Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial.

OBJECTIVE: To compare the efficacy of curcumin versus omeprazole in improving patient reported outcomes in people with dyspepsia. DESIGN: Randomised, double blind controlled trial, with central randomisation. SETTING: Thai traditional medicine hospital, district hospital, and university hospitals in Thailand. PARTICIPANTS: Participants with a diagnosis of functional dyspepsia. INTERVENTIONS: The interventions were curcumin alone (C), omeprazole alone (O), or curcumin plus omeprazole (C+O). Patients in the combination group received two capsules of 250 mg curcumin, four times daily, and one capsule of 20 mg omeprazole once daily for 28 days. MAIN OUTCOME MEASURES: Functional dyspepsia symptoms on days 28 and 56 were assessed using the Severity of Dyspepsia Assessment (SODA) score. Secondary outcomes were the occurrence of adverse events and serious adverse events. RESULTS: 206 patients were enrolled in the study and randomly assigned to one of the three groups; 151 patients completed the study. Demographic data (age 49.7±11.9 years; women 73.4%), clinical characteristics and baseline dyspepsia scores were comparable between the three groups. Significant improvements were observed in SODA scores on day 28 in the pain (-4.83, -5.46 and -6.22), non-pain (-2.22, -2.32 and -2.31) and satisfaction (0.39, 0.79 and 0.60) categories for the C+O, C, and O groups, respectively. These improvements were enhanced on day 56 in the pain (-7.19, -8.07 and -8.85), non-pain (-4.09, -4.12 and -3.71) and satisfaction (0.78, 1.07, and 0.81) categories in the C+O, C, and O groups, respectively. No significant differences were observed among the three groups and no serious adverse events occurred. CONCLUSION: Curcumin and omeprazole had comparable efficacy for functional dyspepsia with no obvious synergistic effect. TRIAL REGISTRATION NUMBER: TCTR20221208003.

Vernonia cinerea pastilles is effective for smoking cessation.

BACKGROUND AND AIM: Vernonia cinerea (VC) is a herb that can alleviate nicotine addiction, potentially aiding in smoking cessation. Previous studies have examined four-to eight-week treatments using VC, but have found it to be ineffective. This study aimed to evaluate the smoking cessation effects of VC in addicted smokers over a longer treatment duration with pastilles. EXPERIMENTAL PROCEDURE: This was a randomized double-blinded controlled trial conducted at a community pharmacy. The inclusion criteria were age between 18 and 60 years, intention to quit smoking, and low to moderate level of nicotine addiction. All eligible participants were stratified according to nicotine addiction level and then randomly assigned either VC treatment or placebo. The VC group received two pastilles three times daily, while the control group received a placebo for 12 weeks. The outcomes were continuous abstinence rate (CAR) and point abstinence rate (PAR) at four and 12 weeks. RESULTS: There were 121 eligible participants; 10 participants were not willing to participate. In total, there were 111 eligible participants, 54 of whom were treated with VC (48.65%) and 57 of whom were given a placebo (51.35%). Baseline characteristics were comparable between the two groups. The VC group had a significantly higher chance of smoking cessation at 2.01 (95% CI of 1.03, 3.92) compared with the placebo group at the end of the study. There were no significant side effects in either group. CONCLUSION: The VC pastille group had significantly higher CAR than the placebo group at week 12.

Hypoxic training improves blood pressure, nitric oxide and hypoxia-inducible factor-1 alpha in hypertensive patients.

PURPOSE: To examine the effects of intermittent hypoxic breathing at rest (IHR) or during exercise (IHT) on blood pressure and nitric oxide metabolites (NOx) and hypoxia-inducible factor-1 alpha levels (HIF-1α) over a 6-week period. METHODS: 47 hypertensive patients were randomly allocated to three groups: hypertensive control (CON: n = 17; IHR: n = 15 and IHT: n = 15. The CON received no intervention; whereas, IH groups received eight events of hypoxia (FIO2 0.14), and normoxia (FIO2 0.21), 24-min hypoxia and 24-min normoxia, for 6 weeks. The baseline data were collected 2 days before the intervention; while, the post-test data were collected at days 2 and 28 after the 6-week intervention. RESULTS: We observed a significant decrease of the SBP in both IH groups: IHR (- 12.0 ± 8.0 mmHg, p = 0.004 and - 9.9 ± 8.8 mmHg, p = 0.028, mean ± 95% CI) and IHT (- 13.0 ± 7.8 mmHg, p = 0.002 and - 10.0 ± 8.4 mmHg, p = 0.016) at days 2 and 28 post-intervention, respectively. Compared to CON, IHR and IHT had increased of NOx (IHR; 8.5 ± 7.6 µmol/L, p = 0.031 and IHT; 20.0 ± 9.1 µmol/L, p < 0.001) and HIF-1α (IHR; 170.0 ± 100.0 pg/mL, p = 0.002 and IHT; 340.5 ± 160.0 pg/mL, p < 0.001). At 2 days post-intervention, NOx and HIF-1α were negatively correlated with SBP in IHT. CONCLUSION: IH programs may act as an alternative therapeutic strategy for hypertension patients probably through elevation of NOx and HIF-1α production.

Cost-Effectiveness Analysis of Direct-Acting Oral Anticoagulants for Stroke Prevention in Thai Patients with Non-Valvular Atrial Fibrillation and a High Risk of Bleeding.

OBJECTIVE: The objective of this study was to assess the cost effectiveness of direct-acting oral anticoagulants for stroke prevention in Thai patients with non-valvular atrial fibrillation and a HAS-BLED score of 3. METHODS: Total costs (US$) in 2017 and quality-adjusted life-years were estimated over 20 years using a Markov model. A base-case analysis was conducted under a societal perspective, which included direct healthcare, non-healthcare and indirect costs in Thailand. Clinical events for warfarin and utilities were obtained from Thai patients whenever possible. The efficacy of direct-acting oral anticoagulants was derived from trial-based East Asian subgroups and adjusted for time in the target international normalized ratio range of warfarin. RESULTS: In the base case, use of apixaban instead of warfarin incurred an additional cost of US$20,763 per quality-adjusted life-year gained. Substituting apixaban with rivaroxaban and rivaroxaban with high-dose edoxaban would incur an additional cost per quality-adjusted life-year by US$507 and US$434, respectively. Compared with warfarin, high-dose edoxaban had the lowest incremental cost-effectiveness ratio of US$9704/quality-adjusted life-year, followed by high-dose dabigatran (incremental cost-effectiveness ratio US$11,155/quality-adjusted life-year). The incremental cost-effectiveness ratios based on a payer perspective were similar. The incremental cost-effectiveness ratio was below Thailand's cost-effectiveness threshold when high-dose dabigatran and edoxaban prices were reduced by 50%. Changes in key parameters had a minimal impact on incremental cost-effectiveness ratios. CONCLUSIONS: For both societal and payer perspectives, high-dose edoxaban with a price below the country cost-effectiveness threshold should be the first anticoagulant option for Thai patients with non-valvular atrial fibrillation and a high risk of bleeding.

An Ancient Boxing Exercise Improves Physical Functions, Balance, and Quality of Life in Healthy Elderly Persons.

It has been shown that traditional dances can be effective in improving physical functions in the elderly persons. Unlike other traditional dance exercises, the ancient Thai boxing exercise may be suitable for elderly persons in other ethnicities who are interested in boxing. This randomized controlled study aimed to evaluate the effects of the exercise on physical functions in elderly subjects. Healthy elderly subjects were recruited and randomly divided into two groups: the control group and the ancient Thai boxing group. The control group received education about the exercise and a home program of daily practice. The ancient Thai boxing group performed the modified ancient Thai boxing exercise for 12 weeks. There were six outcomes in this study which were recorded at baseline and at the end of study (week 12) including a six-minute walk test (6MWT), five times sit to stand test (FTSST), flexibility by trunk flexometer, time up and go test (TUGT), and Berg balance scale (BBS), as well as a test to determine quality of life (QOL). All outcomes were compared to the baseline, as well as between groups. There were 56 subjects enrolled in the study, 28 in the control group, and 28 in the ancient Thai boxing group, with mean ages of 68.6 and 65.9 years, respectively. The majority of subjects in both groups were women (96.4% and 89.3%). After 12 weeks of study, significant differences were found in terms of all seven outcomes between the two groups. For example, the 6MWT in the control group was 415.8 vs 480.3 m in the ancient boxing group. In conclusion, the 12-week ancient boxing exercise significantly improved physical functions, balance, and QOL in the elderly.

Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study.

BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS: We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. RESULTS: In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). CONCLUSIONS: RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.

Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report.

PURPOSE: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. MATERIALS AND METHODS: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004-2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. RESULTS: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). CONCLUSIONS: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.

The effect of six-weeks of sauna on treatment autonomic nervous system, peak nasal inspiratory flow and lung functions of allergic rhinitis Thai patients.

BACKGROUND: Allergic rhinitis is a chronic respiratory disease. Sympathetic hypofunction has been identified in allergic rhinitis patients. OBJECTIVE: To investigate the effects of six weeks of repeated sauna treatment on the autonomic nervous system, peak nasal inspiratory flow (PNIF) and lung functions in Thai patients with allergic rhinitis. METHODS: Subjects were diagnosed with allergic rhinitis clinically by an attending physician based on history, physical examination and positive reactions to a skin prick test. Subjects were randomly assigned to two groups. Controlsubjects received education and maintained a normal life. The sauna group received sauna treatment over a six-week period, 3 days per week, with 6 sets of 5 minutes per set per day, totaling 30 minutes. Each 5 minute set alternated with a 5 minute period of rest. Heart rate variability (HRV), peak nasal inspiratory flow and lung function were measured at the beginning and after three and six weeks of sauna treatment. The HRV measurement is composed of three components, including low frequency (indicating sympathetic function in normal units or n.u.), high frequency (indicated parasympathetic function in n.u.), and the ratio of LF/HF (indicating the balance of the autonomic system). RESULTS: Twenty-six allergic rhinitis patients, 12 males and 14 females participated in this study, 13 in the control group and 13 in the sauna treatment group; there were 6 males in each group. Baseline characteristics for the control and sauna treatment groups were comparable. There were significant changes in the HRV after six weeks of sauna treatment. The high frequency component was significantly lower in sauna treatment group (51.8 vs 35.4), while the low frequency component and LF/HF ratio were significantly higher in sauna treatment group than in the control group (48.1 vs 64.5 and 0.9 vs 2.5, respectively). The PNIF and the forced expiratory volume in one second, or FEV1, were also significantly higher in sauna treatment group (103.0 vs 161.9 and 80.1 vs 95.6, respectively). CONCLUSION: The six weeks of repeated sauna treatment can increase sympathetic activity, PNIF, and FEV1 in Thai patients with allergic rhinitis.