RAYONG OIL SPILL CLEANUP WORKERS EXPOSURE AND SYMPTOM ASSESSMENT

In July of 2013, a pipeline connecting an offshore oil platform to a tanker, operated by PTT Global Chemical (PTTGC), a corporation owned by the government of Thailand, leaked and caused crude oil to spill into the Sea of Rayong off the coast of Thailand. The crude oil covered an area of approximately 20 square kilometers and washed ashore on the island of Samet in an area called “Ao Prao” on 28 July, 2013. On-land cleanup lasted about a month and was performed by a combination of territorial defense volunteers, citizen volunteers, Thai military personnel and PTTGC employees. Cleanup procedures included oil containment and dispersal using absorbent pads, and removal and disposal of contaminated soil, sand and rocks. The goal of this dissertation is to determine if Rayong oil spill cleanup workers were exposed to elevated levels of PAHs and benzene and if these exposures are associated with recorded acute symptoms. We measured the concentration of 1-hydroxypyrene-glucuronide (1-OHPG), a metabolite of pyrene, in the 1,343 frozen stored urine samples available from the cleanup workers, and retrieved previously measured trans,trans-muconic acid (t,t-MA) data, a benzene metabolite. This allowed us to quantify the internal dose of polycyclic aromatic hydrocarbons (PAHs) and benzene in these workers and to examine factors related to their dose. During the early days of cleanup, urinary 1-OHPG of the workers was elevated, comparable to occupational exposures, and declined to near background (general population) levels in workers by the end of the cleanup operation. This was consistent with our hypothesis that the exposure levels of PAHs would be the highest in the first week of cleanup and decline thereafter. Detectable levels of t,t-MA also exhibited a decreasing trend over the course of the cleanup period. Job descriptions with the highest levels of urinary 1-OHPG after adjustment were oil dispersant applicators and contaminated sand/trash handlers. Prevalence of several post-shift symptoms, including irritation of throat and nose, increased with concentration of urinary 1-OHPG. Similarly, one group of symptoms determined by factor analysis, designated as “irritative symptoms”, including irritation of the eye, throat and/or nose, eye injection (redness) and excessive tearing (epiphora) was associated with increased concentration of urinary 1-OHPG. In conclusion, Rayong oil spill cleanup workers exhibited evidence of elevated levels of PAH and benzene exposure during the early weeks of cleanup, compared to near background levels 4 weeks after cleanup began. These workers also demonstrated an association between prevalence of acute irritative symptoms and PAH exposure measured by urinary 1-OHPG. Long-term health monitoring of oil spill cleanup workers should be implemented, particularly among those workers suspected of sustaining high exposure to crude oil

COVID-19 incidence and outcomes among patients with kidney replacement therapy

Background We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). Methods The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. Results COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6–0.9) and 0.3 (95% CI, 0.2–0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. Conclusion The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality

Factors associated with awareness of palliative care among patients with chronic obstructive pulmonary disease

Introduction Chronic obstructive pulmonary disease (COPD) leads to respiratory morbidities and mortalities. Despite its importance in alleviating respiratory consequences, palliative services and awareness in COPD patients worldwide is currently limited. The objectives of this study were to measure the prevalence of COPD patients with an awareness that palliative care (PC) is part of COPD care, and to evaluate factors associated with patients’ PC awareness. Methods A cross-sectional study was conducted on COPD patients visiting 2 tertiary hospitals from July to December 2018. A questionnaire containing demographic factors, the severity of COPD, and questions on PC perceptions was developed. Patients who met the inclusion criteria were recruited. Factors associated with PC awareness were assessed by multivariate logistic regression analysis. Results A total of 280 patients were recruited (91.1% male) with median age of 73 years (IQR: 65–78), median FEV1% predicted was 62 (IQR: 47– 80), and 22.6% were aware of PC. Only 19 patients (6.8%) were advised by their doctor about advanced care planning (ACP). Factors associated with PC awareness were: age (p=0.014), mMRC score (p=0.01), knowing the term PC (p<0.001), knowing the term CPR (p=0.004), having an ACP (p=0.049), knowing the term ‘living will’ (p<0.001) and having had discussions with their healthcare providers on PC issues (p=0.037). Multivariate regression analysis showed that the only factor associated with PC awareness was a lower mMRC score (AOR=0.67; 95% CI: 0.51–0.87). Conclusions PC awareness in COPD patients was low. Discussions on PC issues between healthcare providers and patients were not widespread. Suggestions for policy implications and future research are needed

Feature Explanations in Recurrent Neural Networks for Predicting Risk of Mortality in Intensive Care Patients

Critical care staff are presented with a large amount of data, which made it difficult to systematically evaluate. Early detection of patients whose condition is deteriorating could reduce mortality, improve treatment outcomes, and allow a better use of healthcare resources. In this study, we propose a data-driven framework for predicting the risk of mortality that combines high-accuracy recurrent neural networks with interpretable explanations. Our model processes time-series of vital signs and laboratory observations to predict the probability of a patient’s mortality in the intensive care unit (ICU). We investigated our approach on three public critical care databases: Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III), MIMIC-IV, and eICU. Our models achieved an area under the receiver operating characteristic curve (AUC) of 0.87–0.91. Our approach was not only able to provide the predicted mortality risk but also to recognize and explain the historical contributions of the associated factors to the prediction. The explanations provided by our model were consistent with the literature. Patients may benefit from early intervention if their clinical observations in the ICU are continuously monitored in real time

Acceptance of Influenza Vaccination among Pregnant Women attending the Antenatal Care Clinic, King Chulalongkorn Memorial Hospital

Objectives: To determine the acceptance rate and associated factors of influenza vaccination among Thai pregnant women.Materials and Methods:A cross-sectional descriptive study was conducted at King Chulalongkorn Memorial Hospital from November 2014 to March 2015. Pregnant women were asked to complete self-administered questionnaires that collected data on acceptance of vaccination, knowledge, attitude and practice regarding to influenza vaccination during pregnancy. The associated factors were determined by logistic regression analysis.Results: A total of 412 women completed the questionnaires. Acceptance rate of influenza vaccination among the participants was 40.5% (95% CI 35.9-45.3). Most participants (320 women, 77.7%) had good knowledge about influenza and the vaccine. Factors positively associated with the acceptance were ‘advice from physicians’ (adjusted OR 2.61, 95% CI 1.55-4.39), ‘notification about vaccination in current pregnancy’ (adjusted OR 1.84, 95% CI 1.17-2.89), ‘protection of newborn’ (adjusted OR 2.83, 95% CI 1.74-4.62) and ‘cost of vaccination’ (adjusted OR 2.36, 95% CI 1.46-3.82). Negatively associated factors included ‘experience of side effects following past vaccination’ (adjusted OR 0.19, 95% CI 0.05-0.74), ‘belief that vaccination is unnecessary’ (adjusted OR 0.42, 95% CI 0.21-0.86), and ‘unsafe during the first trimester’ (adjusted OR 0.55, 95% CI 0.34-0.90).Conclusion: Acceptance rate of influenza vaccination during pregnancy among women in King Chulalongkorn Memorial Hospital was 40.5%. To increase vaccination rate, health care providers should advise or mention on influenza vaccination and provide information to support that the immunization can protect their newborns and is safe at any trimeste

Coronavirus Disease 2019 (COVID-19) and Its Gastrointestinal and Hepatic Manifestations

Coronavirus disease 2019 (COVID-19) is a severe respiratory disease caused by the virus SARS-CoV-2 that became classified as a pandemic on March 11, 2020. COVID-19 is known to produce similar clinical manifestations to SARS of the last decade. Fever, dry cough, fatigue, myalgia, dyspnea, and sore throat are some of the most common symptoms and the median incubation period is around 4 days. While the respiratory manifestations have been widely reported, clinical manifestations on the gastrointestinal and hepatic side have often been overlooked. Diarrhea and nausea or vomiting have been reported in approximately 1-5% of cases and sometimes they precede respiratory symptoms. COVID-19 has also been reported to cause hemorrhagic colitis in one case Live SARS-CoV-2 have been detected in stool so, there is a possibility of fecal-oral transmission thus it recommended that non-urgent and low prior endoscopies be postponed. For endoscopies that cannot be postponed, SARS-CoV-2 screening of patients, minimal personnel, infection control training, and usage of negative pressure rooms are recommended. Evidence of abnormal liver-associated biomarker values have been commonly reported, however, there is evidence of extrahepatic causes those abnormal biomarker values. The evidence suggest that COVID-19 patients can have true liver injury, however, it is mild and the abnormal liver-associated biomarker values may be caused, at least partially, but muscle injury. Drugs with hepatotoxicity should be used with increased caution in COVID-19 patients

Hepatitis E in Southeast Asia

Hepatitis E is a major cause of acute viral hepatitis in the world. The causative agent of hepatitis E is hepatitis E virus (HEV). In Southeast Asia, the seroprevalence of HEV and the most prevalent genotype of HEV are largely unclear and the available data is either limited or outdated. After a systematic review of literature, we found the seroprevalence of HEV and the most prevalent genotype of HEV appear to vary greatly by countries. The seroprevalence is likely between 17% to 42% and the prevalent genotypes across Southeast Asia are likely 1, 3, and 4, but not 2 as no cases of genotype 2 have been reported in this region. As HEV remains widespread in Southeast Asia and the clinical implications of HEV can be severe, surveillance programs for HEV should be implemented

Latent Trajectories of Haematological, Hepatic, and Renal Profiles after Oil Spill Exposure: A Longitudinal Analysis

Exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) in crude oil has carcinogenic effects on various organ systems. This longitudinal cohort study examined the effects of oil spill exposure on the haematological, hepatic, and renal profiles of Rayong oil spill clean-up workers. The sample included 869 clean-up workers from the Rayong oil spill. Latent class mixture models were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices. Subgroup analysis was used to evaluate the association between the urinary metabolites of PAHs and VOCs and haematological, hepatic, and renal parameters. Most clean-up workers (97.6%) had increasing levels of white blood cells (WBCs) (0.03 × 103 cells/µL), 94.90% of the workers had a significantly increasing trend of blood urea nitrogen (0.31 mg/dL per year), and 87.20% had a significantly increasing trend of serum creatinine (0.01 mg/dL per year). A high–decreasing trend of WBCs was seen in 2.42% (−0.73 × 103 per year). Post-exposure changes in haematological, renal, and hepatic profiles are present in workers exposed to the Rayong oil spill. This indicates possible long-term health complications and worsening renal function after exposure to PAHs and VOCs in crude oil

Latent Trajectories of Haematological, Hepatic, and Renal Profiles after Oil Spill Exposure: A Longitudinal Analysis

Exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) in crude oil has carcinogenic effects on various organ systems. This longitudinal cohort study examined the effects of oil spill exposure on the haematological, hepatic, and renal profiles of Rayong oil spill clean-up workers. The sample included 869 clean-up workers from the Rayong oil spill. Latent class mixture models were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices. Subgroup analysis was used to evaluate the association between the urinary metabolites of PAHs and VOCs and haematological, hepatic, and renal parameters. Most clean-up workers (97.6%) had increasing levels of white blood cells (WBCs) (0.03 &times; 103 cells/&micro;L), 94.90% of the workers had a significantly increasing trend of blood urea nitrogen (0.31 mg/dL per year), and 87.20% had a significantly increasing trend of serum creatinine (0.01 mg/dL per year). A high&ndash;decreasing trend of WBCs was seen in 2.42% (&minus;0.73 &times; 103 per year). Post-exposure changes in haematological, renal, and hepatic profiles are present in workers exposed to the Rayong oil spill. This indicates possible long-term health complications and worsening renal function after exposure to PAHs and VOCs in crude oil