plueme/wizJson huggingface dataset:
One-hundred-five patients diagnosed with drug-induced severe cutaneous adverse reactions (SCARs) were recruited for this study. The results demonstrated that Steven-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptom (DRESS) were caused by similar culprit drug groups, which were different from acute generalized exanthematous pustulosis (AGEP). SJS/TEN phenotype, advanced age, high neutrophil/lymphocyte ratio (NLR) and systemic infections independently increased the risk of in-hospital mortality. The application of NLR to predict mortality in SCARs should be reconfirmed in a large-scale study. The combined measurement of drug-induced IFN-gamma (IFN-γ), granzyme B and IL-22 releasing cells could confirm the causative drugs in 77.8% of SCAR subjects, while α-GalCer supplementation significantly increased the frequencies of drug-induced IFN-γ releasing cells. The appropriate in vitro test panel yields optimal diagnostic values, and cost-effectiveness should be determined. Although SJS/TEN and DRESS are caused by similar drug groups, clinical manifestations and long-term prognosis are clearly different. Our study suggested that keratinocyte death observed in SJS/TEN was partly due to drug-specific exosomes released from peripheral blood mononuclear cells upon stimulation with the culprit drugs in SJS/TEN, but not in DRESS. Five exosomal microsomal RNAs (miRNA-486-5p, miRNA-183-5p, miRNA-96-5p, miRNA-132-3p and miRNA4488) were confirmed statistically different between SJS/TEN and DRESS by microRNA sequencing. The regulatory roles of these exosomal miRNAs on keratinocyte death in SJS/TEN and might be used as the therapeutic roles of exosome inhibitors to prevent SJS/TEN progression warrant further study. The different fates of regulatory T cells (Treg) were observed between SJS/TEN and DRESS patients. While Treg functions in DRESS were stimulated during the acute drug allergic phase, the regulatory/suppressive functions of Tregs in DRESS were subsequently diminished compared to SJS/TEN when followed up during the recovery phase. According to the comparative analyses of Treg mRNA profiles during the acute drug allergic phase, genes regulating T cell differentiation and genes regulating interleukin-10 production were found downregulated in DRESS patients who developed autoimmune consequences compared to healthy individuals and might be used as prognostic factors for long-term complications in DRESS subjects.
Rationale: Founded in 2009, HSRI’s Drug System Research Program has been operated as research granter and manager. In response to continual changes in Thailand’s drug system and its environment, it is necessary to revise the research direction and also enhance the Program’s management capability. Objectives: 1) to propose research direction and questions those help strengthen the Thai drug system; 2) to conduct a review of HSRI’s Drug System Research Program since its establishment in 2009; and 3) to make recommendations to the HSRI concerning drug system research management over the next five years. Methods: This study was conducted during November 2021 to June 2022. Qualitative approaches, namely document analysis, in-depth interview, and focus group discussion were involved. Results: 1. Research direction for Thailand’s drug system: over the next five years, priority should be given to research in six areas: 1) Governance of the drug system, 2) ‘pharmaceutical management and care’ to catch up the transforming health service delivery, 3) Medication literacy, 4) Roles of civil society in drug policy development and implementation, 5) Drug system and disasters /public health emergency, and 6) Development of drug industry for the country’s self reliance. 2. Review of HSRI’s Drug System Research Program: The Program’s focus was on research management at the program and organization level, without formal mechanism to gather and prioritize research questions from policymakers and stakeholders. A framework for drug system research was set annually, but some elements were left without submission from researchers. Most of the research grants were given to address the issue of rational drug use and antimicrobial resistance. Additionally, different tactics were employed in order to encourage research utilization. 3. Recommendations for drug system research management: over the next five years, HSRI should pay attention to managing drug system research at country level. The following actions should be taken: 1) Enhancing the capability of research managers, 2) Learning from past experiences of HSRI and other organizations, 3) Setting a clear definition and scope of “drug system research”, 4) Analysing the landscape of the country’s drug system research, and 5) Building drug system research capacity. Conclusion: The landscape of drug system research in Thailand is complex, as different groups of actors have a role in evidence generation and utilization. This means that national research strategy and effective governance mechanism are required, in order to pursue not only policy-relevant research with high quality, but also efficient use of resources.
Introduction The Subcommittee for Development of the Benefit Package and Service Delivery (SCBP), which holds decision-making authority for the health benefit package of the Universal Coverage Scheme (UC), requested the Health Intervention and Technology Assessment Program (HITAP) to conduct a health technology assessment of “Endovascular treatment for acute ischemic stroke”. This information will be used by the SCBP to decide whether to include endovascular therapy in the UC benefit package. Objectives This study aims to determine the value for money and the fiscal burden to the Thai government of introducing endovascular treatment for acute ischemic stroke into the UC. We also review the feasibility of providing endovascular treatment in Thailand. Methods Model-based economic evaluations, consisting of a decision tree and a Markov model, were conducted to assess the value for money (societal perspective) and budget impact analysis (provider perspective) of endovascular treatment for acute ischemic stroke, either alone or in combination with intravenous alteplase. The methodology follows the Thai methodological and process guidelines for conducting health technology assessment. Model input parameters were collected locally from retrospective data and from a literature review of both national and international studies. In addition, number of hospitals and number of specialists in radiology/neurology were gathered from the relevant Royal Colleges. Results According to the Thai cost-effectiveness threshold of 160,000 THB per quality-adjusted life-year (QALY) gained, treatment with endovascular treatment as an adjunct therapy to intravenous alteplase for alteplase eligible-patients, and endovascular therapy alone for alteplase ineligible patients is cost-effective in treating patients with acute ischemic stroke. Adding endovascular treatment to intravenous alteplase was associated with an ICER of 147,000 THB per QALY gained compared to intravenous alteplase alone. For patients ineligiblefor intravenous alteplase, the ICER of endovascular treatment alone compared to supportive care was estimated at 114,000 THB per QALY gained. With an assumption that there will be 2,000 new cases per year, an additional budget of 887 million THB over a time horizon of 5 years would be incurred if SCBP decides to adopt endovascular therapy under the Thai health benefits package. Currently, in Thailand, there are 50 specialists in radiology and neurology, located across 52 hospitals with the capacity to provide endovascular treatment for acute ischemic stroke. However, most are located in Bangkok. Conclusions Endovascular treatment for acute ischemic stroke represents good value for money, when provided alone and when delivered with intravenous alteplase. Provision of endovascular treatment in Thailand is likely to be feasible in terms of government budget and provider capacity. Thus, endovascular treatment should be included in the Thai health benefits package, with the thrombectomy device priced between 73,800 and 88,100 THB.
Genomics Thailand Project: Database for Common Single Nucleotide Polymorphisms (SNPs) in Non Communicable Diseases (NCD) is a project to study NCD patients. In the first year, 1,800 samples were received from 4 projects as follows. 1) Genetic Study in patients with high risk for cardiovascular events compared to controls, 849 samples, by Prof.Dr. Rungroj Krittayaphong and researcher team (NCD_01). 2) Association of Type 2 Diabetes Mellitus related SNP genotypes, 640 samples, by Assoc.Prof. Somlak Chuengsamarn and researcher team (NCD_02). 3) Advanced clinical phenotyping and genotyping of Thai patients with familial hypercholesterolemia (FH) for clinical application, 73 samples, by Prof.Dr. Weerapan Khovidhunkit and researcher team (NCD_05). 4) Genetic variation study of obesity in Thai patients: To develop a polygenic risk score for clinical risk assessment and personalized medicinal treatment, 238 samples, by Dr. Chartchai Chaichana (NCD_06). SNP genotyping was performed using a chip-based microarray technique on an East Asian-specific platform known as the Asian Screening Array (ASA). This is based on information in the Asian genetic database, which includes data from ethnic groups in Southeast Asia. Quality control of 659,184 SNP genotypes (SNP QC) by the GenomeStudio Software analysis program found that 1,760 samples had a call rate > 98%, (less than 2% missing data). Another 40 samples had a call rate < 98% (more than 2% missing data) and will not be analyzed further. Hardy Weinberg Equilibrium (HWE) testing of 657,060 SNP genotypes from 4 NCD research projects found that most of them had a P-value of 1, which means there were no differences in the population, and that the population is in equilibrium. This study includes examples of NCDs in the Thai population and allele frequencies of genes associated with each disease. Genes with different reported allele frequencies in hypercholesterolemia include GIPR, FAM60A, CAMK1D, HERC4, RRP12, HLA-DRA, HLA-DRB5, and QPCTL genes (P-value < 5.0E−8). The MOV10, SLC4A7, MECOM, SLC39A8, GUCY1A3 and GUCY1B3 genes are associated with hypertension (P-value < 5.0E−8). These preliminary analyses of each group of NCD patients have provided insights into genetic aspects of the diseases. Genetic factors should be analysed in combination with physiological, environmental, and behavioural characteristics of patients. These data will be analysed separately for each research project. Knowledge gained will facilitate further studies into the effective diagnosis, prevention, control, and treatment of non-communicable diseases in Thailand.
This third year research project has the main objective to compare the outcomes of treatment for at-risk of dyslexia children between the supplementary teaching group and the control group, after two years of small group reinforcement teaching with 42 and 77 high-risk students in the supplementary and control group schools entering the experiment in the second year. Teaching for a total of 24 weeks during the 3rd grade has been adjusted for in accordance with the situation of the COVID-19 epidemic. Unfortunately, the school was closed for onsite teaching in the 4th grade level. However, the students was followed up to test reading ability and to measure learning achievement in reading with the WRAT tool at the fifth grade level, with the children in the supplementary group and the control group of 32 and 58 people, respectively. For students in research projects who are not at risk group, the remaining 621 students were monitored for reading ability of elementary school children from grade 1 to grade 5. Reading abilities of not-at risk of dyslexia pupils develop at a faster rate than those of at risk of dyslexia pupils. The result of the reading test when in the fifth grade showed that the children in the at-risk group who received supplemental teaching had higher scores on reading and basic reading skills in almost all areas than the children in the control group, but not reach statistically significance. Learning achievement in reading from the WRAT test showed that 68% of the children in the supplementary teaching group and 58 percent of the children in the control group had a reading domain not lower than the standard value for more than 2 classes as there was a mild reading problem. However, the results showed that more than 90 percent of children from both groups had an achievement of writing domain less than the standard for more than two classes. In addition, reading test scores were highly correlated with WRAT scores. So, scores from the Reading Test at Grade 2 and 5 can be used to help determine the severity of the reading disability.
Primary liver cancers, including both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), is an important cause of cancer-related deaths in Thailand and worldwide due to ineffectiveness of current available treatments. The recently developed organoid technology, which allows long-term culture of patient-derived liver cancer cells in 3D while maintaining morphology, expression pattern, and the genetic heterogeneity of the original tumors, has been shown to be powerful research tool for the discovery of biomarkers and therapeutic drugs for various cancers. In this study we successfully established 31 cancer organoids line from Thai patients with CCA and HCC, and characterized in detail these organoids with whole exome sequencing, whole transcriptomics study, single-cell RNA sequencing and pharmacophenotyping with various anticancer drugs. Our data shows patient specific response in CCA organoids and supports the usage of personalized treatment strategy for CCA. Moreover, we identified new potential biomarkers and novel compounds that can be applied to CCA management. One of the candidates for CCA drugs showed promising result in 3/3 PDX models tested. For HCC, although there is high heterogeneity among patients’ sample and limited drug response to standard drugs used in HCC management, we identified new subpopulation of HCC with high stemness, unique immunogenic profiles, and treatment response which may become interesting candidate for developing new treatment option for HCC. Overall, we successfully generate database and important tools for future development of new treatment for Thai patient with liver cancer.
This project developed the database system for health service management and health status of migrant workers in Health region number 6th of Thailand. The database was developed from public health folder of 43 health databases from the Ministry of Public Health's health information system. The result presents the information through a dashboard which can be accessed through a web browser (http://www.r6-health.info). The display consists of 5 main categories; site of health care center, time to access to health care center, demographics of migrant workers, spatial data of disease distribution, and data of COVID-19. Dashboard is friendly to user and easily for understanding. Example, a case study of COVID-19 situation, found that the prevention measures implemented by the Ministry of Public Health were able to control the outbreak of COVID-19 in the first and second wave of outbreaks. In addition, the developed database may use to show the location of medical facilities and distance to hospital which can be used for further planning of health services. There are still problems on data input to the system. Ministry of Public Health should pay attention on data input process to improve the accuracy of the dashboard.
Background: Obstructive sleep apnea (OSA) was the most common sleep-related breathing disorder. The prevalence of OSA was 15.4 in males and 6.3 in females in Thai population. OSA increased risk of car incidence and cardiovascular diseases and reduced quality of life. Level 1 polysomnography (PSG) was a precision method of OSA diagnosis. To grade the severity of sleep apnea, the number of events per hour was reported as the apneahypopnea index (AHI). Continuous positive airway pressure (CPAP) was the most common treatment for obstructive sleep apnea in patients who do not need surgery. In Thailand, PSG and CPAP were expensive and only reimbursed through the Civil Servant Medical Benefit scheme (CSMBS). Objective: To evaluate the cost-utility analysis and budget impact analysis of OSA diagnosis and treatment by PSG and CPAP compared to standard care. Method: Decision tree model and Markov model were used to estimate total costs, life years (LYs) and quality adjusted life years (QALYs) in societal perspective and governmental perspective. Relevant costs were direct medical costs and direct non-medical costs. Health outcomes were LYs gained and QALYs gained. The results were presented the incremental cost effectiveness ratio (ICER) of PSG diagnosis and CPAP treatment compared to standard care. Uncertainty analysis was conducted by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: Full-night PSG and Split night PSA and CPAP treatment were cost-effective in Thai context at 160,000 Baht per QALY compared to standard care. The ICERs of moderate to severe OSA and only severe OSA patients were 86,635 – 90,014 Baht per QALY for Full-night PSG and CPAP treatment and 85,733 - 88,877 for Split-night PSG and CPAP treatment. If the capacity of PSG diagnosis increased 30% per year, the 5 years budget impact of Full-night PSG and Split-night PSG were 2,204 – 3,730 million Baht and 2,084 – 3,631 million Baht respectively.
Cholangiocarcinoma is a major public health in Thailand, especially in the northeastern region. Due to lack of early detection and poorly responsed of chemotherapeutic treatment, thus new biomarkers are urgently needed. MicroRNA/miRNA is an important genetic molecule that may function as either oncogenes or tumor suppressors. The current study aimed to identify the differential miRNA expression among serum of 50 CCA patients and 50 healthy subjects. The miRNA expression was measured by Nanostring technology. Four miRNA were found siginificantly increased expression in CCA patients; miR-320e, miR-223-3p, miR-122-5p and miR-302d-3p. These miRNA might be played a key role in oncogenesis. And three miRNA that decreased expression in CCA patients were miR-451a, miR-16-5p and miR-23a-3p. The role of these 3 miRNA might be involved with suppressed tumor growth. All these candidate miRNA might be further used as diagnosis markers or prognosis markers.
Food industry intentionally takes actions to protect its benefit through direct or indirect industrial interferences with the public policy makers. The interferences mediate via direct contact with relevant government staff. This study aimed to collect lessons learnt from the experiences of industrial interferences with the public policies from government staff, and to develop recommendations for appropriate interactions between government and the industry. This qualitative study applied 3 methods: 1) a review of the literature and related documents, 2) in-depth interviews with key informants, and 3) a Delphi survey. The present study found that Thai and multinational companies in food industry used same interference strategies, such as, written communication, direct contact with administrators and policy makers. However, multinational companies tended to more often refer to international trade regulations and rules as an important strategy that created arguments when the intervened health policy was implemented. Based on the corporate political activity (CPA), the strategies directly applied to government officials include 1) information and messaging, 2) constituency building, and 3) legal strategy. Recommendations from the present study are 1) transparency throughout the process of communication between government and industry, 2) citation of academic evidence, including the rules and regulations related to international trade in communication, 3) a clearly defined process of communication between government and industry.
The aims of this research and development were to 1) develop a model and 2) study the effectiveness of using the healthier choice nutrition symbol in noodle shops, Mueang Lampang district, Lampang province. The research process consisted of 4 steps: 1) analyze, assess needs by in-depth interview with relevant parties (R1). 2) Design and develop of a model by adjusting the noodle soup recipe using low sodium seasonings to replace the original seasonings (D1). 3) The experimental model consisted of guidelines for adjusting soup recipes, how to cook soup, measurement of sodium salt content in the soup, placement of healthier choice nutrition symbol seasonings in the shop (R2), then assessing knowledge, attitudes, and behaviors on healthier choice nutrition symbol and sodium salt content in noodle soup in the experiment group, assessing satisfaction on new noodle soup recipe with 16 purposively selected experiment samples. Data were collected by using a questionnaire and an in-depth interview. 4) The evaluations on knowledge, attitude, behavior, sodium content in soup and post-satisfaction were undertaken to improve the final optimal soup recipe (D2) using content analysis from group discussions. The results found that: step 1, noodle shop owners realized the need to reduce the use of sodium salt in soup. Step 2, developed new soup recipe using soy sauce containing potassium chloride to replace the original sodium salt. Cooking manual was developed as guidelines explaining new recipes, how to cook soup, measuring the amount of sodium salt and placement of extra seasonings in a noodle shop. Step 3, after serving new soup recipe, the noodle shop owners gained better knowledge, attitude and behavior, with reduced sodium consumption. They were satisfied at the highest level. Step 4: The evaluations revealed that the amount of sodium salt use decreased from the daily measurement. However, the present study was just a pilot scale with small sample size. The model should be extended to a larger population for more reliable results.
Increasing physical activity brings various benefits, not only preventing premature mortality and saving health care expenditure from non-communicable diseases, but also strengthening social solidarity, reducing social inequity, and improving quality of life. Environmental and policy-level interventions for physical activity are promising population-level interventions, however, the number of studies on those interventions were limited in the lower- and middle-income countries. Therefore, this study aimed to assess the existing environmental and policy interventions in Thailand for the future direction of the intervention design and development. A systematic scoping review was conducted in the primary databases (PubMed, Scopus, and Web of Science) and domestic secondary databases. To gain more understanding of the local context, 77 provincial administrative organizations’ strategic plans were further retrieved and analyzed by using the critical interpretative synthesis method. From the systematic review, 11 out of 1,681 studies were included. The results found that evidence on the active environment and active policy physical activity interventions in Thailand were limited in number and diversity, and were rather in sports facilities than physical activity. Infrastructures and urban planning for active transport were seen as a significant facilitating element by adults, while recreational amenities were the most essential factor in improving the elderly’s quality of life. At the local level, only nine provinces out of 77 invested in bicycle pathways, and 16 provinces invested in green spaces, while 42 provinces focused on sports facilities. Policy communication and translation at the local level on a comprehensive concept of physical activity, a collaborative platform between the Ministry of Public Health and Ministry of Interior to provide physical activity implementation, public communication, and routine policy evaluation should be prioritized. Further studies on physical activity policy designs for specific age groups of people were recommended.