Anucha Apisarnthanarak

Thammasat University, Siayuthia, Bangkok, Thailand

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Publications (217)952.98 Total impact

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    ABSTRACT: Limited knowledge of the local molecular epidemiology and the paucity of new effective antibiotics has resulted in an immense challenge in the control and treatment of extensively drug-resistant (XDR) Acinetobacter baumannii infections in Thailand. Antimicrobial combination regimens may be the only feasible treatment option in such cases. We sought to characterize the local molecular epidemiology and assess the bactericidal activity of various antibiotics individually and in combination against XDR A. baumannii in a Thai hospital. All XDR A. baumannii isolates from Thammasat University Hospital were collected between October 2010 and May 2011. Susceptibility testing was conducted according to reference broth dilution methods. Pulse-field gel electrophoresis was used to genotype the isolates. Carbapenemase genes were detected using polymerase chain reaction. In vitro testing of clinically-relevant concentrations of imipenem, meropenem, doripenem, rifampicin and tigecycline alone and in combination with polymyxin B was conducted using multiple combination bactericidal testing. Forty-nine polymyxin B-susceptible XDR A. baumannii isolates were identified. bla OXA-23 and bla OXA-51 genes were detected in all isolates. Eight clonally related clusters were identified, resulting in the initiation of several infection control measures. Imipenem, meropenem, doripenem, rifampicin, and tigecycline in combination with PB respectively, exhibited bactericidal killing in 100%, 100%, 98.0%, 100% and 87.8% isolates respectively at 24 hours. Molecular epidemiologic analysis can aid the early detection of infection outbreak within the institution, resulting in the rapid containment of the outbreak. Imipenem/meropenem/rifampicin in combination with polymyxin B demonstrated consistent bactericidal effect against 49 bla OXA-23-harbouring XDR A. baumannii clinical isolates, suggesting a role of combination therapy in the treatment of these infections.
    12/2015; 4(1):2. DOI:10.1186/s13756-015-0043-x
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    ABSTRACT: A cross-sectional study was conducted on the performance of tuberculin skin test (TST) and QuantiFERON®-TB Gold In-tube test (QFT-IT) for detecting latent tuberculosis infection among Thai healthcare workers (HCWs). Each HCW underwent simultaneous TST and QFT-IT during the annual health screening. Among 260 HCWs enrolled, the median age was 30 (range 19-60 years), 92% were female, 64% were nurses and nurse assistants, 78% were BCG-vaccinated, and 37% had previous TST. Correlation between TST reaction size and level of interferon- γ (IFN-γ) was weak (r = 0.29; P<0.001). Thirty-eight percent and 20% of HCWs had reactive TST and positive QFT-IT, respectively. Using QFT-IT positivity as standard for latent tuberculosis diagnosis, the cut-off for TST reactivity with the best performance was ≥ 13 mm with sensitivity, specificity, false positivity and false negativity of 71%, 70%, 30% and 29%, respectively (area under the curve 0.73; P<0.001). Independent factor associated with false reactive TST was previous TST (adjusted odds ratio 1.83; P=0.04). Our findings suggest that QFT-IT may be a preferred test among HCWs with previous TST. In settings where QFT-IT is not available, appropriate cut-offs for TST reactivity should be evaluated for use among HCWs.
    08/2015; DOI:10.7883/yoken.JJID.2015.181
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    ABSTRACT: The purpose of this study was to design and evaluate the enhancement of an antibiotic stewardship program (ASP) with trained hospital-based infectious diseases clinical pharmacists (IDCPs). The IDCP training entailed a 12-hour course by 3 pharmacists. From January 1, 2012-September 30, 2012, all patients consecutively admitted with presumptive infections to 6 medicine units were prospectively followed to discharge. Standard of care (SoC) included ASP measures with or without infectious diseases consultations (IDCs). Physician teams had the option to request IDCs, IDCPs, or both. The IDCP support included pharmacist participation in daily rounds to inform on antibiotic use. Outcomes examined were inappropriate antibiotic use, antibiotic de-escalation, duration of antibiotic use, and hospital length of stay (LOS) stratified by patient groups who received SoC versus adjunctive IDCPs with and without IDCs. There were 150 patients in the SoC group, 104 in the IDCP group, and 320 in the IDCP plus IDC group. Most antibiotic prescriptions were for empirical therapy (n = 373, 65%), and the top-ranked indications were infections of the respiratory tract (n = 287, 50%) and urinary tract (n = 165, 29%). By multivariate analysis, compared with SoC, the 2 other groups were less likely to be prescribed inappropriate antibiotic use (P < .001), had de-escalation of antibiotics (P < .001), received antibiotics <7 days (P < .001), and had subjects with shorter hospital LOSs (P < .001). There were no group differences in mortality. Our study suggests measurable treatment benefits associated with international IDCP training and the integration of adjunct IDCP services into hospital-based ASPs. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American journal of infection control 06/2015; DOI:10.1016/j.ajic.2015.05.011 · 2.21 Impact Factor
  • Nuntra Suwantarat · Anucha Apisarnthanarak
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    ABSTRACT: Several viral diseases have emerged and impacted healthcare systems worldwide. Healthcare personnels (HCPs) are at high risk of acquiring some emerging infections while caring for patients. We provide a review of risk factors, evidence of infection in HCPs, and prevention strategies with Middle East respiratory syndrome coronavirus, Ebola virus disease (Ebola), severe acute respiratory syndrome (SARS), and avian influenza. HCP-related infections with Middle East respiratory syndrome coronavirus, Ebola, and SARS have been reported among 1-27%, 2.5-12%, and 11-57% of total cases, respectively. The case fatality rate of Ebola in HCPs has been reported up to 73%. The WHO guidelines for the global surveillance of SARS were developed in 2004 and used as a template for other emerging diseases preparedness. Risks to HCPs with emerging diseases are related to inappropriate and insufficient infection control measures during an initial encounter, at the beginning of outbreak and with an overwhelming number of patient cases. To date, there are no reports of avian influenza transmission to HCPs from affected cases. Early and rapid detection of suspected infected patients with communicable diseases along with appropriate infection control practice, education, national and global preparedness guidelines would help to prevent disease transmission to HCPs.
    Current Opinion in Infectious Diseases 06/2015; 28(4). DOI:10.1097/QCO.0000000000000183 · 5.01 Impact Factor
  • M.L. Ling · L.T.A. Thu · N. Jaggi · S. Sengupta · H. Oh · N. Ahmad · N.A. Aziz · T.Y. Ching · W.H. Seto · A. Apisarnthanarak · W. Jarvis
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2015; 48(2):S48. DOI:10.1016/j.jmii.2015.02.088 · 2.35 Impact Factor
  • Piyaporn Apisarnthanarak · Linda M. Mundy · Anucha Apisarnthanarak
    The American journal of emergency medicine 03/2015; 33(6). DOI:10.1016/j.ajem.2015.03.009 · 1.27 Impact Factor
  • Journal of Patient Safety 02/2015; DOI:10.1097/PTS.0000000000000152 · 1.49 Impact Factor
  • Moi Lin Ling · Anucha Apisarnthanarak · Gilbert Madriaga
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    ABSTRACT: A systematic literature review and meta-analysis of the burden of HAIs in Southeast Asia was performed on 41 studies out of the initially identified 14,089 records. The pooled prevalence of overall HAIs was 9·0% (95% CI: 7·2-10·8) whilst the pooled incidence density of HAI was 20 cases per 1000 ICU-days. The pooled incidence density of VAP, CLABSI and CAUTI was 14·7 per 1000 ventilator-days (95% CI: 11·7-17·8), 4·7 per 1000 catheter-days days (95% CI: 2·9-6·5) and 9·1 per 1000 catheterdays (95% CI: 6·2-11·9), respectively. The pooled incidence of SSI was 7·8% (95% CI: 6·3%-9·3%). The attributed mortality and excess length of stay in hospitals of infected patients ranged from 7%-46% and 5-21 days, respectively. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:
    Clinical Infectious Diseases 02/2015; 60(11). DOI:10.1093/cid/civ095 · 8.89 Impact Factor
  • Anucha Apisarnthanarak · Thanee Eiamsitrakoon · Linda M Mundy
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    ABSTRACT: Objective: To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center. Methods: A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3). Results: Among 125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001). Conclusions: HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence.
    Infection Control and Hospital Epidemiology 02/2015; 36(05):1-5. DOI:10.1017/ice.2015.1 · 4.18 Impact Factor
  • Anucha Apisarnthanarak · Nalini Singh · Aila Nica Bandong · Gilbert Madriaga
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    ABSTRACT: OBJECTIVE To analyze available evidence on the effectiveness of triclosan-coated sutures (TCSs) in reducing the risk of surgical site infection (SSI). DESIGN Systematic review and meta-analysis. METHODS A systematic search of both randomized (RCTs) and nonrandomized (non-RCT) studies was performed on PubMed Medline, OVID, EMBASE, and SCOPUS, without restrictions in language and publication type. Random-effects models were utilized and pooled estimates were reported as the relative risk (RR) ratio with 95% confidence interval (CI). Tests for heterogeneity as well as meta-regression, subgroup, and sensitivity analyses were performed. RESULTS A total of 29 studies (22 RCTs, 7 non-RCTs) were included in the meta-analysis. The overall RR of acquiring an SSI was 0.65 (95% CI: 0.55-0.77; I2=42.4%, P=.01) in favor of TCS use. The pooled RR was particularly lower for the abdominal surgery group (RR: 0.56; 95% CI: 0.41-0.77) and was robust to sensitivity analysis. Meta-regression analysis revealed that study design, in part, may explain heterogeneity (P=.03). The pooled RR subgroup meta-analyses for randomized controlled trials (RCTs) and non-RCTs were 0.74 (95% CI: 0.61-0.89) and 0.53 (95% CI: 0.42-0.66), respectively, both of which favored the use of TCSs. CONCLUSION The random-effects meta-analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26% among patients undergoing surgery. This effect was particularly evident among those who underwent abdominal surgery. Infect Control Hosp Epidemiol 2015;36(2): 1-11.
    Infection Control and Hospital Epidemiology 02/2015; 36(2):169-79. DOI:10.1017/ice.2014.22 · 4.18 Impact Factor
  • PLoS ONE 12/2014; · 3.23 Impact Factor
  • Thana Khawcharoenporn · Krongtip Chunloy · Anucha Apisarnthanarak
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    ABSTRACT: To assess HIV risk perception and pre-exposure prophylaxis (PrEP) interest among university students, an anonymous survey was conducted among students from a large public university in Thailand. There were 641 participants; 118 (18%) were categorised into moderate or high-risk group. Of these 118 participants, 111 (94%) perceived themselves as no or low risk. Despite high levels of knowledge about HIV transmission risks, rates of consistent condom use with vaginal, oral and anal sex were all low (43%, 18% and 33%, respectively). The low rates of consistent condom use were significantly associated with false perception of low HIV risk (P < 0.05). Independent factors associated with the false perception were male sex (P < 0.001), living with a domestic partner (P = 0.004), being homosexual or bisexual (P = 0.02) and being students from non-medicine faculty (P = 0.04). Of the 641 participants, 211 (33%) were not interested in PrEP. Consistent condom use with oral sex (P = 0.004), consistent condom use with vaginal sex (P = 0.04) and being heterosexual (P = 0.02) were independently associated with no PrEP interest. Our study suggests the need for enhanced interventions to improve HIV risk perception and safe sex practices among the university students. © The Author(s) 2014 Reprints and permissions:
    International Journal of STD & AIDS 12/2014; DOI:10.1177/0956462414564607 · 1.05 Impact Factor
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    ABSTRACT: The objective of the study is to assess the utility of Alvarado score in the diagnosis of acute appendicitis and the utility of computed tomographic (CT) scan for evaluation of acute appendicitis when stratified by Alvarado scores. Retrospective cohort study comprised adult patients who underwent abdominal CT for suspected acute appendicitis between January 2006 and December 2009. Two abdominal radiologists independently reviewed the CT scans; any discrepancies were resolved by a consensus review. Alvarado scores were calculated and categorized as low (0-3), equivocal (4-6), or high (7-10) probability for appendicitis. The diagnostic utility of CT scans and Alvarado score for acute appendicitis were compared with the criterion standard of combined medical chart review and pathology findings. In a cohort of 158 subjects, 73 (46.2%) had clinical diagnoses of acute appendicitis. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT scan in the diagnosis of acute appendicitis were 97.5%, 98.6%, 96.5%, 96.0%, and 98.8%, respectively. The mean Alvarado score for subjects with complicated appendicitis was significantly higher (7.95) than subjects with uncomplicated appendicitis (6.67) and those with other diagnoses (5.95). Acute appendicitis was confirmed in 2 (13.3%) of 15 subjects with low probability Alvarado scores, 16 (30.8%) of 52 subjects with equivocal scores, and 55 (60.4%) of 91 subjects with high probability scores. The CT scan had high diagnostic utility for acute appendicitis. The Alvarado score was not a reliable independent predictive tool for acute appendicitis and could not replace CT scan. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Emergency Medicine 12/2014; 33(2). DOI:10.1016/j.ajem.2014.11.056 · 1.27 Impact Factor
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    ABSTRACT: Background and objectiveLimited data exist for the performance of QuantiFERON-TB Gold In-tube Test (QFT-IT) in comparison to tuberculin skin test (TST) for detecting latent tuberculosis (LTB) in patients with human immunodeficiency virus (HIV) infection from tuberculosis (TB)-endemic Asia-Pacific countries.MethodsA cohort study of Thai HIV-infected patients without history of TB or LTB treatment was conducted from March 2012 through March 2013. Each patient underwent simultaneous TST and QFT-IT.ResultsAmong the 150 enrolled subjects, the median age was 40 years (range 17–65), 53% were male, and the median CD4 count was 367 cells/μL (range 8–1290). Reactive TST and positive QFT-IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon-γ was moderate (r = 0.34). Independent factors associated with discordant results were long-term smoking (adjusted odds ratio (aOR) 5.74; P = 0.002) for TST-reactive, QFT-IT-negative subjects, and age greater than 52 years (aOR 5.56; P = 0.02) and female gender (aOR 4.40; P = 0.04) for TST non-reactive, QFT-IT-positive subjects. The level of agreement between both tests improved when using a TST cut-off of ≥10 mm (kappa = 0.39).Conclusions In our setting where QFT-IT is available but has limited use due to cost, TST with a cut-off of 10 mm for reactivity should be the initial LTB test. HIV-infected women and persons older than 52 years with non-reactive TST and long-term smokers with reactive TST may benefit from subsequent QFT-IT.
    Respirology 12/2014; 20(2). DOI:10.1111/resp.12442 · 3.35 Impact Factor
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    ABSTRACT: Background: Clinical Pharmacist (CP) is an emerging career in Thailand. We evaluated the efficacy of antimicrobial stewardship programs (ASP) featuring CP with or without infectious diseases consultation (IDC) in Thailand. Methods: From 1/1/12-9/30/12, all patients with infections admitted to 4 medicine units were prospectively followed until hospital discharge for the impact of ASP with or without IDC for outcomes: inappropriate antibiotic use, antibiotic de-escalation, duration of antibiotic use, hospital length of stay (LOS), and mortality. Patients were retrospectively categorized as patients who had CP input without IDC (Group 1), CP input and IDC (Group 2), and no CP input or IDC (Group 3). All groups received basic ASP supervised by hospital pharmacy during the study period. CP was responsible for making daily rounds, alert treating physicians on antibiotic use, and reminders on antibiotic de-escalation. Appropriate antibiotic use was retrospectively evaluated for prehoc prescribing criteria. Results: The cohort was comprised of 574 patients (G1 = 104; G2 = 320; G3 = 150), with no difference in demographics in G1 and G2. Compared to G3, G1 and G2 patients were more likely to have comorbidities and advanced age. Most antibiotic prescriptions were for empirical therapy (373/574; 65%) while antibiotic prescriptions were most often prescribed for respiratory tract infection (287/574; 50%). By multivariate analysis, G1 was associated with <7days duration of antibiotic use (adjusted Odds Ratio 19.6; P<0.001), while G2 was associated with less inappropriate antibiotic use (aOR = 0.03; P<0.001), antibiotic de-escalation (aOR = 3.7; P<0.001), and <7 days duration of antibiotic use (aOR = 6.81; P<0.001). Compared to G3 (as reference), G1 and G2 were less likely to be prescribed inappropriate antibiotic use (P<0.001), have de-escalation of antibiotics (P<0.001), receive antibiotics <7 days (P<0.001) and have subjects with shorter hospital LOS (P<0.001). There were no group differences in mortality. Conclusion: This study suggests the feasibility and efficacy of ASP featuring CP, with or without IDC, among hospitalized patients in Thailand. Appropriate antibiotic use, antibiotic de-escalation, <7 day antibiotic regimens, and shorter hospital LOS was associated with CP participation on medical teams.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • Infection Control and Hospital Epidemiology 09/2014; 35(9):1198-1200. DOI:10.1086/677642 · 4.18 Impact Factor
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    ABSTRACT: We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.
    American Journal of Infection Control 09/2014; 42(9):942-56. DOI:10.1016/j.ajic.2014.05.029 · 2.21 Impact Factor
  • Thana Khawcharoenporn · Anucha Apisarnthanarak
    International Journal of Antimicrobial Agents 08/2014; 44(2). DOI:10.1016/j.ijantimicag.2014.05.003 · 4.30 Impact Factor
  • Sarah S. Tang · Anucha Apisarnthanarak · Li Yang Hsu
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    ABSTRACT: Alexander Fleming's discovery of penicillin heralded an age of antibiotic development and healthcare advances that are premised on the ability to prevent and treat bacterial infections both safely and effectively. The resultant evolution of antimicrobial resistant mechanisms and spread of bacteria bearing these genetic determinants of resistance is acknowledged to be one of the major public health challenges globally, and threatens to unravel the gains of the past decades. We describe the major mechanisms of resistance to β-lactam antibiotics - the most widely used and effective antibiotics currently - in both Gram-positive and Gram-negative bacteria, and also briefly detail the existing and emergent pharmacological strategies to overcome such resistance. The global epidemiology of the four major types of bacteria that are responsible for the bulk of antimicrobial-resistant infections in the healthcare setting - methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobactericeae, and Acinetobacter baumannii - are also briefly described.
    Advanced Drug Delivery Reviews 08/2014; 78. DOI:10.1016/j.addr.2014.08.003 · 15.04 Impact Factor
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    ABSTRACT: HIV/AIDS remains one of the most serious public health problems in Thailand. This study aimed to assess the health-related quality of life (HRQOL) and its related factors among people living with HIV/AIDS (PLWHA) in Thailand. A cross-sectional study was conducted with 259 patients at a tertiary care hospital. HRQOL was assessed using the Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. Socio-demographics and clinical status were measured using a self-administered questionnaire. Multiple linear regression models were used to explore associations between socio-demographic status, clinical status, and HRQL. Multiple linear regression analyses showed that employment status was strongly related to better overall physical and mental health summary scores (PHS, MHS). In addition, patients with disclosure of HIV status, aged over 50 years, and having at least a rating of good health in the nurses' opinion were the independent positive predictive factors for overall PHS. While being on antiretroviral therapy (ART) and good compliance with ART were positive predictive factors for overall MHS. Improving and strengthening quality of life among PLWHAs are important goals for HIV/AIDS services. Regular assessment of HRQL can provide potential information for intervention to improve quality of life.
    The Southeast Asian journal of tropical medicine and public health 07/2014; 45(4):834-42. · 0.72 Impact Factor

Publication Stats

2k Citations
952.98 Total Impact Points


  • 2005–2015
    • Thammasat University
      • Faculty of Medicine
      Siayuthia, Bangkok, Thailand
    • Udon Thani Hospital
      Ban Dua Makeng, Changwat Udon Thani, Thailand
    • Chiang Mai University
      • Faculty of Nursing
      Chiang Mai, Chiang Mai Province, Thailand
  • 2013
    • University of Texas Medical Branch at Galveston
      Galveston, Texas, United States
  • 2010
    • Bryn Mawr College
      Bryn Mawr, Pennsylvania, United States
  • 2005–2009
    • Saint Louis University
      Saint Louis, Michigan, United States
  • 2008
    • University of Hawai'i System
      Honolulu, Hawaii, United States
    • Honolulu University
      Honolulu, Hawaii, United States
  • 2006
    • Lampang Hospital
      Muang Nagorn Lambang, Lampang, Thailand
  • 2001–2004
    • Washington University in St. Louis
      • • Department of Pediatrics
      • • Department of Medicine
      San Luis, Missouri, United States
  • 2002
    • Khon Kaen University
      • Department of Medicine
      Kawn Ken, Khon Kaen, Thailand