Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน

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Acute Toxicity and Sub-acute Toxicity of Pseuderanthemun palatiferum (Nees) Radlk. Leaf Extract
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Peerawit Padee; Somsak Nualkeaw; Chusri Talubmook; Supasorn Sakuljaitrong
Pseuderanthemum palatiferum (Nees) Radlk. is a medicinal plant from the Acanthaceae family. This plant has been introduced for to treatment of many diseases including hypertension, diarrhea, arthritis, nephritis, and diabetes. However, there is no scientific data on in its toxicity. The present study aims to assess the toxicity of an 80% ethanol extract of P. palatiferum leaf both in vitro and in vivo. In vitro, the 80% ethanol extract of P. palatiferum was tested in vero cells (african green monkey kidney) by a green fluorescent protein (GFP) - based assay. No cytotoxicity was detected at the dose of 50 µg/mL, which was the highest dose that could be prepared. In vivo, the 80% ethanol extract was administered once orally to adult Wistar rats in various doses (500, 1000, 1500 and 2000 mg/kg). The results showed that no doses of extract produced any signs or symptoms of toxicity during the first 24 hrs and no rat died with in 14 days. Moreover, the body weight of control and treatment groups were not different. A longer acute toxicity was tested on Wistar rats in various doses of 250, 500 and 1000 mg/kg by daily oral administration for 14 days. None of the dose levels showed show any signs or symptoms of toxicity and no rat died. Compared to the control group, the clinical chemistry values such as creatinine, albumin, total protein, triglycerides, and total cholesterol in each groups were not different, except BUN was significantly lower than the doses of 500 and 1000 mg/kg (p \< 0.05). The alkaline phosphatase in the dose of 250 mg/kg was significantly lower than the dose of 500 mg/kg (p \< 0.05). The gain in body weight of all treated groups were significantly higher than the control group (p \< 0.05).
Adherence to Antiretroviral Therapy in HIV-Infected Adults
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Kamolrat Inthisak
Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by human immunodeficiency virus (HIV). The immunity of HIV-infected patients was impaired so that they could be infected by opportunistic microorganism and lead to be fatal. Patient must comply with antiretroviral therapy (ART) and promise to adhere to the medication higher than 95% in to order achieve effective response, prevent opportunistic infection and decrease dissipated drug resistant virus to the others. The aims of this study were to assess the adherence to ART and explore the factors affecting and adherence to ARV of HIV-infected adults at SriChiangMai Hospital, Nongkai. Study was performed in 21 patients who received ART during April to June 2007. All subjects took regimen I according to National Access to Antiretroviral Programs for People Who Living with HIV and AIDs (NAPHA). Adherences to ART were assessed using visual analog scale, pill counts and medication log book. Data from visual analog scale showed that 81.6% and 61.9% of patient adhered to ART followed NAPHA criteria during 7 days and 1 month respectively, before hospital revisit. Assessment of adherence to ART by pill count and log book indicated that over 90% of patients were follow NAPHA criteria. Factors affecting on adherence were age, marriage status, occupation, communication skill of health care professional, clarify data, sufficient drug supply, numbers of drug item and ease of oral administration.
Anticancer Protein from Bitter Melon Cultivated in Thailand
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Rith Watthanachaiyingcharoen; Wichet Leelamanita
Protein extraction from bitter melon (Momordica charantia L.) cultivated in Thailand composed of amount of different proteins. The major protein was 30 kDa in size. For this study, we purified the proteins by using Resource S (ion exchange column) and following by Superdex 200 HR10/30 (gel filtration) equipped with an FPLC apparatus. They were glycoproteins with Isoelectric point (pI) \> 8.4 and molecular weights of approximately 30 kDa. Both possessed potent anticancer activity against L929 (mouse fibroblasts) at the IC₅₀ of 1.7 \µg/ml possibly via apoptotic pathways determined by DNA fragmentation and cells\’ morphology change methods.
Antioxidant Activity and Cytotoxicity in Breast Cancer Cells Line of Mushrooms Extracts; Lentinus polychrous Lev. Compared to Ganoderma lucidum (Fr.) Karst
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Nipaporn Armassa; Onanong Poungchompu; Somsak Rayan; Srisupha Leethong; Natthida Weerapreeyakul; Sasipawan Machana
This study examined the antioxidative activity, and cytotoxic effect in breast cancer cell line (MCF-7) of medicinal mushrooms extracts; Lentinus polychrous Lev. and Ganoderma lucidum (Fr.) Karst. Antioxidative activity and cytotoxic effect were determined using the 1,1-diphenyl-2-picrylhydrazyl radicals (DPPH) assay and the Neutral red assay, respectively. Results show that G. lucidum extracts from mycelia have antioxidative activity with the DPPH scavenging capacity in the range 1.34\±0.12 and 13.77\±0.98 \µmol/g and the total phenolic compounds in the range 9.91\±2.32 to 119.70\±1.74 mg/100g. L. polychrous Lev. extracts from mycelia had antioxidative activity with the DPPH scavenging capacity in the range 1.33\±1.58 to 11.84\±1.77 \µmol/g and the total phenolic compounds was approximately 10.42\±0.69 to 116.57\±5.27 mg/100g. This study shows that an extract from edible L. polychrous Lev. mushroom extracts exhibited similar antioxidative activity and the total phenolic compounds to the G. lucidum extracts. Moreover, the extract from G. lucidum caused a 50% decrease in breast cancer cell viability with concentration (IC₅₀) of 415.6 \µg/mL. The extract from L. polychrous Lev. mycelia demonstrated IC₅₀ values greater than 500 \µg/mL. It was found that the L. polychrous Lev. Mycelia extract; an edible mushroom in Thailand, possessed radical scavenging activity and the total phenolic content were not different from the G. lucidum extract. Future work on the separation of bioactive compounds contributing to the antioxidant activity and cytotoxicity of the L. polychrous Lev. Mycelia extract should be performed in comparison to the G. lucidum extract.
Antioxidative Activity and Antimutagenicity of Three Plants in Annonaceae in Plant Genetics Conservation at Khok Phutaka, Amphur Phuwiang, Khon Kaen
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) Bungorn Sripanidkulchai; Niramai Fangkratok; Jintana Junlatat; Kittisak Sripanidkulchai
This study aimed to investigate the antioxidative activity and antimutagenicity of six extracts of three plants in Annonaceae, collected from Khok Phutaka area, Amphur Phuwiang, Khon Kaen. The results showed the strong antioxidative activities of the extracts from stem-root of Ellipeiopsis cherrevensis and leaf of Polyalthia evecta with EC₅₀ at 14.3 and 14.7 \µg/ml, respectively. The other extracts with relative order of activity were leaf of E. cherrevensis \> leaf of P. debilis \> stem-root of P. evecta \> stem-root of P. debilis (EC₅₀ = 17.9, 22.8, 46.3 and 177.9 \µg/ml, respectively). The plant total phenolic contents are well correlated with their antioxidative activities. For pre-incubation bacterial mutation test, the extracts from leaf and stem-root of E. cherrevensis showed mutagenic effect on Salmonella typhimurium TA98 and TA100 in the absence of S-9 mix. Whereas in the presence of S-9 mix, the mutagenicity was found in the extracts from leaf of E. cherrevensis, leaf and stem-root of P. debilis and leaf of P. evecta. The antimutagenicity was detected in both TA98 and TA100 in all extracts in the presence of S-9 mix. In contrast, in the absence of S-9 mix only the extracts from stem-root and leaf of P. debilis; and leaf of P. evecta showed the antimutagenicity to TA98. Therefore, these three plants are interesting to be further studied on their anticancer activity.
The Application of Exploratory and Confirmatory Factor Analysis for Assessing the Construct Validity of SF-36 Thai version in Chronic Renal Disease Patients
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Areewan Cheawchanwattana; On-anong Waleekhachonloet; Supon Limwattananon
Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity of SF-36 Thai version in chronic renal disease patients. The patients (n=466) were interviewed at Srinagarind Hospital during March-May 2005. Data were randomly divided into two datasets for cross-validation. The first dataset was analyzed using EFA to reveal alternative models (AMs), while the second dataset was analyzed using CFA to compare the AMs and the original model assigned by SF-36 developers (Ware model). The construct validity of SF-36 Thai version in chronic renal disease patients was confirmed in this study. Results from CFA indicated that the Ware model was more parsimony than two AMs. The constructs of two AMs that resulted from the EFA differed from that was assigned by Ware et at. The results replicated the previous study in a Taiwanese general population, and these results confirmed the suggestion of using CFA to assess the construct validity of known construct measure.
Aromatherapy and Essential Oils in Thai Spa Business
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Rawewan Patin; Mayuree Kanlayavattanakul; Nattaya Lourith
This study collected financial information and information on essential oils used in Thai spas via questionnaires mailed to 105 spa managers or owners who operate spas certified by the Ministry of Public Health of Thailand. The majority of investments were less than 50 million Thai Baht (64.76%), of which hotel and resort spas dominated (44.76%). The predominant spa services given were aromatherapy massage (87.20%), followed by facial and body treatment (80.78%) and steam/sauna (74.82%). Most of the spa owners used natural essential oils (77.14%) as opposed to synthetic essential oils (22.86%). The five most popular essential oils were lavender (35.71%), lemongrass (20.54%), orange (16.07%), peppermint (15.18%) and jasmine oils (12.50%), respectively. Factors affecting essential oil selection in order of importance were organoleptic properties, therapeutic efficacies, purity, certification, price, supplier and tester.
Attitude and Behavior of Consumers on Sunscreen Cosmetics
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) Namnuang Voraphongsathorn; Mayuree Kanlayavattanakul; Surapol Nathakankitkul
This research aimed to study the consumers’ attitudes and behaviors in purchasing and using sunscreen cosmetics. One hundred and seventy nine Thai consumers aged over 15 years old at Pattaya beach, Chonburi Province were randomly interviewed by questionnaire. It was found that 90.5% were women, aged 20-39 years old (83.8%), educated bachelor degree (64.8%) and earned average monthly income 17,013.34 Baht. Most of the consumers daily applied sunscreen cosmetics (75.4%) and mainly purchased from supermarkets, cosmetic stores or mini marts (78.2%). The brand royalty consumers were only 25.1% whereas 71.5% of them always alternated the brand. The consumers’ demography was not significantly affected on purchasing and using behavior except occupation (F-test = 2.43, p=0.037). Purchasing and using attitudes significantly correlated with behaviors. This informative study is available for those who are dealing with public relation and education relevant to cosmetics providing the appropriated information on sunscreen cosmetics selection prevents misuse accordingly.
Bioaccessibility of Aflatoxin B₁ in Grinded Corn and Peanut by in vitro Digestion Model
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Witchada Simla; Supatra Porasuphatana; Piyada Songsermsakul
Aflatoxin B₁ (AFB₁) is a secondary metabolite produced principally by Aspergillus flavus and Aspergillus Parasiticus. This toxin represents a significant health hazard for those exposed to it continually for a prolonged period. Aflatoxigenic molds are commonly found in corn and peanuts, and under certain conditions aflatoxins will be formed. In vitro digestion is a method that has been used to estimate the bioaccessibility of chemicals and contaminants in foods. An in vitro digestion experiment was carried out in this study to analyze the bioaccessibility of AFB₁ in grinded corn and peanut. Trifluoroacetic acid-derivatized AFB₁ was measured using a HPLC-fluorescent detector. Results indicated that the bioaccessibility of AFB₁ in grinded corn and peanut was relatively high at 95% 94%, respectively. When AFB₁-contaminated grinded corn and peanut are ingested, most of the AFB₁ will be dissolved into chyme, with this strongly influencing the bioavailability of AFB₁ in humans. This may have important implications on dietary exposure. Findings from the current study could be applied to improve risk assessment of ingested AFB₁.
Caffeine Topical Gel Formulation
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Thanaporn Amnualkit; Suthimaln Ingkatawornwong; Duangkhae Maneenuan; Kittichote Worachotekamjorn
Caffeine was used topically as one of many ingredients in various cosmetic preparations for reducing under-eye puffiness and dark circles. Gels containing 3% w/w caffeine as an active ingredient were prepared in this study. Suitable co-solvent systems and gel-forming concentrations were studied. Their effects on caffeine release from formulation were also studied. Suitable gel formulations consisted of carbopol Ultrez-21 as a gel-forming agent and propylene glycol (PG) as a co-solvent. The result showed that the increased concentration of Carbopol Ultrez-21, affected the formulation and thereby giving higher viscosity. However, all concentrations Carbopol Ultrez-21 studied (0.2%, 0.5%, 1%, 2% and 4%) did not affect caffeine release significantly. The percentage of PG in the formulation greatly affected caffeine release. Formulation containing 15% and 30% w/w PG gave release rate from Higuchi’s equation of 2.47 ± 0.26 mg/cm²/h½ and 2.37 ± 0.17 mg/cm²/h½, respectively which were lower when compared to release rate of 2.67 ± 0.07 mg/cm²/h½ from formulation containing 7.5% w/w PG. The best formulation of caffeine gel with good physical appearance and good release rate comprised of 3% caffeine, 0.5% carbopol Ultrez-21 and 7.5% PG.
Clinical Efficacy of Plai Gel Containing 1% Plai Oil in the Treatment of Mild to Moderate Acne Vulgaris
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) Chulaporn Limwattananon; Thananan Rattanachotphanit; Areewan Cheawchanwattana; On-anong Waleekhachonloet; Rattanasiri Giwanon; Charoen Choonhakarn; Bang-orn Sripanidkulchai; Sumon Sakolchai
The objective of this study is to test the efficacy and safety of Plai gel containing 1% Plai oil in treatment of mild to moderate acne vulgaris. Randomized, double blinded, placebo controlled trial was conducted in 60 healthy volunteers. The primary outcome is expressed in percentage reduction in total acne lesions (inflammatory lesions and non inflammatory lesions). Assessments were performed at week 2, 4, and 8. A percentage reduction in total acne lesions in plai group was higher than the placebo group at week 2 [6 times (95%CI: -16 to 28)] and week 4 [12 times (95%CI: -12 to 35)]. A percentage reduction in noninflammatory acne lesions in plai group was higher than the placebo group at week 2 [14 times (95%CI: -17 to 43)] and week 4 [26 times (95%CI: -4 to 64)]. However, such differences did not show statistical significance. At week 8, there were no differences between two groups. The plai group showed a significant reduction of noninflammatory acne lesions from the baseline at week 2 (45 ± 29 lesions) and week 4 (41 ± 25 lesions), while the placebo did not so. A percentage reduction in inflammatory acne lesions in plai group was lower than the placebo group at week 2 [2.9 (95%CI:-37.6 to 31.8)] and week 4 [12.1 (95%CI:-42.2 to 17.9), however, there were no significant differences. For the secondary outcome, success rate at week 8 was 39% in plai group and 31% in placebo group. However, this difference did not show statistical significance. Plai gel was safe. Adverse events were not found in this study. The compliance to use plai gel was greater than 90%. In conclusion, plai gel is promising to be used in treatment of mild to moderate acne, which the effect could be seen within the first month as compared to placebo.
Comparative Study of Three Multiple Linear Regression Software Programs
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Bodin Tuesuwan; Nisa Phutong; Mitr Pathipvanich
Two commercial and one free online multiple linear analysis programs were tested with simulated potentiometric titration data for accuracy in determination of equivalent point, dissociation constant and partition coefficient. In many cases, analysis of simulated data yielded inaccurate results, possibly due to programming algorithms. This study highlights a need for regression programs to be tested with simulated data to assess their limitations.
The Cooperation Project of the Development and Establish of Curriculum of Master Degree in Clinical Pharmacy in Module System by Faculty of Pharmaceutical Sciences, Khon Kaen U, Chiangmai U, Silpakorn U and Prince of Songkla U and Bureau of Health Service
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) Kitti Pitaknitinun; Patanong Jongsirilerd
Abstract in Thai
Costs and Treatment Outcomes of Patients with Acute Leukemia in Sappasittiprasong Hospital, Ubonratchathani
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Patcharee Kanjanawat; Dayin Koompalum; Summana Moolasarn; Anoree Surawong
The objective of this study was to determine direct medical costs and treatment outcomes of acute leukemia patients: Acute lymphoblastic leukemia (ALL), acute Myeloid leukemia (AML) and acute promyelocytic leukemia (APL), in Sappasittiprasong hospital. The study was a retrospective descriptive of newly diagnosed acute leukemia patients admitted at Sappasittiprasong hospital was carried out from October 1, 2004 to September 30, 2006. The treatment outcomes data collected for 2 years of treatment and the cost data collected for 1 year of treatment by using a health care providers perspective. As a result, 151 acute leukemia patients were enrolled; 45 were children, all received chemotherapy; 106 were adult. 2-years Survival rates of child patients with ALL, AML, and APL were 68.57%, 37.50% and 100%. In adult patients, who received chemotherapy were 6.25%, 4.69% and 25%, median survival time were 3.50, 2.87 and 14.47 months, respectively. Median survival time in adult AML patients receiving palliative chemotherapy and no chemotherapy were 0.57 and 1.03 months, respectively. The first-year of median direct medical costs for child with ALL, AML, APL were 166,544, 366,147 and 360,647 baht, and for adult patients, who received chemotherapy were 115,911, 349,658, and 169,904 baht, respectively. In conclusion, the costs and treatment outcomes of patients with acute leukemia in Sappasittiprasong hospital were varied by types of acute leukemia, treatment protocols and chemotherapy regimens. Thus, to increase patient survival rates, more studies should be conducted to determine factors associated with costs and treatment outcomes.
Determination of Illegal Adulterant in Herbal Medicines and Dietary Supplements by Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) Nitra Nuengchamnong; Nipa Suwannakij; Watoo Phrompittayarat
Adulterations with synthetic drugs are common problems with herbal medicines and this can potentially cause serious adverse effects. In this paper, a robust LC-MS/MS method for the sensitive and reliable determination of 33 illegal adulterations from herbal medicines and dietary supplements was established. The drugs were isolated from herbal sample using 70% (v/v) methanol. Chromatographic separation was done using C18 column (150x4.6 mm id., 5 µM) with gradient elution of 0.1% (v/v) formic acid and methanol at flow rate of 0.6 ml/min. For most drugs, two transitions were monitored (multiple reaction monitoring; MRM) using protonated or deprotonated as precursor ions under their respective optimal collision energy for each compound. The detection limit was in the level of picogram and the separation of at least 30 compounds can be done in 30 min. The application of this method was used in the sample of herbal medicines, dietary food supplements, coffee for weight controlling and cola drink, totally 49 samples. The adulterate found was dexamethasone in a sample of herbal medicines used for muscle ache, sibutramine was found in 2 samples of dietary food supplements and caffeine was found in 3 samples of dietary food supplements that did not claim on product. With this developed method for analysis of adulterants in herbal medicine, the product quality can be better controlled and regulated to ensure consumers’ safety.
Development of a High Performance Liquid Chromatography with Coulometric Electrochemical Detector Method for the Analysis of Morphine in Human Plasma
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Thanee Tessiri; Viroj Sumyai; Suvatana Chulavatnatol; Poj Kulvanich; Khanittha Tontisirin; Thaned Pongjanyakul; Sirikul Aumpon; Verawan Uchaipichat; Detpon Preechagoon
A HPLC method using reversed-phase chromatography coupled with a coulometric electrochemical detector (ECD) was developed for the determination of morphine in human plasma. Hydromorphone was selected as an internal standard. The compounds were extracted using solid-phase extraction with C₁₈ cartridges and separated on a reversed-phase C\¹⁸ column with the mobile phase consisting of 69% v/v phosphate buffer pH 2.2 (5 mM sodium phosphate monobasic and 0.7 mM sodium dodecyl sulfate) and 31% v/v acetonitrile. The working electrode of the ECD was set at +450 mV for analytical purposes. Under this condition, the limit of detection for morphine was 0.33 ng/mL, whereas the limit of quantitation was 1.88 ng/mL. The percent recovery, intra-day and inter-day variation of morphine determinations were in the percentage range of 85.07-93.41, 2.86-6.41 and 3.76-11.39, respectively. The frozen samples kept at -20\°C proved to be stable for at least one month prior to extraction. Also, the repeated use of cartridges for extraction was found to generate reliable results.
The Development of Feed Supplement Effervescent Tablets for Poultry
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Supatra Kambud; Jomjai Peerapattana
The objective of this research was to develop feed supplement effervescent tablets for poultry. The multivitamins are more stable in the solid dosage form (tablets) and their use is easy because it is dissolved before feeding. In this study, the effect of type and quantity of binder, lubricant, solubilizing enhancer and filler were investigated. Citric acid, tartaric acid and sodium bicarbonate (NaHCO₃) in the ratio of 1:2:3.4 were selected as effervescent base. The physico-chemical properties of the tablets were assessed according to USP29 and BP 2002. The vitamin C content was also measured. The optimum formula for multivitamins effervescent tablets was identified as 50.50% multivitamin blend, 2.5% PVP K30 (added as 30% solution in 95% ethanol), 9% corn starch, 30% effervescent base, 3% tween 80, and 5% PEG 6000. The effervescent tablets were prepared by the wet granulation method. The finished products were yellow, round, flat face tablets with typical vitamin like odor. The uniformity of weight and content, % friability, and disintegration time met the requirements of standard Pharmacopoeias.
Development of Oral Isoniazid and Rifampicin Microspheres
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Wandee Rungseevijitprapa
The objective of this study was to develop oral isoniazid and rifampicin microspheres in order to improve rifampicin stability by avoiding its direct contact with INH and acidic environmental of stomach. In the study, isoniazid microspheres were prepared by w/o/w emulsion solvent diffusion evaporation method using ethylcellulose as wall material. Rifampicin microspheres were prepared by o/o emulsion solvent diffusion evaporation method using Eudragit®L 100-55 as polymer. Formulation variables which effect physical characteristic and microsphere stability were investigated. Result from differential scanning calorimetry showed that isoniazid and rifampicin when kept as drug powder at 37°C and 50°C for 2 weeks were unstable while drug encapsulated in microspheres remained unchange. In vitro drug release showed a faster dissolution rate of rifampicin microspheres in phosphate buffer pH 6.8 than in 0.1 N HCl which dued to the solubility of Eudragit®L 100-55 in the medium. In conclusion, the combined isoniazid and rifampicin microspheres formulation exhibited a potential to improve the rifampicin stability for oral application.
Drug Use Review of Bisphosphonates and Raloxifene for Osteoporosis Treatment at the Postmenopausal Clinic, Health Promoting Hospital, Regional Health Promotion Center 6
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-12) ประชิต กังสวร; อรอนงค์ วลีขจรเลิศ; จุฬาภรณ์์ ลิมวัฒนานนท์; สุมนต์ สกลไชย
This study aimed to review prescribing of bisphosphonates and raloxifene for osteoporosis treatment at the postmenopausal clinic, Health Promoting Hospital, Regional Health Promotion Center 6, Khon Kaen. A review of chart and registry was performed. All medical charts between January 2003 and June 2008 were reviewed (N=103). In this study, indication, dosage, and duration of treatment were examined. Findings showed that all prescribing of alendronate and risedronate were appropriate with recommended indications. The rate of appropriate use of raloxifene was 65% (13 from 20 patients who received raloxifene as the first choice medication). Medications were prescribed as continuous basis. Medications were changed or discontinued only when adverse events occurred or bone mineral density (BMD) T-score decreased from baseline. BMD monitoring for two years after Starting drug treatment was conducted in a small proportion of patients. Three of patients had adverse events in gastrointestinal system including glossitis and abdominal pain from alendronate and risedronate.
Economic Evaluation of Disease Management Program : A Cases Study of Open Heart Surgery
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Pataranuch Rujirawat; Thananan Rattanachotphanit; Thitima Samkaew; Areewan Cheawchanwattana; Nutjaree Pratheepawanit Johns; Chulaporn Limwattananon; Sumon Sakolchai
This study aimed to analyze the cost effectiveness for open heart surgery in disease management program compared with usual care. This study analyzed the cost effectiveness for coronary bypass grafting (CABG) in the 60 years old patients and open heart surgery for patients with valvular heart disease in 40 years old patients. Decision Analysis Model was used to calculate life expectancy, quality-adjusted life expectancy (QALY), lifetime cost and incremental cost-effectiveness ration (ICER). The disease management program was assumed to increase the proportion of patients receiving the surgery by 30% and reduce the proportion of patients who received delayed surgery by 40% when compared with usual care. Mortality rate in the first year of the surgery was based on the clinical data of Queen Sirikit Heart Center of the Northeast, Khon Kaen University. Mortality rate in the second year after surgery and thereafter was obtained from published literatures. Cost data were abstracted from electronic databases of Maharat Nakhonratchasima Hospital and obtained from DGR system. Quality of life data were based on the study of quality of life outcome measured by EuroQol VAS among patients with open heart surgery under the disease management program. Time horizons were 20 years for CABG and 40 years for VHD surgery. Compared to usual care, CABG under the disease management program improved life expectancy and QALY, and was more costly. Life expectancy were 9.83 and 9.36 years which were equivalent to 6.29 and 5.82 QALYs for disease management program and usual care, respectively. An ICER of the disease management program as compared with usual care was 17,276 Baht per QALY. For surgery in VHD, compared with usual care, the disease management program also improved life expectancy and QALY, and was more costly. Life expectancy were 13.17 and 11.54 years which were equivalent to 11.54 and 7.35 QALYs for the disease management program and usual care, respectively. An ICER of the disease management program as compared with usual care was 5,904 Baht per QALY. A cost effectiveness acceptability curve, based on Monte Carlo simulation suggests that at a willingness to pay (WTP) threshold of more than 15,000 Baht per QALY, more than 50% of CABG in the disease management program will be cost effective. For the surgery for VHD, at a WTP threshold of more than 10,000 Baht per QALY, more than 50% of surgery for VHD under the disease management program will be cost effective. Based on the WHO cost-effectiveness threshold, open heart surgery under the disease management program is considered the cost-effectiveness management when compared to usual care.

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