Journal of Medical Bioscience

Serological biomarker of autoimmune liver diseases

Niramol Thammacharoenrach — 2025-06-01

Autoimmune liver diseases (ALD) are the group of liver diseases caused by the immune system that damage cells and tissues of the liver. The patients with this disease have chronic hepatitis or severe hepatitis and up to liver failure. The detection of liver-related autoantibodies is very important for serological diagnosis, monitoring and classification of ALD, such as autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC), etc. Serological markers of ALD include anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) are found in AIH type 1, while anti-liver kidney microsome antibodies type-1 (anti-LKM1) and/or anti-liver cytosol type-1 (anti-LC1) are found in AIH type 2.Anti-mitochondria antibodies (AMA) are specific to PBC. On the other hand, atypical perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) are highly detectable in PSC. Most of the autoantibody tests used indirect immunofluorescence (IIF) on different substrate in each type. In addition, there are many other specific autoantibodies that are detected using enzyme immunoassay (EIA) and line immunoassay (LIA). In conclusion, this review focuses on the serological marker of autoantibodies in each ALD group used in the laboratory for the benefit of medical personnel.

Production of blood typing reagents by the National Blood Centre, Thai Red Cross Society

Sompong Boonhai — 2025-06-01

Monoclonal antibodies are known as proteins that can be biotherapeutic agents. As medicine moves into a new era of personalized medicine, the use of monoclonal antibodies to treat diseases is central to this new approach. Since the first monoclonal antibody was approved for clinical use 30 years ago, the monoclonal antibody industry has expanded rapidly and currentlyis worth a lot of money. Currently, the National Blood Centre, Thai Red Cross Society, has applied the knowledge of monoclonal antibodies to develop and successfully produce monoclonal antibody blood typing reagents, which provide significant benefits to blood banks. This review focuses on the history and development of blood typing reagents production at the National Blood Centre, Thai Red Cross Society. Monoclonal antibodies, which were developed from donor serum, have been shown to have superior properties and efficacy in all dimensions, including higher specificity and potency. The production of monoclonal antibodies requires experienced people, expertise, and great effort to achieve success and bring great benefits to the country, reducing the import of foreign reagents by more than tens of millions of baht per year. In the future, it is being researched to increase its maximum efficiency for use in blood banks.

Application of environmental modification in occupational therapy with universal design for disabled people with physical disability

Tithison Sonthimaneerat — 2025-06-01

The number of disabled people in Thailand has been continuously increasing and most of them are physically disabled with a variety of symptoms and disabilities. With these disabilities, they can do less occupational performance that directly affects their quality of life. To increase their ability in occupational performance is therefore necessary but due to several restrictions, rehabilitation is difficult. As a result, their occupational performance does not increase as expected. Environmental modification in order to increase the capability on occupational performance is considered as an important issue for the disabled people. Presently, the most popular principle used for environmental modification is universal design which is the design created for every gender, age and for disabled people. However, with some restrictions, this principle has not been often followed to modify the environment of disabled people’s residence area. Hence, this review article has applied the environmental modification in occupational therapy, a principle for modifying the environment that mainly focuses on the disabled people with universal design in order to make the adjustment easier and adaptable with their residence’s area. Besides, their occupational performance will be increased and they can live more freely with disabilities and improve their quality of life.

Preliminary design of an underarm brace for improving cobb angle reduction in adolescent idiopathic scoliosis: A case report

Thanyaporn Rakbangboon — 2025-06-01

Adolescent idiopathic scoliosis (AIS) is a condition commonly found in teenagers. The treatment depends on the severity of the curvature and the patient’s skeletal maturity. Brace treatment is a successful conservative method for preventing curve progression. Various brace designs are available, with the underarm brace based on Boston principles being a common choice at a teaching hospital in Thailand. According to the Boston principles, a window is provided contralateral to the thoracic curve; however, no specifications regarding window opening in the lumbar area are mentioned. This study aimed to investigate the impact of a modified underarm brace with openings on in-brace Cobb angle reduction, coronal decompensation, and apical vertebral translation, compared to a conventional underarm brace without openings. Two participants were fitted with two types of underarm braces: one without openings (D1) and one with openings on the contralateral thoracic and lumbar areas (D2). Thoracic Cobb angle (TCA), lumbar Cobb angle (LCA), coronal decompensation (CD), thoracic apical vertebral translation (TAVT), and lumbar apical vertebral translation (LAVT) were measured for both designs and compared to baseline measurements. Additionally, patient satisfaction and feedback were collected. Results indicated that Cobb angle reduction for both thoracic and lumbar regions was superior with D2 compared to D1 for both cases. However, no significant changes were observed in CD, TAVT, or LAVT. Patient satisfaction was higher with D2, except regarding ease of donning and breathing.

Role of imposter syndrome on the relationship between perfectionism and burnout syndrome among preclinical medical students at a University Hospital

Sittikarn Duangprapa — 2025-06-01

Background: Imposter syndrome (IS) represents internal fear and anxiety of being exposed as a fraud that actual abilities are not talented, it can lead to frustrations, stress, and burnout. Medical students have a high achievement expectation and high standard of perfectionism trait, this trait may take an important role to burnout syndrome. Transitioning and adjustment to medical school lead to stress and burnout in preclinical medical students. Moreover, medical students with IS are more at risk of burnout. There has been no investigation on this association, especially imposter syndrome as a mediator.

Objective: To investigate the relationship between perfectionism and burnout syndrome, and to examine the mediating effects of IS on the relationship between perfectionism and burnout syndrome in preclinical medical students.

Methods: We collected data from 185 preclinical medical students, including demographic data, and Clance Imposter Phenomenon scale (CIPS), revised almost perfect scale (RAPS), and Copenhagen Burnout Inventorystudent survey (CBI-SS) scores. The data were analyzed using Pearson's correlation and structural equation modeling (SEM).

Results: A positive relationship between perfectionism and burnout syndrome was observed (all components P < 0.01). It was also found that IS partially mediated the relationship between perfectionism and burnout syndrome ( β = 0.246, P < 0.01), and R2 was 0.382 to 0.397.

Conclusion: Preclinical medical students with perfectionism tend to suffer from burnout syndrome. Perfectionism and imposter syndrome can predict the occurrence of burnout syndrome by about 38.2% - 39.7% probability.

Resilience, depression, coping strategies and quality of life among depressive patients at psychiatric outpatient department at Thammasat University Hospital

Jutamad Sudchuen — 2025-06-01

Background: If coping strategies, quality of life, and resilience are developed in the appropriate direction and support, these may help prevent depression in patients with depression.

Objectives: This study aimed to study resilience, coping strategies, and quality of life and the relationship between resilience coping styles and quality of life in outpatients outpatients with depression receiving treatment at Thammasat University Hospital.

Methods: A cross-sectional descriptive study was conducted with the participation of 110 outpatients with depression who received treatment at Thammasat University Hospital. All questionnaires in Thai were used including personal information questionnaires, Depression Scale (PHQ-9), strength and resilience scale (CDRISC), coping questionnaire, and quality of life (WHOQOL-BREF). The relationship of related factors was analyzed by using the Chi-square test and Pearson correlation.

Results: One hundred and ten outpatients were recruited in the study. The mean score of resilience was 20.5 ± 7.0, 77.3% had a medium quality of life and 60.0% chose problem-focused coping at a high level. The significantly related factors to resilience include depression (r = - 0.522, P < 0.01), problem-focused coping (r = 0.565, P < 0.01), avoidance (r = - 0.425, P < 0.01), and overall quality of life (r = 0.671, P < 0.01).

Conclusion: Resilience was related to depression, overall quality of life in every aspect, and coping strategies, especially problem-focused and avoidant. Therefore, encouraging people to recognize their ability to deal with problems honestly and receive external support may improve the quality of life and resilience among patients with depression.

Factors predicting decision-making time among acute myocardial infarction patients with non-ST segment elevation myocardial infarction

Sarawut Plodrit — 2025-06-01

Background: The delayed decision-making time for patients with non-ST segment elevation myocardial infarction (NSTEMI) from symptom onset is still unable to conclude the cause clearly.

Objective: This study aimed to study the factors affecting the decision-making time for seeking treatment in patients with NSTEMI.

Methods: The study samples included 100 patients with NSTEMI who received treatment at two tertiary hospitals in Thailand. Using questionnaires on demographic data form, comorbidity, illness perception, anxiety, and social support. Data were analyzed using descriptive statistics and stepwise multiple regression.

Results: Median decision-making time was 90 minutes. Illness perception had the highest predictive coefficient (β = - 0.294, P < 0.01), anxiety (β = - 0.237, P < 0.05), comorbid (β = 0.229, P < 0.05), social support (β = - 0.207, P < 0.05), use of emergency medical services or EMS (β = 0.125, P < 0.05), and hospital experience (β = 0.117, P < 0.05), were statistically significant predictors of decision-making time in seeking treatment.

Conclusion: All factors were able to predict the decision-making time for NSTEMI patients, and the results can be used to develop a program that encourages NSTEMI patients to have time to make appropriate decisions about receiving treatment.

Resilience, workplace efficiency, andmental health in registered nurse inKing Chulalongkorn Memorial Hospital

Touchdanai Xuto — 2025-06-01

Background:Resilience is the ability to withstand adversity and bounce back from difficult life events. Previous studies have shown that resilience is important for registered nurses due to it’s related to workplace efficiency and mental health. However, studies concerning these factors in registered nurses in Thailand were still limited.

Objectives:To study resilience, workplace efficiency and mental health among registered nurses at King Chulalokorn Memorial Hospital (KCMH), and to determine the associated factors of resilience.

Methods:The samples were 488 King Chulalongkorn Memorial Hospital’s registered nurses who had over one year work experience at KCMH. The study was conducted by using self-reported questionnaires, composed of: 1) demographic data form; 2) workplace efficiency questionnaire - Thai version; 3) emotional sensitivity questionnaire - Thai version; 4) general health questionnaire - Thai version; 5) resilience quotient questionnaire - Thai version; and 6) social support questionnaire - Thai version.

Results: Most registered nurses (58.0%) had moderate resilience, followed by high (24.8%) and low (17.2%)resilience.The average score of resilience was 61.6 ± 7.3. Most of them (77.9%) had normal mental health. Most of them (73.2%) had high level of workplace efficiency. The associated factors with high level of resilience were age over 34 years (P= 0.024), master degree (P= 0.019), sufficient income (P= 0.024), work experience over 11 years(P= 0.016), work position registered nurse RN6 – RN8 (P= 0.013), morning work shift (P= 0.029), over 37 of patients in care (P= 0.010), having no sleeping problems (P= 0.003), high emotional sensitivity (P< 0.001) and high social support (P< 0.001). Logistic regression showed that the predictors of high level of resilience was no sleeping problems (P= 0.014), high emotional sensitivity (P= 0.011) and high social support (P< 0.001). This study found that resilience was related to both workplace efficiency and mental health (P< 0.001).

Conclusion: Most of the registered nurses in KCMH had moderate resilience. Most of them had normal mental health and a high level of workplace efficiency. Resilience was associated with both mental health and workplace efficiency. Emotional sensitivity and social support played an important role to predict resilience among registered nurses in KCMH. Therefore, improving emotional sensitivity and social support in registered nurse may help to increase resilience.

Carryover impacts on biochemical analytes preceding with whole blood HbA1C samples on automated chemistry

Tatchapol Nanthakhan — 2025-06-01

Background: Automated clinical chemistry analyzers, employing robotic pipetting and cuvette washing systems, are the stan cxdard means for processing patient specimens. The pipetting and washing systems are designed to continuously sample patient specimens and clean sample probes and reaction cuvettes or vessels. An obvious concern is the potential for carryover of analyte from one patient specimen into another or more following patient specimens. Moreover, the sedimentation time of the blood before the sampling process may vary from lab to the other, depending on the device and protocol used, affecting the analysis outcomes.

Objectives: This study aimed to examine the continued effects of residue carried by the sample probe used in whole blood HbA1c analysis on other biochemical analyses performed by the automated system and determine the relationship of the HbA1c level with the sedimentation time of red blood cells.

Methods: This cross-sectional analysis was performed on an archive of blood samples of 100 type-2 diabetic (T2DM) patients collected from May to June 2023. Blood sedimentation time varied from 0 to 7, 15 to 30 min. The samples were analyzed for cumulative sugar levels (HbA1c) with the enzymatic assay, and sample carryover was assessed using Alinity C modules (Abbott Diagnostics, USA). The levels of HbA1c at the initial time point (0 min; T0) were compared with the levels at three different time points (7 min; T1, 15 min; T2, and 30 min; T3).

Results: The carried-over potassium, AST, ALT, ALP, and CPK values are 0.002 ± 0.068 mmol/L, - 0.040 ± 1.008 U/ L, - 0.100 ± 1.454 U/L, -0.080 ± 1.550 U/L, and 0.060 ± 1.308 U/L, respectively. There is no significant difference in the HbA1c level in all comparison groups (T0-T1: 7.0 ± 1.3, T0-T2: 7.0 ± 1.3, T0-T3: 7.1 ± 1.3). The HbA1c values at the initial time point positively correlated with those found in three different 3 time periods (0 - 7 min (T1); r = 0.9990; P < 0.001, 0 - 15 min (T2); r = 0.9985; P < 0.001, and 0 - 30 min (T3); r = 0.9986; P < 0.001), respectively.

Conclusion: Our study demonstrates that carryover residues from 0, 7, 15, and 30 minutes do not interfere with the HbA1c level and other clinical chemistry test results performed by the automated analyzer. Additionally, HbA1c values were not affected by the sedimentation time of red blood cells (up to 30 min).

Romantic relationship quality, adverse childhood experiences, and association between romantic relationship quality and mental health of Chulalongkorn University undergraduate students

Pitcharm Jiamwijitkul — 2025-06-01

Background: Initiating and having a romantic relationship in late adolescence is a significant part of emotional, mental, and social development into adulthood. High-quality romantic relationships are associated with better mental health. Additionally, having a good romantic relationship is linked to a positive parenting and childhood experiences.

Objective: To explore the mental health, romantic relationship quality, and associated factors of undergraduate students from Chulalongkorn University.

Methods: A cross-sectional descriptive study was conducted with the participation of 416 undergraduate students from Chulalongkorn University. All of them had been in a romantic relationship for at least three months and completed four self-reported questionnaires in Thai version: Demographic data form, The perceived relationship quality component scale, General health questionnaire-30, and adverse childhood experiences questionnaire.

Results: Most undergraduate students are male (62.7%), Most of them (85.1%) also reported adverse childhood experiences. Majority of the students (46.9%) had the high level of overall romantic relationship. Nearly half of them (45.9%) had abnormal mental health. The associated factors that related to their abnormal mental health were studying in social sciences and humanities, and physical sciences. Having a grade point average (GPA) below 3.3 (P < 0.05), have an inadequate financial sufficiency, no exercise or not engaging in sports and games as hobbies (P < 0.01), and having a psychiatric chronic condition (P < 0.05). Regarding romantic relationship factors, having a romantic relationship duration of more than 6 months (P < 0.01). Had adverse childhood experiences (P < 0.05), had multiple adverse experiences, and had multiple Household dysfunction issues (P < 0.01). Predictors of normal mental health included studying in medical sciences, having a GPA above 3.3, have sufficient financial sufficiency, exercising 4 times a week or more, engaging in sports or games as hobbies, not having a psychiatric disorder (P < 0.05), having a romantic relationship duration within the first 6 months, and not having adverse childhood experiences (P < 0.01).

Conclusion: High-quality romantic relationships were influenced by having normal mental health whereas low quality of romantic relationship and abnormal mental health were related to adverse childhood experiences. Therefore, having good childhood experiences and normal mental health will also help improving a high-quality romantic relationship among couples.

Lateral chest radiography in the screening of pulmonary metastasis in osteosarcoma patients

Arissa Phothisirisakulwong — 2025-06-01

Background: No previous study has mentioned the value of lateral chest radiography in the screening of pulmonary metastasis from osteosarcoma. We assume that lateral chest radiography gives no additional information that would be clinically significant compared with the frontal view alone.

Objectives: This study aimed to evaluate the value of lateral chest radiography in the screening of pulmonary metastasis in patients with osteosarcoma.

Methods: In total, 400 sets of chest radiographs [posterior-anterior (PA) and lateral projections] were interpreted by a single radiologist for pulmonary mass/nodule, lymph node, and pneumothorax. First, the PA radiographs were interpreted. Thereafter, the PA and lateral radiographs were analyzed together with a specific note made whether any findings were identifiable only on the lateral radiograph or if it was on both views. Then, a determination was made in all cases whether the findings on the lateral radiograph changed the diagnosis made based on the PA radiograph alone.

Results: The PA and lateral chest radiographs showed abnormalities in 80 (20.0%) of the 400 sets of radiographs. There were the abnormalities observed only on the lateral radiographs in 5 sets (6.3%), 4 sets (22.2%), and 0 sets for mass/nodule, lymph node, and pneumothorax, respectively. There was no statistically significant difference between the PA radiographs alone and the combination of PA and lateral radiographs in the detection of abnormalities and in the imaging diagnosis of pulmonary metastasis. However, there are three cases which the abnormalities noted on the lateral radiographs change the diagnosis and alter the further management.

Conclusion: Most abnormal findings were identified on the PA images, however, there are the lesions seen only on the lateral images and helped to change the diagnosis and alter further management.