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
Translation and Validation of the Thai Version of the Quality Nursing Care Questionnaire (T-QNCQ)
Objective: The Quality Nursing Care Questionnaire (QNCQ) has been widely used to assess nurses’ perceptions of care quality. However, there was a lack of studies validating the QNCQ in Thai healthcare settings, highlighting the need for its adaptation. This study aimed to translate the QNCQ into Thai and evaluate its internal consistency and psychometric properties. Materials and Methods: A cross-sectional study design was used in this research. The Thai version (T-QNCQ) was a self-reported questionnaire consisting of 38 items across 5 response categories, covering 6 dimensions: physical environment, staff characteristics, preconditions, task-oriented activities, human-oriented activities, and patient outcomes. A sample of 380 registered nurses from tertiary government hospitals in Thailand was recruited using purposive and convenience sampling. To assess the validity of the translated scale, confirmatory factor analysis (CFA), descriptive statistics, and reliability testing were conducted. Results: The T-QNCQ demonstrated strong reliability and validity. The Cronbach’s alpha coefficient for the total scale was 0.98, with subscale values ranging from 0.86 to 0.94. Item-total correlations for the overall scale were positive, ranging from 0.61 to 0.84. Construct validity was supported by CFA, which yielded the following fit indices: comparative fit index=0.95, Tucker-Lewis index=0.94, root mean square error of approximation=0.05, and standardized root mean square residual=0.04. Conclusion: The T-QNCQ was found to be a reliable and valid tool for assessing nurses’ perceptions of care quality in Thai healthcare settings. These results provide valuable insights for nurse administrators and policymakers, aiding improvements in care delivery.
Copyright (c) 2025 Journal of Health Science and Medical Research http://creativecommons.org/licenses/by-nc-nd/4.0
Correlation of MRI Characteristics with the Histologic Grade of Soft Tissue Sarcoma of the Extremities and Trunk
Objective: The staging and treatment of soft tissue sarcoma depend on the histologic grades, which predicts overall survival. This study aimed to assess magnetic resonance imaging (MRI) characteristics to differentiate between low- and high-grade soft tissue sarcomas of the extremities and trunk. Material and Methods: This retrospective study included patients with soft tissue sarcomas who underwent preoperative MRI between October 2006 and December 2020. The data obtained included qualitative information (size, depth, MRI signal intensity, hemorrhage signal, margin, fascial tail sign, peritumoral edema/enhancement, and organ involvement) and quantitative information (apparent diffusion coefficient value). Logistic regression was performed to identify the MRI characteristics associated with histologic grades. Results: A total of 101 patients were included; 76 were diagnosed with histologically high-grade tumors. The final multivariate regression model showed a combination of 4 MRI characteristics: a large area of intratumoral heterogeneity on T2-weighted images (T2W), a large area of non-enhancing hyperintensity on T2W, a fascial tail sign, and peritumoral edema. These characteristics collectively predicted high-grade soft tissue sarcoma with 81% accuracy. The 2 strongest indicators were intratumoral heterogeneity on T2W (adjusted odds ratio (aOR) 3.96, 95% confidence interval (95% CI) 1.16-13.55, p-value=0.028) and a fascial tail sign (aOR 3.34, 95%CI 1.09-10.22, p-value=0.035). Conclusion: The 2 strongest MRI predictors of high-grade soft tissue sarcoma are marked intratumoral heterogeneity on T2W and a fascial tail sign. Furthermore, the combination of 4 MRI characteristics, including marked intratumoral heterogeneity on T2W, a fascial tail sign, non-enhancing hyperintensity on T2W, and peritumoral edema, can increase the accuracy of histologic grade prediction.
Periodic Fasting: A Strategy for Improving Cardiometabolic Parameters and Antioxidant Levels in Obesity
Objective: Obesity is associated with decreased antioxidant activity, such as Superoxide Dismutase (SOD), and due to metabolic switching processes, Periodic Fasting (PF) as a potential therapeutic approach must be further studied. The study aimed to analyze the effects of PF on cardiometabolic parameters, metabolic switches, and antioxidant levels. Material and Methods: This was a quasi-experimental study conducted in Surabaya, East Java, Indonesia, consisting of the intervention (PFG) group, which received PF for 10 days, and the Control Group (CG), which had daily meals. The measurements of metabolic parameters, such as anthropometric parameters, fasting blood glucose (FBG), total cholesterol (TC), β-Hydroxybutyrate (β-HB), and antioxidant level, were taken pre and post-intervention. Results: Thirty-six young adult men participated in this study. After 10 days, there was a significant improvement in most cardiometabolic parameters in the PFG group (p-value<0.05), including a reduction in FBG and TC (p-value<0.05). In the PFG group, the post-test mean β-HB level was significantly higher than the pre-test (21.48±8.86 vs. 15.63±3.71, p-value<0.05), and the mean SOD level also increased (76.64±3.62 vs. 73.56±4.10, p-value<0.05).There was a negative correlation between PF and the difference (Δ) in FBG (p=0.000) and between post-test SOD, abdominal circumference (AC), and body weight (BW) (p=0.041, p-value<0.05). Conclusion: The ability of PF to improve cardiometabolic parameters, including metabolic switch and antioxidant levels, makes it a feasible dietary intervention for obesity-related and associated health problems.
Comparison between External Oblique Intercostal Plane (EOI) Block and Incisional Local Infiltration Effect in Open Cholecystectomy: A Randomized Controlled Trial
Objective: To compare 24-hour postoperative opioid consumption, converted to intravenous morphine equivalents, between patients receiving external oblique intercostal plane (EOI) block and those receiving incisional local infiltration (LA) in open cholecystectomy. Primary outcome: 24-h morphine equivalents. Secondary: pain intensity on a 0–10 numeric rating scale (NRS). The minimal clinically important difference (MCID) was defined as ≥30% opioid reduction and ≥1-point NRS decrease. Material and Methods: Forty-four patients undergoing open cholecystectomy were randomized to EOI or LA (22 each). The EOI group received 20 mL of 0.25% bupivacaine for EOI block after skin closure, and the LA group received the same dose for local infiltration before skin closure. Results: For the primary outcome, 24-h morphine equivalent consumption showed no significant difference between the groups (–4.09 mg; p-value=0.058). Ward opioid use (2–24 h) was lower in the EOI group (10.2±5.3 mg) than the LA group (14.1±6.9 mg); mean difference –3.96 mg, 95% CI (–7.69 to –0.22), p-value=0.038. This 28% reduction did not meet the 30% MCID. Median movement NRS in the ward was significantly lower with EOI (6 [IQR 5–6]) than LA (7 [IQR 5.75–8]); median difference –1, 95% CI (–2.00 to 0.00), p-value=0.022, meeting the 1-point MCID. Conclusion: Although the EOI block did not significantly reduce total 24-hour morphine consumption, it was associated with a clinically meaningful reduction in movement-evoked pain.
Development and Assessment of Copper-Based Nanoparticles Derived from Dypsis lutescens for Their Antibacterial Properties by in vitro Application
Objective: Phytoconstituents, including polyphenols, tannins, alkaloidsandflavonoids, which are abundant in Dypsis lutescens leaf extract, were utilized for the green synthesis of copper nanoparticles (g-CuNPs). These bioactive compounds served as natural reducing agentsandcapping agents in the synthesis process. Material and Methods: The formation of g-CuNPs was confirmed by ultraviolet spectroscopy (UV), showing a characteristic λmax at 410 nm. Functional groups of the capping agents on g-CuNPs were verified using Fourier transform infrared spectroscopy (FTIR spectroscopy). Results: The nanoparticles demonstrated remarkable stability, as confirmed by Malvern Zetasizer analysis. They exhibited an acceptable particle size and Poly Dispersity Index (PDI), along with a robust positive zeta potential of +40, indicating their suitability for biological applications. Antibacterial assays revealed that the g-CuNPs significantly enhanced antibacterial activity compared to the leaf extract alone. The inhibition zones were slightly higher for both Gram-positive and Gram-negative bacteria, including Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), Staphylococcus aureus (S. aureus) and Enterococcus faecalis (E. faecalis), underscoring the efficacy of the nanoparticles in combating bacterial pathogens. Conclusion: This study underscores the potential of integrating bioactive phytochemicals with copper nanoparticles (CuNPs) to create potent antibacterial agents. The enhanced activity of g-CuNPs against both Gram-positive and Gram-negative bacteria highlights their promise as effective solutions for addressing challenges posed by pathogenic bacteria. This innovative approach paves the way for developing advanced antimicrobial therapies with improved efficiency and stability.
Factors Associated with Early Postoperative Pain after Total Knee Arthroplasty
Objective: Total knee arthroplasty (TKA) is a common operation for geriatric patients. Knowing the factors leading to acute post-TKA pain will lead to personalized pain care. Material and Methods: We recruited 843 patients who underwent TKA. Preoperative, intraoperative, and postoperative data were obtained retrospectively. Results: Moderate to severe postoperative pain in the first 24 hours was found in 87%. Factors associated with moderate to severe postoperative pain were being female [adjusted odd ratio (AOR) 2.34, 95% confidence interval (95% CI) 1.23-4.46], having an ASA physical status classification of II (AOR 9.22, 95% CI 1.9-44.67) or III (AOR 6.75, 95% CI 1.32-34.63), a longer tourniquet time (AOR 1.01, 95% CI 1.01-1.02), and postoperative use of aspirin (AOR 2.04, 95% CI 1.25-3.32). Factors found to be associated with mild postoperative pain were being younger (AOR 0.97, 95% CI 0.94-0.99), being given intrathecal fentanyl (AOR 0.3, 95% CI 0.12-0.73), having a peripheral nerve block (AOR 0.28, 95% CI 0.12-0.66), and taking a systemic corticosteroid (AOR 0.26, 95% CI 0.13-0.55), parecoxib (AOR 0.39, 95% CI 0.19-0.78) or ketorolac (AOR 0.47, 95% CI 0.23-0.99). Conclusion: Being female, having an ASA physical status classification of II or III, a longer tourniquet time, and postoperative use of aspirin were significantly related to having moderate to severe postoperative pain within the first 24 hours after TKA. Factors associated with mild postoperative pain included being younger, intrathecal fentanyl, having a peripheral nerve block, receiving a systemic corticosteroid, and use of parecoxib and ketorolac.
Streptococcus pneumoniae in Nineveh Province: A Comprehensive Infection Survey and Public Health Implications
Objective: Streptococcus pneumoniae causes infections, including pneumonia, meningitis, otitis media, and mortality, particularly in children, the elderly, and immunocompromised patients. Public health is affected by S. pneumoniae in Iraq, and the high number of cases results from insufficient health care, mainly in Nineveh Province. The purpose of this study was to perform a wide-ranging survey of infections in Nineveh from 2020 to 2024. Material and Methods: Patient data were gathered based on clinical symptoms and informed consent. Blood samples were tested for antibodies against S. pneumoniae. A statistical analysis was performed using Statistical Package for the Scocial Science (SPSS) to establish incidence rates and prevalence factors. Results: It was found that pneumonia is common in the area, and the number of cases is predicted to rise noticeably in the years 2023 and 2024. Mosul experienced the highest number of cases. Tal Afar and Hamdaniya were second. The data show that infection affected people more commonly according to their sex and was highly concentrated in teens and young children. Conclusion: The findings emphasize the importance of increasing therapeutic and preventive measures, improving health infrastructure, and raising community knowledge in order to decrease the spread of disease.
The Thai Version of the Updated Perceived Control Over Falling Scale: A Study of Cross-Cultural Adaptation, Reliability, and Validity in Older Adults
Objective: To translate and culturally adapt the Updated Perceived Control Over Falling (UP-COF) into the Thai language and evaluate its psychometric properties among older Thai adults. Material and Methods: The translation and adaptation process followed Beaton’s guidelines. A prefinal version was tested with 20 older adults, with minor modifications. Test-retest reliability was assessed in a sample of 50 older adults. Concurrent validity, internal consistency, and discriminatory ability between fallers and non-fallers were evaluated in 88 older adults. Reliability was determined using the intraclass correlation coefficient ICC (2,1). Concurrent validity was investigated by the Pearson correlation coefficient with the Falls Efficacy Scale-International (FES-I). The Receiver Operating Characteristic (ROC) curve analysis determined the ability to differentiate individuals with and without a history of falls in the past year. Statistical significance was defined as p-value<0.05. Results: The UP-COF showed good test-retest reliability (ICC (2,1)=0.75) and internal consistency (Cronbach’s alpha=0.76). The tool demonstrated a significant negative correlation with the FES-I (r=-0.51, 95% CI [-0.65, -0.34], p-value<0.001), supporting its concurrent validity. ROC analysis yielded an area under the curve (AUC) of 0.66, indicating modest discriminatory ability. A cut-off score of ≤16 out of 20 identified individuals with a history of falls, demonstrating a sensitivity and specificity of 68.18%. Conclusion: The UP-COF Thai is a reliable and valid instrument for assessing perceived control over falling in Thai older adults, supporting its use in clinical assessment and targeted fall prevention strategies.
Development of a Predictive Score for Suicide Attempts in Patients with Treatment-Resistant Depression and Implementation for Suicide Prevention in Thailand
Objective: This study aimed to identify predictors of suicide attempts in treatment-resistant depression (TRD) patients and develop a predictive scoring system for suicide risk assessment and prevention. Material and Methods: This study involved patients aged 20–60 years who were diagnosed with TRD and attended psychiatric outpatient clinics in Bangkok, Thailand. Statistical analysis involved univariate logistic regression to identify potential predictors (p-value<0.05), followed by multivariable logistic regression with backward stepwise selection (p-value<0.01) to develop a predictive model; the model was implemented in a new patient cohort, and suicide attempt rates were compared pre- and post-implementation. Results: Among 653 TRD patients, 221 had attempted suicide. Nine important predictors were found. The model was excellent at making predictions (area under the receiver operating characteristic (AuROC)=0.993, 95% confidence interval (CI): 0.989–0.997) and had strong internal validation (AuROC=0.98, 95% CI: 0.979–0.999). Risk scores categorized patients into low-, moderate-, and high-risk groups. After creating a predictive scoring system for assessing and preventing suicide risk, it was implemented in 185 new TRD patients. At 6 months and 1 year, there was a statistically significant reduction in suicide attempts (p-value<0.05). Conclusion: The developed predictive score effectively stratifies suicide risk among TRD patients and informs tailored suicide prevention care plans. Its implementation resulted in a significant reduction in suicide attempts, underscoring its potential as a clinical tool for suicide prevention in TRD patients. Notably, protective factors identified in this study, such as good compliance and spiritual security, may also contribute to lowering suicide risk.
Effect of Ankle Foot Orthoses on Gait Parameter among Children with Spastic Diplegic Cerebral Palsy
Objective: This study evaluated the effects of solid ankle-foot orthosis (SAFO) and ground reaction ankle-foot orthosis (GRAFO) on gait parameters (kinematic and temporospatial) in children with diplegic spastic cerebral palsy (CP). Material and Methods: This repeated-measure matched pair study included 11 children with diplegic spastic CP (Gross Motor Function Classification System, GMFCS III and IV) who presented with equinus gait from 2 tertiary hospitals in Kota Kinabalu. Participants walked 3 meters under 3 conditions: barefoot, with SAFO, and with GRAFO. Gait was recorded using a high-definition camera in the sagittal plane. Kinematic and temporospatial parameters were analyzed using the Kinovea system and compared with the Wilcoxon signed-rank test. Results: The participants’ average age was 6.91±3.02 years. Walking with SAFO and GRAFO significantly reduced velocity (p-value=0.021 and 0.008 respectively) and shortened step and stride lengths (p-value=0.006 for both). Both AFOs significantly reduced peak knee extension at stance (p-value=0.003 for both), while increasing peak ankle dorsiflexion at stance (p-value=0.003 for both) and ankle angle at initial contact (p-value=0.003 for both). GRAFO further reduced walking speed (p-value=0.008), step length (p-value=0.004), and stride length (p-value=0.005), but improved knee extension at stance (p-value=0.003) compared to SAFO. Conclusion: Both SAFO and GRAFO improved knee flexion, ankle plantarflexion at stance, and ankle angle at initial contact in children with CP. GRAFO offered additional benefits by enhancing knee extension at stance.
Noncontrast Computed Tomography for Differentiating Between Nonhemorrhagic Stroke Mimics and Acute Ischemic Stroke
Objective: To determine the efficacy of noncontrast computed tomography (NCCT) for diagnosing stroke mimics in acute settings to promote confident decision-making and avoid unnecessary treatments and procedures. Material and Methods: We enrolled patients presenting with clinical stroke-like symptoms within 6 hours who underwent NCCT at our institution between 2020 and 2021. Each NCCT scan was independently reviewed by 2 radiologists with consensus. Scans were classified as either stroke or stroke mimic patterns. Our study compared demographic data, clinical characteristics, and CT imaging patterns between the 2 groups. We used statistics to assess the performance of NCCT in diagnosing stroke mimics, in comparison with diagnosed ischemic strokes. Results: The study cohort comprised 559 patients. The results demonstrated excellent interobserver reliability in imaging interpretation. Stroke mimics were identified in approximately 57% of patients, predominantly in older adults (median age: 64.1 years, p-value=0.002), females (51.6%, p-value=0.038), and patients with malignancies (17.9%, p-value<0.001). The most prevalent clinical presentation among stroke mimics was seizures (33.5%). Major etiologies of stroke mimics included idiopathic seizures (20.3%). The most common NCCT finding in stroke mimics was a negative scan (79.7%), with positive findings in only 20.3% of cases. NCCT exhibited a high specificity of 95% and a high positive predictive value of 97% in diagnosing stroke mimics. Conclusion: NCCT is a reliable adjunctive diagnostic tool for differentiating stroke mimics, especially in acute settings. Its high specificity and positive predictive value enhance the accurate distinction between ischemic stroke and other conditions with similar presentations, facilitating appropriate treatment.
Four-Year Impact of Including a Pharmacist in a Multidisciplinary Team on Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: Experience at a Tertiary-Care Hospital in Thailand
Objective: We evaluated the real-world data from Thailand regarding dosage optimization of guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). We also assessed GDMT usage, drug-related problems (DRPs) over 4 years, and performance measures based on HF parameters and cardiac biomarkers. All were evaluated before and after a 1-year follow-up in the HF clinic, where pharmacists served on a multidisciplinary team. Material and Methods: We conducted a retrospective chart review of patients with HFrEF who attended our HF clinic. Data on GDMT dosage optimization, usage, and DRPs were gathered from all patient visits between January 2020 and September 2023. Performance measures were collected from patients who completed a 1-year follow-up within the same period. Results: Among 2907 patient visits over 4 years, the annual GDMT dose rates were 67.4% for beta-blockers, 92.6% for renin–angiotensin–aldosterone system (RAAS) blockade, 40.5% for sacubitril/valsartan, and 100.0% for mineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter-2 inhibitors (SGLT2i). The proportion of visits achieving more than 50% of the GDMT dose was 67.6%, 80.3%, 45.9%, 100.0%, and 100.0%, respectively. Overall, GDMT usage was 90.3% for beta-blockers, 72.0% for RAAS blockade, 78.7% for MRAs, and 35.3% for SGLT2i. Adverse drug reactions were the most frequent DRPs. Conclusion: The inclusion of a pharmacist on a multidisciplinary team in a heart failure clinic can improve GDMT optimization, increase GDMT usage, and resolve DRPs, thereby enhancing therapeutic outcomes and quality of life.
Effect of Metabolic Equivalent-Based Bicycle Ergometer Exercise Training on Functional Outcomes in Phase I Cardiac Rehabilitation: A Non-Randomized Controlled Trial
Objective: Patients undergoing cardiac surgery often experience impaired physical activity and exercise capacity. Safety concerns, including anxiety and fear of unsupervised walking, limit optimal exercise training in the early phase. Metabolic equivalent-based (MET) bicycle ergometer training is another option with quantifiable measures for early exercise training. The unexplored benefits of such training warranted this study. We aimed to compare its efficacy with traditional care in phase I cardiac rehabilitation among a post-cardiac surgery population. Material and Methods: In this non-randomized controlled trial, eligible subjects were patients who had undergone adult cardiac surgeries, such as Coronary Artery Bypass Grafting and Valve Replacement, of both genders, aged 30-70 years, with an LVEF greater than 50%, and an uncomplicated postoperative period. Subjects were allocated either to the control or study group. Subjects with high cardiac risk and musculoskeletal and neurological dysfunction were excluded. The study and control groups received MET-based bicycle ergometer training and routine hospital care, respectively. Functional capacity and Left Ventricular Ejection Fraction were measured before and after training. Physiological response was monitored before, during, and after training in all subjects. Results: Thirty patients completed the trial (15 in each group), with 5 dropouts in each group. Baseline characteristics were similar. Physiological response during MET-based exercise was found to be within safe limits. Functional capacity improved significantly in the study group (228.2m) compared with the control group (74m), with a p-value<0.001. Improvement in Left Ventricular Ejection Fraction was significant in both groups. Conclusion: MET-based bicycle ergometer training was found to be feasible, safe, and had a clinically significant impact on functional capacity.
Prevalence and Determinants of Health Professional Consultation Before Using Herbal and Dietary Supplements among Patients with Non-Communicable Diseases (NCDs): A Study Using a Modified KAP Framework
Objective: This study aimed to determine the prevalence and factors associated with consulting health professionals before using herbal and dietary supplements (HDS) among patients with non-communicable diseases (NCDs). Material and Methods: A cross-sectional survey was conducted among 208 patients diagnosed with one or more of the following NCDs: diabetes, hypertension, or chronic kidney disease, who had used HDS between January and December 2024. Data were collected at Chaturaphakphiman Hospital, Roi Et Province, using a questionnaire based on the Knowledge, Attitude, and Practice (KAP) model. Attitude was assessed with 5 items (Cronbach’s alpha=0.91), and knowledge was measured with 13 items (KR-20=0.78). In addition to KAP, 5 other factors were included: sex, age, educational attainment, comorbidities, and duration since diagnosis. Results: The prevalence of consulting health professionals before HDS use was 37.50%. The mean knowledge score was 8.71±1.49, and the mean attitude score was 3.03±0.85 on a 5-point scale, indicating a neutral perception. Multiple logistic regression analysis showed that participants with higher knowledge scores were less likely to consult health professionals (OR=0.78, 95% confidence interval (CI): 0.64–0.92), whereas attitude was not significantly associated with consultation behavior. Of the 5 additional factors, only education level was significantly associated with consultation behavior. Patients with an education level of grade 6 or lower were more likely to consult (OR=1.80, 95% CI: 1.01–3.22). Conclusion: These findings highlight the need for targeted educational interventions to promote appropriate consultation behavior among NCD patients.
Assessment of Incessant Intake of Levonorgestrel Oral Contraceptive and the Effect of Drug Withdrawal on Liver Function and Integrity
Objective: This study used female Wistar rats to evaluate the impact of incessant intake of levonorgestrel on liver function and integrity, and to observe the effect of drug withdrawal on the organs. (organ). Material and Methods: Sixty rats (110–120g) were randomly placed in 3 groups (n=20). Group A was given the human dose equivalent of 1.83 mg/kg/bodyweight (BW) orally once weekly, Group B was given the same dose orally twice weekly, while Group C, serving as the control, was given the same dose of the vehicle solution. Rats were given food and water ad libitum. At the end of 30 days of treatment, 5 rats from each group were sacrificed by cervical dislocation, blood and the liver were harvested, weighed, and processed for biochemical and histological analyses. This was repeated at 60 and 90 days. The last batch of rats was left for another 30 days for possible recovery. Results: The serum concentration of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (ƴGT), and total protein were significantly elevated in the serum. The histopathological examination showed hyperplastic degeneration and extensive tubular necrosis in the treated groups. After the drug was withdrawn, the altered levels of some of the determined biomarkers were not reversed. Conclusion: This study showed a dose- and time-dependent toxicity of the liver, which was associated with levonorgestrel without improvement after drug withdrawal.
The Effects of Transcranial Direct Current Stimulation in Patients with Chronic Intractable Peripheral Neuropathic Pain: A Randomized Sham-Controlled Study
Objectives: Transcranial direct current stimulation (tDCS) has demonstrated efficacy in managing neuropathic pain associated with spinal cord injury and fibromyalgia, with a low incidence of adverse effects. This study aimed to evaluate the effects of tDCS in patients with refractory peripheral neuropathic pain. Material and Methods: In this prospective, randomized, double-blind, sham-controlled study, 12 patients with chronic intractable peripheral neuropathic pain (≥6 months) were randomly allocated to receive either active tDCS (2 mA for 20 minutes) or sham stimulation for 5 consecutive days. The primary outcome was pain reduction, measured using the Numeric Rating Scale (NRS) at baseline, daily during stimulation (days 1-5), and post-treatment (weeks 1, 2, 4, and 6). Secondary outcomes included the Neuropathic Pain Symptom Inventory (NPSI) and the EQ-5D-5L at the 4-week follow-up. Adverse events were recorded. Results: Active tDCS resulted in a statistically significant pain reduction on days 2, 3, and 5 compared to the sham group (NRS reduction: Day 2, 5.00±2.37 vs. 1.67±1.75, p-value=0.020; day 3, 5.17±2.32 vs. 1.83±1.94, p-value=0.022; day 5, 5.50±2.07 vs. 2.67±2.25, p-value=0.047). However, no significant differences in pain reduction were observed at weeks 1, 2, 4, or 6. NPSI and EQ-5D-5L scores also showed no significant differences between the groups at the 4-week follow-up. Adverse events were mild and comparable between the groups. Conclusion: tDCS demonstrated significant short-term pain relief in patients with chronic intractable peripheral neuropathic pain. However, larger studies with longer follow-up periods are required to validate its long-term efficacy.
Comparison of Antibody Responses in Older Adults Who Had Natural Infection vs. Those Who Received an mRNA Booster Following ChAdOx1 nCoV-19 Vaccination
Objective: This study compared antibody responses in elderly patients who received 2 doses of Chimpanzee Adenovirus Oxford 1 – novel Coronavirus 2019 (ChAdOx1 nCOV-19) and later contracted coronavirus disease 2019 (COVID-19) (COVID-19 group; CVD) with those who remained uninfected but received an mRNA booster (COVID-19 and vaccine group; CVV). Material and Methods: A study was conducted during an outbreak at a nursing home between October and November 2021. Antibodies were tested at 12±2 weeks after recovery from COVID-19 or after the mRNA vaccine booster. Results: Forty-three patients in the CVD group and 16 patients in the CVV group were enrolled. The levels of neutralizing antibodies against SARS-CoV-2 (% inhibition) were 97.9 (interquartile range (IQR) 97.3-98.2) and 96.8 (IQR 75.2- 97.8); p-value=0.007 for wild-type SARS-CoV-2, 98 (IQR 97-98.5) and 88.3 (IQR 55.2-96.8); p-value<0.001 against B.1.1.7 (Alpha), 95.9 (IQR 90.2-97.7) and 79.1 (IQR 47-88.5); p-value<0.001 against B.1.351 (Beta), 98.1 (IQR 97.4- 98.4) and 84 (IQR 37.3-96.6); p-value<0.001 against B.1.617.2 (Delta), and 28.2 (IQR 0-66) and 17.0 (IQR 1.5-36.9); p-value=0.388 against B.1.1.529 (Omicron), respectively. Conclusion: Hybrid immunity elicited higher neutralizing antibody levels than vaccination alone. However, for newer variants like Omicron, both hybrid immunity and vaccination alone resulted in low neutralizing antibody levels during the study period.
Association between Exposure to Alcohol Marketing and Alcohol Consumption among Adolescents in Thailand: A National High School Survey, 2018
Objective: Direct alcohol marketing is illegal in Thailand. However, surrogate marketing, a marketing strategy that uses brand extension, brand association, alcohol-branded merchandise, sponsorships, and corporate social responsibility (CSR) activities, is widely seen. This study examined the extent of exposure to alcohol marketing and its association with alcohol consumption and binge drinking among Thai adolescents. Material and Methods: A multi-stage stratified survey was conducted among high school students in years 7, 9, 11, and vocational college level 2 (V2) from 114 schools in 22 of the 77 Thai provinces, using an anonymous, self-administered questionnaire. Results: Among the 21,847 students surveyed, 53.4% were girls and the mean age was 15 years. The prevalence of current and binge drinking was 19.0% and 12.8%, respectively. Most (65.2%) students were exposed to at least one alcohol advertising media; 32.4% recognized a brand after exposure, and 12.1% expressed a desire to drink the promoted beverage. The association between the desire to drink and current drinking was most pronounced among girls in years 11 and V2 (AOR=4.06, 95% CI: 3.18, 5.18), while its association with binge drinking was strongest among girls in years 7 and 9 (AOR=3.50, 95% CI: 2.42, 5.06). Conclusion: Exposure to surrogate alcohol marketing is not only prevalent among adolescents but also plays a crucial role in shaping cognitive responses, namely, brand recognition and the desire to consume alcohol, which are significantly associated with both current and binge drinking. These associations were particularly strong among girls, with notable differences by age group.
Reducing Ciprofloxacin Prescribing for Acute Uncomplicated Cystitis: A Pilot Study in an Antimicrobial Stewardship Program
Objective: Previous studies have shown the inappropriateness of antimicrobials for acute uncomplicated cystitis (AUC). Fluoroquinolones are among the most commonly prescribed antimicrobials, despite an increasing trend of fluoroquinoloneresistant Enterobacterales. To address this issue, we implemented an antimicrobial stewardship (AMS) program to improve the care of patients with AUC. Material and Methods: A retrospective pre-post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital. The AMS intervention included the development of hospital-specific empirical treatment guidelines for AUC and bi-monthly educational sessions for general practitioners at outpatient clinics, supported by printed algorithms posted in exam rooms. The pre-intervention period was from March 1, 2021 to August 31, 2021, and the post-intervention period was from October 1, 2021 to March 31, 2022. Results: Of the 47 enrolled patients, 28 participated in the pre-intervention period and 19 in the post-intervention period. Clinical characteristics were similar between the groups, except for a higher proportion of patients with urinary frequency in the post-intervention period. Antimicrobial appropriateness increased significantly from 0% in the pre-intervention period to 89.5% in the post-intervention period, driven by improvements in appropriate choice (7.1% vs 94.7%), appropriate dose (32.1% vs 94.7%), and appropriate duration (14.3% vs 94.7%). Treatment failure rates were low and did not differ between the 2 periods (7.1% vs. 5.3%). Conclusion: The appropriateness of antimicrobial treatment improved significantly after the introduction of the AMS, mainly due to the decrease in ciprofloxacin prescribing. Continued AMS efforts in outpatient settings are recommended to maintain appropriate prescribing practices.
Factors Related to Sleep Quality among Older Adults in a Northeastern Province of Thailand
Objective: This cross-sectional study aimed to determine the factors related to sleep quality among older adults aged 60 years and above in a northeastern province of Thailand. Material and Methods: A total of 355 participants were randomly selected by multistage sampling between October and December 2024. Data collection tools included general characteristics, physical environment, family relationships, stress assessment, the Thai Geriatric Depression Scale (TGDS-15), and the Pittsburgh Sleep Quality Index (PSQI). The instrument’s content validity was ≥0.67 for each item, and the reliability was 0.77. Descriptive statistics and multiple logistic regression analysis were performed using a statistical software package. A p-value set at <0.05. Results: Average age of participants was 68.59±8.741 years old; 45.7% had no underlying medical conditions and 23.1% lived in a rural area. Factors associated with sleep quality were being female (aOR, 0.58; 95%CI, 0.352 to 0.954), living in a rural area (aOR, 1.97; 95%CI, 1.104 to 3.493), having severe problems related to their physical environment (aOR, 3.60; 95%CI, 1.362 to 9.510), having moderate stress (aOR, 2.11; 95%CI, 1.219 to 3.635), and having signs of depression (aOR, 2.12; 95%CI, 1.270 to 3.553). Conclusion: People in both urban and rural areas should be supported by intervention programs in order to increase good sleep quality. Furthermore, encouraging family bonding can promote a supportive home environment, strengthen relationships, and enhance overall family well-being. Activities that promote mental health, such as exercise, recreational activities, and meditation, are suggested to help reduce stress and depression in this population.
Content and Face Validation of the Malay Questionnaire on Facilitators and Barriers for Primary Caregivers During Toothbrushing of Their Children with Cerebral Palsy
Objective: This study aimed to assess the content and face validity index of the newly developed Malay language questionnaire on the facilitating factors and barriers for primary caregivers during the toothbrushing of their children with Cerebral Palsy (TB-CCP questionnaire). Material and Methods: The development of the TB-CCP questionnaire was conducted in 2 stages. In stage 1, the items of the instrument were developed, and in stage 2, the items were performed by judgement and quantification. The content validity index (CVI) and face validity index (FVI) were evaluated by 6 experts and 10 caregivers of children with CP, respectively. Each index was analysed using Microsoft Excel. Results: The TB-CCP (Draft 1) consisted of 29 items across 2 domains (environmental context and behaviour regulation) under both facilitating factors and barriers to toothbrushing. Content validation confirmed the acceptability of all domains, with the scale-level CVI (S-CVI/Ave) above 0.9, leading to TB-CCP Draft 2. Face validation results showed I-FVI values exceeding 0.83 and scale-level FVI (S-FVI/Ave) above 0.9, confirming its acceptability. Following these validation analyses, the final 29-item TB-CCP questionnaire was established. Conclusion: The process of developing the questionnaire, along with ensuring content and face validity, was lengthy and involved multiple iterations. Content experts and respondents evaluated the items in order to confirm the instrument’s validity. The newly developed TB-CCP questionnaire achieved acceptable content and face validation. This version of the TB-CCP is ready for the next stage of validation through Exploratory and Confirmatory Factor Analysis.
Factors Influencing Emergency Department Visits for Pain Among Cancer Patients: A Retrospective Study
Objective: To understand the factors influencing emergency department (ED) visits for pain to help optimize palliative care strategies and improve pain management. Material and Methods: This study examined factors linked to pain-related ED visits among cancer patients at a Thai tertiary hospital. A retrospective cross-sectional study was conducted with adult cancer patients (≥18 years) who visited Songklanagarind Hospital ED between January 2010 and December 2020. Extracted data included demographic variables, cancer type, metastasis, treatment history, pain intensity, and pain medication use. Univariable and multivariable logistic regression were performed to assess the factors associated with pain-related ED visits. Results: Among 15,144 patients, 18.8% visited the ED at least once due to pain (more commonly among younger patients and females). Pain complaints varied significantly by cancer type, with the highest rates in metastatic solid organ tumors (19.7%) and the lowest in hematopoietic and lymphoid malignancies (16.0%). Among 37,482 total ED visits, 20.2% were pain-related, which occurred more frequently during nighttime. Opioid use was linked to increased ED visits. An increased likelihood of ED visits due to pain was associated with female sex, nighttime visits, having metastatic cancer, recent chemotherapy and surgery, and prior opioid use. Conversely, older age (≥65 years) and recent radiation therapy were associated with a significantly decreased likelihood of pain-related ED visits. Conclusion: This study highlights the potential benefits of standardized pain assessment and continuous symptom management to reduce unnecessary ED visits. A multimodal approach to pain management is essential to improve the quality of life for cancer patients.
Effects of The Integrative Information-Motivation-Behavioral Skills Program on Food Consumption, Exercise, and Emotional Control Behaviors Modification among University Personnel with Obesity: A Cluster Randomized Trial
Objective: This study evaluated the effectiveness of the Integrative Information-Motivation-Behavioral Skills (IIMBS) program in modifying health behaviors among university personnel with obesity. Material and Methods: This secondary analysis of a cluster-randomized controlled trial evaluated the effectiveness of the Integrative IIMBS program among obese university personnel. Eight faculties (clusters) were randomized to either the intervention group, receiving the 12-week IIMBS program, or the control group, receiving standard care. A total of 64 individuals participated. The intervention integrated face-to-face sessions and online activities (via LINE OA). Outcomes, including food consumption, exercise, and emotional control, measured at the individual level, were collected using the Health Behavior Questionnaire (S-CVI=0.96, Cronbach’s alpha=0.74) and IIMBS program materials. Statistical analysis used repeated measures MANOVA. Results: The IIMBS program significantly improved health behaviors over 12 weeks, with the greatest effects observed in food consumption (F=249.89, p-value<0.001, η²=0.801), followed by exercise (F=100.88, p-value<0.001, η²=0.619), and emotional control (F=8.267, p-value<0.001, η²=0.118). The intervention group showed significantly greater improvements than the control group in total health behavior (F=216.97, p-value<0.001, partial η²=0.778), and food consumption (F=109.33, p-value<0.001, η²=0.638). Conclusion: The study demonstrated that the IIMBS program effectively promoted lasting behavioral changes in obese university personnel. This approach can serve as a comprehensive strategy for enhancing health behaviors in obese adults across various settings.
Intensity of Physical Activity and Cardiovascular Events in Adults: A Systematic Review and Meta-Analysis
Objective: To determine whether the cardiovascular protective effects of physical activity (PA) differ between moderate and vigorous intensities in adults without pre-existing cardiovascular disease (CVD). Material and Methods: A systematic search was performed in PubMed, Scopus, and Web of Science for studies published between 1990 and 2024. Eligible studies were prospective cohorts that examined the association between PA intensity—expressed in metabolic equivalent tasks (METs)—and incident CVD outcomes. PA was categorized as moderate (3–5.9 METs) or vigorous (≥6 METs). Studies included adult populations without prior CVD. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were conducted to evaluate result robustness. Results: A total of 1,057,895 participants were included, with a mean follow-up of 10.4 years. Moderate-intensity PA was associated with a pooled HR of 0.84 (95% CI: 0.73–0.98), while vigorous-intensity PA had a pooled HR of 0.84 (95% CI: 0.78–0.91), suggesting similar cardiovascular benefits. Moderate heterogeneity was present (I²=66.4%), potentially due to varying definitions of intensity and adjustment factors across studies. Sensitivity analyses supported the stability of results, and publication bias was minimal. Conclusion: Both moderate and vigorous physical activity are associated with comparable reductions in CVD risk. These findings reinforce the current public health guidelines recommending either 150–300 minutes of moderate or 75–150 minutes of vigorous PA per week for cardiovascular prevention.
Effectiveness of Tixagevimab/cilgavimab for SARS-CoV-2 Pre‑exposure Prophylaxis in Hemodialysis Patients: A Retrospective Cohort Study from a Tertiary Hospital in Thailand
Objectives: To evaluate the effectiveness and safety of Tixagevimab/cilgavimab as pre-exposure prophylaxis against coronavirus disease 2019 (COVID-19) in patients with end-stage kidney disease (ESKD) undergoing hemodialysis during the Omicron surge. Material and Methods: This retrospective cohort study was conducted at Trang Hospital, Thailand, from September 2022 to March 2024. Adult ESKD patients receiving maintenance hemodialysis were included. Patients who received Tixagevimab/cilgavimab were compared with those who did not. The primary outcomes included asymptomatic and symptomatic COVID-19 infection, COVID-19-related hospitalization, and mortality over 18 months. Kaplan-Meier curves and Cox proportional hazards models were used to assess outcomes. The secondary outcome was adverse events after administration. Results: Among 207 patients (40 intervention, 167 controls), incidence rates of symptomatic infection (0.261 vs. 1.432 per 1,000 person-days) and COVID-19-related hospitalization (0.047 vs. 0.236 per 1,000 person-days) were lower in the intervention group. No COVID–19–related deaths occurred. Tixagevimab/cilgavimab significantly reduced the risk of symptomatic infection (adjusted hazard ratio 0.22; 95% CI, 0.087–0.545). Adverse events were infrequent and mild. Conclusion: Tixagevimab/cilgavimab was associated with a significant reduction in symptomatic COVID-19 infection among hemodialysis patients during the Omicron wave. Although hospitalization rates were lower in the intervention group, the difference was not statistically significant. The treatment was well tolerated and may provide preventive benefits for high-risk ESKD populations.
A Prospective Observational Study on the Evaluation of Early Postoperative Lactate Levels in Predicting the Surgical Outcome in Major Abdominal Surgeries
Objective: Early postoperative lactate levels are emerging as key predictors of surgical outcomes. This study aimed to evaluate their predictive value in patients undergoing major abdominal surgeries. Material and Methods: A prospective observational study was conducted from October 2023 to February 2025 of 238 patients. Lactate levels were measured at 0, 6, 12, and 24 hours postoperatively. Complications and 30-day mortality were recorded. ROC curve analysis and logistic regression were used to assess predictive accuracy using SPSS software. Results: Postoperative complications occurred in 43.5% and mortality in 9.2% of patients. The 24-hour lactate (L24) had the highest predictive value (AUC=0.82 for complications, 0.91 for mortality). Cut-offs of 1.4 mmol/L and 3.0 mmol/L were optimal for predicting complications and mortality, respectively. SOFA score (AUC=0.97) showed stronger mortality prediction. Conclusion: L24 lactate is a reliable biomarker for the early detection of postoperative morbidity and mortality. Integration into routine care can guide early interventions and improve outcomes.
Over-the-Counter (OTC) Antibiotic Use and Its Association with Drug Resistance: A Cross-Sectional Study
Objective: To evaluate the prevalence of over-the-counter (OTC) antibiotic use in Delhi National Capital Region (NCR), assess its association with antimicrobial resistance (AMR), and identify determinants influencing public knowledge and attitudes toward antibiotic consumption. Material and Methods: A cross-sectional survey was conducted from July to August 2024 among 300 adult residents of Delhi NCR. Participants completed a validated, self-administered questionnaire covering demographics, antibiotic usage patterns, awareness of AMR, and personal attitudes. Stratified random sampling ensured demographic diversity. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression, with significance set at p-value<0.05. Results: A total of 62.0% of participants admitted to purchasing antibiotics without a prescription, with 40% selecting antibiotics based on prior experience. While 78.3% were aware of AMR, misconceptions persisted; 27.7% believed antibiotics could alter human genetics. Educational institutions were the most common source of AMR knowledge (67.0%). Respiratory infections were the leading reason for antibiotic use (66.3%). A majority (73.3%) believed that stricter regulation on OTC antibiotic sales is necessary, and 68.3% agreed that antibiotics should only be available via prescription. Conclusion: Despite high AMR awareness, self-medication and OTC antibiotic use remain widespread in Delhi NCR, driven by convenience, cost, and prior experience. Public health strategies must focus on correcting misconceptions, strengthening regulations, and expanding access to affordable, physician-guided care to curb misuse and reduce resistance.
Effect of Herbal Toothpaste Without Fluoride Against Candida Albicans and Streptococcus Mutans: An In Vitro Study
Objective: This study aimed to evaluate the antimicrobial effects of herbal toothpaste without fluoride on Candida albicans ATCC 90028 (C. albicans ATCC 90028) and Streptococcus mutans ATCC 25175 (S. mutans ATCC 25175). Despite limitations, such as the discrepancy between in vitro conditions and the human oral environment, the findings have provided valuable insights for consumers and dental professionals, guiding informed decisions in toothpaste selection. Material and Methods: C. albicans ATCC 90028 was cultured in Sabouraud’s dextrose agar (SDA), and S. mutans ATCC 25175 was cultured in brain heart infusion broth (BHI) at 37 °C with 5% CO₂ for 18 hours. The bacteria suspension was adjusted to the turbidity standard according to the 0.5 McFarland standard (1.5×10⁸ colony forming unit (CFU)/ml). Twenty-seven commercially available herbal toothpaste formulations were diluted with 2% Dimethyl Sulfoxide at a 1:1 ratio and mixed using a vortex mixer. Antimicrobial sensitivity testing was performed using SDA for C. albicans and BHI for S. mutans. The results were recorded by measuring the diameter of the clear zone. The minimum inhibitory concentration (MIC) was determined using a 96-well plate with resazurin, while the minimum bactericidal concentration (MBC) was assessed by culturing on agar and counting colony forming units. Biofilm formation was analyzed using crystal violet staining and the optical density measurement at 560 nm. All tests were performed in triplicate. Results: All 27 herbal toothpaste formulations tested at 1 g/ml effectively inhibited and killed C. albicans ATCC 90028 and S. mutans ATCC 25175 in the MIC and MBC tests. In the antimicrobial sensitivity testing, 5 formulations (A005, A018, A025, A004, and A023) showed notable inhibition zones against C. albicans, with A005, A018, and A025 demonstrating superior antifungal activity. The biofilm formation inhibition assay indicated that 15 formulations completely inhibited biofilm formation. All formulations successfully inhibited acid production by S. mutans. In patient saliva tests, most herbal Fluoride-free formulations effectively inhibited S. mutans growth, while some demonstrated reduced antibacterial and antifungal activity. Formulations A018 and A025 showed the highest overall efficacy. Conclusion: The study confirms the antifungal potential of herbal toothpaste formulations against C. albicans ATCC 90028 and S. mutans ATCC 25175. Some formulations were more effective than others, highlighting the need for further investigation into their active ingredients and mechanisms of action. The ability to inhibit biofilm formation is particularly valuable in preventing persistent infections. These findings support the potential use of herbal toothpaste as a preventive measure against C. albicans and S. mutans-related oral infections.
In Vivo and in Silico Antimalaria Activity of Carica Papaya Leaves from Bali
Objective: to determine the antimalarial effect of Carica papaya leaves and to examine the affinity and interaction models of selected Carica papaya compounds with a Plasmodium falcipain-2, which has an important role in parasite development. Material and Methods: The design of the study was in vivo and in silico. This in vivo study used Peter’s four-day suppressive test, and it was conducted using 18 mice to evaluate the antimalarial effect of Carica papaya leaves. Parasitemia levels were analyzed statistically using one-way analysis of variance (ANOVA). The screening of Carica papaya compounds was carried out in silico using AutoDock 4.2 software to examine their antimalarial activity. The molecular structure of the isoquercetin, falcipain-2, was downloaded from the Protein Data Bank (PDB ID: 3BPF). The docking method was valid if the root mean square deviation (RMSD) was less than 2 Ångströms. Results: The in vivo results showed that the administration of ethanol extracts of Carica papaya leaves at doses of 100 and 1,000 mg/kg BW inhibited the increase in parasitemia levels, which were 82.1% and 83.8% on the second day and 95.9% and 95.9% on the third day, respectively. Meanwhile, in silico results showed that quercetin, isoquercetin, carpain, and caricaxanthin exhibited lower energies than the native ligand. Conversely, violaxanthin showed a positive energy value. Conclusion: In vivo and in silico findings suggest that Carica papaya leaf extract at 100 and 1,000 mg/kg BW has antimalarial activity, and carpaine demonstrates promising in silico activity against falcipain-2, warranting further validation.
Five-Year Evaluation of SS-Suction: A Moisture Control Innovation for Dental Sealant Application by Dental Nurses Without Assistants in Children Aged 6–8 Years
Objective: This study aimed to evaluate the 5-year effectiveness of the SS-suction (moisture control device) in maintaining sealant retention and preventing dental caries when used without dental assistance. Material and Methods: A retrospective cohort study with a cross-sectional follow-up study was conducted among children who received pit and fissure sealants using the SS-suction in 2020. Data were collected using questionnaires and clinical examination forms. Quality control included validation and reliability testing of the questionnaire and examiner calibration. Results: A total of 105 children were examined at the 5-year follow-up, including 157 teeth, with an average of 1.5 teeth examined per child. This corresponded to follow-up rates of 58.7% for participants and 59.0% for teeth. Sealant retention outcomes showed 11.5% full retention, 59.2% partial loss, and 29.3% total loss. Caries was detected on 14.0% of sealed surfaces, while 86.0% remained caries-free. Binary logistic regression revealed that teeth with total sealant loss were 5.9 times more likely to develop caries (p-value<0.05). Additionally, children with a plaque index ≥2 were 4.8 times more likely to have caries than those with lower scores (p-value<0.05). Furthermore, females were 3.7 times more likely to develop dental caries than males (p-value<0.05). No significant associations were found with oral hygiene practices or daily consumption of snacks and sweetened beverages. Conclusion: This study shows better retention over a 5-year period than other studies conducted within the country. This suggests that the SS-suction can assist dental nurses with moisture control and sealant quality for long-term caries prevention.
Copyright (c) 2026 Journal of Health Science and Medical Research http://creativecommons.org/licenses/by-nc-nd/4.0
Effects of Shallow Retentive Designs on the Fracture Resistance of Resin Nanoceramic Overlays
Objective: This study aimed to assess the impact of two shallow retentive designs on the fracture resistance of maxillary molars restored with resin nanoceramic overlays. Material and Methods: Thirty extracted human maxillary molars were randomly divided into three groups (n=10): an intact control group and two experimental groups with different shallow retentive designs (shallow occlusal canal and shallow central dowel). All preparations included a standardized 1.5-mm occlusal reduction with additional cavity modifications according to the respective design. Overlays were fabricated using a resin nanoceramic and bonded with a dual-cured resin cement. Specimens underwent artificial aging through 5,000 thermal cycles and 120,000 mechanical loading cycles. Fracture resistance under axial compressive loading and failure modes were evaluated. Data were analyzed using one-way ANOVA and Tukey’s post hoc test (p-value=0.05). Results: No cracks or fractures were observed after the cyclic loading. The mean fracture resistance values of the shallow occlusal canal (2,742.88±354.37 N) and shallow central dowel groups (2,807.30±373.03 N) were significantly higher than the control group (2,309.33±341.67 N) (p-value<0.05), although no significant difference was found between the two preparation designs. Failure modes were predominantly Type II (mixed fracture within restoration and tooth structures) in both experimental groups. Conclusion: Under the adhesive protocol, two shallow retentive designs in resin nanoceramic overlays may represent a feasible option for occlusal restoration, demonstrating mechanical properties superior to those of sound teeth in the short term and showing potential for future clinical application.
Evaluating Access to Dental Services in Primary Health Care Units: A Cross-Sectional Study of the Rotational Dentist Model in Rural Thailand
Objective: To evaluate access to dental services and identify the associated factors following the implementation of a rotational dentist model in primary care units in rural Thailand. Material and Methods: A cross-sectional study was conducted in seven Subdistrict Health Promoting Hospitals in Krasang District, Buriram Province. A total of 497 participants across six age groups were selected using proportional stratified random sampling. Data were collected through a validated questionnaire based on the five dimensions of access: availability, accessibility, accommodation, affordability, and acceptability. Chi-square tests and logistic regression identified predictors of service utilization. Results: Most participants were female farmers with low household income and covered by the Universal Coverage Scheme. Overall, participants reported favorable access across all dimensions. Logistic regression showed that dental service utilization declined progressively with age, with utilization lowest among older adults ≥60 years (AOR=0.07; 95% CI: 0.02–0.23; p-value<0.001). Denture need was also positively associated with utilization (AOR=2.41; 95% CI: 1.30–4.47; p-value=0.005). Three access-related factors were strong predictors of utilization: awareness of service schedules (AOR=3.88; 95% CI: 2.40–6.28; p-value<0.001), awareness of basic services (AOR=9.50; 95% CI: 3.21–28.13; p-value<0.001), and ability to receive care without prior appointments (AOR=3.62; 95% CI: 1.96–6.69; p-value<0.001). Conclusion: The rotational dentist model showed better access across multiple dimensions in primary care. However, disparities in access to dental services remain, particularly among older adults. Addressing these inequities requires enhanced service awareness and more flexible appointment systems. These findings can inform community-based oral health strategies and support the development of equitable policies in rural Thailand.
Accommodative Amplitude and Facility in Orang Asli Schoolchildren: A Pilot Study from a Single Sample in Petaling District, Selangor
Objective: Accommodation response is essential for visual performance, enabling focus adjustment for near and far objects. This study examined the distribution of the accommodative amplitude (AA) and accommodative facility (AF) of Orang Asli (indigenous) primary schoolchildren in Petaling District, Selangor, Malaysia. Material and Methods: This purposive sampling study design was conducted among 28 Orang Asli schoolchildren aged 8-10 years. AA was measured using a Royal Air Force (RAF) ruler using the push-up method, while AF was assessed with ±2.00 diopters sphere (DS) flipper lenses. Results: The mean monocular AA was 14.59 diopters (D) ±2.95 and binocular AA was 15.81 D ±3.14, with a statistically significant difference between the two (p-value=0.025). Compared with Hofstetter’s average age-expected values, monocular AA (p-value=0.063) and binocular AA (p-value=0.484) showed no significant differences. Monocular accommodative facility (MAF) averaged 8.68 cycles per minute (cpm) ±3.05 and binocular accommodative facility (BAF) averaged 7.46 cpm ±2.89, with a significant difference between them (p-value=0.006). Both MAF and BAF values were significantly higher than established normative values (p-value=0.005). Conclusion: This pilot study provides preliminary accommodative function data for Orang Asli schoolchildren; however, the purposive sampling and limited sample size restrict the generalisability of the findings. Clinicians are encouraged to integrate these results with established guidelines for improved assessment and management of visual function in underserved indigenous populations.
A Case Report on the Lumbar Artery Perforator Flap for Coverage of a Non-Healing Ulcer on the Back
The lumbar arteries are critical for supplying blood to the lower back and flank regions. They provide a robust vascular network that can be utilized for flap surgeries, potentially enhancing flap viability and reducing complications associated with flap loss. The vascular anatomy and skin territory supplied by a single lumbar artery are crucial for establishing a clinically reliable flap that minimizes donor site complications. To address the problem, surgery was performed on the vascular anatomy of the lumbar arteries along with the skin territory supplied by a single lumbar artery. The following case is of a 65-year-old man who presented with a non-healing ulcer in the middle of his back for 9 months. The lumbar artery perforator flap (LAP flap) procedure was performed in this study. The patient underwent tumor excision and split-thickness skin graft for a growth over his back, which was proven to be dermatofibrosarcoma protuberans by histopathology. Coverage of the defect was performed using a LAP flap in a propeller fashion. The flap surgery showed a greater rotational arc and allowed for primary closure of the donor site, addressing the limitations seen in the transverse lumbosacral flaps.
Comprehensive Review of a Particularly Intriguing Bacterial Genus, Streptomyces: Traits and Antimicrobial Potential
This review aimed to thoroughly investigate the changing traits, ecological roles, and current studies pertaining to the soil-dwelling bacteria of the genus Streptomyces, which morphologically resemble fungi. These gram-positive bacteria exhibit a filamentous structure and are found in diverse environments, including various types of soil, compost, water, and plant matter. A defining feature of Streptomyces is their capacity to synthesize secondary metabolites, particularly antibiotics. They are responsible for producing more than two-thirds of the clinically relevant antimicrobials derived from natural sources, such as chloramphenicol, neomycin, etc. Streptomyces are noted for their broad substrate with branches and aerial mycelium. Factors such as carbon and nitrogen sources, oxygen levels, acidity or alkalinity, temperature, ions, and certain precursors can influence antibiotic production. This review also explored different approaches for evaluating the antimicrobial characteristics of Streptomyces species. The increasing problem of microbial resistance to traditional antibiotics, along with the difficulties in controlling infectious diseases, has prompted continuous global initiatives to identify new antibiotics.