Journal of Associated Medical Sciences

Cut-off determination of HLA crossmatching by flow cytometry

Puntharawan Sitthipornworakul — 2026-01-09

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

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

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

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

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

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

Yasmina Azfa Putri Alif — 2026-01-09

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

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

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

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

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

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

Suwatsin Kittikunnathum — 2026-01-09

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

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

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

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

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

Dhafer Alghezi — 2026-01-13

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

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

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

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

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

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

Kwanchon Jearakitiwanich — 2026-01-13

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

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

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

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

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

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

Nitipon Pongphaw — 2026-01-23

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

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

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

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

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

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

Kaviya Muralidharan — 2026-01-23

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

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

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

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

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

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

Houda El Bouhissi — 2026-01-27

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

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

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

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

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

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

Emmanuel Esien-umo — 2026-01-28

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

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

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

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

Blood donation and blood components utilization in Suratthani Hospital

Weerasak Jornpakdee — 2026-01-28

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

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

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

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

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

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

Chitpon Seeljunya — 2026-01-29

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

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

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

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

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