Mahidol University's Institutional Repository
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Recent Submissions
Association of Serum ADA Levels in Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis
(2026-04-01) Songsri J.; Thanasai J.; Tangpong J.; Chittamma A.; Klangbud W.K.; Songsri J.; Mahidol University
Background: The early diagnosis of pulmonary tuberculosis (PTB) remains a global challenge. While serum adenosine deaminase (ADA) has been associated with tuberculosis-related immune activation, its consistency across different regions and laboratory methods remains unclear. This study aims to evaluate group-level differences in serum ADA levels and identify factors influencing these variations. Methods: A systematic search was conducted across PubMed, Embase, and Scopus up to February 2026. A meta-analysis using a random-effects model was performed to calculate the pooled standardized mean difference (SMD), reflecting group-level differences in serum ADA levels between PTB patients and control groups. Results: Thirty-four studies were included. Serum ADA levels were significantly higher in PTB patients compared to healthy controls (SMD = 3.15, 95% CI: [2.51–3.79], p < 0.0001) and other respiratory diseases (SMD = 2.06, 95% CI: [1.38–2.74], p < 0.0001). Subgroup analyses revealed that geographical region and ADA measurement methods did not significantly account for the observed high heterogeneity (I2 > 95%), indicating that ADA elevation was consistently observed across studies. Conclusions: Serum ADA levels were significantly elevated in patients with PTB, indicating a consistent biological association with disease status. However, given the high heterogeneity and the absence of diagnostic accuracy measures (e.g., sensitivity and specificity), these findings should not be interpreted as evidence of clinical diagnostic performance. Further diagnostic test accuracy studies are required to establish its clinical utility.
Association between a 24-h increase in blood urea nitrogen and clinical outcomes in acute non-variceal upper gastrointestinal bleeding: a dual-center retrospective cohort study
(2026-01-01) Bunnag K.; Chang A.; Chuaypetch W.; Rujipattanapong N.; Chienwichai K.; Rugivarodom M.; Chirapongsathorn S.; Prachayakul V.; Bunnag K.; Mahidol University
Background and aim: Blood urea nitrogen (BUN) is incorporated into admission-based risk scores for acute non-variceal upper gastrointestinal bleeding (NVUGIB); however, the clinical relevance of early in-hospital BUN kinetics remains unclear. Objectives: To evaluate whether a 24-h increase in BUN is independently associated with adverse clinical outcomes in patients with acute NVUGIB. Design: Dual-center retrospective cohort study. Methods: We conducted a dual-center retrospective cohort study of adult patients with endoscopically confirmed NVUGIB admitted between 2018 and 2023. The exposure was defined as any absolute increase in BUN within 18–30 h after the baseline measurement at presentation. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, in-hospital rebleeding, red blood cell transfusion, length of hospital stay, and need for radiologic or surgical intervention. Multivariable regression was performed in a propensity score-matched cohort with confirmatory analyses in the original cohort. Results: Among 611 patients, 218 (35.7%) demonstrated a 24-h increase in BUN. Propensity score matching yielded 400 patients (200 per group). In the matched cohort, a 24-h BUN increase was independently associated with higher 30-day mortality (adjusted odds ratio (aOR) 3.307; 95% confidence interval (CI) 1.604–6.819) and in-hospital mortality (aOR 2.732; 95% CI 1.208–6.178). No independent associations were observed with rebleeding, transfusion requirements, or radiologic/surgical intervention. Conclusion: An increase in BUN within the first 24 h of hospitalization is independently associated with higher short-term mortality in acute NVUGIB. Early BUN kinetics may serve as a complementary risk marker, but prospective validation and formal predictive-performance testing are needed before clinical integration.
Effect of leucine-enriched essential amino acid supplementation combined with different exercise regimen on appendicular skeletal muscle mass and muscle performance in older adults: an open label randomized controlled trial
(2026-05-01) Thavonlun C.; Limsapjaroen J.; Yoosuk P.; Mahaisavariya C.; Thavonlun C.; Mahidol University
Sarcopenia in older adults increases fall risk and frailty. Improving muscle mass and function enhances balance and supports basic activities of daily living. Leucine-enriched essential amino acid supplementation combined with resistance training has been shown to enhance muscle performance. The present study evaluated muscle performance outcomes after 6 mo of these treatments. In an open-label randomized controlled trial, 66 participants were randomized equally to control and intervention groups (n = 33 each). Both groups consumed daily leucine-enriched essential amino acid supplements after exercise. The intervention group performed resistance training, and the control group followed regular walking and strengthening exercises. Primary outcomes were appendicular skeletal muscle mass index (ASMI), gait speed, and hand grip strength. Safety was assessed by adverse event reporting and laboratory tests. The results of this study show no significant improvement in ASMI in either group after 6 mo. Both groups demonstrated significant gait speed improvements, with no between-group difference. Hand grip strength improved only in the non-dominant hand of the control group. No serious adverse events occurred, and kidney function remained stable. In conclusion, 6 mo of daily leucine-enriched essential amino acid supplementation combined with exercise did not increase ASMI among healthy older adults. Gait speed showed a positive association with supplementation and daily exercise regardless of regimen. Improvement in hand grip strength was observed only in the non-dominant hand, warranting further investigation to clarify the effect of supplementation combined with exercise. Additional clinical studies are required to establish the effectiveness of this regimen in preserving muscle mass and enhancing functional performance. Clinical trial registration: This study has been registered with the Thai Clinical Trials Registry (ID: TCTR20210824002).
Clinical Characteristics and Outcomes of Asian Coral Snake Bites in Thailand: A Retrospective Cohort Study
(2026-04-01) Tansuwannarat P.; Trakulsrichai S.; Pathumarak J.; Tongpoo A.; Tansuwannarat P.; Mahidol University
Asian coral snakes are distributed throughout Southeast Asia, including Thailand, but clinical data on their envenomation remain limited. Using a 10-year retrospective dataset from the Ramathibodi Poison Center, we investigated the epidemiology, clinical characteristics, management, and outcomes of Asian coral snake envenomation in Thailand. Patient demographics, clinical and laboratory data, treatments, and outcomes were analyzed descriptively. Fifty-two patients were included. Sinomicrurus macclellandi was the most frequently reported species. Most bites occurred during the rainy season and involved the lower extremities. Clinical manifestations were predominantly mild and localized. No cases of systemic neurotoxicity, bulbar weakness, respiratory compromise, or death were observed. Laboratory results were generally within normal limits. Two patients developed anaphylaxis, which resolved with standard emergency treatment, while two experienced severe pain. Calliophis intestinalis lineata was associated with a higher proportion of tachycardia at presentation and longer hospitalization. No patients required mechanical ventilation or antivenom therapy. Supportive care and short-term hospital observation are generally sufficient in confirmed cases. The median duration of hospitalization was 1–3 day. Local manifestations were the predominant clinical findings following Asian coral snake envenomation in Thailand, and systemic neurotoxicity was not observed. These findings differ from reports of Micrurus envenomation, which primarily involve New World coral snakes, whereas the species implicated in Thailand belong to Old World genera.
Social Media Addiction, Perceived Stress, Emotional Intelligence, and Cyberbullying Among Thai Adolescents During the Transition from the COVID-19 Pandemic to the Endemic Phase
(2026-04-01) Rodpet S.; Thaweekoon T.; Napa W.; Rodpet S.; Mahidol University
The COVID-19 pandemic significantly increased adolescent digital engagement, but whether the rise in cyberbullying persists beyond the crisis is not well understood, especially in Southeast Asia. This study examined social media addiction, perceived stress, emotional intelligence, and cyberbullying among 416 Thai secondary students (grades 7–12) during the pandemic-to-endemic transition (June–October 2023). Participants completed validated Thai-language instruments assessing cyberbullying, social media addiction, perceived stress, and emotional intelligence. Results showed 66.4% of adolescents were involved in cyberbullying, with 32.2% as bully-victims. Social media addiction correlated with cyberbullying perpetration (rs = 0.33, p < 0.001) and victimization (rs = 0.22, p < 0.001), as did perceived stress (rs = 0.20 and 0.29; p < 0.001). Emotional intelligence showed negative correlations with cyberbullying perpetration (rs = −0.15, p = 0.002) and victimization (rs = −0.10, p = 0.048). Over one-third (34.4%) were at high risk for social media addiction. These findings indicate that during the pandemic-to-endemic transition, Thai adolescents showed elevated cyberbullying involvement, high social media addiction, and moderate-to-high stress—a profile consistent with sustained digital risk. These results highlight the need for integrated interventions that address digital wellness, stress management, and the development of emotional intelligence among Thai adolescents.