Srikiatkhachorn, Anan

Preferred name

Alternative Name

Srikiatkhachorn, Anon

Main Affiliation

Faculty of Medicine

anan.sr@kmitl.ac.th

Now showing 1 - 10 of 22

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Individual, Household, and Community Drivers of Dengue Virus Infection Risk in Kamphaeng Phet Province, Thailand
(2022-10-15)
Ribeiro Dos Santos, Gabriel
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Buddhari, Darunee
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Iamsirithaworn, Sopon
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Khampaen, Direk
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Ponlawat, Alongkot
Background: Dengue virus (DENV) often circulates endemically. In such settings with high levels of transmission, it remains unclear whether there are risk factors that alter individual infection risk. Methods: We tested blood taken from individuals living in multigenerational households in Kamphaeng Phet province, Thailand for DENV antibodies (N = 2364, mean age 31 years). Seropositivity ranged from 45.4% among those 1-5 years old to 99.5% for those >30 years. Using spatially explicit catalytic models, we estimated that 11.8% of the susceptible population gets infected annually. Results: We found that 37.5% of the variance in seropositivity was explained by unmeasured household-level effects with only 4.2% explained by spatial differences between households. The serostatus of individuals from the same household remained significantly correlated even when separated by up to 15 years in age. Conclusions: These findings show that despite highly endemic transmission, persistent differences in infection risk exist across households, the reasons for which remain unclear.
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Household immunity and individual risk of infection with dengue virus in a prospective, longitudinal cohort study
(2024-01-01)
Hamins-Puértolas, Marco
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Buddhari, Darunee
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Salje, Henrik
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Cummings, Derek A.T.
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Fernandez, Stefan
Although it is known that household infections drive the transmission of dengue virus (DENV), it is unclear how household composition and the immune status of inhabitants affect the individual risk of infection. Most population-based studies to date have focused on paediatric cohorts because more severe forms of dengue mainly occur in children, and the role of adults in dengue transmission is understudied. Here we analysed data from a multigenerational cohort study of 470 households, comprising 2,860 individuals, in Kamphaeng Phet, Thailand, to evaluate risk factors for DENV infection. Using a gradient-boosted regression model trained on annual haemagglutination inhibition antibody titre inputs, we identified 1,049 infections, 90% of which were subclinical. By analysing imputed infections, we found that individual antibody titres, household composition and antibody titres of other members in the same household affect an individual’s risk of DENV infection. Those individuals living in households with high average antibody titres, or households with more adults, had a reduced risk of infection. We propose that herd immunity to dengue acts at the household level and may provide insight into the drivers of the recent change in the shifting age distribution of dengue cases in Thailand.
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Neurobiology of migraine progression
(2022-08-01)
Rattanawong, Wanakorn
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Rapoport, Alan
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Srikiatkhachorn, Anan
Chronic migraine is one of the most devastating headache disorders. The estimated prevalence is 1.4–2.2% in the population. The factors which may predispose to the process of migraine progression include high frequency of migraine attacks, medication overuse, comorbid pain syndromes, and obesity. Several studies showed that chronic migraine results in the substantial anatomical and physiological changes in the brain. Despite no clear explanation regarding the pathophysiologic process leading to the progression, certain features such as increased sensory sensitivity, cutaneous allodynia, impaired habituation, identify the neuronal hyperexcitability as the plausible mechanism. In this review, we describe two main mechanisms which can lead to this hyperexcitability. The first is persistent sensitization caused by repetitive and prolonged trigeminal nociceptive activation. This process results in changes in several brain networks related to both pain and non-pain behaviours. The second mechanism is the decrease in endogenous brainstem inhibitory control, hence increasing the excitability of neurons in the trigeminal noceptive system and cerebral cortex. The combination of increased pain matrix connectivity, including hypothalamic hyperactivity and a weak serotonergic system, may contribute to migraine chronification.
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Correlation between reported dengue illness history and seropositivity in rural Thailand
(2021-06-01)
Buddhari, Darunee
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Anderson, Kathryn B.
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Gromowski, Gregory D.
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Jarman, Richard G.
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Iamsirithaworn, Sopon
In the latest World Health Organization (WHO) recommendation for Dengvaxia implementation, either serological testing or a person’s history of prior dengue illness may be used as supporting evidence to identify dengue virus (DENV)-immune individuals eligible for vaccination, in areas with limited capacity for laboratory confirmation. This analysis aimed to estimate the concordance between self-reported dengue illness histories and seropositivity in a prospective cohort study for dengue virus infection in Kamphaeng Phet province, a dengue-endemic area in northern Thailand. The study enrolled 2,076 subjects from 516 multigenerational families, with a median age of 30.6 years (range 0–90 years). Individual and family member dengue illness histories were obtained by questionnaire. Seropositivity was defined based on hemagglutination inhibition (HAI) assays. Overall seropositivity for DENV was 86.5% among those aged 9–45 years, which increased with age. 18.5% of participants reported a history of dengue illness prior to enrollment; 30.1% reported a previous DENV infection in the family, and 40.1% reported DENV infection in either themselves or a family member. Relative to seropositivity by HAI in the vaccine candidate group, the sensitivity and specificity of individual prior dengue illness history were 18.5% and 81.6%, respectively; sensitivity and specificity of reported dengue illness in a family member were 29.8% and 68.0%, and of either the individual or a family member were 40.1% and 60.5%. Notably, 13.4% of individuals reporting prior dengue illness were seronegative. Given the high occurrence of asymptomatic and mild DENV infection, self-reported dengue illness history is poorly sensitive for prior exposure and may misclassify individuals as ‘exposed’ when they were not. This analysis highlights that a simple, highly sensitive, and highly specific test for determining serostatus prior to Dengvaxia vaccination is urgently needed.
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Stakeholder perspectives on skills required for health technology developers: a qualitative study in Thailand
(2025-01-01)
Phaisawang, Sranya
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Na Nakorn, Thanyaphong
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Trivijitsilp, Prasert
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Srikiatkhachorn, Anan
Background: Throughout history, medical education has developed in response to societal changes and advances in biological research and technology. Health technology, encompassing devices, medicines, vaccines, and digital health systems, is transforming healthcare with increased effectiveness and efficiency. Thailand, a popular medical tourism destination, intends to shift its focus to high-quality healthcare services and advanced technologies for long-term economic sustainability. This study identifies necessary skills for health technology developers to help create a technology-driven healthcare ecosystem and prepare human capital in the field. Methods: In this qualitative study, in-depth interviews with diverse stakeholders in health and health technology industries were conducted to investigate the role of health technology in future healthcare and the skills required for health technology developers. Qualitative Content Analysis was carried out. Participants included national health policy makers, university presidents, hospital directors, and health technology company administrators. The study utilized the electronic Delphi method for ranking skills through multiple interview rounds, ensuring thorough evaluation of significant topics. Results: This study involved interviews with sixteen stakeholders in health technology, focusing on its importance and impact on future healthcare. Participants discussed three major areas of technology: molecular technologies, biomedical engineering technologies, and health information technologies. Delocalization, personalization, and digitalization are key components of healthcare transformation. The challenges and skills needed for health technology developers were categorized into four domains including, Health Science, Health Technology, Product Development & Design and Marketing & Entrepreneurship. Conclusion: Our study revealed the significance of technology in healthcare transformation. We identified four skill categories that health technology developers must possess. (1) Health Science, (2) Health Technology, (3) Product Development & Design, and (4) Marketing & Entrepreneurship were among these domains. A systematic strategy for developing these skills is a crucial success factor in human capital preparation for future technology-driven healthcare.
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Linking multiple serological assays to infer dengue virus infections from paired samples using mixture models
(2025-12-20)
Hamins-Puértolas, Marco
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Buddhari, Darunee
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Salje, Henrik
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Huang, Angkana T.
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Hunsawong, Taweewun
Dengue virus (DENV) is an increasingly important human pathogen, with already half of the globe’s population living in environments with transmission potential. Since many cases are missed by direct detection methods (RT-PCR or antigen tests), serological assays play an important role in the diagnostic process. However, individual assays can suffer from low sensitivity and specificity and interpreting results from multiple assays remains challenging, particularly because interpretations from multiple assays may differ, creating uncertainty over how to generate finalized interpretations. We develop a Bayesian mixture model that can jointly model data from multiple paired serological assays, to infer infection events. We first test the performance of our model using simulated data. We then apply our model to 677 pairs of acute and convalescent serum collected as a part of illness and household investigations across two longitudinal cohort studies in Kamphaeng Phet, Thailand, including data from 232 RT-PCR confirmed infections (gold standard). We compare the classification of the new model to prior standard interpretations that independently utilize information from either the hemagglutination inhibition assay (HAI) or the enzyme-linked immunosorbent assay (EIA). We find that additional serological assays improve accuracy of infection detection for both simulated and real world data. Models incorporating paired IgG and IgM data as well as those incorporating IgG, IgM, and HAI data consistently have higher accuracy when using PCR confirmed infections as a gold standard (87–90% F1 scores, a combined metric of sensitivity and specificity) than currently implemented cut-point approaches (82–84% F1 scores). Our results provide a probabilistic framework through which multiple serological assays across different platforms can be leveraged across sequential serum samples to provide insight into whether individuals have recently experienced a DENV infection. These methods are applicable to other pathogen systems where multiple serological assays can be leveraged to quantify infection history.
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Early individualized risk prediction using clinical data for children during the febrile phase of dengue in outpatient settings in Vietnam and Thailand
(2026-02-01)
Sangkaew, Sorawat
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Daniels, Bethan Cracknell
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Ming, Damien K.
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Hernandez, Bernard
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Herrero, Pau
Dengue severity prediction models are usually developed using hospitalized patient data, but triage and hospital admission are mainly evaluated in outpatient settings. This study developed models using clinical and laboratory data from patients in outpatient settings during the febrile phase. Data from two cohort studies in Vietnam and Thailand were used to develop and validate six models: logistic regression with warning signs, Lasso-selected logistic regression, random forest, extreme gradient boosted classification, support vector machine, and artificial neural network. Models predicted dengue shock syndrome (DSS) as the primary endpoint and moderate plasma leakage and/or DSS as the secondary endpoint. We assessed model performance, discrimination, and calibration, using sensitivity, specificity, accuracy, Brier score, AUROC, CITL, calibration slope, calibration plots, and decision curve analysis. The optimal model was the Lasso-selected logistic regression for predicting DSS and the combined endpoint of moderate plasma leakage and/or DSS (Brier score: 0.044 [95% CI 0.043, 0.044] and 0.104 [95% CI 0.104, 0.105]; AUROC: 0.789 [95% CI 0.787, 0.791] and 0.741 [95% CI 0.740, 0.742]). We identified hematocrit, platelet count, lymphocyte count, and aspartate aminotransferase as predictors for DSS, and abdominal pain or tenderness, vomiting, mucosal bleeding, white blood cell count, lymphocyte count, platelet count, aspartate aminotransferase, and serum albumin as predictors for the secondary endpoint. Logistic regression and machine learning models using clinical and laboratory data during the febrile phase can support early prediction of severe disease in outpatient settings. Integrating risk prediction models into a decision support system could improve triage and optimize healthcare and resource allocation in endemic and resource-limited areas.
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Standardization and evaluation of an Anti-ZIKV IgM ELISA assay for the serological diagnosis of zika virus infection
(2021-10-01)
Sirikajornpan, Kanittha
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Suntarattiwong, Piyarat
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Suwanpakdee, Detchvijitr
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Tabprasit, Sutchana
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Buddhari, Darunee
Here, we describe the development of the in-house anti-Zika virus (ZIKV) IgM antibody capture ELISA (in-house ZIKV IgM ELISA) for the detection and diagnosis of acute ZIKV infections. We compared the in-house ZIKV IgM ELISA assay performance against two commercial kits, Euroimmun ZIKV IgM and InBios 2.0 ZIKV IgM ELISA. We tested the assays' ability to detect anti-ZIKV IgM using a well-defined serum sample panel. This panel included 80 ZIKV negative samples (20 negative, 20 found to be primary dengue virus [DENV][ infections, 20 secondary DENV infections, and 20 Japanese encephalitis virus [JEV] infections) and 67 ZIKV reverse transcriptase-polymerase chain reaction-positive acute serum samples. The OD values were calculated to enzyme immunoassay (EIA) unts by comparing them to weak positive controls. The results demonstrated the high sensitivity (88.06%) and specificity (90.00%) of our in-house ZIKV IgM ELISA and its 89.12% overall percentage agreement. The kappa values were deemed to be within excellent range and comparable to the InBios ZIKV IgM ELISA. Some cross-reactivity was observed among secondary DENV and JEV samples, and to a much lower extent, among primary DENV samples. These data indicate that our in-house ZIKV IgM ELISA is a reliable assay for the detection of anti-ZIKV IgM antibodies in serum.
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Preventive and therapeutic effects of genistein and daidzein on anxiety-like behaviors in ovariectomized rats
(2025-01-10)
Kalandakanond-Thongsong, Sarinee
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Daendee, Suwaporn
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Tongta, Sushawadee
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Thongsong, Boonrit
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Srikiatkhachorn, Anan
Estrogen has demonstrated beneficial effects; however, it can also have unfavorable effects. Phytoestrogens are present in many consumable products and commonly used as supplements. These are of interest as they may have beneficial effects on mood with fewer undesirable effects on reproductive tissues. This study investigated the anxiolytic-like effects of the phytoestrogens genistein and daidzein on ovariectomized (Ovx) rats and their effects on the expression of uterine estrogen receptors (ER) and brain monoamines. In experiment 1, Ovx rats received either vehicle, 17β-estradiol, or 0.25 − 1 mg/kg of genistein or daidzein for 4 weeks before behavioral tests of anxiety. In experiment 2, we assessed the therapeutic effects of genistein and daidzein. The ovariectomies were used to induce anxiety, so the treatments were started 3 weeks post-ovariectomy. The Ovx rats received vehicle, 17β-estradiol, or 0.25 mg/kg of genistein or daidzein daily for 4 weeks before behavioral tests. We found daidzein and genistein comparable to 17β-estradiol in their anxiolytic-like effects. Further, while 17β-estradiol decreased body weight gain, increased uterine weight, and increased the uterine ERα/ERβ ratio, neither genistein nor daidzein had these undesirable effects. The alterations in brain monoamines following genistein or daidzein treatments were somewhat different from those seen after 17β-estradiol treatment. In conclusion, daily daidzein or genistein administration for 4 weeks did not negatively affect body weight, food intake, uterine tissue, uterine ER expressions, or ERα/ERβ ratio but demonstrated anxiolytic-like effects on Ovx rats. We conclude that low-dose (0.25 mg/kg) genistein or daidzein can alleviate anxiety in a female anxious rat model.
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The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update
(2021-05-01)
Sun-Edelstein, Christina
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Rapoport, Alan M.
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Rattanawong, Wanakorn
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Srikiatkhachorn, Anan
Medication overuse headache (MOH), the development or worsening of chronic headache resulting from frequent and excessive intake of medications used for acute treatment of headache, is a common secondary headache disorder and is associated with significant personal and societal burdens. The plausible physiologic mechanism is that chronic exposure to acute care migraine treatment leads to suppression of endogenous antinociceptive systems, consequently facilitating the trigeminal nociceptive process via up-regulation of the calcitonin gene-related peptide (CGRP) system. Recognizing and preventing its development is an integral aspect of migraine management, as medication overuse is a modifiable risk factor in the progression from episodic to chronic migraine. Over the years, MOH has been difficult to treat and has generated much controversy. Ongoing debates exist over the diagnostic criteria and treatment strategies, particularly regarding the roles of formal detoxification and preventive treatment. The arrival of the anti-CGRP monoclonal antibodies has also challenged our views of MOH and its treatment. This review outlines the evolution of MOH diagnostic criteria, presents the current understanding of MOH pathogenesis and discusses the debates over its development and treatment. Data on the efficacy of anti-CGRP monoclonal antibodies in the setting of medication overuse is also presented. These results indicate that patients with medication overuse, who are treated with these new medications, may not need to be detoxified in order to treat MOH. In light of these developments, it is likely that in the future MOH will be more readily diagnosed and treatment will result in better outcomes.

Srikiatkhachorn, Anan

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