Journal of Associated Medical Sciences

Fibroblast growth factors in female reproductive disorders: A systematic review

Naam Ali Hamza — 2025-01-21

Background: Fibroblast Growth Factors (FGFs) are a family of signaling proteins that play key roles in various biological processes, including cell proliferation, differentiation, and tissue repair. In recent years, there has been growing interest in the role of FGFs in reproductive biology, particularly in the context of female fertility and assisted reproductive technologies (ART).

Objective: This systematic review aimed to evaluate the role of Fibroblast Growth Factors (FGFs) in female reproductive disorders with a focus on repeated implantation failure (RIF), diminished ovarian reserve (DOR), polycystic ovary syndrome (PCOS), and premature ovarian insufficiency (POI).

Materials and methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases for studies published between January 2014 and December 2024, yielding 8 eligible studies.

Results: The review found: reduced FGF-2 levels in PCOS patients’ serum and follicular fluid, contrasting with earlier research; lower serum FGF-1 levels and specific genetic variants in RIF patients; elevated FGF-13 levels associated with increased androgen levels and ovarian volume in PCOS; altered FGF-5 expression in DOR cases; and unexpectedly elevated FGF-2 levels in biochemical POI.

Conclusion: FGF isoforms may be a contributor to the pathophysiology of female reproductive disorders. However, these findings while important, the review identified important limitations including small sample sizes and the tendency to focus on individual FGF isoforms. For future studies, there’s a need for larger and more comprehensive studies examining the entire FGF family and their connections in reproductive dysfunction.

A systematic review of the effect of music therapy compared to speech therapy on social communication skills in preschool children with autism spectrum disorder

Vich Boonrod — 2025-02-13

Background: Autism spectrum disorder (ASD) is defined by impairment in social communication and the presence of restricted interests and repetitive behaviors. Individuals with ASD receive a variety of interventions tailored to their specific needs, enhancing their social, communication, and adaptive skills. Speech therapy (ST) aims to promote speech and language development and further improve social and communication skills in children diagnosed with ASD. Music therapy (MT) has been recognized as an intervention for individuals with ASD to facilitate social and communication skills. At present, there is no systematic review (SR) of MT compared to ST on social communication skills in preschool children with ASD.

Objective: This SR aimed to (a) investigate the effectiveness of MT compared to ST on social communication skills for preschool children with ASD and (b) investigate which type of MT, compared to ST, affects the social communication skills of preschool children with ASD.

Materials and methods: This SR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using five databases: the CINAHL Complete, PubMed, Scopus, ERIC, and Cochrance. The researchers also conducted a hand search for reference lists of identified articles and pertinent reviews for additional studies. We assessed the risk of bias using the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool and the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2).

Results: The initial literature search yielded 63 articles. Following the exclusion of non-relevant studies, 2 studies met the inclusion criteria for this review. The results indicated that the differences in overall efficacy between MT and ST were not statistically significant. Both therapies are effective for speech production, including semantics, phonology, pragmatics, and prosody in preschool children with ASD. MT, specifically developmental speech and language training through music (DSLM), is equally successful as ST in enhancing speech production. Behavioral intervention, applied behavior analysis verbal behavior (ABA-VB), is also effective in improving core symptoms of autism, such as social and communication deficits.

Conclusion: MT has comparable efficacy in enhancing speech production compared to ST, which impacts social communication in preschool children with ASD. Nevertheless, ST remains a cornerstone in addressing communication deficits in children with ASD, focusing on structured speech and language development. MT provides a complementary approach that can enhance speech production and bring more enjoyment to these young children, who frequently struggle with social communication. Therefore, MT could be viewed as a complementary approach to traditional ST. Limitations included research on the use of DSLM and ABA-VB by music therapists has been sparse, and the number of studies has been small. Further study would allow for more precise conclusions regarding the effect of MT compared to ST on social communication skills in preschool children with ASD.

Future of orthopaedic in bone defect by using 3D-printed personalized implants: A systematic review

Muhammad Nanda Firdaus — 2025-03-27

Background: Definitive management and treatment of bone defects caused trauma, infection, inflammation or tumour are still challenging problems in orthopaedics. Three-dimensional (3D) printing is a development strategy that is currently being widely discussed to overcome this problem. This technology has dramatically improved teaching and advanced patient care by giving innovative tools for challenging clinical conditions.

Objective: The aim of this study was to conduct in-depth observations and critical analysis of the current state of 3DPIs (3D-printed personalized implants) for bone defects.

Materials and methods: This study’s search was performed in PubMed, Science direct, Elsevier, Google Scholar, in October 2023. We included studies involving all bone defects that received 3DPIs in surgery and had been followed up for outcomes in several months. There was no date restriction. The recorded outcomes were anatomical outcome, functional outcome, and complication.

Results: We identified 157 studies and 35 studies remained after screening. Finally, 9 studies fulfilled the criteria. These studies consist of 39 bone defects (25 tumours, 12 traumas, 2 infections) which received 3DPIs. The result suggested that the patient who received the 3DPIs had an excellent condition including minimal anatomical deformity, good functional outcome after several months evaluation (between 6 and 24 months) and minimal complication.

Conclusion: 3DPIs show promising outcome as treatment for bone defect with minimal anatomical deformity, good functional outcome and minimal complication. However, as this review was limited by the number of available studies, more studies are required to investigate the definite outcome of such technology.

In vitro activity of ethanolic extract of propolis (EEP) against Candida albicans pathogenicity mechanisms

Supakit Khacha-ananda — 2025-01-03

Background: Candidiasis is an opportunistic fungal infection mainly caused by an overgrowth of Candida albicans. Several virulence factors, including the ability to change its morphology from yeast to hyphae and the secretion of hydrolytic enzymes, contribute to and promote the pathogenesis of the disease.

Objective: We aimed to investigate the efficacy of ethanolic extract of propolis (EEP) on growth and some major virulence factors of C. albicans that involved pathogenesis development, such as adhesion, hyphal germination, invasion, and virulence enzyme activities.

Materials and methods: C. albicans DMST 21424 was treated with various concentrations of EEP, and the growth of yeast cells was determined by colonyforming unit assay. An investigation of morpho-transformation ability was carried out using a hyphal germination assay and a hyphal length measurement. The adhesion ability of EEP-treated yeast cells was determined on both abiotic and biotic materials using acrylic discs and HeLa cell surfaces, respectively. The infected cells were treated with EEP to study invasion ability, and the cell damage was indicated by lactate dehydrogenase (LDH) activity assay. The effect of EEP on virulence enzyme activity was evaluated on sheep blood agar for hemolysin, egg yolk agar for phospholipase, and bovine serum albumin (BSA) agar for proteinase. Then, the mRNA expression levels of virulence enzyme-related genes such as ALS1, SAP1, SAP2, SAP3, and SAP6 were assessed by quantitative reverse transcriptase polymerase chain reaction (RT-PCR).

Results: The growth of EEP-treated yeasts was suppressed in a dose-dependent manner. The yeast-to-hyphae transition property was significantly reduced in EEP-treated yeast. EEP treatment also significantly decreased adhesion, invasion, and proteinase activity. However, there was no difference in hemolysin and phospholipase activities between EEP-treated yeast and the control. Moreover, EEP also remarkably down-regulated agglutinin-like-sequence 1 (ALS1) and secreted aspartyl proteinase (SAPs) genes.

Conclusion: The findings revealed that EEP exhibited potent anti-C. albicans virulence factors associated with pathogenesis. Therefore, this study suggested that propolis might be an effective complementary medicine alternative for candidiasis treatment.

The short effect of sports liniment on muscular physiological responses and physical performance among male Muay Thai fighters: Case study

Lee David Johnson — 2025-01-03

Background: Sports liniments are commonly used as a preparatory phase before an activity. Muay Thai fighters, such as Namman Muay (NM), have generally been used, but the scientific evidence on physiological and sports performance effects has not been studied.

Objective: This case study aimed to investigate the effects of NM sport ‘boxing’ liniment on muscular physiological responses and physical performance outcomes among male Muay Thai fighters.

Materials and methods: Four Muay Thai fighters were recruited into the case study and equally divided into two groups: the tape stripping (TS) (N=2) and the massage (MG) groups (N=2). The TS group received 20 tape strips across the muscle before receiving 3 mL of NM, while the MG group received 3 mL of NM with an effleurage massage for 5 minutes. Two tests were performed on Day 1) with no application of NM, and on Day 2), 3 mL NM was applied and randomly allocated into the TS group or MG group. Physiological responses such as skin temperature (ST), muscle oxygen (SmO2 ), myoglobin (Mb), and hemoglobin (Hb) were evaluated by Fluke thermography and Moxy Monitor (Near Infrared Spectroscopy; NIRS). Physical performance as knee extensor and hip flexor strength was assessed using a Lafayette handheld dynamometer and isometric endurance hip flexion test as a time to failure (TTF). Data analysis was performed using a descriptive study, evaluating the data results between two days of the experiment.

Results: ST did not increase after application of NM or receiving either TS or MG. SmO2 Mb percentage for the TS group increased between day 1 and day 2, with a mean difference of 10.78. The MG group observed only one participant increasing Mb with a group mean difference of 7.56. The Hb percentage observed little change and remained relatively constant between the two days. There were no observational differences in knee extension strength; however, Hip flexion strength observed more significant increases in the TS group, with a mean of 2.45 kg, while the MG group observed a mean increase of 0.65 kg after receiving the NM. The isometric endurance test observed increases in both groups, with higher increases in the MG group mean of 66.43 sec and TS group mean of 37.33 sec, after having NM applied. The 3 mL NM applied onto the Rectus Femoris muscle as a precursor to a warm-up increased SmO2 values.

Conclusion: Tape stripping with NM enhances its permeation and may improve isometric strength, while massage with NM appears to increase isometric muscular endurance among male Muay Thai fighters.

Impact of increasing tube potential and additional filtration on image quality and radiation dose for digital chest radiography

Thanyawee Pengpan — 2025-01-07

Background: Chest radiography is one of the most commonly performed examinations as routine check-ups in radiology departments. Radiographers should be concerned with minimizing patient radiation dose while maintaining high diagnostic image quality.

Objective: This study aimed to investigate the effect of increasing tube potential (kV) and adding filtration on image quality and radiation dose for posteroanterior (PA) chest radiography using a digital radiography (DR) system.

Materials and methods: Eighty-five kV with no filter was used as the reference exposure technique. Subsequently, the kV was increased to 96, 117, and 133, and additional filtrations of 2 mm Al, 1 mm Al+0.1 mm Cu, and 1 mm Al+0.2 mm Cu were applied. A total of sixteen images were produced. The entrance surface air kerma (ESAK) was measured and evaluated. Signal-to-noise ratio (SNR) and contrastto-noise ratio (CNR) were accessed for objective image quality. Five independent radiographers assessed a subjective image quality (IQ) score using two alternative forced choices (2AFC).

Results: Increasing kV and adding filtration reduced the ESAK while enhancing the SNR and CNR. However, the IQ score declined relative to the reference image when higher kV and additional filtration were applied except 85 kV. The IQ score indicated that an image acquired at 85 kV with 1 mm Al+0.2 mm Cu showed superior quality compared to the reference image. Notably, the SNR for this image was significantly higher (p<0.05). Additionally, this image resulted in a lower radiation dose (13.44 mGy) compared to the reference image (24.97 mGy). Furthermore, the image quality (IQ) score was higher than the reference images.><0.05). Additionally, this image resulted in a lower radiation dose (13.44 mGy) compared to the reference image (24.97 mGy). Furthermore, the image quality (IQ) score was higher than the reference images.

Conclusion: This study’s findings indicate that using an 85 kV with 1 mm Al+0.2 mm Cu additional filtration for digital PA chest radiography can reduce the radiation dose while improving image quality. However, this study used an anthropomorphic chest phantom; further clinical research is recommended.

Intuitionistic fuzzy RFE-based prognostic model for liver transplantation

Juby Raju — 2025-01-09

Background: Survival prediction after liver transplantation is a very challenging but complex task. LT is often the best treatment for advanced liver disease, provided no other medical conditions contraindicate it. This article explores clinical predictors, such as MELD scores and hormone levels, along with computational algorithms for forecasting post-transplant survival.

Objective: This study evaluates the performance of machine learning models for predicting survival outcomes in liver transplant recipients using UNOS data. It develops and validates a donor and recipient-based prognostic model.

Materials and methods: The UNOS database contains 65,535 donor-recipient pairs in transplants conducted in the U.S. between October 1987 and June 2021, with 421 attributes. The top 24 features, including logistic regression, random forest, artificial neural networks, XGBoost, CART, and K-nearest neighbors, were used to train the models upon feature selection. Models were compared using AUROC, accuracy, specificity, sensitivity, and precision.

Results: ANN outperformed other models for the UNOS dataset, with an AUROC of 0.98–0.99. Validated results in the KCH dataset are robust at AUROC: 0.94–0.95.

Conclusion: The model offered exceptional generalizability performance to guide clinical decisions in transplantation support, yet variability in patients’ characteristics may differ significantly among the cohorts and impact the results.

Evaluation of the modified-indirect hemagglutinin assay using chicken red blood cells as a routine melioidosis detection in Maharaj Nakorn Chiang Mai Hospital

Dararat Dankai — 2025-01-09

Background: Melioidosis is a life-threatening illness caused by Burkholderia pseudomallei, which is endemic throughout Thailand. The indirect hemagglutination assay (IHA), a serological test, is widely used to diagnose melioidosis. However, the conventional IHA available in Thailand still requires more than 4 hours for measurement time, limiting its efficiency in clinical settings. This study addresses the need for a quicker and more efficient diagnostic method for melioidosis.

Objective: The study aimed to evaluate the agreement between a modified indirect hemagglutination (modified IHA) assay and the commercially available IHA kit for routine melioidosis diagnosis at Maharaj Nakorn Chiang Mai Hospital. Chicken red blood cells were used instead of sheep red blood cells to reduce diagnostic time and costs while maintaining high accuracy and reliability.

Materials and methods: A total of 368 serum samples were tested using the modified IHA assay, which utilized chicken red blood cells instead of sheep red blood cells used in the commercial IHA kit. The results were compared with those of the commercial IHA kit for melioidosis detection.

Results: The modified IHA assay showed 99.46% agreement, with an excellent kappa value of 0.98, compared to the commercial kit. In the validation step, the modified IHA assay correctly identified 100% (54 out of 54) of positive samples and 100% (54 out of 54) of negative samples. However, 0.63% (2 out of 320) false positives were observed in the diagnostic samples with the modified IHA assay.

Conclusion: The modified IHA assay may serve as a valuable alternative for the routine diagnosis of melioidosis because it is less time-consuming and more cost-effective than the commercial IHA kit. However, further studies with more clinical samples are warranted to confirm its utility.

Effect of structured exercise program on fundamental motor skills in children with Down syndrome: A randomized controlled trial

Myo Thein Tun — 2025-01-10

Background: Down syndrome (DS) is one of the most common chromosomal abnormalities, and it has a deficiency in fundamental motor skills (FMS).

Objective: This study aimed to determine how a structured exercise program impacted children with Down syndrome’s fundamental motor skills.

Materials and methods: This study was conducted in a randomized controlled trial at the School for Disabled Children, Yangon. Thirty participants (15 in each group) with DS were divided into the experimental and control groups. The experimental group participated in a structured exercise program (focusing on stability, object control skills, and locomotor skills) for six weeks, while the control group did artistic and recreational activities (singing, dancing, drawing, and coloring). Lower extremity functional strength (five times sit-to-stand test), static balance (modified Stroke test), and FMS proficiency (TGMD-2) were assessed by blinded assessors at the start of the intervention, three weeks later, and six weeks later. Independent sample t-tests and repeated measure ANOVA were used to compare the two groups and within each group.

Results: Post-test analyses of all outcome measures between the two groups revealed statistically significant differences. In the third- and sixth-weeks following intervention, the FMS, static balance, and lower extremity functional strength were significantly higher in the experimental group than in the control group.

Conclusion: The current study’s findings highlight that a structured exercise program focused on FMS can be applied in educational and clinical settings to improve the FMS of children with DS.

Detection and characterization of SARS-CoV-2 variants in Thailand from 2020-2023 using next-generation sequencing

Sumonmal Uttayamakul — 2025-01-11

Background: The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to multiple variants with significant public health implications.

Objective: This study aimed to detect and characterize SARS-CoV-2 genomic variants in Thailand using next-generation sequencing (NGS) from 2020 to 2023.

Materials and methods: A total of 2,592 oro/nasopharyngeal swab specimens with high viral loads (cycle threshold; Ct≤25.0) were collected from SARS-CoV2-positive patients in Nonthaburi, Nakhon Phanom, and Tak Provinces. NGS was performed using Ion Torrent, Oxford Nanopore Technologies, and Illumina platforms to identify and analyze SARS-CoV-2 variants.

Results: The sequencing revealed various SARS-CoV-2 variants circulating in Thailand, with 2,592 lineages identified. The Omicron variant was predominant, accounting for 93.44% (2,422/2,592). The most common Omicron subvariants were BA.2 (54.86%, 1,422/2,592), BA.5 (20.22%, 524/2,592), and XBB (14.51%, 376/2,592). The Delta variant constituted 2.66% (69/2,592) of the cases, with AY.30 (1.20%, 31/2,592) and AY.85 (1.27%, 33/2,592) being the most frequent sub-lineages. The Alpha variant (B.1.1.7) was detected in 33 cases (1.27%), and the Beta variant (B.1.351) in 1 case (0.04%).

Conclusion: The findings reveal a significant shift in the SARS-CoV-2 variant landscape in Thailand, with Omicron becoming the dominant strain post-2022. Continuous genomic surveillance is critical for tracking viral evolution, informing public health strategies, and supporting pandemic control efforts in Thailand and Southeast Asia.

Core stabilization exercise can improve lumbar joint position sense in healthy individuals

Wallika Prasertkul — 2025-01-14

Background: Core stabilization exercises (CSE) are based on motor learning concepts focusing on sensorimotor function. It has been proposed that CSE can improve core stabilizer muscle function, leading to enhanced joint position sense. However, evidence to support the effects of CSE on joint position sense is still limited.

Objective: To compare the immediate effect of CSE on joint position sense of the lumbar spine using a smartphone application in healthy individuals.

Materials and methods: Fifty-six healthy individuals (9 males and 47 females) were recruited in the study. Two smartphones with the application were attached to the lumbar spine (L1) and sacrum (S2). They were asked to perform 45-degree lumbar flexion and return to neutral position, while lumbar joint position errors were recorded in each direction. They were then randomly assigned to CSE and control groups. After the intervention, they were asked to perform 45-degree lumbar flexion and return to a neutral position.

Results: The CSE group demonstrated significant improvement (p<0.05) in lumbar joint position sense during the 45-degree flexion, whereas the control group did not show improvement. Both groups did not show significant improvement during the return to a neutral position.

Conclusion: Findings suggested that one session of the CSE can improve lumbar joint position sense, which could be due to the increased activities of muscle spindles and Golgi tendon organs. In addition, our findings support the clinical utility of this smartphone application in measuring lumbar joint position sense.

Effect of pre-exposure to low-dose radiation followed by H2 O2 treatment on leukemic cells proliferation

Suratchanee Phadngam — 2025-01-15

Background: Leukemia is a blood cancer illness that causes morbidity and mortality around the world. A new approach to treatment is challenging.

Objective: The objective was to investigate the effects of pre-exposure to low-dose radiation (LDR) followed by H2 O2 treatment on cell proliferation in leukemic cells.

Materials and methods: The human leukemic doxorubicin-sensitive K562 and doxorubicin-resistant K562/adr cells were exposed to 0.1 mGy of gamma radiation from radioactive 137Cs at a dose rate of 0.001 Gy/min followed by treatments with various concentration of H2 O2 at 4 hrs-post irradiation. The cell morphology and metaphase cells in treated groups were compared with a control group at 72 hrs post-irradiation. The cell proliferation was determined at days 1-8 post irradiation.

Results: The results showed that the number of cells in treated groups with 50, 100, and 200 µM of H2 O2 was less than the control group (0 µM H2 O2 ). The pattern of the cells rapidly increased at 24-48 hrs and then decreased until the 5th and 6th days. This was found in all treated groups, except those treated with 200 µM of H2 O2 alone and with pre-exposure to LDR followed by H2 O2 groups. The microscopic images showed rough cells, shrinking cells, irregular-shaped cells, and swelling cells in H2 O2 alone and pre-exposure to LDR followed by H2 O2 groups. The metaphase cells were significantly decreased in H2 O2 alone groups in a concentration-dependent manner. In addition, the metaphase cells were also considerably reduced in pre-exposure to LDR, followed by H2 O2 groups when compared with control and LDR alone groups.

Conclusion: This data provides a basis for additional studies to help clarify the potential use and benefits of pre-exposure to LDR followed by H2 O2 treatment in cancer cells.

Improving the effectiveness of DHF prevention: Lessons from Pariaman City

Harisnal — 2025-01-21

Background: The Aedes aegypti mosquito transmits the viral disease dengue hemorrhagic fever (DHF), a significant public health problem in many tropical countries. The 1 House 1 Larva Monitoring (G1R1J) Movement, which involves every household as a mosquito larva monitoring agent, is one of the efforts to help communities control mosquito growth. Dengue Hemorrhagic Fever (DHF), transmitted by the Aedes aegypti mosquito, remains a significant public health issue in many tropical regions. The “1 House 1 Larva Monitoring” (G1R1J) movement, which mobilizes households as mosquito larvae monitoring agents, represents a community-based approach to controlling mosquito proliferation.

Objective: This study highlights a knowledge gap regarding the effectiveness of the G1R1J program with larvae-monitoring students compared to a program solely relying on larva-monitor cadres.

This study addresses a knowledge gap by comparing the effectiveness of the G1R1J program integrated with larva-monitoring students against the traditional approach relying solely on larva- monitor cadres.

Materials and methods: This study used a comparative design to compare the efficiency of the G1R1J program with the number of DHF cases in two DHF-endemic areas in Pariaman City, West Sumatra. A comparative study was designed to evaluate the efficiency of the G1R1J program concerning the incidence of DHF cases in two endemic areas in Pariaman City, West Sumatra. The researchers focused on field surveys and community attitudes because these aspects are directly linked to the implementation and success of the G1R1J program.

Results: The main results, with p=0.000 and OR 0.03, showed that comprehensive field-based interventions can significantly reduce the risk of vector presence. The study also demonstrated the importance of community attitudes in vector control, with p=0.002 and OR=0.15, suggesting that positive attitudes towards vector control practices can enhance the program’s effectiveness. Statistical analysis revealed significant results, with a p-value of 0.000 and an odds ratio (OR) of 0.03, indicating that comprehensive, field-based interventions markedly reduce vector presence. Additionally, the study highlighted the role of community attitudes, with p=0.002 and OR=0.15, underscoring that positive perceptions and practices towards vector control significantly enhance program effectiveness.

Conclusion: This study shows that integrating the G1R1J program with larvamonitoring students can reduce the density of Aedes Aegypti mosquito vectors and dengue fever incidence. In addition, it offers strategic guidance for building more sustainable and efficient vector control policies in other endemic areas. Integrating the G1R1J program with larvae-monitoring students reduces Aedes aegypti vector density and DHF incidence. This approach offers strategic insights for developing sustainable and efficient vector control policies in other endemic regions.

Swallowing problems and oral health status among dwelling older adults in the community

Pongsak Saleedaeng — 2025-01-29

Background: Oral health factors affecting oral food processing may comprise swallowing. Swallowing problems are commonly observed in older adults and are associated with various complications such as malnutrition, dehydration, and an increased risk of aspiration pneumonia. Age-related physiological changes in the swallowing mechanism, along with chronic diseases and dry mouth, further elevate the risk of dysphagia in this population.

Objective: This study aimed to investigate the relationships between oral health status and swallowing problems in community-dwelling older adults from Sukhothai Province, Thailand.

Materials and methods: A cross-sectional study was conducted with 297 older adults aged 60 years and above, and a community-based study was conducted among the residents of Sukhothai province. Participants were assessed using the 10-item Eating Assessment Tool (EAT-10) questionnaire to evaluate swallowing problems. In addition, demographic data, underlying diseases, oral health status, and the incidence of dry mouth were recorded. The Thai Mental Status Examination (TMSE) was used to screen for cognitive function. Logistic regression analysis examined the association between these factors and the swallowing problem.

Results: The prevalence of swallowing problems was 48.8%. Swallowing problems were reported significantly with age, particularly in those aged ≥70 years, with a higher prevalence of swallowing issues at 84.7%, compared to 24.7% in participants aged 60-69 years (OR=25.56, p<0.001). Dry mouth was also strongly associated with swallowing problems. Participants suffering from dry mouth had higher odds of experiencing swallowing issues (OR=3.31, p><0.01). Underlying diseases further increased the risk of dysphagia (OR=4.41, p><0.001). No significant association was found between swallowing problems and gender, occlusal pairs, or denture use.><0.001). Dry mouth was also strongly associated with swallowing problems. Participants suffering from dry mouth had higher odds of experiencing swallowing issues (OR=3.31, p<0.01). Underlying diseases further increased the risk of dysphagia (OR=4.41, p<0.001). No significant association was found between swallowing problems and gender, occlusal pairs, or denture use.

Conclusion: 48.8% of community-dwelling older adults suffer from swallowing problems. This study highlights age, underlying diseases, and dry mouth as critical factors contributing to swallowing problems in older adults. Screening for swallowing issues in those aged ≥70 years, underlying disease, or dry mouth should be integrated into routine health assessments.

Holistic intelligence and smart organization affecting the performance of standard medical laboratory guidelines of medical technologists at community hospitals in Health Region 7

Warunyu Phordee — 2025-02-07

Background: Medical laboratories are vital components of healthcare systems in community hospitals, serving as frontline facilities in public healthcare. The development of laboratory quality standards requires comprehensive improvement in personnel and organizational aspects to ensure public confidence and safety in service delivery.

Objective: This cross-sectional descriptive research aimed to study the effects of holistic intelligence and intelligent organization on medical laboratory standard practices among medical technologists in community hospitals within Health Region 7.

Materials and methods: The sample consisted of 187 medical technologists from community hospitals in Health Region 7, selected through stratified random sampling proportionally by province, followed by simple random sampling within each province. Data were collected between November 13-23, 2024, using an online questionnaire validated for content by three experts, with an overall reliability coefficient of 0.988. Data analysis employed descriptive statistics, Pearson’s correlation coefficient, and stepwise multiple linear regression.

Results: The results revealed that overall holistic intelligence was at a high level (Mean=4.12, SD=0.45), overall intelligent organization was at a high level (Mean=3.80, SD=0.65), and overall adherence to medical laboratory standards was at a high level (Mean=4.27, SD=0.49). Both holistic intelligence and intelligent organization showed statistically significant moderate positive correlations with medical laboratory standard practices (r=0.599, p<0.001 and r=0.557,><0.001 and r=0.557, p<0.001 and r=0.557,><0.001, respectively). Predictive factor analysis identified organizational learning system co-creation (B=0.266), moral and ethical intelligence (B=0.262), and emotional intelligence (B=0.213) as significant predictors, collectively explaining 47.2% of the variance in medical laboratory standard practices (R²adj=0.472).

Conclusion: Based on these findings, relevant agencies should develop organizational learning systems through the establishment of learning centers and mentoring systems, enhance moral and ethical intelligence through training and knowledge exchange, and improve personnel emotional management skills to elevate the quality and safety standards of medical laboratory operations in community hospitals.

Biomechanical analysis of movement time and center of pressure during single-leg and double-leg sit-to-stand in healthy adults

Naphat Inthana — 2025-02-08

Background: The sit-to-stand (STS) task is a fundamental movement integral to daily activities and is widely used as a functional test to evaluate lower limb strength, balance, and postural control across various populations. However, limited literature provides biomechanical analysis comparisons between traditional double-leg STS tasks and single-leg STS tasks.

Objective: This study aimed to compare muscle strength, movement times, and center of pressure (COP) variables across three STS conditions: single-leg STS on the dominant limb, single-leg STS on the non-dominant limb, and double-leg STS.

Materials and methods: Twenty healthy participants (10 males and 10 females; 21.60±1.14 years old) participated in a cross-sectional study. Maximal voluntary isometric contraction of the knee extensors and hip abductors was assessed for both the dominant and non-dominant limbs. Participants performed the three STS testing conditions on the Zebris FDM pressure plate. Movement time and COP outcome variables (sway area, total path length, velocity, and path length in anteroposterior and mediolateral directions) were recorded and analyzed across the three STS tasks. A paired t-test was used to compare the means of the primary outcome variables within groups. A one-way repeated measures ANOVA was conducted to assess outcome differences among the testing conditions, with significance set at p<0.05.

Results: Findings indicated no significant difference in knee extensor or hip abductor muscle strength between the dominant and non-dominant limbs. Movement times for the single-leg STS tasks on both limbs were significantly longer than for the double- leg STS task (p<0.001), with no difference between dominant and nondominant limbs. Additionally, COP variables (sway area, total path length, mean velocity, and mediolateral path length) were significantly lower in the single-leg STS tasks on both limbs compared to the double-leg STS task (all p><0.001), with no differences observed between dominant and non-dominant limbs.><0.001), with no difference between dominant and nondominant limbs. Additionally, COP variables (sway area, total path length, mean velocity, and mediolateral path length) were significantly lower in the single-leg STS tasks on both limbs compared to the double-leg STS task (all p<0.001), with no differences observed between dominant and non-dominant limbs.

Conclusion: Compared to double-leg STS tasks, single-leg STS tasks are associated with longer movement times and reduced COP measures. These findings provide preliminary reference values for STS tasks and suggest that the single-leg STS may serve as a potentially useful tool for assessing balance impairments and functional mobility. Further research is required to validate its sensitivity in pathological populations.

Cause-specific mortality in reproductive-age breast cancer patients: A competing risk approach

Subhadra Priyadarshini — 2025-02-17

Background: Breast cancer (BC) is a leading cause of mortality among women, particularly those in the reproductive age (15-49 years).

Objective: This study aims to examine the survival outcomes of female BC patients in reproductive age groups using a competing risk approach, with a focus on identifying significant determinants of BC-specific mortality and mortality due to other causes.

Materials and methods: This study utilized data from the Surveillance, Epidemiology, and End Results (SEER) database. The analysis included women diagnosed with breast cancer within reproductive age groups. The Cumulative Incidence Function (CIF), cause-specific hazard, and Fine-Gray subdistribution hazard models were employed to estimate the impact of potential determinants on BC-specific and other-cause mortality.

Results: A total of 67063 patients were included in the study. The cumulative incidence of breast cancer-specific mortality and other cause mortality at 5 years was 4.8% and 0.95%, respectively. Age at diagnosis, race, tumor stage, and hormone receptor status were significant predictors of breast cancer-specific mortality. The Fine-Gray model revealed that younger age (15-39 years), advanced tumor stage, and negative hormone receptor status were associated with higher hazards for breast cancer mortality (p<0.05).

Conclusion: The study highlights the importance of using a competing risk model to evaluate the cumulative incidence of prognostic factors in breast cancer patients of reproductive age, especially when competing clinical risks are present. These findings can guide personalized treatment strategies based on individual risk profiles.

Radiation safety assessment of patient and staff during intracranial aneurysm treatment: A phantom study

Puengjai Punikhom — 2025-02-17

Background: Endovascular treatment using coiling embolization for intracranial aneurysms is common in interventional neuroradiology (INR). However, it is associated with high radiation exposure to both patients and medical staff. The assessment and management of radiation risk have been a concern.

Objective: To evaluate patient and scatter radiation doses at INR staff working position during the coiling embolization procedure in a phantom study.

Materials and methods: An anthropometric phantom from head to pelvis was placed on an angiographic table. To determine the phantom’s entrance skin dose (ESD), 19 NanoDot optically stimulated luminescence dosimeters (OSLDs) were placed on the surface of the head phantom. Moreover, 6 NanoDot OSLDs were also placed on the surface of the phantom at 3 critical organs (eyes, thyroid, ovaries). To determine the scatter radiation dose at staff working position, polyvinyl chloride pipes (150 cm height) were placed at the position of all staff, including interventional radiologist (IR), radiology resident (RR), scrubbed nurse (SN), radiologic technologist (RT), circulating nurse (CN), and nurse anesthetists (AN). The InLight® OSLDs were placed on each PVC pipe at 50, 100, and 150 cm height from the floor level. Coiling embolization was simulated following the standard procedure using a bi-plane digital subtraction angiography unit with standard radiation protective equipment. The patient doses from the radiation dose structured report (RDSR) were also recorded.

Results: The highest ESDs were observed in the occipital part (1,631.56±36.97 mGy). These ESD peaks were also observed within the safety limit and produced no skin reaction. The radiation dose at the left eye was observed to be the highest value among critical organs. The highest scatter radiation dose was observed at the position of IR at 100 cm level. Among CN, AN, and RT positions, the highest dose was recorded at the RT position at the level of 150 cm. The RDSR showed that most of the patient radiation dose was received from the 2-dimension angiography.

Conclusion: The distribution of radiation dose varied across different staff positions. As the key person conducting the coiling embolization procedure, the IR position received the highest radiation dose. Thus, close monitoring and development of additional radiation protection methods for this position are essential. Although the radiation dose at the back of the head was elevated, it remained within safety limits. Nevertheless, the monitoring of potential radiation effects should not be neglected.

MALDI-TOF mass spectrometry in transfusion medicine

Teerakul Arpornsuwan — 2025-02-17

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a valuable tool in clinical research. In transfusion medicine, DNA-based genotyping is increasingly replacing serological methods for precise blood group determination. MALDI-TOF MS platforms for SNP genotyping have been rigorously developed and validated against serological techniques. MALDITOF MS offers high-throughput capacity, exceptional multiplexing, and direct detection, resulting in high accuracy and flexibility. The ability to perform blood group genotyping, bacterial identification via peptide barcoding, and detection of hemoglobinopathies and hemoglobin adducts in both donors and recipients makes MALDI-TOF MS a promising technology for resolving complex blood typing cases and enhancing clinical utility in transfusion medicine.

Development of dysphagia screening questionnaire for Thai older adults

Phichaya Baramee — 2025-02-19

Background: Oropharyngeal dysphagia is a common condition in the older person and can lead to serious complications. In Thailand, there is currently no standardized dysphagia screening tool for gathering preliminary information about clients for early evaluation and intervention.

Objective: This study aimed to develop a dysphagia risk screening tool for older persons and investigate its psychometric properties. This study examined the content validity, criterion validity, and test-retest of the Geriatric Dysphagia Risk Screening Tool (GDRST).

Materials and methods: 26 questions were developed from literature review and expert opinion. Five expert occupational therapists examined content validity. The Index of Congruence (IOC) was calculated from five experts, and the items that showed IOC scores of over 0.5 were incorporated into the target screening tool. Thirty older adults who had a risk of dysphagia (Mean±SD, 66.13±4.66 years) participated in the study. The internal consistency was assessed using Cronbach’s alpha. An intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the screening tool. The criterion validity of the GDRST was evaluated by investigating the relationships between a score of the Functional Oral Intake Scale (FOIS) and the Swallowing Quality Assessment Form for Occupational Therapists (SQAOT) using Spearman’s correlation coefficients.

Results: Based on the literature review and occupational therapy expert opinions, the screening tool covers three domains, including the cognition domain, oral phase swallowing ability domain, and pharyngeal phase swallowing ability domain. Content validity IOC scores were between 0.6 and 1.0 for all items. The internal consistency of the GDRST was high, with 0.971 Cronbach’s alpha for the test. The screening tool had excellent test-retest reliability on all items (p<0.05). The score of the GDRST was significantly correlated with the score of FOIS (r=-0.468, p=0.009), and SQAOT (r=-0.705, p=0.000).

Conclusion: The GDRST demonstrated excellent reliability and validity against the clinical assessment. It was simple to administer and could be beneficial for screening older people in the community for dysphagia.

Modified wall-stretching exercises: A practical strategy to promote an immediate effect of shoulder flexibility

Gresilia Tambing — 2025-02-24

Background: The decreased flexibility could attribute numerous adverse impacts to daily functions and risk of joint injury, especially in the joint with a large range of motion (ROM), such as that of the shoulder. Current management to increase shoulder flexibility mostly face the problems of regular adherence due to the need for expert guidance and the requirement of specific and numerous poses that are difficult to remember and time-consuming.

Objective: To investigate the immediate effects of the modified wall-stretching exercise on shoulder flexibility using a quasi-experimental design. Moreover, the study explored the proportion of arms (dominant and non-dominant) with limited shoulder flexibility.

Materials and methods: Fifty-six participants (38 females, 68%) with limited shoulder flexibility as determined using the back scratch test performed a modified wall-stretching exercise. The method required the participants to place their hands against the wall at the shoulder levels with elbow and wrist extensions while the hands were in three positions: upward, sideward, and downward. Participants moved the upper trunk downward and held at the maximal stretch position for 15 seconds in each hand position. After a sufficient rest period, participants were re-assessed for their shoulder flexibility using the back scratch test. The paired samples t-tests were used to analyze the study findings.

Results: Most participants had limited shoulder flexibility in both arms (N=35, 63%), especially in the non-dominant arm (60%). Immediately after 45 seconds of a modified wall-stretching exercise, participants significantly improved their shoulder flexibility by approximately 3 cm (p<0.001).

Conclusion: The limited shoulder flexibility, particularly on the non-dominant arm, suggests that a sedentary lifestyle, characterized by spending the most time in a flexed posture using social media, may have contributed to reduced muscle strength, particularly in the non-dominant arm when performing overhead activities. The present findings suggest using a modified wall-stretching exercise as an alternative practical, self-administering, and effective method to promote shoulder flexibility that can be applied easily in various settings.

Comparing the effectiveness of lumbar contralateral rotation to unilateral posteroanterior mobilization in the treatment of unilateral low back pain: A singleblinded randomized placebo-controlled trial

Phitchaya Leevattananukool — 2025-03-03

Background: The use of manipulative therapy to treat patients with non-specific low back pain (NSLBP) has been proposed based on the patient’s clinical presentation.

Objective: To investigate the effects of the lumbar contralateral rotation and unilateral posteroanterior (uniPA) mobilizations on LBP intensity and lumbar range of motion (LROM) in the treatment of unilateral NSLBP patients.

Materials and methods: A single-blinded randomized placebo-controlled trial was conducted. Sixty of unilateral NSLBP were randomly allocated using concealed opaque envelopes into 2 groups either; rotation or uniPA groups and collected the pre-intervention data (O1). All participants were received a detuned short-wave diathermy technique and collected the after-placebo data (O2). Then, the therapist treated the participants according to their group allocation and collected the aftermobilization data (O3). Lastly, the participants were recalled within 2 days to collect the follow-up data (O4). Two-way mixed repeated analysis of variance and Paired t-test was used to investigate the immediate and latent effects, and placebo and flare-up effects, respectively.

Results: The result showed no placebo effect (p>0.05). There was no difference between groups and time effects (both immediate and latent effects) (p>0.05). However, there were statistically significant differences within group of immediate and latent effects on pain reduction and LROM improvement (p<0.001). Moreover, results noted on the flare-up on pain alleviation at rest in the uniPA group (p<0.05).

Conclusion: These findings partially support the recommendation of using mobilization techniques in the treatment of NSLBP patients with unilateral symptoms.

Development, validity, and reliability of harm perception and attitudes questionnaire for smokers of roll-your-own and factory-made cigarettes: A pilot study in Southern Thailand

Phailin Thaworncheep — 2025-03-11

Background: Understanding roll-your-own (RYO) and factory-made (FM) cigarette smokers’ perceptions of harm and their attitudes toward smoking is essential for identifying the barriers they face in effective smoking cessation counseling. However, there are few tools available for measuring these perceptions and attitudes among smokers of RYO and FM cigarettes.

Objective: This study aimed to develop and subsequently test the validity and reliability of a questionnaire designed to measure harm perception and attitudes among smokers of RYO and FM cigarettes in Thailand.

Materials and methods: The questionnaire was developed based on data from focus groups with eight adult RYO and FM cigarette smokers and in-depth interviews with four medical professionals with experience in caring for smokers. The content validity of the questionnaire was measured by three experts. The Cronbach’s alpha coefficient was used to measure the internal consistency and reliability of the questionnaire. Data from 30 adult RYO and FM cigarette smokers were considered for the test-retest of reliability, measured using the intraclass correlation coefficient.

Results: The harm perception and attitudes questionnaire for RYO and FM cigarette smokers demonstrated good content validity. The item content validity index of 21 out of 29 items was higher than 0.79, and the scale content validity index was 0.9. Additionally, Cronbach’s alpha coefficient of 0.719 and the intraclass correlation coefficient of 0.975 (p<0.001) indicated the good reliability of the tool.

Conclusion: This study presented a validated questionnaire to assess harm perception and attitudes among smokers of RYO and FM cigarettes. The development and validation process ensured the tool’s reliability and effectiveness in elucidating smoking behavior and facilitating targeted cessation interventions.

The Effect of walking with eyes closed (Makarach) on postural control and the autonomic nervous system (ANS) function: A randomized controlled trial

Eka Agustiani — 2025-03-11

Background: Postural control (PC) is essential for performing complex movements and often deteriorates over time due to various factors, necessitating more flexible exercise options. Mind-body practices are purported to improve postural control.

Objective: To determine the effect of Makarach, a mind-body practice, on postural control and the autonomic nervous system (ANS) function.

Materials and methods: A randomized controlled trial (RCT) was conducted involving 76 participants, divided into two groups: experimental group (EG, N=38) and control group (CG, N=38). The EG walked forward and backward on two yoga mats with eyes closed while the CG performed tandem walking (TW). Both groups underwent a four-week training program (15 minutes per day, three days per week). The Y Balance Test (YBT) assessed the dynamic postural control (PC) in the anterior (A), posterolateral (PL), and posteromedial (PM) directions. The composite score (CS) was used for overall performance in the YBT. The Balance Error Scoring System (BESS) assessed static PC on firm (FIS) and foam (FOS) surfaces. Heart Rate Variability (HRV) components, including low frequency (LF), high frequency (HF), and low to high frequency (LF/HF) ratio, were used to evaluate the ANS function. All outcomes were measured before and after training. Data analyses were performed using intention-to-treat analysis.

Results: The dynamic and static PC was found to increase in EG only. Significant differences were found in A, PL, PM, and overall dynamic PC (CS) in dominant and non-dominant legs (p<0.05) and (p<0.05), respectively. Significant differences were also found in static PC in FIS (p<0.05), while no significant difference was observed in FOS. There were no significant differences in any HRV components (p≥0.05). There was significant interaction between groups and time in dynamic PC and FIS, but no significant within-group difference in any CG variables.

Conclusion: Walking with eyes closed (Makarach) was found to significantly increase dynamic and static PC among healthy individuals after four weeks of training in comparison to before training. Additionally, Makarach demonstrated greater effectiveness in improving PC than TW.

Relationship between risk factors at workplace and upper limb work-related musculoskeletal pain among poultry slaughterhouse workers: A cross‑sectional study

Benjamaporn Hancharoenkul — 2025-03-13

Background: Poultry slaughterhouse workers (PSW) are exposed to various risk factors at work that contributes to upper limb work-related musculoskeletal pain (UL-WMSP) at workplace.

Objective: This study evaluated the relationship between various risk factors at workplace and UL-WMSP among PSW.

Materials and methods: A cross-sectional descriptive study was conducted in Thailand among 98 PSW (52 women and 46 men). A self-reported form was used to collect demographic factors and job task profile among PSW. Rapid upper limb assessment (RULA) was used to evaluate the risk of poor posture at work. The relationship between the risk factors and prevalence of UL-WMSP was evaluated through univariate logistic regression analysis (AMSEC-64EX-112).

Results: About 86.7% (N=85) of PSW reported UL-WMSP over the last 12 months, and 68.4% (N=67) reported UL-WMSP during the period of the last 7 days. Around 91.8% (N=90) of PSW exhibited a poor posture at work with RULA scores at 7 or more indicating a high level of risk for UL-WMSP. Risk factors such as age (p<0.04) was significantly related with prevalence of UL-WMSP over the period of the last 7 days. A significant relationship was also found between job tasks such as poultry abdominal slitting task (p<0.02), poultry cutting-up task (p<0.03), types of tool use (p<0.01), poor posture (p<0.01) and prevalence of UL-WMSP over the last 12 months.

Conclusion: Risk factors such as age, job tasks and poor posture are related to UL-WMSP among PSW at workplace. There is an essential need to develop musculoskeletal health and wellbeing program for the PSW to reduce UL-WMSP at the workplace and to create a healthy working environment.

Development of a self-report questionnaire for evaluating the occupational performance and satisfaction in daily occupations in seven occupational areas of university students with game addiction

Sithikorn Surintaramon — 2025-03-27

Background: Nowadays, the prevalence of internet usage for university students’ game playing is increasing worldwide. However, overabundant gaming may lead to game addiction. Studies have demonstrated that game addiction increases the risks of health problems. Moreover, it also decreases occupational performance via cognitive and psychosocial skill reduction. In occupational therapy, cognitive and psychosocial performance are necessary for daily activities. Furthermore, occupational satisfaction also correlates positively with participation in occupations. Thus, occupational therapists should know the occupational performance and satisfaction in daily occupations of university students with game addiction to explore occupational issues and plan interventions. However, an instrument for evaluating the occupational performance and satisfaction in daily occupations of university students with game addiction has never been investigated.

Objective: This study developed a questionnaire to evaluate the occupational performance and satisfaction in the daily occupation of university students with game addition.

Materials and methods: The questionnaire, comprising 22 items, assessed the impacts of game addiction on occupational performance and satisfaction in daily occupations of seven occupational areas. Afterwards, the psychometric properties of the questionnaire were investigated in 78 university students with game addiction.

Results: This study showed that the questionnaire had sufficient content and construct validity for evaluating the impacts of game addiction on occupational performance and satisfaction in the daily occupations of university students. Moreover, the internal consistency of the questionnaire in occupational performance is good (Cronbach’s alpha coefficient =0.812). Also, the internal consistency of the questionnaire in satisfaction of daily occupation is good (Cronbach’s alpha coefficient =0.82).

Conclusion: The questionnaire is valid and reliable for evaluating the occupational performance and satisfaction in daily occupation of university students with game addiction. Screening these components can provide a new occupational therapy tool for such students.

The innovative development of the aphasia speech application for Thai adults with aphasia

Somjit Ruamsuk — 2025-03-27

Background: The growing trend of internet usage among the Thai population, both in terms of user numbers and time spent online, has led to a growing demand for self-training applications. This trend presents opportunities to enhance access to healthcare services, especially in speech rehabilitation for aphasic patients. However, Thailand faces a shortage of speech-language pathologists (SLPs), making mobile applications a viable solution to expand access to treatment and improve patient outcomes.

Objective: This study aimed to develop a digital tool for speech training in adult aphasic patients under the supervision of SLPs and a multidisciplinary team. It also sought to evaluate the tool’s effectiveness in improving speech outcomes for aphasic patients and assess user satisfaction among healthcare professionals, healthy participants, aphasic patients, and their caregivers.

Materials and methods: This developmental research was conducted in four phases, starting with a literature review, developing the speech training application, expert validation of the application’s content, and tool implementation. The application was tested with 15 SLPs, six physicians, six nurses, six occupational therapists, six physical therapists, six healthy participants, 15 aphasic patients, and 15 caregivers. Based on the feedback from these diverse groups, the application was further refined to address suggestions and improve its usability. The application’s efficiency was measured through satisfaction surveys, while its effectiveness was evaluated using Thai adaptation of the Western Aphasia Battery test (WAB-Thai). Pre- and post-training scores were compared following 12 traditional speech therapy sessions with the Aphasia Speech application, each lasting 60 minutes over three months.

Results: Satisfaction levels among healthcare professionals and healthy participants ranged from 4.0 to 4.2, whereas satisfaction levels among patients and caregivers were 3.9 to 4.6, indicating high satisfaction. The WAB-Thai scores showed statistically significant improvements in all areas, including fluency, comprehension, repetition, naming, reading, and the Aphasia Quotient (AQ) scores, with p<0.05.

Conclusion: The developed application significantly enhanced the effectiveness of speech training, as evidenced by improved language and speech outcomes across all metrics. High satisfaction levels from users supported its implementation as a valuable tool for continuing speech therapy at home. Further refinements are necessary to optimize its usability, with plans for broader dissemination among healthcare providers to address the shortage of SLPs in underserved regions.

The reference intervals for biochemistry analytes obtained through the indirect method indicate the metabolic shifts in the Thai adult population

Sudawadee Kongkhum — 2025-03-27

Background: Reference intervals (RIs) of biochemistry analytes are required to make medical decisions. According to the standards, medical laboratories shall validate and/or verify RI for their own uses because there are biological and laboratory variations.

Objective: To determine RIs of 14 biochemistry analytes, including fasting blood glucose, total cholesterol, HDL cholesterol, triglyceride, total protein, albumin, BUN, creatinine, uric acid, AST, ALT, ALP, amylase, and lipase in Thai adults.

Materials and methods: RIs were determined by using the indirect method. Test results from 18 years old or older out-patient department patients were collected from the hospital laboratory database from January 2019 to December 2021. The results from subjects with a high likelihood of disease were excluded, outliers were removed, data distribution was tested, and RIs were determined as either mean±2SD or the 2.5th to 97.5th percentile for normal and non-normal distribution data, respectively.

Results: There were 197,897 test results available for RI determination. Most of the determined RIs were comparable to those from the manufacturer, except uric acid. All 14 RIs passed verification criteria in the population served. Interestingly, our RIs for blood total cholesterol, triglyceride, and uric acid were higher than those established in the previous reports in Thai population.

Conclusion: The RIs were established and verified in Thai adults; therefore, they could be implemented for the population. In addition, our RIs of total cholesterol, triglyceride, and uric acid reflect metabolic changes of the studied population.

A survey of foodborne bacterial contamination in Chiang Mai Province, Thailand: A pilot study focused on Aeromonas and Vibrio

Wannika Kaewma — 2025-03-27

Background: The consumption of raw or undercooked food contaminated with microbial pathogens is a major cause of foodborne illness. Vibrio and Aeromonas are significant pathogenic bacteria found in raw seafood. Currently, the consumption of raw and undercooked seafood, including salmon, is becoming popular in Thailand. Nevertheless, studies focusing on the prevalence of human pathogenic Vibrio and Aeromonas in seafood and salmon in Thailand are scarce.

Objective: This study aimed to detect Vibrio and Aeromonas in undercooked foods from Chiang Mai Province, Thailand.

Materials and methods: Ten food samples (five spicy mixed seafood salads and five salmon sushi) individually collected in Chiang Mai, Thailand, from August to October 2024. Samples were processed as previously described and bacteria were identified by 16S rRNA gene amplification by PCR and Sanger sequencing.

Results: The results indicated that three of ten (30%) were contaminated with human pathogenic Vibrio, V. parahaemolyticus, V. cholerae, and V. vulnificus. Moreover, Aeromonas species regarded as potential human pathogens, A. caviae, A. dhakensis, A. veronii, and A. hydrophila, were isolated from eight food samples (80%).

Conclusion: Our findings suggest that undercooked seafood in Chiang Mai, Northern Thailand, frequently contains pathogenic bacteria, posing significant food safety risks.

In vitro anti–leukemia activity of Gynostemma pentaphyllum (Thunb.) on HL-60 leukemia cell line

Khin Khin Gyi — 2025-04-09

Objective: This study aimed to investigate the in vitro anti-leukemia activities of the active extract derived from the leaves of Gynostemma pentaphyllum, focusing on its cytotoxic properties, cell cycle regulation, and impact on key protein markers involved in leukemia cell proliferation.

Materials and methods: G. pentaphyllum fractional extracts were prepared through sequential extraction using hexane, ethyl acetate, and ethanol solvents through maceration. The cytotoxicity of these extracts was determined against HL-60 leukemia cell line using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The most cytotoxic extract was further fractionated through column chromatography. The anti-leukemia activities of the active extract and its active fraction were evaluated through cell cycle analysis using flow cytometry. Western blotting was performed to assess the expression levels of key proliferation markers, Feline McDonough Sarcoma (FMS)-like tyrosine kinase 3 (FLT3) and Wilms’ tumor 1 (WT1) proteins.

Results: The intermediate-polar ethyl acetate fractional extract (F-EtOAc) was found to be highly cytotoxic against HL-60 leukemia cells, with an IC50 value of 43.41±2.75 μg/mL. Among the isolated fractions of F-EtOAc, fraction F10 was identified as the most active. It was shown that F-EtOAc and F10 significantly induced S-phase cell cycle arrest and reduced the expression levels of FLT3 and WT1 proteins in HL-60 cells in a dose-dependent manner (p <0.001), suggesting that anti-proliferative molecular pathways contribute to their anti-leukemia potential.

Conclusion: This study’s findings indicate that the ethyl acetate extract of G. pentaphyllum contains bioactive compounds with anti-leukemia potential, supporting further investigation into its underlying molecular mechanisms.

The state of occupational therapy practice in the community settings in Thailand: A scoping review

Chirathip Thawisuk — 2025-04-11

Background: Community-based occupational therapy (CBOT) extends beyond traditional institutional care to address social, cultural, and environmental factors that influence health and participation. In Thailand, demographic shifts, the rise of non-communicable diseases, and gaps in the healthcare system underscore the potential of CBOT for meeting community needs. However, the extent to which occupational therapy (OT) practice in Thailand is implemented within community settings remains unclear. A clearer understanding of existing practices, key interventions, and emerging trends is therefore needed to guide policy, inform practice, and expand CBOT effectively.

Objective: This scoping review aims to map current OT practice in Thai community settings. Specifically, it explores areas of practice, key interventions, and emerging trends, examining how they align with CBOT principles. By identifying gaps and opportunities, this review seeks to inform future research, practice, and policy development toward evidence-based CBOT.

Materials and methods: Following Arksey and O’Malley’s scoping review framework, a systematic search of PubMed, Scopus, and the Thai-Journal Citation Index Center was conducted. Articles published in English or Thai describing OT in Thai community settings were included, yielding 14 studies. Data extraction followed a structured template, and a content analysis was performed to identify thematic patterns.

Results: Two overarching categories emerged: areas of practice and implementation strategies. The areas of practice primarily emphasized physical rehabilitation, particularly for stroke survivors, focusing on functional recovery and activities of daily living. Fewer studies addressed mental health, but those that did underscored the importance of social participation and caregiver education. Implementation strategies included improving functional recovery, collaborating with village health volunteers, integrating technology, and developing CBOT models.

Conclusion: Occupational therapy in Thai community settings demonstrates promising practices, such as integrating village health volunteers and employing technology in rehabilitation. However, limited attention to mental health, underutilization of OT-specific skills, and uneven geographical distribution highlight areas for further development. Expanding community-based services to underserved regions and strengthening the evidence base-especially in mental health and policy engagement will be crucial for maximizing CBOT’s impact. Future research should explore diverse populations, assess model sustainability, and align current practices more firmly with evidence-based strategies.

Assessment of colistin resistance in Enterobacteriaceae: Comparison of the rapid polymyxin NP test, MicroScan system, and broth microdilution in Thailand

Anek Pootong — 2025-04-12

Background: Antimicrobial resistance is a global health crisis, with colistin serving as a last-resort antibiotic for the treatment of multidrug-resistant Enterobacteriaceae. However, colistin resistance is becoming increasingly prevalent, necessitating rapid and accurate susceptibility testing.

Objective: This study evaluated the rapid polymyxin NP (RPNP) test and the MicroScan antimicrobial susceptibility system compared to the reference broth microdilution (rBMD) method for detecting colistin resistance in colistin-resistant Enterobacteriaceae (CRE) isolates from clinical setting in Thailand.

Materials and methods: A total of 158 non-repetitive Enterobacteriaceae isolates (85 Escherichia coli and 73 Klebsiella pneumoniae) were collected from a tertiary hospital in Bangkok between August 2021 and January 2023. Colistin susceptibility was assessed using the RPNP, MicroScan system, and rBMD method following the Clinical and Laboratory Standards Institute (CLSI) guidelines. The categorical agreement (CA), very major errors (VME), and major errors (ME) of colistin resistance test results from the RPNP and MicroScan methods were determined by comparison with the rBMD method.

Results: Among the 158 Enterobacteriaceae isolates, 46.2% were intermediate and 38.6% were colistin-resistant by rBMD. The sensitivity of RPNP was 98.4% and the specificity was 95.9%, compared to 95.1% and 97.9% for MicroScan. Both RPNP and MicroScan achieved high CA (96.8%) with rBMD. Discrepancies, primarily in isolates with borderline MICs (1-4 mg/L), accounted for 4 of the 8 discordant strains. In addition, mobilized colistin resistance-1 (mcr-1) gene were detected in 5 colistin-resistant E. coli isolates with MIC of 8 mg/L.

Conclusion: Both the RPNP and MicroScan systems demonstrated high categorical agreement with the rBMD method, underscoring their reliability as practical tools for routine colistin susceptibility testing in clinical microbiology laboratories where rBMD may not be feasible.

Variation of sputum expectoration within day in bronchiectasis: Preliminary observational descriptive study

Aung Aung Nwe — 2025-04-12

Background: Effective prescription of physical therapy airway clearance (ACT) is crucial for bronchiectasis patients, yet the optimal timing and frequency remain undefined. Understanding sputum expectoration patterns may determine the most suitable times for patients to undergo ACT.

Objective: This study aimed to investigate the daily sputum expectoration patterns in patients with bronchiectasis.

Materials and methods: Sputum was collected from ten bronchiectasis patients at home over three days, during morning (6 to 9 am), daytime (9 am to 6 pm), and evening (6 to 9 pm) periods. Collected sputum was centrifuged to remove saliva, weighed, and then converted to grams per hour for analysis.

Results: A total of 90 sputum containers were collected over three days from 10 patients. Most patients (N=8) expectorated a median (IQR) of 14.34 (7.96, 23.67) gm, showing a higher trend in the morning (2.07 (1.16, 4.03) gm/hr), followed by evening (1.18 (1.86, 1.92) g/hr) with the least during daytime (0.41 (0.32, 0.82) gm/hr). A minority of patients (N=2) with massive sputum production (72 and 63.98 for participant 1 and participant 2 respectively) exhibited the highest rate of expectoration during daytime (5.71 /hr), followed by the evening (3.83 /hr) and morning (1.69 /hr) on average over three days.

Conclusion: Most bronchiectasis patients exhibited higher rates of sputum expectoration in the morning and evening. Therefore, it is recommended to administer physical therapy for airway clearance twice daily, in the morning and evening, to prevent accumulation and enhance clearance.

The effects of computer-based cognitive training on attention and working memory in Thai older adults with mild cognitive impairment

Napat Chumpurat — 2025-04-12

Background: Mild cognitive impairment (MCI) is an intermediate state occurring between healthy aging and dementia among the elderly which result in cognitive, especially regarding attention and working memory. However, the declined state can be abated if training or stimulations are promptly promoted by a computerbased cognitive training program.

Objective: The aim of this study was to explore the effects of the Neofect Cognition as a computer-based cognitive training program on attention and working memory in Thai older adults with MCI.

Materials and methods: Twenty-three Thai older adults with MCI were divided into two groups; the experimental group (N=13) receiving the Neofect Cognition program for 6 executive weeks, 3 times per week, 45 minutes per session, and the control group (N=10) receiving education about MCI. Data was collected by assessing before and after participating in the program using the Trail Making Test (TMT) and the Memory subtest of the Thai Cognitive-Perceptual Test (Thai-CPT).

Results: The results showed that the experimental group had a statistically significant difference of attention (TMT-B) and working memory scores, while the control group had no statistically significant difference for both attention and working memory. Furthermore, there was a significant difference between the groups in attention (TMT-B) and working memory.

Conclusion: From the results, it can be stated that the computer-based training program (Neofect Cognition) might improve attention and working memory in Thai older adults with MCI.

The applications of three-dimensional computed tomography images of the greater sciatic notch for sex determination in forensic anthropology aspect in Thai population

Apisara Supthaveethanakij — 2025-04-17

Background: The identification of highly decomposed corpses or skeletons remains a significant challenge for forensic medical examiners. The pelvic bone, recognized for its reliability in sex determination, is frequently utilized through visual assessment as an initial step in such cases. However, the subjectivity of this method has prompted research into more accurate and objective approaches than traditional anatomical morphological evaluations.

Objective: The research was aimed to identify practical osteometric parameters of the greater sciatic notch, measured using a postmortem computed tomographic (PMCT) program, that have significant differences between male and female adults and provide high accuracy for sex determination in the Thai population. In addition, equation with high accuracy for sex determination using discriminant function analysis (DFA) was also developed.

Materials and methods: This study analyzed 385 Thai adults aged over 20, whose postmortem computed tomography (PMCT) scans included the hip region with an intact greater sciatic notch. The sample comprised 129 females and 256 males. The analyzed 6 osteometric parameters include two distances: PIIS-IS; the distance between the posterior inferior iliac spine (PIIS) and the ischial spine (IS), PIIS-SP; the distance between PIIS and Separating point (SP), a ratio of PIIS-SP to PIIS-IS (PIIS- SP/PIIS-IS), and three angles: Angle between planes passing PIIS and IS, and PIIS and DP (PIISA); Angle between planes passing PIIS and DP, and IS and DP (GSNA) and Posterior part when the GSNA is divided by DP-SP plane (GNSPA). Discriminant function analysis was used for data evaluation.

Results: Three-dimensional measurements of the greater sciatic notch demonstrated high reliability, with intra- and inter-observer ICC values exceeding 0.8 (p<0.05). All five measurements and the ratio achieved over 92% accuracy in multivariate analysis for cross-validated cases. DFA confirmed the suitability of all parameters for inclusion in the discriminant equation, which provided thresholds for sex determination: D<-1.03 indicated male, D>2.04 indicated female, and intermediate values were indeterminate, accounting for 67.73% of population variance.

Conclusion: This study demonstrates that all the selected measurements of the greater sciatic notch can effectively differentiate between male and female adults through the application of discriminant function with an overall accuracy of 92%.