Journal of Health Science and Medical Research

Metabolomics in Chronic Kidney Disease: The Emerging Role in Detection and Diagnosis of Mineral and Bone Disorders

Mon, 17 Nov 2025 00:00:00 +0700

Chronic kidney disease (CKD) affects over 10% of the global population and is increasingly prevalent, placing a substantial strain on healthcare systems. In Malaysia, CKD prevalence rose from 9.05% in 2011 to 15.48% in 2018, largely driven by diabetes mellitus. CKD often progresses to mineral and bone disorders (CKD-MBD), a condition starting as early as stage 3a CKD, characterized by disturbances in mineral and bone metabolism that contribute to significant morbidity and mortality. Current diagnostic methods for CKD-MBD, including bone biopsy and imaging, have limitations such as invasiveness, cost, and insufficient sensitivity. Biochemical markers offer some insight but are often not robust enough for the accurate detection and diagnosis of the disease. New protein biomarkers such as sKhloto and FGF23 are restricted by methodological issues and conflicting research outcomes. Metabolomics, the study of small molecule metabolites, provides a promising alternative. By analyzing metabolic profiles in biological samples, metabolomics reveals detailed biochemical changes linked to CKD-MBD. Recent studies have identified certain key metabolites associated with CKD-MBD. Despite some inconsistencies existing across studies, metabolomics, especially when combined with advanced techniques and machine learning, may hold great potential for discovering novel biomarkers for CKD-MBD. This review provides a comprehensive overview of the emerging role of metabolomic profiling in the detection and diagnosis of CKD-MBD. It aimed to enhance the understanding of the disease at a molecular level and explore new avenues for improving the diagnosis and management of this complex condition.

A Qualitative Exploration of Parental Interventions in E-Cigarette Cessation among Adolescents

Mon, 17 Nov 2025 00:00:00 +0700

Objective: The rising prevalence of e-cigarette use among Malaysian adolescents could expose them to long-term health risks. In addressing the rising issues of adolescent e-cigarette consumption, it is crucial to explore the current parental interventions for smoking cessation. This qualitative study examines parental interventions for adolescents using e-cigarettes and identifies the challenges in implementing these interventions.
Material and Methods: The study employed semi-structured interviews to gather data from a sample of 14 parents residing in Kuala Selangor, Malaysia. The individual interviews were conducted through online meetings on the Google Meet platform between April 2023 and June 2023. All data were subjected to thematic analysis using NVivo, whereby emerging themes were identified.
Results: The findings revealed 3 primary themes concerning parental approaches: verbal counseling, direct interventions, and the adoption of a third-person approach. Furthermore, it underlined the challenges that impede parental prevention efforts, such as the child’s individuality and sense of self, the ease of accessing e-cigarettes, and the impact of the surrounding environment.
Conclusion: The study emphasizes the importance of parental involvement in preventing adolescent e-cigarette use and highlights the need for effective prevention initiatives through education, policy interventions, and community participation. By addressing the barriers, stakeholders, including policymakers, public health practitioners, and parents, can create targeted interventions to protect future generations’ health and well-being. This research emphasizes the need for parental education and a support framework that serves as guidance for effective parental interventions in adolescent e-cigarette smoking cessation efforts.

Effect of Proprioceptive Training on Neck Pain Intensity, Joint Position Sense and Functional Performance Among Non-Specific Neck Pain Desk-Job Workers with Kinesiophobia

Mon, 17 Nov 2025 00:00:00 +0700

Objective: The current study aimed to examine the effect of 4 weeks of proprioceptive training on neck pain intensity, neck disability, degree of kinesiophobia, joint position sense, and functional performance among desk-job workers with chronic non specific neck pain (NNP).
Material and Methods: Twenty-four desk-job workers (12 males and 12 females) with a mean (standard deviation) age of 30.86 (9.37) were recruited. Proprioceptive training with laser maze and postural correction techniques were given as interventions to the participants. After the interventions, all the participants underwent assessments to evaluate neck pain intensities, the degree of neck disability scores, and joint position errors (neutral head position).
Results: Significant differences were found pre- and post-four-week intervention in the intensity of neck pain and the neck disability score (p-value<0.05). There was a significant improvement in neck pain intensity, neck disability index and kinesiophobia scores after the four-week treatment (p-value<0.05). Significant results were also seen in cervical joint position error in neutral head position (p-value<0.05).
Conclusion: Proprioception training significantly reduced neck pain, neck disabilities, and degree of depressive symptoms while improving joint position sensitivities and functional performances among desk workers with neck pain. The findings of this study validate our hypothesis that integrating proprioceptive training into the rehabilitation process can greatly enhance the results for patients suffering from neck pain by promoting the development of enhanced control and awareness of their neck muscles, which in turns contributes to a healthy lifestyle.

Epidemiology of Sepsis and Septic Shock in the Medical Intensive Care Unit after Implementing the National Early Warning Score for Sepsis Detection

Mon, 17 Nov 2025 00:00:00 +0700

Objective: This study aimed to investigate the characteristics, microbiological profile, and mortality of patients with sepsis and septic shock in the medical intensive care unit (MICU).
Material and Methods: Demographic data, clinical characteristics, microbiological profiles, empirical antimicrobial regimen, and hospital mortality were collected retrospectively from patients with sepsis or septic shock that were admitted to the MICU in 2020. The National Early Warning Score (NEWS) of ≥5 was utilized for sepsis screening, and the Sepsis-3 definition was applied to categorize cases of sepsis and septic shock.
Results: Out of the 642 patients admitted to the MICU, 123 patients (19.2%) were included in this study. From these, 70.7% were diagnosed with sepsis and 29.3% with septic shock. The hospital mortality rates of overall patients, sepsis, and septic shock were 28.5%, 20.7%, and 47.2%, respectively. Comorbidities were identified in 89.4%. Septic shock and mortality were associated with higher Sequential Organ Failure Assessment scores, NEWS, and lactate levels (p-value<0.05). The majority of cases were hospital-acquired infections. The respiratory tract was the most affected site of infection. Gram-negative bacteria; particularly Enterobacterales and multidrug-resistant Acinetobacter baumannii, were identified as major pathogens in this study. Carbapenems and vancomycin were primarily prescribed in patients with septic shock, while carbapenems and β-lactam-β-lactamase inhibitors were commonly prescribed for sepsis patients.
Conclusion: Sepsis and septic shock are commonly observed in the MICU, and they are associated with a high mortality rate. The NEWS is a practical tool for sepsis screening in the MICU.

Comparative Accuracy of Qualitative and Quantitative Contrast-Enhanced CT Analysis in Differentiating Intrahepatic Mass-Forming Cholangiocarcinoma from Colorectal Liver Metastasis

Mon, 17 Nov 2025 00:00:00 +0700

Objective: To compare the diagnostic performance of qualitative and quantitative computed tomography in differentiating intrahepatic mass-forming cholangiocarcinoma (IHMCC) from colorectal liver metastasis (CRLM).
Material and Methods: A retrospective study analyzed 79 patients (IHMCC n=41, CRLM n=38). Two abdominal radiologists separately reviewed the following parameters: size, location, number, margin, calcification, hepatic capsular retraction, peripheral bile duct dilatation, proximal bile duct enhancement, extrahepatic spreading, regional lymph node enlargement, vascular and adjacent organ invasion, arterial and delayed enhancement. For the quantitative study, regions of interest were placed on lesions and adjacent liver in the non-contrast, portovenous and delayed phases. The percentage attenuation ratio, absolute percentage delayed enhancement, and the enhancement ratio on the portal venous and delayed phases (ERPV and ERD) were calculated. Multivariate logistic regression was used to determine the significant factors.
Results: Ten qualitative features showed statistically significant differences. Satellite lesions (p-value<0.001), right hepatic lobe location (p-value=0.009), irregular margin (p-value=0.028), hepatic capsular retraction (p-value<0.001), peripheral bile duct dilatation (p-value<0.001), proximal bile duct enhancement (p-value=0.002), extrahepatic spreading (p-value=0.002), regional lymph node enlargement (p-value<0.001), vascular invasion (p-value<0.001), and adjacent organ invasion (p-value=0.01) were found more often in IHMCC versus CRLM. For quantitative analysis, size, ERPV, and ERD showed statistically significant differences (p-value=0.003 and p-value=0.001). Peripheral duct dilatation (OR 21.1,95% CI 5.07,77.7), regional node enlargement (OR 5.8, 95% CI 1.32, 26.085) and ERD (OR 4.4, 95% CI 1.02, 6.54) were significant predictors on multivariate analysis. From the ROC curve, an optimal cut-off of ERD was 0.79 (AUC0.704, 95% CI 0.59, 0.818).
Conclusion: Peripheral bile duct dilatation, regional lymph node enlargement, and ERD greater than 0.79 can be useful in differentiating IHMCC from CRLM.

Comparing Harm Perception and Nicotine Dependence between Adult Roll-Your-Own and Factory-Made Cigarette Smokers in Southern Thailand

Mon, 17 Nov 2025 00:00:00 +0700

Objective: This study aimed to compare harm perception and nicotine dependence between roll-your-own (RYO) and factory-made (FM) cigarette smokers among adults in Southern Thailand.
Material and Methods: A cross-sectional survey was conducted using structured questionnaires administered both online and in person to assess smoking behavior and nicotine dependence, and harm perceptions. A total of 385 adult cigarette smokers were recruited, including 191 RYO smokers and 194 FM smokers.
Results: RYO smokers were generally older, married, and had lower levels of education and monthly income compared to FM smokers. The most frequently cited reasons for choosing RYO cigarettes included lower cost, taste, smell or pleasantness, and perceived lower harm. Notably, 36.1% of RYO smokers believed these cigarettes contained fewer addictive and harmful substances than FM cigarettes. Additionally, 45.5% of RYO smokers acknowledged their harmful effects, while 30.4% perceived RYO cigarettes as less harmful than FM cigarettes. The Fagerström Test revealed higher nicotine dependence among RYO smokers.
Conclusion: This study highlights differences in harm perception and nicotine dependence between RYO and FM cigarette smokers. RYO smokers exhibited higher nicotine dependence and were more likely to perceive RYO cigarettes as less harmful than FM cigarettes. Men were more likely to smoke than women. Factors influencing smoking initiation included curiosity, peer pressure, social acceptance, socioeconomic conditions, and education levels.

Cross-Cultural Adaptation of the University of Western Ontario Questionnaire for Musculoskeletal Conditions in Thai Senior Golfers

Mon, 17 Nov 2025 00:00:00 +0700

Objective: This study aimed to cross-culturally adapt and evaluate the content validity and test-retest reliability of the Thai version of the University of Western Ontario Questionnaire for musculoskeletal conditions in senior golfers.
Material and Methods: The questionnaire was translated into Thai following established cross-cultural adaptation guidelines. A cognitive review with 10 senior golfers was conducted to assess content validity, focusing on the relevance, clarity, and comprehensibility of the items. Test-retest reliability was evaluated twice over a 2-week interval in 100 senior golfers. Additionally, data on playing characteristics and golf-related injuries were collected and analyzed.
Results: Cognitive review indicated that participants found the questions relevant and easy to understand, contributing to the content validity of the questionnaire. The questionnaire items showed high test-retest reliability, with intraclass correlation coefficients ranging from 0.87 to 1.00 for continuous data, and moderate to high reliability, with Kappa values ranging from 0.45 to 0.96 for dichotomous data. Thirty percent of Thai senior golfers reported golf-related musculoskeletal injuries, and 45% experienced low back pain after a round of golf. For continuous data, the standard error of measurement and minimal detectable change values were calculated to quantify the precision and smallest detectable change in the items related to golf activity, warm-up, and exercise habits.
Conclusion: The Thai version of the questionnaire has demonstrated adequate validity and reliability for assessing musculoskeletal conditions in senior golfers. Insights from playing characteristics and injury data can aid health professionals in developing targeted injury prevention strategies.

The Minimal Important Difference of the Thai Version of the Shoulder Pain and Disability Index and the Bodily Pain Subscale of the Thai Short Form 36 Version 2 Among Patients with Shoulder Pain

Thakorn Tawatkiratipol, Chanwit Phongamwong — Mon, 17 Nov 2025 00:00:00 +0700

Objective: The present study aimed to determine the minimal important difference (MID) of the Thai version of the shoulder pain and disability index (Thai SPADI) and the bodily pain subscale of the thai short form 36 version 2 (Thai SF36v2-BP) among patients with shoulder pain.
Material and Methods: A prospective observational study was conducted. Participants with unilateral shoulder pain were assessed using the Thai SPADI and the Thai SF36v2-BP at the baseline and follow-up sessions. Using an anchor-based approach, the MID value was the mean difference in value between the minimal improvement group and the no change group.
Results: Of 92 participants, 70 (76%) were diagnosed with myofascial pain, 53 (58%) had pain>6 months. Additionally, the number of participants whose symptoms had undergone deterioration, no change, minimal improvement, and marked improvement were 4, 13, 32, and 43, respectively. The MID (95% confidence interval [CI]) for the total Thai SPADI scale was 10.1 (0.7 to 19.5), while the MID (95% CI) for the Thai SF36v2-BP was 3.1 (-7.2 to 13.5).
Conclusion: In patients with shoulder pain, the Thai SPADI had more sensitivity to minimal clinical improvement than the Thai SF36v2-BP.

Nutritional Status and Outcomes of Thai Elderly Patients Hospitalized with Heart Failure

Mon, 17 Nov 2025 00:00:00 +0700

Objective: To assess the prevalence of undernourishment, nutritional status, and clinical outcomes among patients with heart failure admitted to Bangkok Heart Hospital using the Mini Nutritional Assessment-Short Form (MNA-SF).
Material and Methods: This cross-sectional retrospective study enrolled 361 patients hospitalized with heart failure in Bangkok Heart Hospital between January 2019 and December 2022. The MNA-SF was used as a screening scale to assess nutritional status. Clinical outcomes included length of stay, hospital-acquired infections, in-hospital mortality, unscheduled 30-day hospital readmission, and all-cause mortality within 180 days post-discharge.
Results: The study included 239 hospitalized patients with a median age of 80 years (interquartile range, IQR: 72.0-80.0); among them, there were 128 men. Most patients experienced heart failure with preserved ejection fraction. The prevalence of undernutrition was 61.1%, with a median length of stay of 8 days (IQR: 5.0–15.0). The median length of stay of the well-nourished patients (6 days, IQR: 4.0-11.5) was significantly lower than that of the undernourished patients (9 days, IQR: 6.0–15.0; p-value<0.01). In addition, the hospital-acquired infection rate was significantly higher in undernourished patients (43.8% and 16.1%; p-value<0.01). The unscheduled 30-day hospital readmission rate and mortality rate within 6 months post-discharge were significantly higher among undernourished patients than among well-nourished patients.
Conclusion: Undernutrition resulted in worse clinical outcomes, including prolonged hospital stay, hospital-acquired infections, unscheduled 30-day readmission, and a high mortality rate within 6 months post-discharge.

Meaning in Life, Self-Esteem, and Self-Harm Among Adult Depressive Patients at a Thai University Hospital

Peerachat Wongchai, Kamonporn Wannarit, Juthawadee Lortrakul — Mon, 17 Nov 2025 00:00:00 +0700

Objective: We aimed to study the prevalence of self-harm in the adult population with depressive disorder and its association with risk and protective factors; especially self-esteem and meaning in life.
Material and Methods: This cross-sectional study recruited 128 depressive outpatients that visited Siriraj Hospital from July to October 2021 and were willing to participate. Data was collected through self-reports via six online questionnaires; including sociodemographic data, a self-harm behavior questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Screening Instrument for Borderline Personality Disorder (SI-Bord), the Revision of Rosenberg Self-Esteem Scale (Revised RSES) and the Meaning in Life Questionnaire (MLQ). Data was analyzed using bivariate and multivariate logistic regression.
Results: The one-year prevalence of self-harm in adult depressive patients was 39.84% (N=51). Significant risk factors for self-harm included: younger age (Mann-Whitney U= 828.0, p-value<0.001), low education (X2=4.337, p-value=0.037), substance use (X2= 9.862, p-value=0.002), more depressive symptoms (X2=9.407, p-value=0.009), suicidal ideation (X2=17.212, p-value<0.001) and borderline personality disorder traits (X2=10.334, p-value=0.001). Protective factors included: high self-esteem (Mann-Whitney U=1315.5%, p-value=0.002) and meaning in life (X2=15.633, p-value=0.001).
Conclusion: The high prevalence of self-harm in adults with depressive disorder emphasizes the need for greater awareness. Identifying significant risk factors is crucial for effective intervention. Promoting self-esteem and meaning in life should be considered a key protective strategy to reduce the risk of self-harm and suicide in this population.

Does Helicobacter pylori Infection Affect Postoperative Outcomes after Bariatric Surgery?

Kanokkarn Chupisanyarote, Siriluk Thaiyanun, Pakkavuth Chanswangphuvana — Mon, 17 Nov 2025 00:00:00 +0700

Objective: The impact of Helicobacter pylori (HP) infection on postoperative outcomes remains controversial. This study aimed to investigate the relationship between HP infection and postoperative outcomes, including the percentage of postoperative excessive weight loss (%EWL) at 3, 6, and 12 months and post-surgical complications.
Material and Methods: This study involved a retrospective cohort study of 173 patients who underwent weight loss surgery at Thammasat University Hospital, Thailand, between 2015 and 2023. Participants met the indications for bariatric surgery and were preoperatively screened for HP infection.
Results: The majority of the participants were female (77.3%). The mean age and preoperative BMI were 35.3±8.1 years old and 44.2±9.4 kg/m2 respectively. Seventy-five patients (43.3%) tested positive for HP infection. Baseline characteristics were similar between the HP-positive and non-HP groups. The %EWL of the HP-positive group at 3, 6 and 12 months was 42.72, 62 and 74, respectively. For the non-HP group, the %EWL at 3, 6 and 12 months was 36, 57 and 70.5, respectively. No statistically significant difference of %EWL was observed between the 2 groups. Postoperative adverse effects were reported with no statistically significant difference between the groups. In the HP-positive group, complications were observed in 5 patients (6.7%), whereas in the non-HP group 7 patients (7.14%) had complications.
Conclusion: HP infection did not influence postoperative weight loss outcomes or complications after bariatric surgery.

Prognostic and Predictive Value of Permeability-Glycoprotein, Ki-67, and Interleukin-6 in Lung Cancer Patients

Noor Hameed Hanoush, Rashied Mohammed Rashied, Abdul Rahman Mohammed Geeran — Mon, 17 Nov 2025 00:00:00 +0700

Objective: Lung cancer patients often present with metastatic disease at the time of diagnosis, which affects their treatment regimen. Therefore, early diagnosis is crucial for improving patient survival. This study aimed to evaluate the roles of P-glycoprotein (P-gp), Ki-67, and interleukin-6 (IL-6) as diagnostic and predictive indicators in lung cancer. A secondary aim was to assess the prevalence of multi-drug resistance associated with P-gp gene expression in these patients.
Material and Methods: This study included 90 lung cancer patients, consisting of 60 with non-small cell lung cancer (NSCLC) and 30 with small cell lung cancer (SCLC). Additionally, 75 control samples were matched for age, gender, and smoking status. The levels of P-gp, Ki-67, and IL-6 in serum were determined using enzyme-linked immunosorbent assay (ELISA). P-gp gene expression was assessed via reverse transcription-polymerase chain reaction (RT-PCR).
Results: The results indicated that P-gp levels were significantly elevated in SCLC and NSCLC patients (10.35±0.51 ng/ml and 10.06±0.32 ng/ml, respectively) compared to the control group (3.79±0.21 ng/ml; p-value=0.0001). Ki-67 and IL-6 levels also significantly increased in SCLC patients (15.28±0.27 ng/ml and 54.46±2.11 ng/ml, respectively) compared to NSCLC (13.97±0.52 ng/ml and 46.17±1.18 ng/ml, respectively) and the control group (8.43±0.24 ng/ml and 26.40±1.01 ng/ml, respectively; p-value=0.0001). Additionally, mRNA expression of P-gp was significantly higher in lung cancer patients compared to controls.
Conclusion: Elevated levels of P-gp, Ki-67, and IL-6 may serve as useful diagnostic and predictive markers for lung cancer. Moreover, increased mRNA expression of P-gp suggests that lung cancer patients may exhibit resistance to chemotherapy.

Does the Sidedness of Colon Cancer Affect Long-Term Oncological Outcomes?

Krisada Paonariang, Chawisa Thongoumyai, Weeraput Chadbunchachai — Mon, 17 Nov 2025 00:00:00 +0700

Objective: Tumor location, or sidedness, affects the prognosis of colon cancer. While recent studies generally suggest better prognoses for left-sided colon cancer, some report conflicting results. This study examined the association between colon cancer sidedness and oncologic outcomes at Khon Kaen University Hospital.
Material and Methods: Patients with non-metastatic adenocarcinoma of the colon (stage I-III) who received curative treatment at Khon Kaen University Hospital from January 2012 to December 2015 were included. Survival analyses according to primary tumor location (right-sided vs. left-sided) were conducted using the Kaplan-Meier method. Cox proportional hazards regression was used to calculate the adjusted hazard ratios for 5-year overall survival (OS) and 5-year disease-free survival.
Results: Among the 212 patients, 126 had left-sided colon cancer, and 86 had right-sided colon cancer. Those with left-sided colon cancer had better OS in the univariate analysis (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34-0.96, p-value=0.037), but this was not significant in the multivariate analysis (HR 0.63, 95% CI 0.36-1.09, p-value=0.11). No relationship was found between cancer-sidedness and disease-free survival (Log-rank p-value=0.83). Other factors, including gender, lymph node status, tumor staging, and grading, were non-significant, except for T4 tumor status, which significantly affected OS (HR 3.71, 95% CI 1.91-7.12, p-value<0.001) and disease-free survival (HR 4.42, 95% CI 2.26-8.65, p-value<0.001).
Conclusion: The sidedness of colon cancer did not significantly affect OS and disease-free survival. However, left-sided colon cancer tended to have a better prognosis. T4 tumor status significantly affected oncologic outcomes.

One Year of Real-Life Practice in Treatment Strategies and Future Exacerbation among Asthma Patients with Exacerbation Required Emergency Department Visits

Nataree Rujipattanapong, Narongwit Nakwan — Mon, 17 Nov 2025 00:00:00 +0700

Objective: To investigate the treatment patterns and clinical outcomes regarding future exacerbation in patients with a history of emergency department (ED) visited exacerbation.
Material and Methods: We analyzed the treatment patterns and moderate/severe asthma exacerbation rates over a year. The Kaplan-Meier method was used to determine the probability of an asthma exacerbation, and the time to the first exacerbation was compared.
Results: Of the 155 patients, 59 (38.1%) had naïve treatment, 53 (34.2%) and 43 (27.7%) received GINA-classified steps 1-2 and 3-5 treatments, respectively. Approximately 50% of those with naïve treatment lost adherence after a year of follow-up. However, the annual moderate/severe exacerbation rate was reported as the lowest and increased from 0.34 to 0.49 (p-value=0.236) compared to those with steps 1-2 and 3-5 treatments, from 0.66 to 0.47 (p-value=0.085) and 3.00 to 1.19 (p-value=0.006), respectively. Patients with GINA-classified steps 3-5 treatment were prescribed controllers 10.9 more than the 7.8 canisters prescribed to those with naïve treatment (p-value<0.001). In contrast, there were no differences in total reliever prescriptions between the groups (p-value=0.274). Finally, there was no significant difference in the likelihood of having future exacerbations (p-value=0.107). The estimated time of exacerbation in naïve treatment, GINA-classified steps 1-2, and 3-5 treatment were 42.2, 36.6, and 34.2 weeks, respectively.
Conclusion: This study confirms that the frequency of future exacerbations following an ED-visited exacerbation increases as the stepwise treatment increases. This finding may help clinicians understand the natural history of treatment patterns and exacerbation outcomes. Patients with naïve treatment may have a unique history of significantly less exacerbation despite discontinuing controllers.

A Novel Technique for Simple Double-J Stent Placement after Intraperitoneal Laparoscopic Ureterolithotomy

Mon, 17 Nov 2025 00:00:00 +0700

Objective: The insertion of a double-J (DJ) stent during laparoscopic ureterolithotomy can be challenging, invasive, and time-consuming when using the various techniques available for its placement. This study aimed to present a simplified method for DJ stent placement following intraperitoneal laparoscopic ureterolithotomy.
Material and Methods: Twenty-five patients with proximal ureteral stones who underwent intraperitoneal laparoscopic ureterolithotomy and placement of DJ stent between November 2023 and February 2024 in a teaching hospital were selected for this study. After the stone was successfully removed, the ureteroscope was inserted through a 5-mm trocar and passed into the distal ureter, followed by threading the guidewire through it. Subsequently, the distal tip of a 6-French DJ stent was attached to the guidewire and inserted into the distal ureter. The proximal tip of the DJ stent was guided along the wire through the ureteral incision and advanced toward the pyelum.
Results: The stent was successfully placed in, on average, below 5.9 minutes. No complications were found. Postoperative plain abdominal X-ray confirmed the correct placement of the DJ stent. An efficient patient recovery was found with an average hospital stay of 2.7 days.
Conclusion: This novel DJ stent placement technique, with its simple and efficient features, was found to be successful. Further comparative studies with larger patient populations are required in order to evaluate its efficacy.

Cancer Detection Yield of TRUS-Guided Biopsy in Nepalese Men in the Fusion Biopsy Era

Mon, 17 Nov 2025 00:00:00 +0700

Objective: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is performed to obtain a histopathological diagnosis of prostate cancer and has been the mainstay of urological practice for years. In the era of fusion biopsy this study aimed to investigates the relevance of TRUS-guided biopsy and its role in cancer detection rates, particularly in resource-limited settings.
Material and Methods: This retrospective study was carried out in a tertiary care institute. All symptomatic patients who underwent TRUS-guided biopsy for indication of raised serum prostate-specific antigen (PSA) level (>4 ng/mL) or suspicious digital rectal examination (DRE) findings (nodule, irregularity, hard consistency) from January 2021 to December 2023 were included. The data obtained were entered in statistics package for social sciences (SPSS). Statistical analyses used were Chi-square test and Spearman’s rank correlation analysis.
Results: Out of the 77 patients included in the study, 24 were diagnosed with malignancy, resulting in an overall cancer detection rate of 31.16%. The detection rates for PSA levels of 4-10 ng/mL and 10-20 ng/mL were low, at 14.81% and 18.18%, respectively, while the rate exceeded 50% for PSA levels greater than 30 ng/mL. Additionally, 13 patients (16.88%) had post-biopsy complications, with one requiring hospital admission for fever.
Conclusion: Despite advancements in fusion biopsy, TRUS-guided biopsy remains an essential diagnostic tool for prostate cancer. This study emphasizes the technique's ongoing significance, especially where access to advanced imaging modalities is limited, underscoring its crucial role in clinical decision-making.

Effectiveness of Kelakai (Stenochlaena palustris (Burm.) Bedd) Extract as an Anti-diabetic through Increased GLUT 4 Expression without Affecting Insulin Levels

Kiki Rizky Ananda, Muthmainah, Nur Hafidha Hikmayani — Mon, 17 Nov 2025 00:00:00 +0700

Objective: Untreated hyperglycemia disrupts insulin secretion and blocks glucose transporter 4 (GLUT 4), consequently affecting the glucose levels of patients with type 2 diabetes mellitus. This study aimed to investigate the effectiveness of kelakai on GLUT 4 expression.
Material and Methods: In this study, a laboratory experiment was performed, with a pre and posttest group design for fasting blood glucose and insulin levels and using posttest only expression GLUT 4 immunohistochemistry methods. A total of 25 rats were divided into 5 groups: nondiabetic, diabetic, diabetic+glimepiride, diabetic+kelakai extract 400 mg/kgBW, and diabetic+kelakai extract 800 mg/kgBW for 21 days.
Results: The 400 and 800 mg/kgBW groups had significant effects (p-value<0.05) on decreasing the fasting glucose levels. A 400 mg/kgBW dose gave a better picture of the fasting glucose levels and reversed the GLUT 4 expression to normal levels. The kelakai extract lowered the fasting blood glucose levels by increasing the GLUT 4 expression in the soleus muscle tissue without affecting the insulin secretion.
Conclusion: Kelakai (S. palustris (Burm.f) Bedd) extract significantly reduced the fasting glucose levels by increasing the GLUT 4 expression without affecting the insulin levels at the best dose of 400 mg/kgBB. Thus, it has potential for use in anti-diabetic therapy.

The Effects of Laser Acupuncture Versus Ultraviolet Radiation on Ovarian Parameters in Obese Women with Polycystic Ovarian Syndrome: A Randomized Controlled Trial

Mon, 17 Nov 2025 00:00:00 +0700

Objective: Complementary therapies are important in the treatment of polycystic ovarian syndrome (PCOS) Aim: This study was designed to assess the response of serum follicle-stimulating hormone (FSH), body mass index (BMI), serum 25-hydroxyvitamin D (25OHD), waist circumference (WC), serum luteinizing hormone (LH), LH/FSH ratio, and mean follicular size to laser acupuncture maneuverer (LAM) versus ultraviolet radiation (UVR) in PCOS women.
Material and Methods: One hundred five women were randomly divided into 3 equal groups: A, B, and C. The number of PCOS women within each group was 35. All groups received 500-mg metformin 3 times weekly. For group A, 2-minute LAM was applied to women’s selected acupoints 3 times weekly. For group B, 3 UVR sessions weekly for 12 weeks were applied on PCOS women’s abdomen for 10-20 minutes. Before and after 12 weeks, FSH, BMI, 25OHD, WC, LH, LH/FSH ratio, and mean follicular size were assessed.
Results: A significant improvement in PCOS women’s outcomes was reported in the 3 groups. Besides the significant decrease in LH, BMI, LH/FSH ratio, and WC, the comparison of outcomes’ post values among groups A and B or groups A and C showed a significant increase in FSH, mean follicular size, and 25OHD toward group A. Also, the comparison of outcomes’ post values among groups B and C documented a significant decrease in LH, BMI, LH/FSH ratio, and WC in addition to the significant increase in FSH, mean follicular size, and 25OHD toward group B.
Conclusion: Adding LAM or UVR to metformin can improve PCOS.

Predominance of the ST22-MRSA-IV-t32 Clone and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Tertiary Hospital in Thailand

Mon, 17 Nov 2025 00:00:00 +0700

Objective: This study aimed to determine the molecular characteristics of Methicillin-resistant Staphylococcus aureus (MRSA) strains in a tertiary hospital in Bangkok, Thailand.
Material and Methods: Twenty-one MRSA isolates were collected from clinical specimens; between December 2022 and May 2023. These isolates were characterized by determining their antimicrobial susceptibility profiles, Staphylococcal Cassette Chromosome mec and staphylococcal protein A types, multilocus sequence types, biofilm-forming abilities and whole-genome sequences from six representative strains.
Results: ST22-MRSA-IV-t032 was the most common clone (57.1%), followed by ST22-MRSA-IV-t628, ST22-MRSA-IV-t1467, ST5-MRSA-II-t21248, ST3976-MRSA-IV-t32, ST764-MRSA-II-t045, ST8502-MRSA-V-t21247; ST1-MRSA-IV-t1784, ST188-MRSA-IV-t189 and ST8-MRSA-IV-t008 (4.8% each).Most (66.6%) MRSA strains produced a strong biofilm: 28.6% produced a moderate biofilm and 14.8% produced a weak biofilm. When the strains were divided into two groups (ST22 and non-ST22), ST22 strains had a greater ability to produce biofilm than non-ST22 strains. All six genomes carried the exoenzyme aureolysin gene, hemolysin-associated hlgA, hlgB, and hlgC genes, and host-immune system modulator genes; including a staphylokinase and staphylococcal complement inhibitor.
Conclusion: This study revealed that ST22-MRSA-IV-t32 was the dominant clone related to the ST22 EMRSA-15 epidemic in Europe. These results emphasize the necessity of continuous surveillance for effective management and control measures to understand microbial infections and their patterns of antibiotic resistance, as well as to identify the emergence of new clones.

Evaluation of the Efficacy and Safety of Chimeric Antigen Receptor-Modified T (CAR-T) Cell Therapy in Leukemia: A Five-Year Updated Systematic Review and Meta-analysis

Mon, 17 Nov 2025 00:00:00 +0700

Objective: Despite the progress made by conventional treatments in reducing mortality rates, the significant number of relapsed or refractory patients necessitates the exploration of novel therapies. Recent studies on chimeric antigen receptor T-cell therapy (CAR-T) cells have shown promising outcomes for individuals battling blood cancers. However, the outcomes are still inconsistent due to the structural complexity of CAR-T cells and the rapid development of more advanced versions. This study evaluated the efficacy and safety of various CAR-T cells in Leukemia patients.
Material and Methods: The preferred reporting items for systematic reviews and meta-analysis 2020 protocol was used for the literature search and systematic review. Studies reporting CAR-T cell therapy’s efficacy and safety in Leukemia patients were included. Statistical analyses were performed using R statistical software v.3.3. P-values≤0.05 were considered statistically significant.
Results: Eighteen single-arm clinical trials were included based on the inclusion criteria. Most of the studies involved patients with acute Lymphoblastic Leukemia. CAR-T cell therapy in Leukemia achieved a 79% (95% confidence interval [CI] [69%-87%], I²=74%) complete response, 79% (95% CI [59%-91%], I²=87%) cytokine release syndrome event, 18% (95% CI [9%-33%], I²=72%) immune effector cell-associated neurotoxicity syndrome event rate, 69% (95% CI [47%-85%], I²=82%) minimal residual disease-negative, and a 9% (95% CI [8%-13%], I²=37%) mortality rate.
Conclusion: CAR-T therapy has demonstrated efficient responses in Leukemia patients, reinforcing the positive outcomes observed with favorable toxicities. Further data regarding the durability of CAR-T cell therapy are essential for strengthening our understanding of CAR-T cell efficacy and safety in Leukemia patients.

Comparative Evaluation of Non-Steroidal Anti-Inflammatory Drugs on Ovarian Microstructural Anatomy, Serum Antioxidants and Hormones in Wistar Rats

Mon, 17 Nov 2025 00:00:00 +0700

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for the management of dysmenorrhea. Additionally, self-medication involving combinations of NSAIDs is frequent. We hypothesized that exposure to NSAIDs, either singly or concomitantly, may alter ovarian microstructures, hormones, and antioxidative status.
Material and Methods: Forty young, adult female Wistar rats, weighing between 122-173 g, were divided into eight groups (A-H): five rats per group. Group A served as the control and received distilled water (5 mL/kg body weight). Group B received piroxicam (0.3 mg/kg), Group C received Ibuprofen (6.7 mg/kg), and Group D received diclofenac (1.7 mg/kg). Groups E, F, and G were administered combinations of two NSAIDs: piroxicam+ibuprofen (0.3 mg/kg+6.7 mg/kg), piroxicam+diclofenac (0.3 mg/kg+1.7 mg/kg), and ibuprofen+diclofenac (6.7 mg/kg+1.7 mg/kg), respectively. Group H received a combination of all three NSAIDs: piroxicam, ibuprofen, and diclofenac (0.3 mg/kg+6.7 mg/kg+1.7 mg/kg). All administrations lasted for 3 days, and animals were sacrificed 24 hours later under ketamine anesthesia. Blood and ovaries were harvested for analyses using standard protocols.
Results: Ovarian histology demonstrated stromal hyperplasia, degenerative zona-pellucida, atretic and vacuolated follicles in groups D to H. Progesterone and estradiol concentrations showed increasing trends in groups C, D, F, G, and H compared to A. Superoxide dismutase concentrations significantly (p-value<0.05) increased in drug-administered groups, except in B and H, compared to the normal control (NC). All groups had significantly (p-value<0.05) increased catalase and glutathione peroxidase concentrations compared to the NC group, except group B.
Conclusion: A 3-day NSAIDs oral administration is associated with gonadotoxicities in the ascending order: diclofenac >ibuprofen >piroxicam, and in the combination groups: piroxicam+ibuprofen+diclofenac >piroxicam+diclofenac; ibuprofen+diclofenac; piroxicam+ibuprofen, respectively, in female Wistar rats.

Serum 1,5-Anhydroglucitol Serves as An Additional Biomarker for Diagnosing and Monitoring Type 2 Diabetes: Vietnamese Cohort

Thuy Thi Le, Van Cao, Cong Phi Dang, Linh Thi Hong Nguyen — Mon, 17 Nov 2025 00:00:00 +0700

Objective: The incidence of diabetes is increasing worldwide, at an incredible pace and with a substantial burden. Precise and early diagnosis of type 2 diabetes (T2D) can help patients control complications. It has been found that decreased levels of 1,5-anhydroglucitol (1,5-AG) in serum can serve as a marker for diagnosing and monitoring degrees of T2D. Our study validated the value of 1,5-AG in T2D patients in a Vietnamese population over their treatment course.
Material and Methods: A cohort of 100 participants; including 50 T2D patients and 50 healthy individuals were recruited from Da Nang hospital. Demographic features were recorded. Blood samples over the period of treatment were collected for measurement of 1,5-AG, fasting blood glucose, hemoglobin A1C (HbA1c) and fructosamine.
Results: Patients with T2D showed significant decreases in 1,5-AG compared to the control group: 10.91±6.53 µg/mL and 26.83±9.98 µg/mL, respectively. Among T2D patients, individuals with more severe degree, as classified by kinds of treatment and control of hyperglycemic markers, demonstrated lower levels of 1,5-AG compared to patients with less severity (p-value<0.001). A negative correlation was found between 1,5-AG and other hyperglycemic markers, including HbA1C (r=-0.591, p-value<0.001), fasting blood glucose (r=-0.431, p-value<0.0001), and fructosamine (r=-0.482, p-value<0.001). Levels of 1,5-AG showed an increasing trend, while fasting blood glucose and other hyperglycemic markers reduced over patients receiving treatment periods.
Conclusion: Monitoring 1,5-AG could be applied as an additional biomarker to strengthen diagnosis and provide efficacious follow-up on T2D patients.

Magnitude and Determinants of Unsuccessful Tuberculosis Treatment Outcomes in Ethiopia: A Systematic Review and Meta-Analysis

Sisay Moges, Bereket Abreham Lajore, Abera Feyisa Oleba — Mon, 17 Nov 2025 00:00:00 +0700

Objective: Unsuccessful treatment outcomes of tuberculosis (TB), including treatment failure, death, and loss to follow-up, pose significant challenges to TB control programs. This systematic review and meta-analysis aimed to assess the magnitude and determinants of unsuccessful TB treatment outcomes in Ethiopia.
Material and Methods: A comprehensive literature searches were conducted using databases such as PubMed, Scopus, and Google Scholar. Observational studies published between 2000 and 2024 that reported on TB treatment outcomes in Ethiopia were included. The pooled magnitude of unsuccessful TB treatment outcomes was estimated using a random-effects model. Subgroup analysis, and meta-regression, and publication bias assessments were also conducted in order to explore potential sources of heterogeneity.
Results: The overall pooled magnitude of unsuccessful TB treatment outcomes in Ethiopia was 17% (95% confidence interval (CI): 15%-20%). Significant heterogeneity was observed between studies (I²=98.49%, p-value<0.01). Subgroup analysis revealed that unsuccessful outcomes were higher among patients with multidrug-resistant TB (31.7%) and those co-infected with Human Immunodeficiency Virus (HIV) (24.5%). Older age >45 years (HR: 1.82; 95% CI: 1.25-2.65) , HIV co-infection (HR: 2.10; 95% CI: 1.23-3.58), and retreatment (HR: 1.67; 95% CI: 1.13-2.47) were significant predictors of unsuccessful outcomes.
Conclusion: Unsuccessful treatment outcome in Ethiopia is high. Multi-drug resistance TB and HIV co-infection had significant impact on TB treatment outcome. Therefore, the findings underscore the need for targeted interventions that address the key determinants of unsuccessful TB treatment outcomes in Ethiopia, particularly among high-risk populations such as multidrug-resistant TB (MDR-TB) patients and those co-infected with HIV.

Reviewer Acknowledgement, 2025

Saranyou Chusri — Wed, 17 Sep 2025 00:00:00 +0700

Undiagnosed and Untreated Postdural Puncture Headache Following Myomectomy under Subarachnoid Block: A Case Report

Sotonye Fyneface-Ogan, Alexander A. Dimoko, Fiekabo Hart, Raymond Samuel Oyugi — Mon, 17 Nov 2025 00:00:00 +0700

Postdural puncture headache can be a complication of either unintentional or intentional dural puncture. Although the incidence is low, it could arise from subarachnoid block. This case report describes the management of a 6-month history of severe unrelenting, intractable headache with accompanying photophobia following a myomectomy performed under spinal anaesthesia. Twenty millilitres of autologous blood was taken from the patient and aseptically administered into the epidural space. Following this, a transient tonic-clonic seizure with loss of consciousness was observed but was immediately controlled. This case report highlights the possible complications that could follow the administration of an autologous epidural blood patch.

Non-Bilharzial Squamous Cell Carcinoma of Urinary Bladder – Tailored Management Yields Better Outcomes: A Single Centre Experience

Mon, 17 Nov 2025 00:00:00 +0700

Urothelial carcinoma constitutes 90.0% to 95.0% of bladder malignancies and the rest are associated with epithelial and mesenchymal tumors. Squamous cell carcinoma (SCC) can be either bilharzial or non-bilharzial in origin; 2.0% to 5.0% of individuals with bladder cancer have non-bilharzial SCC, an unusual diagnosis. Here we report 3 cases of non-bilharzial SCC in males. Hematuria was the most common presenting symptom. Transurethral resection of the bladder tumor was performed and the histopathological study confirmed SCC in all 3 cases. Radical cystectomy was done in 2 patients and the third patient underwent partial cystectomy.

Anesthetic Management for Laparotomy of Necrotizing Enterocolitis in a Preterm Infant with Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Darunee Sripadungkul, Noriko Miyazawa, Atsushi Shinto — Mon, 17 Nov 2025 00:00:00 +0700

Anesthetic management of preterm infants with Tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), complicated by necrotizing enterocolitis (NEC), poses significant challenges. This case report describes a 1540-g male infant, born at 34 weeks and 4 days of gestation, diagnosed with TOF and PDA. Lipo-prostaglandin E1 (lipo-PGE1) was administered immediately to maintain PDA patency. At 18 days old, the infant developed lethargy, sepsis, and NEC stage IIIB, requiring an emergency exploratory laparotomy. Anesthetic management involved maintaining heart rate, contractility and preload, avoiding increases in the pulmonary vascular resistance (PVR) to the systemic vascular resistance (SVR) ratio, preventing PDA closure, and promptly addressing hypercyanotic spells. Surgical findings included extensive intestinal necrosis, necessitating multiple resections and the creation of an ileostomy and a jejunostomy. Postoperative care included meticulous cardiovascular and respiratory support, careful use of vasopressors, and precise lipo-PGE1 adjustments. The case highlights the need to maintain PDA patency in TOF, perform early surgical intervention for NEC, and provide precise postoperative care. The successful outcome was due to timely diagnosis, effective anesthetic care and surgery, and careful management, underscoring the importance of a coordinated, multidisciplinary approach.