the glass density from 3.7546 gm/cm³ to 5.4604 gm/cm3. Replacing B2O3 with Gd2O3 enhanced the mass attenuation coefficients (μm), effective atomic number (Zeff) and effective electron density (Neff). HVL values decreased, Pb equivalent values increased, and the effective dose was reduced.

Conclusion: The incorporation of Gd2O3 into germanoborate glasses significantly enhances their gamma-ray attenuation capabilities, confirming their effectiveness as lead-free shielding materials. The developed glasses exhibit optimized radiation protection properties, highlighting their potential for transparent shielding applications in medical, industrial, and nuclear fields. and infliximab exert protective effects on liver function in acetic acid induced UC model. These findings suggest potential benefits of these therapies in mitigating liver damage associated with UC, highlighting the importance of considering liver health in UC management.

Evaluation of ciprofloxacin, prednisolone, and infliximab effects on liver functions in acetic acid-induced ulcerative colitis rat model

2025-05-22T17:14:21+07:00

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by recurring episodes of gastrointestinal inflammation and damage, affecting millions worldwide. Emerging evidence suggests a complex relationship between UC and liver dysfunction, with increased risk of hepatotoxicity and liver-related disorders.

Objectives: To investigate the effects of ciprofloxacin, prednisolone, and infliximab on liver function in an acetic acid-induced UC rat model.

Materials and methods: Fifty male Sprague-Dawley rats were divided into five groups of ten rats each: control, UC, ciprofloxacin, prednisolone, and infliximab group. UC was induced with 2 ml of 4% acetic acid solution transrectal. Liver function tests (AST, ALT, ALP), oxidative stress markers (MDA), protein synthesis (total protein, albumin), and bilirubin processing were evaluated, and histological examination of liver tissues was performed.

Results: The UC group showed significant increase in liver function enzymes (ALP, AST, ALT), oxidative stress markers (MDA) and significant decrease in total protein, albumin, total bilirubin and conjugated bilirubin level when compared with the control group. Respective treatment groups demonstrated improved liver enzyme levels, reduced oxidative stress, enhanced protein synthesis and bilirubin processing. Histological examination revealed improved liver architecture and reduced inflammation in treatment groups when compared with the UC group.

Conclusion: This study provides evidence that ciprofloxacin, prednisolone, and infliximab exert protective effects on liver function in acetic acid induced UC model. These findings suggest potential benefits of these therapies in mitigating liver damage associated with UC, highlighting the importance of considering liver health in UC management.

Case Report: Two cases of Hb Malay (HBB: c.59A>G) found in Northern Thailand

2025-08-26T22:53:23+07:00

Background: Hemoglobin (Hb) Malay is a common β-hemoglobinopathy in Malaysia resulting from an AAC to AGC mutation at codon 19, which produces an abnormal β-globin chain and manifests as a β+-thalassemia phenotype characterized by mild anemia and increased HbA2 levels. Although Hb Malay is commonly prevalent in Southern Thailand, there have been few reported cases in Northern Thailand.

Objectives: This study aims to report two cases of Hb Malay detected in Chiang Mai, Northern Thailand, highlighting the diagnostic complexities. Materials and methods: Two female patients, aged 50 and 67, presenting with anemia were investigated. Initial hematological profiles, Hb analysis by HPLC (Case 1) and CE (Case 2), and iron studies were performed. Due to hypochromicmicrocytic
anemia and elevated HbA2 levels in both cases, genomic DNA was extracted. Multiplex real-time PCR with HRM analysis was performed to detect common α0-thalassemia deletions. Further genetic analysis was conducted using next-generation sequencing (NGS) targeting HBA1, HBA2, and HBB genes.

Results: Both cases were identified to carry the Hb Malay variant. Case 1, a 50- year-old female with mild anemia, was diagnosed with double heterozygosity for Hb Malay (βMalay/βA) and α+-thalassemia (-α3.7/αα). Case 2, a 67-year-old female with severe anemia and iron deficiency, was diagnosed with heterozygosity for Hb Malay (βMalay/βA).

Conclusion: The diagnosis of Hb Malay can be complicated especially when it coexists with other thalassemia traits or iron deficiency. Therefore, better understanding of the hematological and clinical characteristics, as well as the laboratory detection of this hemoglobin variant, would be beneficial for genetic counseling, particularly in areas with a high prevalence of thalassemia, hemoglobinopathy, and iron deficiency such as Northern Thailand.

The reliability and validity of the Thai version of Visual Cognitive Assessment Test (VCAT:Th )

2025-09-09T18:38:07+07:00

Background: The global prevalence of dementia is projected to nearly double every 20 years, significantly impacting the quality of life for both individuals with dementia and their caregivers. Early detection is therefore critical, particularly in the context of Thailand’s rapidly aging population. The Visual Cognitive Assessment Test (VCAT) is a visual-based cognitive screening tool designed to overcome educational limitations commonly associated with traditional assessments. Widely adopted across Southeast Asia, the VCAT demonstrates high sensitivity in detecting cognitive impairments from the earliest stages.

Objectives: This study aims to evaluate the validity and reliability of the Thai version of the Visual Cognitive Assessment (VCAT: Th)

Materials and methods: This study employed a cross-sectional, psychometric design and included 98 participants, consisting of 31 healthy controls (HC), 31 individuals with mild cognitive impairment (MCI), and 36 individuals with mild Alzheimer’s disease (AD). The HC group was recruited from community-dwelling individuals residing in Bangkok and its surrounding metropolitan areas, while the MCI and mild AD groups were recruited from the Faculty of Medicine Ramathibodi Hospital, Mahidol University. All participants completed the Thai version of the Visual Cognitive Assessment Test (VCAT: Th), which was culturally adapted from the original version to suit the Thai context. The collected data was then used to evaluate internal consistency, test–retest reliability, concurrent validity, and known-group validity.

Results: The VCAT: Th demonstrated strong psychometric properties. Internal consistency was highly acceptable (α=0.78), and test-retest reliability was excellent (ICC=0.95). Concurrent validity showed a strong and significant correlation with MoCA scores (r=0.79,p<0.001). Known-group validity revealed significant group differences with a large effect size (η²=0.53).

Conclusion: The VCAT: Th is a culturally adapted cognitive assessment tool that effectively identifies impairments typically present in the early stages of cognitive decline. It demonstrates acceptable psychometric properties and is appropriate for use within the Thai population.

Cross-cultural adaptation and psychometric evaluation of the Communication Function Classification System-Thai version for individuals with cerebral palsy in Thailand

2025-09-01T16:55:31+07:00

Background: Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor functions and is often accompanied by impairments such as speech and communication challenges. Functional classification systems are increasingly used to describe daily activities and participation, aiming to guide comprehensive and effective treatment planning that improves patients’ quality of life. The Communication Function Classification System (CFCS) is a tool designed to describe communication functions in the daily lives of individuals with CP. Nonetheless, the absence of a Thai version of the CFCS highlighted the need for this study.

Objectives: This study aimed to translate and culturally adapt the CFCS into Thai (CFCS-TH) and to evaluate its psychometric properties, including validity and reliability, in individuals with CP in Thailand.

Materials and methods: The study was conducted in two phases: (1) cross-cultural adaptation and translation of the CFCS into Thai using a six-step forward and backward translation method, and (2) psychometric evaluation of the CFCS-TH, focusing on content validity, inter-rater reliability, and intra-rater reliability. Validity was assessed using the content validity index (CVI), while reliability was measured using weighted kappa statistics (ƙ). A total of 35 individuals with CP, aged 2-18 years, participated in the study. The raters included one speech-language pathologist (SLP), two physical therapists (PTs), and 35 parents, each of whom rated the level of communication function of the individuals with CP twice.

Results: The cross-cultural adaptation of the CFCS to Thai was carried out by ensuring that the language and terminology were appropriate for Thai users while maintaining the conceptual integrity and purpose of the tool. The CFCS-TH translation steps included vocabulary and syntax selection, equivalency review, and revisions from translators, an expert committee, and pretest users, followed by approval from the instrument developers. The CFCS-TH demonstrated excellent content validity, with an item-level CVI and scale-level CVI of 1.0, indicating that the CFCS-TH could measure its intended construct. Inter-rater reliability was good between the SLP and PTs (ƙ=0.71), good between the SLP and parents (ƙ=0.66), and fair between PTs and parents (ƙ=0.55). When separating the data by the first and second classification rounds, agreement between the SLP and PTs remained good with a slight decrease (ƙ=0.73 and 0.69). The SLP-parent agreement remained consistently good across both rounds (ƙ =0.61 and 0.66), while the PTs-parents agreement improved from fair to good (ƙ=0.48 and 0.62). Intra-rater reliability was excellent for the SLP (ƙ=0.92) and very good for PTs (ƙ = 0.91) and parents (ƙ=0.86).

Conclusion: The CFCS-TH is a valid and reliable tool for describing the communication functions of individuals with CP in Thailand. This tool provides a standardized framework for assessing communication performance to support clinical and research efforts aimed at intervention planning and improving the quality of life for individuals with CP.

A systematic review of the effect of the integration of speech therapy with music therapy on swallowing for patients with Parkinson’s disease

2025-09-24T06:44:49+07:00

Background: Dysphagia, or swallowing impairment, is a common complication in individuals with Parkinson’s disease. Speech therapy is a non-pharmacological intervention that employs behavioral techniques to address this condition. A growing body of research also suggests that music therapy may have beneficial effects on swallowing function in this population. However, the effectiveness of integrating speech and music therapy for improving swallowing in individuals with Parkinson’s disease has not yet been systematically evaluated.

Objectives: The objective of this systematic review was to examine the effectiveness of integrating speech therapy with music therapy for swallowing in patients with Parkinson’s disease.

Materials and methods: This study was registered in PROSPERO (CRD420251118370) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of two studies met the inclusion criteria. The authors systematically reviewed four electronic databases: PubMed, CINAHL Complete, the Cochrane Library, and Google Scholar. A hand search of the reference list of related articles was performed to identify any additional eligible studies. The assessment of bias risk was conducted using the Joanna Briggs Institute’s (JBI) critical appraisal tools.

Results: A total of two studies investigated the effects of speech therapy in combination with music therapy. One study implemented an interdisciplinary choral singing therapy program that included vocal exercise and choral singing. The other study applied a conventional speech therapy protocol-specifically, Lee Silverman Voice Treatment (LSVT LOUD®) and vocal exercises-combined with music therapy incorporating motor, breathing, vocal, and singing exercises. The integration of speech and music therapy demonstrated promising results in improving swallowing function in individuals with Parkinson’s disease.

Conclusion: The findings highlight the potential benefits of integrating speech and music therapy to improve swallowing function in individuals with Parkinson’s disease. However, due to the limited number of studies and methodological heterogeneity, definitive conclusions regarding the most effective intervention components cannot yet be drawn. While encouraging, the current evidence underscores the need for further high-quality research particularly randomized controlled trials to establish standardized protocols. Advancing this interdisciplinary approach may enhance rehabilitation outcomes and improve quality of life for this population.

Prevalence of stress, anxiety, depression, and reported self-esteem among mothers of children with autism spectrum disorder

2025-09-29T10:54:58+07:00

Background: Mothers of children with autism spectrum disorder (ASD) have an increased risk of depression, anxiety, stress, and diminished self-esteem due to the numerous challenges involved in raising children with socio-behavioural difficulties.

Objectives: This study investigated the prevalence of depression, anxiety, stress, and low self-esteem among mothers of children with ASD.

Materials and methods: A cross-sectional descriptive study was conducted among 246 mothers of children with ASD. The prevalence of depression, anxiety, and stress was assessed using the Depression, Anxiety and Stress Scale-21 Items, and self-esteem was measured using Rosenberg’s Self-Esteem Scale. Demographic data for both mothers and children were collected using a pro forma. Data are summarised as frequencies, means (M), standard deviations (SD), and percentages.

Results: The prevalence rates among mothers were as follows: depression, 84.14% (N=207); anxiety, 77.2% (N=190); stress, 74% (N=167); and diminished self-esteem, 67.9% (N=167). Mean severity scores indicated moderate levels of depression (M=17.26, SD=7.7), anxiety (M=12.7, SD=7.7), and stress (M=19.49, SD=8.0), and low self-esteem (M=23.25, SD=9.5).

Conclusion: Mothers of children with ASD had high prevalence rates of depression, anxiety, stress, and low self-esteem. These findings highlight the psychological challenges faced by mothers caring for children with ASD. Therapeutic interventions should therefore address the mental health needs of these mothers alongside the rehabilitation of their children.

A review on the prevalence of unexpected alloantibodies in Thai patients across Thailand

2025-09-11T15:02:50+07:00

Background: Alloantibodies are immune responses produced by exposure to foreign red blood cell antigens. However, sensitized alloantibodies can lead to hemolytic transfusion reactions and complicate cross-matching procedures.

Objectives: This review article aims to demonstrate the prevalence of unexpected alloantibodies across Thailand’s four major geographical regions.

Materials and methods: A comprehensive literature search was conducted across PubMed, Google Scholar, and ThaiJo databases using keywords related to unexpected alloantibodies in Thailand, yielding 17 articles categorized by geographical region. Studies were filtered using strict criteria (published 2013-2025, sample size > 100, reporting > 2 alloantibody types) for final data analysis.

Results: It is revealed that anti-Mi^a is the highest unexpected alloantibody, with a prevalence rate of 25.9-37.2% across all four regions, followed by anti-E (15.6-20.7%), anti-Le^a (4.7-14.6%), and anti-Le^b(4.6-8.0%), respectively. Interestingly, anti-P1 is remarkably increased in the Northern region (15.1%), whereas anti-Jk^a(4.7%) and anti-Jk^b(2.5%) are specifically higher in the Northeastern region.

Conclusion: This review highlights the importance of practicing antibody screening protocols, choosing compatible antigen status, and establishing rare donor registries in Thailand to avoid unexpected alloimmunization, thereby ensuring optimal transfusion safety.

A study of correlation between Cholelithiasis and Fatty liver from ultrasonography of patients in Vajira Hospital

2025-08-27T11:32:19+07:00

Background: The rising consumption of Western-style fast food—high in carbohydrates, sugar, and fat—together with a fast-paced lifestyle, occupational stress, and physical inactivity, represents a major risk factor for fatty liver disease, which can progress to hepatitis, cirrhosis, or hepatocellular carcinoma. Evidence linking fatty liver and cholelithiasis is growing globally, yet data from Thailand and Southeast Asia remain scarce, despite both conditions being increasingly prevalent. Cholelithiasis, a common gastrointestinal disorder affecting 5–10% of the Thai population, particularly females and older adults, may also be associated with fatty liver disease.

Objectives: This study investigated the correlation between cholelithiasis and fatty liver disease using ultrasonographic data from patients at Vajira Hospital, aiming to address this regional knowledge gap and inform preventive strategies.

Materials and methods: A retrospective analysis was performed on 311 patients aged ≥50 years who underwent upper abdominal ultrasonography at Vajira Hospital between 2023 and 2024. Collected data included gender, age, gallstone size, and diagnostic findings. Patients were classified into two groups: 132 with cholelithiasis and 179 without. Statistical analyses included descriptive statistics (mean, SD, frequency, percentage) and inferential tests (t-test, chi-square test, and logistic regression).

Results: Of the 311 patients, 162 (52.1%) had fatty liver, with a mean age of 62±8.46 years; 62.3% were female and 37.7% were male. Among these, 73 patients (45.1%) had concurrent cholelithiasis (66% female, 34% male), with a mean gallstone size of 1.09±0.53 cm. The remaining 89 patients (54.9%) had fatty liver disease without cholelithiasis (60% female, 40% male). A significant inverse association was observed between age and fatty liver disease (p=0.003), indicating that younger patients within this ≥50-year cohort were more likely to be affected.

Conclusion: Cholelithiasis was not significantly associated with fatty liver disease. However, fatty liver showed a novel inverse correlation with age, with higher prevalence among younger adults within the ≥50-year cohort. This finding, which contrasts with previous reports of increasing prevalence with age, may reflect methodological factors and lifestyle influences in Thailand’s urban population. These results emphasize the need for early screening and targeted public health interventions for working-age adults, while acknowledging limitations related to study design, absence of key confounders, and restricted age range.

Work performance assessment in Thai homeless shelters: An exploratory factor analysis

2025-10-24T19:05:10+07:00

Background: Institutional sheltering can lead to occupational deprivation and psychosocial disengagement, particularly among adults with mental health-related disabilities. In Thailand, homeless shelters operate under rigid custodial systems that may hinder functional recovery, highlighting the need for culturally adapted assessment tools.

Objectives: To validate an adapted version of the Assessment of Work Performance (AWP) for use in Thai homeless shelters and to identify functional skill patterns and psychosocial barriers that inform allied health service planning.

Materials and methods: A cross-sectional study was conducted with 60 adults with mental health–related disabilities residing in a government-operated destitute shelter. Participants completed a work-based AWP task rated across seven subskills. Exploratory factor analysis (EFA) examined the underlying factor structure, while regression analysis tested the predictive value of extracted factors on occupational performance.

Results: The EFA supported a two-factor solution; 1) task adaptation and relational organization, and 2) communication and expression-accounting for 56.78% of the total variance (KMO=0.696, Bartlett’s test significant). Regression analysis showed that task adaptation and relational organization significantly predicted occupational performance, explaining 69.6% of the variance (R²=0.696).

Conclusion: Task adaptation and environmental structuring are key determinants of occupational engagement in institutional shelter settings. Performance-based assessment, combined with structured observation during task engagement, provides a culturally relevant strategy for allied health professionals to guide individualized rehabilitation for marginalized populations in Thai homeless shelters.

Assessment of natural radioactivity concentrations in soil samples from Mae Chaem District, Chiang Mai Province, Thailand using a HPGe detector

2025-09-23T10:47:41+07:00

Background: Understanding the existence of natural radioactivity in different soil origins is essential for evaluating associated radiological risks.

Objectives: The purpose of this study was to determine the natural radioactivity concentrations in soil samples from Mae Chaem district using a HPGe detector.

Materials and methods: Thirty-five soil samples were randomly collected for laboratory analysis from four geological regions, ten from Triassic granite (Trgr), Silurian Devonian-Carboniferous (SDCtp), and Ordovician (O) locations and five from the Quaternary sediments, namely the Terrace deposits (Qt) area. The radioactivity of ²²⁶Ra, ²³²Th, and ⁴⁰K was measured using a gamma spectrometry with a high-purity germanium detector. The three radiation hazard indices for soil samples, including absorbed dose rate in outdoor air (D_air), the annual effective dose equivalent (AED_out), and the excess lifetime cancer risk outdoor (ELCR_out) were determined.

Results: The concentration of natural radioactivity for ²²⁶Ra of Trgr, SDCtp, O, and Qt were found in the range of 50 to 172, 46 to 179, 59 to 285, and 46 to 77 Bq kg^-1, respectively. The activity concentration of ²³²Th varied from 69 to 148, 53 to 239, 60 to 273, and 51 to 120 Bq kg-1, whereas the activity concentration of ⁴⁰K ranged from 351 to 1100, 299 to 1356, 190 to 1364, and 779 to 1188 Bq kg^-1, respectively. The D_air varied from 88 to 207, 68 to 275, 94 to 345, and 85 to 146 nGy h^-1, with average values 139, 131, 170, and 110 nGy^h-1 for Trgr, SDCtp, O and Qt samples, respectively. All sample values were higher than the worldwide population-weighted value of 59 nGy h^-1 reported by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR, 2000). The AED_out and the ELCR_out values also were higher than global average values by UNSCEAR.

Conclusion: In soil samples collected from four specific regions in the Mae Chaem district, the average natural activity concentrations of 226Ra, 232Th, and 40K were found to be above the worldwide population-weighted value. The Dair, AEDout in external terrestrial radiation from outdoor sources and ELCRout values were higher than reported by UNSCEAR. These results indicate a high radiological health risk associated with prolonged exposure to natural radionuclides in soils from the Mae Chaem district.

Reliability of the Thai version of the Spinal Cord Independence Measure Self-Report (SCIM-SR-Thai)

2025-10-24T19:27:11+07:00

Background: The SCIM-SR, a self-report instrument, offers a patient-centered perspective. To ensure its clinical and scientific utility in Thailand, it is essential to establish the reliability of a translated and culturally adapted Thai version.

Objectives: To investigate the reliability of the SCIM-SR-Thai in chronic persons with SCI using a test-retest approach after 7 days.

Materials and methods: Thai adults aged 20-80 years with chronic SCI for at least 1 year were recruited. Participants filled out the SCIM-SR-Thai in-office once and were given a second copy to be completed at 7 days at their leisure. Participants were instructed to mail the questionnaire back within 14 days or would be considered a drop-out.

Results: A total of 59 participants completed the study. The majority were male (62.7%). The mean (SD) age was 48.5 (15.4) with median (IQR) time since SCI of 12 (6-21) years. Most of the participants were diagnosed with T1-S3 AIS A, B, and C 38/59 (64.4%). The SCIM-SR-Thai demonstrated excellent internal consistency and test-retest reliability (Cronbach’s alpha 0.99, ICC=0.97; 95% CI=0.95-0.98). Analyses of individual subscales yielded similar results.

Conclusion: SCIM-SR-Thai demonstrates good reliability and internal consistency. The authors encourage adoption of this questionnaire as a standardized tool in clinical practice to assess functional independence in people with SCI.

A comparative study of diagnostic performance for tuberculosis and rifampicin- resistant tuberculosis between standard and pooled sputum methods using GeneXpert Ultra at Lampang Hospital, Thailand

2025-09-17T14:20:19+07:00

Background: Molecular diagnosis using the Xpert MTB/RIF Ultra assay enables rapid detection of Mycobacterium tuberculosis and rifampicin resistance.

Objectives: This study evaluated the diagnostic performance and cost efficiency of a two-sample pooled testing approach compared with standard individual testing.

Materials and methods: A cross-sectional diagnostic study was conducted among 3,504 presumptive TB patients. Sputum specimens were tested by Xpert Ultra individually, with those results serving as the reference standard, and in two-sample pools. The pooling protocol utilized 2.0 mL from each specimen to maximize load volume. Deconvolution, which required retesting both individual specimens, was mandatory for all positive and invalid pooled results. Performance metrics, RIF resistance concordance, and cost-effectiveness modeled on cartridge consumption and direct cost 550 Thai Baht per unit were compared.

Results: The pooled method showed excellent concordance with the individual method, yielding 240 concordant positives and 3,249 concordant negatives, with no statistically significant difference in MTB detection (McNemar χ²=0.267, p=0.605). The pooled approach achieved a sensitivity of 96.39% (95% CI, 93.25-98.33) and a specificity of 99.82% (95% CI, 99.60-99.93). The assay maintained reliable detection of RIF resistance, indicating that pooling did not compromise molecular accuracy. In practice, 1,752 pooled runs were performed, with 105 (5.7%) error results and 246 positive pools requiring deconvolution. Including repeats and deconvolution, total cartridge use was 2,349 compared with 3,504 for individual testing, corresponding to an actual cost reduction of 32.96% (approx. 180,000 Thai Baht saved per 1,000 tests).

Conclusion: Two-sample pooled Xpert Ultra testing demonstrated high diagnostic accuracy and doubled analytical throughput. Although deconvolution limited cost savings to approximately 33%, the strategy proved highly cost-effective and operationally feasible. This method offers a practical, scalable approach for optimizing molecular TB diagnostics and resource utilization, especially in low- to moderate-prevalence settings.

Factors affecting hemoglobin levels of patients with end-stage kidney disease in the maintenance phase: A prospective observational study

2025-09-16T11:38:13+07:00

Background: Patients with end-stage kidney disease (ESKD) undergoing hemodialysis almost invariably develop anemia, which can significantly impair their quality of life. It is uncommon to find patients with consistently normal hemoglobin (Hb) levels; therefore, identifying the contributing factors is essential.

Objectives: This study aimed to identify factors affecting Hb levels in ESKD patients during maintenance phase.

Materials and methods: This prospective observational study was conducted at a regional hospital in Yogyakarta. The Hb cutoff point of 10 g/dL was used as the minimum standard for the maintenance phase, based on the Dialysis Consensus of the Indonesian Nephrology Association. The study included ESKD patients aged ≥18 years undergoing hemodialysis. The initial sample comprised 76 patients (38 with Hb >10 gm/dL and 38 with Hb ≤10 gm/dL); however, 65 patients were included in the final analysis after 11 were excluded due to dropout. Samples were matched based on age, sex, duration of hemodialysis, and comorbidities. Data were collected using patient medical record observation sheets, food record sheets, and the brief illness perception questionnaire (B-IPQ). Statistical analyses were performed using chi-square and logistic regression with a backward elimination method.

Results: A total of 65 participants were analyzed (33 patients with Hb >10 and 32 patients with Hb ≤10). Factors that showed significant associations with Hb levels were erythropoietin-stimulating agent (ESA) therapy odds ratio (OR)=7.162, 95% confidence interval [CI]=2.046-25.071, p=0.002), duration of hemodialysis (OR=4.909, 95% CI=1.299-18.551, p=0.019), and vitamin B12 intake (OR=4.238, 95% CI=1.183-15.176, p=0.027).

Conclusion: Erythropoietin stimulating agent therapy, duration of hemodialysis, and vitamin B12 intake were identified as factors influencing the improvement of Hb levels in patients with ESKD. Educational interventions are needed to enhance patients’ understanding of the importance of maintaining balanced nutritional intake and adhering to optimal hemodialysis duration.

Manufacturing and effectiveness evaluation of effective breast suit for breast radiotherapy

2025-05-28T19:12:36+07:00

Background: Various techniques and devices are used to immobilize the breast satisfactorily during radiation therapy for breast cancer, and they are adopted and utilized in treatment centers according to their preferences.

Objectives: In this study, a breast suit was manufactured using the advantages of thermoplastics used in breast cancer and thoracic radiotherapy, and the breast suit was validated by analyzing the reproducibility of setup errors.

Materials and methods: A computed tomography simulator and phantom were used to acquire reference images of a breast suit and a commercial bra, respectively. After acquiring the images in the CBCT system, the setup error reproducibility was analyzed using a Volume View™ 3D image acquisition tool. The image analysis method used automated mode and manual mode, and the validity was evaluated by analyzing the change of setup error reproducibility in the X, Y, and Z axis directions and pitch, roll, and yaw rotation directions of each matched image.

Results: The reproducibility of setup errors between the breast suit and the commercial bra ranged from 0.4 mm to 5.6 mm on the X-axis and from 0.3 mm to 5.8 mm on the Y-axis. In contrast, the Z-axis exhibited larger variations, ranging from 0.8 mm to 16.2 mm. Rotational setup errors were all less than 1°, indicating no significant differences. While the breast suit showed comparable setup errors to the commercial bra in the X and Y directions, it demonstrated improved reproducibility along the Z-axis (p = 0.09) and significantly lower rotational errors (p < 0.05).

Conclusions: The validity of the reproducibility change of setup errors was confirmed in the X, Y, and Z directions for the breast suit, and valid results were obtained for more stable reproducibility change in the Z-axis direction. Therefore, it is inferred that the breast suit can be used as a fixation device to reduce setup error reproducibility by limiting breast movement.