Medicine In Thailand Research Articles

Dehydrostephanine Isolated from Stephania venosa Possesses Anti-Inflammatory Activity in Lipopolysaccharide-Activated RAW264.7 Macrophages

Stephania venosa (Blume) Spreng. is a medicinal herb wildly used as a folklore medicine in Thailand. Many studies have reported that S. venosa tuber revealed a variety of pharmacological activities including anti-malarial, anti-microbial, anti-cancer, anti-oxidant, and anti-inflammatory activities. In this study, we investigated the effects of (–)-stephanine and dehydrostephanine isolated from S. venosa tuber on anti-inflammation in lipopolysaccharide (LPS)-activated RAW264.7 macrophages. RAW264.7 cells were treated with (–)-stephanine and dehydrostephanine in the presence of LPS and cell viability was determined by MTT assay. The levels of inflammatory mediators, nitric oxide (NO) and pro-inflammatory cytokines were determined by Griess reagent and enzyme-linked immunosorbent assay, respectively. Pre-treatment of dehydrostephanine significantly suppressed NO secretion in LPS-activated RAW264.7 cells with the half-maximal NO inhibitory concentration (IC50) value of 26.81±0.25 μM. However, (–)-stephanine had IC50 value on the inhibition of NO secretion of >40 μM. In addition, dehydrostephanine at concentrations of 20 - 80 μM significantly reduced LPS-induced tumor necrosis factor-α, interleukin-1b, and interleukin-6 production in RAW264.7 cells. The present study showed that dehydrostephanine possesses the anti-inflammatory effect on LPS-activated RAW264.7 macrophages by suppression of inflammatory mediators. Dehydrostephanine may be a promising candidate compound for further investigation of a novel class of anti-inflammatory drug.

Sleep medicine in Thailand.

Citation:Chirakalwasan N, Preutthipan A, Maranetra KN, Yongchaiyudh P, Kotchabhakdi N. Sleep medicine in Thailand. J Clin Sleep Med. 2020;16(3):451–453.

Effect of Thunbergia laurifolia Herbal Tea on Glucose Homeostasis in Healthy Volunteers: A Single-Arm Phase I Study.

Background Thunbergia laurifolia (TL) is a commonly used herbal medicine in Thailand and in other Asian countries. TL has been approved as a Thai traditional medicine for detoxifying poisons, and the list of possible adverse effects includes hypoglycemia. TL showed hypoglycemic effect in animals possibly due to antioxidant effect and beta-cell preservation. However, the safety of TL herbal tea and its effects on glucose homeostasis have never been investigated in humans. Methods Twenty healthy volunteers (10 men and 10 women) drank TL herbal tea 3 times/day for 2 weeks. Ten subjects took TL herbal tea 9 grams daily. After the safety of TL herbal tea was established, 10 more subjects took TL 12 grams daily. Clinical and biochemical tests were assessed at baseline and at 2 weeks. Results Mean age was 34.9 ± 10.2 years, and mean body mass index was 27.5 ± 5.8 kg/m2. Baseline and posttreatment plasma concentrations were as follows: fasting plasma glucose (89 ± 6 vs. 89 ± 7 mg/dL), fructosamine (213 ± 32 vs. 212 ± 33 μmol/L), fasting insulin (8.8 [IQR: 5.9–18.4] vs. 10.4 [IQR: 7.4–15.2] μU/mL), HOMA-B (101.6 [IQR: 82.3–189.8] vs. 120.4 [IQR: 93.2–153.2]), and HOMA-IR (1.1 [IQR: 0.8–2.3] vs. 1.4 [IQR: 0.9–2.0]), all respectively. There were no significant changes in these parameters, including body weight, blood pressure, lipid profile, and C-reactive protein. No serious adverse events were observed during the study period. Conclusions TL herbal tea at doses of 9 and 12 grams daily had good tolerability without any significant adverse effects on fasting plasma glucose level or other glucose homeostasis parameters measured.

Current state of cancer patient care incorporating Thai traditional medicine in Thailand: A qualitative study

ObjectiveTo assess the current state of cancer treatment incorporating Thai traditional medicine (TTM) and to identify problems in the system, by using the health system framework of the World Health Organization. MethodsA qualitative study was conducted by interviewing three groups of people involved in the healthcare system. The groups were constructed via purposive sampling of patients with cancer, caregivers and service providers. The study groups included 37 individuals from five TTM hospitals. In-depth interviews were conducted from October 2017 to March 2018. The interview questions were developed based on the six building blocks of a health system framework. Free form answers from participants were analyzed and interpreted to develop the study conclusions. ResultsAll five TTM hospitals provided treatment to patients with cancer based on provincial public health policy. The policy allows patients with cancer to obtain TTM services in outpatient and inpatient departments and via home visits; most patients used outpatient services. The TTM services were primarily provided by TTM practitioners and included massage, herbal steam, herbal compress and meditation. Herbal medicines were widely used and included Benja-amarit, an anticancer formulation made from Wat Khampramong and Phytoplex. The problems included poor acceptance of TTM practitioners by other healthcare practitioners, lack of experience among TTM practitioners in treating patients with cancer, lack of herbal medicine research trials, contamination in herbal medicine preparations and absence of practical treatment guidelines. ConclusionTTM is an alternative treatment modality for patients with cancer and is supported by a national policy in Thailand. To increase accountability to patients and other practitioners, TTM treatments should be refined to rely on scientific principles and practitioners of TTM should receive academic training. Practical treatment guidelines need to be established and thoroughly disseminated to TTM practitioners.

Factors associated with patient satisfaction in laparoscopic adrenalectomy

Laparoscopic adrenalectomy a treatment that is recommended for patients with adrenal adenoma and has been shown to lead to a 94% biochemical remission rate of aldosterone as well as improvements to quality of life in five domains of the SF-36. This method is also associated with high rates of patient satisfaction. However, there is little information available on the factors associated with patient satisfaction in cases of laparoscopic adrenalectomy. This study aimed to evaluate these factors in patients with Conn's syndrome who underwent laparoscopic adrenalectomy. This study was based on a survey and was conducted at Srinagarind Hospital at the Khon Kaen University Faculty of Medicine in Thailand. The inclusion criteria were that patients were between 15 and 60 years of age, had been diagnosed with adrenal gland tumors, and had undergone trnasperitoneal laparoscopic adrenalectomy. All eligible patients were asked to fill out a self-report questionnaire in which they rated their satisfaction (out of 10) and factors associated with their level of satisfaction in the areas of clinical treatment and scarring. There were 44 patients who participated in the study. The average (SD) age of all patients was 47.10 (10.90) years. The average overall satisfaction scores for the surgery and with regard to scarring post surgery were 9.47 (1.15) and 8.11 (2.21), respectively. Only the presence of headaches was an independent factor associated with the overall satisfaction, with a coefficient of -0.29 (p value 0.001). Only age was significantly predictive of overall satisfaction with regard to scarring with a coefficient of 0.05 and p value of 0.046. In conclusion, the presence of headaches was related to overall satisfaction and age was associated with satisfaction with regard to scarring in patients Conn's syndrome who underwent laparoscopic adrenalectomy.

Precision medicine in Thailand

Extraordinary advances in high throughput next generation sequencing (NGS) technology and bioinformatics are the main thrust that transforms the current state of healthcare into the era of precision medicine where clinical practice takes individual variability into account. Here, we summarize the current status of the infrastructure we have and the adoption of precision medicine in Thailand in four spheres: rare diseases, oncology, pharmacogenomics, and noncommunicable diseases. Moreover, we provide our perspectives to the future of precision medicine in Thailand, especially the manpower and ethical, legal, and social issues. We believe that with decreasing costs of NGS, increasing ability to interpret the genomic data, a greater number of actionable and available treatments, implementation of precision medicine at the public health level is not a matter of if but when.

First Report of Anthracnose Caused by Colletotrichum brevisporum on Gac (Momordica cochinchinensis) in Thailand.

Gac (Momordica cochinchinensis Spreng) is known as “fruit from heaven” and could promote longevity, health, and vitality (Ishida et al. 2004). Gac fruit has been used as both food and medicine in Thailand. In October 2016, anthracnose-like symptoms were found only on leaves of gac plants in Chiang Mai, Thailand (18.79°N, 98.99°E). Approximately half of the plants in a 0.3-ha field of gac were symptomatic. Spots on leaves appeared as circular to irregular in shape, medium brown to blackish in color, and 0.5 to 1.5 cm in diameter. On necrotic lesions, small and black fruiting bodies developed in concentric rings. Abundant brown setae and hyaline, cylindrical, guttulate conidia were observed from necrotic leaves by microscope. To isolate the causal organism, fragments from the lesion margins were surface disinfested with 75% ethanol for 40 s and rinsed thoroughly with sterile distilled water. The fragments were then placed on potato dextrose agar (PDA) and incubated at 26°C in the dark. Six isolates with similar morphology were isolated from single spores. Colonies on PDA at 25°C for 7 days were cottony, grayish white to gray, dark brown at the center in reverse, with orange conidial mass. Conidia (n = 100) were hyaline, one-celled, smooth walled, cylindrical with round ends, guttulate, and 10.5 to 16.8 × 4 to 6 μm. Appressoria (n = 50) formed in culture were brown to dark brown, ovoid or slightly irregular, and 9 to 12 × 7 to 10 μm. The internal transcribed spacer (ITS), actin (ACT), and calmodulin (CAL) gene regions from all six isolates were amplified with primer pairs ITS1 (5′-TCCGTAGGTGAACCTGCGG-3′)/ITS4 (5′-TCCTCCGCTTATTGATATGC-3′), ACT-512F (5′-ATGTGCAAGGCCGGTTTCGC-3′)/ACT-783R (5′-TACGAGTCCTTCTGGCCCAT-3′), and CAL-228F (5′-GAGTTCAAGGAGGCCTTCTCCC-3′)/CAL-2Rd (5′-TGRTCNGCCTCDCGGATCATCTC-3′), respectively (Cai et al. 2009). The resulting 558-bp ITS, 259-bp ACT, and 661-bp CAL sequences from all six isolates were 100% identical. Sequences of isolate MBG16102401 were deposited in GenBank (accession nos. MH063256 for ITS, MH063257 for ACT, and MH063258 for CAL), and BLAST searches showed 100% identity with those of Colletotrichum brevisporum sequences (accession nos. KY986893.1 for ITS, KU315567.1 for ACT, and KU319454.1 for CAL), respectively. The isolate MBG16102401 was deposited at the culture collection of the Institute of Vegetables and Flowers, Chinese Academy of Agricultural Sciences, for future reference. Based on morphological and molecular characteristics, the pathogen was identified as C. brevisporum (Noireung et al. 2012). In pathogenicity test, leaves of 15 potted gac plants (4 weeks old) were pinpricked with a sterile needle and inoculated by spraying onto the leaves with a conidial suspension (10⁶ conidia/ml). For the control, wounded leaves of 15 gac plants were sprayed with sterilized distilled water. Approximately, each gac plant has 8 to 10 leaves. These inoculated plants were kept in a greenhouse (temperature 25°C; relative humidity 90%). The inoculation experiments were replicated three times, and each replicate included five gac plants. Ten days later, inoculated plants developed typical anthracnose symptoms identical to those observed in the field, whereas the control plants remained healthy. C. brevisporum was successfully reisolated from symptomatic leaves to fulfill Koch’s postulates. To our knowledge, this is the first report of C. brevisporum as a pathogen on M. cochinchinensis in Thailand as well as in the world (Farr and Rossman 2018). The identification of the pathogen is important for providing management recommendations to growers, which have a significant economic impact on gac fruit production in Thailand.

Two decades’ contribution of occupational medicine training in Thailand: experience from the foundation with a view toward the future

Abstract For 2 decades, the Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, has served the Occupational Medicine Residency training program in Thailand. Graduates of this program undertake to work in occupational medicine to promote health and prevent morbidity and mortality in the workplace and provide occupational medical services for the working population in Thailand. Qualifying for a Postgraduate Diploma in Occupational Medicine in Thailand can be achieved in 2 ways: through a 3-year residency training or 5 years of working experience in the field of occupational medicine combined with an elective 2-month short course. There are currently 159 Thai board-certified occupational medicine physicians. Occupational medicine physicians in Thailand work in both public and private healthcare facilities. A number of certified occupational physicians occupy leading national health positions in various government and academic organizations. Knowledge of occupational medicine is currently essential for undergraduate medical students as specified in the medical competency assessment criteria of the Thai Medical Council. Updating content and incorporating needs of employers are keys to success for Thailand, as a country with an occupational medicine training program in its initial stages. In Thailand, the supply of occupational medicine physicians is still less than the increasing demand. Advancement of health research schemes would contribute to the curriculum. Occupational medicine development in Thailand needs to address challenges in local issues including work in the informal sector, particularly in agriculture, and incorporate standardization and international consistency into the training curriculum and qualifying management.

Ethnomedicinal plant diversity in Thailand

Ethnopharmacological relevancePlants have provided medicine to humans for thousands of years, and in most parts of the world people still use traditional plant-derived medicine. Knowledge related to traditional use provides an important alternative to unavailable or expensive western medicine in many rural communities. At the same time, ethnomedicinal discoveries are valuable for the development of modern medicine. Unfortunately, globalization and urbanization causes the disappearance of much traditional medicinal plant knowledge. Aim of the studyTo review available ethnobotanical knowledge about medicinal plants in Thailand and to estimate its diversity. MethodsInformation about ethnomedicinal uses of plants in Thailand was extracted from 64 scientific reports, books, and theses produced between 1990 and 2014. Plant identifications in the primary sources were updated to currently accepted names following The Plant List website and the species were assigned to family following the Angiosperm Phylogeny Website. Use Values (UV) were calculated to estimate the importance of medicinal plant species (UVs) and families (UVf). Medicinal use categories, plant parts used, preparations of the medicine, and their applications were noted for each use report. ResultsWe found 16,789 use reports for 2187 plant species in 206 families. These data came from 19 ethnic groups living in 121 villages throughout Thailand. The health conditions most commonly treated with medicinal plants were in the categories digestive system disorders, infections/infestations, nutritional disorders, muscular-skeletal system disorders, and genitourinary system disorders. Plant families with very high use values were Fabaceae, Asteraceae, Acanthaceae, Lamiaceae, and Zingiberaceae and species with very high use values were Chromolaena odorata (L.) R.M.King & H.Rob., Blumea balsamifera (L.) DC., and Cheilocostus speciosus (J.Koenig) C.D.Specht. Stems and leaves were the most used plant parts, but also other parts of the plants were used in medicinal recipes. The most common way of using the medicinal plants was as a decoction in water. ConclusionWe found 2187 plant species that were used in traditional medicine in Thailand. Of these a few hundred had high use values, suggesting that they may produce bioactive compounds with strong physiological effects.

Inhibitory effect of Phlai capsules on skin test responses among allergic rhinitis patients: a randomized, three-way crossover study

BackgroundZingiber cassumunar Roxb., commonly known as Phlai in Thai, has been used as a traditional medicine in Thailand for the treatment of various diseases, including inflammation and chronic airway disease. ObjectiveThe purpose of this study was to assess the antihistaminic effect of Phlai on skin testing. Design, Setting, Participants and InterventionThis was a randomized, open-label, three-way crossover study. Twenty allergic rhinitis (AR) patients were enrolled. In randomized sequence, patients received a single dose of Phlai capsules (100 or 200 mg) or loratadine (10 mg) with a washout period of 1 week between each treatment. Main Outcome MeasuresSkin prick testing for histamine and common aeroallergen (house dust mite) were performed before treatment and after 1, 2, 3, 4, 6, 8, 12 and 24 hours of treatment. The main treatment outcomes were the mean wheal and flare responses to the skin prick test after treatment. ResultsBoth 100 mg and 200 mg Phlai doses suppressed wheal and flare responses to house dust mite allergen, but only 200 mg of Phlai capsules significantly suppressed wheal and flare responses to histamine. Repeated measures analysis of variance showed that loratadine caused more wheal and flare suppression than Phlai capsules in responses to the histamine skin prick test. However, there were no significant differences among the effects of 100 mg Phlai capsules, 200 mg Phlai capsules and loratadine in suppression of wheal and flare induced by the mite skin prick test. Both doses of Phlai were well-tolerated with no adverse events. ConclusionBoth 100 mg (compound D 4 mg) and 200 mg (compound D 8 mg) Phlai capsules, when taken as a single therapeutic dose, inhibited skin reactivity to histamine and mite skin prick tests in AR patients. Trial RegistrationThai clinical trial registry (TCTR20160510001).

From AIDS to Free Trade Agreements: Knowledge Activism in Thailand’s Movement for Access to Medicines

This article examines the movement for access to medicines in Thailand, a country that is a privileged site of observation of the new world order of pharmaceuticals and has been at the forefront in many international negotiations on intellectual property. The movement relies on the appropriation of knowledge and expertise about intellectual property laws, which developed in the context of the fight against HIV/AIDS. Treatment activism in Thailand is particularly vigorous and studying it allows us to grasp both the national and transnational dimension of this type of collective action: a global movement that is structured around the notion of "access to medicines," and is in close but rather orthodox relation to medical knowledge. The relations that one can draw between AIDS activism and the movement for access-to-medicines allows one to trace the origins of the latter and helps us understand key features at the core of this movement. But the analysis also shows that, from the outset, the access to medicines movement in Thailand developed through a new form of activism. The notion of knowledge activism is developed in this paper to seize the particularities of the activism at play in Thailand as compared with other forms of collective action relying on the use of knowledge. Knowledge activism is defined not only by the activists’ relation to knowledge–– authoritative and institutionalized knowledge, or lay expertise––but also by the inclusion in the movement of “expert activists” such as doctors, lawyers, or academics, together with “grassroots activists.” Knowledge activism also implies a permanent circulation of knowledge and information between the various categories of actors involved inside, outside and on the fringes of the movement, and results in a hybrid form of collective action that develops beyond the movement and is constantly reconfigured, according to opportunities or pressures.

Association between Internet addiction and depression in medical students, faculty of medicine in Thailand

IntroductionInternet addiction has become a harmful behavioral problem found to be highly prevalent in high school and college students. Many studies demonstrated significantly association between Internet addiction and depression.AimsTo study the prevalence of Internet addiction and the association between internet addiction and depression in medical students, faculty of medicine, Ramathibodi hospital.MethodsA cross-sectional study was conducted. Participants were the first to fifth-year medical students who agreed to participate in this study. Demographic characteristics were derived from self-rated questionnaire and were analyzed by descriptive statistics. Thai version of Young's Internet Addiction Diagnostic Questionnaire and Thai version of Patient Health Questionnaire (PHQ-9) were used to assess internet addiction and depression, then Chi2 test and logistic regression were used to analyze the associations between internet addiction, depression and associated factors.ResultsFrom 705 participants, 24.5% had internet addiction and 29.0% had depression. There was statistically significant association between Internet addiction and depression (odd ratio: 1.92; 95% confidence interval [CI]: 1.34–2.77, P-value < 0.000). Logistic regression analysis illustrated that the Internet addiction group had risk of depression 1.58 times higher than the group without Internet addiction (95% CI: 1.04-2.38; P-value < 0.031). Academic problem was found to be a significant predictor of both Internet addiction and depression. Furthermore, Internet addiction, relationship problems with friend and lover, and health problem were also significant predictors of depression.ConclusionsInternet addiction was common psychiatric problem which associated with depression among medical students. We suggest that surveillance of Internet addiction should be considered in medical schools.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect of Curcuma comosa extracts on the functions of peptide transporter and P-glycoprotein in intestinal epithelial cells.

Curcuma comosa has been widely used as a herbal medicine in Thailand; however, it remains unclear whether C. comosa influences the absorption of drugs that are substrates for the transporters in the small intestine. In this study, we investigated the effect of C. comosa extracts on the functioning of peptide transporter 1 (PEPT1), an influx transporter, and P-glycoprotein (P-gp), an efflux transporter, in Caco-2 cells and rat intestine. In Caco-2 cells, the ethanolic extract of C. comosa (CCE) lowered the uptake of glycylsarcosine (Gly-Sar), a PEPT1 substrate, while it enhanced the uptake of rhodamine 123 (Rho123), a P-gp substrate, in a concentrationdependent manner. In addition, CCE inhibited apical-to-basal transport of Gly-Sar and basal-to-apical transport of Rho123. Furthermore, the absorption of cephalexin, another PEPT1 substrate, and the exsorption of Rho123 across the rat intestine were inhibited by CCE. Conversely, CCW, the hot water extract of C. comosa, suppresses the function of PEPT1 but not of P-gp in Caco-2 cells. These results suggest that C. comosa used as a herbal medicine in Thailand may affect the intestinal absorption of certain drugs.

Dysregulated Expression of MITF in Subsets of Hepatocellular Carcinoma and Cholangiocarcinoma.

Cholangiocarcinoma represents the second most common primary liver tumor after hepatocellular carcinoma. Mahanine, a carbazole alkaloid derived from Murraya koenigii (Linn.) Spreng, has been used as folk medicine in Thailand, where the liver fluke-associated cholangiocarcinoma is common. The expression of microphthalmia-associated transcription factor (MITF) is maintained at immunohistochemically undetectable levels in hepatocytes and cholangiocytes. To explore the regulation of MITF expression in the liver, we immunohistochemically analyzed the MITF expression using hepatocellular carcinoma and cholangiocarcinoma specimens of the human liver cancer tissue array. MITF immunoreactivity was detected in subsets of hepatocellular carcinoma (6 out of 38 specimens; 16%) and cholangiocarcinoma (2/7 specimens; 29%). Moreover, immunoreactivity for glioma-associated oncogene 1 (GLI1), a transcription factor of the Hedgehog signaling pathway, was detected in 55% of hepatocellular carcinoma (21/38 specimens) and 86% of cholangiocarcinoma (6/7 specimens). Importantly, MITF was detectable only in the GLI1-positive hepatocellular carcinoma and cholangiocarcinoma, and MITF immunoreactivity is associated with poor prognosis in patients with hepatocellular carcinoma. Subsequently, the effect of mahanine was analyzed in HepG2 human hepatocellular carcinoma and HuCCT1 and KKU-100 human cholangiocarcinoma cells. Mahanine (25 µM) showed the potent cytotoxicity in these hepatic cancer cell lines, which was associated with increased expression levels of MITF, as judged by Western blot analysis. MITF is over-expressed in subsets of hepatocellular carcinoma and cholangiocarcinoma, and detectable MITF immunoreactivity is associated with poor prognosis in patients with hepatocellular carcinoma. MITF expression levels may be determined in hepatic cancer cells by the balance between the Hedgehog signaling and the cellular stress.

Family medicine in Thailand: System, training, and obstacles

Family medicine in Thailand: System, training, and obstacles

Sleep medicine in Thailand

Sleep medicine practice and research in Thailand had been initiated since 20–30 years ago by physicians, scientists, and researchers from various specialties. The first polygraphic studies performed involved 2 diseases: Sudden Unexplained Death in Sleep and obstructive sleep apnea (OSA). Formal sleep laboratories services were first established in university hospitals in 1993–1994. Organization in sleep research, the Thai Sleep Research and Sleep Medicine Society (TRSMS) were founded in 1991 to help promote the interest in sleep medicine. Later on, physicians established the Sleep Society of Thailand in 2009 with the following missions: (1) to promote sleep medicine in Thailand through education, research and improvement of patient care; (2) to give sleep education to physicians, sleep technicians, other sleep related professions, and the public; and (3) to promote sleep health, education, and research and standardize the investigation and treatment of sleep disorders. However, with the burden of sleep disorders in Thailand, there is still the unmet need for the care of patients with sleep disorders. The crucial problems are insufficient amount of sleep professionals both sleep specialists and sleep technicians, as well as inadequate sleep laboratories with capacity to perform polysomnography. Thus, academic trainings for sleep professions in every discipline are urgently required to encourage the progression of sleep medicine in Thailand in the future.

Medicine information leaflets for non-steroidal anti-inflammatory drugs in Thailand

The importance of promoting the use of patient-oriented medicines leaflets is recognized in many countries. Leaflets should include basic information plus specific warnings, and be provided with all medicines, but there is little attempt at enforcement of these requirements in Thailand. To determine content and availability of Thai information leaflets for nonsteroidal anti-inflammatory drugs (NSAIDs). Leaflets for all NSAIDs available for purchase from 34 pharmacies in a large city were evaluated against a checklist and number of leaflets assessed against number of medicine packs available in each pharmacy. Of the 76 leaflets for ten different NSAIDs, 67 (88 %) were for locally manufactured products. Only 22 % of 76 leaflets were sufficient in number for distribution with medicines, while only 4 % had patient-oriented leaflets. No leaflet covered all topics in the checklist. Less than half included safety information, such as contraindications (46 %), precautions (47 %), and adverse drug reactions (34 %). Locally-produced leaflets provided less information than those for originator products and no leaflet included all the warnings required by Thai regulations. This study illustrates the variable availability and quality of NSAID information leaflets. The lack of accessible essential information about medicines in Thailand requires urgent attention to enable patients to minimise adverse reactions.

Enhancement of energy production by black ginger extract containing polymethoxy flavonoids in myocytes through improving glucose, lactic acid and lipid metabolism.

Enhancement of muscular energy production is thought to improve locomotive functions and prevent metabolic syndromes including diabetes and lipidemia. Black ginger (Kaempferia parviflora) has been cultivated for traditional medicine in Thailand. Recent studies have shown that black ginger extract (KPE) activated brown adipocytes and lipolysis in white adipose tissue, which may cure obesity-related dysfunction of lipid metabolism. However, the effect of KPE on glucose and lipid utilization in muscle cells has not been examined yet. Hence, we evaluated the effect of KPE and its constituents on energy metabolism in pre-differentiated (p) and differentiated (d) C2C12 myoblasts. KPE (0.1-10 μg/ml) was added to pC2C12 cells in the differentiation process for a week or used to treat dC2C12 cells for 24 h. After culturing, parameters of glucose and lipid metabolism and mitochondrial biogenesis were assessed. In terms of the results, KPE enhanced the uptake of 2-deoxyglucose and lactic acid as well as the mRNA expression of glucose transporter (GLUT) 4 and monocarboxylate transporter (MCT) 1 in both types of cells. The expression of peroxisome proliferator-activated receptor γ coactivator (PGC)-1α was enhanced in pC2C12 cells. In addition, KPE enhanced the production of ATP and mitochondrial biogenesis. Polymethoxy flavonoids in KPE including 5-hydroxy-7-methoxyflavone, 5-hydroxy-3,7,4'-trimethoxyflavone and 5,7-dimethoxyflavone enhanced the expression of GLUT4 and PGC-1α. Moreover, KPE and 5,7-dimethoxyflavone enhanced the phosphorylation of 5'AMP-activated protein kinase (AMPK). In conclusion, KPE and its polymethoxy flavonoids were found to enhance energy metabolism in myocytes. KPE may improve the dysfunction of muscle metabolism that leads to metabolic syndrome and locomotive dysfunction.

QUALITY IMPROVEMENT OF MAH-KHWUAEN (ZANTHOZYLUM LIMONELLA ALSTON) USING DIFFERENT DRYING METHODS AND AN OPTIMAL MATHEMATICAL MODEL

Mah-Khwuaen (Zanthoxylum limonella Alston) is commonly used as food flavoring and traditional medicine in Thailand. This study was conducted to evaluate the effects of different drying methods and temperatures on the quality of dried Mah-Khwuaen and determine the appropriate mathematical model for drying. Drying by hot air oven, alternating hot air oven (AHAO) and solar dryer-assisted hot air oven (SHAO) was tested and compared with conventional oven drying. Three drying temperatures, 60, 70 and 80°C, were tested. Mah-Khwuaen shoots were dried to 18% moisture content (dry basis). Results showed that suitable drying time ranged from 75-185 min. Hot air oven and SHAO gave better color and flavor than conventional oven. AHAO gave the least desirable quality. The appropriate drying temperature was 70°C. SHAO had the lowest energy consumption. The Page Model was the optimal mathematical model that can describe the drying behavior.

Policies and programs to facilitate access to targeted cancer therapies in Thailand.

BackgroundIncreasing access to clinically beneficial targeted cancer medicines is a challenge in every country due to their high cost. We describe the interplay of innovative policies and programs involving multiple stakeholders to facilitate access to these medicines in Thailand, as well as the utilization of selected targeted therapies over time.MethodsWe selected two medicines on the 2013 Thai national list of essential medicines (NLEM) [letrozole and imatinib] and three unlisted medicines for the same indications [trastuzumab, nilotinib and dasatinib]. We created timelines of access policies and programs for these products based on scientific and grey literature. Using IMS Health sales data, we described the trajectories of sales volumes of the study medicines between January 2001 and December 2012. We compared estimated average numbers of patients treated before and after the implementation of policies and programs for each product.ResultsDifferent stakeholders implemented multiple interventions to increase access to the study medicines for different patient populations. During 2007–2009, the Thai Government created a special NLEM category with different coverage requirements for payers and issued compulsory licenses; payers negotiated prices with manufacturers and engaged in pooled procurement; pharmaceutical companies expanded patient assistance programs and lowered prices in different ways. Compared to before the interventions, estimated numbers of patients treated with each medicine increased significantly afterwards: for letrozole from 645 (95% CI 366–923) to 3683 (95% CI 2,748–4,618); for imatinib from 103 (95% CI 72–174) to 350 (95% CI 307–398); and for trastuzumab from 68 (95% CI 45–118) to 412 (95% CI 344–563).ConclusionsGovernment, payers, and manufacturers implemented multi-pronged approaches to facilitate access to targeted cancer therapies for the Thai population, which differed by medicine. Routine monitoring is needed to assess clinical and economic impacts of these strategies in the health system.