Scopus 2025

Permanent URI for this collectionhttps://repository.li.mahidol.ac.th/handle/123456789/102712

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Aplasia Cutis Congenita on the Scalp
(2025-05-01) Wongdama S.; Sriphrapradang C.; Wongdama S.; Mahidol University
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Financing and purchasing mechanisms of primary health care in Southeast Asia region: Findings from a scoping review
(2025-12-01) Mon H.M.; Pholpark A.; Lim L.T.S.; Tsilaajav T.; de Oliveira Cruz V.; Hanvoravongchai P.; Mon H.M.; Mahidol University
Background Despite commitment to Primary Health Care (PHC), financing has been a persistent challenge in Southeast Asia, with limited discussions. To address this knowledge gap, this study explores three key financing mechanisms: revenue mobilization, pooling, and purchasing across the region. Methods A scoping review, with searches in PubMed, Scopus, Embase, and Google Scholar, was conducted. Screening was done via Covidence, with data extracted and analyzed in Excel using a framework analysis. Results Of 2521 sources, 171 were included. Limited information specific to PHC was found. Revenue mobilization mainly includes out-of-pocket payment, government funding, social insurance contributions, and a mix of government and external funding. Pooling for PHC financing was seen in Thailand, while other countries showed multiple levels of pooling under general health financing. The prevalent purchasing method for public facilities is line-item budgeting, with salaries as the primary payment method for healthcare providers. Some countries employ performance-linked methods and capitation for provider payments. Significant challenges include inadequate budget allocations, financial flow fragmentation, and poor coordination and low capacity for financial management. Conclusion Financing for PHC is found to be insufficient and inefficient, mainly using traditional mechanisms. Cross-country learning and collaboration can support the development of strategic PHC financing mechanisms.
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Acute febrile illness in remote and rural communities: Perspectives of health providers and managers in Chattogram, Bangladesh
(2025-12-01) Liverani M.; Ahmed S.; Sen A.; Chew R.; Chandna A.; Islam S.; Maude R.J.; Islam A.; Lubell Y.; Liverani M.; Mahidol University
Acute febrile illness is a major public health issue in tropical regions, particularly in remote and rural areas where healthcare access is difficult. In these areas, patients often seek care too late or rely on self-medication, leading to increased risks of complications and death. This qualitative study examined challenges and opportunities for managing acute febrile illness in Chattogram Division, Bangladesh. The research involved interviews with 35 stakeholders across the health sector in Bangladesh, including health managers and frontline health workers, and international experts. Findings show that referral barriers, health seeking behaviour and financial considerations influence case management and outcomes in complex ways. Community health workers are vital in managing local health issues, but they have limited ability to address the evolving concerns about febrile illness. Gaps in the referral system and inadequate emergency care resources further complicate the situation. Many episodes of fever remain undifferentiated and are often managed with presumptive antibiotic treatment, which may be inappropriate and contributes to antimicrobial resistance. This study highlights the pressing need for an integrated approach to febrile illness management in rural Bangladesh, one that accounts for the changing epidemiology of infectious diseases, health seeking behaviour, and the limitations of the existing healthcare infrastructure. Expanding the ability of community health workers to manage patients with non-malarial febrile illnesses, stronger triage and referral systems, and addressing the financial and logistical barriers to care are critical steps toward improving health outcomes in these regions.
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Comparing the effectiveness and drug persistence of methotrexate, cyclosporine, and acitretin for psoriasis
(2025-12-01) Chaiyabutr C.; Paringkarn T.; Silpa-archa N.; Wongpraprarut C.; Chularojanamontri L.; Chaiyabutr C.; Mahidol University
Background: – Conventional systemic agents remain the cornerstone treatment for psoriasis because of their availability and cost-effectiveness. However, few studies have compared the effectiveness and drug persistence of these agents in Asian populations. Objectives: – To evaluate the effectiveness and drug persistence of methotrexate, cyclosporine, and acitretin, and to identify factors associated with these outcomes. Methods: – We reviewed data from 338 psoriasis patients treated with methotrexate, cyclosporine, or acitretin. Results: – Out of 473 treatment courses, 239 (50.5%) involved methotrexate, 123 (26%) involved acitretin, and 111 (23.5%) involved cyclosporine. After 1 year, the proportion of patients who achieved absolute Psoriasis Area and Severity Index (PASI) ≤ 2 was greater with methotrexate (30.6%) and cyclosporine (22.2%) than with acitretin (9.5%). For absolute PASI ≤ 4, methotrexate (57%) and cyclosporine (47.2%) showed greater effectiveness than did acitretin (34.9%), with a significant difference only between methotrexate and acitretin (P = .017). The effectiveness findings were consistent in both the 1- and 3-year analyses. Multivariate analysis revealed that a high baseline PASI score significantly reduced the effectiveness of both methotrexate and cyclosporine. For methotrexate, a high body mass index was also associated with reduced effectiveness, whereas for acitretin, scalp involvement and male sex were key factors. Methotrexate demonstrated the longest drug survival at 1 year. Higher ages at psoriasis onset and systemic treatment-naive status were correlated with longer drug survival. Conversely, a higher body mass index and psychiatric comorbidities were linked to shorter survival. Limitations: – Methotrexate is typically the first-line systemic therapy in Thailand, which may underestimate the true efficacy of cyclosporine and acitretin when used subsequently. Conclusion: – Methotrexate was more effective and persistent than were cyclosporine and acitretin in a real-world setting.
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Iris metastasis as the initial presentation of male breast cancer
(2025-01-01) Kritfuangfoo T.; Techasatian T.; Sainamthip P.; Kritfuangfoo T.; Mahidol University
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Dose-Dependent Effects of Benzodiazepines and Other Psychotropic Drugs on Seizure Duration in Electroconvulsive Therapy
(2025-01-01) Pariwatcharakul P.; Homhual P.; Prachgosin P.; Sa-nguanpanich N.; Thongchot L.; Liao P.; Suansanae T.; Pariwatcharakul P.; Mahidol University
Objective: – To examine the effects of psychotropic drugs on the seizure duration in patients receiving electroconvulsive therapy (ECT). Materials and Methods: – Medical records of patients receiving ECT at a university hospital in Bangkok from March 2014 to February 2017 were retrospectively reviewed. Demographics, psychotropic drug use, ECT parameters, and motor seizure duration were recorded. Daily doses of drugs with antipsychotic properties and benzodiazepines were converted to risperidone and diazepam equivalent doses, respectively. Besides descriptive statistics, logistic regression analyses were performed using the linear quantile mixed model analysis to examine the association between seizure duration and the use and daily dose of psychotropic drugs. Results: – Data from 249 inpatients were analyzed. Seizure duration was inversely associated with benzodiazepine dosage (β=−0.070, P=0.026), especially at diazepam-equivalent dose ≥20 mg (β=−5.303, P=0.031). After adjustment for thiopental dose, charges, age, and sex, this association remained significant (β=−5.321, P=0.033). Antipsychotic use (P=0.672) and risperidone-equivalent daily dose (P=0.996), as well as clozapine use (P=0.395) and dose (P=0.733), were not associated with seizure duration. The use of anticonvulsants (P=0.989), including valproate (P=0.500), and antidepressants (P=0.649), including SSRIs (P=0.666), SNRIs (P=0.713), and trazodone (P=0.249), also showed no significant associations. After adjusting for thiopental dose, charge, age, sex, and BZD dose, other psychotropic medications showed no significant association with seizure duration. Conclusions: – Benzodiazepine doses at diazepam equivalents of ≥20 mg were associated with shorter seizure duration. If patients benefit from benzodiazepine use during ECT, clinicians may consider prescribing it at a diazepam-equivalent dose of <20 mg/d if necessary.
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PROTEOMIC PROFILING OF BIOACTIVE PROTEIN FRACTIONS FROM PHLEBOPUS PORTENTOSUS AND THEIR POTENTIAL TO INDUCE NITRIC OXIDE PRODUCTION IN RAW 264.7 MACROPHAGES
(2025-07-01) Changsangfa C.; Tabtimmai L.; Tangsombatvichit P.; Choowongkomon K.; Sedtananun S.; Changsangfa C.; Mahidol University
Background. The tropical black bolete Phlebopus portentosus is a well-recognized wild edible mushroom with significant bioactive potential and promising food applications; however, the bioactivities of its proteins remain poorly understood. Materials and methods. This study aimed to isolate protein fractions from P. portentosus, assess their cytotoxicity, and evaluate their immunostimulatory activity in RAW 264.7 macrophages. Protein fractions (PF) were prepared using (NH₄)₂SO₄ precipitation followed by ion-exchange chromatography and subsequently analysed by integrating mass spectrometry with protein-based bioinformatics. Results. The crude proteins were separated into four fractions (PF5, PF10, PF20, and PF30). In an in vitro immunostimulation model, PF5 enhanced nitric oxide (NO) production in LPS-stimulated RAW 264.7 macrophages, while co-treatment with PF5 modulated cellular NO levels. UniProt data for Boletinellaceae indicate that only 12 proteins have been functionally characterized, while 2 remain uncharacterized, including various carbohydrate-active enzymes (CAZymes) and oxidase-related proteins. Gene Ontology (GO) analysis further linked these proteins mainly to carbohydrate metabolism and catalytic activity. Conclusion. Collectively, these findings advance current knowledge of P. portentosus proteins and underscore their potential in functional food and nutraceutical applications.
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Developing K-12 AI Literacy in Different Countries: Approaches and Challenges
(2025-01-01) Grover S.; Ravindran B.; Kong S.C.; Rodrigo M.M.T.; Wong L.H.; Naowaprateep W.; Grover S.; Mahidol University
As artificial intelligence (AI) becomes increasingly pervasive across sectors, AI literacy has emerged as foundational for K-12 learners worldwide. How are education systems around the world addressing this challenge? This panel brings together representatives from India, Philippines, Singapore, Thailand, and the US to examine their strategies for advancing AI literacy through curriculum design, pedagogical innovation, professional development, and policy frameworks. The panelists will discuss their national approaches against the backdrop of initiatives such as India's AI Samarth program reaching over five million participants, Hong Kong's integration of AI modules into computational thinking curricula, Singapore's coordinated AI for Everyone strategy, Thailand's national AI curriculum development, Philippines’ pilot efforts with the Education Center for AI Research (E-CAIR), and the US’s 2025 executive order establishing AI education as a federal priority. Despite varied implementation pathways, shared challenges persist: preparing learners equitably, defining learning goals and developmentally appropriate AI concepts, addressing teacher readiness, aligning curricula with evolving frameworks, and ensuring that ethical dimensions receive adequate attention alongside technical competencies. Panelists will explore design principles, opportunities, and challenges in building inclusive, human-centered AI literacy that prepares students to thrive in an algorithmically mediated world.
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Clinical performance of four intraoral scanners: assessing precision, scanning time, and comfort
(2025-12-01) Papasratorn D.; Jindanil T.; Cavalcante Fontenele R.; Jacobs R.; Papasratorn D.; Mahidol University
Objective: To assess the clinical precision of four intraoral scanners (IOSs), with secondary aims of assessing scanning time and comfort for patients and operators. Methods: Four IOSs—Panda Smart, Trios3, Fussen S6500, and Emerald S—were assessed using standard tips. Eleven patients received two complete arch scans/visit, performed by each operator, across two visits. This resulted in 44 complete arch scans/IOS (44 maxilla and 44 mandible), totaling 352 arches across four IOSs. Precision was assessed using root mean square (RMS) from 3D mesh comparisons. Six comparisons/arch were made: two intra-operator across visits, two inter-operator within visit, and two inter-operator across visits, totaling 12 comparisons/patient. RMS differences were analyzed using generalized linear mixed models and shown on color-coded maps. Scanning times were observed for correlation with operator experience. Operator comfort, considering ease of use and scanning flow, and patient comfort were rated using a visual analog scale. Results: Median clinical precision remained within 0.118 mm (IQR: 0.072–0.094 mm). RMS was significantly lower in the maxilla for two IOSs (p < 0.01) and the mandible for the other two (p < 0.05), while operator and visit had no significant effect. Scanning time was unaffected by operator experience. Operator comfort correlated negatively with scanning time (ease: rs = −0.73, p = 0.04; flow: rs = −0.88, p < 0.01), while patient comfort correlated negatively with tip size (rs = −0.40, p = 0.01). Conclusion: All IOSs demonstrated high clinical precision. Scanner-dependent differences in precision were noted between maxillary and mandibular scans. Fast scanning and small tip size were favored for operators and patients, respectively.
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Comparative Enzymatic Hydrolysis of Desalted Duck Egg White Using Proteases for Functional Hydrolysates
(2025-10-01) Tosuk N.; Thongsook T.; Rungchang S.; Winuprasith T.; Numthuam S.; Tosuk N.; Mahidol University
The valorization of salted duck egg white (SDEW), a high-salt by-product of the egg industry, was investigated through desalting and enzymatic hydrolysis to produce protein hydrolysates with enhanced functional properties. The desalting process resulted in a 97.13% reduction in sodium content while maintaining protein integrity, confirming desalted SDEW (DS-DEW) as a suitable substrate for enzymatic modification. Two proteases with distinct catalytic properties were compared: Protease M “Amano” SD (MSD, a dual endopeptidase and exopeptidase) and Thermoase GL30 (GL, an endopeptidase). Both enzymes showed time-dependent increases in the degree of hydrolysis (DH), with GL achieving a higher final DH at 6 hours, while MSD exhibited a faster initial hydrolytic rate. Total amino acid (TAA) content increased in both groups, with MSD yielding consistently higher levels of free amino acid. Predominant amino acids included glutamic acid, aspartic acid, glycine, and leucine, along with increased levels of hydrophobic and aromatic amino acids such as tyrosine, phenylalanine, and tryptophan. Antioxidant activity evaluated by the DPPH assay was significantly higher in MSD-treated samples, peaking at 3 hours (88.36%). In contrast, GL-treated samples exhibited lower activity, which declined over time. These results demonstrate the potential of controlled enzymatic hydrolysis of DS-DEW for producing antioxidant-active hydrolysates and support the development of value-added functional ingredients, contributing to the sustainable and industrial-scale utilization of egg industry by-products within the bio-circular-green economic model.
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Experience and Satisfaction with Non-surgical Hallux Valgus Treatment Among Patients in Siriraj Hospital
(2025-09-01) Tantamacharik P.; Chadchavalpanichaya N.; Thanakiatpinyo T.; Srisoongnern S.; Tantamacharik P.; Mahidol University
Objectives: To describe patient experiences, treatments, outcomes, side effects, and satisfaction with hallux valgus treatments at Siriraj Hospital. Study design: A cross-sectional study Setting: Siriraj Hospital, Bangkok, Thailand Subjects: Two hundred thirty participants aged over 18 who were diagnosed with hallux valgus by their physician for over a year and were able to communicate in Thai. Participants had to use the treatment for at least 5 hours per day, 5 days per week, for a minimum of 1 month. Methods: Data was collected via questionnaires from July 2021 to April 2022. Proportions of experience and satisfaction with non-surgical hallux valgus treatment were calculated to measure the patient’s experience and satisfaction with treatment options from the patient’s perspective. Mean pain score differences before and after treatment were analyzed using a paired sample t-test. Results: The study included 217 females (94.3%) with a mean age of 56 SD = 16.4. Fifty-six percent had bilateral hallux valgus. The most common treatment was changing footwear or shoe modification, which was used by 93.0% of participants. The most preferred treatment was changing footwear or shoe modification (65.2%), followed by insoles (20.0%) and dynamic splints (5.7%). These treatments all showed statistically significant clinical improvement (p < 0.001, p < 0.001 and p = 0.008, respectively). Most participants (81.3%) felt their deformity remained unchanged. The median satisfaction score was high for all treatments (8 out of 10). No serious complications were reported. Conclusions: Changing footwear or shoe modification was the most utilized and the preferred treatment, demonstrating significant clinical improvement. Further studies are recommended to investigate the effectiveness of newer treatments and potential alternatives, e.g., bunion shields, toe separator socks, and cotton toe separators.
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The Correlation of Iliac Crest Morphology and Safe Working Zone for Lateral Lumbar Interbody Fusion
(2025-01-01) Keorochana G.; Chaibanjongwat N.; Kraiwattanapong C.; Lertudomphonwanit T.; Fuangfa P.; Jaipanya P.; Chanplakorn P.; Leelapattana P.; Keorochana G.; Mahidol University
Study Design: – Imaging parameter study. Objective: – This study aims to evaluate iliac crest height and slope on plain radiographs and assess their correlation with the positions of the safe working zone (SWZ), lumbar plexus, and iliac great vessels on MRIs. Summary of Background Data: – Despite the advantages of lateral lumbar interbody fusion (LLIF), complications related to patient anatomy and the surgical approach can occur. Variations in iliac crest morphology may affect the location of neurovascular structures. Methods: – We reviewed lumbar plain films and MRIs of 98 patients. Iliac crest height was classified into high and low iliac crest height (HICH and LICH), and iliac crest slope was classified into high and low iliac crest slope (HICS and LICS). The SWZ, lumbar plexus position, and L4-5 oblique corridor were assessed from the MRIs. Results: – The LICH group had statistically significant wider SWZ on the left side compared with HICH (P=0.007). For the lumbar plexus, the HICH group had significantly more patients in Moro zone II (P=0.024) and significantly fewer patients in Moro zone IV (P=0.002). For the iliac slope showed similar results, there were statistically significant wider SWZ (P=0.003) and more posterior left-sided lumbar plexus position in the HICS group (P=0.002). The mean L4-5 oblique corridor showed no significant difference between the high and low iliac crest height or slope groups. Conclusion: – The LICH and HICS had a correlation with more widening SWZ and more posterior lumbar plexus position on axial MRI. These iliac crest types are suitable to perform LLIF of L4-5.
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Prevalence of and Factors Associated with Depression in Caregivers of Children with Cerebral Palsy
(2025-01-01) Phongdara K.; Pajareya K.; Phongdara K.; Mahidol University
Objectives: To investigate the prevalence of depression in caregivers of children with cerebral palsy including the quality of life of caregivers and factors associated with depression Study design: Cross-sectional study Setting: Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University Subjects: Ninety-two caregivers of children with cerebral palsy Methods: Caregivers of children with cerebral palsy were recruited and asked to complete a three-section questionnaire: demographic and personal information of both caregivers and the children they care for, The Patient Health Questionnaire-9 (PHQ-9) Thai version, and The World Health Organization Quality of Life Brief Thai version (WHOQOL-BREF-THAI). Results: Sixty-three percent of the participants were female, with a median age of 39 and an interquartile range (IQR) of 32-44. The children with cerebral palsy had a median age of 8 years (IQR: 4-11). The prevalence of depression in the primary caregivers of children with cerebral palsy was 20.7%, with statistically significant findings indicating that caregivers of children with cerebral palsy who were non-verbal were more likely to experience depression at a rate 3.4 times higher than caregivers of children who could communicate using language (p < 0.05). Overall, the quality of life of the primary caregivers of children with cerebral palsy was moderate (65.5%). Caregivers with depression had significantly lower quality of life scores in all domains with the exception of social relationships. Conclusions: The prevalence of depression among primary caregivers of children with cerebral palsy at Siriraj Hospital was 20.7%, with lack of language communication of their children with cerebral palsy a significant factor.
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Prevalence, Characteristics, and Impacts of Urinary Tract Infection on Functional Outcomes: A Retrospective Study of Inpatient Stroke Rehabilitation at Siriraj Hospital, Thailand
(2025-09-01) Aueaananratthakit P.; Harnphadungkit K.; Aueaananratthakit P.; Mahidol University
Objectives: To investigate the prevalence, characteristics, associated factors, and impacts of urinary tract infections (UTI) on the Barthel Index (BI) during inpatient stroke rehabilitation. Study design: Retrospective study Setting: Inpatient Rehabilitation Unit, Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand Subjects: Inpatients with stroke, aged ≥ 18 years old, admitted to the Rehabilitation Ward, Siriraj Hospital during 2019-2021 Methods: Demographic, clinical, and functional data of eligible patients were retrieved from the rehabilitation admission medical records in the hospital information system. Results: Of 399 stroke patients identified, 11.5% had been diagnosed with UTI. Of these, 30.4% had catheter-associated UTIs (CAUTIs), while 69.6% had non-CAUTIs. Escherichia coli was identified as the most common pathogen. UTI was significantly associated with advanced age (p < 0.001), indwelling catheter use (p < 0.001), recurrent stroke (p = 0.031), and dysphagia (p < 0.019). Patients with UTI exhibited a statistically significant reduction in BI normalized gain per 21-day length of stay (BIg21days) (p = 0.033) and experienced longer rehabilitation length of stay (LOS) (p = 0.002). Using forward stepwise linear regression, only age and dysphagia, but not UTI, were found to be statistically significantly associated with BIg21days. Conclusions: The prevalence of UTI is 11.5%, with higher rates in older individuals, those with recurrent stroke, dysphagia, and those using urinary catheters. Functional gain per 21 days of rehabilitation admission is associated with age and dysphagia, but not with UTI.
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Early Psychological Effects Among Citizen Responders Activated to Out-of-Hospital Cardiac Arrests
(2025-01-01) Saparbek A.; Turusbek N.; Saparbek A.; Mahidol University
Dispatching lay volunteers to suspected out-of-hospital cardiac arrest (OHCA) can enhance early resuscitation efforts, yet the experience may also influence volunteers’ psychological well-being. This study explored how citizen responders perceived their psychological state during the first hours after being mobilized to an OHCA event. In the Capital Region of Denmark, a smartphone platform was used to alert trained and untrained volunteers to initiate cardiopulmonary resuscitation. All individuals activated between September 2017 and May 2019 were asked to complete a brief questionnaire 90 minutes after receiving an alert. The survey included a four-tier rating scale to capture the degree of psychological impact (ranging from 1 = no impact to 4 = severe impact). Of the 5,395 individuals alerted, 88.6% submitted responses within the first 24 hours. Most respondents (68.6%) indicated they experienced no psychological effect, while 24.7% reported mild effects, 5.5% moderate effects, and 1.2% severe effects. Severe impact was disproportionately reported by volunteers without prior CPR instruction (3.8% versus 1.2%, p = 0.02), by those younger than 30 years (2.0% versus 0.9%, p < 0.001), by women (1.8% versus 0.7%, p < 0.001), by individuals who carried out CPR (2.7% versus 1.0%, p < 0.001), and by responders who reached the patient before emergency medical services (2.8% versus 0.7%, p < 0.001). Statistical comparisons were conducted using chi-square, Mann–Whitney U, Fisher’s exact tests, and multivariable logistic regression. Only a minority of citizen responders experienced severe psychological distress following activation to an OHCA case. Factors associated with greater impact included lack of CPR training, younger age, female sex, performing CPR, and arriving ahead of emergency personnel. Although pronounced distress was uncommon, integrating options for professional debriefing may improve the support structure within citizen responder initiatives.
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A Preliminary Study of the Effectiveness of a Custom-made Compression Garment with Simplified Tailoring for Breast Cancer-related Lymphedema: A Randomized Control Trial
(2025-05-01) Srisuthep N.; Kongsri N.; Pajareya K.; Srisuthep N.; Mahidol University
Objectives: To study the changes in arm volume and quality of life of breast cancer-related lymphedema patients after using a custom-made compression garment with simplified tailoring compared with a pressure garment tailoring by a standard method Study design: A single-blinded randomized controlled trial Setting: The Outpatient Physical Medicine and Rehabilitation Clinic in Siriraj Hospital, Bangkok, Thailand Subjects: Females aged 18 years or older diagnosed with breast cancer-related lymphedema Methods: Forty-three participants were randomly assigned to one of two groups. Both groups received complex decongestive therapy (CDT) over a period of three weeks. The control group was provided custom-made compression garments made using the conventional method, while the experimental group received custom-made compression garments made using a simplified technique of tailoring. Results: Of the forty-three participants, 22 were in the intervention group and 21 were in the control group. In the control group, the mean arm volume decreased by 77.6 ml (SD = 201.8) after three weeks. The volume in the control group was not statistically significant different from baseline (p = 0.058). During the same period, the mean arm volume reduction in the intervention group was 172.7 ml (SD = 304.3), a statistically significant reduction in the affected arm volume from baseline (p = 0.015). However, no statistically significant difference was observed in other direct comparisons between the two groups, i.e., both groups statistically significantly improved their quality of life as measured by changes in the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL). However, there was no statistically significant difference between the two groups regarding quality-of-life improvement. Conclusions: The data suggests a trend towards a more significant reduction in affected arm volume with the new custom-made tailoring method of making the compression garment over the conventional tailoring technique. These results suggest promising avenues for future larger-scale studies.
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Clinical Competency Needs of Physiatrists in Thailand: A Cross-Sectional Study
(2025-01-01) Supasirimontri K.; Triloga N.; Harnphadungkit K.; Supasirimontri K.; Mahidol University
Objectives: To determine the degree to which the clinical competency needs of Thai practicing physiatrists in the current rehabilitation medicine residency curriculum align with topics validated by the Board of Training and Examination in Rehabilitation Medicine of Thailand Study design: Cross-sectional study Setting: Department of Rehabilitation Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand Subjects: Total Thai physiatrists in 2020-2021 Methods: A total of 731 physiatrists in Thailand were surveyed using the questionnaire which was composed of two parts. The first part covered participants’ characteristics. The second part included 96 rehabilitation medicine topics which had been validated by the Board of Training and Examination in Rehabilitation Medicine of Thailand. Participants rated each of the topics on a four-point (1-4) Likert scale for both “Frequency” and “Importance”. Frequency refers to how often the participant applied each topic in their practice and importance refers to the significance of each topic in their clinical practice. Results: The response rate was 15.3% (112/731). The five most frequently encountered conditions rated 4 were low back pain (N=86.6%), osteoarthritis of the knee (N=83.0%), stroke (N=79.5%), spondylosis/spondylolisthesis (N=78.6%), and radiculopathy (N=70.5%). The five most essential conditions rated 4 were stroke (N=87.5%), osteoarthritis of the knee (N=79.5%), low back pain (N=78.6%), chronic pain (N=75.9%), and radiculopathy (N=75.0%). Conclusions: The survey provides essential information which the Royal College of Physiatrists of Thailand and could use to help improve the curriculum content for entrustable professional activities.
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Potential Role of Coronoidectomy for Stroke-Induced Spastic Trismus Patients with Botulinum Toxin Insensitivity: A Case Report
(2025-05-01) Benjapornlert P.; Tuakta P.; Chatdokmaiprai C.; Thongjood T.; Benjapornlert P.; Mahidol University
Background: Trismus is a consequence of muscle spasticity, often secondary to stroke, leading to compromised oral functions and increased aspiration pneumonia risk. However, in some cases, the patient does not respond to conservative treatment such as rehabilitation procedures, medication, and botulinum toxin injection. Objective: To evaluate the efficacy of coronoidectomy in managing spastic trismus unresponsive to conventional and botulinum toxin treatments post-stroke. Case description: A 40-year-old man, with post right middle cerebral artery (MCA) infarction presented with spastic trismus, exhibiting an incisor gap of 1 cm. The patient remained nonresponsive after receiving 25 units of botulinum toxin serotype A in the bilateral masseter muscles and consequently suffered an aspiration pneumonia episode. Computerized tomography (CT) imaging identified left temporomandibular joint (TMJ) ankylosis. A bilateral coronoidectomy and interposition gap arthroplasty on the left condyle expanded the mouth opening to 5 cm. Post-surgical management included intensive swallowing rehabilitation and a dental splint to preserve the achieved incisor gap. Conclusion: Coronoidectomy can be a potential therapeutic intervention for stroke-induced trismus, particularly when nonresponsive to conservative therapies.
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Human-in-the-Loop for Machine Learning in Offensive Cybersecurity
(2025-01-01) Ruengsurat S.; Eawsivigoon J.; Sookplang V.; Sumongkayothin K.; Siritanawan P.; Beuran R.; Kazunori K.; Ruengsurat S.; Mahidol University
Penetration testing is one of the methods that is used to find the exploitable vulnerabilities so that we are able to fix those vulnerabilities. Intrusion detection system is one of the defensive systems that needs to be improved all the time to prevent the intruders or the cyber criminals from bypassing the detection system and stealing important and valuable information or data. Nowadays, there are automation tools that are used to support the adversarial attack on intrusion detection systems. However, those tools may have some errors that, even if they can not be detected by intrusion detection systems, they can be seen by human experts. Including the human experts in the development of the tool therefore is a way to improve the attack performance and decrease the errors of the tool. In this study, we developed a model that mimics normal traffic behavior while also being capable of evading existing detection systems, with human expert assistance to improve the performance. The result of the experiment shows that the model successfully decreases the detection rate and the performance of the attack is up to the attack types. Moreover, with the help from the expert in developing the model and in the attack process, the errors in the tool are reduced and the performance of the attack is increased.
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Effectiveness of Metformin Prolonged-Release Formulation on Achievement of Optimal Glycemic Control in Gestational Diabetes Mellitus: Protocol for a Pilot, Randomized, Double-Blind, Clinical Trial
(2025-01-01) Boriboonhirunsarn D.; Sunsaneevithayakul P.; Boriboonhirunsarn D.; Mahidol University
Background: Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. Optimal glycemic control is key to reducing the risk of adverse pregnancy outcomes. If glycemic control is inadequate, additional medications are needed. A large body of evidence has shown that metformin is an effective medication for GDM. Compared to the immediate-release formulation, the prolonged-release (PR) formulation of metformin offers some advantages with a single daily dose and has less frequent side effects, leading to better compliance. To date, no study has specifically reported the effectiveness of metformin PR in the treatment of GDM or the time required to achieve glycemic control after treatment. The results will help clinicians plan a better choice of treatment and follow-up for women with GDM and inadequate glycemic control. Objective: This study aims to evaluate the effectiveness of metformin PR in the treatment of GDM in terms of achieving glycemic control within 6 weeks, time to achieve glycemic control, and associated factors. Methods: A randomized, double-blind, placebo-controlled clinical trial will be conducted among 80 pregnant women diagnosed with GDM who had inadequate glycemic control at a university hospital in Thailand. The women will be randomized into 2 equal groups, receiving either metformin PR or a placebo in addition to nutritional therapy and behavioral modification. Dosage adjustment will be made every 2 weeks. If the glycemic target is not achieved within 6 weeks, insulin therapy will be initiated. All the participants and the investigators are blinded to the treatment provided. The primary outcome is the rate of achievement of glycemic control, and secondary outcomes are time to achieve glycemic control, rate of insulin therapy, and factors associated with the success of metformin PR use. Results: The study was funded in May 2025 when recruitment started. The study is projected to be completed in October 2026. Women with GDM who experienced inadequate glycemic control by nutritional therapy were assessed for eligibility. As of October 2025, 24 women with GDM agreed to participate and follow-ups were scheduled. The results are expected to be published in 2027. Conclusions: The results of this study will provide additional information on the use of metformin in the treatment of GDM, including the use of different formulations, rate of glycemic control, time to achieve glycemic control, and associated factors. This will help physicians better plan care for pregnant women with GDM, especially when glycemic control is inadequate, including choices of metformin formulation and dosage, follow-up schedule, and identification of women at risk of treatment failure.

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