Chulalongkorn Medical Journal

Exploring the therapeutic potential of Trigonella foenumgraecum extract-loaded transferosomal gel in complete Freund’s adjuvant-induced rat models

2025-03-10T08:59:04+07:00

Background: Rheumatoid arthritis (RA) is a debilitating autoimmune disorder that is characterized by inflammation and joint damage.

Objective: This study evaluated the antiarthritic activity of Trigonella foenum-graecum (TFG) transferosomal gel in a Freund’s adjuvant-induced arthritic rat model and compared it with diclofenac gel, a standard antiinflammatory drug.

Methods: Arthritis was induced in rats by injecting 0.1 mL (1 mg/mL) of complete Freund’s adjuvant suspension into the subplantar region of the left hind foot, and they were allowed to develop arthritis for 21 days.

Results: Arthritis induction led to a considerable increase in paw volume, which is indicative of inflammation. Treatment with both TFG-transferosomal gel and diclofenac gel substantially reduced the paw volume, thus demonstrating their anti-inflammatory effects. In addition, the TFG-transferosomal gel reduced the arthritic scores, indicating its potential to ameliorate arthritic symptoms. Both treatments improved locomotor activity, which suggests relief from pain-induced hypoactivity. Furthermore, biochemical analysis revealed that the TFG-transferosomal gel effectively reduced inflammatory enzyme activity and mediator levels, comparable to that of diclofenac gel.

Conclusion: These results demonstrate the anti-inflammatory efficacy of the TFG-transferosomal gel, thus highlighting its potential as a therapeutic option for managing arthritis-associated inflammation and symptoms. Further research is warranted to elucidate its mechanisms of action and assess its clinical utility

Quality control of clinical protocols using the CT accreditation phantom

2025-03-10T09:32:08+07:00

Background: The daily quality control of the computed tomography (CT) system consists of measuring the accuracy of the CT number and artifact evaluation. The annual quality control includes a clinical protocol review. The quality assurance requirements are the responsibility of the CT radiologist, whereas the clinical team reviews and manages the CT protocol to deliver the appropriate radiation dose to the patient for each examination.

Objectives: This study aimed to examine CT number accuracy, review clinical protocols, and verify that the low-contrast performance of clinical protocols was adequate for diagnosis.

Methods: The American College of Radiology (ACR) CT accreditation phantom (CTAP) was scanned by five CT systems with four clinical protocols. The acquisition parameters for the four clinical protocols of each CT manufacturer were set according to the ACR CTAP standard criteria. The CT number calibration was performed, and the low contrast performance in terms of the contrast-to-noise ratio (CNR) was quantitatively evaluated.

Results: The mean CT numbers of polyethylene, acrylic, water, bone, and air were –96, 125, 0, 919, and –993 Hounsfield Unit (HU), respectively. The CNR of the adult brain protocol from the five CT systems was 1.6, 1.8, 1.9, 2.5, and 2.2, and the pediatric brain protocol was 1.5, 1.1, 1.1, 1.1, and 2.0, respectively. The CNR of the adult abdomen protocol was 1.1, 1.1, 1.1, 1.3, and 1.0, and the pediatric abdomen protocol was 0.5, 0.5, 0.5, 1.1, and 0.4, respectively.

Conclusion: The CT numbers in HU were within the calibration criteria for polyethylene (–107 to –84), acrylic (110 to 135), water (–7 to 7), bone (850 to 970), and air (–1005 to –970). The CNR of four clinical protocols were within the ACR Guidelines of the adult head >1.0, pediatric head >0.7, adult abdomen >1.0, and pediatric abdomen >0.4.

Reliability and validity of the Thai version of the genital appearance satisfaction questionnaire

2025-03-10T10:13:36+07:00

Background: The genital appearance satisfaction (GAS) questionnaire was constructed to measure women’s feelings toward their own genitals in a broader spectrum. The Thai language GAS questionnaire is valuable for clinical and research purposes.

Objectives: This study aimed to assess the reliability and validity of the Thai version of the GAS questionnaire.

Methods: For this study, 90 Thai women attending the gynecologic outpatient clinic at King Chulalongkorn Memorial Hospital between July 2017 and June 2018 were recruited. Ten participants dropped out because they did not answer the second questionnaire. The original English version of the GAS questionnaire was translated into the Thai version and backward translated by another linguist. The questionnaire content was then validated by two urogynecologists. After informed consent was obtained, the participants were asked to complete the Thai version of the GAS questionnaire and the Thai version of the female sexual function index (FSFI) at their first visit and only the Thai version of the GAS questionnaire at a 2-week interval (sent back by mail).

Results: The average age of the participants was 33.9 ± 7.0 years. The mean Thai version of the GAS questionnaire total scores at week 0 and week 2 were 6.0 ± 3.0 and 6.4 ± 2.8, respectively. The total score’s internal consistency (Cronbach’s alpha) was 0.9, and the intraclass correlation coefficient of the total score was 0.9 (0.8, 0.9).

Conclusion: We found that the Thai version of the GAS questionnaire is reliable and valid. It can be used to evaluate the satisfaction of genitalia in Thai women.

Blood TNF-α and GABRA-1 levels in individuals with poor ovarian response who underwent in vitro fertilization

2025-03-10T10:28:00+07:00

Background: Poor ovarian response (POR) to ovarian stimulation during in vitro fertilization (IVF) procedures is a critical issue that contributes to decreased ovarian reserves and cancelation of IVF cycles. Nevertheless, the complete etiology of this condition remains poorly understood.

Objective: This study aimed to determine the levels of a blood pro-inflammatory cytokine (TNF-α) and apoptotic marker (GABRA-1) between patients exhibiting normal ovarian response (NOR) and those with POR during the process of IVF.

Methods: This was a cross-sectional study that involved the collection of whole blood from 25 participants (NOR group n = 15, POR group n = 10). The relative gene expression levels of TNF-α and GABRA-1 were assessed using reverse transcription quantitative polymerase chain reaction.

Results: Our findings indicated that the relative gene expression levels of TNF-α were markedly elevated in the POR group compared with the NOR group (POR = 6.1 ± 1.8 vs. NOR = 3.1 ± 1.2, P < 0.001). Furthermore, a positive correlation was observed between the relative gene expression levels of TNF-α and various factors, including ovarian reserve (anti-Müllerian hormone), antral follicle count, and the total number of retrieved oocytes. In contrast, the relative gene expression levels of GABRA-1 did not exhibit any significant differences between the participant groups.

Conclusion: Elevated levels of TNF-α may be a crucial factor that contributes to the pathogenesis of POR, including diminished ovarian reserve and low quantity of retrieved oocytes, after ovarian stimulation and IVF programs.

Antioxidant and chemotherapeutic synergy: Triphala enhances doxorubicin cytotoxicity in breast cancer cells and reduces toxicity in non-tumorigenic cells

2025-03-17T08:51:27+07:00

Background: The combination of antioxidants with chemotherapy is increasingly being explored to minimize toxicity in noncancerous cells during breast cancer treatment. Triphala (TPL), a Thai herbal compound rich in antioxidants, shows potential as a complementary candidate for use in breast cancer chemotherapy.

Objective: This study investigated the combined effects of TPL and low-dose doxorubicin (DOX) on human breast cancer and non-tumorigenic mammary epithelial cells.

Methods: TPL’s bioactive compounds were analyzed using high-performance liquid chromatography. Cell viability and the levels of reactive oxygen species (ROS) were assessed in breast cancer (MDA-MB-231, MCF-7) and epithelial (MCF-10A) cells using MTT and chloromethyl 22 ,72- dichlorodihydrofluorescein diacetate assays performed in triplicate. The combination index (CI) values were determined by CompuSyn. Furthermore, the mRNA expression of apoptosis- and antioxidant-related genes was evaluated using qPCR.

Results: Gallic acid (11.9%) was identified as the major component in TPL. The combination of TPL and lowdose DOX synergistically enhanced the cytotoxicity in MCF-7 and MDA-MB-231 cells. This combination significantly reduced the expression of the antioxidant genes SOD1 and GPX1 in MDA-MB-231 (SOD1: P < 0.001, GPX1: P = 0.035) and MCF-7 (SOD1: P = 0.035, GPX1: P = 0.036) cells, which resulted in increased ROS levels in MDA-MB-231 (P = 0.005) and MCF-7 (P = 0.008) cells. Elevated ROS triggered apoptosis via the increased BAX/BCL2 ratio in MDA-MB-231 (P < 0.001) and MCF-7 (P = 0.02) cells. Conversely, TPL displayed protective effects in nontumorigenic MCF-10A cells by upregulating SOD1 (P = 0.031) and GPX1 (P < 0.001), reducing ROS (P = 0.002), and lowering the BAX/BCL2 ratio (P < 0.001), thereby promoting cell survival.

Conclusion: TPL, in combination with low-dose DOX, effectively induces cytotoxicity in breast cancer cells while protecting non-tumorigenic cells, which suggests its potential as complementary therapy in breast cancer treatment.

Appropriate international normalized ratio follow-up interval for patients with atrial fibrillation taking warfarin

2025-03-10T11:07:53+07:00

Background: The recommended follow-up for international normalized ratio (INR) measurement is every 4 weeks in patients with atrial fibrillation (AF) who take warfarin. However, data regarding the appropriate INR follow-up interval are lacking in these patients.

Objective: We aimed to investigate the appropriate INR follow-up intervals in patients with AF receiving warfarin between 6- and 12-week intervals for follow-up appointments.

Methods: We retrospectively enrolled patients with AF taking warfarin at the Central Chest Institute of Thailand between January 2017 and May 2023. The primary outcome was the time in therapeutic range (TTR) for each follow-up interval group, and the secondary outcome was the composite outcome of acute ischemic stroke/transient ischemic attack (TIA)/systemic embolic events, major bleeding, minor bleeding, and/or allcause mortality between the 6- and 12-week groups.

Results: A total of 400 patients with AF taking warfarin were recruited for the study. The average CHA2DS2- VASc score was 3.6 and 3.7 in the 6- and 12-week groups, respectively. The average HAS-BLED score was 1.8 in both groups. The TTR in the 12-week group was not inferior to that in the 6-week group (absolute difference 1.5 percentage points; 95% confidence interval –2.4 to 5.3; P < 0.001 for non-inferiority). In addition, the incidence of acute ischemic stroke/TIA/systemic embolic events, major bleeding, minor bleeding, and/or all-cause mortality was not significant between patients in the 6- and 12-week groups.

Conclusion: The TTR in the 12-week group was not inferior to that in the 6-week group in patients with AF taking warfarin. Thus, an extended 12-week follow-up interval may be applied in clinical practice. A larger prospective study will be required in the future.

Optimizing premature nutrition: An updated review of human and donor milk fortification and its implication in growth and neurodevelopmental outcomes

2025-03-10T11:19:06+07:00

Poor intra- and extrauterine growth, as well as inadequate protein supplementation during the first weeks in premature babies, are linked to long-term growth failure and impaired brain development. The calorie requirements of premature newborns cannot every time be fulfilled, even with routine and traditional fortification. This is because conventional fortification relies on the presumed well-known composition of human milk rather than the measured and calculated composition thereof. The protein content of milk in mother’s of preterm babies, varies with breastfeeding duration and the content of donor human milk varies when it is pasteurised and preserved in human milk banks for prolonged duration. Newer fortification techniques, such as individualized, targeted approaches, are required to address these challenges of protein and micronutrient undernutrition, which have led to the concept of “lacto-engineering.” This review article focuses on recent feeding practice updates, including traditional and targeted fortification, bedside human milk content analysis, lacto-engineering, and their implications in neonatal intensive care units, particularly in developing countries.

Dengue Cases in Hanoi, Vietnam: Unseasonal Surge Foreshadows Increased Incidence That Demands Organized Preventive Action

2025-03-10T08:47:21+07:00

Dengue is now a major public health risk to the people of southeast Asia, as forewarned in an editorial published by a regional biomedical journal a decade ago.⁽¹⁾ In the intervening years, this threat has escalated due to dramatic changes in climatic factors that have facilitated the extended distribution and increased numbers of the vector mosquito Aedes spp., Like its neighboring countries, Vietnam has not been spared the public health impact of this arboviral infection. Together with other mosquito-transmitted diseases, dengue is regarded almost exclusively as a problem confined to the southern part of the nation, especially Ho Chi Minh City, which experiences a year-round tropical climate. This (mis) perception has dictated national policy on vector surveillance, control, and prevention. Guidelines on dengue for central and north Vietnam now need to be urgently revised. This is exemplified by the situation in Hanoi, the capital city, located in the north of the country, in which there was a surge in dengue cases in the first quarter of 2024, a time when dengue transmission is historically not at its peak.