EQ-5D-3L and EQ-5D-5L population norms for Thailand

BACKGROUND

The previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20-70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases.

METHODS

Individual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases.

RESULTS

The means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558-0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments.

CONCLUSIONS

The Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Genomic analysis of KEL*03 and KEL*04 alleles among Thai blood donors

Background

The Kell blood group system is clinically important in transfusion medicine, particularly in patients with antibodies specific to Kell antigens. To date, genetic variations of the Kell metallo-endopeptidase (KEL) gene among Thai populations remain unknown.

Objective

This study aimed to determine the frequencies of KEL*03 and KEL*04 alleles among Thai blood donors using an in-house polymerase chain reaction-sequence-specific primer (PCR-SSP) method.

Methods

Blood samples obtained from 805 unrelated central Thai blood donors at a blood bank in Pathumthani, Thailand, from March 2023 to June 2023, were typed for Kpa and Kpb antigens using the column agglutination test, and the results for 400 samples were confirmed using DNA sequencing. A PCR-SSP method was developed to detect the KEL*03 and KEL*04 alleles, and genotyping results were validated using known DNA controls. DNA samples obtained from Thai donors in central (n = 2529), northern (n = 300), and southern (n = 427) Thailand were also genotyped using PCR-SSP for comparison.

Results

All 805 (100%) donors had the Kp(a-b+) phenotype. The PCR-SSP genotyping results agreed with the column agglutination test and DNA sequencing. All 3256 Thai blood donors had the homozygous KEL*04/KEL*04 genotype. Frequencies of the KEL*03 and KEL*04 alleles among Thai donors differed significantly from those of Japanese, Native American, South African, Brazilian, Swiss, and German populations.

Conclusion

This study found a 100% KEL*04 allele frequency in three Thai populations. These data could provide information on KEL*03 and KEL*04 allele frequencies to estimate the risk of alloimmunisation in Thai populations.

What this study adds

This study demonstrates that in-house PCR-SSP can be used to determine KEL*03 and KEL*04 alleles to predict Kpa and Kpb antigens. Even though only homozygous KEL*04/KEL*04 genotypes were found among Thai donor populations, the established PCR-SSP method may be useful for estimating the risk of alloimmunisation in other populations.

Psychometric evaluation of the WHOQOL-BREF and its shorter versions for general Thai population: confirmatory factor analysis and Rasch analysis

PURPOSE

Rasch analysis was employed to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its existing shorter versions in the general Thai population.

METHODS

1200 respondents were randomly selected to complete the questionnaire. Confirmatory factor analysis (CFA) was employed to test the structure of the WHOQOL-BREF and its shorter versions with the random sub-sample of 900 respondents, while Rasch analysis was performed with a random sub-sample of 300 respondents.

RESULTS

The CFA confirmed the factor structure of WHOQOL-BREF and its shorter versions. The Rasch analysis revealed that the WHOQOL-BREF, when a four-domain structure was tested using a subtest approach, achieved acceptable model fit to the Rasch model and met the expectations of unidimensionality with high reliability (PSI = 0.87). Individual domain models were also unidimensional, but reliability of the 3-item social domain was inadequate. While the 8-item EUROHIS-QOL-8 and 5-item WHOQOL-5 achieved an overall acceptable fit and met the expectations of unidimensionality, the reliability of the WHOQOL-5 was below the acceptable threshold (PSI = 0.66). Reliability of the EUROHIS-QOL-8 was satisfactory (PSI = 0.79).

CONCLUSIONS

The WHOQOL-BREF is a valid instrument for use in the Thai general population, both as a total score as well as individual subscales. Rasch analysis also supports the use of EUROHIS-QOL-8, but the WHOQOL-5 lacks good reliability. While the reliability of the EUROHIS-QOL-8 is sufficiently high for between-group analysis, the Thai WHOQOL-BREF total score can also be used for within-participant analyses. Rasch investigation with a more varied health conditions of general Thai samples or patient groups is encouraged for future studies.

Normative profile of the EQ-5D-5L dimensions, EQ-5D-5L index and EQ-VAS scores for the general Thai population

PURPOSE

To generate a normative profile for the EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores of the general Thai population and to examine the associations between sociodemographic characteristics and their norm-based scores.

METHODS

Data from 2019 general Thai samples were employed to estimate the norm-based scores elicited using the Thai EQ-5D-5L value set. Descriptive statistics were used to estimate the norm-based scores stratified by gender and six age bands to obtain the normative profile for the general Thai population. Multivariable logistic and Tobit regression models were used to investigate the relationships between sociodemographic characteristics and EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores.

RESULTS

The mean EQ-5D-5L index and EQ-VAS scores were 0.931 and 82.3, respectively. Approximately 88.9% of the participants reported 19 out of 3125 (3%) possible health states. The odds of having problems with mobility was greatest for the sample aged ≥ 65 years and declined with decreasing age. Women, samples with advancing age, and those with a household income of ≤ 10,000 Baht/month and fair and poor health perceptions were more likely to report a lower EQ-5D-5L index. Furthermore, advanced age and fair and poor health perception were significantly associated with lower EQ-VAS scores.

CONCLUSION

The EQ-5D-5L population norms were established as the benchmark for both EQ-5D-5L index and EQ-VAS scores for the general Thai population. This is expected to support the health service research and inform policymakers on the allocation of limited healthcare resources.

Stature estimation using the sacrum in a Thai population

Stature is an essential component of biological profile analysis since it determines an individual's physical identity. Long bone dimensions are generally used to estimate the stature of skeletal remains; however, non-long bones such as the sternum, cranium, and sacrum may be necessary for some forensic situations. This study aimed to generate a regression equation for stature estimation of the skeletal remains in the Thai population. Ten measurements of the sacrum were measured from 200 dry sacra. The results revealed that the maximum anterior breadth (MAB) provided the most accurate stature prediction model among males (correlation coefficient [r]=0.53), standard error of estimation (SEE=5.94 cm), and females (r=0.48, SEE=6.34 cm). For the multiple regression model, the best multiple regression models were stature equals 41.2+0.374 (right auricular surface height [RASH])+1.072 (anterior-posterior outer diameter of S₁ vertebra corpus [APOD])+0.256 (dorsal height [DH])+0.417 (transverse inner diameter of S₁ vertebra corpus [TranID])+0.2 (MAB) with a SEE of 6.42 cm for combined sex. For males, stature equals 63.639+0.478 (MAB)+0.299 (DH)+0.508 (APOD) with a SEE of 5.35, and stature equals 75.181+0.362 (MAB)+0.441 (RASH)+0.132 (maximum anterior height [MAH]) with a SEE of 5.88 cm for females. This study suggests that regression equations derived from the sacrum can be used to estimate the stature of the Thai population, especially when a long bone is unavailable.

Factors contributing to the quality of life among Thai patients diagnosed with colorectal cancer with a stoma: An integrative review

AIM

To appraise and synthesize research investigating the factors contributing to the quality of life (QOL) among Thai patients diagnosed with colorectal cancer (CRC) with a stoma.

DESIGN

An integrative review.

DATA SOURCES

The scientific databases CINAHL, Medline, PubMed, Web of Science, Google Scholar and ThaiJO were queried for English or Thai research articles published between 2011 and 2021.

REVIEW METHODS

Included studies were searched utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. The eligible studies were critically appraised by evaluating the study level and quality using the John Hopkins Research Evidence Appraisal Tool. Whittemore and Knafl's five-stage framework was used to guide this integrative review. Primary data from each suitable study were abstracted, coded and categorized into sub-themes. Finally, themes were identified based on the review question and objective.

RESULTS

Eight articles met the inclusion criteria. Twelve sub-themes and five significant themes were identified: Sociodemographic and clinical, physiological, psychological, social and spiritual aspects.

CONCLUSION

Factors contributing to QOL among Thai CRC ostomates can be categorized into five domains. The sociodemographic and clinical, physiological and psychological aspects are similar to those in other countries. In the meanwhile, the social and spiritual domains differ from those in other countries, particularly in extended family support and Buddhist belief.

IMPACT

By providing the QOL contributing factors, nurses can investigate the significant QOL predictors and create the appropriate interventions for promoting QOL, specifically among Thai CRC adults with a stoma. Likewise, it will be helpful to integrate this result into the nursing curriculum in Thailand and other similar countries to teach nursing students who could give direct holistic care to CRC adults with a stoma. In addition, it will serve as the basis for healthcare policy regarding nursing practice guidelines for assessing the individuals' QOL factors and promoting QOL activities after ostomy surgery. Patient or Public contribution: The ostomy nurses in Thailand are involved in the data analysis stage. They read all the included studies before the meeting. They considered and commented on the generating and synthesizing of codes, subthemes and themes.

Stature estimation using the sternum in a Thai population

Stature estimation is an important process of biological profile analysis for the identification of skeletal remains. In forensic practice, non-long bones might be needed for estimating stature, in case long bones were not recovered or well preserved. This study developed the stature estimation model from dry sterna in a Thai population. The combined length of manubrium and mesosternum (CMM) was the best single stature estimation indicator for males and combined sex samples, whereas the sternal area (SA) was the best stature estimation indicator for females in our study. The best multiple regression analysis models of our study were stature equal 122.685+0.182 (CMM)+0.592 (intercostal length between the third and fourth ribs [ICL₃₄]) with a standard error of estimation (SEE) of 6.134 cm for males, stature equal 130.676+0.005 (SA) with SEE of 5.370 cm for females, and stature equal 79.412+0.342 (CMM)+0.506 (corpus sterni width at first sternebra [CSW_S1])+0.794 (ICL₃₄) with SEE of 6.222 cm for unknown sex samples. The results indicated that a sternum can be used for estimating the stature of skeletal remains in a Thai population. However, these models might not be suitable for other populations, especially, in case the suspected stature is over the stature range in our study.

An anthropometric study of the external ear in the Thai population

Auricular dimensions are important data for the treatment of auricular deformities, either congenital or acquired. Many previous studies have shown that the auricular dimension varies among ethnic groups; however, there are currently no available data for the Thai population. The objective of this investigation was to provide normative values regarding the adult ear dimensions in Thailand. A total of 200 Thai volunteers between the ages of 18 and 70 years (80 men, 120 women) were enrolled in this study. We measured six dimensions, including the auricular, lobular, and conchal length and width and the auricular projection at the superaurale and tragal levels. Moreover, we calculated the auricular, lobular, and conchal indices. The selected dimensions of the external ears were shown as means ± standard deviations. These parameters were then compared between the right and left sides, men and women and participants aged ≥50 and <50 years. We found that men have a significantly larger and more projected ear than women do. The length of the entire auricles and the length of the earlobe were also significantly longer in the population ≥50 years than those <50 years. This study provides normative data of the external ear dimension and projection in the adult Thai population. These data can be used to reconstruct the ear and face more appropriately for Thai individuals.

Prevalence of complex root canal morphology in the mandibular first and second premolars in Thai population: CBCT analysis

Background

Mandibular premolars demonstrate high variability in root canal morphology, especially mandibular first premolars. The purposes of this study were to determine the prevalence of root canal configurations of mandibular premolars according to Vertucci classification in a Thai population.

Methods

Total of 1159 CBCT images of Thai patients who received radiographic imaging at the Department of Radiology, Faculty of Dentistry, Chulalongkorn University in 2017–2018 was evaluated. The data were reported using descriptive statistics and the relationship between the prevalence of the root canal complexities and sex was analyzed using the chi-squared test.

Results

The most common root canal configuration was Vertucci type I, with a 63.1% and 98% prevalence in the mandibular first and second premolars, respectively. More than 98% of mandibular premolars had a single root. The prevalence of a bifurcation was 28.5% and 1.5% in the mandibular first and second premolars, respectively. The prevalence of a trifurcation was 3.2% in the mandibular first premolar. A C-shaped root canal was observed at 23.7% and 0.7% in the mandibular first and second premolars, respectively. The level of branching was mostly found at the middle 1/3 of the root. Bilateral appearance of the same root canal configuration was identified in 80.3% and 95.9% in the mandibular first and second premolars, respectively. There was no relationship between sex and the prevalence of a bifurcation, trifurcation, or C-shaped root canal.

Conclusion

Mandibular first premolars have more root canal complexities than mandibular second premolars. Horizontal tube shift x-ray technique, CBCT, dental operating microscope, and knowledge of root canal configurations have an important role in root canal identification in mandibular premolar with suspected complex root canal morphology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01822-7.

The Effect of Containment Measures during the Covid-19 Pandemic to Sedentary Behavior of Thai Adults: Evidence from Thailand's Surveillance on Physical Activity 2019-2020

Measures to contain the spread of coronavirus disease 2019 (Covid-19) imposed by governments have undoubtedly impacted on preventing its spread but may have also produced longer periods of sedentary living across all segments of society. To examine this phenomenon, this study compared the sedentary behavior (SB) of Thai adults before and during the Covid-19 pandemic. The 2019 and 2020 datasets of Thailand's Surveillance on Physical Activity (SPA) were employed. A total of 5379 (SPA2019) and 6531 (SPA202020) persons age 18-64 years who had access to the Internet were included in the analysis. Measures imposed to contain the spread of Covid-19 infection were significantly associated with lower opportunity of Thai adults for work-related physical movement, and that increased their SB, particularly with the shift from onsite to online working platforms. Cumulative SB increased from 824 (before the pandemic) to 875 min/day during the pandemic. The odds of accumulating >13 h/day of SB was highest among females, young adults, those who completed post-secondary education, unemployed or working in the non-agriculture sector, having a chronic disease/condition, residing in an urban area, and living in a 'higher-risk' pandemic zone. The insignificant association of physical activity (PA) and the Fit from Home (FFH) intervention in reducing SB during the pandemic suggests that PA is not directly associated with SB, and that the FFH intervention was insufficient to prevent SB.

Detection of antibodies to duck tembusu virus in human population with or without the history of contact with ducks

Duck tembusu virus (DTMUV) is an emerging duck pathogen in China and other Asian countries. It is unclear whether this emerging zoonotic infection poses a threat to humans. A previous study in 2012 showed surprisingly high rates of seropositivity and positive viral detection by RT-PCR in duck farm workers in China. To understand the nature of the threat of this emerging virus, we studied the neutralizing antibody response to a local isolate of DTMUV in an at-risk population, who were workers in duck farms and residents around farming areas in Central Thailand where DTMUV had been previously detected, and in a not-at-risk population, who were people living in the same or neighbouring province, but at a distance from the farms and who had no contact with ducks. The sera from the at-risk population showed higher anti-DTMUV neutralizing antibody titres as compared with those of the not-at-risk population. However, within the at-risk population, workers with direct contact with ducks did not show higher neutralizing titres than those without direct contact. Interestingly, some people in the not-at-risk group also displayed high neutralizing antibody titres to DTMUV. These sera were tested against other endemic Flaviviruses and showed no or low cross-reactivity suggesting the specificity of the neutralizing activity against DTMUV. These data raise a possibility of DTMUV as a potential zoonotic pathogen but the mode of transmission of the virus from ducks or other possible hosts to humans should be explored further.

Protection motivation theory to predict intention of healthy eating and sufficient physical activity to prevent Diabetes Mellitus in Thai population: A path analysis

BACKGROUND AND AIMS

Diabetes mellitus is a global health problem causing premature death and economic burden. The study aimed to investigate an application of the protection motivation theory (PMT) model to explain the intention of healthy eating behaviors and physical activity among healthy Thais.

METHODS

This study was a part of a large case control focused only on the control group without noncommunicable diseases. Nine hundred ninety-seven subjects were drawn from eleven provinces of Thailand. A self-administered questionnaire was constructed based on the PMT model to gather information on predictive factors on eating behaviors and physical activity. Path analysis was used to determine whether the empirical data fit the PMT structure as well as to assess the strength of association among PMT constructed factors predicting behavioral intention.

RESULTS

The findings demonstrated that empirical data of eating behaviors (CMIN χ2 p-value = 0.462; CMIN/df = 0.901; NFI = 0.997; CFI = 1; RMSEA <0.001) and physical activity (CMIN χ2 p-value = 0.053; CMIN/df = 2.187; NFI = 0.987; CFI = 0.993; RMSEA = 0.035) fit the PMT. The strongest predictive factor of behavioral intention on eating behaviors was response efficacy (β = 0.146), while self-efficacy was found to be the strongest factor for physical activity (β = 0.11). Knowledge had the only indirect effect on behavior intention through perceived susceptibility and perceived severity.

CONCLUSION

In conclusion, information on susceptibility and severity should be incorporated in intervention strategies to enhance response efficacy and self-efficacy to prevent diabetes.

Simultaneous Characterization of Deletional and Nondeletional Globin Gene Mutations by Multiplex Real-Time-Polymerase Chain Reaction and High-Resolution Melting Curve Analysis

Both deletional and nondeletional globin gene mutations are common in Southeast Asians. Normally, deletional gene mutations are characterized separately from nondeletional gene mutations. Therefore, we developed a new approach of multiplex real-time polymerase chain reaction (qPCR) followed by high-resolution melting (HRM) analysis without a fluorescently-labeled probe for the simultaneous detection of deletional and nondeletional gene mutations in a single tube. Three sets of primer pairs were used to establish the qPCR-HRM method that was used to genotype more than 20 different globin genotypes. Twenty known genotypes were used to optimize the qPCR and HRM conditions. Eight genotypes were used to determine the reproducibility of the method. A total of 351 blinded known DNA samples were used for the validation study in three separate reactions and revealed 16 distinct patterns of fragments and/or HRM. The melting temperatures (Tm) of the 3.5 kb, - -^THAI, HBB-FR2 (exon 1 of the HBB gene), - -^SEA (Southeast Asian), α2 and 3'-ψζ1 fragments were 79.44, 81.01, 86.47, 87.89, 90.54 and 94.15 °C, respectively. The HRM analysis was performed with the HBB-FR2 fragment to differentiate several alleles. We report a rapid and high-throughput technique that showed 100.0% concordance and low variability for each run. Our developed technique is one of the alternative techniques recommended for screening samples with both deletional and nondeletional globin gene mutations.

Meta-analysis of genome-wide association study identifies FBN2 as a novel locus associated with systemic lupus erythematosus in Thai population

BACKGROUND

Differences in the expression of variants across ethnic groups in the systemic lupus erythematosus (SLE) patients have been well documented. However, the genetic architecture in the Thai population has not been thoroughly examined. In this study, we carried out genome-wide association study (GWAS) in the Thai population.

METHODS

Two GWAS cohorts were independently collected and genotyped: discovery dataset (487 SLE cases and 1606 healthy controls) and replication dataset (405 SLE cases and 1590 unrelated disease controls). Data were imputed to the density of the 1000 Genomes Project Phase 3. Association studies were performed based on different genetic models, and pathway enrichment analysis was further examined. In addition, the performance of disease risk estimation for individuals in Thai GWAS was assessed based on the polygenic risk score (PRS) model trained by other Asian populations.

RESULTS

Previous findings on SLE susceptible alleles were well replicated in the two GWAS. The SNPs on HLA class II (rs9270970, A>G, OR = 1.82, p value = 3.61E-26), STAT4 (rs7582694, C>G, OR = 1.57, p value = 8.21E-16), GTF2I (rs73366469, A>G, OR = 1.73, p value = 2.42E-11), and FAM167A-BLK allele (rs13277113, A>G, OR = 0.68, p value = 1.58E-09) were significantly associated with SLE in Thai population. Meta-analysis of the two GWAS identified a novel locus at the FBN2 that was specifically associated with SLE in the Thai population (rs74989671, A>G, OR = 1.54, p value = 1.61E-08). Functional analysis showed that rs74989671 resided in a peak of H3K36me3 derived from CD14+ monocytes and H3K4me1 from T lymphocytes. In addition, we showed that the PRS model trained from the Chinese population could be applied in individuals of Thai ancestry, with the area under the receiver-operator curve (AUC) achieving 0.76 for this predictor.

CONCLUSIONS

We demonstrated the genetic architecture of SLE in the Thai population and identified a novel locus associated with SLE. Also, our study suggested a potential use of the PRS model from the Chinese population to estimate the disease risk for individuals of Thai ancestry.

Genetic Variations and Frequencies of the Two Functional Single Nucleotide Polymorphisms of SLCO1B1 in the Thai Population

Aim

To investigate the variations and the frequencies of the SLCO1B1 gene in the Thai population.

Methods

Collected samples were categorized into five regions of Thailand. DNA samples were genotyped for two variants, c.388A>G and c.521T>C of the SLCO1B1, using TaqMan^® real-time PCR.

Results

The minor allele frequencies (MAFs) of two single nucleotide polymorphisms (SNPs) were not significantly different among the five regions. The most frequent haplotype was SLCO1B1*1b (frequency: 0.654), followed by *1a (frequency: 0.217), *15 (frequency: 0.128), and *5 (frequency: 0.001). We observed a similar frequency of OATP1B1 transporter phenotypes compared to other populations. 75.85% of the Thai subjects showed normal OATP1B1 activity, 22.5% showed intermediate OATP1B1 activity, and 1.58% showed low OATP1B1 activity.

Conclusion

This study reported the frequencies of the SLCO1B1 variants and the subsequent OATP1B1 activity in a large cohort of Thais that can provide important information for the guidance of personalized drug therapy.

Neck circumference as a predictor of metabolic syndrome: A cross-sectional study

BACKGROUND

Data relating to the association between neck circumference (NC) and metabolic syndrome (MetS) in Southeast Asian population are scarce.

AIMS

We aimed to investigate association between NC and MetS in Thai adults, and to determine gender-specific NC cutoff values for predicting MetS.

METHODS

This cross-sectional study enrolled patients aged ≥18years that attended the health examination center at Siriraj Hospital (Bangkok, Thailand) during February 2016 to January 2017. Demographic, clinical, anthropometric data, and biochemical investigations for diagnosing MetS were collected.

RESULTS

390 patients (age 35.5±9.7years with range 20-73years; 81.3% women) were included. Mean NC was significantly higher in MetS than in non-MetS (p<0.001). Receiver operating characteristic curve analysis revealed NC ≥38cm and ≥33cm to be the optimal cutoff points for MetS in men and women, respectively. Body mass index and anthropometric indices were positively correlated with NC in both men and women. Among women, all components of MetS were significantly associated with NC.

CONCLUSIONS

Using the identified gender-specific cutoff values, NC is a useful tool for predicting MetS in Thais. NC was found to be well-correlated with almost all of the metabolic risk factors, anthropometric indices, and MetS components evaluated in this study.

Genetic Diversity of HLA Class I and Class II Alleles in Thai Populations: Contribution to Genotype-Guided Therapeutics

Human leukocyte antigen (HLA) class I and II are known to have association with severe cutaneous adverse reactions (SCARs) when exposing to certain drug treatment. Due to genetic differences at population level, drug hypersensitivity reactions are varied, and thus common pharmacogenetics markers for one country might be different from another country, for instance, HLA-A*31:01 is associated with carbamazepine (CBZ)-induced SCARs in European and Japanese while HLA-B*15:02 is associated with CBZ-induced Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among Taiwanese and Southeast Asian. Such differences pose a major challenge to prevent drug hypersensitivity when pharmacogenetics cannot be ubiquitously and efficiently translated into clinic. Therefore, a population-wide study of the distribution of HLA-pharmacogenetics markers is needed. This work presents a study of Thai HLA alleles on both HLA class I and II genes from 470 unrelated Thai individuals by means of polymerase chain reaction sequence-specific oligonucleotide (PCR-SSO) in which oligonucleotide probes along the stretches of HLA-A, -B, -C, -DRB1, -DQA1, and -DQB1 genes were genotyped. These 470 individuals were selected according to their regional locations, which were from North, Northeast, South, Central, and a capital city, Bangkok. Top ranked HLA alleles in Thai population include HLA-A*11:01 (26.06%), -B*46:01 (14.04%), -C* 01:02 (17.13%), -DRB1*12:02 (15.32%), -DQA1*01:01 (24.89%), and -DQB1*05:02 (21.28%). The results revealed that the distribution of HLA-pharmacogenetics alleles from the South had more HLA-B75 family that a typical HLA-B*15:02 pharmacogenetics test for SJS/TEN screening would not cover. Besides the view across the nation, when compared HLA alleles from Thai population with HLA alleles from both European and Asian countries, the distribution landscape of HLA-associated drug hypersensitivity across many countries could be observed. Consequently, this pharmacogenetics database offers a comprehensive view of pharmacogenetics marker distribution in Thailand that could be used as a reference for other Southeast Asian countries to validate the feasibility of their future pharmacogenetics deployment.

The pattern of substance abuse in Thai elderly: Ramathibodi Poison Center

Objective

To describe substances, clinical manifestations, treatment, and medical outcomes of substance abuse exposures among older adults in Thailand.

Method

This is a retrospective study of individuals aged 60 years or older with intentional abuse exposures reported to the Ramathibodi Poison Center from 1 January 2010 to 31 December 2017.

Results

Forty-four cases were reported. The most common manifestation was somnolence (20, 45.5%). The most common substance used was kratom. There were 12 severe and fatal cases. Only one died due to methadone abuse. The most frequent manifestation among severe cases was respiratory failure (8 of 12 cases, 66.7%). Two cases had severe metabolic acidosis and were treated with hemodialysis. Three cases received norepinephrine.

Conclusion

Substance abuse in the elderly is a serious problem that is often overlooked. Health personnel should promptly recognize and address this issue in order to reduce morbidity and mortality in the elderly population.

Minimal clinically important difference for the rhinoconjunctivitis quality of life questionnaire in allergic rhinitis in Thai population

Background

Clinical measurement of the severity of allergic rhinitis (AR) can be assessed by symptoms score and patient quality of life (QoL). The magnitude of change in both symptoms and patient QoL should be considered in the management of AR.

Objective

The aim of this study was to determine the minimal clinically important difference (MCID) in AR in Thai population.

Methods

This prospective study recruited AR patients that attended our clinic during September 2011 to February 2012. The Rhinoconjunctivitis Quality of Life (Rcq-36) questionnaire was used to evaluate patient QoL. The Global Rating of Change Scale (GRCS) was used to assess improvement or deterioration in condition. The MCID was determined using an anchor-based method based on the GRCS, which was compared to the MCID determined by a distribution-based method based on the standard deviation (SD).

Results

Three hundred seventy-two patients with chronic rhinitis were recruited. Eighty-four of those had positive skin prick test and be diagnosed as AR. Of those, 79 completed the study and were included in the final analysis. A change of 2 points on the GRCS yielded an MCID for overall QoL of 0.21 ± 0.57. When applying the distribution-based method, an SD of 1.5 SD yielded an MCID for QoL of 0.27. For the rhinitis symptoms domain, the MCID was 0.42 ± 0.72.

Conclusions

The MCID for overall QoL and rhinitis symptoms in Thai AR patients was found to be 0.21 ± 0.57 and 0.42 ± 0.72, respectively. MCID can be applied for determining the clinical significance of treatment efficacy in AR.

Linguistic and Psychometric Validation of the Thai Version of Simplified Diabetes Knowledge Scale: A Measure of Knowledge of Diabetes in a Thai Population

Purpose

To develop a linguistically and psychometrically validated Thai version of the Simplified Diabetes Knowledge Scale (T-SDKS) for adults with Type 2 diabetes mellitus (T2DM).

Design

A cross-sectional study was carried out among people with T2DM.

Methods

Consecutive sampling was undertaken to recruit participants at the outpatient diabetes clinic of a hospital in Northern Thailand.

Results

A total of 502 patients with T2DM were recruited. The mean age of the participants was 60.2 years, and 60.5% were female. The T-SDKS attained a reliability coefficient of .79. The item-total correlation value was greater than 0.20 for each item, and the inter-item correlation ranged between 0.03 and 0.49. Respondents attained a mean percentage knowledge score of 42.39% ± 15.45 on T-SDKS.

Discussion/conclusions

The T-SDKS has demonstrated to be a brief and simple diabetes knowledge assessment tool to use in a busy clinical setting.

Implication for practice

The findings can be used to improve health education interventions.

Impact of KCNQ1, CDKN2A/2B, CDKAL1, HHEX, MTNR1B, SLC30A8, TCF7L2, and UBE2E2 on risk of developing type 2 diabetes in Thai population

BACKGROUND

Several type 2 diabetes (T2D) susceptibility loci identified via genome-wide association studies were found to be replicated among various populations. However, the influence of these loci on T2D in Thai population is unknown. The aim of this study was to investigate the influence of eight single nucleotide polymorphisms (SNPs) reported in GWA studies on T2D and related quantitative traits in Thai population.

METHODS

Eight SNPs in or near the KCNQ1, CDKN2A/2B, SLC30A8, HHEX, CDKAL1, TCF7L2, MTNR1B, and UBE2E2 genes were genotyped. A case-control association study comprising 500 Thai patients with T2D and 500 ethnically-matched control subjects was conducted. Associations between SNPs and T2D were examined by logistic regression analysis. The impact of these SNPs on quantitative traits was examined by linear regression among case and control subjects.

RESULTS

Five SNPs in KCNQ1 (rs2237892), CDK2A/2B (rs108116610, SLC30A8 (rs13266634), TCF7L2 (rs7903146) and MTNR1B (rs1387153) were found to be marginally associated with risk of developing T2D, with odds ratios ranging from 1.43 to 2.02 (p = 0.047 to 3.0 × 10-4) with adjustments for age, sex, and body mass index. Interestingly, SNP rs13266634 of SLC30A8 gene reached statistical significance after correcting for multiple testing (p = 0.0003) (p < 0.006 after Bonferroni correction). However, no significant association was detected between HHEX (rs1111875), CDKAL1 (rs7756992), or UBE2E2 (rs7612463) and T2D. We also observed association between rs10811661 and both waist circumference and waist-hip ratio (p = 0.007 and p = 0.023, respectively). In addition, rs13266634 in SLC30A8 was associated with glycated hemoglobin (p = 0.018), and rs7903146 in TCF7L2 was associated with high-density lipoprotein cholesterol level (p = 0.023).

CONCLUSION

Of the eight genes included in our analysis, significant association was observed between KCNQ1, CDKN2A/2B, SLC30A8, TCF7L2, and MTNR1B loci and T2D in our Thai study population. Of these, CDKN2A/2B, SLC30A8, and TCF7L2 genes were also significantly associated with anthropometric, glycemic and lipid characteristics. Larger cohort studies and meta-analyses are needed to further confirm the effect of these variants in Thai population.

Vitamin D-binding protein and its polymorphisms as a predictor for metabolic syndrome

AIM

To investigate the relationship of vitamin D-binding protein (GC) and genetic variation of GC (rs4588, rs7041 and rs2282679) with metabolic syndrome (MetS) in the Thai population.

MATERIALS & METHODS

GC-globulin concentrations were measured by quantitative western blot analysis in 401 adults. All participants were genotyped using TaqMan allelic discrimination assays.

RESULTS

GC-globulin levels were significatly lower in MetS subjects than in control subjects, in which significant negative correlations of GC-globulin levels with systolic blood pressure, glucose and age were found. Male participants who carried the GT genotype for rs4588 showed an increased risk of MetS compared with the GG wild-type (odds ratio: 3.25; p = 0.004).

CONCLUSION

GC-globulin concentrations and variation in GC rs4588 were supported as a risk factor for MetS in Thais.

Association of HLA-A and HLA-B Alleles with Lamotrigine-Induced Cutaneous Adverse Drug Reactions in the Thai Population

Background: Lamotrigine (LTG) is commonly used for treatment of epilepsy and bipolar disorder. It is one of the common cause of cutaneous adverse drug reactions (CADR). Clinical symptoms of LTG-induced CADR range from maculopapular exanthema (MPE) to severe cutaneous adverse reactions (SCAR). This study aimed to determine the association of the LTG-induced CADR with human leukocyte antigen (HLA) alleles in Thai patients.

Methods: Fifteen patients with LTG-induced CADR [10 MPE; 4 Stevens–Johnson syndrome; and 1 drug reaction with eosinophilia and systemic symptoms] and 50 LTG-tolerant controls were included in the study. HLA-A and HLA-B genotyping was performed using polymerase chain reaction-sequence-specific oligonucleotides probes.

Results: The proportion of HLA-A^∗02:07 and HLA-B^∗15:02 allele carriers were significantly higher in the LTG-induced CADR group than in the tolerant controls [odds ratio (OR): 7.83; 95% confidence interval (CI): 1.60–38.25; P = 0.013, and OR: 4.89; 95% CI: 1.28–18.67; P = 0.014]. In addition, subjects with HLA-A^∗33:03, HLA-B^∗15:02, and HLA-B^∗44:03 were significantly higher in the LTG-induced MPE group than in the tolerant controls (OR: 8.27; 95% CI: 1.83–37.41; P = 0.005, OR: 7.33; 95% CI: 1.63–33.02; P = 0.005; and OR: 10.29; 95% CI: 1.45–72.81; P = 0.029). In contrast to the LTG-induced MPE group, there were no significant differences between HLA alleles and LTG-induced SCAR group.

Conclusion:HLA-A^∗02:07 and HLA-B^∗15:02 were associated with LTG-induced CADR in Thai patients. We also identified an association between HLA-A^∗33:03, HLA-B^∗15:02, and HLA-B^∗44:03 and LTG-induced MPE in this population. These results suggest that these alleles could be useful screening markers for preventing CADR before LTG treatment in Thai patients, but further replication studies with larger sample sizes are needed.

A Cone-beam Computed Tomographic Study of Root and Canal Morphology of Maxillary First and Second Permanent Molars in a Thai Population

INTRODUCTION

Understanding tooth anatomy is crucial for effective endodontic treatment. This study investigated the roots and root canal morphology of maxillary first and second permanent molars in a Thai population using cone-beam computed tomographic (CBCT) imaging.

METHODS

This study evaluated 476 maxillary first molars and 457 maxillary second molars receiving CBCT examination and determined the number of roots and canal morphology according to Vertucci's classification, and the prevalence of a second mesiobuccal (MB2) canal in the mesiobuccal (MB) root was correlated with sex, age, and tooth side.

RESULTS

Three roots were most commonly found in maxillary first and second molars. MB2 canals in the MB root were found in 63.6% and 29.4% of first and second molars, respectively. The most common canal morphology in the first molar MB roots was type I (36.4%) followed by type II (28.8%), and type IV (25.3%). The most common canal morphology in the second molar MB roots was type I (70.6%) followed by type II (14.6%) and type IV (7.5%). Bilateral MB2 canals in the MB roots were present in 80.93% and 82.59% of the first and second molars, respectively. There was a significant correlation between males and the prevalence of MB2 canals in first molars (P < .05).

CONCLUSIONS

CBCT imaging is useful to determine root canal morphology. The prevalence of MB2 canals is approximately 60% and 30% in first and second molars, respectively. Furthermore, bilateral MB2 canals were commonly found. Our results can help endodontists to improve endodontic treatment outcomes.

Single nucleotide polymorphisms minisequencing in hypervariable regions for screening of Thais

Mitochondrial DNA (mtDNA) analysis has displayed an important role and been considered as a powerful tool in various fields of forensic science applications. Nowadays, single nucleotide polymorphisms (SNPs) on mtDNA have become additional DNA markers when conventional STR typing practically fails. mtDNA sequencing of polymerase chain reaction (PCR) products from the hypervariable region I (HVRI) and II (HVRII) is the standard method of mtDNA analysis. However, mtDNA sequencing is rather expensive, time consuming and technically complex. This study aims to develop the SNPs minisequencing for screening of Thai populations. For this purpose, sixteen SNPs that possess high discriminating power in hypervariable regions were selected. The DNA samples were obtained from 100 buccal swab samples of Thai healthy individuals. All DNA samples were extracted and were subsequently amplified by single duplex PCR technique. The duplex PCR products were genotyped by SNPs minisequencing. Based on 16 SNPs, a total of 63 haplotypes were observed of which 46 haplotypes were unique. The haplotype diversity, discriminating power and random match probability were calculated to be 0.9830, 0.9732 and 0.0268, respectively. The SNPs at 150, 199, 489, 16129, 16189, 16223, and 16304 were highly polymorphic in the studied population. Our results suggested that the SNPs minisequencing can be an alternative method of SNPs genotyping. This method can be used for an exclusion of a large number of mismatch samples and as a presumptive test prior to do confirmatory mtDNA sequencing.

New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population

Age estimation is one of the major components of forensic identification. Cranial suture closure has long been used as indicator for age estimation. Maxillary sutures have been less studied for estimation of age at death because they vary in their timing of closure with age. The purpose of this study was to estimate age by examining 190 Thai skulls with age ranging between 15-93 years from Forensic Osteology Research Center, Faculty of Medicine, and Chiang Mai University. Four parts of maxillary suture (incisive, anterior, transverse, and posterior sutures) were investigated the suture obliteration of each suture by computerizing from photograph. The suture were measured by pixel counting.The prediction model which based on the support vector machine (SVM) for regression or support vector regression (SVR) was utilized for data analysis. The results showed high correlation (R2 = 0.9086) between the predicted age and actual age. Plot between actual age group and predicted age in seven groups also revealed high correlation (R2 = 0.9434). These can be implied that we are able to use this SVR model to predict age at death using maxillary suture information.The interesting issue is to further apply this model in more cases to ensure the generalization of the finding. This study is the first attempt to estimate age at death using a new method based on novel analysis which considers a characteristic of relationship between maxillary suture closures with age that are not in linear form. The present study may contribute as a basis knowledge and method for further study of age estimation in archaeological and forensic anthropological contexts, especially when only skull or base of skull are found.

Clinically relevant genetic variants of drug-metabolizing enzyme and transporter genes detected in Thai children and adolescents with autism spectrum disorder

Single-nucleotide polymorphisms (SNPs) among drug-metabolizing enzymes and transporters (DMETs) influence the pharmacokinetic profile of drugs and exhibit intra- and interethnic variations in drug response in terms of efficacy and safety profile. The main objective of this study was to assess the frequency of allelic variants of drug absorption, distribution, metabolism, and elimination-related genes in Thai children and adolescents with autism spectrum disorder. Blood samples were drawn from 119 patients, and DNA was extracted. Genotyping was performed using the DMET Plus microarray platform. The allele frequencies of the DMET markers were generated using the DMET Console software. Thereafter, the genetic variations of significant DMET genes were assessed. The frequencies of SNPs across the genes coding for DMETs were determined. After filtering the SNPs, 489 of the 1,931 SNPs passed quality control. Many clinically relevant SNPs, including CYP2C19*2, CYP2D6*10, CYP3A5*3, and SLCO1B1*5, were found to have frequencies similar to those in the Chinese population. These data are important for further research to investigate the interpatient variability in pharmacokinetics and pharmacodynamics of drugs in clinical practice.

Wellness and Religious Coping Among Thai Individuals Living with Chronic Kidney Disease in Southern California

This qualitative research is based on eight Thai participants living with chronic kidney disease living in Southern California. Four emerging themes are (a) wellness, (b) self-care, (c) impact of illness on life, and (d) religious coping. Family relations, social support, and religious coping affected self-care and how they managed their everyday activities. Knowledge about the disease and its mechanism were crucial to the decision-making process in relation to self-care. Good self-care and appropriate self-management led to wellness and improved quality of life. Religion provided a belief system focusing on the place of acceptance that was essential for coping with emotional stressors.

Association of adiponectin +276G/T polymorphism with knee osteoarthritis

Osteoarthritis (OA) is a prevalent, degenerative joint disorder leading to the destruction of articular cartilage, osteophyte formation and subchondral bone sclerosis. Genetic and environmental factors are involved in the development of OA. The role of adiponectin gene polymorphisms in OA has not yet been established. The aim of this study was to investigate the association of adiponectin +276G/T (rs1501299) gene polymorphism with knee OA. Genotype distributions and allelic frequencies of adiponectin gene, +276G/T polymorphism were determined in a total of 200 subjects (100 knee OA patients and 100 healthy controls). Single-nucleotide polymorphism (SNP) of the adiponectin +276G/T gene was genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis. The genotype distribution of +276G/T SNP was observed in the Hardy-Weinberg equilibrium for OA patients and controls. No statistically significant difference was identified between the two groups with respect to genotype distributions and allelic frequencies (P>0.05). The T- and G-allele frequencies were indicated as 24.5 and 75.5%, respectively, in OA patients, whereas the frequency was 23-70% in the control group. Findings of this study therefore suggest that the +276G/T SNP was not associated with susceptibility to knee OA.

CYP2C19 polymorphisms in the Thai population and the clinical response to clopidogrel in patients with atherothrombotic-risk factors

Genetic variation in the cytochrome P450 2C19 (CYP2C19) gene has been documented gradually as the determinant conversion and variability in the antiplatelet effect of clopidogrel. The aims of this study were to determine the prevalence of clinically relevant allele variants (CYP2C19*2, CYP2C19*3, and CYP2C19*17) in a Thai study population, and finally determine whether the allele distributes and predicts metabolic phenotypes in clopidogrel treated patients. A total of 1,051 Thai patients participated in this study. Genotypes for CYP2C19 polymorphisms were detected by the microarray-based technique. Furthermore, results of genotyping and platelet aggregation in 96 cardiovascular disease patients on 75 mg clopidogrel maintenance daily dose therapy also were analyzed. Among 1,051 samples, the allele frequencies of CYP2C19 *1/*1, *1/*2, *1/*3, *2/*2, *2/*3, and *1/*17 were found in 428 (40.72%), 369 (35.10%), 72 (6.85%), 77 (7.32%), 59 (5.61%), and 45 (4.30%) of the patients, respectively. Homozygous CYP2C19 *3/*3 was found in one patient (0.10%). Therefore, 40.72% of the patients were predicted as extensive metabolizers, 41.95% as intermediate metabolizers, 13.03% as poor metabolizers, and 4.30% as ultra-rapid metabolizers. Among 96 patients, the frequency of poor metabolizers was significantly higher in the clopidogrel non-responder group than in the responder group (36.0% and 15.5%, respectively, P = 0.03). CYP2C19*1/*17 was observed in responders (n = 2; 2.8%). As a result, CYP2C19 variants were associated with clopidogrel non-responders. However, there is a need for further elucidation of the clinical importance and use of this finding to make firm and cost-effective recommendations for drug treatment in the future.