Perceptions of Medical Students by Using Internal Medicine Educational Environment Measure (IMEEM) In a Rural Affiliated Teaching Hospital

Background and Objectives: Students’ perception of the educational setting is an important source for improving and applying changes to the medical educational environment. This study aimed to determine how medical students perceive the important factors of the learning environment in Internal Medicine at a rural affiliated teaching hospital. Methods: This was a descriptive study carried out in the Department of Medicine, Sakon Nakhon Hospital, Thailand, from May 2021 to April 2023. Sixth-year medical students completed a validated Internal Medicine Education Environment Measure (IMEEM) questionnaire at the end of four weeks of learning the Clerkship Internal Medicine course. Results: A total of 48 sixth-year medical students were enrolled, male 27 (56.3%) and female 21 (43.7%). The mean age was 23.56±0.50 years. No significant difference in satisfaction was observed between genders in all aspects, including Course (P=0.674), Teaching (P=0.986), Teacher (P=0.425), Supporting factors (P=0.216), and Social relationship (P=0.074). The average satisfaction scores (4.64–4.83 for males and 4.56-4.81 for females) were at the highest level across all aspects. The highest mean satisfaction score was rated in the Course aspect (4.81-4.83), while the lowest was in the Social relationship aspect (4.56-4.64). Conclusion: There was no gender difference in the highest level of satisfaction found in the medical educational environment measurement for medical students studying Internal Medicine at this rural affiliated teaching hospital

Native warm-season grasses: Species, nitrogen fertilization, and harvest date effects on biomass yield and composition

For traditional forage use, native warm-season grasses are highly productive in the summer months and are suited for a complementary role with cool-season forages in full-season forage systems of the Midwest. For renewable energy sources, these grasses can be used to produce biofuels, an alternative energy source in the future for fossil fuel which is becoming less available. Farmers may integrate forage and biomass cropping for flexibility and diversity in their farming systems. For dual-purpose crops (forage or biomass), the production of warm-season grasses would provide farmers some protection against the market failure of a single purpose. The goals for the production of warm-season grasses as biomass differ from those when used as forage. The goal for biomass production is to maximize the concentration of lignocellulose in the feedstock and minimize the concentration of N and minerals. To achieve the production potential, optimal management practices are required. The purposes of this research were to determine in some detail the yield and quality of four native warm-season grasses as influenced by nitrogen application and harvest timing for (i) forage and (ii) biomass production. In the first study (Chapter 3), we investigated the nutritive quality of native warm-season grasses as influenced by N fertilization rate and harvest timing. Forage quality of native warm-season grasses decreases as the plants mature. For all species, harvesting at early maturity increased forage quality including increased IVDMD and crude protein, and decreased NDF concentrations, whereas allowing forage to reach later maturity reduced forage quality with declines in IVDMD and crude protein and increases in NDF concentration. There were variations in NDF and IVDMD concentration among warm-season grass species in response to N application rates, but none was observed for crude protein. The concentration of crude protein for four warm-season grass species increased as higher rates of N fertilization. Therefore, although there were variations in the effect of N fertilization on NDF and IVDMD making drawing conclusions difficult, N fertilization could improve forage quality for warm-season grasses through increasing the concentration of crude protein in warm-season grasses. Across big bluestem, switchgrass, and indiangrass, quadratic regression equations used for predicting the changes in forage quality parameters from mean stage count (MSC) had high coefficients of determination yy 0.96 for IVDMD, 0.88 for NDF, and 0.88 for CP, respectively. However, predicting forage quality changes based on MSC did not provide reasonable estimates for eastern gamagrass. In the second study (Chapter 4), we determined optimum N fertilization rates and harvest timing for the biomass production of native warm-season grasses and investigated if traits of canopy architecture including mean stage by count and tiller demographics of native warm-season grasses can explain observed yields of warm-season grasses with varied harvest dates and N fertilization rates. Biomass yields increased with advancing maturity but differently among species before declining during senescence. Eastern gamagrass obtained the maximum yield at the highest mean stage count (MSC; 1.6 and 2.2) when the largest seed ripening tillers are present. Big bluestem, switchgrass, and indiangrass are more determinate in their growth patterns. Their maximum yields occurred at MSC 3.5, 3.9, and 2.9, respectively when the largest reproductive tillers are present. Delaying harvest to late fall may improve biomass quality, but it decreased yield due to a large proportion of senescenced tillers and increased litter. In terms of a biomass supply strategy, eastern gamagrass may be used as a feedstock in early summer, while big bluestem and switchgrass may be used between mid-and late summer, and indiangrass in early fall. Nitrogen fertilization increased yield by increasing the proportion of elongating, reproductive, seed tillers for determinate grasses (big bluestem, indiangrass, and switchgrass) and increasing tiller density for indeterminate grass (eastern gamagrass). In the third study (chapter 5), we determined biomass quality of four warm-season grasses as influenced by nitrogen fertilization rates and harvest timing. In both years, delaying harvest dates increased cellulose, lignin, and C concentrations, but decreased ash and N concentrations, however, the magnitude of these effects varied among species. The concentration of N, C, cellulose, and lignin increased, whereas ash content declined with increasing rates of N fertilization, but also varied among species. Our results indicated that the warm-season grasses supplied with N fertilizer at 140 kg ha-1 and delayed to harvest until fall provide the optimal composition for biomass feedstock production. Therefore, the four native warm-season grasses in this study could serve dual purposes as forage when harvested at early maturity, and as biomass feedstocks when harvested during late maturity. Optimal N fertilization could provide economically feasible alternative uses of these warm-season grasses by improving both total yields and quality of forage and biomass

Comparative Control of Type 2 Diabetes Mellitus Between Primary Care Center and Tertiary Care Hospital in A Thai Rural Area

Introduction: Diabetes mellitus (DM) significantly contributes to morbidity, mortality, and healthcare costs. This study aims to evaluate diabetes control and treatment outcomes in individuals treated at primary healthcare centers and a tertiary care hospital in rural Thailand.Methods: Data from 27,266 type 2 diabetes patients receiving care in Sakon Nakhon province in 2023 were analyzed. Participants’ treatment outcomes, including blood sugar, blood pressure control, and screening rates, were compared across urban community health centers, subdistrict health-promoting hospitals, and a tertiary care hospital.Results: Primary care settings demonstrated better management of central obesity and renal screening compared to tertiary care. However, blood sugar and blood pressure control rates were suboptimal across all settings, and HbA1c testing frequency remained low. Mortality rates did not differ significantly between settings.Conclusion: While diabetes management in primary and tertiary care showed similarities, primary care settings were more effective in managing BMI and renal screening. These findings highlight the importance of reinforcing diabetes management strategies, particularly in primary care, to enhance outcomes

Fungal peritonitis in peritoneal dialysis: a 5 years retrospective review in Northeast Thailand

Introduction: Peritoneal dialysis (PD) is a widely used renal replacement therapy for end-stage renal disease patients, offering various advantages. However, fungal peritonitis, a rare but life-threatening complication, remains less understood than bacterial peritonitis. Material and methods: This retrospective single-center study included all cases of fungal peritonitis in PD patients at Sakon Nakhon hospital, Northeast Thailand, from October 2017 to September 2022. Data on demographics, co-morbidities, prior antibiotic uses, laboratory values, microbiological features, treatments, and outcomes were collected. Results: The study involved 32 PD patients with fungal peritonitis. Patients were on average 59.0 ± 11.29 years old, with a majority of females (68.8%). Diabetes (62.5%) was the leading cause of chronic kidney disease. Common co-morbidities included hypertension (75.0%) and diabetes (62.5%). Laboratory values showed variations, including elevated serum creatinine, urea levels, and low hemoglobin. Abdominal pain (81.3%) and clouding of dialysate (68.8%) were typical symptoms at presentation. Sepsis was present in 18.8% of patients. Candida species were the most common causative agents, with 100% receiving Amphotericin-B and 87.5% receiving Fluconazole for treatment. Most patients underwent catheter removal (93.8%). In terms of outcomes, 37.5% resumed PD, 43.8% transitioned to permanent hemodialysis, and the overall mortality rate was 15.6%. Conclusions: This study provides valuable insights into fungal peritonitis in PD patients, underlining the significance of regional considerations in clinical management. The findings underscore the need for standardized guidelines for diagnosis and treatment, accounting for local variations in causative agents and outcomes

Doxorubicin improves cancer cell targeting by filamentous phage gene delivery vectors.

Merging targeted systemic gene delivery and systemic chemotherapy against cancer, chemovirotherapy, has the potential to improve chemotherapy and gene therapy treatments and overcome cancer resistance. We introduced a bacteriophage (phage) vector, named human adeno-associated virus (AAV)/phage or AAVP, for the systemic targeting of therapeutic genes to cancer. The vector was designed as a hybrid between a recombinant adeno-associated virus genome (rAAV) and a filamentous phage capsid. To achieve tumor targeting, we displayed on the phage capsid the double-cyclic CDCRGDCFC (RGD4C) ligand that binds the alpha-V/beta-3 (αvβ3) integrin receptor. Here, we investigated a combination of doxorubicin chemotherapeutic drug and targeted gene delivery by the RGD4C/AAVP vector. Firstly, we showed that doxorubicin boosts transgene expression from the RGD4C/AAVP in two-dimensional (2D) cell cultures and three-dimensional (3D) tumor spheres established from human and murine cancer cells, while preserving selective gene delivery by RGD4C/AAVP. Next, we confirmed that doxorubicin does not increase vector attachment to cancer cells nor vector cell entry. In contrast, doxorubicin may alter the intracellular trafficking of the vector by facilitating nuclear accumulation of the RGD4C/AAVP genome through destabilization of the nuclear membrane. Finally, a combination of doxorubicin and RGD4C/AAVP-targeted suicide gene therapy exerts a synergistic effect to destroy human and murine tumor cells in 2D and 3D tumor sphere settings

Targeting human osteoarthritic chondrocytes with ligand directed bacteriophage-based particles

Osteoarthritis (OA) is a degenerative joint disease characterized by progressive deterioration and loss of articular cartilage. There is currently no treatment to reverse the onset of OA. Thus, we developed a targeted delivery strategy to transfer genes into primary human chondrocytes as a proof-of-concept study. We displayed a chondrocyte-affinity peptide (CAP) on the pIII minor coat protein of the M13 filamentous bacteriophage (phage)-based particle carrying a mammalian transgene cassette under cytomegalovirus CMV promoter and inverted terminal repeats (ITRs) cis elements of adeno-associated virus serotype 2 (AAV-2). Primary human articular chondrocytes (HACs) were used as an in vitro model, and the selectivity and binding properties of the CAP ligand in relation to the pathogenic conditions of HACs were characterized. We found that the CAP ligand is highly selective toward pathogenic HACs. Furthermore, the stability, cytotoxicity, and gene delivery efficacy of the CAP-displaying phage (CAP.Phage) were evaluated. We found that the phage particle is stable under a wide range of temperatures and pH values, while showing no cytotoxicity to HACs. Importantly, the CAP.Phage particle, carrying a secreted luciferase (Lucia) reporter gene, efficiently and selectively delivered transgene expression to HACs. In summary, it was found that the CAP ligand preferably binds to pathogenic chondrocytes, and the CAP.Phage particle successfully targets and delivers transgene to HACs

Next-generation of targeted AAVP vectors for systemic transgene delivery against cancer

Bacteriophage (phage) have attractive advantages as delivery sys-tems compared to mammalian viruses, but have been consideredpoor vectors because they lack evolved strategies to confrontand overcome mammalian cell barriers to infective agents. Wereasoned that improved efficacy of delivery might be achievedthrough structural modification of the viral capsid to avoid pre-and post-internalization barriers to mammalian cell transduction.We generated multifunctional hybrid AAV/phage (AAVP) particlesto enable simultaneous display of targeting ligands on the phage’sminor pIII proteins and also degradation-resistance motifs on thevery numerous pVIII coat proteins. This genetic strategy of directedevolution, bestows a next-generation of AAVP particles that fea-ture resistance to fibrinogen adsorption or neutralizing antibodies,and ability to escape endolysosomal degradation. This results insuperior gene transfer efficacyin vitroand also in preclinicalmouse models of rodent and human solid tumors. Thus, the uniquefunctions of our next-generation AAVP particles enable improvedtargeted gene delivery to tumor cells

Nitrogen and harvest date affect developmental morphology and biomass yield of warm-season grasses

Information on the growth and development of warm-season grasses in response to management is required to use them successfully as a biomass crop. Our objectives were to determine optimum harvest periods and effect of N fertilization rates on the biomass production of four warm-season grasses, and to investigate if traits of canopy structure can explain observed yields with varying harvest dates and N rates. A field study was conducted at Sorenson Research Farm near Ames, IA, during 2006 and 2007. The experimental design was split-split plot arranged in a randomized complete block with four replications. Big bluestem (Andropogon gerardii Vitman), eastern gamagrass (Tripsacum dactyloides L.), indiangrass (Sorghastrum nutrans L. Nash), and switchgrass (Panicum virgatum L.) were main plots. Three N application rates (0, 65, and 140 kg ha−1) were subplots, and 10 harvest dates were sub-sub plots. Biomass of warm-season grasses increased with advanced maturity, but differently among species. The maximum yield of eastern gamagrass occurred at the highest MSC (1.6 and 2.2) when the largest seed ripening tillers were present. Big bluestem, switchgrass, and indiangrass obtained the maximum yields at MSC 3.5, 3.9, and 2.9, respectively when the largest reproductive tillers were present. In terms of a biomass supply strategy, eastern gamagrass may be used during early summer, while big bluestem and switchgrass may be best used between mid- and late- summer, and indiangrass in early fall. Nitrogen fertilization increased yield by increasing tiller development. Optimum biomass yields were obtained later in the season when they were fertilized with 140 kg ha−1