The response to 6-mercaptopurine (6-MP) can be altered by genetic polymorphisms in genes encoding drug-metabolizing enzymes and drug transporters. The purpose of this study was to investigate the association between genetic polymorphisms of drug-metabolizing enzymes (TPMT 719A > G (*3C), ITPA 94C > A and ITPA 123G > A) and drug transporters (MRP4 912C > A and MRP4 2269G > A) with 6-MP-related myelotoxicity and hepatotoxicity in Thai children with acute lymphoblastic leukemia (ALL). The prescribed dosage of 6-MP and its adverse effects were assessed from medical records during the first 8 weeks and 9–24 weeks of maintenance therapy. Children with the TPMT*1/*3C genotype had a higher risk of leukopenia with an odds ratio (OR) of 4.10 (95% confidence interval (CI) of 1.06–15.94; p = 0.033) compared to wild type (TPMT*1/*1) patients. Heterozygous TPMT*3C was significantly associated with severe neutropenia with an increased risk (OR, 4.17; 95% CI, 1.25–13.90); p = 0.014) during the first 8 weeks. No association was found among ITPA94C > A, ITPA123G > A, MRP4 912C > A, and MRP4 2269G > A with myelotoxicity and hepatotoxicity. The evidence that TPMT heterozygotes confer risks of 6-MP-induced myelotoxicity also supports the convincing need to genotype this pharmacogenetic marker before the initiation of 6-MP therapy.

Background: Tuberculosis (TB) remains a primary global health concern, despite the widespread availability of effective chemotherapeutic interventions. The emergence and dissemination of drug-resistant strains of Mycobacterium tuberculosis, particularly those exhibiting resistance to rifampicin, present significant obstacles to the success of TB control programs. Consequently, there is an urgent need for rapid, sensitive, and specific molecular diagnostic tools to inform timely clinical decision-making and reduce the transmission of disease. Loop-mediated isothermal amplification (LAMP) has gained attention as a promising alternative to conventional polymerase chain reaction (PCR) techniques. This method, which facilitates DNA amplification under constant temperature conditions, offers advantages including high specificity, rapid turnaround time, and operational simplicity—features that render it especially suitable for implementation in resource-limited settings. Methods: In this study, a LAMP assay targeting the rpoB gene was developed, with particular focus on detecting the codon 531 C→T mutation associated with rifampicin resistance. A set of four to six primers was designed to recognize six distinct regions of the target sequence. Allele-specific amplification was achieved by incorporating a deliberate single nucleotide mismatch at the 3′ terminus of the B2 primer to enable precise discrimination between wild-type and mutant alleles. The assay was conducted at an optimized temperature of 61 °C for 60 min, followed by visual detection using a lateral flow dipstick (LFD) within five minutes. Results: The LAMP-LFD assay demonstrated 100% concordance with drug susceptibility testing (DST) and DNA sequencing. No cross-reactivity with wild-type strains was observed, underscoring the assay’s high specificity. Conclusions: This platform offers a robust, field-deployable solution for detecting the codon 531 C→T mutation associated with rifampicin resistance in low-resource settings.

Background: Coronavirus disease (COVID-19), caused by SARS-CoV-2 infection, presents a broad spectrum of clinical manifestations, ranging from asymptomatic cases to severe and fatal outcomes. Studies have shown that laboratory parameters fluctuate in patients with COVID-19, and these parameters serve as valuable biomarkers for monitoring disease progression. This study examines the relationship between changes in biochemical and hematological markers and patient survival among early COVID-19 cases. Materials and methods: In this retrospective cohort study, data from adult (≥18 years) hospitalized COVID-19 patients with positive PCR results at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand, between March and December 2021, were analyzed. Univariate and multivariate logistic regression analyses were conducted on mortality-related laboratory parameters. All measures are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: The cohort included 397 patients with pneumonia (median age: 52.2 years (IQR: 40.5–64.6); 61.96% female). Among them, 42 patients (10.58%) succumbed during hospitalization, with a median hospital stay of 12.92 days (IQR: 10.03–15.94). Independent mortality predictors were identified as follows: age (aOR = 1.11; 95% CI: 1.04–1.19; p = 0.002), potassium (aOR = 6.27; 95% CI: 1.31–29.93; p = 0.021), creatinine (aOR = 1.62; 95% CI: 1.05–2.50; p = 0.028), hemoglobin A1c (aOR = 1.96; 95% CI: 1.30–2.97; p = 0.001), and red cell distribution width (aOR = 1.45; 95% CI: 1.05–2.02; p = 0.026), respectively. Furthermore, patients with lower platelet counts had a notably higher risk of mortality (aOR = 0.98; 95% CI: 0.97–0.99; p = 0.001). Conclusions: Our findings suggest that age, potassium, creatinine, hemoglobin A1c, red cell distribution width, and platelet count are significant predictors of mortality risk in patients with COVID-19. Clinicians should consider these biochemical and hematological markers critically before initiating treatment for COVID-19 patients.