Chulalongkorn Medical Journal

Bioprinting: revolutionizing biology with 3D innovation

2026-01-27T10:52:50+07:00

Three-dimensional (3D) bioprinting is an innovative technology that enables the fabrication of bioengineered structures through computer-guided processes. It has been in use for over 35 years, contributing hugely to biomedicine. Utilizing biomaterials with regenerative properties has significantly impacted tissue engineering, regenerative medicine, and pharmaceutical research. Various bioprinting techniques, including inkjet, extrusion, laser-assisted, and stereolithography, offer unique advantages for precise tissue construction. The “bioinks” used for such printing can be derived from natural sources or synthesized; the ink ensures biocompatibility, mechanical integration, and controlled degradation. Advanced bioinks—such as nanoengineered, biomolecular, multimaterial, self-assembling, and stimuli-responsive variants—enhance applicability in tissue regeneration. Bioprinting is widely employed, including for organ fabrication, cancer detection, and in food technology. However, its efficiency is limited by challenges like cell positioning and nozzle clogging. Techniques such as pollen-based bioinks and the Freefrom Reversible Embedding of Suspended Hydrogels help address these issues by improving precision and structural stability. This review summarizes the types of 3D printing, their applications in medicine and industry, as well as their advantages and limitations. Owing to ongoing and achieved advancements, the potential uses of bioprinting continue to expand in personalized medicine, organ transplantation, and sustainable food production.

Emotional intelligence: The road to the development of professionalism

2026-01-30T15:45:35+07:00

The development of medical professionalism poses a considerable challenge in medical education, eventhough it is essential for medical practitioners. The dynamics and ambiguity of medical professionalism cause difficulty in setting specific learning objectives, creating validated assessment methods, and designing effective teaching methodologies. Meanwhile, emotional intelligence is an expanding area of study in medical education. There is a substantial connection between medical professionalism and emotional intelligence,and certain attributes of emotional intelligence contribute to the development of professionalism. Numerousreports have illustrated emotional intelligence development and assessment in health professions education,and thus, emotional intelligence is potentially a path to developing medical professionalism.

Treatment outcomes and factors associated with treatment failure among patients with mild-to-moderate COVID-19 receiving five-days of oral molnupiravir vs. three-days of intravenous remdesivir in a real-world practice

2026-01-27T09:30:26+07:00

Background: The initiation of antiviral treatment for coronavirus disease 2019 (COVID-19) is based on the patient’s risk of developing severe symptoms. Molnupiravir and remdesivir are new antiviral agents with limited data in real-world practice, especially in Thailand.

Objectives: This study aimed to evaluate the treatment outcomes, adverse drug reactions (ADRs), and factors associated with treatment failure in adults with mild-to-moderate symptoms of COVID-19 who received five days of oral molnupiravir or three days of intravenous remdesivir at treatment initiation.

Methods: This retrospective study was conducted at King Chulalongkorn Memorial Hospital, Thai Red Cross Society. The inclusion criteria were patients 18 years or older with mild-to-moderate symptoms of COVID-19 who were treated during April 2022 and received five days of oral molnupiravir or three days of intravenous remdesivir at treatment initiation. Factors associated with treatment failure were analyzed by logistic regression with statistical significance at P < 0.05.

Results: Of the 182 included patients, 105 (57.7%) received remdesivir and 77 (42.3%) received molnupiravir. Treatment failure between the six cases (7.8%) of the molnupiravir group and 24 cases (22.9%) of the remdesivir group was statistically significant (P = 0.007). By day 10, 30 patients (39.0%) in the molnupiravir group and 75 patients (71.4%) in the remdesivir group had clinically resolved (P < 0.001). Male gender (adjusted odds ratio = 3.375) and pneumonia (adjusted odds ratio = 2.495) were associated with treatment failure. No deaths or rehospitalizations within 30 days after antiviral therapy were observed in this study. The recorded ADRs included headaches or dizziness with remdesivir (3.8%) and diarrhea with molnupiravir (5.2%).

Conclusion: Oral molnupiravir for five days and three days of intravenous remdesivir are still recommended treatments for patients with mild-to-moderate COVID-19 at risk of developing severe symptoms. Both antiviral agents are safe with few and mild ADRs. This study suggests closely monitoring patients with COVID-19 and pneumonia.

Etiologies, management, and outcomes of pediatric stroke at a tertiary care center in Thailand

2026-01-27T09:45:32+07:00

Background: Recent developments in neuroimaging and treatments, such as thrombolysis and endovascular thrombectomy, have improved pediatric stroke diagnosis and management. However, limited contemporary data exist on stroke characteristics related to the clinical outcomes among Thai children.

Objectives: This study aimed to examine the clinical characteristics, investigations, treatments, and outcomes in pediatric Thai patients with stroke.

Methods: Children aged 28 days to 18 years with “cerebrovascular disease” recorded as the ICD-10 code and inpatient records from January 2011 to September 2022 were enrolled. The outcomes included disability at discharge (modified Rankin scale (mRS) grade 4–5), in-hospital mortality, and 2-year recurrent stroke rate.

Results: Of the 206 included patients, 53.4% had ischemic stroke, 36.4% had hemorrhagic stroke, and 10.2% had cerebral venous sinus thrombosis. The main presentations were weakness (49.5%), headache (35.4%), and altered consciousness (26.2%). The most prevalent etiologies for each stroke type were moyamoya vasculopathy in acute ischemic stroke, arteriovenous malformation in hemorrhagic stroke, and medicationrelated conditions such as L-asparaginase and oral contraceptive use in cerebral sinus venous thrombosis. Hemorrhagic stroke had the highest mean mRS (2.8 ± 2.2, P < 0.001) and in-hospital mortality (21.3%, P < 0.001). Only one case underwent endovascular thrombectomy.

Conclusion: Pediatric stroke in Thai children presents with diverse etiologies and clinical manifestations, with hemorrhagic stroke exhibiting the highest disability and mortality rates. These findings emphasize the need for targeted research into early diagnostic protocols, risk stratification tools, and the feasibility of advanced interventions such as endovascular thrombectomy in pediatric populations.

Diagnostic accuracy of cerebral amyloid angiopathy criteria in the first pathologically confirmed Thai cohort: A pilot study

2026-01-27T10:10:07+07:00

Background: The gold standard for diagnosing cerebral amyloid angiopathy (CAA) is full brain postmortem examination, which is rarely performed. Current diagnostic criteria are primarily based on clinical-radiological features and were developed from Western populations and thus may have limited applicability to Asian populations.

Objectives: We aimed to evaluate the accuracy of current diagnostic criteria and examine the clinicalradiological characteristics of Thai patients with CAA.

Methods: Brain histopathological specimens were reviewed from patients with clinical symptoms of CAA who underwent neurosurgical procedures, including intracerebral hemorrhage (ICH) evacuation, between 2011 and 2021 at King Chulalongkorn Memorial Hospital, Thai Red Cross Society. Patient characteristics and clinical events were collected retrospectively. Trained investigators systematically rated the radiological biomarkers from brain imaging performed closest to the date of pathological confirmation. The diagnostic accuracies of the Modified Boston Criteria v1.5, Boston Criteria v2.0, and Simplified Edinburgh Criteria were compared.

Results: Thirty-five pathological reports were reviewed. Eight patients (median age of 76.7 years) with confirmed CAA had 11 clinical events, including weakness, altered consciousness, headache, seizures, and aphasia. Receiver operating characteristic curve analysis revealed that the Boston Criteria v2.0 had higher sensitivity compared to the Modified Boston Criteria v1.5. Moreover, the Simplified Edinburgh Criteria demonstrated lower sensitivity compared to both of the Boston Criteria. The area under the curve for probable CAA using the Modified Boston Criteria v1.5 was 0.9 (95% confidence interval 0.8–1.0).

Conclusion: This pilot study reveals the diagnostic performance of CAA criteria and demonstrates its applicability among the Asian population. In resource-limited settings, the simplified Edinburgh criteria, which are computerized tomography-based criteria, are valuable for diagnosing patients with CAA-ICH. This is a pilot study with a relatively small sample size; larger studies with Asian cohorts are warranted to further validate these findings.

Elucidation of hub genes and pathway associated with gut microbiome dysbiosis-linked irritable bowel disease and Alzheimer’s disease via data analytic approaches

2026-01-30T14:50:23+07:00

Background:Recent studies have highlighted the relationship between gut microbiome and Alzheimer’s disease (AD), revealing how gut microbial balance impacts conditions ranging from inflammatory bowel diseases to neurological disorders. The emerging field of the gut-brain axis suggests that the production of microbial metabolites influences AD progression. However, there is limited understanding of molecular mechanisms involved in neurological disease when gut microbiome dysbiosis occurs, especially in irritable bowel disease (IBD).

Objective:This study aimed to identify hub genes and pathways associated with gut microbiome dysbiosis in IBD and AD through data analytics approaches.

Methods:Public gene expression datasets on gut microbiome dysbiosis, and AD were obtained from the GEO and pre-processed for gene symbol annotation. Differentially expressed genes were identified withP< 0.05 and Log2FC≥1. Functional genomics analysis using DAVID (P< 0.05 and FDR < 0.05) was performed.Validated protein-protein interactions for differentially expressed genes (P< 0.05) were integrated into a comprehensive network using GeneMANIA and STRING.

Results:In total, AD and inflammatory bowel disease samples shared 1,715 genes in common. The top 10 common hub genes involved in positive regulation of leukocyte activation (CLEC7A, VNN1, SASH3, IL33,CD6, NFKBIZ, AIF1, ZBTB1, SIRBP1, LILRB1) were selected from the protein-protein interactions based on their top scores.

Conclusion:This study discovered that AD and IBD share hub genes in their pathogenesis mainly through positive regulation of leukocyte activation in the gut-brain axis that involves immune cell trafficking associated with inflammatory activation in IBD and microglia activation in AD, leading to neuroinflammation and neurodegeneration. The finding provides an insight into anti-neuroinflammatory therapeutic development targeting genes and molecular pathways within GBA.

Expanding the clinical spectrum of Hirayama disease: a rare case of Hirayama disease with ulnar nerve palsy

2026-01-27T10:40:44+07:00

Hirayama disease, also known as monomelic amyotrophy, is a rare, self-limiting condition that primarily affects young males. It leads to muscle atrophy and weakness, especially in the hands and forearms, which is often due to cervical spinal cord compression during neck flexion. Here, we report a case of a 41-year-old female from rural India who presented with progressive weakness in her left hand, resulting from ulnar nerve compression. The patient was unable to actively extend the metacarpophalangeal joint of her left hand, thus substantially impairing her hand function. Notably, she did not exhibit autonomic symptoms, which are commonly present in cervical myelopathy. This case highlights the importance of considering Hirayama disease in females, despite its male predominance, as well as the need for early diagnosis and targeted rehabilitation. Timely intervention is essential for managing functional impairments and improving patient outcomes.