Bamrasnaradura Infectious Diseases Institute

Despite numerous recent advances in infectious disease diagnostic technologies including quantitative (q) polymerase chain reaction (PCR) and antigen test kit (ATK), there remains a need to develop more efficient point-of-care assays for large-scale operations. In an effort towards such a screening test for low-resource settings, we have established a colorimetric loop-mediated isothermal amplification assay and detected the amplified DNA via naked-eye observation to maximize assay simplicity using monkeypox (Mpox) as a model. The assay is cheap, highly sensitive and specific to Mpox with the potential for translation into broader applications.•Our protocol offers a simpler, faster, and cheaper test for Mpox than the current gold-standard qPCR, with 100% accuracy.•assay enables decentralized screening and provides visually interpretable results immediately after incubation•The versatility of this protocol allows for easy adaptation to detecting new or re-emerging diseases, utilizing a visual readout for maximum simplicity.

Background Addressing the under-recognition of osteoporosis in men necessitates the use of suitable screening tools tailored to the male population. The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a reliable tool for evaluating the risk of osteoporosis. This cross-sectional study aims to assess the predictive performance of the OSTA index in Thai men. Additionally, the study compares the performance of the OSTA index with the Khon Kaen Osteoporosis Study (KKOS) score and an age cutoff value of ≥70 years. Methods Between November 2017 and October 2024, men aged 50 years or older who underwent dual-energy X-ray absorptiometry and did not receive any osteoporosis treatment were included. The performance of the individual OSTA index cutoff values in predicting osteoporosis was assessed. Results A total of 427 men were included in this study and classified into normal bone mineral density (BMD) (175 men, 41%), osteopenia (210 men, 49.2%), and osteoporosis (42 men, 9.8%). The mean age, weight, and body mass index were 76.4 years, 65.9 kg, and 24.1 kg/m², respectively. The OSTA index cutoff of -1 at any BMD site produced a Youden index of 0.187, with a sensitivity of 85.7% and a specificity of 33%. Meanwhile, the OSTA index cutoff of -4 at any BMD site resulted in a Youden index of 0.395, with a sensitivity of 59.5% and a specificity of 80%. The area under the receiver operating characteristic curve (AUC) of the KKOS score ≤-1 was 0.636. The AUC of the OSTA index ≤-1 was 0.594, which was significantly lower than the AUC of the KKOS score ≤-1 (P = 0.003). The AUC of age ≥70 years was 0.494, which was significantly lower than the AUC of the OSTA index ≤-1 (P < 0.001). Conclusion For osteoporosis screening in Thai men, the OSTA index cutoff value of -1 is more appropriate than a cutoff value of -4. However, the KKOS score cutoff value of ≤-1 serves as the most effective predictor for osteoporosis screening.

This sub‐study sought to characterize the pharmacokinetics (PK) of favipiravir (FPV) within Thai adults and quantitatively assess differences in exposure to those previously reported in other populations as a basis to understand putative differences in efficacy between studies conducted in different regions. It was nested within a prospective trial of adults with symptomatic COVID‐19 infection without pneumonia receiving 1800 mg FPV twice‐daily on day 1 and 800 mg twice‐daily thereafter. Individual PK profiles were fitted with a one‐compartment disposition model (first‐order absorption). Eight adults (seven female) with a median age of 39 years and BMI of 27.9 kg/m2 were included. Seven adults achieved plasma concentrations above the EC90 in vitro target (25 mg/L), with minimum–maximum concentrations decreasing with repeat dosing. The mean FPV apparent clearance observed in this study was 1.1 L/h (coefficient of variation [CV]: 60%), apparent volume of distribution 20.6 L (CV: 40%), absorption rate constant 6.1 h (CV: 100%), and 2.4 daily % change in apparent clearance (CV: 315%). Higher exposures were observed in these Thai adults compared with data from previous studies in Chinese, Japanese, and Turkish populations, respectively. Current FPV doses recommended in Thailand achieved target plasma concentrations with higher exposures than those described previously in other populations. The limited sample size prohibits firm conclusions from being drawn but the presented data warrants confirmation with a view to interrogate the appropriateness of doses used in randomized clinical trials that failed to demonstrate efficacy.

BackgroundAge and weight are not only strong predictive parameters for osteoporosis diagnosis but can also be easily acquired from patients. This study aimed to develop and validate a new diagnostic screening model for postmenopausal osteoporosis that uses only 2 parameters, viz., age and weight. The discriminative ability of the model was analyzed and compared with that of the osteoporosis self-assessment tool for Asians (OSTA) index.MethodsThe age–weight diagnostic screening model was developed using a retrospective chart review of postmenopausal women aged ≥50 years who underwent dual energy X-ray absorptiometry at a tertiary hospital from November 2017 to April 2022. Logistic regression analysis was used to derive a diagnostic screening model for osteoporosis.ResultsA total of 533 postmenopausal women were included in the study. According to the highest Youden index value, a probability cut-off value of 0.298 was used in the diagnosis screening model at any site, which yielded a sensitivity of 84.3% and a specificity of 53.8%. For increased sensitivity as a screening tool, a cut-off value of 0.254 was proposed to obtain a sensitivity of 90.2% and a specificity of 42.2%. The area under receiver operating characteristic curves from all screening models were significantly higher than those from the OSTA index model (P<0.05).ConclusionsThis study showed the feasibility of a postmenopausal osteoporosis diagnostic screening model that uses 2 strong predictors for osteoporosis diagnosis: age and weight. This age–weight diagnostic model is a simple, effective option in postmenopausal osteoporosis screening.

Chikungunya is a mosquito-borne disease mainly characterized by fever with polyarthralgia. Currently, liver complications of chikungunya remain rarely described. This study assesses the prevalence, severity, and risk factors of liver involvement, and the association between liver involvement severity and prognosis. We conducted a retrospective cohort study at two referral centers for tropical infectious diseases-the Hospital for Tropical Diseases and Bamrasnaradura Infectious Diseases Institute in Thailand-from January 2016 to April 2021. The study included 400 patients diagnosed with chikungunya. Of them, 254 (63.5%) were female with a mean age of 41.5 ± 14.1 years, and 98.5% of them presented with fever with arthralgia. Gastrointestinal presentations included nausea or vomiting (n = 62, 15.5%), diarrhea (n = 33, 8.3%), and abdominal pain (n = 4, 1%). Of 88 patients with available liver function tests, 39.8% had hepatitis (abnormal alanine aminotransferase levels), of whom 5.7% had moderate hepatitis. Nausea or vomiting is a clinical risk factor associated with liver involvement (adjusted odds ratio, 5.17; 95% CI, 1.20-22.34). Liver involvement was usually observed during the first 2 weeks of illness and resolved eventually. None of the patients experienced severe hepatitis, liver failure, or death caused by a liver problem. In conclusion, most of the patients with chikungunya did not have significant liver involvement. In those patients with severe liver injury, coexisting causes should be considered.

Kidney transplant recipients (KTRs) have a suboptimal immune response to COVID-19 vaccination due to the effects of immunosuppression, mostly mycophenolic acid (MPA). This study investigated the benefits of switching from the standard immunosuppressive regimen (tacrolimus (TAC), MPA, and prednisolone) to a regimen of mammalian target of rapamycin inhibitor (mTORi), TAC and prednisolone two weeks pre- and two weeks post-BNT162b2 booster vaccination. A single-center, opened-label pilot study was conducted in KTRs, who received two doses of ChAdOx-1 and a single dose of BNT162b2. The participants were randomly assigned to continue the standard regimen (control group, n = 14) or switched to a sirolimus (an mTORi), TAC, and prednisolone (switching group, n = 14) regimen two weeks before and two weeks after receiving a booster dose of BNT162b2. The anti-SARS-CoV-2 S antibody level after vaccination in the switching group was significantly greater than the control group (4051.0 [IQR 3142.0–6466.0] BAU/mL vs. 2081.0 [IQR 1077.0–3960.0] BAU/mL, respectively; p = 0.01). One participant who was initially seronegative in the control group remained seronegative after the booster dose. These findings suggest humoral immune response benefits of switching the standard immunosuppressive regimen to the regimen of mTORi, TAC, and prednisolone in KTRs during vaccination.

Anemia is a significant public health concern in pregnant women and women of reproductive age globally. The prevalence of anemia in Thailand was approximately 36.7%. Common causes of anemia were iron deficiency anemia (IDA) and beta-thalassemia trait (BTT). World Health Organization (WHO) recommends that dietary adjustments focusing on iron-rich foods foster the improvement of IDA and IDA with BTT. This study aimed to evaluate the effect of nutrition counselling in pregnant women with IDA on anemia parameters and dietary intake records. Retrospective data were obtained from the Division of Nutrition and Antenatal Care (ANC) Clinic at Bamrasnaradura Infectious Diseases Institute (BIDI) in Nonthaburi, Thailand. Nutrition Care Process Model was used in nutrition service at BIDI. During the second trimester, nutrition counselling was provided at the ANC Clinic by a dietitian routinely based on WHO guidelines for nutritional anemia. The anemia parameters and dietary intake records were recorded during ANC visits at the second and third trimesters. A paired t-test was used to evaluate differences within each group. Collected data from 61 pregnant women with anemia were analyzed (IDA: 55; BTT: 6). In the third trimester, the changes in hematocrit levels were significantly high in both IDA (p ≤ 0.001) and BTT groups (p = 0.016). In addition, the improvement in daily energy consumption and iron-rich foods was significantly observed in both groups (p ≤ 0.001). In conclusion, the delivery of nutrition counselling focusing on iron-rich foods significantly enhanced IDA parameters and eating behaviours, including increased hematocrit levels, and improved daily energy intake and iron-rich foods intake among pregnant women with anemia.

We report the clinical outcomes following implementation of initial COVID-19 treatment guidelines in Thailand. A composite poor outcome was defined as death, ICU admission, requiring intubation, or high-flow oxygen. 744 COVID-19 patients (48.8% male) were included, median (IQR) age was 37 (27-48) years [8.4% &gt;60 years] and 21.4% had pneumonia at admission. Admission &lt;4 days from symptom onset had a reduced risk of poor outcome. In a subgroup analysis, favipiravir use reduced the risk of a poor outcome for patients admitted &lt;4 days from symptom onset (OR 0.320 (0.152-0.662), P=0.003). Thai guidelines now include favipiravir to treat all symptomatic COVID-19 patients.

BackgroundIndividuals with end-stage renal disease have a higher risk of hepatitis C virus (HCV) acquisition during long-term hemodialysis (HD). Our report was designed to investigate HCV prevalence and genotype, in addition to the clinical use of HCV core antigen (HCVcAg), within multiple HD facilities in Thailand.MethodsThis cross‐sectional report was investigated between January and June 2019. HCV infection was assessed by anti-HCV and confirmed active infection by measuring HCV RNA and HCVcAg. HCV genotype was determined by phylogenetic analysis using nucleotide sequences of NS5B region.ResultsOverall, 140 of 3,305 (4.2%) patients in 15 dialysis centers had anti-HCV positive. Among them, HCV RNA was further assessed in 93 patients and was detectable in 59 (63.4%) persons. Considering HCV viremia, HCVcAg measurement exhibited high accuracy (96.8%), sensitivity (94.9%) and specificity (100%) in comparison with HCV RNA testing. Moreover, individuals infected with HCV received a longer duration of dialysis vintage when compared to anti-HCV negative controls. The major sub-genotypes were 1a, 1b, 3a, 3b, 6f and 6n. Regarding phylogenetic analysis, there were 7 clusters of isolates with high sequence homology affecting 17 individuals, indicating possible HCV transmission within the same HD centers.ConclusionsHCV frequency and common sub-genotypes in HD centers were different from those found in the Thai general population. HCVcAg might be an alternate testing for viremia within resource-limited countries. Enhanced preventive practices, dialyzer reuse policy and better access to antiviral therapy are crucial for HCV micro-elimination within HD facilities.