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Recognition of tramadol abuse, dispensing practices, and opinions about its control policy among community pharmacists in Bangkok, Thailand

Abstract

Background

Tramadol is classified as a pharmacist-only (restricted) medicine by the Food and Drug Administration of Thailand (Thai FDA). Because of concern about its abuse, in September 2013 the Thai FDA announced a policy to control the distribution of tramadol in community pharmacies.

Objectives

To identify tramadol dispensing practices by community pharmacists in Bangkok, their recognition of tramadol abuse and the Thai FDA control policy announcement; and opinions about the tramadol control policy.

Methods

This descriptive cross-sectional study was conducted in community pharmacies located in Bangkok. Pharmacists on duty were interviewed from September 2015 to April 2016.

Results

Data from 305 pharmacists working in 305 pharmacies revealed that tramadol, both single (tramadol alone) and combination (tramadol plus acetaminophen) formulations, was available in 185 pharmacies (60.7%). Most pharmacists dispensed tramadol to supply regular medicine along with previous prescriptions (74%). Among 305 pharmacists, 304 (99.7%) recognized tramadol abuse in combination with cold–cough remedies and carbonated beverages can create euphoria. Most (97.7%) knew about the announcement of the tramadol control policy, and most (82.6%) thought that the policy was practical. Approximately 43% of pharmacists agreed that the policy was effective in reducing the tramadol abuse problem, whereas 36.7% disagreed. Moreover, 60.3% disagreed with rescheduling tramadol as a prescription-only medicine. In their opinion, tramadol should still be available in pharmacies, to be dispensed by community pharmacists to patients with medical necessity.

Conclusions

Further studies nationwide in Thailand are likely to be useful to represent and compare information in different parts of the country.

Open access
Treatment outcomes for elderly patients in Thailand with pulmonary tuberculosis

Abstract

Background

Elderly patients with pulmonary tuberculosis are less likely to achieve treatment success than younger patients, and patients aged ≥60 years have a substantial increase in mortality.

Objectives

To compare treatment outcomes over 2 periods during the transition of Thai national tuberculosis (TB) reporting systems and determine treatment success rates and mortality for elderly patients in TB treatment-care settings in Thailand.

Methods

Retrospective cohort study of all records of elderly patients extracted from 2 national TB databases in Thailand: the TB Case Management (TBCM) database of the National TB Program (2014–2015) and the database of the National Health Security Office (NHSO; 2010–2011).

Results

There were 8,301 elderly patients with TB in the TBCM cohort and 11,869 in the NHSO cohort. Overall treatment success rates were 78.5% for patients in the TBCM cohort and 87.5% for patients in the NHSO cohort. High success rates for treatment were found for those aged 60–69 years: 91.1% in 2010–2011 and 85.0% in 2014–2015. High mortality was reported for patients aged ≥90 years: 34.6% in 2010–2011 and 50.0% in 2014–2015.

Conclusions

Compared with the NHSO historical cohort, success rates for treatment were lower and death rates were higher in the TBCM cohort. Because NHSO enforced intensive case monitoring and follow-up while TBCM has no such mechanism, the estimates from the TBCM database may be less accurate for TB circumstances in Thailand. Frequent routine home visits may ensure more complete treatment-care information and support, and increase the treatment success rate in the elderly.

Open access
Analysis in silico of the single nucleotide polymorphism G–152A in the promoter of the angiotensinogen gene of Indonesian patients with essential hypertension

Abstract

Background

Single nucleotide polymorphism (SNP) G–152A (rs11568020) in the promoter of the angiotensinogen gene (AGT) may modulate its transcription. Translation of mRNA to angiotensinogen induces hypertension during hypoxia. The G allele at position –152 is located within the hypoxia-response element (HRE) transcription factor-binding site for the hypoxia-inducible factor 1 (HIF-1) heterodimer. However, the function of the –152 site in HIF-1 binding is not fully elucidated.

Objectives

To determine the frequency of SNP G–152A in Indonesian patients with hypertension and the function of this SNP.

Methods

We determined the frequency of the SNP in 100 patients by direct sequencing, and the influence of SNP G–152A on predicted binding of HIF-1 to the HRE using a docking approach in silico.

Results

The AGT promoter in our patients had genetic variants –152G and –152A (19:1). Predicted binding indicated that HIF-1 directly contacts the major groove of the G allele, but not the A allele. Scoring according to weighted sum High Ambiguity Driven biomolecular DOCKing showed that the score for the A allele–HIF-1 complex (–47.1 ± 6.9 kcal/mol) was higher than that for the G allele–HIF-1 complex (–94.6 ± 14.1 kcal/mol), indicating more favorable binding of HIF-1 to the G allele.

Conclusions

SNP G–152A reduces the favorability of binding of HIF-1 to the HRE. The occurrence of this SNP in the AGT promoter of Indonesian patients with essential hypertension suggests that the G allele is a genetic susceptibility factor in hypertension regulated by HIF-1.

Open access
Bioactivity of a sol–gel-derived hydroxyapatite coating on titanium implants in vitro and in vivo

Abstract

Background

Hydroxyapatite is widely used as a coating on metallic implants to promote bioactivity. The coating is typically produced using a high temperature, resulting in phase heterogeneity and coating delamination, which may lead to failure of the coating clinically. Development of a simple and low-temperature hydroxyapatite coating technique may improve the bone bonding ability of implants.

Objectives

To investigate responses to hydroxyapatite-coated titanium produced by a newly developed sol–gel by osteoblasts in vitro and bone in vivo.

Methods

Osteoblast proliferation was characterized using a methyl thiazolyl tetrazolium assay and cell calcification with an Alizarin red S assay, and the results were compared with those of uncoated titanium. Uncoated and coated screws were inserted into the trabecular bone of New Zealand white rabbit legs. These implants were evaluated mechanically and histologically after 7, 12, and 24 weeks.

Results

Hydroxyapatite-coated titanium showed a significantly greater cell proliferation and mineralization than uncoated titanium. Extraction torques for the coated screws increased with time of implantation and were significantly greater than those of uncoated screws. We observed bone fragments attached to the surface of all coated screws after removal, but none on uncoated screws. Hematoxylin and eosin-stained bone showed no active inflammatory responses to implantation at any time examined. Bone surrounding either uncoated or coated screws followed typical remodeling stages, but maturation of bone healing was faster with coated screws.

Conclusions

The sol–gel-derived hydroxyapatite coating showed bioactivity, indicating its potential application as an alternative coating technique to improve the bone bonding ability of implants.

Open access
Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan: a call for more action

Abstract

Background

The burden of diabetes has increased rapidly with an increasing cost of treatment.

Objectives

To describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin.

Methods

This cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) <7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar <180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist.

Results

We studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P < 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe.

Conclusions

Glycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.

Open access
Risk factors for Opisthorchis viverrini infection in Nakhon Phanom, Thailand, where the infection is highly endemic

Abstract

Background

Opisthorchiasis caused by Opisthorchis viverrini is a serious health issue in the Mekong basin region, resulting in a high prevalence of cholangiocarcinoma. Nakhon Phanom province had the highest prevalence of O. viverrini infection in Thailand at 60% of the surveyed population in 2009, despite the attempted control of opisthorchiasis for >50 years. Knowing risk factors for O. viverrini infection in Nakhon Phanom may lead to improved control and prevention of opisthorchiasis.

Objectives

To determine risk factors for O. viverrini infection in Nakhon Phanom.

Methods

We conducted a cross-sectional survey in Nakhon Phanom province from February to March 2014. The community was selected using a stratified random sampling method, and then, participants were selected by systematic random sampling. Individuals ≥15 years old were included. Knowledge of O. viverrini infection, and attitudes and practice to avoid it were assessed using a questionnaire. O. viverrini infection was determined by stool examination with a formalin–ether concentration method. Factors associated with the infection were determined using multivariate logistic regression analysis.

Results

Of the 134 participants, 75 (56%) were infected with O. viverrini. In the multivariate logistic regression analysis, 3 independent factors were associated with O. viverrini infection: age ≥ 55 years, odds ratio (OR) adjusted 6.36 (95% confidence interval (CI) 1.28–31.66); consumption of chopped raw-fish salad (koi pla), OR adjusted 28.74 (95% CI 3.59–230.24); and perceived susceptibility, OR adjusted 0.15 (95% CI 0.03–0.74).

Conclusions

Age ≥ 55 years, consuming koi pla, and perceived susceptibility were independently associated with O. viverrini infection in Nakhon Phanom.

Open access
Statin use and histopathological change in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is one of the major causes of chronic liver disease. The primary treatment of NAFLD by statins has not been clearly elucidated.

Objectives

To evaluate the effectiveness of statin use in patients with biopsy-proven NAFLD or non-alcoholic steatohepatitis on the change in liver histology.

Methods

We searched MEDLINE, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials for clinical trials and observational studies investigating the effects of statins on histological change regardless of type or dosage from inception to December 2015. Random-effect model meta-analyses were used to compute changes in outcomes of interest. The study protocol was registered in advance with the International Prospective Register of Systematic Reviews (PROSPERO 2016 CRD42016033132).

Results

We identified 6 studies (111 patients), representing 5 cohort studies and 1 randomized controlled clinical trial. There was significant decrease in steatosis grading with a standardized mean difference of –2.580 (95% confidence interval [CI] –4.623 to –0.536; P = 0.013) and NAFLD activity score standardized mean difference of –1.488 (95% CI –2.506 to –0.471; P = 0.004). However, there was no significant change in fibrosis stage (0.156; 95% CI –0.553 to 0.865; P = 0.667).

Conclusions

Statin use can possibly reduce the extent of steatohepatitis but not the stage of fibrosis. Further randomized controlled studies to assess histological evidence with adequate sample size and duration are required in order to establish the role of statin as a primary treatment of NAFLD.

Open access
Antimicrobial activity of some novel 2-(2-iodophenylimino)-5-arylidenethiazolidin-4-one derivatives

Abstract

Background

Infectious diseases, especially those caused by multidrug-resistant bacteria, are becoming a serious problem worldwide because of the lack of effective therapeutic agents. Moreover, most antifungal drugs exhibit low efficacy and high toxicity because of the similarity between fungal and human cells. These issues warrant the search for potential new agents.

Objectives

To synthesize potent 2-(2-iodophenylimino)-5-arylidenethiazolidin-4-one derivatives, improve the synthetic process, elucidate their structures, and determine their antimicrobial activity.

Methods

2-Iodoaniline was used as an initial reactant in a 3-step process for the synthesis of 2-(2-iodophenylimino)-5-arylidenethiazolidin-4-one derivatives, including an acylation reaction, a cyclization reaction, and aldol condensation reactions. The structures of the obtained derivatives were investigated and elucidated using spectral methods. Antimicrobial activity toward 5 bacterial strains and 2 fungal strains was determined using Kirby–Bauer and agar dilution methods.

Results

We successfully synthesized 12 novel compounds and elucidated their structures. The derivatives had no antifungal activities. By contrast, they showed remarkable antibacterial activities. Some of them with minimum inhibitory concentrations (MICs) ≤8 μg/mL in both Staphylococcus aureus and methicillin-resistant S. aureus.

Conclusions

A simple and flexible way to synthesize new compounds with a thiazolidin-4-one ring was determined. Some of these new compounds have outstanding effects with low MICs for bacteria. Their further investigation as therapeutic agents is warranted.

Open access
Autoimmune hemolytic anemia and autoantibodies in a patient with Plasmodium falciparum infection: report of a rare case and review of the literature

Abstract

Background

Anemia is a common problem among patients with malaria infection, which induces hemolysis during treatment. A few patients present with autoimmune hemolytic anemia (AIHA) and autoantibodies, such as autoanti-E and autoanti-I, during malaria infection.

Objective

To report the clinical response of a patient with Plasmodium falciparum malaria infection with a hemolytic condition.

Methods

We reviewed medical records of a patient with P. falciparum malaria and related literature.

Results

Our patient presented with P. falciparum malaria infection and received artesunate and ceftriaxone to cover potential tropical infectious diseases. After malaria parasite was eradicated, her hemoglobin declined, and AIHA and autoantibodies were found, explaining the cause of anemia. Corticosteroid was given at a standard dosage, and her hemoglobin became normal within 1 week.

Conclusion

Patients with falciparum malaria and both AIHA and autoantibody complications are rare. Our patient responded to malaria eradication and corticosteroid treatment. Most cases reported seem to respond to corticosteroid with a variety of recovery times. However, corticosteroids might increase the severity of infection; more clinical data to support a standard regimen to treat properly rare hematologic complications (AIHA and autoantibodies) in malaria patients are warranted.

Open access