Phramongkutklao College of Medicine

Opisthorchis viverrini infection remains a significant public health issue in rural Thailand and is strongly linked to cholangiocarcinoma. For twenty years, the Na-yao community, a central Thai settlement founded by northeastern migrants, has been subject to traditional control interventions that rely primarily on periodic stool examinations, treatment, and health education. This study assesses long-term infection patterns and socio-behavioral determinants following these interventions. An explanatory sequential mixed-methods design was used. The quantitative strand included a prospective cohort study (n = 246) to estimate incidence density and identify risk factors, using stool examinations and Poisson regression models. The qualitative strand included focus group discussions and in-depth interviews, and framework analysis was used to explore sociocultural factors influencing infection control. The quantitative strand reported an incidence density of 6.38 per 100 person-years (95

Background: Cobras (Naja sp.) are medically important snakes in Thailand. Envenoming by the monocled cobra (N. kaouthia) often causes neurotoxicity, most notably ptosis, ophthalmoplegia, local tissue necrosis and progressive paralysis leading to respiratory failure. Early antivenom administration and respiratory support are medically significant for effective treatment. Methods: In this study, we determined the association between the time course of cobra envenoming and related neurotoxic outcomes using the clinical profiles of cobra envenomed patients. We also demonstrated histopathological changes in the neuromuscular junction of the diaphragm in experimentally envenomed rats. Results: A retrospective study of 69 cases of cobra envenoming in Central and Southern Thailand shows that delayed arrival beyond one hour at hospital was common among younger adults (47.0% aged 10-29) and associated with more severe neurotoxicity, including higher rates of ptosis (41.2%, p = 0.032) and referrals (41.2% vs. 15.4%, p = 0.040). Antivenoms (22 Monovalent and 1 Polyvalent) were administered to 23 (33.3%) envenomed victims and caused adverse reactions in 9 cases (39.1%). Neurotoxicity following cobra envenoming in the clinical section correlated with histopathological examination of envenomed rat diaphragms. Transmission electron microscopy (TEM) revealed degeneration of the neuromuscular junction and diaphragm within 1 h following experimental cobra envenomation, which worsened by 4 h. Intravenous administration of antivenom at recommended doses reduced diaphragmatic damage but failed to prevent presynaptic degeneration after 90 min of envenoming. Conclusions: Clinically, extraocular muscle paralysis was the earliest manifestation. Early monitoring and prompt administration of antivenom are essential to reduce neurotoxicity and relevant complications.

BACKGROUND:The activated partial thromboplastin time (aPTT) mixing test is widely used to investigate prolonged aPTT from factor deficiencies, inhibitors, or lupus anticoagulant (LA), but its interpretation remains challenging. Refining protocols and indices may improve accuracy. OBJECTIVES:To compare classical and modified aPTT mixing tests using conventional and novel indices for distinguishing FVIII deficiency, FVIII inhibitors, LA, and heparin, and to develop a structured interpretation algorithm. METHODS:A total of 215 plasma samples (50 factor deficiencies, 51 FVIII inhibitors, 64 LA-positive, 50 heparinized) underwent classical and modified 1:1 mixing tests. ICA and %Correction were calculated for immediate and 2-h incubated mixes, while ΔICA and Δ%Correction were derived from their differences. Diagnostic performance was assessed by ROC analysis, and a proposed algorithm was designed. RESULTS:Both protocols demonstrated excellent reliability (ICC > 0.90) and substantial agreement in interpretation (κ = 0.65-0.75). The modified protocol consistently outperformed the classical approach, with index of circulating anticoagulant (ICA)-based indices showing the greatest improvement. Novel indices ΔICA and Δ%Correction further enhanced diagnostic specificity compared with single indices. ΔICA achieved the highest performance, with near-perfect accuracy in distinguishing factor deficiency from FVIII inhibitors and FVIII inhibitors from LA (AUC = 0.99 for both). The algorithm applying ΔICA after ICA of the immediate mix effectively separated factor deficiencies, FVIII inhibitors, and LA with high sensitivity and specificity, minimizing diagnostic overlap. CONCLUSIONS:The modified aPTT mixing test provides a reliable and practical approach for interpreting prolonged aPTT. The structured algorithm, combining the modified protocol with ΔICA, offers a systematic and clinically applicable framework for laboratory evaluation.

We examined the association between anemia and ischemic heart disease (IHD) risk in adults with hypertension in Thailand. A total of 14,744 participants were analyzed. The mean hemoglobin (Hb) level was 12.6 ± 1.8 g/dL, and 5,867 participants (39.8

Objectives: Overuse of antibiotics is one of the drivers of antimicrobial resistance, especially in acute respiratory tract infection. We examined factors associated with antibiotic prescription among patients treated at two Thai hospitals during 2018-2022. Methods: Medical records of patients with respiratory illness were reviewed to abstract demographics, clinical features, diagnostics, treatments, and outcomes. Factors associated with antibiotic prescribing were assessed. Inappropriate use was defined as antibiotic receipt without laboratory-confirmed bacterial infection, severe symptoms, or clinically suspected bacterial pneumonia. Results: Among 905 inpatients and 1811 outpatients, 46.7% and 31.9% received antibiotics, of which 7.8% and 45.1% were inappropriate, respectively. In-hospital antibiotic use was stable in 2018-2020 (59.0-64.0%) before declining sharply in 2022 (22.7%). Outpatient antibiotic use was stable in 2018-2019 (36.3-29.0%), increased in 2020-2021 (41.8-41.7%), and declined in 2022 (11.5%). Patients aged >65 years (adjusted relative risk [aRR] 1.30); males (aRR 1.11); and those with unstable vital signs (aRR 1.18), ancillary testing (aRR 1.37), hospitalization (aRR 1.23), or bacterial infection (aRR 1.71) had higher odds of receiving antibiotics. Children aged 1 year (aRR 0.81), those with a positive rapid influenza diagnostic test (aRR 0.32), and those treated at a study hospital (aRR 0.83) were less likely to receive antibiotics. Antiviral treatment was associated with lower antibiotic use in 2021-2022 (aRR 0.44 and 0.19) but not in 2019-2020. Conclusion: Antibiotic use among patients with respiratory illness was common, although nearly half of outpatient prescriptions were inappropriate. A positive result from rapid influenza diagnostic test was associated with reduced antibiotic prescribing.