Journal of Health Science and Medical Research
Journal of Health Science and Medical Research (JHSMR), abbreviation name: J Health Sci Med Res; formally known as: Songklanagarind Medical Journal. The academic health science journal of Prince of Songkla University, Thailand, goal is to provide open opportunities for publication of the highest quality manuscripts. The journal is dedicated to: research or other academic topics, patient reports, interesting new scientific articles, suggestions, and new concepts that will be beneficial to medical professionals, public health workers and any other readers interested in this field. All articles are double-blindly peer-reviewed by experts in the corresponding field. Our frequency times of publication are: 6 issues per year (Jan-Feb, Mar-Apr, May-Jun, Jul-Aug, Sep-Oct, and Nov-Dec). Aims and scope JHSMR offers an interdisciplinary forum for basic or applied medical and health sciences research, evidence-based and scientifically written articles. Our content focuses on, but is not limited to, these areas of medicine and health science; - Clinical medicine - Biomedical science and biomedical engineering - Public health research - Data science in medicine and health care Publication type Since 2018, JHSMR has published 4 types of paper; including original articles (including systematic reviews), review articles, case reports and selected editorials. Frequency: 6 issues per year January – February March – April May – June July – August September – October November – December Language: English Free Access: online and print ISSN: 2586-9981 (Print) ISSN: 2630-0559 (Online) *ISSN (Print and Online) start date Vol.36 No.2 Apr-Jun 2018
Faculty of Medicine, Prince of Songkla University
Prescription Patterns of Antibiotics, Nonsteroidal Anti-Inflammatory Drugs, and Anti-ulcer Drugs: A Prospective Cross-Sectional Observational Study
Objective: The study of prescription patterns of antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and anti-ulcer drugs is crucial, as these combinations are widely used in managing diseases with overlapping needs. In infections with inflammatory components, these drugs treat infection, pain, and inflammation. Post-surgical care uses them to prevent infections, manage pain, and reduce NSAID-induced gastrointestinal risks. In chronic conditions like arthritis, long-term NSAIDs and infections require anti-ulcer drugs to prevent complications. Studying these patterns ensures rational use and minimizes risks. Analyzing these patterns ensures rational use, minimizes adverse effects, and optimizes therapeutic outcomes. Material and Methods: One hundred prescriptions were analyzed, documenting patient demographics, diagnosis, drug regimens, and prescribing patterns within 6 months. Result: Among 29 antibiotics, 71% were prescribed in combination therapy, with 64.98% via the intravenous (IV) route. Ceftriaxone 1000 mg was the most common dose (65%) and the most prescribed antibiotic (37.57%). Seven NSAIDs were mainly prescribed as monotherapy (79%) and orally (89.06%), with paracetamol, 650mg, being the most common (39.84%). Eight anti-ulcer drugs were mostly monotherapy (89%), often IV for proton pump inhibitors (PPIs) (67.77%), with pantoprazole the most common (80.49%). Conclusion: The study identified a predominance of male patients (41-50 years). Combination therapy and brand-name prescriptions were frequent for antibiotics, while NSAIDs and anti-ulcer drugs favoured monotherapy and brand names. IV administration was prevalent for antibiotics and anti-ulcer drugs, contrasting with oral NSAID administration. Ceftriaxone, paracetamol, and pantoprazole emerged as the most prescribed drugs in their respective categories.
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Heterogeneous Apolipoprotein B Response to the Paleolithic Diet in South Asian Adults: A Novel Phenotypic Pattern
Objective: While European-ancestry populations demonstrate consistent apolipoprotein B elevation on low-carbohydrate diets, South Asian responses remain unexplored. This study investigated apolipoprotein B response patterns to the culturally adapted Paleolithic diet in South Asian adults. Material and Methods: A prospective study involving 232 South Asian adults aged 18-55 years following the culturally adapted Paleolithic diet (20:15:65 carbohydrate:protein:fat) for 90-215 days. Primary outcomes included apolipoprotein B, apolipoprotein A1, and cardiovascular markers. Results: Three distinct response phenotypes emerged: apolipoprotein B reducers (40.1%), moderate elevators (45.7%), and significant elevators (14.2%). Mean apolipoprotein B increased modestly (+8.9 mg/dL, p-value=0.003) while apolipoprotein A1 increased significantly (+13.8 mg/dL, p-value<0.001). The apolipoprotein B/apolipoprotein A1 ratio remained unchanged (p-value=0.684), demonstrating preserved cardiovascular risk balance. Baseline Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) ≥2.5 predicted favorable response area under the curve (AUC)=0.782, sensitivity=72.3%, specificity=71.4%). Conclusion: This report of heterogeneous apolipoprotein B response provides novel evidence that differs from the universal elevation paradigms and demonstrates population-specific adaptations. Maintained apolipoprotein B/apolipoprotein A1 ratio confirms cardiovascular safety, while baseline insulin resistance enables personalized recommendations.
Vijayasamundeeswari Chinnathambipalayam Kandaswamy
Phytochemical Components and Antimicrobial Activity of Ethanolic Extracts From Different Parts Of Calotropis gigantea (L.) Dryand.
Objective: The present study aimed to determine the antimicrobial activity and phytochemicals of different parts of C. gigantea. Material and Methods: The flower, leaf, stem bark, and latex of C. gigantea were extracted using 50%, 70%, and 95% ethanol. Phenolic and flavonoid content were measured using colorimetric assays. The disc diffusion method was used to evaluate antimicrobial activity against a panel of microorganisms. Results: The ethanolic extracts of C. gigantea (2 mg/disc) from the tested parts contained total phenolic and flavonoid contents ranging from 13-38 mg GAE/ g extract and 1-175 mg RTE/ g extract. Extracts from the flower, leaf, and stem bark showed similar inhibitory effects against Pseudomonas aeruginosa TISTR 1467. Additionally, extracts from the flower and leaf demonstrated inhibition zones against Candida tropicalis TISTR 5136. No inhibitory activity was observed against Staphylococcus aureus ATCC 6538, Acinetobacter baumannii ATCC 19606, Candida albicans TISTR 5554, and Candida krusei TISTR 5351 from any of the tested samples. Conclusion: The ethanolic extracts from various parts of C. gigantea contained a high amount of phenolics and flavonoids, and exhibited antimicrobial activity, particularly against P. aeruginosa and C. tropicalis. These findings suggest that C. gigantea may be a promising natural source for further isolation and purification, which could enable the discovery of new antimicrobial agents.
Efficacy of a Health Education And Self-Awareness Booklet With Specific Therapeutic Exercises Versus Vitamin D3 Supplementation For Managing Chronic Low Back Pain: An Assessor-Blinded, Multicentre Randomised Clinical Trial
Objective: Maintaining optimal vitamin D3 levels may play a key role in managing chronic low back pain (CLBP) and enhancing functional outcomes. This study aimed to compare the effects of health education and self-awareness booklets versus vitamin D3 supplementation combined with therapeutic exercises on pain intensity, vitamin D levels, and functional disability in individuals with CLBP. Material and Methods: This randomized clinical trial was conducted at two physiotherapy rehabilitation centers in Dhaka, Bangladesh, involving 84 participants with chronic low back pain (CLBP), randomly allocated into two equal groups. Group A received specific therapeutic exercises and a health education/self-awareness booklet, while Group B received vitamin D3 supplementation alongside the same exercises over a three-month period. Primary outcomes included pain intensity (assessed via the Brief Pain Inventory) and serum vitamin D3 levels. Functional disability, measured using the Roland-Morris Disability Questionnaire (RMDQ), served as the secondary outcome. Assessments were conducted at baseline and post-intervention, with a per-protocol analysis applied. Results: Both groups demonstrated significant improvements in pain intensity and functional disability following the intervention (p-value<0.001). However, Group B showed significantly greater reductions in disability scores (p-value<0.001), which corresponded with a marked increase in serum vitamin D3 levels (p-value<0.001). Conclusion: Both interventions were effective in reducing pain and disability in individuals with CLBP. However, the addition of vitamin D3 supplementation led to significantly greater improvements, highlighting its potential role in enhancing the efficacy of conservative CLBP management.
Diagnostic Impact of ANA Interference on p-ANCA Interpretation in Autoimmune Testing
Objective: Antineutrophil cytoplasmic antibodies (ANCA) are crucial for diagnosing ANCA-associated vasculitis (AAV). The indirect immunofluorescence assay (IIFA) is commonly used but may produce perinuclear ANCA (p-ANCA) positivity in non-AAV, especially in antinuclear antibody (ANA)-positive cases. Specific ANA patterns and high titers may increase the frequency of non-AAV–p-ANCA positivity. This study aims to assess the correlation and impact of ANA patterns and titers on p-ANCA interpretation by IIFA. Material and Methods: This retrospective study analyzed ANA-positive serum samples collected between 2019 and 2024. IIFA tested ANA and ANCA, while antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) were assessed by enzyme-linked immunosorbent assay (ELISA). Only ELISA-negative cases were included. IIFA classified samples into non-MPO–p-ANCA-positive and p-ANCA-negative groups. ANA patterns and titers were interpreted using International Consensus on ANA Patterns (ICAP) guidelines. Chi-square and logistic regression identified factors associated with non-MPO–p-ANCA positivity. Results: Non-MPO–p-ANCA positivity was identified in 23.9% of cases (n=32). The homogeneous ANA pattern showed a significant association (adjusted OR: 4.11, 95% confidence interval [CI]: 1.18–14.37, p-value=0.027). High ANA titer (≥1:1280) was also independently related to this outcome (adjusted OR: 4.47, 95% CI: 1.50–13.33, p-value=0.007), whereas intermediate titers were associated with a lower likelihood of positivity. Conclusion: Homogeneous pattern and high titer were associated with non-MPO–p-ANCA positivity. Standardized ANCA testing, including ANA assessment and confirmatory MPO/PR3-ANCA ELISA, improves diagnostic accuracy and reduces misinterpretation in autoimmune serology.
Withdrawal Symptoms and Executive Functions After 24-Hour Caffeine Abstinence in Office Workers with Habitual Coffee Consumption
Objective: This research aimed to investigate withdrawal symptoms and executive functions (EFs) after 24-hour caffeine abstinence in office workers with habitual coffee consumption. Material and Methods: Eighteen male office workers (age 32.94±4.14 years, computer use for work 5.33±0.77 h/d, caffeine consumption 225.83±88.80 mg/d) participated in this within-subjects designed experiment. Participants completed the Caffeine Withdrawal Symptoms Questionnaire, Trail Making Test (TMT), and Flanker Test after 24-hour caffeine abstinence, preceded by a baseline measure during normal consumption. Results: The mean score for total caffeine withdrawal symptoms, drowsiness/fatigue, decreased alertness/difficulty concentrating, mood disturbances, decreased sociability/motivation to work, flu-like feeling, and headache was greater after caffeine abstinence compared with the baseline normal consumption (all p-values<0.05). The mean value for the TMTB number of errors was also greater after caffeine abstinence than the baseline normal consumption (p-value <0.05). Conclusion: Acute caffeine abstinence produces withdrawal symptoms and impaired EFs in office workers with habitual coffee consumption, and the occurrence is different among individuals. Based on the earlier evidence and the findings of this research, habitual caffeine consumers should be cautious when abstaining from caffeine in their daily routine, and more occupational research is required to elucidate the impacts of caffeine abstinence among regular coffee consumers.
Study of Microvascular Complications in Type 2 Diabetes Mellitus with Special Reference to Advanced Glycation End-Products (AGEs) and Pentosidine Levels
Objective:This cross-sectional study aimed to assess and compare the association between the serum levels of Advanced Glycation End-Products (AGEs), Pentosidine, and microvascular complications (retinopathy, nephropathy, and neuropathy) in patients with type 2 diabetes mellitus to explore the potential of AGEs and Pentosidine as predictive biomarkers for the early detection of microvascular complications in T2DM. Material and Methods: The study involved 149 patients, divided into five groups based on the presence of microvascular complications: non-diabetic volunteers, type II diabetics without microvascular complications and with retinopathy, nephropathy, and peripheral neuropathy. AGEs and Pentosidine levels were measured and compared across these groups. Results: The results showed statistically significantly higher AGE levels in diabetics (354.5 ng/ml) compared to non-diabetics (193.8 ng/ml) (p-value<0.001), indicating a clear association between AGEs and diabetic status. Additionally, diabetic patients with retinopathy had markedly higher AGE levels (443.6 ng/ml) compared to those without retinopathy (325.7 ng/ml) (p-value<0.001). Pentosidine levels were also elevated in diabetics (793.8 ng/ml) compared to non-diabetics (95.4 ng/ml) (p-value=0.043), with the most significant elevation observed in diabetics with peripheral neuropathy (p-value<0.001). The study found a positive correlation between AGE and the duration of diabetes and also between AGE levels and HbA1c, indicating that inadequate glycaemic control and long-term hyperglycaemia may contribute to AGE accumulation. Conclusion: The findings emphasize the critical role of AGEs and Pentosidine in the progression of diabetic microvascular complications and conclude that these biomarkers could serve as valuable tools for identifying and monitoring the progression of T2DM complications.
Prasad Mayagondanahalli Chandrashekaraia
Red Blood Cell Alloantibodies among Multi-Transfused Patients in a Single Tertiary Center
Objective: This study investigated the prevalence and specificity of red blood cell (RBC) alloantibodies and assessed the factors associated with their development in multi-transfused patients at a single tertiary center. Material and Methods: This cross-sectional study retrospectively analyzed data from 384 multi-transfused patients who underwent pre-transfusion or immunohematology (IH) testing at Hospital Raja Permaisuri Bainun, Malaysia. Patients were selected using systematic random sampling, and data were extracted from electronic hospital systems and IH test reports. Variables included demographics, clinical diagnosis, transfusion history, and transplant status. Data were analyzed using descriptive statistics and logistic regression. Results: A total of 5,675 multi-transfused patients were identified during the study period. Of the 384 patients selected for analysis, 155 (44.5%) exhibited RBC alloantibodies. Anti-E was the most frequently identified alloantibody (39.6%), followed by anti-Mia (26.2%). Patients with chronic kidney disease and thalassemia had a significantly higher risk of alloantibody development (p-value<0.001 and p-value=0.032, respectively). Conclusion: The high rate of RBC alloimmunization in multi-transfused patients highlights the importance of extended RBC antigen matching, not only for thalassemia patients but also for those with chronic kidney disease, to reduce the risk of alloantibody formation.
The Physical Activity Patterns and Exercise Routines during the Heatwave Season Among Young Adults
Objective: Regular participation in physical activity (PA) during the heatwave season is extremely challenging due to its potential to cause heat-related illness. While previous research has examined exercise practices during cold weather, exercise behaviours during the heatwave season, particularly in Southeast Asian countries, have not been sufficiently explored. Hence, this study aimed to determine the patterns of PA and exercise routines among young adults during the heatwave season. Material and Methods: An online cross-sectional survey was conducted among 220 young adults, with a mean age of 21.09 (standard deviation [S.D.] 1.68) years. Validated questionnaires assessing PA and exercise routines were utilised. The data were analysed using established statistical software. Results: The amount of energy expended in low-intensity activity during the heatwave season was notably high (1,173.65±1,303.19 metabolic equivalent of task [MET]-minutes/week), in contrast to moderate- and high-intensity activities (517.82±1,128.36 MET-minutes/week and 447.91±763.27 MET-minutes/week, respectively). Correspondingly, more time was spent on light-intensity activity (62.93 minutes per day ±60.14) than on moderate- and high-intensity activities (39.91 minutes ±48.24 and 26.36 minutes ±45.07, respectively). The data also showed that a large proportion of participants reported a low exercise frequency (62%). Regarding gender differences, male participants had higher levels of PA and were more likely to engage in vigorous exercise during the heatwave season (p-value<0.01). Conclusion: The PA and exercise routines were found to be substandard during the heatwave season. Health professionals should develop evidence-based exercise guidelines tailored to heatwave conditions and the specific needs of
Comparative Effects of Closed-Chain Exercises Versus Mobilization with Movement on Pain, Range of Motion, Balance, and Function in Professional Footballers with Ankle Sprains
Objective: The purpose of this experimental research was to compare the effects of closed-kinetic-chain exercises (CKCE) versus mobilization with movement (MWM) on pain, range of motion (ROM), balance, and functional outcomes before and after 4 weeks of training in professional footballers with an ankle sprain. Material and Methods: The football players with inversion ankle sprain (N=40) were equally and randomly assigned to 2 groups. Participants in intervention group A (n=20) received the closed-kinetic-chain exercises, whereas participants in intervention group B (n=20 underwent mobilization with the movement technique. Each participant received the intervention every other day for 4 consecutive weeks. Pain, range of motion, balance, functional ability, and sprint performance were assessed. All outcomes were measured one day before and after the intervention. Results: Within-group analysis showed significant improvements in pain, range of motion, balance, functional stability, and sprint performance for both CKCE and MWM. Between-group comparisons revealed that MWM was superior in enhancing range of motion and reducing pain, whereas CKCE achieved greater gains in balance, functional stability, and sprint performance. Conclusion: Both groups demonstrated statistically significant improvements in pain reduction, range of motion, balance, and functional outcomes in footballers with ankle sprains; however, mobilization with movement was found to be more effective overall compared to closed kinetic chain exercise.
Food Security and Food Safety for Healthcare Sustainability in Indonesia
Objective: This research sought to describe the strategies employed to address food security and safety within Indonesian healthcare environments, with a particular emphasis on the principles of sustainable healthcare. In light of the multifaceted challenges presented by climate change, it is imperative for hospitals and other healthcare facilities to not only guarantee the nutritional adequacy of their food services but also to implement rigorous measures to prevent foodborne illnesses. Material and Methods: This qualitative study comprised semi-structured interviews with 11 participants, including healthcare facility managers and nutritionists from seven hospitals and four community healthcare centres (PUSKESMAS). The interviews aimed to gather participants’ insights regarding the role of food security and safety in achieving sustainable healthcare. The data were analysed using NVivo 12 software. Results: Healthcare sustainability depends heavily on ensuring adequate nutrition and preventing food insecurity. However, recent statistics show that only 22.11% of sustainable health facilities meet food security standards, whereas food safety standards are met by 62.1%. Conclusion: The findings suggest that food security plays a crucial role in supporting sustainable healthcare practices. Institutions striving for long-term sustainability appear to prioritise achieving food security as a fundamental objective. These insights underscore the need to incorporate food-related considerations into comprehensive sustainability strategies within the healthcare sector.
HPV Vaccination Decision-Making Stages and Associated Factors Among Young Men Who Have Sex with Men in Thailand
Objective: To examine human papillomavirus (HPV) vaccination stages and identify key determinants of HPV vaccination decision stages among young Thai men who have sex with men. Material and Methods: This cross-sectional study recruited 397 young men who have sex with men (YMSM) aged 18-26 years. Data collection utilized an electronic questionnaire covering general information, health and sexual risk behaviors, HPV knowledge and attitudes, self-efficacy, subjective norms, and contextual perceptions of the HPV vaccine. Multivariate multinomial logistic regression was used to analyze the factors associated with vaccination across three stages: unawareness, undecided, and decided to vaccinate. Results: YMSM in Thailand fell into three HPV vaccination decision-making stages: 42.3% unaware/unengaged, 39.8% undecided, and 17.9% committed to vaccination. Subjective norms had the strongest influence: participants with higher norms were more likely to be committed to vaccinating versus the undecided (adjusted odds ratio [AOR]=5.56, 95% confident interval [CI]: 2.30-13.45) or unaware (AOR=2.54, 95% CI: 1.05-6.14). Positive attitudes increased the odds of a vaccination commitment versus undecided (AOR=4.85, 95% CI: 1.78-13.21) and unaware participants (AOR=4.58, 95% CI: 1.41-12.23). Higher self-efficacy was associated with vaccination commitment versus undecided (AOR=2.94, 95% CI: 1.01-8.51) and unaware participants (AOR=3.31, 95% CI: 1.17-9.37). Neither HPV knowledge nor contextual perceptions were significantly associated with the decision-making stages. Conclusion: Subjective norms and positive attitudes were the primary drivers of HPV vaccination decisions among YMSM in Thailand. Interventions targeting social influences and attitude change may be more effective than knowledge-based approaches alone for promoting vaccine uptake in this population.
Cyclooxygenase-2 Expression in Oral Squamous Cell Carcinoma and Dysplasia of Oral Epithelium – A Comparative Study
Objective: Cyclooxygenase-2 or COX-2 has been shown to play a vital role in pain and inflammation by mediating the conversion of arachidonic acid to prostaglandin, and the altered expression of cyclooxygenase-2 has been reported in carcinogenesis. The present study aimed to compare the expression of COX-2 in epithelial dysplasia (OED) and squamous cell carcinoma of the oral region (OSCC) via immunohistochemistry. Material and Methods: The present study included 30 formalin-fixed paraffin-embedded samples, of which 10 were histopathologically diagnosed as oral epithelial dysplasia, 10 oral squamous cell carcinoma, and 10 normal oral mucosa. The samples were subjected to immunohistochemical staining with COX-2, following which the intensity and the area of staining were assessed and scored. The Kruskal-Wallis test was performed for statistical analysis with Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: A statistically significant increase in the expression of COX-2 was observed in OED and OSCC in comparison with the control. Conclusion: Thus, COX-2 expression could be further explored as a marker for early diagnosis and prevention of cancer progression.
COVID-19 Vaccine Acceptance Among Patients with Mental Illness: A Case-Control Study After the Pandemic
Objective: To investigate the prevalence of anxiety, optimism, and coronavirus disease 2019 (COVID-19) vaccine acceptance among patients with mental illnesses in Southern Thailand in the period after the pandemic. Material and Methods: A total of 160 outpatients, 80 with mental disorders and 80 age- and gender-matched individuals without mental disorders, participated in this study between August and November 2023. Data were collected using self-reported questionnaires on perception and personal experience of COVID-19 vaccination, including the Thai version of the COVID-19 Anxiety Scale. Results: The psychiatric group had significantly higher rates of unemployment (p-value=0.02), residence in the armed-conflict areas of Southern Thailand (p-value=0.03), and self-payment for treatment (p-value=0.003) compared with the non-psychiatric group. A smaller proportion of patients in the psychiatric group had received full vaccination, including at least one booster dose (52.5%), compared with the control group (75.0%; p-value=0.005). Levels of optimism and anxiety toward COVID-19 infection were mostly moderate and not significantly different between the groups. Statistically, individuals with mental illnesses perceived the severity of COVID-19 2.4 times lower than those without (p LR test=0.016). Most participants in both groups were willing to receive the COVID-19 vaccine if advised by their psychiatrists (68.8%), family doctors (73.8%), pharmacists (63.7% and 70.0%), or village health volunteers (VHVs) (56.2%). Conclusion: Psychiatric patients were more likely to be unemployed, live in armed-conflict areas, pay for their own medical care, and have lower vaccination rates. At the same time, optimism and anxiety levels were similar compared to those of non-psychiatric groups regarding COVID-19.
Medication Reconciliation: A Step Towards Patient Safety – An Interventional Approach in Geriatrics
Objective: To evaluate the effect of pharmacist-led medication reconciliation in geriatrics. Material and Methods: A prospective interventional study was conducted in the inpatient units of KIMS Al-Shifa Hospital from June 2022 to June 2023. The study focused on geriatric patients admitted to the General Medicine, Pulmonology, Gastroenterology, and Nephrology departments. Patient demographics and medication histories were collected at various stages of hospitalization. A standardized questionnaire was used to assess the knowledge and perceptions of healthcare professionals regarding pharmacist-led medication reconciliation. Results: A total of 73 healthcare professionals participated, including 31 pharmacists (43.0%), 30 nurses (41.0%), and 12 physicians (16.0%). Among the 165 patients studied, 1,697 medication discrepancies were identified, of which 95.0% (n=1,611) were intentional and 5.0% (n=86) were unintentional. The most common overall discrepancy was the addition of an order (56.0%), followed by the omission of an order (31.0%). Among unintentional discrepancies, the omission of an order was the most frequent (55.0%), especially during admission (46.0%). On average, each prescription contained four discrepancies. Pharmacists performed 86 interventions, and 66.0% were accepted by physicians (p-value<0.001). Discrepancies most often involved antimicrobials (25.0%) and drugs for acid-related disorders (11.0%). Conclusion: Unintentional discrepancies, particularly omissions, were the most frequent errors during admission. Pharmacist-led medication reconciliation significantly reduced medication discrepancies, highlighting the importance of pharmacist involvement in improving medication safety among geriatric patients.
Quality of Life and Associated Factors of Depressive Symptom Outcomes at Baseline and During Treatment Follow-Up: A Prospective Observational Study in a University Hospital Setting
Objective: This study investigated the influence of quality of life (QoL) and its associated factors on depression, using a prospective design. Material and Methods: Longitudinal data were collected at baseline and three months post-treatment between March 2023 and March 2024 at a university hospital outpatient clinic. Depressive symptoms and QoL were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the WHOQOL-BREF Thai Version, respectively. Relationships between depression and QoL were analyzed using Spearman’s correlation, while multivariable regression analyses identified predictors of depression at both time points. Results: A total of 80 participants with Major Depressive Disorder (MDD) were enrolled, with 53 completing the three-month follow-up. Significant improvements in depressive symptoms and QoL were observed following treatment. At three months, depressive symptoms were negatively correlated with QoL (ρ=-0.60, p-value<0.001). Key predictors of depression symptoms severity included stressors within the past month at baseline (adjusted coefficient=8.63, p-value=0.005), younger age, as well as the psychological and physical health domains of QoL at three months post-treatment (adjusted coefficients=-0.79, p-value<0.001; -0.49, p-value=0.012; -0.09, p-value=0.030, respectively). Conclusion: These findings highlight the importance of addressing stressors and QoL domains during treatment. Future research should incorporate larger cohorts, longer follow-up periods, and more comprehensive assessments of stressors to validate these results and improve clinical practice.
Effects of the Knowledge and Attitude Development Program to Promote Preventive Behaviors for Prescription Drug Misuse among High School Students in Central Thailand: A Quasi-Experimental Study
Objective: Prescription drug misuse (PDM) among adolescents is an increasing public health issue, leading to significant physical, psychological, and social consequences. There is a pressing need for preventive strategies targeting young people to address this growing concern in Thailand. Material and Methods: A quasi-experimental study using a repeated-measure design with 2 groups aimed to evaluate the effect of a knowledge and attitude development program on promoting preventive behaviors related to PDM. This study recruited 102 high school students, aged between 16 and 18, enrolled at a school in Central Thailand. The students were divided into 2 groups using multi-stage sampling: the intervention group (n=51) participated in a 4-week knowledge and attitude development program, while the control group (n=51) received a health education booklet. Assessments were conducted through structured questionnaires at 3 points: baseline, post-intervention, and 3-month follow-up. Data analysis was performed using descriptive statistics and a repeated measures analysis of variance. Results: Significant differences were found in the mean scores of knowledge (F=142.166, p-value<0.001), attitudes (F=219.680, p-value<0.001), and preventive behaviors related to PDM (F=68.871, p-value<0.001) between the intervention and control groups at the 3-month follow-up. Furthermore, the mean scores of all outcomes in the intervention group significantly increased at post-intervention and 3-month follow-up (p-value<0.001). However, no significant improvement was observed in the control group across all time points (p-value>0.05). Conclusion: The intervention group demonstrated significantly better knowledge, attitudes, and preventive behaviors on PDM than the control group. These findings indicate that the program might support efforts to promote preventive behaviors, and healthcare personnel can consider using it in the planning and management of PDM prevention.
Assessing the Disparities in Pressure Injury Prevention Knowledge and Practices Among Critical Care Unit Nurses in Government and Private Hospitals in Madinah City, Saudi Arabia
Objective: To examine the level of knowledge and practice regarding pressure injury prevention in the critical care units of nurses working in Medina City, Saudi Arabia. Material and Methods: A cross-sectional quantitative study design was applied. A total of 598 staff nurses working in King Fahad Hospital and the Saudi German Hospital, Madina, completed the questionnaires. Data were collected using the pressure injury prevention knowledge questionnaire and the pressure injury prevention practices questionnaire. Statistical analysis was conducted using descriptive statistics, Chi-square, independent sample t-test, and multiple linear regression inferential analysis of IBM SPSS version 27. Results: Nurses’ total knowledge of pressure ulcer prevention was moderate (17.31±2.86), within the possible score of 22 points. The mean practices of pressure injury prevention among the nurses were reported at 56.64 (S.D.=3.095). The study was found to be clinically significant, but there were no statistically significant differences in the mean pressure injury knowledge scores between those working in private hospitals and those in the public hospitals (17.41±2.82 and 17.26±2.88, respectively, t=0.631, df=596, p-value=0.528). However, the pressure injury practices among nurses in private hospitals were significantly better (p-value=0.004) than those from governmental hospitals (57.17±2.718 vs 56.39±3.234, respectively). Knowledge and practices of pressure injury prevention in government and private hospitals varied according to many factors, including age, duration of employment, formal training, marital status, and level of education (p-value<0.05). Conclusion: Nurses in private hospitals showed clinically significantly better preventive practices, spotlighting quality of care differences.
The Prevalence of Transfusion-Transmitted Infections among Blood Donors at Kuala Terengganu and Its Associated Factors
Objective: Blood transfusion is a widely used measure in modern medicine. It is, however, not without risk. One of the risks is transfusion-transmitted infections (TTIs). This study aimed to determine the prevalence of these infections among blood donors in a tertiary hospital in Kuala Terengganu and the associated factors. Materials and Methods: This study involved retrospective data collection of all blood donations from 2011 until 2017, retrieved from the registry at the Transfusion Medicine Unit. The association of the identified risk factors with each TTI was checked for significance using Fisher’s exact test. The association between seropositivity and sociodemographic characteristics was checked for significance by simple and multiple logistic regressions. Results: There was a total of 330 (0.3%) seropositive donations and 13 (0.014%) seroconvert donors. The majority of the identified risk factors were unsafe sexual practices (51.7%). The seropositivity was significantly higher in males, first-time donors, occupations other than government servants, and donations at mobiles. Conclusion: The low prevalence of seropositive and seroconvert donors observed in this study reflects the overall effectiveness of donor selection procedures. Nonetheless, strengthening donor recruitment, improving pre-donation counselling, and encouraging repeat donations may further enhance transfusion safety. Strategies that focus on retaining return donors and converting first-time donors into repeat donors should be implemented. A more sensitive screening method, such as nucleic acid testing, would be very beneficial. Findings from this study can be used as a guide for an effective donor recruitment strategy to achieve zero-risk blood transfusion.
Therapeutic Potential of Ethanolic Extract of Garcinia Kola in Managing Hyperglycemia and Hepatic Dysfunction in Diabetic Male Wistar Rats
Objective: There has been an increase in age-standardized mortality rates from diabetes. This study aimed to evaluate the therapeutic potential of the ethanol extract of Garcinia kola in managing hyperglycemia and organ damage in streptozotocin-induced diabetic adult male albino rats. Material and Methods: A total of 25 adult male Wistar rats (120–230 g) were used in this study, randomly assigned to five groups, comprising five rats each. Group A served as the normal control, while Group B was the diabetic control. Diabetes was induced in Groups B, C, D, and E using a single intraperitoneal injection of streptozotocin at 120 mg/kg body weight. Following induction, Groups C and D received oral doses of G. kola extract at 300 mg/kg and 500 mg/kg body weight, respectively, whereas Group E was treated with glibenclamide at 5 mg/kg body weight. All treatments were administered once daily for 14 consecutive days. Results: The results demonstrated a statistically significant (p-value<0.05) reduction in glucose levels in the treated groups compared to the untreated diabetic control (Group B). Significant variations in body weight were also observed across the experimental groups. Groups C and D exhibited elevated serum liver enzymes and bilirubin levels relative to Group B. However, no statistically significant differences (p-value>0.05) were observed in kidney function parameters between Groups C and D. Conclusion: This study confirmed the anti-diabetic efficacy of G. kola and also established that exposure to G. kola may cause liver dysfunction.
Association Between Gross Motor Functions and Upper Limb Functions in Indian Children with Spinal Muscular Atrophy
Objective: A progressive neuromuscular disease called Spinal Muscular Atrophy (SMA) is characterized by anterior horn cell degeneration, which leads to proximal muscle weakening and compromised motor function. Although upper limb and gross motor skills are frequently impacted, little is known about how these functions interact in the paediatric population of India. The objective of this study was to investigate the relationship between gross motor functions and upper limb functions in Indian children with Spinal Muscular Atrophy. Material and Methods: Indian children with SMA Types II and III, ages 2 to 18, participated in the cross-sectional study. The Hammersmith Functional Motor Scale Expanded (HFMSE) was used to measure gross motor function, and the Revised Upper Limb Module (RULM) kit was used to evaluate upper limb function. Pearson’s correlation test was used to assess the relationship between gross motor and upper limb scores. Results: A total of 22 participants (mean age: 8.84±5.31; 77% male) were included. A significant positive correlation was found between HFMSE and RULM scores (r=0.579 and p-value=0.005), indicating that higher gross motor functions are associated with higher upper limb functions. The strength of association varied with SMA type and ambulatory status. Conclusion: In Indian children with SMA, there is a strong association between gross motor functions and upper limb functions. This suggests that both domains should be taken into account in assessment and rehabilitation plans to improve functional status and quality of life in children with SMA. A limitation that can be considered in future studies is to gather data from different regions of India.
Oral Cancer and Its Risk Factors: A Case-Control Study in Haryana
Objective: Oral cancer, a common and deadly mouth cancer, is linked to oral health behaviors and dietary imbalances, which cause 11–15% of oral and laryngeal cancers. This study aimed to establish the relationship between oral cancer and its risk factors in the study population and to compare these findings with healthy controls to determine their significance. Material and Methods: This hospital-based case-control study included 86 oral squamous cell carcinoma patients aged 18+. Categorical data are shown as frequencies and proportions; continuous data as mean±S.D. Chi-square test assessed categorical variables. Results: All 86 cases were in the age range of 44-62 years. The difference in occurrence of oral cancer in relation to education, marital status, type of food consumed, frequency of the consumption of fresh fruits, hot/spicy foods, saturated fats, consumption of onion/garlic, iron deficiency anaemia, malaligned, decayed and missing teeth, halitosis, frequency of toothbrushing, and using mouthwash, presence of dentures, and past history of dental procedure/trauma were statistically significant (p-value<0.05). Conclusion: We found that the type of food consumption and poor oral hygiene play a significant role in the causation of oral cancer. The prevalence of OC can be decreased by altering one’s lifestyle through education, the promotion of healthy eating habits, practicing proper oral hygiene, and avoiding denture/brush stress to the oral cavity.
Effectiveness of Visual Vestibular Habituation versus Optokinetic Training for Chronic Motion Sensitivity
Objective: To compare the effectiveness of visual vestibular habituation exercises and optokinetic training for subjects with chronic motion sensitivity. Material and Methods: This comparative study of the pre-test and post-test type included 50 healthy women based on the inclusion criteria and then randomly divided into Group A and Group B, containing 25 subjects each. Group A performed visual vestibular habituation exercises, Group B performed optokinetic training, and both groups performed balance exercises for 6 weeks. The paired t-test was adopted to find the statistical difference within the groups, and the independent t-test (Student t-Test) was adopted to find the statistical difference between the groups. A p-value of ≤0.05 was considered statistically significant. Results: Both visual vestibular habituation exercises (Group A) and optokinetic training (Group B) produced significant improvements in motion sensitivity symptoms, as measured by Motion Sickness Susceptibility Questionnaire (MSSQ), Motion Sensitivity Quotient (MSQ), State Trait Anxiety Inventory (STAI), and Video Induced Dizziness Time (VIDT) scores (p-value≤0.05). Group A showed lower post-intervention scores for MSSQ (56.67±6.21) and MSQ (11.92±3.17), lower anxiety levels on STAI (41.76±3.43), and higher tolerance to video-induced dizziness time (216.72±18.23) compared to Group B. Conclusion: Visual vestibular habituation exercises are more effective than optokinetic training for alleviating the symptoms of motion sickness in individuals with chronic motion sensitivity.
Addressing Perceived Barriers to Dietary Adherence in Type 2 Diabetes Management: Development and Evaluation of a Targeted Intervention Strategy
Objectives: This pilot study sought to assess the effectiveness of an intervention aimed at addressing perceived barriers to dietary adherence among patients with type 2 diabetes in Iraq in response to the critical issue of insufficient dietary compliance in diabetes management. Material and Methods: A quasi-experimental pilot study design (single blinding for participants) was used, with 60 participants (30 in the intervention group and 30 in the control group) from the Sekanyan Health Centre in Kirkuk, Iraq. The control group continued to receive their usual care. The intervention group participated in an eight-week educational program focused on the perceived barriers to dietary adherence, followed by a one-month follow-up. Outcomes were assessed using the validated 15-item perceived barriers for the dietary adherence questionnaire (PBDAQ). Higher PBDAQ scores indicate fewer perceived barriers. The Statistical Package for the Social Sciences (SPSS), version 26, was used in the data analysis. Results: The intervention group exhibited a notable decrease in perceived barriers from baseline to post-intervention (mean difference=-0.639, 95% CI: 0.427 to 0.850, p-value=0.004) and a significant enhancement in dietary adherence (mean difference=0.448, 95% CI: -0.668 to -0.227, p-value=0.006). The control group showed no significant changes. Conclusion: This pilot study suggests that targeted interventions addressing the perceived barriers may enhance dietary adherence among Iraqi patients with type 2 diabetes. The findings support further investigation into integrating barrier assessment and culturally tailored strategies into standard diabetes care.
Validation of the STOP, STOP-BANG Questionnaire and Its Modifications for Screening Obstructive Sleep Apnea in Southern Thailand
Objective: To evaluate the diagnostic performance of STOP, STOP-BANG, and their modifications against apnea-hypopnea index (AHI) cutoffs of ≥5 and ≥15. Material and Methods: This retrospective cross-sectional study analyzed OSA patients (≥18 years) treated at the Dental Sleep Medicine Clinic, Prince of Songkla University, Thailand, from December 2007 to April 2021. Screening tools included STOP, STOP-BANG, and modified versions with different body mass index (BMI) and NC cutoffs. Patients were classified by AHI (≥5 and ≥15), and the accuracy of each questionnaire was evaluated against these thresholds. Results: Of the 112 eligible patients, 66.1% were male, with a mean age of 46.9±11.9 years. For AHI ≥5, sensitivities were high: STOP (93.1%), STOP-BANG (89.8%), and modified STOP-BANG with BMI ≥30/NC ≥40 (90.8%), BMI ≥26/NC ≥40 (93.9%), and BMI ≥35/NC ≥35 (93.8%). Specificities were moderate: STOP (45.5%), STOP-BANG (54.5%), and 45.5% for all modified versions. For AHI ≥15, sensitivities remained high: STOP (91.3%), STOP-BANG (89.4%), BMI ≥30/NC ≥40 (87.9%), BMI ≥26/NC ≥40 (93.9%), and BMI ≥35/NC ≥35 (92.3%). However, specificities were low: STOP (14.0%), STOP-BANG (16.3%), modified STOP-BANG with BMI ≥ 30/NC ≥ 40 (18.6%), BMI ≥26/NC ≥40 (16.3%), and BMI ≥35/NC ≥35 (14.3%). Conclusion: The modified STOP-BANG (BMI ≥26 kg/m², NC ≥40 cm) showed the highest sensitivity and may be the most suitable OSA screening tool in our region.
Cod Liver Oil Phonophoresis as a Non-Invasive Intervention for Chronic Knee Osteoarthritis
Objective: Osteoarthritis is a degenerative joint disorder affecting millions of older people worldwide. Conventional treatments include the use of oral NSAIDs, which can cause potential complications like stomach ulcers, gastrointestinal bleeding, and other digestive problems. Identifying an alternative natural anti-inflammatory drug, such as cod liver oil, which can be delivered transdermally by phonophoresis, reducing the potential complications of oral drug administration, was the primary requirement of the study. Material and Methods: This cross-sectional study included 60 participants selected from Saveetha Medical College and Hospital and other rehabilitation centers, based on defined inclusion and exclusion criteria. They were divided into two groups: one received cod liver oil phonophoresis and the other conventional ultrasound. Treatment spanned five days per week over four weeks, with each session lasting 8 minutes. Baseline and week 4 assessments included pain intensity (Numerical Pain Rating Scale) and functional capacity (Six-minute walk test). Data were analysed using paired and independent t-tests with significance set at p-value<0.005. Results: Both groups demonstrated statistically significant reductions in pain intensity and functional limitation scores. However, the phonophoresis group showed greater reductions in NPRS scores (mean decrease 3.83 vs. 2.40; p-value<0.001) and superior gains in 6MWT distance (mean increase 21.97 m vs. 10.62 m; p-vaue<0.001) compared to the ultrasound group. Increased knee flexion ROM and patient satisfaction scores also favored the phonophoresis group. Conclusion: Cod liver oil phonophoresis is an effective, non-invasive intervention for reducing pain and functional limitations in chronic knee osteoarthritis. Its natural composition and safety profile make it a promising alternative or adjunct to traditional pharmacological treatments.
Associations between Lower-Limb Motor Coordination, Muscle Strength, and Fall Risk in Older Adults: A Cross-Sectional Study
Objective: This study investigated the associations between lower-limb motor coordination, assessed using the Foot Tapping Test (FTT) and Four Square Step Test (FSST), and muscle strength, measured by the Five Times Sit-to-Stand Test (FTSST), with functional performance and fall risk classification in community-dwelling older adults. Material and Methods: A total of 200 community-dwelling adults aged 60 years and older were recruited. Fall risk was evaluated using the Timed Up and Go (TUG) Test as the primary outcome measure. Participants were assessed for lower-limb motor coordination using the FTT and FSST, and for muscle strength using the FTSST. Multiple logistic regression analysis was performed to determine the independent contributions of coordination and strength measures (FTT, FSST, and FTSST) to the classification of high fall risk. Results: Two models were analysed. Model 1 included the FTT and FTSST, while Model 2 included the FSST and FTSST. In Model 1, the FTT showed an adjusted odds ratio (AOR) of 0.803 (95% CI: 0.720–0.896), and the FTSST had an AOR of 1.702 (95% CI: 1.322–2.191). In Model 2, the FSST showed an AOR of 1.455 (95% CI: 1.197–1.770), and the FTSST had an AOR of 1.546 (95% CI: 1.195–2.001). All findings were statistically significant (p-value<0.001). Conclusion: These findings suggest that the coordination and strength of lower extremity muscles are associated with fall risk in older adults and may help indicate or reflect the likelihood of mobility impairment related to falling.
Enhancing Patient Satisfaction through Effective Doctor-Patient Communication: A Mixed-Methods Study in Eastern India’s Secondary and Tertiary Care Hospitals
Objective: Effective doctor-patient communication (DPC) is critical for patient satisfaction and improved health outcomes. Despite physicians often perceiving their communication as adequate, patient feedback highlights significant gaps, especially in complex socio-economic and cultural contexts. This study examines DPC and patient satisfaction in secondary and tertiary care hospitals in Bankura District, Eastern India. Material and Methods: This observational, cross-sectional study used a mixed-methods approach over 18 months, assessing DPC and patient satisfaction among 212 inpatients in two hospitals. Data collection included reviews of medical records, patient questionnaires (DPC-15 and Patient Satisfaction Questionnaire Short Form (PSQ-18) scales), and qualitative interviews. Statistical analyses, including Mann-Whitney U, Kruskal-Wallis tests, and multivariate linear regression, explored associations between DPC and socio-demographic factors. Results: Findings revealed lower DPC scores among patients from lower socio-economic backgrounds, marginalized castes, and urban areas. Higher satisfaction correlated with longer consultations and fewer prior incidents involving doctors. Regression analysis indicated that residence, socio-economic status, caste, consultation duration, and doctor experience with prior incidents explained 71.9% of DPC score variability. Qualitative data highlighted concerns about care quality, delays in diagnosis, and challenges related to inadequate infrastructure. Conclusion: DPC quality in Bankura District is influenced by socio-economic and structural factors. Improvements in DPC require addressing systemic issues, such as consultation time and doctor-patient ratios, and fostering supportive environments to reduce physician burnout. Enhancing doctors’ awareness of patient-specific social and cultural factors could bridge communication gaps, fostering greater patient satisfaction and better healthcare outcomes.
Influence of Watching 3D Video on Accommodation, Vergence Function, and Visual Fatigue
Objective: 3D video consumption has become increasingly popular these days. This study aimed to evaluate the effect of different 3D video-watching techniques: Virtual reality (VR), polarised filter (PR), and red/green filter(R/G) on accommodation, vergence parameters, and associated subjective symptoms. Material and Methods: This cross-sectional study included 25 young adults with refractive error +0.50D and stereo acuity better than 60 arc seconds. Participants with binocular vision anomalies and ocular pathologies were excluded. Baseline binocular vision parameters were measured, followed by a 30-minute 3D video watching session under each condition (VR, PR, and R/G) in dim illumination. Post-task binocular vision assessment was performed for each condition, and the ODAS (Ocular Discomfort Analog Scale) questionnaire was administered to assess the subjective symptoms. Results: A significant reduction in median distance negative fusional vergence (NFV) was observed with R/G (6±4 PD, p-value=0.002) and PR (6±4 PD, p-value=0.04) compared to the baseline (10±4 PD). Compared to baseline, negative relative accommodation (NRA), accommodative facility (AF), and vergence facility (VF) were significantly impaired across all three viewing conditions. ODAS scores indicated higher eye fatigue with VR (4±4), followed by PR (3±2) and R/G (2±3). Conclusion: All three 3D video-watching techniques caused significant deterioration in accommodation and vergence functions. Subjective symptoms, including dryness, burning, blurred vision, and visual fatigue, were the most pronounced with VR, followed by PR and R/G filter.
Assessment of Serum Interferon Gamma-Induced Protein 10 in Chronic Hepatitis B Patients
Objective: This study assessed the serum levels of IP-10 alongside standard liver function parameters, including Alanine Transaminase (ALT), Aspartate Transaminase (AST), Total Serum Bilirubin (TSB), Albumin, and Prothrombin Time (PT), in patients with Chronic hepatitis B (CHB). Additionally, the study sought to analyze the correlations among these variables. Material and Methods: A case-control study was conducted with a total of 80 participants, comprising 40 patients diagnosed with CHB and 40 healthy controls. Serum IP-10 levels were quantified utilizing a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. The standard automated methods were employed to conduct liver function tests. Results: Patients with CHB demonstrated significantly elevated levels of IP-10 (221.6±68 vs. 111.2±32.1 pg/mL; p-value<0.001), ALT, AST, and TSB, while showing significantly reduced albumin levels compared to the control group (p-value<0.001). IP-10 exhibited remarkable diagnostic performance, achieving an Area Under the Curve of 0.96, with sensitivity at 92.5%, and specificity at 87.0% when using a cut-off of >156.2 pg/mL. A significant negative correlation was observed between IP-10 and albumin (r=-0.41, p-value<0.01), alongside a positive correlation with TSB (r=0.32, p-value<0.05). Conclusion: Serum IP-10 is a highly sensitive and specific biomarker for CHB, demonstrating a significant correlation with the markers of liver dysfunction and synthetic function. Its strong inverse relationship with albumin suggests its potential role in indicating impaired hepatic synthesis, supporting its utility in the clinical evaluation and treatment of CHB.
Outcomes of Nasalance Scores in Children with Cochlear Implants in Ramathibodi Hospital
Objective: The study compared the nasalance scores of Thai children with cochlear implants in Ramathibodi Hospital with normative data. Material and Methods: From August 2021 to December 2022, a cross-sectional study was conducted in Ramathibodi Hospital. The participants were 20 children, ranging in age from 6.10 to 14.1 years, with severe to profound sensorineural hearing loss who received cochlear implants and were evaluated for nasalance using the Nasometer. They were instructed to read three standard Thai passages for nasalance assessment. Descriptive statistics and a sample t-test were employed to compare the nasalance scores with normative data. Results: A significant difference in the mean nasalance scores between the Thai children with cochlear implants and the normative data for the oral passage in all three age groups. Furthermore, only the 12.1 to 15.0 age range in the nasal passage showed a significant difference in mean nasalance scores compared to the normative data. However, the remaining age of the nasal and oro-nasal passage showed no significant differences between the mean nasalance scores compared to the normative data (p-value<0.05). Conclusion: Children with cochlear implants may have improved nasalance scores. Their scores were still higher than those of children with normal hearing, suggesting that even after cochlear implants are fitted, speech therapy is still necessary to rehabilitate nasal resonance in children with hearing impairment.
Optimizing Chemotherapy Outcomes for Elderly Thai Cancer Patients: Development of a Predictive Tool for Severe Adverse Events
Objective: To develop a predictive model for grade 3–5 CAEs in older Thai cancer patients using clinical and geriatric parameters. Material and Methods: This retro-prospective cohort study enrolled patients aged ≥60 years with solid tumors who were undergoing chemotherapy at Chulabhorn Hospital between January 2023 and June 2024. Clinical data and geriatric assessments were collected at baseline and during each treatment cycle. Predictors were identified using multilevel logistic regression, and model performance was evaluated using AUROC with internal validation. Results: Ninety-four patients contributed 634 chemotherapy cycles, with 124 grade 3–5 CAEs (19.6%) recorded. Significant predictors included low income, ECOG performance status, white blood cell count, and absolute neutrophil count, while polypharmacy and prolonged Timed Up and Go Test (>20 seconds) showed protective trends, likely reflecting more cautious physician management. The final model achieved an AUROC of 0.72 (95% CI: 0.67–0.77), with a sensitivity of 81.2%, a specificity of 41.7%, a positive predictive value of 25.5%, and a negative predictive value of 90.0%. Conclusion: A Thai-specific clinical tool incorporating geriatric and clinical parameters can help identify older patients at risk of severe chemotherapy toxicity. Its high sensitivity and negative predictive value support its use as a screening tool in routine oncology care.
Visual Perception Status and Its Relationship with Academic Performance among Primary Indigenous Schoolchildren in Selangor, Malaysia
Objective: Visual perception (VP) is often linked to academic tasks and performances that involve literacy and numeracy skills. However, there is limited literature that discusses VP among primary indigenous children. This study investigated VP status among primary indigenous schoolchildren in Selangor and its relationship with academic performance. Material and Methods: In this study, 90 primary indigenous schoolchildren aged 7-11 were recruited. They underwent a preliminary assessment for visual acuity using the Sonksen logMAR chart to ensure optimum visual function. The VP status was then assessed using the Test of Visual Perceptual Skills 4th Edition (TVPS-4). In addition, academic performance data for four core subjects, namely Bahasa Melayu, English, mathematics, and science, were obtained retrospectively and classified into six mastery levels known as Tahap Penguasaan (TP). Results: The VP scores of primary indigenous schoolchildren were independent of gender and school attendance rate. Compared with the standard norms, the participants’ subtest scaled scores and overall standard scores (mean±S.D.=93.26±6.58, p-value<0.001) were significantly lower. Most VP subskills showed no correlation with academic performance, except for the sequential memory subtest, which showed the strongest association in Bahasa Melayu and science. Furthermore, the visual discrimination subtest and overall VP scores were significantly correlated with Bahasa Melayu, English, and science proficiency, but not mathematics. Conclusion: Generally, primary indigenous schoolchildren demonstrated below-average VP performance. While not all VP subskills were found to be linked to academic performance, specific interventions that heavily target the sequential memory and visual discrimination sub-domains may be effective in improving the educational outcomes of primary indigenous schoolchildren.
Visual Acuity and Refractive Error Profile of Indigenous Schoolchildren in Selangor
Objective: Uncorrected refractive errors are the leading cause of visual impairment in indigenous communities, with hyperopia reported as the most prevalent refractive error among indigenous people in Malaysia. Given the global rise in myopia, this study aimed to determine the visual acuity and current refractive status of indigenous schoolchildren in Selangor. Material and Methods: This cross-sectional study involved purposively selected 106 indigenous schoolchildren aged from 7 to 12 years in Selangor with no history of ocular surgery, neurodevelopmental disorders, or active ocular diseases. Distance (DVA) and near visual acuity (NVA) were measured using Sonksen LogMAR charts. Refractive assessment was conducted via retinoscopy and subjective refraction. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 29, with descriptive statistics and the Wilcoxon Signed-Rank test used to compare inter-eye differences. Results: Among 106 indigenous schoolchildren with a mean age of 9.00±0.137 years, 50.9% were males. Unaided DVA was 0.02 ±0.01logMAR and 0.01±0.01logMAR, and near VA was 0.01±0.01logMAR and 0.00±0.00logMAR, for the right and left eye, respectively. Best corrected VA was 0.01±0.01logMAR at distance and 0.00±0.00logMAR at near. Spherical equivalent showed a high prevalence of emmetropia (79.25%), followed by hyperopia (17.92%) and myopia (2.83%). Additionally, 7.55% had astigmatism. Statistically significant inter-eye differences were observed for spherical equivalent (p-value<0.001) but not for the cylindrical power (p-value=0.979). Conclusion: The refractive profile of Indigenous schoolchildren in Selangor remained dominated by emmetropia and hyperopia, with a low prevalence of myopia, despite the global rise in myopia among children.
Serum Irisin Dynamics in Response to Proprioceptive and Strengthening Training in Adolescent Inline Skaters
Objective: This study investigated the effects of an eight-week proprioceptive and strengthening training program on serum irisin dynamics in adolescent inline skaters and explored its potential implications for performance optimization and injury prevention. Material and Methods: A quasi-experimental pretest–posttest design with a control group was conducted involving 30 adolescent inline skaters (15 males, 15 females; aged 11–15 years). Participants were randomly allocated into an experimental group (n=15), which received the proprioceptive–strengthening intervention three times weekly for eight weeks, and a control group (n=15), which continued their regular training routines. Serum irisin levels were measured pre- and post-intervention. Statistical analyses included paired t-tests for within-group comparisons and independent t-tests for between-group differences, with a significance threshold set at p-value<0.05. Results: The experimental group showed a significant increase in serum irisin concentration from 1.310±0.15 ng/mL at baseline to 3.349±0.25 ng/mL post-intervention (p-value<0.001), while the control group demonstrated only a modest rise (1.453±0.20 to 1.603±0.22 ng/mL, p-value=0.016). Between-group analysis confirmed a significant difference in post-test irisin levels favoring the experimental group (p-value=0.004). Conclusion: The proprioceptive and strengthening training program effectively enhanced circulating irisin levels, indicating positive neuromuscular and metabolic adaptations. These findings suggest that integrating proprioceptive and strengthening exercises into routine training may support performance optimization and injury prevention in adolescent inline skaters.
Case Series Utilizing a Novel Rotational Mechanical Thrombectomy Device for the Treatment of Thrombosed Arteriovenous Grafts in Thailand
Endovascular treatment of thrombosed hemodialysis access is a standard option for restoring flow. Standard treatments, including pharmacomechanical thrombolysis, mechanical thrombectomy, or a combination of therapies, have been commonly used. Mechanical thrombectomy is widely accepted for the treatment of thrombosed arteriovenous fistulas or grafts because the devices have been proven effective and easy to use. Hence, we present a case series of thrombosed hemodialysis grafts successfully salvaged with endovascular mechanical thrombectomy utilizing a rotational thrombectomy system.
Monitoring Osseointegration: The Role of Bone Biomarkers in Dental Implant Success
Dental implant success hinges on the biological processes of bone remodeling and osseointegration, with bone biomarkers now recognized as powerful adjuncts to conventional clinical and radiographic assessments. Recent prospective and systematic studies indicate that dynamic biomarker monitoring can inform predictions of implant prognosis, illuminate the mechanisms of peri-implant bone turnover, and enable the early diagnosis of complications, such as peri-implantitis. Advances in omics technologies and molecular imaging have expanded our understanding, while new candidate biomarkers have emerged from peri-implant crevicular fluid, blood, and metabolomic profiles. This review critically synthesizes the major developments between 2000 and 2025 and evaluates the clinical utility, challenges, and future direction of bone biomarker analysis in modern implant dentistry.