 Good afternoon, everyone. Last year, I was here, and then the other global leader, and they probably identified a pharmacogenomics as a flagship of the meeting. If you would like to, and today I will focus on implementation rather than talking about the research and how the best I have the pharmacogenic testing in our hand. Because without proper implementation, you're going to cause a lot of nightmare when you deal with the Stephen Johnson syndrome, and I'm going to tell you, the implementation of genomics in clinical practice, the low-hanging throat would be pharmacogenomics. The pharmacogenomics, if you're talking about the Stephen Johnson and TEN, Rick's Aerial Screening Test, might be the low-hanging throat in pharmacogenomics. In Thailand, we interviewed many who suffer and survive Stephen Johnson syndrome, and TEN. They say that they like a burning alive, their eyes like someone pour acid into their eyes. So extreme, they would like to die, but they cannot because the doctor won't let them go. In Thailand, pharmacogenomics project started in 2004 with HIV pharmacogenomics. The first drug is Nebiorapine, induced Stephen Johnson and TEN, with the Remantivity Hospital, the Thailand Center of Excellence for Life Science, and Ministry of Science and Technology. However, with regard to Thai government reimbursement program for routine pharmacogenomics screening to prevent drug-induced Stephen Johnson and TEN, Kamamazubin was the first drug of choice to implement nationwide 2014, which is 10 years later, under the Ministry of Public Health, Thai FDA University Hospital, Thai University Health Care Coverage Program. So in Thailand, who pay for PGX screening, the government. So during the last 10 years, with the collaboration firmly with the Remantivity Hospital, where I'm working, the Faculty of Pharmacy, Mahidong University, Thai Ministry of Public Health, this includes Thai FDA, Thailand Center of Excellence for Life Science, partnering with the RIKEN, the Center for Genetic Medicine, from the former director, Yasuke Nakamura, and president, the director, Dr. Nikiya Kubo, having a lot to do, what we call the Genomic Association and HIV Genotyping. And more than 3,000 cases in control. So that's why we realize that in Thailand and in Southeast Asia, we have a very high frequency of ADR-related gene or aerials. And you can see that Kamamazubin, always located in Asia or in Southeast Asia. Aloparino, more or less the same. Kamamazubin, that grade that maybe Europe take care of it. And then for the new RIKEN, it's the anti-retroviral drug again in Southeast Asia, D40, this is also the anti-retroviral drug in Asia too. So because of, we have a lot of drugs that have, this is a top 10 drug induced Stephen Johnson and 10 in Thailand. And with the, during the past NDAV, we probably can say that our scientists in many hospitals and institutions could work out to get the genetic marker that have been fine utilized for predictive tools. So these are, I'd like to show you in total ADV come up with the prototype of a molecular point of care for pharmacogenomics screening assay for neuropeen ratch. You can see that we not only focus on HLA, because you know why association help us to find the two other causative SNPs. So maybe when you might wonder why the HLA is not so accurate, because there are other SNPs that would help to complete nearly 100%. And for the HIV, I'd rather say that it's quite typical, the target is moving. I spend, our team spend too much time to find the marker and they try to implement it, implement it with the government. It turned out that within five year Thailand at first, neuropeen base anti-retroviral have now been chained to F-overance. So the target is keep moving. So if you would like to do research and try to implement it, you have to make it fast. That's why the, now for the HIV instead of focus on neuropeen, we have to focus also other like F-overance, D4T, and also about career. This is all in one. That's why did we have the award, the Thailand Award in Innovation Award in 2011 for what we call the service and the diagnosis or the essay HIV, ADR, all in one. And in 2010, beside HIV, there is a brainstorming to pharmacogenomic and it's used to avoid severe adverse drug reaction, cutaneous drug reaction. This time, organized by Department of Medical Science, Ministry of Public Health, 2010, three of these people now in this room. And also at that time, we invite Professor Chen from Taiwan to be our keynote speaker at that time. And four years later, the government's been induced, Steve Entertainment was the first strike of choice for the government reimbursement nationwide under the Ministry of Public Health, Thai FDA, University Hospital, and University Health Health Care Coverage scheme. Let's go back to where I'm working, the Ramanantivity Hospital. You manage to have the, what do you call, the pharmacogenomic lab. And this is my colleague, Dr. Chalapas Sukase, who invented PJ Card, pre and post pharmacogenomic counseling program, warning and monitoring system. And this is a list of the pharmacogenomic, as they routinely support the hospital. Every time that the patient have the HII positive or many other gene positive, there is a sign of adverse reaction has been clearly shown in the prescription. This is the folder that we always hand it to the person who have the blood tested. And this is a report and this is a pharmacogenomic card that Terry mentioned earlier. At first we, during last year, I hesitated to show you the card. Because my colleague said that this is just simply the paper, what people will be fascinated about. And in the US, the EMR is quite effective. But it turned out to be, I don't know why they still like it. But all of this, all foolproof way that we could prevent and eradicate genetically mediated Steven Jones' hand is in Thailand. From the time being right now, sadly said no, we will not be able to save our life if we do not implement it completely. Usually, if you have a pre-PJC counseling, fine, the doctor will order her blood tested. She will test positive. Then the post-PJC counseling should be in place. And then advisor to take out the drug instead. And the PGA card should be provided. But the nightmare always happened and occurred to me that if you know pre-counseling, to have the her blood tested for positive, because of PGA screening as it is just $33 in Thailand, it's easily to implement, rather than warning system. So for the second doctor, she may enshrine the woman from the ward, prescribing her with the cover on the screen, because there is no post-counseling, no warning system, no PGA card provided. And she will go back home and then take the medication, no monitoring, following. And she may die because of the unit within a few days later on. Okay? So what we are currently doing at Burma-Tibet hospital to make sure that the PGA should be effectively and safely imposed, or implemented, sorry, one, we try to combine because we have the EMR but not quite effective, link all the unit pre- and post-PJC counseling and also PGA screening assay. And we try to emphasize to the patient and the doctor that the PGA is the screening assay, it is not diagnostic test. So it's not that accurate when you compare, okay? And then after that, after they leave the hospital, they have the post-monitoring for the patient. This is the manually call to the, after this job, making phone call every two weeks in two months. We have a PGA and also in order to educate patient, public and clinician, we come up with the MP games on Android and iOS device. I just heard that Terry mentioned about in the morning that we would like to educate the clinician. I think that I cannot wait for five years from now. I'd like to make it now today. That's why I have the MP games. MP game is what it is. MP game is the what they call mobile pharmacogenomics game. In last month, there is a university in the race of university, I mean, it's the of information and communication technology approached me, asked me to help to make the education to the children. I said that maybe Lord Buddha or God answered my question. So I, from my work, I just transform, we transform all my work to be on this application. And this is a genomic medicine, particularly pharmacogenomics. When you click, you can let them study that is pre and post test. And then the game three would be make sure that you will not miss the Stephen Johnson anymore. I will let Terry to test that first when we have the English version. So for the Southeast Asian, we have the Pharmacogenomics Research Network, CFARM, 2012, 2013 was held in Thailand, 2014 held in Indonesia, 2015 will be held in Malaysia next week. And Professor Caroline would be chair with you about the workshop. And this reading material, if you would like to study our work in 10 years, studying from Nature Review Genetics, the book called Genomic and Health in Developing World and HIV Pharmacogenomics, and who wrote it and moving that you can read online. Free of charge. Thank you. Thank you very much. So education and implementation with the emphasis here. Are there questions or comments? Yes. I was wondering, you were showing one little baby affected with the disease. And I was wondering if you observed that women who during pregnancy receive never a pain have healthy children, yes or not. From our South African colleagues, I know that all the ladies they had that during pregnancy were given never a pain because of HIV infection who developed SJSTN had healthy children and that none of the children, even though these babies receive the same drug for six months after birth, ever had SJSTN, which you could expect or could think it might happen. Do you have any ideas on that? I do not have any idea. And then the picture that I show you, that is the NIPT, not the pharmacogenomics, sorry. Dr. Surakamit, do you have any idea? We never do any pharmacogenomics on the pregnant women at all. We did some pharmacokinetics study on the developing level in pregnancy women and the SIP, I can't remember, but one of the SIP has influence on the developing level of neuropathy in pregnancy women. But we didn't see that Steven tends in the children related to the mother. I think we don't have the data. Has anyone seen, just to broaden your question, has anyone seen in late pregnancy Steven Johnson where the baby is delivered with or without Steven Johnson? If it's transmitted with granulocin, one would expect something there. Of course, there may be other genes in the child. If it's T-cell mediated, then you would expect the fetus to be protected because they would be tolerized to the amygdals. The reason I raised the question is because of Dr. Chung. Yes. Obviously, no answer to that. Did you have a question? No. But what we observe is that the SAB 305.05, which is the risk and leave for neuropathy induced rash, is a protective risk for HIV or low load in Thai populations. So the same unused, that caused rash from neuropathy is actually protected from disease locations in HIV infection. So this might explain some things. So I'd like to thank all the questions. Yes. Sorry, I was just going to ask along those lines. Did you have, was that your neuropathy dress cohort? And were those the B3505s that were protected or just from the previous work that's been published, I think, from Thailand with neuropathy dress and B3505, the ones that had protected viral loads, those were the B3505s, the ones that carried HLA B3505, or? The protective effect of the 3505 is not a study in our dataset, but it was study in another dataset in Northern Thailand. And in that cohort, they observed both this drug as well as reaction and the protective effect of the B3505 on HIV disease progressions. So it's like a replication cohort of our data. Thank you. Thank everyone. And Terry has a few announcements. Just to remind you, we're now going to break. Those of you who ordered your lunch in advance, it's in room nine there. So if you would just grab it and bring it back in here where we're going to have a discussion. Those of you who are going to make the trek down to the cafeteria, you need to take the elevator to do that. Mark Williams has volunteered to lead you effectively and quickly down there and back up. We will reconvene at 1 o'clock for a discussion. And we'll see you then.