Mahidol University's Institutional Repository
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Recent Submissions
Myocardial Infarction in a Patient with Coexisting Protein C Deficiency: A Single Case Report and Systematic Review and Pooled Analysis of Published Case Reports
(2026-07-01) Kanitthamniyom C.; Rungjirajittranon T.; Towashiraporn K.; Lalitrojwong T.; Leelakanok N.; Ruchutrakool T.; Chinthammitr Y.; Suwanawiboon B.; Owattanapanich W.; Kanitthamniyom C.; Mahidol University
Objective: To report a case of MI in a patient with PC deficiency and to conduct a systematic review and pooled analysis of published cases to summarize clinical features, laboratory findings, recurrence patterns, and management strategies. Materials and Methods: A systematic review and pooled analysis of reported cases with concurrent MI and PC deficiency was performed. Literature published through June 2024 was identified by searches of MEDLINE and Embase. Results: Thirty-three patients, including the present case, were analyzed. Median age at presentation was 37 years (IQR 26.5–44). Traditional atherosclerotic risk factors were reported in 6 patients (18.2%). Recurrent arterial and/or venous thrombosis occurred in 19 patients (57.6%). Median PC activity and antigen levels were 42.8% (IQR 32.3–50.5%) and 44.0% (IQR 39.7–52.2%), respectively. Four distinct PROC mutations were described. Coronary angiography most often showed thrombotic occlusion without clear atherosclerotic disease. Combination anticoagulant and antiplatelet therapy was the most common treatment approach. Active smoking was associated with recurrent thrombosis (odds ratio 6.667, 95% CI 1.047–42.431; p=0.045). Conclusions: PC deficiency may be associated with MI and a high rate of recurrent thrombosis. Targeted evaluation may be considered in selected MI patients, particularly when coronary angiography shows no significant atherosclerosis.
Prevalence, infection status and associated factors of H. Pylori among adult dyspeptic patients in Jalalabad, Afghanistan
(2026-12-01) Chierakul W.; Maneerattanaporn M.; Charunwatthana P.; Poovorawan K.; Kittitrakul C.; Muangnoicharoen S.; Shinwari A.J.; Chierakul W.; Mahidol University
Background: Helicobacter pylori is a globally prevalent chronic bacterial infection, disproportionately affecting low- and middle-income countries. Despite its significant gastrointestinal burden, epidemiological data from Afghanistan are limited. This study aimed to determine the prevalence, infection status, and associated factors of H. Pylori among adult dyspeptic patients in Jalalabad. Methods: A cross-sectional study was conducted in Jalalabad, Afghanistan, from August 2023 to February 2024 among 363 adult dyspeptic patients. Cumulative H. pylori prevalence was defined by serum IgG and/or stool antigen positivity, active infection by stool antigen alone, and associated factors were identified using multivariable logistic regression (p < 0.05) analysis. Results: The cumulative prevalence of Helicobacter pylori infection was 79.1% (287/363), defined by combined serum IgG and/or stool antigen positivity. Infection status included chronic active infection (41.3%), acute infection (20.7%), prior exposure (17.1%), and non-infected status (20.9%). Independent factors associated with cumulative H. pylori infection were age ≥ 50 years (AOR = 6.50), married status (AOR = 3.90), low education (AOR = 2.20–5.80), multigenerational households (AOR = 7.30–7.50), crowded sleeping conditions (AOR = 2.30–4.50), family history of gastric disease (AOR = 8.90), low income (AOR = 4.80–9.20), and shared drinking glass use (AOR = 12.30). All associations were statistically significant (p ≤ 0.03). Conclusion: H. pylori affects 79.1% of dyspeptic adults in Jalalabad, with higher risk among older, married, low-education/income individuals, multigenerational households, crowded sleeping, shared drinking, or family history, highlighting the need for targeted interventions in this high-prevalence, resource-limited setting. Clinical trial: Not applicable.
Outcomes of Technically Optimal Intraoperative Radiation Therapy With Electrons Versus Whole-Breast External Beam Radiation in Suitable Patients With Breast Cancer
(2026-11-01) Jitwatcharakomol T.; Setakornnukul J.; Chuthapisith S.; Ratanawichitrasin A.; Petsuksiri J.; Thephamongkhol K.; Jitwatcharakomol T.; Mahidol University
Purpose: Intraoperative radiation therapy (IORT) with electrons is associated with higher rates of ipsilateral breast tumor recurrence in early-stage breast cancer than whole-breast external beam radiation therapy (EBRT). Although limited randomized and retrospective data suggest that this approach may suit a subset of patients, its role remains uncertain. This study aimed to compare oncological outcomes between technically optimal IORT with electrons and whole-breast EBRT in suitable patients with breast cancer. Methods and Materials: In this single-center retrospective cohort study, patients were grouped by radiation treatment: IORT with electrons or whole-breast EBRT. Endpoints included disease-free survival (DFS), local control, and breast cancer–specific survival (BCSS). Results: From January 2011 to December 2021, 204 eligible patients were reviewed (IORT, 74; EBRT, 130). The median follow-up was 5.1 years. The 5-year DFS rates were 95.61% for IORT and 98.08% for EBRT (log-rank P = .02). The 5-year local control rates were 98.46% for IORT and 100% (no event) for EBRT (log-rank P = .07). The 5-year BCSS rates were comparable: 98.61% for IORT and 100% (no event) for EBRT (log-rank P = .23). On univariable analysis for DFS, receipt of systemic treatment was a statistically significant protective factor (hazard ratio, 0.09; 95% CI, 0.01-0.74). Receipt of whole-breast EBRT was associated with a reduced risk of events, although this did not reach statistical significance (hazard ratio, 0.12; 95% CI, 0.02-1.01). Conclusions: IORT with electrons was associated with a modest but statistically significant reduction in 5-year DFS in appropriately selected patients compared with whole-breast EBRT, whereas BCSS remained comparable between groups. Therefore, electron-based IORT should be approached with caution and reserved for patients who prioritize treatment convenience.
Spring-Assisted Cranioplasty in Multisuture Craniosynostosis: Initial Experience From Thailand
(2026-01-01) Chaisrisawadisuk S.; Chaikangwan I.; Khampalikit I.; Chankaew E.; Runyan C.M.; Moore M.H.; Chaisrisawadisuk S.; Mahidol University
Spring-assisted cranioplasty is a minimally invasive, dynamic technique for cranial expansion in craniosynostosis. This report describes its initial application in Thailand for posterior vault expansion in multisuture cases. Two patients were treated: a 14-month-old boy with secondary multisuture synostosis from a ventriculoperitoneal shunt and an 11-month-old girl with Pfeiffer syndrome. Custom springs were fabricated in-house from 316 stainless steel Kirschner wire, with forces ranging from 2.68 to 4.77 N. A 1-cm wide parieto-occipital strip craniectomy was performed, and 4 springs were placed per patient. Substantial cranial expansion was achieved. The boy’s cephalic index improved from 1.29 preoperatively to 1.05 at 1 year, and the girl’s normalized from 1.07 to 0.91. Operative times were 100 and 190 minutes, with blood losses of 100 mL and 20 mL, respectively. Springs were removed at 7 and 10 months postoperatively without bony encasement. The first case required ventriculoperitoneal shunt revision for hydrocephalus, highlighting a key consideration in secondary synostosis. Both children showed appropriate developmental progress at follow-up. This initial experience suggests that spring-assisted cranioplasty is a feasible, cost-effective option for posterior vault expansion in complex multisuture craniosynostosis. It provides the benefits of an internal device, reduced operative time and blood loss, and effective cranial reshaping. Careful patient selection is essential, especially for shunt-dependent cases. The technique offers a valuable surgical option in resource-limited settings.
Sodium alginate/aloe vera/mangosteen peel extraction hydrogel composite films with anti-staphylococcal properties as a promising alternative material in biomedical applications
(2026-06-08) Chimwai P.; Apikarnsakulchai P.; Jindaratanaporn T.; Liangaumnuay W.; La-Ongthitirat T.; Somnuake P.; Somnuake P.; Chimwai P.; Mahidol University
This study focuses on the development of alternative biodegradable hydrogel films from sodium alginate as a matrix and curing into a hydrogel by CaCl₂. Thus, the aloe vera (AV) and the crude extract of mangosteen peels (MPE) were additionally blended. The polymer films were prepared using the casting film process, and their morphology, functional groups, water absorption, antibacterial, thermal, and mechanical properties were characterized using SEM, FTIR, water swelling test, disk diffusion method, DSC-TGA, and UTM. The results demonstrated the heterogeneity between the composites and the polymer matrix, and a lower polarity from the decreased %water swelling from 45% to 22%. The mechanical properties showed that the rigidity and strength of the composites were improved, while those without particle blends showed a superior elongation at break. The DSC-TGA revealed a lower melting temperature, but a higher thermal degradation temperature when the additives were added to the films. The Staphylococcus aureus protection provided a clear inhibition zone of 15 ± 1 mm. Lastly, the results of polymer composites hydrogel demonstrated a potential for biomedical applications, particularly as wound dressing materials.