plueme/wizJson huggingface dataset:
Antibody-dependent enhancement (ADE) has been considered as one of the mechanism that leads to the development of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). During secondary dengue infection monocytes can be infected by the ADE phenomenon. This study aimed to investigate the proteins involved in ADE of DENV infection in the primary human monocytes isolated from volunteers. The phosphoproteins were used to perform and analyze for protein expression using mass spectrometry (GeLC-MS/MS). The differential phosphoproteins revealed 517 altered proteins compared between isotype- and DENV-specific antibody-treated monocytes. The altered proteins revealed 253 upregulated proteins and 264 downregulated proteins. Approximately 70-80% of altered proteins was classified into binding and catalytic activity proteins, while 20-30% was proteins with molecular function regulator, molecular transducer activity, structural molecule activity, transcription regulator activity or translation regulator activity and transporter activity. Protein disulfide isomerase (PDI), which is an enzyme that had a high-ranking fold change and that catalyzes the formation, breakage, and rearrangement of disulfide bonds within a protein molecule, was selected for further study. PDI was found to be important for dengue virus infectivity during the ADE model. The effect of PDI inhibition was also shown to be involved in the early stage of life cycle by time-of-drug-addition assay. These results suggest that PDI is important for protein translation and virion assembly of dengue virus during infection in human monocytes, and it may play a significant role as a chaperone to stabilize dengue protein synthesis. Moreover, other proteins were further performed by interaction network analysis and found that most structural proteins were interacted together. Alpha-actinin was observed to be altered and may be associated to play important role in viral replication and viral infection in monocytes.
In Thailand, nowadays, there is an increasing number of terminally ill patients who need palliative care. Opioids are deemed to be an essential treatment for severe pain that can help to reduce suffering and increase the quality of life significantly. Even though opioids have been already included in the National List of Essential Medicines in Thailand, access to this kind of treatment remains a problem. This study aims to explore the factors that influence the access to opioids for palliative care in Thailand. The methodology used in this study includes literature and document review, in-depth interview, as well as focus group discussion which obtained data from personnel in the national institutes related to opioids regulation and palliative care. Key informants consisted of patients’ representatives, doctors, nurses, and pharmacists. Data collection was performed in nine secondary- and four tertiary-hospitals. Thereafter, record files were transcribed verbatim in accordance with key informants’ consent and analyzed as content analysis. This study found that obstacle factors to access opioids for palliative care are divided into four issues including (1) opioids regulations are inconsistent with practices when opioids are suddenly out of stock or nearly expired; however, hospitals cannot borrow or swap these drugs from each other. (2) Inadequate drug management system leads to insufficient amount of drugs stored in hospitals as recommended by the WHO. (3) Doctors, nurses, and pharmacists acquire scarce knowledge of and have negative perspectives toward opioids that cause them afraid to prescribe opioids. Besides that, patients and relatives and laypeople are lack knowledge and understanding of opioids which results in unacceptance. (4) Governance and palliative care system are not robust together with vague policy, deficient budget for operation, unreadiness of services, lack of monitoring and evaluation. This study recommended (1) revising regulations for consistency with opioids administration and management. (2) developing a management system for medical supplies in areas. (3) improving the education system and training for professions as well as counselling or advising patients and their relatives and within the community. (4) Promoting governance for accessing opioids.
Integration of genome sequencing in the diagnostic process for Thai infants with infantile cholestatic jaundice co-operated by Faculty of Medicine, Prince of Songkhla University and Health Systems Research Institute, Ministry of Public Health. To discover new genetic susceptibility of infantile cholestasis, next generation sequencing was implemented to operate in our study together with clinical finding and investigation. Focusing on biliary atresia, a half of cases had successful bile drainage from the hepatoportoenterostomy. According to similarity of clinical finding, the poor prognosis with naïve liver may be miss diagnosis from other cholestatic jaundice disease. Genetic biomarker became an important application to help discrimination of isolated biliary atresia and the others, improve post-operative outcome and delay queuing for liver transplantation. In our study, 64 individuals with cholestatic jaundice were included together with consent for blood sampling and genomic investigation under standard operation procedure of Genomic Thailand Consortium. All of retrieved samples and metadata information were processed at Translational Medicine Research Center (TMRC), Faculty of Medicine, Prince of Songkla University and delivered to Department of Medical Science, Ministry of Public Health. For the leftover specimens, whole exome sequencing was undergone to intensively discover pathogenic variants related to the cholestatic syndromes. Annotated exome sequences were comprehensively reviewed and discovered 45 possible deleterious variants. Moreover, genetic association was performed for SNPs located in ADD3 and EFEMP1 genes (rs2501577, rs17095355, rs6761893 and rs727878). The statistical appraisal of susceptibility shown significant association of first three SNPs with the disease together with additive biological interaction between both genes. In summary, we purpose that our study will be a beginning of implementation of high-throughput sequencing and genetic biomarker in pediatric surgical diseases.
Dengue disease is an important problem in global public health. Annually, 390 people are infected with dengue virus. The majority of infections results in asymptomatic cases. For symptomatic cases, patients will develop either mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF). DF is a self-limiting disease meaning the patients will recover within 4-7 days without any significant intervention. However, DHF patients will eventually develop plasma leakage which may progress into potentially fatal hypovolemic shock known as dengue shock syndrome (DSS) without prompt and adequate fluid management. Dengue disease is caused by dengue virus which belongs to the genus Flavivirus. There are four serotypes of the virus including dengue virus 1, 2, 3 and 4. The virus is transmitted by Aedes mosquitoes. There is no antiviral drug against dengue virus and the only available vaccine has limited efficacy and elevates the risk of hospitalization from dengue disease in seronegative vaccines. We previously conducted a phase 2/3 trial by repurposing ivermectin to treat adult dengue patients. We found that ivermectin was safe, and the drug could significantly speed dengue virus non-structural protein NS1 clearance. In addition, the drug showed a potential efficacy in reducing the severity of the disease. In this study, we primarily evaluated the safety and pharmacology of ivermectin in pediatric dengue patients (age younger than 15 years and weighing more than 15 kilograms). Since ivermectin ingestibility, absorption, metabolism and excretion in pediatric patients were expected to be dissimilar from adult patients, this study was essential for determining the appropriate dose of ivermectin before conducting a trial for evaluating clinical efficacy. Two doses of ivermectin were studied: 400 μg/kg per day for three days and 600 μg/kg per day for three days. The patients in each dosage group were also stratified by weights into two groups including those weighing over 30 kg and those weighing between 15 to 30 kg. Our analyses showed that both doses of ivermectin were safe for treating pediatric dengue patients. However, no dose dependent relationship in efficacy against viral load or NS1 levels were found between the two administered doses. Advanced pharmacological analysis is required to confirm this finding. If the finding is confirmed, the more appropriate dose for phase 3 clinical trials in pediatric patients will be 400 μg/kg per day for three days.
Cancers are still the major cause of death in Thai population. Personalized treatment that targets specific genes or proteins is efficacious in cancer patients. Various molecular analyses of patients' tumors are used to determine whether they contain somatic mutations that could be used as reliable predictive biomarkers for tailoring therapy. Patients with primary lung adenocarcinomarcinoma harboring activating EGFR gene mutations respond well to targeted treatment by EGFR Tyrosine Kinase Inhibitors (EGFR-TKIs). Approximately 50 percent of Thai lung Adenocarcinomarcinoma patients have these mutated variants of EGFR gene in their tumors. Some patients who do not have EGFR mutation harbor mutations of other genes, such as ALK fusions and BRAF mutations that may benefit from treatment with other targeted therapy. However clinical samples yield nucleic acids in limited quantity and often of low quality. Sensitive molecular assays are therefore crucial to detect these somatic mutations. We engage in the development of new polymerase chain reaction (PCR)-based assays for determination of predictive molecular biomarkers for targeted medications. We have developed assays that efficiently detect clinically important mutant alleles, including mutations in EGFR, BRAF and ALK genes, presented in ultrashort nucleic acid sequences. These simple, highly sensitive and cost-effective mutation detection assays will be useful tools to enhance precision medicine in oncology.
Tobacco control is one of the most contentious political-economic issues at present. The Framework Convention on Tobacco Control (FCTC) of 2003 was crafted to be a global mechanism for tobacco control. However, the degree of tobacco control differs greatly among countries. FCTC has faced strong resistance because tobacco markets are globalized and highly profitable. This study employed global health governance (GHG) as an analytical framework and argued that the FCTC was not sufficient as an effective tobacco control instrument. It required a regional mechanism such as the European Union as well as national level actors, both state and non-state, for effective tobacco control. This research study used the European Union, France, and Germany as case studies. Findings show that France had strict tobacco control measures because political actors, non-governmental organizations, and medical personnel had strong influences on shaping tobacco control policy and took stance against transnational tobacco companies and retailers. In contrast, Germany encountered significant delays in developing effective tobacco control policies because of both the ignorance of political actors, and the weakness of the anti-tobacco civil society network. Moreover, powerful and profitable international and national tobacco companies stood firm against Germany’s tobacco control policies. This research study discovered that the European Union performed a significant role in harmonizing member states’ tobacco control policies, and ushered them in developing their own tobacco control policy measures, especially in the case of Germany. Tax measures had a positive impact on people’s health. They helped reduce the number of deaths from tobacco consumption, as well as reduce tobacco consumption rates among smokers. However, tax harmonization measures respected national jurisdiction and minimized economic impacts. Tobacco tax still remained a national source of income. This research study proposes that ASEAN and its member countries adopt the EU’s harmonization of tobacco-related legislations in order to develop ASEAN’s tobacco control mechanisms and to minimize the gap between members’ tobacco control policies.
Walking and cycling are common physical activities that can be performed regularly in daily life which provide health, environmental and economic benefits. This study aimed to 1) assess community-level walking and cycling promotion strategies or activities by stakeholders in selected communities, 2) investigate implementation gaps and 3) provide recommendations on walking and cycling promotion in community. Qualitative method was employed. A total 28 key informants in 4 communities of 4 regions were recruited: 1) King Taksin community in Bangkhla district, Chachoengsao province, 2) Suksabaijai community in Mueang Kalasin district, Kalasin province, 3) Ban Khaoniwet municipality school community in Mueang Ranong district, Ranong province, and 4) Ban Thatsobvan community in Chiang Kham district, Phayao province. Content analysis was used. The results showed that three main actors to promote walking and cycling in community were local government, civil society, and academia. These actors had different roles but worked collaboratively to achieve common goals. The implementation gaps were the negative attitude as well as improper and unsafe built environments towards walking and cycling. Recommendations for further program implementation include communication campaign to promote positive attitude and social awareness on the value of walking and cycling, improvements on built environments especially a speed reduction intervention in community, and leadership and supportive policy towards walking and cycling in daily life.
Palliative care is crucial care for cancer patients, especially those who are moving toward the end-stage. The World Health Organization states that palliative care is low cost. However, a cost analysis of such care is limited in Thailand. This study aimed to perform a cost analysis of palliative care for cancer in a community hospital. The analysis was conducted based on two perspectives: the health care provider’s and the patient’s. Cost data of 42 palliative cancer patients were recorded from January 1 to December 31, 2018. The cost of the provider’s perspective included labor and material costs from three departments: outpatient, inpatient, and home-visit, whereas the patient’s perspective covered the direct medical cost, direct non-medical cost, and opportunity cost. Results show that the average cost of the provider’s perspective was 16,525 ± 14,979 baht per patient: from outpatient 4,309 ± 7,103 baht, inpatient 10,915 ± 11,704 baht, and home care 1,301 ± 1,977 baht. The cost on provider’s perspective was mainly born by medical materials (68%). The average cost on the patient’s perspective was 38,707 ± 32,943 baht per patient: 5,262 ± 5,571 baht for outpatient, 6,231 ± 7,355 baht inpatient, 20,806 ± 20,454 baht home care, and 6,408 ± 17,336 baht for seeking other healthcare. The patient cost was predominantly opportunity cost (69%). The Ministry of Public Health and the National Health Security Office should consider the budget plan for palliative care.
Background and Rationale: Hip fracture in the elderly is a common problem in all countries worldwide and tends to increase every year along with the number of older adults. Treatment and rehabilitation of the patients take a long time, resulting in financial burdens for each country. The repeated fractures rate within 1 year was 2-11%. The current treatment of hip fracture patients was to cure and focus on the prevention of recurrent fractures. Therefore, the Refracture Prevention Program with multidisciplinary care was created. The purpose of this study was to investigate the cost-effectiveness of patients with fractured hips in Refracture Prevention Program compared with traditional treatment in healthcare provider’s aspect. Methodology: A prospective and retrospective study was conducted in 2 sample groups, with the control group receiving traditional treatment and the experimental group in the Refracture Prevention Program. Data were collected from 130 fractured hip patients of each group starting from admission day in Lerdsin Hospital for up to 1 year. The economic evaluation used a decision tree to show an incremental cost and effectiveness of each group. Results: The refracture prevention group had statistically significant higher quality-adjust life years (QALYs) than the traditional group (p < 0.05) and the program could prevent refracture better than the traditional group. Refracture rate per year reduced from 6.27% to 4.29%. The unit cost of hip fracture treatment in the Refracture Prevention Program was THB 139,504, while the traditional group was THB 150,720. The QALYs of the refracture prevention group was 0.6023, while the traditional group was 0.5106. New intervention was dominant: treatment under the Refracture Prevention Program was cheaper and better than traditional treatment. Conclusion and Discussion: The model of care for elderly patients with hip fracture should be the fracture liaison service model, with multidisciplinary cooperation and prevention of recurrent fracture risk factors. During the first year, there were 3 main costs of the program (operation, osteoporosis treatment and fall prevention) compared to only surgical treatment cost in the traditional treatment. Further study should be the long-term follow-up of the project. Besides the costing perspective, there should be a study on the financial burden of Thailand, in order to know the magnitude of the problem for future planning.
This study is a retrospective study using real-world data to compare treatment patterns with the guidelines for drug administration of the National List of Essential Medicine (NLEM) category E(2), and to compare effectiveness with the efficacy of clinical studies. This study focused on the treatment pattern and effectiveness of trastuzumab for early breast cancer (ICD-10 C50). Data were retrieved from the reimbursement database of the NLEM category E(2) during fiscal year 2015-2018. Time to follow-up was truncated at the end of fiscal year 2018. The data were analyzed by using descriptive statistics and non-parametric with Kaplan-Meier method. As a result, there were a total of 2,492 early-stage breast cancer patients, mostly between the ages of 50-59 years (37%), with a median follow-up of 34.98 months (interquartile range 16.75 months). The majority of patients received trastuzumab in accordance with the NLEM category E(2) guideline, 1,996 cases (80%) received drug less than 18 treatment cycles and 2,217 cases (89%) received drug less than 14 months. Subgroup analysis of the less than 14 months found 942 patients (38%) received the drug less than 12 months. Analyses of real-world effectiveness by using survival analysis in all trastuzumab patients found a 4-year survival rate of 80.02% (95% CI: 77.69-81.62); 78.74 % (95% CI: 76.36-80.90) for less than 18 treatment cycles, and 85.07 % (95% CI: 82.24-87.48) for the 12-14 months. These rates were lower than the efficacy reported from randomized controlled trials. Therefore, the present study of real-life data analysis concludes that most of patients received the trastuzumab in line with the NLEM E(2) guideline. Non-adherence may result in reducing the effectiveness of treatment lower than the efficacy from the RCT. However, this study did not explain the reason of non-adherence due to lack of important data, such as responses to treatment, recurrence and occurrence of side effects from drug use.
The cost of health service is an important indicator for hospital administrators in making decision for efficient health service provision. The study aimed at exploring hospital care cost and unit cost of the top five diseases of patients hospitalized at the Queen Sirikit Medical Center, Ramathibodi Hospital, in fiscal year 2016. This was a retrospective study from health care provider’s perspective covering patients hospitalized to a special medical ward of a university hospital in Bangkok. Costing data were collected using a standard tool of unit cost analysis categorized by source of expenses, namely labor cost, material cost, and capital cost. Cost analyses consisted of two major processes: 1) hospital cost and 2) cost center analysis using top-down costing method. Top-down costing included four steps: 1) cost center identification, 2) direct cost determination, 3) indirect cost determination and 4) total cost determination. Unit cost analysis of top five diseases was classified by diagnosis upon hospital admission. Results show that the annual total cost was approximately 12,448,667 Thai baht: direct cost and indirect cost was 10,373,889 and 2,074,778 baht, respectively. For the direct cost; the proportions of labor cost, material cost, and capital cost were 88 : 8 : 4. Unit costs of the top five diseases were as follows: neoplasms 19,145 baht/day and 142,769 baht/admission, diseases of the genitourinary system 17,167 baht/ day and 182,710 baht/admission, diseases of the musculoskeletal system and connective tissue 15,495 baht/day and 122,765 baht/admission, diseases of the circulatory system 12,901 baht/day and 144,488 baht/admission, and diseases of the respiratory system 9,414 baht/day and 98,573 baht/admission. Results from this study could be utilized as guidance for cost management by reduction in the unnecessary admission days while maintaining quality. This will provide benefits and efficiency improvements in resource use to Ramathibodi Hospital and clients.
The objective of this study was to estimate the cost of emergency patients in public hospitals for financial policy recommendation to the Universal Coverage for Emergency Patients (UCEP). Financial and service information for the fiscal year 2019 was gathered from eight hospitals, two of which were general hospitals of the Department of Medical Services, four regional hospitals, and two general hospitals of the Office of the Permanent Secretary, Ministry of Public Health. The traditional cost method with the cost matrix method was applied to analyze the unit cost of emergency patients. We used the cost matrix in two steps: (1) cost distribution of the fundamental cost centers to each patient based on the services received; (2) summing all medical activity costs on each patient and reporting them as individual patient data. The result showed that there were a total of 82,811 emergency patients from eight hospitals, 20,503 were triaged as resuscitation patients (red), and 62,308 emergency patients (pink). Labor costs were the highest share of the overall costs, followed by material costs, and capital costs. Unfortunately, the present study could analyze complete cost information from only one hospital (hospital A). The total cost of 18,027 emergency patients was THB 472,317,273. The average cost per person was THB 26,201, and the average cost per adjusted relative weight by diagnosis related group was THB 9,661. This costing method that required accurate hospital financial and emergency medical service information reported only data from one hospital. Further studies should explore alternative appropriate costing methods that data from more hospitals could be analyzed as more representative.