Eastern Asia University

Background and Objectives: While non-vitamin K antagonist oral anticoagulants (NOACs) show better renal preservation than warfarin in nonvalvular atrial fibrillation (NVAF) patients, real-world evidence within Asian populations remains limited. This study compared the renal outcomes between NOACs and warfarin in Thai patients with NVAF. Materials and Methods: A retrospective cohort study was conducted among NVAF patients who received either NOACs or warfarin from two university hospitals in Thailand from January 2015 to December 2019. The primary outcome was a ≥30% decline in the estimated glomerular filtration rate (eGFR) with a doubling of the serum creatinine (SCr), while acute kidney injury (AKI) and incidence rate of stroke and systemic embolism event (SEE) were secondary outcomes. All outcomes of each NOAC versus the warfarin group were analyzed using Cox proportional hazards regression. Results: A total of 1456 patients were enrolled. During a follow-up period of 24 months, NOACs were associated with a lower risk of a ≥30% decline in the eGFR than warfarin after inverse probability of treatment weighting (IPTW) and multivariable adjustment (adjusted hazard ratio (aHR) of 0.67, 95% confidence interval [CI] 0.45-1.00, p = 0.050). No significant differences were observed between NOACs and warfarin regarding the doubling of SCr (aHR 0.64, 95% CI 0.24-1.72, p = 0.373) or AKI (aHR 0.69, 95% CI 0.41-1.17, p = 0.169), although a trend toward a lower risk was noted in the NOAC group. Similarly, a trend toward a lower risk of the incidence rate of ischemic stroke and SEE were observed in the NOAC group (aHR 0.49, 95% CI 0.22-1.10, p = 0.084). Conclusions: In real-world data, NOACs may be associated with a lower eGFR decline and lower doubling of SCr and AKI than warfarin. Additionally, NOACs may reduce the risk of ischemic stroke and SEE, supporting their potential benefit over warfarin in both renal and thromboembolic outcomes.

There has been incongruent evidence on the outcomes relating to whether continuing or withholding renin-angiotensin-aldosterone system inhibitors (RAASi) preoperatively. This study aimed to systematically analyze the effect of preoperative RAASi on perioperative and postoperative outcomes in patients undergoing noncardiac surgeries. PubMed, Scopus, ScienceDirect, and Cochrane databases were used with no limitation of the starting date, till 30th September 2024. The revised Cochrane risk-of-bias tool (RoB-2) and the Newcastle-Ottawa Scale were used for quality assessment. The primary study outcomes were hemodynamic outcomes while the secondary outcomes included postoperative 30-day mortality, myocardial infarction (MI), stroke and postoperative atrial fibrillation (POAF). Among 1897 articles, 6 eligible randomized control trials and 6 observational studies were enrolled. The patients preoperatively continuing RAASi had a higher risk of intraoperative hypotension [OR (odds ratio) = 1.54; 95% CI (confidence interval) = 1.31, 1.82], along with lower systolic and diastolic blood pressures compared to those withholding RAASi. Postoperative complications including 30-day mortality, MI, stroke, atrial fibrillation, acute kidney injury, septicemia, myocardial injury, postoperative hypertension and unplanned ICU admission, showed no significant differences. However, there was a marginal significance in lower POAF in the RAASi-continuing group (OR = 0.73, 95% CI = 0.52, 1.02). Withholding RAASi prior to noncardiac operation significantly reduced the risk of intraoperative hypotension but may increase the chance to develop POAF without significant impact on 30-day mortality and other postoperative complications. Discontinuation of RAASi before noncardiac surgery is recommended unless obligate indication.

Abstract Background No data was available regarding the sensitivities of pharmacotherapy-related and disease-specific quality of life measures to pharmacist-led pharmaceutical care (PC). Objective To compare the sensitivities of two health-related quality of life (HRQoL) measures, i.e. the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) vs. the Functional Assessment of Cancer Therapy-General (FACT-G), in response to pharmacist-led PC for cancer outpatients. Methods A randomised controlled trial was conducted on the cancer outpatients of a tertiary Thai hospital. Eligible patients were randomly allocated to a PC group receiving PC interventions or a usual care (UC) group acquiring pharmacist’s ordinary care. The HRQoL of both groups was assessed using the PROMPT-QoL and the FACT-G before and after a session. The data were gathered and the sensitivities of the two measures using standardised mean differences (SMDs) were analysed. Results A total of 237 patients in two arms (120 PC vs. 117 UC patients) completed the trial. With PC interventions, all eight PROMPT-QoL domains and 3 out of 4 FACT-G domains were significantly improved. The PROMPT-QoL yielded SMDs ranging from 0.24 to 1.68 that were considered a moderate-to-high sensitivity, whereas the FACT-G provided a moderate sensitivity with SMDs of 0.31–0.64. The average SMDs of four FACT-G domains was 0.50 and SMD of its total score was 0.80. Eight PROMPT-QoL domains had the average SMD of 0.60 and the total score SMD was 1.40. Conclusions The PROMPT-QoL is more sensitive to detect HRQoL when delivering pharmacist-led pharmaceutical care to cancer outpatients. Trial registration TCTR20210809008 on August 9, 2021.

Various drug delivery systems were developed using a modified form of gum ghatti. Modifying gum ghatti using thioglycolic acid improves its mucoadhesive property, and hence, it is a suitable approach for the fabrication and development of controlled drug delivery systems. In accordance with regulatory guidelines, namely, the Organization for Economic Co-operation and Development’s (OECD) 423 guidelines, an acute oral dose toxicity study was performed to examine the toxicological effects of gum ghattiin an animal (Wistar rat) after a single oral dose administration of pure gum ghatti and thiolated gum ghatti. Orally administered pure and thiolated gum ghatti do not reveal any considerable change in the behavioral pattern, food intake, body weight, hematology, or clinical symptoms of treated animals. Furthermore, histopathological studies showed no pathological mutations in the vital organs of Wistar rats after the oral administration of single doses of both types of gumghatti (i.e., 300 mg/kg and 2000 mg/kg body weight). Whole blood clotting studies showed the low absorbance value of the modified gum (thiolated gum ghatti) in contrast to the pure gum and control, hence demonstrating its excellent clotting capability. The aforementioned toxicological study suggested that the oral administration of a single dose of pure and thiolated gum ghatti did not produce any toxicological effects in Wistar rats. Consequently, it could be a suitable and safe candidate for formulating various drug delivery systems.

This study aimed to develop and optimize a topical Clinacanthus nutans liquid spray that dries quickly after spraying and has low stickiness. An experimental design was adopted to evaluate the effects of the amounts of polyvinylpyrrolidone (X1) and glycerol (X₂) and the ratio of acetone:ethanol (X₃) on the stickiness (Y1 ), solution viscosity (Y₂), evaporation rate (Y₃), and spray coverage radius (Y₄) of the solution. Results revealed that all independent factors had a substantial effect on Y1 -Y₃. In this model, the synergistic effect was uncommon. The optimized formulation consisted of X1 of 0.1%, X₂ of 1.0%, and X₃ of 59:41. The response values of Y1, Y₂, Y₃, and Y₄ were 92.24 mN, 4.63 cP, 0.0959%, and 9.40 cm, respectively. The actual results were close to those predicted by the experimental design model. Therefore, the optimized topical spray formulation can be used in actual practice.

The aim of this work was to synthesize carboxymethyl cellulose (CMC) and produce CMC films from the cellulose of palm bunch and bagasse agricultural waste. The effect of various amounts of H2O2 (0–40% v/v) during delignification on the properties of cellulose, CMC, and CMC films was studied. As the H2O2 content increased, yield and the lignin content of the cellulose from palm bunch and bagasse decreased, whereas lightness (L*) and whiteness index (WI) increased. FTIR confirmed the substitution of a carboxymethyl group on the cellulose structure. A higher degree of substitution of CMC from both sources was found when 20%–30% H2O2 was employed. The trend in the L* and WI values of each CMC and CMC film was related to those values in their respective cellulose. Bleaching each cellulose with 20% H2O2 provided the cellulose with the highest viscosity and the CMC films with the greatest mechanical (higher tensile strength and elongation at break) and soluble attributes, but the lowest water vapor barrier. This evidence indicates that cellulose delignification with H2O2 has a strong effect on the appearance and physical properties of both CMCs.

In this work, a curcumin-diglutaric acid (CurDG) prodrug was synthesized by conjugation of curcumin with glutaric acid via an ester linkage. The water solubility, partition coefficient, release characteristics, and antinociceptive activity of CurDG were compared to those of curcumin. The aqueous solubility of CurDG (7.48μg/mL) is significantly greater than that of curcumin (0.068μg/mL). A study in human plasma showed that the CurDG completely releases curcumin within 2h, suggesting the ability of CurDG to serve as a prodrug of curcumin. A hot plate test in mice showed the highest antinociceptive effect dose of curcumin at 200mg/kg p.o., whereas CurDG showed the same effect at an effective dose of 100mg/kg p.o., indicating that CurDG significantly enhanced the antinociceptive effect compared to curcumin. The enhanced antinociceptive effect of CurDG may be due to improved water solubility and increased oral bioavailability compared to curcumin.

This paper presents the concept of a speed estimation of sensorless control for asymmetrical parameter type two-phase induction motor drive, by using the adaptive observer system. The motor speed is estimated on the rotor-flux reference frame to simplicity for application. The design guideline of the gain of speed estimate system for a motor has speed change. The experimental results for all test conditions show that the responses of current, torque and speed are stable for the entire operating region.