Clinical outcomes of intravenous levetiracetam treatment in patients with renal impairment

Intravenous levetiracetam has been approved for use as an antiepileptic drug, as well as in cases of status epilepticus. There are few reports that detail the clinical data and outcomes associated with this antiepileptic drug, particularly in patients with renal impairment. This was a retrospective analytical study conducted at Khon Kaen University’s Srinagarind Hospital in Thailand. The study period was between January 1, 2010 and December 31, 2014. The inclusion criteria were that patents were over 15 years old, had renal impairment, and had received intravenous levetiracetam treatment. The main clinical outcomes were seizure control and mortality. Clinical outcomes were compared between those with and without status epilepticus. Mortality of patients with status epilepticus were compared in terms of seizure control and order of intravenous levetiracetam treatment. During the study period, there were 247 patients who met the study criteria. The average age of the patients was 58 years with nearly equal sex distribution. Of those, 90 patients (36.4%) had GRFs of less than 15 mL/min/1.73 m2 and 60 patients (24.3%) received intravenous LEVE due to status epilepticus. The seizure control rates in the status epilepticus and non-status epilepticus groups were 36.7% and 88.7%, respectively (P<0.001). The mortality rate did not differ significantly between the two groups (33.3% vs 27.8%; P=0.418). There was no significant overall difference in mortality rate between seizure-controlled and seizure-uncontrolled patients in the status epilepticus group. In the convulsive status epilepticus group, variations in terms of treatment order of intravenous levetiracetam and seizure control resulted in no significant difference in mortality rates (P=0.311). No major side effects were detected in any patients after the intravenous levetiracetam treatment. In conclusion, intravenous levetiracetam treatment was effective and safe in patients with renal impairment

Smoking Cessation Services by Community Pharmacists: Real-World Practice in Thailand

This study aimed to report the effectiveness of community pharmacy smoking cessation services in 13 health regions in Thailand using a retrospective data-collecting method from the Foundation of Community Pharmacy database. The participants were smokers aged at least 18 years. The outcomes were the abstinence of smoking at least 30 consecutive days by self-report only and self-report with exhaled CO level &lt;7 ppm (if available), the number of cigarettes smoked daily, exhaled carbon monoxide (exhaled CO), and % peak expiratory flow rate (%PEFR); smokers measured these outcomes before and after receiving the smoking cessation services. Of 58 community pharmacies, 532 smokers (93% male, mean age of 42.4 ± 14.9 years) received smoking cessation services from community pharmacists. Of 235 smokers with complete data, 153 (28.8%, 153/532) smokers reported smoking abstinence by self-report. The mean number of cigarettes smoked daily reduced from 15.3 ± 8.7 to 1.9 ± 3.8 cigarettes, p-value &lt; 0.001. The exhaled CO levels of smokers significantly reduced from 11.7 ± 5.9 ppm to 7.2 ± 4.4 ppm, p-value &lt; 0.001. The %PEFR also significantly increased from 84.2 ± 19.4 to 89.5 ± 19.5, p-value &lt; 0.001. In conclusion, Thai community pharmacy smoking cessation services could aid smokers to quit smoking. This study is the outcome of the real-world community pharmacy smoking cessation service; policymakers should consider this service to be included in the national healthcare policy

Efficacy and Safety of Cytisine in Combination with a Community Pharmacists&rsquo; Counselling for Smoking Cessation in Thailand: A Randomized Double-Blinded Placebo-Controlled Trial

Background: Cytisine is a prospective pharmacological alternative for community pharmacy smoking cessation services. However, it has not yet been licensed because of a lack of efficacy and safety information in Thailand. Objective: The aim of this study was to evaluate the efficacy of cytisine in combination with community pharmacists&rsquo; counselling on smoking cessation in a community pharmacy in ThailandDesign. Setting, participants, and interventions: A double-blinded randomized placebo-controlled trials was carried out. Participants aged &gt;18 years old who smoked &gt;10 tobaccos/day were randomly assigned to receive cytisine or placebo and five sessions of counselling by a community pharmacist. The primary outcome was a continuous abstinence rate (CAR) at week 48. The CAR was also measured at weeks 2, 4, 12, and 24. Adverse events were monitored. Results: A total of 132 participants were included, with 67 receiving cytisine and 65 receiving a placebo. Approximately 95% of participants were male. The CARs were determined to be 14.93% and 6.15% for cytisine and placebo, respectively, at week 48. The relative risk (RR) was 2.41 (95% confidence interval (CI); 0.80&ndash;7.35, p = 0.102). The RRs for CAR at weeks 2, 4, 12, and 24 were 2.43, 2.91, 2.50, and 1.78, respectively. Only the RRs for weeks 2, 4, and 12 were statistically significant. Common and non-serious gastrointestinal and neurological adverse events were observed. Conclusion: Cytisine, when combined with community pharmacists&rsquo; counselling, did not statistically improve the CAR at week 48, although it did improve the CAR at weeks 2, 4, and 12. Adverse events of cytisine were common and non-serious (registration number: TCTR20180312001)

Smartphone Application for Smoking Cessation (Quit with US): A Randomized Controlled Trial among Young Adult Light Smokers in Thailand

This study aimed to determine the efficacy of a smartphone application named Quit with US among young adult smokers. An open-label, parallel, 2-group, randomized controlled trial with a 12-week follow-up was conducted between March and November 2020 among undergraduate students (18 to 24 years) in Chiang Mai Province, Thailand. A total of 273 participants were assigned by simple randomization procedure to the Quit with US intervention group (n = 137) or the control group (n = 136). All participants received pharmacists&rsquo; smoking cessation counseling at baseline and follow-ups. In addition, the intervention group&rsquo;s participants were advised to use Quit with US. The baseline and 12-week follow-up assessments were conducted at a study unit, whereas other follow-ups were completed over the telephone. The primary abstinence outcome was the exhaled CO concentration level (&le;6 ppm) verified 7-day point prevalence abstinence. At baseline, the participants&rsquo; mean (standard deviation) age was 21.06 (1.62) years. Most identified as daily smokers (57.9%, n = 158), consumed &le;10 cigarettes daily (89.4%, n = 244), and expressed low level of nicotine dependence as measured by Heaviness of Smoking Index score (86.1%, n = 235). Regarding intention-to-treat analyses, participants in the Quit with US intervention group achieved significantly greater smoking abstinence rate than those in the control group (58.4% (80/137) vs. 30.9% (42/136), risk ratio = 1.89, 95% confidence intervals = 1.42 to 2.52, p &lt; 0.001). In conclusion, Quit with US integrated with pharmacists&rsquo; smoking cessation counseling significantly enhanced smoking abstinence rates among young adult light smokers consuming &le; 10 cigarettes daily

Prevalence of Provocative Seizures in Persons with Epilepsy: A Longitudinal Study at Khon Kaen University Hospital, Thailand

Background and Objective. Provocative factors are one causative factor of seizure attacks in persons with epilepsy (PWE). There are limited data of prevalence and major provocative factors in Asian populations. Methods. This study was performed at the Epilepsy Clinic, Khon Kaen University Hospital. The patients who aged 15 years or over, who had been treated at least 3 months with at least one antiepileptic drug, and who were followed up for at least one year were included. Data of seizure control and triggers were collected retrospectively from medical records. Data analysis was performed to identify independent provocative factors. Results. A total of 382 PWE met the study criteria. The mean age was 40.4±0.8 years. Approximately 44% of the patients had at least one provocative factor. By multivariate analysis, the independent provocative factors with the first three highest adjusted odds ratios were sleep deprivation (adjusted OR=8.64, 95% CI 3.73–19.99), alcohol consumption (adjusted OR=6.76, 95% CI 1.44–31.78), and feeling stressful (adjusted OR=2.97, 95% CI 1.29–6.86). Conclusion. Almost half of seizure attacks may be caused by provocative factors in Thai PWEs and some factors may be preventable. Avoidance of these factors should be emphasized to epilepsy patients for improving clinical outcomes and quality of life

Therapeutic drug monitoring in epilepsy clinic: a multi-disciplinary approach

Epilepsy is a common public health problem and needs multi-disciplinary treatment. Therapeutic drug monitoring (TDM) is one of step of the multi-disciplinary treatment in epilepsy at Epilepsy clinic, Khon Kaen University (Thailand). The TDM service has been established since 2008. Here, we aimed to study the roles of TDM order and epilepsy control. This is a prospective descriptive study in which data collection was done from January 1 to December 31, 2010, the period when pharmacists took part in assessing the appropriateness in measurement and interpretation of TDM in order to provide suggestions for physicians. The 112 patients under study had an average age of 38.21±15.36 years; 254 samples were collected for therapeutic drug monitoring; phenytoin was submitted mostly for drug monitoring at 46.46%; 44.49% of sub-missions for drug level monitoring were made owing to a suspected sub-therapeutic level. Associations were found between reasons of sending samples for drug level monitoring and the measured drug levels, <em>i.e.</em>, 66.67% of drug levels found was so low that they were undetectable in sample for patients’ compliance investigation and 38.94% of the drug levels were found to be sub-therapeutic as for the case where submission of samples was done because of suspected sub-therapeutic level, 40% of the cases were found to be in toxicity range in the cases with suspected over-therapeutic levels and monitoring levels, 58.25% were found to be within the therapeutic range. Pharmacists used the interpreted results in patients’ care by recommending physicians to monitor therapeutic drug closely, to adjust the dosage of drugs, and to recommend checking patients’ compliance in their use of drugs at 56.5, 38.9, and 4.3%, respectively. Physicians’ responses were found to be absolute follow, partial follow and not follow at 77.95, 11.03, and 7.48%, respectively. In conclusion, associations were found between reasons of TDM order and measured drug level. Therapeutic drug monitoring services at the Epilepsy Clinic was useful in supporting clinical information queries. Pharmacists could make use of interpreted drug level information by recommending physicians to monitor drug levels and adjust individual dosage regimen accordingly. It should be noted that physicians accepted pharmacists’ recommendation, denoting multi-disciplinary care team that would lead to greater efficiency

Clinical Outcomes of Intravenous Levetiracetam Treatment in Patients with Renal Impairment

Intravenous levetiracetam has been approved for use as an antiepileptic drug, as well as in cases of status epilepticus. There are few reports that detail the clinical data and outcomes associated with this antiepileptic drug, particularly in patients with renal impairment. This was a retrospective analytical study conducted at Khon Kaen University’s Srinagarind Hospital in Thailand. The study period was between January 1, 2010 and December 31, 2014. The inclusion criteria were that patents were over 15 years old, had renal impairment, and had received intravenous levetiracetam treatment. The main clinical outcomes were seizure control and mortality. Clinical outcomes were compared between those with and without status epilepticus. Mortality of patients with status epilepticus were compared in terms of seizure control and order of intravenous levetiracetam treatment. During the study period, there were 247 patients who met the study criteria. The average age of the patients was 58 years with nearly equal sex distribution. Of those, 90 patients (36.4%) had GRFs of less than 15 mL/min/1.73 m2 and 60 patients (24.3%) received intravenous LEVE due to status epilepticus. The seizure control rates in the status epilepticus and non-status epilepticus groups were 36.7% and 88.7%, respectively (P&lt;0.001). The mortality rate did not differ significantly between the two groups (33.3% vs 27.8%; P=0.418). There was no significant overall difference in mortality rate between seizure-controlled and seizure-uncontrolled patients in the status epilepticus group. In the convulsive status epilepticus group, variations in terms of treatment order of intravenous levetiracetam and seizure control resulted in no significant difference in mortality rates (P=0.311). No major side effects were detected in any patients after the intravenous levetiracetam treatment. In conclusion, intravenous levetiracetam treatment was effective and safe in patients with renal impairment

Public Awareness and Practices Towards Self-Medication with Antibiotics Among Malaysian Population: Questionnaire Development and Pilot Testing

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