Background: Most Thai patients with systemic sclerosis (SSc) have diffuse cutaneous SSc (dcSSc) unlike most Caucasians and some Asians. A longitudinal cohort study among Thai dcSSc is needed. Objectives: We aimed to determine the overall clinical characteristics, define the clinical difference between limited cutaneous SSc (lcSSc) and dcSSc, and ascertain the mortality rate and the factors associated with mortality. Method: We conducted a cohort study including 566 Thai adult SSc patients between January 2013 and June 2019. Clinical difference between lcSSc and dcSSc was investigated using generalized estimating equations (GEE). Results: Females presented more than males (356 vs 210 cases). The majority of cases were dcSSc (411; 72.6%). The median duration of disease at the time of pulmonary fibrosis (PF) detection was 2.5 years, pulmonary arterial hypertension 8.1 years, and renal crisis 4.1 years. By GEE analysis, dcSSc was significantly associated with salt-and-pepper skin, hand deformity, and every 1-point increase in modified Rodnan skin score (mRSS). A greater mortality risk was associated with age at onset >60 years (hazards ratio [HR] 5.5), a World Health Organization functional class (FC) III (HR 5.1), FC IV (HR 34.8), edematous skin (HR 11.4), early onset of PF (HR 1.7), each 5-point increase in the mRSS (HR 4.5), and ≥2 internal organ involvements (HR 10.1). Conclusion: dcSSc is a common SSc subset among Thais. PF was an early complication in SSc and earlier PF detection was associated with a poorer prognosis. Elderly onset, high FC, severe skin tightness, and multiple organ involvements were associated with a greater mortality risk.

BackgroundThere are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods.Materials and methodsWe retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS.ResultsWe included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67–75) years and the median LOS was 5 (4–7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4–13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01–1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09–1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60–0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02–1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67–0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02–1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30–1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14–1.74], P=0.001).ConclusionAccording to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.

Background: This model demonstrated the correlation between lung cancer incidences and the parts of ambient air pollution according to the National Aeronautics and Space Administration (NASA)'s high resolution technology satellites. Methods: Chemical type of aerosols was investigated by the Aerosol Diagnostics Model such as black carbon, mineral dust, organic carbon, sea-salt and SO4. The model investigated associations between the six year accumulation of each aerosol and lung cancer incidence by Bayesian hierarchical spatio-temporal model. Which also represented integrated geophysical parameters. Results: In analyses of accumulated chemical aerosol component from 2010 -2016, the incidence rate ratio (IRR) of patients in 2017 were estimated. We observed a significant increasing risk for organic carbon exposure (IRR 1.021, 95%CI 1.020-1.022), SO 4 , (IRR 1.026, 95% CI 1.025-1.028) and dust, (IRR 1.061, 95% CI 1.058-1.064). There was also suggestion of an increased risk with, every 1 ug/m 3 increase in organic carbon compound is associated with 21% increased risk of lung cancer, whereas a 26% excess risk of cancer per 1 ug/m 3 increase in mean SO 4 and 61% increased risk of lung cancer for dust levels. The other variables were the negative IRR which did not increase the risk of the exposed group. Conclusion: With our results, this process can determine that organic carbon, SO 4 and dust was significantly associated with the elevated risk of lung cancer.

This research examined the relationship between colon cancer risks and pollution in various areas of Thailand, using satellites to gather quantities of aerosols in the atmosphere. Bayesian hierarchical spatio-temporal model and the Poisson log-linear model were used to examine the incidence rates of colon cancer standardized by national references; from the database of the National Health Security Office, Ministry of Public Health of Thailand and NASA’s database from aerosol diagnostics model. Modern-Era Retrospective Analysis for Research and Applications, Version 2 (MERRA-2) was used to explore disease-gender-specific spatio-temporal patterns of colon cancer incidences and accumulated air pollution-related cancers in Thailand between 2010 and 2016. A total of 59,605 patients were selected for the study. Due to concerns regarding statistical reliability between aerosol diagnostics model and colon cancer incidences, the posterior probabilities of risk appeared the most in dust PM2.5. It could be interpreted as relative risk in every increase of 10 μg/m3 in black carbon, organic carbon, and dust-PM2.5 levels were associated respectively with an increase of 4%, 4%, and 15% in the risks of colon cancer. A significant increase in the incidence of colon cancer with accumulated ambient air quality raised concerns regarding the prevention of air pollution. This study utilized data based on the incidences of colon cancer; the country’s database and linked cancer data to pollution. According to the database from NASA’s technology, this research has never been conducted in Thailand.

Occupational and environmental associations with systemic sclerosis (SSc) have been confirmed; however, the association between aerosol components and mortality is uncertain. The study aimed to define the association between aerosol components and hospital mortality among Thai SSc patients. A study was conducted using a national database of patients covered by the National Health Security Office, hospitalised between 2014 and 2018. Data included all patients over 18 having a primary diagnosis of SSc (ICD-10: M34). Spatial resources used map information based on GPS coordinates of Thailand. Aerosol components—including organic carbon, black carbon, dust particulate matter diameter < 2.5 µm (PM2.5), and sulfate—were assessed using the NASA satellite MERRA-2 Model M2TMNXFLX v5.12.4. Spatial modelling with R Package Integrated Nested Laplace Approximation (R-INLA) was used to analyse the association between the incidence of mortality and the 5-year accumulation of each aerosol component adjusted by age, sex, and comorbid diseases. The study included 2,094 SSc patients with 3,684 admissions. Most (63.8%) were female. During admission, 1,276 cases died. R-INLA analysis indicated an increase of 1 µg/m3 of dust PM2.5 was associated with a respective increase in the risk of overall mortality and death due to pneumonia of 96% and 79%. An increase of 1 µg/m3 of dust PM2.5 resulted in 1.17, 1.18, 1.64, and 2.15 times greater risk of mortality due to pulmonary fibrosis, cardiac involvement, renal involvement, and cancer, respectively. Aerosol components—particularly dust PM2.5 exposures—increased the risk of overall, cardio-pulmonary-renal, and cancer mortality among SSc patients.