Songklanagarind Hospital

To assess the impact of an integrated model of care in curing hepatitis C in people who use drugs in Thailand. The C-Free Study enrolled people with current or prior drug use and their partners in a prospective cohort at community drop-in centres providing harm reduction services. Participants were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and sexually transmitted infections. Eligible participants with HCV infection received a 12-week course of sofosbuvir-velpatasvir. The main impact outcome was sustained virological response, measured 12 weeks after treatment completion. Between June 2019 and April 2023, we enrolled 2871 participants in 10 sites across Thailand: 1601 (55.8%) had HCV antibodies; 1275 (44.4%) had active HCV infection; 846 (29.5%) had HIV; and 221 (7.7%) had HBV. Of 1134 participants with active HCV who started treatment with sofosbuvir-velpatasvir, 939 (82.8%) achieved a sustained virological response. Among 987 participants completing treatment, 95.1% achieved a sustained virological response. In multivariable analysis, age > 40 years (adjusted odds ratio, aOR: 1.63; 95% confidence interval, CI: 1.04-2.54) and poor treatment adherence (aOR: 0.06; 95% CI: 0.02-0.20) were associated with sustained virological response. Of 34 serious adverse events during treatment, six led to treatment discontinuation including five non-treatment-related deaths. Community-based HCV treatment of people who use drugs in Thailand, within harm reduction settings, is safe and effective. Integration of this strategy into national programmes could enhance HCV elimination in people who use drugs.

ObjectivesThe 7-item Hamilton Depression Rating Scale (HAM-D7) is commonly used to assess depression severity and remission; however, its standard cut-off scores may not be optimal for elderly populations. This study aimed to establish GRID-HAM-D7 remission thresholds among elderly Thai patients diagnosed with depressive disorders, including both any depressive disorder and major depressive disorder (MDD).MethodsA total of 803 elderly participants were recruited from four tertiary care hospitals across Thailand as part of a larger psychiatric study. Diagnoses were determined using the Mini International Neuropsychiatric Interview, and depression severity was assessed via the GRID-HAM-D7. Statistical analyses, including sensitivity, specificity, predictive values, and Receiver Operating Characteristic curves, were performed to determine optimal remission cut-off scores.ResultsFor any depressive disorder, a GRID-HAM-D7 score of ≤ 4 yielded sensitivities of 88.86% and specificity of 77.66%. In major depressive disorder, the optimal threshold was ≤ 6, resulting in 91.68% sensitivity and 79.73% specificity. Both values surpassed the diagnostic accuracy of conventional lower thresholds. These results suggest that higher GRID-HAM-D7 remission cut-offs better reflect depressive symptomatology in older adults.ConclusionsThe study underscores the necessity of tailoring standardized assessment tools for specific populations to enhance clinical management and decision-making in geriatric psychiatry.

Objectives: The relationship between preoperative psychological distress and weight loss following bariatric surgery remains limited in Asian populations. This study aimed to investigate whether preoperative psychological distress, as a general screening measure, predicted weight loss following bariatric surgery in a Thai population. Methods: We conducted a retrospective cohort study of 464 patients who underwent bariatric surgery at a university hospital between 2020 and 2023. Preoperative psychological distress was assessed using the General Health Questionnaire-28 (GHQ-28), with a score of ≥6 indicating high psychological distress. The primary outcome was successful weight loss (SWL), defined as achieving >50% excess weight loss at 6 and 12 months postoperatively. We used multivariable logistic regression models, adjusted for age, sex, surgery type, obesity-related comorbidities, and baseline body weight, to analyze the association between psychological distress and SWL outcomes. Results: Patients with high psychological distress (n = 270) demonstrated significantly higher rates of SWL compared to those with low distress (n = 194) at both 6 months (59.7% vs. 43.5%, p = 0.003) and 12 months (83.6% vs. 74.6%, p = 0.068). In adjusted regression analyses, patients with high distress had approximately twice the odds of achieving SWL at 6 months (adj. OR 1.99, 95% CI: 1.25–3.17, p = 0.004), with this association persisting at 12 months (adj. OR 1.86, 95% CI: 1.02–3.39, p = 0.044). Subgroup analyses revealed consistent associations across both sexes, with no significant interaction effects. Conclusions: Contrary to traditional assumptions, higher preoperative psychological distress was associated with greater odds of achieving successful weight loss after bariatric surgery. This suggests that psychological distress may not be a barrier to successful outcomes but could, when supported appropriately, be a predictor for significant weight loss. These findings highlight the value of psychological assessment in optimizing, rather than restricting, bariatric surgery candidates.

Background/Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with the Asia-Pacific (APAC) region bearing a disproportionate burden. This paper examines HCC challenges within seven APAC health systems, identifies key barriers at each stage of the patient journey, and proposes tailored, actionable solutions. To effectively address HCC challenges, a stepwise approach should prioritise high-impact solutions, focusing on prevention, early diagnosis, and expanding surveillance to maximise health outcomes and economic benefits, while tailoring strategies to each health system's unique resources and constraints. Methods: A mixed-methods approach was used, including expert consultations from the 2024 HCC APAC Policy Forum, a literature review, and a review of Japan's HCC management model. Data were collected through workshops and stakeholder feedback from healthcare professionals, policymakers, researchers and patient advocates across Australia, India, Malaysia, South Korea, Taiwan, Thailand, and Vietnam. Results: Key findings include significant disparities in HCC awareness, prevention, early detection, diagnosis, and access to treatment. Common challenges across APAC include limited public awareness, suboptimal surveillance infrastructure, and financial barriers to care. The integration of novel biomarkers and advanced surveillance modalities were identified as crucial priorities for improving early detection. Japan's multi-faceted approach to HCC management serves as a successful model for the region. Conclusions: A customised and targeted approach is essential for reducing the HCC burden across APAC. The proposed recommendations, tailored to each health system's needs, can significantly improve patient outcomes and reduce healthcare costs. Effective collaboration among stakeholders is necessary to drive these changes.

BackgroundThailand is classified by the World Health Organization (WHO) as a high tuberculosis-burden country with an expected that there are 120,000 TB incidences per year in 2016. Reported cases of tuberculosis among prisoners may account for 30% of tuberculosis with an incidence of 880-5,803 cases per 100,000 inmates in low- to middle-income countries. Beginning in 2017, an active case–finding strategy for tuberculosis was implemented in all prisons in Thailand. Mass chest radiograph screening is performed on all prisoners to identify and bring into treatment tuberculosis cases as soon as possible.Incidence of pulmonary tuberculosis among prisoners in Songkhla Province in the South of Thailand 2016-2023MethodsA retrospective descriptive study was conducted at Songkhla Provincial Hospital between 2016 and 2023. Inmates from four prisons in Songkhla Province were assessed by tuberculosis screening using mass chest radiographs yearly from 2017. If abnormal chest radiography revealed compatibility with tuberculosis, sputum microscopy and sputum GeneXpert were performed. Data were analyzed using descriptive statisticsResultsAfter implementing the active case-finding strategy in 2017, the incidence of pulmonary tuberculosis in prisons rose from 584 cases per 100,000 inmates in 2016 to 3,483 per 100,000 inmates in 2019. Then the trend declined to 2,264 per 100,000 inmates in 2021 and 1,982 per 100,000 inmates in 2023. Tuberculosis cases in the prisons accounted for 15% in 2016 and continued to rise to 60% in 2019 then decline to 41% in 2023 of all tuberculosis cases in Songkhla Province. Furthermore, sputum microscopy or GeneXpert detected tuberculosis positive between 10% and 16% of all tuberculosis cases in the four prisons. The rates of treatment success were 90%-94% and the case fatality rates were 11-58 cases per 100,000 inmates at the four prisons.ConclusionThe active case-finding strategy using mass chest radiography increases the early detection of tuberculosis cases and early treatment in prisons. After 3 years of implementing strategies, the incidence of pulmonary tuberculosis has declinedDisclosuresAll Authors: No reported disclosures

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

1) convened to address key topics pertinent to thoracic diagnostic imaging within both the private and public sectors.

Abstract Background Bleeding assessment tools (BATs) are used by trained medical personnel for screening bleeding disorders on a one-to-one basis with patients; hence, they are time consuming and limited its use for large population screening Objectives To develop, validate, and demonstrate a Thai version mobile application (mBAT) for self-screening of bleeding disorders Methods mBAT was developed and validated from the paper-based Thai pediatric bleeding questionnaire (TPBQ). Then, mBAT was applied to 916 subjects from communities and hematology clinics. Those with scores ≥ 3 were consented for further investigation of bleeding disorders. Results mBAT was developed for Thai children using simple sentences, video, pictures, and auto-calculation. It showed a high correlation with the TPBQ: r = 0.96 and 0.97 in the PBQ and ISTH scoring systems, respectively (P < 0.01). A score ≥ 3 was considered abnormal. The mBAT was applied to 916 subjects, with a mean (range) age of 10.5 (0.07-18.0) years. The majority of the subjects (97.3%) were from the community; and the rest (2.7%) were from hematology clinics. The results showed 41 subjects had abnormal scores, and 35 of them (16 from the community and 19 from clinics) consented for diagnostic investigation. Eleven subjects (31.4%) were found to have bleeding disorders, including four with VWD, two each with hemophilia A and thrombocytopenia, and one each with factor VII deficiency, platelet dysfunction, and MYH9-related disorder. Thus, the prevalence rates of bleeding disorders in the subjects whose score ≥ 3 from community and hematology clinics were 6.25% and 52.6%, respectively. Conclusion The mBAT had a high correlation with the TPBQ. As a self-screening tool, it could enhance the diagnosis of bleeding disorders.