Thai Red Cross Society

Isometric handgrip exercise may help reduce blood pressure, but its effectiveness using inexpensive, home-based devices remains unclear. This study aimed to evaluate the impact of home-based isometric handgrip exercise on resting systolic blood pressure (SBP) in hypertensive older adults. Secondary outcomes included diastolic blood pressure (DBP), heart rate (HR), grip strength, safety, and satisfaction. A randomized controlled trial was conducted at the Comprehensive Geriatric Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Thirty hypertensive participants aged over 60 with handgrip maximum voluntary contraction (MVC) of 10-40 kg were randomized into two groups. The intervention group (n = 15) performed isometric handgrip exercises using spring devices at 20-50% MVC. The control group (n = 15) performed non-resistive handgrip exercises. Both groups exercised 3 times/week for 8 weeks (4 sets of 2-minute holds, 1-minute rest between sets). The intervention group showed significant reductions in SBP (-7.33 ± 9.63 mmHg, P = 0.011) and DBP (-3.6 ± 5.79 mmHg, P = 0.03). Grip strength improved in both groups, but only SBP reduction showed a significant between-group difference (-8.19 mmHg, P = 0.03). No complications were reported, and satisfaction was high in the intervention group. Home-based isometric handgrip exercise using commercial spring devices at 20-50% MVC significantly reduced SBP in hypertensive older adults. It is a simple, safe, and affordable exercise option, suitable for those unable to perform standard aerobic activities.

IntroductionAlpha-synucleinopathies (ASs), including Parkinson’s disease, multiple system atrophy and dementia with Lewy bodies, are characterised by autonomic dysfunction that may predispose to cardiovascular events and sudden death. Heart rate variability (HRV) is a non-invasive marker of autonomic regulation, yet its modulation across sleep stages in ASs remains unclear.MethodsWe retrospectively analysed 25 patients with ASs and 35 age-matched controls who underwent overnight polysomnography between 2020 and 2023. 5 min ECG segments from wakefulness, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep were used to compute time- and frequency-domain HRV indices. Statistical comparisons and multivariate models were adjusted for sex and REM sleep behaviour disorder.ResultsHRV indices, particularly percentage of successive RR intervals that differ by more than 50 milliseconds (pNN50) and root mean square of successive differences, were significantly reduced in ASs compared with controls. The most pronounced difference occurred during NREM sleep (pNN50, p=0.008), where controls exhibited normal parasympathetic elevation that was absent in ASs.ConclusionPatients with ASs demonstrate blunted nocturnal parasympathetic activity, most evident during NREM sleep. Sleep-stage-specific HRV analysis provides sensitive insights into cardiac autonomic dysfunction and may serve as a potential biomarker of disease severity and cardiovascular risk in synucleinopathies.

To evaluate real-world outcomes of dolutegravir (DTG)-based first-line antiretroviral therapy (ART) among people with HIV in Thailand, where baseline HIV-1 RNA and resistance testing is not routinely available. This retrospective cohort study enrolled ART-naive Thai people with HIV aged ≥15 years who initiated DTG-based ART between 2020 and 2023 under the national Universal Health Coverage programme. People with HIV with ≥1 post-baseline HIV viral load (VL) measurement were included. Virological non-suppression (VNS) was defined as VL ≥1000 copies/mL after ≥6 months of ART. The primary outcome was the proportion achieving virological suppression (VL <50 copies/mL). Competing-risk regression was used to identify factors associated with VNS, accounting for death and loss to follow-up (LTFU). Mortality data were confirmed via the national death registry. Of 10 475 people with HIV initiating DTG-based ART, 84.5% achieved virological suppression and 95.3% achieved VL < 200 copies/mL within 1 year. The cumulative VNS incidence was 10.1% (95% confidence interval [CI]: 9.6%-10.5%), and highest among those with late ART initiation (10.6% [95% CI: 7.4%-14.3%]). VNS was significantly associated with younger age, 15-24 years (aSHR 2.28, 95% CI:1.66-3.12), 25-34 years (aSHR1.43, 95% CI:1.07-1.90), baseline CD4 < 100 cells/mm3 (aSHR 2.11, 95% CI: 1.36-3.27) and residence in northern (aSHR 1.64, 95% CI: 1.12-2.40) or southern Thailand (aSHR 1.99, 95%: 1.30-3.04). Same-day/rapid ART initiation, sex and WHO HIV clinical staging were not associated with VNS. Nationwide rollout of DTG-based ART achieved excellent virological outcomes in Thailand. However, higher VNS risk among adolescents, individuals with advanced HIV disease and those in specific regions underscores the need for targeted interventions to improve treatment equity and long-term viral suppression.

Background:Human epidermal growth factor receptor 2 (HER2) is an important predictive and prognostic biomarker in breast cancer. Immunohistochemistry (IHC) is the preferred initial test due to its cost-effectiveness and simplicity. While fluorescence in situ hybridization (FISH) is the traditional gold standard test for HER2 gene amplification, DISH has emerged as an accepted alternative that allows evaluation under a standard light microscope.Objectives:To evaluate agreement between HER2 IHC (2+/3+) and DISH in node-positive primary breast cancers and compare findings with published IHC and FISH data.Design:Retrospective single-center cohort study using nationwide referral specimens.Methods:Cases of pathologically confirmed lymph node metastasized invasive breast carcinoma with HER2 IHC scores of 2+ and 3+ were retrieved. Interpretation of HER2 IHC was performed using the 2023 ASCO/CAP guideline. HER2 DISH was conducted and evaluated by the HER2/CEP17 signal ratio on primary tumors first, and on metastasized lymph nodes in cases of persistent technical failure.Results:Among 1,307 breast cancers, DISH detected HER2 amplification in 933 cases, including 92% (760) of IHC 3+ cases and 36% (173) of IHC 2+ cases. Seven cases with persistent technical failure on primary tumors were resolved when switching to lymph node specimens. Comparison with the meta-analysis data of IHC and FISH showed no significant differences, indicating that DISH is a reliable alternative to FISH.Conclusion:Our study demonstrates a high concordant rate between HER2 IHC and DISH in the IHC 3+ group and a low positive rate in the IHC 2+ group. We found no significant difference in the positive rates of HER2 IHC to DISH when compared with prior data of IHC to FISH, reaffirming the use of HER2 DISH as an effective and more accessible alternative to FISH in HER2 2+/3+ breast cancer.

This study examined a community-based disaster risk reduction initiative in a rural area of Sai Yok District, Kanchanaburi Province, Thailand. The study focused on the village’s proactive strategies to address natural hazards such as drought, flooding, and extreme weather conditions. It highlighted the importance of local participation, comprehensive risk assessments, and tailored preparedness programs in reducing the community’s vulnerability. The project illustrated how local communities can enhance their resilience through education, collaboration with governmental and non-governmental organizations, and strategic disaster risk planning. The findings revealed that a well-organized, community-based approach can significantly mitigate the impact of natural disasters, leading to improved economic stability and public health outcomes.

BackgroundAlzheimer's disease (AD) is characterized by early neuropathological changes in the entorhinal cortex (EC), which plays a crucial role in spatial navigation and probably abstract space navigation. While EC‐dependent navigation tasks show promise for early AD detection, existing paradigms require extensive learning periods, limiting clinical utility. We aimed to develop and validate a novel digital non‐spatial navigation task that tests EC function without requiring prior learning, hypothesizing that performance would correlate with hippocampal‐entorhinal cortex dependent memory but not other cognitive domainsMethodThe study enrolled 38 participants, aged 40‐70 years‐old, who performed a computerized task navigating 2D abstract space using stripe and ellipse width dimensions. The task comprised 96 trials, each presenting three successive visual stimuli forming a trajectory, with participants selecting the correct fourth stimulus from three choices. Performance was assessed against standard cognitive measures, including MoCA, CDR, VPA delayed recall, WCST, Go/No‐Go test, and Spatial Span.ResultPerformance decreased with increasing difficulty in distance deviation trials, suggesting navigation strategy usage. Trials with angular deviation showed possible prepositional strategy involvement. Task accuracy analyzed only with trials with distance deviation significantly correlated with episodic memory measures: MoCA delayed recall (r = 0.425, p = 0.008), MoCA memory index score (r = 0.431, p = 0.007), VPA delayed recall (r = 0.377, p = 0.020), and CDR memory (r = ‐0.535, p = 0.001). No significant correlations emerged with non‐memory cognitive domains. Correlations persisted after adjusting for age and education, except for VPA delayed recall.ConclusionThe study demonstrates that this novel non‐spatial navigation task probably engages EC‐hippocampal circuits, as evidenced by selective correlation with episodic memory measures. The task's design, requiring no prior learning period, represents a significant advantage over existing paradigms and potential clinical utility. Future research should investigate concurrent neural activities and evaluate diagnostic value participants with confirmed AD biomarkers.

BackgroundPlasma p‐tau217 is widely regarded as a specific biomarker for Alzheimer's disease (AD). However, recent studies have reported substantial elevations in prion disease, suggesting prion‐induced p‐tau release. This study investigates the relationship between plasma p‐tau217 and AD/prion pathology and examines its diagnostic implications in rapidly progressive dementia (RPD), where prion disease is predominant but rapidly progressive AD is also significant.MethodParticipants were from three sources: (1) the Thai National Prion Disease Surveillance Center (NPDSC), a prospective registry of suspected prion disease cases (March 2023–December 2024); (2) additional CSF from RT‐QuIC–positive patients across Thailand (March 2022–June 2024); and (3) memory clinic patients with disease duration >2 years from King Chulalongkorn Memorial Hospital and the Neurological Institute of Thailand (2022–October 2024). AD pathology was confirmed by CSF amyloid‐β42/p‐tau or florbetaben PET. Prion disease was defined by positive CSF RT‐QuIC or MRI criteria for “Definitely CJD”, absence of an alternative diagnosis, and death within six months. Memory clinic patients were presumed prion‐negative based on prolonged disease duration (>2 years) and negative MRI. A multivariable linear regression model assessed the effects of AD and prion pathology, including their interaction. Pairwise comparisons were adjusted using Benjamini‐Hochberg correction. The diagnostic accuracy of plasma p‐tau217 for AD, prion disease, or both was evaluated using ROC analysis in the prospectively‐enrolled NPDSC participants.ResultA total of 192 participants were included (31 NPDSC, 23 RT‐QuIC–positive, 138 memory clinic, Table 1). Both AD and prion pathology were individually associated with increased plasma p‐tau217. Interestingly, an interaction effect was observed, with lower plasma p‐tau217 levels in individuals with both AD and prion disease compared to AD alone, demonstrating non‐linearity or even decreasing effects on plasma p‐tau217 (Table 2 and Figure 1). Plasma p‐tau217 showed poor‐to‐moderate accuracy for AD (AUC 0.76, 95% CI 0.58–0.94), prion disease (AUC 0.63, 95% CI 0.42–0.85), and for detecting any pathology (AUC 0.79, 95% CI 0.62–0.97).ConclusionPlasma p‐tau217 is not specific for AD, as it is elevated in prion disease irrespective of AD pathology. These findings highlight its limited diagnostic utility in RPD. The interaction between pathologies in modulating plasma p‐tau217 warrants further investigation.

BackgroundFibromyalgia (FM) is a chronic disorder characterized by widespread pain and immune dysregulation. Emerging evidence suggests that gut microbiota and inflammatory proteins may contribute to the development of FM. The aim of this study was to investigate the causal relationships between gut microbiota, inflammatory proteins (cytokines/chemokines), and FM using bidirectional Mendelian randomization (MR) and meta-analysis approaches.MethodsMR analyses were conducted using genetic data from European populations, employing methods such as MR-IVW, MR-Egger, and MR-weighted median. Reverse MR was also performed, with FM treated as the exposure. A meta-analysis was conducted to consolidate the findings.ResultsRuminococcus gauvreauii was identified as a risk factor for FM, while Enterorhabdus, Parabacteroides, Butyricicoccus, and Prevotella 9 were found to be protective. Five inflammatory proteins—C-X-C motif chemokine 5 (CXCL5), S100-A12, Leukemia inhibitory factor receptor (LIFR), Monocyte chemoattractant protein 2 (MCP-2/CCL8), and Tumor necrosis factor (TNF-α)—exhibited protective associations, while Natural killer cell receptor 2B4 (NKCR-2B4/CD244) and Interleukin-12 subunit beta (IL-12β) were associated with an increased risk of FM.ConclusionThis study highlights the role of gut microbiota and inflammatory proteins (cytokines/chemokines) in the pathogenesis of FM. Through Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses, the findings suggest their involvement in immune regulation, inflammatory responses, and viral pathways. These findings provide new insights into potential therapeutic targets for modulating gut health and immune responses, opening new avenues for future research and clinical interventions.

BackgroundAdolescent pregnancy constitutes a critical public health issue worldwide. Young mothers face substantial physical and psychological changes as they transition to motherhood, while limited knowledge, experience, and maturity may impair parenting and increase stress. The study aimed to evaluate the effects of the parental enhancing program with mobile application on parental stress and competence among Thai adolescent postpartum women.MethodsA quasi-experimental study using a matched control design was conducted among sixty adolescent postpartum women, aged 15−19. Participants were sequentially allocated to an intervention group (n = 30) receiving a parental enhancing program with mobile application, and a control group (n = 30) receiving standard postpartum care. Adolescent postpartum women in the intervention group received two sessions from the parental enhancing program before discharge with weekly follow-up through the Line Official Account™. Data were collected using questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Parenting Stress Index (PSI-4-SF), and Parenting Sense of Competence Scale (PSOC). Evaluations were conducted during the 6-week postpartum. ANCOVA was used to compare post-intervention mean scores of parental stress and competence between groups.ResultsAll enrolled participants completed the study (Intervention: 30; Control: 30). At 6-weeks postpartum, after controlling baseline EPDS scores, the results revealed that adolescent postpartum women in the intervention group demonstrated significantly lower parental stress (F(1,57) = 14.40, partial η² = 0.20, 95% CI [−14.05, −4.34], p < .001) and higher parental competence (F(1,57) = 8.79, partial η² = 0.13, 95% CI [1.90, 9.80], p < .01) compared to the control group.ConclusionThe parental enhancing program with mobile application demonstrates promise for evidence of reducing parental stress and improving parental competence in postpartum adolescent mothers. However, further studies in randomized controlled trials are warranted to confirm its effectiveness and generalizability.Trial registrationThai clinical trials registry (TCTR20250309010).