Ramathibodi Medical Journal

The Past, Present, and Future of Genetic Manipulation in Human Fungal Pathogen Talaromyces marneffei

Tanaporn Wangsanut — 2024-03-25

The fungus Talaromyces marneffei has been discovered and its pathogenicity to humans has been recognized for over 60 years. The advances in organism-wide studies and the development of genetic manipulation tools contribute greatly to our current understanding of host-pathogen interactions. Several classes of genes have been identified to be involved in stress response, morphogenesis, and virulence based on the characterization of the generated mutants. Here, we summarize the main techniques for T. marneffei genetic manipulation, including chemical mutagenesis, insertional mutagenesis, homologous recombination-mediated gene replacement, knockdown methods, and the recent popular clustered regularly interspaced short palindromic repeats-CRISPR-associated protein 9 (CRISPR-Cas9) technology. The advantages and disadvantages of each technique were determined from a historical perspective. We also describe potential strategies to improve the current genetics studies, such as the generation of new selection markers and genetically modified strains. Our review has demonstrated that Thailand will continue to make efforts to become a leader in T. marneffei genetics research. The genetic approaches have impacted the studies of T. marneffei and can lead to the discovery of new diagnostic tools, drugs, and vaccines.

Crickets as a Protein Source: An Alternative Future Food for Promoting Nutrition and Food Security

Alongkote Singhato — 2024-03-25

Increasing the global population trend potentially affects food security due to the raising food demand. The livestock industries are well known for high greenhouse gas emission production that led to climate change and impacts the environment. Therefore, preparing adequate food sources for future demand and enhancing food security by lowering emission production is the necessary plan. Nowadays, there are edible insects, especially crickets that are used to be food ingredients because of their good nutritive value and obtained high biological value of protein. In addition, crickets farming is required less water, feed, and other resources than other animal live stocks. This made cricket farming less production emission. This review article aimed to present information on edible crickets as a food source of protein by demonstrating the nutritive values of different species of crickets, clinical efficacy from current pieces of evidence, and safety aspects of crickets. The information could be beneficial to nutritionists, dietitians, and other professionals in food and health to generate clinical knowledge on edible crickets and develop food products by using edible crickets to be one the alternative food sources of protein in the future.

Perception of Learning Environment Among Clinical Year Thai Medical Students in Surat Thani Hospital Under the Collaborative Project to Increase Production of Rural Doctors

Panipilat Yensabai — 2024-03-25

Background: Appropriate learning environments were associated with better well-being of medical students, resulting in good learning.

Objective: To study perceptions and factors affecting perceptions of the learning environment among clinical year medical students in Surat Thani Hospital, Thailand.

Methods: In a cross-sectional descriptive study, data were collected among 89 medical students (4th - 6th year) from September 1, 2022, to November 30, 2022, using an online questionnaire consisting of the Thai Learning Climate Measure and an open-ended questionnaire.

Results: The response rate was 65.17% of the total medical students. Most participants were female and had a GPA of 3.00 - 3.49. The average score of learning environment perception was 70%. The aspect with the highest score were “colleagues” and “mental support”. The aspect with the lowest scores was “health and stress”. Female 6th-year medical students perceived the learning experience aspect significantly better than males, while other aspects showed no statistically significant difference (P > .05) when comparing gender, school year, and GPA. “Physical environments” and “health and stress” aspects were the areas that need to be improved in clinical years medical students’ perspective.

Conclusions: Most medical students perceived the learning environment positively. Strengths include “teachers”, “colleagues”, “learning experience”, “motivation”, and “mental support” aspects. The “physical environments” and “health and stress” aspects were the areas that need to be improved.

Cost Analysis of Autologous Hematopoietic Stem Cell Transplantation for Lymphoma and Myeloma

Nilawan Upakdee — 2024-03-25

Background: Currently, autologous hematopoietic stem cell transplantation (HSCT) combined with high-dose chemotherapy is important for the treatment of lymphoma and myeloma.

Objective: To analyze the cost and hospital charges of autologous HSCT for lymphoma and myeloma at Naresuan University Hospital (NUH).

Methods: This was the cost descriptive study. The cost information was obtained from the primary data sources by cost data collection forms and interviews of relevant persons. Patients underwent autologous HSCT at NUH between 2009 and 2021. The charge information was collected from secondary data sources, such as the hospital database. Data was analyzed according to the treatment process 6 steps: 1) chemotherapy, 2) stem cell collection, 3) stem cell preservation, 4) high-dose chemotherapy, 5) recovery, and 6) follow-up care after the autologous HSCT. Descriptive statistics and one-way sensitivity analysis were performed.

Results: A total of 106 cases were 51 (48.11%) lymphoma patients and 55 (51.89%) myeloma patients. The cost of autologous HSCT for lymphoma and myeloma patients was ฿400,863.84 and ฿197,862.08, respectively. According to the sensitivity analysis, autologous HSCT costs ranged from ฿298,467.09 - ฿518,968.75 for lymphoma patients and ฿136,065.67 - ฿275,366.63 for myeloma patients. Medical care charges for lymphoma and myeloma were ฿359,391.74 (SD ฿143,935.92) and ฿162,763.56 (SD ฿48,649.74), respectively.

Conclusions: The cost of autologous HSCT was within the per capita budget allocation.

Antimicrobial Drug Susceptibility Test of Pythium insidiosum by Disc Diffusion Method

Sophit Khanthawong — 2024-03-25

Background: Pythiosis is a life-threatening disease caused by the fungus-like organism Pythium insidiosum. It causes disease in both animals and humans. Amphotericin B antifungal is less effective because it lacks ergosterol, a drug target in the cell membrane.

Objective: To evaluate antimicrobial susceptibility test of P. insidiosum isolated from human pythiosis by disc diffusion method.

Methods: The antimicrobial drug susceptibility test by disc diffusion method was tested against 10 clinical isolated strains of P. insidiosum. Antimicrobial drugs comprise of 8 antibiotics (chloramphenicol, cefotaxime, ciprofloxacin, gentamycin, tetracycline, meropenem, oxacillin, and vancomycin) and 2 antifungal drugs (itraconazole and amphotericin B) which were included in the test.

Results: Antimicrobial drugs susceptibility tests were performed on 10 clinically isolated strains of P. insidiosum. Six of them showed susceptibility to antimicrobial drugs. The cutaneous pythiosis strain (SIMI 8569) showed the highest number of susceptibilities to antimicrobial agents (chloramphenicol, ciprofloxacin, gentamycin, tetracycline, vancomycin, and itraconazole). In addition, 4 strains of P. insidiosum (M 29, SIMI 6666, SIMI 7873, and SIMI 2989-42) were not inhibited by all antimicrobial drugs.

Conclusions: This result concluded that chloramphenicol, tetracycline, and itraconazole inhibited the mycelial growth of P. insidiosum better than the other drugs. The inhibition effects of these drugs were observed in 40% - 60% of the strains. Further experiments should be carried out to evaluate the tested drugs in various concentrations with other more susceptible methods to get more precise concentrations exposed to P. insidiosum isolates such as broth dilution or dilution assays.

Exploring the Feasibility of Implementing Telepractice Innovation for Speech-Language Pathologists in Thailand

Tipwaree Aueworakhunanan — 2024-03-25

Background: The speech clinic at Ramathibodi Hospital has been using telepractice for 2 years. These outcomes have clearly shown many benefits. It is a new system in Thailand that has not been studied in terms of innovation before.

Objective: To explore the possibility of speech-language pathologists (SLPs) in Thailand implementing the telepractice innovation through a survey of their attitudes toward the characteristics, diffusion, and limitations of innovation.

Methods: In this survey study, SLPs responded to a questionnaire. Data regarding SLPs’ attitudes toward telepractice innovation were collected and then analyzed using descriptive and inferential statistics.

Results: A total of 86 SLPs responded, who agreed characteristics, diffusion, and both were 54.66%, 45.34%, and 37.21%, respectively, most of them used telepractice. SLPs who used telepractice expressed limitations from patients at 52.24% and SLPs who did not use telepractice expressed limitations from systems at 47.36%.

Conclusions: SLPs in Thailand equally expressed attitudes of agreement and disagreement toward the characteristics and diffusion of telepractice innovation. However, SLPs who used telepractice agreed more than those who did not. SLPs agreed on the characteristic of telepractice innovation, though not all of them agreed to the diffusion of telepractice. The limitations of telepractice innovation depended on SLPs’ telepractice experience, occurring from patients for SLPs who used telepractice, but from the system for SLPs who did not. Therefore, telepractice may be an option that can be used according to the needs of the patients and its appropriateness for specific situations.