Search Results (181)

Fragile X syndrome (FXS) is the most common form of X-linked intellectual disability (ID). This study aimed to share 30 years of experience in diagnosing FXS and determine its frequency in Thailand. We retrospectively reviewed 1480 unrelated patients (1390 males and 90 females) with ID, developmental delay, or autism spectrum disorder, or individuals referred for FXS DNA testing at Songklanagarind Hospital, Thailand, over a 30-year period. The samples were analyzed using cytogenetic methods, PCR-based techniques, and/or Southern blot analysis. Full mutations (>200 CGG repeats) were identified in 100 males (7.2%) and three females (3.3%). An intermediate allele was detected in one male, while no premutation was found in the index cases. Two males were suspected to have FMR1 gene deletions. Twelve families underwent prenatal testing during this study. Most families undergoing prenatal FXS diagnosis involved mothers who were premutation carriers and had given birth to children affected by FXS. This study represents the largest series of molecular genetic FXS testing cases reported in Thailand. The frequency of FXS identified in different cohorts of Thai patients across various periods was approximately 7%. This study enhances public awareness of at-risk populations and highlights the importance of prenatal testing and genetic counseling for vulnerable families. Full article

Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients’ anxiety was assessed using the State–Trait Anxiety Inventory—State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025. Full article

Background and Objectives: Thailand’s demographic shift toward an aging population increases vulnerability among older adults to the long-term mental health effects of childhood trauma. While childhood adversity is linked to heightened risks of late-life depression and PTSD, the moderating role of resilience remains underexplored in Thai older adults. This study investigated whether resilience moderates the association between childhood trauma and depressive or PTSD symptoms in this population. Materials and Methods: A cross-sectional survey was conducted with 201 older patients (mean age 68.6 years) from the Family Medicine and Geriatric Psychiatry Clinics at Maharaj Nakorn Chiang Mai Hospital. Participants completed validated measures on trauma history, resilience, depression, and PTSD symptoms. A moderation analysis was performed, adjusting for covariates including education, family support, and psychiatric history. Results: The findings revealed that resilience significantly buffered the impact of childhood trauma on depression but did not mitigate PTSD symptoms. Conclusions: These results underscore the protective role of resilience against depression following childhood trauma in older adults, yet also point to its limitations in alleviating trauma-specific responses such as PTSD. This study highlights the need for trauma-informed geriatric mental health strategies and calls for further research on resilience, focusing on cultural context and adaptive mechanisms, including emotion regulation and social connectedness, in older populations. Full article

(1) Background: Wilms’ tumor (WT) is the most common pediatric renal malignancy. Although survival outcomes have improved with multimodal therapy, the optimal sequence of surgery and chemotherapy remains debated, particularly in resource-limited settings. This study evaluates the effect of treatment strategy on surgical complications and survival, utilizing two decades of data from Thai tertiary centers. (2) Methods: A retrospective cohort study was conducted on 83 children who underwent radical nephrectomy for WT between 2002 and 2022 at two university hospitals in Thailand. Patients were grouped by treatment protocol: primary nephrectomy (n = 59) or neoadjuvant chemotherapy (n = 24). Clinical, pathological, operative, and follow-up data were analyzed to identify predictors of surgical complications and survival. (3) Results: Short-term postoperative complications occurred in 16.9% of cases, more frequently in males and in patients with hypoalbuminemia, anemia, or large tumors. Estimated blood loss greater than 5 mL/kg, serum albumin less than 3.5 g/dL, and hemoglobin lower than 10 g/dL were independent predictors of complications. The five-year overall survival (OS) and progression-free survival (PFS) rates were 82.4% and 68.1%, respectively. Patients with unfavorable histology or short-term complications experienced significantly poorer OS. Neoadjuvant chemotherapy was associated with increased nutritional compromise and a trend toward higher complication rates, although it was not directly linked to inferior OS. (4) Conclusions: In pediatric WT, the perioperative nutritional and hematologic statuses significantly influence surgical outcomes. While neoadjuvant chemotherapy may assist in tumor downsizing, it might also compromise surgical fitness. Customized preoperative risk assessment and nutritional support can enhance outcomes, particularly in low- and middle-income countries. Full article

Background/Objectives: Misinformation significantly impacts self-care behaviors and treatment outcomes in patients with type 2 diabetes mellitus (T2DM). We investigated the prevalence and content of diabetes-related misinformation among Thai patients with T2DM, examining the influence on cognitive attitudes and intentions to share such information. Methods: We employed a mixed-methods approach, conducting initial qualitative interviews with healthcare professionals and patients with T2DM to identify key misinformation themes. These themes guided the development of a validated questionnaire that was distributed to 107 patients with T2DM. Spearman’s correlation and multiple linear regression analyses were used to assess the relationships between misinformation exposure, attitudes, and sharing intentions. Results: Misinformation was categorized into four domains: medication side effects, alternative treatments, imbalanced lifestyle, and symptom perception. Exposure to misinformation ranged from 19.6% to 94.4%, with word of mouth identified as the primary source (81.18%). Misconceptions regarding symptom perception and alternative treatments were most prevalent. Information source, especially healthcare providers (β = 0.4); personal attitudes towards misinformation (β = 0.24); and exposure level (β = 0.46) significantly influenced the intention to share misinformation. Conclusions: This study highlights the need for targeted educational interventions to address widespread misconceptions in the management of T2DM, particularly those related to symptom perception and alternative treatments. Addressing these misinformation sources may be associated with improved self-management practices and could inform strategies aimed at enhancing patient outcomes. Full article

Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely clinical decision-making but also for timely diagnosis and promoting appropriate antibiotic use. Methods: This cross-sectional study analyzed 475 adult patients with suspected sepsis who presented to the emergency department of a Thai community hospital, using retrospective data from January 2021 to December 2022. Six screening tools were evaluated: Systemic Inflammatory Response Syndrome (SIRS), Quick Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), National Early Warning Score version 2 (NEWS2), and Search Out Severity (SOS). Diagnostic accuracy was assessed using International Classification of Diseases, Tenth Revision (ICD-10) codes as the reference standard. Performance metrics included sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (AUROC) curve, all reported with 95% confidence intervals. Results: SIRS had the highest sensitivity (84%), while qSOFA demonstrated the highest specificity (91%). NEWS2, NEWS, and MEWS showed moderate and balanced diagnostic accuracy. SOS also demonstrated moderate accuracy. Conclusions: A two-step screening approach—using SIRS for initial triage followed by NEWS2 for confirmation—is recommended. This strategy enhances nurse-led screening and optimizes limited resources in emergency care. Early sepsis detection through accurate screening tools constitutes a feasible public health intervention to support appropriate antibiotic use and mitigate antimicrobial resistance, especially in resource-limited community hospital settings. Full article

Background: Melasma is an acquired hyperpigmentation disorder with multifactorial etiologies and limited response to conventional therapies. Recent evidence suggests that Botulinum Toxin A (BoNT-A) may modulate ultraviolet (UV)-induced pigmentation and offer therapeutic benefits. Objective: We sought to evaluate the efficacy and safety of two intradermal dilutions of Letibotulinum toxin A (LetiBoNT-A) in Thai patients with melasma. Methods: In this randomized, double-blind, split-face study, 30 participants aged 32–62 years received a single intradermal injection of LetiBoNT-A, with 20 units administered per cheek. A 1:5 dilution was injected on one side of the face, and a 1:10 dilution was injected on the contralateral side. Outcomes were evaluated over a 6-month period using the Hemi-modified Melasma Area and Severity Index (Hemi-mMASI), VISIA^® brown spot analysis, and quantitative assessments of skin texture. Results: Both dilutions significantly improved Hemi-mMASI scores (1:5, p = 0.043; 1:10, p = 0.002) and brown spots (1:5, p = 0.002; 1:10, p < 0.001). The 1:10 dilution showed earlier and more sustained improvements. Subgroup analysis revealed greater reductions in Hemi-mMASI scores among patients with telangiectatic melasma, particularly with the 1:10 dilution, though they were not statistically significant. Additionally, the 1:10 dilution significantly reduced pore volume, pore area, and sebum levels. One case of transient facial asymmetry was reported with the 1:5 dilution. Conclusions: LetiBoNT-A is a safe and effective adjunct in melasma treatment. The 1:10 dilution offered superior clinical outcomes. Full article

Background/Objectives: The influence of single-nucleotide polymorphisms (SNPs) on hepatocellular carcinoma (HCC) in terms of etiological factors remains to be explored. This study evaluated the distribution of PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs6834314 and overall survival of HCC patients with metabolic dysfunction-associated steatotic liver disease (MASLD-HCC) and viral-related HCC (VIRAL-HCC). Methods: This study included 564 patients with HCC: 254 with MASLD-HCC and 310 with VIRAL-HCC. The SNPs were determined by real-time PCR using TaqMan assays. Results: The mean ages of patients with MASLD-HCC and VIRAL-HCC were 68.4 vs. 60.9 years (p < 0.001), with a significant difference between groups. The prevalence of PNPLA3 GG genotype in MASLD-HCC was significantly higher in MASLD-HCC than in VIRAL-HCC (24.0% vs. 15.5%, OR = 1.86, 95% CI = 1.14–3.05, p = 0.009). Similarly, the prevalence of TM6SF2 TT genotype in MASLD-HCC and VIRAL-HCC was 7.1% vs. 2.6% (OR = 3.39, 95% CI = 1.36–9.21, p = 0.003), while HSD17B13 GG genotype in the corresponding groups was 7.1% vs. 12.6% (OR = 0.53, 95% CI = 0.27–1.01, p = 0.039). The overall median survival of MASLD-HCC was significantly shorter than that of the VIRAL-HCC group (42 vs. 66 months, p = 0.035). In Cox regression hazard analysis, HSD17B13 GG genotype was significantly associated with a lower mortality rate in MASLD-HCC (HR = 0.38, 95% CI = 0.18–0.81, p = 0.011). In contrast, PNPLA3 and TM6SF2 were not associated with overall survival in patients with MASLD-HCC or VIRAL-HCC. Conclusions: Our data demonstrated that the prevalence of the SNPs significantly differed between MASLD-HCC and VIRAL-HCC. The HSD176B13 GG genotype was also associated with a survival benefit in Thai patients with MASLD-HCC. Thus, assessing the HSD176B13 genotype might be beneficial in risk stratification and potential therapeutic inhibition of HSD17B13 among patients with MASLD-HCC. Full article

Dating applications (DAs) are widely used to establish social and sexual connections among men who have sex with men (MSM), particularly in urban areas. In this study, we aimed to examine the associations between DA use and mental health among Thai MSM. An online cross-sectional survey was completed by 442 MSM residing in Bangkok and urban municipalities across all regions of Thailand. Psychological distress (PD) and probable depression were assessed using the General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9), respectively. Of the participants, 62.7% were current users, with 33.2% experiencing PD and 33.9% having depression. A logistic regression analysis showed that PD was significantly associated with late-night use (AOR = 2.02, 95% CI: 1.08–3.78), matching failure (AOR = 1.95, 95% CI: 1.12–3.38), rejection (AOR = 2.07, 95% CI: 1.18–3.62), and ghosting (AOR = 1.78, 95% CI: 1.02–3.11). Simultaneously, depression was significantly associated with using DAs with the motivation of hooking up (AOR = 2.27, 95% CI: 1.05–4.93), privacy violations (AOR = 2.76, 95% CI: 1.42–5.38), unsolicited sexual images (AOR = 2.04, 95% CI: 1.11–3.74), physical assault (AOR = 2.97, 95% CI: 1.57–5.61), harassment (AOR = 2.54, 95% CI: 1.37–4.70), scams (AOR = 2.59, 95% CI: 1.41–4.77), and extreme disappointment from DA use (AOR = 5.98, 95% CI: 1.84–19.41). These findings highlight how DA usage patterns and negative experiences may contribute to the poorer mental health among MSM in urban areas. Full article

Background: Chronic kidney disease (CKD) is a prevalent complication among individuals with type 2 diabetes (T2D), posing significant diagnostic challenges in resource-limited settings due to infrequent testing and missed hospital visits. This study aimed to develop a simple, effective ML model to identify T2D patients at high risk for reduced kidney function. Methods: We retrospectively analyzed data from 3471 T2D patients collected over a ten-year period at a university hospital in Bangkok, Thailand. Two models were developed using readily available clinical features: one including hemoglobin A1c (HbA1c) levels (the “with-HbA1c” model) and one excluding HbA1c levels (the “non–HbA1c” model). Three tree-based ML algorithms—decision tree, random forest, and extreme gradient boosting (XGBoost) algorithms—were employed. The outcome label was CKD, defined as an estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m² that persisted for more than 90 days. The model performance was evaluated using the AUROC. The feature importance was assessed using Shapley additive explanations (SHAP). Results: The XGBoost algorithm demonstrated a strong predictive performance. The “with-HbA1c” model achieved an AUROC of 0.824, while the “non–HbA1c” model attained a comparable AUROC of 0.819. Both models were well-calibrated. SHAP analysis identified age, HbA1c, and systolic blood pressure as the most influential predictors. Conclusions: Our simplified, interpretable ML models can effectively stratify the risk of reduced kidney function in patients with T2D using minimal, routine data. These models represent a promising step toward integration into clinical practice, such as through EHR-based alerts or patient-facing mobile applications, to improve early CKD detection, particularly in resource-limited settings. Full article

Background: Currently, no information exists on the clinical course of anti-topoisomerase I antibody (ATA)-positive limited cutaneous systemic sclerosis (lcSSc). We aimed to evaluate the incidence of and time to the development of interstitial lung disease (ILD), pulmonary hypertension (PHT), scleroderma renal crisis (SRC), and maximal modified Rodnan skin score (max-mRSS) in patients with lcSSc and dcSSc, with and without ATA. Methods: This cohort study included 522 patients with systemic sclerosis (SSc). The incidence of and time to the development of ILD, PHT, SRC, and max-mRSS were assessed. Results: ATA-positive dcSSc (dcSSc-posATA) was the most common presentation among Thai patients (321 cases; 61.5%). The median time to the development of ILD was shorter than that in lcSSc-posATA, comparable to that in dcSSc-posATA (1.0 vs. 1.8 years, p = 0.21), and shorter than that in ATA-negative dcSSc (dcSSc-negATA) (1.0 vs. 4.8 years, p = 0.001). The time to max-mRSS in lcSSc-posATA was comparable to that in dcSSc-posATA (p = 0.17) but shorter than that in dcSSc-negATA (p < 0.001). Conclusions: Patients with lcSSc-posATA had a similar risk of ILD development and time to reach max-mRSS as those with dcSSc, regardless of the presence of ATA, but had earlier ILD development and max-mRSS compared to those with dcSSc-negATA. Their prognosis appeared to be better than that of dcSSc-posATA. Full article

Background/Objectives: This predictive research aimed to examine the influences of gender, perceived patients’ ability to perform activities of daily living, perceived impact of behavioral and psychological symptoms of dementia (BPSD), perceived caregiver burden, and perceived social support on the psychological distress of family caregivers of persons with dementia. Methods: The sample consists of 172 family caregivers of persons with dementia who received services at the outpatient department of a hospital in Bangkok and met the inclusion criteria. The research tools used in this study included a demographic questionnaire, the Kessler Psychological Distress Scale, the Barthel Activities of Daily Living Index, a Thai tool for assessing behavioral and psychological symptoms of dementia, the Thai Burden Interview for Caregivers of Patients with Chronic Illness, and Social Support Scale. The data were analyzed using descriptive statistics and multiple regression analysis. Results: The research findings revealed that 26.2% of the sample experienced psychological distress. Multiple regression analysis indicated that gender, perceived patients’ ability to perform activities of daily living, perceived impact of BPSD, perceived caregiver burden, and perceived social support could jointly explain 66.3% of the variance of psychological stress of family caregivers of persons with dementia (R² = 0.663, F = 65.303, p < 0.001). The factors that significantly influenced psychological distress in family caregivers of dementia were perceived caregiver burden (β = 0.693, p < 0.001) and perceived impact of BPSD (β = 0.164, p < 0.01). Conclusions: The findings from this study can serve as a basis for developing strategies to reduce or prevent psychological distress in family caregivers of persons with dementia. Full article

Background: Delirium frequently manifests in hospitalized geriatric patients and is associated with negative health outcomes. Available large-scale data regarding its prevalence rate and impact on older Thai patients are limited. This study aimed to analyze trends in the prevalence rate, its consequences, and the factors contributing to death at discharge among this population. Methods: A retrospective study of inpatients over the age of 60 who received a diagnosis of delirium was conducted, utilizing inpatient medical expense documentation for the fiscal years 2019–2023. The identification of delirium was conducted by the National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) code F05. Results: The 5-year prevalence rate and mortality rate of delirium were 215.1 and 18.7/100,000 population, respectively, and tended to rise over the studied periods. The average hospitalization was 10 days, and the average healthcare expenditure was about 1470 USD/visit. Respiratory disease emerged as the most common primary diagnosis in delirious patients (23.5%). Factors associated with mortality were individuals aged >80 years when juxtaposed with the cohort aged 61–70 years (adjusted odds ratio [AOD] 1.07), being female (AOR 1.13), and a primary diagnosis of respiratory disease (AOR 2.72), cardiovascular disease (AOR 1.68), musculoskeletal disease (AOR 0.61), systemic infection/septicemia (AOR 2.08); or malignancy (AOR 2.97). Conclusions: There was an upward trend in rates of both prevalence and mortality associated with delirium among hospitalized geriatric patients. Advancing age, gender, and particular primary diagnoses were associated with mortality at hospital discharge. Full article

Background/Objectives: Wannachawee recipe (WCR) has been listed in the Hospital Traditional Medicine Formulary and has been used as a Thai medicine to treat psoriasis in the Thai Traditional Medicine Clinic of Prapokklao Hospital since 2006. Previous reports have found that WCR demonstrates good results for the treatment of patients with psoriasis. Among 136 Thai psoriasis patients who received WCR, 92.80% responded well. Although WCR is effective, there is still a lack of scientific data, especially relating to the bioactive compound in WCR. Therefore, this study aims to evaluate the phytochemicals in WCR via bioassay-guided isolation. Methods: In this study, the WCR was extracted via decoction with water, in a process based on traditional Thai medicine. The water extract was concentrated and dried using a spray dryer. The crude water extract was isolated using the partition technique with organic solvents, namely petroleum ether and ethyl acetate. These fractions were then separated and tested for anti-inflammatory activity using the bioassay-guided fractionation method. Results: Two particular types of pro-inflammatory cytokines are involved in inflammation and are among the factors that cause psoriasis—TNF-α and IL-6. Thus, we evaluated the isolated samples in terms of anti-inflammatory activity. The isolation resulted in two pure compounds—p-coumaryl aldehyde and trans-p-coumaryl alcohol. In the efficacy test of the isolated compounds, compared to the standard indomethacin at the same concentration of 12.5 ug/mL, trans-p-coumaryl alcohol was found to have the best efficacy, inhibiting TNF-α by 29.28% and IL-6 by 36.75%, with the standard compound showing inhibitions rates of 15.80% for TNF-α and 27.44% for IL-6. Conclusions: This study is the first report to identify the bioactive compound of WCR as trans-p-coumaryl alcohol or 4-hydroxycinnamyl alcohol. Full article

Background/Objectives: This study aims to investigate the effects of a home-based cardiac rehabilitation (HBCR) program via a LINE application on functional capacity and quality of life (QOL) in open-heart surgery patients. Methods: This study involved 54 open-heart surgery patients divided into a control group and an experimental group (27 intervention, 27 control) using pair matching. Participants in the intervention group participated in the HBCR program, while the control group received standard care. Orem’s self-care theory was used as the conceptual framework. Functional capacity was measured via a six-minute walk test and the Duke Activity Status Index, while QOL was measured via the Thai version of the Short Form-36 Survey. Results: The findings from the study reveal that the patients who underwent open-heart surgery in the experimental group had significantly higher functional capacity compared to those in the control group (p < 0.05). Additionally, the overall QOL of the open-heart surgery patients in the experimental group was significantly better than that of the control group, alongside physical functioning, emotional roles, vitality, mental health, social functioning, and general health (p < 0.05). However, there were no significant differences between the two groups in terms of physical roles and bodily pain (p > 0.05). Conclusions: Using an HBCR program via the LINE application has the potential to enhance the at-home self-care ability of post-open-heart surgery patients, thus improving their functional capacity and QOL. Full article