Current perspectives on opisthorchiasis control and cholangiocarcinoma detection in southeast asia (Review)

Similar to bile duct cancer or cholangiocarcinoma (CCA) in the western world, opisthorchiasis-associated CCA in Southeast Asia is an aggressive cancer with high mortality rates. It is known to cause a significant health burden in the opisthorchiasis region in Thailand and possibly throughout mainland Southeast. To reduce this health burden, a comprehensive prevention and control program for opisthorchiasis, as well as CCA, is required. In this review, our aim is to provide a brief update of the current situation regarding the natural history of opisthorchiasis and health burden of CCA in Southeast Asia. A comprehensive approach to tackling these issues being implemented in Thailand under the "Cholangiocarcinoma Screening and Care Program" is described. This comprehensive program consists of a three stage prevention and patient care program. The primary prevention component involves opisthorchiasis screening using a new and sensitive urine assay. The secondary prevention component involves screening for CCA and periductal fibrosis, with suspected CCA patients following the protocol for confirmation and appropriate treatment. Due to the eco-epidemiology of opisthorchiasis-induced CCA, the anticipated impacts and outcomes of the program include short-, medium-, and the long-term goals for the reduction of CCA incidence. To achieve long-term sustainable impacts, concerted efforts to raise social awareness and participating action by general public, non-government organizations, and government agencies are necessary. The strategic plans developed for this program can be expanded for use in other endemic areas as well as being a model for use in other chronic diseases

The outcomes of midline versus medio-lateral episiotomy

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Elevated Plasma IL-6 Associates with Increased Risk of Advanced Fibrosis and Cholangiocarcinoma in Individuals Infected by Opisthorchis viverrini

Opisthorchis viverrini is considered among the most important of the food-borne trematodes due to its strong association with advanced periductal fibrosis and bile duct cancer (cholangiocarcinoma). We investigated the relationship between plasma levels of Interleukin (IL)-6 and the risk of developing advanced fibrosis and bile duct cancer from chronic Opisthorchis infection. We show that IL-6 circulates in plasma at concentrations 58 times higher in individuals with advanced fibrosis than age, sex, and nearest-neighbor matched controls and 221 times higher in individuals with bile duct cancer than controls. We also observed a dose-response relationship between increasing levels of plasma IL-6 and increasing risk of advanced fibrosis and bile duct cancer; for example, in age and sex adjusted analyses, individuals with the highest quartiles of plasma IL-6 had a 19 times greater risk of developing advanced periductal fibrosis and a 150 times greater risk of developing of bile duct cancer than individuals with no detectable level of plasma IL-6. Finally, we show that a single plasma IL-6 measurement has excellent positive predictive value for the detection of both advanced bile duct fibrosis and bile duct cancer in regions with high O. viverrini transmission. These data support our hypothesis that common mechanisms drive bile duct fibrosis and bile duct tumorogenesis from chronic O. viverrini infection. Our study also adds a unique aspect to the literature on circulating levels of IL-6 as an immune marker of hepatobiliary pathology by showing that high levels of circulating IL-6 in plasma are not related to infection with O. viverrini, but to the development of the advanced and often lethal pathologies resulting from chronic O. viverrini infection

POS0849 DEVELOPMENT AND VALIDATION OF A MACHINE LEARNING FOR MORTALITY IN THAI SYSTEMIC SCLEROSIS

BackgroundClinical predictors of mortality in systemic sclerosis (SSc) are diversely reported due to different healthcare conditions and populations. A universal and simplified predictive model for SSc mortality is needed so that practitioners can be used for managing their patients appropriately.ObjectivesWe aimed to develop and validate a simple predictive model for predicting mortality among patients with SSc.MethodsPrognostic research with a historical cohort study design was conducted between January 1, 2013, and December 31, 2019, in adult SSc patients and attending the Scleroderma Clinic at a university hospital in Thailand. The data were extracted from the Scleroderma Registry Database. A deep learning algorithm with Adam optimizer and different machine learning algorithms (including Decision tree, AdaBoost, Random Forest, Gradient Boosting, and XGBoost) was used to classify SSc mortality. In addition, the model’s performance was evaluated using the area under the receiver operating characteristic curve (auROC) and its 95% confidence interval (CI) and values in the confusion matrix.ResultsThe analysis and predictive model development included 658 SSc patients, 416 (63.2%) females, 452 (69.1%) had dcSSc, and 218 died. The final model included the modified Rodnan skin score (mRSS) and the WHO functional class (WHO-FC) ≥II (model 1). The final model provided the highest predictive performance, followed by model 2 (mRSS and WHO-FC ≥III). After internal validation, the accuracy and auROC were good, and the specificity was high in models 1 and 2 (81.1%, 0.84, and 95.5% in model 1 vs. 82.7%, 0.82, and 87.1% in model 2).Table 1.Generalizability of selected model(s) presented as accuracy, area under ROC, positive predictive value, positive likelihood ratio, specificity, and sensitivitySelected ModelAccuracyAUC (95%)PPV (95%)+LR (95%CI)Specificity (95%)Sensitivity (95%)Model 1 mRSS and WHO FC ≥ II81.183.6 (77.5 – 89.6)84.6 (69.5 - 94.1)11.3 (5.0-25.7)95.5 (90.4 - 98.3)51.6 (38.7 - 64.2)Model 2 mRSS and WHO FC ≥ III82.782.4 (75.8 - 88.9)73.4 (60.9 - 83.7)5.7 (3.6-9.187.1 (87.2 - 92.3)73.4 (60.9 - 83.7)95%CI 95% confidence interval, AUC Area Under the receiver operating characteristics (ROC), mRSS modified Rodnan skin scoreConclusionThis simplified machine learning model for predicting mortality among patients with SSc could guide early referrals to specialists and help rheumatologists with close monitoring and management planning. External validation across multi-SSc clinics should be considered for further study.References[1]Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine (Baltimore). 2002;81(2):139–53.[2]Rubio-Rivas M, Royo C, Simeón CP, Corbella X, Fonollosa V. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum. 2014;44(2):208–19.[3]Foocharoen C, Peansukwech U, Mahakkanukrauh A, Suwannaroj S, Pongkulkiat P, Khamphiw P, et al. Clinical characteristics and outcomes of 566 Thais with systemic sclerosis: A cohort study. Int J Rheum Dis. 2020;23(7):945–57.[4]Tyndall AJ, Bannert B, Vonk M, Airò P, Cozzi F, Carreira PE, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010;69(10):1809–15.[5]Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.[6]Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A, et al. Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis. 2017;76(11):1897–905.[7]Wangkaew S, Prasertwitayakij N, Phrommintikul A, Puntana S, Euathrongchit J. Causes of death, survival and risk factors of mortality in Thai patients with early systemic sclerosis: inception cohort study. Rheumatol Int. 2017;37(12):2087–94.AcknowledgementsThe authors thank (a) Thailand’s National Science, Research, and Innovation Fund for funding support, (b) the Scleroderma Research Group for research assistance, and (c) Mr. Bryan Roderick Hamman—under the aegis of the Publication Clinic Khon Kaen University, Thailand—for assistance with the English-language presentation.Disclosure of InterestsChingching Foocharoen Speakers bureau: By Boeringer Ingelheim, Bandit Thinkhamrop: None declared, Wilaiphorn Thinkhamrop: None declared, Nathaphop Chaichaya: None declared, Ajanee Mahakkanukrauh Speakers bureau: By Boeringer Ingelheim, Norvatis, Johnson &amp; Johnson, Siraphop Suwannaroj Speakers bureau: By Boeringer Ingelheim, Johnson &amp; Johnson, Norvatis</jats:sec

Methodological issues in conducting a survey of construction workers in Northeastern Thailand

Social and health problems among the construction workers in Thailand were studied in a multicenter cross-sectional survey. This paper documents methodological issues related to conducting the survey in the northeastern Thailand. These issues include defining suitable sampling frames for building sites and workers and collecting data. A number of practical problems and the approaches to solve them are discussed