Chulalongkorn Medical Journal

Beyond lipid lowering: Pleiotropic effects of statins in inflammation, coagulation, and cell proliferationmechanisms and clinical implications

2026-07-31T09:43:06+07:00

Statins are widely used lipid-lowering agents that substantially reduce cardiovascular morbidity and mortality by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase. Beyond their cholesterol-lowering properties, increasing evidence indicates that statins exert several pleiotropic effects that are independent of lipid reduction. These effects include anti-inflammatory, antithrombotic, and antiproliferative actions mediated primarily via the inhibition of the mevalonate pathway and downstream signaling molecules such as Rho, Rac, and Ras. Experimental and clinical studies have suggested potential benefits of statins in various noncardiovascular conditions, including autoimmune diseases, venous thromboembolism, sepsis-associated coagulopathy, and certain malignancies. In addition, pharmacoepidemiologic studies have provided insights into the real-world effects and safety profile of statins, including the risk of new-onset diabetes mellitus. This review summarizes the current evidence on the molecular mechanisms and clinical implications of statin pleiotropic effects beyond its lipid-lowering properties. However, much of the evidence supporting noncardiovascular benefits is derived from observational studies. Therefore, further randomized controlled trials are required to clarify causality, optimal patient selection, and therapeutic strategies for statin repurposing.

Role of perceived control over falls in older adults

2026-07-31T14:34:57+07:00

Falls among older adults constitute a considerable public health challenge, often leading to severe physical injuries, reduced independence, and a diminished quality of life. Perceived control, a critical psychological construct, plays a substantial role in sustaining physical health, cognitive function, and overall life satisfaction, and it is strongly associated with positive health outcomes. This review aims to examine the role of perceived control in fall risk among older adults. Concern about falling (CaF) is a prevalent psychological factor that influences fall risk by affecting behaviors linked to physical activity, balance, and adaptive responses. Perceived control theory provides a framework for understanding how older adults’ confidence in managing falls shapes their emotional responses and behavioral adaptations, thereby influencing fall-related outcomes and overall health. This review highlights the complex and multidimensional nature of perceived control related to falls. High levels of perceived control are positively correlated with better physical and mental health, whereas lower perceived control is associated with an increased fall risk and compromised well-being. A thorough analysis of theoretical models and empirical studies highlights perceived control as a mediator that promotes adaptive behaviors, supports emotional resilience, and encourages proactive engagement in fall prevention strategies. By identifying knowledge gaps in the existing literature, this review encourages further research on factors that influence perceived control and the development of standardized assessment tools that address the psychological and physical aspects of fall prevention. Such tools could enhance the independence and well-being of older adults.

Prevalence of stunting and environmental determinants among children under 5 years of age: A systematic review and meta-analysis

2026-07-09T14:08:17+07:00

Background: Stunting remains a major global public health issue, particularly in low- and middle-income countries. It is driven by inadequate nutrition and environmental factors, such as limited access to clean water, sanitation, and hygiene practices.

Objectives: This study aimed to estimate the prevalence of stunting among children under 5 years of age and to assess its correlation with environmental determinants.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. Four international e-databases—Scopus, PubMed, ScienceDirect, and Springer—and reference lists were searched. In total, 20 studies involving 103,313 children met the inclusion criteria. A random-effects model was employed to estimate combined prevalence and associations; the I² statistic was used to assess heterogeneity.

Results: Stunting prevalence was 32.9% (95% CI: 28.6–37.8; I2 = 99.5%). Children from households with inadequate sources of drinking water were at a 1.2-times higher risk of stunting (adjusted odds ratio (AOR) = 1.2; 95% CI: 1.0–1.4; I2 = 78.5%). Inadequate toilet facilities increased the risk by 1.3 times (AOR = 1.3; 95% CI: 1.0–1.6; I2 = 86.5%), poor sanitation by 1.2 times (AOR = 1.2; 95% CI: 1.0–1.4; I2 = 75.0%), and poor handwashing practices by 2.3 times (AOR = 2.3; 95% CI: 1.0–5.5; I2 = 68.1%).

Conclusion: Stunting prevalence was significantly associated with environmental determinants. Integrating interventions for such factors with nutrition programs is essential to controlling stunting, particularly in rural areas. Policy efforts should prioritize improving access to safe drinking water, providing adequate sanitation facilities, conducting hygiene promotion programs, and community-based nutritional interventions to support child growth and development.

Beyond idiopathic ventricular fibrillation: Vasospastic angina uncovered after ICD implantation

2026-08-13T16:29:32+07:00

A woman in her 40s presented with epigastric pain and subsequently developed ventricular fibrillation (VF) cardiac arrest requiring resuscitation. The initial coronary angiography (CAG) revealed no significant stenosis. Due to limited resources and the unavailability of a provocation test, the patient was diagnosed with idiopathic VF, and an implantable cardioverter-defibrillator (ICD) was placed. Despite experiencing epigastric pain for two years with no significant endoscopic findings, an exercise stress test (EST) later identified ventricular arrhythmia, which suggested an ischemia-related mechanism despite normal coronary anatomy. During followup, she developed ST-elevation myocardial infarction, and a subsequent CAG revealed coronary spasm. She was diagnosed with vasospastic angina (VSA) and treated with nitrates and diltiazem. The patient is now free of epigastric pain and arrhythmic episodes. This case highlights the diagnostic challenges of VSA because of its atypical presentation and the limitations of resource-constrained settings, which can result in delayed diagnosis. Clinicians should consider VSA in patients with angina, sudden cardiac death, and abnormal EST results, especially in the absence of significant stenosis. While CAG with provocative testing is the standard diagnostic approach, alternative diagnostic pathways should be applied in resource-limited settings. Treatment options include medications and ICD placement, which should be considered for patients with high-risk VSA and recurrent ventricular arrhythmias.

Identifying Pyle’s metaphyseal dysplasia: An incidental finding of skeletal pathology on a dental checkup

2026-07-13T12:48:46+07:00

Pyle’s disease, also known as familial metaphyseal dysplasia, is a rare autosomal recessive genetic disorder that primarily affects the skeletal system, particularly in children and adolescents. Furthermore, it is characterized by distinctive radiographic features, including Erlenmeyer flask deformity and metaphyseal widening. Pyle’s disease often goes underdiagnosed because of its mild clinical manifestations. This case report details a 15- year-old female patient presenting with retained milk teeth and unerupted permanent teeth, alongside notable skeletal abnormalities, including genu valgum and kyphosis. Clinical and radiographic evaluations revealed considerable dental anomalies, including multiple impacted permanent teeth and mild dysmorphic facial features. Although genetic testing was not performed in this case, a diagnosis of Pyle’s disease was made based on the clinical presentation and radiographic findings. This case highlights the importance of recognizing dental manifestations as potential indicators of underlying skeletal dysplasias or other systemic conditions. Prompt diagnosis and early intervention could enhance the quality of life and treatment outcomes in such cases.

Incidental leftward displacement of the appendix due to redundant sigmoid colon: A case report of anatomical variation

2026-06-17T09:07:20+07:00

A left-sided appendix is an uncommon clinical finding, often attributed to congenital anomalies, such as situs inversus or intestinal malrotation. However, it can also arise from anatomical displacement by other organs, such as redundant colonic loops. While rare, such variations may complicate the clinical and radiological diagnosis of abdominal pain and result in potentially serious consequences if not recognized. This case report highlights a left-sided appendix due to a redundant sigmoid colon incidentally discovered during the evaluation of right lower quadrant pain. A 22-year-old woman presented to the emergency department with right flank pain, which later localized to the right lower quadrant (RLQ). There was localized tenderness in the RLQ, with no systemic symptoms. A working diagnosis of acute appendicitis was considered. A noncontrast abdominal computed tomography scan revealed a 0.4 cm right lower pole nephrolithiasis without signs of appendiceal inflammation. Unexpectedly, the appendix was visualized at the mid-left lower quadrant due to displacement by a type C redundant sigmoid colon. The patient was referred to urology for further management. This report highlights the importance of recognizing anatomical variations. They may substantially alter the expected location of intra-abdominal organs and result in diagnostic confusion. Although the patient in this report did not have appendicitis, the displacement of the appendix into the left lower quadrant could have been misleading had inflammation occurred. Radiologists and clinicians should both be cognizant of atypical disease presentations, and accurate diagnosis and treatment are crucial for an optimal outcome, especially in emergency settings.

Bilateral heel eccrine syringofibroadenoma treated with serial cryotherapy

2026-08-06T13:54:44+07:00

Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal neoplasm. Although it most frequently manifests on the lower extremities, particularly at acral sites, its various subtypes can result in diverse clinical presentations. Here, we report the case of a 49-year-old male presenting with a 14-year history of bilateral heel lesions. The right heel exhibited a hyperkeratotic, erythematous, and edematous plaque with focal erosion that had progressively worsened, accompanied by a burning sensation and intermittent serous discharge. Histopathological analysis revealed anastomosing epithelial cords with eccrine ductal differentiation within a fibrovascular stroma, thus confirming the diagnosis of ESFA. Due to the weight-bearing nature of the bilateral heel involvement, which posed considerable challenges for postoperative wound care, serial cryotherapy was chosen for this case. Following multiple sessions, the lesions exhibited substantial regression, characterized by plaque softening and localized scar formation.

Arthroscopic management of a rare multiloculated prefemoral fat pad cyst associated with Hoffa’s fat pad edema: A case report

2026-08-06T15:31:01+07:00

Cystic lesions arising from the prefemoral fat pad of the knee are rare. They may present with nonspecific symptoms, such as anterior knee pain and restricted movement, thus making diagnosis challenging. Magnetic resonance imaging (MRI) plays a pivotal role in identifying these uncommon lesions and differentiating them from other intra-articular pathologies. We report a 40-year-old man who presented with progressive anterior knee pain and discomfort during knee movement. MRI results revealed a 15 × 12 mm multiloculated cystic lesion within the lateral prefemoral fat pad associated with secondary Hoffa’s fat pad edema. Due to persistent symptoms despite conservative management, the patient underwent arthroscopic excision of the cyst and partial resection of the inflamed fat pad. Histopathological examination confirmed a benign cystic lesion. The patient experienced substantial postoperative pain relief, restoration of knee function, and no recurrence during follow-up. This case highlights a rare presentation of a multiloculated prefemoral fat pad cyst causing secondary Hoffa’s fat pad impingement and edema. Early MRI evaluation and arthroscopic management facilitated accurate diagnosis, symptom resolution, and favorable clinical outcomes.

Opioid-free total intravenous anesthesia for valvular cardiac replacement surgery

2026-07-22T09:25:22+07:00

A 44-year-old woman with rheumatic heart disease with severe mitral stenosis, moderate–severe mitral regurgitation, and severe tricuspid regurgitation underwent mitral valve replacement and tricuspid repair under cardiopulmonary bypass using opioid-free total intravenous anesthesia (OF-TIVA) with propofol, ketamine, lidocaine, and dexmedetomidine, combined with a transversus thoracic plane (TTP) block. The patient’s intraoperative hemodynamics remained stable, and the patient was extubated six hours postoperatively with minimal pain and no complications. OF-TIVA with TTP block provided effective analgesia, hemodynamic stability, and early recovery, thus highlighting its potential as a safe alternative to opioid-based anesthesia in cardiac valve surgery.

Pre-excited atrial fibrillation in a woman with minimal pre-excitation: A case report

2026-07-10T10:30:41+07:00

A 46-year-old Thai woman presented with palpitations. A 12-lead electrocardiogram (ECG) showed rapid preexcited atrial fibrillation (AF). The ECG following electrical cardioversion demonstrated minimal pre-excitation with a short PR interval and small apparent delta waves only in leads II, III, V4, and V5. An electrophysiologic study was performed and revealed sinus rhythm with a short H-V interval compatible with pre-excitation. A programmed electrical stimulation revealed orthodromic atrioventricular re-entrant tachycardia via the left lateral accessory pathway. Catheter ablation was successfully performed using a retrograde aortic approach to the left lateral accessory pathway. There was no recurrence of Wolff–Parkinson–White ECG pattern, supraventricular tachycardia, or AF during the 12-month follow-up visit. This is a rare case of minimal preexcitation presenting with pre-excited AF as the first presentation. This case report reflects that minimal preexcitation does not indicate a low risk of ventricular fibrillation and sudden cardiac arrest.

Integrated analysis of bioinformatic databases to identify thyroid cancer drug target candidates

2026-08-14T15:02:16+07:00

Background: Thyroid cancer (TC) is an endocrine malignancy whose global incidence continues to rise. Although it generally has a favourable prognosis, aggressive subtypes, such as anaplastic thyroid cancer, remain a therapeutic challenge. Drug repurposing strategies offer the opportunity to accelerate the development of therapies by utilising available drugs with an established safety profile.

Objectives: This study aimed to identify candidate thyroid cancer risk-associated genes by analyzing GWAS and PheWAS data and to evaluate their potential therapeutic relevance through drug recycling.

Methods: Significant gene variants were obtained from these databases and functionally annotated using HaploReg, ClinVar, SIFT, PolyPhen, CADD, cis-eQTL, and a review of PubMed literature. Candidate genes from seven functional annotations with scores ≥ 2 were designated as risk-associated and further analyzed using the STRING database. Drug candidates were searched for in DrugBank and ClinicalTrials.gov.

Results: Ten risk-associated genes may be involved in thyroid cancer pathogenesis, with DIRC3 having the highest score. However, no drugs that could directly interact with these genes were recognized. These findings highlight the therapeutic gap between thyroid cancer risk-associated genes and available drugs.

Conclusion: This study identified ten risk genes involved in thyroid cancer pathogenesis, with DIRC3 as the topmost candidate. Although no approved drugs directly targeted these genes, the findings highlight their potential as biomarkers and novel therapeutic targets. Integrative genomics and drug repurposing approaches remain promising strategies for advancing precision therapy in thyroid cancer.

Machine learning-based gene signature detection highlights CXCL12 as a key marker for acute myeloid leukemia prediction

2026-07-14T08:58:03+07:00

Background: Acute myeloid leukemia (AML) is a severe hematologic malignancy that is marked by the uncontrolled proliferation and impaired differentiation of myeloid cells, which disrupts normal hematopoiesis and results in poor clinical outcomes. Conventional diagnostic approaches often lack the precision needed to accurately classify AML subtypes; therefore, integrating advanced computational methods is required to improve diagnostic and therapeutic strategies.

Objectives: This study aimed to apply machine learning (ML) techniques to transcriptomic data to identify a concise, informative gene signature that can distinguish AML cases from normal samples. In addition, the study sought to evaluate the performance of predictive models in supporting AML prediction and facilitating biomarker discovery.

Methods: Gene expression data were obtained from the TARGET-AML project via the Genomic Data Commons portal. Feature selection was performed using SelectKBest with chi-square scoring to identify the top 10 AML-associated genes. To address class imbalance, SMOTE was employed. Several ML models, including Random Forest, XGBoost, LightGBM, and a Stacking ensemble, were trained and optimized via hyperparameter tuning to classify AML vs. normal samples.

Results: The selected gene panel included CXCL12, SELENBP1, SLC4A1, IFIT1B, ALAS2, CAMP, OLFM4, DEFA3, CRISP3, and HBG1, which are functionally associated with immune response, inflammation, and hematopoietic processes. All models demonstrated robust classification performance: Random Forest (88.6%), XGBoost (88.8%), LightGBM (89.4%), and Stacking (89.4%). SMOTE effectively enhanced the model performance, particularly for underrepresented classes, thereby improving precision and recall.

Conclusion: This study identified a small, yet informative gene set that accurately differentiates AML from normal samples, with LightGBM revealing the highest predictive accuracy. The involvement of immune and inflammatory genes aligns with AML’s biological foundations. These findings suggest the clinical potential of ML-based tools for AML diagnostics. Future validation on independent cohorts and the integration of multi-omic data could further improve the model’s robustness and facilitate broader applications in precision medicine for hematologic malignancies.

Supervised learning algorithms for subject- and textlevel classification of depression-related context among Thai-language Facebook users

2026-07-21T13:08:50+07:00

Background: Depression is an increasing concern worldwide that requires urgent attention, particularly in Thailand. Without timely intervention, it can lead to serious consequences, such as health complications, reduced social participation, and even suicide. Consequently, research has increasingly focused on developing algorithms to identify and classify social media data into depression severity.

Objectives: This study aimed to examine label mismatches between self-assessment forms and social media behaviors and to evaluate the feasibility of using experts’ opinions to classify Thai Facebook text into depression categories.

Methods: The methodology involved data collection through surveys and Facebook scraping, followed by data preprocessing, feature engineering, and model training and validation. The models employed included the support vector machine, logistic regression, and decision tree, applied at the subject and text levels. Labels were derived from the Thai Depression Inventory (TDI) and experts’ evaluations.

Results: Only 30 out of 60 participants actively used Facebook during the study period, with substantial variation in posting behavior. Subject-level classification using TDI labels yielded better, more balanced performance metrics than classifications based on experts’ opinions at the subject and text levels. Part-ofspeech tagging showed slight correlations with depression severity, whereas emotions did not.

Conclusion: Subject-level classification using self-assessment labels performed better than expert-derived labels and text-level classification when compared to a dummy baseline model. This suggests a slight correlation between the self-assessment forms and social media behaviors. In contrast, the poor agreement between labeling approaches suggests that text data alone may be insufficient as a reliable clinical indicator of depression.

Ameliorative effect of the ethanolic extract of Nardostachys jatamansi against high-fat diet-induced dyslipidemia in Wistar albino rats

2026-07-09T14:26:08+07:00

Background: Dyslipidemia is a key contributor to metabolic disorders such as oxidative stress and is a major risk factor for cardiovascular diseases. Herbal interventions are increasingly preferred due to fewer side effects. Nardostachys jatamansi has demonstrated antioxidant and lipid-lowering properties, but its effects on high-fat diet (HFD)-induced dyslipidemia remain insufficiently studied.

Objective: The present study aimed to evaluate the antioxidant and hypolipidemic effects of the ethanol extract of N. jatamansi in an HFD-induced obesity model in male Wistar albino rats.

Methods: Thirty-six male Wistar albino rats were randomly divided into 6 groups, each comprising 6 animals. Group I received a normal diet for 9 weeks, whereas Group II was fed an HFD for the same period. Groups III– VI were also fed an HFD throughout the investigation period. From week 5, Group III received rosuvastatin (10 mg/kg), and Groups IV–VI were treated with N. jatamansi extract at 100, 200, and 300 mg/kg, respectively, for 4 weeks. All treatments were administered orally. At the end of the study, the animals were fasted overnight, anesthetized, and blood was collected for lipid and hematological analyses. In addition, the organs were excised for histological evaluation.

Results: N. jatamansi (100, 200, and 300 mg/kg) reversed HFD-induced increases in body weight, fat pad size, organ weight, total cholesterol, triglycerides, low-density lipoprotein, and very low-density lipoprotein levels while restoring high-density lipoprotein levels in a dose-dependent manner. Moreover, elevated white blood cells, lymphocyte counts, and serum urea, creatinine, and uric acid levels were normalized. Histological improvements in the liver suggest antioxidant and bioactive effects of N. jatamansi.

Conclusion: Our results revealed that the herbal drug N. jatamansi effectively ameliorates HFD-induced dyslipidemia through its potent antioxidant activity, thereby reducing oxidative stress and restoring lipid homeostasis.

Factors associated with colorectal cancer screening decision-making among older adults at the Comprehensive Geriatric Clinic, King Chulalongkorn Memorial Hospital, Thai Red Cross Society

2026-08-13T15:00:23+07:00

Background: The incidence of colorectal cancer (CRC) in Thailand is constantly increasing and is highest in individuals aged 60-75 years. However, the number of older individuals undergoing CRC screening remains suboptimal.

Objectives: This study aimed to identify factors associated with CRC screening decision-making among Thai older adults attending the Comprehensive Geriatric Clinic at King Chulalongkorn Memorial Hospital. The secondary objective was to identify factors associated with the choice of screening method—colonoscopy versus fecal occult blood testing (FOBT).

Methods: A cross-sectional study was conducted using a data record form at the Comprehensive Geriatrics Clinic, King Chulalongkorn Memorial Hospital in Bangkok, Thailand, from September to October 2023. Participants aged 60-75 were interviewed to collect information about factors associated with CRC screening decision-making, which were categorized into five groups: demographic, health, psychological, physician, and social factors. Participants were classified into two groups based on their intention to undergo CRC screening. The factors preliminarily associations using the Chi-square test and the Mann-Whitney U test. The factors with a P < 0.2 were then analysed by a binary logistic regression for identifying factors that were significantly associated with the decision to undergo CRC screening as primary outcome and the choice of method as secondary outcome.

Results: A total of 424 valid responses were obtained, with 320 respondents intending to undergo CRC screening. The binary logistic regression analysis revealed significant associations between CRC screening decision and the following factors: high risk for CRC (aOR 6.05, 95%CI 2.42 15.13), positive attitude towards cancer screening (aOR 3.65, 95%CI 2.19 6.10), recognition of the importance of early detection (aOR 2.33, 95%CI 1.32 4.11), and being divorced, as compared to being married (aOR 0.06, 95%CI 0.01 0.49). The decision to undergo colonoscopy for the CRC screening was associated with an education level of having at least a bachelor’s degree (aOR 0.43, 95%CI 0.24 0.75), being single, as compared to being married (aOR 2.08, 95%CI 1.20 3.58), and concerns about physical discomfort from CRC screening (aOR 0.41, 95%CI 0.19 0.90).

Conclusion: Factors associated with CRC screening decision-making uptake amongst older adults, attending a geriatric clinic in a tertiary care hospital in Bangkok, that can be promoted include having a positive attitude towards cancer screening and the recognition of the importance of early detection. Therefore, raising awareness and highlighting the importance of cancer screening may help increase the rates of CRC screening in Thailand in the future.