Leishmania Infection among HIV-Infected Patients in a Southern Province of Thailand: A Cross-Sectional Study.

Leishmaniasis, a neglected tropical disease, imposes a notable health burden, especially on immunocompromised individuals such as HIV patients. Recognizing its prevalence and risk factors in specific populations is vital for effective prevention. This study in Satun Province, southern Thailand, aimed to ascertain leishmaniasis prevalence and identify associated risks among HIV-infected patients. A cross-sectional study was conducted among 650 HIV-infected individuals at a tertiary care hospital. Data on demographic characteristics, clinical parameters, and potential risk factors were collected. Individual plasma, buffy coat, and saliva samples were collected. Leishmania infection was determined using the direct agglutination test and nested polymerase chain reaction (nPCR) of nPCR-buffy coat and nPCR-saliva. The association between risk factors and Leishmania infection was assessed with logistic regression analysis. The prevalence of Leishmania infection was 8.61% (56/650). Species was identified among 20 HIV-infected patients as follows: Leishmania orientalis (N = 14), Leishmania martiniquensis (N = 4), and Leishmania donovani complex (N = 2). The factors associated with Leishmania infection included age (adjusted odds ratio [OR] = 1.03), intravenous drug use (adjusted OR = 2.39), CD4 cell count <500 cells/mm3 (adjusted OR = 2.40), and a viral load ≥50 copies/mL (adjusted OR = 5.16). The prevalence of Leishmania infection among HIV-infected patients in Satun Province was considerable. These findings underscore the need for integrated care and targeted interventions to address this infection and improve public health outcomes. Further research and collaborative efforts are warranted to develop effective prevention and control strategies for Leishmania infection in the HIV-infected Thai population.

Low Genetic Diversity of Plasmodium vivax Circumsporozoite Surface Protein in Clinical Isolates from Southern Thailand.

The genetic diversity within the circumsporozoite surface protein (PvCSP) of Plasmodium vivax, the predominant malaria species in Thailand, is primarily observed in the northwestern region along the Thailand-Myanmar border. However, as P. vivax cases shift to southern provinces, particularly Yala Province near the Thailand-Malaysia border, PvCSP diversity remains understudied. Between 2018 and 2020, 89 P. vivax isolates were collected in Yala Province, a significant malaria hotspot. Employing polymerase chain reaction amplification, restriction fragment length polymorphism (PCR-RFLP), and DNA sequencing, the gene encoding PvCSP (Pvcsp) was analyzed. All Yala P. vivax isolates belonged to the VK210 type, distinct from strains in the western region near the Myanmar border. The central repeat region of Pvcsp revealed two common peptide repeat motifs-GDRADGQPA and GDRAAGQPA-across all southern isolates. Sequence analysis identified two subtypes, with S1 more prevalent (92%) than S2 (8%). This study underscores the limited diversity of VK210 variants of P. vivax populations in southern Thailand. These baseline findings facilitate monitoring for potential new parasite variants, aiding in the future control and management of P. vivax in the region.

Prognostic nomogram for uncontrolled type 2 diabetes using Thailand nation-wide cross-sectional studies.

BACKGROUND: Uncontrolled type 2 diabetes (T2DM) and limited hemoglobin A1c (HbA1c) levels examination are a burden in community hospitals in Thailand. The nomogram from the patients' information might be a practical solution to identify a high-risk group of diabetic complications. Thus, this study aimed to establish an effective prognostic nomogram for patients with uncontrolled T2DM. METHODS: Sequential nationwide cross-sectional studies of T2DM patients in 2018 and 2015 were utilized for development and validation groups, respectively, with this chronological order aiming to capture recent trends during development and assess the nomogram's robustness across diverse timeframes. The predictive outcome was uncontrolled T2DM, defined as HbA1c ≥9%. The model was determined by multivariable regression analysis and established an effective prognostic nomogram. The receiver operating characteristic curve, Hosmer-Lemeshow goodness of fit test, and decision curve analysis (DCA) was applied to evaluate the performance of the nomogram. RESULTS: In 2018, 24% of the 38,568 participants in the development group had uncontrolled T2DM (defined as Hba1c ≥9%). The predictive nomogram of uncontrolled diabetes consisted of demographic characteristics, prescription medications, history of diabetic complications, and laboratory results (C-statistic of 0.77). The goodness of fit test and DCA showed good agreement between the result and clinical application for T2DM. CONCLUSION: The predictive nomogram demonstrates simplicity, accuracy, and valuable prediction to enhance diabetic care in resource-limited countries, including Thailand.

Associations of triglyceride-glucose index with hyperuricemia among Royal Thai Army personnel.

BACKGROUND: Hyperuricemia has placed an immense burden on the global healthcare system. Studies have discovered a close correlation between serum uric acid (SUA) and insulin resistance (IR). The objective of this investigation is to examine the association between the triglyceride-glucose (TyG) index, a simple surrogate for IR, and the presence of hyperuricemia. METHODS: Between 2017 and 2021, an epidemiologic study was conducted on Royal Thai Army (RTA) personnel aged 35-60 years, involving a total of 231,286 participants. In the study, hyperuricemia was defined as a SUA level of 7 mg/dL and 6 mg/dL among male and female participants, respectively. Using linear regression analysis and logistic regression analysis, the association between the TyG index and SUA was determined. RESULTS: A positive relationship was demonstrated between the TyG index and the SUA. Overall, SUA increased by 0.32 per unit of TyG index growth (95% CI: 0.31-0.32). In comparison with the first quartile, employees in the fourth TyG quartile had a greater likelihood of having hyperuricemia [adjusted odds ratio (AOR): 2.45, 95% CI: 2.38-2.52]. Effect modification by obesity on the association between the TyG index and SUA was observed (P-interaction < 0.001). Among individuals with obesity, compared with the first TyG index quartile, the AOR for hyperuricemia was 2.15 (95% CI: 2.06-2.25) and 2.14 (95% CI: 1.81-2.53) for the fourth quartile of the TyG index for males and females, respectively. However, for nonobese personnel, in comparison to the top quartile of the TyG index, the AOR for hyperuricemia was 2.73 (95% CI:2.61-2.84) and 5.03 (95% CI: 4.03-6.29) for the fourth quartile of the TyG index for males and females, respectively. Personnel in the fourth TyG index quartile revealed that the prevalence of hyperuricemia reached 44.2%. CONCLUSION: A robust positive association between the TyG index and SUA was illustrated among active-duty RTA personnel. Obesity was identified as a modifier influencing this relationship. Furthermore, individuals in the fourth quarter of the TyG index, regardless of their obesity status, could be considered appropriate candidates for screening SUA levels.

An increase in urinary primaquine and a reduction in urinary primaquine-5,6-orthoquinone in the Thai population with CYP2D6 reduced enzyme function.

Objectives: Primaquine is metabolized by the cytochrome P450-2D6 enzyme (CYP2D6) to an active primaquine-5,6-orthoquinone (POQ). No relationships of CYP2D6 polymorphisms with the pharmacokinetics of primaquine and POQ were reported in the Thai population. Methods: We evaluated the genetic distribution of CYP2D6 in 345 Thai army populations together with the pharmacokinetic profiles of primaquine and POQ in plasma and urine (n = 44, descriptive data are presented in median (range)). All dose-related pharmacokinetic parameters were normalized by primaquine dose per body weight before statistical analysis. Results: CYP2D6*10 was the allele observed with the highest frequency (56.62%) corresponding to CYP2D6*10/*10 (32.94%) and CYP2D6*1/*10 (27.94%) genotypes. CYP2D6 intermediate metabolizers (CYP2D6 IM) were found in 44.41% of the cohort and had an increase in the cumulative amount of primaquine excreted (CAE) in urine compared to normal metabolizers of CYP2D6 (CYP2D6 NM); (CYP2D6 IM vs. CYP2D6 NM: 2444 (1697-3564) vs. 1757 (1092-2185) µg/mg/kg, p = 0.039), a reduction in urine CAE of POQ (CYP2D6 IM vs CYP2D6 NM: 115 (46-297) vs. 318 (92-498) µg/mg/kg, p = 0.047) and a reduction in the POQ/primaquine CAE ratio in urine (CYP2D6 IM vs. CYP2D6 NM: 0.06 (0.01-0.11) vs. 0.16 (0.06-0.26), p = 0.009). No significant differences were found in the pharmacokinetic profiles of plasma primaquine and POQ. Conclusions: The CYP2D6 polymorphisms influenced the changes in primaquine and POQ that were noticeable in the urine, supporting the role of the CYP2D6 gene testing before drug administration.

In vitro drug susceptibility using a parasite-rescue and transformation assay of Leishmania (Mundinia) martiniquensis and Leishmania (Mundinia) orientalis amastigotes against antileishmanial drugs.

Leishmaniasis is an emerging infectious disease in Thailand, with Leishmania martiniquensis and Leishmania orientalis identified as the primary causative agents among immunocompetent and immunocompromised individuals. Variations in drug susceptibility among different Leishmania species have been reported in different regions. Therefore, drug susceptibility assays are essential to assess the effectiveness of antileishmanial drugs used or potentially used in the affected areas. This study investigated the in vitro drug sensitivity of L. martiniquensis and L. orientalis, along with two reference species causing VL, namely L. donovani and L. infantum, against six antileishmanial drugs. Using a parasite-rescue and transformation assay, the results demonstrated that the IC50 values of amphotericin B (AmB), miltefosine (MIL), and sodium stibogluconate (Sb(III)) against all Leishmania species tested were within the sensitive range of each drug. On the contrary, the IC50 values of artemisinin (ART) and dihydroartemisinin (DHA), drugs primarily used for malaria treatment, were outside the sensitive range of the Leishmania species tested except L. infantum. This in vitro study highlights that AmB could effectively exhibit good sensitivity against the intracellular amastigotes of L. martiniquensis and L. orientalis. Also, MIL and Sb(III) could be considered alternative drugs for antileishmanial treatment in Thailand.

Genetic variation and geographic distribution of Leishmania orientalis and Leishmania martiniquensis among Leishmania/HIV co-infection in Thailand.

Since 1999, the number of asymptomatic leishmaniasis cases has increased continuously in Thailand, particularly among patients with HIV who are prone to develop symptoms of cutaneous and visceral leishmaniasis further. The asymptomatic infection could play a key role in Leishmania transmission and distribution. Understanding population structure and phylogeographic patterns could be crucially needed to develop effective diagnoses and appropriate guidelines for therapy. In this study, genetic variation and geographic distribution of the Leishmania/HIV co-infected population were investigated in endemic northern and southern Thailand. Interestingly, Leishmania orientalis was common and predominant in these two regions with common regional haplotype distribution but not for the others. Recent population expansion was estimated, probably due to the movement and migration of asymptomatic individuals; therefore, the transmission and prevalence of Leishmania infection could be underestimated. These findings of imbalanced population structure and phylogeographic distribution patterns provide valuable, insightful population structure and geographic distribution of Leishmania/HIV co-infection to empower prevention and control of transmission and expansion of asymptomatic leishmaniasis.

Identification of a unique conserved region from a kinetoplastid genome of Leishmania orientalis (formerly named Leishmania siamensis) strain PCM2 in Thailand.

Mitochondrial DNAs (mtDNAs) appear in almost all eukaryotic species and are useful molecular markers for phylogenetic studies and species identification. Kinetoplast DNAs (kDNAs) are structurally complex circular mtDNA networks in kinetoplastids, divided into maxicircles and minicircles. Despite several kDNAs of many Leishmania species being examined, the kDNAs of the new species, Leishmania orientalis (formerly named Leishmania siamensis) strain PCM2, have not been explored. This study aimed to investigate the maxicircle and minicircle DNAs of L. orientalis strain PCM2 using hybrid genome sequencing technologies and bioinformatic analyses. The kDNA sequences were isolated and assembled using the SPAdes hybrid assembler from the Illumina short-read and PacBio long-read data. Circular contigs of the maxicircle and minicircle DNAs were reconstructed and confirmed by BLASTn and rKOMICs programs. The kDNA genome was annotated by BLASTn before the genome comparison and phylogenetic analysis by progressiveMauve, MAFFT, and MEGA programs. The maxicircle of L. orientalis strain PCM2 (18,215 bp) showed 99.92% similarity and gene arrangement to Leishmania enriettii strain LEM3045 maxicircle with variation in the 12s rRNA gene and divergent region. Phylogenetics of the whole sequence, coding regions, divergent regions, and 12s rRNA gene also confirmed this relationship and subgenera separation. The identified 105 classes of minicircles (402-1177 bp) were clustered monophyletically and related to the Leishmania donovani minicircles. The kinetoplast maxicircle and minicircle DNAs of L. orientalis strain PCM2 contained a unique conserved region potentially useful for specific diagnosis of L. orientalis and further exploration of this parasite population genetics in Thailand and related regions.

Validation of quantitative loop-mediated isothermal amplification assay using a fluorescent distance-based paper device for detection of Escherichia coli in urine.

Uropathogenic Escherichia coli (UPEC) causes up to 90% of urinary tract infections (UTI) which is more prevalent among females than males. In urine, patients with symptomatic UTI usually have a high concentration of bacterial infection, ≥ 105 colony-forming units (CFU) per mL, in which the culture method is regularly the gold standard diagnosis. In this study, a simple and inexpensive distance-based paper device (dPAD) combined with the fluorescent closed tube LAMP assay was validated for simultaneously screening and semi-quantifying the infection level of E. coli in 440 urine samples of patients with UTI. The dPAD could measure the LAMP amplicons and semi-quantify the levels of E. coli infection in heavy (≥ 104 CFU/mL), light (≤ 103 CFU/mL) and no infection. The sensitivity and specificity had reliable performances, achieving as high as 100 and 92.7%, respectively. The one step LAMP assay could be performed within 3 h, which was 7.5 times faster than the culture method. To empower early UTI diagnosis and fast treatment, this inexpensive dPAD tool combined with the fluorescent closed tube LAMP assay is simple, reliably fast and practically portable for point-of-care settings, particularly in resource-limited areas, which can be set up in all levels of healthcare facilities.

Effect of the weight-loss program using daily self-weighing combined with personalized counseling led by village health volunteers in adults with obesity in a rural community, Thailand: a randomized controlled trial.

BACKGROUND: In a remote rural community in central Thailand, obesity prevalence among adults significantly rose from 33.9% in 2012 to 44.8% in 2018. Limited information on weight reduction studies in Thai rural communities was available. The present study aims to evaluate the effect of daily self-weighing combined with personalized counseling in order to reduce body weight (BW) and body mass index (BMI) as well as blood pressure (BP). METHODS: A randomized controlled trial was carried out in a rural community in central Thailand. One-hundred and seven adults were randomly allocated (1:2) to intervention and control groups. For 20 weeks, participants in the weight-loss program performed self-weighing twice daily and recorded their weight on the calendar. The program also offers weekly counseling visits by village health volunteers (VHV) who make home visits to participants. The primary outcomes were differences in mean change in BW at 20 weeks from baseline between the intervention and control groups. RESULTS: A total of 107 participants were initially recruited. Of these, 36 participants were allocated to the intervention group and 57 participants to the control group. Significant differences in mean change in BW and BMI at the twelve-, sixteen-, and twenty-week follow-up from baseline between the two groups were observed. At twenty weeks, the mean change in BW was -1.2 kg (95% CI: -2.2, -0.3) and 0.3 kg (95% CI: -0.3, 0.8) in the intervention and control groups, respectively, with p-value = 0.007. Over 20 weeks of the study period, the estimated mean change in BW among the intervention group was 1.0 kg (95% CI -1.7, -0.2) lower than in the control group, with p-value = 0.015. Furthermore, changes in mean BMI and BP over the 20-week follow-up period in intervention participants were recognized. CONCLUSIONS: Our study demonstrates that daily self-weighing combined with personalized counseling led by VHV is feasible and can induce weight loss among adults with obesity in a rural community. In addition, the weight-loss program may be a promising additional tool for reducing BP. TRIAL REGISTRATION: Trial identification number was TCTR20201020004; first submitted date: 20/10/2020.

Trends in Serum Total Cholesterol and High Total Cholesterol Prevalence Among Royal Thai Army Personnel in Thailand, 2017-2022.

INTRODUCTION: High total cholesterol (TC) is a robust-documented risk factor for atherosclerosis cardiovascular diseases. Approximately one-fourth (23.5%) of Thai civilians had high TC. However, the information on high TC among the Royal Thai Army (RTA) personnel is limited. AIM: The study aimed to identify the trends in serum TC and high TC prevalence among RTA personnel from 2017 to 2022. METHODS: A serial cross-sectional study from 2017 to 2022 was conducted. A total of 318,353 active-duty RTA personnel aged 35-60 years were included in the study. High TC was defined as fasting TC ≥ 240 mg/dL. A multivariable log-binomial regression analysis was performed to investigate factors associated with high TC. RESULTS: The overall age- and sex-adjusted high TC prevalence was 26.3% in 2017 and dropped to 22.9% in 2020; then, it increased to 26.4% in 2022 (p for quadratic trend < 0.001). Younger-aged RTA personnel have significantly rising trends in sex-adjusted high TC prevalence over 6 years. In the south, the age- and sex-adjusted high TC prevalence was 24.4% in 2017 and substantially rose to 33.6% in 2022 (p for quadratic trend < 0.001). Meanwhile, in the northeast, it rose by 3.6% over 6 years. High body mass index, high blood pressure, and hyperglycemia were associated with high TC prevalence among this population. CONCLUSION: High TC was a common essential health issue among RTA personnel. Rising trends in mean serum TC and high TC prevalence from 2017 to 2022 were discovered, especially in younger participants and those residing in the south and northeast.

Trends in baseline triglyceride-glucose index and association with predicted 10-year cardiovascular disease risk among type 2 diabetes patients in Thailand.

Triglyceride-glucose (TyG) index is an independent risk factor for cardiovascular diseases (CVD). Our study determined the trends of the TyG index and its relationship to predicted CVD risk among patients with type 2 diabetes (T2D). A serial cross-sectional study was conducted including 63,815 participants with T2D aged 30-74 years without a history of CVD. The predicted CVD risk was based on the Framingham Heart Study (FHS). The receiver operating characteristic (ROC) curve was utilized for identifying the cutoff point of TyG index to predict intermediate-to-high CVD risk. The relationship between TyG index and predicted CVD risk was tested using linear and logistic regression. Decreasing trends of TyG index were observed between 2014 and 2018 (p < 0.001). ROC curve analysis of the TyG index indicated an AUC of 0.57 (95% CI 0.56-0.57, p < 0.001) in predicting intermediate-to-high predicted CVD risk, with a cutoff value of TyG index > 9.2 (sensitivity of 55.7%, specificity of 46.8%). An independent relationship between the TyG index and predicted CVD risk was observed. High TyG index was independently associated with intermediate-to-high predicted CVD risk. From our study, the TyG index was positively related to predicted 10-year CVD risk. However, the predictive ability of the TyG index in predicting the intermediate-to-high predicted 10-year CVD risk among patients with T2D remained questionable.

Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand.

BACKGROUND: Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel. METHODS: A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m2 was classified as obesity I, whereas BMI ≥ 30.0 kg/m2 was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI. RESULTS: A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m2, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m2, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively. CONCLUSION: PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.

Incidence and risk factors of warfarin therapy complications in community hospitals, central and eastern regions, Thailand: a retrospective, multicenter, cohort study.

OBJECTIVES: Warfarin, like many other anticoagulants, has been linked to an elevated risk of bleeding proportional to the amount of anticoagulation used. Not only was the incidence of bleeding raised by the dosage, but the subtherapeutic international normalized ratio (INR) was also associated with increased thrombotic events. This retrospective cohort and multi-center study evaluated the incidence and risk factors of warfarin therapy complications in community hospitals in Thailand's central and eastern regions from 2016 to 2021. RESULTS: Among 335 patients (683.90 person-year of follow-up), The incidence rate of warfarin complications was 4.91 events per 100 person-year. The independent factor associated with warfarin therapy complications was propranolol prescription (Adjusted RR: 2.29, 95%CI: 1.12-4.71). The secondary analysis was divided according to the outcome of the major bleeding and thromboembolic event. Major bleeding events, hypertension (Adjusted RR: 0.40, 95%CI: 0.17-0.95), amiodarone prescription (Adjusted RR: 5.11, 95%CI: 1.08-24.15), and propranolol prescription (Adjusted RR: 2.86, 95%CI: 1.19-6.83) were the independent risk factors. While in the major thrombotic event, non-steroidal anti-inflammatory drugs (NSAIDs) prescription was an independent factor (Adjusted RR: 10.65, 95%CI: 1.26-90.35).

Trends in predicted 10-year risk for cardiovascular diseases among patients with type 2 diabetes in Thailand, from 2014 to 2018.

BACKGROUND: Cardiovascular diseases (CVD) are the leading causes of death globally, including Thailand. Approximately one-tenth of Thai adults have type 2 diabetes (T2D), a significantly increasing CVD. Our study aimed to determine the trends of predicted 10-year CVD risk among patients with T2D. METHODS: A series of hospital-based cross-sectional studies were conducted in 2014, 2015 and 2018. We included Thai patients with T2D aged 30-74-year-old without a history of CVD. The predicted 10-year risk for CVD was calculated based on Framingham Heart Study equations both with simple office-based nonlaboratory and laboratory-based. Age- and sex-adjusted means and proportions of predicted 10-year risk for CVD were calculated. RESULTS: A total of 84,602 patients with T2D were included in the present study. The average SBP among study participants was 129.3 ± 15.7 mmHg in 2014 and rose to 132.6 ± 14.9 mmHg in 2018. Likewise, the average body mass index was 25.7 ± 4.5 kg/m2 in 2014 and elevated to 26.0 ± 4.8 kg/m2 in 2018. The age- and sex-adjusted mean of the predicted 10-year CVD risk (simple office-based) was 26.2% (95% CI: 26.1-26.3%) in 2014 and rose to 27.3% (95% CI: 27.2-27.4%) in 2018 (p-for trend < 0.001). While the age- and sex-adjusted mean of the predicted 10-year CVD risk (laboratory-based) ranged from 22.4-22.9% from 2014 to 2018 (p-for trend < 0.001). The age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (simple office-based) was 67.2% (95% CI: 66.5-68.0%) in 2014 and significantly rose to 73.1% (95% CI: 72.4-73.7%) in 2018 (p-for trend < 0.001). Nevertheless, the age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (laboratory-based) ranged from 46.0-47.4% from 2014 to 2018 (p-for trend = 0.405). However, among patients with available laboratory results, a significantly positive correlation was noted between predicted 10-year CVD risk, simple office-based and laboratory-based (r = 0.8765, p-value < 0.001). CONCLUSION: Our study demonstrated significant rising trends in the predicated 10-year CVD risk among Thai patients with T2D. In addition, the results empowered further improved modifiable CVD risks, especially regarding high BMI and high blood pressure.

Relationship between triglyceride-glucose index and aminotransferase among Royal Thai Army personnel 2017-2021: a serial cross-sectional study.

BACKGROUND: Insulin resistance (IR) is a major pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity to assess IR and NAFLD due to its simplicity and low cost. The aim of the current study was to evaluate the relationship between the TyG index and aminotransferase. METHODS: A serial cross-sectional study was conducted among 232,235 Royal Thai Army (RTA) personnel aged 35-60 years from 2017-2021. Elevated aminotransferase was defined as ≥ 40 U/L and ≥ 35 U/L among males and females, respectively. A linear regression analysis between the TyG index and log-transformed aminotransferase was performed. High- and low-TyG index groups were divided according to Youden's index cut point for predicting elevated aminotransferase. Multivariable logistic analysis was also utilized to investigate the association between the TyG index and elevated aminotransferase. RESULTS: The TyG index revealed a dose‒response relationship with log-transformed aminotransferase in both sexes and all age groups. The TyG index was positively associated with the prevalence of elevated aminotransferases. In comparison with the first TyG quartile (< 8.37), participants in the fourth quartile (> 9.23) had a higher chance for elevated ALT (AOR: 2.81, 95% CI: 2.71-2.90 for males and AOR: 4.01, 95% CI: 3.50-4.60 for females, P < 0.001 for both). In the fourth TyG quartile, the prevalence of elevated ALT was 47.8% and 40.2% in the participants aged 35-44 and male participants, respectively. CONCLUSION: A high TyG index is a novel risk factor for elevated aminotransferase among RTA personnel. Those with a high TyG index should be screened for elevated aminotransferase, particularly males aged 35-44 years.

Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021.

Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.

Current prevalence and geographic distribution of helminth infections in the parasitic endemic areas of rural Northeastern Thailand.

BACKGROUND: Helminth infection is a global health issue that not only causes acute helminthiasis but long-term infection may lead to complicated symptoms as well as severe complications. The World Health Organization cooperated with the Ministry of Public Health in many countries, particularly where high prevalence, spending a lot of resources for limiting the infection. In Thailand, the incidence of parasitic helminth infections was continuously declined in the last few decades according to several campaigns for parasitic elimination. However, the rural community in the northeast of Thailand where the highest prevalence of the country still needs to be monitored. This present study aims to report the current prevalence of parasitic helminth infections in Nakhon Ratchasima and Chaiyaphum provinces where sharing a huge area of the northeastern region of Thailand but only a few studies have been published. METHODS: The stool specimens were collected from 11,196 volunteers and processed by modified Kato-Katz thick smear, PBS-ethyl acetate concentration techniques, and PCR. The epidemiological data were collected, analyzed, and used for generating of parasitic hotspots. RESULTS: The results indicated that O. viverrini remains the major parasite in this area with a total prevalence of 5.05% followed by Taenia spp., Hookworms, T. trichiura, and Echinostoma spp., respectively. Mueang district of Chaiyaphum province has the highest prevalence especially O. viverrini with a prevalence of 7.15% that higher than the latest national surveillance. Interestingly, the prevalence of O. viverrini was hugely reported (more than 10%) in five subdistricts. The geographic localization of O. viverrini infections revealed that a lot of water reservoirs such as the lakes or branches of the river in the two-most prevalent subdistricts. Our finding indicated that gender and age were insignificantly different. CONCLUSION: This finding suggested that the parasitic helminth infection in the rural areas of northeast of Thailand remains high and the housing location is a major contributing factor for the parasitic infection.

Association between raised blood pressure and elevated serum liver enzymes among active-duty Royal Thai Army personnel in Thailand.

BACKGROUND: The relationship between hypertension (HT) and serum liver enzymes was reported in a few studies, but the findings were inconsistent. Therefore, the present study aimed to identify the association between elevated serum liver enzymes and raised BP through the use of a large sample of Royal Thai Army (RTA) personnel. METHODS: The dataset obtained from the annual health examination database of RTA personnel in Thailand was utilized. A total of 244,281 RTA personnel aged 35-60 were included in the current study. Elevated serum liver enzymes were defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 40 U/L in males and ≥ 35 U/L in females. HT was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg. A multivariable linear regression model was used to estimate the coefficient and 95% confidence intervals (CI), whereas a multivariable logistic regression model was applied to estimate adjusted odds ratios (AORs) and 95% CI for the association between raised BP and serum liver enzymes. RESULTS: Compared to individuals with SBP < 120 and DBP < 80 mmHg, the ß coefficients of log-transformed AST and ALT were 0.13 (95% CI: 0.12-0.13) and 0.11 (95% CI: 0.11-0.12) in males with HT. Meanwhile, the ß  coefficients of log-transformed AST and ALT were 0.03 (95% CI: 0.02-0.04) and 0.07 (95% CI: 0.05-0.08) in females with HT. In males, HT was associated with elevated AST (AOR: 1.92; 95% CI: 1.85-2.01) and elevated ALT (AOR: 1.43; 95% CI: 1.38-1.48). On the other hand, in females, HT was associated with elevated AST (AOR: 1.42; 95% CI: 1.21-1.66) and elevated ALT (AOR: 1.38; 95% CI: 1.21-1.57). CONCLUSION: Raised BP was positively correlated with elevated AST and ALT in active-duty RTA personnel. Moreover, HT was independently attributed to higher odds of elevated AST and ALT in comparison to optimal BP in both males and females. Furthermore, the relationship between serum liver enzymes and BP was modified by sex.

In vitro activity of rhinacanthin analogues against drug resistant Plasmodium falciparum isolates from Northeast Thailand.

BACKGROUND: New anti-malarial drugs are needed urgently to address the increasing challenges of drug-resistant falciparum malaria. Two rhinacanthin analogues containing a naphthoquinone moiety resembling atovaquone showed promising in-vitro activity against a P. falciparum laboratory reference strain (K1). The anti-malarial activity of these 2 compounds was further evaluated for P. falciparum field isolates from an area of multi-drug resistance in Northeast Thailand. METHODS: Using a pLDH enzyme-linked immunosorbent assay, four P. falciparum isolates from Northeast Thailand in 2018 were tested for in vitro sensitivity to the two synthetic rhinacanthin analogues 1 and 2 as well as established anti-malarials. Mutations in the P. falciparum cytochrome b gene, a marker for atovaquone (ATQ) resistance, were genotyped in all four field isolates as well as 100 other clinical isolates from the same area using PCR-artificial Restriction Fragment Length Polymorphisms. Pfkelch13 mutations, a marker for artemisinin (ART) resistance, were also examined in all isolates. RESULTS: The 50% inhibitory concentrations (IC50) of P. falciparum field isolates for rhinacanthin analogue 1 was 321.9-791.1 nM (median = 403.1 nM). Parasites were more sensitive to analogue 2: IC50 48.6-63.3 nM (median = 52.2 nM). Similar results were obtained against P. falciparum reference laboratory strains 3D7 and W2. The ART-resistant IPC-5202 laboratory strain was more sensitive to these compounds with a median IC50 45.9 and 3.3 nM for rhinacanthin analogues 1 and 2, respectively. The ATQ-resistant C2B laboratory strain showed high-grade resistance towards both compounds (IC50 > 15,000 nM), and there was a strong positive correlation between the IC50 values for these compounds and ATQ (r = 0.83-0.97, P < 0.001). There were no P. falciparum cytochrome b mutations observed in the field isolates, indicating that P. falciparum isolates from this area remained ATQ-sensitive. Pfkelch13 mutations and the ring-stage survival assay confirmed that most isolates were resistant to ART. CONCLUSIONS: Two rhinacanthin analogues showed parasiticidal activity against multi-drug resistant P. falciparum isolates, although less potent than ATQ. Rhinacanthin analogue 2 was more potent than analogue 1, and can be a lead compound for further optimization as an anti-malarial in areas with multidrug resistance.