Chulalongkorn Medical Journal

Perspective in the biomedical sciences field: Education and career

2026-03-20T15:27:31+07:00

The biomedical sciences are a dynamic, multidisciplinary field that is pivotal to advancing human health through research, education, and innovation. This review explores the evolving landscape of biomedical education and its related career pathways, driven by technological advancements, interdisciplinary integration, and global health demands. A literature search was performed using the PubMed, Scopus, and Web of Science databases for articles published between 2009 and 2024. Search terms included “biomedical science education,” “biomedical laboratory scientist,” “BLS career,” “biomedical engineering,” and “biomedicine.” The inclusion criteria were peer-reviewed articles in English addressing biomedical education, career pathways, or workforce development. Whereas the exclusion criteria included non-English publications, editorials, and conference abstracts without the full text being available. We examine the distinctions between biomedical science, biomedicine, and biomedical engineering and present their historical origins and contemporary roles. The education and career trajectories of biomedical laboratory scientists (BLS) are analyzed, emphasizing the diverse competencies, core curricula, and the impact of regional policies on professional qualifications. Furthermore, emerging trends and ethical/regulatory challenges are discussed. The identified key trends include the emergence of artificial intelligence, nanotechnology, synthetic biology, and digital health, which are shaping research. BLS require core scientific competencies, as well as skills such as bioinformatics and entrepreneurship. In addition, there are differences in BLS qualifications and education worldwide, and collaboration between BLS and physicians is essential in clinical research. By synthesizing recent literature, this review identifies key opportunities and challenges in preparing BLS for impactful careers and offers recommendations to optimize education and workforce development in this rapidly changing field. Collaboration and responsible innovation are critical for promoting scientific discovery and improving global health.

Malignant transformation of a giant epidermal cyst in the gluteal region–A case report

2026-03-19T14:55:46+07:00

Epidermal cysts are common cutaneous lesions, and a giant epidermal cyst is defined by its size being greater than 5 cm in diameter. The buttock is an unusual site for an epidermal cyst to occur, and the malignant transformation of an epidermal cyst is an exceedingly rare phenomenon. Clinicians should be vigilant of such an occurrence, especially in instances of a giant epidermal cyst, despite seemingly benign imaging findings. The long-term outcome of surgery for such tumors remains uncertain.

Sequential presentation of diabetic ketoacidosis, acute ischemic stroke, and ST-elevation in myocardial infarction: a case report

2026-03-19T15:24:47+07:00

Cardio-cerebral infarction is the simultaneous occurrence of acute ischemic stroke (AIS) and acute myocardial infarction (AMI), and it is a rare and life-threatening emergency. Management thereof is more challenging when it is accompanied by metabolic complications such as diabetic ketoacidosis (DKA). Here, we report a case of a 45- year-old man with hypertension and a history of chronic smoking, who was found unresponsive with right-sided hemiparesis. He was well when last seen 6 hours before arrival. Upon examination, he was hypertensive, tachypneic, had a ketotic breath odor, a Glasgow Coma Scale of 12, and a National Institutes of Health Stroke Scale score of 15. Laboratory results confirmed DKA, with a random blood glucose of 412 mg/dL and metabolic acidosis, and a noncontrast brain computed tomography revealed an acute infarct in the left parietal lobe. Initial management included intravenous fluids, insulin, and clopidogrel. Six hours after admission, he developed sudden chest pain radiating to the jaw with diaphoresis; an electrocardiogram revealed inferior–posterior ST-segment elevation. He was treated with intravenous morphine and dual antiplatelet therapy. Echocardiography on day 2 revealed akinetic left ventricular anterior segments and a reduced ejection fraction (39.0%). This case emphasizes the need for the rapid, multidisciplinary management of concurrent DKA, AIS, and ST-elevation myocardial infarction. Careful timing of the interventions to balance bleeding, thrombolysis, and hemodynamic risks, combined with the coordinated input from neurologists, cardiologists, and endocrinologists, enabled patient stabilization and discharge on day 6 with improved neurological and cardiac outcomes.

Superior mediastinal cut-off measurements in chest radiographs for the screening of silent thoracic aortic diseases

2026-03-19T15:07:05+07:00

Background: Analyzing the diagnostic cut-off values of chest radiographs provides an in-depth understanding of unrecognized aortic diseases, thereby contributing to a more comprehensive approach to identifying subtle aortic abnormalities.

Objectives: The objective of this study was to determine the cut-off measurements for superior mediastinal width and mediastinal width-to-thoracic cage ratio from chest radiographs for the early detection of unrecognized thoracic aortic diseases. In addition, this study aimed to enhance diagnostic strategies for identifying aortic abnormalities.

Methods: This retrospective analysis included 152 patients who underwent computed tomography angiography (CTA) of the thoracic aorta and chest radiograph between April 2007 and January 2021. Superior mediastinal width was measured at three levels on chest radiographs. Thoracic CTA findings were categorized into normal and abnormal groups, the latter comprising aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aneurysm. The cut-off values for the superior mediastinal width and mediastinal width-to-thoracic cage ratio were calculated using receiver operating characteristic (ROC) curve analysis.

Results: The optimal cut-off values were a mediastinal width ≥8.4 cm at the aortic knob level (ROC 77.3, 95% confidence interval (CI) 69.8–84.9, P < 0.001; sensitivity 72.7%, specificity 71.1%, positive predictive value (PPV) 58.8%, negative predictive value (NPV) 82.1%) and a mediastinal width-to-thoracic cage ratio ≥ 0.294 at the same level (ROC 78.6, 95% CI 70.8–86.3, P < 0.001; sensitivity 80.0%, specificity 61.9%, PPV 54.3%, NPV 84.5%).

Conclusion: The established superior mediastinal width and ratio cut-off values from chest radiographs can aid clinicians in identifying patients who are at risk for silent thoracic aortic disease, prompting further CTA evaluation that can prevent fatal outcomes and improve patients’ quality of life.

Clinical characteristics of cystic biliary atresia

2026-03-27T09:47:15+07:00

Background: Cystic biliary atresia (BA) is a unique form of BA that can be mistaken for a choledochal cyst. This study reviews the clinical characteristics of cystic BA to better understand its nature.

Objective: To characterize cystic biliary atresia in terms of clinical presentation, imaging findings, and surgical outcomes, and to highlight key features that aid in differentiating it from choledochal cysts.

Methods: We retrospectively reviewed the charts of all infants diagnosed with cystic BA from January 2005 to December 2019. The diagnosis of BA was confirmed in all cases by intraoperative cholangiography. Moreover, clinical data, pre-operative laboratory and imaging, intraoperative findings, and postoperative outcome were recorded, and data were expressed as mean ± standard deviation.

Results: Out of the 227 patients with BA, there were 14 patients with cystic BA (6.2%) during the studied period. The mean pre-operative ultrasound size at the maximal part of the cyst was 2.1 ± 1.2 cm, and 11 of 14 patients underwent a Kasai operation. The mean age at the time of Kasai operation was 95.3 ± 37.6 days, and only 1 in 11 patients (9.0%) underwent a Kasai operation before 60 days. Moreover, 6 patients (54.5%) underwent a Kasai operation at 61–90 days, whereas 4 patients (36.3%) underwent a Kasai operation at 113– 154 days. Intraoperative findings revealed BA type III proximal to the cysts in all cases. Based on the surgeons’ decision, 3 patients did not receive a Kasai operation, and only a liver biopsy was performed. After the Kasai operation, 8 out of 11 patients (72.7%) experienced no jaundice within 3 months. In addition, gross cirrhosis was recorded by the surgeons in 9 patients, and of these patients, 7 underwent a Kasai operation. Interestingly, 5 of the 7 patients with gross cirrhosis undergoing surgery (71.4%) were jaundice-free within 3 months. Briefly, an overall jaundice-free state was achieved in 72.7% of patients with cystic BA who underwent a Kasai operation. In addition, 71.4% of patients with cystic BA and gross cirrhosis undergoing surgery were jaundice-free.

Conclusion: Cystic BA is a rare pathology that needs to be distinguished from choledochal cysts in neonates. Awareness of the existence of cystic BA may facilitate the diagnosis and dissection around the porta hepatis area during the Kasai operation. This may increase the chance of better results for the patients. Even in the presence of gross cirrhosis, the Kasai procedure may still be considered to provide an opportunity for bile drainage.

Performance and cost comparison of a rapid diagnostic test for malaria and microscopy: A cross-sectional diagnostic study in Gusau, Nigeria

2026-03-27T10:07:43+07:00

Background: The shift from traditional microscopy to rapid diagnostic tests (RDTs) for malaria diagnosis is gaining popularity, especially in resource-limited settings where electricity supply is unstable and expertise is limited. However, trust issues arise from inconsistent performance across different RDT kits.

Objectives: This study aimed to identify variations in the performance and cost of an RDT brand for malaria among different population demographics, including pregnant women, young children, and adults, compared with microscopy as a gold standard.

Methods: The research was conducted in northwestern Nigeria and involved 360 participants who were stratified into three groups: children (5–17 years), adults (≥ 18 years), and pregnant women. Samples were examined using RDT and microscopy, and cost data were gathered from retrospective study expenses.

Results: The RDT exhibited higher sensitivity (86.1%) and a positive predictive value of 87.9% in children, but lower sensitivity (59.5%) and specificity (54.3%) in pregnant women. Logistic regression analysis indicated that the likelihood of testing positive decreased by 2.0% for each year of age (P = 0.046) and by 10.0% for each unit increase in body mass index (BMI) (P < 0.001) and was twice that of positivity in those who experienced vomiting (P = 0.004). Moreover, RDT had lower labor costs (₦61) than microscopy (₦746), which requires higher technical expertise.

Conclusion: RDTs offer a rapid diagnostic option for malaria, which may be suitable in resource-constrained settings for certain populations, such as children or adults. However, their limitations in pregnant women and the impact of age and BMI on accuracy necessitate supplementary tests where resources permit.

Effect of music therapy on the biophysical profile and oxygen consumption in preterm babies in a rural hospital

2026-03-13T08:47:05+07:00

Background: Music therapy in preterm babies helps in early weight gain and stabilization of the heart and respiratory rates, and also affects their biophysiological profile. Moreover, it has a beneficial effect on oxygen consumption and hospital stay.

Objective: This study aimed to assess the effect of music therapy on the biophysical profile and oxygen requirement of preterm babies.

Methods: The present comparative, observational study was performed in the Department of Neonatology at a rural tertiary care hospital, Sawangi Meghe, Wardha, Maharashtra, India, for one year. All relevant data were collected and analyzed using the prevalidated performa.

Results: The male-to-female ratio in the music and nonmusic groups was 1.5:1, and the ratio of normal delivery to cesarean section was 1.2:1. The mean gestational age in the two groups was 31.0 ± 4.0 weeks and 32.0 ± 5.0 weeks. The common etiology in the two groups was respiratory distress syndrome requiring continuous positive airway pressure. The mean birth weight of both groups was 1,240.0 ± 112.0 g and 1,285.0 ± 124.0 g, respectively. The heart rate in the music therapy group was 140.0 ± 14.0 beats/min vs. 122.0 ± 8.0 beats/min before and after intervention, respectively. The number of days that they required oxygen was lower in the music therapy group (8 vs. 12 days). We did not find any significant variations in desaturation episodes, respiratory rate, oxygen saturation, blood pressure, and temperature between the two groups.

Conclusion: Music therapy in the neonatal intensive care unit (NICU) benefits babies in the form of weight gain, stability, oxygen requirement, and physiological profile compared to no music therapy.

Artificial intelligence decision support in automated breast ultrasound: improving diagnostic accuracy and reducing unnecessary biopsies

2026-03-13T09:13:22+07:00

Background: The emerging roles of artificial intelligence (AI) support in the imaging of the breast have led to improved radiologist performance.

Objective: This study assessed the diagnostic performance of the AI decision support in the evaluation of breast masses using automated breast ultrasound (ABUS).

Methods: One hundred eighty-two patients (415 breast masses) who received ABUS were included. Two readers, including an experienced breast radiologist (reader 1) and the breast imaging fellow (reader 2), separately reviewed the ABUS images and the AI decision support according to the American College of Radiology BI-RADS 5th edition guidelines.

Results: In the 415 masses that were evaluated, 395 (95.2%) were benign, and 20 (4.8%) were malignant. The area under the receiver operating curve (AUC) of the AI decision support was 0.74 (95% confidence interval Original article (CI) 0.72–0.77) with a sensitivity and specificity of 100.0% and 48.6%, respectively. The integration of AI decision support significantly increased the AUC for both readers, from 0.82 (95% CI 0.74–0.91) to 0.85 (95% CI 0.76–0.93) for reader 1 (P < 0.001) and from 0.79 (95% CI 0.71–0.88) to 0.81 (95% CI 0.73–0.89) for reader 2 (P < 0.001). Furthermore, the AI decision support led to a 14.2% and 16.9% alteration in BI-RADS, with a 22.2% and 10.7% reduction in biopsies of benign masses for reader 1 and reader 2, respectively.

Conclusion: AI decision support demonstrates diagnostic performance comparable to that of radiologists, exhibiting high sensitivity and a high negative predictive value. Integrating AI into the diagnostic workflow may potentially enhance the diagnostic performance of radiologists across various experience levels and thereby contribute to a reduction in unnecessary biopsies of benign masses.