plueme/wizJson huggingface dataset:
Project: A cohort of CKD patients with high risk for cardiovascular events or renal disease progression multicenter study (CORE-CKD Thailand) Phase 2: Outcomes and Cost-Effectiveness Extension Study Introduction: Chronic kidney disease (CKD) has effects on quality of life, high cost of care, increases the risk of cardiovascular disease, renal disease progression and other complications. Both traditional factors including hypertension and non-traditional factors including arterial stiffness, salt and water retention, genetic factors and other biological molecules contribute to the cardiac complications and renal decline. Methods: CORE-CKD (Thailand) Phase 2 is multicenter, hospital-based, non-interventional prospective cohort which follow patients with CKD stage 1-4 enrolled in Phase 1. CORE-CKD phase 2 study comprises of 3 objectives: Evaluate risks for 1) cardiovascular disease and 2) renal decline over 3-5 years and 3) Economic impact of CKD by evaluating direct and indirect cost and cot-effectiveness of various treatment. This study will also collect data from elderly patients, patients with on hemodialysis or peritoneal dialysis for comparisons with CKD stage 1-4; Aim 3 Collect DNA, blood and urine into biobank for studies in biomarker studies. Results: 1,409 patients have been enrolled from 21 centers covering all regions of Thailand. Over 1000 samples have been stored in biobank. This report will focus on cross-sectional analysis of the baseline data 1) Control of blood pressure in Thai CKD subjects in comparison to International cohort. Among Thai CKD patients, the proportion above target BP were: <130/80 mmHg 73.1%, and <140/90 mmHg 45.5%. Just over 50% were on angiotensin receptor blockers or ACE inhibitors. 2) Relationship of arterial stiffness measured by cardio-ankle vascular index (CAVI) and abnormal cardiac contraction by echocardiography in the development heart failure in CKD. Both mean CAVI and Ventricular-arterial Coupling (VA coupling) was significantly higher in CKD patients with heart failure compared with patient without heart failure. 3) Researchers currently evaluating relationship of psychosocial impact, risks of CVD, relationship of CAVI and pelvic vascular calcification, CKD staging using creatinine or cystatin C, 24 hr. urine sodium intake, prevalence of anemia and other complications, development of metabolomics for identification of renal disease progression and economic impact in CKD patients. Conclusions: CKD patients have high prevalence of many risk factors. Arterial stiffness and abnormal cardiac contraction is associated with heart failure in CKD. The treatment of hypertension in still inadequate. This knowledge will be useful to make strategies to achieve control of various risk factors. This is the first year of a three year project. In the next 2 years data analyses on other parameters will be more complete and more information would be available on risks for CVD, kidney disease progression and economic burden of CKD in Thailand.
Background: In our previous clinical study showed that probiotic Lactobacillus paracasei SD1 was safe, and the strain could reduce salivary cariogenic mutans streptococci resulting in reduce caries progression in volunteers by receiving everyday milk powder containing probiotic L. paracasei SD1. Aims: This continued study aimed to examine the efficacy of caries prevention by receiving probiotic milk powder every day, 3 days/week compared to normal milk (without probiotic). Methods: The study designed as randomized double blind controlled trial taking 1 year of monitoring. After consented, all participants have been randomized into 3 groups including: probiotic group who received probiotic milk every day, mixed group who received probiotic milk 3 days a week and control group who received milk without probiotic every day, 3 grams for 6 months. All participants were monitor at baseline (T0), 6 (T6) and 12 (T12) months for caries status, salivary immune, human neutrophil peptides (HNP) 1-3 by ELISA kit, and bacterial levels (total lactobacilli, L. paracasei/L. casei and S. mutans) by real time PCR. Results: It showed that probiotic L. paracasei SD1 could prevent caries progression and promote regression among children who received probiotic milk either every day or 3 days/week compared to control group. This is the results from the findings of reducing of cariogenic S. mutans and stimulating of salivary immune HNP 1-3 among children who received probiotic milk either every day or 3 days/week compared to control group. In conclusions: Results of study indicated that the consumption of probiotic milk either every day or 3 days/week could prevent dental caries. However, it noticed that salivary immune HNP 1-3 level was significant higher in children who received probiotic milk every day than in children who received probiotic milk 3 days/week, which may effect on caries prevention in long term. This study provides information that may be useful for administration of giving probiotic L. paracasei SD1 to prevent caries in young children.
Background This study aimed to synthesize policy recommendations for future planning in family physician training and effective primary care cluster policy implementation with regards to actual needs and responsive to the situation Methods Situation review and value chain analysis were done in 8 primary care clusters in Central, Eastern, Southern, and Bangkok Metropolitan areas in 2018. A national survey in all 13 health services areas was deployed during the second and the third trimesters of 2018 in order to assess major stakeholders’ perceptions and opinions; including administrators, academics, and family physicians, on national primary care cluster policy implementation as well as the performance and roles of family physician in their settings. The data from primary and secondary sources were analyzed and policy recommendations were synthesized accordingly. Results 213 subjects were participated in the study. 50.7% was female, and median age was 38 years (range 24-84 years). Regarding performance and roles, all groups of the stakeholders indicated that expectable performances of family physicians had not been achieved yet in accordance with 6 performance dimensions of Royal College of Family Physician of Thailand. For primary care cluster policy implementation, there were significant hurdles from frequent changes in policy contents, unclear messages, incongruencies with community situation, rigid specifications, lack of positive retention strategies on healthcare personnel, misunderstanding and acceptance problems among healthcare professionals as well as community, imbalance between demand and supply, lack of policy advocacy at local areas, and problems in family physician training system including trainers, trainees, and related resources. Policy recommendations 1) The Ministry of Public Health should allow those in local areas to propose their own operation plans as well as appropriate and feasible performance indicators. 2) The Ministry of Public Health should modify their policy contents by allowing any physicians to perform as family physician without the necessity to train in family medicine program. 3) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should develop self-directed learning system for the physicians and other health professionals to gain knowledge and experience in family medicine. 4) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should discontinue their diverse approaches in family medicine training, and preserve only a standard training program. Moreover, they should develop specialty training programs that are in needs for the society such as longterm care, elderly care, etc. 5) The Ministry of Public Health should develop networking system in the local areas that can effectively link specialists with family physicians by using “Shared care and responsibility”.
At present, the management of drugs and medical supplies in the emergency is not very efficient. In addition, Thailand very much relies on the importation of drugs and medical supplies in the normal circumstance. This research study aims to review and analyse the management situation of drugs and medical supplies and to propose the recommendations to reform the management of drugs and medical supplies for Thailand in emergency and at normal situation. This study was designed as a qualitative study. The data was collected using qualitative approaches including the literature review, focus group discussion with stakeholders, in-depth interview with experts and Delphi Technique. The study revealed that to reform the system towards the goal of drugs and medical supplies security in the emergency, the national master plan is needed. There is also a need to assign Division of Public Health Emergency Management (DPHEM), Office of the Permanent Secretary, Ministry of Public Health to be the focal body with the aim to integrate and cooperate with all other related agencies. The Information and Communication Technology Center should be assigned as the main responsible organization in the reform of the IT system. In addition, the study also indicated that the national list of drugs and medical supplies to be reserved, the quantity to reserve should be determined using the scenario planning technique. Moreover, a new law specific to the management of drugs and medical supplies in the emergency should be developed to enhance the efficiency of the management system. Regarding the self-reliant capability, the study indicated that the reform should first start with fast re-structuring of the existing organizations which are responsible for the improvement of drugs and medical supplies industry and reviewing of their roles and responsibilities to put special focus on drugs and medical supplies. The approaches to reform should be performed throughout the entire supply chain. Furthermore, it is really essential to change the budgeting system and unite the working mechanisms among related authorities. Reduction of selling privilege of the Government Pharmaceutical Organization and other organizations which have similar privilege, aiming to create equity and enable real market competition, is one of the main findings from this study. The government should also support the budget to drugs and medical supplies industry to facilitate more efforts and investment in research and development and production, To conclude, the government should place as much emphasis as possible on this reform. Extensive effort should be carried out to facilitate the system reform. The focal authority should be strengthened on every aspect thus the actual integration could be established and the security of drugs and medical supplies of Thailand could be expected.
Heart failure (HF) is a major health problem globally. Multidisciplinary team care increases standard medication treatment, decreases risk of hospitalization with heart failure and all-causes mortality, also improve quality of life in patient with heart failure. However, with the increasing of number of patients and lacking the clinical practice guidelines in the HF clinic, are affecting the problems of data management, redundancy of documentation. These are obstacles for data management in patient care, quality assurance and initiating of academic work. This is a participatory action research among staffs inside the HF clinics and outside the HF clinic, also patients or care givers. The objectives of this study including the development of multidisciplinary care model and the clinical practice guidelines for HF patients in the clinic, the development of data management system and other tools, and the comparisons of outcomes between before-after receiving care from the HF clinic The results from problem survey found that problem related to data management was the most important including data collection, documentation and report, redundancy of data documentation and communication within the clinic. The patient’s data-base system was developed, as well as the clinical practice guidelines and other tools for supporting patients’ care. A total of 100 patients, 58.00 percent were male, the mean age of 6 1 . 9 2 + 1 5 . 7 5 years old. Patients received treatment in the HF clinic for at least 6 months. The mean of ejection fraction (EF) was 30.80 + 8.48 %. The common cause of cardiomyopathy (CMP) was ischemic CMP (70.00%). The evaluation of all process outcomes found improved significantly including patient’s knowledge for self-care score, the mean guideline adherence indicator (GAI) increased from 64.35 + 38.25 % to 88.50 + 21.76 (p=0.009), the New York heart association functional class was improved, and also the 6-minute walk test. All drug related problems (DRPs) found were 134 problems. The common DRPs were dosage too low (47.00%), non-compliance (37.00%), and adverse drug reactions (21.00%). The DRPs were solved mostly by physicians adjusted the medication combined with pharmacist provided counseling to patients (61.94%). The majority of DRPs were solved completely (70.00%) with 29.00 percent were pending for following-up. The outcomes after development of patient’s care model resulted in the numbers of hospitalization with heart failure decreased significantly (33.0 and 8.0%, p<0.001) and saved the total of hospitalization cost 8,839.72 baht per patient, the quality of life score increased significantly, and the mean patient satisfaction score was in the level of good-best after received the developed patient’s care system.
Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Northern Thailand (EPNT) was formulated. EPNT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPNT and non-EPNT patients in the first 15 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPNT patients and 101 non EPNT patients. EPNT group had lower cumulative rate of AVA infection (EPNT: 0% vs non EPNT 2.52%, p = 0.087), than those in non EPNT. Also 11.9% in non EPNT patients had history of CVC sepsis. EPNT group had lower rates of central vein stenosis (EPNT: 1.23% vs non EPNT 5.11%, p = 0.146), than those in non EPNT group. However, these trends did not reach a statistically significance. The rates of maturation, AVA complications, and MACE were not different between two groups. The score in the general mental health in EPNT group was significantly better than those in non EPNT group. Conclusion: EPNT patients had a trend toward lower rates of sepsis and central vein stenosis, and better general mental health scores than those non EPNT patients. However, this 15-month result does not make any solid conclusions to determine the difference between EPNT and Non-EPNT. Further results will shed more light on this field.
Tuberculosis (TB), an infectious disease remains a major public health concern in Thailand. This research, we focused on design and discovery of potent anti-tuberculosis agents to overcome fluoroquinolone drug resistant using molecular modeling, computer aided molecular design approaches combined with biological assay evaluations. In order to design and develop structure of DNA gyrase inhibitors targeting at ATPase domain of DNA gyrase subunit B including 4-aminoquinoline, 4-(piperazin-1-yl)quinolone, 2-(1H-benzo[d]imidazol-2-yl)-2-cyanovinyl, Nitro-thaizole and benzo[d]isothiazole derivatives, molecular docking calculations, quantitative structure–activity relationship (QSAR), molecular dynamics (MD) simulations and FMO calculations were performed. The crucial interactions in ATPase domain and structural requirement of inhibitors revealed the key information for ration design highly potent DNA gyrase inhibitors.  Virtual screening and biological assay were applied to discovery of novel and highly potent DNA gyrase inhibitors. 17 compounds showed the inhibitory activity based on ATPase assay closed to reference compound, Novobiocin. For antimicrobial assay, two active compounds, G24 and G26 were obtained the 12.5 µg/ml. DNA supercoiling assay of active compounds in wild-type and N538D mutant type of DNA gyrase were investigated. The obtained results showed that the inhibitory activity of two compounds (G18 and G24) were higher potent than the reference drug, ciprofloxacin. There active compounds (G18, G22 and G24) showed the DNA supercoiling inhibition higher than the reference drug. Pharmacokinetic properties of active compounds were predicted using ADMET predictions. The obtained results revealed that new active compounds were suitable for structural modification to improve the biological activity. MD simulations and X-ray crystallography were used to investigate the binding mode and binding interactions of active compounds in ATPase domain. The obtained results provided the crucial interactions for developing novel and highly potent compounds for fluoroquinolone drug resistant tuberculosis.
Tuberculosis (TB) remains a public health problem in Thailand and causes socio-economic consequences. Studying of epidemiology and biology of Mycobacterium tuberculosis, a causative agent of TB, development of rapid diagnosis of drug-resistant TB, and effective treatment are urgently required for effective prevention and control of TB. Genotyping of M. tuberculosis strain based on specific genomic markers has been widely used for epidemiological study. Particularly, single nucleotide polymorphisms (SNPs) are current genomic markers appropriate for epidemiological and evolutional study and also for prediction of drug resistance. From the first-year study, we could develop the whole genome sequence analysis pipeline for prediction of resistance to first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) and for rapid genotyping. Comparison with results obtained from standard drug susceptibility testing, the analysis pipeline had sensitivity and specificity of 94.6% and 98.5% for isoniazid, of 92.4% and 99.6% for rifampicin, of 85.3% and 98.9% for streptomycin, and of 66.7% and 97.9% for ethambutol, respectively.  For genotyping the pipeline showed 100% concordant results with the standard LSP. In addition, SNPs databases for drug resistance and genotyping were created from this study. In the second year of the study, the automatic genome analysis pipeline for prediction of drug resistance and for genotyping was developed and validated with a test sample set of 50 M. tuberculosis strains comprising of 41 isoniazid-, 43 rifampicin-, 23 streptomycin-, 27 ethambutol-, 12 amikacin-, 13 kanamycin-, 25 fluoroquinolone-, 11 ethionamide- and 15 PAS-resistant strains. Results were compared with those obtained from the standard drug susceptibility testing and revealed the sensitivity and specificity from 82.6 to 92.6% and from 87.0 to 100%, respectively, for prediction of first-line anti-TB drugs. The sensitivity was lower for prediction of second-line drugs; sensitivity and specificity ranged from 66.7 to 80.0% and from 92.0 to 100%, respectively. The automatic genome analysis pipeline also showed 100% concordant results with the standard LSP for genotyping.
The present study was invention of an instrument for balance assessment and feedback in second year. The purpose of this research was to test the efficiency of the instrument by testing reliability. Forty-two participations, aged range 40-93 years, were recruited into this study. Participants were divided into two groups, including aging group (n=22) and people with stroke group (n=20). The finding showed that reliability of force measurement was very high for both plates (ICC (3,1) = 0.945 for plate 1 and 0.978 for plate 2, p<0.000) in aging group, while reliability of force measurement in people with stroke group was between high and very high (ICC (3,1) = 0.872 for plate 1 and 0.968 for plate 2, p<0.000). Reliability of center of pressure was between middle and high in both groups. In conclusion, the instrument was able to measure force efficiently. However, this instrument should be developed in order to increase effectiveness of measuring center of pressure.
The present study was aimed to develop a method to detect cancer cells in venous blood of cancer patients, either for screening for following-up. Heparinized venous whole blood of about 10 milliliters from the subjects were processed for red blood cell lysis and white blood cell depletion. The cells remained were cryo-fixed and stained using commercially available reagents claimed to give a good morphology of the fixed cells that could be stored for many months. Blood samples were collected from 25 colon cancer patients and 12 subjects who were negative for colon cancer screened by colonoscopy. Early in the study, blood samples from 2 breast cancer patients, 5 hepatocellular carcinoma patients, 1 cholangiocarcinoma patient, 1 lung cancer patient and 1 osteosarcoma patient were also collected. Antibodies against vimentin, cytokeratin, CD45, CDX2, CD31 and CD34 were used. Due to a technical problem on red blood cell lysis and staining temperature, a few weeks were spent to solve it and later cells could be fixed and stained at low temperature. Other optimizations included low temperature handling steps and concentrations of antibodies. The immuno-stained cells appeared mostly to be white blood cells of good morphology. A pathologist had investigated the stained samples and found that there were only 2 cases out of 25 colon cancer patients that seemed to have some abnormal/cancer cells. These were larger and their neclei were also bigger than the nearby white blood cells. They were especially positive for CK 20 and CDX2, the latter being reported to be specific for adenocarcinoma. However, the size of many abnormally stained cells found in many cases was similar to white blood cells, it may be concluded that in this present study abnormal cells could be found in blood samples of colon cancer patients but perhaps with a very low sensitivity. Also owing to quite a high cost of reagents for cell isolation and low temperature processing, this method at the moment could not be used as a routine colon cancer screening.