Journal of Medical Bioscience

Effectiveness of skin traction and skeletal traction simulating modules

Weerachai Kongwan — Thu, 23 Apr 2026 00:00:00 +0700

Background: Lower extremity immobilization by skin and skeletal traction are fundamental skills for medical students (MS). An increasing number of MS in training preclude them from a hand-on direct experience with patients. A skin and skeletal traction-simulating module for lower extremity thus developed and included in the orthopaedic curriculum.

Objective: To assess the effectiveness of the developed skin and skeletal traction-simulating module in teaching MS skill.

Methods: During the 2016 - 2018 study period, 16 groups of students (420 MS), were enrolled into a randomized controlled study. Each group rotates in orthopaedic department for 2 weeks. The groups were random into either controlled or module group of skin or skeletal traction. One hundred and two MS were trained with the skin traction module (group M1) using the standardized protocol while 106 MS served as a control (group C1), and 107 MS trained with skeletal traction module protocol (M2) while 105 MS are control for skeletal traction (C2). Outcomes were assessed by Objective Structured Assessment of Technical Skills scores (OSATS) and Modified Global Rating Scale (MGRS) at the end of the rotation.

Results: For skin traction, the average scores of M1 and C1 were 17.2 ± 2.4 vs. 16.5 ± 3.1 (mean difference 0.7, 95% CI – 0.1 to 1.4, P= 0.08) for OSATS and 30.8 ± 5.6 vs.18.8 ± 4.20 (mean difference 12, 95% CI 10.7 to 13.3, P < 0.0001) for MGRS scores, respectively. For skeletal traction, the average scores of M2 and C2 were 18.8 ± 2.1 vs. 12.1 ± 3.8 (mean difference 6.7, 95% CI 5.9 to 7.5, P < 0.0001) for OSATS and 33.3 ± 5.5 vs. 17.6 ± 4.2 (mean difference 15.7, 95% CI 14.4 to 17.0, P < 0.0001) for MGRS scores, respectively.

Conclusion: The developed skin and skeletal traction simulating modules is effective in imparting the skill to the trainee. It should be included to the orthopaedic rotation. Similar models might be broadened to other fields of orthopaedic teaching.

Anxiety and related factors among geriatric patients undergoing surgical treatment for hip fractures at King Chulalongkorn Memorial Hospital

Nuttida Ratchatarom, Saran Tantavisut, Siriluck Suppapitiporn — Thu, 23 Apr 2026 00:00:00 +0700

Background:Hip fractures significantly affect the daily lives of elderly individuals. Patients with hip fractures should undergo surgery as soon as possible. However, surgery is often perceived as a threatening event, affecting patients both physically and psychologically, which may lead to anxiety. This anxiety can arise from both internal and external factors.

Objective:This study aimed to determine the anxiety experienced by elderly patients admitted to the hospital for hip fracture surgery and to investigate the factors associated with anxiety in patients prior to undergoing hip fracture surgery at King Chulalongkorn Memorial Hospital, Thai RedCross Society.

Methods:This cross-sectional descriptive study included 85 patients aged 60 years or older admitted with hip fractures to the Orthopedic Department at KCMH. All subjects completed a demographic form, the State-Trait Anxiety Inventory (STAI)Form X-I and X-II,Visual Analog Scale-Anxiety (VASA), pain scale, andSocial Support Questionnaire (SSQ6).

Results:Most subjects were female 72.9%. The mean (standard deviation) of preoperative anxiety before surgery, as measured by State Anxiety, was 48.2 (11.1), with a median (interquartile range) of 47 (40.0 – 57.5). The level of preoperative anxiety, as assessed by the VASA, was 3.2 (1.95), with a median (interquartile range) of 3.0 (1.4 – 4.4). The primary cause of patient anxiety was concerns about daily living activities after surgery. Factors associated with preoperative anxiety were history of previous surgery, pain levels, social support satisfaction, and trait anxiety.

Conclusion:These findings can be applied in reducing anxiety among the patients by guiding healthcare providers to better manage anxiety and improve care during both the preoperative and postoperative periods.

Prevalence of depression and anxiety among Thai recreational scuba diver

Ratchada Saengsanon, Sookjaroen Tangwongchai — Thu, 23 Apr 2026 00:00:00 +0700

Background: Scuba diving accidents linked to psychiatric medication side effects have been reported internationally. Prior studies have identified a significant prevalence of depression and anxiety among divers, with some individuals continuing to dive despite existing physical or psychiatric conditions. However, no such data exist for Thailand.

Objective: To examine the prevalence and associated factors of depression and anxiety among Thai recreational scuba divers.

Methods: A cross-sectional study consecutively recruited 126 certified Thai recreational scuba divers aged 18–60 years visiting Koh Tao, Surat Thani Province, between July and November 2024. Data were collected using an online questionnaire comprising five sections: demographic information, diving profile, health screening, the 9-item Patient Health Questionnaire(PHQ-9), and the 7-item Generalized Anxiety Disorder scale (GAD-7). Descriptive statistics and logistic regression analyses were used to identify factors associated with moderate to severe depression and anxiety.

Results: The prevalence of moderate to severe depressive symptoms was 18.3%, while 8.7% of participants reported moderate to severe anxiety. The most frequently reported medical condition was a previous COVID-19 diagnosis. Divers with fewer than 40 logged dives in the past 12 months were significantly more likely to report moderate to severe depression(OR = 4.56; 95% CI: 1.38–15.07;P= 0.013), as were those with a history of depression or suicidal ideation/attempt (OR = 5.61;95% CI: 1.18–26.63;P= 0.030). The presence of bipolar disorder was significantly associated with moderate to severe anxiety (OR = 9.80; 95% CI: 1.54–62.50;P= 0.016).

Conclusion: A substantial proportion of Thai scuba divers exhibit clinically relevant symptoms of depression and anxiety,particularly those with psychiatric histories. Routine mental health assessments, conducted by professionals familiar with both psychiatric care and diving medicine, are essential for ensuring diver safety.

A comparison between anti-M monoclonal antibodies derived from humans versus mice produced by the National Blood Centre, Thai Red Cross Society

Sompong Boonhai — Thu, 23 Apr 2026 00:00:00 +0700

Background: Since the first monoclonal antibody was approved for clinical use 30 years ago, the monoclonal antibody industry has grown rapidly and is of enormous value. Today, the National Blood Centre,Thai Red Cross Society, has successfully produced a monoclonal antibody blood typing reagent, which has brought many benefits to blood banks.

Objective: To comparatively study the efficiency of anti-M monoclonal reagents derived from humansvs.mice produced by the National Blood Centre, Thai Red Cross Society.

Methods: Serological tests for specificity and potency of anti-M monoclonal antibodies, the effect of proteolytic enzyme using papain enzyme, and the effect of different temperature and pH values on antigen-antibody binding reactions were performed. In addition, anti-M human monoclonal (anti-M NBC3) and anti-M mouse monoclonal (anti-M NBC2) reagents were delivered to the Kanto-Kosshinetsu Block Blood Center, Japanese Red Cross Society, to assist in testing rare blood cells for M antigen subclasses. Donor blood samples with unknown MN antigens were also studied.

Results: The anti-M human monoclonal was found to be significantly more effective than the anti-M mouse monoclonal.In terms of specificity, it showed similar effects against M and N antigens. In terms of potency, there were clear differences,with anti-M human monoclonal having a titer and total hemagglutination score of 1,024 (OMM), 512 (OMN), and 107(OMM), 103 (OMN), respectively, while anti-M mouse monoclonal had a titer and total hemagglutination score of 32(OMM), 8 (OMN), and 60 (OMM), 57 (OMN), respectively. In terms of the proteolytic enzymeseffect, both were negative.The effect of temperature and pH on the reaction tended to be in the same direction; that is, anti-M reacted well at 40C and room temperature, while the optimum pH was 7.0. In terms of the results of the M antigen subclass tests, it was found that anti-M human monoclonal could detect Mc (MNS8), while anti-M mouse monoclonal was negative. In the study of 600 blood donors with unknown MN antigens, 270 (45.0%) had MM antigens, 252 (42.0%) had MN antigens, and 78 (13.0%)had NN antigens.

Conclusion: Based on the comparative study of the efficacy of all these agents, it was shown that human monoclonal anti-M is much more effective than mouse monoclonal anti-M. Thus, it can replace the production of mouse monoclonal anti-M for distribution. Additionally, the high potency can be diluted to reduce the production cost very well.

A practical and inexpensive alginate-based tool for semiquantitative detection of vitamin C in juices and beverages

Thu, 23 Apr 2026 00:00:00 +0700

Background: Vitamin C is an essential nutrient for maintaining good health. However, vitamin C cannot besynthesized in the human body, and its bioavailability depends solely on dietary intake. InThailand,9.9% of adults are deficient in vitamin C. Therefore, development of a simple anduser-friendly test kit for determiningvitamin C levels in foods and beverages is needed.

Objectives: This study aimed to develop a rapid, practical, and low-cost semiquantitative test kit formeasuring vitamin C content in juices and commercial beverages.

Methods: Calcium alginate beads loaded with a starch–iodine complex (blue-colored beads) were used for vitamin C detection. In the presence of vitamin C, iodine molecules in the beads werereduced to iodide ions, and the blue beads became colorless. The reaction rate wasproportional to the vitamin C concentration. A total of 88 juice and beverage samples wereanalyzed, and vitamin C contents in those samples were categorized into four levels: very high, high, medium, andlow.

Results: Vitamin C levels werevery high in juices from Indian gooseberry, Chinese jujube, redguava,chili,and bell pepper; high in strawberry and guava juices; medium in kiwi and lemonjuices; and low in orange and melon juices. Among commercial beverages, vitamin C levels werehigh in fortified products but low in diluted fruit/vegetable juices and functional drinks. Importantly, the entiretesting procedure required only 5 minutes.

Conclusion: A quick, practical, and inexpensive test kit for semiquantitative detection of vitamin C in juicesand commercial beverages was successfully developed. This innovative tool could be beneficialfor health-conscious consumers who want to measure the content of vitamin C in their foods.

Coexposure to Noise and Ototoxicants as a Risk Factor for Hearing Loss in Healthcare Workers in a Tertiary Hospital

Pitchaya Chevasutho — Thu, 23 Apr 2026 00:00:00 +0700

Background: Authorities have highlighted the need to study the threat posed by the combined effects of noise and other occupational hazards, including ototoxicants. Few studies focus on the combined effects among healthcare workers.

Objectives: This study aimed to investigate the prevalence of hearing loss among those who expose to noise alone and those with combined exposure to both noise and ototoxicants.

Methods: In this cross-sectional study among healthcare workers exposed to noise during their work, data were retrieved from annual check-up results, including audiometric findings and personal and work-related factors.Chemical exposure was determined through environmental and personal sampling data review. Hearing loss was diagnosed according to Cole’s criteria. Logistic regression was performed to determine the association between noise-induced hearing loss (NIHL) and factors of interest, including ototoxicants exposure.

Results: Among 108 participants, a prevalence of NIHL of 29.6% was observed. None of the workplace chemical exposure monitoring exceeded 10.0% of the permissible exposure limit (PEL), and no biological exposure indices(BEI) were detected. Logistic regression analysis exhibited no significant association between NIHL and any risk factors, including exposure to ototoxicants.

Conclusion: Both noise and chemical exposure levels in this study were much lower than the recommended standards, which likely contributed to the statistically non-significant results. The absence of widely accepted diagnostic criteria for hearing loss caused by noise, chemicals, or combined exposure necessitates discussion on proper diagnostic standards.

Histological comparison of skin damage between hydrochloric acid exposure and typical postmortem skin changes: Establishing a novel database for Dermatological Pathology

Tanaporn Viasuwan, Suttida Deeprom, Irin Lertparinyaphorn — Thu, 23 Apr 2026 00:00:00 +0700

Background: Hydrochloric acid (HCl) is a widely used industrial chemical that can cause severe tissue damage upon contact. Studying the distinctive histopathological patterns can help forensic pathologists accurately identify cases of acid burns.

Objectives: To investigate the effects of skin tissue exposure to 20.0% HCl and compare these effects with the usual post-mortem changes after death following an extended postmortem interval (PMI)

Methods: An experimental, prospective, descriptive data collection study was conducted from 2023 to 2024, encompassing 32 human cadavers’ skin from the Department of Forensic Medicine department, Chulalongkorn University, Bangkok,Thailand. Samples were divided into three groups: control (no HCl exposure), exposed to 20.0% HCl for 3 minutes, and exposed to 20.0% HCl for 10 minutes. Skin specimens were fixed in 10.0% formalin, embedded in paraffin wax, and stained with hematoxylin-eosin (H&E) and Periodic acid-Schiff (PAS). Histological alterations were evaluated under light microscopy.The histologic features of postmortem skin change were descriptively documented.

Results: In control samples, postmortem changes included partial disruption of the basket-weave (BV), vacuolization of the basal layer, thickening of upper collagen fibers, papillary dermis, and swelling of skin appendages. With prolonged PMI,features of dermo-epidermal separation were observed. When skin is exposed to 20.0% HCl, coagulative necrosis increases with longer exposure times, leading to homogenization and coagulative necrosis in the dermis.

Conclusion: Skin exposure to 20.0% HCl leads to progressive histological damage that differs from natural changes seen in postmortem skin.

Work stress and work addiction among media professions of digital media companies in Bangkok

Natcha Mitvareesamphun, Peeraphon Lueboonthavatchai — Thu, 23 Apr 2026 00:00:00 +0700

Background: A number of studies across the world have revealed the fact that media professions could be stressful occupations. In spite of that, the research regarding work stress among this group has not been done in Bangkok, and the studies identified work addiction are considered limited. Therefore, this study aimed to explore work stress and work addiction among full-time media professions of digital media companies in Bangkok, Thailand.

Objective: To identify work stress, work addiction, and possible associated factors that could affect the work stress of media professions of digital media companies in Bangkok.

Methods: A cross-sectional descriptive study conducted in 295 media professions from 32 digital media companies within the Bangkok area. The questionnaires included: 1) Demographic data form; 2) Work data form; 3) Work Stress Scale; 4)Bergen Work Addiction Scale (BWAS) Thai version; 5) Social Support Questionnaire; and, 6) Work Happiness Questionnaire.The associated factors were analysed using Chi-square test. Then, the predictors of high work stress were identified by using binary logistic regression.

Results: More than half (56.3%) of the sample group had high work stress, and the average score was 53.7 ± 12.4. The associated factors with such high stress were work addiction, low-to-moderate social support, low-to-moderate work happiness, and more than 9 hours of work per day. These are also the predictors of high levels of work stress.

Conclusion: The majority of media professions of digital media companies in Bangkok had high work stress. Work addiction,low-to-moderate social support, low-to-moderate work happiness, and long working hours were greatly associated with high levels of work stress.

Comparison of smartphone photography and dermoscope-assisted photography in evaluation of color changes of bruise in forensic patients

Anchalin Techarungpaisarn, Pongpon Traithepchanapai — Thu, 23 Apr 2026 00:00:00 +0700

Background: The dermoscope has been widely developed for enhancing diagnostic capabilities. However, its application within the medicolegal aspect remains limited. This study explored the potential of dermoscopeassisted imaging in improving the bruises assessment for forensic purposes.

Objective: This study aimed to evaluate and compare the efficacy of smartphone photography and cross-polarized dermoscope-assisted photography in assessing bruise color in forensic patients.

Methods: Thirty bruises of varying durations (1 - 7 days) and sizes (1 - 12 cm²) were analyzed in a forensic clinic. Bruises were photographed using a Samsung Galaxy Note 20® with and without a DermliteV® cross-polarized dermoscope (PD) attached. The colorimetric parameters from the color space developed by the International Commission on Illumination (CIELAB), namely, L* (relative luminance), a* (change in red to green) and b* (change in blue to yellow) were measured and color difference (∆E) was calculated. Statistical analyses were conducted to assess the differences of the mean ∆E of the two imaging modalities.

Results: Both modalities demonstrated clear differentiation between normal skin and bruised areas (∆E > 5). The cross-polarized dermoscope showed higher ∆E values for purplish-blue (17.7vs. 14.0, P < 0.001) and yellowish bruises (9.6 vs. 5.4, P < 0.001), indicating superior color distinction. Dermoscope-assisted images exhibited greater consistency and less variability in L*, a*, and b* values, particularly for older or faint yellow bruises.

Conclusion: Cross-polarized dermoscopes enhance bruise visualization and documentation, While smartphones suffice for vivid bruises, dermoscopes are recommended for detailed assessments of faint or older bruise.

Relationship satisfaction of couples and self-esteem in a patient with depression at King Chulalongkorn Memorial Hospital

Amitta Khanthap, Chutima Roomruangwong — Thu, 23 Apr 2026 00:00:00 +0700

Background: Couple Relationships can be both supporter and stressor for patients with depression which may impact on both clinical outcomes of depressive symptoms and self-esteem. However, there is no previous study that specifically examines couple relationships/ relationship satisfaction in patients with depression as well as its impact on self-esteem of depressivepatients.

Objectives: To examine the level of couple relationship satisfaction and the level of self-esteem, as well as the predictors in patients diagnosed with depression.

Methods: The subjects were recruited from Psychiatry Outpatient Clinic, King Chulalongkorn Memorial Hospital during October 2023 - February 2024. The inclusion criteria were 1) age≥18 years; 2) was diagnosed with “depression” (any diagnosis categories in DSM-5/ICD-10 by self-identified); 3) currently in romantic relationship for at least 3 months. The measurements used were 1) Personal data questionnaire; 2) Relationship assessment scale (RAS)-Thai version; 3) The Rosenberg’s self esteem scale (RSE)-Thai version; and 4) Beck depression inventory - IA (BDI-IA) Thai version.

Results: There were 113 patients with depression recruited in the study. The Average RAS score was 3.6 (SD = 0.6), and most of them (49.6%) having a low level of self-esteem from RSE. Interestingly, RAS score was not significantly correlated with RSE score. From multiple linear regression analysis, we found that 3 factors namely; 1) frequency of conflicts within 3 months (β= - 0.503); 2) age (β= - 0.300); and 3) impact of love relationship on depression (β= - 0.274) could be together,predict 45.0% of the variables of RAS score, whereas only severity of depressive symptoms (β= - 0.610) predict (37.3%)of the variables of RSE score when controlling for other variables.

Conclusion: Most depressed patients were having moderate to high level of couple relationship satisfaction whereas having a low level of self-esteem. Relationship satisfaction in depressed patients is not related with level of self-esteem.