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
A Randomized Controlled Trial of a Mindfulness-Based Relapse-Prevention Program with Problem-Solving Skills for Male Substance Users
Objective: This Randomized Controlled Trial (RCT) aimed to examine the effectiveness of a mindfulness-based relapse-prevention program with problem-solving solution skills (MPSS) for male substance users on stress, deliberate self-harm, and drug-abstinence intention. Material and Methods: Thirty-six male substance users aged 18–59 were recruited from a rehabilitation institute in Thailand and randomly assigned to the intervention and control groups equally. The MPSS was based on a mindfulness program with added problem-solving skills. Implementation included 8 sessions over a four-week period at the setting site, and a follow-up and an assessment were delivered via a mobile phone. Data were collected 3 times: at pre-intervention (week 0, T1), post-intervention (week 4, T2), and follow-up (week 6, T3). A three-month assessment followed in order to determine any addiction relapse. The Thai Perceived Stress Scale-10, the Revised Deliberate Self-Harm Inventory, and the Drug Abstinence Intention Questionnaire were used to assess the main outcomes. The reliability values were 0.82, 0.81, and 0.86, respectively. A two-way repeated measures ANOVA was used to determine the outcome differences between the groups and times. Results: After completion of the intervention, participants in the intervention group had significantly higher drug-abstinence intentions and lower deliberate self-harm both at T2 and T3. They had lower stress at T3 than the control group. The intervention group underwent no emotional, mental or physical relapse 3 months after the program’s completion. The control group had about a 60% relapse rate. Conclusion: These findings indicate that an MPSS is effective in lowering stress and deliberate self-harm, and increasing drug-abstinence intention without emotional, mental or physical relapse in male substance users.
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Incidence Trend and Climate Influence on Dengue Fever in Banjarmasin, Indonesia: A Path Analysis Approach
Objective: Dengue hemorrhagic fever (DHF) remains a significant global health burden, especially in tropical and subtropical regions. This study aims to determine climate trends and their influence on dengue incidence in Banjarmasin. Material and Methods: DHF data were collected monthly from the health centers through the Health Office from 2016- 2023. Climate data (temperature, humidity and rainfall) were obtained from the Banjarbaru Class II Meteorology and Geophysics Agency. Decomposition approach and path analysis were used in this study. Results: The results show that DHF cases exhibited a strong seasonal pattern, with the peak occurring in the first quarter of each year. The incidence of DHF in Banjarmasin has shown an increasing trend since 2016, with the highest incidence reported in 2023 (88 cases, 12.10 per 100,000 population). Temperature had the most significant direct impact on DHF cases, followed by rainfall and humidity. Humidity and temperature also indirectly affected dengue cases, as demonstrated in the path analysis (direct effect of rainfall: 0.269; indirect effect through temperature: -0.0643). These results underscore the influence of climate on the incidence of dengue fever. Conclusion: Case trends can reveal the seasonal pattern of DHF cases. Mitigation efforts by local health authorities early in the year are essential to reducing morbidity and mortality from dengue fever in Banjarmasin.
Langer’s Axillary Arch: A rare Phenomenon and Its Clinical Importance
Objective: Langers axillary arch (LAA) is a muscular slip encountered in the axillary region with various clinical implications. Knowledge about this muscle is important for surgeons because of its proximity to various nerves and axillary structures. Material and Methods: In this report, we present a case series of patients in whom the LAA was identified during surgical procedures such as axillary dissection, sentinel lymph node biopsy, breast lumpectomy, and breast conservation surgery. Results: Among the 5 LAA cases identified, 2 were complete and 3 were incomplete. Intraoperatively, all 5 cases were handled well, and prior awareness of this anatomical variation allowed surgeons to identify it immediately, which helped in avoiding any potential complications, both intra- and postoperative. All patients were followed up closely and their post-operative periods were found to be uneventful. Conclusion: LAA was accurately identified and exposed in all patients during surgery to achieve complete axillary clearance. Early recognition and pre-operative knowledge of such an anomaly assisted us in preventing many unwanted surgical and clinical implications.
Impact of Diabetic Retinopathy on Ocular Surface Temperature: Insights from Medical Thermography
Objective: This study aimed to investigate the impact of diabetic retinopathy on the ocular surface temperature (OST) profile, exploring potential links between temperature variations and the inflammatory processes associated with the condition. Material and Methods: Medical thermography, a non-invasive technique that captures thermal radiation emitted from body organs, was employed to measure OST and lacrimal sac temperature in patients with diabetic retinopathy (DR) compared to healthy controls. Statistical analyses were conducted to assess temperature differences between the 2 groups. Results: The analysis revealed a significant difference in OST and lacrimal sac temperature between eyes affected by DR and healthy eyes, with a p-value of 0.006. This finding indicates notable temperature deviations in the presence of diabetic retinopathy. Conclusion: The observed temperature variations support the hypothesis that inflammation may play a significant role in the pathophysiology of diabetic retinopathy, highlighting the potential of thermography as a valuable diagnostic tool in understanding ocular surface changes in this condition.
Prediction of Gestational Diabetes Mellitus using First-Trimester Parameters during Pregnancy: A Prospective Study in Southern Thailand
Objective: To assess the incidence of gestational diabetes mellitus (GDM) in pregnant women who have tested negative for gestational diabetes during first-trimester screening. Additionally, to identify first-trimester factors that can predict GDM at 24–28 weeks or later in Southern Thailand. Material and Methods: A prospective study was conducted from March 2018 and March 2020 in two tertiary hospitals. A two-step approach for GDM screening was performed at the first trimester (≤14 weeks) and at 24–28 weeks or later. First-trimester factors associated with the development of GDM at 24 weeks or later were analyzed using multivariable logistic regression. Results: Of 408 pregnant women who had no GDM from screening at the first trimester, 43 women (10.5%) were diagnosed with GDM at 24 weeks of gestation or later. One-hour plasma glucose after 50 grams (g) GCT and HbA1c at the first trimester were found to be significantly higher in GDM women than in non-GDM women. Women with a history of hypertensive disorders of pregnancy (HDP) or GDM in a prior pregnancy, subscapular fat thickness >18.8 millimeter, 1-hour plasma glucose after 50g GCT >165 milligrams per deciliter (mg/dL), and HbA1c >5.3% at first trimester had 2- to 4-fold higher odds of developing GDM. Conclusion: Approximately, one of 10 pregnant women having had no GDM at first trimester was diagnosed GDM at 24 weeks or later. Close monitoring for the diagnosis of GDM and early treatment should be systematically planned in women with history of HDP or GDM in a prior pregnancy, high subscapular fat thickness, and 1-hour plasma glucose after 50g GCT or HbA1c at first trimester.
Delayed Onset Time of Gluteus Medius Muscle and Frontal Mechanics of Trunk and Pelvis in Individuals with Medial Knee Osteoarthritis
Objective: An increased strengthening of hip abductor muscles helps to improve pain and functional activity in medial knee osteoarthritis (OA). However, the mechanism analysis of the functional benefits is still incomplete. The objective was to compare the function of the gluteus medius (GMed) muscle, the contralateral pelvic drop, and ipsilateral trunk lean between the with and without knee OA groups. Material and Methods: Twenty individuals participated in the study. Kinematics and kinetics were recorded during level walking using a 10-camera ViconTMNexus system and a force plate. GMed activity was recorded using a Delsys Trigno system. The data of 2 participants were excluded because they were incomplete. Finally, 18 data (9 knee OA and 9 asymptomatic) were reported. Independent T-test and the Mann-Whitney U test were used for statistical analysis. Results: A delayed time of GMed muscle (32.73±30.42 ms) was significantly (p-value=0.006) exhibited in individuals with knee OA after foot contact. A lower knee injury and OA outcome score was noted in individuals with knee OA. No significant difference in manual muscle strength test, contralateral pelvic drop, lateral trunk lean, and average GMed muscle activity was observed between the groups. Conclusion: A significant delay of GMed activation was noted in individuals with knee OA who had moderate severity in the current study, and it might be a sensitive indicator for the observation of neuromuscular deficits. In future studies, interventions aimed at improving the onset time of GMed should be investigated in individuals with knee OA in order to assess the clinical implications.
Piperine, an Alkaloid Component of Nigerian Propolis, Improves the Glomerular Filtration Rate (GFR) and other Markers of Renal Health in Nephropathic Diabetic Rats
Objective: This study investigated the effects of piperine isolated from Nigerian propolis on renal function in nephropathic diabetic rats and evaluated its efficacy when combined with the antidiabetic drug metformin. Materials and Methods: Male Wistar rats were induced with diabetes using streptozotocin and subsequently developed nephropathy. The rats were divided into 5 groups: a healthy control group, a diabetic (untreated) control group, a piperinetreated group, a metformin-treated group, and a group receiving a combination of piperine and metformin. Each treatment group received its respective interventions for 6 weeks. Renal function was assessed by measuring glomerular filtration rate (GFR) using inulin clearance tests. Biochemical markers of kidney injury and inflammation were also analyzed. Results: The results indicate that the combination of piperine and metformin was more effective at improving renal function in nephropathic diabetic rats compared to either treatment alone. The rats receiving the combined therapy exhibited significantly higher GFR values and reduced markers of kidney injury and inflammation. In contrast, the individual treatments with piperine or metformin alone produced only moderate improvements. The untreated diabetic control group had substantially impaired renal function compared to all the treatment groups, while the healthy control group maintained normal GFR levels. Conclusion: The synergistic effects of piperine from Nigerian propolis and metformin significantly enhanced GFR in nephropathic diabetic rats compared to either treatment alone. The combination therapy appears to offer a more effective approach for improving renal function in diabetic nephropathy.
A Preliminary Report on the Outcomes of A Short-Course Intensive Rehabilitation Program for Spinal Cord Injury: A Prospective Observational Study
Objective: To study the effect of a short-course intensive rehabilitation program on functional outcomes in individuals with spinal cord injury (SCI). Material and Methods: Individuals diagnosed with SCI who met the inclusion and exclusion criteria between January and December 2023 attended a short-course intensive SCI rehabilitation program lasting 1-2 weeks. Participants were assessed for functional outcomes using the Spinal Cord Independence Measure III (SCIM III) and the Modified Barthel Index (MBI) before the program, after the program, and at the 2-, 4-, and 6-month follow-ups. Furthermore, complications such as depression and urinary tract infection (UTI) were evaluated. Results: The intensive SCI rehabilitation program was performed on 23 patients over 9.61±4.75 days. They demonstrated significant improvements (p-value<0.05) in SCIM III and MBI scores. After completion of the SCI rehabilitation program, mean SCIM III scores rose from 28.43 to 51.26, while MBI scores increased from 5.35 to 10.48 (Cohen’s d=1.14 and 1.08, respectively). UTI was the most frequently occurring complication, with an incidence of 48%. During the follow-up phases, the maximum UTI rate was 39.13% at the 2-month follow-up, and the highest depression rate was 8.70% at the 2- and 6-month follow-ups. Conclusion: The short-course intensive SCI rehabilitation program significantly improved functional outcomes, which were sustained for >6 months. However, UTIs and depression were observed as complications during and after the rehabilitation program.
In Vitro Synergistic Activity of Fosfomycin-Colistin Combination Against Carbapenem-Resistant Pseudomonas Aeruginosa from Ventilator-Associated Pneumonia Patients
Objective: Infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a global health problem due to its multidrug resistance, often leading to treatment failure. This study aimed to assess the synergistic activity of fosfomycin plus colistin combination against clinical CRPA isolates from ventilator-associated pneumonia (VAP) patients. Material and Methods: This cross-sectional study retrospectively collected clinical data on 40 VAP patients with CRPA infections in 2023. CRPA clinical isolates were obtained between 2022 and 2023 from the sputum of VAP patients as part of the carbapenem-resistant isolate collection. The susceptibility to carbapenems, fosfomycin, and colistin was evaluated on CRPA isolates using the broth microdilution method. The synergistic activity of fosfomycin and colistin combination against CRPA isolates was assessed using the checkerboard assay. The time-kill study was then conducted on CRPA isolates that exhibited treatment synergism with the combination. Results: The most common comorbidities were chronic pulmonary disease and diabetes mellitus, which were found in 73% and 70% of VAP patients with CRPA infection. Previous carbapenem exposure was observed in 93% of the patients. Since VAP diagnosis, these patients were on a ventilator for a median of 13 days with an interquartile range of 10-22 days. Approximately 92% and 95% of the CRPA isolates exhibited high and low carbapenem and colistin resistance, respectively. In contrast, only 3 (7%) isolates were extremely resistant to fosfomycin, classifying as the non-wild type (bacterial isolates with reduced susceptibility or resistance). Synergism between fosfomycin and colistin was only observed in 2 (5%) isolates. Time-kill kinetics of these 2 isolates revealed a ≥2-log reduction in 1/4 minimum inhibitory concentration of fosfomycin and colistin. Conclusion: In vitro findings indicate that the synergistic activity of fosfomycin combined with colistin against CRPA isolates was rare. While this combination showed potential activity in these few isolates, further studies are needed to determine its clinical relevance and effectiveness in treating severe CRPA infections.
The Prevalence and Etiology of Delayed Puberty in Southern Thailand: A 20-Year Experience
Objective: Delayed puberty (DP) arises from various etiologies. Distinguishing self-limited DP (SLDP) from congenital hypogonadotropic hypogonadism (CHH) proves challenging due to similar clinical and biochemical markers during adolescent presentation. To identify the etiology of DP, the associated clinical characteristics, and the predictive factors differentiating SLDP from CHH. Material and Methods: A retrospective study was conducted on 75 patients seeking DP evaluation in a tertiary-care hospital between 2002 and 2021. Etiologies were classified based on clinical and biochemical data. Results: Among the 75 patients (47 boys, 28 girls), the etiologies differed by sex. In boys, SLDP was the most common cause (38.3%), followed by permanent hypogonadotropic hypogonadism (PHH, 29.8%), functional hypogonadotropic hypogonadism (FHH, 25.5%), and hypergonadotropic hypogonadism (HHH, 6.4%). In girls, HHH was the most prevalent diagnosis (57.1%), followed by PHH (17.9%), SLDP (14.3%), and FHH (10.7%). Kallmann syndrome was the leading cause of PHH in boys, while central nervous system (CNS) tumors were the most common cause in girls. Turner syndrome was the predominant etiology among girls with HHH (n=8, 28.5%). In the comparison between SLDP and CHH, micropenis was observed only in CHH boys (p-value=0.01), and cryptorchidism was significantly more frequent in the CHH group (36.4%) than in the SLDP group (5.6%) (p-value=0.05). Conclusion: The etiology of DP showed distinct sex patterns in the Thai population, with SLDP predominant in boys and HHH predominant in girls. Clinical predictors, such as micropenis and cryptorchidism, can help differentiate CHH from SLDP.
Phytochemical Profiling and Pharmacological Evaluation of the Methanol Extract of Persicaria chinensis L.H. Gross Leaves for Thrombolytic, Antidepressant, and Anxiolytic Activities through the In Vitro and In Vivo Approach
Objective: Persicaria chinensis L.H. Gross is an herbal member of the Persicaria genus and the Polygonaceae family. The objective of this study was to analyze the thrombolytic, antidepressant, and anxiolytic activities of the methanol extract of Persicaria chinensis leaves. Material and Methods: The current study uses several different experimental methods to investigate the presence of bioactive metabolites and the roles that Persicaria chinensis methanol leaf extract (MEPCL) plays in reducing thrombosis, anxiety, and depression. Blood was withdrawn from volunteers who underwent an in vitro examination to assess thrombolytic activity. The anxiolytic effects were observed by employing elevated plus maze (EPM) and hole-board (HBT) tests, while the antidepressant effects were evaluated using forced swimming (FST) and tail suspension tests (TST). Results: Alkaloids, steroids, saponins, glycosides, phenols, tannins, flavonoids, terpenoids, quinones, and reduced sugar are the secondary metabolites present in MEPCL, which was the preliminary investigation of this study. The MEPCL showed mild thrombolytic activity. The immobility duration of both doses of MEPCL was significantly decreased in TST and FST. In HBT, the higher doses showed a considerable increase in head dipping, and, in the EPM test, time spent in the open arm was increased significantly with an increased dose. Conclusion: This herb has potential for managing thrombosis, anxiety, and depression-like disorders.
Whole Genome Sequencing of A Pooled Sample of Bedaquiline and Clarithromycin Resistant Mycolicibacterium smegmatis Exhibits Mutations in Genes Associated with Efflux Family Protein and ATP Synthase
Objective: This study aimed to evaluate the pooled sequencing of mixed samples with different minimum inhibitory concentrations (MIC) of bedaquiline (BDQ) and clarithromycin to identify genes associated with drug resistance and explore those that could predict cross-resistance to both drugs. Additionally, it aimed to preliminarily investigate the association between single-nucleotide polymorphisms (SNPs) from pooled samples and the progression of drug resistance. Material and Methods: Mycolicibacterium smegmatis wild type (WT) and hup B (MDP1) knock-out strains were obtained from the Bacteriology Laboratory, Graduate School of Medical and Dental Science, Niigata University. Drug-resistant strains were generated through stepwise passaging on drug-containing agar plates, followed by MIC determination. Whole-genome sequencing was performed using the MinION Nanopore platform, with pooled samples categorized based on MIC levels. Bioinformatics analysis, including SNP identification and annotation, was conducted using burrows wheeler aligner, Samtools, genome analysis toolkit, and SnpEff pipelines. Molecular docking and molecular dynamics simulations were employed for in silico validation of SNP-drug interactions. SNP frequency was calculated, and statistical analysis was performed using a paired t-test in Prism® software. Results: High-impact SNPs that changed the amino acid were found in both pooled samples, one in pooled sample A (atpA p.Glu429Gln) and 5 in pooled sample B (MSMEG_0639, MSMEG_1867, MSMEG_4765, and MSMEG_6302). Conclusion: Pooled samples of BDQ and clarithromycin-resistant M. smegmatis strains exhibited mutations in the genes associated with the efflux family and the adenosine triphosphate synthase protein. A pooled sample sequencing method can be used to identify variant sites and predict genes associated with cross-resistance.
Thai Version of the Modified Yale Food Addiction Scale 2.0: Cultural Adaptation, Reliability, and Validity
Objective: This study aimed to adapt the Thai version of the modified Yale Food Addiction Scale 2.0 (mYFAS-TH 2.0), taking cross-cultural considerations into account. Material and Methods: The mYFAS 2.0 was translated into Thai, resulting in the mYFAS-TH 2.0. In total, 530 participants from the Northeast of Thailand completed the Thai version of the mYFAS 2.0 (mYFAS-TH 2.0). Its psychometric properties, including content validity, were investigated using the index of item-objective congruence (IOC). Internal consistency reliability was investigated using Kuder–Richardson 20 (KR-20), and convergent validity was investigated by confirmatory factor analysis. Results: The mYFAS-TH 2.0 demonstrated strong content validity, with IOC values ranging from 0.67 to 1.00. The internal consistency reliability was robust, as indicated by a KR-20 score of 0.82 (95% confidence interval [CI]: 0.751 to 0.879). Furthermore, the mYFAS-TH 2.0 exhibited good convergent validity, as evidenced by standardized factor loadings between 0.360 and 0.741 (p-value<0.05). Conclusion: The mYFAS-TH 2.0 exhibits acceptable content validity and reliability. The findings support the use of the mYFAS-TH 2.0 in clinical settings in the Thai population.
Palliative Esophageal Stenting for Esophagorespiratory Fistula in Patients with Esophageal Cancer
Objective: This study aimed to evaluate the clinical outcomes following the placement of self-expandable metal stents (SEMS) in patients with esophagorespiratory fistula (ERF), due to esophageal squamous cell carcinoma (ESCC). Material and Methods: Forty-three patients with ERF in ESCC underwent esophageal SEMS placement at Songklanagarind Hospital, Thailand, from January 2008 to June 2023. Data on initial clinical success and failure, complications, stent patency, and survival were collected. Results: Technical success was achieved in all patients, with an initial clinical success rate of 28 of 43 (65.1%) and initial clinical failure occurring in 15 of 43 (34.9%). Among the 28 patients with initial clinical success, 13 developed recurrent symptoms: aspiration symptoms recurred in 61.5% (8 of 13) and dysphagia symptoms recurred in 38.5% (5 of 13). Persistent aspiration pneumonia, 53.3% (8 of 15), and persistent dysphagia symptoms, 46.7% (7 of 15), occurred in the 15 patients who had initial clinical failure. The overall major complication rate was 34.9% (15 of 43). The median stent patency duration was 38.5 days (interquartile range (IQR), 25.8-112.2) and the median survival duration was 40 days (IQR, 14-89.5). Survival was significantly lower in cases of initial clinical failure (14 days, IQR 6.5–32 days) compared to initial clinical success (72 days, IQR 27-197.2 days) (p-value<0.001). Conclusion: Palliative esophageal SEMS placement for ERF in patients with ESCC is technically easy, effective, safe, and provides short-term relief of aspiration, including dysphagia. Initial clinical success led to longer survival than initial clinical failure.
Evaluation of Red Blood Cell Indices and Reticulocyte Parameters for Thalassemia Carrier Screening Using the Dymind Automated Hematology Analyzer
Objective: The Dymind automated hematology analyzers, comprising the DF55, DH76, and DH615, were recently released. The appropriate cutoffs of the mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) for hemoglobinopathy screening are related to the study population and automated analyzers. This study aimed to evaluate the Dymind automated hematology analyzers for screening thalassemia and common abnormal hemoglobin (Hb). Material and Methods: Blood samples of known α0-thalassemia and β-thalassemia carriers were analyzed to establish the suitable cutoffs for each analyzer, derived from the receiver operating characteristic curve. These selected cutoffs were used for prospective validation for screening α0-thalassemia and β-thalassaemia, in combination with the dichlorophenolindophenol (DCIP) test for Hb E screening. Thalassemia genotypes were determined using Hb typing and Deoxyribonucleic acid (DNA) analyses. Results: MCV 80 fL and MCH 27 pg, analyzed using the DF55, DH76, and DH615 analyzers, were the appropriate cutoffs. Using these cutoffs in combination with the DCIP test for screening α0-thalassaemia, β-thalassaemia, and Hb E revealed 100% sensitivity and 100% negative predictive value. Our study showed that a reticulocyte hemoglobin equivalent (Ret-He) less than 26 pg could be indicative of both the thalassemia trait and iron deficiency. Interestingly, the cutoff below 23.7 pg is more indicative of the α0-thalassemia trait. For the sample stability study, the MCV and MCH remained stable at 4 °C. Additionally, the MCH remained stable at room temperature. Conclusion: Therefore, the combined MCV and MCH analyzed using the Dymind automated hematology analyzers with the DCIP test, together with Ret-He parameters from the DH615, are effective for screening thalassemia and common abnormal Hb in the Thai population.
Prevalence and Determinants of Eating Disorders and Mental Health Among University Students in Morocco, 2024
Objective: The goal of this study was to evaluate the prevalence and frequency of mental health and eating disorders among university students in Morocco. It sought to identify how widespread these issues are, examine the associated risk factors, raise awareness, provide valuable data for future interventions, and contribute to the academic field of mental health and eating disorder research, with a particular focus on underrepresented groups such as Moroccan university students. Material and Methods: We conducted a cross-sectional survey including 396 students from universities in the Rabat-Salé-Kénitra region, Morocco, in 2024. To gather data, we employed standardized tools, including the Beck Anxiety Inventory, the Hamilton Depression Rating Scale, and the Sick/Control/One stone/Fat/Food (SCOFF) questionnaire. The data analysis was performed using the Epi Info 7.2 software. Results: The results indicate that 64.3% (CI 95% [59.6%; 69.0%]) of the students reported symptoms of psychological distress, 28.8% (CI 95% [24.1%; 33.5%]) experienced anxiety, 26.4% (CI 95% [21.7%; 31.1%]) showed signs of depression, and 32.2% (CI 95% [27.5%; 36.9%]) exhibited symptoms of eating disorders, with a strong correlation between anxiety, depression, socio-economic status, psychological distress, academic pressure, and eating behaviors. Conclusion: The findings of this prevalence study provide valuable insights into the occurrence of mental health and eating disorders among university students in the region of Rabat-Salé-Kenitra. The data highlight the significant impact of these issues on university students, emphasizing the need for increased awareness, early intervention, and support systems within academic settings.
The Prevalence and Risk Factors of Hyperuricemia in Chinese Children and Adolescents: A Meta-Analysis
Objective: To explore the prevalence and risk factors of hyperuricemia in Chinese children and adolescents by meta-analysis. Material and Methods: The China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service platform, VIP Periodical Chinese Journal Service platform, PubMed, Embase database, Chinese BioMedical Literature database (CBM), Cochrane Library, Web of Science, and a manual search were all included in the extensive search, which had a final search date of September 2024. The meta-analysis was conducted using RevMan 5.4 and Stata 17.0. Results: A total of 14 pieces of literature comprising 89359 patients were included. According to our review, the common risk factors reported were gender (male), age, overweight or obesity, hypertension, impaired glucose regulation, dyslipidemia, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, and urea nitrogen were the key risk factors for hyperuricemia (HUA) in Chinese children and adolescents (p-value<0.05). In contrast, HUA in children and adolescents was not linked to a diet high in animal offal, waist circumference, or town residence (p-value>0.05). Conclusion: The high rate of hyperuricemia in Chinese children and adolescents serves as a reminder to the general public, medical professionals, and those who determine health policy to get ready for the challenges that lie ahead.
Antimalarial Potency of Vernonia Amygdalina Ethanolic Extracts in the Prevention and Treatment of Plasmodium Berghei-Infected Mice
Objective: This study assessed the anti-malarial potency of Vernonia amygdalina ethanolic extracts (leaf and stem-bark) in the prevention and treatment of Plasmodium berghei-infected mice. Material and Methods: Fresh leaves and stem bark of Vernonia amygdalina were collected in Kurmi LGA, Taraba State, based on ethnobotanical guidance, and authenticated at Ahmadu Bello University, Zaria (voucher number 02006). Non-pregnant mice (20–35 g) were acclimatized at the Modibbo Adama University Infectious Diseases Research Laboratory, Yola, for 14 days before curative (70 mice) and prophylactic (40 mice) tests. Plant extracts were administered orally, and parameters such as parasitemia, body weight, temperature, packed cell volume (PCV), and mean survival time (MST) were monitored. Results: The leaf extract at 600 mg/kg demonstrated the highest parasitemia suppression (60.78%) with a significant increase in the MST of the infected mice. Similarly, the stem-bark extract at the same dose exhibited 60.62% parasitemia suppression, with the MST also significantly extended. In both cases, suppression rates and MST were dose-dependent, with higher doses providing better outcomes. The prophylactic test revealed that a dose of 200 mg/kg of leaf extract achieved 91.67% suppression of parasitemia, outperforming the stem-bark extract. The MST was significantly increased in all treated groups compared to the untreated controls. Conclusion: The study demonstrates that Vernonia amygdalina ethanolic extracts, particularly from the leaf, possess significant anti-malarial activity, supporting its potential use in malaria treatment. In addressing artemisinin resistance, Vernonia amygdalina extracts may exert their antiplasmodial effects through molecular mechanisms distinct from those targeted by artemisinin.
Efficacy of Combining Extracorporeal Shock Wave Therapy and Physical Therapy in the Treatment of Rotator Cuff Tendinopathy
Objective: This study aimed to evaluate the combined effectiveness of extracorporeal shockwave therapy (ESWT) and physical therapy in treating rotator cuff tendinopathy (RCT). Material and Methods: A total of 62 patients diagnosed with RCT were enrolled in this study and randomly assigned to 2 groups. The intervention group received a treatment protocol consisting of infrared therapy, transcutaneous electrical nerve stimulation (TENS), mobilization, and active extracorporeal shockwave therapy (ESWT). The control group receives TENS, mobilization, and infrared therapy. All patients received 5 treatment sessions per week for 4 consecutive weeks, with ESWT administered once weekly. All patients were assessed for pain intensity using visual analog scales (VAS), and shoulder joint function using the Constant–Murley Shoulder Score at baseline, 2, and 4 weeks after the intervention. Results: Although both groups exhibited significant reductions in pain intensity compared to the baseline, a statistically significant difference between the groups was observed after only 2 weeks of intervention (p-value<0.05). Furthermore, the shoulder joint function in the intervention group was significantly improved at both 2 and 4 weeks of follow-up compared to the control group (all p-value<0.05). Conclusion: The combination of ESWT with TENS, infrared therapy, and mobilization demonstrated a superior efficacy in reducing pain in rotator cuff tendinopathy. Notably, this pain relief effect was correlated with improvements in shoulder joint function.
Protease-Mediated Recovery of Amnion from Placenta and Its Application as a Bioprocessed Therapeutic Biomaterial for Wound Healing
Objective: Wound healing presents significant challenges to healthcare systems, particularly in the management of chronic wounds. Amnion, a collagen-rich membrane traditionally discarded after childbirth, has shown promise in skin regenerative medicine due to its anti-inflammatory, antimicrobial, and biocompatible properties. However, conventional methods for separating amnion from the placenta often result in tissue damage and inconsistent material quality, limiting their therapeutic potential. This study introduces an enzymatic process using Bacillus sp. S2 MTCC 13117 protease to separate the amnion from the placenta while preserving its collagen structure and mechanical properties. Material and Methods: The enzymatic treatment effectively removes non-collagenous proteins and epithelial layers, creating high-quality amnion suitable for wound-healing applications. Biophysical characterization of the biomaterials demonstrated suitable tensile strength, permeability to oxygen and water vapor, and high surface area, all critical for effective wound coverage and healing. Results: In vitro studies showed that amnion scaffolds promoted fibroblast proliferation with low toxicity and high biocompatibility, while in vivo rat models indicated significantly faster wound healing, with complete closure observed in 7 days compared to 12–14 days for controls. Histological analysis confirmed enhanced collagen organization and skin structure regeneration in treated wounds. Conclusion: These results demonstrate that enzymatically processed amnion scaffolds are an effective and cost-efficient alternative for wound care, with superior healing outcomes compared to conventional therapies. This study supports the use of amnion-derived biomaterials in treating chronic wounds, including diabetic and venous leg ulcers.
Anandhakrishnan Rajaram Heamchandsaravanan
Association Between Prescription Opioid Misuse and Risky Health Behaviors Among High School Students in the U.S.: A Cross-Sectional Study 2017–2021
Objective: The objective of this study was to investigate the association between prescription opioid misuse and 18 risky health behaviors among high school students in the United States. Material and Methods: This study utilized the most recent 2017, 2019, and 2021 Youth Risk Behavior Surveillance System (YRBSS) nationally representative data of n=44,329 high school students (Grades 9-12). We created 2 groups based on participants who reported lifetime prescription opioid misuse and those who did not. Bivariate analysis included Pearson’s chi-squared tests to compare the baseline differences between the 2 groups. For multivariate analysis, a survey-weighted logistic regression model, which adjusted for socio-demographic factors, was used to explore the association between prescription opioid misuse and selected risky health behaviors. Results: The adjusted multivariate model showed a significant association between prescription opioid misuse and risky health behaviors related to driving, suicidal ideation, and illicit substance use. Significant associations were found between prescription opioid misuse and suicidal ideation, which included feelings of hopelessness and seriously considering suicide. However, no significant relationship was observed between making plans for suicide and attempting suicide. Conclusion: The findings highlight that high school students with a history of prescription opioid misuse engaged in other adverse health behaviors. Public health policymakers should consider these findings in order to take a multifaceted approach by working with teachers, counselors, and clinicians to create programs to assist the high school students who are part of this high-risk population.
Vitamin B-6 Reduces Nitrite Oxide Levels, Interleukin-6, and Plasminogen Activator Inhibitor-1 in the Small Intestines and Reduces the Incidence of Post-Laparotomy Intraperitoneal Adhesions in Wistar Rats: A Randomized Trial
Objective: Intraperitoneal adhesions occur in approximately 95% of cases after laparotomy. Vitamin B6 has a few effects, including the inhibition of nitric oxide (NO), suppression of Interleukin-6 (IL-6) production, and decreased fibrinolytic capacity. This study was conducted to determine whether intramuscular administration of Vitamin B6 reduces levels of NO, IL-6, and plasminogen activator inhibitor-1 (PAI-1) and the incidence of intraperitoneal adhesions. Material and Methods: This experimental study was conducted with a Randomized Post-Test Only Control Group Design. This study used 20 male Wistar rats divided into 2 groups (treatment and control groups). The treatment group received an intramuscular injection of 10 mg/kg/day of Vitamin B6. NO, IL-6, and PAI-1 were measured using the Enzyme-linked Immunosorbent Assay (ELISA) method. Intraperitoneal adhesions were determined based on the Zuhkle criteria. Results: The incidence of adhesion was 30% in the treatment group and 100% in the control group. NO, IL-6, PAI-1 levels, and the incidence of adhesion in the treatment group were significantly lower in the treatment group (p-value 0.002; <0.001; <0.001; 0.002, respectively). Furthermore, NO, IL-6, and PAI-1 levels were significantly lower in subjects without adhesions compared with those with adhesions (p-value<0.001, respectively). Vitamin B6 also decreased the risk of adhesions 3.3 times compared to the control group (HR 3.3; 95% CI: 1.29-8.59). Conclusion: There was a significant reduction in NO, IL-6, and PAI-1 levels after intramuscular administration of Vitamin B6, which contributed to a lower incidence of intraperitoneal adhesions.
Geographical Accessibility and Dental Service Cost in Client-Centered Perspective under Universal Health Coverage Between Community Medical Units and the Dental Clinic at Hatyai Hospital
Objective: This study aimed to examine the geographical accessibility and cost in client-centered perspective associated with dental services at Community Medical Units (CMUs) and dental clinics at Hatyai Hospital, Thailand. Material and Methods: A total of 380 dental patients from three CMUs under Hatyai Hospital were included, with proportional sampling based on patient volume at each unit. Data on service-related costs, travel distance, and transportation modes were collected using a structured questionnaire. Client costs were assessed for non-medical out-of-pocket expenses (transportation, food, lost wages), as all patients were covered under the Universal Coverage Scheme and did not incur medical treatment costs. Descriptive statistics and analysis of variance (ANOVA) were applied for data analysis. Results: The findings revealed statistically significant differences in both travel distance and travel time among the three CMUs. Patients from CMU3 had the longest median [Interquartile Range (IQR)] distance of 15.0 (5.8) kilometers (KM). Motorcycles were the predominant mode of transportation, although automobile use increased from 20.3% to 39.2% during hospital visits. While median (IQR) total costs of CMUs were not significantly different from those at the hospital, visits to the hospital incurred significantly higher out-of-pocket costs (p-value<0.001). The median (IQR) of total client costs was 46.2 (117.4), 39.5 (117.6), and 37.5 (101.5) THB for CMU1-3. Conclusion: The main cost components were transportation, food/snacks, and lost income due to the time spent receiving care. These findings underscore the impact of geographical access on service utilization and the economic burden on dental patients in semi-urban settings.
Copyright (c) 2026 Journal of Health Science and Medical Research http://creativecommons.org/licenses/by-nc-nd/4.0
Time Until Tooth Loss Among Pre-Elderly Southern Thais under Universal Coverage: A Retrospective Cohort Study
Objective: This study used dental data to determine the time until tooth loss and its associated factors among pre-elderly individuals aged 45–59 in Southern Thailand. Material and Methods: A retrospective cohort study was conducted using dental data from 2019 to 2023. The study included individuals under the Universal Health Coverage Scheme who received dental examinations and follow-up care. Tooth loss was defined as permanent tooth extraction (excluding impacted third molars). Data were censored if no extraction occurred by the end of the study or if participants were lost to follow-up. Cox proportional hazards models and Kaplan-Meier analyses were applied with statistical significance at p-value<0.05. Time-varying covariates were also examined. Results: A total of 4,177 participants were included; 1,582 (37.9%) experienced tooth loss. The overall median time until tooth loss was 40.0 months (95% confidence interval [CI]: 37.9–42.3). Individuals with fewer than 20 teeth, ≥3 decayed teeth, no dental scaling, and aged 55–59 had a shorter median time until tooth loss. Multivariable analysis showed that lack of dental scaling (Hazard rate [HR] 1.53; 95% CI: 1.29–1.81) and ≥3 decayed teeth (HR 1.30; 95% CI: 1.14–1.49) were associated with earlier tooth loss. Conclusion: Tooth loss among pre-elderly Thais occurred earlier in those with untreated caries and without dental scaling. These findings highlight the critical importance of timely caries treatment and regular scaling in preserving teeth for long-term function.
Usability Assessment Of Wowbot: A Chatbot Platform For Healthcare Applications
Objective: Chatbots have emerged as valuable tools in healthcare; however, existing platforms’ features are not designed to support user engagement and data collection for healthcare research. This study aimed to assess the usability issues of Wowbot, a chatbot platform developed as a plugin to the Botnoi platform, through usability testing with chatbot developers. Material and Methods: Usability testing was conducted with five chatbot developers, who were recruited to perform six tasks using platform functions: dialogue creation, push messages, application programming interfaces (APIs) in creating photo frames and score comparisons, data export, agent-mode chat, and natural language processing (NLP) for parameter recognition. One expert user served as a control. The think-aloud method, semi-structured questionnaires, and exit interviews were used to collect data. Effectiveness was assessed using performance scores, task completion time, and incomplete task incidence, while efficiency was evaluated by comparing task completion time with the expert. Results: Four out of five participants completed all tasks. The overall task completion rate within two attempts was 74.5%, with lower rates in photo frame creation (20%), score comparison (40%), and message pushing (40%). Participants required more time to complete tasks than the expert (188 vs. 130 minutes). Nevertheless, users reported high satisfaction (mean 4.2/5) and acknowledged the platform’s potential to enhance engagement in healthcare applications. Conclusion: The Wowbot platform showed potential usefulness for healthcare applications, with new features that may enhance user engagement. However, task completion challenges highlight the need for further refinement, particularly in API design and documentation, to optimize user experience and platform adoption.
Cardiac Arrest after Adding Mirtazapine in an Older Patient with Depression Who Already Used Escitalopram: A Case Report
A 65-year-old woman with underlying hypertension and ischemic stroke was diagnosed with dysthymia and prescribed escitalopram 10 mg/day by a psychiatrist. Three months later, she received mirtazapine 15 mg/day from another physician to alleviate myofascial pain syndrome and sleeping problems. The following day, she developed jaw pain and later suffered cardiac arrest at the emergency unit, with her electrocardiogram revealing a prolonged QT interval. Emergency coronary artery angiography suggested myocardial infarction. Antidepressants were immediately discontinued, and she underwent coronary artery bypass grafting. After one year, her clinical symptoms had stabilised, allowing her to continue daily activities without chest pain, though she still experienced recurrent mild headaches and sleeping problems. This case underscores the importance of vigilant medication management in older adults with depression, especially in the context of a combination regimen and polypharmacy.
Middle Ethmoid Artery Epistaxis: A Case of Post-Traumatic Severe Bleeding
Post-traumatic epistaxis is a common sequela of head trauma, typically arising from injury to the nasal mucosa or disruption of vascular structures, including the anterior-posterior ethmoid and sphenopalatine arteries. The ethmoid arterial system exhibits considerable anatomical variation, with middle ethmoid arteries identified in approximately 30-36% of cases. This report presents a rare instance of post-traumatic epistaxis originating from the middle ethmoid arteries in a pediatric patient with congenital thrombocytopenia, confirmed through computed tomography imaging and intraoperative assessment. The case emphasizes diagnostic and therapeutic challenges, highlighting the role of endoscopic surgical intervention in achieving hemostasis. Understanding the anatomical complexity of the ethmoid arterial system is crucial for accurate diagnosis and optimal management in similar cases.
Pathogenic Variants in TUBGCP6 of Familial Microcephaly and Chorioretinopathy
Microcephaly and chorioretinopathy type 1 (MCCRP1) is an autosomal recessive syndrome characterized by severe microcephaly, facial dysmorphisms, chorioretinopathy, and developmental delays. This rare condition is caused by homozygous or compound heterozygous pathogenic variants in the Tubulin Gamma Complex Component 6 (TUBGCP6) gene. We present 2 siblings from a non-consanguineous family in Indonesia diagnosed with MCCRP1. Both had a history of intrauterine growth retardation (IUGR) and were born with microcephaly and low birth weight. They exhibited developmental delays and hyperactive behavior. Facial dysmorphisms included upslanting palpebral fissures, strabismus, long philtrum, and a low anterior hairline. Ophthalmologic examination revealed chorioretinopathy in both siblings, while cardiac and hearing evaluations were normal. Microarray analysis revealed no likely pathogenic copy number variants (CNVs). Whole exome sequencing (WES) was performed on DNA from the siblings and their parents. The variant analysis identified a paternal pathogenic splice variant c.2066-6A>G and a maternal pathogenic nonsense variant c.3393G>A in the TUBGCP6 gene (NM_020461.4) in both siblings, indicating a compound heterozygous variant. This is the first case report of familial MCCRP1 in Indonesia, presenting both clinical features and genetic analysis of the TUBGCP6 gene.
The Role of Probiotics on Depression and Quality of Life in Irritable Bowel Syndrome Patients
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and/or constipation, often accompanied by altered stool frequency and shape. The gut microbiota, predominantly residing in the distal small and large intestines, comprises approximately 100 trillion microorganisms. Studies have identified a higher prevalence of Firmicutes (e.g., Lactobacillus, Ruminococcus), Proteobacteria, and Veillonella in IBS patients, alongside reduced populations of Lactobacillus and Bifidobacterium. Probiotics haves a role in alleviating IBS symptoms and depressive symptoms. Emerging evidence highlights the potential of probiotics to modulate the brain-gut axis, particularly in IBS patients with coexisting depressive symptoms, in order to alleviate IBS symptoms and depressive symptomps.
Mapping the Landscape of Palliative Care in Indonesia: A Scoping Review of Availability, Accessibility, and Quality
Indonesia has made notable strides in palliative care services over recent decades, yet substantial challenges persist, particularly in rural and under-resourced regions. This scoping review assesses the current landscape of palliative care in Indonesia, focusing on service availability, accessibility, and quality, including the effects of the coronavirus disease 2019 (COVID-19) pandemic. Following the Joanna Briggs Institute’s methodology and the PCC (Population, Concept, Context) framework, relevant studies published between 2016 and 2024 were sourced from databases such as ScienceDirect and PubMed. Findings indicate that although some progress has been achieved, palliative care services remain limited and unevenly distributed, with stark urban–rural disparities and a heavy reliance on out-of-pocket payments or charitable support. Integration into the national healthcare system remains minimal, hindered by inadequate infrastructure, insufficient policy implementation, and a shortage of trained providers. In the absence of formal support, the burden of care largely falls on family members, who face significant financial and emotional strain. These findings underscore an urgent need for strengthened policy frameworks, dedicated funding mechanisms, and culturally appropriate care models to improve access and equity. Future efforts should prioritize embedding palliative care into Indonesia’s core health services while addressing the diverse needs of patients and families across the country.