Journal of Associated Medical Sciences

Development of the Occupational Therapy Cognitive Outcome Measure-Computer-Based Assessment (OTCOM-CA) for older adults with cognitive impairment: A prototype mobile application

Pachpilai Chaiwong — 2026-05-14

Background: Cognitive impairment is common in older adults and increases with age. It affects independence in daily activities, such as financial management, meal preparation, medication management, and driving. In healthcare, outcome measurement tools are essential for evaluating a patient’s status, establishing baseline performance, guiding intervention planning, and monitoring intervention effectiveness. Computer-based assessments are feasible and well-accepted by patients, providing immediate and accurate scoring, real-time feedback, and automated reporting of results. However, in the Thai context, the availability of standardized assessment tools specifically designed for older adults with cognitive impairment remains limited. Consequently, occupational therapists require comprehensive and contextually appropriate instruments to effectively guide cognitive interventions throughout the continuum of care. To address this gap, a new assessment tool was developed and implemented as an Android tablet-based application to facilitate evidence-based practice.

Objectives: To develop the Occupational Therapy Cognitive Outcome Measure-Computer-Based Assessment (OTCOM-CA) for older adults with cognitive impairment and evaluate its content validity and feasibility.

Materials and methods: This study employed a research and development (R&D) design to establish the content and workflow structure of OTCOM-CA. Following the content validity evaluation, the application’s workflow and interface were designed in accordance with established user experience (UX) and user interface (UI) principles and subsequently validated. A pilot study involving 10 healthy older adults was conducted to evaluate the clarity of the workflow and the appropriateness of the language used within the application.

Results: Content validity evaluation of the OTCOM-CA’s structure, workflow, and screen design showed acceptable ratings for all items (IOC=0.66-1.00). Most participants understood the workflow and test instructions.

Conclusion: OTCOM-CA demonstrated acceptable content validity. The prototype Android version shows a good workflow and language validation. Once revisions are made, its psychometric properties should be evaluated.

Altered visfatin and adiponectin levels and their interaction with HEGF in the metabolic dyslipidemia of overt hypothyroidism: A case-control study

Murtadha Najim — 2026-05-14

Background: Hypothyroidism is a common endocrine disorder associated with significant metabolic dysregulation, including dyslipidemia. Adipokines such as visfatin and adiponectin are key regulators of metabolism, but their specific roles and potential as markers of metabolic dysfunction in overt, treatment-naive hypothyroidism require further elucidation.

Objectives: This study aimed to investigate the association of visfatin and adiponectin levels with hypothyroidism, assess their potential utility for metabolic risk assessment, and explore their associations with metabolic parameters and human epidermal growth factor (HEGF).

Materials and methods: This case-control study included 71 hypothyroid patients and 67 frequency-matched euthyroid controls. All patients were newly diagnosed and therapy‑naive. Serum levels of adipokines (visfatin, adiponectin), HEGF, thyroid hormones, and lipids were assessed. Statistical analyses included ROC curves, Spearman’s correlation, multivariate regression, and ANCOVA to adjust for BMI and age.

Results: After adjusting for BMI and age, hypothyroid patients had significantly lower visfatin (adjusted LS mean: 11.04±1.56 vs 19.36±1.59 ng/mL, p<0.001) and adiponectin (10.77±2.04 vs 23.61±2.09 ng/mL, p<0.001) compared to controls and exhibited atherogenic dyslipidemia (all p<0.001). A strong positive correlation was observed between visfatin and adiponectin (ρ=0.533 and p<0.001). Regression analysis revealed significant interactions in the hypothyroid group: visfatin×HEGF was associated with an increased LDL-C (β=0.1306, p=0.0188), while adiponectin×HEGF was associated with decreased LDL-C (=-0.0919, p=0.0062). Adiponectin showed a good screening for metabolic risk in hypothyroidism (AUC=0.80) compared to visfatin (AUC=0.68).

Conclusion: Hypothyroidism is associated with altered adipokine levels and a specific interplay with HEGF that influences LDL-C. Adiponectin shows promise as adjunctive marker for assessing metabolic dysfunction severity in hypothyroidism, and the HEGF-adipokine network represent

Preliminary study: Effect of breathing exercise on hemodynamics and heart rate variability in hypertension

Sirinut Chaiduang — 2026-05-18

Background: Various types of breathing exercises (BE) have been investigated, mostly focusing on their effects on blood pressure (BP) in hypertension (HT). However, each study has had a different BE program, and strong evidence based on a standard protocol is lacking.

Objective: The present study was designed to compare the effects of BE across different breathing patterns within the same protocol on hemodynamic and heart rate variability (HRV) parameters.

Materials and methods: The study was a randomized crossover design. 20 hypertensive patients performed deep and slow, pursed-lip, and bee-humming breathing in a random sequence of the three breathing patterns. Hemodynamics and HRV parameters were measured before and immediately after exercise.

Results: At a rate of six breaths/min for ten minutes, there was a significant effect of time on SBP (F (1,19)=5.17, p<0.05). The post hoc Bonferroni test indicated a significant reduction in SBP during pursed-lip breathing compared to baseline (p<0.01). In addition, no significant differences were found in DBP, HR, and HRV parameters. Moreover, pursed-lip breathing showed the largest change in mean difference with 95% CI in SBP (-3.9 (-6.6, -1.1)). While deep and slow and bee-humming breathing were (-3.5(-7.4, 0.5)) and (-0.4(-4.4, 3.6)), respectively.

Conclusion: Among the three breathing exercises, only pursed-lip breathing significantly reduced SBP after a single 10-minute session at six breaths per minute, while no significant changes were observed in DBP, HR, or HRV parameters. These findings suggest that pursed-lip breathing may be the most effective technique for short-term BP reduction in hypertensive patients under standardized conditions.

Effectiveness and satisfaction of the elastic ankle support devices for walking and mobility among healthy people

Sugalya Amatachaya — 2026-05-19

Background: A plastic non-hinged ankle-foot orthosis (AFO) is a standard ankle support device (ASD) commonly prescribed for individuals with walking impairments in general clinical settings of a developing country. Although it promotes toe clearance during the swing phase, its inherent rigidity can limit ankle rocker during the stance phase, thereby facilitating the development of compensatory strategies that affect walking and mobility in these individuals.

Objectives: To develop an alternative practical ASD assisting movements not only the swing but also the stance phases and compare their effects to a non-hinged AFO and no-ASD conditions on walking and mobility of healthy participants.

Materials and methods: This study developed elastic ASDs from a 3- to 4-inch bandage, called a long ankle sling, and elastic bands with buttonholes, called elastic ankle support equipment (EASE). Their effects and satisfaction were compared with those of no-ASD and non-hinged AFO in 18 healthy participants. Outcomes were measured as spatiotemporal gait variables, mobility using the timed up and go test (TUG), and satisfaction using a self-report questionnaire.

Results: Spatiotemporal and TUG data of the elastic ASD conditions showed no significant differences from the no-ASD condition, but significantly better than those of the AFO condition. The elastic ASDs met the criteria for dimensions, weight, safety, and effectiveness (p<0.001). The EASE was also comfortable and easy to adjust, whereas the AFO was durable (p<0.01).

Conclusion: The present study suggests the potential clinical benefit of elastic ASDs as they did not hinder the walking and mobility of healthy participants, i.e., allowed healthy participants to maintain walking ability and mobility comparable to unassisted walking. Given its ease of adjustment and application, the EASE is a particularly promising and user-friendly ASD for implementation in various clinical and community settings.

Analysis of associations between personal attributes, emotional state, and functional performance after stroke

Ko Euna — 2026-05-20

Background: Emotional problems such as depression, anxiety, and apathy frequently occur after stroke and can negatively impact the functional recovery process. However, most previous studies have focused on specific emotional factors or examined the relationship between emotional and functional variables in a predominantly one-directional manner. Because emotional management is also important in stroke rehabilitation, further research is needed to clarify the complex associations among emotional, functional, and personal variables.

Objectives: The purpose of this study was to examine the bidirectional associations between emotional factors and functional performance in stroke patients undergoing inpatient rehabilitation and to explore the role of personal factors in emotional status.

Materials and methods: The study was conducted with 102 stroke patients hospitalized in a rehabilitation hospital. Emotion was assessed using the Korean version of the Positive and Negative Affect Schedule (PANAS), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and the Apathy Evaluation Scale (AES). Function was measured by cognitive function (MMSE), balance ability (BBS), gait ability (FAC), and activities of daily living (K-MBI). Personal factors included sex, age, duration of illness (DISEASE_DUR), and length of stay (LOS). Statistical analyses included simple and multiple regression.

Results: Simple regression analysis showed that better functional performance was associated with lower negative affect, depression, and anxiety. Conversely, higher negative affect, depression, and anxiety were associated with poorer cognitive function, balance, gait ability, and activities of daily living. Apathy showed a limited positive association with cognitive function. Among personal factors, positive affect decreased slightly with increasing age, and apathy was higher in patients with a shorter illness duration. Multiple regression analysis showed that most relationships disappeared, but depression remained independently associated with functional performance after adjustment for other emotional variables. Among functional domains, only activities of daily living independently explained emotional state.

Conclusion: Emotional state and functional performance in stroke patients were significantly associated, particularly with respect to negative emotions and depression. These findings suggest that a functional-focused rehabilitation approach alone may be insufficient, highlighting the potential need for rehabilitation strategies that integrate emotional interventions with functional training. This study can serve as foundational data for developing integrated rehabilitation models to promote recovery in stroke patients.

The interplay between serum Interleukin-33 and vitamin D3 in childhood asthma: Diagnostic utility and severity predictors in an Iraqi community

Zahraa Hazim Aziz — 2026-05-20

Background: The epithelial alarmin Interleukin-33 (IL-33) and the immunomodulator vitamin D3 are implicated in asthma pathogenesis, yet their combined clinical utility and interplay in pediatric populations remain underexplored.

Objectives: This study aimed to investigate the diagnostic performance and predictive value of serum IL-33 and vitamin D3 in childhood asthma, and their association with disease severity.

Materials and methods: A case-control study was conducted involving 120 children (60 asthmatics and 60 age- and gender-matched healthy controls) in Karbala, Iraq. Serum levels of IL-33 and 25-hydroxyvitamin D3 were quantified using enzyme-linked immunosorbent assay (ELISA). Diagnostic utility was evaluated via Receiver Operating Characteristic (ROC) curve analysis, and independent predictors were identified using multivariate binary logistic regression.

Results: Asthmatic children exhibited significantly elevated IL-33 (395.56±218.75 vs 159.95±55.32 ng/L, p<0.001) and lower vitamin D3 (17.01±7.38 vs 28.20±10.60 ng/mL, p<0.001) than controls. A strong inverse correlation was observed between IL-33 and Vitamin D3 (r = -0.614, p<0.001), both of which showed a dose-dependent relationship with asthma severity. ROC analysis revealed exceptional diagnostic accuracy for IL-33 (AUC=0.933). Multivariate regression identified body mass index (aOR = 1.528, p=0.014) and IL-33 (aOR=1.015 per 1 ng/L increase, p=0.020) as significant independent predictors of asthma, yielding an overall model accuracy of 95.8%. Notably, male asthmatics exhibited significantly lower vitamin D3 levels than females (p<0.001).

Conclusion: The inverse relationship between elevated IL-33 and vitamin D3 deficiency underscores their synergistic role in asthma exacerbation. IL-33 serves as a highly accurate diagnostic biomarker, highlighting the potential for targeted anti-alarmin therapies and gender-stratified nutritional interventions in pediatric asthma management.

Predicting dyscalcemia using machine learning models based on routine laboratory data

Busadee Pratumvinit — 2026-05-21

Background: Dyscalcemia is associated with significant clinical complications, and the demand for calcium testing is rising disproportionately.

Objectives: This study aimed to develop machine learning (ML) models to predict total calcium abnormalities using routine available demographic and laboratory data to optimize laboratory test utilization.

Materials and Methods: This retrospective study analyzed data from 7,951 patients at Siriraj Hospital between April 2023 and March 2024. Feature selection identified ten predictors, including patient status, absolute lymphocyte count, albumin, bicarbonate, hematocrit, hemoglobin, platelet count, potassium, red blood cell count, and total protein. Seven ML algorithms were developed and validated using an 80:20 training-testing split with 10-fold cross-validation and hyperparameter tuning. The Synthetic Minority Oversampling Technique was applied to address class imbalance. Additionally, model calibration was evaluated using Brier scores, and Platt scaling was applied to ensure the reliability of predicted probabilities.

Results: XGBoost achieved the highest AUC (0.84), indicating slightly better discriminative performance, and the highest specificity (0.86), reflecting a stronger ability to correctly identify normal cases. Random forest yielded the highest F1 score (0.71) and recall (0.76), indicating a better balance between precision and recall, with higher sensitivity for detecting abnormal cases.
Following Platt scaling, the calibrated models achieved robust Brier scores (e.g., 0.1496 for random forest and 0.1497 for XGBoost), demonstrating highly accurate probability risk estimation. SHAP analysis identified albumin as the most influential feature, followed by total protein and hemoglobin.

Conclusion: ML models utilizing demographic and laboratory data can accurately predict plasma total calcium status, and probability calibration ensures reliable risk estimates. XGBoost and random forest demonstrated robust performance with complementary strengths. These models show promise as screening tools for identifying high-risk patients and optimizing rational laboratory utilization.

Comparison of radiation and light field congruence between a developed collimator test tool and a standard collimator test tool in the general X-ray units of Lamphun Province hospitals

Kampol Taywadithep — 2026-05-25

Background: Assessment of radiation and light-field congruence is a key quality-control procedure for general X-ray machines. This process typically requires a standard collimator test tool, which can be costly. Therefore, the author developed an innovative collimator test tool as a cost-effective alternative for evaluating the congruence between the radiation field and the collimator light field.

Objectives: The present study aims to evaluate and compare radiation and light-field congruence measured using the developed collimator test tool and a standard tool on general X-ray units across eight hospitals in Lamphun Province.

Materials and methods: The developed collimator test tool was constructed from an etched stainless-steel plate measuring 20×25 cm, with scale resolutions of 2.5 mm and 5 mm. The standard collimator test tool (GAMMEX, Model 161B) is made from a brass plate of the same dimensions with a scale resolution of 5 mm. Measurements followed the 2023 diagnostic X-ray quality standards established by the Department of Medical Sciences, Ministry of Public Health. Radiation and light field borders were measured three times on each of four sides, yielding a total of 96 measurements. Error and percentage error were calculated, and a paired-sample t-test analysis was performed.

Results: Comparison of radiation and light-field congruence between the developed collimator and the standard collimator test tools revealed a maximum error of 0.5 mm, corresponding to a percentage error of 3%, which is below the acceptable limits of 1 mm or 5%. Statistical analysis using a paired-sample t-test (p<0.05) indicated no significant difference between measurements obtained from the two test tools (p≥0.05).

Conclusion: The developed collimator test tool can be used as an alternative to the standard tool for radiation and light field congruence testing in general X-ray units. It offers a cost-effective option for self-quality control and monitoring in radiology departments while maintaining the same measurement accuracy.

Effect of prospective memory training on instrumental activities of daily living skills among individuals with mild dementia

Punitha P — 2026-06-04

Background: Dementia is a neurodegenerative disease brought on by a longterm, progressive illness that impairs decision-making, behavior, emotions, memory, and other brain processes that interfere with day-to-day functioning. Mild dementia is an early stage of cognitive decline that interferes with daily activities but allows for independent function in many areas. Prospective memory (PM), which enables one to remember to carry out delayed intentions, is crucial for everyday functioning.

Objectives: This study aims to determine the effect of prospective memory training on instrumental activities of daily living skills among individuals with mild dementia.

Materials and methods: A True experimental study was conducted. A total of 45 participants were initially screened using the Mini-Mental State Examination (MMSE). Based on the inclusion criteria, 30 participants with mild dementia were selected. Through simple randomization, 30 participants were divided into two groups: the experimental group (N=15) and the control group (N=15). The Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale was used to assess functional performance. The experimental group received prospective memory training focused on improving instrumental activities of daily living, while the control group underwent conventional occupational therapy for 3 months, with sessions held 3 days per week (36 sessions), each lasting 45 minutes. Data analysis was performed using IBM SPSS version 23.0 with paired and independent t-test.

Results: Post-test scores showed statistically significant improvements in the experimental group for instrumental activities of daily living skills (p=0.000, which p<0.001). The results of this study showed that prospective memory training was effective in enhancing instrumental activities of daily living skills among individuals with mild dementia.

Conclusion: This study found that prospective memory training improves instrumental activities of daily living among individuals with mild dementia.

Complications of hyaluronic acid fillers in HIV-positive patients: A narrative review

Kaewkan Thasana-Ekachit — 2026-06-05

Background: The introduction of antiretroviral therapy (ART) has improved the survival of people living with HIV, yet facial lipoatrophy remains a visible and stigmatizing complication. Hyaluronic acid (HA) fillers are widely used for volume restoration due to their safety, biocompatibility, and reversibility.

Objectives: This narrative review focuses exclusively on HA fillers in HIV-positive patients, aiming to clarify their complication profile.

Materials and methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2000-2024) identified 120 records. After screening and eligibility assessment, 13 studies were included. Data on study design, population, filler type, complications, and management were extracted and narratively synthesized, with results summarized in tabular form.

Results: Early adverse events, such as swelling and erythema, occurred in 50-80% of patients, and bruising in ~50%. Intermediate complications included nodules in 5-10% and indurations up to 30%, usually resolving with conservative management or hyaluronidase. Delayed infections (2-4%) were most often due to Staphylococcus epidermidis, Propionibacterium acnes, or atypical mycobacteria and required antibiotics or drainage. Granulomatous reactions and abscesses were rare (<5%) and typically occurred in patients with prior permanent filler exposure. No severe vascular events were reported in HIV-specific cohorts, though such risks remain relevant.

Conclusion: HA fillers are effective and generally safe for treating HIV-associated facial lipoatrophy, with most complications being mild and transient. However, immune dysregulation, low CD4 counts, and prior filler history may predispose to granulomas or infections. This review highlights the need for careful patient selection, meticulous technique, and further prospective research to establish standardized safety guidelines.

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

Uthaikan Thanapet — 2026-06-08

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

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

Materials and methods: A cross-sectional study was conducted with 60 adults with mental health-related disabilities residing in a governmentoperated destitute shelter. Participants completed a work-based AWP task rated across 14 work-skill items. Exploratory factor analysis (EFA) examined the underlying factor structure, while regression analysis tested the predictive value of extracted factors on occupational performance.

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

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

Wideband acoustic immittance (WAI) normative data in Thai normal hearing adults

Thanawan Wongkor — 2026-06-14

Background: The evaluation of middle ear function is important for accurately diagnosing middle ear disorders. However, conventional single-frequency tympanometry provided insufficient information to differentiate pathologies, especially in cases with normal otoscopic findings, such as otosclerosis or ossicular chain discontinuity.

Objectives: This study aimed to establish normative data for wideband acoustic immittance (WAI) measurements using stimuli across a wideband frequency range.

Materials and methods: The study focused on a Thai population with normal hearing aged 18-60 years and compared two age groups: 18-40 years and 41-60 years. A total of 245 participants were included in this study. WAI measurements were performed for wideband absorbance (WBA), resonance frequency, tympanic peak pressure, and ear canal volume.

Results: The WBA₀ and WBA_TPP gradually increased from the lowest value at 226 Hz to the highest at 3174.8 Hz. The analysis revealed no statistically significant differences in WBA0 and WBATPP between the two age groups. However, statistically significant differences were observed in WBA₀ and WBA_TPP between sexes.

Conclusion: This study provides normative data for WBA₀ and WBA_TPP in adults with normal middle ear function. The overall absorbance patterns were generally comparable to those reported in previous studies.

The re-emerging shadow: A systematic review of scrub typhus in India

Abhishek Mehta — 2026-06-16

Background: Scrub typhus, caused by Orientia tsutsugamushi and transmitted by larval trombiculid mites, has re-emerged as an important cause of acute febrile illness (AFI) in India. The disease is frequently underdiagnosed because of its non-specific clinical presentation, variable occurrence of eschar, and limited availability of reliable diagnostic facilities. Delayed diagnosis and treatment may result in severe complications and significant mortality.

Objectives: To systematically review the available literature on scrub typhus in India and to assess its epidemiology, pooled prevalence among patients with acute febrile illness, case fatality rate (CFR), clinical manifestations, diagnostic challenges, treatment outcomes, and emerging public health concerns.

Materials and methods: A systematic review of the published literature from 2013 to 2023 was conducted in accordance with the PRISMA 2020 guidelines. Electronic databases, including PubMed, Google Scholar, and Indian biomedical journals, were searched using predefined keywords related to scrub typhus and acute febrile illness. Two independent reviewers screened studies, extracted data, and assessed eligibility. Information regarding epidemiology, diagnostic methods, clinical features, prevalence, CFR, and treatment outcomes was synthesized. Heterogeneity among studies was assessed using the I² statistic, and sensitivity analysis was performed by excluding studies utilizing the Weil–Felix test.

Results: Scrub typhus has emerged as a major contributor to acute febrile illness across India, particularly in the Himalayan region, northeastern states, and southern India, with increasing reports from western and central regions. Pooled analyses indicate that approximately one-fourth of patients presenting with acute febrile illness are positive for scrub typhus. State-specific prevalence ranged from 15% to over 50%, while pooled CFR varied from <5% to over 20% depending on disease severity and healthcare setting. High heterogeneity was observed across studies (I² range: 32-71%), largely attributable to differences in diagnostic methods and study populations. Sensitivity analysis showed an increase in pooled prevalence from approximately 24% to 29% after excluding Weil-Felix-based studies, suggesting that less sensitive diagnostic methods underestimate the disease burden. Common clinical manifestations included high-grade fever, headache, myalgia, lymphadenopathy, and elevated live enzymes, whereas eschar was present in only 30-50% of patients. Severe complications included acute respiratory distress syndrome, meningoencephalitis, myocarditis, acute kidney injury, and shock. Doxycycline remained the cornerstone of therapy, although emerging reports of reduced treatment response have raised concerns regarding antimicrobial resistance.

Conclusion: Scrub typhus is a significant and growing public health challenge in India, accounting for a substantial proportion of acute febrile illness and preventable mortality. Early clinical suspicion, prompt initiation of appropriate antimicrobial therapy, improved access to reliable diagnostics, strengthened surveillance systems, and continued monitoring of circulating genotypes are essential for reducing disease burden and improving patient outcomes. Greater integration of clinical, laboratory, epidemiological, and One Health approaches is required to address the re-emergence of scrub typhus in India.

Association of serum Interleukin-13 and arginase-1 with disease severity and control in patients with asthma: A biomarker-based study

Hayder Yaseen Ali — 2026-06-22

Background: Asthma is a heterogeneous chronic inflammatory airway disease characterized by variable clinical severity and control status. Among these, Interleukin-13 (IL-13) and arginase-1 have emerged as potential biomarkers reflecting immune dysregulation and airway remodeling.

Objectives: This study was designed to examine the correlation between serum Interleukin-13 and arginase-1 levels with asthma severity and control status in Iraqi patients, as well as to assess their viability as biomarker-based indicators of disease activity.

Materials and methods: A case-control study was conducted involving 180 participants, comprising 90 individuals with asthma and 90 healthy controls, from April 2025 to January 2026. According to GINA standards, asthma severity and control were divided into groups. We employed an enzyme-linked immunosorbent assay (ELISA) to quantify the concentrations of arginase-1 and IL-13 in serum and analyzed the data using nonparametric statistical methods to evaluate the findings.

Results: The levels of serum arginase-1 and IL-13 were significantly higher in asthmatic patients than in healthy controls (p<0.001). IL-13 was strongly associated with the severity of the disease, with levels being much higher in severe asthma than in moderate asthma (p<0.0001) and rising steadily as control status got worse (p=0.0009). On the other hand, arginase-1 levels were much higher in people with severe asthma (p=0.0384), but they didn’t differ much across asthma control groups (p=0.6079). Correlation analysis demonstrated a weak but statistically significant positive association between IL-13 and arginase-1 levels (r=0.251, p=0.017). Binary logistic regression showed that the overall model was highly significant (χ²=212.18, p<0.0001) and had excellent explanatory power (Nagelkerke R²=0.923).

Conclusion: Serum IL-13 is strongly associated with both asthma severity and loss of disease control, reflecting active type-2 inflammation, whereas arginase-1 appears to be primarily linked to disease presence and severity rather than control status. The combined assessment of arginase-1 and IL-13 provides valuable biomarker-based insight into asthma phenotyping and may improve clinical evaluation of disease activity in Iraqi patients.

Effectiveness of individualized multicomponent intervention for sensory food aversion feeding disorder in children: A case series

Kowsalya M — 2026-06-23

Background: Sensory food aversion feeding disorder is a feeding problem in which children refuse to eat all or most foods. This condition can be treated effectively using a multicomponent intervention that combines both sensory and behavioral strategies.

Objectives: This study aimed to determine the effectiveness of a multicomponent intervention for children with sensory food aversion feeding disorder. The specific objective was to increase acceptance and consumption of non-preferred foods and to improve parents’ positive coping attitude towards the child’s mealtime.

Materials and methods: This case series highlights seven cases that met the inclusion criteria. Informed consent was obtained from the parents. There were four boys and three girls, with ages ranging from 3.11 years to 4.9 years. The multicomponent intervention included sensory integration and behavioral modification strategies. Additionally, parents received education on the causes of food refusal and strategies for increasing food acceptance during meals.

Results: Seven children with sensory food aversion feeding disorder demonstrated increased food acceptance of previously refused foods. The incidence of food refusal behaviors, including gagging, spitting, and vomiting during mealtime, was also reduced.

Conclusion: This case series study provides information that may inform treatment strategies for sensory food aversion feeding disorder and may serve as a catalyst for larger-scale clinical trials.

Diagnostic accuracy of urine AlereLAM and FujiLAM assays for diagnosing active tuberculosis in people living with HIV: a systematic review and meta-analysis

Andiesta Asriyah Mariam Saman — 2026-06-23

Background: People living with HIV (PLHIV) remain at high risk of active tuberculosis (TB), yet diagnosis is often challenging due to difficulty obtaining sputum and reduced sensitivity of conventional tests. Urine-based lipoarabinomannan (LAM) assays offer a rapid, non-sputum diagnostic approach. The more recent Fujifilm SILVAMP TB LAM (FujiLAM) may provide better diagnostic performance than the extensively used Alere Determine TB-LAM (AlereLAM).

Objectives: To evaluate the diagnostic accuracy of urine AlereLAM and FujiLAM for diagnosing active TB in PLHIV, and to compare the pooled diagnostic performance of AlereLAM versus FujiLAM.

Methods: We conducted a systematic review and a meta-analysis of diagnostic test accuracy in accordance with PRISMA-DTA guidelines. PubMed, Scopus, and SpringerLink were searched for studies published between 2016 and 2025. Eligible studies enrolled PLHIV evaluated for suspected active TB and assessed urine AlereLAM and/or FujiLAM against microbiological reference standards (MRS) and/or composite reference standards (CRS), with MRS prioritized. Diagnostic 2×2 data were extracted or reconstructed. Pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were estimated using a bivariate random-effects model, with separate analyses for AlereLAM and FujiLAM.

Results: Twenty-five diagnostic accuracy studies were included. AlereLAM demonstrated a pooled sensitivity of 0.364 (95% CI 0.272-0.467) and specificity of 0.928 (95% CI 0.875-0.960). In contrast, FujiLAM showed a substantially higher pooled sensitivity of 0.642 (95% CI 0.567-0.711) while maintaining a high specificity of 0.901 (95% CI 0.872-0.924). FujiLAM yielded a higher diagnostic odds ratio (16.34 vs 7.38), a higher positive likelihood ratio (6.49 vs 5.06), and a lower negative likelihood ratio (0.40 vs 0.69) than AlereLAM. Summary receiver operating characteristic (SROC) analyses demonstrated superior overall diagnostic accuracy for FujiLAM.

Conclusion: Urine FujiLAM showed markedly higher sensitivity than AlereLAM while maintaining high specificity for diagnosing active TB in PLHIV. These findings suggest that next-generation urine LAM assays may substantially improve TB case detection in this high-risk population, particularly in settings where sputum-based diagnostics are limited.

Serum Galectin-3 as a diagnostic and discriminatory biomarker for chronic kidney disease: A case-control study

Asmaa. H. Nasser — 2026-06-24

Background: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide. Conventional markers, such as serum creatinine, estimated glomerular filtration rate, and albuminuria, have limited sensitivity for distinguishing among etiologies of advanced chronic kidney disease (CKD) and become abnormal only after substantial nephron loss. Galectin-3 (GAL-3), a beta-galactoside-binding lectin implicated in renal inflammation and fibrosis, has emerged as a candidate biomarker; however, its diagnostic accuracy in distinguishing DKD from non-diabetic CKD in advanced CKD populations remains unclear.

Objective: To quantify serum GAL-3 concentrations in patients with DKD, non-diabetic CKD, and healthy controls, and to evaluate its diagnostic performance in discriminating between these groups in an advanced CKD population.

Materials and methods: A case-control study that enrolled 128 participants: 32 patients with DKD (all with type 2 diabetes mellitus), 32 with non-diabetic CKD (both groups on regular hemodialysis classified as CKD stage 5/end-stage renal disease [ESRD]), and 64 healthy controls. Serum GAL-3 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Fasting blood glucose, glycated hemoglobin (HbA1c), renal function tests, and serum albumin levels were assessed using an automated analyzer.

Results: Serum GAL-3 concentrations increased progressively from controls (210.04±34.65 ng/mL) to non-diabetic CKD (262.21±3.19 ng/mL) and then to DKD (368.50±67.10 ng/mL, p<0.001). Receiver operating characteristic (ROC) analysis demonstrated very high discrimination in this cohort between DKD and healthy controls area under the curve (AUC=1.00, 95% CI: 0.963-1.000, sensitivity, 100%, specificity, 100%; cutoff, ≥275.77 ng/mL), excellent differentiation of DKD from non-diabetic CKD (AUC=0.987, 95% CI: 0.905-0.999, sensitivity, 84.37%, specificity, 100%), and strong discrimination of all CKD patients from controls (AUC=0.926, 95% CI: 0.866-0.965; sensitivity, 98.44%, specificity, 73.44%). These cutoff values were derived from the same dataset and should be considered exploratory.

Conclusion: Serum GAL-3 demonstrated very high diagnostic accuracy in identifying and stratifying DKD within this cohort of end-stage renal disease patients on hemodialysis. These exploratory findings suggest that GAL-3 may have potential as a discriminatory biomarker in advanced CKD populations; however, prospective validation in larger, independent cohorts including patients with early-stage CKD is warranted before clinical integration can be recommended.

Effect of a behavioral strategy program on quality of life: A quasiexperimental study in women with cognitive impairment receiving chemotherapy

M. Arun Kumar — 2026-06-24

Background: Women who undergo chemotherapy for cancer frequently develop cognitive problems referred to as chemo brain. These cognitive deficits harm memory functions and attention skills as well as processing speed, which leads to decreased quality of life (QoL). Behavioral approaches are non-drug solutions that show promise in enhancing cognitive abilities and everyday functioning in this specific group.

Objectives: To evaluate the effectiveness of a behavioral strategy program compared with conventional occupational therapy in improving quality of life among women with chemotherapy-related cognitive impairment.

Materials and methods: A quasi-experimental pre- post study design was employed. Thirty women aged 45-60 years undergoing chemotherapy were recruited from Madras Cancer Care Foundation, Kumaran Hospital, Chennai. Participants were allocated into two groups (N=15 each): an experimental group receiving structured behavioral strategies and a control group receiving conventional occupational therapy for 12 weeks (36 sessions). Quality of life was measured using the WHOQOL-BREF. Data were analyzed using non-parametric tests (Wilcoxon signed-rank test and Mann-Whitney U test).

Results: Both groups demonstrated significant improvement in quality of life following intervention. The control group improved from 49.53±6.14 to 52.27±7.36 (p=0.029), while the experimental group improved from 47.33±5.58 to 59.73±6.58 (p=0.001). Between-group comparison showed a statistically significant difference in favor of the experimental group (p=0.015). Effect size analysis demonstrated large improvements in the experimental group.

Conclusion: Behavioral strategies showed greater improvement in quality of life compared with conventional occupational therapy among women with chemotherapy-related cognitive impairment. Integrating structured behavioral interventions into oncology rehabilitation may enhance patient outcomes.

Evaluation of changes in diabetes distress, resilience, and self-care behavior following Occupational Therapy Diabetes Self-Management (OTDSM) among adults with type 2 diabetes: A preliminary Quasi-experimental study

Kamala AR — 2026-06-25

Background: Type 2 diabetes mellitus (T2DM) is a growing health concern that necessitates consistent self-management practices to avoid complications and maintain health. Psychological factors like diabetes distress and poor resilience levels frequently interfere with self-care practices of individuals, resulting in less than adequate diabetes related self-care. By integrating selfmanagement into daily routines, occupational therapy plays a major role in preventing secondary complications of diseases.

Objectives: To find the changes in diabetes distress, resilience, and self-care behavior following the Occupational Therapy Diabetes Self-Management (OTDSM) intervention among adults with type 2 diabetes.

Materials and methods: A quasi-experimental single-group pre-test posttest study was conducted in a community setting, with 12 adults diagnosed with type 2 diabetes. The Occupational Therapy Diabetes Self-Management (OTDSM) intervention was provided for 4 weeks in 10 sessions. Outcomes were assessed using the Diabetes Distress Scale (DDS -17), the Connor-Davidson Resilience Scale (CD-RISC-25), and the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA). Pre- and post-intervention data were analyzed using Paired t-tests and Repeated Measures ANOVA.

Results: Diabetes distress showed marked reduction from 3.72±0.25 to 2.53±0.28 (p<0.001). Resilience scores improved from 42.91±3.53 to 49.45±3.24 (p<0.001). Self-care behavior also showed improvements across multiple domains (p<0.001).

Conclusion: The OTDSM intervention was associated with positive changes in diabetes distress, resilience, and self-care outcomes among adults with T2DM. These preliminary findings may suggest the potential integration of OTDSM into diabetes care to address both psychosocial and behavioral aspects of disease management.

Design and preliminary study of VP1-encoding mRNA-lipid nanoparticles for Enterovirus 71

Parnuphan Panyajai — 2026-06-29

Background: Hand, foot, and mouth disease (HFMD) remains a major public health concern in the Asia-Pacific region, with Enterovirus 71 (EV71) being a major cause of severe neurological complications in children. The genetic diversity of EV71 highlights the need for adaptable vaccine platforms.

Objective: This study aimed to design and preliminarily evaluate an EV71 VP1-encoding mRNA-lipid nanoparticle (mRNA-LNP) construct as an antigen delivery approach for EV71 vaccine development.

Materials and methods: A codon-optimized VP1 mRNA was synthesized by in vitro transcription and formulated into lipid nanoparticles via microfluidic mixing. Physicochemical properties were characterized, and in vitro expression was assessed in FreeStyle 293F cells by western blot and immunofluorescence. VP1-specific humoral immune responses were evaluated in BALB/c mice following a prime-boost immunization regimen using ELISA.

Results: The mRNA-LNPs exhibited a mean particle size of 99.24±0.46 nm, a low polydispersity index (0.041±0.004), a slightly negative zeta potential (-20.54±0.98 mV), and an encapsulation efficiency of 92.56±1.53%. In vitro studies demonstrated VP1 protein expression following mRNA delivery. Immunization induced VP1-specific IgG responses, with antibody levels significantly increased after prime (1.254±0.775) and boost (4.225±0.322) compared with control groups (p<0.01 and p<0.001, respectively). Endpoint titers increased from a geometric mean titer of 2,000 (95% CI: 901.50-4,437.00) after priming to 256,000 following booster immunization.

Conclusion: This study demonstrates that EV71 VP1 mRNA-LNPs induce antigen-specific humoral immune responses in mice, providing preliminary evidence of their potential as an antigen delivery approach for EV71 and supporting further studies in vaccine development.