Mahidol University's Institutional Repository
คลังสารสนเทศสถาบันของมหาวิทยาลัยมหิดล
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Recent Submissions
Determinants of Cardiovascular Disease Risk Among LGBTQ+ Populations: A Systematic Review of Empirical Evidence
(2026-05-01) Sriprasong S.; Sukumanukoon K.; Chantab N.; Chaosangkate N.; Ruksakulpiwat S.; Sriprasong S.; Mahidol University
Background: Understanding the multifactorial drivers of cardiovascular disease (CVD) risk in LGBTQ+ populations is critical to advancing equitable cardiovascular care. Objective: To evaluate and synthesize empirical evidence on factors influencing CVD risk among sexual minority populations. Methods: A systematic review was conducted following PRISMA guidelines. Five databases (PubMed, Scopus, MEDLINE, ScienceDirect and ProQuest) were searched for studies published between 2019 and 2024 that examined CVD risk factors among LGBTQ+ adults. Eligible studies were appraised using the Joanna Briggs Institute critical appraisal tool, and findings were synthesized using a convergent integrated approach. Results: Twenty studies met the inclusion criteria, most of which were cross-sectional and conducted in high-income countries. Identified CVD risk factors were classified into six domains: behavioural (e.g., nicotine use, health behaviours, substance use), blood biomarker (e.g., lipid or total cholesterol, HbA1c, C-reactive protein), physical (e.g., BMI, blood pressure, age), comorbidities (e.g., metabolic syndrome, COPD, HIV), psychological (e.g., positive and negative factors) and social (e.g., discrimination, loneliness, marital status). Bisexual, lesbian and gay individuals were most frequently represented. Across studies, minority stress and adverse social determinants were consistently associated with elevated CVD risk. Conclusion: Sexual minority populations face disproportionate cardiovascular risk shaped by behavioural, biological and psychosocial stressors. These findings highlight the need for inclusive, culturally competent nursing practice and identity-informed screening strategies. Implications for Nursing Practice and Policy: Nurses should integrate sexual orientation and gender identity into cardiovascular risk assessments, adopt trauma-informed and resilience-promoting approaches, and advocate for policies that reduce structural barriers to equitable care. Patient or Public Contribution: No patients or members of the public were directly involved in the design, conduct or reporting of this systematic review.
The Grammar of Science: How “Robust” Are Your Study Results?
(2025-04-01) Kaewkungwal J.; Kaewkungwal J.; Mahidol University
Beyond iron deficiency: A comprehensive national survey of anaemia etiology in Sri Lankan young adults
(2026-12-01) Amarasingha D.; Silva R.; Perera L.; Wickramasinghe N.; Piyathunga D.; Gooneratne L.; Jayatissa R.; Dharmabandu S.; Chen P.; Fucharoen S.; Perera S.; Premawardhena A.; Amarasingha D.; Mahidol University
Previous studies in Sri Lanka have explored the prevalence and causes of anaemia, mainly emphasizing iron deficiency while overlooking other important factors such as enzymopathies, membranopathies, and haemoglobinopathies. Moreover, many studies reported unexplained cases of anaemia even after detailed evaluation. This study aimed to determine the prevalence and underlying causes of anaemia among community-based young adults in Sri Lanka. A descriptive cross-sectional study was conducted from January 2023 to December 2024 among young adults aged 18–30 years. Data and blood samples were collected using a pretested questionnaire. Anaemic individuals underwent serum iron studies, CRP, vitamin B12 and folate assays, and thalassaemia screening. Those with uncharacterized anaemia were further assessed using red cell enzyme assays, EMA dye binding assays, and whole-exome sequencing. The mean (± SD) age of the study participants was 23.90 ± 1.98 years. Anaemia prevalence was 15.0%. The main causes were iron deficiency (49.3%), folate deficiency (27.8%), vitamin B12 deficiency (14.4%), and haemoglobinopathy traits were identified in 25.6% of anaemic individuals, frequently in combination with nutritional deficiencies. A substantial proportion of anaemic individuals exhibited coexisting aetiologies rather than a single cause. Initially, 17.4% remained uncharacterized, but advanced testing identified variants suggestive of hereditary spherocytosis and congenital dyserythropoietic anaemia or dyskeratosis congenita. This first community-based Sri Lankan study integrating advanced diagnostics revealed that, although iron deficiency predominates, genetic and enzymatic disorders contribute notably, highlighting the need for broader diagnostic strategies in anaemia screening in the community.
The Outcomes of Siriraj’s Classification for Giant Inguinal Hernia: A Literature Review and Meta-analysis
(2026-05-01) Tangkullayanone W.; Nampoolsuksan C.; Tawantanakorn T.; Suwatthanarak T.; Sriworanan N.; Taweerutchana V.; Parakonthun T.; Phalanusitthepha C.; Swangsri J.; Akaraviputh T.; Methasate A.; Chinswangwattanakul V.; Trakarnsanga A.; Tangkullayanone W.; Mahidol University
Objective: Giant inguinal hernia is a rare condition associated with high perioperative morbidity. Siriraj's classification was developed to guide surgical management according to hernia extent; however, clinical outcome data remain limited. This study aimed to evaluate postoperative complications associated with giant inguinal hernia repair according to Siriraj's classification. Materials and Methods: A literature review and proportion meta-analysis were conducted to assess the surgical outcomes of giant inguinal hernia repair. PubMed and Google Scholar were systematically searched for studies reporting surgical management and complications of giant inguinal hernia. Studies were included if the hernia type could be classified according to Siriraj's classification or sufficient clinical information was available. The primary outcome was postoperative complications. Pooled complication rates with 95% confidence intervals (CI) were calculated using fixed- or random-effects models based on heterogeneity. Results: Ten studies involving 101 giant inguinal hernias were included in the meta-analysis. The overall postoperative complication rate was 35% (95% CI: 0.17–0.59). Type I giant inguinal hernia showed a complication rate of 43%, while non-Type I hernias demonstrated a complication rate of 37%. Although overall complication rates were comparable, major complications were predominantly observed in cases not adhering to Siriraj's classification. Protocol adherence was significantly associated with reduced risk of major complications (odds ratio 0.007, 95% CI: 0.0003–0.142; p=0.0013). Conclusion: Siriraj's classification provides a practical framework for guiding surgical management of giant inguinal hernia and may reduce major postoperative complications. Further large-scale studies are required to validate these findings.
Characterizing viral clearance kinetics in acute influenza
(2026-04-30) Wongnak P.; Seers T.; Jittamala P.; Imwong M.; Schilling W.; Watson J.; White N.J.; Wongnak P.; Mahidol University
Pharmacometric assessment of antiviral efficacy in acute influenza informs treatment decisions and pandemic preparedness. We characterized natural viral clearance in acute influenza to guide phase II trial design using simulations based upon observed data. Standardized duplicate oropharyngeal swabs were collected daily over 14 days from 80 untreated low-risk Thai adults, with viral densities measured using quantitative polymerase chain reaction. We evaluated three models to describe viral clearance: exponential, bi-exponential and growth-and-decay. The growth-and-decay model provided the best fit, but the exponential decay model was the most parsimonious. The median viral clearance half-life was 10.3 h (interquartile range (IQR): 6.8-15.4h), varying by influenza type: 9.6 h (IQR: 6.2-13.0 h) for influenza A and 14.0 h (IQR: 10.3-19.3 h) for influenza B. Simulated trials using parameters from the exponential decay model showed that 148 patients per arm provide over 90% power to detect treatments accelerating viral clearance by 40%. Variation in clearance rates strongly impacted the power; doubling this variation would require 232 patients per arm for an antiviral with a 60% effect size. A sampling strategy with four swabs per day reduces the required sample size to 81 per arm while maintaining over 80% power. We recommend this approach to assess and compare current anti-influenza drugs. This article is part of the Theo Murphy meeting issue 'Evaluating anti-infective drugs'.