Predictive MERRA-2 aerosol diagnostic model for oral, oropharyngeal and laryngeal cancer caused by air pollution in Thai population.

Introduction: Head and neck cancers were generally characterized with many possible causes. Exposure to outdoor particulate matter affected to multiple organ systems but it was unknown whether which species in PM was an association with cancer incidence. Objectives: The study aimed to examine the oral- oropharyngeal- laryngeal cancer incidence and accumulated air pollution-related cancers in the spatial patterns. Methods: Observational study was conducted, and the Poisson log-linear models were used which were analyzed on subgroups-specific incidence rates by national references of Thailand and NASA's database of aerosol diagnostics model (MERRA-2). Results: With a significant influence on increasing of 1 µg/m3 black carbon, organic carbon, Dust-PM2.5, and SO4 were associated with increased cancer risk in 1.433 times (95%CI: 1.215-1.690), 1.272 times (95%CI: 1.139-1.420), 3.640 times (95%CI: 2.011-6.589), and 1.704 times (95%CI: 1.334-2.177), respectively. Conclusion: This study indicated that oral-oropharyngeal-laryngeal cancer incidence could worsen because of adverse air pollution conditions. These issues should be addressed and the importance of the monitoring procedure for dust-PM2.5, sulfate, black carbon, and organic carbon should be emphasized.

Impact of Hospital Level on Stroke Outcomes in the Thrombolytic Therapy Era in Northeast Thailand: A Retrospective Study.

INTRODUCTION: Stroke is a common neurological disease. Thrombolytic therapy has been shown to be beneficial in acute ischemic stroke. This treatment can be given in various hospital levels. This study aimed to evaluate the quality of acute ischemic stroke care among various hospital levels. METHODS: Data were randomly selected from the medical records that were sent to the National Health Security Office (NHSO) for reimbursement purposes between October 2015 and August 2016. Patient demographics, risk factors, stroke subtypes, stroke severity, quality of care indicators, and complications were recorded. Paired comparisons between two groups were carried out using the Bonferroni correction. RESULTS: A total of 947 patients, including 169 patients from community hospitals (CHs), 629 from regional hospitals (RHs), and 149 from tertiary hospitals (THs), were included in the final analysis. The CH group had a higher median age but lower median initial National Institutes of Health Stroke Scale (NIHSS) score than the RH and TH groups (median age = 70, 66, and 67 years, respectively, and initial NIHSS = 6, 8, and 9, respectively). The CH group had shorter onset-to-needle times for intravenous recombinant tissue plasminogen activator (rt-PA) treatment than the other two groups (147 vs. 178.5 and 180 min). After adjustment for baseline characteristics, stroke type, and stroke severity, the CH group was significantly associated with lower mortality and presence of complications. The adjusted odds ratios (95% confidence intervals) for the two factors were 0.13 (0.03, 0.67) and 0.59 (0.35, 0.99). None of the patients received endovascular therapy or non-thrombolytic interventional therapy. CONCLUSION: CHs may have the potential for acute ischemic stroke care in the same way as RHs or THs, with faster rt-PA treatment, in northeast Thailand. However, further studies should be performed to evaluate appropriate patient characteristics for CHs.

Aerosol components associated with hospital mortality in systemic sclerosis: an analysis from a nationwide Thailand healthcare database.

Occupational and environmental associations with systemic sclerosis (SSc) have been confirmed; however, the association between aerosol components and mortality is uncertain. The study aimed to define the association between aerosol components and hospital mortality among Thai SSc patients. A study was conducted using a national database of patients covered by the National Health Security Office, hospitalised between 2014 and 2018. Data included all patients over 18 having a primary diagnosis of SSc (ICD-10: M34). Spatial resources used map information based on GPS coordinates of Thailand. Aerosol components-including organic carbon, black carbon, dust particulate matter diameter < 2.5 µm (PM2.5), and sulfate-were assessed using the NASA satellite MERRA-2 Model M2TMNXFLX v5.12.4. Spatial modelling with R Package Integrated Nested Laplace Approximation (R-INLA) was used to analyse the association between the incidence of mortality and the 5-year accumulation of each aerosol component adjusted by age, sex, and comorbid diseases. The study included 2,094 SSc patients with 3,684 admissions. Most (63.8%) were female. During admission, 1,276 cases died. R-INLA analysis indicated an increase of 1 µg/m3 of dust PM2.5 was associated with a respective increase in the risk of overall mortality and death due to pneumonia of 96% and 79%. An increase of 1 µg/m3 of dust PM2.5 resulted in 1.17, 1.18, 1.64, and 2.15 times greater risk of mortality due to pulmonary fibrosis, cardiac involvement, renal involvement, and cancer, respectively. Aerosol components-particularly dust PM2.5 exposures-increased the risk of overall, cardio-pulmonary-renal, and cancer mortality among SSc patients.

Accumulated ambient air pollution and colon cancer incidence in Thailand.

This research examined the relationship between colon cancer risks and pollution in various areas of Thailand, using satellites to gather quantities of aerosols in the atmosphere. Bayesian hierarchical spatio-temporal model and the Poisson log-linear model were used to examine the incidence rates of colon cancer standardized by national references; from the database of the National Health Security Office, Ministry of Public Health of Thailand and NASA's database from aerosol diagnostics model. Modern-Era Retrospective Analysis for Research and Applications, Version 2 (MERRA-2) was used to explore disease-gender-specific spatio-temporal patterns of colon cancer incidences and accumulated air pollution-related cancers in Thailand between 2010 and 2016. A total of 59,605 patients were selected for the study. Due to concerns regarding statistical reliability between aerosol diagnostics model and colon cancer incidences, the posterior probabilities of risk appeared the most in dust PM2.5. It could be interpreted as relative risk in every increase of 10 µg/m3 in black carbon, organic carbon, and dust-PM2.5 levels were associated respectively with an increase of 4%, 4%, and 15% in the risks of colon cancer. A significant increase in the incidence of colon cancer with accumulated ambient air quality raised concerns regarding the prevention of air pollution. This study utilized data based on the incidences of colon cancer; the country's database and linked cancer data to pollution. According to the database from NASA's technology, this research has never been conducted in Thailand.

Clinical characteristics and outcomes of 566 Thais with systemic sclerosis: A cohort study.

BACKGROUND: Most Thai patients with systemic sclerosis (SSc) have diffuse cutaneous SSc (dcSSc) unlike most Caucasians and some Asians. A longitudinal cohort study among Thai dcSSc is needed. OBJECTIVES: We aimed to determine the overall clinical characteristics, define the clinical difference between limited cutaneous SSc (lcSSc) and dcSSc, and ascertain the mortality rate and the factors associated with mortality. METHOD: We conducted a cohort study including 566 Thai adult SSc patients between January 2013 and June 2019. Clinical difference between lcSSc and dcSSc was investigated using generalized estimating equations (GEE). RESULTS: Females presented more than males (356 vs 210 cases). The majority of cases were dcSSc (411; 72.6%). The median duration of disease at the time of pulmonary fibrosis (PF) detection was 2.5 years, pulmonary arterial hypertension 8.1 years, and renal crisis 4.1 years. By GEE analysis, dcSSc was significantly associated with salt-and-pepper skin, hand deformity, and every 1-point increase in modified Rodnan skin score (mRSS). A greater mortality risk was associated with age at onset >60 years (hazards ratio [HR] 5.5), a World Health Organization functional class (FC) III (HR 5.1), FC IV (HR 34.8), edematous skin (HR 11.4), early onset of PF (HR 1.7), each 5-point increase in the mRSS (HR 4.5), and ≥2 internal organ involvements (HR 10.1). CONCLUSION: dcSSc is a common SSc subset among Thais. PF was an early complication in SSc and earlier PF detection was associated with a poorer prognosis. Elderly onset, high FC, severe skin tightness, and multiple organ involvements were associated with a greater mortality risk.

Construction of polluted aerosol in accumulation that affects the incidence of lung cancer.

BACKGROUND: This model demonstrated the correlation between lung cancer incidences and the parts of ambient air pollution according to the National Aeronautics and Space Administration (NASA)'s high resolution technology satellites. METHODS: Chemical type of aerosols was investigated by the Aerosol Diagnostics Model such as black carbon, mineral dust, organic carbon, sea-salt and SO4. The model investigated associations between the six year accumulation of each aerosol and lung cancer incidence by Bayesian hierarchical spatio-temporal model. Which also represented integrated geophysical parameters. RESULTS: In analyses of accumulated chemical aerosol component from 2010 - 2016, the incidence rate ratio (IRR) of patients in 2017 were estimated. We observed a significant increasing risk for organic carbon exposure (IRR 1.021, 95%CI 1.020-1.022), SO4, (IRR 1.026, 95% CI 1.025-1.028) and dust, (IRR 1.061, 95% CI 1.058-1.064). There was also suggestion of an increased risk with, every 1 ug/m3 increase in organic carbon compound is associated with 21% increased risk of lung cancer, whereas a 26% excess risk of cancer per 1 ug/m3 increase in mean SO4 and 61% increased risk of lung cancer for dust levels. The other variables were the negative IRR which did not increase the risk of the exposed group. CONCLUSION: With our results, this process can determine that organic carbon, SO4 and dust was significantly associated with the elevated risk of lung cancer.

Effect of season on clinical outcomes of Thai systemic sclerosis: Analysis of the Thai national healthcare database.

Objectives: We aimed to determine rate of admission, mortality rate, and causes of death in systemic sclerosis (SSc) patients after stratifying by season.Method: A cross-sectional analysis was performed of patients over 15 in the national database with a primary diagnosis of SSc (ICD-10:M34) covered by the National Health Security Office hospitalized between 2014 and 2018. The seasons were stratified into hot, rainy, and Cool dry seasons.Results: Included were 2480 SSc patients with 3684 admissions: most (64.3%) were female. The respective mean age and median length of stay was 56.9 ± 12.3 years and 3 days (IQR 2-6). The admission rate was highest during the rainy season (1574 visits, 42.7%), followed by the cool dry season (1183 visits, 32.1%) then the hot season (927 visits, 25.2%). During the 13,180 person-days, 1660 SSc patients died resulting in a mortality rate of 12.1 per 100 person-days. The proportion of SSc patients who died in the Cool dry season was significantly higher than in the hot or rainy season (p = .04). Pulmonary involvement in SSc was the most common cause of death in the hot season, which is greater than in the other seasons (p = .004). By comparison, death due to cardiac involvement in SSc was common during the rainy season and cool dry seasons (p = .04).Conclusion: The admission rate among Thai SSc patients was greatest during the rainy season, while mortality was highest during the cool dry season. The most common causes of death were SSc-related irrespective of season, particularly cardiopulmonary involvement.

Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke.

BACKGROUND: There are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods. MATERIALS AND METHODS: We retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS. RESULTS: We included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67-75) years and the median LOS was 5 (4-7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4-13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01-1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09-1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60-0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02-1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67-0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02-1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30-1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14-1.74], P=0.001). CONCLUSION: According to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.

The roles of the diffusion-weighted imaging in orbital masses.

INTRODUCTION: Causes of orbital masses can be either benign or malignant. An MRI with diffusion-weighted imaging (DWI) may be helpful to differentiate causes of orbital masses. This study aimed to evaluate the diagnostic properties of an apparent diffusion coefficient (ADC) in orbital masses. METHODS: We retrospectively reviewed patients with orbital masses who underwent DWI and had histopathological results. Orbital lesions were categorized as benign or malignant and compared with respect to the ADC and ADC ratio. A receiver operating characteristic curve (ROC) was plotted to evaluate the sensitivity and specificity of the ADC and ADC ratio threshold. RESULTS: The mean age of all 42 patients in this study was 36.31 years (S.D. 22.12) and 26 of the patients were male (61.9%). The malignant orbital masses accounted for 43% (18 patients). The most common cell type was meningioma (10 patients; 23.8%). There was no statistical difference between the ADC values of benign and malignant tumours (1.18 vs 0.99 ×10-3  mm2 /s; P-value 0.200). The myxoid tumours had significantly higher ADC values than the non-myxoid (1.58 vs 0.99; P-value 0.008) tumours. Non-metastatic non-myxoid tumours also had significantly lower ADC values than metastatic non-myxoid tumours (0.73 vs 1.32; P-values 0.006). The ADC cut-off point of greater than or equal to 0.95 × 10-3  mm2 /s was given a sensitivity of 87.50% for myxoid orbital masses, while the cut-off point of greater than or equal to 1.01 × 10-3  mm2 /s was given a sensitivity of 80.00% for metastatic, non-myxoid malignant orbital masses. CONCLUSIONS: Benign and malignant orbital masses cannot be distinguished by using the ADC values. However, the ADC values were useful in differentiating between myxoid vs non-myxoid orbital masses and metastatic non-myxoid vs non-metastatic non-myxoid orbital masses.

Who should be checked for hepatitis C virus infection in endemic areas?

OBJECTIVE: To find additional factors suggestive of hepatitis C virus (HCV) infection in the general population by using data from a hepatitis virus survey. METHODS: This study collected data of HCV infection from a hepatitis virus survey. The survey was conducted in 13 provinces in the northeast Thailand in 2014 and 2015. During the survey, a blood test was performed to screen for HCV. A questionnaire was also distributed to all participants asking about baseline characteristics, risk factors for HCV infection, and daily life activities. Risk factors for HCV infection were executed. RESULTS: There were 2112 participants for the survey. Of those, 110 participants (5.21%) tested positive for HCV infection. After adjustment by multivariate logistic regression, three factors were significantly associated with HCV infection, namely male gender, age, and family history of liver cancer. The adjusted ORs and 95% CI of these factors were 3.14 (1.50, 6.56), 3.78 (1.12, 12.76), and 2.28 (1.08, 4.80), respectively. CONCLUSIONS: Male gender, increasing age, and family history of liver cancer are predictors of HCV infection in endemic areas. Males with a family history of liver cancer in their first-degree relatives should be tested for HCV infection regardless of symptoms.

Prevalence of Provocative Seizures in Persons with Epilepsy: A Longitudinal Study at Khon Kaen University Hospital, Thailand.

Background and Objective. Provocative factors are one causative factor of seizure attacks in persons with epilepsy (PWE). There are limited data of prevalence and major provocative factors in Asian populations. Methods. This study was performed at the Epilepsy Clinic, Khon Kaen University Hospital. The patients who aged 15 years or over, who had been treated at least 3 months with at least one antiepileptic drug, and who were followed up for at least one year were included. Data of seizure control and triggers were collected retrospectively from medical records. Data analysis was performed to identify independent provocative factors. Results. A total of 382 PWE met the study criteria. The mean age was 40.4 ± 0.8 years. Approximately 44% of the patients had at least one provocative factor. By multivariate analysis, the independent provocative factors with the first three highest adjusted odds ratios were sleep deprivation (adjusted OR = 8.64, 95% CI 3.73-19.99), alcohol consumption (adjusted OR = 6.76, 95% CI 1.44-31.78), and feeling stressful (adjusted OR = 2.97, 95% CI 1.29-6.86). Conclusion. Almost half of seizure attacks may be caused by provocative factors in Thai PWEs and some factors may be preventable. Avoidance of these factors should be emphasized to epilepsy patients for improving clinical outcomes and quality of life.