Journal of Medical Bioscience

Early physical rehabilitation in critically ill patients: The role and application in intensive care units

Thitapa Issaragraisil — 2026-08-05

Critically ill patients in the intensive care unit (ICU) often develop ICU-acquired weakness (ICU-AW). Early Mobilization (EM) is a vital intervention that initiates physical activity as early as possible after admission, from passive exercises to walking. This review article focuses on the scientific evidence supporting the use of early physical therapy rehabilitation in critically ill patients. It delves into the potential benefits of EM, exploring its role, application in the ICU, patient assessment, physical therapy guidelines, and the necessary tools and equipment. This review synthesizes findings from various research methodologies, including randomized controlled trials, observational studies, and meta-analyses published in recent years, to highlight the safety and efficacy of EM interventions in the ICU setting. The article also emphasizes the importance of interdisciplinary collaboration and addresses the limitations and challenges of implementing EM. Scientific evidence suggests that starting physical therapy early in critically ill patients is safe and leads to positive outcomes. It helps prevent ICU-AW and reduces the risks associated with prolonged mechanical ventilation. In conclusion, promoting early physical therapy is crucial for improving the physical and mental well-being of critically ill patients. We emphasize the importance of tailoring EM programs to each patient’s unique condition to maximize the benefits of this lifechanging intervention.

Fetal bovine serum in cell culture

Sompong Boonhai — 2026-07-10

The purpose of this literature review is to summarize the procedures for producing fetal bovine serum (FBS), various testing standards, manufacturing sources, benefits, and applications of FBS in cell culture media preparation. FBS is the most widely used serum for in vitro eukaryotic cell culture. It is commonly used in biomedical research, drug development, and biomanufacturing. Due to its very low antibody levels and a higher content of growth factors, it is versatile in a wide range of cell culture applications. FBS is derived from peripheral blood collected from bovine fetuses through closed collection systems at slaughterhouses. A protein called bovine serum albumin (BSA) is the major component of FBS and plays a key role in maintaining osmotic balance and molecular transport within the cell culture medium. In addition to BSA, FBS is a rich source of growth and adhesion factors, lipids, hormones, nutrients, and electrolytes essential for supporting cell growth in culture. FBS is typically added to basic cell culture media such as Dulbecco’s Modified Eagle Medium (DMEM) or Roswell Park Memorial Institute medium (RPMI) at concentrations of 5.0% – 20.0%.

Depression, communication styles, social skills and social functioning of patients with depressive disorders in outpatient psychiatric department, King Chulalongkorn Memorial Hospital

Nitikarn Prakobtham — 2026-07-13

Background: Patients with depressive disorders often have problems with communication styles; 46.7% have impairments in social skills and 65.3% have impairments in social functioning. However, there are still relatively limited studies on communication styles, assertiveness, social skills, and social functioning, even though these factors are related to depression in patients with depressive disorders.

Objective: This study aimed to study depression, communication styles, social skills, social functioning, and factors related to depression of patients with depressive disorders.

Methods: This study was a cross-sectional descriptive study. The samples consisted of patients with depressive disorders who received treatment at the Outpatient Psychiatric Department, King Chulalongkorn Memorial Hospital, totalling 270 participants. Participants completed 6 parts of questionnaires by themselves, which are: 1) Demographic Data Form; 2) Beck Depression Inventory II (BDI-II) – Thai Version; 3) Social Skills Inventory (SSI) – Thai version; 4) The Social Functioning Questionnaire (SFQ) – Thai Version; 5) Assertiveness Behavior Questionnaire for Self-Protection of Rights; and 6) Appropriate Assertiveness Scale.

Results: Most patients with depressive disorders (39.3%) had depression at a severe level, and the mean score of depression was 24.4 ± 13.3, which indicated moderate depression. Most patients (86.3%) had assertiveness communication styles, and the majority (68.5%) had assertiveness at a moderate level. Most patients (59.6%) had impairment in social functioning, and the majority (31.9%) had overall social skills at a moderate level. Factors related to moderate to severe depression included duration of treatment for depressive disorders ≤ 3 years (P < 0.05), age ≤ 30 years, average income ≤ 20,000 baht, low assertiveness, impairment in social functioning, very low to low social skills, low emotional expressivity, low emotional control, low social expressivity, and low emotional control (P < 0.01). Additionally, the predictive factors of moderate to severe depression were average income ≤ 20,000 baht, duration of treatment for depressive disorders ≤ 3 years (P < 0.05), Impairment in social functioning, low emotional expressivity, and low emotional control (P < 0.01).

Conclusion: Most patients with depressive disorders had severe depression. Most of the samples had assertiveness communication style in general situations, and had moderate appropriate assertiveness. Promoting assertiveness communication skills, social skills through interpersonal psychotherapy, and improving problems in social functioning can reduce depression in patients with depressive disorders.

Prevalence and predictors of dementia among older adults with memory complaints at a primary care hospital in Nakhon Ratchasima province

Kunlapan Petchpeng — 2026-08-05

Background: Thailand’s rapid transition into a completely aged society has brought cognitive impairment and dementia to the forefront of public health challenges. In primary care settings, the lack of systematic screening in routine practice often leads to delayed or missed diagnoses of dementia.

Objectives: This study aimed to determine the prevalence of dementia and related factors among older adults presenting with memory complaints at the geriatric clinic of Phimai Hospital, a general hospital in Nakhon Ratchasima Province, Thailand.

Methods: This cross-sectional descriptive study included 125 older adults aged 60 years or older who attended the geriatric clinic with memory complaints. Data were collected using a demographic questionnaire; the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); the Thai Geriatric Depression Scale (TGDS-15); the MiniMental State Examination, Thai 2002 version (MMSE-Thai 2002); the Montreal Cognitive Assessment (MoCA); the Barthel Activities of Daily Living (ADL) Index; the Chula ADL Index; and clinical diagnosis based on DSM-5 criteria. Data were analyzed using descriptive statistics, the chi-square test, Fisher’s exact test, Pearson’s correlation coefficient, and binary logistic regression.

Results: The participants were predominantly female (60.8%), with a mean age of 76.7 years. Clinical diagnosis showed prevalences of dementia, mild cognitive impairment (MCI), and depression of 45.6%, 44.8%, and 4.8%, respectively. Factors independently associated with dementia in the binary logistic regression analysis included being without a partner (adjusted odds ratio [aOR] = 2.733), monthly income below 5,000 Thai baht (aOR = 15.530), poor self- perceived health status (aOR = 4.482), lack of regular exercise (aOR = 3.577) and abnormal IQCODE result (aOR = 6.921).

Conclusion: In a geriatric clinic of a general hospital, nearly half of the older adults presenting with memory complaints were diagnosed with dementia. Systematic cognitive screening and identification of associated factors may support early diagnosis and individualized care planning for cognitive impairment.

Comparison of short-term postoperative complications between free flap and locoregional flap reconstruction in stage III-IV oral cavity cancer

Premsak Sakarinpanichakul — 2026-07-14

Background: Optimal reconstruction for advanced oral cavity cancer requires balancing functional restoration against surgical morbidity. Free tissue transfer is the standard, yet locoregional flaps remain crucial in resource-limited settings. Their comparative short-term complication rates remain contested.

Objective: To compare short-term postoperative complications between free flap and locoregional flap reconstruction in stage III-IV oral cavity cancer.

Methods: A retrospective cohort study included 92 patients with stage III-IV oral squamous cell carcinoma who underwent immediate reconstruction at Buriram Hospital between August 2012 and August 2025 . Patients were grouped into free flap (n = 40) and locoregionalflap (n = 52) groups. The primary outcome was the 30-day overall complication rate. Multivariable logistic regression identified independent predictors of postoperative complications.

Results: Overall complication rates were similar between free flap and locoregional flap groups (47.5% vs. 44.2%; P = 0.755). Operative time was longer for free flaps (P < 0.001), but hospital stay and mortality were comparable. Positive surgical margins were more common with locoregional flaps (46.2% vs. 15.0%; P = 0.002). Advanced disease stage was associated with increased complication risk; T4 stage was an independent predictor of postoperative complications, while nodepositive disease showed a similar trend.

Conclusion: Free flap and locoregional flap reconstruction demonstrate dcomparable short-term complication rates in advanced oral cavity cancer. Complication risk appeared to be more strongly associated with advanced tumor burden than reconstruction technique. Flap selection should be individualized based on defect characteristics, patient factors, and available resources.

Hybrid digital lifestyle medicine program and glycemic trends in type 2 diabetes: a pilot study in a Thai primary care setting

Weerin Susiriwatananont — 2026-08-06

Background: To align with Thailand’s 2025 “non-communicable diseases Remission” policy, the researchers developed the Hybrid Digital Lifestyle Medicine Program.

Objective: To evaluate the effectiveness of this program on glycemic and metabolic outcomes in patients with type 2 diabetes mellitus (T2DM) within a primary care setting.

Methods: This quasi-experimental pilot study enrolled patients with T2DM at primary care unit of Bangplee Hospital. Participants self-selected into the intervention (LM) or control groups. Both received standard care, motivational interviewing, and Lifestyle Medicine counselling. The LM group received an additional hybrid digital lifestyle medicine program. A follow-up was conducted over six months, with the primary endpoint being 3-month HbA1c change. Data were analyzed using modified Intention-to-Treat method and analysis of covariance.

Results: Forty-six participants were enrolled (LM = 22, control = 24). At 3 months, the primary endpoint did not demonstrate between-group superiority (P = 0.17). However, the LM group demonstrated a significant within-group HbA1c reduction of 0.65% (P = 0.012). By month 6, the LM group achieved a sustained within-group HbA1c decrease of 0.8% (P = 0.031) and a significant reduction in antihypertensive pill burden (P = 0.026). Inter-group analysis showed superior improvements in LM group for body mass index (P = 0.001), systolic blood pressure (P = 0.038) and triglycerides (P = 0.049). Behavioral analysis revealed 65.0% of LM group were progressors in their stages-of-change (P = 0.007) with zero regression.

Conclusion: The hybrid digital LM program is feasible and effective for enhancing metabolic profiles and behavioral change in Thai primary care. It facilitates NCD remission without escalating pharmacotherapy, offering high scalability for resource-constrained clinical settings.

Work stress and drug use behaviors for stress relief of medical representatives in Bangkok Metropolitan

Phaiyawat Amponratmanee — 2026-07-15

Background: In 2021, the Department of Mental Health Thailand, found that 9.4% of Thais experience stress, with the highest rates in Bangkok at 14.1%, primarily attributed to work-related stress. One of the top 10 professions with the highest stress levels is medical representatives.

Objectives: To study work-related stress and medication usage behaviors among pharmaceutical representatives in Bangkok and its suburbs, including factors influencing these behaviors and the correlation between stress levels and medication usage behaviors.

Methods: Online data were collected from medical representatives responsible for Bangkok and its suburbs, aged ≥ 22 years, totaling 330 individuals. The study utilizes a questionnaire covering 1) personal information, 2) assessment of stress perceptions related to work factors, and 3) evaluation of stress-relieving medication usage behaviors.

Results: The majority of participants were female with an average age of 33 years. Among pharmaceutical representatives, two-thirds reported moderate stress levels, averaging 50.6%. Regarding behaviors related to stress-relief medication, a significant majority, 62.8%, exhibited good practice. This study showed a significant positive correlation between drug use behaviors and stress levels among participants (P < 0.001).

Conclusion: Medical representatives in Bangkok and its metropolitan area exhibit an average stress level score of 50.6 out of 100, with two-thirds reporting moderate to high stress levels related to work factors. Additionally, two-thirds of them demonstrate favorable behaviors towards using stress-relief medication. Specifically, 62.8% engage in these behaviors at a good level.

Antibiotic self-medication in a rural filipino community: patterns, determinants, and implications for responsible antibiotic use

Shella Mae Besonia — 2026-08-10

Background: Antibiotic self-medication is a persistent public health concern that contributes to inappropriate infection management, adverse drug reactions, and antimicrobial resistance, particularly in communities with limited access to formal healthcare.

Objective: This study assessed the patterns, adverse-effect experiences, and determinants of antibiotic self-medication among household respondents in Barangay Pagatpatan, Butuan City, Agusan del Norte, Philippines.

Methods: A community-based cross-sectional descriptive quantitative study was conducted among 293 randomly selected household respondents. Data were collected using a semi-structured questionnaire adapted from a previously validated instrument and analyzed using Microsoft Excel and JASP version 0.16. Descriptive statistics were used to summarize respondent characteristics and antibiotic-use patterns, while association analyses were performed to examine factors related to selected antibiotic use.

Results: Nearly half of the respondents (49.2%) reported self-medicating with antibiotics within the previous 12 months. Respondents were predominantly female (80.6%), married (63.1%), self-employed (62.5%), and aged 39–48 years (26.3%). Amoxicillin was the most commonly used antibiotic (55.0%), with cost-related reasons reported as the leading driver of self-medication (42.7%). Although 65.5% of respondents were aware that antibiotics may cause adverse effects, only 10.9% reported experiencing adverse reactions, most commonly allergic reactions (34.3%). Association analyses showed statistically significant but weak relationships between selected reasons for self-medication and specific antibiotic use, suggesting that antibiotic self-medication was shaped by multiple overlapping factors rather than a single dominant determinant.

Conclusion: Antibiotic self-medication was common in this rural Filipino community and was influenced by economic, behavioral, and access-related factors. These findings emphasize the need for community-based health education and strengthened antimicrobial stewardship policies to promote rational antibiotic use and reduce risks associated with selfmedication.

Incidental CAC on non-gated chest CT: prognostic value for cardiovascular events in patients without prior cardiovascular disease

Jitanart Tantisirivit — 2026-07-15

Background: Non-gated chest computed tomography (CT) is routinely performed for the evaluation of thoracic conditions. Although the heart is not the primary focus of this examination, coronary artery calcification (CAC) is frequently encountered as an incidental finding and reflects underlying atherosclerotic burden.

Objective: The study aimed to assess whether incidentally detected CAC on non-gated chest CT is associated with fiveyear cardiovascular outcomes in patients without prior cardiovascular disease (CVD).

Methods: We conducted a retrospective cohort study of adults aged 40-70 years who underwent non-gated chest CT at Bangkok Metropolitan Administration (BMA) General Hospital between July 2019 and June 2020. CAC was assessed using a visual coronary artery calcium (vCAC) scoring system. Demographic characteristics, cardiovascular risk factors, and cardiovascular events occurring within five years after the index CT were obtained from electronic medical records.

Results: Incidental CAC (vCAC ≥1) was present in 54.3% of patients. Individuals with CAC were significantly older and had a higher burden of cardiometabolic risk factors. Cardiovascular events occurred more frequently in patients with CAC than in those without CAC (14.6% vs. 3.3%), corresponding to an approximately fourfold higher event rate. Event rates also increased with CAC severity (P < 0.001 for trend), with a notable increase observed among patients with vCAC scores ≥ 2.

Conclusion: Incidental CAC on routine non-gated chest CT is associated with future cardiovascular events in patients without known CVD. Visual CAC assessment may provide clinically useful prognostic information and support opportunistic cardiovascular risk stratification in routine radiology practice.

Psychological capital as a mediator between perceived stress and depression in Thai adults during COVID-19: A mediation analysis

Thanayot Sumalrot — 2026-08-10

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has caused substantial psychological distress, including elevated stress and depression. Psychological capital (PsyCap)—a positive psychological resource comprising hope, efficacy, resilience, and optimism—may function as a psychological resource that helps buffer the adverse effects of stress on mental health.

Objective: This study aimed to examine whether PsyCap mediates the relationship between perceived stress due to the COVID-19 pandemic and depression among Thai adults.

Methods: A cross-sectional online survey was conducted with 298 Thai adults aged 18–60 years. Participants completed the COVID-19 Pandemic-Related Perceived Stress Scale (PSS-10-C), the Thai Psychological Capital Inventory, and the depression subscale of the Thai Mental Health Questionnaire. Descriptive statistics, Pearson’s correlations and mediation analyses were performed using the PROCESS Macro Model 4 with 5,000 bootstrap resamples.

Results: COVID-19-related stress was positively correlated with depression (r = 0.449, P < 0.001) and negatively correlated with psychological capital (r = – 0.323, P < 0.001). Psychological capital was negatively correlated with depression (r = – 0.579, P < 0.001). Mediation analysis indicated that psychological capital partially mediated the relationship between stress and depression, with a variance accounted for (VAF) of 34.7%. The full mediation model explained 41.2% of the variance in depression. In the parallel mediation analysis, only hope demonstrated a significant indirect effect.

Conclusion: PsyCap, particularly hope, may help buffer the association between pandemic-related stress and depression. These findings highlight the importance of incorporating strengths-based interventions that enhance PsyCap to promote mental well-being during public health crises.

Determination of central-to-peripheral blood diazepam concentration ratio (C/P ratio) in Thai postmortem cases: a postmortem redistribution study

Benya Pornwattanakul — 2026-07-16

Background: Interpretation of postmortem blood diazepam concentrations is important in establishing the cause of death. However, this may be complicated by postmortem redistribution (PMR). Currently, there is limited information regarding PMR of diazepam in the Thai people.

Objective: To compare cardiac and femoral blood diazepam concentrations to examine PMR in Thai postmortem cases.

Methods: A prospective study was performed on medico-legal cases sent for autopsy at the Department of Forensic Medicine, Siriraj Hospital. Thai individuals who were 18 years of age or older and had received diazepam during hospitalization were recruited. Cardiac and femoral blood samples were obtained during autopsy. Blood diazepam concentrations were analyzed, and the cardiac-to-femoral blood ratio (C/P ratio) was calculated. Statistical analysis was performed using the Wilcoxon signed-rank test, and the Mann–Whitney U test.

Results: Forty two subjects were recruited for this study. The median/mean diazepam concentrations in cardiac and femoral blood were 52.0/83.1 ng/mL and 53.6/69.9 ng/mL, respectively. The median/mean C/P ratio of diazepam was 1.0/1.2. Diazepam concentrations in cardiac blood were not significantly different from those in femoral blood (P = 0.385). Although no significant correlation between the C/P ratio and body mass index, postmortem interval, or hospitalization time was observed, the C/P ratio was significantly higher in cases with chest injury than in cases without chest injury (P = 0.007).

Conclusion: The median/mean C/P ratio of diazepam in Thai postmortem cases was 1.0/1.2. Chest injury was the only factor that had an impact on the C/P ratio of diazepam.

Prevalence of academic burnout and its association with the big five personality traits and social support among preclinical medical students at a University, Faculty of Medicine in Thailand

Kunutprasert Witoonset — 2026-07-17

Background: Academic burnout is a mental health problem that adversely affects learning and quality of life among medical students, particularly during the preclinical years when students face intensive coursework, high academic demands, and persistent stress. Although academic burnout has been extensively investigated, evidence regarding the roles of the Big Five personality traits and social support among Thai medical students remains limited.

Objective: To determine the prevalence of academic burnout and to identify the factors associated with and predictive of academic burnout among preclinical medical students at a faculty of medicine in Bangkok, Thailand.

Methods: A cross-sectional analytical study was conducted among 340 preclinical medical students during May–June 2024. Data were collected using self-administered questionnaires, including a personal information questionnaire, the Thai version of the Big Five Personality Inventory, a social support questionnaire, and the Maslach Burnout In ventory–Student Survey (MBI-SS). Associations between potential factors and academic burnout were examined using the Chi-square test and Fisher’s exact test. Predictive factors were identified using multivariable logistic regression analysis.

Results: Among the 340 participants, 56.4% exhibited a high level of academic burnout in at least one burnout dimension. High burnout in one, two, and three dimensions was observed in 32.6%, 17.1%, and 7.1% of participants, respectively. Using the predefined criterion of high scores in all three dimensions—emotional exhaustion, cynicism, and reduced academic efficacy—the prevalence of academic burnout was 7.1%. Factors significantly associated with academic burnout included age > 21 years, being in the second or third year of study, psychiatric disorders, neutral to low satisfaction with medical education, infrequent or no regular exercise, preference for listening to music, sleep problems, sleeping pill use, low extraversion, low openness to experience, low conscientiousness, low emotional social support, and low overall social support. Multivariable logistic regression analysis identified infrequent or no regular exercise and low openness to experience as significant predictors of academic burnout (P < 0.05), whereas neutral to low satisfaction with medical education, low extraversion, low conscientiousness, and low emotional social support showed stronger associations with academic burnout (P < 0.01).

Conclusion: Academic burnout was common among preclinical medical students. Behavioral factors, personality traits, and social support were important contributors to burnout. These findings highlight the importance of promoting regular physical activity, strengthening emotional support, and developing personality-tailored interventions to prevent academic burnout and enhance psychological well-being among medical students.

Jejunoileal atresia with umbilical entrapment of distal bowel: a rare embryologic insight and surgical challenge

Sirima Liukitithara — 2026-07-10

Jejunoileal atresia is a common cause of neonatal intestinal obstruction with various etiologies. We report a rare case of type IIIa jejunoileal atresia in which the distal bowel was entrapped within the umbilicus, suggesting failed midgut return during embryogenesis as a possible alternative pathogenic mechanism. A term male newborn presented with progressive abdominal distention and failure to pass meconium within the first 48 hours of life. Imaging studies were consistent with jejunoileal atresia. Intraoperatively, the distal small bowel was found entrapped within the umbilical cord, and a blindending proximal dilated bowel confirmed type IIIa atresia. Resection with end-to-end anastomosis was performed successfully. The patient remained well at the 4-year follow-up. This rare presentation suggests a possible embryologic mechanism of jejunoileal atresia. Caution is advised when evaluating abnormal umbilical cord features in neonates to avoid injury to underlying structures. Despite these unusual findings, bowel resection with primary anastomosis remains the standard treatment, while meticulous assessment of the umbilical cord is essential to prevent iatrogenic intestinal injury.