Thai Bulletin of Pharmaceutical Sciences

OXIDATIVE STRESS MECHANISMS IN CHRONIC KIDNEY DISEASE

2024-07-14T10:16:24+07:00

Chronic kidney disease (CKD) is a significant health concern resulting from damage to the kidneys and ureters. CKD is characterized by a decreased glomerular filtration rate and proteinuria. Recent studies suggest that oxidative stress plays a crucial role in the pathophysiology of CKD. During CKD progression, an imbalance in free radical production leads to excessive reactive oxygen species (ROS) and reactive nitrogen species (RNS), overwhelming the body's antioxidant defenses. This imbalance causes oxidative stress, damaging target molecules such as DNA, proteins, and lipids, ultimately leading to cell death. Evidence indicates that CKD is associated with oxidative stress, contributing to disease progression through several mechanisms: (1) mitochondrial dysfunction resulting in increased ROS production, (2) activation of NADPH-Oxidase (NOX) isoforms, a significant source of oxidative stress in the kidneys, (3) disassembly of eNOS, a key contributor to oxidative stress and kidney damage, (4) myeloperoxidase (MPO) involvement in the development and progression of kidney disease, (5) increased xanthine oxidase (XO) activity in CKD patients, (6) elevated superoxide dismutase-1 levels in dialysis patients, and (7) presence of inflammatory factors, which enhance oxidative stress and disrupt redox balance, further increasing inflammation. This oxidative stress and inflammation lead to tissue injury, disease progression, and the severity of CKD. To combat oxidative stress and mitigate clinical symptoms, drugs and antioxidants are employed, aiming to delay CKD progression and reduce its clinical impact.

GAS CHROMATOGRAPHY-MASS SPECTROMETRY CHEMICAL PROFILING AND ANTIOXIDATION ACTIVITY OF THE THAI HERBAL FORMULA “PIKAD TRISUKKHATI SAMUTHARN” EXTRACT

2023-12-02T19:20:27+07:00

Pikad Trisukkhati Samutharn (PTS) is a medicinal formula used in Thai traditional medicine for treating severe fever, inflammation, and diarrhea, as well as for general health promotion. This herbal formula was made from the roots of three plants: Oroxylum indicum (L.) Kurz, Sesbania grandiflora (L.) Pers and Ficus racemosa L. The purpose of this study was to investigate the antioxidation activity and chemical profiling of PTS and its herbal components. The antioxidation activity of the extracts was determined using the DPPH free radical scavenging assay, as well as the Folin-Ciocalteu method, to investigate the total phenolic contents. The thiobarbituric acid reactive substance (TBAR) assay was used to test lipid peroxidation activity. The chemical profiling of PTS was demonstrated using gas chromatography–mass spectrometry (GC-MS) analysis. The results revealed that the total phenolic content of the ethanolic extract (79.57 ± 2.33 mg GAE/g extract) was greater than that of the aqueous extract (12.55 ± 2.83 mg GAE/g extract) of the PTS. The DPPH free radical scavenging activity of the PTS ethanolic extract (IC₅₀ value 80.69 ± 0.40 mg/mL) was also stronger than that of the PTS aqueous extract (IC₅₀ value
650.10 ± 98.20 mg/mL). Lipid peroxidation of the PTS ethanolic extract was moderate with 32.47 ± 0.71% inhibition. GC-MS revealed the presence of several phenolic compounds contained in the PTS ethanolic extract in which the identified compounds had previously been reported to have several pharmacological activities such as antioxidation, anti-inflammation, and antimicrobial. In conclusion, the antioxidation and chemical constituents of the PTS extract were demonstrated for the first time, and more pharmacological activities of PTS should be explored to confirm its traditional use.

DEVELOPMENT OF ADMISSION MEDICATION RECONCILIATION IN SONGKLANAGARIND HOSPITAL

2023-12-21T21:35:02+07:00

Hospitalized patients are prone to medication errors (MEs) which usually occur at transition points during care. Communication problems or the transfer of information between patients and healthcare professionals are among the causes of MEs. This study developed a medication reconciliation system with pharmacists who were specifically responsible for identification of medication discrepancy and intervention. This action research on patient admissions at Songklanagarind Hospital between October 2018 - September 2022 is divided into 4 phases: 1. Designed and developed medication reconciliation system with pharmacists in collaboration with a multidisciplinary team. 2. Conducted trial with one pharmacist and piloted it among patients with a previous history of using warfarin. 3. Developed medication reconciliation program. 4. Expanded the program to patients who are at risk of MEs by increasing the number of pharmacists to two. 70-78% of patients had medication reconciliation processed by a pharmacist within 24 hours of hospital admission. Pharmacists found MEs of 11-17%, with the most common being the incorrect dosage or frequency of medication (50-70%), followed by omission (15-45%). In 70-77% of the MEs, the medication did not reach the patient. Pharmacists have an important role in preventing MEs by reconciling medications. Through the medication reconciliation process, pharmacists can assess the completeness and accuracy of medication lists to reduce MEs and prevent those errors from affecting patients.

INCIDENCE AND RISK FACTORS ASSOCIATED WITH NEUROLOGICAL ADVERSE REACTIONS IN FOCAL EPILEPSY PATIENTS USING LEVETIRACETAM

2023-11-19T15:09:00+07:00

Levetiracetam is commonly prescribed as an anticonvulsant drug to treat epilepsy, but it may also cause neuropsychiatric adverse events such as drowsiness, aggression, and depression. However, the incidence and risk factors associated with neuropsychiatric adverse events to levetiracetam among patients with focal epilepsy in Thailand remain unclear. The objective of this study was to determine the incidence and risk factors associated with neuropsychiatric adverse events in focal epilepsy patients receiving levetiracetam. For this purpose, we retrospectively collected data from the medical chart review of patients with focal epilepsy between January 2018 and December 2021 who received treatment in the epilepsy clinic at Chulalongkorn Hospital. The results revelaed that of the total of 220 patients included in the study, 78 patients (35.3%) experienced neuropsychiatric adverse events. Females, persons of young age, and patients with drug-resistant epilepsy have risk factors associated with neuropsychiatric adverse events. Therefore, it can be concluded that the incidence of neuropsychiatric adverse events in this study was not different from that of previous studies. The female gender, persons of young age, and patients with drug-resistant epilepsy should be closely monitored.

DEVELOPMENT OF A PAPER-BASED DEVICE USING INDOXYL ACETATE AS A CHROMOGENIC SUBSTRATE FOR RAPID QUALITATIVE DETERMINATION OF LIPASE INHIBITOR

2024-03-28T10:30:07+07:00

An improved paper-based device using indoxyl acetate as a chromogenic substrate was developed for rapid qualitative determination of lipase inhibitory activity. Colorless indoxyl acetate can be catalytically hydrolyzed by lipase to produce the blue-colored indigo dimer on the paper device. In the presence of a lipase inhibitor, enzyme activity diminishes, resulting in reduced hydrolysis of indoxyl acetate. Consequently, this leads to a decrease in the intensity of the blue coloration, which can be visually observed across a range of blue shades and analyzed using image analysis. Orlistat was used as the representative lipase inhibitor in the assay. The LODs obtained from visual detection and the image analysis were comparable. The paper-based device using indoxyl acetate for lipase inhibition assay was simple and convenient. It could be useful as a simple screening method for the detection of orlistat adulteration in weight loss supplements.

DETERMINATION OF EXTRACTIVE VALUES BY UV/VIS SPECTROPHOTOMETRY COUPLED WITH CHEMOMETRIC METHODS: CASE STUDIES OF TURMERIC, ANDROGRAPHIS AND ROSELLE

2024-04-27T13:15:28+07:00

An extractive value is a quality control parameter of herbal raw materials. Its determination process requires patience and consumes a lot of electrical energy. This study explored the correlation between the extractive values and UV/Vis spectral data. The spectroscopic data was analyzed using partial-least square regression and multiple linear regression to estimate the extractive values. Turmeric, andrographis, and roselle were selected as case studies due to the diverse polarities exhibited by their chemical components. The predictive models for the ethanol-soluble extractives of all herbs, as well as the water-soluble extractives of andrographis and roselle, were effectively developed. Nevertheless, the model for the water extractive of turmeric did not yield successful results. The effectiveness of the chemometric approach relied on the chemical composition of the individual herbs. The reliability of the developed models was assessed by the acceptable root mean square error of cross-validation and root mean square error of prediction. The accuracy of each model was greater than 94%. This study presented an innovative concept that had the potential applicability to other herbs.

BEYOND MEDICINE AVAILABILITY: UNPACKING THE CHALLENGES OF METHADONE MAINTENANCE THERAPY IMPLEMENTATION IN NORTHERN THAI HOSPITALS

2024-05-01T16:40:21+07:00

Methadone maintenance therapy (MMT) is a harm reduction-based approach that has been part of national policies since 2018. Despite its inception, MMT provision faces challenges, particularly in North Thailand, where opioid use disorders are the most prevalent. This study assessed MMT provisions in terms of system input, performance, and output in all 147 public hospitals under the Ministry of Public Health in Northern Thailand. This cross-sectional study employed an online questionnaire based on the World Health Organization’s six building blocks and the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. Northern Thailand data collection spanned from September 1, 2022, to February 1, 2023. The results revealed that ninety-eight hospitals (66.70%) responded. Only 37.76% actively provided MMT, 4.08% discontinued it, and 58.16% did not offer it. In areas where opioid overuse disorder is reported, MMT is available in 70.59% of the hospitals. The strong system governance and value proposition of MMT in hospitals with MMT services helped 78.49% of patients with opioid use disorder access services and maintained a one-year retention rate of 71.35%. Though patients with MMT services had a high retention rate, gaps still existed such as a lack of staff and training, limited data collection, and insufficient collaboration with stakeholders to expand the referral capacity. Inactive and pending hospitals lacked an MMT service policy, hindering service launches. According to the findings, the scaling up of MMT services still faces challenges, including the fact that most hospitals do not offer these services and even those that do often lack staff, training, and resources. Support for MMT services must be tailored to the specific needs and contexts of different hospitals.

DEVELOPMENT OF FLUCONAZOLE-LOADED POLY(VINYL ALCOHOL)/POLY(ETHYLENE GLYCOL) BLENDED FILM FOR TREATMENT OF CANDIDA-INFECTED CUTANEOUS WOUNDS

2024-07-12T12:48:26+07:00

In this work, we aimed to develop fluconazole (FLU)-loaded polymer blended film (FLU-film) for candidiasis wounds. The films were prepared from poly(vinyl alcohol) (PVA) and poly(ethylene glycol) 1000 (PEG 1000) mixed at different proportions by weight, casted on a petri dish, and dried at 60ºC for 12 h. Tensile strength, swelling ratio, and morphology were analyzed to determine an appropriate film for wound application. The selected film was loaded with 0.5% w/w FLU, where the drug homogeneity was ascertained. Then, the drug release profile, cytotoxicity of the films, and antifungal activity were determined. The findings revealed that the suitable film was PVA:PEG 1000 (95:5), showing anticipated flexibility and stretchability, as well as a soothing texture, while the swelling and molecular attributes were comparable to other films. FLU was homogenously loaded into the selected film and presented a prolonged release profile following Higuchi’s model. The film was found to be non-toxic to the human skin fibroblast. Lastly, the FLU-film presented 1.16-fold greater antifungal effectiveness than the free FLU. Overall, the FLU-film has been developed and proven to be effective for treating Candida-infected wounds.