Sunpasitthiprasong Hospital

BACKGROUND:Antimicrobial resistance (AMR) poses a major global health threat, with health-care-associated infections contributing substantially to mortality. Attributable disease burden remains poorly quantified by relying on cross-sectional and microbiology data. We aimed to characterise AMR epidemiology and disease burden associated with ventilator-associated pneumonia and bloodstream infection in a network of hospitals in Asia. METHODS:This large-scale, prospective, multinational, multicentre cohort study consecutively enrolled patients of any age with microbiologically-confirmed ventilator-associated pneumonia, hospital-acquired bloodstream infections, or health-care-associated bloodstream infections from 41 selected hospitals capable of standardised prospective data collection in 19 Asian countries and regions. Patients with pathogens typically associated with community-acquired infection or not recognised causes of health-care-associated infection were excluded according to predefined protocol criteria, and patients were followed for 28 days. The primary outcome was 28-day mortality from infection onset. Pathogen profiles, antimicrobial prescriptions, attributable mortality, and health-related quality-of-life outcomes were analysed. FINDINGS:Between Sept 1, 2022, and Feb 28, 2025, 10 111 patients were enrolled, and after exclusions, 9496 patients were included in the final analysis. 9642 infection episodes were analysed, comprising 6597 (68·4%) bloodstream infections and 3045 (31·6%) ventilator-associated pneumonia. Of these infections, 7102 (73·7%) of 9642 infection episodes were associated with AMR bacteria, and Gram-negative bacteria were predominant (7599 [78·8%]). Crude 28-day mortality was 2674 (37·7%) of 7102 AMR infection episodes and 1900 (40·6%) of 4683 multidrug resistance infection episodes, with the highest for carbapenem-resistant Acinetobacter spp (CRA; 51·3%) and carbapenem-resistant Enterobacterales (CRE; 48·4%). AMR-attributable mortality was the highest in ventilator-associated pneumonia (16·9%, 95% CI 13·0-20·9), individuals aged 5-14 years (11·7%, 95% CI 1·6-21·8), individuals aged 15-49 years (11·2%, 95% CI 7·2-15·2), and lower-middle-income countries (10·7%, 95% CI 7·0-14·4). By pathogens, CRA and CRE had the highest attributable mortality (19·4%, 95% CI 14·1-24·7 vs 16·2%, 95% CI 12·8-19·6) and also had the poorest quality-of-life outcomes. Most carbapenem-resistant Gram-negative infections were treated with carbapenems (57·8%) or polymyxins (35·6%). INTERPRETATION:AMR bacterial bloodstream infections and ventilator-associated pneumonia were common and associated with high mortality and reduced quality of life in Asia, particularly in infections due to carbapenem-resistant Acinetobacter spp and CRE, and among children and younger adults. The widespread use of suboptimal antimicrobial regimens highlights the urgent need for equitable access to effective therapies and context-specific evidence to guide antimicrobial stewardship. FUNDING:Wellcome Trust, National University of Singapore, Yong Loo Lin School of Medicine, Duke-NUS Medical School, Nanyang Technological University (Lee Kong Chian School of Medicine), Singapore National Centre for Infectious Diseases, and Singapore Medical Research Council.

INTRODUCTION:TIGIT and PD-1 trigger distinct but interconnected immunosuppressive pathways. We investigated first-line domvanalimab (Fc-silent anti-TIGIT) plus zimberelimab (anti-PD-1) in PD-L1-high (≥50%), stage IIIB-IV NSCLC. MATERIALS AND METHODS:This phase 2, multicenter, randomized, open-label study (ARC-10, Part 1) randomized (2:2:1) patients to intravenous domvanalimab 15 mg/kg plus zimberelimab 360 mg (DZ), zimberelimab 360 mg (Z), or platinum-doublet chemotherapy every 3 weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), confirmed objective response rate (ORR), and safety. RESULTS:Of 98 randomized patients, 95 received treatment (DZ, n = 38; Z, n = 40; chemotherapy, n = 17). As of May 17, 2024, median follow-up was 24.5 months; 22patients remained on first-line treatment (DZ, n = 11; Z, n = 10; chemotherapy, n = 1). Median (95% CI) PFS was 11.5 (4.0-26.2) months for DZ, 6.2 (2.5-12.3) months for Z, and 9.6 (2.6-16.4) months for chemotherapy. Median (95% CI) OS was not reached (13.7-not evaluable [NE]) for DZ, 24.4(7.8-NE) months for Z, and 11.9(2.7-NE) months for chemotherapy. DZ vs Z hazard ratio (95% CI) was 0.69 (0.40-1.18) for PFS and 0.64 (0.32-1.25) for OS. ORR (95% CI) was 44.7% (28.6-61.7) for DZ, 35.0% (20.6-51.7) for Z, and 35.3% (14.2-61.7) for chemotherapy. Grade ≥ 3 treatment-related adverse events (AEs) were lower for DZ (21.1%) and Z (15.0%) vs chemotherapy (47.1%). Immune-mediated AEs were similar between DZ (23.7%) and Z (20.0%). Infusion-related reactions were low (0%-7.9% across arms). CONCLUSIONS:Adding Fc-silent anti-TIGIT (domvanalimab) to anti-PD-1 (zimberelimab) led to encouraging efficacy and showed no new safety concerns in patients with previously untreated stage IIIB-IV NSCLC.

Cannabis is the most widely used illicit drug globally, with an increasing use for both medicinal and non-medical purposes. Despite evolving policies and regulations, knowledge gaps persist among the youth, particularly regarding cannabis use, its integration into food products, and associated health risks. Many adolescents rely on unverified sources such as social media and peer networks for cannabis-related information, thereby increasing the risk of misinformation and unsafe consumption. This cross-sectional descriptive study assessed knowledge levels with respect to medical cannabis use, cannabis in food, and health literacy among late adolescent students in educational institutions. Additionally, it examined factors influencing knowledge, experience, and willingness to try cannabis while exploring opinions on medical cannabis use and cannabis in food. Data were collected from 252 students aged 15 - 18 years, using self-administered questionnaires. Descriptive statistics were used to analyze participant characteristics, while the chi-square test was applied to assess relationships between demographic factors, knowledge, and health literacy. The Decision Tree method (CART Algorithm) identified key determinants, classified participants based on significant factors, and predicted cannabis use and abstinence. The findings revealed that 49.2% of the participants had low cannabis-related knowledge, whereas 62.3% demonstrated moderate health literacy. Gender and field of study significantly influenced knowledge and health literacy. Most of the participants acknowledged the benefits and risks of cannabis use. These results highlight the need for targeted educational interventions to enhance cannabis-related knowledge and health literacy among late adolescents, considering their unique contexts and experiences.

Abstract Background Thailand’s decriminalization of cannabis in June 2022 substantially increased adolescent exposure. Cannabis knowledge and health literacy among vocational students remain poorly characterized. Methods A cross-sectional online survey was conducted from January to March 2024 among vocational secondary students at one vocational institution in a province in northeastern Thailand. Of 2,656 eligible students, 555 provided valid responses (response rate 20.9%). Two 15-item instruments were used to measure cannabis knowledge and cannabis health literacy. Bivariate analyses and three multivariable regression models examined factors associated with knowledge scores, health literacy scores, and cannabis use experience. Results Cannabis knowledge was low (mean 7.23/15, SD 4.43; 55.0% low), as was cannabis health literacy (mean 41.72/75, SD 12.72; 48.8% low). Knowledge level was not significantly associated with health literacy level (χ2[4] = 7.04, p = 0.134). In adjusted analyses, prior cannabis education and other substance use were associated with higher knowledge scores, whereas male sex and Year 3 enrollment were associated with lower knowledge scores. Higher health literacy scores were associated with prior cannabis education and family relationship quality in adjusted analyses; male sex showed only a weak adjusted association with lower health literacy. Cannabis use experience was associated with other substance use (OR 4.115), prior cannabis education (OR 3.683), male sex (OR 2.621), Year 2 enrollment (OR 1.733), and family relationship quality (OR 1.558). Conclusions Cannabis knowledge and health literacy were predominantly low among Thai vocational secondary students. Factual knowledge alone may not translate into functional cannabis health literacy. School-based interventions should strengthen critical appraisal, communication, self-management, and digital health literacy, with attention to male students, students without prior cannabis education, and those with other substance use experience.

Current data on the genetic and lifestyle factors associated with Epstein-Barr virus (EBV) reactivation in the oral cavity are limited for the Thai population. Furthermore, comprehensive data linking EBV reactivation to head and neck cancers in Thailand remains scarce. The present study aimed to detect EBV reactivation using quantitative PCR in normal oral buccal cells and to examine the associated risk factors. A total of 982 oral buccal cell samples collected across Thailand were analyzed. EBV was detected in 36% (350/974) of samples when targeting the Epstein-Barr nuclear antigen-1 gene, 52% (458/885) of samples when targeting latent membrane protein-1 (LMP-1) and 20% (196/981) of samples when both genes were investigated. The highest prevalence of LMP-1 and dual gene positivity was observed in individuals aged 11-20 years. Several SNPs in the TNF-α promoter region, including rs1452146766, rs1799964, rs1554283139, rs924800313, rs1799724 and rs1771099055, were more frequently observed in EBV-positive samples than in EBV-negative samples. Notably, the TNF-α mutation rs1799964 (-1031 TC and CC) was present in 17.3% vs. 9.3% of EBV-positive cases, respectively. Multivariate analysis identified sex, smoking, alcohol consumption, soft drink intake, age of 21-30 years and having four children as significant factors associated with EBV reactivation. In the 21-30-year-old age group, LMP-1 positivity was elevated, and higher rates of alcohol use, sexual activity and oral ulcers were observed. Furthermore, in individuals with mouth ulcers, the TNF-α mutation (TC; n=81) was more common than wild-type TNF-α (CC; n=16).