Drinking and Night-Time Driving May Increase the Risk of Severe Health Outcomes: A 5-Year Retrospective Study of Traffic Injuries among International Travelers at a University Hospital Emergency Center in Thailand

Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further

Pharmaceutical Equivalence of Distributed Generic Antiretroviral (ARV) in Asian Settings: The Cross-Sectional Surveillance Study - PEDA Study.

Ensuring that medicines meet quality standards is mandatory for ensuring safety and efficacy. There have been occasional reports of substandard generic medicines, especially in resource-limiting settings where policies to control quality may be less rigorous. As HIV treatment in Thailand depends mostly on affordable generic antiretrovirals (ARV), we performed quality assurance testing of several generic ARV available from different sources in Thailand and a source from Vietnam.We sampled Tenofovir 300mg, Efavirenz 600mg and Lopinavir/ritonavir 200/50mg from 10 primary hospitals randomly selected from those participating in the National AIDS Program, 2 non-government organization ARV clinics, and 3 private drug stores. Quality of ARV was analyzed by blinded investigators at the Faculty of Pharmaceutical Science, Chulalongkorn University. The analysis included an identification test for drug molecules, a chemical composition assay to quantitate the active ingredients, a uniformity of mass test and a dissolution test to assess in-vitro drug release. Comparisons were made against the standards described in the WHO international pharmacopeia.A total of 42 batches of ARV from 15 sources were sampled from January-March 2015. Among those generics, 23, 17, 1, and 1 were Thai-made, Indian-made, Vietnamese-made and Chinese-made, respectively. All sampled products, regardless of manufacturers or sources, met the International Pharmacopeia standards for composition assay, mass uniformity and dissolution. Although local regulations restrict ARV supply to hospitals and clinics, samples of ARV could be bought from private drug stores even without formal prescription.Sampled generic ARVs distributed within Thailand and 1 Vietnamese pharmacy showed consistent quality. However some products were illegally supplied without prescription, highlighting the importance of dispensing ARV for treatment or prevention in facilities where continuity along the HIV treatment and care cascade is available

Efficacy and safety of a once-daily single-tablet regimen of tenofovir, lamivudine, and efavirenz assessed at 144 weeks among antiretroviral-naïve and experienced HIV-1-infected Thai adults

Objective: To assess the efficacy and safety of a new single-tablet regimen (STR) of tenofovir disoproxil fumarate (TDF) 300 mg, lamivudine (3TC) 300 mg, and efavirenz (EFV) 600 mg in HIV-infected Thai patients. Methods: This was a prospective study performed for 144 weeks among 51 treatment-naïve patients and 49 experienced patients on separate tablets of TDF, 3TC, and EFV with HIV RNA<50 copies/ml. CD4, HIV RNA, liver and renal function, and lipid profiles were assessed at baseline, weeks 12, 24, and 48, and then every 24 weeks. Results: The median baseline CD4 cell count was 512 cells/μl for treatment-experienced patients and 230 cells/μl for treatment-naïve patients. Median baseline log10 HIV-1 RNA for treatment-naïve subjects was 4.9 copies/ml. From the intention-to-treat (ITT) analysis, the proportion of subjects with HIV RNA <50 copies/ml at week 48, 96, and 144 was 95%, 94%, and 94%, respectively, for antiretroviral-experienced patients and 88%, 90%, and 80%, respectively, for antiretroviral-naïve patients. One virological failure at week 12 had primary drug resistance of K70R, T69D, V75L. Three serious adverse events occurred (tension headache, infective endocarditis, and cervical dysplasia) and another three discontinued the study drug due to EFV intolerance. Conclusions: This generic STR TDF/3TC/EFV is effective and well-tolerated. These findings lend support to the use of this generic STR as first-line antiretroviral therapy in resource-limited settings

New-onset diabetes in HIV-treated adults: predictors, long-term renal and cardiovascular outcomes

To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART). Prospective study conducted between July 1996 and 30 April 2015. A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126 mg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus. During a median follow-up of 9 years (16 274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25 kg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, P = 0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, P = 0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60 ml/min/1.73 m) (15.3 vs. 1.9%, P  < 0.001) over total follow-up. In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essentia

Tenofovir (300 mg) drug sources and characteristics.

<p>Tenofovir (300 mg) drug sources and characteristics.</p

Geographic location of sampling sites in Thailand and Vietnam.

<p>Geographic location of sampling sites in Thailand and Vietnam.</p

Lopinavir (200 mg)/Ritonavir (50 mg) drug sources and characteristics.

<p>Lopinavir (200 mg)/Ritonavir (50 mg) drug sources and characteristics.</p

Sampled drugs, ordered by site ID.

<p>Sampled drugs, ordered by site ID.</p

Descriptive statistics of drug content, uniformity of mass and dissolution tests.

<p>Descriptive statistics of drug content, uniformity of mass and dissolution tests.</p

Percent of label amount of each sampled ARV, by sampling site.

<p>Percent of label amount of each sampled ARV, by sampling site.</p