Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน

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Instructions for the Authors
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) . .
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.
Exploration the Results of Cancer Pain Management Following Implementation of World Health Organization (WHO) Pain Guideline
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Suphat Subongkot; Sugunya Khounnikhom; Nutjaree Pratheepawanit Johns; Aunkhae Sookprasert
Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care.Methods: This cross sectional study aimed to explore a result of pain management at Srinagarind Hospital, Khon Kaen University following the implementation of World Health Organization (WHO) Pain Guideline. Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the-clock and 3) analgesics used for break-through pain for patients receiving strong opioids.Results: From Dec 2005 to Jul 2006, 261 patients were enrolled, 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain.In Naïve group (n=159), 32.7% (n=52) of patients were given analgesics following the WHO on both day 1 and day 3 of admissions; 3.8% (n=6) of patients followed WHO only on day 1; 23.3% (n=37) of patients followed WHO only on day 3 whereas 40.2% (n=64) of patients did not follow WHO on both days. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO both days on day 1 and a decreased pain score was much improved (3.9, SD±1.8) as continuing to follow WHO on day 3 (p \< 0.0001) compared to those not following WHO on both days.In Routine group (n=102), 31.4% (n=32) of patients were given analgesics following WHO guideline on both day 1 and day 3 of admission. 5.9% (n=6) of patients followed WHO only on day 1; 27.5% (n=28) of patients followed WHO only day 3 while 35.3% (n=36) of patients did not follow WHO on both days. A decreased pain score was statistically significant greater (2.6, SD±1.8) in a routine group following the WHO both days on day 1 (p \< 0.0001). Furthermore, a decreased pain score was even greater (3.9, SD±2.3) in the routine group continuing to follow WHO on day 3 compared to those not following WHO on both day 1 and day 3 of admission. The most common of adverse effects related to analgesics was constipation.Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO regardless the history of analgesics exposure.
Inspection Cooperation Scheme Views of Pharmaceutical Manufacturers in Thailand about the Code of Good Manufacturing Practice of the Pharmaceutical Inspection Cooperation Scheme
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Somying Pumtong; Sathaporn Nimkulrat; Pannipa Akanithapichat; Kunyada Nilwas; Benjaporn Kingrungpetch; Dusadi Suriyapanpong
The aim of this survey is to investigate views of pharmaceutical manufacturers concerning the Code of Good Manufacturing Practice (GMP) of the Pharmaceutical Inspection Cooperation Scheme (PIC/S). Between 19 October and 5 December 2007, data were collected from all modern pharmaceutical manufacturers in Thailand (n=165) using mailed questionnaires. Data were analyzed using descriptive statistics and ANOVA to compare differences across the manufacturer business size as well as spearman correlation to investigate the associations among variables. Fifty-six questionnaires were completed (response rate 34%). The average age of the modern pharmaceutical manufacturers in this study was 35 years. According to business size by small and medium enterprises (SMEs), the manufacturers were divided into three groups: small, medium, and large-sized businesses (23.2%, 50.0% and 19.6% respectively). Thirty-three of the manufacturers (59%) are exporters of drug products. The respondents were asked to assess their potential to achieve the GMP of PIC/S and the data revealed that the majority rated at a moderate to high level. There was a statistically significant difference in overall potential to achieve the GMP of PIC/S scores among the three groups (p \< 0.001) and the small-sized businesses had the lowest mean scores. Regarding views of obstacles to achieve the PIC/S GMP, the comparison demonstrated a significant difference for size of manufacturer business (p=0.005). The small-sized businesses had significantly higher obstacle scores. The major obstacle faced was financial difficulties (i.e. investment in infrastructure: machines, equipments and premises). Additionally, there were correlations between sale value and overall potential; and sale value and obstacles to achieve the GMP of PIC/S (r=0.553, p \< 0.001 and r=-0.400, p=0.004 respectively). Forty-five percent of respondents suggested that Food and Drug Administration (FDA) should not enforce the GMP of PIC/S upon all modern pharmaceutical manufacturers at present as such an action could cause difficulties in management and expenditure. However, 30% agreed to comply with the GMP of PIC/S as they believed that the new GMP could increase the standards of manufacturing practice. Consequently, the image of pharmaceutical manufacturers in Thailand would be improved. The findings could be used by the FDA in order to provide a suitable option for modern pharmaceutical manufacturers and introduce a policy to explore and ultimately improve the standard of manufacturing practice in Thailand.
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.
Pharmacists’ Responsibilities with Respect to Dietary Supplements : Perceptions of Thai Community and Hospital Pharmacists
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Tipaporn Kanjanarach; Ines Krass; Robert G. Cumming
This study aimed to explore Thai pharmacists\’ perceptions of their responsibilities when providing services in relation to dietary supplements (DS). Self-administered postal questionnaires were used to collect data from community pharmacists and hospital pharmacists in the North-eastern region of Thailand. Structural Equation Modelling was performed to develop factor models of the tasks which pharmacists perceived as their responsibilities. Data from 207 community pharmacists and 178 hospital pharmacists were used for the analysis. A factor model showed that community pharmacists perceived that their responsibilities should include five tasks: being the public\’s source of DS information; determining the necessity of DS use; advising clients in choosing DS products; giving education on eating and healthy lifestyles and providing counseling on DS use. This factor model fitted data at a moderate level (\χ\²₅=13.87, n=207, P=0.021, Relative Chi-square = 2.77, AGFI=0.92, CFI=0.96, RMSEA=0.07). The reliability of the factor model was 0.81. A factor model of hospital pharmacists showed that hospital pharmacists perceived that their responsibilities should include six tasks: being the public\’s source of DS information; determining the necessity of DS use; advising clients in choosing DS products; referring clients to doctors if using DS is not appropriate; providing counseling on DS use and reporting DS adverse effects to the authority. The factor model fitted data well (\χ\²₉=11.43, n=178, p=0.247, Relative Chi-square = 1.27, ADFI=0.95, CFI=0.99, RMSEA=0.04). The reliability of factor model was 0.84. The findings from this study suggested that although community and hospital pharmacists had different views about their responsibilities in relation to DS, both groups of pharmacists appeared to be willing to adopt professional responsibilities for safe use of DS.
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.
Quality of Life of Cholangiocarcinoma Patients: Preliminary Study
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Woraya Manprasert; Nutjaree Pratheepawanit Johns; Auemkae Sukprasert; Jaturat Kanpittaya; Thiti Weerapreeyakul; Parichart Pongthai
This study was of longitudinal prospective design and sough to evaluate quality of life (QOL) of cholangiocarcinoma patients at before and one month after treatment. The incidence of adverse events and their impact on a patient’s QOL were also analyzed. The study population were new patients with cholangiocarcinoma receiving treatment at Khon Kaen or Srinagarind Hospitals. QOL was assessed using Thai Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) version 4 and adverse events were assessed using Common Toxicity Criteria Adverse Event (CTCAE) version 3. The report of QOL was categorized as improved, no change and worsening based on clinical meaningful scores of the measures. The mean difference of QOL scores before and after treatment, the relation of adverse events, and their severity on QOL were analyzed using Wilcoxon Sign rank test, Mann-Whitney U test and Kruskal Wallis, respectively. Preliminary results from 16 cholangiocarcinoma patients indicate that. Most patients were male (69%), median age 59, able to work or do high activities at baseline (ECOG ≤ 1, 87%) and only 12 out of 16 patients received chemotherapy treatment (75%). After a one month period, 12 out of 16 patients reported no change or worsening QOL (75%). The most common adverse events reported were fatigue (69%), anorexia (69%), weight loss (44%) and nausea/vomiting (37%). There were more reports of grade 3 or 4 adverse events at one month after treatment in terms of fatigue (12.6% vs. 6.3%), anorexia (43.8% vs. 18.8%) and nausea/vomiting (12.5% vs. 6.3%) compared to baseline. Patients experiencing weight loss after the treatments had reported a statistically significant lower QOL than those without (p \< 0.05). The alteration of fatigue severity from worsening, no-change or better after treatment has significantly affected QOL of these patients (p=0.05).
Effects of Counseling for Stress and Depression in Pharmacy Students at Mahasarakham University
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Juntip Kanjanasilp; Kritsanee Saramunee; Suratchada Kongsree; Saithip Suthiraksa; Isara Chummalee; Rodchares Hanrinth
The aims of this study were to evaluate the stress and depression screening scores, and the quality of life in the part of physical and mental health scores after counseling and follow-up between the study group (the counseller was educated) and the control group (regular system). The first to fifth year students in the Faculty of Pharmacy, Mahasarakham University were screened between July 2007-Febuary 2008, using questionnaires from the Mental Health Department, Ministry of Public Health, and the Short Form-12. Students who had stress and/or depression were divided into 2 groups: the study (n=34) and the control (n=57) groups. Most of them were female both in the study group (73.5%) and in the control group (84.5%). The average age was 19.8±1.54 years in the study group and 19.9±1.54 years in the control group. The screening stress and depression scores in both groups were significantly reduced from baseline (p \< 0.05). However, there was no significant difference between two groups. The physical health scores did not improve from baseline in both groups and there was no significant difference between the two groups. The scores of stress were positively related with the scores of depression. The scores of stress and depression were negatively related with the scores of quality of life both in physical and mental parts. This study proposes that the university should arrange an effective counseling system and continue to follow-up the students, establish a mental counseling center and hot-line to help and resolve problems for students.
Quality Indicators for Diabetes Care in Practice Guidelines and Applying in the District Hospital
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Utoomporn Parinyasakulwong; Thananan Rattanachotphanit; Onanong Waleekhachonloet; Chulaporn Limwattananon; Sumon Sakolchai; Denpong Patanasethanont
This study had two main objectives. The first objective was to conduct a systematic document review to identify and summarize quality indicators of diabetes care. An electronic search of English and Thai language literature published between 1990 and 2008 was performed. Eleven established guidelines were included. Thirty-eight indicators were extracted and categorized into eight diabetes management topics: glycemic control, nephropathy assessment, lipid profile assessment, eye examination, foot examination, blood pressure control, antiplatelet use, and others. The secondary objective was to perform a cross-sectional study to describe the quality of diabetes care in term of process and outcome in two district hospitals in Amnatcharoen Province. All diabetic patients who had fasting blood sugar (FBS) monitored at least three times per year during the period 2003 to 2007, were analyzed by hospital electronic database and medical chart review. In 2003, 2004, 2005, 2006, and 2007, there were 759, 991, 1,212, 1,389, and 1,481 diabetic patients, respectively. The proportions of serum creatinine and lipid profile monitoring increased gradually over time whereas HbA1c and proteinuria monitoring was performed in a small number of cases. The hospitals began to provide complete foot examinations in 2007 and nearly half of patients were examined. The percentage of the patients receiving eye examinations varied over the years. The proportion of patients who were prescribed angiotensin-converting enzyme inhibitors improved substantially between 2003 (17%) and 2007 (49%), whereas most patients were not prescribed aspirin and statins during these years. The percentage of the patients who reached the American Diabetes Association (ADA) 2004 goals of therapy for FBS and blood pressure were relatively low over the five year period. In conclusion, most processes of diabetes care were improved over the five year period. However, there is still room for improvement in the quality of diabetes care in district hospitals. Appropriate management programs should be implemented to improve diabetes care.
Therapeutic Drug Monitoring of Vancomycin at Queen Sirikit Heart Center of the Northeast
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-02-25) Cheardchai Soontornpas; Jintawee Chaichun; Supaporn Noimay
The purpose of this study was to investigate the therapeutic drug monitoring (TDM) of vancomycin at Queen Sirikit Heart Center of the Northeast, Thailand about the patients\’ characteristics, indicators of vancomycin, frequency of TDM service, vancomycin levels and pharmacokinetic parameters of vancomycin. The study was retrospective descriptive study in patients admitted at Queen Sirikit Heart Center of the Northeast, Thailand aged over 15 years old and received vancomycin injection during 1 June 2005 to 31 May 2007. There were 43 patients received TDM services in that time but only 27 patients were recruited in this study. The median of age, weight, serum creatinine, blood urea nitrogen and creatinine clearance were 51.00 years old, 51.20 kg, 1.40 mg/dl, 24.30 mg/dl, and 44.41 ml/min, respectively. The indications of vancomycin were for treating infection of heart, skin and heart and lung in 24, 2 and 1 patients, respectively. Fifty six of 80 TDM services could be assessed. Maximum concentrations were within and beyond therapeutic range for 19 times (33.93%) and 37 times (66.07%), respectively. Minimum concentrations were within and beyond therapeutic range for 30 times (53.57%) and 26 times (46.43%), respectively. Pharmacists had provided 39 recommendations to modify the dosage regimen of vancomycin and 34 (87.18%) recommendations had been responded by physicians as absolute following. Twenty three vancomycin level were rechecked after physician response and they became within and beyond therapeutic range for 11 and 12 times, respectively. The median of pharmacokinetic parameters; volume of distribution, elimination rate constant, half life, and vancomycin clearance were 0.7800 l/kg, 0.0545 h⁻\¹, 12.7237 h, and 35.8253 ml/min, respectively. In conclusion, the therapeutic drug monitoring of vancomycin was useful for dosage adjustment in individual patient for effectiveness of treatment outcome and to prevent adverse drug reaction.
Quality of Work Life of Community-Hospital Pharmacists Registered at Public Health Region 10, Ministry of Public Health
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Watcharanukoon Boonlert; Witat Janposri
The objectives of this cross-sectional descriptive study were to assess the quality of work life of community-hospital pharmacists and to assess the effect of the strategic management of 7-S on the quality of work life of community-hospital pharmacists registered at Public Health Region 10, Ministry of Public Health. The research instrument was the questionnaires; content validity was evaluated by 3 experts, and the reliability was tested by using cronbach’s alpha coefficient (0.91). Information from 111 pharmacists was collected. Statistical methods used in this research were frequency, percentage, mean, 95% CI, standard deviation, median, max, min, Fisher’s exact test, Pearson’s product moment correlation coefficient, Spearman’s correlation coefficient and stepwise multiple regression analysis. The data shows that the quality of work life of community-hospital pharmacists was of medium level (3.31±0.48). The strategic management of 7-S was also of the medium level (3.48±0.57). The strategic management of 7-S factors had highly positive level relationship to the quality of work life of community-hospital pharmacists (r=0.793, p \< 0.001). In addition, dimension of shared values was applied to predict the quality of work life of community-hospital pharmacists registered at Public Health Region 10, Ministry of Public Health at 64.6%. The prediction equation form could be stated as follows: the quality of work life of community-hospital pharmacists = 0.910 + (0.685)(dimension of shared values of the strategic management of 7-S). Therefore, the top administrators of the Ministry of Public Health should consider improving the quality of work life of community-hospital pharmacists, especially the total life space and the adequate and fair compensating.
Instructions for the Authors
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) . .
Perspectives on Professionalism: Shared Responsibility for the Future of Pharmacy
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Cynthia J. Boyle; Cheryl Simmons Gray; Ganesh Kumaraschandran; Jackie Lu; Sara Low
The goal of this article is to relate perspectives of a faculty member, a pharmacy preceptor, a recent graduate, and two students from the University of Maryland School of Pharmacy about the key attributes of a pharmacy professional and to link them to education and the future of pharmacy. With growing numbers of schools/colleges of pharmacy and qualified candidates for admission, professionalism continues to be an important, yet elusive, focus. As a top-ranked school, we pride ourselves on comprehensive programs, an innovative curriculum, and a notable tradition of advancing practice. However the educational enterprise is challenged to recruit faculty, to compete for students with other schools/college of pharmacy and even other health professions, to balance budgets, and to build relationships with stakeholders, alumni, legislators, and donors for support. This article, written in the form of a conversation in this current environment, will identify foundational definitions of professionalism and the opportunities to apply professional attributes and traits to the profession of pharmacy and our communities. In order for the profession to flourish, such conversations should occur regularly so that the professional relationships among faculty, preceptors, graduates, and students are fortified for the future.
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.
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.
Enhanced Bromhexine Hydrochloride Solubility and Dissolution by Inclusion Complexation with Methylated β-cyclodextrin
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Nattha Kaewnopparat; Thitima Chuchom; Arunsri Sunthornpit; Amaravadee Jangwang; Sanae Kaewnopparat
The aim of this study was to enhance the solubility and dissolution of bromhexine hydrochloride by inclusion complexation with the cyclodextrin derivative, methylated \β-cyclodextrin (M\βCD). Inclusion complexes in 1:1 molar ratio were prepared by the kneading and coevaporation methods. The solubility of drug in methylated \β-cyclodextrin was studied. The complexes were characterized by differential scanning calorimetry (DSC), X-ray diffractometry, Fourier transform infrared (FT-IR) spectroscopy and dissolution studies. The solubility of bromhexine hydrochloride increased linearly with the concentration of methylated \β-cyclodextrin. The phase-solubility profile was classified as AL-type, indicating the formation of a 1:1 stoichiometric inclusion complex with an apparent stability constant (Ks) of 110 M⁻\¹. The crystallinity of drug from inclusion complexes was reduced. The inclusion complex prepared by the coevaporation method showed interaction between drug and methylated \β-cyclodextrin. Both kneaded and coevaporated samples gave similar dissolution profiles; of 50-, and 5-fold increases in drug dissolution were observed within the first 5 mins compared to pure drug and physical mixtures, respectively. These inclusion complexes were effective in enhancing drug dissolution, with bromhexine hydrochloride completely dissolving within 10 mins.
Study on Cytotoxicity and Genotoxicity of Repeatedly Fried Cooking Oils by Cell Culture
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Jetana Weerakul; Wongwiwat Tassaneeyakul; Pramote Mahakunakorn; Supattra Porasuphatana
This study aimed to investigate the formation of polycyclic aromatic hydrocarbons (PAHs) and cytotoxicity of extracts from repeatedly fried cooking oils. Special focus was on the correlation between the level of total polar compounds (TPCs) and toxicity to the hepatoma cell line (HepG2). Soybean (SBO) and palm (PO) oil samples were prepared by frying dough at high temperature (165°C), and periodically determining %TPCs by the standard IUPAC 2.507 method. Analysis of PAHs was carried out by liquid extraction followed by gas chromatography (GC), using PAHs mixed consisting of 18 PAHs compounds as standards. Cytotoxicities were measured using cell viability (MTT assay) and micronucleus assays. Results showed undetectable levels of PAHs in frying SBO at %TPCs less than 25%. By comparing fluorene, phenanthrene and anthracene were detected in PO at 20.30% and higher, indicating the formation of PAHs in PO when its %TPCs were close to or exceeding the legal limitation of 25%. Cytotoxicity of extracts from repeated frying PO was confirmed by the reduction of cell viability at 48 and 72 hours incubation. Formation of micronucleus gradually increased with increases in %TPCs, and reached significant levels at 39.66%TPCs and 29.54%TPCs for SBO and PO, respectively. Results from this study suggest that carcinogenic PAHs form when cooking oils are repeatedly used. This is the case for higher %TPCs especially. These findings may aid campaigns for consumer protection against toxic substances generated from repeatedly used cooking oil.
Progression and Outcomes of Chronic Kidney Disease Patients in District Hospitals
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2010-03-14) Pongpitak Mikkata; Denpong Patanasethanont; Supon Limwattananon
The objective of this retrospective study was to determine the progression and outcomes of chronic kidney disease (CKD). Participants were patients who had serum creatinine (SCr) measurement in two district hospitals of Amnat Charoen province between 1 January 2003 and 31 December 2007. Based on definitions of the Kidney Disease Outcome Quality Initiative guideline, patients who had glomerular filtration rate (GFR) less than 60 ml/min/1.73 m² in two separate SCr measurements for at least 3 months were included. GFR was estimated using the abbreviated Modification of Diet in Renal Disease study equation. Descriptive statistics and Kaplan-Meier plots were used for analysis. At baseline, mean age was 61.5±11.3 years and 68.6% were female. At the end of a four-year follow up, 143 of 749 (19.1%) CKD stage 3 patients developed stage 4, 56 of 162 (34.6%) stage 4 patients developed stage 5, and 63 of 103 (61.2%) stage 5 patients died. Among the 103 stage 5 patients, 83 patients (80.6%) were hospitalized 4.7 times for 3.5 days, on average. For stage 4 or 5 patients, 2.3% of all prescriptions were unadjusted dosage regimens based on renal function. In conclusion, disease progression was still rapid in this study population leading to high rates of death and hospitalization. Further implementations on intervention aiming to slow the progression of patients with CKD in district hospitals should be conducted.
Immunomodulating, Antioxidant and Antimicrobial Activities of Northeastern Thai Edible Plant and Medicinal Plant Extracts
(Isan Journal of Pharmaceutical Sciences - วารสารเภสัชศาสตร์อีสาน, 2009-12-22) Chutinun Prasitpuriprecha; Aekachai Damkliang; Payoongsak Surintha; Wasun Deelum
The aim of this study was to investigate the immunological, antioxidant and antimicrobial activities of the ethanolic extracts of four Northeastern Thai edible plants; Tiliacora triandra, Cratoxylum formosum, Kanchanaburi gratum, Polygonum odoratum and one medicinal plant; Eupatorium odoratum. The immunomodulating activity of these extracts was evaluated using mouse splenocyte proliferation by the colorimetric MTT assay. The results showed that C. formosum, K. gratum, P. odoratum and T. triandra extracts had immunostimulating activity. K. gratum and C. formosum extracts could stimulate T- and B-lymphocytes at concentration of 12.5-50 \µg/mL. P. odoratum and T. triandra extracts stimulated only T-lymphocytes at concentration of 12.5-100 \µg/mL and 12.5-25 \µg/mL, respectively, while E. odoratum extract displayed cytotoxic effect. These extracts were also examined for antioxidant activity using the DPPH assay. The ethanolic extracts of K. gratum, C. formosum and P. odoratum exhibited strong antioxidant activity with the EC₅₀ values of 8.17\±0.17, 9.9\±0.14 and 58.03\±1.02 \µg/mL, respectively. The antimicrobial activity of these extracts was investigated against the organisms Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Salmonella typhimurium, Propionibacterium acne, Pseudomonas aeruginosa, Candida albicans and Aspergillus niger by the disc diffusion method. Results showed that all were active against S. aureus. Moreover, C. formosum, K. gratum, P. odoratum and E. odoratum extracts had some activity against B. subtilis, P. acne and P. aeruginosa. K. gratum had the most potent activity with MICs of 1.5625, 3.125, 1.5625 and 3.125 mg/mL against S. aureus, B. subtilis, P. acne and P. aeruginosa, respectively.

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