Risk Prediction Model for Chronic Kidney Disease in Thailand Using Artificial Intelligence and SHAP.

Chronic kidney disease (CKD) is a multifactorial, complex condition that requires proper management to slow its progression. In Thailand, 11.6 million people (17.5%) have CKD, with 5.7 million (8.6%) in the advanced stages and >100,000 requiring hemodialysis (2020 report). This study aimed to develop a risk prediction model for CKD in Thailand. Data from 17,100 patients were collected to screen for 14 independent variables selected as risk factors, using the IBK, Random Tree, Decision Table, J48, and Random Forest models to train the predictive models. In addition, we address the unbalanced category issue using the synthetic minority oversampling technique (SMOTE). The indicators of performance include classification accuracy, sensitivity, specificity, and precision. This study achieved an accuracy rate of 92.1% with the top-performing Random Forest model. Moreover, our empirical findings substantiate previous research through highlighting the significance of serum albumin, blood urea nitrogen, age, direct bilirubin, and glucose. Furthermore, this study used the SHapley Additive exPlanations approach to analyze the attributes of the top six critical factors and then extended the comparison to include dual-attribute factors. Finally, our proposed machine learning technique can be used to evaluate the effectiveness of these risk factors and assist in the development of future personalized treatment.

Correlation Between Presurgical Alveolar Cleft Volume Measured by Simulation Software Using CBCT and Actual Bone Volume Used for Grafting.

OBJECTIVE: To assess correlation between presurgical alveolar cleft volume measured by simulation software using CBCT and actual bone volume used for grafting. DESIGN: Prospective. SETTING: University hospital. PATIENTS: Patients with UCCLP who underwent alveolar bone grafting. INTERVENTIONS: 23 CBCT images of patients with UCCLP, aged 8.6-22.9 years, were taken. Alveolar cleft volume was measured using Mimics® software. Paired t-test was used to compare volume calculated from two measuring methods. Independent t-test was used to compare the volume between two age groups. Pearson's correlation coefficient was used to assess correlation between two measuring methods. MAIN OUTCOME MEASURES: Paired t-test showed statistically significant difference between two measuring methods. Independent t-test showed statistically significant difference between both measuring methods in both age groups. Differences between two variables in both age groups were not significantly different. Pearson's correlation coefficient indicated significantly positive correlation between presurgical alveolar cleft volume measured by simulation software using CBCT and actual bone volume used for grafting. RESULTS: Mean alveolar cleft volume measured by computer simulation was 1.30 ± 0.40 ml, whereas actual bone volume used for grafting was 1.10 ± 0.39 ml. Mean difference between both measuring methods was 0.20 ± 0.14 ml. Mean alveolar cleft volume measured by simulation software, as well as actual bone volume used for grafting, differ significantly between 2 age groups. CONCLUSIONS: There was significantly positive correlation between two measuring methods. CBCT method overestimated actual bone graft volume. Surgeons may harvest alveolar bone grafts ranging from 82% to 100% of CBCT volume.

Role of booster vaccines and hybrid immunity against severe COVID-19 outcomes during BA.5 omicron predominance in Thailand.

Owing to both vaccine- and infection-induced immunity, the COVID-19 seroprevalence is ~90% in most countries. It is important to examine the protective role of booster vaccines and hybrid immunity in the COVID-endemic state. Utilizing a hospital information system for COVID-19, we conducted a cohort study by linking laboratory-confirmed COVID-19 case data to the national immunization records during the BA.5 omicron predominant period (1 August-31 December 2022) in Chiang Mai, Thailand. Out of 63,009 adults with COVID-19 included in the study, there were 125 (0.2%) severe COVID outcomes and 6.4% had a previous omicron infection. Protection against severe COVID-19 was highest among those with at least one booster vaccine (63%; aHR 0.37 [95%CI 0.19-0.73]) as compared to those without prior vaccination or natural infection. Hybrid immunity offered better protection (35%; aHR 0.65 [95%CI 0.09-4.73) than primary vaccine series alone or previous infection alone. Evaluating risk by age group, those aged 70 years or more had nearly 40 times (aHR 39.58 [95%CI 18.92-82.79]) the risk of severe-COVID-19 as compared to the 18-39-year age group. While booster vaccines remain the most effective way of protecting against severe COVID-19, particularly in the elderly, hybrid immunity may offer additional benefit.

Heterologous booster vaccines reduce severity and mortality in COVID-19 during BA.2 and BA.4/BA.5 omicron predominance in Thailand.

BACKGROUND: The COVID-19 pandemic has evolved quickly, with variants of concern resulting in the need to offer booster vaccinations. Unfortunately, the booster uptake has been slow and vaccine response has shown to wane over time. Therefore, it's critical to evaluate the role of vaccinations on outcomes with newer sub-lineages of omicron. METHODS: Utilising a Hospital Information System established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data of laboratory-confirmed COVID-19 cases to the national immunization records, during BA.2 and BA.4/BA.5 predominance. RESULTS: In adjusted cox-proportional hazard models, BA.4/BA.5 was not associated with more severe COVID-19 outcomes or deaths as compared to BA.2. Risk of severe outcomes and deaths were significantly reduced with third (87% and 95%) and fourth (88% and 95%) dose vaccination, while events were not observed with a fifth dose. Across the regimens, vaccination within 14-90 days prior showed the highest level of protection. All the vaccine types used for boosting in Thailand offered similar protection against severe COVID-19. CONCLUSIONS: Boosters provide high level of protection against severe COVID-19 outcomes and deaths with newer omicron sub-lineages. Booster campaigns should focus on improving coverage utilising all available vaccines to ensure optimal protection.

Predisposing factors of non-syndromic cleft lip and cleft palate in the northern Thai population: A 10-year retrospective case-control study.

The most common congenital anomaly is orofacial cleft, which is categorized into two main types: cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO). One of the most accepted etiologies is multifactorial (gene-environment). This study aimed to identify the amendable risk factors of an orofacial cleft in Northern Thailand. A retrospective case-control study in Maharaj Nakorn Chiang Mai Hospital was conducted from 2011 to 2020. One hundred and seventeen cases of CL/P and CPO were included. Forty-nine normal children were enrolled in a time-matched control group. Exploratory survey data on maternal exposures were collected. Multivariate logistic regression was used to estimate the adjusted association between maternal exposures and CL/P, and CPO occurrence. Multivariate analysis identified three predisposing factors that increased the risk of CL/P and CPO. The first factor was caffeine consumption with a total amount of 560 mg/week (adjusted OR: 7.59; 95% CI: 2.48-23.23; p < 0.001). The second factor was any smoker or passive smoking (adjusted OR: 8.47; 95% CI: 1.63-43.92; p = 0.011). The third factor was a low socioeconomic status (income of lower than 270 USD/month; adjusted OR: 4.05; 95% CI: 1.07-15.27; p = 0.039). From the 10-year study in Northern Thailand: caffeine consumption, exposure to cigarette smoke, and low socioeconomic status were identified as associated negative factors for orofacial clefts. We propose that preconceptional counseling for risk reduction should be emphasized in reducing the mother's exposure to these factors. Future investigations in large multicenter populations are suggested.

Waning vaccine response to severe COVID-19 outcomes during omicron predominance in Thailand.

BACKGROUND: The COVID-19 pandemic has evolved quickly, with different variants of concern resulting in the need to offer continued protection through booster vaccinations. The duration of enhanced protection with booster doses against severe COVID-19 is still unclear. Understanding this is critical to recommendations on the frequency of future booster doses. METHODS: Utilising a Hospital Information System for COVID-19 established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data of laboratory-confirmed COVID-19 cases to the national immunization records, during the omicron predominant period (1 February- 31 July 2022). RESULTS: Out of 261,103 adults with COVID-19 included in the study, there were 333 (0.13%) severe COVID-19 cases and 190 (0.07%) deaths. Protection against severe COVID-19 was highest with boosters received >14-60 days prior to positive test (93%) and persisted at >60-120 days (91%) but started to wane at >120-180 days (77%) and further at >180 days (68%). The rate of waning differed with age. Those ≥70 years showed faster waning of booster vaccine responses as compared to those aged 18-49 years, who retained good responses up to 180 days. Equivalent risk reduction against severe COVID-19 was seen with all the vaccine types used as boosters in Thailand. CONCLUSIONS: Booster doses provided high levels of protection against severe COVID-19 with omicron, up to 4 months. Repeat boosters will be required to continue protection beyond 4 months, particularly in the elderly. mRNA and viral vector vaccines can be used flexibly to improve booster coverage.

Reduction in severity and mortality in COVID-19 patients owing to heterologous third and fourth-dose vaccines during the periods of delta and omicron predominance in Thailand.

OBJECTIVES: The COVID-19 pandemic has evolved quickly, with different variants of concern resulting in the need for countries to offer booster vaccinations. Although studies have assessed homologous schedules in detail, the effectiveness of heterologous booster vaccine schedules against severity and mortality with newer variants remains to be explored fully. METHODS: Utilizing a Hospital Information System for COVID-19 established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data on laboratory-confirmed COVID-19 cases to the national immunization records, during delta-predominant and omicron-predominant periods. RESULTS: Compared to omicron, COVID-19 cases during the delta period were 10 times more likely to have severe outcomes and in-hospital deaths. During omicron, a third vaccine dose had an 89% reduced risk of both severe COVID-19 and death. The third dose received 14-90 days before the date of the positive test showed the highest protection (93%). Severe outcomes were not observed with the third dose during delta, and the fourth dose during the omicron period. All the vaccine types used for boosting in Thailand offered similar protection against severe COVID-19. CONCLUSION: Booster doses provided a very high level of protection against severe COVID-19 outcomes and deaths. Booster campaigns should focus on improving coverage by utilizing all available vaccines to ensure optimal protection.

Comparison of Preoperative Measurement Methods of Alveolar Cleft Volume Using Cone Beam Computed Tomography between Computer Simulation and Water Displacement Methods.

OBJECTIVE: To compare the use of a computer simulation by Mimics software and the water displacement method as means for measurement of alveolar cleft volume on cone beam computed tomography (CBCT) data. DESIGN: Prospective study. SETTLING: Institutional research. PATIENTS: Patients with unilateral complete cleft lip and palate (UCCLP) who would undergo alveolar bone grafting. INTERVENTIONS: CBCT images of twenty patients with UCCLP were included in the study. In the first method, the water displacement method was adopted to measure volume of plasticine filled in the alveolar cleft imprinted on 3D printed model of maxilla. In the second method a volumetric assessment function in Mimics software was adopted to measure volume of 3D virtual model of alveolar cleft constructed from CBCT images. A comparison on the alveolar cleft volumes derived from the two methods was assessed using the statistical paired t-test. MAIN OUTCOME MEASURE: The paired-t test showed no statistically significant difference between alveolar cleft volumes measured by the two methods (P = 0.075). RESULTS: Mean volume of the alveolar cleft measured by the water displacement method was 1.03 ± 0.31 ml whereas by the computer simulation using Mimics software the value was 1.00 ± 0.31 ml. The mean difference between the two methods was 0.03 ± 0.08 ml. CONCLUSION: The computer simulation by Mimics software as a means for measurement of alveolar cleft volume on CBCT data is as accurate as the measurement by the water displacement method.

Alterations in DNA Methylation in Orofacial Clefts.

Orofacial clefts are among the most common craniofacial anomalies with multifactorial etiologies, including genetics and environments. DNA methylation, one of the most acknowledged mechanisms of epigenetics, is involved in the development of orofacial clefts. DNA methylation has been examined in patients with non-syndromic cleft lip with cleft palate (nsCL/P) from multiple specimens, including blood, saliva, lip, and palate, as well as experimental studies in mice. The results can be reported in two different trends: hypomethylation and hypermethylation. Both hypomethylation and hypermethylation can potentially increase the risk of nsCL/P depending on the types of specimens and the specific regions on each gene and chromosome. This is the most up-to-date review, intending to summarize evidence of the alterations of DNA methylation in association with the occurrence of orofacial clefts. To make things straightforward to understand, we have systematically categorized the data into four main groups: human blood, human tissues, animal models, and the factors associated with DNA methylation. With this review, we are moving closer to the core of DNA methylation associated with nsCL/P development; we hope this is the initial step to find a genetic tool for early detection and prevention of the occurrence of nsCL/P.

Clinical and Genetic Studies of the First Monozygotic Twins with Pfeiffer Syndrome.

Objective: To report the clinical and radiographic findings and molecular etiology of the first monozygotic twins affected with Pfeiffer syndrome. Methods: Clinical and radiographic examination and whole exome sequencing were performed on two monozygotic twins with Pfeiffer syndrome. Results: An acceptor splice site mutation in FGFR2 (c.940-2A>G) was detected in both twins. The father and both twins shared the same haplotype, indicating that the mutant allele was from their father's chromosome who suffered severe upper airway obstruction and subsequent obstructive sleep apnea. Hypertrophy of nasal turbinates appears to be a newly recognized finding of Pfeiffer syndrome. Increased intracranial pressure in both twins were corrected early by fronto-orbital advancement with skull expansion and open osteotomy, in order to prevent the more severe consequences of increased intracranial pressure, including hydrocephalus, the bulging of the anterior fontanelle, and the diastasis of suture. Conclusions: Both twins carried a FGFR2 mutation and were discordant for lambdoid synostosis. Midface hypoplasia, narrow nasal cavities, and hypertrophic nasal turbinates resulted in severe upper airway obstruction and subsequent obstructive sleep apnea in both twins. Hypertrophy of the nasal turbinates appears to be a newly recognized finding of Pfeiffer syndrome. Fronto-orbital advancement with skull expansion and open osteotomy was performed to treat increased intracranial pressure in both twins. This is the first report of monozygotic twins with Pfeiffer syndrome.

Large Isolated Nasoorbital Type of Frontoethmoidal Encephalomeningocele: A Case Report With Long-Term Follow-up.

ABSTRACT: Frontoethmoidal encephalomeningocele (FEEM) is a rare congenital craniofacial malformation with increased incidence in Southeast Asia, especially in Thailand. Because of its rarity, main treatment obstacles include the lack of surgical treatment techniques and long-term postoperative follow-up data. The authors present the case of a 9-month-old boy who was born with a large isolated nasoorbital type of FEEM, which had a pressure effect on his right eye, nose, and facial complex. Preoperative computed tomography of the facial bone was performed to evaluate the external bony defect. This study aims to present surgical correction of FEEM with Chula's technique and long-term 7-year postoperative follow-up including both clinical and imaging aspects.

AUTOMATIC ICD-10 CODING USING PRESCRIBED DRUGS DATA.

This article discusses the emerging trends and challenges related to automatic clinical coding. We introduce an automatic coding system, which assigns short ICD-10 codes (restricted to the first three symbols, which define the category of the disease) based only on drugs prescribed to patients. We show that even with limited input data, the accuracy levels are comparable to those achieved by entry-level clinical coders as depicted by Seyed Nouraei et al.1 We also examine the standard method for performance estimation and speculate that the actual accuracy of our coding system is even higher than estimated.

Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol.

OBJECTIVES: To develop and evaluate a serious game to deliver knowledge about the cleft lip with or without cleft palate (CL/P) protocol used in Craniofacial Center, Chiang Mai University. METHODS: The game "Cleft Island" was developed then extensively evaluated using different criteria, including the measured knowledge gained by participants, and gameplay experience. A group of 53 fourth and fifth-year medical students (male: 24, female: 29) were recruited to take part in an experiment. They were from the Faculty of Medicine, Chiang Mai University, and had just rotated to the Department of Surgery. Three evaluations were conducted: 1) to test whether the players had competently gained CL/P knowledge; 2) to evaluate the usability of the game according to the System Usability Scale (SUS); and 3) to evaluate the game experience in terms of a Game Experience Questionnaire (GEQ) test. RESULTS: The results indicate a statistically significant improvement of medical students' knowledge after performing the Wilcoxon Signed-Ranks test (p < 0.5) between pre-test and post-test scores of the same medical student group; the acceptable average SUS score (M = 55.28) of the serious game; a moderate degree of experience of the GEQ components including positive affect (M = 2.64), competence (M = 2.49), and immersion (M = 2.21). CONCLUSIONS: Cleft Island can be used as an effective supplementary instructional material, which has the potential to provide significant knowledge of CL/P treatment protocol for the players. As far as the authors are aware, this is the first study to implement and assess a serious game for training in CL/P protocol.

Treatment of apert syndrome: a long-term follow-up study.

BACKGROUND: Patients with Apert syndrome have severe malformations of the skull and face requiring multiple complex reconstructive procedures. The authors present a long-term follow-up study reporting both surgical results and psychosocial status of patients with Apert syndrome. METHODS: A retrospective study was performed identifying patients with Apert syndrome treated between 1975 and 2009. All surgical procedures were recorded and a review of psychosocial and educational status was obtained when patients reached adulthood. RESULTS: A total of 31 patients with Apert syndrome were identified; nine with long-term follow-up had complete records for evaluation. The average patient age was 30.4 years. Primary procedures performed included strip craniectomy and fronto-orbital advancement. Monobloc osteotomy and facial bipartition were performed in eight patients, and all underwent surgical orthognathic correction. Multiple auxiliary procedures were also performed to achieve better facial symmetry. Mean follow-up after frontofacial advancement was 22.5 years. Psychosocial evaluation demonstrated good integration of patients into mainstream life. CONCLUSIONS: This report presents one of the longest available follow-up studies for surgical correction of patients with Apert syndrome. Although multiple reconstructive procedures were necessary, they play an important role in enhancing the psychosocial condition of the patients, helping them integrate into mainstream life.

Reducing lower extremity amputations due to diabetes: the application of diabetic-foot protocol in Chiang Mai University Hospital.

The aim of this study was to determine whether intensive treatment and education strategies for diabetic patients with ulcers help in preventing leg amputation. From August 2005 to March 2007, a diabetic-foot protocol using a multidisciplinary approach was applied at our hospital. All the subjects were educated regarding diabetic-foot disease and its complications and prevention. This report compares the amputation rate in patients receiving the protocol care from August 2005 to March 2007 with those who had standard care from August 2003 to July 2005. Seventy-three and 110 diabetic-foot ulcer patients received protocol and standard foot care, respectively. The incidence of major amputations in the protocol and standard care groups was 4.1% and 13.6%, respectively (P= .03). Our protocol was associated with improved diabetic-foot care outcomes. It can be used by any hospital to improve outcomes for patients with diabetes.