Asian Medical Journal and Alternative Medicine

Chest Specialists versus Non-Specialists following International COPD Recommendations in Real-World Clinical Practice

2023-05-01T08:50:03+07:00

Introduction: Real-world clinical practice for management of chronic obstructive pulmonary disease (COPD) differs from international guidelines by the Global Initiative for Chronic Obstructive Lung Disease and this affects clinical outcomes.

Objectives: To determine rates of following the guidelines and the impact on the clinical outcomes in COPD patients.

Methods: A prospective study was conducted in 2 outpatient clinics at a University Hospital in Thailand. Demographics and clinical data were collected. Chest specialist (CS) and non-CS groups were compared in clinical data.

Results: One hundred forty-five patients (87.6% male) were included. Of these, 81 (55.9%) were followed up at a CS outpatient department. The overall prevalence of COPD management following guidelines was 29.0% (27.2% in the CS group and 31.3% in the non-CS group, P=0.590). Compared to the non-CS group, the CS group had higher proportions of chronic kidney disease (21.0% vs 7.8%, P=0.028), coronary heart disease (35.8% vs 15.6%, P=0.007), and modified Medical Research Council scores (1.9±1.1 vs 1.5±1.2, P=0.038). The CS group also had higher rates of vaccinations and pulse oximetry measurement than the non-CS group. There were no differences in pulmonary functions or exacerbation and hospitalization rates between the two groups.

Conclusions: One-third of patients were managed following the COPD guidelines in real-world practice. The rates of following the guidelines did not significantly differ between the CS and the non-CS groups. This finding may explain the similar clinical outcomes. Nevertheless, a large prospective study is required to compare clinical outcomes between the two groups.

Comparison of The Efficacy and Safety of Topical 2% Minoxidil and 5% Minoxidil Solution in Fingernail Growth Rate

2023-03-13T13:27:09+07:00

Introduction: Nails are one of the organs which have activity throughout human life. Topical 2% minoxi-dil has been shown to accelerate nail development by being applied topically on the nails. However, the main mechanism to such effect remains unknown. Moreover, the appropriate preparation and concentration of minoxidil still have not yet been identified. It has been postulated that the higher concentration of minoxidil could accelerate the nail growth more than the 2%, lower concentration.

Objectives: To compare the efficacy and safety of fingernail growth rate between topical 5% minoxidil solution and topical 2% minoxidil solution.

Methods: Thirty participants were randomized into 3 groups: 2% minoxidil, 5% minoxidil, and placebo. Each group of participants was instructed to apply the solution twice daily on the 2nd and 4th finger on both hands. Nail lengths were measured at weeks 4 and 8 by using a digital caliper. Possible side effects were assessed by a dermatologist.

Results: The mean nail growth rate of the 2% minoxidil application (3.32 ± 0.63 mm) was greater than the 5% minoxidil application (2.88 ± 0.50 mm) and placebo (2.87 ± 0.08 mm) at week 8 (p-value = 0.002). No cutaneous or systemic side effects were observed.

Conclusions: In conclusion, 2% topical minoxidil has shown to stimulate a greater nail growth rate than the 5% topical minoxidil solution. Therefore, 2% topical minoxidil is an adequate concen-tration for effectively accelerating nail growth rate, without any side effects.

Detection of Circulating Tumor Cells in Peripheral Blood by Use of The High-Gradient Magnetic Separation Technique in Ovarian Tumor Patients

2023-07-18T15:34:33+07:00

Objective: To evaluate the performance of the high-gradient magnetic separation (HGMS) technique in detecting circulating tumor cells (CTCs) for the preoperative diagnosis of ovarian cancer.

Methods: Women who had ovarian tumors and were admitted to Thammasat University hospital during January 2018-December 2019 were enrolled into the study. Ten milliliters of fresh peripheral blood for HGMS were collected within 24 hrs prior to surgery. After healthy cell depletion by HGMS, the remaining cells including CTCs were spun onto gelatinized standard laboratory slides and stained with a panel of specific antibodies against CD45, CD31, CD34, CD73, CAM5.2, C-11, VIM and PKM2. The findings were classified into five classes, as based on cell types and their quantities: Classes I-III were categorized as a negative test and Classes IV-V were categorized as a positive test. The CTCs findings were compared to the final histopathological report.

Results: There were 67 participants in the study, with a mean age of 44.8 years. The detection rate of the test was 72.92%. Overall sensitivity and specificity were 45.45% and 94.12%, respectively. The accuracy of this method was 85.48%, with a negative predictive value of 88.89% and a positive predictive value of 62.50%.

Conclusion: The HGMS technique has a promising capacity for detecting ovarian cancer CTCs in patients with ovarian tumors. This technique should be optimized further and utilized, instead of a tumor markers, as a preoperative method for detecting ovarian cancer in the near future.

Effect of Ocimum americanum Water Leaf Extract on Antioxidant System in Rat

2023-04-03T14:21:37+07:00

Introduction: O. americanum has been reported to possess various medicinal properties. No study has been conducted in the antioxidant properties of O. americanum from the Thailand region.

Objectives: The objective of this study was to examine the antioxidant and cytoprotective aspects of the herb O. americanum.

Methods: Aqueous leaf extract of O. americanum was screened for phytochemical contents. Antioxidant properties were determined by the DPPH method. The rats were fed aqueous leaf extract for 28 days. Blood was drawn and collected to estimate the levels of BUN, Creatinine, AST, ALT, and ALP. After that, the rats were sacrificed. Their liver tissues were collected and processed for histological study. Western blot analysis was performed to determine the expression of γ-GCL.

Results: Phytochemical contents of O. americanum are phenolic compounds, alkaloids, cardiac glycosides, tannin, and steroids. The phenolic content was 41.27 ± 1.86 mg/gram of gallic acid equivalents. DPPH assay of the free radical scavenging activity determined that IC50 was 36.91 ± 0.66 µg/ml (compared to BHT = 12.34 ± 1.14 µg/ml). Throughout the 28 days of the experiment, the rats did not seem to be adversely affected by the extract considering their . They were found to have normal ranges of serum AST, ALT, ALP, BUN, and creatinine. The histology of their liver tissue was normal. The protein expression of GCL, which is a key enzyme in GSH biosynthesis, was found to have increased significantly compared with normal control.

Conclusions: The study found that Ocimum americanum extract does have antioxidative properties and can induce cytoprotective properties in vivo.

Efficacy and Safety of Medical Treatment in Acute Angle Closure Glaucoma at Thammasat Hospital

2023-03-13T15:51:48+07:00

Introduction: Acute angle closure glaucoma (AACG) is a suddenly high intraocular pressure (IOP) from pupillary block which cause optic neuropathy. The key concept of AACG management is to break pupillary block and lower the IOP in order to prevent blindness. The IOP-lowering medical treatments are prescribed to reduce the IOP in the initial stage, which are used to help clear up the cornea and reduce ocular inflammation before performing laser-peripheral iridotomy (L-PI). The purpose of this study is to determine the effectiveness and safety of medical treatments in the initial management of AACG at Thammasat University Hospital.

Methods: Prospective pre-experimental study. Twelve cases of AACG were diagnosed at Thammasat Hospital. All participants were enrolled in this study. Patients without a history of drug allergy underwent a protocol of management in which they received one tablet of oral acetazolamide (250 mg), followed by one tablet every six hours, topical timolol (0.5%) twice daily and brimonidine (0.2%) twice daily which is applied to the affected eye. Patients were recorded IOP at regular interval, and patients were given medication until resolution of AACG which is defined as IOP <= 30 mmHg and resolution of acute symptoms. Qualitative data were calculated into percentage. Quantitative data were calculated as mean and standard deviation.

Results: Fifteen eyes of 12 patients, 5 (41.67%) men and 7 (58.33%) women, with the mean age of 70.58 (6.1) years were studied. With medical therapy, the number of AACG resolved within 1, 12, and 24 hours are 6 (50%), 4 (33.33%), and 1 (8.33%), respectively. No serious adverse effects of IOP-lowering medical treatment were observed in this study. Successful L-PI was performed in all subjects within 1 to 3.5 days after the medical treatments were applied.

Conclusion: According to the result in this study found that IOP-lowering medical treatments prescribed to reduce initial stage of IOP is effective and safe. Medical management of AACG should still remain as the first-line treatment.

In Vitro Anti-oxidation, Anti-inflammatory and Anti-aging activities of Oak Extract

2023-08-03T11:31:59+07:00

Introduction: Intrinsic and extrinsic factors can influence skin aging. Intrinsic skin aging can occur due to the formation and accumulation of reactive oxygen species, furthermore UV radiation contributes up to 80% of extrinsic aging. Anti-oxidation bioactive components from natural sources have been recommended for skin aging prevention.

Objectives: we explored the anti-oxidation, anti-inflammatory and anti-aging activities of oak extract (freeze-dried) product.

Methods: Anti-oxidation activity was determined using superoxide dismutase (SOD) activity assay and radical scavenging activity assay (DPPH). Anti-inflammatory activity was determined by hyaluronidase activity inhibitory assay and hexosaminidase release inhibitory assay. Anti-aging activity was determined using inhibitory assay of human neutrophil elastase activity, inhibitory assay of matrix metalloproteinase-1 (MMP-1) and promoting assay of hyaluronic acid production.

Results: Anti-oxidation activity was observed for oak extract in both SOD activity assay and radical scavenging activity assay with IC₅₀of 2.27µg/mL and 3.25 µg/mL respectively. Anti-inflammatory activity was detected in hyaluronidase activity inhibitory assay with an IC₅₀of >400µg/ml and hexosaminidase release inhibitory effect was observed with IC₅₀ of 223.4 µg/mL. The oak extract also exhibited anti-aging activity with human neutrophil elastase activity inhibitory at an IC₅₀ of 20.87µg/mL and MMP-1 activity inhibitory effect at an IC₅₀ of 125.7µg/mL. Oak extract did not promote any hyaluronic acid production in epidermal keratinocytes.

Conclusions: Oak extract exhibits a strong antioxidant effect comparable to control Baicalin and ascorbic acid. Together with the inhibitory effect on human neutrophil elastase and MMP-1, these results suggest that oak extract is a promising agent as an anti-aging material.

Molnupiravir Metabolite--N4 -hydroxycytidine Causes Cytotoxicity and DNA Damage in Mammalian Cells in vitro

2023-09-21T13:14:53+07:00

N⁴-hydroxycytidine (NHC) is the active metabolite of molnupiravir—a new drug for COVID-19 treatment. NHC exerts antiviral activity by incorporating into SAR-CoV-2 RNA leading to false base-paring and lethal mutations to the virus. However, the risk of non-specific mutagenesis to host cells has been a concerned. The goal of this study is to detect cytotoxic activity and DNA damage induced by NHC in rapid-growing cells including human keratinocyte (HaCaT), and human adenocarcinomic alveolar basal epithelial (A549) cells in vitro by using sulforhodamine B (SRB) colorimetric and comet assays. NHC induced cytotoxicity in a concentration-dependent manner (0.1-30µM) in HaCaT and A549 cells. Half-maximal inhibitory concentration (IC₅₀) values of NHC were lower in HaCaT compared to A549 cells after 3, 5, 10 days of exposure (4.40±0.09 vs 23.21±3.42, 5.82±0.91 vs 16.35±2.04, and 5.41±0.88 vs 13.83±2.05 µM, respectively), suggesting that the cytotoxic effect of NHC is more potent in HaCaT cells than in A549 cells. Significant increase in DNA damage parameters were observed in comet assay for HaCaT and A549 cells after exposure to NHC. NHC-induced DNA damage in HaCaT cells was concentration-dependent (1-10µM), and time-dependent (3-10 days). NHC-induced DNA damage in A549 cells was concentration-dependent (1-10µM), but not time-dependent (3-10days). Within the limitations of this in vitro study, we conclude that NHC could induce cytotoxic and DNA damage in mammalian cells at therapeutic and supratherapeutic concentrations. We propose caution in the use and supervision of molnupiravir, especially in patients with impaired xenobiotic clearance.

Potential in vitro Anti-inflammatory and Anti-oxidant Activities of Various Extracts of Etlingera elatior Inflorescences.

2023-08-11T16:05:48+07:00

Introduction: Etlingera elatior (Jack) Smith, an edible plant in the Zingiberaceae family, used as food and folk medicine for earaches and wound cleansing. Although some parts of the plant have been studied for their anti-inflammatory properties, however, there is a lack of research on the inhibition of nitric oxide (NO), prostaglandin E₂ (PGE₂), and tumor necrosis factor α (TNF-α) production of the inflorescences. The findings demonstrated its anti-inflammatory effects and suggested an effective extraction method for further investigation, quality control, and product development.

Objectives: This study aims to explore the anti-inflammatory and antioxidant properties of E. elatior inflorescence extracts.

Methods: The bracts of E. elatior inflorescences were dried and separately extracted by 95%, 70%, and 50%ethanol maceration and decoction. The anti-inflammatory activity was investigated by inhibiting the production of nitric oxide (NO), prostaglandin E2 (PGE₂), and tumor necrosis factor (TNF-α) in lipopolysaccharide-induced RAW264.7 cells. Additionally, the anti-oxidant activity was assessed by DPPH scavenging assay.

Results: The 70%ethanolic extract of E. elatior exhibited both inhibitory effect on NO production (IC₅₀ = 16.36 µg/mL) and DPPH scavenging activity (EC₅₀ = 23.78 µg/mL), whereas the 95% ethanolic showed comparable inhibitory activity on NO (IC₅₀ = 16.78 µg/mL) but not in antioxidant activity. EE95 also showed moderate inhibition of PGE₂ production (IC₅₀ = 45.26 µg/mL).

Conclusion: The ethanolic extracts of E. elatior inflorescences, obtained through maceration with 70% ethanol and 95% ethanol exhibited remarkable anti-inflammatory and anti-oxidant properties. Consequently, it is imperative to further explore the 95% and 70% ethanolic extracts through in-depth research, including in vivo studies, phytochemical analysis, and anti-inflammatory product development.

The Correlations between Three Methods of Pelvic Floor Muscle Strength Assessment in Nulliparous Women: 2D Transperineal Ultrasound, Modified Oxford Scale, and PFX2® Perineometer

2023-07-19T13:38:23+07:00

Objective: To study the correlation between three methods for pelvic floor muscle strength assessment in nulliparous women.

Methods: A cross-sectional study, 50 nulliparous were recruited. Modified oxford scale (MOS) was assessed by one author (OW) and highest maximum squeeze value was recorded. The vaginal pressure during maximum squeeze with PFX2^® perineometer was recorded by one trained nurse. The midsagittal view of anteroposterior (AP) hiatal dimension using 2D transperineal ultrasound (TPUS) was done by the other author (PL) to measure the difference between the AP hiatal dimension in the resting stage compared to maximum squeeze.

Result: The mean MOS + SD was 4.4 + 0.7. The mean + SD PFX2^® perineometer was 10.4 + 1.8 cmH2O. The mean + SD difference of AP dimension using TPUS was 1.1 + 0.6 cm (22.8 + 10%). PFX2^® perineometer was poorly correlated with the different AP dimension using TPUS (r = 0.19, p-value = 0.18) and weakly correlated with the percent of difference AP dimension using TPUS (r = 0.21, p-value = 0.15). MOS was moderately correlated with the difference and percent of difference AP dimension using TPUS (r = 0.35, p-value<0.05 and r= 0.34, p-value<0.05 respectively). MOS was strongly correlated to PFX2^® perineometer (r= 0.73, p-value < 0.05).

Conclusion: In healthy nulliparous women, PFX2^® perineometer and MOS could be used to assess the strength of the pelvic floor muscles, but two-dimension TPUS could not be used to assess it. Because the difference hiatal dimension is small due to nulliparous characterization.

Recipe 2, A Thai Herbal Remedy in Worayokasarn Scripture, for reducing obesity

2023-10-04T20:26:28+07:00

Recipe 2 is a Thai herbal medical remedy for treating obesity in Worayokasarn scripture. The recipe consists of three plants i.e., Terminalia chebula Retz. (Sa-Mor-Thai) fruits, Cyperus rotundus L. (Hua-Haw-Mhoo) rhizomes, Tinospora crispa (L.) Miers ex Hook. f. & Thomson or Tinospora cordifolia (Thunb.) Miers (Bo-Ra-Pet) vines.¹ The three herbal ingredients of the remedy showed anti-obese effects by reducing lipid accumulation and lipogenesis. The ethanolic extract of T. chebula fruit decreased lipogenesis in obese mice by reducing fatty acid synthase, increasing fatty acid oxidation through peroxisome proliferator-activated receptors α (PPARα) and carnitine palmitoyltransferase-1 (CPT-1).² After 14 days of treatments, Haritaki or T. chebula at 1.05 and 2.10 mg/kg body weight (b.w.) concentrations reduced total cholesterol (TC) and total triglycerides (TG) in hyperlipidemia-induced Wistar rats with atherogenic diet.³ Majeed M, et. al., presented Piceatannol, Scirpusin A and Scirpusin B in the C. rotundus rhizome extract reduced adipogenesis in 3T3-L1 adipocytes.⁴ 450 mg/kg concentrations of aqueous T. crispa extract in 0.5% cholesterol chow diet-inducing New Zealand White rabbits showed effect in reducing blood serum TC, TG and low density lipoprotein-cholesterol (LDL-C) levels and increasing high density lipoprotein-cholesterol (HDL-C) level.⁵ After feeding of high fat diet in rats for 12 weeks leading to the development of obesity, the obesity rats receiving T. cordifoliastem powder at 1 mg/g b.w. for 12 weeks subsided body weight, adiposity index, serum cholesterol, and serum triglyceride.⁶

These scientific studies presented anti-obese effect of the herbal ingredients of the remedy by reducing lipid accumulation and serum lipids. This remedy may be effect to reduce obesity and lipid profile following a Thai traditional medical theory.