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
Isosativan from the Nigerian Propolis Activates the mTORC2/AKT Pathway and Suppresses Muscle Atrophy Genes Atrogin-1 and MuRF1 in Diabetic Rats
Objective: The study investigated the effects of Isosativan on the mTORC2/AKT pathway and diabetic muscle atrophy in a rat model of the disease. Material and Methods: Diabetes was induced by a high-fat diet and administration of a low-dose streptozotocin injection. The animals confirmed to be diabetic were subsequently treated with Isosativan (50 mg/kg) and their responses were evaluated based on muscle atrophy and body weight. Key biochemical pathways were assessed, particularly the mTORC2/AKT signaling pathway and the muscle atrophy genes Atrogin-1 and MuRF1, in order to determine the mechanism underlying the effects of this Isosativan. Results: Administration of Isosativan resulted in significant improvements in diabetic muscle atrophy. The treated rats exhibited increased levels of the mTORC2 and AKT proteins and maintained relatively higher body weights compared to untreated diabetic controls. The muscle atrophy-related genes, Atrogin-1 and MuRF1, were also significantly suppressed in the treated group. Conclusion: Isosativan shows promise as a therapeutic agent for combating diabetes and diabetic muscle atrophy, operating through the activation of the mTORC2/AKT pathway, thereby leading to better utilization of glucose. This finding suggests that Isosativan could be a viable treatment option for managing diabetes-related metabolic problems, offering a novel approach for therapeutic intervention in diabetic muscle atrophy.
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Mobility’s Impact on COVID-19 Cases in ASEAN: A Panel Data Regression Study
Objective: This study aimed to analyze the impact of community mobility on the Corona virus disease 2019 (COVID-19) cases in ASEAN countries using panel data regression. Material and Methods: The Google Mobility Report and World Health Organization (WHO) COVID-19 Global Data were analyzed from February 15, 2020, to October 13, 2022. Three distinct periods were examined: pre-vaccination, vaccination rollout, and post-herd immunity. Panel data regression models were employed to assess the impact of various mobility factors on daily COVID-19 cases. Results: The analysis revealed that mobility patterns significantly influenced COVID-19 case numbers during the pre-vaccination period. As vaccination programs progressed and herd immunity was achieved, the impact of mobility on new cases diminished. The models explained with R2 were between 20.15% and 33.33% of the variations in case numbers across the periods. Conclusion: This study emphasizes the importance of community mobility in COVID-19 transmissions. Effective vaccination strategies and public health measures are crucial in mitigating the impact of mobility on disease spread.
Long-Term Exposure to Bitters (A&Y) Exacerbates Inflammation in Wistar Rats: A Study on Male Renal Function
Objective: This study aims to evaluate the effects of long-term exposure to bitters (A&Y) on inflammation and renal functions in male Wistar rats. Specifically, the research focuses on assessing weight changes, lipid profiles, pro-inflammatory and anti-inflammatory markers, oxidative and anti-oxidative markers, renal function markers, electrolytes, and kidney histology. Material and Methods: Forty-nine male Wistar rats weighing between 160-180g were used for this study and were evenly divided into 7 groups (n=7): control (normal saline, 1ml), Y bitter low dose [YBL, 0.22 ml/kg], Y bitter average dose [YBA, 0.43 ml/kg], Y bitter high dose [YBH, 0.65 ml/kg], A bitter low dose [ABL, 0.22 ml/kg], A bitter average dose [ABA, 0.43 ml/kg] and A bitter high dose [ABH, 0.65 ml/kg] administered for 8 weeks. Biochemicals were assayed using enzyme-linked immunosorbent assays kits. Hematoxylin and eosin stains were used for kidney histology. Statistically significant values (p-value<0.05) were accepted. Results: The results of malondialdehyde, glutathione transferase, superoxide dismutase, catalase, creatinine, urea, and gamma glutamyl transferase significantly increased. The inflammatory cytokines like tumor necrotic factor, C-reactive protein, and interleukin-6 significantly increased, whereas the anti-inflammatory cytokine interleukin-1 significantly decreased in the bitters-treated groups. The histology results showed a progressive decrease in the glomerular count of the bitters treated groups. Conclusion: The findings of this study suggest that the arbitrary use of bitters has a significant negative impact on kidney health, leading to the development of glomerular nephritis and architectural changes in the renal tissue at a dose differential severity.
Effect of Board Games on the Social Skills Development of At-Risk Children with Attention Deficit Hyperactivity Disorder (ADHD) in Upper Elementary Schools in Thailand
Objective: This study investigated the impact of board games on social skills development among at-risk children diagnosed with attention deficit hyperactivity disorder (ADHD) in upper elementary schools in Thailand. Material and Methods: This quasi-experimental study involved at-risk students with ADHD from Wat Tham Nava School and Wat Puech Nimit School. Each group consisted of 44 students, selected based on the Student Behavior Assessment Scale. The sample size was calculated using G*Power software, with participants purposefully assigned to either the control group or the experimental group. The primary intervention was a board game program specifically designed to enhance social skills. Outcome evaluation tools included a social skills questionnaire and a social behavior interview. Data analysis was conducted using descriptive statistics, paired sample t-tests, and independent sample t-tests to assess the effectiveness of the intervention. Results: The experimental group demonstrated significantly higher social skills scores compared to the control group (p-value<0.001), with mean scores of 39.66±3.227 and 7.36±3.596, respectively, indicating the effectiveness of the board game program in enhancing the social skills of at-risk children with ADHD. Conclusion: These findings suggest that board game programs can effectively promote and cultivate social skills in children, providing schools and teachers with a valuable intervention strategy.
Study Protocol for a Single-center Randomized Clinical Trial: Evaluating the Effectiveness of Combined Therapy versus Conventional Therapy Approaches to Improve Physical & Behavioral Status among Children with Autism Spectrum Disorder
Objective: Currently, traditional Autism Spectrum Disorder (ASD) treatments include occupational therapy and speech and language therapy (SLT), however, physiotherapy has little evidence of efficacy. Hence, this study aims to compare physiotherapy, occupational therapy as well as speech and language therapy as need-based interventions for ASD patients with physical and behavioral deficits. Material and Methods: An assessor and participant blinded randomized clinical trial (RCT) was designed for 70 cases diagnosed with ASD, according to Diagnostic and Statistical Manual of Mental Disorders (DSM) V, from July 2024 to April 2025, with each being randomly assigned to either Group A or Group B. Participants of Group A will receive physiotherapy plus occupational therapy with SLT and group B will receive only occupational therapy plus speech and language therapy for 4 weeks. The outcome of this study will be physical status determined by modified SF-36 scores and behavioral status via GARS-3 scores. The study site will be Proyash (an Institute of Special Education), Jashore Area, Bangladesh. Study analysis will be conducted according to the nature of the data, and will include intention-to- treat analysis. Results: The results of this study are expected to determine that comprehensive multidisciplinary practices of ASD can advocate the benefits for children and adolescents with ASD, the parents, other stakeholders and special schools throughout Bangladesh. Conclusion: This study will address the research gap on the impact of the outcome of physiotherapy interventions, along with occupational therapy with SLT, on behavioral and physical status for the participants of ASD.
Comparing the Effectiveness of Colorimetric Reverse Transcription-Loop-Mediated Isothermal Amplification (SCoV-2 Detection Kit L1) with that of Reverse Transcription-Quantitative Polymerase Chain Reaction in SARS-CoV-2 Detection
Objective: To determine the diagnostic sensitivity and specificity of reverse transcription-loop-mediated isothermal amplification (RT-LAMP) compared to those of reverse transcription-quantitative polymerase chain reaction (RT-qPCR) for coronavirus disease 2019 (COVID-19). Material and Methods: A total of 382 nasopharyngeal swab samples obtained from 154 patients with COVID-19 were tested using RT-LAMP and RT-qPCR. The sensitivities and specificities of RT-LAMP were compared with those of RT-qPCR and analysed as a function of time from onset. Results: Up to the third day after onset, the RT-LAMP SARS-CoV-2 positivity was 68.33%, and the sensitivity and specificity compared to those of RT-qPCR were 100.0%. However, on the third day after onset, the RT-LAMP SARS-CoV-2 positivity decreased to less than 50%. The limit of detection for the RT-LAMP assay was log10 SARS-CoV-2 RNA 2.2 copies/reaction. RT-LAMP had the same diagnostic accuracy as RT-qPCR until day 9 after symptom onset. Conclusion: The findings suggest that RT-LAMP can be used as an alternative to RT-qPCR as a diagnostic tool for detecting COVID-19 during the acute symptomatic phase of COVID-19.
A Pilot Randomized Controlled Trial of a Non-pharmacological Smoking Cessation Program for Males with Chronic Obstructive Pulmonary Disease in Japan
Objective: Smoking cessation is considered the most reliable approach for preventing the worsening of chronic obstructive pulmonary disease (COPD). However, the majority of the previous studies on the effectiveness of non-pharmacologic smoking cessation support methods for people with COPD have been conducted in European and North American populations. This study aimed to fill a gap in the knowledge by focusing on the Japanese population. Material and Methods: This pilot randomized controlled trial included Japanese male participants aged above 50 years, diagnosed with COPD. Participants were allocated equally to the intervention group and the control group. The intervention group received a non-pharmacological cessation program developed in this study (twice online) in addition to outpatient smoking cessation at the collaborating institutions (5 visits in 12 weeks). The control group received only outpatient smoking cessation treatment at the collaborating medical institutions. Results: In total, 12 males (6 each in both groups) participated. No participants in the intervention group reported a tendency to smoke unconsciously, and none had resumed smoking. This suggests that the program was effective in helping participants maintain their motivation to quit smoking after the end of smoking cessation visits. Because of the small sample size, no statistically significant difference was observed in the smoking cessation rates between the 2 groups. However, the effect size between the 2 groups was large (Φ=0.517). Conclusion: The non-pharmacological cessation program developed in this study may be effective for males aged over 50 years with COPD in Japan.
Retrospective Evaluation of an Antimicrobial Stewardship Program in a Tertiary Care Hospital: A Pharmacist’s Perspective
Objective: This study aimed to evaluate the impact of antimicrobial stewardship (AMS) programs by analysing the dose appropriateness, antibiotic consumption, surgical prophylaxis compliance, drug selection, and de-escalation of antibiotic therapy based on culture and sensitivity reports. Material and Methods: A retrospective evaluation of data from medical records and antibiotic consumption in the departments of medicine, surgery, paediatrics, and orthopaedics at a tertiary care hospital from November 2021 to February 2022 was conducted. Through coding, the data entered on the pre-designed proforma were converted into statistical variables. Results: Total overall consumption, daily defined dose, of antibiotics decreased from 412.49 grams (g) to 391.60 g (p-value=0.540, confidence interval [CI]=-10.12–17.08). The percentage of antibiotics prescribed was reduced from 61% to 58%, the average duration of antibiotics per patient was reduced from 4.3 days to 3.7 days, and days of therapy was reduced from 399 to 302 (p-value≤0.001, CI=-465.57–353.24). The time compliance of surgical antibiotic prophylaxis was improved from 95.65% to 99.09% (p-value=0.063, CI=-5.256–0.256). Periodically updated, cumulative hospital antibiogram and antibiotic treatment guidelines were functional, culture and sensitivity-based dosage adjustments were practised in the facility. Conclusion: A well-run AMS program helps hospitals in promoting compliance with antibiotic prescribing guidelines, preventing antimicrobial resistance by decreasing unnecessary antibiotic use.
Factors Influencing Retention of Medical Graduates in the Health System: A Study from The First Collaborative Project to Increase Production of Rural Doctors (CPIRD) in Thailand
Objective: To identify the factors affecting doctor retention in the public health system. Material and Methods: This cross-sectional study surveyed 426 doctors who graduated from Prapokklao Hospital (1976-2018). Data collected included: (1) Basic information (gender, age, resignation age, service length, medical program); (2) Personal factors (income, work hours, shifts, patient load, education, position); (3) Psychological factors (job satisfaction, pride); (4) External factors (relationships, welfare, culture, risks). Statistical analysis involved t-tests, Chi-square tests, and logistic regression to adjust for biases. Results: Continuing in a residency program significantly increased retention in the public health service (odds ratio=7.14, 95% confidence interval=4.72, 10.81, p-value<0.05). Conclusion: Residency training is a key factor for enhancing doctor retention in the public health system.
Synergistic Wound Healing Effects of Hibiscus rosa-sinensis and Centella asiatica Extracts Combination (HRSCA): in vivo and 3D Organotypic Models
Objective: Hibiscus rosa-sinensis and Centella asiatica are medicinal plants used as an alternative therapy for wound healing, and many studies have reported evidence of their effectiveness in treating wounds. This study aimed to evaluate the histological and molecular changes observed in the healing properties of a Hibiscus rosa-sinensis and Centella asiatica extracts combination (HRSCA) on wounds. Material and Methods: Twenty-four rats were randomly divided into 4 groups (untreated, 10% Povidone-Iodine solution; 5.0% and 10.0% HRSCA). The excisional wounds were inflicted using a tissue biopsy punch and treated once daily for 14 days. The wound healing properties and tensile strength test were measured. A 3D organotypic skin model using human keratinocytes and human dermal fibroblast cell lines in a collagen type 1 scaffold was developed to further evaluate the wound healing properties. Full-thickness wound was induced and was either treated with 5% HRSCA or left untreated. qRT-PCR was used to evaluate the affected genes involved in the wound healing pathway. Results: The in vivo model showed no significant differences in tensile strength between groups. However, HRSCA treatment significantly enhanced wound healing. The 3D assay revealed HRSCA modulated genes like COL53A, CSF2, CXCL11, CXCL5, IL6ST, ITGA5, PLAT, and WISP1. Conclusion: HRSCA enhanced wound closure in in vivo and 3D organotypic skin models, potentially through several pathways, such as inflammatory as well as extracellular matrix and adhesion pathways. The findings from this study provide substantial evidence regarding the wound healing potential of HRSCA.
Dosage Form of Moisturizer Gel and Evaluation of Antibacterial, Anti-inflammatory, Antioxidant of Erythrina crista-galli L. Flowers Extract
Objective: This study aimed to determine the antioxidant, antibacterial, and anti-inflammatory activities of ethanol extracts from red Dadap flowers (Erythrina crista-galli L). In addition to formulate the extract into a moisturizing gel preparation of good physical quality. Material and Methods: Antioxidant activity was determined using a 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging capacity assay. Antibacterial activity was evaluated using the disc diffusion method. Anti-inflammatory activity was evaluated using carrageenan-induced paw edema in mice in vivo. Additionally, in silico studies were performed and the physical quality of the extract-gel formulation was evaluated. Results: Antioxidant testing resulted in a half-maximal inhibitory concentration (IC50) value of 79.1 ppm and an AAI value of 0.4. Antibacterial testing obtained the largest inhibition zone, with an average of 9.0 mm. Anti-inflammatory testing obtained the greatest anti-inflammatory effect at a dose of 300 mg/kg body weight in mice, with a percentage of inflammation inhibition that reached 59.32%. In silico testing, the smallest binding affinity values were obtained: respectively, at -10.3, -12.0, and -10.2 kcal/mol, by the specific compound Cyanidin-3-O-glucoside. Physical quality evaluation obtained values that are in accordance with the Indonesian National Standard. Conclusion: Ethanol extract of red Dadap flower (Erythrina crista-galli L.) has antioxidant and antibacterial activity in the weak category; however, in contrast it has anti-inflammatory activity in the strong category. In silico also obtained good activity in accordance with the results of in vivo testing. Erythrina crista-galli L. flower extract can be formulated into a moisturizer gel, this can be seen from the results of good physical stability.
An Accuracy Study of Defibrillator Performance Measurement at Songklanagarind Hospital, Thailand
Objective: To assess and validate the accuracy and reliability of key parameters. The performance of manual external defibrillators (MEDs) at Songklanagarind Hospital was evaluated. Material and Methods: This study sampled 60% of the defibrillators from various departments and brands within the hospital. Key performance parameters, including delivered energy output, charge time, and synchronized time, were evaluated against the specified tolerance limits outlined by manufacturer specifications and industry standards. The accuracy of delivered energy was assessed by integrating absolute error and %relative error, along with expanded uncertainty (U(E)). The acceptable charge time was defined as not exceeding 15 seconds, while the discharge in synchronized mode was required to occur within 60 milliseconds. Results: The findings demonstrated that all the tested models showed a high degree of accuracy in delivered energy. Additionally, the mean charge time for all defibrillators followed the 15-second threshold established by both manufacturer specifications and universally recognized standards. Furthermore, the synchronized shock delivery capability of all 3 defibrillator models successfully met the critical 60-millisecond timeframe essential for clinical efficacy. These validated results confirm that the evaluated parameters consistently fell within acceptable ranges, thereby substantiating the reliability of these models in assessing defibrillator performance. Conclusion: These findings emphasize the significance of assessing the reliability and accuracy of the MEDs through calibration techniques for continuous monitoring and regular maintenance. These devices are imperative to guarantee adherence to the prescribed standards before medical practice.
Impact of Smear Layer Removal Protocols on Color Dynamics and Dentin Hardness Following Intracoronal Bleaching
Objective: This study evaluated the impact of smear layer removal protocols on intracoronal bleaching outcomes, focusing on color shifts and dentin hardness. Material and Methods: Artificially stained human premolars underwent dentin surface treatments: distilled water, 17% EDTA, and 37% phosphoric acid (PA) before intracoronal bleaching with sodium perborate. Control teeth received no treatment. Tooth color and dentin hardness were measured at 7, 14, and 21 days post-bleaching with a VITA Easyshade spectrophotometer and Vickers hardness tests, respectively. Statistical analysis included Shapiro-Wilk and Levene’s tests, and two-way repeated ANOVA with Tukey’s HSD for shade and microhardness comparison (α=0.05). Results: All the bleaching treatments effectively lightened teeth, with the most pronounced color change (ΔE00) observed after the first week. This was followed by a significant decrease in intensity during the second and third weeks. Color metrics showed reduced redness (a* values) and increased yellowness (b* values) across all the groups, with no significant differences in color change or dentin hardness between the treatments (p-value>0.05). However, a notable decrease in dentin hardness was observed in the cervical sections compared to the coronal sections in all the groups (p-value<0.05). Conclusion: Smear layer removal with 37% PA or 17% EDTA did not significantly improve bleaching efficacy or affect dentin hardness. These findings support streamlined treatment protocols that omit smear layer removal without compromising clinical outcomes.
The Modulatory Effects of Pinocembrin from the Nigerian Propolis on IL-6, IL-1β, and Adipokines in Rats with Chronic Glucose and Fructose Administration
Objective: The study investigated the effects of pinocembrin on cytokines and the adipokines associated with metabolic disturbances that arise from prolonged sugar intake. Material and Methods: Twenty-four male Wistar rats were divided into 4 groups: control, glucose/fructose administration, glucose/fructose administration plus pinocembrin treatment, and glucose/fructose administration plus metformin treatment. The control group was administered distilled water orally, while the glucose/fructose group received an oral sugar solution comprising 30% glucose and 20% fructose. The pinocembrin and metformin treatment groups were given the same sugar solution, but received either pinocembrin or metformin as an additional component, respectively. Administration continued for 8 weeks, after which blood samples were collected for biochemical analysis. Results: Chronic administration of glucose and fructose led to the dysregulation of adipokines and inflammatory markers, hyperinsulinemia and hyperglycaemia. However, treatment with pinocembrin significantly mitigated these metabolic and inflammatory alterations. Conclusion: The findings suggest that the prophylactic use of pinocembrin from the Nigerian propolis has the potential to modulate glucose and lipid metabolism, as well as inflammatory pathways, thereby preventing sugar-induced metabolic disturbances.
Validity and Reliability of a Thai-Translated Malnutrition Screening Tool in an Outpatient Setting: A Comparison with the GLIM Criteria
Objective: The malnutrition screening tool (MST) has been widely validated for detecting malnutrition in various countries. However, its applicability in Thai outpatient settings remains unexplored. This study aimed to translate the MST into Thai and assess its validity and reliability compared to the global leadership initiative on malnutrition (GLIM) criteria. Material and Methods: A cross-sectional study was conducted at a tertiary care hospital, including 248 participants. Nutritional status was evaluated using the Thai-translated MST (T-MST), mini nutritional assessment-short form (MNA-SF), and GLIM criteria, which included bioelectrical impedance analysis for muscle mass assessment. Sensitivity, specificity, area under the receiver operating charateristic curve (ROC-AUC), test-retest reliability, inter-rater reliability, and internal consistency (item-total score correlation and Cronbach’s alpha) were analyzed to assess the MST’s performance relative to the GLIM criteria. Results: The Thai version of the MST demonstrated excellent test-retest reliability (intraclass correlation coefficient [ICC]=0.976, p-value<0.001) and inter-rater reliability (ICC=0.917, p-value<0.001). It showed strong agreement with the GLIM criteria (Kappa=0.843), comparable to the MNA-SF (Kappa=0.834). Internal consistency was satisfactory (Cronbach’s alpha=0.794). The T-MST achieved a sensitivity of 86.5% and specificity of 96.0%, while the MNA-SF showed a sensitivity of 93.2% and specificity of 93.1% against the GLIM criteria. Both tools demonstrated excellent predictive accuracy (ROC-AUC: T-MST=0.907, MNA-SF=0.929). Conclusion: The T-MST is a reliable and efficient tool for malnutrition screening in outpatient settings. Its simplicity and ease of use make it particularly valuable in time-constrained environments. However, ongoing validation across diverse populations and settings is essential to ensure consistent performance across different clinical contexts.
Negotiations on Drug Prices in China and Health Insurance Sustainability: Retrospective and Future Trends
Objective: This study examines the drug price negotiation process in China from 2017 to 2023, with a particular focus on its impact on drug pricing, especially for innovative therapies, and its influence on healthcare affordability and the sustainability of the health insurance system. Material and Methods: Data were sourced from public reports and official announcements by the National Healthcare Security Administration (NHSA). A mixed-method approach was employed, combining quantitative analysis of price reductions, success rates, and healthcare expenditure with qualitative insights into policy challenges, focusing on high-cost treatments like oncology drugs and innovative therapies. Results: From 2017 to 2023, price negotiations led to average reductions of 50-62%, with oncology drugs experiencing a maximum price reduction of 94%. The efficiency of negotiations improved significantly, with a success rate of 85% by 2023. These reductions enhanced access to costly treatments, particularly cancer therapies, but rising demand for innovative treatments continued to strain the healthcare budget. The inclusion of more high-cost therapies in the National Reimbursement Drug List (NRDL) further contributed to the growth in expenditure. Additionally, the proportion of domestically produced drugs in negotiations increased from 39% in 2021 to 69% in 2023, reflecting efforts to enhance self-sufficiency. Conclusion: Negotiations on drug prices in China have effectively reduced drug prices and improved access to critical therapies, such as innovative and life-saving treatments. However, ongoing demand for innovative treatments poses challenges to the financial sustainability of the health insurance system. Further improvements in value-based pricing and regulatory frameworks are needed to maintain affordability and foster innovation.
Mobile App Engagement and Effective Weight Management
Objective: This study aimed to investigate the relationship between mobile application engagement and lifestyle outcomes, specifically physical activity and dietary habits, during a 36-day virtual competition designed to promote healthier behaviors, including increased physical activity and adherence to a plant-based, whole-food diet. Material and Methods: A secondary data analysis of the ThaiSook prospective cohort study was conducted. Participants were divided into 2 groups based on their engagement with the mobile application: “High-engagement Users” (>50% of challenge days) and “Low-engagement Users” (<50% of challenge days). Results: Among 154 participants (74.7% female; mean age 39.1±10.7 years; median body mass index 23.1 kg/m²), “High-engagement Users” (n=97) had significantly higher average daily step counts (4,921.64±5,721.22 steps) compared to “Low-engagement Users” (n=57) (3,508.81±4,270.00 steps, p-value<0.001). Similarly, High-engagement Users had longer average daily workout durations (35.55±49.59 minutes) than Low-engagement Users (14.14±34.29 minutes, p-value<0.001). High-engagement Users also achieved greater weight loss, with a mean reduction of −0.77 kg. Multiple logistic regression revealed that using the application for more than 18 days was significantly associated with weight loss, with an adjusted odds ratio of 3.64 (p-value=0.017). Conclusion: High engagement with a mobile application is positively associated with improved physical activity and weight loss outcomes. These findings underscore the potential of mobile health applications to drive healthier lifestyle behaviors, highlighting the critical role of consistent usage.
Prediction of Regional Lymph Node Metastasis from the Clinicopathological Features of Breast Carcinoma: Application of Deep Learning
Objective: Breast cancer is the leading cause of cancer-related mortality in women globally, with invasive ductal carcinoma (IDC) as the predominant subtype. Regional lymph node (LN) metastasis significantly impacts prognosis, staging, and treatment strategies. However, the role of deep learning in predicting LN metastasis is underexplored. To develop and evaluate a deep learning model leveraging clinicopathological features for predicting LN metastasis in IDC patients, with an aim to enhance diagnostic accuracy and reduce reliance on invasive methods. Material and Methods: A cross-sectional study was conducted on 351 IDC cases from a tertiary-care hospital. Input variables included clinicopathological features: age, tumor size, modified Bloom-Richardson grade, ER, PR, HER2 receptor status, Ki-67 index, and microvessel density (MVD). LN status was dichotomized using a cut-off ratio of 0.3. A neural network model with an input layer of 8 neurons, 3 hidden layers (50 neurons each), and ReLU activation was developed. Data were split into training (70%) and test (30%) sets. Predictive accuracy was evaluated using standard performance metrics. Results: The mean age was 46.4±11.29 years and tumor volume averaged 44.9 cm³. Low ER (35.6%) and PR (26.8%) positivity rates were observed, with HER2 positivity at 21.7%. The model achieved 78.3% accuracy in predicting LN metastasis. The F1 score of the model was 0.83. Conclusion: The study demonstrates the utility of deep learning models in predicting LN metastasis using clinicopathological data. With 78.3% accuracy, the model highlights AI’s potential in oncology diagnostics, supporting personalized treatment approaches. Further integration of imaging and molecular data could enhance model performance and clinical applicability.
In Vitro Study of the Effects of Postbiotic Mouthwash Prototype with Cannabis Extracts on the Reduction of Inflammatory Cytokine: Tumor Necrosis Factor Alpha
Objective: This study evaluated the effects of postbiotic mouthwash containing cannabis extracts (CBD) on the reduction of tumor necrosis factor alpha (TNF-α) levels in vitro. Material and Methods: Seven mouthwash formulations were prepared using CBD at concentrations ranging from 0.25% to 1.0% v/v. TNF-α reduction was assessed using a lipopolysaccharide (LPS) model to activate the THP-1 human monocytic cell line (ATCC, TIB202). The enzyme-linked immunosorbent assay (ELISA) technique was employed to quantify TNF-α. Results: All formulations reduced TNF-α levels compared to the control. The most effective formulations (Preparations 1–4) achieved approximately 91% inhibition. Formulations 5–7 showed inhibition levels of 49.3%, 80.9%, and 82.5%, respectively. Conclusion: The postbiotic mouthwash containing CBD effectively reduced TNF-α levels, indicating its potential for clinical application in inflammation management.
Risk Factors of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux
Objective: Vesicoureteral reflux (VUR) is a significant risk factor for urinary tract infections (UTI) in children, potentially leading to renal damage. Antibiotic prophylaxis is essential for the pediatric patients with VUR aiming to reduce the chance of UTI. However, breakthroughs UTI can occurred despite adequate prophylactic antibiotics. We aimed to identify the factors contributing to breakthrough UTIs in the patients with VUR. Material and Methods: This retrospective study analyzed medical records from 238 children with primary VUR from 2000-2019. This study included children aged less than 10 years old at the time of VUR diagnosis and excluded those with secondary VUR, incomplete medical records, or lost to follow-up. Univariate and multivariate analyses were utilized to determine the predictors of breakthrough UTIs. Results: This study comprised 238 children diagnosed with VUR, including 133 males and 105 females; 86 patients experienced a breakthrough infection. Multivariate analysis revealed that each additional UTI before prophylactic antibiotics significantly increased the likelihood of breakthrough infections (OR 1.62; 95% CI 1.10-2.37; p-value=0.013). Upper pole renal scarring and generalized abnormal renal scans were also significant risk factors with OR 5.57; 95% CI (2.16-14.40); p-value<0.001 and OR 5.19; 95% CI (1.36-19.75); p-value=0.016, respectively. Bowel bladder symptoms emerged as a substantial risk factor (OR 30.16; 95% CI 1.43-633.86; p-value=0.028), whereas the use of cephalexin appeared protective (OR 0.22; 95% CI 0.05-0.94; p-value=0.042). Conclusion: The number of UTIs before prophylaxis antibiotics, abnormal renal scan at the upper pole and generalized kidney and bowel bladder symptoms were independent risk factors for breakthrough infections. Moreover, the study showed that the use of cephalexin was a statistically significant protective factor against breakthrough UTI.
Anti-thromboinflammation of Triherbal Extract in Diabetic Rats
Objective: To evaluate the effects of a blended aqueous extract of Moringa oleifera, Ocimum gratissimum, and Vernonia amygdalina on some markers of thromboinflammation in diabetic rats. Material and Methods: We administered 150 mg/kg body weight of the individual extracts and the blended extract (1:1:1) to diabetic induced rats for 28 days. Acute toxicity of the extracts were determined by the Lorke technique while the markers of thromboinflammation, involving platelet count, mean platelet volume, platelet distribution width, plateletcrit, platelet large cell ratio, absolute white blood cell, lymphocytes, neutrophils, monocytes, basophils and eosinophils, were determined as part of the complete blood count using an automated hematology analyzer. Results: The LD50 of both the individual and blended extracts were observed to be above 5,000 mg/kg body weight. There was a significant increase in the serum glucose and markers of thromboinflammation involving the total white blood cell count, neutrophil count, platelet count, plateletcrit, mean platelet volume, platelet distribution width and the platelet large cell ratio, but a decrease in the lymphocyte and eosinophil count for the diabetic non-extract treated rats. The diabetic rats treated with the blended extract showed a significant restoration of the parameters. Conclusion: This study revealed that the blended aqueous extracts of Moringa oleifera, Ocimum gratissimum, and Vernonia amygdalina are non-toxic and may have synergistic effects in limiting thromboinflammation in a diabetic state.
Anion Gap is a Predictor of Elevated Serum Lactate in Patients Diagnosed with Sepsis without Shock in the Emergency Department
Objective: To determine whether high anion gap levels predict increased serum lactate >2 mmol/L, and to determine the best AG cut-off point for predicting serum lactate levels greater than 2 mmol/L and greater than 4 mmol/L. Material and Methods: This is a retrospective study among patients with sepsis without shock admitted to the emergency department of a tertiary care, university hospital. Anion gap and serum lactate were collected. Patients’ baseline characteristics and laboratory results were also incorporated to calculate the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score. Analysis of diagnostic accuracy and Receiver Operator Characteristics (ROC) was used to demonstrate the appropriate cut-off point of the anion gap for predicting serum lactate >2 mmol/L. Results: The study included 236 patients. Anion gap >12 mmol/L had a sensitivity of 93.3% (95%CI 88.2-96.6%) and a specificity of 13.7% (95%CI 6.8-23.8%) for predicting serum lactate >2 mmol/L. There was poor discriminative performance of the anion gap to predict serum lactate >2 mmol/L (area under ROC is 0.65; 95%CI 0.58-0.72). In contrast, there was good discriminative performance of the anion gap to predict serum lactate >4 mmol/L (area under ROC 0.83; 95%CI 0.77-0.88). The optimal cut-off point was anion gap > 18 mmol/L, which was good for predicting serum lactate >4 mmol/L. Conclusion: An anion gap >12 mmol/L is not suitable for assessing lactate >2 mmol/L; however, an anion gap >18 mmol/L can predict serum lactate >4 mmol/L in patients with sepsis who had mean arterial pressure (MAP) >65 mmHg.
Isosativan from Nigerian Propolis Modulates AMP-activated Protein Kinase, Glucose-6-Phosphatase and Lipoprotein Lipase levels in Rats with Insulin Resistance
Objective: This study investigated the effects of isosativan, a bioactive compound isolated from Nigerian propolis, on the activities of key metabolic regulators, including AMP-activated protein kinase (AMPK), glucose-6-phosphatase (G6Pase), and lipoprotein lipase (LPL), in an animal model of insulin resistance. Material and Methods: Male Wistar rats were fed a high-fat diet and fructose solution for 8 weeks to establish an animal model of insulin resistance. Eighteen of the animals were sorted into 3 groups: the insulin-resistant group, the isosativan group, and the metformin group, while a fourth group of 6 healthy rats served as the control group. The isosativan treatment group received daily oral administration of isosativan for 4 weeks, while the metformin group served as a positive control. Plasma glucose, insulin, and lipid profiles were measured, and the activities of AMPK, glucose-6-phosphatase in the liver, and lipoprotein lipase in the adipose tissue were assessed. Results: Compared to the control group, the insulin-resistant group showed significantly increased fasting plasma glucose and homeostatic model assessment of insulin resistance (HOMA-IR) levels. The high-fat diet and fructose consumption also disturbed the lipid profile. Treatment with isosativan improved insulin resistance and modulated the altered activities of AMPK, glucose-6-phosphatase, and lipoprotein lipase in insulin-resistant rats, indicating its potential and probable mechanism of improving glucose and lipid homeostasis. Conclusion: Isosativan, a compound isolated from Nigerian propolis, demonstrated the ability to modulate key metabolic regulators involved in insulin resistance, suggesting its therapeutic potential for managing metabolic disorders.
Cross-Cultural Adaptation and Psychometric Properties of the Thai Version of the Modified COVID-19 Yorkshire Rehabilitation Scale in Individuals with Long COVID
Objective: To translate and cross-culturally adapt the modified coronavirus disease 2019 (COVID-19) Yorkshire Rehabilitation Scale (C19-YRSm) into a Thai version, and assess its psychometric properties in individuals with long COVID. Material and Methods: The C19-YRSm underwent translation and cross-cultural adaptation to produce a Thai version. Its 2 subscales, symptom severity and functional ability, were examined using confirmatory factor analysis (CFA). In instances where the results were deemed unfit, alternative factor structures were explored through exploratory factor analysis (EFA). After that, internal consistency and test-retest reliability were calculated at 2-day intervals. Construct validity was assessed by examining correlations between the Thai version of the 36-item Short Form Health Survey questionnaire (Thai SF-36) and the Thai Fall Efficacy Scale-International (Thai FES-I). Results: The study sample comprised 338 individuals with long COVID. The results of the CFA indicated a poor fit. Subsequent evaluation using EFA revealed that the symptom severity and functional ability subscales were rearranged into 3 new subscales: major symptoms, minor symptoms, and functional ability. Internal consistency was found to be good to excellent (Cronbach’s alpha: 0.77-0.90). Test-retest reliability for all subscales of the Thai C19-YRSm demonstrated high consistency (intraclass correlation coefficients (ICC(2,1)): 0.88-0.95). Convergent validity showed moderate to strong correlations with the Thai SF-36, while discriminant validity, compared to the FES-I, showed fair to poor correlations. Conclusion: The vigorous psychometric properties of the questionnaire make it highly suitable for cross-cultural research, enabling the assessment of long COVID severity among Thai individuals in clinical and research settings.
Eight Weeks of Plyometric Training for a Professional Volleyball Athlete Four Months Post-Knee Arthroscopy and Bone Repair: A Case Report
Knee surgery can significantly diminish muscle strength, power, and vertical jump performance in athletes, particularly in volleyball athletes. Plyometric exercises are well-established for their efficacy in enhancing these physical attributes. This case report aimed to demonstrate the application of an 8-week plyometric exercise program to improve knee muscle strength, power, and vertical jump performance in a 20-year-old professional volleyball athlete, 4 months post-arthroscopic removal and repair of left knee osteophytes during the return-to-sport phase. The athlete, who was pain-free and had full knee range of motion at the program’s start, showed significant gains: quadriceps and hamstring strength increased by 42%-116% in the left knee and 31%-78% in the right knee, with power output rising up to 400%. Vertical jump performance also improved notably. These results suggest that plyometric training can effectively boost recovery and performance in athletes following knee surgery.
A Review of Genetic Alteration Correlated with Primary and Acquired Resistance to EGFR-TKIs in EGFR-Mutant Non-Small Cell Lung Cancer
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) significantly enhance both survival and quality of life for non-small cell lung cancer (NSCLC) patients with EGFR mutations. Nevertheless, an increasing number of patients exhibit primary or acquired resistance. Currently, discoveries of concurrent genetic alterations in EGFR and other genes besides EGFR have been made. Several studies have demonstrated an association between these alterations and resistance to EGFR-TKI. Therefore, it is crucial to gain more understanding of gene alterations and their impact on the effectiveness of EGFR-TKI treatment. In this review, concurrent gene alterations that can predict primary and acquired resistance to EGFR-TKIs in advanced NSCLC are discussed. This may assist clinicians in selecting the appropriate treatment for patients who have failed to respond to EGFR-TKIs.